Psychology 1000 Chapter 17: Chapter 17
13 May 2018
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THE HELPING RELATIONSHIP!
•The basic goal of all treatment approaches is to help people change maladaptive, self-
defeating thoughts, feelings, and behaviour patterns so that they can live happier and more
productive lives’!
•A majority of people with mental-health problems first seek help not from mental-health
professionals, but from family members, physicians, members of the clergy, acquaintances,
or self-help groups !
•nearly 30 percent of North Americans have sought psychological counselling from
professionals at some point in their lives!
•These people receive treatment from mental-health professionals who fall into
several categories.!
•Counselling and clinical psychologists make up one group. These psychologists, who
typically hold a Ph.D. (Doctor of Philosophy) or Psy.D. (Doctor of Psychology) degree, have
received five or more years of intensive training and supervision in a variety of
psychotherapeutic techniques as well as training in research and psychological assessment
techniques. !
•A second group, psychiatrists, are medical doctors who specialize in psychotherapy
and biomedical treatments, such as drug therapy.!
•In addition to psychologists and psychiatrists, a number of other professionals provide
treatment. !
•These professionals typically receive master's degrees based on two years of highly
focused and practical training. !
•They include psychiatric social workers, who often work in community agencies;
marriage and family counsellors, who specialize in problems arising from family
relations; pastoral counsellors, who tend to focus on spiritual issues; and abuse
counsellors, who work with substance and sexual abusers and their victims.!
PSYCHODYNAMIC THERAPIES!
•The psychodynamic approach to psychotherapy focuses on internal conflict and
unconscious factors that underlie maladaptive behaviour.!
•The term psychoanalysis refers not only to Freud's theory of personality, but also to the
specific approach to treatment that he developed.!
Psychoanalysis
•The goal of psychoanalysis is to help clients achieve insight, the conscious awareness of
the psychodynamics that underlie their problems. Such awareness permits clients to adjust
their behaviour to their current life situations, rather than continuing to repeat the old
maladaptive routines learned in childhood.!
•Free Association!
•Freud believed that mental events are meaningfully associated with one another, so
that clues to the contents of the unconscious are to be found in the constant stream
of thoughts, memories, images, and feelings we experience. !
•In his technique of free association, Freud asked his clients to recline on a
couch and to report verbally without censorship any thoughts, feelings, or
images that entered awareness. !
•Freud sat out of sight behind the client so that the client's thought processes
would be determined primarily by internal factors!
•For example, a client's stream of thoughts may suddenly stop after she has
mentioned her father, suggesting the possibility that she was approaching a
“loaded” topic that activated repressive defences.!
•Dream Interpretation!
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•Psychoanalysts believe that dreams express impulses, fantasies, and wishes that
the client's defences keep in the unconscious during waking hours !
•Even in dreams defensive processes usually disguise the threatening material to
protect the dreamer from the anxiety that the material might evoke. !
•In dream interpretation, the analyst tries to help the client search for the
unconscious material contained in the dreams. !
•One means of doing so is to ask the client to free associate to each element of the
dream and to help the client arrive at an understanding of what the symbols in the
dream really represent.!
•Resistance!
•Although clients come to therapists for help, they also have a strong unconscious
investment in maintaining the status quo. !
•After all, their problems result from the fact that certain unconscious conflicts
are so painful that the ego has resorted to maladaptive defensive patterns to
deal with them. !
•These avoidance patterns emerge in the course of therapy as resistance,
defensive manoeuvres that hinder the process of therapy. !
•Resistance is a sign that anxiety-arousing sensitive material is being approached. !
•An important task of analysis is to explore the reasons for resistance, both to
promote insight and to guard against the ultimate resistance: the client's
decision to drop out of therapy prematurely.!
•Transference!
•the analyst sits out of view of the client and reveals nothing to the client about
himself or herself. !
•Nonetheless, clients will eventually begin to project onto the “blank screen” of the
therapist important perceptions and feelings related to their underlying conflicts.
Transference occurs when the client responds irrationally to the analyst as if he or
she were an important figure from the client's past. !
•Transference is considered a most important process in psychoanalysis, for it brings
out into the open repressed feelings and maladaptive behaviour patterns that the
therapist can point out to the client.!
•Transference takes two basic forms. !
•Positive transference occurs when a client transfers feelings of intense
affection, dependency, or love to the analyst, whereas negative transference
involves irrational expressions of anger, hatred, or disappointment. !
•Analysts believe that until transference reactions are analyzed and resolved,
there can be no full resolution of the client's problems!
•Interpretation!
•A general rule in psychoanalytic treatment is to interpret what is already near the
surface and just beyond the client's current awareness. !
•Offering “deep” interpretations of strongly defended unconscious dynamics is
considered poor technique because even if they are correct, such interpretations
are so far removed from the client's current awareness that they cannot be
informative or helpful!
Brief Psychodynamic Therapies!
•Classical psychoanalysis is an expensive and time-consuming process, for the goal is no
less than rebuilding the client's personality. !
•In classical psychoanalysis, it is not uncommon for a client to be seen five times a
week for five years or more. !
•The researchers also found that regardless of how many sessions the clients attended, the
rate of improvement was highest at the beginning and decreased over time!
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•Leichsenring conducted a meta-analytic review of research on psychodynamic and
psychoanalytic therapies and concluded that psychoanalytic therapy is more effective in
treating psychological disorders than are shorter forms of psychodynamic therapy. !
•The authors of a three-year, randomized controlled clinical trial of 326 therapy
clients in Helsinki, Finland, similarly reported that while short-term psychodynamic
therapy was more effective than long-term therapy in decreasing symptoms of
depression and anxiety in the first year of the study, and there were no differences
between therapy groups after two years, at the three-year follow-up the clients in
the long-term psychodynamic therapy group showed significantly greater
improvement than those in the short-term therapy groups !
•Many of these brief therapies utilize basic concepts from psychoanalysis, such as the
importance of insight and the use of interpretation, but they employ them in a more focused
and active fashion !
• The therapist and client are likely to sit facing each other, and conversation typically
replaces free association. !
•Clients are seen once or twice a week rather than daily, and the goal is typically
limited to helping the client deal with specific life problems rather than attempting a
complete rebuilding of the client's personality. !
•Therapy, therefore, is more likely to focus on the client's current life situations than
on past childhood experience, and may teach the client specific interpersonal and
emotion-control skills!
•One brief psychodynamic therapy is called interpersonal therapy !
•This therapy is highly structured and seldom takes longer than 15 to 20 sessions,
focuses on the client's current interpersonal problems. !
•These include dealing with role disputes such as marital conflict, adjusting to the
loss of a relationship or to a changed relationship, and identifying and correcting
deficits in social skills that make it difficult for the client to initiate or maintain
satisfying relationships. !
• interpersonal therapy has proven to be one of the more effective current therapies for
depression and for somatic system disorder!
HUMANISTIC PSYCHOTHERAPIES!
•In contrast to psychodynamic theorists, who view behaviour as a product of unconscious
processes, humanistic theorists view humans as capable of consciously controlling their
actions and taking responsibility for their choices and behaviour. !
•These theorists also believe that everyone possesses inner resources for self-
healing and personal growth, and that disordered behaviour reflects a blocking of
the natural growth process. !
•This blocking is brought about by distorted perceptions, lack of awareness about
feelings, or a negative self-image.!
•The therapist's goal is to create an environment in which clients can engage in self-
exploration and remove the barriers that block their natural tendencies toward personal
growth !
•These barriers often result from childhood experiences that fostered unrealistic or
maladaptive standards for self-worth. !
•humanistic approaches focus primarily on the present and future instead of the past. !
•Therapy is directed at helping clients become aware of feelings as they occur!
Client-Centred Therapy
•The best-known and most widely used form of humanistic therapy is the client-centred
developed by Carl Rogers !
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