Lecture 1 - Historical Perspectives on Psychotherapy Flashcards
Zeitgeist
➢German word meaning ‘spirit of the times’
➢Dominant form of psychotherapy has changed over time
➢Contextual Considerations:
▫What is believed to be the cause of psychological problems?
▫Who is thought to be qualified to perform psychotherapy?
▫Can we use the scientific method to understand human behaviour?
▫Can we study psychotherapy using the scientific method
Etiology = cause
Initially only psychiatrists performing psychotherapy
Early Treatment Traditions
➢Prior to 19thcentury
▫Individuals with mental illness troublesome and need to be removed from society
No hope that would recover
Mental hospitals like prisons, seen as animals, could pay a penny to view the locked up patients (zoo)
➢19thcentury: Moral treatment
▫“Warm and trusting familial environment in which patients could feel that their mental condition did not preclude participation in normal human activities
Gardens, everyone had a job
Picture in slide = Athens, Ohio Asylum
Psychoanalysis
➢Sigmund Freud
▫Trained as a neurologist
▫Established first private psychotherapy practice
-First formal psychotherapy
-office instead of hospital setting
▫Early works: Hysteria (1895); Interpretation of Dreams (1900)
▫Invited by G. Stanley Hall to US in 1908
Discussed case of Anna O: diagnosed with hysteria, psychological problem
Work translated into English
Professional societies, journals, and training institutes on psychoanalysis developed in US
Freud from Austria, but went to US and work translated to English so became more widespread
➢Freud’s major contributions
▫Drive Theory = sex instincts, avoiding death and facing mortality
▫Levels of consciousness
-Psychoanalysis tried to get to the unconscious
▫Personality structure (id, superego and ego)
▫Psychosexual stages of development: oral, anal, phallic, latency, genital…
▫Defense mechanisms: (repression, denial…)
Most of these theories didn’t really stick around
▫Therapy techniques: free association, dream analysis… not really used in psychotherapy now
▫Therapy processes: transference (how patient feel about therapist perhaps based on past experiences with parents) , countertransference (therapist develops feelings about their clients related to certain behaviours…)
-important to consider these relationships between patient and psychotherapist = main thing important from Freud for psychotherapy!!!
Other Developments
➢G. Stanley Hall (1892): Established American Psychological Association (APA)
-at the time very focused on the science or research of psychology, not the practice
-practiced considered part of psychiatry
➢Lightner Witmer (1896): First to use term “clinical psychology”; First psychological training clinic at University of Pennsylvania
➢Psychologists initially responsible for assessment, not therapy
▫Intelligence testing
▫Personality testing
➢WWII and “shell shock” (ptsd) created need for additional psychotherapists
➢Academic psychologists became interested in practice-based issues
Eysenck’s Critique of Psychotherapy
➢The Effects of Psychotherapy: An Evaluation (1952)
▫Examined 19 studies; psychoanalytic or eclectic psychotherapy (mix of things)
▫“Neurotic” patients: equivalent to today’s depression/anxiety ▫“Recovery”:
44% from psychoanalysis 64% from eclectic psychotherapy
72% from general practitioners
Conclusions: Concluded there was an inverse correlation between amount of psychotherapy received and recovery….. basically that it doesn’t work (less likely to recover)
But lots of limitations to this meta analysis..
But inspired controlled research in psychotherapy and development of alternatives to psychoanalysis
➢Consequence:
▫Inspired controlled research studies of psychotherapy ▫Inspired development of alternatives to psychoanalysis10
Client/Person-Centered Therapy
➢Carl Rogers
▫Book: “Client-Centered Therapy” (1951)
▫Therapeutic process over technique; Focus on person rather than problems
▫Three core therapist qualities necessary: genuineness, empathy, unconditional positive regard
▫Mobilize self-actualizing tendency
▫First to conduct research on psychotherapy process and outcome
Three “Waves” of Behaviour Therapy
➢First wave
▫Focus on observable behaviour and objective environment (behaviourism)
➢Second wave
▫Focus on cognitive representations of the environment
(not just the objective environment)
-interpretation of the environment
➢Third wave
▫Focus on how internal processes are functionally related to objective environment
First wave of Behaviour Therapy
Behaviour Therapy: Origins ➢British empiricism
▫Knowledge comes from experience
▫Tabula rasa = blank state
➢Learning theory
▫Ivan Pavlov and classical conditioning (Pavlov’s dogs)
▫Edward Thorndike and the Law of Effect (cats and puzzle boxes… cat learns behavior produces positive effect, so more likely to repeat behaviour)
Behaviourism
➢John B. Watson
▫“Psychology as the Behaviorist Views It”(1913)
▫Famous quote: “Give me a dozen healthy infants, well-formed, and my own specified world to bring them up in and I’ll guarantee to take any one at random and train him to become any type of specialist I might select—doctor, lawyer, artist, merchant-chief and, yes, even beggar-man and thief, regardless of his talents, penchants, tendencies, abilities, vocations, and race of his ancestors.”
…can shape behaviour
▫Little Albert (conditioned to be afraid of white rat… and generalize fear to other white and fuzzy things).. generalization
Behaviour Therapy
➢Mary Cover Jones (1924)
▫Little Peter and deconditioning
-One of Watson’s graduate students
➢Mowrer & Mowrer (1938)
▫Bell and pad method for treating enuresis (bed wetting)
➢Skinner (1953)
▫Applied operant conditioning to increase social behaviour in patients with psychosis
➢Joseph Wolpe(1959)
▫Systematic desensitization… deeply relaxed state and then present feared stimuli
-considered first alternative treatment to psychoanalysis
Second Wave of behaviour therapy
➢Albert Bandura: Social learning theory
▫Behaviour influenced by stimulus events, reinforcement, AND cognitive processes
▫Learning through modelling suggests direct reinforcement unnecessary
➢Aaron Beck: Cognitive theory
▫People respond to cognitive representations of environment
▫Biased information processing
-biases
Cognitive Therapy
➢Aaron Beck
▫Academic Psychiatrist at U Penn
▫Depression due to beliefs of being inadequate and unlovable
▫Focus on beliefs as inaccurate, but not necessarily irrational
▫Use empirical disconfirmation (e.g., behavioural experiments) to test accuracy of beliefs
▫Conducted randomized controlled trials on cognitive therapy, compared to medication
-first person to conduct randomized controlled trials on cognitive therapy,
➢First evidence that psychotherapy at least as effective as medication (Rush, Beck, Kovacs, & Hollon, 1977)21
▫Developed treatment manuals for research and practice
Beck depression inventory
➢Mediational approach
▫Mahoney (1974)
To generalize, need cognition
From stimulus response relationship
To stimulus mediated by the organism (interpretation) to response
➢Albert Ellis: Rational Emotive Behaviour Therapy
-Both Beck and Ellis trained as psychoanalysts, but dissatisfied with the method
▫Focused on beliefs as irrational and illogical (whereas Beck did not see them as irrational, only inaccurate)
▫Used logic and persuasion to help patients see thinking errors and adopt more “rational philosophies”
▫Developed ABCDE model
–Activating event or adversity
–Beliefs about the event or adversity
–emotional Consequences
–Disputations to challenge irrational beliefs (by the therapist)
–Effective new beliefs replace the irrational ones
▫Clinician and supervisor, not a researcher
Beck supervised therapists’ learning to conduct CBT, while Ellis did not supervise therapists in REBT
Third wave of behaviour therapy
➢Distinct from traditional CBT in emphasis on learning to accept emotions, cognitions, and behaviours, rather than trying to change
➢Thoughts do not correspond to objective reality –distance oneself rather than engage with thoughts
➢Focus on valued living versus symptom reduction
-reducing impairment from the symptoms rather than the symptoms themselves
➢Examples:
▫Acceptance and Commitment Therapy
▫Mindfulness-based cognitive therapy
▫Dialectical Behavior Therapy
