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Psychotherapy
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1Psychotherapy
The examination consists of 40 multiple-choice questions, each with three answer
options. Examination questions are carefully designed and cover all indicated material,
including chapters from the textbook and reader that were assigned but not discussed during the
lectures. The exam questions are based on lectures, demonstrations, textbook and reader. This is
not to say that the lecturers have to cover all the material in the examination questions. Lecturers
have a measure of freedom in this regard. Demonstrations are also included in the exam.
1. Psychotherapeutic change: Intro
A few praises/concerns…
- There is a gap between academic psychology and clinical practice. The clinical
field had to find practical knowledge and their own answers. They don't have
restrictions by academic research, they have freedom to work how they want.
Research findings have a small impact.
- Psychotherapy is quite effective (better than the effects of medicine!). The effects
of psychotherapy are better than those found in medicine. We help patients, not
getting completely rid of their problems but get on the right track. Helping is
possible.
- Although the effects are good and the empirical research is good, there is a
problem with theory. There is little theoretical integration across schools.
Lousie has panic disorder (panic attacks out of the blue). In the video the therapist was
fishing for answers, especially asking her what she was afraid of when she has panic
attacks.
Feelings that stay constantly or reoccur.
Or maybe an absence of those feelings
like with depression where you can’t feel
joy. Or maybe instead of feelings,
ruminating thoughts that you can’t get
out of your head. Or maybe behavior
tendencies like alcoholism or pulling
their hair. Or sensations like fatigue or
deja-vu. If you pull your hair but you
don’t want to, so who is pulling it? You
are the problem, having recurring experience which you think is a problem. You decide
that it is a problem, it is a subjective experience. You are not able to control your panic
attacks. They typically feel hopeless, they are not in charge, they can’t help it. They are
not the actor of their behavior anymore.
, 2
Psychotherapy is about changing unwanted
patterns of subjective experience. It’s not
about reality but about subjective. All
psychotherapy schools find different
answers and ideas about why it’s so difficult
to change and about how the relationship
between you and yourself is. (Reader:
overview of large psychotherapy
schools).
MEANS (These means are overarching ideas that come from the different schools
and from brain research)
Is treatment effective when
you argue with the patient?
Are these language-based
deductive arguments
helpful? We don’t have a
specific area for reasoning in
the brain, but we are very
language-oriented. We can
think and talk about things
we have never experienced,
like the future. We can talk
about causes and
consequences not based on
experience. Propositional
information is reasoning,
words, consequences (“dogs
are fearful because I am
afraid of them”). Reasoning not based on experience, is this helpful and should this be
part of psychotherapy? (-Reasons for the patient to be happy, “it is a beautiful day…”).
(In cognitive therapy the arguments need to be experience-based in order to work, for
example: “I am depressed, I can’t do anything!” and the therapist says “Well you were
able to ride the bike here so you can do something”. This is a logical argument but it is
not helpful because it does not reach the part where the problem is. It does not help with
the immediate feelings. But this persuasive and argumentative style sometimes works,
namely when patients have wrong information, concepts and ideas; “Poisonous spiders
are not as common as you think in Holland, there are none actually”. This info can be
helpful when the patient has a wrong factual belief. But the immediate disgust reaction
towards a spider is much harder to change, because you can’t reach the experience)
, 3
You can use this style for psychoeducation which is offering factual information.
Psychotherapy is never about opposing the idea of the patient but rather going along
with the idea of the patient and somewhere along you turn to another direction.
Reasoning, words, consequences.. “dogs are fearful because I fear them”, reasoning
that is not based on experience. Should this reasoning be part of psychotherapy?
This can work when they have wrong information and offer factual information when they
have these wrong beliefs. But it’s difficult to change these immediate reactions like fear
of spiders.
Is psychotherapy about
discovering who you are? For
client-centered therapy and
psychodynamic therapy (2 of the
oldest psychotherapy traditions)
understanding and discovering
yourself was the main goal. Both
traditions stem out of philosophy.
It was important for Greek
philosophers to discover who you
are.
The basis of this is not working. It
may be more about changing
patterns of ideas. It's not about
finding yourself. This is not the
whole picture or the end goal. It’s about changing schemas and ideas. (Schemas
(dominant ideas) like “I am worthless” that are based on experiences in your life, and it is
reenacted throughout your life). So how can we change such a schema is a good
question for treatment.
Psychotherapy started with Sigmund Freud and he was mostly interested in personality. He
was intrigued by how we become the person we are and digging out through childhood. But
this sort of digging and trying to find the answer for the question of who you are doesn't seem
very efficient. In classical psychoanalysis you had 4 year treatment with 4 sessions a week to
find out who you are but this psychoanalysis is not efficient.
In client-centered therapy you have this idea that you only have to offer a correct relationship
with the patient. Talking to them, really respect them, empathy, and acceptance. And then the
patient will self-actualize themselves. When you offer a true therapeutic relationship you
become who you are. But nowadays nobody believes this is the case anymore, people no
longer believe that a good therapeutic relationship is enough for people to develop their
potential and you become who you are.
English butlers: (The butler keeps the drunk landlord from throwing the wine glass to
the carpet and the landlord doesn't even know he is there but the butler catches the
glass before it falls). It is an automatic process that works very effectively, but we do not
direct these processes (or butlers).
, 4
Example: Someone yells and you
see the person (light falls on retina),
olfactory receptors, project to the
primary visual cortex… and during
this process there are stages of
pattern recognition so in the end you
will realize it’s the porter yelling at
you. In addition, in a parallel process
the information is placed into
electrical stimuli… and there is
semantic information processing
where you understand the words
yelled. Thalamus sends info to the
amygdala which is in charge of detecting if there is danger or not. The amygdala sees
this situation and goes DANGER!! which sends info to the hippocampus and other brain
parts which start all sorts of processes (motor areas, emotions) so you step back. In
milliseconds, all these processes have started. But you are unaware. Only at the
moment where all the info is in convergence zones (high cortical areas), then you will
become aware that it is the porter who is yelling to shut up at you. “Consciousness is the
last to know”. You process all the information before you actually feel and act, these
processes of awareness are already there. These are English butlers and there are a lot
of them involved in psychotherapy. For example the immediate fear of dogs. So how can
we change these automatic butlers? And this will change experiences.
So there are a lot of things that occur not consciously (unawarely English butlers do the work for us).
Consciousness is the last to know, it is a by-product (we feel as if we are acting but things happen
automatically within us - Gazzaniga). So in Psychotherapy we have to change these automatic processes,
many pathologies are these processes out of balance. So can we even change them?
When looking at the brain literature on automatic processes, we find that we can change them
through exercises. With repeated encounters, we can change automatic behavior. When we have
associative representations (immediate fear when seeing a dog), then learning to stay in a room with a
dog for a couple hours for several locations will lead to gradually desensitizing from the fear of the dog.
“Cells that fire together wire together”. This is the principle of exposure; a repeated encounter in which you
change the associative representations between the stimulus and the response.
Whenever you want to change automatic processes it’s easier to change them with experiences,
rather than with words. Also, emotions can help
change automatic behavior. Emotions signify
biological relevance; certain situations are
emotionally latent for you.
In short, No. Discovering who you are is not a real
part of treatment. But with 2 exceptions:
- It’s not about discovering who you are, but
it’s about changing dominant or schematic
representations and ideas you have about yourself.
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