Psych 481 Exam 3

Goals and Characteristics of family therapy

-General systems theory: family is seen as a "system" and therapy deals with relationship between individual members and the family system -Therapist goal is to improve communication within the family. Deemphasize problems of the individual vs treating problems of the family -diagnostically important to see how different family members construe the problem in very different ways

Definition of Psychological Intervention

-Method of inducing changes in a person's behavior, thoughts, or feelings -intervention in a context of a professional relationship

Features common to many therapies

-Most psychotherapies have more common features than differences -Not all forms of psychological intervention have been tested empirically However, of the tested therapies, very limited evidence that one approach or technique is more effective than others Positive changes may be the result of a set of common factors that cuts across various theoretical and therapeutic boundaries

Why therapy is undertaken

-SOLVE a specific problem or achieve certain goal -Improve individual's capacity to DEAL with existing behaviors, feelings, thoughts -PREVENT future problems -Increase person's ability to take pleasure in life

Cognitive-behavioral therapy

-a major force in clinical psych -experimental approach to the study of human behavior -problematic behaviors can be best understood and treated by principles derived from psychological experimentation -any behavior that is learned can be unlearned

transference cont

-analysis of transference relationship is considered the most powerful technique in accessing the unconscious and resolving inner conflicts -Counter-transference can occur when the analyst experiences transference towards the patient and this can impede on the progress of the therapy

superego

-aspect of personality shaped primarily by experiences with the environment -internalization of moral principles, or the conscience, and the rules that govern all organized societies

Does psychodynamic therapy work?

-average patient receiving psychodynamic therapy is functioning better than 75% of those who receive no treatment -depends on patient achieving insight through therapist interpretation -not effective or efficacious with children and adolescents -research suggests that there is support for the efficacy when treating major depressive disorder, panic disorder, borderline personality disorder, and substance abuse -IPT showed moderate to large effects over no treatment for depression. Combining it with meds was better than meds alone. But comparing meds vs. IPT shows that meds are more efficacious

Rational Restructuring

-based on the theory that maladaptive behavior is determined by ways in which people construe their world or by the assumptions they make -behavior therapist must help patient see the irrationality of their beliefs

systematic desensitization cont.

-begins with history of patient's problem, and explanation of treatment rationale -training in progressive relaxation. Teach patient to tense then relax different muscle groups, and identify different sensations -establishment of anxiety hierarchy: patient and therapist work together to create a hierarchy of situations that cause anxiety and rank them from lowest to highest

Rogerian theory cont.

-believed each person has own unique vantage point, and each viewpoint is valid -emphasized phenomological perspective: maintains that people react to their experiences of the world and inner emotions and thoughts (rather than reacting to the external objective reality) Basic human urge is to preserve the phenomenal self. Self-esteem becomes the fountainhead of behavior -the most important psychological data were the individual's subjective impressions and experiences

ID

-born with predetermined set of psychological needs, drives or instincts -innate drives lead us to seek immediate gratification of sexual and aggressive needs -we are driven to experience pleasure and avoid pain

short-term dynamic therapy

-brief or time-limited psychodynamic therapy (started in the 70s) -therapist is more active in interpretation -therapies range from 12-50 sessions -more explicitly problem focused -demonstrated that patients with long-term neurotic personality issues could exhibit change in much shorter time frame

Derivations of psychoanalytic theory and therapy

-carl jung -alfred adler contemporary psychodynamic theory: -ego psychology -object relations -short-term dynamic theory -interpersonal therapy contemporary psychodynamic therapy shifts focus to the here and now and to interpersonal exchanges. Therapy is now more flexible

Key issues in psychotherapy research

-comparative studies (compare two or more techniques in terms of efficacy. but are designs powerful enough to detect differences?) -process research vs. outcome research (process research is concerned with what occurs during therapy and the interactions. Rogerians were pioneers of this. Strong association found between therapeutic bond and outcome) -effectiveness of specific treatments (cognitive-behavioral has best evidence for anxiety, works better than no therapy at all) -Practice guidelines (professional orgs have developed practice guidelines to recommend specific forms of intervention for specific disorders) -Manualized treatment (debate over whether manuals should be used in therapy

Aaron Beck's cognitive therapy

-development of cognitive-behavioral treatments for a variety of clinical problems -uses cognitive behavior techniques to modify dysfunctional thinking patterns that characterize disorder -one of the most effective techniques for treating depression

Freud's ideas

-disturbing or unacceptable experiences to person are blocked from awareness, this dissociation causes symptoms (hysteria, paralysis, etc.) -if individual becomes aware of the blocked material, symptoms will go away -awareness is the overarching goal of psychoanalysis -developed techniques such as free association

dream analysis

-during sleep the ego is more relaxed and unconscious material can be expressed in dreams -dreams represent fulfillment of manifest content (what actually happens in the dream) (symbolic expression of real desires) and latent content (its symbolic meaning) -if latent content is too easily recognizable, we become anxious and awaken (nightmares)

The negatives of client-centered therapy

-efforts do not change clients, they release client's inner potential for growth instead -how do you experience the same phenomonological world? Especially if you do not consider their past or do assessments? -involves only one technique: empathy, acceptace, and positive regard for everyone and all problems -too much faith in the client's abilities? what if they are schizophrenic? -verbal reports are often distorted, defensive, and incomplete -undefined terminology -probably not going to be best for those with psychosis, poor verbal skills, or limited education

Theory behind cognitive behavioral therapy

-emphasizes the role of thinking in etiology and maintenance of problems -seeks to modify patterns of thinking that are contributing to patient's problems -viewed as among the most efficacious of all psychological interventions -shown to be equal or superior to alternative treatments, including medications

Research on these therapies

-few empirical studies have been conducted -moderately efficacious but no more effective than any other psychotherapy -least frequently endorsed by contemporary clinical psychologists (less than 2 percent) -no evidence that core conditions (especially therapist warmth, empathy, and genuineness are either necessary or sufficient for producing client change -however these conditions may still represent important communication and relationship skills valuable for the therapist

The psychodynamic approach

-focuses on unconscious motives and conflicts -depends heavily on analysis of past experiences -psychic determinism: everything we do has meaning and purpose and is goal directed -the goal of therapy is to make the unconscious conscious

Strengths of phenomenological, existential/humanistic approaches

-has brought therapists in touch with the essential data of EXPERIENCE -humans make choices, are not just made of urges and insticts -focus on the present, positive change does not only have to come from insight of the past -focus on a strong therapeutic relationship -an emphasis on positive growth

ego

-individual's connection to the world -involves awareness of self and ability to accurately perceive and interact with one's environment -ego must try to balance the sexual and aggressive drives of the id and the moral constraints of the superego

Interpretation

-involves restating the patient's behavior or feelings in new langauage and from a new frame of reference -analyst must consider whether the patient is able to accept interpretation (will not accept if not ready) WORKING THROUGH -process of repeated interpretations of patient's unconscious wishes, feelings, memories and patients understanding

Application to specific problems cont.

-most appropriate for use with clients with mild to moderate symptoms/distress -much more difficult with clients who focus on external factors or who are seeking advice -not for clients with major thought disorders, impulse control, or antisocial personality disorders, or those in crisis and need immediate intervention

Interpersonal Therapy

-most striking differences from Freud's original concepts and methods -theories emphasize how the most important manifestations of early childhood experiences appear in current interpersonal relationships -emphasis of treatment on successful development of current interpersonal interactions Applied mainly to depressive disorders MOST EMPIRICALLY SUPPORTED OF ALL PSYCHODYNAMIC THERAPIES

Strengths of client-centered therapy

-person is not the victim of their history -freedom to choose substituted for a mechanically determined set of behaviors in freudian view -not necessary to dig up the past -shorter therapy -use of research. Rodgers used tape recorders to study the effectiveness of the therapeutic process -client functioning better than 73% of people with no therapy. No more effective than other treatments

Limitations of phenomenological, existential/humanistic approaches

-prejudicial language (freedom, humanistic, acceptance) -emphasis on feelings and emotions leaves therapist with subjective experiences that can be biased of reason -can one truly know the phenomenological field? -total disregard for assessment and diagnosis -technique centered: treating every patient the same -lack of research, makes it harder for insurance to pay for these therapies and schools to teach it -obscure language, vague and ill-defined

How client centered therapy works

-sessions are once a week. Phone calls/extra sessions are discouraged -diagnosis/assessment is deemphasized -therapist does not give information, advice, use reassurance or persuasion, ask questions, offer interpretations, make criticisms -Therapist reflects what client says, and recognizes/clarifies feelings associated with the client's statements. The client is the active participant, not the therapist

Humanistic/existential therapy: Rogerian Theory

-shared assumption with Freud that humans are born with innate drives and needs -differed with Freud that human nature is selfish and destructive. Saw people as constructive and reaching toward health and wellbeing -self-actualization: innate drive toward actualization of all one's competencies and potential -emphasized the role of the conscious processes and enviornment

Techniques of existential therapy

-similar to Rogerian perspective, existential therapy views therapist-client alliance as critical for achieving change and growth -emphasis on genuineness and openness with clients; focus on the present not the past -power to bring about change is assumed to reside with the client, not in therapist or therapy

Goals of Humanistic/Existential therapy

-similar to psychodynamic/psychoanalytic therapy in facilitating greater insight and self understanding in client in order to bring about personality change -different in emphasis on setting goals for psychotherapy -offer support and empathy to help clients explore the true nature and meaning of their behaviors, emotions, and relationships

Factors associated with better outcomes in brief therapy

-the therapist/patient relationship..positive therapeutic alliance -nature and frequency of interpretations made by the therapist: focused on transference process and was provided in low concentrations -the ways in which the patient views the relationship with the therapist is positively correlated

Exposure therapy

-this technique evolved from "flooding" and "implosion" -patients are exposed to stimuli or situations that were previously feared or avoided -exposure can be in real life or in fantasy. But it must provoke anxiety, long duration, graduated, and repeated until all fear is eliminated. Will not work if the simulation does not provoke real anxiety

The nature of specific therapeutic variables-the therapist

1. Age, sex, and ethnicity (therapist age is not related to outcome, female vs. male doesn't make much of a difference, and patient-therapist similarity in regards to ethnicity does not mean a better outcome)?? 2. Personality (highly dominant therapist better for clients that are culturally similar. Low-dominance therapists better for culturally dissimilar clients) 3. Empathy, Warmth, and genuineness (swenson says successful therapists have interest in people and commitment to the patient. Necessary but not sufficient 4. Emotional well-being (important for therapist to be aware of aspects of their life they are sensitive to) 5. Experience and professional identification (mixed results. paraprofessionals have equal or even exceeding outcomes. One profession (social work, psychiatry) is not better than the other

The nature of specific therapeutic variables-the patient

1. Degree of distress (evidence is all over the place. many generalizations that individuals who need therapy least are the ones who benefit the most) 2. Age (younger people are more likely to go to therapy but older people will get just as much out of therapy. Efficacy of cognitive-behavioral, behavioral, and brief psychodynamic treatments with older adults suffering from anxiety and depressive disorders) 3. Intelligence (insight requires a reasonable level of intelligence but behavioral forms of therapy works well for all intelligences and is often used with young children) 4. Motivation (successful psychotherapy requires motivation) 5. Openness (openness to the therapeutic process appears to make the patient a better bet for therapy) 6. Gender (research does not support that women do better in therapy than men. However, sex of the therapist may matter) 7.Race, ethnicity, social class (many techniques developed for white middle/upper class. It might be a better outcome when patient and therapist have same race and background because a big difference reduces willingness to remain in therapy. No evidence to support that minorities do worse . no relationship between social class and outcome.) 8. Therapists reaction (patients who receive higher global ratings of attractiveness or whom the therapist can relate better tend to have better outcomes in therapy)

Strengths of CBT

1. Efficacy 2. Efficiency: much faster and shorter than psychodynamic. Can be done by non PhD personnel 3. Evidence-based techniques: CBT is a very active collection of procedures 4. Symptom substitution: layed to rest this notion that is often popular in psychiatry and psychodynamic theory. A symptom is not always a part of some underlying psychic illness that will just return again in the form of another symptom 6.Breath of application: not just for the wealthy middle class. operant procedures and token economy can improve financially strapped and mentally retarded 7. Scientist-Practitioner: heritage that is experimental and oriented towards research

3 core features of therapists in client-centered therapy

1. Empathy: conveying to client a sense of being understood 2. Unconditional positive regard: respect for the client as a human being. One of the most important tenants 3. Congruence (genuineness): express behaviors, feelings, or attitudes that the client stimulates; be honest because they can tell. express your emotions

Limitations

1. Linking practice to science: has not been ruled out that other non-behavioral aspects of the therapy are causes the symptom relief (such as the therapeutic alliance) 2. Bad rep for being "dehumanizing" 3. Inner Growth: criticized for not facilitating inner growth. Reduces symptoms and changes behavior but falls short of promoting understanding 4. Manipulation and control: some say that CBT assaults capacity to make decisions and reduces dignity and integrity of patient 5. Generalization: does CBT effects generalize outside of the places where they are practiced? 6. Lack of a unifying theory: many frameworks going on at once here

Client's stages of change

1. Precontemplation (50-60% of clients are in this stage! client has no intention of changing his or her behavior in the near future. Going to therapy b/c of outside pressure) 2. Contemplation (30-40% are in this stage! Client is aware that a problem exists but has not yet committed himself to trying to make changes) 3. Preparation (client intends to make a change in near future) 4. Action (10-20% are in this stage. change doesn't happen until this stage) 5. Maintenance (maintaining the status quo) 6. Termination (relapse is no longer a threat)

Features common to many therapies 2

1. The expert role: it may help to reach out to a loved one but an expert has the training and experience 2. The release of emotions (catharsis) 3. Therapeutic alliance (the most important feature) 4. Anxiety Reduction (release of tension) 5. Interpretation/Insight 6. Building competence/mastery 7. Non specific factors (faith, hope, expectations for increased competence, placebo effect etc.)

The Freudian View

1. The instincts -life and death 2. Personality Structure -id, ego, superego 3. Psychosexual stages -oral, anal, phallic, latency, genital 4. Anxiety -reality, neurotic, moral 5. Ego defenses (defense mechanisms) -repression, fixation, regression, reaction formation, projection

The course of clinical intervention

1. initial contact -provide basic information, answer questions 2. Assessment -Clinical interview, psychological tests 3. Goals of treatment -involve client in this process 4. Implementing treatment -therapist decides on specific form of treatment 5. Termination -evaluation and follow up

systematic desensitization

1950's, Joseph Wolpe. Primarily used to reduce anxiety -based on "reciprocal inhibition" the idea that one cannot be relaxed and anxious simultaneously -has been shown efficacious for anxiety disorders-animal phobias, public speaking anxiety, social anxiety, general anxiety -for people who have adequate coping potential but still react with severe anxiety

Curative Factors 2

6. Imitate behavior: watching and listening can lead to modeling of more useful behavior 7. Corrective Recapitulation of the family: group context can help clients understand and resolve problems related to their family 8. Catharsis: Learning how to express feelings about others in the group, helps build trust and understanding 9. Group cohesiveness: become tightly knit. enhances self esteem through group acceptance

Aversion Therapy

Administering aversive stimuli to inhibit unwanted emotional responses -strength diminishes when response is followed by an unpleasant consequence -used in treatment of smoking, alcoholism, and sexual deviations a form of conditioning Covert Sensitization: -techniques relying on imagery rather than actual punishment or drugs

Group Therapy

Almost every school has a group counterpart -psychoanalytic group therapy -psychodrama -transactional analysis -gestalt groups -behavior therapy groups

Ego psychology

Anna Freud emphasizes ego over ID and superego. Ego recognized for learning & memory -focuses more on current problems and conflicts (vs early childhood experiences) -helps patients recognize and build strengths through reparenting Led to the development of psychoanlanalytic treatment for disturbed children

Modeling

Bandura -also known as observational learning -based on theory that a new skill or set of behaviors can be learned more efficiently by observing another person -most widespread use is in treatment of participant modeling when the patient observes the therapist holding the feared object

Emotionally Focused Coupled Therapy

Brief treatment that seeks to: -change partner's problematic interaction styles and emotional responses -establish stronger, more secure emotional bonds This treatment approach assumes marital problem is caused by negative affect and destructive interactional styles More secure attachment to one's partner is necessary to stabilize the couple

Efficacy of behavioral therapy

CBT is treatment of choice for many disorders functions better than 75% of those not receiving any treatment -superior compared to psychodynamic and client centered -most successful with disorders involving specific, maladaptive behaviors. Not problems that are vague or existential in nature -leader in "manualizing" treatments so that therapy can be administered in a standardized manner -facilitates research and training of -ideal therapeutic orientation choice for scientist-practitioner and clinical scientists.

Couples Therapy

Can be construed as a form of family therapy remarkable growth for this therapy since the 60s Most popular forms: -behavioral marital therapy -cognitive couples therapy -emotionally focused couples therapy -sex therapy -insight-oriented (psychodynamic) couples therapy

Behavior Therapy Groups

Can be highly efficient to conduct behavior therapy in a group setting (teaching relaxation, establishing anxiety hierarchies) -usually time limited (12 sessions) -patients in particular groups have similar problems Research supports efficacy of behavioral and cognitive-behavioral group therapy for treatment of depression, social skill deficits, pain, agoraphobia, and social phobia

Existential psychotherapy

Closely aligned with Roger's humanistic and client-centered views, but distinct -emphasizes human potential for free will and human limitations -highlights both self-determination and existential anxety -people are engaged in a search for meaning, this is the fundamental human characteristic -the ultimate goal of existential psychotherapy is to help the individual reach a point at which awareness and decision making can be exercised responsibly "the exercise of cognitive abilities will allow for the achievement of higher states of love, intimacy, and constructive social behavior."

Gestalt Therapy (Fritz Perls)

Combines humanistic and existential traditions with a mix of ideas and techniques -focus on helping the client understand the self better. A person is an organized whole, not a disjointed collection of emotions, cognitions and behaviors. Emphasis on present experiences and immediate awareness of emotion and action -Negative emotions are created by being preoccupied by either the past or the future -opposed to research -THE NOW!?

Empirically supported treatment (EST)

Criteria for well-established treatments Have at least two good group design studies, conducted by different investigators, demonstrating efficacy in one or more of the following ways: -better than a pill or psychological placebo or to another treatment -Equivalent to an already established treatment in studies with adequate statistical power OR a large series of single case design studies demonstrating efficacy. These studies must have: -good experimental design -and compared the intervention to another treatment

Evolution of client-centered therapy

Developed primarily in counseling psych and still remains its chief application -emphasis on relationships, warmth, acceptance -often integral part of training programs for crisis centers, paraprofessionals, counselors -also used outside therapy "person-centered" approaches in HR, labor-management, churches, business, school systems -Provided an alternative to traditional psycho-analytic therapy. -Private practice least likely to endorse this approach

Efficacy vs. Effectiveness of treatment

Efficacy: treatment is efficacious if the average person receiving treatment in clinical trials is demonstrated to be significantly less dysfunctional than the average person not receiving any treatment. INTERNAL VALIDITY Effectiveness: treatment is effective if clients report clinically significant benefit from it. EXTERNAL VALIDITY -empirical evidence supports efficacy of psychotherapy -the average person receiving psychological treatment is functioning better than 80% of those not receiving treatment

Conjoint family therapy

Entire family is seen at the same time by one therapist -therapist can be passive and non directive, or active and directing the discussion, assigning tasks to family members, imparting direct instruction etc. Five Basic Modes of Communication 1. placating (always agreeing no matter what) 2. Blaming (highly critical) 3. Super-reasonable (even if not congruent w feelings) 4. Irrelevant (completely unrelated to whats going on) 5. Congruent (words related to what is going on)

Transactional analysis

Eric Berne Stems from the humanistic approach Process in which interactions among various aspects of people in the group are analyzed The analyses focus on 3 main "ego states" within each person: -each ego state has positive and negative features -individuals tend to manifest various aspects of positive and negative characteristics "transactions" are analyzed interactions between ego states in 2 or more people at any given time

Gestalt Groups

Focuses on leading patient to awareness of and appreciation of being in the world Attention is focused on one member at a time while other members are observers. Being in the "hot seat" Emphasis on resident seminars, weekend retreats, brief workshops, popular methods -lack of research on this method

Psychodrama

Form of role-playing developed by Moreno (1946, 1959) Patients act out roles as if they were in a play -acting is said to bring about a degree of emotional relief (catharsis) and spontaneity that heightens insight and self-understanding -patients may be asked to play themselves or another role -drama may involve event from patient's past or future

Psychoanalysis timeframe

Frequent sessions over a period of time. Hour long sessions 3-4 times a week. Up to 3-5 years typically -very different approach from targeted behavior therapy -attempts to bring about significant, long-lasting change in patient's personality -difficult and time consuming

Catharsis

It is not enough just to understand unconscious feelings or underlying conflicts -patient must deeply express these feelings and conflicts -catharsis is the process of experiencing these feelings as a release of powerful emotions that have been repressed or blocked from direct expression

Stress Inoculation Training (SIT)

Meichenbaum, prevent problems from developing by "inoculating" individuals to ongoing and future stressors -used for treatment of rape, trauma, PTSD, anger management -helps ppl develop new coping skills 3 stages: -conceptualization: identify potential stressors -skill acquisition and rehearsal: practice coping skills -application: apply coping skills across stressful conditions

What problems are amenable to change?

Not all problems are equally responsive to psychological interventions -some conditions are very difficult to change -Depth of problem depends on: 1. Innate/biologically determined 2. Difficulty of disconfirming underlying beliefs 3. Power of underlying beliefs

Logotherapy

One of the most widely known forms of existential therapy. Encourages to find meaning in what appears to be a callous, uncaring, and meaningless world. Developed by Viktor Frankl -paradoxical intention: client consciously attempts to perform behavior or response that is the object of anxiety and concern. Fear is thus replaced by a paradoxical wish -de-reflection: instructs the client to ignore a troublesome behavior or symptom. clients are aware of their responses/reactions. Dereflection diverts their attention to more constructive activities

Research on psychodynamic and interpersonal psychotherapy

Outcome research: -best predictor of successful therapy is quality of patient's interpersonal relationships -Not more effective than other forms of therapy Process Research: -focuses on characteristics of therapists and patients that affect positive change

Resistance

Patient subconsciously uses defense mechanisms to keep from experiencing unacceptable drives, imples, feelings, memories that would cause anxiety and distress AND to prevent therapist from uncovering unconscious material -inevitable part of psychoanalysis activates and strengthens patient's use of defense mechanisms

Behavior Rehearsal

Role playing technique designed to increase patient's coping skills -an example is assertiveness training which is often used in treating depression, sexual problems, and marital conflicts 4 Stages 1.prepare the patient to aquire new behaviors and accept behavior rehearsal as a useful device 2. select specific target situations 3. Actual behavior rehearsal 4. patient applies skills to real life

Gestalt therapy cont.

Rules -communication only in the present tense and between equals. Saying "I" to take responsibility. Gossip not allowed. questions are discouraged Games -topdog/underdog role playing, "I take responsibility," repeat phrases louder Moral Precepts -rules patient should live by: live now, live here, stop imagining, stop unnecessary thinking, express directly, take responsibility, reject "shoulds" and "oughts"

Time-Limited Group Therapy

Strong interpersonal focus -often recommended for personality disorders Typically meet on a weekly basis for pre-determined number of sessions Involves: -pregroup preparation and screening -establishing working focus -group cohesion -reactions to time limits

Contingency management

Techniques designed to modify behavior by manipulating consequences. Skinnerian and operant techniques -shaping (also called successive approximation. reward behaviors that are closer to desired behavior) -timeout (behavior is extinguished by removing person from situation) -contingency contracting (formal agreement between patient and therapist specifying the consequences of certain behaviors) -grandma's rule (child is allowed to play ball after homework is completed) Token economies -modifies behavior of institutionalized populations through control of reinforcements -reinforcement works best immediately following behavior

psychoanalytic therapy carried out in group setting

The focus is still on phenomena such as free association, transference, interpretation of resistance, working through, etc. The role of the therapist is key -group members react to one another, to the therapist, and to relationships of authority and intimacy Typically groups consist of 8-10 ppl. Meet for 90 min 3x a week

Goals of psychoanalysis

Transfer of material from unconscious to conscious: -represents gain in insight -facilitates process of change -reduces or eliminates patient's need to use defense mechanisms (to keep material unconscious) -frees up libido (energy that can be used for more adaptive functioning)

Process-experiential psychotherapy (emotion focused therapy)

a contemporary approach -an integration of Roger's client-centered therapy, gestalt therapy, and existential therapy -an emotion focused therapy -emotional self-regulation is necessary for personal growth -clients have unique access to information about their own emotional and personal experiences. Clients are experts on their own experiences

Ellis's rational-emotive therapy RET

a type of rational restructuring -aims to change behavior by altering ways in which patient thinks about things Ellis believed that all behavior is determined by person's interpretation of events -it is BELIEFS about ACTIVATING events or situations that determine the problematic emotional or behavioral consequences.

Behavioral Marital Therapy (BMT)

application of reinforcement principles to the couple's interactions -Contingency contracting: spouses are trained to modify their own behavior to effect a specific desired change in their partner's behavior -support-understanding techniques: aim to increase positive behaviors and feelings by partners and increase collaborations within couple -problem-solving techniques: training couples in positive communication skills to encourage effective decision making and negotiating

process-experiential psychotherapy cont.

clients encouraged to explore their inner experience rather than have therapist offer interpretations -similar to client-centered and existential tx, this method focuses on the client's present experience (the here and now) -individual is seen as an active participant in therapy -authentic client-therapist relationship is central to therapeutic progress

Linehan's Dialectical Behavior Therapy

cognitive-behavioral treatment for borderline personality disorder and related conditions involving emotional instability and impulsivity -skills training in problem solving techniques, emotional regulation, interpersonal skills -usually involves both individual and group therapy -clients cycle through 4 skills training modules: mindfulness, emotional regulation, distress tolerance, interpersonal effectiveness

Time-limited dynamic psychotherapy (TLDP)

developed by Hans Strupp -attempts to modify the way a person relates to others and to self by analyzing transference relationship between patients and therapists -views psychopathology as emerging from recurrent interpersonal patterns in patient's life that create/maintain dysfunctional relationships.

collaborative family therapy

each family member sees a different therapist therapists get together to discuss the family

Transactional analyses cont.

emphasis on "games" -behaviors that people frequently use to avoid getting -considered transactions with ulterior motives Therapist analyzes how members play gamed with one another to cover their real feelings and beliefs Emphasis is on present, immediate problems -faster pace, can be appealing alternative to slower, traditional forms of therapy -very little research

Do family and couples therapy actually work?

few well-controled empirical studies have been conducted to evaluate effectiveness -average treated client is functioning better than 68% of those not receiving treatment -Eclectic and behavioral treatments are the most effective. Humanistic is the least Group treatment is more effective than no treatment at all. Particularly true for patients with panic disorder, social phobia, and eating disorders Not more effective than other forms of treatment Major advantage is that it is more efficient and economical

Becks CT for depression

focus: connection between thinking patter/styles, emotions, and behavior. length: 14-16 sessions. remission of symptoms in 8-12 sessions role of therapist: active and supportive collaborator. helps through psychoeducation, guided discovery, socratic questioning, role-playing, and behavioral experiments structure: homework, review of previous session, symptoms checked phases: first phase (8 sessions) includes cognitive model, skills are aquired, some mastery is achieved. Second half challenges beliefs about relapse. termination issues discussed

Application to specific problems

humanistic/existential have generally not developed specific techniques for use with particular problems or disorders or with specific types of clients -but rogers believed that client centered tx applied to universally all clients, regardless of the presenting problem. He argued against the need for specific treatments for specific problems or diagnoses

Methods

hypnosis free association dream analysis resistance transference catharsis interpretation

Normal development

id ego and superego will conflict internal conflicts will cause great anxiety if individual is aware of them (?) what determines behavior is not within conscious awareness but unconscious

Behavioral approaches to family therapy

identifies behaviors whose frequency should be increased or decreased as well as reinforcers

Free association

most common technique -originally used by freud as an alternative to hypnosis -allow patient to say whatever comes to mind in an uninterrupted flow of ideas -therapist listens, but does not guide verbalizations. does not interrupt -analyst assumes each is related in some way to the previous verbalization, and unconscious material will emerge -analyst's job is to understand and interpret importance of rumblings

Concurrent family therapy

one therapist sees each family member in individual sessions

Family Therapy

problem effects the whole family -therapy for a child almost always involves therapy for parents -to influence a family member, one must deal with the entire family system Concept of the "double-bind" in schizophrenia Emphasis on communication -pathology typically seen as failure of communication among family members

Traditional techniques of behavior therapy

systematic desensitization exposure therapy behavior rehearsal contingency management aversion therapy

Curative Factors

the essence of what these group methods offer: 1. Imparting information: receive advice and guidance not just from the therapist but also from other group members 2. Instilling hope: observing others who have successfully grappled with problems helps to instill hope 3. Universality: others have the same problems, you are not alone 4. Altruism: it becomes apparent that you can help others in your group and this gives you feeling of greater self-value and competence 5. Interpersonal learning: interactions with group can teach you social skills, interpersonal relationships, sensitivity to others, resolution of conflicts

transference

the relationship between the patient and the analyst is at the core of psychoanalysis -critical that the patient form an attachment or alliance with the therapist in order for effective treatment -transference is unconscious process for managing inner conflicts by transferring them onto the therapist -the relationship with the therapist is representative of the patient's unconscious conflcits

hypnosis

traditionally used to gain access to patient's unconscious material -patient's symptoms usually not present when under hypnosis -freud used this at first but switched over to other methods because hypnosis did not have lasting effects. Short term relief only. No everyone is susceptible to hypnosis