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Summary Exam Notes Psychotherapy
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- Radboud Universiteit Nijmegen (RU)
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Voorbeeld van de inhoud
Psychotherapy lecture notesExam material
The book
Notes from all lectures and demonstrations
Reader psychotherapy
Lecture 1: introduction lecture
A few concerns and a few praises
Gap: academic psychology and clinical practice: small impact of research findings
Strong effects for disorder-specific treatments
Little theoretical integration across psychology schools
Gap between clinical psychologists and the scientists. Psychologists need to have a more scientific
view and the scientists need to know more about what is happening in the clinical field.
Psychotherapy have better effect in psychological problems than in medicines. Medicines work for
common problems but the psychological problems are often very heterogeneity.
There are findings in research that should be implemented in the clinical field. In clinical field much
freedom.
Talk about theories
What are mental disorders?
Experiences of:
Feelings, thoughts, behavior tendencies, bodily sensations (that reoccur)
As a problem / you do not want them: unwanted, intolerable, abnormal, uncontrollable absurd
Who is in charge? Fragmented sense of ‘self’. (urge to pull hair while not wanting it)
In DSM there should be suffering, without suffering no disorder. Scared of heights but never have
problems with it because you do not live in high apartment, then no disorder according to DSM.
What is the goal of psychotherapy?
Correct: change unwanted patterns of subjective experiences
Or viewed from medical model: reduce agreed upon symptoms, disorders etc
Wrong: make patients happy (again), not about the 100% but people change as side effect also
happy.
Wrong: help patients understand reality, It is not about the meaning of life
Psychotherapy = psychological treatment
Means, why does psychotherapy work?
1. Changing propositional representations?
o Language-based, symbolic, deductive, arguments
o Change is easy: provide information; reason, persuade, psycho-education, cognitive therapy.
o The therapist gives reasoning to the patient.
, o Problems:
Therapist is authoritarian
Patient is likely to be passive
Persuasion is often ineffective of transient
o Can work when the patients have wrong concepts or ideas, factual information
o But when saying: the dog doesn’t bite don’t be afraid, that does not research the fearfull
experiences.
2. Discover who you are?
o Self-knowledge: classical philosophical proposition
o Core of psychoanalysis and client-centered therapy
o Problems:
Classical psychoanalysis (interpretations ‘archaeology’) inefficient; client-centered
therapy assumptions untenable
Unsupported by academic psychology; mental processes hardly accessible, fragmented
sense of self; instead ‘English butlers’ = automatic processes. We do not direct those
butlers. If a man yells: you process this via visual and emotional brain areas etc, these
are already there while you are not aware of it already. ‘’consciousness is the last to
know.’’
o It is more about how to find a way to change these automatic processes like being scared of
a dog.
Literature: psychotherapy: a brief note on schools in
psychotherapy
Non-directive forms of therapy
Hallmark =
o the therapist exerts no direct influences, gives no advice, homework or assignments.
o The effects of this therapy arise or take shape during the consultation.
o The principal aims are isgniht and improved self-knowledge.
Principal school 1
Psychoanalysis: classic analysis with free association and interpretation as the main therapeutic
procedures. The theoretical background is derived from Freud
Psychodynamic psychotherapy: uses forms
Principal school 2
Directive forms of therapy
Lecture 2: behavior therapy
2. Discover who you are? (continued)
Not important in psychotherapy according to lecturer. Not a real part of treatment. Exceptions,
maybe it is not about discovering who you are but about:
, Possibility 1: change dominant schematic representations by simultaneously activating multiple
neural networks.
o E.g. you have the idea that you are a worthless person. Building up other
ideas to change these.
o E.g. induce emotions; connect past present future, images and previous
experiences. Example: anorexia nervosa following mother / cannont
do it herself was the dominant view, new idea: craving freedom.
Experimental techniques: chair technique, imagery rescripting
Problem: typically within sessions
Possibility 2: changing narrative (propositional representations) but may be helpful. Talking about
who you are may lead to positive ideas of yourself, that is helpful. Not always realistic tho.
Adaptation of English butlers
These need to be changed in order for psychotherapy to work. Changed by: repeated encouters (cells
that fire together wire together): associative representations. Exposure effect: change the association
between stimulus and response. this is a experience-based; noticing that fear drops when hours with
a dog. Emotion helps changing problematic
3. Systematic exercise?
o The patient has to do exercises.
o Change associative representations
o Core business in cognitive therapy, behaviour therapy, systems therapy.
o In and between (homework assignments) sessions
o E.g. exposure, systematically challenging negative automatic thoughts, behavioural
rehearsal, assertiveness training, role playing, communication skills
o A lot of evidence for effectiveness
o Problem: patients have to participate
4. Patient activation and involvement?
o Without involvement no change in the wat we experience things
o Preferability in and between sessions
o E.g. disclosure (patient), emotional experiences (optimal), training, etc.
5. High quality therapeutic alliance
o Core ingredient in client-centered therapy and psychoanalysis
o Used for motivation and involvement in behaviour therapy and cognitive therapy
o Consistently (but moderately strong) related to psychology results
o Problem: fuzzy and untested theories about the importance of the alliance in clinical
psychology
o But: sound theories from social psychology and communication science about (resistance to)
social influence.
6. Reorganizing environment & social interactions
o E.g spouse and family support, enhance/increase social or daily activities, reduce stress (e.g.
moving), job-related interventions
o Also, (family) care plan (multiple professionals), alert plan, relapse prevention plan
o Strong (and last resort) treatment packages for severe psychiatric disorders
, Conclusions
Psychotherapy = undertaking aimed at changing unwanted patterns of
experience: ‘that things are otherwise’ (= the power of new insights or behaviours
consists of letting go the older ones) has to be made available. The picture will
never be neutral anymore once you see the other face.
Means:
1. Patients’ involvement
2. High quality therapeutic relationship
3. Providing information (propositional)
4. Systematic exervcise (associative) change needed when not changing
possible via self-control
5. Simultaneous activation of meanings (schema) changing the not
helpful ideas
6. For severe psychiatric disorders: rearranging eviorment
Behavior therapy
Cognitive behavior therapy (CBT) is the dominant form of treatment in the Netherlands (world 3th).
The most used is an eclectic form, second most used is psychodynamic therapy. 90% of disorders
have CBT available. Cat video that ring a bell and getting food: operant learning. You can learn via
yourself that dogs are scary or via modelling = your dad is scared of the dog.
BT characteristics
Psychopathology (psychological problems) are based on Stimulus-Response associations, that is,
an interaction between person and environment.
Rather symptom- than person-oriented
Observation and self-monitoring (writing down when depressed/anxiety) are part of treatment
and treatment planning / evaluations. Bc these should change over time when in treatment.
Incorrect characteristics are: BT involves behaviour only (are techniques to change emotions
rather than cognitions, emotions also important next to behaviour) BT is cold and mechanical (a
friend or adviser) BT is fully evidence-based all wrong.
BT process
1. Problem inventory = have a clear idea about the problem
o What is the problem? How often? How servere?
o How did it start? Course? Why treatment now?
o What elicits or exacerbates the problem?
o What prevents or reduces the problem?
o Positive consequences? Short-term? Long-term?
o Negative consequences? Short-term? Long-term?
o What means or solutions have already been tried?
o What is the treatment goal?
o This can be 1-2 sessions.
2. Position in holistic theory = check if you are on the right
track
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