Exam 2 Lange Flashcards
THE EMERGENCE OF
PSYCHOTHERAPY
As a medical doctor, Freud worked with patients with “hysteria”
* He began using hypnosis to get patients to talk about important
incidents that they couldn’t typically recall.
* After practicing hypnosis and reporting that it made him feel like
“a miracle worker,” Freud began working alongside Viennese
physician Josef Breuer, who was successfully treating hysteria
symptoms without hypnosis— simply by having patients talk
about emotionally laden childhood experiences.
* Freud developed a theory from which a talking cure–
psychotherapy– emerged
DRIVE OR INSTINCT THEORY
We all have and are driven by life instinct (constructive) and
death instinct (destructive*)
* psychic determinism: nothing we think is random; if it seems
random, it is unconsciously driven
* libido - the impulse that motivates action
* every impulse has an:
* origin - originates from some place in the body
* aim - we want something/what need we want satisfied
* object- where we’re going to direct energy to try to meet that need
* intensity - may vary, stronger is a more powerful motivator
psychic determinism
nothing we think is random; if it seems
random, it is unconsciously driven
libido
the impulse that motivates action
every impulse or libido has…
origin - originates from some place in the body
* aim - we want something/what need we want satisfied
* object- where we’re going to direct energy to try to meet that need
* intensity - may vary, stronger is a more powerful motivator
internal working model
an observed pattern that informs us
about what to expect and how to react to the world
* repetitive impulse–energy–relationship pattern that we use to meet
our needs
DEVELOPMENTAL STAGES
ied how we behave to
how we learned things about ourselves and the world we interact
with as our brains developed and learned during childhood
* as children, we are very self-focused and driven by satisfying our
own needs, which are primarily bodily at that point
* where we learn dysfunctional lessons in childhood, those will
persist as our IWMs until they are reconciled and corrected
TOPOGRAPHIC MODEL
conscious - only a small portion of our thoughts
* preconscious/subconscious – pathway to conscious awareness where
“unacceptable” thoughts are detected and prevented from entering conscious
awareness
* unconscious - most of our thoughts, but ones we either don’t assess to be
important or that threaten to or cause discomfort for us
* Jung variation: Jung divided the unconscious into the personal unconscious and
the collective unconscious. The personal unconscious is unique to individuals and
the collective unconscious is a shared pool of human inherited motives, urges, fears,
and potentialities.
* The main mechanism of psychoanalytic therapy is to make the unconscious
conscious.
* WHY?
STRUCTURAL MODEL
We all have mental structures through which our constructive and destructive
urges flow and are processed into choices and beliefs
* Id: pleasure, mostly unconscious
* First to develop
* Ego: rational, conscious thoughts and decision-making processes
* Arises once we learn that immediate gratification is not always possible and we have to
learn patience and reliable steps to getting what we want
* Has tools to help it navigate the conflict of addressing unconscious (id) wants →
defense mechanisms
* Superego: moral/conscience, conscious evaluator of our thoughts and choices
* Develops as we understand choices have consequences that will be judged as good or
bad by the people we rely on to keep us alive, and who serve as our guide for how to be
in the world (or, classically, who we have unconscious sexual urges toward)
defense mechanisms
tool of the ego designed to ward off
unpleasant anxiety feelings associated with internal conflicts
among the id, superego, and reality
* Defense mechanisms have four primary characteristics:
* They are automatic (reflexive)
* They are unconscious
* They ward off unacceptable impulses
* They distort reality
classic vs modern freud
Classic Psychoanalytic:
* Therapist acts as a blank slate and listens for unconscious conflicts and motivations that
underlie repetitive, maladaptive patterns of behavior.
* Therapist is expert/teacher
Modern Psychodynamic:
* Does not retain focus on everything is sexual
* Two person, collaborative
* More relationship focused, not just on early childhood relationships but current relationships
as well
* Therapist is not all-knowing, will be imperfect, and navigating and accepting that is part of
acceptance of one’s own imperfections
* Interpretations are a collaborative process
PSYCHOANALYTIC/ PSYCHODYNAMIC
THERAPY GOALS:
GOALS:
* Make the unconscious conscious
* Help clients develop greater control over maladaptive impulses
* Help clients rid themselves of maladaptive or unhealthy
internalized objects and replace them with more adaptive
internalized objects
* Become less critical of self and others by experiencing and
practicing empathy during optimal therapeutic failures
PSYCHOANALYTIC/ PSYCHODYNAMIC
THERAPY HOW TO GET THERE:
HOW TO GET THERE:
1. Connect psychopathology to internalized, dysfunctional working
model/childhood experiences.
2. Knowing that dysfunctional childhood experiences are not completely
understood, recalled, or dealt with consciously, acknowledge that repetitive
maladaptive behavior and thinking patterns will feel beyond the client’s control
so long as they are unconscious.
3. Meaningful change involves insight, developing conscious awareness in a non-
threatening, not overwhelming way.
* ego supportive: help the ego—a rational and logical entity—deal more effectively with
conflict between desires and expectations
4. Accept enduring change isn’t instantaneous; it requires a working-through
process where practicing new ways of understanding and dealing with inner
impulses and human relationships occurs.
psycho dynamic THROUGH WHAT MEANS?:
Free association
* Dream analysis
* Other interpretations
* Facilitating corrective emotional experience
DREAM ANALYSIS
Dreams are viewed as moving between unconscious,
preconscious, and conscious
* Contemporary psychoanalytic dream work doesn’t rely on
authoritarian, symbol-based, analyst-centered interpretations
* Client is an active collaborator, their own thoughts and potential
interpretations about the dream should be discussed
* Awareness that therapists may project their own issues onto their
clients’ ambiguous dream symbols
NOTES ON FREUDIAN INTERPRETATIONS
Ego defenses protect clients from unconscious conflicts and
distort information rising up from the unconscious
* Therapists listen for the use of these defenses, distortions, and
other indicators of unconscious material
* Psychological defenses are interpreted first, before the underlying
conflicts.
* If you interpret the underlying conflict first, clients will use
preexisting defense mechanisms (e.g., denial) to resist the
interpretation.
Interpretations focus on repeating themes or patterns in the
client’s life
* The therapist uses interpretation to clarify and bring unconscious
patterns into awareness
* Interpretation works best if therapists establish a strong working
alliance and use good timing:
* Watch for when the client is just a step away from becoming aware
of something new.
* Wait until you have data to support your interpretation; you should
be able to link your interpretation to your client’s concrete behaviors
or specific statements.
corrective emotional experience
“re-exposing clients, under
more favorable circumstances, to emotional situations which they
couldn’t handle in the past” (Alexander and French, 1946, p. 66)
* “The patient needs an experience, not an explanation.” (Fromm-
Reichmann, 1948)
freud RESEARCH SUPPORT
Generally, psychoanalytic approaches have been viewed as less
scientific than behavioral or cognitive approaches
* Psychoanalytic approaches are often less symptom- or diagnosis-
focused, more insight and relationally focused. This is more difficult
to measure in terms of efficacy and in short-term studies
* However, recent meta-analyses and RCTs have shown that
psychoanalytic therapy is efficacious for several different mental
health problems
* Studies show benefits of psychoanalytic therapy tend to increase and
last longer over time
* This implies that psychoanalytic clients develop insights and skills that
continue to improve their functioning into the future
Even neuroscience research shows some support:
* Researchers focusing on brain lateralization generally support the idea
that the two hemispheres of the brain perform distinct, but highly
integrated, functions…Interestingly (and despite our wishes to think of
ourselves as primarily guided by logic and reason), the right hemisphere
is dominant in many respects.
* Why? Because ‘emotional’ processes are largely responsible, in evolutionary
terms, for survival. Threat assessment requires ‘fast-track’ processing; the
quicker right-mode processing (RMP), as it’s sometimes called, provides the
best chance for responding soon enough to ensure survival. In contrast,
while left-mode processing (LMP) may be more accurate, its slowness
relative to RMP creates a hazard for the organism.
* in effect, humans have a conscious left brain and an unconscious right
brain
* in this less-than-conscious process, memory plays more of a role than
current circumstances
Freud CULTURAL LIMITATIONS
Studies looking at psychodynamic treatment with non-white
subjects are rare
* Psychoanalytic treatment’s strong focus on internal psychological
processes has the potential to neglect sociocultural elements of
the external world that impact clients from marginalized
backgrounds.
behavioral Historical Context
As a reaction to psychoanalytic theory, with
* Similarities:
* determinism: what happened before shapes what happens in the
future
* Differences:
* Observable behavior only vs. inner mental dynamics
* Therapist as scientist and educator vs. collaborative explorer
* Techniques derived from scientific research vs. derived from
clinical practice
* Brief and symptom focused vs. longer and growth focused
Behavioral Theory of Psychopathology
Learning causes maladaptive behavior/psychopathology
* Psychopathology can also involve a skill deficit
Main goal: determining the stimuli that directly precede and
follow maladaptive client behaviors
* Behaviorists systematically:
* Observe and assess client maladaptive or unskilled behaviors
* Test behavioral hypotheses with empirically supported interventions
* Observe and evaluate the results of their intervention
behavioral ways of Gathering Information
Clinical interview
* Observation
* Limitations
* Standardized questionnaires
* Self-monitoring
Functional Behavior Assessment
FBAs help determine the function of specific behaviors.
A = The behavior’s antecedents (everything that happens
just before the maladaptive behavior is observed)
B = The behavior (operationally defined)
C = The behavior’s consequences (everything that happens
immediately following the problem behavior)
Developing a Treatment Plan
Problem solving strategy:
1. Define the problem, goals, and foreseeable obstacles (including
ABCs)
2. Brainstorm: generate alternative possible ways of behaving and
overcoming obstacles (use ABCs)
3. Decision-making: conduct a cost–benefit analysis of the
possible choices, and develop a plan for how to follow through
on the desired choice
4. Implementation: trying out the plan, monitoring outcomes, and
determining success
How To Change Behavior
Skills Training
* Modeling
* Operant Conditioning
* Classical Conditioning
Operant Conditioning
Behavior change occurs through the consequence of intentionally
administered rewards and punishments
* Contingency management: the systematic delivery of reinforcing
or punishing consequences contingent on the occurrence of a
target response, and the withholding of those consequences in
the absence of the target response
* What is rewarding and punishing is not always straightforward in
real life.
Operant Conditioning: A Note on
Punishment
Although punishment is a powerful behavior modifier, it has major
drawbacks:
* Results in ST compliance, but may yield LT negative effects. However,
because of the ST “success,” it can give a powerful dose of reinforcement
to those administering it
* In a meta-analysis of the effects of corporal punishment on children’s
behavior (Gershoff, 2002), punishment was associated with 1 desirable
outcome (i.e., behavioral compliance) and 10 undesirable outcomes
* E.g., less internalization of moral principles, abuse, delinquent behavior, later abuse within
adult relationships
* Severe physical punishment has also been associated with adverse effects on brain
development, increased rates of adult mental disorders, and poorer adult physical health
Token Economies
Token economies: you get credits for target behaviors you can
redeem for something you want as those add up
* Effective in short-term, but long-term concerns:
* Coercive (under pressure, not free will)
* Will people keep up with the behavior once it is no longer being
extrinsically rewarded?
* Applying tangible rewards undermines intrinsic motivation
Operant Conditioning: Special Topics
Behavioral activation, aka activity scheduling, aka fake it til you
make it
* supported in producing positive treatment outcomes for clients with
depression
* increases the rate of naturally occurring positive reinforcement
* Applied Behavior Analysis (ABA): later this semester
Classical Conditioning
Behavior change occurs through re-pairing or unpairing two or more
environmental stimuli that have been maladaptively paired
* We won’t review US, UR, CS, CR in detail
* Extinction: the gradual elimination of a problematic conditioned response.
* repeatedly presenting conditioned stimulus without a previously associated
unconditioned stimulus
* Counterconditioning: the pairing of a positive (and often incompatible)
stimulus with a stimulus that elicits a negative or undesirable response (e.g.,
fear)
* a blend of both operant and classical conditioning, but more classical
* main difference between operant and classical conditioning
Exposure treatment
exposing clients to the very thing they want
to avoid, to break the pairing between US and CS
* in vivo (in real life), computer simulated/VR, in imagination
Response prevention
the therapist supports clients in not
engaging in an avoidance response during exposure to the CS
Systematic
Desensitization
step by step exposure
method
* Planning:
* The client identifies a range of fear-inducing situations or
objects
* Using a measuring system referred to as subjective units of
distress (SUDs), the client rates each fear-inducing situation or
object on a 0 to 100 scale (0 = no distress; 100 = total distress),
creating a fear hierarchy
Implementation:
* Engage in relaxation strategies
* Exposure to least feared situation
* Gradually progresses to most feared situation
* Stay at any given level as long as needed to extinguish fear
response
Criticisms/Shortcomings behavioral
Lack of emphasis on free will and higher order thought
* Watson viewed humans and other animals as indistinguishable.
His claims about the potential of behaviorism in predicting and
controlling human behavior were bold and startling.:
Behavior therapy tends to focus exclusively on
symptoms, and problems are characterized as
centered within individuals, sometimes ignoring
systemic social, political, and familial factors
Primary process thought
another facet of id functioning, is characterized by hallucination-like images of fulfilled sexual or aggressive desires.
secondary thought processes
help us cope with sexual and aggressive drives
Repression
involves forgetting an emotionally painful memory. When clients repress a memory, there may be behavioral evidence that it exists, but there’s genuine absence of recall: “Nope. I don’t remember anything unusual about my childhood.”
Denial
is expressed more forcefully than repression. Shakespeare’s famous line about protest[ing] too much captures its essence. Clients using denial might say, “No way, that’s not true” and repeat their denial forcefully.
Projection
occurs when clients push unacceptable thoughts, feelings, or impulses outward, onto another person. Clients may accuse another person of being angry, instead of owning their anger: “Why are you so angry?”
Reaction formation
occurs if it’s dangerous to directly express aggression, and so the opposite behavior (obsequiousness) is expressed instead. Instead of expressing sexual attraction, individuals might act disrespectfully toward whomever they’re feeling attracted.
Displacement
occurs when the aim of sexual or aggressive impulses is shifted from a dangerous person to a less dangerous person. Aggressive displacement involves the proverbial “kicking the dog.” Sexual displacement occurs when sexual feelings toward a forbidden person are displaced on to a more acceptable person.
Rationalization
occurs when clients use excessive explanations to justify their behavior. Students who make a hostile comment in class might overexplain and justify their comment.
Regression
involves reverting to less sophisticated methods of doing things. Traumatized children may regress to wetting the bed or pooping their pants rather than using more advanced toileting skills. Adults who are skillful communicators may regress to shouting rather than logical argument.
Sublimation
occurs when sexual or aggressive energy is channeled into positive loving or vocational activities. Sexual energy is thought to be sublimated into creative tasks and aggression into hard work (e.g., house cleaning, yard work).
