Psychotherapy Exam 1

Psychotherapy

refers to a particular process rather than just to any experience that leads to desirable psychological outcomes

planned, emotionally charged, confiding, interaction between a trained, socially sanctioned healer & a sufferer

• healer seeks to relieve sufferer’s distress & disability

Behavior

any observable, measurable action, response, or habit that an individual exhibits in reaction to their internal state or external environment

Cognition

mental processes of thinking, perceiving, remembering, & evaluating that shape how a person interprets experiences, emotions, & behaviors

Affect

immediate, outward, observable expression of an emotion

• facial expressions, tone of voice, or body language

History of Psychopathology

Spiritual models

• Deuteronomy

• Plato

• Malleus malleficarum

Physiological models

• Hippocrates (4 bodily humors)

  • Blood, Yellow bile, Black bile, Phlegm

“Moral treatment” 18th & 19th centuries

• Philippe Pinel

• William Tuke

• Eli Todd

• Dorothea Dix

Beginnings of treatment

• Jean Charcot, Sigmund Freud, Josef Breuer

  • Hypnosis & Hysteria

• Advent of Psychoanalysis--Freud

• World War II

• Reactions to psychoanalysis

  • Behaviorism & Humanism

• Evidence-based treatments

Pathologizing Human Behavior

Evaluation of certain emotions, actions/behaviors, thoughts/cognitions as abnormal, unhealthy, &/or maladaptive

• negatively impacts functioning &/or well-being

Medical model

• psychiatry vs psychology

  • abnormal behavior occurs from organic brain dysfunction

Reflection of cultural & societal norms

• homosexuality

Beginnings of Assessment

Sir Francis Galton

• 1st psychological tests

• “anthropometric lab”

Alfred Binet

• valid assessment of intellegence

• educational accommodations

Robert Woodworth

• military personality & psychopathology

DSM

1st edition published in 1952

5th edition published in 2022

“classicifcations” of psychopathology

• explicit diagnoses: e.g. major depressive disorder

• specific symptoms: markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day

atheoretical

shifting away from categories to dimensions

Rise of Psychopharmacotherapies

sedations vs treatment

• heavy sedatives & hypnotics common in asylums

  • chlorpronazine (thorazine)

growth from 1960s onward

• treatment for specific disorder categories

side effects vs clinical benefits

• integration w/psychotherapy often most effective

  • client motivation = key

Integration with Medicine

team-based treatment models

• psychotherapists

• psychiatrists

• social work

• occupational therapists

• physicians

Evidence-Based Practice

health care movement

therapy & assessment approaches must be validated by rigorous science

• psychotherapies that are more effective than placebo/ no intervention

• assessments that are valid & reliable tests of the underlying process

still guided by client & clinician preferences

integration of best available research w/clinical expertise in context of patient characteristics, culture & preferences

Research + clinical expertise + client characteristics/preferences/culture

Intergrative Practices

less focus on treating specific disorders

more focus on transdiagnostic treatments

psychotherapies function, in part, through “treatment mechanisms”

blends diff theoretical frameworks & evidence-based techniques to create a treatment plan for each client

Treatment Mechanisms

psychotherapies function, in part, through this

psychological processes that are changed by psychotherapy & lead to improved outcomes for clients

• “active ingredients” of psychotherapy

  • help to prevent mental illness

factors that are changed by treatment & subsequently imporve outcomes

manualized treatments seek to act on these factors

may be “common factors”

• e.g. increasing social support

or “specific factors”

• e.g. increasing mindfulness

Understanding how treatments work to improve outcomes

• Common factor: positive therapeutic relationship (through all psychotherapy approaches)

What are the psychological processes that are changed by treatment that ultimately improves symptoms & outcomes

Treatment Mechanisms Example

shared mechanisms across psychopathology

alcohol use disorder:

• giving up important social, occupational, or hobbies

• emotional difficulties

• restlessness

PTSD:

• not being interested in activites you once enjoyed

• high negative/low positive emotions

• restlessness

Correlational Research

observe & measure relationship between 2 variables

may be positive (move together), negative (opposite directions), or have none

pearson correlation coefficient ( r )

advantage:

• great for observation

• efficient

disadvantage:

• 3rd variable problem

• can’t infer causation (bad at explaining)

Experimental Research

Used to study cause-effect relationship between an IV on a DV

Independent Variable

• e.g. control vs treatment groups

  • waitlist vs. cognitive behavioral therapy

Dependent Variable

• e.g. psychotherapy outcomes

  • depression symptoms

key: random assignment

advantages:

• proves cause & effect

• high control

• standardization

• evidence-based support

disadvantages:

• artifical settings

• ethical limits

• rigid rules

• narrow participants

RCT is an example of this

Psychotherapy Outcome Studies

comparing diff individual therapies

Does therapy work?

• Better than no treatment?

• How do different therapies compare?

Big push for “empirically supported” or “evidence-based” therapies

Randomized Control Trials

Experimental research within the context of an intervention

Important in determining how effective a treatment is

IV: manipulation of a type of treatment

DV: how a particular outcome is affected

• random assignment

Individuals with a particular diagnosis/problem are divided into:

• Treatment group
  OR

• Control group:

  • No treatment

  • Waitlist

  • Attention-control

  • Standard treatment

“Gold standard” of treatment research

Placebo Effects

In psychotherapy interventions

• difficult to control

• expectation that treatment will improve one’s outcome

Symptoms improve after receiving fake treatment, driven by their expectation & belief that treatment is real

Single Blind Studies

participants don’t know whether they’re receiving actual treatment or a placebo but researchers do

Double Blind Studies

breaking the blind

neither participants nor researchers know who’s receiving actual treatment & who is receiving placebo

Random Assignment

In RCTs everyone is assigned to a group

selection bias

• existing systematic group differences occuring before an intervention

Null Hypothesis

H₀

is no significant differences in depression score at follow-up

Alternative Hypothesis

H_a

is significant differences in depression score at follow-up

Hypothesis Testing Within RCTs

null hypothesis

alternative hypothesis

is there a “treatment effect?”

• does independent variable produce a difference in dependent variable

  • does our outcome change between treatment vs control?

• is this difference likely due to chance?

Problems with p-values

no info on how groups vary on the outcome variable

sensitive to sample size (N used to denote sample size)

Describing Effects

statistical significance

• is the diff in our outcome likely chance?

magnitude of the effect

• how strong is the effect?

• effect sizes

clinical significant

• is the diff in our outcome clinically significant?

Treatment Efficacy

how well treatments perform in controlled research studies

• tightly controlled experimental research, really specific & done in a very controlled way

E.g. randomized control trials (RCTs) determine efficacy of a treatment; gold standard

• have internal validity

• how treatments function in optimal, controlled conditions

Treatment Effectiveness

how well interventions perform outside of research settings, in the real world

• have high exteral validity

  • External validity: generalizes study findings to situations outside of study

• how treatments function in real-world, messier conditions

Review Articles

synthesis of results of a collection of research studies on given topic to find answers to a specific research question or hypothesis

Meta-Analyses

statistical process that synthesizes results from similar studies on a given topic

where results from each study are analyzed & combined to obtain more reliable results

Individual Differences

Understanding how well treatments work between different individuals

Psychological Assessment

Why do clinicians assess people?

Gathering client info relevant to therapy:

• presenting problems

  • e.g. symptoms, daily functioning, specific diagnoses

• history

  • e.g. background, culture

• personality

• relationships

• treatment targets

  • e.g. areas of strength/growth, therapy goals

• intrapersonal: what’s happening inside the individual?

• interpersonal: what’s happening between people?

• systematic: how do family, community, & other systems affect the problem?

Personality trait

Objective personality testing

Projective personality testing

Case Conceptualization

working model of client

• integration of assessment data

• provides guidance for psychotherapy goals

active process that occurs explicitly & in partnership w/client

considered tool for building curiosity & interest, & engaging client

• suggests pathways for reaching intermediate & ultimate goals

• can lead to greater understanding of difficulties & a sense of mastery

Psychological Assessment Steps

1. determine reason for referral & presenting problem

2. choose what to assess

3. select method of assessment

4. gather assessment data

5. consider data & draw conclusions

6. convey conclusions to appropriate parties

Psychological Testing

Personality testing

• Objective personality testing

  • Structured, doesn’t use clinician interpretation

• Projective personality testing

  • Unstructured, uses clinician interpretation

Intelligence testing

• g : Overall intellectual ability

• Fluid: Flexible thinking/problem solving

• Crystalized: Accumulation of knowledge

Neuropsychological testing

Personality Trait

Stable & consistent way of perceiving world & of behaving

Not merely a collection of individual traits or disconnected behaviors, but is structured, organized, & integrated

Emerges over time out of a matrix of biological & social influences

Objective Personality Testing

Factual, not influenced by personal opinions

Have standardized questions or statements, w/fixed-option responses

Advantages:

• Simple instructions: simple scoring

• Easier to establish reliability & validity

  • But how reliable & valid test actually is varies depending on assessment

• Economical: can be given to groups or individuals

Disadvantages:

• Responses may not indicate actual behavior

  • Some measures have poor validity

• Respondents may more easily fake responses

• Experience, culture, & context can influence question interpretation & responses

Projective Personality Testing

Unconscious, related to unrecognized thoughts or emotions

Performance based tests

Characteristics

• completely unstructured

• unstructured or ambiguous stimuli

• forced to impose structure

• method is indirect

• freedom of response

• many variables

ex:

• Rorschach Inkblot Test

• Hermann Rorschach used inkblots for psychiatric diagnosis

• Observed responses of people to ambiguous situations (inkblots)

Reliability

stability/consistency of a measurement

results of an assessment for a person is consistent when administered repeatedly

example:

• IQ score for a child is about the same when assessed in Fall semester and again in Spring semester

Validity

how accurately an assessment measures what it’s intended to measure

results of an assessment accurately measure what it’s designed to measure

example:

• scale of extraversion measures extraversion & how liked person is by their peers

Reliability Effects Validity

Unreliability decreases test validity

Unreliability decreases our confidence that observed scores reflect “true” scores

Rorschach Inkblot Test

Several approaches of administering, scoring, interpreting results exist

Description

• has 10 printed inkblots

• 10 black & white (& grays), 5 include colors

Administration

• respondent tells what is seen

• clinician records responses verbatim

Inquiriy

• clinician asks for causes/prompts for responses; elaboration & clarification of responses

Scoring methods may vary, 3 criteria often used

1. location: area of card to which individual responds

2. content: nature of object perceived in inkblot

3. determinants: aspects of card that evoked response

Interpretation is complex, & subject to illusory correlation

Reliability & Validity

• Reliability of scoring system is contentious

  • Clinicians often go w/vibes on interpretive approaches

• Evidence of validity is debated

  • what can it assess?

  • what does it add?

Reliability and Validity of Projectives Difficult to Assess Because

difficult to establish

• Many variations in:

  • instructions

  • methods of administration

  • number of cards used

  • type of scoring/interpretation system

• Clinicians typically rely on qualitative impressions rather than computing scores

  • Lack of norms

    • How client’s responses compares to broader population

Intelligence

psychological construct

broad view:

• Evaluates diff cognitive processes

• Collection of diff cognitive processes

• Mental activities necessary for developing knowledge including acquiring, transforming, storing, retrieving, & using info for everyday functioning

• Different domains are evaluated w/diff tests

• Attention, perception, memory, learning, language, thinking, conceptual understanding, problem solving, etc

Spearman’s “g”

• generalized intelligence

• overall intellectual ability

Raymond B. Cattell

• 2 factors under “g”

  • Fluid ability

  • Crystalized ability

Fluid Ability

think adapt & learn w/out a lot of prior info or practice in that area

free form

w/age goes down

flexible thinking/problem solving

Crystalized Ability

structure, built up, formed overtime

accumulation of knowledge

collection of facts, skills & info gathered through education & life experience

w/age goes up

IQ Measures

structured, standardized test administration

example measures:

• Wechsler Adult Intelligence Scale (WAIS-5)

• Wechsler Intelligence Scale for Children (WISC)

• Stanford Binet-5th edition

Neuropsychological Assessment

Assessments identify possible organic brain dysfunction

• Traumatic injury

• Cerebrovascular accidents

• Tumors

• Degenerative diseases

• Nutritional deficiencies

  • Chronic alcohol/substance abuse

• Toxic disorders

Results:

• Identify severity of impairment

• Establish prognosis

• Informs treatment approach

  • Use of cognitive rehabilitation vs psychotherapy

  • Psychotherapy adaptations

Neuropsychology

study of relations between neurological functioning & behavior

focuses on brain injuries/illnesses & how they impact human functioning

Therapeutic Relationship

alliance between client & clinician including cooperation & rapport between both parties

• begins w/1st contact

• emphasis varies depending on type of psychotherapy

includes

• trust

• collaboration

• empathy

• cohesion

• goal agreement

• positive regard

• affirmation

• bidirectional feedback

  • client & therapist both consistetly share observations, insights, & data to guide treatment process

Clinical Interviewing

planned conversation between a clinician & client to gather info

• each person contributes to the convo

• each person’s responses influences the response of other person

Interview types:

• social history interview

• diagnostic interview

• crisis interview

Elements of an Interview

Physical setting

Rapport building

Taking notes/recording sessions

Communication style

• casual conversation

• language

• silence

• listening

• nonverbals

Types of questions

• open-ended

• facilitative “tell me more..”

• clarifying

• confronting

• direct

Social History Interview

purposes

• obtain thorough history of client

• understand context in which problems are occuring

• understand possible etiological mechanisms

  • potential causes of psychotherapy

What’s included?

• Childhood/family history

• Social & relationship history

• Trauma history

• Educational history

• Occupational history

• Medical history

• Psychiatric history

• Substance use history

• Legal history

• Sexual history

• Religious beliefs

• Hobbies

Diagnostic Interviewing

Used to formulate a formal DSM-based diagnostic picture of client

• gather detailed health history & symptoms to make an accurate mental health diagnosis

unstructured interviews

• open-ended, flexible question's based on clinician’s judgment

• less reliable

structured interviews

• follow strict, scripted set of questions

• e.g., Structured Clinical Interview for DSM-5 Disorders (SCID)

• ex: MINI International Neuropsychiatric Interview

• may miss important symptoms

Major Depressive Disorder

most of day, nearly every day, for 2 weeks…

1. Sad, depressed mood

2. Loss of interest/pleasure

3. Weight/appetite loss or gain

4. Insomnia or hypersomnia

5. Psychomotor agitation or retardation

6. Fatigue or loss of energy

7. Worthlessness or guilt

8. Difficulty thinking or concentrating

9. Recurrent thoughts of death/suicide

Other criteria:

• Symptoms cause significant distress/impairment

• Symptoms not attributable to effects of substance or another medical condition

• Not better accounted for by another mental disorder

• No evidence of previous manic episode

Typically recurrent

Episode length

Age of onset

Crisis Interview

conducted when somebody, self or other, in immediate danger

goals:

• meet immediate problems of client

• decrease distress

• motivate client to seek treatment in appropriate place

• keep client (& others) safe

• involuntary hospitalization if necessary

what’s assessed?

• ideation

• plan

• means

• intent

Clinical Judgement

subjective form of decision-making

• therapist relies on personal experience, memory, & in-the-moment impressions

clinican uses

• expert knowledge

• personal experience

• client perspectives

Actuarial Judgement

objective form of decision-making

• human guess is removed

clinician uses:

• statistically determined probabilities

• statistical formulas & historical data to predict patient outcomes

Actuarial vs Clinical Judgement

Actuarial prediction provides most accurate info for decision making

Clinical judgement subject to errors & bias

so what should we do?

• statistical decision making can be problematic for rare, extreme events

• don’t have statistical formulas for everything

  • misses what we don’t assess

• “Broken leg rule”

  • statistical models almost always beat human intuition

  • except when a rare, decisive piece of real-world info exists outside model’s data

listen to data w/guidance from clinical judgement

Psychological Report

identifying info

refferal info

behavioral observations

history of the presenting problem

other important history

assessment results

diagnostic impressions

case conceptualization &/or conclusions

recommendations &/or treatment plan

Freud

influential in development of psychotherapy

• trained in hypnosis + applied to treat psychopathology

  • hysteric & neurotic cases

    • psychosomatic conditions

  • case of Anna O

    • suffering from a variety of hysterical symptoms

    • wanted the opportunity to talk & have a “catharsis”

    • marked birth of psychoanalysis as the “talking cure”

• Free Association

development of psychoanalysis

Psychoanalytic Theory

Intrapsychic influence on development of personality

Emphasis on:

• the unconscious

  • Intrapsychic processes are outside of our awareness

• early psychological development

  • Motivations, desires, anxieties occurring in childhood

Not exclusive to psychotherapy per se

• Understanding broad human experience from the unconscious:

  • arts & culture

  • personality

  • psychopathology

Drive-Defense Model

Psychoanalytic Theory

Drive = instinct that drives behavior

• sex & aggression

Defense = constraints against drives to avoid anxiety

Intrapsychic conflict between drives & defenses is inevitable

• Behavior reflects a compromise between drives & defenses to address conflict

Conflict mediated by 3 structures of personality:

1. Id: our sexual & aggressive instinctual strivings

2. Ego: variety of functions that work together to determine the cost–benefit of expressing particular id urges

3. Super Ego: 2 aspects

   • our internalized values (i.e., our conscience)

   • our ego ideals (our criteria for feeling good about ourselves)

Structural Theory

Superego:

• conscience thinking

• driven by moral principles

  • societal norms + expectations dictate what a person “should” do

Id:

• illogical, emotional, irrational thinking

• driven by: pleasure principle

  • maximizing pleasure + minimizing pain dictates what a person “wants” to do

Ego:

• logical, rational thinking

• driven by reality principle

  • reality forces person to give up on fantasy so they can focus solely on meeting moral demands of society or maximizing pleasure

Compromise formation

• structure of personality that functions to express desires, while taking into account potential anxiety & guilt caused by these desires

p-values

Is difference between groups (e.g., treatment v. control group) likely due to chance?

< .05 indicates outcome is likely not due to chance & can reject null hypothesis

• is a significant difference between our groups

• statistical significance

Effect Sizes

measure of absolute magnitiude of treatment effect independent of sample size

large samples &/or small standard errors can meet significance criteria w/out being meaningful effects

Cohen’s D

common measure of effect size

magnitude of diff between groups

diff in standard deviations (SD) between the means of groups on outcome variable

• 0 - .19: trivial effect

• .20: small effect

• .50: medium effect

• .80+: large effect

Psychoanalytic Sources of Psychopathology

Maladaptive compromise formations:

• more pain than pleasure

  • e.g. excessive anxiety, interpersonal conflict

• excessive expression/inhibition of id, ego &/or superego

Failure to recognize & accept unconscious motivation

Problems occuring during psychosexual development

Regression

Fixation

Psychosexual Development

oral

• focus on pleasure & satisfaction through mouth

anal

• pressure to meet performance standards during toilet training

phallic

• focus on anxiety around genitals

latency

• focus on non-sexual experiences & other domains (e.g. school)

genital

• full sexual maturity & ego development

Regression

returning to a form of satisfaction/functioning from an early stage as way of avoiding certain feelings or anxieties

psychoanalytic source of psychopathology

Fixation

focusing on a form of satisfaction within a particular stage

rigid clinging to a particular mode of satisfaction characteristic of that stage

psychoanalytic source of psychopathology

Psychodynamic Defense Mechanisms

repression

displacement

projection

reaction formation

sublimation

splitting

isolation of affect

rationalization

denial

undoing

intellectualization

Psychoanalytic Therapy

based more heavily in Freudian theory

• Strongly focused on sexual & aggressive drive

highly intensive

• frequent therapy sessions

• multiple times per week

Psychodynamic Therapy

based in more contemporary thought

• more contempered approach, still based in psychoanalytic theory

  • reduced emphasis on sexual/aggressive drives

less intensive

• less frequent sessions, more typical of other types of psychotherapies

• once per week

focuses on gaining insight into unconscious psychological forces thought to underlie target problems

Psychodynamic Focus of Therapy

Establishing a positive “working alliance”

• strong therapeutic relationship

  • neutrality, empathy, non-judgmental

Addressing transference-countertransference

• can damage the working alliance

Managing resistance

• Defensive reactions that interfere w/therapy

Transference

When client transfers past feelings, drives, defenses onto therapist

• Often repeating past experiences from a childhood figure

Unconscious transfer of past intrapsychic processes (e.g., feelings, drives, defenses) onto a person in the present

• Due to a past relationship w/a significant childhood figure placed onto a present relationship

Example:

• During childhood, client experienced violent urges toward their parents when scolded

• In therapy as adult, when client is gently corrected for arriving late to session, they throw their phone at therapist

Countertransferencee

Clinician’s reaction to client’s transference

May be due to clinician’s past relationship w/a childhood figure

Example:

• During childhood, therapist would go emotionally numb when hit by their siblings

• When client throws their phone at therapist, therapist goes numb

Psychodynamic Therapeutic Techniques

Free association, the “talking cure”

Analysis of transference

Managing transference & countertransference

• addressing ruptures in therapeutic relationship

Interpretation

• attributing meaning to feelings, behaviors, & emotions
  w/focus on unconscious processes that may be
  impacting these experiences

Addressing resistance

• identifying areas of avoidance & associated defense mechanisms

Free Association

the “talking cure”

• keeping therapy sessions unstructured

• allowing client to verbalize whatever comes to mind

• making the unconscious, conscious

• identifying defense mechanisms

• accepting “unacceptable” aspects of self

Analysis of Transference

exploring early life experiences & unresolved childhood conflict

identifying false connection between past childhood conflicts & the present situation

Psychodynamic Treatment Mechanisms

insight

• interpretation

  • meaning making of unconscious experiences

• motivation to change

• psychological mindedness

• ego strength & frustration tolerance

• self-exploration

relationship

• positive & strong therapeutic alliance

  • trusting, gratifying, safe, nonjudgmental, relationship

• management of transference/countertransference

Relational Therapy History

Freudian -—> Interpresonal

Harry Stack Sullivan

• focused on severe psychopathology

• interpersonal psychiatry

• cultural & societal influence

Karen Horney

• feminist psychology

• challenged many Freudian views of women’s psychology

Object Relation Theory

developed from psychoanalytic theory

• instinctual drives center on other people

  • unconsciously effect how we develop & behave

people internalize their experiences w/other people

• internalized experiences = “objects”

human psychology based primarily in relationships

• childhood development

  • relationships w/objects form at infancy

• personality

• behavior change from therapy

objects including one’s own personality is split into “selves”

• e.g. “good me", “bad me”

Relational Therapy

influenced by developmental psychology

explores how your interactions w/others shape mental well-being & daily life

• attachment theory

  • relationships from infancy persist into adult relationships

  • parental/care-taker relationships = most critical

Attachment Styles

secure

• child becomes distressed when caregiver leaves, but is easily comforted when they return

insecure-avoidant attachment

• child is indifferent to caregiver’s presence & avoids them upon return

insecure-resistant attachment

• child is anxious before separation & shows ambivalene/resistance to caregiver upon their return

disorganized attachment

• child displays a mix of behaviors that indicate confusion or fear toward their caregivers

Freudian vs Relational Approaches

Relational approaches share commonalities w/psychoanalytic theory & therapy but differ in important ways

Similarities:

• early childhood experiences unconsciously influence personality & behaviors

• interpreting unconscious experiences improves insight on intrapsychic processes

  • major focus in psychotherapy

Differences:

• relationships drive personality & behavior, not sexual or aggressive instincts

• clinician is a participant observer, not a neutral observer

  • clinician influences how client participates in session (& vice versa)

Relational Sources of Psychopathology

Unhealthy or traumatic relationships

• insecure or disorganized attachment styles

• overemphasis on relationship needs/desires

• relationship history w/:

  • abuse

  • neglect

  • betrayal

  • instability

  • isolation

Internal conflict w/aspects of the self

• difficulties integrating “bad” aspects

  • using defense mechanisms to keep aspects of self in the unconscious

• rigid, dominate view of self

• dissociation

  • loss of connection w/internal & external experiences & behaviors

• motivated forgetting

  • avoiding upsetting experiences that conflict w/how one views one’s self

Focus of Relational Therapy

the therapeutic relationship

• identifying how past relationships unconsciously effect present relationships

• how relationship patterns have been helpful in the past, but unhelpful in the present

• mutuality

• enactment

understanding the meaning/purpose of symptoms

• addressing what psychological problems symbolize

bringing different selves into consciousness

Mutuality

Recognition that client & clinician influence the relationship & development of empathy towards each other

Relationship is considered mutual because there is inevitably mutual influence, recognition, & empathy

A focus of relational therapy

Enactment

Similar to countertransference

Client intentionally elicits a specific response from clinician

Breaks neutrality & objectivity

Unconscious & unavoidable

Often repeats interpersonal patterns from childhood

Patient & therapist are drawn into & engage in neurotically based interactions, w/out awareness

Is most common cause of a disruption in alliance

Focus of relational therapy

Relational Therapeutic Techniques

Managing transference & countertransference

• Addressing enactment when it occurs

Relationship tear & repair

• Managing conflict within the therapeutic relationship

• Asymmetrical disclosure

  • Limited self-disclosure from clinician

Imagining past social situations in the present

De-mystifying the unconscious

• Unstructured, non-directive sessions

• Use of free association & silence

• Interpretation of unconscious material

“Going for the affect”

• Helping client bring anxiety to consciousness & learn how to handle/regulate these feelings

  • reduces defense mechanisms

Relational Treatment Mechanisms

Therapeutic Relationship

• breaking unhelpful relationship patterns

• developing new approaches to managing relationships

New experiences

• seeking new social interactions

• developing outside relationships

Increased insight

• awareness of unconsious processes

• understanding relationship patterns

• experienceing relationship grief

Carl Rogers

Early work focused on psychotherapy among children

Research-oriented

Developed Person-Centered Therapy

• also called “client-centered”

• interested in growth, harnessing peoples’ potentials

• all people have inherent worth & value

  • not defined by what they do or contribute

Person-Centered Therapy

personality is a structure in process

• humans are constantly changing

• unlimited potential to learn & grow

rooted in the phenomenological tradition

• the phenomenal field

  • everything experienced by a person in a given time

  • determines all human behavior

• the phenomenal self, “I”

  • updating sense of self to form a single, cohesive phenomenal self

integration between self-concept w/personal experiences is key to psychological health

• congruence

• incongruence

assess client–therapist relationship & unconditional positive regard to promote full growth potential

The Phenomenal Self

Self-concept or sense of self

Dialectical constructivism

• Change → Updates to phenomenal self

• Different selves depending on environmental needs

Congruence

Strong integration between self-concept & experience

Incongruence

Poor integration between self-concept & experience

primary cause of disfunction

Person Centered Theory Sources of Psychopathology

Threats to the phenomenal self

• unresolved incongruence

  • disconnection & difficulties integrating selves & experiences

  • rigid self-view

Conditions of worth

• beliefs that one’s value must conform to the values of others

Difficulties learning from past experiences

• maladaptive coping

  • difficulties learning that thoughts, emotions, & behaviors that were helpful in previous environments are less helpful in current environment

Person Centered Focus of Therapy

Emphasis on emotions & feelings

• emotions ≠ feelings

  • emotion: specific event, duration shorter than moods, & have a clear identifiable trigger, more intense

• emotions & feelings are adaptive

  • primary adaptive emotions vs dysfunctional responses

    • secondary emotions

      • complex feelings, develop in response to initial, automatic primary emotion

    • instrumental emotions

      • serve functional purpose or help achieve specific goal

Learning difficulties

• overlearning

  • overapplying learning to situations where they’re not helpful

Self-actualization

• tendency for people to maintain & enhance themselves

Focus on the present

Self Discovery