Final Flashcards
What is efficacy in psychotherapy
extent to which psychotherapy works in controlled
research:
Maximizes internal validity
Features well-defined groups
Minimizes variability among
therapists
What is Effectiveness: in psychotherapy
extent to which psychotherapy works in the real
world
* Includes a wider range of clients
* Allows for greater variability
* Lacks internal validity
* Has greater external validity
Results of Efficacy Studies
- Benefits endure over long periods
- Psychotherapy not a panacea
- Transdiagnostic approach
- Emotional disorder
- Unified protocol- Barlow and associates
Bridging the Gap Between Research and Practice
- Efficacy study results not always heeded by practitioners in the
real world - Understanding reluctance of practitioners
- Higher value placed on own intuition and judgments
- Research seen as irrelevant to day-to-day practice
- Dissemination of treatments affected by this gap
- Practice-oriented research
- Practice-research networks
Results of Effectiveness Studies
- Not as frequent as efficacy studies
- Consumer Reports study of 1995
- Very positive, lasting effects of psychotherapy for majority of
respondents - Treatment by mental health professional usually worked
- Findings converge with meta-analyses of efficacy
- Study constrained by methodological questions
Which Type of
Psychotherapy
Is Best?
The “Dodo Bird Verdict” and Common Factors
* Dodo bird verdict
* Empirical outcomes of therapies shows that
competing therapies work about equally well
* Common factors across all forms of
psychotherapy
Therapeutic Relationship/Alliance .1
Strong relationship between therapist and client
contributes to psychotherapy outcome
* Relationship has multiple names
* Therapeutic relationship,
* Therapeutic alliance, or
* Working alliance
Therapeutic Relationship/Alliance .2
- Most crucial single aspect of therapy
- Best predictor of therapy outcome
- Accounts for more variability
- Facilitates positive change
- Quality of therapeutic relationship vital to therapy
- Reciprocal relationship between client and therapist
- Demonstrably effective relationship components
Other Common Factors of psychotherapy (which one is better)
- Hope or positive expectations
- Attention or Hawthorne effect
- Goal Consensus
- Empathy
- Positive regard and affirmation
- Therapist genuineness
- Three-stage sequential model of common factors
- Support factors
- Learning factors
- Action factors
Eclectic therapy
Therapy involves selecting the best treatment
for a given client based on empirical data from studies
of the treatment of similar clients
Integrative therapy
Therapy involves blending approaches in
order to create a new hybrid
Psychodynamic Psychotherapy
- It came first historically
- Many other therapies were reactions against it
- Despite a recent decline, it still influences many clinical
psychologists
Goal of Psychodynamic Psychotherapy
The primary goal of psychodynamic psychotherapy is to make the
unconscious conscious
* “Insight” into thoughts, feelings, and other mental activity previously
outside of awareness
* Awareness of unconscious processes to control them deliberately,
rather than being controlled by them
* The very presence of the unconscious was a fundamental idea of
Sigmund Freud
* Unconscious exerts powerful influence on day-to-day and minute-tominute lives; underlies all forms of psychopathology
Freudian “slips”
Verbal or behavioral “mistakes” reveals unconscious wishes
2 Freudian slips
dreams, resistance
Dreams
Manifest content represents latent content, which contains
unconscious wishes
* “Royal Road” to unconscious
Resistance
- Anxiety of unconscious thoughts/feelings being laid bare too
quickly - Creation of distractions/obstacles that impede exploration of
thoughts and feelings
Ways of accessing the unconscious
by Defence Mechanisms
Defence Mechanisms that protect the unconscious
Unconscious techniques created by ego, as an attempt
to handle conflict between id and superego
* Repression—keep impulse in unconscious
* Projection—attribute impulse to others
* Reaction formation—do opposite of impulse
* Displacement—redirect impulse
* Sublimation—redirect impulse in a way that benefits
others
Defence Mechanisms that protect the unconscious-Transference
-Transference
* Clients’ tendency to form relationships with therapists in which they
unconsciously and unrealistically expect the therapist to behave like
important people from the clients’ pasts
* Clients bring transference issues to the client-therapist relationship,
just as they do to many of the other relationships in their lives
* Help clients become aware transference tendencies and the ways these unrealistic perceptions affect relationships and lives
* Interpretation, followed by working through phase
* “Blank screen” role of therapist facilitates transference
-Counter transference
Psychodynamic
psychotherapy reinvented
in countless forms
Most revisions
deemphasize biological
and sexual elements of
theory
Ego psychology (Erik Erikson)
Emphasizes social relationships over
psychosexual stages
Object relations (Melanie Klein)
Emphasizes relationships between
internalized “objects”
Self-psychology (Han Kohut)
Emphasizes parental
roles in the development of the self,
with special attention to
narcissism
Most recent forms of psycho dynamic therapy emphasize efficiency or brevity
Brief Psychodynamic Psychotherapies
* Fewer than 24 sessions
* Successful when
Problems are mild and narrowly defined
Therapist is active / quick alliance
Focus is on the present rather than solely on the past
Interpersonal Therapy (IPT)- psychodynamic
- Designed to treat depression in 14–18
sessions - Improving interpersonal relationships will
alleviate depression - Emphasis on role expectations
- Assumption that depression happens in the
context of interpersonal relationships - Improving relationships facilitates
improvement in depressive symptoms - Three stages of IPT
Interpersonal and Social Rhythm Therapy
(IPSRT)
- Variation of IPT for clients with bipolar disorder
- Control and stabilize daily rhythms, sleep cycles,
social interactions
Time-Limited Dynamic Psychotherapy
(TLDP)
- Focus on transference and a therapy relationship
that doesn’t follow the same unhealthy,
unconscious “script” as previous relationships - Modern application of “corrective emotional
experience”
How Well Does Psychodynamic Psychotherapy
Work?
Very difficult to empirically measure the outcome of psychodynamic
psychotherapy
* Improvement can’t be objectively measured
* Also difficult to manualize, which inhibits empirical study
* Regardless, large-scale reviews support its benefits with some disorders,
but remains unproven with others
Allegiance effects may influence outcome studies, particularly for
psychodynamic therapy
* Few empirical outcome researchers are psychodynamic
* Researchers’ own orientations may bias the results of their studies
Humanistic
Psychotherapy
Carl Rogers was a leading figure
Humanism was a reaction against Freud’s approach
Assumed that human nature wasn’t so bad (e.g., iddriven)
Overlapping terms for humanism include
“nondirective,” “client-centered,” and “personcentered”
Humanistic
Concepts: Clinical
Implications
Self-actualization u People have an inborn
tendency toward self
- actualization
Occurs when an
inborn tendency
develops if
environment fosters it Positive regard u Warmth, love, and
acceptance of those
around us
Prizing
Basic Concepts of Humanistic therapy
Psychological problems byproducts of
blocked self-actualization.
To foster self-actualization
Work to remove conditions that interfere
with growth
Goal of Humanistic Therapy
In humanistic therapy, there are no
conditions of worth on the client
Clients’ real selves can match their
ideal selves
This match is known as congruence, and
is the root of psychological wellness
Mismatch between real and ideal selves
is known as incongruence, and is the
root of psychopathology
Elements of Humanistic
Psychotherapy
Empathy, Unconditional Positive Regard, Genuineness