Chapter 1 - Introduction

1. Chapter 1 - Introduction

2. Identify a thorough definition of psychotherapy Distinguish different views of how to live life espoused by different schools of psychotherapy Recognize the structure of the text

3. Orlinsky and Howard’s (1987) definition: • Psychotherapy is: • A relation among persons, engaged in by • one or more individuals defined as needing special assistance to • improve their functioning as persons, together with • one or more individuals defined as able to render such help.

4. Optimistic / Comic: • View hard work and personal improvements as leading to good outcomes if the client participates as prescribed • E.g., Cognitive-Behavioral Therapy, Experiential therapy • Tragic: • Coming to terms with the limitations imposed by the troubled world • E.g., Psychoanalysis, Existential therapy

5. Emphasis on most widely practiced schools of psychotherapy Concern with theory To be used as a launching pad to further exploration

6. This book is NOT: • Focused on specific personal factors that make a good therapist • A training manual • A how-to guide to the specifics of each treatment • Focused on differences in treatments between adults and children/adolescents

7. Chapter 2 – Behavior Therapy

8. Classical Conditioning: learning that occurs when two stimuli are presented in close temporal proximity and with some degree of contingency or correlation between them Instrumental Conditioning: learning that occurs when a response is consistently followed by either a positive or negative consequence

9. Generalization: when one stimulus comes to elicit an emotional response, other stimuli that resemble the original stimulus will also elicit a similar emotional response Extinction: a weakening of the strength of the learned response that occurs when the unconditioned stimulus or reinforcer is no longer contingent on the conditioned stimulus, instrumental response, or discriminative stimulus

10. Pavlov – classical conditioning • Unconditioned stimulus • Unconditioned response • Conditioned stimulus • Conditioned response • Extinction: of particular importance for behavior therapy • Watson – classical conditioning • Behavior can be understood without reference to mental constructs • Watson and Rayner: Little Albert • Mary Cover Jones: Peter, tx of phobia by in vivo exposure

11. Skinner – neobehaviorism • Operationalism: concepts should be defined via objective measurement • Psychology should focus on describing the relationships between responses and their outcomes • Functional Analysis – identification of reinforcers • Operant conditioning • Reinforcement • Positive • Negative • Punishment • Positive • negative • Problem behaviors can be modified by changing environmental contingencies

12. Mowrer – two-factor theory • Studied avoidance behavior, which can help in understanding many psychological disorders • Tried to explain avoidance behavior without relying on expectancies • Combined classical and operant conditioning • Relationship between a stimulus and a fear response is learned (classical) • Relationship is learned between avoidance and reduction in fear (operant)

13. Systematic Desensitization: Wolpe • Reciprocal inhibition: opposite emotional states cannot be experienced simultaneously • Fear hierarchy • Prolonged Exposure Therapy: Foa • Fear network – many stimuli associated with trauma, exposure to as many as possible - habituation • Flooding • Response prevention – prevent maladaptive response, e.g. avoidance • Behavioral Rehearsal • Patient and therapist act out various situations that are problematic • Social/observational learning – modeling: Bandura

14. prepare the client: give rationale, test alternative behaviors, discuss appropriate expectations Identify targets for change: hierarchy of situations to rehearse Role-play or behavioral rehearsal: should be as realistic as possible Carry out the behaviors in the real world

15. Behavioral Activation • Targeted toward depression, based on the notion that people with depression lack positive reinforcers for healthy behaviors in their lives, while depression may be reinforced • Positive reinforcement of healthy or pleasurable activities • Interoceptive Exposure in Panic Control Treatment • Exposure to bodily sensations associated with panic, e.g. hyperventilation, chair-spinning

16. Specific behavioral goals • Assessment • Functional assessment • Single case design • Process of Psychotherapy • Active and directive therapist • Short-term • Therapeutic alliance

17. Extinction Stimulus Control Contingency management Skill acquisition Shaping Homework- behavioral assignments are necessary and sufficient for improvement in therapy

18. Specific Strategies • Role of worry as avoidance strategies • Exposure to negatively valenced imagery • Empirical support for treatment of generalized anxiety disorder (GAD) • High end state functioning achieved in approximately 50% of cases