PSY343 more lecture notes.docx

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Neil Rector

1: Definitions of Psychotherapy FREUDIAN HISTORY “hysteria” – concept of transference – by Freud & Breuer Freud mostly cares for neurotic women.  1895: Abandons hypnosis for free association: noticed that patients would sometimes hesitate (assumed it was cuz blocks were showing up for painful memories or taboo subjects.)  childhood memories & sexual themes would allways come up. (mebs cause yr a lady lying near a man)  5 yrs later: publishes Interpretation of Dreams – concept of unconsc, theories of neuroses  1909: G. Stanley Something brings Freud to Clark Univ –talks published in 1910 in American Journal of Psychology. o ACADEMIA not interested (slowly warms,) PUBLIC likes it Psychoanalysis is about abnormality & case studies – others do EXPERIMENTS on psychoanalytical practices  MAINSTREAMING CLINICAL HISTORY  >20 clinics already existed, in universities. Most dealt w/ KIDS  WW1  NEED  1919 CLINICAL section of APA appears  WW11  MORE NEED, PTSD  GOV’T funds university programs for clinical psychology  1949: APA says to be clinical, gotta be TRAINED as scientist & practitioner  Now: more & more clinical psychologies  more & more varied theories about the subject 1950s & 60s 1959 1976 1979 Today Psychoanalytical, humanistic, more 36 distinct, 100 >200 400-500 developed comprehensive behavioral therapies DIFFERENT DEFINITIONS OF PSYCHOTHERAPY: Norcross, 1990: informed & intentional application of clinical methods & interpersonal stances derived from ESTABLISHED psychologies. GOAL  assist people to MODIFY their behaviours, cognitions, emotions, and/or other personal characteristics in directions that the participants deem DESIRABLE. Desirability? Corsini, 2007: Formal process of interaction between two parties, each usually consisting of one person but can be 2/+ in each. GOAL  amelioration of distress in 1 of the parties relative to any/ all of the following areas of disability or malfunction: cognitive functions (disorders of thinking), affective functions (suffering or emotional discomforts), or behavioural functions (inadequacy of behaviour). THERAPIST: has some theory of personality’s origins, development, maintenance, and change, applies some method of treatment logically related to the theory, and has professional and legal approval to act as a therapist. Theory, logic, legal approval, distress ** Anyone in Canada can theoretically call themselves a PSYCHOTHERAPIST. Vs. Clinical psychologist ** THE ROLE OF THEORIES All psychotherapies are METHODS OF LEARNING– they intended to change people – make them think or feel differently & to make them act differently(cog, affective, behavioral)  help the person learn something new  relearning something they have forgotten  unlearning  learning what one already knows. …??? All psychotherapies are pathways to: a new way of seeing life - a re-evaluation of self and others. - The psychotherapist is a persuader or FACILITATOR attempting to CHANGE OPINIONS. CORE ASPECTS OF PSYCHOTHERAPY: relationship + target of intervention WORKING ALLIANCE INVENTORY MEASURES THINGS THAT MAKE THERAPY GOOD: o Trust BOND (necessary, o Caring/Acceptance but not o Confidentiality sufficient) GOALS o Understanding & agreement on GOALS of treament TASKS o Agreeing upon TASKS & methods BUT HOW IS THIS DIFFERENT FROM PLAIN OL’ FRIENDSHIP?  distilled ROLES of each member in the therapeutic relationship  TRAINING  specific TECHNIQUE TECHNIQUES / METHODS ANXIETY SENSITIVITY INDEX: question checklist – fear of bodily sensations CBT is v. good for PANIC DISORDER – treats fear of bodily sxs  REDUCES panic attacks For OCD - supportive therapy (where relationship is most important) is almost USELESS. Behav & Cog are best. Ex: ERP – Exposure & Response-Prevention BECK’S MODEL OF DEPRESSION Psychonalysts said people with depression really had REPRESSED ANGER. Beck found out this was false. Negative events  Cognitive appraisal  Depressed emotion  behaviors… Neg events etc. SOOOOOO…. SPECIFIC TECHNIQUES & RELATIONSHIP FACTORS INTERACT  THERAPEUTIC RESPONSES 2: Aspects of Clinical Research HYPOTHESES: Clearer hypotheses  better-constructed study RELIABILITY OF FINDINGS: replicability & robustness (sample size etc.) INDEPENDENT & DEPENDENT VARIABLES: have to be operationalized. What’s the diff INTERNAL VALIDITY: how well a measure measures what it’s supposed to measure. Potential Problems: confound.  Establish good Inclusion Criteria  Make Control Groups  Randomize EXTERNAL VALIDITY: how well findings represent general population EFFICACY Effectiveness within tightly controlled populations? STUDY – Meta-Analysis of Efficacy of Psychotherapy – 1977, SMITH & GLASS Any therapy seems better n none (.68 effect size) but none better than others. Amt of training, type of therapy did not correlate w/ outcomes. RELATIONSHIP seemed important STUDY – WESTEN & MORRISON META-ANALYSIS OF depression, panic, GAD studies Multiple Meanings of Efficacy > Effect Size Estimates vs. Clinically Significant Improvement Effect Sizes: quantitative not qualitative  small - 0.3  medium - 0.5  large – 0.8 (means that ~83% of those treated got better) … this doesn’t tell us how MUCH people have actually improved. Just how MANY. > Improvement vs. Complete Recovery Maybe interview to check if patients still have sxs that qualify for a DSM diagnosis > Intent to Treat sample vs. Completers Sample The final sample doesn’t necessarily take attrition into account. Modal # of sessions of therapy per person in therapy= 1 > Effective Efficacy > The number of patients that seek additional treatment Often not taken into account, but might be a sign of remission, having contracted a NEW problem (perhaps even CAUSED by the study!)  relapse plan: patients taught to notice early warning signs & get treatment before they get bad. > The absolute magnitude of mean # of symptoms after treatment Initial Response vs. Sustained Efficacy *Treatment effects at post-treatment vs. effects at longer follow-up intervals *Efficacy versus Effectiveness Research Treatment States Vs. Treatment of Disorders *Reducing an episode of depression versus preventing its recurrence by targeting underlying vulnerability *Risk of repeated episodes = 85% over 10-15yrs *Treating symptoms versus characterological disorders *Short vs. Long-term Focus of change Empirically Unsupported vs. Empirically Untested Criteria for inclusion:  published between 1990-1998
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