Twenty-First Century Psychotherapies

2. Twenty-First Century Psychotherapies Chapter 4 – Experiential Therapy

3. Learning ObjectivesIdentify the key common principles of experiential therapiesRecognize the contributions of key figures in the fieldArticulate the principle components of experiential therapyIdentify the empirical support for experiential therapyExperiential Therapy – Key Names • Carl Rogers • Father of the humanistic movement in USA • Developer of person-centered/client-centered therapy • Key elements: • Empathy • Unconditional positive regard • congruence

4. Experiential Therapy – Key Names • Eugene Gendlin – experiencing • Meaning-making is produced in the interaction of a felt meaning and the symbols that we use to contain it • Focusing-oriented psychotherapy • Felt sense • Focusing attitude • Fritz Perls • Gestalt therapy • Shoulds • Creative adjustment • Techniques – empty chair

5. Gestalt Therapy • Focus on here and now • Dialogical Gestalt Therapy (Yontef) • Critical of Gestalt Therapy’s lack of attention to: • The past • Client’s psychological safety • More accepting than traditional Gestalt Therapy • Mahrer: Experiential Psychotherapy • Client suffers from disjunction between “operating” and “deeper” potentials • Each session should be transformative

6. Experiential therapy • Session structure • Client focuses on reexperiencing a strong feeling • Client explores deeper potential of the strong feeling • Imagines reentering the past scene and relives them from the new perspective • Imaginatively projects into new scenes, “test drives” new experience, critically evaluates options • Leaves session with a new perspective • Client and therapist sit side-by-side and therapist acts as a coach

7. Experiential therapy • Content goals • What the client brings in to therapy • Process goals • what the therapist sees as the means toward achieving the client’s content goals • The therapeutic relationship • Experiential and emotional processing

8. Existential Therapy Normal anxiety Existential anxiety Authenticity Good faith Bad faith

9. Experiential Therapy – Key Names • Leslie Greenberg • Emotion-Focused Therapy (EFT) • emotion as fundamental datum of human experience • Primary adaptive emotion – immediate and helpful emotional response • Primary maladaptive emotional response – overlearned responses from previous (often traumatic) experiences • Secondary emotional response – emotional reactions to primary emotional experiences • Instrumental emotional response – emotional responses used to control or influence others

10. Experiential therapy • Three phases: • Bonding and awareness  • evocation and exploration (arriving at core emotion) • transformation and generation of alternatives • Change occurs by means of awareness, regulation, reflection, and transformation of emotion taking place in an empathically attuned relationship

11. Experiential Therapy • Fundamental principles • Experiencing • Potential for agency • People as pluralities • Authentic relationships • Growth and development are lifelong • Pathology due to incongruence

12. Experiential Therapy • Theory of Psychotherapy • Goal: to deepen experience and symbolize it accurately in awareness • Content goals versus process goals • Process diagnostic versus person diagnostic • Core processes: therapeutic relationship and experiential/emotional processing

13. Dialectical Constructivist Experiential Therapy People as biological dynamic systems who live in and adapt to social environments Social construction of emotion Self-narrative/narrative identity Pluralistic view of dysfunction

14. Experiential Therapy • Empirical support • Strongest (and most) for EFT, especially EFT for depression • Extensive process research showing increased experiencing relates to better outcomes

15. Twenty-First Century Psychotherapies Chapter 5 – Mindfulness- and Acceptance-Based Therapy

16. Mindfulness and Acceptance • Mindfulness- intentionally focusing attention on the experiences occurring in the present moment in a nonjudgmental or accepting way • Present moment experiences include all observable internal stimuli (e.g., cognitions, bodily sensations, emotional states) and external stimuli (e.g., sights, sounds, smells) • Acceptance- a willingness to experience a wide range of unwanted or unpleasant internal phenomena without attempting to avoid, escape, or terminate them

17. Types of Mindfulness- and Acceptance-Based Therapies • Acceptance and Commitment Therapy (ACT) • Dialectical Behavior Therapy (DBT) • Mindfulness-Based Cognitive Therapy (MBCT) • Mindfulness-Based Stress Reduction (MBSR)

18. ACT: History and Theory • ACT • Developed by Steven Hayes in the 1970s • Relational frame theory • Psychological difficulties result from cognitive fusion and experiential avoidance • ACT teaches six components of psychological flexibility, the alternative to cognitive fusion and experiential avoidance • Contact with the present moment • Acceptance • Defusion • Self-as-context • Values • Committed action

19. DBT: History and Theory • DBT • Developed by Marsha Linehan • Targets suicidal and self-injurious women with borderline personality disorder (BPD) • Biosocial theory of BPD • BPD is a dysfunction of the emotion regulation system brought on by the transaction of an emotionally vulnerable temperament and invalidating childhood environment

20. MBSR and MBCT: History and Theory • MBSR developed by Jon Kabat-Zinn • Sought to integrate the Buddhist teachings of mindful meditation into Western medicine • MBCT is an adaptation of MBSR developed by Zindel Segal, John Teasdale, Mark Williams • Treatment for people in remission from a depressive episode • Decentering- see thoughts as transient mental events that do not necessarily reflect important truths or necessitate specific reactions

21. Theory of Psychotherapy: Common Elements Potential harm resulting from experiential avoidance Importance of decentering or defusion Treatment goal: increased awareness of present-moment experiences Initial assessment and tracking throughout therapy Importance of therapeutic relationship Homework Use of metaphors

22. MBSR: Strategies and Interventions 8-week group therapy Raisin Exercise Body scan Sitting meditation Hatha yoga Walking meditation Mindfulness in daily life All-day meditation session Incorporation of poetry

23. MBCT: Strategies and Interventions 8-week group therapy Three-minute breathing space Bringing difficulties to mind in sitting meditation Cognitive therapy exercises Pleasure and mastery activities Relapse prevention plans

24. DBT: Strategies and Interventions • Individual and weekly meetings for 1 year consisting of four modules • Core mindfulness • Interpersonal effectiveness • Emotion regulation • Distress tolerance skills • Three states of mind • Reasonable mind: rational, logical • Emotion mind • Wise mind: integration of reasonable and emotion mind • Mindfulness “What” Skills • Mindfulness “How” Skills • Mindfulness skills in emotion regulation and distress tolerance

25. ACT: Strategies and Interventions • Behavior change strategies tailored to the individual • Mindfulness and acceptance strategies • Several different strategies (e.g., cubbyholing, leaves on the stream, observer exercise)

26. Twenty-First Century Psychotherapies Chapter 6 – Postmodern / Poststructuralist Therapies

27. Learning Objectives Differentiate postmodern therapies from modern therapies Define postmodernism Recognize the similarities and differences between Solution-Focused, Narrative, and Collaborative therapies Identify empirical support for each type of therapy

28. Postmodernism / Poststructuralism • Postmodernism • The end of a single, universal worldview • Respect for difference, celebration of local • Social constructionism • Poststructuralism • Deconstruction • Rejection of “true self” • Text analogy / narrative metaphor

29. Common Characteristics • Transdisciplnary Inspiration • Social/Interpersonal view of knowledge and identity • Attention to context • Language as central concept • Therapy as partnership • Valuing multiplicity of perspectives/voices • Valuing local knowledge • Client as a star • Being public/transparent • Interest in what works well • Personal agency

30. Solution-Focused Therapy: Key Concepts DeShazer & Kim Berg Inductive process Goals as client-directed No assessment phase Brief treatment Main focus: build and implement solutions The Miracle Question Use of scales

31. Solution-Focused Therapy: Empirical Support Modest (but most of the postmodern therapies)

32. Narrative Therapy: Key Concepts • White & Epston • Poststructuralist • Thick versus thin stories • Dominant discourses • Client-directed goals • No assessment phase • “decentered but influential” • Transparency

33. Narrative Therapy: Key Concepts • Techniques: • Externalizing conversations • Unique outcomes • Re-membering • Use of therapeutic documents • Accountability • Working with external witnesses

34. Narrative Therapy: Empirical Support “Coresearch” Case studies

35. Collaborative Therapy – Key Terms • Anderson & Goolishian • Language systems • Conversational breakdowns • Client-directed goals • No assessment phase

36. Collaborative Therapy - Approach Conversational partnerships Therapy as research Client as expert Assuming a “not knowing” position Being public Therapy as everyday life

37. Collaborative Therapy – Empirical Support No specific quantitative studies Qualitative support Studied through study of therapist and client experiences