treatment
TRANSCRIPT
Psychotherapy Outcome Research
¨ Eysenk, 1950, no impact ¨ Meta-‐analysis: review literature and find effect size (Smith)
¨ Effect size: ¤ Measure of standard deviaHon units of difference between treated and untreated
Average effect size of .85
50% improved by 8th session
75% imporved after 6 months
People do well, women more likely to seek treatment
Research Overview META-ANALYSIS • Smith, Glass and Miller
Effect Size Meta-Analysis • Eysneck said untreated
people did better than treated people
• What’s the criticism of meta-analysis?
• You end up crunching numbers, and can’t control for the quality of the research
RESULTS: • 50% of clients showed
marked improvement after 8 sessions.
• Dose dependent effect • Howard et al. (1986): • The bigger the does, the
better the outcome • 75% at 26 sessions, and
85% at 52 sessions, 2 years, a little more!
How Much Does Therapy Help?
Average effect size of .85
50% improved by 8th session
75% improved after 6 months
Effects of Treatment Length
Remoralization
Remediation
Rehabilitation
Phase Model
Dose dependent effect • Howard et al. (1986): • The bigger the does, the better the outcome • 75% at 26 sessions, and 85% at 52 sessions, 2 years, a little more!
Therapy Variables
¨ Client: ¤ Largest contribuHon to outcome
¤ Lower SES and educaHon, drop out earlier and more frequently (but doesn’t effect outcome if you stay)
¤ Individual and Group similar ¤ Individuals over 65 less problems (except demenHa)
¤ Highest rates 25-‐44
Therapy Variables: Therapist and Relationship
Therapy relationship
alliance,
cohesion,
empathy,
collecting feedback
Therapist:
Non-technical aspects most important, little difference in outcome
If matched ethnicity, therapist factors account for 30% of outcome variance
IntervenHons Based on Behaviorism
¨ Behaviorists believe behavior is generated and maintained by factors external to the person
Systematic Desensitization
Systematic desensitization is a
specific technique that breaks the link
between the anxiety-provoking stimulus and the anxiety response.
This treatment requires the patient to gradually confront the
object of fear.
Punishment
¨ Influences on punishment: ¤ Immediacy ¤ Consistency ¤ Intensity ¤ Verbal clarification ¤ Removal of All Positive
Reinforcement ¤ Reinforcement for
Alternative of Behaviors
Beck’s Cognitive Therapy
¨ AutomaHc thoughts: maladapHve lead to symptoms
¨ Cognitive targets of CT: ¤ Cognitive Schemas ¤ Automatic Thoughts ¤ Cognitive Distortion ¤ Cognitive Profile
Beck’s Cogni4ve Profiles
Negative View of Self
Negative View of World
Negative View of Future
Beck’s CogniHve Profile of Depression Beck’s CogniHve Profile of Anxiety
Excessive Form of Normal Survival Mechanisms • Unrealistic Fears about
Physical Threats • Unrealistic Fears about
Psychological Threats
Basic Cognitive Therapy Techniques. • Usually takes about 12 - 20 weeks. • The essential goal of cognitive therapy is to understand the realities of an anxiety-provoking situation and to respond to reality with new actions based on reasonable expectations. Treatment
• First, the patient must learn how to recognize anxious reactions and thoughts as they occur. • One way of accomplishing this is by keeping a daily diary that reports the occurrences of anxiety attacks and any thoughts and events associated with them. A patient with OCD, for instance, may record repetitive thoughts. Recognize Reactions
• These entrenched and automatic reactions and thoughts must be challenged and understood. • Again, using the OCD example, one approach is to record and play back the words of the repetitive thoughts, over exposing the patient to the thoughts and reducing their effect. One effective approach for patients with generalized anxiety disorder targets their intolerance of uncertainty and helps them develop methods to cope with it.
Understand and Challenge
• Patients are usually given behavioral homework assignments to help them change their behavior. • For example, a person with generalized social phobia may be asked to buy an item and then return it the next day. As the patient performs this action, they observe any unrealistic fears and thoughts triggered by such an event. Homework
• As the patient continues with self-observation, they begin to perceive the false assumptions that underlie the anxiety. • For example, patients with OCD may learn to recognize that their heightened sense of responsibility for preventing harm in non-threatening situations is not necessary or even useful.
Perceive false assumptions
• At that point, the patient can begin substituting new ways of coping with the feared objects and situations. New Ways of Coping
Linehan’s DialecHcal Behavioral Therapy
¨ OutpaHent for borderline ¨ DialecHc: Acceptance and Change
¨ Focus on present ¨ Four requirements:
¤ commit to period of Tx & a^end all sessions,
¤ reduce suicidal behavior, ¤ work on behaviors that interfere with therapy,
¤ a^end skills training
Psychodynamic Therapies
¨ Insight oriented ¨ Past determines the
present: ¤ Transference (Past will
determine present relationships through projection).
¨ General principles apply to everyone ¤ Defense mechanisms,
Dr. Freud said every one of us must use them to allay fears
¨ Conflicts affect personality development
Classical Psychoanalysis • Primitive • Ruled by Instinct • Libido • Aggression • Immediate Pleasure
Id
• Operates on reality principe • Defer immediate gratification • Executive functioning • Manage Id impulses • Social Acceptable
Ego
• Conscious • Moral code • Standards internalized from
parents and society • Right and Wrong: GUILT
Superego
Deterministic: irrational forces, unconscious
motivations, bio drives, and psychosexual events up to age 6 determine behavior
Anxiety and the Defense Mechanisms
Repression
Regression
Projection
Displacement
• Behaviors exactly opposite of what we are feeling
Reaction Formation
• Cut off from affect
Intellectualization
Rationalization
• Normal and desirable • Channel into something else
Sublimation
We get anxious when Id impulses get too
strong and start moving into
consciousness. Prevent us from becoming
aware of forbidden id impulses
Freudian Psychoanalysis Psychopathology results from unconscious, unresolved conscious from childhood
Defense Mechanisms: Include repression, reaction formation, and displacement
Therapy goal: Reduce maladaptive behavior by bringing unconscious material into conscious awareness
Therapy process: • Clarification, confrontation, interpretation, and working through
PsychoanalyHc Treatment and Techniques ¨ Make conscious the unconscious ¨ Bring to the light id conflicts ¨ Free associaHon ¨ Treatment includes:
¤ ClarificaHon ¤ ConfrontaHon ¤ InterpretaHon ¤ Working Through
¨ Transference and Countertransference
Freudian Therapy process:
Clarification
Confrontation: • Bring up something below the surface
Interpretation
Working through
Jung’s Analytic Psychology Stood alone for decades
Personality is not shaped by age 5 or 6, it is a life long continuum
Focus is on adulthood. Personality changes are made mid-life, they don’t necessarily, but they can
Components of the Unconscious: the personal unconscious consists of personal experiences and the collective unconscious consists of collective epeirneces of the human race (archetypes).
Personality Theory: Development continues throughout the lifespan. Individuation is a key task of the second half of life and involves developing a unique, integrated identity
Jungian Concepts:
Collective Unconscious • We humans share a collective
unconscious. Two unconscious layers personal and collective. There from beginning of time.
Archetypes • Primordial images that exist in the
collective unconscious.
Archetypes
¨ Universal and Pa^erns of experience passé dhtrough generaHons (art, literature, dreams)
¨ Neurosis is a^empt to free ourselves from our archetypes, they are prevenHng us from fulfiling our potenHal. Part of process on way to individuaHon.
Therapies and IntervenHons Based on Humanism/ExistenHalism
Emphasize subjective experience
Phenomenlogical approach: • Enter client’s
subjective world
Trust clients’ capacity
Focus on freedom, choice,
autonomy, purpose,
meaning, focuse on present
Humanists: Move toward
actualization if nurture
Existentialists: NO internal
nature, world lacks intrinsic meaning, we must make sense of
meaninglessness
Rogers: Client/Person Centered Therapy
Inborn capacity for purposive, goal-directed behavior
Faulty learning leads to hateful, self-
centered, ineffective, antagonistic approaches
Therapy: expand awarnes and liking of
self
Key characteristics of treatment: • Empathy • Warmth • Genuiness
Unconditional Positive Regard!
Gestalt Boundary Disturbances • Taking information in whole
without crtical examination • Become overly compliant
Introjection
• Put out our feelings on to others
• Leads to Paranoia Projection
• Turn onto you what you would like to do to someone else
Retroflection
• Distancing from your feelings and others. Excessive humor.
• Asking a lot of questions Deflection
• Lack of awareness of how you and someone else are actually two different people
Confluence
Boundary Disturbances: When you engage, you don’t have true
contact
Existential Therapy Overview
• Personal choice and responsibility for developing meaningful life • We are evolving and becoming
• Inability to cope authentically with concerns of existence • Existential versus neurotic anxiety
• Live more committed, self-aware and authentic life
• Here and now • Therapeutic relationship
Hypnotherapy
Hypnosis
• State or condition in which person can respond to suggestions by experiencing alternations in perceptions, memory, or mood
Can lead to altered or dissociated state
Used for:
• Pain, asthma, conversion, substance use, Acute stress and other anxiety, Obesity, insomnia
Aid memory, but can create false memories (and exagerrate comnfidence in them)
True memory or not, reflects relevant treatment issues
Ekricksonian involves techinques that rely on psycholinguistic nuance
Consequences of Oppression
¨ Internalized Oppression ¨ Conceptual Incarceration
¤ Adopt White worldview/lifestyle
¨ Split-self syndrome ¤ Polarizing self into good
and bad (bad represent one’s African American identity)
¨ Survival Mechanisms ¤ Playing it cool ¤ Happy-go-lucky
Cultural versus Functional Paranoia
Cultural Paranoia • Lack of disclosure due to experiences
of prejudice in past • Healthy response • When meaning of paranoia is
discussed, client encouraged when it is desirable or not to disclose
Functional Paranoia • Pathology, won’t disclose to anyone,
general distrust
Intercultural Nonparanoiac Discloser • Low functional, low cultural • Willing to disclose
Functional Paranoiac • High Fucntional, low cultural • Generally nondisclosive • Primarily pathology • Therapist competence rather than race
or culture • Alleviate pathology
Healthy Cultural Paranoiac • Low functional, high cultural • Reluctant with Anglo therapists • Explore meaning, make conscious,
therapist disclosure • Disclosure flexibility
Confluent Paranoiac • High fucntional, high cultural • Combination of pathology and effects
of racism • Combine approaches • Likely therapist from same racial/ethnic
group
Ridley’s Paranoia and Disclosure
Model