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Psychotherapy

Psychotherapy. ASPECTS OF THERAPY A. Free Choice - Client must want therapy for change. B. Hopes & Expectations 1. Expectations about the future affect the present => Belief that therapy will work = powerful treatment itself Placebo effects Hormones & immune system.

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Psychotherapy

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  1. Psychotherapy ASPECTS OF THERAPY A. Free Choice - Client must want therapy for change

  2. B. Hopes & Expectations 1. Expectations about the future affect the present => Belief that therapy will work = powerful treatment itself Placebo effects Hormones & immune system

  3. 2. Different expectations of therapy by client & therapist => increase similarity in expectancies

  4. C. Therapist-Client Interaction 1. Therapist Qualities “Nonspecific Factors” - Empathy - Warmth - Genuineness

  5. Experience Client-therapist matching

  6. Therapeutic Alliance - Joint goals & how to achieve them - Therapist’s cooperative spirit - Client’s ability to trust => Stronger alliance = better outcome

  7. Insight-Oriented Therapies Psychoanalysis & Psychoanalytic Psychotherapy 1. Assumptions a) Disorder = childhood problems & unconscious conflicts

  8. b) Purpose of Symptoms = express conflict & protect from conscious awareness of conflict c) Goal of therapy = uncover conflict to free person from symptoms

  9. Methods a) Therapist behavior Anonymous Abstinent Ambivalent

  10. b) Free association & dream interpretation - analyst interprets

  11. c) Transference - patient comes to regard therapist as parent& enacts old relationship d) Countertransference - therapist develops personal feelings for client

  12. Psychoanalysis vs. PsychoanalyticPsychotherapy a) Time & Expense - 5 times/week for 5+ years vs. 1-2 times/week for 1-2 years

  13. b) Interaction: - little vs. much therapist input - couch vs. chair - focus = child sexuality & aggression vs. other issues

  14. Humanistic Therapy Assumptions a) Optimistic: People are good & seek self-actualization b) Disorder = incongruence - parents don’t provide unconditional positive regard - person conforms to them

  15. c) Goal of therapy = client accepts self - restructure self-concept to match reality - strive toward self-actualization

  16. Methods • Therapist behavior = nonjudgmental, warm, genuine • Relationship: Therapist & client are equals - “client” vs. “patient” - therapist is nondirective - client knows what is best - needs facilitator to discover • Method - therapist mirrors/reflects client

  17. Gestalt Therapy Assumptions a) Disorder = out of touch with true self - not accepting gestalt (whole) b) Goal of therapy - improve awareness of self-aspects - take responsibility for them

  18. Methods a) Therapist behavior = confrontational & directive b) Nonverbal cues c) Role-playing - act out relationships - “empty chair” - letter writing d) Dream interpretation

  19. Cognitive-Behavioral • WHY of behavior is unimportant • Change current thoughts/behaviors (sx focus)

  20. Ellis’ Rational Emotive Therapy (RET) 1. Assumptions a) Disorders = irrational beliefs - perfectionism b) Goal of Therapy = substitute rational for irrational thoughts

  21. Methods • Therapist Behavior: dispute beliefs - Therapist as Educator - Therapist & client are active - Homework

  22. Beck’s Cognitive Therapy 1. Assumptions a) Disorders = irrational beliefs - irrational beliefs differ by disorder - Affect, Behavior, & Cognition b) Goal of Therapy = change irrational beliefs

  23. Methods a) Therapist: warm, but disputes b) Guided Imagery: move from unrealistic fantasies toward realistic gratification c) Homework - test out irrational beliefs - situational analysis

  24. Behavior Therapy 1. Assumptions a) Disorders = learned responses that can be unlearned - Behavior is situationally specific so treatment must be specific

  25. b) Accept client’s report as valid c) Goal of Therapy = change maladaptive behavior - substitute adaptive behavior

  26. Methods a) Therapist Behavior - directive, gives advice - also warm - Client controls focus of therapy - Therapist = how to change

  27. Functional Analysis reinforcements & contingencies Problem - What Antecedents - When - Where Consequence - How (is problem rewarded) - Change cues/contingencies to change behavior

  28. c) Flooding - expose to worst fears until person can tolerate without anxiety - imaginal or in vivo

  29. d) Systematic Desensitization - gradually expose to fear - start with least fearful - in vivo or imaginal - with or without relaxation

  30. e) Aversive Conditioning - pair negative behavior with aversive stimulus - in vivo or imaginal - last resort

  31. Family & Couples Therapy Assumptions a) Disorder occurs in context of family & marital relationships - Communication = biggest problem - Relationship issues

  32. b) Goal of Therapy = change interactions so that “patient” no longer needs the problem behavior

  33. Methods a) Problem-Solving: State problem *Restate in other’s words Suggest solutions Evaluate solutions Agree on solution & try it

  34. b) Structural Family Therapy - problems in family structure - change by “unbalancing” current system c) Family Systems Tx - reduce over-involvement - promote healthy individuation

  35. Group Therapy Assumptions a) Advantages - Not alone in problem - Additional support of group members - Some problems = relevant for groups - Cheaper

  36. b) Disadvantages - self-disclosure to many - confidentiality - less therapist attention

  37. Methods: General - 8-10 people in circle • All provide feedback & support • Therapist is less directive • Therapist may self-disclose

  38. Methods: Specific a) Psychodrama - each person’s problems enacted as a play b) Assertiveness Training passive — assertive — aggressive c) Social Skills Training

  39. Eclecticism Technical Eclecticism • Use techniques of different orientations • Theory: either one or none • Many therapists

  40. Theoretical Eclecticism • Integrate different theories • Based on common principles of behavior and on nonspecific factors • Problem = basic assumptions of theories conflict

  41. Challenge = rigid adherence to one theoryvs. superficial knowledge of several **Must have a plan, conceptualization of each case that drives therapy

  42. Effectiveness of Psychotherapy • Outcome studies • Meta-analysis - statistical combination of many studies

  43. Smith & Glass (1977) • 375 controlled studies • Average client better than 75% of controls Smith, Glass, & Miller (1980) • 475 controlled studies • Average client better than 80% of controls

  44. Some research: Effectiveness generalizes to real therapy (external validity) • Other research: research therapy vs. clinic therapy

  45. Effects seen in 3-4 months for 50% • Effects seen in 6 months for 75% • But, many clients terminate early • Few differences among therapy types

  46. Issues • Match therapy to problem • Match therapy to client

  47. Ethical & Legal Issues Clients’ Rights 1. To treatment - cannot just be confined

  48. 2. To efficacious treatment - statistical vs. clinical significance - 70% spontaneous remission - but therapy is better - continued improvement - right to not be abused

  49. Must terminate therapy (refer to someone else) if - not efficacious - problem between therapist & client

  50. 3. To confidentiality - increases trust & disclosure - exceptions: suicide/homicide child abuse subpoenas

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