Clinical Psychology

Psychodynamic Psychotherapies: Shared Assumptions

human behavior is motivated largely by unconscious processes

early development has a profound effect on adult functioning

universal principles explain personality development and behavior

insight into unconscious processes is a key component of psychotherapy

psychodynamic psychotherapies: key concepts

Freudian psychoanalysis (defense mechanisms, analysis)

Adler’s individual psychology (Teleological approach, Style of Life)

Jung’s Analytical psychotherapy (collective unconscious, archetypes, individuation)

Separation-individuation (Mahler)

Humanistic Psychotherapies: Shared characteristics

phenomenological approach which assumes that, to understand a person, one must understand their subjective experience

a focus on current behavior

a belief in the individual’s inherent potential for self-determination and self-actualization

a view of therapy as involving an authentic, collaborative, and egalitarian relationship between therapist and client

a rejection of tradition assessment techniques and diagnostic labels

Adler’s individual psychology (Teleological approach, style of life)

Adler’s personality theory and approach to therapy stress the unity of the individual and the belief that behavior is purposeful and goal-directed.

Key concepts are inferiority feelings, striving for superiority, and style of life (which unifies the various aspects of an individual’s personality)

Maladaptive behavior represents a mistaken style of life that reflects inadequate social interest,.

Adler’s teleological approach regards behavior as being largely motivated by a person’s future goals

Alloplastic vs autoplastic

Refers to the focus of an intervention with regard to the environment.

The goal of alloplastic intervention is to make changes in the environment, so it better accommodates the individual

The goal of autoplastic intervention intervention is to change the individual so that they are bettter able to function effectively in their environment

Evidence-based treatments

the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences.

Existential therapy

derived from existential philosophy and share an emphasis on choice and responsibility for developing a meaningful life.

They describe maladaptive behavior as the result of an inability to cope authentically with the ultimate concerns of existence (death, freedom, existential isolation, and meaninglessness)

Feminist therapy (NONSEXIST THERAPY, SELF-IN-RELATION THEORY)

Based on the premise that the “personal is political”

Focuses on empowerment and social change and acknowledges and minimizes the power differential inherent in the client-therapist relationship.

Self-in-relation theory applies feminism to object relations theory and proposes many gender differences in the early mother-daughter and mother-son relationships.

Feminist theory must be distinguished from nonsexist therapy, which focuses more on the personal causes of behavior and personal change.

Freudian Psychoanalysis (defense mechanisms, analysis)

when the ego is unable to ward off danger (anxiety) through rational, realistic means, it may resort to one if its defense mechanisms (repression, reaction formation) which share 2 characteristics:

They operate on an unconscious level and they serve to deny or distort reality.

In psychoanalysis, the analysis of free associations, dreams, resistances, and transferences consists of a combination of confrontation, clarification, interpretation, and working through.

Gestalt Therapy (Boundary disturbance, transference, awareness)

views “awareness” (a helpful understanding of one’s thoughts, feelings, and actions in the here and now) as the primary curative factor and defines neurosis as a “growth disorder: that is often attributable to a boundary disturbance that leads to an abandonment of the self or the self-image.

Gestaltians regard a client’s transference to be counterproductive and respond to it by helping the client recognize the difference between their “transference fantasy” and reality.

Interpersonal therapy (primary problem areas)

A brief manual-based therapy that was originally developed as a treatment for depression, but has since been applied to a number of other conditions. IPT focuses on symptom reduction and resolving one or more primary areas of interpersonal functioning- unresolved grief, interpersonal role disputes, role transitions, and interpersonal deficits.

Jung’s analytical psychotherapy (collective unconscious, archetypes, individuation)

Analytical psychotherapy views behavior as being determined by both conscious and unconscious factors, including the collective unconscious which is of latent memory traces that have been passed down from one generation to the next.

Included in the collective unconscious are archetypes (primordial images) that cause people to experience certain phenomena in universal ways.

Therapeutic strategies include the interpretation of dreams and transferences (which reflect projections of both the personal and collective unconscious)

A key concept in Jung’s personality theory is individuation, which refers to an integration of the conscious and unconscious aspects of the psyche that occurs in the later years and leads to a unique identity and the development of wisdom.

Motivational interviewing (OARS)

specifically developed for clients who are ambivalent about changing their behavior and combines the transtheoretical model with client-centered therapy and the concept of self-efficacy. The specific techniques are:

Open-ended questions

Affirmations

Reflective listening

Summaries

Network Therapy

identified as an effective intervention for Native American clients and is often used as a treatment for alcohol and drug abuse.

Multimodal treatment that incorporates family and community members into the treatment process and situations an individual’s problems within the context of their family, workplace, community, and other social systems.

Person-centered therapy (Facilitative Conditions)

Roger’s personal-centered therapy is based on the assumptions that people possess an inherent ability for growth and self-actualization and that maladaptive behaviors occurs when “incongruence between self and experience” disrupts this natural tendency.

Therapeutic strategies include therapist’s role is to provide the client with 3 facilitative conditions: Empathy, genuineness, and unconditional positive regard; that enable the client to return to their natural tendency for self-actualization.

Personal construct Therapy

George Kelly

Focuses on how the client experiences the world. It assumes that a person’s psychological processes are determined by the way they “construe” (perceive, interprets, and predicts) events, with construing involving the use of personal constructs which are bipolar dimensions of meaning (happy/sad, competent/incompetent) that begin to develop in infancy and may operate on an unconscious or conscious level.

The goal of therapy is to help the client identify and revise or replace maladaptive personal constructs so that the client is better able to “make sense” of their experiences.

Prevention (Primary, Secondary, Tertiary)

Primary: make an intervention available to all members of a target group or population in order to keep them from developing a disorder

Secondary: identify at-risk individuals who are showing early signs of a disorder and offer them appropriate interventions

Tertiary: designed to reduce the duration and consequences of an illness that has already occurred

Reality Therapy

Glasser

Based on choice theory. Assumes people are responsible for the choices they make and focuses on how people make choices that affect the course of their lives.

Proposes that people have 5 basics innate needs (survival, love and belonging, power, freedom, and fun) that a person adopts a success (vs failure) identity when they fulfill these ends in a responsible way

Ps. Love and belonging was stressed as the most important

Separation-Individuation (Mahler)

Mahler’s version of object-relations theory focuses on the processes by which an infant assumes their own physical and psychological identity, and her model of early development involves several phases.

The development of object-relations occurs during the separation-individuation phase which begins at 4-5 months of age.

According to Mahler, adult psychopathology can be traced to problems that occurred during separation-individuation.

Solution-focused therapy (questions)

focus on solutions to problems rather than on the problems themselves.

In therapy, the client is viewed as the “expert” while the therapist acts as a consultant/collaborator who phases questions designed to assist the client in recognizing and using their strengths and resources to achieve specific goals (miracle question, exception questions, scaling questions).

Transtheorretical model (stages of change)

Prochaska and DiClemente’s transtheoretical model of behavior change proposes that the change process involves 6 stages (precontemplation, contemplation, preparation, action, maintenance, termination) Interventions are most effective when they match the person’s stage of change

(consciousness raising, dramatic relief, and environmental reevaluation are useful for helping clients transition from the precontempation to the contemplation stage)

Eyesenck

British psychologist know for his factor analysis of personality traits, contributions to behavior therapy, and 1952 review of psychotherapy outcome studies. Which he found that 72% of untreated neurotic individuals improved without therapy, while 66% of patients receiving eclectic psychotherapy and 44% receiving psychoianalytic psychotherapy showed a substantial decrease in symptoms. Based on these findings, Eysenck concluded that any apparent benefit of therapy is due to spontaneous remission

Smith, Glass, and Miller (Meta-analysis-Effect Size)

Smith et al., used meta-analysis to combine the results of psychotherapy outcome studies and found, contrary to Eysenck, that psychotherapy does have substantial benefits. ‘’In one study, they obtained an average effect size of .85, which indicates that the typical therapy client is better off than 80% of individuals who need therapy but are untreated.

Communication/Interaction family therapy (symmetrical vs Complementary Communication)

associated with Jackson, Satir, Haley and others.

Focuses on the impact of communication on family and individual functioning. ‘Distinguishes between 3 communication patters:

Symmetrical: occurs between equals but mat escalate into a competitive one-upsmanship game

Complementary: occurs between individuals who are unequal and emphasizes their differences

extended Family Systems Therapy (Differentiation, Emotional Triangle, Genogram)

Bowen’s approach to family therapy extends general systems theory beyond the nuclear family.

Key terms:

Differentiation: a person’s ability to separate their intellectual and emotional functioning which helps keep the person from becoming “fused” with the emotions that dominate the family

Emotional Triangle: Deelopes when. Two-person system attempts to reduce instability or stress by recruiting a third person into their system.

Therapy often begins with the construction of a genogram, which depicts the relationships between family members, the dates of significant life events, and other important information.

The therapist often sees two members of the family (spouses) and for a a therapeutic triangle in which the therapist comes into emotional contact with the family members but avoids becoming emotionally triangles. Therapy often begins goal is to increase the differentiation of all family members.

Group therapy (formative stages, cohesiveness, premature termination)

Yalom.

3 formative stages

1. Orientation, participation, searching for meaning, and dependency

2. Conflict, dominance, and rebellion

3. Development of cohesiveness

Cohesiveness described to be the most important curative factor provided by group therapy and the group therapy analog for the therapist-client relationship in individual therapy.

He proposes that prescreening of potential group members and post-selection preparation can reduce premature termination from group therapy and enhance therapy outcome.

Object-relations family therapy (projective identification, multiple transferences)

for object relations family therapists, maladaptive behavior is the results of both intrapsychic and interpersonal factors. A primary source of dysfunction is protective identification, which occurs when a family member projects old introjects onto another family member and then reacts to that person as though they actually have those projected characteristics or provides the person to act in ways consistent with those characteristics.

The primary goal of therapy is to resolve each family members attachment to family introjects and involves addressing multiple transferences

Strategic family therapy (paradoxical interventions)

Haley’s strategic family therapy focuses on transactional patterns and views symptoms as interpersonal events that serve to control relationships.

Therapy focuses on symptom relief (rather than insight); and involves the use of specific strategies, especially paradoxical interviewing (ordeals, prescribing the symptom, reframing) that are designed to alter behavior of family members by helping them see a symptom in an alternative way or recognize their have control over their behavior or by using their resistance in a constructive way.

Structural family therapy (boundaries, rigid triads, joining)

Minuchin

Emphasizes altering the family’s structure in order to change the behavior patterns of family members. Boundaries (rules that determine the amount of contact that is allowed between family members) are one element of the family structure: When boundaries are overly rigid, family members are disengaged and when they are too diffuse or permeable, family members are enmeshed.

Minuchin distinguished between 3 chronic boundary problems, or rigid triads: detouring, stable coalition, and triangulation.