Psychotherapy Flashcards
What is the Criteria for Evidence-Based Practice?
- Concerned with efficacy and clinical utility
- initially developed via RCT with a specific tx and using tx manual
- Four areas of EBP: research, clinical, patients, culture
- Three central features: best available empirical data, patient preferences and values, and clinical judgement/experiences in skills
What are the controversies surrounding Devision 12’s list of ESTs?
- overrepresentation of short-term and cognitive behavioral therapies
- overemphasis on RCTs and manualized therapy
- ignores common factors that contribute to therapies’ successes independent approach
- Problems of generalizing research findings to clinical practice
- methodological issues (defining “placebo”)
- problems with diagnosis/comorbidity
- shouldn’t say a treatment is not effective just because it can’t be studied
What is the difference between efficacy and effectiveness in research?
Efficacy:
- causal relationship in tx of symptoms
- very controlled (to establish validity)
- does x really treat Y, this is an internal validity question
- RCT are common method
Effectiveness:
- Clinical utility
- Generalizability; cost-effectiveness
- How does it work in real world? Concerned with external validity
- More naturalistic implementation of interventions is the area of focus
efficacy> effectiveness in original requirements
What are the top five common factors that contribute to therapy outcome?
- Client Characteristics (e.g. positive expectations)
- Therapist Qualities (e.g. ability to cultivate hope)
- Change Processes (e.g., “catharsis”)
- Treatment Structure (e.g. use of concrete techniques)
- Therapeutic Relationship (most common across all categories)
What are the different types of Humanistic Psychology and there creators?
Person-centered – Rogers
Existential – Frankl
Gestalt – Perls
Process-experiential/Emotion-focused - Greenberg
Humanistic Themes
1) Human capacity for reflective consciousness, which can lead to self determination and freedom
2) Self Actualization: humans strive toward growth and development
3) Choice and free will are central to human functioning
4) Respect for each person and their subjective experience
Person Centered Therapy
View of Human Nature, Therapeutic Goals and Therapists Function and Role
Rogers - Client Centered
- Emphasis on research
- View of Human Nature: people have vast potential for understanding themselves and resolving own problems. Clients are capable of self-directive growth without direct therapeutic intervention if they are involved in a good therapeutic relationship
- Therapeutic Goals: Empathy, unconditional positive regard, congruence, assist clients with growth process, encourage clients towards self actualization
- Therapist’s function/role: Non directive- primary responsibility on client, therapist try to create conditions that will enable to engage in meaningful self-exploration
Existential Therapy
View of human nature, therapeutic goals, Therapist function and role
Frankl
- View of Human Nature: assumes we have free will and therefore responsible for our choices and decisions, believes that humans are in a constant state of transition, emerging, evolving and becoming
- Therapeutic Goals: increase awareness, help clients recognize the ways in which they are not living fully authentic lives and make choices that will lead to their becoming what they are capable of becoming (turn wishes into actions)
- Therapist’s function/role:tries to understand subjective world of client, techniques secondary to establishing a therapeutic relationship that will allow therapist to effectively challenge yet understand client, present focused
Gestalt
View of human nature, therapeutic goals, Therapist function and role
Perls- even more focused on what’s going on in current moment in session
- View of Human Nature: clients are manipulative and avoid self-reliance and responsibility, individuals have capacity to regulate themselves in their environment if they’re fully aware of what is happening in and around them
- Therapeutic Goals: increase self awareness, help client accept responsibility for actions and for making change, move from external to internal support
- Therapist’s function/role:more directive, encourage clients to attend to present awareness, present experiments and share observations, call attention to clients body language and speech patterns, therapists give feedback that allows client to develop awareness of what they are actually doing
Process-Experiencing/ Emotion-focused (Greenberg)
Greenberg
- based on case formulation approach
- focuses on “moment-by-moment awareness, regulation, expression, transformation, and reflection on emotion”
- View of Human Nature: people have a vast potential for understanding themselves and resolving their own problems, demphasize therapist as the active, directing agent, as had been the case in psychoanalysis and behaviorism
- Therapeutic Goals: assist clients in their growth process so they can better cope with present and future problems
- Therapist’s function/role: non directive role, rejects DSM and diagnosing clients, techniques secondary to establishing therapeutic relationship
Psychoanalysis
Organized set of clinical inferences about the nature of patent’s psychopathology, personality (e.g. id vs. superego), dynamics (wishes vs. defenses) and development
View of Human Nature:
+ deterministic (behavior controlled by things outside our control, unconscious influences us)
+ instincts are central to understanding human behavior
+ concept of unconscious conflict is central
+ assumptions: patients problems are due to repressed conflicts, conflicts are based on instinctual wishes originating in early childhood, by providing a “blank screen” the analyst creates conditions where the patient will project conflicts onto the analysts (i.e. transference)
- Therapeutic Goals: make unconscious conscious, strengthen the ego so that behavior is based more on reality and less on instinctual cravings or irrational guilt
- Therapist’s function/role: blank screen, interpretation
Object Relations Theory
- places less emphasis on sexual/aggressive impulses and more emphasis on internalized objects
- object relations are interpersonal relationships as they are represented intra psychically
- people search for relationships that match patterns established by earlier experiences
- places primary emphasis on therapeutic relationship which is understood as therapeuic agent in its own right
Core Conflictual Relationship Theme (CCRT)
- not central to psychoanalysis
- way to assess one’s central relationship pattern in session
- helps therapist make a formulation about patients main conflicts, shape interpretations, set treatment goals and limit countertransfernce
Time Limited Psychodynamic Therapy
interpersonal, time sensitive approach for patients with chronic, pervasive, dysfucntional ways of relating to each other
Formulation
• Choose most problematic interpersonal style and what underlies current distress
• Acts of self: thoughts, behaviors, feelings motives, and perceptions of the client of interpersonal nature
Goals
• Overarching goal: change how person relates to him or herself or others (not sx reduction)
• New experience
Interpersonal Models of Psychotherapies
- Focused, short term, time limited treatment
- Focus on current problems (not past)
- Developed initially to treat depression but has expanded
Goals of treatment: Mastery of current social roles and adaptation to interpersonal situations
• Grief and loss
• Role disputes, and transitions
• Interpersonal deficits
