Psychotherapy/Psychotherapies

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

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

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

Social Treatments –Environmental therapy –Work therapy –Moral therapy

Psychological treatments –Talk-therapy –Hypnosis –Psychodrama –Behavioral therapy

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

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

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

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

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

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)

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

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)

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

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

Psychoanalysis in practice –Free association –Transference –Resistance

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

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.

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

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.

Interpersonal functioning and Depression Grief Role Transition Interpersonal Disputes Interpersonal Deficits

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.

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

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