Introduction to Psychotherapy

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Introduction to Psychotherapy
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Psychotherapy Elements

• Specific factors
• unique to each type of therapy
• composed of the techniques used in each
  therapeutic modality
• claim that specific factors responsible for
  effectiveness
• Common factors
• Aka nonspecific factors
• generalize across therapy modalities
• three types client, therapist, and relationship.

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Common factor types

• Characteristics of the client
• level of functioning, expectations, motivation
• Characteristics of the therapist
• personal style, experience, competence
• Characteristics of the therapeutic relationship
• supportive, empathic, good rapport

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Psychoanalysis and psychodynamic therapies

• Brief history
• Sigmund Freud in Vienna, Austria 1900
• United States in the 1930s
• Nazi persecution
• dominated psychiatry and clinical psychology for
  gt 40 years

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Psychoanalysis

• Classic elements
• intensive treatment
• 4 or more sessions a week for several years
• based on Freuds theory of personality
• three elements the id (pleasure), the ego
  (reality) and the superego (conscience)
• Defense mechanisms

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Psychodynamic approaches

• Core principles
• All are concerned with explaining the motives
  behind why people think feel, and behave as they
  do.
• All assume that early childhood experiences
  determine personality development. Namely, the
  bases of subsequent clinical disorders can be
  found in problems in these early interactions
  between children and their parents
• All recognize that conflict between opposing
  psychological forces is an inevitable aspect of
  human development. Among the sources of conflict
  are those between a persons identity as a
  instinctual animal versus as a social being as
  well as those between a persons conscious and
  unconscious motives.
• All suggest that the motives behind behavior are
  mainly unconscious they remain hidden because
  our conscious minds find them too threatening or
  unacceptable. We develop different defense
  mechanisms to keep these unacceptable motives out
  of consciousness.
• 5. All suggest that a critical feature of
  effective psychotherapy is the establishment and
  development of a special relationship between the
  patient and therapist.

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Concepts and techniques

• Free Association
• talk about whatever feelings and thoughts come to
  mind
• without any censoring or editing
• indirect means of exploring the unconscious
  motives that underlie patients behavior

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Concepts and techniques

• Resistance.
• Unconscious wish not to change
• Examples being unable to free associate,
  refusing to discuss certain topics, remaining
  silent, disagreeing with the therapists
  interpretations, missing or arriving late for
  treatment sessions, and failing to pay the
  therapist
• may occur despite patients conscious desires to
  cooperate with proposed treatment and overcome
  their problems
• Explanation change as threatening or painful,
  because in order to change, patients must become
  aware of previously repressed emotional conflicts
  
• easier to repress or avoid these inner conflicts
  than to confront them

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Concepts and techniques

• Transference.
• the developing relationship between the patient
  and therapist
• patient responds to the therapist as he did
  toward significant individuals in his childhood
  (usually his parents)
• primary means for therapeutic change
• structure of psychoanalytic therapy promotes the
  development of transference
• Therapists act in an understanding but strictly
  neutral, nonjudgmental manner
• Therapists as a blank slate on which patients can
  project (that is, transfer) their feelings
• Patients frustrated and angry at therapist
• necessary and natural part of therapy
• Developing and working through the transference
  relationship is the most basic and important
  element of psychoanalytic therapy.
• Countertransference - notion is the same as in
  transference except that the feelings are those
  of the therapist

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Concepts and techniques

• Interpretation.
• therapist shifts from passively observing to
  interpreting what the patient has said or done
• therapist confronts the individual with
  information about her behavior that he/she was
  previously unaware of
• makes the individual aware of unconscious
  conflicts and thereby induces psychological
  change
• first interpret the behavior close to the
  patients awareness
• defense mechanisms and resistance
• later interpret the content of the unconscious
  conflicts that give rise to defense mechanisms

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Concepts and techniques

• Dream Interpretation
• patients are encouraged to report their dreams
• royal road to the unconscious
• Freud assumed ego defense mechanisms reduced
  during sleep
• dreams might provide clues about the hidden
  motives behind behavior
• therapists must still distinguish between what
  is consciously remembered and the hidden
  expression of unconscious processes

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Concepts and techniques

• Insight
• goal of all psychoanalytic therapies is to help
  individuals gain insight into their problems
• refers to increased awareness of unconscious
  conflicts and psychological defenses
• resulting in more adaptive behavior
• not simply an intellectual awareness
• an emotional process that occurs only in the
  context of the unique, emotion-arousing
  interpersonal interaction that is the
  transference relationship

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Neo-Freudian Therapies

• derived throughout the years after Freuds death
  in 1939
• ego-analytic therapy, self-psychology, and brief
  dynamic therapy
• Neo-Freudians either participated in Freuds
  original Vienna Psychoanalytic Society or were
  trained by another member of that exclusive group
  
• Carl Jung, Alfred Adler, Harry Stack Sullivan

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Carl Jung

• developed Analytic Psychology
• rejected Freuds insistence that sexuality is the
  fundamental source of human motivation
• Instead, proposed that sexuality was only one
  form of a more general psychic energy
• focused not only on treating abnormal behavior
  but also on normal adult development
• proposed the concept of introversion-extroversion
  as a dimension of personality.

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Alfred Adler

• Also rejected Freuds view of the primacy of
  instinctive forces and the overriding importance
  of sexuality in personality development
• more optimistic view of human development
• the self most significantly influencing
  development

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Harry Stack Sullivan

• credited with emphasizing the interpersonal
  nature of psychological disorders
• felt that the therapists role should be more
  directive
• focused on events in the here and now

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Brief Dynamic Therapy

• One example of a contemporary psychodynamic
  therapy
• major limitations of classical psychoanalysis are
  length and cost
• brief therapy approximately 40 hours
• Modest treatment goals core conflict
• Therapist more active directive
• Frequent interpretations

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Psychodynamic Therapy-Hans Strupp

• focuses on disturbances in past interpersonal
  relationships interactions with the therapist
  in the present
• Early experiences have made a person sick.
• purpose of therapy is to provide a new
  relationship that helps the person change
• importance of creating a good human relationship
  and an understanding of the inner world of the
  client

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Hans Strupp cont.

• relationship not sufficient for change
• patient clings to maladaptive patterns that
  resulted from early childhood experiences
  cyclical maladaptive patterns
• Therapy involves identifying these patterns,
  bringing them to the patients attention, and
  exploring how they affect the patients life.

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Hans Strupp cont.

• Transference is an important issue for both the
  patient and the therapist
• chance to have a corrective experience
• patient can play out his or her relationship
  problems with a non-judgmental, non-reactive
  therapist in a safe environment
• patient learns to use the context of the
  relationship with a sympathetic listener to
  acquire new patterns of thinking, feeling, and
  acting

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Discussion of video

• What concepts and techniques did you notice on
  this video clip?
• Did these techniques work?
• Did you notice any defense mechanisms at work?
• How does this type of dynamic therapy compare to
  your original conceptualization of
  psychoanalysis?

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Evaluation of psychodynamic therapies

• remain influential in the United States and
  Europe
• breadth, extensive explanation of the motives
  behind human behavior
• widely criticized on several counts
• bizarre concepts, lack of scientific validation
• important contributions
• early learning and childhood experiences are
  important, human functioning influenced by
  unconscious processes, personal conflicts can
  interfere with interpersonal relationships

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