Psychotherapy

Therapeutic Alliance : a relationship between the client and the therapist that is facilitated when the therapist is genuine, when the therapist treats the client with unconditional positive regard, and when the therapist develops empathy with the client.

  • the development of a positive therapeutic alliance is exceedingly important to successful therapy

  • the ideas of genuineness, empathy, and unconditional positive regard in a nurturing relationship in which the therapist actively listens to and reflects the feelings of the client is probably the most fundamental part of contemporary psychotherapy

  • psychodynamic and humanistic therapies are recommended primarily for people suffering from generalized anxiety or mood disorders, and who desire to feel better about themselves overall

Example :

Donna tells her therapist that she came home from work in a bad mood and kicked her dog. Her humanistic therapist does not judge her for this action, but rather asks Donna to discuss what she was feeling at that time. The therapist is using unconditional positive regard.

COGNITIVE THERAPY

cognitive therapy : a psychological treatment that helps client identify incorrect or distorted beliefs that are contributing to disorder

  • the therapist helps the patient develop new, healthier ways of thinking about themselves and about the others around them

  • the idea of cognitive therapy is that changing thoughts will change emotions, and that the new emotions will then influence behavior

  • the goal of cognitive therapy is not to get people to think more positively but to think more accurately

Aaron T. Beck & Albert Ellis

together provided the basic principles of cognitive therapy

  • ELLIS called his approach rational emotive behavior therapy (REBT) or rational emotive therapy (RET)

  • he focused on pointing out the flaws in the patient’s thinking

  • he noticed that people experiencing strong negative emotions tend to personalize and overgeneralize their beliefs, leading to an inability to see situations accurately

  • in REBT the therapist’s goal is to challenge these irrational thought patterns, helping the patient replace the irrational thoughts with more rational ones, leading to the development of more appropriate emotional reactions and behaviors

  • BECK’s cognitive therapy was based on his observation that people who were depressed generally had a large nummber of highly accessible negative thoughts that influenced their thinking

  • his goal was to develop a short term therapy for depression taht would modify these unproductive thoughts

  • his approach challenges the client to test their beliefs against concrete evidence

EXAMPLE

Marsha: I feel like my husband doesn’t appreciate me. I wonder if he cares about me anymore. It just makes me feel rotten thinking I am not loved.

Therapist 1: So what I am hearing is that you don’t feel appreciated by your spouse and this makes you worry he doesn’t care about you anymore? That maybe you are not loved?

Therapist 2: What makes you think you are unloved by your spouse? Just last week you mentioned how he took you out for a nice dinner to celebrate all of your recent accomplishments at work. This doesn’t seem like something that an uncaring or unappreciative partner would do.

What approach is the first therapist using? non-directive

in summary, cognitive therapy works by identifying and changing maladaptive thoughts

BEHAVIORAL THERAPY

behavioral therapy : psychological treatment that is based on principles of learning

  • the most direct approach is through operant conditioning using reward or punishment

  • reinforcement may be used to teach new skills to people, for instance, those with autism or schizophrenia

  • as the patient practices the different techniques, the appropriate behaviors are shaped through reinforcement to allow the client to manage more complex social situations

  • in some cases, observational learning may also be used and beneficial

  • people who learn to improve their interpersonal skills through skills training may be more accepted by others and this social support may have substantial positive effects on their emotions

exposure therapy : a behavioral therapy based on the classical conditioning principle of extinction in which people are confronted with a feared stimulus with the goal of decreasing their negative emotional responses to it

  • exposure treatment can be carried out in real situations or in the patients imagination

  • it is used with panic disorder, agoraphobia, social phobia, OCD, and posttraumatic stress disorder

flooding : a client is exposed to the source of their fear all at once

  • a person with agoraphobia may be brought to a shopping mall

  • someone with extreme fear of heights may be brought to a tall building

  • the assumption is that the fear will subside as the client habituates to the situation while receiving emotional support from the therapist during the stressful experience

  • an advantage of flooding is that it is quick and often effective

  • a disadvantage of flooding is that the patient may relapse after a short period of time

  • more often exposure is done more gradually

systematic desensitization : a behavioral treatment that combines imagining or experiencing the feared object or situation with relaxation exercises

  • the client and the therapist work together to prepare a hierarchy of fears, starting with the least frightening and moving to the most frightening scenario

  • the patient then confronts their fear in a systematic manner, sometimes using their imagination, but most often, in real life

  • desensitization techniques use the principle of counter conditioning

counter conditioning : a second incompatible response ( relaxation) is conditioned to an already conditioned response (the fear response)

  • the continued pairing of the relaxation response to the feared stimulus as the patient works up the hierarchy gradually leads the fear response to be extinguished and the relaxation response to take its place

  • behavioral therapy works best when people directly experience the feared object

  • it is often difficult and expensive to create these experiences in real life, so virtual reality has allowed clinicians to provide behavioral therapy in what seems like real situations to the patient

virtual reality CBT : the therapist uses computer-generated, three-dimensional, lifelike images of the feared stimulus in a systematic desensitization program

  • specially designed computer equipment is used to create a simulated environment

  • a common use is to help soldiers who are experiencing PTSD return to the scene of the trauma and learn how to cope with the stress it invokes

  • some advantages of the VR approach are that is is economical, the treatment session can be held in the therapists office with no loss of time or confidentiality, the session can easily be terminated as soon as a patient feels uncomfortable, and many patients who have resisted live exposure to the object of their fears are willing to try the new VR option first

aversion therapy : a type of behavior therapy in which positive punishment is used to reduce the frequency of an undesirable behavior

  • an unpleasant stimulus is intentionally paired with a harmful or socially unacceptable behavior until the behavior becomes associated with unpleasant sensations and is hopefully reduced

  • alcoholism has long been treated with aversion therapy, patients are treated at a hospital where they are administered a drug, antabuse, that makes them nauseous if they consume any alcohol

  • the technique works very well if the user keeps taking the drug, but unless it is combined with other approaches the patients are likely to relapse after they stop the drug

COGNITIVE BEHAVIOR THERAPY

cognitive-behavior therapy (cbt) : a structured approach to treatment that attempts to reduce psychological disorders through systematic procedures based on cognitive and behavioral principles

  • cbt is based on the idea that there is a recursive link among our thoughts,, our feelings, and our behavior

  • the thoughts, feelings, and behavior amplify and distort each other

  • it is used for the treatment of a variety of problems, including mood, anxiety, personality, eating, substance abuse, attention deficit and psychotic disorders

  • cbt treats the symptoms of the disorder and does not attempt to address the underlying issues that cause the problem

  • the goal is to simply stop the negative cycle by intervening to change cognition or behavior

  • the client and therapist work together to develop the goals of the therapy, the ways that the goals will be reached, and the timeline for reaching them

  • problem solving and action oriented

  • the treatment usually lasts between 10 and 20 sessions

  • some cbt treatments may be behavioral whereas others are cognitive

  • almost all cbt treatments use a combination of behavioral and cognitive approaches

COMBINATION (ECLECTIC) APPROACHES TO THERAPY

  • the most common approach to therapy is eclectic therapy

eclectic therapy : an approach to treatment in which the therapist uses whichever techniques seem most useful and relevant for a given patient

dialectical behavioral therapy ( DBT ) : essentially a cognitive therapy, but it includes a particular emphasis on attempting to enlist the help of the patient in their own treatment

  • the therapist aims to accept and validate the clients feelings at any given time while nonetheless informing the client that some feelings and behaviors are maladaptive, and showing the client the better alternative

  • the therapist will use both individual and group therapy

LEARN BY DOING

if you asked a psychotherapist what type of therapy they practice, the answer would most likely be eclectic (combination).

ellis is to rational emotive therapy as beck is to cognitive therapy. many therapists integrate multiple approaches to treat an individuals probllems; that is, they use an eclectic approach