Treatment of Psychological Disorders – Humanistic, Existential, and Systemic Approaches

Quick Review & Questions

• Lecturer opened by inviting questions from Monday’s session (no pressing questions were raised).
• Monday’s coverage recap:
  • Psychodynamic Psychotherapies
  • Cognitive-Behavioural Therapies (CBT)
  • Interpersonal Therapy (IPT)

Overview of Today’s Content

• Humanistic–Existential therapies (contrasting philosophy to Monday’s approaches)
• “Other modes” of therapy when more than one person is in the room:
  • Group Therapy
  • Family Therapy
  • Couples Therapy
• Concluding material:
  • Evaluating & matching therapies
  • Cultural considerations, empirical evidence & integration
  • Inter-professional collaboration
  • Australian training pathways toward psychology registration

Humanistic Therapies (General Principles)

• Originated as a critique of deterministic models (psychodynamic, CBT).
  • Determinism: “If X happened / you think X → then Y behaviour or Y distress is inevitable.”
  • Humanistic stance: dehumanising & underestimates human potential.
• Core assumptions:
  • People possess everything they need for growth; therapy supplies a safe, accepting context.
  • Aims: reduce alienation, heighten awareness, foster acceptance, live fully in the present.
  • Links to Maslow’s Hierarchy of Needs (bottom → top):
  1. Physiological
  2. Safety
  3. Love & Belonging
  4. Esteem
  5. Self-Actualisation (living up to fullest potential).

Person-Centred Therapy (PCT)

• Founder: Carl Rogers (terms: empathy, warmth, genuineness, unconditional positive regard – UPR).
• Central quotation: “How can I provide a relationship which this person may use for his or her own personal growth?”
• Psychopathology explained by conditions of worth:
  • Learned rules such as “If I get A grades → I’m lovable.”
  • Produces a perfectionistic Ideal Self far from Actual/Real Self → Incongruence → distress.
• Goals:
  • Provide UPR so client unlearns restrictive conditions, moves toward Congruence (Ideal ≈ Real), maintaining goals but not tying worth to them.
• Techniques (non-directive):
  • Active listening, reflective paraphrasing, empathic attunement, accepting body language conveying UPR.
• Video resource: 1965 “Gloria” films (single-session demos with Rogers, Perls, Ellis).

Gestalt Therapy

• Historical roots in Gestalt perception (“whole > sum of parts”).
• Assumptions:
  • Distress arises from limited awareness & over-control/restriction of genuine feelings.
• Goals:
  • Expand awareness of present-moment feelings, integrate disowned parts, express emotion safely.
• Hallmark interventions:
  • Highlight non-verbals (e.g.
    clenched fists vs “I’m fine”).
  • Empty-Chair: client speaks to imagined other.
  • Two-Chair: intra-personal dialogue (e.g.
    Critical Self vs Criticised Self) seeking integration.

Narrative Therapy

• Key founders: Michael White, David Epston.
• Assumptions:
  • We make sense of life via stories; problems persist when stories are “problem-saturated.”
• Goals: Re-author empowering stories of resilience, survival & agency.
• Core techniques:
  1. Story-telling & Inquiry – therapist probes overlooked details.
  2. Unique Outcomes – amplify moments hinting strength/change.
  3. Externalisation – separate person from problem (“The person is not the problem, the problem is the problem.”) → e.g.
     “a person who struggles with depression” not “a depressed person.”
• Cultural strengths:
  • Aligns with oral traditions (e.g.
    Aboriginal & Torres Strait Islander yawning).
  • Useful with marginalised & trauma-impacted populations.
• Suggested readings/resources provided (books/articles on cross-cultural narrative practice).

Humanistic Therapy – Criticisms

• Core constructs (meaning, authenticity, self-actualisation) difficult to operationalise & measure.
• UPR, empathy, genuineness are necessary across therapies but often insufficient alone (may need skills training, cognitive restructuring, etc.).
• Direction of causality unclear: strong therapeutic alliance ⇔ symptom improvement (“chicken–egg”).

Existential Therapies

• Philosophical focus on meaning, freedom, choice, responsibility.
• View distress as product of restricted existence when one evades responsibility/choice.
• Goals: help clients discover/create meaning through love, work, creativity, altruism.

Logotherapy

• Founder: Viktor Frankl (Holocaust survivor; book Man’s Search for Meaning).
• “Logos” = meaning.
• Tenets (triangle):
  1. Life has meaning under all circumstances – even suffering.
  2. Primary human motivation = search for meaning.
  3. Humans have freedom to find meaning in attitude toward unavoidable pain & in actions they choose.

Group Therapy

• Definition: Several clients work simultaneously on therapeutic goals, facilitated by ext{≥}1 therapists (ideally lead + co-lead).
• Functions & benefits (examples):
  • Mutual support, universality (“I’m not alone”), modelling, skill rehearsal, cost-effective.
• Formats:
  1. Therapeutic/Process (e.g.
     CBT skills group, interpersonal group).
  2. Psycho-educational (didactic info transfer; e.g.
     carer education).
  3. Skills Development (e.g.
     social-skills for ASD, assertiveness).
  4. Support groups (focus on shared experience, community).
  5. Self-Help (no professional leader) – e.g.
     Alcoholics Anonymous (12-step; outcomes ≈ formal CBT for SUD). Effective esp. for stigmatised conditions.
• Structural variables:
  • Open vs Closed membership.
  • Homogeneous vs Heterogeneous composition.
  • Typical size 8\text{–}12; mini-groups 3\text{–}4 also possible.

Family Therapy

• Systems perspective: behaviour inseparable from family functioning; problem is shared.
• Applications:
  • Life transitions (e.g.
    divorce), school refusal, adolescent conduct, child anger masking marital conflict.
• Concepts:
  • Circular Causality A \rightarrow B \rightarrow C \rightarrow A (vs linear).
  • Maladaptive interaction patterns maintain symptoms.
• Process:
  • Engage all members as clients.
  • Build balanced therapeutic alliance with each stakeholder (avoid “taking sides”).
  • Extensive assessment using Genogram (3 generations; symbols indicate marriages, divorces, deaths, mental illness, emotional bonds: hostile, distant, fused, etc.).
• Goals: restructure relationships, modify interaction cycles, create harmonious system.
• Schools (brief mention): Structural, Bowenian, Strategic, Milan, etc.

Couples Therapy (Variant of Family Therapy)

• Dyadic system focus; members usually seen together (occasionally split sessions).
• Two broad orientations:
  1. CBT-based Couples Therapy
  • Targets communication skills, cognitive distortions, scheduling quality time.
  1. Psychodynamic/Attachment-based Couples Therapy
  • Explores early attachment templates shaping repetitive patterns (e.g.
    abandonment fear → pre-emptive distancing or sabotage).
  • Insight used to break cycles & foster secure relating.
• Media example: SBS series Couples Therapy.

Selecting & Evaluating Treatments

• Considerations when matching:
  • Nature & severity of disorder
  • Client characteristics (culture, preferences, readiness)
  • Evidence base for disorder–treatment fit
  • Clinician competence & training
• Culture:
  • Culture not limited to ethnicity; includes gender, sexuality, religion, socioeconomic group, etc.
  • Clinicians must develop cultural responsiveness:
  • Knowledge of diverse values/practices
  • Intra-cultural self-reflection to recognise one’s biases
  • Seek cultural supervision as needed
• Research findings:
  • Psychotherapy recipients fare better than untreated controls (meta-analytic support since 1977).
  • Combining meds + therapy often minimises relapse; sometimes therapy alone suffices (depends on chronicity/stage/severity).
  • Therapist expertise correlates with outcomes.
• Empirically Supported / Evidence-Based Treatments (EST/EBT):
  • Backed by high-quality trials; e.g.
    CBT has among the strongest evidence.
  • Ethical duty to offer ESTs unless contraindicated.
• Tripartite model (Sackett-style):
  \text{Evidence} \cap \text{Clinical Expertise} \cap \text{Client Culture & Preference}

Psychotherapy Integration

• Eclectic (technique mixing): discouraged; may blend conflicting assumptions and confuse client.
• Integrative (theory-level synthesis → new coherent model): encouraged but complex.
  • Example: Cognitive Analytic Therapy (psychodynamic + cognitive).
• Integration must be empirically scrutinised.

Inter-Professional Collaboration

• Multidisciplinary team (MDT): psychiatry, nursing, pharmacy, OT, PT, social work, family, etc.
• Psychologist’s roles: assessment, therapy, behavioural planning, liaison, advocacy.
• Principles:
  • Mutual respect for expertise; consistent communication; unified care plan.
  • Goal: highest quality, client-centred care.
• Required reading reminder: MacLean et al., 2022 (details collaborative practice).

Training Pathways to Become a Psychologist (Australia, summary)

• 3-year accredited undergraduate psychology sequence.
• +1 year Honours / Postgrad-Dip = 4th year → eligibility for Provisional Registration.
• Path A: Master of Professional Psychology (1 yr) + 1-yr supervised internship → General Registration.
• Path B: Master of Clinical Psychology (2 yrs) → General Registration.
• Endorsement as Clinical Psychologist requires:
  • Either 2-yr Master’s + 1.5\text{–}2 yr registrar program, or
  • Combined PhD/DPsych (Clinical) + registrar requirements.
• UNE offerings:
  • Master of Professional Psychology (5th yr)
  • Master of Clinical Psychology (5th & 6th yrs)
  • Master of Clinical (Advanced Entry) for 6th yr
  • PhD in Clinical Psychology.

Closing Remarks & Resources

• Lecturer available via discussion forum for questions.
• Encouragement to watch 1965 “Gloria” film triad to compare therapeutic styles.
• Reminder to stay warm (end-of-lecture friendly sign-off).