Psychotherapy Approaches Copyright © 2007 Brooks/Cole, a division of Thomson Learning, Inc. Questios… • What is psychotherapy? • Today, How many psychotherapy systems exist? • What can be the factors that contribute to change in psychotherapy? Growth & Confusion • Field of psychotherapy fragmented by future shock & staggered by over-choice; ≥ 400 systems of psychotherapy today • Developers of systems often claim superior effectiveness without controlled research • Fragmentation & confusion are reduced by a comparative analysis of psychotherapy systems • Comparative analysis requires an understanding of each systemCopyright & an©overarching, integrative structure 2007 Brooks/Cole, a division of Thomson Learning, Inc. Defining Psychotherapy The informed & intentional application of clinical methods & interpersonal stances, derived from established psychological principles, for the purpose of assisting people to modify their behaviors, cognitions, emotions, &/or other personal characteristics in directions that the participants deem desirable. Copyright © 2007 Brooks/Cole, a division of Thomson Learning, Inc. Prevalence of Theoretical Orientations Copyright © 2007 Brooks/Cole, a division of Thomson Learning, Inc. Theory • In scientific usage, a consistent perspective on human behaviour, psychopathology, & mechanisms of therapeutic change • Theories describe clinical phenomena, delimit & organise mass of information, & integrate it all into knowledge that directs psychotherapy • Good clinicians are flexible, & good theories are widely applicable Theory_CBT Her zaman en doğru olanı yapmalıyım. -meli -malı tarzı düşünce Hiçbir şeyin doğru düzgün yapamıyorum. Aşırı genelleme Annem üzüldüğümü görürse çok üzülecek. Falcılık, Felaketleştirme Theory_ST 18 yaşında sevgilisi ile öpüştüğü için hala suçluluk yaşama Suçluluk hisleri yüzünde babasını mezarını ziyaret edememe Duygularını kimseye göstermeme Oğluna yeterinde bakım veremediğini düşünme Kusurluluk, Duyguları bastırma, Yüksek standartlar Therapeutic Commonalities Everbody has won and all must have prizes. Dodo bird verdict Alice in Wonderworld Therapeutic Commonalities • Common (nonspecific) factors shared by all psychotherapies & not specific to any one. • Largely neglected by theories as centrally important, but research suggests they are: • Most consensual common factors: client’s positive expectations & facilitative therapy relationship Positive Expectations • Positive expectations frequently correlate with positive outcomes • Responsible for up to 1/3 of successful psychotherapy • Necessary but not sufficient for treatment success • An active, common ingredient in all forms of psychotherapy Positive Expectations Psychotherapy > Placebo > Kontrol group Therapeutic Relationship • 12%+ of psychotherapy outcome due to therapeutic relationship • Accounts for second largest proportion of outcome behind client contribution • Its relative importance remains controversial: range from the essential process of change to helpful precondition of change Therapeutic Alliance Therapeutc alliance according to Bordin (1979): • Agreement on the Goals of the treatment • Agreement on the tasks • Development of a personal bond Rogers’ Facilitative Conditions •Therapist is congruent or genuine •Therapist relates with (unconditional) positive regard •Therapist expresses accurate empathy Hawthorne Effect • People improve as a result of having special attention paid to them • Psychotherapist gives special, undivided attention to client • 50% of public-speaking phobias show improvement following attention placebo • Placebo groups are used to control for Hawthorne effect Specific Factors • In addition to common factors, psychotherapies have factors relatively specific to them • Psychotherapists cannot practice “nonspecifically” – they say & do specific things • Processes of change are specific or unique contributions of therapy systems Processes of Change A middle level of abstraction between global theories & specific techniques Awareness or Insight Therapies: Processes of Change Consciousness Raising • Experiential level: Feedback • Environmental level: Education Catharsis • Experiential level: Corrective emotional experiences • Environmental level: Dramatic relief Choosing • Experiential level: Self-liberation • Environmental level: Social liberation Action or Behavioral Therapies: Processes of Change Conditional Stimuli • Experiential level: Counterconditioning • Environmental level: Stimulus control Contingency control • Experiential level: Reevaluation • Environmental level: Contingency management Therapeutic Content • Content to be changed is largely a carry- over from system’s theory of personality & psychopathology • Distinction between process & content is fundamental • Theories of personality & psychopathology tell us what is changed; theories of process tell us how change occurs Therapeutic Content I Intrapersonal conflicts • Anxieties & defences • Self-esteem problems • Personal responsibility Therapeutic Content II Interpersonal conflicts • Intimacy and sexuality • Communication • Hostility • Control of others Therapeutic Content III Individuo-social conflicts • Adjustment vs. transcendence • Impulse control Therapeutic Content IV Beyond conflict to fulfilment •Meaning in life •The ideal person Case of Rain 47 yaşında kadın danışan 47 yaşında kadın danışan, 6 çocuğu var. Arlene(17), Barry(15), Charles(13), Debra(11), Ellen(9), Frederick(7) Temizlik, Biriktirme, Cinsellik/Din, Kontrol Günde 25-30 kez yaklaşık 5-10 dakika el yıkayıp, 2 saat banyo yapıyor. İç çamaşırları sadece 1 kez giyilip atılıyor. Evi çöp ev olmuş. Öz bakımı düşmüş (7 yıldır alışveriş yapmamış). Çocuklarını yıkanmaya zorluyor, eve arkadaş davet edemiyorlar. Cinsel uyarılma bozukluğu var. Depresif belirtileri var. Psikotik şüphesi elenmiş. Case of Rain 10 yıl önce en büyük kızı okuldan grip geliyor ve kıl kurtları döküyor. Bütün aileye kendisi de dahil bu grip bulaşıyor ve hepsine bakmak zorunda kalıyor. Doktor tüm çamaşırların kaynatılması ve önlem alınması konusunda uyarıyor. Rain’in kaygıları çok artıyor ve hastalık geçtikten sonra da bu kaygılar devam ediyor. 6 yıl başarısız tedavi süresi geçiriyor. Eşiyle 2 senedir araları çok bozuk eşini de banyo ritüellerine katıyor. Sabahları bu ritüelleri eksiksiz gerçekleştirebilmek için çok erken saatte uyanıyor. Çocuklarıyla ilişkileri de kötü sürekli yıkanmalarını istiyor . Case of Rain Katolik, tutucu ve cinsel konuların konuşulmasına izin verilmeyen bir aile. Baba çok otoriter, kızlarının fikirlerini söylemesine tahammül edemeyen bir yapıda. Çocuklarını sürekli takip edip sorgulayan bir baba. Anne soğuk ve saplantılı bir kadın. Cinselliğin kötü ve iğrenç bir şey olduğunu söylüyor. Kızlarını temiz olmaları konusunda sürekli uyarıyor.