psychotherapy Flashcards
Defining Psychotherapy
“…the informed and intentional application of clinical methods and interpersonal stances derived from established psychological principles for the purpose of assisting people to modify their behaviors, cognitions, emotions, and/or other personal characteristics in directions that the participants deem desirable.”
Many specific theories, many common factors
- Expectation
By seeking help, one will change - Therapeutic relationship/alliance
Important, but varies according to theory (behaviorism < cognitive < CBT < psychoanalytic) - Hawthorne effect
Improvement as a result of receiving attention
SUMMARY
- You need to be able to detect the type of psychotherapy in a vignette
- You should know all about CBT
- You should know all about classical and instrumental conditioning!
Expectation
By seeking help, one will change (you want to create optimism to the client)
Therapeutic relationship/alliance
Important, but varies according to theory (behaviorism < cognitive < CBT < psychoanalytic)
Hawthorne effect
Improvement as a result of receiving attention
6 types of psycotherapy?
- Psychoanalytic/Psychodynamic
- Interpersonal
- Family
- Behavioral
- Cognitive
- Cognitive Behavioral
Psychoanalysis and Psychodynamic
- Based on idea that unconscious conflicts are repressed and cause difficulty (insight-oriented)
- Aims
Making unconscious -> conscious
Understanding conflicts/behaviors - Techniques
- Free association
- Analysis of transference
- Analysis of resistance
- Dream interpretation
Analysis: Long-term therapy
Multiple meetings/week, usually over several years
Shorter, time-limited dynamic therapy focuses
on the present
Used to treat:
Depression
Anxiety
Some personality disorders
interpersonal?
Based on idea that problematic attachments early in life predispose one to develop disorders that are expressed through troubled interpersonal relationships in present
4 main major interpersonal problems?
- loss and grief
- role disputes (husband thinks that wife should do everything)
- role transitions
- interpersonal deficits
compared to psychodyamic interpersonal is
short term (12-16 sessions) and focus on relationship
family systems?
based on the idea that an identified patient reflects a dysfunction in the whole family system (The assumption is that the child is NOT a identified pt, the entire system is the identified pt.) –> the aim is to improve the family’s relationship
Group Therapies
- Used to treat people with common experiences, a particular disorder, or interpersonal difficulties
- Allows members to learn skills, discuss own feelings, as well as provide feedback and support to others
- Therapist as facilitator
- Typically consists of ~ 8 people, meet weekly
- Often time-limited
Behavioral therapy
- Based on learning theory
- Aim: Relieve symptoms by unlearning maladaptive behaviors
- Techniques based on classical conditioning and operant conditioning
1) Systematic desensitization
2) Aversive conditioning
3) Flooding/implosion
4) Token economy (Chocolate economy)
Behavioral therapy is
Used to treat:
- Phobias (systematic desensitization, flooding)
- Depression (behavioral activation)
- Autism Spectrum Disorders (Applied Behavior Analysis/token economy)
- Psychotic disorders (token economy)
unconditioned stimulus means
automatic, no need to teach
the process of conditioning is
to turn the neutral stimulus (Tone) –> conditioned stimulus
changes over time in the strength of the conditioned response
- acquisition (CS and UCS paired)
- extinction (UCS withheld)
- spontaneous recovery (CS again presented)
- -> extinction if UCS again withheld
some applications of classical conditioning
can lead to the development of intense, irrational fears of objects or situations (eg - phobias)
what is stimulus discrimination?
Stimulus discrimination: An organism learns to differentiate among similar stimuli
- Complementary process to stimulus generalization
Some Applications of Classical Conditioning
- Can lead to the development of intense, irrational fears of objects or situations (e.g., phobias)
- Systematic desensitization uses classical conditioning principles to treat such fears
- -> Used in addictions treatment
the most common treatment for phobia?
systematic desensitization
antabuse for alcohol is
classical conditioning
what is reinforcer?
a stimulus event that increases the probability that the operant behavior will occur again
what is a positive reinforcer?
stimulus that strengthens the response if it follows that response
what is a negative reinforcer?
remove the unpleasant stimulus that if removed, strengthens the response that removes the stimulus
delay and size of reinforcement?
- the effect of a reinforcer is stronger when it comes soon after a response occurs
- Generally, the larger the reinforcer, the more vigorous the behavior
what is continuous reinforcement schedule?
reinforcer is delivered every time a particular response occurs
Partial or Intermittent Reinforcement Schedule:
Reinforcement is given only some of the time
Fixed Ratio (FR):
Fixed number of responses required for reinforcement
Variable Ratio (VR):
Number of responses required for reinforcement varies
Fixed Interval (FI):
Fixed set of time must elapse before next opportunity for reinforcement
Variable Interval (VI):
Time interval that must elapse before next opportunity for reinforcement varies
Punishment:
The presentation of an aversive stimulus or the removal of a pleasant one following some behavior
- Results in a decrease in the frequency of a response
Negative Reinforcement vs. Punishment
Negative Reinforcement: Strengthens behavior
Punishment: Weakens behavior
drawbacks of punishment?
- Does not “erase” an undesirable habit, merely suppresses it. Can produce unwanted side effects
- Can often be ineffective unless it is given immediately after the response and each time the response is made
- Can become aggression, even abuse, when given in anger
- Signals what is inappropriate behavior but does not specify correct alternative behavior
Clinical Applications of Learning Theory
- View problems as learned behaviors
Therefore, these behaviors can be changed without searching for hidden meanings or unconscious causes - Goal of treatment is to understand the learning principles maintaining the undesired behaviors and learn new responses in those situations
Systematic desensitization:
The patient visualizes a series of anxiety-provoking stimuli while remaining relaxed
Flooding / implosion:
Direct exposure without the possibility of avoidance / escape
Positive Reinforcement:
Used to alter problematic behavior and to teach new skills
- token economy
Aversive condition:
Classical conditioning principles are used to associate physical or psychological discomfort with undesired behaviors
Self Monitoring:
maintain detailed record of daily activities; used to establish antecedents/consequences
Stimulus Control:
modification of environmental cues that maintain or elicit behavior(s)
cognitive therapy?
Cognitive therapy – developed by Beck in 1960s
Originally focused on depression but later expanded
Treatment aims to replace presumed distorted appraisals (driven by schemas) with more adaptive appraisals
Therapist helps clients to:
Monitor thoughts
Recognize the relations among cognition, behavior and affect
Test the validity of automatic thoughts
Substitute more realistic cognitions
Identify and later alter schemas that predispose people to think in negative ways
Based on idea that problems develop as a result of errors in thinking
cognitive therapy is all about
monitoring and ???
the goal of the cognitive therapy is to
remove the distorted thought (appraisals) with more adaptive appraisals
aim of the cognitive therapy is
to correct errors in logic (cognitive distortions –> examples: catastrophizing, overgeneralization, dichotomous thinking)
Cognitive Behavioral Therapy (CBT)?
combines both cognitive and behavioral techniques
CBTs share 3 fundamental propositions?
- cognitive activity affects behavior (mediated model)
- cognitive activity may be monitored and altered
- desired behavior change may be effected through cognitive change
In addition to the meditational nature of CBT, all CBTs share in common:
- Emphasizes homework and outside of session activities
- Direction of session activity
- Teaching skills to cope with symptoms
- Focus on a patient’s future experiences
- Providing the patient with information about his or her treatment, disorder, or symptoms
- Focuses on a patient’s cognitive/intrapersonal experience (specifically illogical or irrational thoughts and beliefs)
4 elements to CBT case formulation?
- Assessment – diagnosis yields information that is helpful; nomothetic idiographic
- Treatment planning – “mechanism change goals of treatment” – what psychological mechanisms need to change in order to attain goals?
- Treatment – technical eclecticism or manual driven (fidelity with flexibility)
- Continuous monitoring and hypothesis testing – collect data very often and test formulation and monitor progress (practiceground.org list of assessment tests)
the aim of the psychoanalysis and psychodynamic
- making unconscious –> conscious
2. understanding conflict/behaviors
what are the techniques of psychoanalysis and psychodynamic?
- free association
- analysis of transference
- analysis of resistance
- dream interpretation
3 major classes of CBT –
orient themselves towards different amounts of cognitive v. behave change
- coping skills therapies – focus on developing repertoire of skills to manage stressors
- cognitive restructuring methods – assume emotional distress is the consequence of maladaptive thoughts
- problem solving therapies – combination of the other two
CBTs share 3 fundamental propositions
- cognitive activity affects behavior (meditational model)
- cognitive activity may be monitored and altered
- desired behavior change may be effected through cognitive change
In addition to the meditational nature of CBT, all CBTs share in common:
- Emphasizes homework and outside of session activities
- Direction of session activity
- Teaching skills to cope with symptoms
- Focus on a patient’s future experiences
- Providing the patient with information about his or her treatment, disorder, or symptoms
- Focuses on a patient’s cognitive/intrapersonal experience (specifically illogical or irrational thoughts and beliefs)
What is the CBT session structure framework?
Session structure framework for the 50-minute therapy hour is the “10-30-10” guideline
- Use the first 10 minutes for the check-in, distress rating, bridge from the last session, brief discussion of the week, and agenda setting
- The middle 30 minutes can then be spent doing the therapeutic work that helps the client change and achieve their goals.
- Use the final 10 minutes for the summary, homework discussion and feedback
what are the 4 elements to CBT case formulation?
4 elements to CBT case formulation
- Assessment – diagnosis yields information that is helpful; nomothetic idiographic
- Treatment planning – “mechanism change goals of treatment” – what psychological mechanisms need to change in order to attain goals?
- Treatment – technical eclecticism or manual driven (fidelity with flexibility)
- Continuous monitoring and hypothesis testing – collect data very often and test formulation and monitor progress (practiceground.org list of assessment tests)
what are the elements of the case-level formulation?
Elements of the case-level formulation
- Disorders and problems – symptoms and impairments, not just symptoms
- Mechanisms – what is causing and maintaining the problems and symptoms
- Precipitants – diathesis-stress model
- Origins – how the patient acquired the mechanisms that cause the problems
