INTERVENTION: Subdomain 6 -- Systems of Psychotherapy Flashcards
What are the core elements of psychodynamic therapy?
(Prochaska & Norcross, 2010)
- We are shaped by early experiences
- Unconscious motives and conflicts lead to presenting behaviors
- Maladaptive interpersonal relationship patterns develop in childhood
- A collection of therapies stemming from Freud’s work (Adler, Jung, Object relations, brief psychodynamic)
- Focus of treatment –> consciousness raising
——Using insight to promote change - Importance of psychodynamic therapies:
——Set historical precedence
——Focus on insight - Need more evidence
What is the research suggest about psychodynamic therapy’s effects?
(Prochaska & Norcross, 2010)
- Meta-analyses comparing to other therapies suggest it is as effective to slightly less effective
(Halbur & Halbur, 2011)
* Some support as being equally effective to other tx in depression and anxiety
——Less effective with GAD
What are the important factors of Freudian Psychoanalysis?
(Freud, 1901)
Assumes:
——Must balance sexual and aggressive urges to function healthily
(Prochaska & Norcross, 2010)
- Id, ego, superego
- Psychosexual stages (oral, anal, phallic, latent, genital)
- Defense mechanisms keep trauma out of consciousness
- The dynamic –> interaction and conflict among psychic forces
- To remove symptoms, we must become aware of our resistance to releasing symptoms
- Importance of transference
(Halbur & Halbur, 2011)
- To do –> bring unconscious to conscious
——Free association
——Dream analysis
——Interpretation and analysis of transference
——Analyst must be psychoanalyzed first
——To avoid countertransference
What is Adlerian (Individual) therapy?
(Adler, 1923)
- Focus –> striving for superiority (ideal self) or ultimate goal
(Prochaska & Norcross, 2010)
- Rejected Freud’s sexual overtones/focus on sex
- Assumption:
——Striving for superiority –> core motive for human personality
————Superiority means rising above current level not necessarily distinction or
leadership
————Superiority means aiming for a more perfect and full life
————We develop an ideal self that represents who we want to be
——Feeling inferiority is intrinsic to human birth - Pathology = being discouraged from attaining superiority
(Halbur & Halbur, 2011)
- Tx focus: understanding and insight of client’s constellation of roles in family
What is Time Limited Dynamic Psychotherapy?
(Levenson, 1995)
Time-Limited Dynamic Psychotherapy (TLDP)
- Brief approach to treat chronic interpersonal or personality problems
- Assumptions:
——Dysfunctional interpersonal styles develop in childhood – maintained
————Modify with new life experiences -
Cyclical maladaptive patterns (CMPs)
—— Reenact with therapist
—— Acts of the Self (how they wish they were)
—— Expectations of Others’ Reactions (how they imagine others will react)
—— Acts of Others Towards Self (interpretations of others’ behaviors)
—— Acts of Self towards Self (how clients treat themselves) - Tx focus –> modify CMPs within therapy → insight into interpersonal interaction style
- Countertransference can guide
What is interpersonal therapy?
(Norcross & Prochaska, 2010)
- Part of psychodynamic school (acknowledges past influence)
——Similar to CBT – focus on present
(Klerman & Weissman, 1984)
Assumptions:
* Presenting problems interrelated to interpersonal issues
* Mood is connected to current events
Four Major Interpersonal Problem Areas:
1. Interpersonal losses
2. Role dispute (conflict with significant other)
3. Role transitions (changing job/becoming parent)
4. Interpersonal deficits (social isolation)
(Norcross & Prochaska, 2010)
Tx goals:
* Improve the “here and now” of interpersonal situations
* Develop more effective strategies to deal with interpersonal problems
* Improve social support
* Problems frequently targeted:
—▪ Empty time
—▪ Being alone
—▪ Feeling unwanted
—▪ Frequent arguments
—▪ Criticism
- Related/Alternative Transactional Analysis
——Focus on interactions between therapist/client for change (so like CMP in TLDP)
What is existential therapy?
(Yalom, 1995; Yalom, 2012)
- Assumption:
—— People create their own life meaning and purpose - Anxiety/worry = existential anxiety
- Concept that problems come back to the 4 basic anxieties:
1. Awareness of eventual death
——▪ existential terror
2. Responsibility to make decisions and accept their consequences
——▪ Freedom of choice means we are responsible for our actions
3. Meaninglessness
——▪ We must create our own meaning
4. Isolation and aloneness
——▪ No one can ever entirely know another person or be entirely known by
another person - Lying to the authentic self = psychopathology
- Tx focus:
—— Empower clients to develop awareness
—— Acknowledge freedom
—— Make own choices
—— Create meaning - May use self-disclosure to reveal experience of a client
- Therapist is a fellow traveler on the road with the client
- Look for themes in the client’s stories to help them gain understanding
What are humanistic therapies?
(Norcross & Prochaska, 2010)
- Individuals viewed positively
- Use present-focused approach
- Assumption:
——Clients = experts in own lives - Strive for self-actualization
What is person-centered therapy?
(Norcross & Prochaska, 2010)
- A humanistic therapy
- Psychopathology
—— incongruence between believed self and true self
—— Conditions of worth: the conditions put on us about how to be seen as worthy by
others
————▪ i.e., parents who are preoccupied by academic achievement
Tx focus:
* Congruence between two selves
* Self-understanding
(Rogers, 1961)
* Therapist display six conditions
1. Vulnerability
2. Accurate empathy
3. Genuineness
4. Relationship
5. Unconditional positive regard
6. Perception of genuineness
(Norcross & Prochaska, 2010)
* Rogers considered these six qualities to be necessary and sufficient for therapy
What is Motivational Interviewing?
(Miller & Rollnick, 1991)
- Assumption:
——Client is ambivalent about change - Fewer sessions than CBT
- Pre-contemplation or contemplation stage – need motivation
- Involves expression of empathy
—— Pointing out discrepancy between behavior and values (cognitive dissonance)
—— Rolling with resistance
—— Supporting self-efficacy
What is Gestalt therapy?
(Norcross & Prochaska, 2010)
- Fritz Perls
- Parts only make sense as a whole – look at world holistically
—— A “Gestalt” means a whole
—— Trying to maintain integrity of the person as a whole - Psychopathology
—— Phony layer: we play games and enact roles
—— We disown aspects of ourselves for fear of rejection
Tx focus:
* Consciousness raising
—▪ Letting go of fantasy and living in reality
—▪ Change from future oriented thinking to present oriented thinking
* Gain awareness → integration of parts
* Then cathartic explosion of emotions
* Self-actualization
Technique:
* Empty chair – move past unfinished business
What is emotion-focused therapy?
(Greenberg & Goldman, 2006)
- Combines Gestalt and person-centered therapy
- Assumptions:
——Innate, emotion-based system
————▪ Processes internal/external experience for meaning
——Innate ability to develop/change in adaptive ways - Healthy functioning = fully attending to and processing their experiences for meaning
- Maladaptive functioning = blocked emotion-processing
- Tx focus:
——Finding better ways to cope with feelings
——Transform old emotional responses via catharsis
——Choosing a new way of being
What is behavioral therapy?
(basics, assumptions, + tx focus)
(Norcross & Prochaska, 2010)
- Leading school of thought in US in response to psychoanalysis
- Skinner → focus on observable bx
——Gave legitimacy and scientific rigor to field
Assumptions:
* Most abnormal behavior is acquired the same way as normal behavior
* Symptom is the problem and the target of treatment
* Lack free will
* Shaped completely by reinforcements and punishments
* Capable of change
* Psychopathology = maladaptive behaviors
Tx focus:
* Action-oriented
* 3 C’s:
—▪ Counterconditioning,
—▪ Contingency management
—▪ Cognitive-behavior management
What is behavioral therapy?
(3 broad examples of intervention approaches)
(Norcross & Prochaska, 2010)
Counterconditioning
* Based on classical
* Find response incompatible with reaction/behavior and repeatedly pair
—▪ i.e., pairing relaxation with anxiety
—▪ Adaptive response replaces maladaptive
* Systematic desensitization
* Assertiveness training
* Behavioral activation
Contingency Management
* Based on operant
* Increasing adaptive behavior with reinforcement, decreasing maladaptive with punishment
* Patterns = antecedent, behavior, consequence
* Maladaptive extinguish without reinforcement
* Good for parent training
* Continuous reinforcement = easiest to train AND extinguish
* Variable reinforcement (than fixed) = harder to train AND extinguish
Cognitive-Behavior Modifications
* Cognitive restructuring
What are exposure therapies?
(Norcross & Prochaska, 2010)
Exposure Therapies
* Most effective –> OCD, panic, agoraphobia, PTSD
* Tx goal –> let anxiety peak then gradually decrease with feared stimulus
* Imaginal, in vivo, or virtual reality exposure
Eye Movement Desensitization Restructuring
* EMDR
* Previous gold standard for PTSD
* Deep breathing/imagery actually is what is important about this therapy
* Bad research
