1. CHAPTER 1 uzm. Psk. Özlem ataoğlu
What is psychotherapy?
CHAPTER 1
uzm. Psk. Özlem ataoğlu

2. How do you picture a regular psychotherapy session?
How the therapist and the patient are positioned?
What are they talking about?
How are the therapist’s reactions to the patient? Does s/he direct the patient to one way if s/he feels what the patient really wants?

6. What is the psychotherapist’s role within the session?
People consult you with many problems – stress, illness, alcohol, grieve, loss of something (pet, job, loved one), adaptation, depression, anxiety, bonding, body image, etc.
What you should NOT do is – direct the patient to the way you want, you believe what is right, tell what to do or not to do

7. Psychotherapy is a process where the patient discovers him/herself
At the beginning of the sessions, you may start with daily problems BUT you have to set the goals with your patient on a realistic base
What does that mean?
If the patient says – “I do not want to experience any anxiety any more. Even while on my way here to your office, I needed to climb the stairs instead of taking the elevator.” – What will you say?

8. You have to definitely take care of these daily problems because it affects your patient’s quality of life but in order to set realistic goals what do you need to change in the previous sentence?
How do you say this?
“Bu kaygı problemi sizi oldukça etkilemiş gözüküyor, üstelik hayat kalitenizi de epeyce etkilediğini düşünüyorum. 11 kat çıkmak zorunda kalmak gerçekten çok yorucu olmalı ve tahmin ederim ki buna benzer örnekleri de sıklıkla yaşıyorsunuzdur gün içinde. Bunların üzerinde çalışıp halletmemiz gerektiğine kesinlikle katılıyorum. Fakat cümlenizin başında söylediğiniz dikkatimi çekti, hiç kaygı yaşamak istemiyorum dediniz. Bu nasıl bir şey olurdu sizin için? Hiç kaygı yaşamayan bir Ayşe’nin hayatını bana anlatabilir misiniz?”

9. Firstly what you did is to share the emotion with the patient and use feeling validation. You give the assurance that you are with him/her together.
Then, you give the message that something made you curious about him/herself. By this way you take your patient’s attention  You will be able to collect more realistic information
You want him/her to use imagination about the goal.

10. S/he will tell a perfect world for him/herself without any anxiety
S/he will tell a perfect world for him/herself without any anxiety. What is you job here?
Make it more realistic because this goal is way too far from real world
“Gerçekten anlattıklarınız çok mükemmel bir dünya gibi gözüküyor fakat ben size farklı bir senaryo anlatmak istiyorum. Mutlaka karşıdan karşıya geçmişsinizdir. Geçerken de sağa sola bakıyorsunuzdur. Hiç gözünüzden kaçan bir araba oldu mu? Son anda farkettiğiniz? (….) Ne yaptınız peki o anda? (….) Kaçmasaydınız ne olabilirdi? (….) Peki sizce bu kenara kaçma hareketini sağlayan neydi?”

11. “Olumlu ya da olumsuz duygularımızın her zaman bir işlevi vardır
“Olumlu ya da olumsuz duygularımızın her zaman bir işlevi vardır. Kaygınızı bir araba üzerinize doğru gelirken hissetmemeniz hayatınıza mal olabilir – dolayısıyla hiç kaygı hissetmediğiniz mükemmel dünyanın o kadar da mükemmel olmayacağını söylemem lazım, sanıyorum siz de katılırsınız buna. Burada kaygı duygusu deneyimlenerek doğru bir yerde kullanılmış olur. Fakat asansöre binemediğiniz için 11 kat merdiven çıkmanın çok da işlevsel olmadığını düşünüyorum. Dolayısıyla kaygı hissedeceğimiz yerleri ayıklamamız en doğru hedef olacaktır. Ne dersiniz?”

12. In the psychotherapy session, you give psychoeducation to your patient
What is psychoeducation?
You teach the emotions, thoughts, behaviours, how they affect each other, relaxation, regulation, procrastination, acceptance, etc.
By teaching what is right/wrong, you will be able to progress with your patient more easily
Then you start to work on the unfunctional areas with your patient

13. BRIEF HISTORY OF PSYCHOTHERAPY
SIGMUND FRUED AND PSYCHOANALYSIS
Psychoanalysis actually based on Freud’s personal life
His father was 20 years older than his mother, authoritative and tough  created both fear and love
His mother was protective and affectionate  created severe dependence on mother
This situation created a phenomenon which Freud will call Oedipus complex
Another thing is Freud was the oldest of the eight siblings and his mother was very proud of him, believed on his future’s perfection
This created self-confidence, passion, will for success and fame desire
“If a son is his mother’s favourite, then he will never lose the desire for conquest.”
He had a great jealousy on his fiancée, Martha. In one of his letters to her, he wrote “Şu andan sonra kendi ailende ancak bir misafirsin. Seni hiç kimseye bırakmam. Eğer benim hatırım için ailenden vazgeçecek kadar beni sevmiyorsan beni kaybedersin ve hayatını bir enkaza çevirirsin. Zorbalık yapmak zorunda kalırım.”

14. Case of Anna O.: Anna, 21 year-old, has some hysteric symptoms such as paralysis, amnesia, mental disorders, nausea, sight and speech disorder
These symptoms occur while she was taking care of her near – to – death father. It is known that she was kind of in love with her father.
Breuer was using hypnosis to treat her – under hypnosis she was able to remember the experiences which are thought to create the symptoms and talking about them helps to reduce these symptoms – drinking water

15. They talked about daily things that bother Anna, gradually reduce the symptoms which he called catharsis. Breuer realized that all of the memories include fear or disgust emotions
Once Breuer realized that they experience transference and countertransference, he stopped seeing her
Freud, then added free association to his techniques – by this way he was able to reach his patients’ childhood memories and repressed memories

16. JOHN WATSON AND BEHAVIOURISM
Watson started to work on animals and declared his choice on not to work on people
His colleagues and professors told that he lacks introspection which probably lead him to work more on objective behaviouristic psychology
At the age of 31, he was the head of psychology department in Johns Hopkins University
He wanted to see the effects positive and negative effects of educational alcohol and sex tapes on adolescents however the university wanted him to stop
During a conference in Columbia University, he declared his thoughts on more objective psychology approach and behaviourism started
He encouraged the advertisement sector to work with famous people and create anxiety feelings in order to sell the products
His attitude towards raising a child affected many people but found very distant and lack of emotions

17. GESTALT PSYCHOLOGY (WERTHEIMER, KOFFKA, KÖHLER)
It revealed with behaviourism but they differentiate in a main point – gestalt psychologists accepted the existence of consciousness however behaviouristic psychologists do not accept
Basically, they say that when we look outside, we do not see brightness and colours but trees and sky
They suggest that sensory elements merge and create a new pattern, figure that we perceive
The whole pattern is different than the sum of all of the elements that generate the pattern itself
Our perception is beyond physical input
Phi phenomenon: If you show two lights to a participant with more than 200 milliseconds between them, it will appear as two different lights. However, if you set the gap around 60 milliseconds, it will appear as only one light

18. ANNA FREUD She is the youngest and least expected daughter of Freud.
She was born in 1895 when also the psychoanalysis was born – it has a symbolic meaning because only Anna became an analyst among Freud’s children
She was not taken care of in the family, was lonely, has anxiety of abandonment.
Eventually she became the best child of her father
At the age of 22, she was concerned about her dependency on her father and started analysis with her father
S. Freud was criticized because of this, argued that this is incest, evoking Oedipal issues, impossible to hear confidential issues
She declared a case in Psychoanalysis Association in Vienna – actually telling her incest father – daughter fantasies, how she overcame them and how she reached sexual satisfaction by masturbating

19. OBJECT RELATIONS THEORY AND MELANIE KLEIN & HEINZ KOHUT
According to object relations theory, we have a relation with any object that can satisfy our instincts
The first thing that satisfies this instinct is mother’s breast
As we get older, people around us become the objects that satisfy our needs/instincts
How we develop a relationship with those objects matter
In order to create a self and develop relationships with other objects (people), we have to separate from the main object (mother). Gradually, if we develop skills and with our needs, we can make it real
Klein felt that her parents reject her, lived with depression in her whole life, had weak bonds with her children.
First 6 months of the baby is very important – since the mother’s breast is the first object, depending on the satisfaction of the id, baby codes it good or bad which foresee the future relationships (satisfactory or hostile)
According to Kohut, our main self – object (objects that we identify as a piece of our self) is our mother and she has to satisfy the psychological needs, as well. In order to do that, a mother should give uniqueness, perfection, acceptance feelings.
If she is able to do that, the child is reinforced with pride. If she is not, the child will experience shame and guilt.

20. ANALYTICAL PSYCHOLOGY AND CARL JUNG
The main difference from psychoanalysis is about libido – Freud suggests it more of a sexual phenomenon, Jung takes it more of a generalized energy of life.
Libidinal energy of life shows itself in reproduction but also on all of the other activities that a person decides on the most important things in their lives
According to Jung, main energy of life is not all about sexual qualities but also nourishment and development
Jung also does not accept Oedipus complex, explains this with a necessity dependency – this phenomenon is not related to his personal life
The other main difference is according the Freud we are the victims of our childhood memories but according to Jung our future goals, desires, wills shape us as well as our past

21. INDIVIDUAL PSYCHOLOGY OF ALFRED ADLER
According to Adler, our behaviours are affected by future expectations (life after death) and social factors.
Our personality can only be understood by person’s social relationships and manners towards others.
Social interest (collaboration with others) arise during childhood in order to develop personal and social goals
We can develop it only with experiencing
Consciousness is important for Adler, he suggests that people are aware of their needs and motives, behave accordingly
Our final goal is to reach superiority that includes perfect, complete development, success and self – comprehension. Sexuality is only one of the many ways to reach this superiority.

22. HUMANISTIC PSYCHOTHERAPY
In humanistic psychotherapy, the focus is on immediate, here – and – now experiences
The main goal is to reach the self – actualization. If everything goes on the right path, we are able to see our full potential.
Carl Rogers generated person – centered therapy. He suggests that the patient has a will to health, therapist guide the patient to self – acceptance. All people are human beings, awareness of uniqueness lead to health.
There is a if  then relationship: if the correct circumstances appear then the improvement will emerge

23. We recognize our likes/dislikes, abilities, etc (real self) & other ppl’s regards of the person’s self – experiences (ideal self)
So, accepting a child when something bad happened, but not approving; giving feedback about the behaviour not their self – unconditional positive regard
More acceptance by others  More incorporation of the self
The discrepency between the real and ideal self creates incongruence. If positive regard depends on what others feel &act, the gap between real & ideal self will be more extent

24. What are the goals in person – centered therapy?
Unconditional (+) Regard: Don’t judge, listen. Express (+) feelings, make them free to express themselves. Shape a “willing – to – listen” portrait. Accept regardless of feelings/behaviours which lead to growth/improvement
Empathy: Try to see the world as the client sees it (empathic listening/understanding). Underlie the internal conflicts, motives, emotions
Congruence: Therapists feelings/actions should be consistent. When you are congruent, real relationships will occur – become more self – aware, less defensive and rigid