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PSYCHOLOGICAL THERAPY
Outline
• Psychotherapy
• Important elements of Psychotherapy
• Effectiveness of Psychotherapy
• History of psychological therapy
• Classification of Psychological therapy
• Indications of psychotherapy
• Psychoanalysis
• Behavioralcognitive
• Humanistic
• Systemic
Definition: Psychotherapy
• Psychotherapy is the informed and intentional
application of clinical methods and interpersonal
stances derived from established psychological
principles for the purpose of assisting people to
modify their behaviors, cognitions, emotions,
and/or other personal characteristics in directions
that the participants deem desirable
Definition
• An professional interactional process for help,
• The therapeutist communicate by linguistic or
nonlinguistic methods with the patient or
other client positively.
• The psychological principles and techniques, to
improve patient’s mental state and behavioral
model,
• For relieving the symptoms or enhance the
healing of the patient.
What is psychotherapy?
• A (hopefully) healing interaction between a
client and a mental health professional, such
as a psychologist, psychiatrist, counselor, or
social worker.
• It is NOT the same thing as psychoanalysis!
Important elements
• ( 1 ) Professional
• ( 2 ) Object (patients)
• ( 3 ) Therapeutic tools
• ( 4 ) Purpose
Who Seeks Therapy?
• Not everyone has a diagnosis of a mental
disorder
• More often women than men
• More often have insurance
• Move often more education
• Some people don’t want to admit
weakness
• Some people think it is too expensive.
Who Provides Therapy?
– Psychologists
• clinical and counselling
• Ph.D., Psy.D., or Ed.D. (5 to 7 years postgraduate work)
• More likely to use behavior therapies and group therapies
– Psychiatrists
• Physicians, specialize in severe mental disorders
• 4 years of coursework (same for all M.D.s), 4 year residency.
• More likely to use psychoanalytic therapies
– Clinical social workers
• Master’s degree
• Work with patients and families, transitioning to community
– Psychiatric nurses
• Bachelor’s or master’s degree
• More involved in hospital care
– Counselors
• Usually have a master’s degree
• Often specialize in vocational counseling, marital counseling,
rehabilitation counseling, drug counseling.
Professionals who do Therapy
Individual Psychotherapy
I. What is it?
A. Features:
B. 1. A dyad (not always)
C. 2. One is an expert
D. 3. Something to be changed
E. 4. Professional relationship
F. 5. There is communication
G. 6. Advice given?
H. 7. Other?
The difference and similarly points
between psychological therapy and
psychological counseling
• Clientpatient
• Key points of working
• Settings
• Methods of working
• Others
Comparison
• psychological therapy: • psychological counseling:
• Primary Focus: • Primary Focus:
• prevention, diagnosis, and • prevention, diagnosis, and
treatment of abnormal treatment of abnormal
behaviors. behaviors.
• Serve: • Serve:
• more severe forms of • less sever forms of behavior
behavior pathologies. disorders and the “everyday
patient problems in living.” client
• Employed in: • Employed in:
• hospitals, public and private • schools, colleges, and
mental health centers, universities, where they
independent practice and teach or work in the school
academic areas. counseling center.
Comparison
• psychological therapy: • psychological counseling:
• Times: • times:
• 1~6 • > 6
• Transient • longer
similarly points
• To foster the personal
growth of people
• Have the same theory
When does psychotherapy help?
• Is psychotherapy helpful at all?
– Difficulties in measuring the outcome of
psychotherapy
– The average therapy client improves more than
the average untreated person.
– About 20% of untreated people improve as
much or more than the average psychotherapy
client.
Overall conclusions about the
effectiveness of therapy
• Therapy is better than no therapy.
• Those who improve most are motivated to
improve.
• Shortterm therapy is sufficient for most
common, mild disorders.
• Therapy can be harmful if the therapist is
incompetent, biased, unethical, or ignorant.
Effectiveness of Psychotherapy
• Most people do not seek help with problems
• Many people report spontaneous remission
• Metaanalyses show that psychotherapy is more
effective than no treatment
• Generally no differences among the types
of psychotherapy
Effectiveness of Therapy
• Does it matter what type of therapy you seek out?
• Probably not as long as you are comfortable with it
Therapy is most likely to help
when:
• The client has sufficient distress to motivate
change.
• Client has a commitment to therapy,
willingness to work.
• Client has support from family.
• Client is cooperative.
• Therapist is empathetic, expressive, warm,
genuine.
• There is good rapport between the client
and therapist.
• Therapist is aware of ethnic/cultural
variations in behavior.
History of psychological therapy
• Hippocrates:
• Pinel(at the end of 18 century)
• Mesmer (17341815) :Hypnosis
• Freud
• Wolpe; B.Waston ; Ivan Pavlov
• Carl Rogers
Classification of Psychological therapy
According to psychological theories:
• Psychoanalysis ( 精神分 析治疗 )
• Behavioralcognitive ( 行为 认知治疗 )
• Humanistic ( 人本主义治 疗 )
• Systemic ( 系统治疗 )
5 Major Types of Psychological Therapies
Psychotherapy refers to the treatment of mental disorders by
psychological means
• Insight Therapies
Psychoanalysis
Client Centered Therapies
Cognitive Therapies
Types of
Psychotherapies Group Therapy
• Behavior Therapies
Systematic Desensitization
Aversive Therapy
Token Economy
• Biomedical Therapies
– ECT
– Lobotomy
– Chemical Therapy
Classification of Psychological therapy
• Individual therapy ( 个别心理治 疗 )
• Couple therapy ( 夫妻心 理治疗 )
• Family therapy ( 家庭心理治 疗 )
• Group therapy ( 集体心理治疗)
Indications of psychotherapy
• Neuroses and stressrelated mental dis.
• Neurosislike syndromes
• Emotional and conduct dis. of childhood
• Psychosomatic disorders
• Psychoses and other mental disorders
psychoanalytic psychotherapy
• S.Freud
• Personality theory
• Unconsciousness
• Cause of psychological disorders
:conflict, libido.
• Means of therapy: free association and
interpretation, dream analysis, transference
Introduction——Sigmund Freud 1
• Sigmund Freud was born on
May 6, 1856, in Freiburg, a
small town in Moravia, which
is now a part of the Czech
Republic. When Freud was 4
years old, his father, a Jewish
wool merchant, moved the
family to Vienna, where Freud
spent most of his life.
Introduction——Sigmund Freud 2
• Following medical school, he specialized in
neurology and studied for a year in Paris with
JeanMartin Charcot. He was also influenced by
AmbroiseAugust Liebault and HippolyteMarie
Bernheim, both of whom taught him hypnosis
while he was in France. After his education in
France, he returned to Vienna and began clinical
work with hysterical patients. Between 1887 and
1897, his work with these patients led him to
develop psychoanalysis.
Psychoanalytic Perspective
“first comprehensive theory of personality”
(1856-1939)
Specialized in Nervous
Disorders
Some patients’ disorders
had
no physical cause!
1.Topographic model of the mind
• The Conscious
• The Preconscious
• The Unconscious
The Conscious
• The conscious system in the topographic model
is characterized as the part of the mind in
which perceptions coming from the outside
world or from within the body or mind are
brought into awareness. Consciousness is
viewed as a subjective phenomenon whose
content can be communicated only by means of
language or behavior.
The Preconscious
• The preconscious system comprises those mental events,
processes, and contents that are capable of being
brought into conscious awareness by the act of focusing
attention. Although most people are not consciously
aware of the appearance of their firstgrade teachers,
they can ordinarily bring that image to mind by the
deliberate focusing of attention on the memory.
• Conceptually, the preconscious interfaces with both the
unconscious region and the conscious region of the
mind.
The Unconscious
• The unconscious system is a dynamic one; the
mental contents and processes of the
unconscious are kept out of conscious
awareness through the force of censorship or
repression.
• The unconscious is closely related to instinctual
drives. In Freud's theory of development,
instincts were then thought to consist of sexual
and selfpreservative drives, and the
unconscious was thought to contain primarily
the mental representations and derivatives of
the sexual instinct.
The Unconscious
• The content of the unconscious is limited to wishes seeking
fulfillment. Those wishes provide the motivation for dream
and neurotic symptom formation. That view is now
considered reductionistic.
• The unconscious system is characterized by primary
process thinking, which has as its principal aim the
facilitation of wish fulfillment and instinctual discharge.
Primary process thinking is governed by the pleasure
principle and, therefore, disregards logical connections, ha
no conception of time, represents wishes as fulfillments,
permits contradictions to exist simultaneously, and denies
the existence of negatives.
The Unconscious
• The contents of the unconscious can
become conscious only by passing through
the preconscious, where censors are
overpowered, allowing the elements to enter
into consciousness.
The Unconscious
“the mind is like an iceburg - mostly hidden”
Repression
banishing unacceptable
thoughts & passions to
unconscious
Dreams & Slips
Structural Model of
Personality
A. Id
B. Ego
C. Superego
Freud & Personality Structure
“Personality arises from conflict twixt agressive,
pleasure-seeking impulses and social restraints”
Satisfaction
without the guilt?
Super
Ego
Ego
Id
Freud & Personality Structure
Id - energy constantly striving to satisfy basic drives
Pleasure Principle
Freudian personality components
• ID the source of psychic power. Primitive
urges
seeking release.
• EGO conscious planner
seeking outlets for urges in the real world
• SUPERGO – final filter.
Stops some anti social behaviour with guilt,
shame
2 Instinct or drive theory
• Instincts
• Pleasure and Reality Principles
• Infantile Sexuality
• Object Relationships in Instinct
Theory
• Concept of Narcissism
2.1 Instincts
• Libido
• Ego Instincts
• Aggression
• Life and Death Instinct
口唇期 ( 0---1 岁):
弗洛伊 德 肛门期 ( 1---3 岁):
的 前生殖 器期 ( 3---6 岁):
心理发 展阶 段
说 潜伏期 ( 6---1 1 岁):
青春 期( 11-- -13 岁开 始):
Psychosexual Stages
• Oral Stage birth 18 months old
• Anal Stage 18 months 3 years
• Phallic Stage 3 years 6 years
• Latency Stage 6 years 12 years
• Genital Stage 12 years adult
Freud & Personality Development
“personality forms during the first few years of life,
rooted in unresolved conflicts of early childhood”
Psychosexual Stages
Oral (0-18 mos) - centered on the mouth
Anal (18-36 mos) - focus on bowel/bladder elim.
Phallic (3-6 yrs) - focus on genitals/“Oedipus Complex”
(Identification & Gender Identity)
Latency (6-puberty) - sexuality is dormant
Genital (puberty on) - sexual feelings toward others
Strong
conflict can fixate an
individual at Stages 1,2 or 3
Defense Mechanisms
Ego Id
When the inner war
gets out of hand, the
result is Anxiety
Individual Psychotherapy:
Psychodynamic Therapies
• 4 Internal representations of experiences are
organized around interpersonal relationships
with others
• 5 It is expected that significant life issues and
dynamics will reemerge in the relationship the
patient forms with the therapist, leading to
transference (feelings toward the therapist) and
countertrnsference (therapist feelings about the
patient), each of which can be positive or
negative.
Individual Psychotherapy:
Psychodynamic Therapies
1. Free association is a major method for
revealing internal conflicts and problems,
especially through exploration of wishes,
dreams, and fantasies
2. Interpretations focus on transference,
defense mechanisms, and current
symptoms, and working through of these
problems
Individual Psychotherapy:
Psychodynamic Therapies
8.Insight is central or at least highly desirable
for success in therapy, not just catharsis, or
expression of feelings
Psychoanalysis
Developed by Sigmund Freud based on his
theory of personality
Psychoanalysis
• Freud’s brand of psychotherapy
• Goal is to uncover and confront
unconscious conflicts
• Tools of the psychoanalyst:
– free association
– dream analysis
– catharsis
• Resistance
• Transference
Techniques of Psychoanalysis
• Free association—spontaneous report of all mental
images, thoughts, feelings as a way of revealing
unconscious conflicts
• Resistance—patient’s unconscious attempt to
block revelation of unconscious material; usually
sign that patient is close to revealing painful
memories
More Psychoanalytic Techniques
• Dream interpretation—dreams are the
“royal road to the unconscious”;
interpretation often reveals unconscious
conflicts
• Transference—process where emotions
originally associated with a significant
person are unconsciously transferred to the
therapist
Other Dynamic Therapies
• Most therapies today are shorterterm
• Based on goals that are specific and
attainable
• Therapists are more directive than
traditional psychoanalysis
• Traditional psychoanalysis is seldom
practiced today
Behavior Therapy
• Behavioristic perspective emphasizes that
behavior (normal and abnormal) is learned
• Uses principles of classical and operant
conditioning to change maladaptive behaviors
• Behavior change does not require insight into
causes
• Often called behavior modification
Individual Psychotherapy:
Behavior Therapy
• 1. Abnormal behavior is typically acquired and
maintained according to the same principles as
adaptive behaviors
• 2. Most behaviors (abnormal & normal) can be
modified via social learning principles
• 3. Assessment should be continuous and focus on
antecedents and consequences of behavior
Individual Psychotherapy/
Behavior therapy
• 4. People may be best described by what they do,
think, and feel in specific situations
• 5. Theory and experimental findings of scientific
psychology guide treatment
• 6. Treatment methods, goals, and concepts are
operationally defined, typically measurable and
replicable
• 7. Treatment is individually tailored to specific
persons and their specific problems
Individual Psychotherapy/
Behavior Therapy
• 8. Treatment goals and interventions are
designed collaboratively with the client
• 9. The effectiveness and utility of specific
interventions for specific problems are
systematically evaluated
• 10. Outcome is evaluated in terms of the
amount of change, its generalizability, and
maintenance
Techniques of Behavior Therapy
• Systematic Desensitization
• Flooding or exposure
• Aversion Therapy
• Token Economy
• Behavioral therapies emphasize changing
maladaptive behaviors
– systematic desensitization
– flooding
– aversion therapy
– token economies
Systematic Desensitization
• Based on classical conditioning
• Uses three steps:
– Progressive relaxation
– Development of anxiety hierarchy and control
scene
– Combination of progressive relaxation with
anxiety hierarchy
Sample Anxiety Hierarchy
Flooding
• For exam. wreath
Aversion Therapy for
Alcoholism
• Relatively
UCS
ineffective, does (drug)
not generalize
UCR
very well (nausea)
beyond therapy
• Pairs and CS UCS
aversive (alcohol) (drug)
stimulus with
the undesired UCR
behavior CS
(nausea)
(alcohol)
CR
(nausea)
Token Economy
• Based on operant conditioning
• Use for behavior modification in group
settings (prisons, classrooms, hospitals)
• Has been successful with severely disturbed
people
• Difficult to implement and administer
Cognitive Therapy
• Based on the assumption that psychological
problems are due to maladaptive patterns of
thinking
• Therapy focuses on recognition and
alteration of unhealthy thinking patterns
Cognitive & behavioral therapies
• Cognitive therapies: irrational beliefs and
negative thoughts relate to psychological
disorders
• The interpretation (or perception) of events
lead to depression.
• Albert Ellis’s ABC Model of emotional
reactions
• Appearance
Activating Event Consequence
• Reality
Activating event Belief system Consequence
• Ellis’s rational emotive therapytherapist
attacks client’s irrational belief systems
• Aaron Beck’s cognitive therapymore
subtle; lead client to discover their own
irrationalities
Rational Emotive Therapy
• Developed by Albert Ellis
• ABC model
– Activating Event
– Beliefs
– Consequences
• Identification and elimination of core
irrational beliefs
Individual Psychotherapy/
Cognitive Therapy
• 1. The link between events, their appraisal, and
resulting emotional and psychological states is
presented to the client
• 2. Interventions are typically short term
• 3. Therapy aims to identify and modify basic
assumptions, core beliefs, and schemata that are
maladaptive
• 4. Therapy is goal oriented & problem focused
IndividualPsychotherapy/
Cognitive Therapy
• 5. Therapy aims to modify automatic thoughts
those that occur habitually, rather than as rational
reactions to events
• 6. Therapy aims to modify cognitive errors such
as overgeneralization
• 7. Therapy often involves assignment of outof
session activities that disconfirm maladaptive
beliefs and cognitive errors
• 8. Client and clincian collaborate
Eleven Irrational Beliefs
• 1. It is absolutely necessary for me to be love and
aproved of by nearly everybody
• 2. I must be thoroughly competent & adequate in
all respects or I am worthless
• 3. Certain people are bad and wicked and must be
punished and blamed
• 4. If things are not the way I like them, then it is a
terrible catastrophe
• 5. Unhappiness is caused by external events over
which I have no control.
Eleven Irrational Beliefs
• 6. Some things are terribly dangerous and life
threatening, so I must keep thinking about them
most of the time
• 7. It is easier to avoid difficulties and
responsibilities than to face them
• 8. I am not able to do things myself; I must find
somebody stronger on whom I can rely
• 9. I should be very upset over other people’s
problems and disturbances
Eleven Irrational Beliefs
• 10. What happened to me in the past
determines what I do and think now, and
because some event was traumatic in the
past, it will be traumatic now
• 11. There is always and right and precise
solution to human problems, and if that is
not found, I must be very upset
Individual Psychotherapy/
Humanistic Theories
• I. Clientcentered counseling (Carl Rogers)
• II. Gestalt therapy (Fritz Perls)
• III. Existential Psychotherapy
Individual Psychotherapy/
Humanistic Therapies
• 1. Humans have a natural tendency toward
healthy emotional development
• 2. Selfactualization is the tendency toward more
complex and integrated levels of development
• 3. Self determinism means that humans have
control, select behaviors, and construct reality
• 4. Relationship with the client is central.
Individual Psychotherapy/
Humanistic Therapies
• 5. Clinicians must be genuine, and the client must
perceive them as such
• 6. Therapy recognizes and reduces incongruence
between experiences and selfconcept
• 7. Unconditional positive regardan accepting,
nonjudgmental, supportive, and empathic
approachis a necessary therapist characteristic
Humanistic therapies
• Goal: to help client gain insight into his/her
own selfworth and value
• Personcentered therapy (Carl Rogers)
– unconditional positive regard
– genuineness
– empathy
Group and Family Therapy
• Group therapy—one or more therapists working
with several people at the same time
• Family therapy—based on the assumption that the
family is a system and treats the family as a unit
• Couple therapy—relationship therapy that helps
with difficulty in marriage or other committed
relationships
Individual Psychotherapy/
Common Factors
• 1. Fostering insight promotion of self
examination and selfawareness
• 2. Encouraging release of emotions (catharsis,
corrective emotional experience)
• 3. Educatinggiving knowledge & info
• 4. Tasks outside therapy encouraged
• 5. Importance of therapeutic relationship
• 6. Reduce emotional discomfort
• 7. Change in something is expected
Is Psychotherapy Effective?
• >400 types of psychotherapies for >300 types of
abnormal conditions, as of 1995
• Early 1980’s, using a technique called meta
analysis, got an effectiveness quotient of .85
SDaverage person who receives psychotherapy
is better off than 80% who do not
• Through 80s & 90s, realization that there were
differences among studies in results, as a
function of specific problems and specific
therapies
Is Psychotherapy Effective?
4. This finding spurred by managed care interests
have led to the development of empirically
validated treatments
A. Most are cognitivebehavioral
B. Most are controlled lab studies and not field studies
– Led to manualized treatments
– Although great excitement by some, have been
criticisms, such as
1. Most manuals are created in research settings
2. Most studies are of people with “pure” diagnoses when
generally clients have many comorbid problems
Solutionfocused Brief Treatment
• I. Features:
• A. No attention to the development of a problem
• B. Constant focus on change
• C. Problems are not viewed as symptoms of a
disorder
• D. Solutions that have been used in the past are
emphasized
• E. Short Term
Solutionfocused Brief Treatment
• II. Who is it for? From the readings:
• “Particularly good candidates include people who
are motivated to face their difficulties and change,
have a history of good relationships, can be
flexible and creative, have succeeded in finding
solutions to past problems, and have a support
network that will encourage and reinforce
change.”
Solutionfocused Brief Treatment
• III Issues
• A. It is not theory based
• B. It is driven by economic concerns of
managed care companies
• C. It is not applicable to most clients in
most settings, especially where there are
comorbid conditions and multiple risk
factors
Counseling and Diversity
• I. European Americans75% of USA
• II. Other25%; growing
• III. 50% of minority culture clients terminate
therapy after one session as opposed to 30% of the
majority culture clients
• IV. Difficult to discriminate between cultural
factors and poverty factors
Counseling & Diversity
• I. Major theories of psychopathology and
psychotherapy were developed by European
Americans and were applied to European
Americans. Do these theories apply to everyone?
• II. Are differences between people’s cultural and
demographic backgrounds that are larger than
differences among people with the same cultural
and demographic backgrounds?
• III. Do we have enough of a knowlge base to be
able to do therapy differently depending on a
person’s culture when most research evidence is of
the laboratory nature anyway?
Individual Psychotherapy:
Summary thoughts
• I. Psychotherapy generally seems to effective, but
nobody really knows why
• II. There is a large demand (& expectation) from
media presentations of psychotherapy
• III. Psychotherapy is an individualistic activity
less is known about how to improve mental health
on a systems basis (e.g., 5060% of people
needing treatment do not receive it)
• IV. Almost all research on psychotherapy utilizes
voluntary clients
Individual Psychotherapy:
Summary thoughts
• V. Little research on sources of harm from
the focus of psychotherapy
• VI. Most research and most clients are
YAVIS (young, attractive, verbal,
intelligent, and successful)
Basic techniques of psychological therapy
• (1)Make & maintain therapeutic
relationship
• Opening techniques ( 开场白)
• Reception and reflection (接纳 与回应
)
• Structure (结构)
• Listening (倾听)
• Leading (引导)
• Comfort and promise (承诺)
• Suggestion (暗示 )
• Terminating (终止治疗 )
(2)Strategy & techniques of
promoting changes
• Restructure selfperception
• Interpretation
• Metaphorical interpretation
• Cognitive restructuring
• Managing physical and emotional
distress
• Relaxation
• meditation
• hypnotherapy
• systematic desensitization
• flooding
Changing behavior
• Problemsolving and coping skills
• Homework assignment
(3) Others
• Talking: body language, et al.
• Join in
• Distance
• Affects of behaviors