PSYCHOTHERAPY I:Psychotherapeutic Orientations, Clinical Psychologists

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Introduction to Psychology PSY101

Lesson 38

PSYCHOTHERAPY I

When does one need to go to a psychotherapist?

According to Engler and Goleman (1992) the following list of symptoms can serve as a guideline

for people in determining whether they need outside intervention, and whether it can be of help:

Long-term feelings of distress that interfere with your sense of well-being, competence, and ability to function effectively in

daily life activities.

Occasions in which you experience overwhelmingly high stress, accompanied by feelings of inability to cope with the situation.

Prolonged depression or feelings of hopelessness, particularly in the absence of a cause.

Withdrawal from other people.

A chronic physical problem for which no physical cause can be determined.

A fear or phobia that prevents you from engaging in everyday activities.

Feelings that other people are out to get you or are talking about you or plotting against you.

Inability to interact effectively with others, preventing the development friendships and loving relationships.

Varieties of psychotherapies

·About 400 psychotherapies are available to us.

·Psychotherapists can choose any of these depending upon their theoretical orientation, as well as the

nature of the problem they are dealing with.

·Also, depending upon their prior knowledge if any, patients and sufferers may choose a psychotherapeutic

approach that they prefer to undergo.

Psychotherapeutic Orientations

Although a variety of psychotherapies are available, the primarily stem from four major psychological approaches:

Psychodynamic approach

Behavioral approach

Cognitive approach

Humanistic approach

Who can be a psychotherapy provider?

Clinical Psychologists

Counseling Psychologists

Psychiatrists

Psychoanalysts

Licensed Professional Counselors or Clinical Mental Health Counselors

Clinical or Psychiatric Social Workers

Clinical Psychologists

They are psychologists with a Ph.D. or Psychology. Degree.

They have to complete a postgraduate internship prior to practicing.

They have a specialization in the assessment and treatment of psychological problems.

Counseling Psychologists

Counseling Psychologists have Ph.D. or Ed.D. Degree.

They typically provide help in solving routine-life adjustment problems.

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Their usual workplace is a university mental health clinic.

Psychiatrists

Psychiatrists are primarily medical doctors.

They have an M.D., M.B.B.S. or any other qualifying medical degree according to the law of any nation.

They undergo post-graduate training in dealing with mental disorders.

Being medical doctors, psychiatrists can prescribe medicine.

Although there are no restrictions on which they can treat, psychiatrists generally treat severer cases of mental disorders.

Psychoanalysts

These professionals specialize in psychoanalysis.

They can be medical doctors or psychologists trained in psychoanalysis.

Licensed Professional Counselors or Clinical Mental Health Counselors

These professionals hold a master's degree, with a national or state certification in therapy.

They provide therapy to suffering individuals, couples, and families.

Clinical or Psychiatric Social Workers

These professionals are basically master's degree holders.

They undergo specialized training.

As a result of their training, they can provide therapy regarding family and personal problems.

Psychotherapies based upon the psychodynamic approach

These therapies are primarily based upon the psychodynamic model introduced by Freud.

This approach is based upon two assumptions:

· Unresolved past conflicts is the root cause of abnormal behavior.

· Unacceptable unconscious impulses will enter consciousness.

Psychoanalysis

Introduced by Sigmund Freud.

Therapy is based on the premise that the roots of all abnormal behavior reside as unresolved conflicts in the unconscious.

To avoid these conflicts, people use defense mechanisms

·Psychoanalysis is an intensive, long term, psychotherapeutic procedure.

·Requires long sessions over extended periods----- may be years

·Better suited to intelligent individuals.

·Involves a special relationship between the therapist and the patient

Target: To explore unconscious motivation, conflicts, desires

Goal: Establishing intra psychic harmony by developing awareness of the role of the id, reducing over

compliance with super ego, and by strengthening the ego

Understanding of `repression': The therapy gives central importance to the understanding of the manner

in which the person uses repression to handle conflictInterventions used in Psychoanalysis

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Free association

Kept in a comfortable position, the patient is asked to talk aloud and say whatever comes to his

mind without considering whether or not it is relevant, rational, or sensible

The patient is asked to reveal even the most undesirable and strong thoughts that have been

repressed. This leads to emotional release, called `catharsis'.

Dreams in Freudian Approach

Dreams reflect unconscious needs, desires, impulses.

With the help of these dream analysis, psychotherapists seeks an understanding about the unconscious

motives, desires and conflicts

There are two parts of dreams.

Dream content

1. Latent content

2. Manifest content

Manifest part is what the patient describes about the dream and its surface interpretation

Latent part is the hidden part or the " true massage" within the dream.

Symbolism

The manifest content is in a symbolic form.

Converted into this form by the `dream censor, a mechanism that ensures that sleep is not

disturbed by unconscious desires, and those desires are presented in a socially acceptable form.

Analysis of Resistance

· At times patient feels inhibitions, and is unable or unwilling to express some thought or feeling

i.e., barriers between conscious and unconscious. The psychoanalyst aims to break down such

resistances so that the patient is enabled to face the unpleasant thoughts, impulses, and events.

Dream Analysis

· The therapist tries to uncover the latent content of dreams and decipher the symbolism involved

Analysis of Transference & Counter Transference

Transference: The patient's emotional response toward the therapist is often an indication of the

patient's relationship with a person who had been the center of the conflict. It may be negative or

positive

Counter Transference: The therapists' emotional reaction toward the patient.

Criticism Against Freudian Psychodynamic Theory

There is no scientific proof that many psychodynamic constructs, e.g. unconscious, exist

Psychic Determinism: Freudian approach is deterministic and leaves not much room for conscious,

rational, decision making or personal will to act.

It ignores the external variables and the environment.

It emphasizes the early childhood experiences too much.

Mostly criticized for its interpretation of the relationship between the genders

The therapy is too time consuming and therefore expensive.

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Behavioristic Approach to Treatment

A psychological approach that considers the relationship between behavior and environmental

stimuli as the focus of study; observable behavior is what psychology should be studying,

understanding and explaining.

An approach that dominated psychology for most of the 20th century.

What do the Behaviorists Study?

Observable/ overt behavior

Specific measurable responses

How particular types of behaviors are controlled by particular types of environmental stimuli

Method of investigation: Data typically collected under controlled laboratory conditions, employing

technological assistance.

What the Behaviorists Are Not Interested in:

·Unconscious

·Inner motivation

·Biochemical processes

Behavior Therapy Is More Directed Towards

· Behavioral therapists focused on unlearning the mal- adaptive patterns of behavior which

people acquired through learning; and abnormal behavior would be treated by making them to

relearn new experiences

Changing individual's behavior and make them able to function more efficiently definitely

solves the problem

Classical Conditioning and Behavior Therapy:

Behavior therapy uses various classical conditioning strategies for modifying the mal- adaptive

behavior. These important techniques are;

Systematic desensitization

Aversive therapy

Flooding and implosive therapy.

Systematic Desensitization

A procedure used in behavior therapy in which a stimulus that generates pleasant feeling is repeatedly paired with the

anxiety provoking stimulus in hope to alleviate anxiety. In the beginning the therapist prepares a hierarchical list of the fear

provoking stimuli, beginning from the least fear provoking.

Before using this procedure, the patient has to learn muscle- relaxation techniques by the therapist.

The patient is kept in a relaxed state. Then the therapist utters the names of the fear provoking stimuli, one by one. He

keeps taking the names till the patient shows signs of discomfort and anxiety. The process is repeated the next time, till a

stage when the patient can tolerate the whole list, showing that his fear is gone.

Aversive therapy

Developed by Ivan Pavlov.

A technique used to unlearn the unwanted habits by associating it with the unwanted impulses. An aversive stimulus is

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attached with an undesirable behavior, e.g. adding an emetic substance to the cigarettes of the patient.

This technique is frequently used with alcoholics, smokers and substance abusers. Implosive Therapy:

Making the patient directly encounter the fear-provoking stimulus.

Observational Learning

Learning the experiences through modeling and imitation. The patient observes others perform the behavior that he finds

difficult to perform. This can be done with live modeling or with video recordings.

Behavior therapists used modeling for teaching the patient new skills and habits and alleviate their anxieties, fears and

phobias.

Operant Conditioning

Operant conditioning approaches uses the rewards and punishment strategies for modifying behaviors.

Token Economy/ Token System

The person is rewarded with some form of a token every time a desired behavior is exhibited.

The token can be play money/token or a chip representing money; it can be the silver or gold stars earned by the child;

parents can give different colored paper tokens for good behavior.

After a specific number of token have been earned, they can be exchanged for something desirable.

Contingency Contracting

A written contract is held between the client and the therapist, specifying all goal-behaviors as well as consequences: parents

and teachers can also use it.

The contract is followed strictly no matter if the consequences of behavior are negative, and the client may in fact dislike

them; the purpose is to promote target behavior.

e.g. if an over-eater fails to refrain from confectionary throughout the week, he will have to send a donation cheque for drinks

in a marathon; the cheques are prepared at the beginning of the program

Usefulness of Behavior Therapy

Found to be effective with 50-90% of patients especially treating phobias, anxiety disorder and other unwanted behaviors

such as smoking and drug abuse.

Also helpful in the sense that it cal also be employed by non- professionals too.

Cheap and economical as it directly focused on the problem to be unlearn.

Cognitive Approach in Behavior Modification

Negative and unacceptable behavior is modified through constructive strategies.

According to this theory, person's beliefs and attitudes effect the motivation and behavior of a person.

In order to modify the behavior, reinforcement techniques are used.

For attaining the desired goal, realistic strategies are used with continuous feedback.

Behavior Modification

A therapeutic/intervention strategy used for modifying behavior in such a manner that the frequency of desired behavior is

increased up to the optimal level, and the frequency of undesired behavior is brought down to the minimum...or to

extinction level.

The intervention is based upon the principles of learning.

Steps in Behavior Modification

Identification of goals in terms of target behavior.

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Recording the preliminary/background information concerning the behavior in question.

Designing the intervention, issues involved and deciding its components

Implementation of the planned program as well as careful monitoring.

Altering the Belief System

Psychologists are of the view that psychological problems arise due to the way people perceive themselves in relation with the

people they interact.

Main focus of the therapist is to alter the irrational belief system of a person.

Cognitive Therapy for Depression

· Aaron Beck formulated the therapy for depression patients.

· Therapist helps the depressive person to change the faulty patterns of thinking through problem- solving techniques.

· Believed that depression reoccur in depressive patients because the negative thoughts occur automatically from which they are

unaware.

Rational-Emotive Behavior Therapy

Developed by Albert Ellis (1962, 1977).

Focused on altering the irrational beliefs into more acceptable way.

Clients are forbidden to use "should", "must"," ought" etc.

Confrontation techniques are used which focused on changing the attitudes through rational reasoning.

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