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).