Therapy 101

1. Therapy 101

2. Psychotherapy • Literally: Treatment of the Psyche • Minds or personalities in distress

3. Psychotherapy is a process by which you examine your thoughts, feelings, actions and relationships, evaluate where problems exist, and learn how to make whatever changes are necessary to achieve better life adjustment and satisfaction

4. Therapeutic Relationship • Varies with approaches • Objective • Ethical • Confidential • Professional

5. Patient/Therapist Relationship Terminology: Patient vs. Client • How well patients relate to therapists and vice versa is important to the progress that they make in therapy. • According to much of the research on psychotherapy, a positive therapeutic relationship may even be more important for recovery than the type of therapy used.

6. Elements of Counseling Relationship • Rapport-the patient and therapist seem to "click with one another." • Trust-the patient views the therapeutic relationship as helpful and the therapist finds the patient interested in changing. • Confidentiality- a therapist keeps what is said in therapy between himself and the patient except when the patient or others are in danger.

7. Empathy-an empathic therapist tries to understand the situations and feelings through the patient 's eyes. • Insight-the patient is able to understand how his/her illness, attitudes and behaviors affect his/her life, (i.e. self-understanding). • Motivation-the patient has a desire to feel better and improve his/her situation.

8. Therapeutic Goals • Fostering Insight • Encouragement • Reducing emotional discomfort • Providing new information • Facilitating change

9. Continuum of Care Consultation Outpatient Intensive outpatient Day Treatment • Residential Supervised living Inpatient Hospitalization

10. Individual Therapy • One on one delivery of services focused on theoretical perspective and client need • Brief, solution focused therapy • Supportive therapy • Match client needs with orientation

11. Group Therapy • Simultaneous treatment of serveral individuals • Yalom’s theory of group therapy • Therapist’s training • Screening of candidates • Group composition • Open, closed, size, other considerations

12. Family Therapy • Identifying and changing patterns of family interaction • “Identified client” • Systems view • Structural, strategic view • Virginia Satir

13. Family Therapy • Family therapy focuses on change within the family, and recognizes than family relationships all have an impact on the feelings and behavior of each of the members of a family. • Instead of meeting with an individual, all or most family members are involved in the therapy process.

14. Occasionally, the non-custodial parents are also involved in family therapy, but this depends on the potential for divorced parents working together to help their children resolve psychological problems.  • Family therapy is most frequently used when a child or adolescent is identified as having a psychological problem • For example, a teen with chronic depression or substance abuse problems might benefit from family therapy to address the impact of their problem on family relationships, while also receiving individual psychotherapy to directly address their personal change issues.

15. Marital Therapy • Relationship counseling, couple therapy • Focus on interaction, communication • Dynamics • Legal issues • Problem solving • Therapist’s mine field !

16. Relationship CounselingCouple Therapy (Marriage Counseling) • Couple therapy is often seen as somehow different from psychotherapy because one individual is not identified as having a specific psychological problem. • All psychological problems involve both individual symptoms and changes in interpersonal relationships.  • Couple therapy focuses on the problems existing in the relationship between two people.

17. These relationship problems always involve individual symptoms and problems, as well as relationship conflicts. • Changes may be different ways of interacting within the relationship, or may be individual changes related to other psychological problems. • Couple therapy involves learning how to communicate more effectively, and how to listen more closely.

18. Couples must learn how to avoid competing with each other, and need to identify common life goals and how to share responsibilities within their relationship. • Sometimes the process is very similar to individual psychotherapy, sometimes like mediation, and sometimes educational. • The combination of the three is what makes it effective. 

19. Who’s Who in Mental Health? • Psychiatrist (MD) • College, four years of medical school, four years of a psychiatry residency. • Diagnose and treat patients with medication and/or therapy. Oversee patient care.

20. Clinical Psychologist(Ph.D./PsyD) • College, five to seven years of graduate study, a written dissertation on a specialized topic, specialized clinical training. • Diagnosis, psychological testing, and therapy. May refer people for medication but do notprescribe medication.

21. Counselor/Therapist(MA/MS) • College, two year graduate study in psychology or counseling. • Counseling or therapy, psychological testing.May refer people for medication but do not prescribe medication.

22. Psychiatric Nurse (RN/BSN) RN: Two or three year hospital or community college program. BSN:college degree in nursing. Psychiatric nurse certification: specialty training in medication management and group therapy . Works in inpatient and outpatient settings. Plans, implements, and evaluates patient care; monitors medications;and provides individual and/or group therapy

23. Social Worker (MSW) College, two years of graduate study which includes clinical training. Usually works in outpatient settings. Diagnosis, therapy, and medication management under the supervision of a physician.

24. Therapist Orientations (APA Data, 1989)

25. Therapy Types • Insight Therapies • Behavioral Therapies • Cognitive Therapies • Biological Therapies

26. Not All Psychotherapy Is Psychoanalysis • Many people have misconceptions about what psychotherapy is. Some people think psychotherapy involves laying on a couch and talking with a psychoanalyst who just says "tell me more.". • Most therapies focus on reducing symptoms quickly and returning the patient to a relatively normal level of functioning.

27. Insight Therapies • Psychodynamic • Person-centered Therapy • Gestalt Therapy • Existential Therapy

28. Comparing Major Therapies

29. Psychodynamic

30. Psychodynamic • Usually lengthy • Free Association and Dream Analysis • Barriers: Resistance, Transference • Exploring unconscious

31. Psychodynamic • Free association • Analysis of Resistance • Dream analysis • Analysis of Transference

32. Psychodynamic • Minimizes patient responsibility • Neglects conscious motives and the present • Fairly costly

33. Psychoanalytic Orientation The Nature of Psychoanalysis Techniques in psychoanalysis: Analysis of free associations Analysis of resistances Analysis of dreams Analysis of transference Offshoots of psychoanalysis

34. Freud’s Psychoanalysis Psychoanalysis - an insight therapy based on the theory of Freud, emphasizing the revealing of unconscious conflicts. Dream interpretation Manifest content – the actual content of one’s dream. Latent content – the symbolic or hidden meaning of dreams. Free association – Freudian technique in which a patient was encouraged to talk about anything that came to mind without fear of negative evaluations.

35. Freud’s Psychoanalysis Resistance - occurring when a patient becomes reluctant to talk about a certain topic, either changing the subject or becoming silent. Transference - in psychoanalysis, the tendency for a patient or client to project positive or negative feelings for important people from the past onto the therapist.

36. Psychoanalysis Today Psychodynamic therapy - a newer and more general term for therapies based on psychoanalysis, with an emphasis on transference, shorter treatment times, and a more direct therapeutic approach. Nondirective- therapy style in which the therapist remains relatively neutral and does not interpret or take direct actions with regard to the client, instead remaining a calm, nonjudgmental listener while the client talks. Directive- therapy in which the therapist actively gives interpretations of a client’s statements and may suggest certain behavior or actions. Psychoanalysis today is more directive.

37. _______________ formed a large part of Freud’s psychoanalytic method.a) Reflectionb) Empathyc) Dream interpretationd) Unconditional positive regard

38. _______________ formed a large part of Freud’s psychoanalytic method.a) Reflectionb) Empathyc) Dream interpretationd) Unconditional positive regard

39. Humanism • Only the client can judge if he or she is better • No way to independently verify success

40. Person Centered

41. Person-Centered Therapy • A Humanistic therapy • Founded by Rogers • Uses mirroring & unconditional positive regard to promote self actualization • Therapist must genuinely like the client • Therapist must have empathy for the client

42. Person Centered (Nondirective) • Warm, supportive environment • Unconditional positive regard • Reveal true feelings to achieve self-growth • Understand past conditions of worth • Need for therapist to identify with client (empathy)

43. Gestalt Therapy • Founded by Perls • Therapist directs client to get in touch with feelings, resolve unfinished business

44. Gestalt • Challenge with questions, activities designed to challenge clients to increase self-awareness • Role playing • Confrontation, but encouraging, supportive

45. Today’s View of Humanistic Therapy Humanistic therapies are not based in experimental research and work best with intelligent, highly verbal persons.

46. Humanistic Orientation Person-Centered Therapy; Carl Rogers Reflection of feelings main technique Unconditional positive regard Gestalt Therapy; Perls

47. Roger’s Person-Centered Therapy Person-centered therapy - a nondirective insight therapy based on the work of Carl Rogers in which the client does all the talking and the therapist listens. Four Elements: Reflection - therapy technique in which the therapist restates what the client says rather than interpreting those statements. Unconditional positive regard - referring to the warmth, respect, and accepting atmosphere created by the therapist for the client in person-centered therapy. Empathy - the ability of the therapist to understand the feelings of the client. Authenticity - the genuine, open, and honest response of the therapist to the client.

48. What did Carl Rogers view as a cause of most personal problems and unhappiness? a) reinforcement of maladaptive behavior patterns b) unrealistic modes of thought employed by many people c) mismatch between an individual’s ideal self and real self d) unresolved unconscious conflicts occurring between the id and superego

49. What did Carl Rogers view as a cause of most personal problems and unhappiness? a) reinforcement of maladaptive behavior patterns b) unrealistic modes of thought employed by many people c) mismatch between an individual’s ideal self and real self d) unresolved unconscious conflicts occurring between the id and superego

50. Gestalt Therapy form of directive insight therapy in which the therapist helps clients to accept all parts of their feelings and subjective experiences, using leading questions and planned experiences such as role-playing. Try to help clients deal with things in their past that they have denied and will use body language and other nonverbal cues to understand what clients are really saying.