Samenvatting Behandelmethoden 2024-
2025
Inhoudsopgave
Artikel - How important are the common factors in psychotherapy? An Update................................3
Common factors............................................................................................................................................3
Hoofdstuk 3 – Klassieke conditionering.............................................................................................5
3.1 Inleiding: klassieke conditionering en het leren van betekenissen..........................................................5
3.2 Het verwerven van nieuwe betekenissen................................................................................................5
3.3 Wat wordt er geleerd tijdens klassieke conditionering?..........................................................................7
3.4 Het wijzigen van verworven betekenissen...............................................................................................8
Hoofdstuk 4 – Operante conditionering...........................................................................................10
4.1 Inleiding: de operante leerprincipes......................................................................................................10
4.2 De zes procedures voor operante conditionering..................................................................................11
4.3 De operante leerprincipes: verdieping...................................................................................................11
4.4 Complexe vormen van operante conditionering....................................................................................14
4.5 Theoretische verklaringen voor operante conditionering......................................................................14
4.6 Interacties tussen klassieke en operante conditionering: het tweefactorenmodel van Mowrer............15
Hoofdstuk 6 – De empirische cyclus.................................................................................................17
6.1 Inleiding................................................................................................................................................17
6.2 De empirische cyclus.............................................................................................................................17
6.3 De empirische cyclus binnen de gedragstherapie..................................................................................17
6.4 De empirische cyclus en aandacht voor het functionele........................................................................18
6.5 Tot besluit: het gedragstherapeutische proces in de praktijk.................................................................18
Hoofdstuk 14 – Basisbegrippen.......................................................................................................19
1. Inleiding..................................................................................................................................................19
2. Open versus gesloten systemen..............................................................................................................19
3. Context....................................................................................................................................................19
4. Lineaire causaliteit versus circulariteit.....................................................................................................19
5. Feedbackprocessen en recursiviteit.........................................................................................................19
6. Inhoud en betrekking..............................................................................................................................20
7. Interpunctie............................................................................................................................................20
8. Interactiepatronen..................................................................................................................................20
9. Betekenisgeving......................................................................................................................................20
10. Familieorganisatie.................................................................................................................................21
11. Dialoog..................................................................................................................................................21
12. Triades...................................................................................................................................................21
13. Gezinsontwikkeling...............................................................................................................................22
, 14. Intergenerationele patronen.................................................................................................................22
15. Narratieven...........................................................................................................................................22
16. Veerkracht en hulpbronnen...................................................................................................................23
Hoofdstuk 15 – Methoden en technieken.........................................................................................24
1. Inleiding..................................................................................................................................................24
2. Informeren..............................................................................................................................................24
3. Systemische vragen.................................................................................................................................24
4. Focussen, uitvergroten en vertragen.......................................................................................................25
5. Heretiketteren.........................................................................................................................................25
6. Externaliseren.........................................................................................................................................25
7. Genogrammen........................................................................................................................................26
8. Gezinskaart en levenslijn.........................................................................................................................26
9. Opdrachten.............................................................................................................................................26
10. Non-verbale interventies.......................................................................................................................27
11. Rituelen.................................................................................................................................................27
12. Verhalen en metaforen..........................................................................................................................28
13. Teams en cotherapie.............................................................................................................................28
Chapter 1 – Theoretical and Empirical Foundations of Contemporary Psychodynamic Approaches. .29
The revival of psychoanalytical approaches to psychopathology.................................................................29
The psychodynamic approach to psychopathology.....................................................................................29
Basis assumptions of psychodynamic approaches.......................................................................................30
Psychodynamic treatment options..............................................................................................................31
Common and specific features of psychoanalytic treatments......................................................................32
Hoofdstuk 2 – Het modusmodel......................................................................................................33
2.1 Schemamodi: Overzicht.........................................................................................................................33
2.2 Casusconceptualisatie met het modusmodel........................................................................................37
2.3 Specifieke modusmodellen voor verschillende persoonlijkheidsstoornissen.........................................38
Mentalization-based treatment bij kinderen (MBT-K) met complexe problematiek en hun ouders...40
Belangrijkste behandelprincipes.................................................................................................................41
Behandelresultaten.....................................................................................................................................42
Conclusies...................................................................................................................................................42
,Artikel - How important are the common factors in psychotherapy? An Update
Common factors collectively shape a theoretical model about the mechanisms of change in
psychotherapy. The contextual model proposes that there are three pathways through which
psychotherapy produces benefits: (1) a real relationship, (2) the creation of expectations through
explanation of disorder and the treatment involved, and (3) the enactment of health promoting
actions.
An initial bond between therapist and patient needs to be created before the work of therapy
can begin, which is a combination of bottom-up and top-down processing. The real relationship (1) is
“the personal relationship between therapist and patient marked by the extent tot which each is
genuine with the other and perceives/experiences the other in ways that befit the other”. It is an
unusual social relationship because the interaction is confidential (with some statutory limits) and
disclosure of difficult material does not disrupt the social bond. Expectations (2) in psychotherapy can
have a strong influence on experience and can work in several possible ways. The patient comes to
believe that participating in and successfully completing the tasks of therapy, whatever they may be,
will be helpful in coping with his or her problems, which then furthers for the patient the expectation
that he or she has ability to enact what is needed. Critical to the expectation pathway is that patients
believe that the explanation provided and the concomitant treatment actions will be remedial for
their problems. Consequently, the patient and therapist will need to be in agreement about the goals
of therapy as well as the tasks, which are two critical components of the therapeutic alliance. A strong
alliance indicates that the patient accepts the treatment and is working together with the therapist,
creating confidence in the patient that the treatment will be successful. The contextual model posits
that specific ingredients (3) universally produce some salubrious actions. That is, the therapist induces
the patient to enact some healthy actions, whether that may be thinking about the world in less
maladaptive ways and relying less on dysfunctional schemas (cognitive-behavioral treatments),
improving interpersonal relations (interpersonal psychotherapy and some dynamic therapies), being
more accepting of one’s self (self-compassion therapies, acceptance and commitment therapy),
expressing difficult emotions (emotion-focused and dynamic therapies), taking the perspective of
others (mentalization therapies), and so forth.
Common factors
The alliance is composed of three components: the bond, the agreement about the goals of
therapy, and the agreement about the tasks of therapy. Typically, the alliance is measured early in
therapy (at session 3 or 4) and correlated with final outcome. There have been a number of criticisms
on alliance, but this has been found to not attenuate the importance of the alliance.
First, it could well be that early symptom relief causes a strong alliance at the third or fourth session –
that is, early responders report better alliances and have better outcomes. Studies are converging on
the conclusion that the alliance predicts future change in symptoms after controlling for already
occurring change. Second, it could be that the correlation between alliance and outcome is due to the
patients’ contributions to the alliance. However, it was found that more effective therapists were able
to form a strong alliance across a range of patients. Patients’ contribution did not predict outcome:
patients who are able to form better alliances, perhaps because they have secure attachment
histories, do not have better prognoses. Third, there may be a halo effect if the patient rates both the
alliance and the outcome. However, meta-analyses have shown that the alliance-outcome association
is robust even when alliance and outcome are rated by different people.
A distinction has been made between the bond, as defined as a component of the alliance, which is
related to purposeful work, and the real relationship, which is focused on the transference-free
genuine relationship. There is some evidence that the real relationship is related to outcome, after
controlling for the alliance.
Empathy, a complex process by which an individual can be affected by and share the emotional
state of another, assess the reasons for another’s state, and identify with the other by adopting his or
, her perspective, is thought to be necessary for the cooperation, goal sharing, and regulation of social
interaction. Empathy can by shown by using active listening, appropriate silences for reflection, and a
communication of confidence and positive expectation. There have been numerous studies that have
correlated ratings of therapist empathy with outcome, resulting in a relatively large effect. It should be
recognized that several of the threats to validity for the alliance are also present with regard to
empathy. For example, it is clearly easier for a therapist to be warm and caring toward a motivated,
disclosing and cooperative patient than to one who is interpersonally aggressive, and the former types
of patients will most likely have better outcomes than the latter, making the empathy/outcome
correlation an artifact of patient characteristics rather than therapist action.
In psychotherapy, creating the expectations, through explanation of the patient’s disorder,
presenting the rationale for the treatment, and participating in the therapeutic actions, is part of
therapy. It is difficult to design experimental studies of expectations in psychotherapy.
The contextual model emphasizes that the explanation given for the patient’s distress and the
therapy actions must be acceptable to the patient. Acceptance is partly a function of consistency of
the treatment with the patient’s beliefs, particularly beliefs about the nature of mental illness and
how to cope with the effects of the illness. Research shows that adaptive evidence-based treatments
by using an explanation congruent with the cultural group’s beliefs was more effective than unadapted
evidence-based treatments.
Therapist effects are said to exist if some therapists consistently achieve better outcomes with
their patients than other therapists, regardless of the nature of the patients or the treatment
delivered. The contextual model predicts that there will be differences among therapists within a
treatment. That is, even though the therapists are delivering the same specific ingredients, some
therapists will do so more skillfully and therefore achieve better outcomes than other therapists
delivering the same treatment. Consistent differences among therapists in such trials, although
modest, are instructive. Studies have shown that effective therapists are able to form stronger
alliances across a range of patients, have a greater level of facilitative interpersonal skills, express
more professional self- doubt, and engage in more time outside of the actual therapy practicing
various therapy skills.
To many, the dismantling design is the most valid way to identify the effects of specific
ingredients. In this design, a specific ingredient is removed from a treatment to determine how much
more effective the treatment is in total compared to the treatment without the ingredient that is
purportedly remedial for the psychological deficit. In clinical trials, it is required that adherence to the
protocol and the competence at delivering the treatment are rated. There is evidence that rigid
adherence to a protocol can attenuate the alliance and increase resistance to the treatment (i.e.,
failing to accept the treatment, a contextual model tenet), and that flexibility in adherence is related
to better outcomes. In regards to competence: what is rated is the skill in providing the elements of
the treatment protocol, rather than common factors, such as empathy, alliance, affirmation, and so
forth – aspects of therapy that do predict outcome and seem to differentiate more effective therapists
from less effective therapists.
Concluding, research strongly suggests that the common factors must be considered therapeutic and
attention must be given to them.
