Introduction to Treatment Methods
!!! with summing up tables at the end !!! (notes of a student that got a 10)
Introduction
Long therapies : many sessions, many months
1. Classic psychoanalysis: first one, longer (many years every week), client talks through free association,
analysis of dreams and early childhood, trauma, subconscious. Clear difference in hierarchy between client
and psychoanalyst
2. Humanistic, client centered therapy: (Rogers)hierarchy is not there, non-directive, client is own expert, they
already have the solution we give support and listening to help them recognise the solution, therapist can be
authentic/human
3. Integrative therapies: they were separated but merged together
- Schema therapy; part psychodynamic, part emotion focused, part cbt
4. Emotion-focused therapy (Greenberg)
5. Modern psychodynamic approaches: there are negative sides to psychoanalysis (x long, difficult) made
shorter, focused on particular mechanisms.
- Mentalisation based treatment: client put themselves in the place of others and learn to understand
the feelings and reactions, more time limited
Short therapies: some can be done in a couple of months, 4 sessions, usually ten
6. Cognitive therapy: created by Aaron Beck, not look in the subconscious but the conscious already presents
issues, distorted thinking that makes them feel bad
7. Behavior therapy: focused on actions and how these perpetuate the disorder, es. Anxiety makes people
withdraw and therefore more fear in the future. Change theme through learning-based techniques
(rewarding the good things
(later cognitive and behavioral therapy merged into one CBT: behavioral experiments (es. Social anxiety:
do something to provoke it) to make the fear response habitualised, and cognitively learn that their
predictions are not true (being judge does not change their life))
+ New CBT related therapies: focusing on self-esteem, emotion regulation, self-compassion
8. Acceptance and commitment therapy: not focused on reducing complaint but on well being, value, learn to
live with the problem.
, 9. EMDR: eye movements desensitization and reprocessing therapy, works x trauma, following lights/finger
with the eyes to make eye movements that are suiting and help with the complaints (it works but we don't
know why)
Lecture 1
All methods are effective, but need more research on why and what works on whom, so focus on common factors.
Although treatment methods differ in their approach (eg., with different interventions,therapist attitudes, vocabulary,
assumptions etc), the general belief is that there are also measurable, yet not so perceivable mechanisms at work that
contribute towards change in people.
▪ They are common mechanisms in most people and it is expected to be part of our sociobiological heritage.
Common factors in psychotherapy
Common factors: set of therapeutic elements common to most psychotherapies that shape a theoretical model and its
mechanisms of change.The most important common factors are the therapeutic relationship and managing it.
Secondly, expectations and motivational factors are important.
How important are the common factors in psychotherapy?
X Contextual model: there are three path-ways through which psychotherapy produces benefits
1. the real therapeutic relationship/alliance: first of all needed a good initial therapeutic relationship, first
impression (moment of most dropout) (made of both bottom-up and top-down processes). Then the
personal relationship has to become genuine, confidential, not broken by disclosure of difficult material.
Characters of the relationship:
a. Different roles each plays (patient and therapist)
b. Trustworthiness (safety and confidentiality)
c. Reliability (will you be there for me?)
d. Verbal and non-verbal communication (and so called “undercurrent” not said but sense it)
e. Level of cooperation towards forming “a working alliance”
f. Empathy or closeness and “warmth” (but not everybody like it)
g. Holding: Or the capacity of the therapist to manage all these factors and maintain a secure
therapeutic relationship.
provides human connection with empathic caring person= this is very health promoting, healing relationship:
- Understanding, Mentalisation, perspective taking, sense of togetherness
- Attachment: Especially an important factor in persisting psychopathology like personality disorders, also
predictor for mood disorders, eating disorders, PTSS, anxiety disorder, aggression, other regulatory
pathology. BUT most importantly, it predicts treatment outcomes.
- Secure attachment: Easy forming of treatment alliance
- Anxious-preoccupied attachment: Easy forming of treatment alliance, Difficulties in terminating
treatment, Therapist needs to have abundant patience
- Fearful-avoidant attachment: Forming a secure alliance takes time! Might seem less motivated,
but this is not the case. At risk of rejection by the therapist. More focused on skill and
problem-solving. Less on the relationship.
- Disorganized attachment: Therapist needs to have abundant patience…
Epistemic trust is the capacity to learn through a relationship and attachment. Insecure attachment styles interfere the
presence of epistemic trust
2. the creation of expectations:
- For the therapy: Important factors are Timing (when starting the therapy), Previous experiences,
Beliefs about the complaints of the patient, Beliefs about the solutions for the complaints problems
which most of the time lead to→ Demoralization → motivational problems
, - through explanation of disorder and the treatment involved: to remoralize them because they have
tried to change alone and could not. They also come with folk psychology/ explanations for their
disorder that are not adaptive because no room for change, we give right explanation that needs to
be adaptive (how to cope)= give sense of mastery, self-efficacy + agree on goals and task to do
How: Providing the patient a working model (framework) with a therapy method or conceptualization of
the problem (from a rigid to an adaptive explanation model). Psycho-education about their problem and the
treatment (remoralisation and establishing hope). Improving the sense of self-esteem and capacity to
change their behavior and situation.
Therapist and patient should be in agreement about the above described factors before continuation (and
should be discussed over and over if needed). Consider it a contract for the treatment.
3. the enactment of health promoting actions: the right treatment is one that patients find acceptable, think
will work (to have right expectations). Each treatment has specific therapeutic actions that create
expectations and produce adaptive/good actions (less dysfunctional schema, improving relationships,
accepting self)
!!!!!!!Transference as a threat for the therapeutic relationship:
Transference is the interaction between a patient and a therapist and is
complicated. One influences the thoughts and emotions and reaction
of the others (es. Patient critics therapist, he believes it, but he said it
because reminded of another situation)
Factors influencing the transference:
- Patient - How are you doing? (Mood)
- Past - Past (failed) therapy
- Present - Problems at home
Not only influenced by the patient but also by the therapist: because
influenced by his own life, experience, feelings.
The therapeutic relationship is always in danger.
Boundaries: Clear boundaries are necessary in every treatment in every method. They identify what the relationship
should look like and help the therapist identify when there is a healthy working alliance, or when trouble arises. It
also provides clarity, and with clarity security and safety for the patient, it provides an opportunity to talk about
transference.
A common method for managing transference is using Leary’s rose:
but often this method on its own is insufficient! Different treatment methods have
additional techniques.
Furthermore: Intervision and supervision are important
in recognizing therapist transference and own limitations!
Managing stress is important
