Evolution of Treatment Theories in Psychotherapy

1. Treatment Models

2. Theory vs. Treatment • Theories are the way we think about how someone came to be. • Treatments arise out of the way we think about people. • Theories (and treatments) are constantly evolving based on research • Theories and treatment should be considered in historical context.

3. Psychoanalytic Theory • Focus on internal “drives” and how they are met or not met. We become stuck when we don’t move through stages (personality d/o). • Works to move past resistance (defense mechanisms) through things like free association. • Transference is important. • We interpret people’s free associations and dreams to find latent meaning • This takes place several times a week and can last years.

4. Psychodynamic • Recognized people don’t exist in bubbles. • More emphasis on early relationships (external experiences) rather than internal struggles. • Tends to be shorter term (1x per week). • Interpretation is still key, but modern practitioners practice mirroring, reflection, psycho-education, and confrontation. • Both of these are considered unscientific because we cannot empirically measure them

5. Behaviorism • Arose out of Psychodynamic theory to focus more on concrete, measurable outcomes. • By changing our behaviors, we change our feelings. • Includes exposure therapy (systematic desensitization or flooding), PMR, and aversive conditioning. • ABA focuses on those techniques and includes operant conditioning (token economies). • Works well for phobias, children, and pets • Critics see this as a band-aid and fear it denies underlying internal struggles and has limited long-term efficacy.

6. Cognitive • Cognitivists felt that behaviors alone couldn’t change feelings. • Our way of thinking is based on learning, so we must relearn • By changing our thoughts, we will feel better • Challenging and Socratic questioning prevents the catastrophizing and “all or nothing” thought that causes us distress

7. Cognitive Behavioral Therapy • The natural progression of Cognitive and Behaviorism. • Uses techniques from both treatments Thoughts Feelings Behaviors

8. Humanistic-Existentialism • Humanism uses many of the same techniques as Psychodynamic therapy, but focuses on today and the future (instead of the past) • The most important feature is unconditional positive regard. • Non-directive. The client knows what is best for him or her. Follows the premise that people naturally want to move towards their greatest potential. • Clinicians are a mirror for their client.

9. Humanistic-Existentialism cont: • Existentialism focuses on the “big issues” • Death • Meaning in life • Nothingness • Freedom and responsibility • People react to these questions with anxiety or compassion. The therapist’s goal is to provide mirroring and empathy so compassion is the outcome.

10. Family Systems • Belief that people cannot be independent of their settings (especially family). • The family is the client. • Utilizes many of the same techniques as in other treatments, but encourages communication and utilizes dyads (pairing).

11. Supplemental Treatments • EMDR: While remembering traumatic events, clients focus an object that causes their eyes to move rapidly. • Eye movement may not be the mechanism behind the effectiveness • Special training is required for this • Light Therapy: shows some effectiveness in SAD. Morning light is also effective • Clients can buy light boxes and this is usually done on their own

12. Psychopharmacology • Medications tend to be prescribed by Psychiatrists, not Psychologists. • Anti-Psychotic Medications • Target dopamine, positive symptoms, side effects! • Anti-Anxiety Medications • High dependence capacity (benzos). • Anti-Depressant Medications • Most common SSRI’s, but many types. Serotonin, dopamine, nor-epinephrine. • Best with therapy. • Mood Stabilizers • Traditionally anti-convulsants • Can be used to treat bipolar disorder and psychotic disorders.

13. Brain Stimulation • Brain Stimulation • ECT • Last attempt for treatment resistant depression • Much more humane than in the past • Memory loss • We don’t know what it does! • Transcranial magnetic stimulation • Less invasive, magnetic energy to speed or slow certain areas of the brain. • Psychosurgery • Rarely, if ever, used.