L15 Introduction to Psychotherapy?

參考文獻(xiàn)：Pomerantz, A. (2013). Clinical psychology: science, practice, and culture (3rd ed.). Thousand Oaks, CA: SAGE Publications.

15.1 Theoretical Orientations

? Theoretical orientation: Preference for a specific theory that provides a psychologist with a conceptual framework for understanding a client’s needs and for formulating specific interventions.

? A variety of perspectives:

- Psychoanalytic & Psychodynamic

- Humanistic / Client-Centered

-?Behavioral

- Cognitive

- Cognitive-Behavioral

- Mindfulness & Acceptance Based

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Psychodynamic Approaches?- Sigmund Freud

? View: Problems are symptoms of unresolved traumas and?conflicts.

? Focus of treatment:

- Inner, often unconscious motivations

- Resolving conflicts between personal needs and social requirements

? Approach:

- Clients work through problems by developing a better understanding the relationships between overt problems and unresolved, internal conflicts that cause them;

- Making the unconscious conscious.

?

Humanistic Approaches?- Carl Rogers

? View: Problems result from difficulties in daily life, especially a lack of meaningful relationships and goals.

? Focus of treatment:

- The whole person ;

- Achieving potential for personal performance and greater richness of experience.

? Approach:

- Relationship with the therapist is key;

- Empathy, genuineness, and unconditional positive regard.

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Behavioral Approaches?- Joseph Wolpe & B. F. Skinner

? View:

Problems are the result of learned behaviors that are not?helpful or adaptive.

? Focus of treatment:

Observable maladaptive behavior(s) and?the environmental contingencies that sustain them.

? Approach:?Clients learn healthy behaviors by applying the principles of conditioning (e.g., reinforcement, punishment).

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Cognitive Approaches?- Aaron T. Beck

? View: Problems result from what we think (cognitive content) and how we think (cognitive process)

? Focus of treatment:

- Identifying and changing cognitive distortions

? Approach: Clients learn adaptive ways of thinking about experiences through identifying and challenging problematic thought patterns

?

Mindfulness/Acceptance Approaches - Steve Hayes

? View: Problems result from an inability to?accept what is out of one’s control

? Focus of treatment: Maximize potential for?a full and meaningful life

? Approach:

- Learn skills to deal with painful?thoughts/feelings so that they have less?impact and influence over you

- Clarify your values

- Use skills/knowledge to guide, inspire?and motivate changes for for a life worth?living

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15.2 Types of Psychotherapy Practiced by Psychologists

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Most Common Types of Therapy Practiced

? Most popular theoretical orientations have changed over time

? Cognitive and cognitive-behavioral approaches have become?very popular

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Eclectic & Integrative Approaches

? Eclectic therapy: Selecting the best treatment for a given client?based on empirical data?- Usually based on client diagnosis

? Integrative therapy: Blending techniques in order to create an?entirely new, hybrid form of therapy

? Assimilative approach

- Therapist is grounded in one primary?theoretical orientation

- Other techniques are incorporated

? Distinguished from an eclectic?approach because techniques are?blended together; Distinguished from an integrative?approach because one single?theoretical orientation is dominant

15.3 Common Factors in Treatment?Approaches

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? Common factors: Features observed across all forms of?therapy

? Therapeutic Alliance: A trusting relationship of two partners?working toward a common goal

- Different from other relationships

? Unilateral: Focus is on the client’s needs

? Systematic: Agree on steps to reach an identified goal

? Formal: Specified boundaries

? Time-limited: Specific time limit

? Of common factors, therapeutic alliance is best predictor of outcome

? Hope: Positive expectations for treatment

- Optimism that treatment will produce desired changes

? Attention: Acknowledging a problem and focusing on it may?lead to improvement

- Even before treatment techniques are used, some improvement?may be observed

?

Three-Stage Model

? Sequence of common factors over the?course of therapy

? Three-stage sequential model of?common factors

1.?Support factors

-?Therapeutic alliance, trust, warmth

2. Learning factors

-?Changing expectations, thought?patterns, increasing insight

3. Action factors

-?Facing fears, taking risks, practicing new?behaviors, working through problems

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How do do it:?Genuineness; Respect; Empathy; Warmth

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15.4 Differences across Approaches

? Insight versus action

- Psychodynamic

? Insight-oriented

? Focus on gaining insight into one’s?unconscious motives

- Cognitive and Behavioral Therapies

? Action-oriented

? Focus on changing overt behaviors

? More specific behavioral goals

? Focus on therapeutic relationship

- Important in all schools of therapy

- Emphasized the most in humanistic therapy

? Thought to be the necessary & sufficient element in?humanistic therapy

? Focus within versus outside therapy session

- Emphasis within sessions

- Psychodynamic

- Humanistic

- Emphasis outside sessions

? “Homework”: Tasks and activities assigned to be completed?between treatment sessions

- Behavioral

- Cognitive

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15.5 Which one is more important?

Are Common Factors More Important?

? Dodo-bird Verdict

- Argument that different types of therapy generally produce?equivalent outcomes

- Must be due to common factors

? Evidence used to support this?verdict comes from studies that?compared different treatments?(without considering the?specific problems/disorders?being treated)

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Are Specific Techniques More Important?

? Evidence-based treatments movement

- Specific therapies for specific disorders

- Analysis leading to dodo-bird verdict collapses across:

? Many different kinds of therapy

? Many different kinds of problems

? Direct comparisons for?specific disorders

- For some disorders and?symptoms, certain?therapies appear superior

- Strong support for?cognitive-behavioral?techniques

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Multiple Factors are Important!

“The treatment method, the?therapist, the client, and the?principles of change are vital?contributors, and all must be studied.?Comprehensive evidence-based?practices will consider all of these?determinants and their optimal?combinations. Common and specific?effects and art and science appear?properly complementary, not at?either/or dichotomies.”?(Paul, 2007, p. 141)

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15.6 Does Psychotherapy Work?

? Efficacy studies: Does therapy work “in the lab”?

- Well-defined group of clients

- Meet diagnostic criteria only for the disorder being studied

- Manualized treatment

- Random assignment to treatment or control

? Landmark meta-analysis (Glass & Miller, 1980)

- 475 psychotherapy efficacy studies

- “The average person who receives therapy is better off than?80% of the persons who do not” (effect size =?0.85)

? Effectiveness studies: Does therapy work “in the real world”?

- Wider range of clients

- Complex diagnostic profiles

- Variability in therapist methods (i.e., no manuals)

- Typically does not include a control group

? “Mental Health” (Consumer Reports, 1995)

- ~90% of people who felt “very poor” or “fairly poor”?before starting therapy felt “so-so, good or very good”?after completing therapy