COUN110 Lecture Notes - Lecture 1: Communication, Acculturation, Psychopathology
What is Counselling or Psychotherapy? Are they different?
Defining Psychotherapy
“
Psychotherapy
is the
informed
and
intentional
application of clinical methods
and interpersonal stances derived from established psychological principles for
the purpose of assisting people to modify their behaviours, cognitions, emotions
and/or other personal characteristics in directions that the participants deem
desirable.”
Prochaska & Norcross 2014 p.4
Defining Counselling
“Therapists are not in business to change clients, to give them quick advice, or to
solve their problems for them. Instead, counsellors facilitate healing through a
process of genuine dialogue with their clients.”
(Corey, 2017, p. 4)
Why are there so many different approaches to counselling?
What do we know about what works in therapy?
All therapies work (for someone)
Rosenzweig (1936): all forms of psychotherapy have evidence of being
effective
Dodo bird verdict from
Alice in Wonderland
: “Everybody has won
and all must have prizes”
○
•
If effectiveness doesn’t depend on the approach . . .
... perhaps there’s something that’s common to all therapies that makes the
difference
Common features may be what makes therapy effective
○
•
Common Factors Research
Positive Expectations
Treatment effectiveness is related to the extent to which clients expect
treatment to be effective (placebo-effect)
Clients need to believe in the process○
Therapists need to cultivate hope and enhance positive expectations○
•
Client and Extra-therapeutic Factors
Clients come to therapy with varying levels of:
Motivation○
Internal resources - resitentance○
External resources - money○
•
Importance of:
Readiness to change○
Strengths○
Level of functioning before treatment○
Social support network○
Socio-economic status○
Personal motivation○
Life events○
•
“Clients are not inert objects or diagnostic categories to whom techniques are
administered. They are not dependent variables on which independent variables
operate….people are agentive beings who are effective forces in the complex of
causal events”
Models and Techniques
Therapies achieve their effects in large part through:
Placebo○
Hope○
Expectancy○
•
A placebo or technically inert, provided in a way that offers positive
expectations for improvement, reliably produces effects as large as an
“active” treatment
•
researchers and practitioner’s allegiance to a particular therapy almost (if
not entirely) explains the difference it makes, in terms of outcome
•
A good predictor of a negative outcome is a lack of structure and focus in
treatment
•
Therapeutic Alliance
strong therapeutic alliance important in over 1000 studies•
therapeutic alliance contributes about 5-7 times more than specific models
or techniques
•
Rogers (1957) three core conditions found to be important•
Outcome depends on Client’s evaluation of the alliance (not therapists’)•
Early alliance quality predicts outcomes•
Hawthorne Effect: people change their behaviour just because they are
being “observed”
•
different clients have different capacities to form an alliance
Therapists
•
Some therapists are more effective than others•
Clients of the
most
effective therapists experience:
50% more improvement○
50% less dropout○
•
Variability amongst practitioners is not due to:
age, gender, years of experience,○
training, theoretical orientation and amount of supervision○
•
Evidence suggests better therapists use common factors to achieve better
outcomes
Better therapists formed better alliances with a range of clients○
•
Are All Psychotherapies Equivalent?
“are all psychotherapies equivalent?”
“are all treatments for a particular disorder equivalent?”
“are all treatments for a particular disorder, for a particular
client-group equivalent?”
▪
○
•
For specific disorders, some treatments are more effective because they
contain “specific psychological procedures targeted at the
psychopathology at hand” (Barlow, 2004; Crits-Christoph, 1997)
e.g., anxiety disorders
Behavioural and Cognitive Behavioural treatments are
generally thought to be more effective
▪
○
•
However – when therapist allegiance was included, CBT was no more
effective than other therapie
•
A Brief History of Beliefs
A QUICK HISTORY OF WESTERN CULTURE
The Church
Control of
Beliefs ○
Ecomony ○
Knowledge ○
•
God present in the world and part of everything•
Early Times
European society
small rural communities○
lived according to religious principles○
•
“Problems in living” dealt with from a religious perspective in local
community
•
Seriously disturbed and insane tolerated as part of community•
Emotional and interpersonal problems dealt with by priest – “cure of
souls”
Important element was confession followed by repentance○
Catholic confessional○
Earlier Christian rituals were communal affairs with admonishment,
prayer
○
•
Early Remedy of Mental Disorders
Healing rituals of shamanistic societies
Mental illness attributed to spirits○
•
Trephining - hole in skull to let out 'evil spirits' ○
•
Early Remedy of Mental Disorders
Temple-like asklepeia and retreat centres of Eastern Mediterranean
Religio-philosophical lectures○
Meditation○
Rest○
•
16th Century – Renaisance (independent of the church)
Great exploration •
Travel – Trade (&disease)
Monet and new artifacts ○
Changed economic structures of society
Beginning of middle class ▪
Education of self ▪
○
•
Middle Ages
Education•
Rise of Philosophy•
Descartes (1596-1650) – mind/body dualism – largely how we see our self
today – mind superior (men and purity) Body (women inpure)
•
17th Century – Enlightenment – science
Discorvery of Greek Culture: Plato, Aristotle, Socrates, Pythagorus •
Birth of Science •
Deism
God is outside of the world ○
•
Rediscovery
Secular Medicine
Empirical studies of Hellenist physicians found brain was
implicated in both:
Learning and knowledge▪
Depression, delerium and madness▪
○
•
Hippocrates 5th c. BCE insisted:
Illness be addressed by natural means○
Repudiated notion that seizures were “divine” and should be treated
by appealing and placating gods
○
•
19th Century – Darwinism
Naturalism
We are determined by our genetics ○
•
Freud, Skinner •
Capitalism: money = power and control •
Industralisation•
War•
18th & 19th Centuries
Capitalism & Industrialisation
people moved to the cities and worked in factories○
Work on land, more mechanized and profit oriented○
•
Changes in:
Relationships○
Way people dealt with emotional and psychological issues○
•
Workhouse system established to take care of old, sick and poor as family
networks now fragmented
•
Population influenced by scientific rather than religious beliefs•
Psychological shift from “tradition-centred” to “inner direction”•
Development of help that addressed issues related to inner life•
Asylums (industrialisation of mental health)
Asylums established for containment of “lunatics”
Some asylums run by Quakers who provided “moral treatment”○
1845 Asylums act in UK that required publicly run asylums to be
provided
○
•
Political power of medical profession enabled them to influence Acts of
Parliament that gave them control over publicly funded asylums
•
Asylums for insane members of upper classes established•
Bethlem hospital (Bedlam) in London was open to public in 18th – early
19th century, who paid 1d to watch lunatics
•
Science and Religion
Science replaced religion as dominant ideology in treatment of the insane•
Religious methods viewed as “demonology”•
Medical and biological explanations for insanity psychiatry a medical
speciality by end of 19th C
•
BEGINNINGS OF PSYCHOTHERAPY
(AS WE UNDERSTAND IT)
19th Century – 3 Streams
19th Century – Natural Science Empiricists
emphasis on measurement and classification - became known
as
somatiker (organicist)
tradition
○
1.
16th Century – Psychologist Philsophers
exploration of inner life and enigmas○
2.
17th Century - Clinical Researchers
Clinical observations informed theories○
Psychiker
tradition – only a
psychological
approach to mental
illness would prove effective
○
3.
Many clinicians made discoveries that had implications for psychotherapy
and the development of theories of personality
•
Freud, Jung, Adler•
1950s – Existentialism/humanism
Subjective meaning •
What does it mean to be me? •
Rise of individualism, focus on individual responsibility •
Key landmarks in theoretical development
Decade of Emergence Approach
1890 •Freudian Psychoanalysis
1910 •Post Freudian
1940 •Person-Centered
•Behavioural
•Psychodynamic/Object Relations
•Existential
1950 •Psychodynamic/Self-Theory
1960 •Cognitive, REBT
•Family/Systemic
•Gestalt
•Transactional Analysis
Decade of Emergence Approach
1970 •Cognitive-Behavioural Therapy
•Feminist Therapy
•Multicultural Therapy
1980 •Psychodynamic: Cognitive analytic & Interpersonal
1990 •Narrative
•Third-wave CBT
•Emotion Focused Therapy
2000 •Postmodern
•Positive Psychology
•Acceptance and Commitment Therapy (ACT)
PSYCHOTHERAPY
TODAY
Psychotherapy Streams Today
Psychoanalytic (Naturalist – Darwinism)
Goal: Self-awareness & insight into conflicts•
Focus on first 6 years of life as determinants for personality development•
Therapeutic process:
Unconscious thoughts and feelings explored○
Defensive processes which obstruct emotional awareness○
Consideration of issues related to sense of self and self esteem.○
•
Cognitive behavioural (Empiricism, Enlightenmnet – Birth of science)
(Postmodism)
Emotions & behaviour strongly influenced by cognitions•
Cognitions - Emotions•
Behaviour can maintain or change cognitions & emotions•
Psychiatric concerns arise from over reactive typical processes•
The now, not the past, and processes that maintain difficulties•
Evidence-based, time-limited, brief, intervention•
The Humanistic Approach (
Every person has their own unique way of perceiving and understanding
the world
•
Priority of a humanistic therapist is understanding the subjective world of
an individual
•
Other approaches take an objective view of people•
The scientific method is rejected as a way of studying people•
Qualitative research methods preferred•
The Postmodern Approach
truth depends on how you look at the world (i.e., your epistemology)
changing your perspective can change your experience○
•
social forces shape individuals
life is political
some groups are privileged▪
some groups are marginalised/disempowered▪
○
•
What makes an effective counsellor/therapist
Capacity to develop a therapeutic relationship and a strong working
alliance within the first few sessions
How do therapists do this?
Communication skills, empathy (Rogers),▪
○
•
An awareness of, and allegiance to a set of beliefs about
How clients develop difficulties○
How clients resolve these difficulties○
How therapists assist in this process○
•
What are your beliefs?•
Counselling/Therapy is . . .
Informed
•
Intentional
•
Informed & Intentional Practice
Beliefs (philosophy) •
Explanations (theory) •
Practice (approach) •
A contemporary perspective
BIO-PSYCHO-SOCIAL MODEL
Biopsychosocial Model
•Health or illness results from a complex interplay between biological,
psychological and social factors
•Holistic approach, attempts to avoid the mind-body split inherent in the
biomedical model
Impact of Biological Science
Life events change us and our neurons•
brain biology and thinking/feeling/experiencing are interactive
we can change our brain structure by how we feel, think, behave○
•
Klaus Grawe: “Psychotherapy achieves its effect through changes in gene
expression at the neuronal level”
•
Epigenetics: expression of certain genes that result from activation by
common environmental factors
•
Cultural Factors
Multicultural psychotherapy addresses our demographics, acculturation,
communication, conflicts, and biases
•
Western culture stresses the development of individual•
Non-Western cultures focus on social frameworks•
Language and metaphor reflect our mental structures and backgrounds•
Summary
Effective therapists
build strong alliances with clients○
have a set of beliefs, expressed in a theory that inform their
intentional practices
○
build hope and expectancy○
•
Clients bring different resources•
Many different approaches
based on different beliefs about people, how problems develop, how
problems are solved
○
theories of change○
professional practice○
•
Different (collective) beliefs have developed over time as a result of many
factors
•
All approaches can be helpful•
People are complex and experiences occur in a biopsychosocial (spiritual)
context
•
Lecture Week 1
What is Counselling or Psychotherapy? Are they different?
Defining Psychotherapy
“
Psychotherapy
is the
informed
and
intentional
application of clinical methods
and interpersonal stances derived from established psychological principles for
the purpose of assisting people to modify their behaviours, cognitions, emotions
and/or other personal characteristics in directions that the participants deem
desirable.”
Prochaska & Norcross 2014 p.4
Defining Counselling
“Therapists are not in business to change clients, to give them quick advice, or to
solve their problems for them. Instead, counsellors facilitate healing through a
process of genuine dialogue with their clients.”
(Corey, 2017, p. 4)
Why are there so many different approaches to counselling?
What do we know about what works in therapy?
All therapies work (for someone)
Rosenzweig (1936): all forms of psychotherapy have evidence of being
effective
Dodo bird verdict from
Alice in Wonderland
: “Everybody has won
and all must have prizes”
○
•
If effectiveness doesn’t depend on the approach . . .
... perhaps there’s something that’s common to all therapies that makes the
difference
Common features may be what makes therapy effective ○
•
Common Factors Research
Positive Expectations
Treatment effectiveness is related to the extent to which clients expect
treatment to be effective (placebo-effect)
Clients need to believe in the process
○
Therapists need to cultivate hope and enhance positive expectations
○
•
Client and Extra-therapeutic Factors
Clients come to therapy with varying levels of:
Motivation
○
Internal resources - resitentance
○
External resources - money
○
•
Importance of:
Readiness to change
○
Strengths
○
Level of functioning before treatment
○
Social support network
○
Socio-economic status
○
Personal motivation
○
Life events
○
•
“Clients are not inert objects or diagnostic categories to whom techniques are
administered. They are not dependent variables on which independent variables
operate….people are agentive beings who are effective forces in the complex of
causal events”
Models and Techniques
Therapies achieve their effects in large part through:
Placebo
○
Hope
○
Expectancy
○
•
A placebo or technically inert, provided in a way that offers positive
expectations for improvement, reliably produces effects as large as an
“active” treatment
•
researchers and practitioner’s allegiance to a particular therapy almost (if
not entirely) explains the difference it makes, in terms of outcome
•
A good predictor of a negative outcome is a lack of structure and focus in
treatment
•
Therapeutic Alliance
strong therapeutic alliance important in over 1000 studies
•
therapeutic alliance contributes about 5-7 times more than specific models
or techniques
•
Rogers (1957) three core conditions found to be important
•
Outcome depends on Client’s evaluation of the alliance (not therapists’)
•
Early alliance quality predicts outcomes
•
Hawthorne Effect: people change their behaviour just because they are
being “observed”
•
different clients have different capacities to form an alliance
Therapists
•
Some therapists are more effective than others
•
Clients of the
most
effective therapists experience:
50% more improvement
○
50% less dropout
○
•
Variability amongst practitioners is not due to:
age, gender, years of experience,
○
training, theoretical orientation and amount of supervision○
•
Evidence suggests better therapists use common factors to achieve better
outcomes
Better therapists formed better alliances with a range of clients○
•
Are All Psychotherapies Equivalent?
“are all psychotherapies equivalent?”
“are all treatments for a particular disorder equivalent?”
“are all treatments for a particular disorder, for a particular
client-group equivalent?”
▪
○
•
For specific disorders, some treatments are more effective because they
contain “specific psychological procedures targeted at the
psychopathology at hand” (Barlow, 2004; Crits-Christoph, 1997)
e.g., anxiety disorders
Behavioural and Cognitive Behavioural treatments are
generally thought to be more effective
▪
○
•
However – when therapist allegiance was included, CBT was no more
effective than other therapie
•
A Brief History of Beliefs
A QUICK HISTORY OF WESTERN CULTURE
The Church
Control of
Beliefs ○
Ecomony ○
Knowledge ○
•
God present in the world and part of everything•
Early Times
European society
small rural communities○
lived according to religious principles○
•
“Problems in living” dealt with from a religious perspective in local
community
•
Seriously disturbed and insane tolerated as part of community•
Emotional and interpersonal problems dealt with by priest – “cure of
souls”
Important element was confession followed by repentance○
Catholic confessional○
Earlier Christian rituals were communal affairs with admonishment,
prayer
○
•
Early Remedy of Mental Disorders
Healing rituals of shamanistic societies
Mental illness attributed to spirits○
•
Trephining - hole in skull to let out 'evil spirits' ○
•
Early Remedy of Mental Disorders
Temple-like asklepeia and retreat centres of Eastern Mediterranean
Religio-philosophical lectures○
Meditation○
Rest○
•
16th Century – Renaisance (independent of the church)
Great exploration •
Travel – Trade (&disease)
Monet and new artifacts ○
Changed economic structures of society
Beginning of middle class ▪
Education of self ▪
○
•
Middle Ages
Education•
Rise of Philosophy•
Descartes (1596-1650) – mind/body dualism – largely how we see our self
today – mind superior (men and purity) Body (women inpure)
•
17th Century – Enlightenment – science
Discorvery of Greek Culture: Plato, Aristotle, Socrates, Pythagorus •
Birth of Science •
Deism
God is outside of the world ○
•
Rediscovery
Secular Medicine
Empirical studies of Hellenist physicians found brain was
implicated in both:
Learning and knowledge▪
Depression, delerium and madness▪
○
•
Hippocrates 5th c. BCE insisted:
Illness be addressed by natural means○
Repudiated notion that seizures were “divine” and should be treated
by appealing and placating gods
○
•
19th Century – Darwinism
Naturalism
We are determined by our genetics ○
•
Freud, Skinner •
Capitalism: money = power and control •
Industralisation•
War•
18th & 19th Centuries
Capitalism & Industrialisation
people moved to the cities and worked in factories○
Work on land, more mechanized and profit oriented○
•
Changes in:
Relationships○
Way people dealt with emotional and psychological issues○
•
Workhouse system established to take care of old, sick and poor as family
networks now fragmented
•
Population influenced by scientific rather than religious beliefs•
Psychological shift from “tradition-centred” to “inner direction”•
Development of help that addressed issues related to inner life•
Asylums (industrialisation of mental health)
Asylums established for containment of “lunatics”
Some asylums run by Quakers who provided “moral treatment”○
1845 Asylums act in UK that required publicly run asylums to be
provided
○
•
Political power of medical profession enabled them to influence Acts of
Parliament that gave them control over publicly funded asylums
•
Asylums for insane members of upper classes established•
Bethlem hospital (Bedlam) in London was open to public in 18th – early
19th century, who paid 1d to watch lunatics
•
Science and Religion
Science replaced religion as dominant ideology in treatment of the insane•
Religious methods viewed as “demonology”•
Medical and biological explanations for insanity psychiatry a medical
speciality by end of 19th C
•
BEGINNINGS OF PSYCHOTHERAPY
(AS WE UNDERSTAND IT)
19th Century – 3 Streams
19th Century – Natural Science Empiricists
emphasis on measurement and classification - became known
as
somatiker (organicist)
tradition
○
1.
16th Century – Psychologist Philsophers
exploration of inner life and enigmas○
2.
17th Century - Clinical Researchers
Clinical observations informed theories○
Psychiker
tradition – only a
psychological
approach to mental
illness would prove effective
○
3.
Many clinicians made discoveries that had implications for psychotherapy
and the development of theories of personality
•
Freud, Jung, Adler•
1950s – Existentialism/humanism
Subjective meaning •
What does it mean to be me? •
Rise of individualism, focus on individual responsibility •
Key landmarks in theoretical development
Decade of Emergence Approach
1890 •Freudian Psychoanalysis
1910 •Post Freudian
1940 •Person-Centered
•Behavioural
•Psychodynamic/Object Relations
•Existential
1950 •Psychodynamic/Self-Theory
1960 •Cognitive, REBT
•Family/Systemic
•Gestalt
•Transactional Analysis
Decade of Emergence Approach
1970 •Cognitive-Behavioural Therapy
•Feminist Therapy
•Multicultural Therapy
1980 •Psychodynamic: Cognitive analytic & Interpersonal
1990 •Narrative
•Third-wave CBT
•Emotion Focused Therapy
2000 •Postmodern
•Positive Psychology
•Acceptance and Commitment Therapy (ACT)
PSYCHOTHERAPY
TODAY
Psychotherapy Streams Today
Psychoanalytic (Naturalist – Darwinism)
Goal: Self-awareness & insight into conflicts•
Focus on first 6 years of life as determinants for personality development•
Therapeutic process:
Unconscious thoughts and feelings explored○
Defensive processes which obstruct emotional awareness○
Consideration of issues related to sense of self and self esteem.○
•
Cognitive behavioural (Empiricism, Enlightenmnet – Birth of science)
(Postmodism)
Emotions & behaviour strongly influenced by cognitions•
Cognitions - Emotions•
Behaviour can maintain or change cognitions & emotions•
Psychiatric concerns arise from over reactive typical processes•
The now, not the past, and processes that maintain difficulties•
Evidence-based, time-limited, brief, intervention•
The Humanistic Approach (
Every person has their own unique way of perceiving and understanding
the world
•
Priority of a humanistic therapist is understanding the subjective world of
an individual
•
Other approaches take an objective view of people•
The scientific method is rejected as a way of studying people•
Qualitative research methods preferred•
The Postmodern Approach
truth depends on how you look at the world (i.e., your epistemology)
changing your perspective can change your experience○
•
social forces shape individuals
life is political
some groups are privileged▪
some groups are marginalised/disempowered▪
○
•
What makes an effective counsellor/therapist
Capacity to develop a therapeutic relationship and a strong working
alliance within the first few sessions
How do therapists do this?
Communication skills, empathy (Rogers),▪
○
•
An awareness of, and allegiance to a set of beliefs about
How clients develop difficulties○
How clients resolve these difficulties○
How therapists assist in this process○
•
What are your beliefs?•
Counselling/Therapy is . . .
Informed
•
Intentional
•
Informed & Intentional Practice
Beliefs (philosophy) •
Explanations (theory) •
Practice (approach) •
A contemporary perspective
BIO-PSYCHO-SOCIAL MODEL
Biopsychosocial Model
•Health or illness results from a complex interplay between biological,
psychological and social factors
•Holistic approach, attempts to avoid the mind-body split inherent in the
biomedical model
Impact of Biological Science
Life events change us and our neurons•
brain biology and thinking/feeling/experiencing are interactive
we can change our brain structure by how we feel, think, behave○
•
Klaus Grawe: “Psychotherapy achieves its effect through changes in gene
expression at the neuronal level”
•
Epigenetics: expression of certain genes that result from activation by
common environmental factors
•
Cultural Factors
Multicultural psychotherapy addresses our demographics, acculturation,
communication, conflicts, and biases
•
Western culture stresses the development of individual•
Non-Western cultures focus on social frameworks•
Language and metaphor reflect our mental structures and backgrounds•
Summary
Effective therapists
build strong alliances with clients○
have a set of beliefs, expressed in a theory that inform their
intentional practices
○
build hope and expectancy○
•
Clients bring different resources•
Many different approaches
based on different beliefs about people, how problems develop, how
problems are solved
○
theories of change○
professional practice○
•
Different (collective) beliefs have developed over time as a result of many
factors
•
All approaches can be helpful•
People are complex and experiences occur in a biopsychosocial (spiritual)
context
•
Lecture Week 1
What is Counselling or Psychotherapy? Are they different?
Defining Psychotherapy
“
Psychotherapy
is the
informed
and
intentional
application of clinical methods
and interpersonal stances derived from established psychological principles for
the purpose of assisting people to modify their behaviours, cognitions, emotions
and/or other personal characteristics in directions that the participants deem
desirable.”
Prochaska & Norcross 2014 p.4
Defining Counselling
“Therapists are not in business to change clients, to give them quick advice, or to
solve their problems for them. Instead, counsellors facilitate healing through a
process of genuine dialogue with their clients.”
(Corey, 2017, p. 4)
Why are there so many different approaches to counselling?
What do we know about what works in therapy?
All therapies work (for someone)
Rosenzweig (1936): all forms of psychotherapy have evidence of being
effective
Dodo bird verdict from
Alice in Wonderland
: “Everybody has won
and all must have prizes”
○
•
If effectiveness doesn’t depend on the approach . . .
... perhaps there’s something that’s common to all therapies that makes the
difference
Common features may be what makes therapy effective ○
•
Common Factors Research
Positive Expectations
Treatment effectiveness is related to the extent to which clients expect
treatment to be effective (placebo-effect)
Clients need to believe in the process○
Therapists need to cultivate hope and enhance positive expectations○
•
Client and Extra-therapeutic Factors
Clients come to therapy with varying levels of:
Motivation○
Internal resources - resitentance○
External resources - money○
•
Importance of:
Readiness to change○
Strengths○
Level of functioning before treatment○
Social support network○
Socio-economic status○
Personal motivation○
Life events○
•
“Clients are not inert objects or diagnostic categories to whom techniques are
administered. They are not dependent variables on which independent variables
operate….people are agentive beings who are effective forces in the complex of
causal events”
Models and Techniques
Therapies achieve their effects in large part through:
Placebo○
Hope○
Expectancy○
•
A placebo or technically inert, provided in a way that offers positive
expectations for improvement, reliably produces effects as large as an
“active” treatment
•
researchers and practitioner’s allegiance to a particular therapy almost (if
not entirely) explains the difference it makes, in terms of outcome
•
A good predictor of a negative outcome is a lack of structure and focus in
treatment
•
Therapeutic Alliance
strong therapeutic alliance important in over 1000 studies•
therapeutic alliance contributes about 5-7 times more than specific models
or techniques
•
Rogers (1957) three core conditions found to be important•
Outcome depends on Client’s evaluation of the alliance (not therapists’)•
Early alliance quality predicts outcomes•
Hawthorne Effect: people change their behaviour just because they are
being “observed”
•
different clients have different capacities to form an alliance
Therapists
•
Some therapists are more effective than others•
Clients of the
most
effective therapists experience:
50% more improvement○
50% less dropout○
•
Variability amongst practitioners is not due to:
age, gender, years of experience,
○
training, theoretical orientation and amount of supervision
○
•
Evidence suggests better therapists use common factors to achieve better
outcomes
Better therapists formed better alliances with a range of clients
○
•
Are All Psychotherapies Equivalent?
“are all psychotherapies equivalent?”
“are all treatments for a particular disorder equivalent?”
“are all treatments for a particular disorder, for a particular
client-group equivalent?”
▪
○
•
For specific disorders, some treatments are more effective because they
contain “specific psychological procedures targeted at the
psychopathology at hand” (Barlow, 2004; Crits-Christoph, 1997)
e.g., anxiety disorders
Behavioural and Cognitive Behavioural treatments are
generally thought to be more effective
▪
○
•
However – when therapist allegiance was included, CBT was no more
effective than other therapie
•
A Brief History of Beliefs
A QUICK HISTORY OF WESTERN CULTURE
The Church
Control of
Beliefs
○
Ecomony
○
Knowledge
○
•
God present in the world and part of everything
•
Early Times
European society
small rural communities
○
lived according to religious principles
○
•
“Problems in living” dealt with from a religious perspective in local
community
•
Seriously disturbed and insane tolerated as part of community
•
Emotional and interpersonal problems dealt with by priest – “cure of
souls”
Important element was confession followed by repentance
○
Catholic confessional
○
Earlier Christian rituals were communal affairs with admonishment,
prayer
○
•
Early Remedy of Mental Disorders
Healing rituals of shamanistic societies
Mental illness attributed to spirits
○
•
Trephining - hole in skull to let out 'evil spirits'
○
•
Early Remedy of Mental Disorders
Temple-like asklepeia and retreat centres of Eastern Mediterranean
Religio-philosophical lectures○
Meditation○
Rest○
•
16th Century – Renaisance (independent of the church)
Great exploration •
Travel – Trade (&disease)
Monet and new artifacts ○
Changed economic structures of society
Beginning of middle class ▪
Education of self ▪
○
•
Middle Ages
Education•
Rise of Philosophy•
Descartes (1596-1650) – mind/body dualism – largely how we see our self
today – mind superior (men and purity) Body (women inpure)
•
17th Century – Enlightenment – science
Discorvery of Greek Culture: Plato, Aristotle, Socrates, Pythagorus •
Birth of Science •
Deism
God is outside of the world ○
•
Rediscovery
Secular Medicine
Empirical studies of Hellenist physicians found brain was
implicated in both:
Learning and knowledge▪
Depression, delerium and madness▪
○
•
Hippocrates 5th c. BCE insisted:
Illness be addressed by natural means○
Repudiated notion that seizures were “divine” and should be treated
by appealing and placating gods
○
•
19th Century – Darwinism
Naturalism
We are determined by our genetics ○
•
Freud, Skinner •
Capitalism: money = power and control •
Industralisation•
War•
18th & 19th Centuries
Capitalism & Industrialisation
people moved to the cities and worked in factories○
Work on land, more mechanized and profit oriented○
•
Changes in:
Relationships○
Way people dealt with emotional and psychological issues○
•
Workhouse system established to take care of old, sick and poor as family
networks now fragmented
•
Population influenced by scientific rather than religious beliefs•
Psychological shift from “tradition-centred” to “inner direction”•
Development of help that addressed issues related to inner life•
Asylums (industrialisation of mental health)
Asylums established for containment of “lunatics”
Some asylums run by Quakers who provided “moral treatment”○
1845 Asylums act in UK that required publicly run asylums to be
provided
○
•
Political power of medical profession enabled them to influence Acts of
Parliament that gave them control over publicly funded asylums
•
Asylums for insane members of upper classes established•
Bethlem hospital (Bedlam) in London was open to public in 18th – early
19th century, who paid 1d to watch lunatics
•
Science and Religion
Science replaced religion as dominant ideology in treatment of the insane•
Religious methods viewed as “demonology”•
Medical and biological explanations for insanity psychiatry a medical
speciality by end of 19th C
•
BEGINNINGS OF PSYCHOTHERAPY
(AS WE UNDERSTAND IT)
19th Century – 3 Streams
19th Century – Natural Science Empiricists
emphasis on measurement and classification - became known
as
somatiker (organicist)
tradition
○
1.
16th Century – Psychologist Philsophers
exploration of inner life and enigmas○
2.
17th Century - Clinical Researchers
Clinical observations informed theories○
Psychiker
tradition – only a
psychological
approach to mental
illness would prove effective
○
3.
Many clinicians made discoveries that had implications for psychotherapy
and the development of theories of personality
•
Freud, Jung, Adler•
1950s – Existentialism/humanism
Subjective meaning •
What does it mean to be me? •
Rise of individualism, focus on individual responsibility •
Key landmarks in theoretical development
Decade of Emergence Approach
1890 •Freudian Psychoanalysis
1910 •Post Freudian
1940 •Person-Centered
•Behavioural
•Psychodynamic/Object Relations
•Existential
1950 •Psychodynamic/Self-Theory
1960 •Cognitive, REBT
•Family/Systemic
•Gestalt
•Transactional Analysis
Decade of Emergence Approach
1970 •Cognitive-Behavioural Therapy
•Feminist Therapy
•Multicultural Therapy
1980 •Psychodynamic: Cognitive analytic & Interpersonal
1990 •Narrative
•Third-wave CBT
•Emotion Focused Therapy
2000 •Postmodern
•Positive Psychology
•Acceptance and Commitment Therapy (ACT)
PSYCHOTHERAPY
TODAY
Psychotherapy Streams Today
Psychoanalytic (Naturalist – Darwinism)
Goal: Self-awareness & insight into conflicts•
Focus on first 6 years of life as determinants for personality development•
Therapeutic process:
Unconscious thoughts and feelings explored○
Defensive processes which obstruct emotional awareness○
Consideration of issues related to sense of self and self esteem.○
•
Cognitive behavioural (Empiricism, Enlightenmnet – Birth of science)
(Postmodism)
Emotions & behaviour strongly influenced by cognitions•
Cognitions - Emotions•
Behaviour can maintain or change cognitions & emotions•
Psychiatric concerns arise from over reactive typical processes•
The now, not the past, and processes that maintain difficulties•
Evidence-based, time-limited, brief, intervention•
The Humanistic Approach (
Every person has their own unique way of perceiving and understanding
the world
•
Priority of a humanistic therapist is understanding the subjective world of
an individual
•
Other approaches take an objective view of people•
The scientific method is rejected as a way of studying people•
Qualitative research methods preferred•
The Postmodern Approach
truth depends on how you look at the world (i.e., your epistemology)
changing your perspective can change your experience○
•
social forces shape individuals
life is political
some groups are privileged▪
some groups are marginalised/disempowered▪
○
•
What makes an effective counsellor/therapist
Capacity to develop a therapeutic relationship and a strong working
alliance within the first few sessions
How do therapists do this?
Communication skills, empathy (Rogers),▪
○
•
An awareness of, and allegiance to a set of beliefs about
How clients develop difficulties○
How clients resolve these difficulties○
How therapists assist in this process○
•
What are your beliefs?•
Counselling/Therapy is . . .
Informed
•
Intentional
•
Informed & Intentional Practice
Beliefs (philosophy) •
Explanations (theory) •
Practice (approach) •
A contemporary perspective
BIO-PSYCHO-SOCIAL MODEL
Biopsychosocial Model
•Health or illness results from a complex interplay between biological,
psychological and social factors
•Holistic approach, attempts to avoid the mind-body split inherent in the
biomedical model
Impact of Biological Science
Life events change us and our neurons•
brain biology and thinking/feeling/experiencing are interactive
we can change our brain structure by how we feel, think, behave○
•
Klaus Grawe: “Psychotherapy achieves its effect through changes in gene
expression at the neuronal level”
•
Epigenetics: expression of certain genes that result from activation by
common environmental factors
•
Cultural Factors
Multicultural psychotherapy addresses our demographics, acculturation,
communication, conflicts, and biases
•
Western culture stresses the development of individual•
Non-Western cultures focus on social frameworks•
Language and metaphor reflect our mental structures and backgrounds•
Summary
Effective therapists
build strong alliances with clients○
have a set of beliefs, expressed in a theory that inform their
intentional practices
○
build hope and expectancy○
•
Clients bring different resources•
Many different approaches
based on different beliefs about people, how problems develop, how
problems are solved
○
theories of change○
professional practice○
•
Different (collective) beliefs have developed over time as a result of many
factors
•
All approaches can be helpful•
People are complex and experiences occur in a biopsychosocial (spiritual)
context
•
Lecture Week 1
Document Summary
Therapists are not in business to change clients, to give them quick advice, or to solve their problems for them. Instead, counsellors facilitate healing through a process of genuine dialogue with their clients. (corey, 2017, p. 4) Rosenzweig (1936): all forms of psychotherapy have evidence of being effective. Dodo bird verdict from alice in wonderland : everybody has won and all must have prizes . If effectiveness doesn"t depend on the approach . Perhaps there"s something that"s common to all therapies that makes the difference. Common features may be what makes therapy effective. Treatment effectiveness is related to the extent to which clients expect treatment to be effective (placebo-effect) treatment to be effective (placebo-effect) Therapists need to cultivate hope and enhance positive expectations. Clients come to therapy with varying levels of: Clients are not inert objects or diagnostic categories to whom techniques are administered.
