Mechanism of Changes and Techniques of Psychotherapies - PowerPoint Presentation

Slide1

Mechanism of Changes and Techniques of Psychotherapies

Zsolt Unoka, M.D., PhD.unoka.zsolt@med.semmelweis-univ.hu

Department

of

Psychiatry

and

Psychotherapy

Semmelweis UniversitySlide2

Psychotherapy is an effective

treatmentmany meta-analyses and even meta-meta-analysis show an effect size of approximately 0.8

0.8 a ‘strong’ effect size in the social sciences

this makes psychotherapy more potent than many well established EBM procedures

includ-ing

(for example) almost all interventions in asthma, geriatric medicine and cardiology

(

Wampold

, 2007). Slide3

Factors

Influencing Psychotherapy Outcome (Lambert & Barley, 2002)

Common Factors (30%)

Alliance

Relationship with therapist

Support

Hopefulness

Expectancy Effects (15%)

Placebo effects

The Dodo bird hypothesis

Specific therapy techniques (15%)

Systematic

desensitisation

,

dream

analysis

,

role

play, etc.

Extratherapeutic

factors (40%)

Spontaneous recovery or remission

Fortunate events

Social supportSlide4

Common factors

or non-specific curative factors in

psychotherapy

“…decades of research consistently demonstrate that

relationship factors

correlate more highly with client outcome than do specialized treatment techniques… therapists need to remember that the

development and maintenance of the therapeutic relationship is a primary curative component of therapy

and that the relationship provides the context in which the specific techniques exert their influence.”

- Lambert & Barley (2001)

Psychotherapy, 38(4):357-361Slide5

Common factors

or non-specific curative factors in

psychotherapy

Working

alliance

:

Goals

: Objectives of therapy that both client and therapist endorse

Tasks

: Behaviors and processes within the therapy session that

leads

to

the

goal

Bonds:

The positive interpersonal attachment between therapist and client of mutual trust, confidence, and acceptance

Patient

rated

alliance

is

the

b

est

predictor

of

effectiveness

and

drop-out

. Slide6

Client-centered therapy

is a common factor therapy

It

’s

specific

factors

are

the

common factors of psychotherapy:Congruence - the willingness to transparently relate to clients without hiding behind a professional or personal facade.Unconditional Positive Regard - the therapist offers an acceptance and prizing for their client for who he or she is without conveying disapproving feelings, actions or characteristics and demonstrating a willingness to attentively listen without interruption, judgement or giving advice.Empathy - the therapist communicates their desire to understand and appreciate their clients perspective.Slide7

Psychoanalysis

The goal:Since psychological problems originate from childhood repressed impulses and conflicts, the aim of psychoanalysis is to bring repressed feelings into conscious awareness where the patient can deal with them.Slide8

Psychoanalysis

Focus on expression of emotionExploration of distressing experienceIdentification of recurring themesDiscussion of developmentFocus on interpersonal relations

Focus on the therapy relationship

Exploration of fantasy life

(

Shedler

, 2010). Slide9

Behaviour therapy

Assumptions of psychopathology:People learn their problems

Problems occur naturally through a learning process

Classical conditioning

(Pavlov)

e.g., phobias

Operant conditioning

(

Skinner

)

e.g., Substance abuse, Personality disorders, depression

Modell

learning (Bandura)Problems are sustained largely through escape and avoidance of aversive eventsSlide10

Behaviour therapy

Assumptions of curative factorsIf problems are learned, new and more effective behaviors can be learned as well Mechanism

:

exposure

extinction

classical and operant conditioning

modell

learning

Techniques

Systematic

desensitization (Wolpe)Graduated exposure treatmentsFloodingSlide11

Cognitive therapy

Albert Ellis and Aaron T. BeckAssumptions of psychopathologyThoughts are the cause of our problemsWay we think about the world dictates how we feel about ourselves, others, and the future

This is a cognitive triad

Depressed people have a negative cognitive triad

Combined with logical errors  get depressedSlide12

Cognitive therapy

Assumptions of curative factorsNeed to identify dysfunctional core schema and replace with more accurate and effective schemaNeed to challenge the cognitive distortions or false beliefs with evidence and look for more accurate thoughts

Techniques

Identify irrational beliefs, maladaptive interpretations of events

Challenge beliefs directly

Encourage more rational beliefs and interpretationsSlide13

Family therapy

Assumptions of psychopathology: Dysfunctional

family

system

Assumption

of

curative

factors

:

Family therapy treats the family as a system.

Therapy guides family members toward positive relationships and improved communication.Slide14

Curative

factors in group therapy(Yalom, 2005)

Universality

The recognition of shared experiences and feelings among group members and that these may be widespread or universal human concerns, serves to remove a group member's sense of isolation, validate their experiences, and raise self-esteem

Altruism

The group is a place where members can help each other, and the experience of being able to give something to another person can lift the member's self esteem and help develop more adaptive coping styles and interpersonal skills.

Instillation of hope

In a mixed group that has members at various stages of development or recovery, a member can be inspired and encouraged by another member who has overcome the problems with which they are still struggling.

Imparting information

While this is not strictly speaking a psychotherapeutic process, members often report that it has been very helpful to learn factual information from other members in the group. For example, about their treatment or about access to services.

Corrective recapitulation of the primary family experience

Members often unconsciously identify the group therapist and other group members with their own parents and siblings in a process that is a form of transference specific to group psychotherapy. The therapist's interpretations can help group members gain understanding of the impact of childhood experiences on their personality, and they may learn to avoid unconsciously repeating unhelpful past interactive patterns in present-day relationships.

Development of socializing techniques

The group setting provides a safe and supportive environment for members to take risks by extending their repertoire of interpersonal

behaviour

and improving their social skillsSlide15

Curative factors in group therapy

(Yalom, 2005)Imitative

behaviour

One way in which group members can develop social skills is through a modeling process, observing and imitating the therapist and other group members. For example, sharing personal feelings, showing concern, and supporting others.

Cohesiveness

It has been suggested[3] that this is the primary therapeutic factor from which all others flow. Humans are herd animals with an instinctive need to belong to groups, and personal development can only take place in an interpersonal context. A cohesive group is one in which all members feel a sense of belonging, acceptance, and validation.

Existential factors

Learning that one has to take responsibility for one's own life and the consequences of one's decisions.

Catharsis

Catharsis is the experience of relief from emotional distress through the free and uninhibited expression of emotion. When members tell their story to a supportive audience, they can obtain relief from chronic feelings of shame and guilt.

Interpersonal learning

Group members achieve a greater level of self-awareness through the process of interacting with others in the group, who give feedback on the member's

behaviour and impact on others.Self-understanding

This factor overlaps with interpersonal learning but refers to the achievement of greater levels of insight into the genesis of one's problems and the unconscious motivations that underlie one's

behaviour

.Slide16

Strategy

Long term goals

Ta

ctics

Tasks

of

the

session

Techni

ques

Moment

to

moment

Yeomans

,

Clarkin

,

Kernberg

2002.

alapján

Principles of interventionsSlide17

THANK YOU!