Medical Model, Maladjustment, and Converging Themes Flashcards
Week 4 material
How is the medical model reductionistic?
suggests that all mental problems are essentially physical problems, and that the brain is inherently a better explanation than the mind. in turn, this suggests that psychotherapy is not a scientific treatment because you can’t use words to treat thinking; rather, you should be treating the brain directly, since the defective brain is actually the problem.
Kempt et al (2014) and Lebowitz et al (2014)
found that the fact that the medical model is reductionistic results in an increase in clients’ pessimistic view about prognosis. clients with anxiety and depression were given fake feedback about a chemical imbalance test, and authors found that clients were more pessimistic about therapy outcome and less so with psychiatric meds.
problems with diagnosis
- forces people into boxes/categories - ignores individual symptom variation among individuals with the same disorder
- can result in circular reasoning - diagnosis causes symptoms, and the diagnosis becomes the explanation for the symptoms so one does not look for other explanations
Yalom (2002) - The gift of therapy
found that diagnosis limits vision - clinicians ignore aspects of the client that do not fit in with their diagnosis. diagnosis also acts as a self-fulfilling prophecy - when client receives label from therapist, manifestation of increase in symptoms - the label reinforces the symptoms. in turn, this makes both the client and therapist pessimistic about the client’s outcome in therapy.
Hofmann and Hayes (2019) - The Future of Intervention Science: Process Based Therapy
- DSM is an invalid classification of disorders, and it is too simplistic to match interventions to symptoms (underlying explanation of diagnoses that needs to be addressed).
- Symptoms represent underlying psychological processes (not a disease entity, a maladaptive psychological process).
- Same symptom in different ppl could come from different processes (treating everyone the same, so some ppl improve while others do not).
- Same process in different ppl will create different symptoms.
- Must target processes with interventions
Leung (2019) - A Need to Specify the Nonspecificity of Mental Disorders and Interventions
a response to Hofmann and Hayes article –> although he also rejected DSM, author argued that we need theory to link together processes, symptoms, and treatments. Otherwise, we are just treating the symptoms randomly or mechanically, suggesting that Hofmann and Hayes’ argument is also a cookbook approach.
Rotter’s 3 Standards/Frameworks for Defining Maladjustment
These standards are not universal and not consistent with one another (can be healthy by one standard and unhealthy by another).
1. Disease/conformity: society sets the standards/defines an illness (problem: diagnosis becomes explanation for behavior - circular reasoning - diagnosis –> symptoms –> diagnosis).
2. Freedom from internal pain, conflict, and anxiety: the client makes a judgment about how they feel inside (may not necessarily have a direct sign of a problem).
3. Lack of contribution to society: individuals have a social responsibility and they become unhealthy when they do not accept their duty to others.
Goldfried (1982) - Converging Themes in Psychotherapy
found that with the 130 types of psychotherapy, there are similarities across schools, depending on their level of abstraction (e.g., similarities with clinical methods and techniques, but they are insignificant). however, there is a lot of diversity and disagreement in the theoretical level.
5 converging strategies across therapies
- Increase expectation therapy is beneficial - hope of change (fosters optimism in client if they are improving after 1st session)
- Therapeutic relationship as a vehicle for change: warmth/trustworthiness of therapist changes client’s relations outside of therapy
- Obtain external perspective: give client alternative views to their subjective distortions (hence, a more accurate pic about their internal and external circumstances)
- Corrective emotional experiences: having clients behave in ways they have avoided in the past in the therapeutic setting allows them to experience that the feared consequences do not occur. Hence, the client experiences relief and freedom as well as increased optimism for therapeutic change.
- Continued reality testing: continuous attempts of the client to correct distortions and behavior patterns
behavior change targets
based on Riddle and Ferrer (2015), there are 3 classes of ___ ___ therapists seek to address (across schools and modalities):
- self-regulation: control of impulses and emotions
- self-reactivity and stress resilience: more adaptive coping (help build repertoire of responses)
- interpersonal and social process: better (more satisfying) relations with others
Barlow et al. (2004) - Toward A Unified Treatment for Emotional Disorders
Found that there is a unified treatment for emotional disorders and it relies on the notion that pathology is equivalent to the suppression of negative emotions. The treatment/therapy is to enhance adaptive emotional self-regulation so that individuals become less prone to suppress their negative affect.
Lapate et al (2014) - Nonconscious emotional activation colors first impressions
Found that conscious awareness of one’s affective experiences reduces the likelihood that this will impact behavioral responses, such that awareness destroys the automaticity of that connection. This gives empirical support for helping clients become more aware of their emotions as it allows for increased conscious control of their behavior.
Kirsch & Lynn (1999) - Automaticity in Clinical Psychology
Argued that the experience of free-will is an illusion - conscious intention does not activate response, rather, it primes response that makes activation more probable. The implications are that we may desire to behave in a certain way, but nonvolitional motives will inhibit our response and that we may desire to NOT behave in a certain way, but nonvolitional motives will activate a response against our will. Therefore, excessive efforts to inhibit thoughts, feelings, or behaviors will inevitably fail.
Ricard & Singer (2017) - Beyond the Self
Argued that both buddhism and neuroscience accept the unconscious - we don’t have control over the processes that transform unconscious signals or stored memories into the conscious.
psychodynamic view of insight (Castonguay & Hill)
confronting unpleasant truths by replacing unconscious motives with rational understanding and integrating affect and cognition, as well as gaining emotional insight through transference in therapeutic setting.
