Psychotherapy
Overview
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What is psychotherapy?
Who does psychotherapy?
Approaches to psychotherapy.
Classification of psychotherapies.
Three examples of psychotherapy:
– psychoanalysis
– cognitive therapy
– interpersonal therapy.
Psychotherapy
• “Psychotherapy…is a fiendish and
expensive way of tampering with the lives
of patients weak enough or foolish enough
to seek outside help with personal problems
for which, in fact, only will power is any
solution.”
• Quentin Crisp
Definitions
• Somatic therapies
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Medicines
Electroconvulsive Therapy
Surgery
Historical
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Insulin coma treatment
Hydrotherapy
Removal of teeth
Hysterectomy
• Social Treatments
– Environmental therapy
– Work therapy
– Moral therapy
• Psychological treatments
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Talk-therapy
Hypnosis
Psychodrama
Behavioral therapy
• “Despite their diversity…all
psychotherapies attempt to relieve suffering
and psychological disability by inducing
changes in patients’ attitudes and behavior.”
– Jerome Frank 1991
Who practices psychotherapy?
• Prescribing
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Psychiatrists
Psychoanalysts
Nurse Practitioners
Psychologists (some)
• Non-Prescribing
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Psychoanalysts
Clinical Psychologists
Social Workers
Counsellors (MA,
Religious counsellors)
– Co-counsellors, peer
therapy
Modes of Psychotherapy
• Dyadic
– Adult
– Child
• Non-dyadic
– Couples therapy
– Family therapy
– Group therapy
Classification Schemes
• Exploratory (insight oriented, expressive,
uncovering)
– insight into unconscious psychic conflict
– Goal: structural change in personality
• Supportive (suppressive)
– support adaptive ego defenses
– Goal: strengthen adaptation
• Evocative Psychotherapies
– Seeks to improve total psychological
functioning by providing a supportive,
accepting therapeutic relationship in which
unconscious experiences can emerge into
awareness leading to change.
• Psychoanalysis
• Existential Psychotherapy
• Self-actualizing therapies (Rogers, Maslow)
• Directive Psychotherapies
– Symptom- or problem-focused.
–  Cognitive
• Cognitive Therapy (Beck)
• Rational Emotive Therapy (Ellis)
• Social Learning Therapy (Bandura)
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Behavioral
• Reinforcement
• Counter-conditioning
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Abreactive
• Primal therapy
• EMDR
• Schools and Practitioners
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Eclecticism
Cross-trained
Self-selection
General (e.g., psychoanalysis, client-centered
therapy) vs. Focused (e.g., Dialectical
Behavioral Treatment for Borderline
Personality Disorder, CBT for Panic Disorder)
Psychoanalysis
• Freud
• Office-based psychiatry
• Drive theory
– Structural model of the mind (ego, id, superego)
• Derivations: Ego psychology, Object
Relations Theory, Self Theory
• Unconscious
• Psychic determinism: past as prologue
• Psychoanalysis in practice
– Free association
– Transference
– Resistance
Cognitive Therapy
• Aaron Beck
• “Common sense psychology”
• Psychological problems result from faulty
learning, making incorrect inferences on the
basis of inadequate or incorrect information,
and not distinguishing between imagination
and reality.
• Patients systematically misconstrue specific
kinds of experiences
Cognitive Distortions
• All-or-nothing thinking (black-white,
polarized, dichotomous thinking)
• Catastrophizing (‘fortune telling’)
• Emotional reasoning
• Mind reading
• Over-generalization
• ‘Should’ and ‘Must’ statements
• Etc.
Core
Beliefs
Intermediate
Beliefs
Event
AT
Behavior
Emotion
• Cognitive Therapy techniques to modify
intermediate and core beliefs:
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Socratic questioning
Behavioral experiments
Cognitive continuum
Rational-emotional role playing
Acting ‘as if’
Using others as reference points
Self-disclosure
Interpersonal Psychotherapy
• Psychotherapy should focus on what
happens between people, not on the brain,
mind, unconscious, etc.
• Social attachments are protective against
stress and depression.
• Depression is related to interpersonal
relationships--as cause and consequence.
Interpersonal functioning and
Depression
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Grief
Role Transition
Interpersonal Disputes
Interpersonal Deficits
Non-specific dimensions of
psychotherapy
• Re-moralization
• Supportive, non-judgmental attitude of
therapist
• Expression of emotions
• Unanalyzed positive transference
• Unanalyzed negative transference
• Identification with the therapist
• Strengthening ego functions
Further Reading
• “Freud and Beyond” by Stephen Mitchell
and Margaret Black
• “Approaches to the Mind. Movement of the
Psychiatric Schools from Sects toward
Science” by Leston Havens
• “Persuasion and Healing” by Jerome Frank