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Understanding Individuality And Abnormality > Week 6 > Flashcards

Week 6 Flashcards

1
Q

What psychotherapy?

A

Term covering the wide and disparate range of techniques used in an attempt to enhance psychological and emotional well being.

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2
Q

Treatment in psychotherapy:

A

Different treatments vary in terms of efficiency (how useful they are), and in terms of their scientific rigour (how well supported by evidence they are.) treatment can also be biased - it may work better for some groups/populations than others.

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3
Q

Who does psychotherapy?

A

Not just psychologists:

  • social workers
  • counsellors
  • nurses
  • GPS
  • psychiatrists
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4
Q

Which settings is psychotherapy done in?

A
  • practitioner rooms/surgeries
  • workplace
  • support services (drug and alcohol, relationships Australia)
  • group/family settings (Alcoholics Anonymous)
  • hospitals
  • schools
  • online/over the phone
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5
Q

Psychotherapeutic tools:

A

Not everyone is qualified to use the same psychotherapeutic tools. For example,

  • there are scales/tests that only a qualified and registered psychologist can use
  • psychiatrists and GPs can prescribe medication - psychologists (and others) can’t
  • it is important (and ethical) to know the boundaries for a given role
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6
Q

What makes a good therapist?

A

Training and experience is a good starting point. But evidence suggests other traits (characteristics) are also important.

  • warmth
  • ability to develop a good therapeutic alliance (working relationship with the client)
  • focus on key issues
  • able to align treatment approach with the person
  • willing to get feedback form client, supervisor and colleagues
  • keep up to date with research

And of course, expected to behave in an ethical manner

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7
Q

The science practitioner model - what we base therapeutic practises on

A

“The scientist practitioner model of education and training in psychology is an integrative approach to science and practise wherein each must continually inform the other. This model represents more than a summation of both parts. Scientist practitioner psychologists embody a research orientation in their practice and a practise relevance in their research.”

This is an important model for psychotherapy. However, it does have limitations - eg if we focus on applying evidence based practice, are we exploring new approaches?

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8
Q

Give an overview of psychotherapeutic perspectives

A
  • psychodynamic
  • humanistic existential
  • behavioural
  • cognitive behavioural
  • biological

Each perspective encompasses many specific types of therapy, plus there are other approaches which do not fit into the above perspectives.

Different approaches are popular in different regions - in Australia, cognitive behavioural approaches are favoured. In some parts of the US, Freudian/psychodynamic approaches are popular.

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9
Q

Who created psychodynamic therapies?

A

Founded by Freud

Based on the assumption that psychopathology develops when people remain unaware of their true motivations and fears.
Such people can be restored to healthy functioning only when they become conscious of what has been represented (kept in the unconscious).

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10
Q

What are the two principles that psychodynamic therapy is contingent on?

A
  1. Insight - the clients capacity to understand their own psychological processes
  2. Therapist - client alliance - crucial in effective change to the disordered psychological processes.
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11
Q

What’re the 5 core beliefs of psychodynamic therapies?

A
  1. Most behaviour is driven by unconscious wishes, impulses, drives and conflicts
  2. There is a meaningful explanation/cause for abnormal behaviour, which can be discovered by the therapist.
  3. Current issues are based on childhood experience.
  4. To overcome problem, emotional expression and reliving of past emotional experiences are crucial.
  5. Once the client understands and has emotional insight into the unconscious drives/material, the symptoms are understood and therefore often resolve themselves.
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12
Q

Psychodynamic theories - stages of psychoanalysis

A
  1. Free association -where a client (stereotypically reclining on a couch) is encouraged to give free rein to thoughts and feelings and to verbalise whatever comes to mind. It is assured that with enough practise, free association will facilitate the uncovering of unconscious material.
  2. Interpretation - the technique of interpretation comes into play as presumable unconscious material begins to surface. At the “right time” the therapist begins to point out to the patient his/her defences and the underlying meaning of his/her behaviours, thoughts, desires, of even dreams. To be effective, interpretations should reflect insights that the patient is on the Verge of making him/herself- then they can be claimed by the patient as their own, rather than coming from the therapist
  3. Dream analysis - the therapist interprets dreams in the context of what is occurring in life for the person. Looks at the dreams manifest (actual dream events) and tries to determine the latent (hidden) meaning.
  4. Resistance - resistance or blockages to free association are thought to arise from unconscious control over sensitive areas. These areas are sought and targeted for exploration by the therapist. Included behaviours such as avoiding appointments, not responding to questions etc.
  5. Transference - the process by which people experience similar thoughts, feelings, fears, wishes and conflicts in new relationships as they did in previous relationships. When the client transfers feelings they have for a person to the therapist and engage in a relationship with the therapist that resembles a prior relationship. Arises in therapy is a highly intimate and disclosing relationship, and the client may then transfer their feelings from another personal relationship onto the therapeutic relationship. Can be useful when identified in guiding therapy
  6. Counter transference: where they therapist transfers their own emotional vulnerabilities onto the client. Has a negative effect on the therapeutic relationship. For example, a depressed client may not progress in therapy, and the therapist may feel guilty or angry at the lack of progress and may behave differently to the client as a result.
  7. Working through - therapist assists the person in processing the information and insights gained during therapy. Also involves continued identification of arising conflicts and resistance.
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13
Q

Criticisms of psychodynamic approach

A

Sample bias- Freud approach based on rich, intelligent, successful individuals.

Confirmation bias - selecting pieces of information that support claims and disregarding information that doesn’t support claims.

Long term = expensive.

Do we really need insight to solve problems?

Lack of scientific rigour in some situations- circular arguments

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14
Q

Humanistic existential psychotherapy

A

Like psychodynamic therapy, humanistic therapy requires the client to develop insight into the problem.

Believe that human nature is inherently positive and good, and that we all have the ability to reach our full potential.

Focus of these therapies is on the phenomenology of the client.

Phenomenology: the way each person consciously experiences the self, relationships and the world.

The aim: to help people get in touch with their feelings, with their ‘true selves’ and with a sense of meaning in life.

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15
Q

Expand on humanistic existential psychotherapy

A

Humanistic therapy often considered as one of three main approaches to psychological therapy (other are behaviourism and psychoanalysis).

Largely created by Abraham Maslow - who viewed psychology as too concerned with the neurotic and disturbed (psychoanalysis) or with those that could be explained by a mechanistic approach (behaviourism). Humanistic therapies are concerned with how a person experiences: self, relationships with others, and the world.

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16
Q

Maslow hierarchy of needs

A

Self actualisation

Esteem needs

Social needs

Safety needs

Physiology needs

(From bottom up)

one myth is you have to satisfy more basic needs before progressing up the hierarchy.
Maslow thought every need is satisfied to a different degree. The more the lower needs are met, the more the higher ones can be given attention.

Another myth is that self actualisation is not the “peak” according to Maslow. Suggests a further level of “peakness” who are distinguished by their experience of peak of mystical experience. More likely to see the sacred in all things and to transcend to their own identity.

17
Q

Humanistic existential psychotherapy (Carl Rogers).

A

Person centred therapy (aka client centered)
Devised by Carl Rogers who rejects the notion of a disease model - is people come to therapy to solve problems not to be “cured” of their disorder.

Core traits of therapist
1. The therapist must be authentic and genuine (sometimes referred to as congruence).

  1. The therapist must express unconditional positive regard (non judgemental acceptance of the client and their feelings)
  2. The therapist must relate to client with empathetic understanding
18
Q

Rogerian assumptions in his humanistic existential psychotherapy

A
  1. People can only be understood from the vantage point of their own perceptions and feelings.
  2. Healthy people are aware of their own behaviour
  3. People are innately good and effective, they become inaffective and disturbed only when faulty learning intervenes
  4. Behaviour is purposive and goal directed
  5. Therapists should not attempt to manipulate events for the individual - rather they should create conditions which will facilitate independent decision making by the client
19
Q

Gestalt therapy (humanistic existential psychotherapy)

A

By Fritz Perls:
Dysfunction is caused by individuals suppressing experiences and traits that are anxiety inducing. Therefore we need to recognise and accept these to become an integrated whole.

Through socialisation, people become overly self controlling of their thoughts, behaviours, and feeling in order to conform. In that process, they lose touch with their “inner self” and this leads to dysfunction (anxiety, depression).

Emphasis of therapy is accepting responsibility for own feelings and focussing on the “here and now”.

20
Q

Gestalt therapy techniques (in Fritz Perls version of humanistic existential psychotherapy) used include:

A

Empty chair technique - provides opportunity to ‘talk’ to another without risk

Two child technique - outline “both sides of the story”

21
Q

Criticisms of humanistic existential psychotherapy

A

Lack of scientific rigour in some situations- difficult to measure self awareness.

positive regard and empathy may not be necessary for effective counselling

Efficacy is variable - some evidence suggests not more beneficial than simply talking to a non professional about problems

Cultural bias? Some argue that humanistic approach is based on Western individualistic values

22
Q

Behavioural and cognitive behavioural therapies

A

Psychodynamic and humanist perspectives focus on insight and emotion as the pathway to improvement.

Behavioural therapy and cognitive behavioural therapy (CBT) evolved as a result of the development of behaviourism and cognitive psychology from the 1940’s onwards. Both have their basis in scientific explorations rather than clinical practice.

23
Q

Basic principles of behavioural and cognitive behavioural therapy

A
  1. Short term therapy
  2. Therapeutic focus is the current behaviour/cognitions, not on past (eg childhood) experiences or inferred motives.
  3. Therapy commences with a behavioural analysis
  4. Therapy targets problematic behaviours, cognitions, and emotional responses
24
Q

Behavioural techniques - exposure

A

Used to treat phobias, anxiety triggered responses.

Involves confronting the client with the stimulus they fear. The way in which this confrontation occurs determines the type exposure used. Exposure techniques include:

  • systematic desensitisation
  • flooding techniques
  • virtual reality exposure

The crucial element in all exposure techniques is that in exposing the client to the feared stimulus they are prevented from escaping the stimulus, whilst anxiety levels subside

Anxiety reactions decay over time due to the energy requirements for maintenance. By preventing the capacity to flee or fight the person experiences anxiety decay and is therefore “Reconditioned”.

25
Q

Exposure techniques (CBT)

A

Systematic desensitisation - involves pairing relaxation with the imagery of anxiety provoking scenes or stimuli - a counterconditioning process

Flooding - client is exposed immediately to feared experience

Response prevention - the therapist stops the person from engaging in their typical avoidance responses - both behavioural (eg leaving) and cognitive (eg thinking about something else).

Virtual reality - the client views computer generated images of the feared experience.

26
Q

Behavioural therapies - modelling

A

Modelling and skills training - learning theory (bandura) developed in the 1960s and has influenced heavily how clinical psychologists explain how disorders develop as well as develop new therapeutic approaches to treatment

It is well established that children and adults model the behaviour of others, often unconsciously

Can learn both maladaptive (eg phobia) and adaptive (eg effective coping) behaviours

Client modelling the behaviour of the therapist can be used either implicitly (client will learn over time the responses and reactions of the therapist and use them externally), or explicitly (role play, role reversal).

27
Q

social skills training in modelling (behavioural therapies)

A

Emphasis is on assisting clients with interpersonal/social problems (eg social phobia, shyness, lack of assertiveness). Direct skills training from the therapist, followed by a role playing with self- examination of behaviour, followed by rehearsal ads the common steps. Virtual reality technology is also being used to assist in the skill based training for social interactional problems.
Can be used to improve social interactions in people with schizophrenia, depression, autism. However when used in this manner can not be considered to “cure” the disorder

28
Q

Criticisms of behavioural therapies

A

Some therapies require a moderate high level of motivation by client

Negative thoughts can be realistic

Insufficient consideration of personal relationships

29
Q

Group therapy

A 
Not a particular type of therapy 
Advantages:
-cost/ time efficient 
-allows peer support 
- helps to normalise experience 
- better opportunities to practise skills 
- can be done online or in person

Disadvantages:

  • people may be reluctant to share/feel comfortable
  • May learn new maladaptive behaviours from others
  • lack of personalised treatment
30
Q

Family therapy

A

Group therapy, but the family members are the group
Therapy is focussed on all members

Strategic family therapy:
Designed to improve communication between family members, help them work together to solve problems etc

Structural family therapy:
The therapist interacts with an observed the family, and helps to change the way they interact

31
Q

Behavioural therapies - conditioning techniques

A

Operant conditioning involves the use of reward based systems to counteract maladaptive behaviours, emotions, or cognitions.

Rewards can be explicit (lollies, chocolate) or implicit (praise, attention) - all of which are positive reinforcers.

The rewards can also be withdrawn or retracted either explicitly (no Lolly given) or implicit (no attention, eye contact, interaction) when the behaviour is inappropriate- negative reinforcement

Such techniques are widely used in dealing with anxiety disorders, especially in children or in high needs environments

32
Q

Assertion training in modelling behavioural therapies

A

Assertion training: teaching people to respond to requests in an appropriate manner - eg not excessively submissive or aggressive.

33
Q

Behavioural rehearsal in modelling behavioural therapies

A

Behavioural rehearsal: therapist uses role play to demonstrate and allow practise of behaviours

34
Q

What is token economy in regards to conditioning techniques of behavioural therapies?

A

Use star chart or similar to promote desired behaviour and discourage unwanted behaviour. Often used with children, but can also be used in adult setting (psychiatric units).

35
Q

Aversion therapies (behavioural therapies - conditioning techniques)

A

Aversion therapies is the pairing of unpleasant stimuli with unwanted behaviour. Not commonly used, however still useful in some situations

Understanding Individuality And Abnormality (11 decks)

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