chapter_17

The Helping Relationship in Therapy

• Therapeutic Elements

  • Effective treatment for behavior disorders hinges on two elements: the therapeutic relationship and various treatment techniques.

  • The relationship between the client and the therapist is a significant factor in treatment success. (Cahill et al., 2013; Gabbard et al., 2005.)

  • Techniques used depend on therapist's theoretical orientation and can range from biomedical approaches (e.g., medication) to psychological treatments.

• Who Seeks Therapy?

  • Many individuals initially seek help from non-professionals (family, friends, physicians) before turning to mental health professionals.

  • Approximately 30% of North Americans have sought professional psychological counseling at some point, a rise from 13% in the 1950s. (Gaylin, 2000; Meredith, 1986.)

• Types of Mental Health Professionals

  • Counseling and Clinical Psychologists: Typically hold a Ph.D. or Psy.D. with extensive training in various psychotherapeutic techniques.

  • Psychiatrists: Medical doctors who provide therapy and utilize biomedical treatments.

  • Various other professionals (psychiatric social workers, marriage and family counselors) offer therapy as well.

Psychodynamic Therapies

• Psychoanalysis

  • Developed by Sigmund Freud, focuses on internal conflict and unconscious factors influencing maladaptive behaviors.

  • Goal is to achieve insight into underlying psychodynamics of problems, thus enabling clients to adaptively deal with current situations.

• Key Techniques

  • Free Association: Clients verbalize any thoughts, feelings, or images without censorship to uncover unconscious material.

  • Dream Analysis: Involves interpreting dreams that reveal underlying impulses and wishes.

  • Resistance: Defensive behaviors indicating anxiety. Exploring resistance helps in gaining insight.

  • Transference: Clients project feelings from past significant relationships onto analysts, which can unveil repressed emotions and maladaptive patterns.

  • Interpretations: An analyst's comments aimed at providing insights into the client’s behavior and dynamics.

• Brief Psychodynamic Therapies

  • A shorter form of psychodynamic treatment focusing more on current issues rather than extensive past histories.

  • Interpersonal Therapy: This structured therapy focuses on resolving current interpersonal issues while enhancing social skills.

Humanistic Psychotherapies

• Overview

  • Emphasizes conscious control over actions and personal responsibility, believing individuals possess inner resources for self-growth.

  • Focus is on the therapeutic relationship between client and therapist as equals.

• Client-Centered Therapy (Carl Rogers)

  • Key therapeutic attributes:

    • Unconditional Positive Regard: Acceptance without judgment.

    • Empathy: Understanding clients’ perspectives.

    • Genuineness: Authenticity in the therapist's feelings and behaviors.

• Gestalt Therapy

  • Developed by Fritz Perls, focuses on achieving awareness of feelings and thoughts blocked due to anxiety, using active techniques like role-playing.

  • Techniques like the empty-chair exercise help clients articulate unresolved issues with significant others.

Cognitive Therapies

• Cognitive Behavioral Therapy (CBT)

  • Addresses irrational thought patterns contributing to emotional disturbance.

  • Albert Ellis's Rational-Emotive Therapy (RET): ABCD model focusing on activating events, beliefs, consequences, and disputation of irrational beliefs.

  • Aaron Beck’s Cognitive Therapy: Helps clients reprogram automatic thought patterns relating to their discontent.

Behaviour Therapies

• Behavior Modification Techniques

  • Focus on changing maladaptive behaviors learned through classical and operant conditioning.

  • Systematic Desensitization: A counterconditioning method used to reduce anxiety in phobias by gradually facing fears while relaxed.

  • Exposure Therapy: Aim to extinguish conditioned anxiety responses.

  • Aversion Therapy: Pairs attractive stimuli with unpleasant effects to create aversion.

• Operant Conditioning:

  • Use of reinforcement techniques like token economies to reinforce desired behaviors in settings like hospitals or schools.

Biological Therapies

• Drug Therapies

  • Categories include Anti-Anxiety Drugs, Antidepressant Drugs, and Antipsychotic Drugs.

  • Antidepressants (SSRIs, tricyclics, MAO inhibitors) target neurotransmitter activity to alleviate moods.

  • Antipsychotic Drugs: Help manage symptoms of severe disorders like schizophrenia but come with side effects like tardive dyskinesia.

• Electroconvulsive Therapy (ECT)

  • Effective in treating severe depression quickly, though it carries risks of memory loss and requires careful administration.

• Psychosurgery:

  • Lobotomy was historically problematic but modern techniques like cingulotomy are reserved for extreme cases.

Cultural and Gender Issues in Therapy

• Cultural Sensitivity:

  • Importance of cultural understanding in therapy, particularly within diverse and minority populations.

  • A culturally competent therapist can improve outcomes significantly by aligning treatment methods with clients' values.

• Gender Sensitivity:

  • Effective therapy for women includes acknowledgment and tackling of societal oppression and barriers.

Evaluating Psychotherapies

• Effectiveness:

  • Meta-analyses have shown diverse psychotherapy approaches yield similar success rates; emphasis on common factors.

• Client Variables: Openness, self-awareness, and fit between therapy and client needs impact outcomes.

• Therapist Variables: Empathy, genuine interest, and ability to form positive therapeutic relationships matter greatly.

Conclusion

• Combining Treatment Approaches:

  • Integrating drug and therapy treatments can optimize recovery and build coping skills.

  • Focus on preventive mental health strategies can lower incidence rates and improve care in communities.