Psychotherapy test 2
Theory of personality
three main factors~ biopsychosocial approach -- Social, physiological, psychological - Born with hardwired innate tendencies to want and need things - Hardwired to condemned ourselves and the world when wants and needs aren't satisfied -- This is called demandingness- not a desire, it's a demand - Born with capacity for growth but also born with tendencies to behave irrationally and self-defeating - We care too much about what others think and can only accept ourselves when we're accepted by others - Psychologically, he says people needlessly upset themselves, distress comes from irrational beliefs
Culture-
ultimate concerns transcend culture - Culture influences defenses - Therapist must acknowledge and adapt - Stay true to belief and interrogate them
Disagrees with Freud about
unconscious being static structure, but we can be unconscious about how we're thinking, feeling, perceiving and behaving -- People can hypothesize and test this - "This is the basic personality theory of REBT: humans largely create their own distress"- Albert Ellis
Meaning- meaninglessness
- How does a being who requires meaning find meaning in a universe that has no meaning - We construct values and narratives of our lives as defense mechanisms - Society acts as defense about ultimate concerns because of values - You can choose not to construct own values but that's how you confront meaninglessness - Existentialists want you to choose meaning consciously
Treatment modality
- Individual therapy - Group therapy - Workshops - Marriage and family therapy - Self-help
Irrational beliefs
- Irrational beliefs use words like must or should- very rigid and dogmatic - Because I want something it is not only desirable but it absolutely should exist and is awful if it doesn't - Wants are flexible, demands are a problem, people go from wants to demands so quickly
Goals of therapy
- Address concerns - Understand unconscious of conflict - ID defense mechanisms - Discovers destructive influence - Develop another way of coping - Life will not be lived without anxiety find tolerable levels and use them constructively - Present day, understand someone's current situation - Not interested in past - Freud was into past, but existentialist is in the moment
Client-centered therapy
- Also termed humanistic, person-centered - Third force in psyc - Relatively revolutionary - Human being is self determining and self-realizing - Developed by Carl Rogers
Demandingness
- Causes distress -Temporary solutions provide relief but don't fix demandingness -- Satisfaction of demands -- Distraction -- Magic and mysticism - someone else is responsible, sometimes there's a belief that therapist will fix them
Evidence base
- Cognition, emotion and behavior occur simultaneously and interdependently - Active-directive therapeutic approach works for some people - Activity-oriented homework can be helpful - Modifying beliefs can propel behavior change - Acceptance- based approaches
Death- ultimate existential concern
- Core inner conflict - As soon as you're aware of existence, you have to be aware of non-existence - Denial-based defenses (aware it exists but doesn't apply to us) -- Specialness- I'm special, this won't happen to me, laws of bio don't apply to us- makes us engage in riskier behaviors ex: smoking -- People also develop preoccupations with planning for the future -- Workaholic -- Ultimate rescuer- existentialists say you need to make your own choice ---G-d, person watching over you, savior ---Can work until it doesn't
Cultural considerations
- Cultural beliefs- culture may have irrational beliefs but question is if patient has irrational belief that you have to achieve what culture is asking of you -- Not argue with culture itself just with the patient if it's rational to go along with that - unconditional acceptance - Members of minority cultures --- May be accepted or criticized for beliefs
Born with potential to be rational or irrational, people are foolish in the way they think and are usually irrational
- Culture and social exacerbate irrational thinking - Approval seeking and perfectionism - fear of failure - Musterbation - so focused on musting ourselves- we must, they must
Goals of therapy
- Decrease demandingness -- Recognize should -- Give up perfectionism - Develop high frustration tolerance -- Accept reality, even when grim -- Is the worst thing that could happen really as mad as I melodramatically fantasize it would be? - Introduce flexibility while still wanting things - Distinguishing rational and irrational thinking -- Ex: because something once affected life, it should define it, we can learn from past experiences but not be overly influenced by them - Distinguish healthy and unhealthy negative emotions emotions -- Unhealthy- jealousy, anxiety, rage, depression, guilt, low frustration tolerance -- Healthy- disappointment, concern, annoyance, sadness, regret, frustration - regret motivates us to change
Therapist: empathy + unconditional positive regard + congruence = trust
- Empathy- profound interest and care - Unconditional positive regard- positive, non judgemental because they're another human - Congruence- therapist needs to be whole people, full people, capable to help relationship - Creates trust in environment that they can explore things in
Carl Rogers
- Followed clients instead of assuming expert role which he didn't like - Influenced by otto ranks' nondirective therapy - Movement to have therapist be an agent - No technique, it's a skill, not rules - 1903 Carl born, - 1940 presents new concepts in psycho - 1942 counseling and psycho published - 1957 classic paper on necessary and sufficient conditions, win award - 1987 dies - Congruence- what I think I will effectively communicate - Confident in genuineness - Carl's early research - predictors of change among people with schizophrenia -- Best (most change) when there's accurate empathy -- Patient's perception of empathy matters way more than if therapist thinks they're communicating it - Carl started association for development of person-centered approach --Interdisciplinary -- Meets annually -- Made a journal
Methods of psychotherapy
- Framework for understanding human condition and suffering - Not a comprehensive system of techniques - address ultimate concerns
Addressing meaning-
- Help patients focus on values beyond themselves - Develop curiosity and concern for others - Removes obstacles to whole - hearted engagement
Mechanisms
- Molecules of change- made of moments of movement -- Experience is capable of being fully experiences -- Acceptable and capable of being integrated - Trying to prepare people for moments of movement and they happen in tiny molecules - Change doesn't happen until people think they are acceptable, integrate them and move on - Patients can move from objective context to subjective context -- Therapist can't attend to something that is not in client's frame of reference -- Therapist will help client develop a frame of reference before they move into subjective context ---Outer experience is more capable to assimilate - Rogers recognizes transference and countertransference - Not just therapeutic factors, but aldo extra therapeutic factors like their own life experiences -- Therapist competency, relationship and patient believing it will work all matter --- But extra therapeutic factors also work - Evidence supports client must perceive therapy, positive regard results in better outcome, client centered therapy also has lasting change - Can be difficult to conduct because every session is so unique
Methods of psychotherapy- principles
- Non directive attitude - Respect- unconditional positive regard - Understanding - Recognize implicit feelings- patients are likely cut-off, not experiencing themselves -- What pieces of the experience do clients not recognize - Clarifying questions, non directive -- They will answer patient's questions without --- Reassurance --- Advise ----This is because with all issues regarding the client, the client can give themselves the best advise, patients need to be sure of themselves
Mechanisms
- Patient belief- irrational beliefs, we think it works because the beliefs change - Therapist approach- logical, direct, empathy without sympathy , we understands but won't sympathize
19 basic propositions- can be categorized into perception, self concept, adjustment
- Perception- we react to world based on own perceptions - We believe perceptions and take them as reality, were looking for consensus in society - Behavior attempts to satisfy needs - Understand behavior through individuals vantage point Self-concept - we are center of own worlds - Structure is consistent yet fluid - Behavior can be consistent to inconsistent with self concept - When inconsistent- not being owned I think I am blank but I did blank Psyc adjustment - Occurs when experience is consistent with self - Understanding of others when adjusted - See values as continuous process
Addressing freedom-
- Point out instances of people not taking responsibilities in the moment - Correct "can't" to "won't"- we have to be authentic - Inquire about patient's role- what are situations that keep us in the present - Encourage ownership - Correct inability to wish- what is it that you want - Reduce impulsivity - Help patients decide - Alternative exclude- exclude other choices
Methods
- Realistic, tolerant philosophy of life - Address musts -- Role play -- Humor -- Unconditional acceptance -- Strong disputing -- Help people see difference between preference and demand - Experiential exercises -- Take risks -- Seek pleasure -- Stay in poor circumstances -- Take on hard tasks - ABCD -- Identify activating event, belief, and consequences (a, b and c) and then dispute it (D) --- Ask, does this serve me? --- Dispute irrational beliefs ---- Admit and face own role in indoctrination -- Techniques for dispute --- Challenge patients to defend them --- Demonstrate logical fallacies --- Show why irrational beliefs do not work --- Reduce irrational beliefs to absurdity ---- Teach thinking in terms of realistic preferences
Addressing isolation-
- Rewards and limits of relationships - Balance isolation and support - Reciprocity and mutuality - Authenticity - Alone together
Alfred Adler (1930s)
- SR theory stimulus-organism-response - Everything depends on your opinion - We determine ourselves by the meanings we give to situations
Theory of psychotherapy
- Therapeutic relationship- active, directive, confrontational- opposite from client centered - Agrees with rogers that we need unconditional acceptance- self, others, life -- This is because we care too much what others think, won't chase approval , humans are fallible -- Life comes with both suffering and pleasure - Only stop them from being irrational by pointing stuff out --Confrontational is better as opposed to Rogers who provides necessary and sufficient conditions - Demandingness
Optimal therapy characteristics
- Time and effort- least amount of time, efficient effort for client and therapist - Symptom reduction- people should start to feel better quickly - Lasting results- feeling good should last, no more reindoctrination - Generalizable- produce effectiveness for large range of clients
Rollo May
- Understands psychological distress, in part, arises from confrontation with our existence - Each of us responsible for who we are and what we become - Only in reflecting on mortality can we learn to live - May got to existentialism because he had a health scare and faced angst about his own mortality- second we become aware we exist, we have the opposite view of nonexistence and that creates anxiety - Will- being intentional with how you communicate and what you do
Cultural considerations
- Uniqueness of every patient - Within group differences can exceed between group differences --Within groups, everyone is unique, and people can belong in multiple groups - Own self-definition constantly evolves, and client-centered therapy agrees with this - Therapists need to be aware of their own biases and need to be open
Freedom- how is this causing distress
- We live in a world without inherent design, humans are authors of world - Requires us to confront destiny- patterns - "Givens" in life- we can choose how to respond, we shall live out our talents - There are things we think are givens but aren't - Responsibility and will -- Living without responsibility is to live in bad faith, diff levels , expectations make us feel like we're not making choices - Failures of willing give rise to pathology -- Impulsivity- can't distinguish wishes from decisions, not being intentional -- Compulsivity- inability to recognize unconscious wishes with conscious desires - Decisional panic- inability to choose, delegating decisions
Addressing death-
- When there's been awakening experience you address death - Examine regret, making new choices to move forward - Choice towards a "lived life"- anxiety about death is proportional to our life
Theory of personality
- all humans have actualizing tendency - Tendency to strive to reach full potential - If they're not, actualizing tendency has been disturbed in some way - Order, complexity, interrelatedness - Reacting as a whole- can't reduce someone to their behavior - The self- experience internal frame of reference, organismic valuing process - Characteristics and values - We have private worlds and that awareness can be limited - Work on symbolization: process of becoming aware - Wants people to come to their own value judgment, choice - When people can do these things, they become a fully formed person
Ultimate concerns
1- freedom- author of own lives, responsibility that can fill with dread, create world of no choices 2- isolation- isolated from self, others, isolation in existence 3- meaning- search for purpose, existence precedes essence, search is anxiety provoking 4- death- consciousness of existence and nonexistence , what does it mean to die If you're willing to confront it enriches your life
Isolation how does this cause distress-
1- interpersonal- between myself and others, can't fully share consciousness with others and we have to learn to be ok with that 2- intrapersonal- can be isolated from parts of self 3- Existential- alone in universe, born alone and die alone - Requires balance between wish for contract and knowledge of aloneness - Defenses against isolation- crave witnesses (use people), fusion (let go of boundaries), conforming to other person
6 necessary and sufficient conditioning for therapy
1- two people in psyc contact- engaged 2- client is in state of incongruence 3- therapist is congruent or integrated in relationship 4- therapist has unconditional positive regard for client 5- therapist has empathetic understanding 6- client perceives therapists
Albert Ellis
1903- born in NYC 1915- parents divorced 1959 developed Albert Ellis institute 2005- separates from Albert Ellis institute -- Ellis wanted to make sure people knew this was very different from cog behavior 2007 dies - Started in training with client centered and psychoanalysis -- He thought people were creating new problems for themselves -- Even after they gained insight they were putting dysfunctional demands on the world -- People re-indoctrinate themselves -- Client centered and psychotherapy fall short because people will eventually create new problems for themselves - Doesn't like the past- early childhood, doesn't like other therapies- they focus on the wrong things - You created your own distress - Thought psychoanalysis and psychotherapy is passive- he wants therapist to do work
Timeline
1940s and 50s, Rollo May, Erich Fromm publish book that explore existential ideas 1958 publish existence - new dimension in psych 1980 Irvin Yalom first textbook and first society Rollo May says classification of people is non-essential
Foundational philosophers -
19th century soren Neitzche, 20th century- Jean Paul Sarte, credited with term "existentialism"
ABC model
A- activating event- people exist in the world and experience events, but how to people interpret events Ex: I did poorly at my job today B- belief I must always be perfect and if it's not it's horrible C- consequence -- Depression - Most people hold irrational beliefs for acceptance from others and perfectionism - After ABC there is reindoctrination → depression becomes the activating event → condemning self - When we have an irrational demands we're going to demands over and over and over - Not interested in trauma- that sets off chain reaction
Neitzche
Dehumanization of people in the tech world - Existence precedes essence, there is no essence to a human being- nothing matters until we choose for it to - We exist without knowing what to do, make choice and see humanity as doing the same thing
Rational emotive behavior therapy
Greek and Roman stoic philosophers - People are disturbed not by things but by the view which they take of them
Existential psychotherapy
Not a formal school of psychotherapy Can be integrated with other types of psychotherapy Represents thinking about human experience
Client : self concept + focus on evaluation + experiencing = trust
Self concept- awareness can be limited These are a given
Theory of personality- how people become distressed
Ultimate concerns - People are meaning-making beings and subjects of experience and objects of self reflection - Emotions and behaviors that constitute personality can be in or out of awareness and may conflict - Concerns if people are living authentically and meaningfully - Central conflict is between individual and concerns of existence - Existential psyc attends to how each individual deals with ultimate concerns
Theory of defenses
Ultimate concerns - anxiety defenses Trying to avoid ultimate concerns
Theory of psychotherapy
We have to recognise therapists and patient are fellow travelers, no one is immune to ultimate concerns - Similar to positive psyc, collaborative
Theory of psychotherapy
common because enhances functioning, but there's not techniques, treatment planning or goal setting