Psychotherapy/Psychotherapies

1. Psychotherapy/Psychotherapies

2. Overview • What is psychotherapy? • Who does psychotherapy? • Approaches to psychotherapy. • Classification of psychotherapies. • Three examples of psychotherapy: • psychoanalysis • cognitive therapy • interpersonal therapy.

3. Psychotherapy • “Psychotherapy…is a fiendish and expensive way of tampering with the lives of patients weak enough or foolish enough to seek outside help with personal problems for which, in fact, only will power is any solution.” • Quentin Crisp

4. Definitions • Somatic therapies • Medicines • Electroconvulsive Therapy • Surgery • Historical • Insulin coma treatment • Hydrotherapy • Removal of teeth • Hysterectomy

6. Social Treatments • Environmental therapy • Work therapy • Moral therapy

7. Psychological treatments • Talk-therapy • Hypnosis • Psychodrama • Behavioral therapy

8. “Despite their diversity…all psychotherapies attempt to relieve suffering and psychological disability by inducing changes in patients’ attitudes and behavior.” • Jerome Frank 1991

9. Psychotherapies • Psychoanalysis (Freudian, Jungian) • Cognitive Therapy • Dialectical Behavioral Therapy • Existential Psychotherapy • Interpersonal Psychotherapy • Gestalt Psychotherapy • Motivational interviewing

10. Prescribing Psychiatrists Psychoanalysts Nurse Practitioners Psychologists (some) Non-Prescribing Psychoanalysts Clinical Psychologists Social Workers Counsellors (MA, Religious counsellors) Co-counsellors, peer therapy Who practices psychotherapy?

11. Dyadic/Individual Adult Child Non-dyadic Couples therapy Family therapy Group therapy Modes of Psychotherapy

12. Classification Schemes • Exploratory (insight oriented, expressive, uncovering) • insight into unconscious psychic conflict • Goal: structural change in personality • Supportive (suppressive) • support adaptive ego defenses • Goal: strengthen adaptation

13. Evocative Psychotherapies • Seeks to improve total psychological functioning by providing a supportive, accepting therapeutic relationship in which unconscious experiences can emerge into awareness leading to change. • Psychoanalysis • Existential Psychotherapy • Self-actualizing therapies (Rogers, Maslow)

14. Directive Psychotherapies • Symptom- or problem-focused. • Cognitive • Cognitive Therapy (Beck) • Rational Emotive Therapy (Ellis) • Social Learning Therapy (Bandura) • Behavioral • Reinforcement • Counter-conditioning • Abreactive • Primal therapy • EMDR

15. Schools and Practitioners • Eclecticism • Cross-trained • Self-selection • General (e.g., psychoanalysis, client-centered therapy) vs. Condition-specific (e.g., Dialectical Behavioral Treatment for Borderline Personality Disorder, CBT for Panic Disorder)

18. Psychoanalysis • Freud • Office-based psychiatry • Drive theory • Structural model of the mind (ego, id, superego) • Derivations: Ego psychology, Object Relations Theory, Self Theory • Unconscious • Psychic determinism: past as prologue

19. Psychoanalysis: Basic premise • By making the implicit explicit, the uncontrollable becomes controllable.

20. Psychoanalysis in practice • Free association • Transference • Resistance

22. Cognitive Therapy • Aaron Beck • “Common sense psychology” • Psychological problems result from faulty learning, making incorrect inferences on the basis of inadequate or incorrect information, and not distinguishing between imagination and reality. • Patients systematically misconstrue specific kinds of experiences

23. Cognitive Distortions • All-or-nothing thinking (black-white, polarized, dichotomous thinking) • Catastrophizing (‘fortune telling’) • Emotional reasoning • Mind reading • Over-generalization • ‘Should’ and ‘Must’ statements • Etc.

25. Cognitive Therapy techniques to modify intermediate and core beliefs: • Socratic questioning • Behavioral experiments • Cognitive continuum • Rational-emotional role playing • Acting ‘as if’ • Using others as reference points • Self-disclosure

26. Interpersonal Psychotherapy • Psychotherapy should focus on what happens between people, not on the brain, mind, unconscious, etc. • Social attachments are protective against stress and depression. • Depression is related to interpersonal relationships--as cause and consequence.

27. Interpersonal functioning and Depression • Grief • Role Transition • Interpersonal Disputes • Interpersonal Deficits

28. Interpersonal Therapy in Practice • Focus on the here-and-now • Personality restructuring is not attempted • Assessment: • inventory of relationships • quality and pattern of interactions • cognitions regarding self, others, roles • associated emotions.

29. Why Does Psychotherapy Work? • Re-moralization • Supportive, non-judgmental attitude of therapist • Expression of emotions • Unanalyzed positive transference • Unanalyzed negative transference • Identification with the therapist • Strengthening ego functions

30. Further Reading • “Freud and Beyond” by Stephen Mitchell and Margaret Black • “Approaches to the Mind. Movement of the Psychiatric Schools from Sects toward Science” by Leston Havens • “Persuasion and Healing” by Jerome Frank