Introduction to Psychotherapy

1. Introduction to Psychotherapy Carolyn R. Fallahi, Ph. D.

2. The Psychotherapy Relationship • What does it involve? • Shared information • Confidentiality • Strict limitations on the place and time of contact • Time-limited

3. Does Psychotherapy work? • Eysenck’s work • 1952 meta-analysis • 24 published studies of “neurotic” patients. • None of the studies included a control group. • 72% of neurotics recovered with non-specialized care. • Quasi-experimental • Concluded that therapy doesn’t work. • Response to that published work.

4. Smith & Glass (1977) • Meta-analysis • Rigorous design • Looked at outcome literature • Found a positive result • average effect size for all psychotherapies was .85.

5. Lambert & Bergin (1994)

6. Empirically Validated Treatments • Anxiety and Stress: • CBT for panic disorder • CBT for GAD • Exposure treatment for Agoraphobia • Exposure/guided mastery for specific phobia • Exposure and response prevention for OCD • Stress Innoculation training for coping with stressors

7. Empirically Validated Treatments • Depression • Behavior therapy for depression • Cognitive therapy for depression • Interpersonal therapy for depression

8. Empirically Validated Treatments • Health Problems • Behavior therapy for headaches • CBT for bulimia • Multicomponent CBT for pain associated with rheumatic disease • Multicomponent CBT with relapse prevention for smoking cessation

9. Empirically Validated Treatments • Problems of Childhood • Behavior modification for enuresis • Parent training programs for children with ODD • Marital Discord • Behavioral marital therapy

10. Therapeutic Skills • What about therapy seems to be important? • 30% of the variance = relationship factors. • Orlinsky, Grawe, & Parks (1994): reviewed 2,300 empirical studies and found that patient participation is the single most important outcome factor. • They need an encouraging, positive relationship.

11. Intervention techniques v. the relationship • What’s more important? • Therapeutic technique? • The relationship? • The relationship*****

12. Therapist Skills • Positive interaction • Show interest • Make the patient feel comfortable • Offer encouragement and reassurance • Instill hope • Show sensitivity to patient feelings • Offer practical assistance • Empathy, warmth, and genuineness (Rogers)

13. Therapist Skills • Eagan (1998). • genuineness • Warmth • How do we convey this?

14. Acquiring necessary skills • Can you teach positive interpersonal skills? • Training • Common responses by novice therapists • Specific skills • EBM • Caring • Emotional involvement • How do you show caring?

15. Behaviors that make the patient wonder if the therapist cares. • Overstructuring therapy • Inappropriate self-disclosures • Rigid use of transference interpretation • Inappropriate use of silence • Criticism • Hostile tone or confrontational approaches

16. Do therapists care about all patients? • Is it necessary to develop feelings of caring for the patient?

17. Coherence, Confidence, goals • The treatment plan • Techniques need to make sense • Confidence on the part of the therapist • Positive beliefs about therapy • How do you translate complaints into goals?

18. Complaints and goals • Vague goals versus specific goals. • Operationalizing goals. • Example, patient with ADHD.

19. ADHD Goals • Psychoeducational Goals • Assign books on ADHD: The patient was referred to specific reading material designed to increase his/her knowledge about ADHD. • Teach Problem-solving skills: The patient was taught problem-solving skills that involve identifying the problem, brainstorming solutions, evaluating options, implementing action, and evaluat8ing results. • Teach self-control strategies: The patient was taught the self-control strategy of “stop, listen, think, and act” to assist him/her in curbing impulsive behavior. • Conduct Psychological Testing • The patient was administered psychological testing in order to establish the presence of ADHD, a learning disability, and to assist with a description of strengths and weaknesses. • Refer for Psychiatric Evaluation • Refer to a psychiatric for possible psychotropic medications.

20. Agreements and Contracts • What does the therapist think? Offered after the first meeting. • Provision that this plan will be updated. • Initial treatment plan. • Signed? Verbal agreement?

21. Comprehensive Treatment Plan Name: Date of first visit: Assets facilitating treatment: Barriers or challenges potentially interfering with treatment: Problem List: Goals, methods, Initial time frame: Patient informed Consent and participation: I have discussed this plan with Dr. Fallahi, understand it, and with my full and informed consent agree to the course of action outlined above. ________________________ __________________ Patient Signature Date

22. Building and maintaining the therapeutic relationship • The first contact. • The first telephone call.. • Every interaction.

23. Building and maintaining the therapeutic relationship • Active listening. • Friendly interpersonal exchange. • Synthesizing the information. • Focus is on the patient. • Avoid negative interchange. • Resist distractions. • Remember information about the patient. • Don’t be judgmental.

24. What if the patient pushes your buttons? • Supervision • Supervision • Supervision • Referral?

25. Five indications of a good working relationship • 1) Desire to see the patient. • 2) Information is shared. • 3) positive affect is expressed. • 4) there is a sense of teamwork. • 5) You can work out negative stuff.