Approaches to psychotherapy 1

APPROACHES TO PSYCHOTHERAPY
• Introduction
• Treatment of psychological distress and disorders through verbal, cognitive and
behavioral techniques;
- many different schools of psychotherapy.
- listening, empathy, interpretation, and action may all be involved.
• At the core of any psychotherapy is an EMPATHIC RELATIONSHIP, the
THERAPEUTIC ALLIANCE.
• THREE MAJOR SCHOOLS:
1. PSYCHOANALYTIC (PSYCHODYNAMIC)
2. COGNITIVE-BEHAVIORAL (CBT)
3. HUMANISTIC
• BUT THE MOST FREQUENTLY USED AND EVIDENCE BASED IS (CBT)

Psychodynamic Psychotherapy
• Sigmund Freud
• There have been a multitude of variations that have evolved and the term most
often used to broadly encompass these approaches is "Psychodynamic."
• Terms such as: neurosis, conflict, attachment, object relations, unconscious,
defense mechanisms, id, ego, superego, drives, libido, transference,
countertransference, and countless more have emerged from this approach.
• A THEORY OF CONFLICTS
• Psychodynamic therapies work to make the unconscious conscious so that we can
have greater insight into our needs and behavior and therefore more control over
how we allow these conflicts to affect us.
PROCESS OF PSYCHODYNAMIC PSYCHOTHERAPY
• - Process more important than content.
• The symbolic meaning to a behavior or pattern of behavior. (E.G., exploring the
process of RESISTANCE)
• Symptom reduction seen as superficial. All behavior seen as symbolic: "nothing
happens by accident." (example of being late).
TECHNIQUES OF THERAPY
• OPENING PHASE (FREE ASSOCIATION): The analyst hardly ever says anything
except to make an “interpretation” (i.e., the unconscious motives behind your
actions or thoughts are pointed out to you). There are no excuses for missing a
session, and payment is required whether you attend the session or not.•. . . and
this goes on for several years.
• CATHARSIS
• DREAM ANALYSIS
• ANALYSIS OF TRANSFERENCE
• ANALYSIS OF RESISTANCE
• Interpretation
Structural Model of Personality:(id, ego, superego)
The Divisions of MIND: consiuoness, pre-conscious, and unconsciousness.

Cognitive Behavior Therapy: The use of cognitions to modify behavior

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• Cognitive behavior therapy is a clinically and research proven breakthrough in

mental health care. Hundreds of studies by research psychologists and psychiatrists
make it clear why CBT has become the preferred treatment for conditions such as:
• Depression and mood swings, Shyness and social anxiety; Panic attacks and phobias;
Obsessions and compulsions (OCD and related conditions); Chronic anxiety or worry;
Post-traumatic stress symptoms (PTSD and related conditions); Eating disorders
(anorexia and bulimia) and obesity; Insomnia and other sleep problems;

Cognitive behavior therapy* combines two very effective kinds of psychotherapy —

cognitive therapy and behavior therapy. Cognitive-Behavioral Therapy (CBT) is a practical
approach that seeks to define concrete goals and uses active techniques to reach them. The
cognitive-behavioral therapist looks at patterns of thinking and behavior and how these
patterns are reinforced and maintained by the person within his or her environment. A
functional analysis of thinking and behavior is performed, often using log sheets and graphs
to better understand thought and behavior patterns in the context of daily routines. Once an
understanding of symptoms and behavior is achieved, the therapist and client together devise
changes in the patterns and continue tracking. This process is repeated until the original
goals are met. Attention to irrational thinking patterns (e.g., automatic thoughts, catastrophic
thinking) is central to the approach as well.

Some of the techniques and programs that are usually associated with CBT are relaxation
training, systematic desensitization, assertiveness training, and social skills training.

Historically, Cognitive-Behavior Therapy (CBT) has its roots in the work of behaviourists
such as Ivan Pavlov, John Watson, Joseph Wolpe, and B.F. Skinner. Skinner, in particular,
developed theories of operant conditioning that were the basis of behavior therapy, which
views the consequences of behavior as shaping future behavior. Associated with Skinner are
terms such as stimulus-response, positive reinforcement, and contingencies of behavior.

Skinner's emphasis was on observable behavior. It was theorists such as Albert Bandura
(Social Learning Theory) and cognitive therapy and cognitive-behavioral therapy originators
such as Albert Ellis (Rational Emotive Behavior Therapy), Aaron Beck (Cognitive Therapy),
William Glasser (Reality Therapy) and Donald Meichenbaum (Cognitive-Behavioral
Therapy) that brought thought and emotion into this approach.

How Cognitive Behavior Modification Works

• Cognitions such as beliefs, attitudes and even emotions can cause behavior
• Much maladaptive behavior is caused by inappropriate or illogical cognitions
• Many of our cognitions may not be accurate representations of reality
• By changing these cognitions, the behaviors that they lead to will in turn be changed
• Usually employed with individuals who suffer from:
• dysfunctional automatic thoughts - involving content specific to an event.
• schemata - general rules about themselves or the world associated with an
event. (THE TRIANGLE).
Cognitive Distortions
• These individuals often engage is self-statements that affect their behavior.
• “All or Nothing” Thinking
• Selective Abstraction
• Overgeneralization
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• Magnification
• Minimization
• Personalization
• Labeling (Mislabeling)
• Catastrophizing
• Mind-reading
• Negative Predictions
Methods of Cognitive Behavior Modification
1. Self-Instruction Training: (Overt-Covert),
2. Thought-Stopping.
3. Cognitive restructuring
4. BEHAVIORAL RE-ATTRIBUTION
5. COGNITIVE RE-ATTRIBUTION
6. BEHAVIORAL EXPERIMENTATION
7. SCHEMA ANALYSIS

REIFROCEMENT
• Positive reinforcer: A stimulus that when added to a situation, increases the
likelihood that a response will occur.
• Positive reinforcement: reward
• Negative reinforcer: A stimulus, that when removed from a situation, increases the
likelihood that a response will occur, relief.
• Negative reinforcement: relief
• Punishment – try to decrease the likelihood of a response
• Positive punishment – something unpleasant occurs
• Negative punishment – something pleasant is removed

TOKEN ECONOMY
• A behavior therapy procedure, based on operant conditioning principles, in which
institutionalized patients are given tokens, such as poker chips, for socially
constructive behavior, and are withheld when unwanted behaviors are exhibited. The
tokens themselves can be exchanged for desirable items and activities such as tea or
coffee and extra time away from the ward.Token economy, in short term trials, was
effective at reducing the negative symptoms of schizophrenia. . For example, patients
in a mental hospital are given tokens they can exchange for food or coffee when they
make their beds, groom themselves, get up and go to sleep at the correct hours, and so
on; they are fined (tokens are taken away) for assault or destruction of property.

Other Techniques
• Time-out: weaken undesired behavior by temporarily removing positive
reinforcement.Example: Sending a student who frequently interrupts classroom
routine to sit in an empty room for 10 min. (Punishment II)
• Response Cost: tokens are withdrawn when child makes an undesired response
• Extinction: weaken undesired behavior by ignoring it.Example: A mother ignoring a
whining child, or a teacher ignoring a student who speaks out of turn.
• FLOODING: This is the type of exposure therapy that starts with the most feared
rather than the least feared stimulus is called flooding; If conducted only in the
imagination, it is sometimes called implosion. The therapist controls the timing and
content of the scenes to be imagined or confronted, and instead of trying to relax, the
Approaches to psychotherapy 4

patient is told to experience the fear fully until it subsides. Flooding is quicker than
systematic desensitization, but relapse may be more common, and the procedure is
simply too frightening for many patients.
• SHAPING: Method of getting a response to occur by reinforcing successive
approximations to the desired response. Successive approximation: the gradual
process of reinforcing behaviors that get closer to some final desired behavior.
Operant conditioning can be used to shape behavior so that patients perform complex
actions or acquire skills that were formerly beyond their capacities.

Client-Centered Therapy

• Developed by Carl Rogers. The goal is to help clients become fully functioning
• Therapist expresses unconditional positive regard
• Therapy is nondirective
Two Basic Human Needs
1. Self Actualization: the need to fulfill all of one’s potential.
2. Positive Regard: the need to receive acceptance, respect, and affection from others.
Positive regard often comes with conditions attached (“Conditions of Worth”): We must meet
others’ expectations to get it. This is called Conditional Positive Regard.
Basic Human Problem: The two needs are often in conflict. Satisfying one may mean
giving up the other.
Effect on Personality: We get a false picture of who we are—our interests, motivations,
goals, abilities.
 We have a need for positive self-regard (to like and respect ourselves).Conditional
positive regard from others becomes conditional positive self-regard.This means we
will like and accept only those parts of ourselves that other people like and accept.The
self-concept pulls away from the real self; we get a false picture of who we really are.
 This mismatch is called Incongruence.
• For a healthy self to emerge, people need positive regard – love, warmth, care and
acceptanc.
• Ideal Self – what the person is striving to become.
• Real Self – what the person is.

The further the ideal self is from the real self, the more alienated and maladjusted persons
become.
Incongruence has many harmful effects. One is that it prevents self-actualization. You have
to know who you are to fulfill your potential.
The therapist tries to bring the self-concept closer to the real self: