lange 3 Flashcards
CBT Theory of Psychopathology
The problem: people are disturbed not by events, but by the view which they
take of them and how they react to those thoughts and interpretations
* The solution: using mental strategies to modify, manage, or eliminate
problematic symptoms
Beck’s Influence on CBT
More conventional and conservative
* Maladaptive thinking
* Cognitive distortions: patterned faulty ways of thinking
* Cognitive distortions are typically related to core beliefs or self-schemas
* Self-schema: enduring beliefs about oneself, some of which may be faulty or
maladaptive
Cognitive distortions
patterned faulty ways of thinking
* Cognitive distortions are typically related to core beliefs or self-schemas
Self-schema:
enduring beliefs about oneself, some of which may be faulty or
maladaptive
Beck’s Influence: Common Cognitive Distortions
Black and White Thinking
* Overgeneralizing (Labeling/Mislabeling)
* Magnification and Minimization
* Mindreading
* Personalization
Ellis’s Influence on CBT
A little more extreme
* Rational and irrational thinking
* Must, ought, should
* Worst case scenario
* Shame attack exercises
Ellis’s Influence: ABCDEF
A activating event
* B belief about the activating event
* C consequence: emotion and behavior in response to the belief
* D dispute irrational belief
* E effect: reconsidering earlier irrational conclusion and arriving at
new belief
* F new feeling in response to new belief
The Core of CBT Theory
Cognitive triad: negative beliefs about self, the world, the future
(|| to Ellis’ Unconditional/radical acceptance for self, others, how things play out)
* ABC
a triggering event activates faulty beliefs→
faulty information processing occurs →
biases become so ingrained they are automatic and spread to several cognitive
domains, e.g., selective attention, memory, and interpretation →
these cognitive processes contribute to consequences of increased emotional
distress and maladaptive behaviors
Cognitive triad
negative beliefs about self, the world, the future
(|| to Ellis’ Unconditional/radical acceptance for self, others, how things play out)
Cognitive Behavioral Therapy: Characteristics
Brief
* Structured (agenda driven)
* Present-oriented
* Educative (can be about known maladaptive ways of thinking, can include
Socratic questioning)
* Collaborative
* Interested in changing both dysfunctional thinking and maladaptive behavior
Cognitive Behavioral Therapy: Treatment (7)
Goal: using mental strategies to modify, manage, or eliminate problematic
symptoms
* How to get there:
1. Identify problems: determine clients’ irrational or maladaptive thoughts
2. Consider origins of the client’s current problems (some acknowledgement of
the role of the past, even though CBT is mostly present-focused)
3. Identify activating events
4. Teach client to ID problematic thinking patterns
5. Help and encourage client to resist automatic thinking and engage higher
level thinking
e.g., generating alternative interpretations
6. Behavioral interventions:
Test assumptions and alternatives
Teach coping strategies
Reinforcing self-statements
7. Support client in applying these skills
Cognitive Behavioral Therapy: Tools
thought record, Self-rating scales
* E.g., 1-10, 1-100
* Self-monitoring
* E.g., thought record
Research Support for CBT
Well supported by both efficacy and effectiveness studies
* However, most studies look only at short-term outcomes
Critiques of CBT
Is a client’s thinking irrational or are they accurately interpreting something
the therapist isn’t attuned to? E.g., microaggressions (subtle insults)
* Works best for problems where the goal is symptom reduction rather than
personal growth or acceptance (case can be argued it helps with those too
though)
Person-
Centered Theory
and Therapy Background: Carl Rogers
“Founder of psychotherapy research”
* First therapist interested in studying what about
the therapy process (vs. content) contributed to
its effectiveness
* First theorist to record actual therapy sessions
Person-Centered Theory
The client is the guide to navigating their psyche
Person-Centered Theory of
Psychopathology
Psychopathology is caused by unmet core needs* impeding
our ability to self-actualize
* Healthy functioning is when we are allowed to be our natural selves, when we accept our natural selves and believe our natural selves are acceptable
Core needs*
need for positive regard and self-regard
Positive regard: the need to be loved and valued
* Self-regard: seeing oneself as valuable and worthy
Self-actualization
pursuing our natural, authentic interests
and drives
* actualizing tendency: an instinct to “move toward greater order,
complexity and interrelatedness” grounded in the belief that your
authentic self has a meaningful place in this world
What leads to unmet needs for
unconditional self regard (USR)?
perceived incongruence between real and ideal self
* Either by negative self-regard and/or by investing in ideal self rather
than real self
* Perception becomes a person’s reality
* People act in ways to meet their perceived needs
* Real self is linked to self-actualization, incongruence and not investing
in the real self blocks self-actualization
* USR depends upon UPR
* Need to experience UPR from at least one meaningful person
Conditions of worth
you are only worthy of love and
acceptance when certain things are true about you, when you
are behaving in certain ways
Unconditional positive regard
you are worthy of love and
acceptance as-is, even when you are imperfect
Person-Centered Therapy
If psychopathology stems from judgment or invalidation of
the self, then a nonjudgmental atmosphere will facilitate
psychological health
* If unconditional positive regard is necessary in order to
facilitate unconditional self regard, then the therapist will
provide unconditional positive regard
* The goal of therapy is to help the client accept themself as a
person of worth
* “If I can provide a certain type of relationship, the other
person will discover within himself the capacity to use that
relationship for growth, and change and personal
development will occur.” - Rogers
What Does Person-Centered Therapy
Look Like?
Taking time and space is essential
* The therapeutic relationship is the mechanism of change
* The client is the guiding figure in the therapy process; the
therapist only helps clients access their powers of self-
creation and choice, including cognitive choice
* The pathway to USR includes receiving UPR – and that can
occur in the present, within the therapy setting
How Does the Therapist Provide UPR?
The therapist sees the client as a person of worth
* The therapist trusts the client*
* The therapist is genuine and authentic with the client
* good and bad
* The therapist aims to communicate empathic understanding
of the client’s perspectives
* UPR does not mean endorsing all of the client’s behaviors
How Does the Therapist Show UPR?
show compassion
* show interest
* listen carefully and remember what clients say
* affirmations when they are genuine
* making a sincere effort counts no matter how successful it
is
Research Support for rogerian theory or person centered
Decades of psychotherapy research confirm that the
relationship between therapist and client is a key
therapeutic factor
* Aspects of Person-Centered Therapy make it not as
inclined toward being studied
* PCT therapists may have caution toward both assessments and
diagnostic labels because they function like conditions of worth
* Using diagnoses does not place clients at the center of
treatment
* The person-centered perspective is that designing
treatments for specific disorders (e.g., generalized anxiety
disorder or post-traumatic stress disorder) misses the
point—which is to treat the individual, not the disorder.
Critiques for person-centered
Not as strongly supported by research as some
other models
* PCT’s emphasis on the self and self-
actualization may not work for clients who value
collectivistic over individualistic identity and
goals
Dialectical
Behavioral
Therapy Background
Marsha Linehan
oInitially developed as a treatment for women who were
exhibiting SI/SIB and suffering from Borderline
Personality Disorder (BPD)
oHas since been found to be successfully applied to other
mental health conditions
oAn integrated theory with a basis in CBT
Biosocial
Model of Psychopathology
Emotional dysregulation is the cause of psychopathology
o Emotional dysregulation occurs because of a
combination of biological predisposition, environmental
factors, and learning
Biosocial
Model of Psychopathology
Biology: emotional responses to environmental stimuli
that occur more quickly, are more intense, and have a
slower return to baseline than other people
Environmental: grew up and/or are currently living in
environments that are a poor fit for their emotional sensitivity
o Over time, this social environment can become “chronically and
pervasively” emotionally taxing and invalidating
o Often, people with BPD are survivors of chronic childhood trauma
and/or have adverse attachment styles
o The people who they depend on and who are a threat to them are
often one and the same
o Child effectively learns they have to escalate to be heard
o Then when punished they might try to regulate using maladaptive
behaviors because they don’t have a roadmap for healthy regulation
Dialectics
Dialectical philosophy emphasizes that reality includes
opposing forces that constantly shift and change
oThrough DBT, clients are encouraged to grapple with
both sides of this seeming contradiction and to arrive at
greater acceptance of transitory meaning– things will
change, two things can be true
oPromotes acceptance and tolerance rather than
resistance
Mindfulness
Mindfulness is a practice that involves
paying attention to the present moment
without judgment
oObserving and making intentional choices
rather than automatically acting/reacting
DBT: Basic Assumptions
Clients are doing the best they can
o Clients want to improve
o Clients need to do better, try harder, and be more motivated to
change
o Clients may not have caused all of their problems, but they have to
solve them anyway
o Clients must learn new behaviors in all relevant contexts
o Clients cannot fail therapy
o Therapists treating BPD (and other highly emotional dysregulated
clients) need support
DBT: Treatment Goals
Enhancing skills and capabilities
o E.g., mindfulness, emotional regulation
oImproving client motivation
oGeneralizing skills and capabilities from therapy to outside of
therapy
oStructuring the client’s environment to support and validate
the client’s capabilities
oImproving the therapist’s capabilities and motivation to treat
patients with BPD
DBT: Treatment Modalities
Individual therapy
oGroup skills training
oPhone skills coaching between sessions
oTherapist consultation team meetings
oCan include family sessions
Research Support DBT
DBT has received empirical validation,
including some LT studies, for BPD and other
conditions with emotional dysregulation
symptoms
Critiques DBT
Research support is largely for the
structured and intensive full DBT protocol
oThe full protocol is an intensive commitment
Motivational Interviewing
A person-centered counseling approach for addressing the common problem
of ambivalence about change
* Originally developed to help people with addiction, and later other health-
related behaviors, but has since been applied to other areas in which people
want to make changes in their lives
Ambivalence Toward
Change
Ambivalence: simultaneously
wanting and not wanting
something, or wanting both of
two incompatible things
* MI can be used effectively at all stages
of change, but is particularly helpful
when individuals are in the
precontemplation or contemplation
stages, where ambivalence is high.
Working With Ambivalence
When faced with a client who is ambivalent about whether to make changes,
it’s not unusual for professional helpers to be tempted to push clients toward
health. Miller and Rollnick (2013) call this the righting reflex.
* problematic because when someone feels ambivalent, they are apt to
argue the opposite side when pushed in one direction, or at least point out
problems and shortcomings of the proposed solution
* In doing this, they would be arguing away from change
* MI therapists don’t confront or pressure clients
* Instead, they use listening skills to encourage clients to talk about the reasons
why and why not, and their reasons and motivations for positive change
Listening: OARS
Open-ended questions
* Affirming
* Reflecting
* Summarizing
* Listen for instances of change talk and sustain talk
* Research has shown that clients who engage in more change
talk are more likely to make efforts toward enacting positive
change
Evocation
In addition to careful listening and other person-centered skills
of collaboration, acceptance for the client as a worthy person
as-is, and compassion toward the client’s struggles, MI
therapists use evocation
* Evocation: the process of drawing out a client’s own reasons
for change, rather than simply providing information or advice
Scaling Questions
Scaling questions are designed to gauge motivation for change and
confidence in one’s ability to change
* “How important is [the change] on a scale of 0-10, with 0 being not important at
all, and 10 being the most important?”
* “How confident are you in your ability to make this change, on a scale of 0-10, with
0 being not confident at all and 10 being the most confident?”
* “Why are you a ____ and not a lower number?”
* Why ask it that way instead of the other direction?
* Follow up with reflection (why?)
* Goal: to move from ambivalence to a plan for change that they feel committed
to and capable of pursuing
Research for MI
MI has been found useful for strengthening the motivation for
behavioral change in patients with various behaviorally
influenced health problems, for promoting treatment adherence,
and to optimize medical interventions.
rogers 3 forms of empathy
Subjective empathy: Identifying with clients in the here and now through intuition, and imagining your clients’ experiences.
Interpersonal empathy: Communication back and forth about clients’ phenomenological experiences (including feedback from clients).
Objective empathy: Using theoretical knowledge and resources to better understand clients (Clark, 2010).
