Psychological Interventions.The basic forms

Zoltan Kovary PhD

ELTE PPKDepartment of Clinical Psychology and Addictology

2015/16 Autumn Semester

Classifications of psychotherapies

ProfoundityFrom supportive to dynamicBasic formsIndividual, group & system approachesBased on trendsFrom PA to cognitive, etc..Different aimsSymptoms, personality or relationshipTimeShort term or long termVerbalityFrom verbal to expressive

Individual Psychotherapies

Psychoanalysis & dynamic psychotherapies

Historical antecedents

Freuds personal and professional developmentHysteriaCharcot & hypnosisBreuers Anna O-case Cathartic technique

Understanding the Unconscious

Analysing symptomsStudies on Hysteria (1895)Analysing dreamsInterpretation of Dreams (1900)Analyisng parapraxesPsychopatology of Everyday Life (1901)Repetition Compulsion

The mind in conflict: the psychoanalytic model of pathologies

Symptoms Intrapsychic conflictsAnxietyDefenceConstructions (Compromise)Primary gain of illnessPathologic balance Suffering pressureMotivation for therapy

Methods and rules of psychoanalytic therapy

NeutralityAbstinenceFundamental rule - Free associationsSymptomsDreamsParapraxesInterpretationInsights or Resistance (defence)Gains from illness

The process of psychoanalysis

The infantile origins of neurosesFixation and regressionTransferenceThe repetition of infantile conflictWorking throughEmotional insightsReleasing libido to achieve the goals of the egoContertransferenceTraining therapy

The goals of psychoanalytic therapy

Where id was, ego shall bePleasure and reality principlesRestart stalled developmentLove and work

Famous case studies of Freud

Dora 1905 - hysteriaLittle Hans1909 - phobiaRatman1909 - obsessional neurosisThe Schreber-case 1911 - paranoiaThe Wolfman1918

Further developments of psychoanalytic (dynamic) therapies

Sndor Ferenczi and the Budapest SchoolThe antecedent of relational psychoanalysisTrauma therapiesEgo-analysisTime limited dynamic therapiesObject relational therapiesPsychoanalytic Selfpsychology

Jungian therapy

Four basis of time limited dynamic therapies

Good first interview (Argelander) with test interpretationRight psychodinamic focusActive treatment of reistenceActive treatment of detachmentt

The central relational conflict in time limited dynamic psychotherapy according to LuborskyActual therapeutical relationshipActual external relationshipsFormer relationshipsCentral relational conflict

The focus the triangle of conflictHidden feelingAnxietyDefence

The focus the triangle of personsTherapistParentsThe triangle of conflict has to be assigned to every peak of the triangleOthersO/PO/TT/P

Behavior therapies

BehaviorismThe phases of BTAnalysis of promlematic behavior S=f(S,O,C,C)Precise targetsTherapeutic planBT methodsSystematic desenzitizationOperant conditioningFloodingSelf-controlNegative practiseBlended into cognitive therapy = CBT

Cognitive TherapiesCognitive approach to pathologiesCognitive distortionsThe cognitive triad in depressionConceptualizationCharacteristicsTime limitedStructured with exact aimsNeeds active cooperation (home works)

The evolution of psychological disorders according to cognitive paradigmEarly life events

Dysfunctional basic assumptions

Significant life event

Basic assumptions Spontanous negative thoughts Cognitive distortions

Symptoms(Cognitive, affective, motivational, somatic, behavioral)Circulus vitiosusactivation

The most inportant methods in CBT

Cognitive techniques

Distratction

Counting the thoughts Reframing

Behavioral techniques

Notation of activities

Planning activties

Cognitive-behavioral techniques

Recognizing spontaneous negative thoughts

Questioning spontanous negative thoughts

Behavioral experiments

The five coloumns techique

Person Centered TherapyCarl Rogers, humanistic psychologyNon specific factorsEmpathyCongruencyUnconditioned positive regardNondirectivitySpecific factorsEncounterMirroring & VerbalizationConcentrating on the here and nowAvoiding authorityNo contraindications

Hypnotherapy

Historical backgroundTheories about hypnotic stateSusceptibilityTechniquesDirectIndirectIndications and fields of application

Relaxation and imagination therapyHistoryJung - ImaginationSchultz ATDesoilles Directed waking dreamLeuner Kathatym imaginated psychotherapyBackgroundPhysiological changes detectedArchaic consciousness-techniquesTransformation and integration of experiencesFormsAutogenic training, progressive relaxationApplicationBroad indications; contraindicationsIndipendent and combined forms individually and in groups; short & long versions

Group Therapies

Features of group therapies

Interpersonal processes are in focusGroup leaderHandling individual, interpersonal and group processes at the same timeThe client has to go beyond medical models of functioningSocialization is lowerFear of the group

The types of groups

SizeSmall (6-15 p.)Medium large (15-40)Large (over 40)CompositionHomogenous vs heterogenousOpen or closed

The nonspecific effects of groups according to I.D. YalomHope UniversalityInformationAltruismSocializationModelingInterpersonal learningCatharsisExistential factorsPrimary groupGroup cohesion

The proportion of individual and group processes in the cases of different techniquesGroup focusIndividual focusAnalytic, Interpersonal, Gestalt, Psychodrama, Person Centered, Cognitive

Therapeutic and group leading consequences

Individual, interpersonal and group processes system approach requiredRelational conflicts are dramatizedGroup as a psychological training groundThe destructive effects of absenteeism, failure and aftergroupsModeling co-therapy

Group analysis

The 1920s: Burrow - neurotic groupsThe 1930s: Slavson childrens groupsLewin Group dynamics1940s Group analysisW. Bion Working group and basic assumption groupUnconsciuos group fabtasiesFoulkes The group s primacyThe matrix-modelThe process of therapyAdvantages and disadvantages

The foundations of psychodrama

Jacob Levi Moreno (1889-1974)Focusing on personality, not symptomsThe group as a micro social mediumFramework and spontaneityReorganizing psychological universeExploring and resocializing aspectsIndication and contraidnicationComposition of groups

The structure of a psychodrama session

System Approaches in Psychotherapy:Couple & Family therapies

System approach in psychotherapy

Open and closed systemsThe principle of nonsummativityHomeostasisCircular reasoningSet of rulesLevels of communicationCoevolution

Couples and marriage therapies

The pair as a system and its disorders: Jrg Willis collusion-theoryPair: a new systemChoice of partner: intrapsychic needsWe bring it from our childhood experiencesThe aim of choice is establishing balance CollusionMutual and covert satisfaction of unconsciously determined needs Forming a joint neurosis constructed from wishes, anxiety and defenceForms of collusion: narcissistic, oral, anal, phallic

Couples and marriage therapies

Joint participationIndicationsCouple & marriage: explicit and implicit set of rulesBrought from childhood familyConflictsResistence - loyalityIntervention a third person out of the system

Family therapies

The family life cycle

Family dynamics

SystemHierarchiesBordersRolesStability and changeCoevolutionNormative and paranormative crisesThe index patients

Family therapy trendsPsychodynamic approachContextual approachIvn Bszrmnyi nagyTheory of familial systemsBowenExperimental schoolCarl Whitaker, Virginia SatyrBehavior therapeutic approach Liebermann, Stuart, PattersonStructual approachSalvador MinnuchinStrategic approachPalo Alto, Millano School (Selvini-Palazzoli), McMaster modell

Thank you for your attention!

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