Introduction to Clinical Psychology Part 3: Psychological Treatments

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Introduction to Clinical PsychologyPart 3
Psychological Treatments
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Psychological Treatments An Overview

• Does therapy work?
• Are there common factors shared by all types of
  treatment?
• Does therapy work for everyone?
• Are some therapies more effective than others?

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Does therapy work?

• Efficacy Research
• Tightly controlled study in which therapy is
  administered by expert therapists, with carefully
  chosen patients, and delivered in a highly
  standardized manner.
• Consensus is that treatment results in enhanced
  functioning.

• Effectiveness Research
• Examines the effects of treatment as they are
  likely to be delivered in the real world by
  therapist who have an average amount of training,
  with real clinical patients that are not
  specifically selected, and not always in the most
  standardized manner.
• Consumer Report study (1995).

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Are there common factors shared by all types of
treatment?
Action
Learning
Support
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Does therapy work for everyone?

• Severity of disorder
• Intelligence
• Belief in psychotherapy process (openness)
• Notes Research on race, ethnicity, and social
  class have failed to show conclusively that these
  variables are related to psychotherapy outcome.
• Significant difference in the social class of the
  patient and therapist however, does seem to
  effect the patients willingness to go to
  treatment

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Are some therapies more effective than others?

• Old question
• Meta-analyses
• Answer
• Compared to no treatment, most psychological
  treatments appear to be effective .
• Differences among treatments

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Are some therapies more effective than others?

• New Question
• Which treatment is useful for specific types of
  patients?
• Practice guidelines
• Empirically supported treatment (EST)
• Manualized treatments
• Ignoring evidence

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Psychology is a science. Seeking to help those in
need, clinical psychology draws its strength and
uniqueness from the ethic of scientific
validation. Whatever interventions that
mysticism, authority, commercialism, politics,
custom, convenience or carelessness might
dictate, clinical psychologist focus on what
works. They bear a fundamental ethical
responsibility to use where possible
interventions that work and to subject any
intervention they use to scientific scrutiny.
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Psychological Treatments

• Psychodynamic Psychotherapy

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Sigmund Freud
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Ladies and Gentleman, I cannot tell how
much knowledge about psycho-analysis each of you
has already acquired from what you have read or
from hearsay. But the wording of my prospectus-
Elementary Introduction to Psycho-Analysis
obliges me to treat you as though you knew
nothing and stood in need of some preliminary
information.
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I, can, however, assume this much-that you
know that psycho-analysis is a procedure for the
medical treatment of neurotic patients. And here
I can at once give you an instance of how in this
field, a number of things take place in a
different way- often, indeed, in the opposite
way-from what they do elsewhere in medical
practice.
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When elsewhere we introduce a patient to a
medical technique which is new to him, we usually
minimize its inconveniences and give him
confident assurances of the success of the
treatment. I think we are justified in this,
since by doing so we are increasing the
probability of success. But when we take a
neurotic patient into psycho-analytic treatment,
we act differently.
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We point out the difficulties of the method to
him, its long duration, the efforts and
sacrifices it calls for and as regards its
success, we tell him we cannot promise it with
certainty, that it depends on his own conduct,
his understanding, his adaptability and his
perseverance. We have good reasons, of course ,
for such apparently wrong-headed behavior, as you
will perhaps come to appreciate later on.
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Ladies and Gentlemen.. .. Your earlier
education has given a particular direction to
your thinking, which leads far away from
psycho-analysis. You have been trained to find an
anatomical basis for the functions of the
organism and their disorders, to explain them
chemically and physically and to view them
biologically.
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But no portion of your interest has been
directed to psychical life, in which, after all,
the achievement of this marvelously complex
organism reaches its peak.
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For that reason psychological modes of
thought have remained foreign to you. You have
grown accustomed to regarding them with
suspicion, to denying them the attribute of being
scientific, and to handing them over to laymen,
poets, natural philosophers and mystics.
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This limitation is without doubt detrimental
to your medical activity, since, as is the rule
in all human relationships, your patients will
begin by presenting you with their mental façade
and I fear that you will be obliged as punishment
to leave a part of the therapeutic influence you
are seeking to the lay practitioners, nature
curers and mystics whom you so much despise.
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This is the gap which psycho-analysis seeks
to fill. It tries to give psychiatry its missing
psychological foundation
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Freud A Brief Biographical History

• Born May 6, 1856
• Father wool merchant
• Always his mothers favorite
• 4 siblings 3 sisters and 1 brother
• Studied medicine
• Decided to go into private practice to help
  support his family and new fiance
• Talking cure treatments were controversial
• Freud was regarded as a quack who emphasized
  sex too much
• Developed psychoanalysis despite the zeitgeist of
  the time

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Freud A Brief Biographical History

• Early Collaboration
• Freuds intellect is soaring at its highest
• I gaze at him as a hen at a hawk

• Later Years
• Seduction theory was too much even for Joseph
  Breuer to accept.
• As Freud emphasized sexual matters more, he
  thought he had made a mistake in working so
  closely with this younger man

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Freud A Brief Biographical History

• Freud was that queer fellow whoimagined himself
  as an interpreter of dreams
• More than that he was the man who saw sex in
  everything. It was considered bad taste to bring
  up Freuds name in the presence of ladies

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Freud A Brief Biographical History

• The time is not ripe for followers. There is too
  much that is new and incredible, and too little
  strict proof.

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Goal of Psychoanalysis

• Intellectual and emotional insight into the cause
  of the problem
• Working though those insights
• Strengthening the egos control over the ed and
  superego

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Development of Psychoanalysis

• Learned the value of hypnosis in treating
  hysterics from Jean Charcot in Paris
• Anna O and the talking cure
• Became aware of the role of the unconscious in
  current conflicts
• Searched for alternate routes to the unconscious

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Course of Psychoanalysis

• Opening phase positive transference
• Working through negative transference,
  uncovering unconscious material, examining how
  unconscious conflicts affects current behavior
• Intellectual and emotional insight

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Psychoanalysis

• Traditional
• 50 minute sessions
• 5 times per week
• Duration of several years

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Psychoanalytic Techniques

• Transference
• Identifying resistance
• Free association
• Dream interpretation
• Psychopathology of everyday life

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Transference

• A process in which the patient projects onto the
  analyst emotional attitudes felt as child toward
  important persons

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Identifying Resistance

• Behavior that prevents insight or prevents
  unconscious material from coming into
  consciousness

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Free Association

• A therapeutic technique in which a person says
  anything that comes to mind with the goal of
  uncovering unconscious material.

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Dream Interpretation Via Regia

• A therapeutic technique used to uncover
  unconscious process
• Manifest content
• Latent content (symbols)

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Psychopathology of Everyday Life

• Analysis of everyday behavior to uncover
  unconscious processes

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Psychoanalysis Post Freud

• Alfred Adler
• first disciple of Freud to disagree with the
  master
• Developed individual psychology
• Behavior motivated by need to be superior

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Psychoanalysis Post Freud

• Carl Jung
• Viewed by Freud as heir apparent
• Jung was a bitter defector from Freuds inner
  circle
• Agreed with the importance of the unconscious
• Felt Freud overemphasized sexual and aggressive
  drives, he felt humans inherited a desire for
  higher religious fufilment and self development
• Felt Freud overlooked the collective unconscious

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Psychoanalysis Post Freud

• Karen Horney (horn-eye)
• Disagreed with Freuds premise that women have
  penis envey
• Felt that men, in contrast, envied women
• Basic anxiety results from disturbances in
  parent-child relationships
• In attempting to deal with basic anxiety,
  individuals develop a characteristic social
  orientation (dependent, submissive, inflated self
  concept, avoidant etc.

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Psychoanalysis Post Freud

• Erik Erikson
• Agreed with Freud that development occurred in
  stages
• He emphasized social as opposed to sexual
  development
• Development occurs across the lifespan
• Ego is relatively powerful part of personality
  that functions to establish and maintain a sense
  of identity (ego psychology)

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Psychoanalysis Post Freud

• Otto Rank
• Devoted follower of Freud
• Rejected theories of Oedipus complex
• Related all neurotic anxieties to birth trauma
• Separation anxiety was central to his theory
• Believed all forms of separation reactivated the
  primal anxiety of the birth trauma

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Psychoanalysis Post Freud

• Ernest Jones
• Wrote the Freuds biograpghy
• Delivered funeral oration

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A great spirit has passed from the world.
How can life keep its meaning for those to whom
he was the center of life? Yet we do not feel it
as a parting in the full sense, for Freud has so
inspired us with his personality, his character
and his ideas that we can never truly part from
him until we finally part from ourselves in whom
he still lives.
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His creative spirit was so strong that he
infused himself into others. . And so we take
leave of a man whose like we shall not know
again. From our hearts we than him for having
lived for having done and for having loved.
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Brief Psychodynamic Therapy

• Interpersonal Psychotherapy- IPT