Models of Psychotherapy Part One

Vocabulary-style flashcards covering core terms and concepts from the lecture on psychotherapy models, waves, and related concepts.

Psychotherapy

A collaborative, goal-directed treatment based on the relationship between a client and a psychologist; grounded in dialogue and a supportive environment to modify behavior, thoughts, and emotions.

Psychotherapy APA

Psychotherapy is a collaborative treatment based on the relationship between an individual and a psychologist. It is grounded in dialogue and provides a supportive environment that allows patients to talk openly with someone who’s objective, neutral, and nonjudgmental.

Psychotherapy is the informed and intentional application of clinical methods and interpersonal stances derived from established psychological principles for the purpose of assisting people to modify their behaviors, cognitions, emotions, and other personal characteristics.

Core Features of Psychotherapy

• A structures, goal-directed, professional helping relationship

• Evidence-based theories and methods guide practice

• Focused on reducing distress and enhancing well-being

• Relies on the therapeutic alliance as a central mechanism of change (have to have a relationship, is a relationship)

Psychotherapy vs Other Roles

Psychotherapy

• Delivered by trained mental health professionals (psychologists, psychotherapists, psychiatrists, clinical social workers, and nurse practitioners, etc.)

• Grounded in psychological theory and evidence-based methods

• Focuses on treating mental health concerns, reducing distress, and fostering growth

• Requires ethical standards, licensure, and supervision

Counseling

• Often shorter-term and problem-focused

• May address life stressor, transitions, or specific challenges (e.g. school, career, relationships)

• May be delivered by counsellors, social workers, or other professionals

Coaching

• Focuses on personal development and performance (e.g., career, leadership, motivation)

• Not designed to treat mental health conditions

• Practitioners may or may not have formal clinical training

Informal Support

• Provides empathy, listening, and encouragement

• Lacks structured methods, professional boundaries, or clinical accountability

• Valuable, but not a substitute for psychotherapy when dealing with mental health issues

Psychodynamic Modalities

• Object-Relations

• Brief Psychodynamic

• Interpersonal Process Therapy (IPT)

Experiential & Relational

• Emotion Focused Therapy (EFT)

• Accelerated Experiential Dynamic Psychotherapy(AEDP)

• Gestalt Therapy

• Emotion-Focused Family Therapy (EFFT)

• Creative modalities (music therapy, art therapy)

• Compassion Focused Therapy

Cognitive Approaches

• Cognitive Behavioural Therapy (CBT)

• Mindfulness Based Cognitive Behavioural Therapy (MBCBT)

• Dialectical Behaivoural Therapy (DBT)

• Acceptance and Commitment Therapy (hybrid)

• Cognitive Processing Therapy (CPT

Post-Modern & Systems

• Internal Family Systems (IFS)

• Gottman Method

• Somatic Experiencing

• Psychedelic-Assisted Psychotherapy (PAP)

• EMDR (trauma-focused)

Therapist and Therapy are inseparable

• In psychotherapy, who the therapist is—their worldview, values, and self-awareness— shapes the therapeutic process

• Developing as a clinician requires not only knowledge of theory and technique, but also reflection on the self as therapist

• The therapeutic relationship is the foundation: the therapist is part of the intervention

Placebo Effect

A beneficial effect produced by an intervention that cannot be attributed to the treatment itself, but rather to the client’s expectation of benefit. In psychotherapy: Expectancy and belief in the process are common factors of change. Therapist’s warmth, credibility, and instilling of hope enhance placebo effects.

Placebo Effect Mechanism

Positive expectations activate brain and body systems (endorphins, dopamine). Strengthens the therapeutic alliance—hope and belief in therapy contribute to real change.

Nocebo Effect

A negative outcome resulting from expectations of harm or ineffectiveness, even in the absence of a harmful intervention. In psychotherapy: Poor framing of therapy, lack of empathy, or therapist doubt can reinforce hopelessness. Highlights the importance of language, framing, and attunement

Nocebo Mechanism

Negative beliefs trigger stress responses (e.g., anxiety, cortisol release). Can undermine treatment, damage alliance, and worsen symptoms.

Polyvagal Theory (Stephen Porges, 1994)

Definition: A neurophysiological model explaining how the autonomic nervous system (ANS) supports regulation, connection, and defense. In psychotherapy: Emphasizes the role of safety and co-regulation in healing trauma. Therapists help clients shift into ventral vagal states where reflection and growth are possible

Key Concepts of Polyvagal

Ventral Vagal System (social engagement): calm, safe, connected states; fosters therapeutic alliance.

Sympathetic Nervous System (mobilization): fight-or-flight; linked to anxiety, hyperarousal.

Dorsal Vagal System (immobilization): shutdown, freeze, dissociation.

AI Made Defs

Therapeutic relationship

The central interpersonal bond in psychotherapy, encompassing the therapeutic alliance, empathy, warmth, and trust that support change across modalities.

Evidence-Based Therapy

Practice guided by a combination of research evidence, clinical expertise, and client values.

Common Factors

Elements shared across therapies (e.g., alliance, empathy, expectancy/hope) that contribute to change beyond specific techniques.

Placebo Effect

Beneficial change driven by client expectation and belief in the process, not the treatment itself; linked to warmth and alliance.

Nocebo Effect

Worsening of symptoms due to negative expectations or framing, highlighting the importance of language and therapeutic framing.

Polyvagal Theory

A neurophysiological model of the autonomic nervous system emphasizing safety and co-regulation (ventral vagal system) as central to healing trauma.

Three Waves of Therapy

First Wave: Behaviorism; Second Wave: CBT; Third Wave: Contextual/Experiential therapies emphasizing mindfulness, acceptance, and values.

First Wave: Behavior Therapy

Focus on observable behavior change using conditioning principles (classical/operant).

Systematic Desensitization

A gradual exposure technique paired with relaxation to reduce fear responses (Wolpe).

Exposure Therapy

A planned confrontation with feared stimuli or situations to reduce avoidance and anxiety.

Behavior Modification

Use of reinforcement, punishment, and token economies to shape behavior.

Second Wave: Cognitive Behavioral Therapy (CBT)

Therapy that focuses on how thoughts, beliefs, and appraisals influence emotions and behavior; structured, evidence-based protocols.

Beck’s Cognitive Therapy

CBT approach for depression emphasizing restructuring negative automatic thoughts and beliefs.

Rational Emotive Behavior Therapy (REBT)

Ellis’s CBT approach targeting irrational beliefs to alter emotional and behavioral responses.

Third Wave: Contextual & Experiential Behavioral Therapies

A group trend emphasizing mindfulness, acceptance, values, and context (e.g., ACT, DBT, MBCT, FAP, CFT).

Controlled Act of Psychotherapy (RHPA, 1991)

Regulates and monitors ethics and standards of psychotherapy. Only regulated professionals are allowed to engage in psychotherapy.

Authorized providers: Psychologists, Psychiatrists, RPs, Social Workers, Nurses, OTs.

Why regulated? → public safety, ethical standards

Evidence-Based Therapy

Research evidence + clinical expertise + client values. It is standardized, and widely supported. However, some modalities are easier to manualize/research (CBT), some are harder to measure (relational), RCTs privilege symptoms over long-term change.

Three waves of therapy

First Wave: Behaviourism > conditioning, exposure

Second Wave: CBT > thoughts, restructuring

Third Wave: ACT, DBT, MBCT > mindfulness, acceptance, values

Behaviour Therapy

First Wave from 1950s - 1960s. Focused on observable behaviour change using principles of classical and operant conditioning. Core modalities include; systematic desensitization (Wolpe), exposure therapy, behaviour modification (reinforcement, punishment, token economies).

Behaviour Therapy Strengths and Limitations

Strengths: Strong empirical foundation, effective for phobias and anxiety.

Limitations: Neglected internal experiences (thoughts, emotions, beliefs)

Cognitive Behavioural Therapy

Second Wave from 1970s - 1980s. Added the cognitive revolution > thoughts beliefs, and appraisals influence behaviour and emotion. Core modalities include; Beck’s cognitive therapy (for depression), ellis’ rational - emotive behaviour therapy (REBT), standard CBT protocols (for anxiety, depression, OCD, etc.)

CBT Strengths and Limitations

Strengths: Empirically validated across many conditions; structured and time- limited.

Limitations: Sometimes criticized as too rationalistic or focused on “fixing thoughts,” less emphasis on context, emotion, or acceptance

Contextual & Experiential Behaviour Therapies

Third Wave from the 1990s to the present. Emphasize midfulness acceptance, values, and context rather than trying to directly change thoughts.

3rd Wave Core Modalities

Acceptance and Commitment Therapy (ACT) → acceptance, values-driven action, psychological flexibility.

Dialectical Behaviour Therapy (DBT) → integrates CBT with mindfulness and acceptance strategies.

Mindfulness-Based Cognitive Therapy (MBCT) → combines CBT with meditation practices.

Functional Analytic Psychotherapy (FAP) → focuses on in-session relational behaviours.

Compassion-Focused Therapy (CFT) → emphasizes self-compassion and emotion regulation.

Common Factors

Common factors refer to the elements that contribute to effective therapy across different modalities, including the therapeutic alliance, empathy, hope and expectancy, and specific therapist qualities. These factors are often more impactful on client outcomes than the particular type of modality employed.

Common factors may explain more variance in outcomes than techniques.

Contextual & Experiential Behaviour Therapies Strengths and Limitations

Strengths: Broader, more integrative; focus on acceptance, lived experience, and culture.

Challenges: Evidence base still emerging in some areas; risk of being seen as “trend-driven” or less structured than classic CBT