Psychotherapy Intro and EthicsCLP 4374PsychotherapyRecognizing our personal assumptions about “helping”In class: Therapist Do’s and Don’tsPsychotherapy1) Theories vs Techniquesi) What are they?ii) What’s the difference?(a) You use techniques based on theoryiii) Why are they necessary?(a) Structure(b) Rules help us figure out what to do when we don’t know what to doPsychotherapy1) What is it?a) Talking treatmentb) Dealing with issues, stressc) Empowermentd) Promote well-beinge) new conceptualizations: positive development/positive psychologyi) symptom reduction vs transformational change(1) symptom reduction: but people aren’t broken!! Not good enough because people are still depressedClients1) “client” vs “patients”a) Client is on the street, just go for an hour..b) Patient is in a hospital2) Who goes to therapy?a) Self-referredb) Court-mandatedc) Kids/adolescents/adultsTherapeutic Process1) Therapist/Client Relationshipa) Solid, trustingi) About empowerment/self-efficacyii) About independence2) Overt vs covert process3) What you see… (like?)a) Overt: visible, measurable signsb) Incongruities: laugh at a funeral… can help take a step forward4) What’s internal and you don’t see… (like?)a) “such a cute dress” 0.ob) If you tell a client to tell his mom to go “f-herself” the client agrees in your face but never comes back5) How is each important?6) How is each necessary?a) Necessary if they become more congruentb) Otherwise you need to keep an open mind about other options7) How is each a positive and potential negative? a) Act depressed but really it’s about an inability to express anger towards abusive parents. Don’t treat depression, treat emotion expression!Lesson for the day: “get life a little messy”Therapy Process Map: 5 steps!!!1) Establish rapporta) “breaking the ice”2) Identify a problem or focal issue3) Working phase4) Practicing5) Terminationa) Think about overall process, how do you know when therapy is over? Can’t prolong it…Establishing Rapport1) What brought you to therapy?2) Access client expectations:a) What are some things you’re afraid of in therapy?b) “Magic Techniques or “Miracle Q”i) If you could make a wish to change anything… what would it be?c) Explain how therapy works: there’s no magic… it’s a process3) Collaboration vs therapist as “healer”Problem Identification1) Try to focus the attention on 1-2 issues2) Why?3) Who decides what to focus on?4) What if therapist and client disagree?Working Phase1) Getting into the presenting problems and what may be feeding/maintaining or causing them2) Not all clients get here easily (or at all)a) What are some of the hindrances?Practicing1) Begin to apply new understanding in the worldTermination1) Don’t just end therapy suddenly—why?Therapist techniques1) Directive (a few examples)a) Empty chair: you pretend your problem person is in the chair: perfectionist!b) Free associationc) Homework assignments2) Indirect (non-directive)a) Reflecting: show same emotions as client, helps them develop a relationshipi) Content and feelings (difference?)b) Silencec) Body languaged) Empathy/empathic listeningi) What is a therapist’s best tool?(1) Themselves!!Role of Research in Therapy1) How do therapists know what to do?a) Dueling positions: scientific vs humanistic2) Scientific:a) Evidence-basedb) Empirically supported practicedc) Therapy is science3) Humanistic:a) Therapy is artPsychotherapy theories…1) For therapists, theories…a) Help describe people and their behaviors…i) Why do they do what they do?b) Explain how people get to be the way they arec) Describes how people “should” bei) Maladaptive vs normatived) Describes how they can change2) For researchers, theories…a) Organize info and give meaning to “facts”b) Guides future research and theory developmentTheoretical Assumptions1) Origin of personality: in-born? Shaped by experience?2) Development: trajectory is smooth? Stage-like (Freud)?3) Significance of early experience: early life or later life is more important?4) Consciousness: conscious or unconscious mind more influential?5) Human nature” are we basically good or basically bad? (or rationalis capex?)a) Inherently bad: Hobbesb) Rationalis capex: capability of being rationalResearch Evidence1) 400 theories out there to explain human behavior/psychology!!!2) 1960s-70s: Carl Rogers and colleagues—“what makes people get better?”a) It seems to be the therapist/client relationship that really helps people improve!!!3) 1970s-80s Population studies/effect sizesa) Crude estimate of which methods work better—why crude?i) Results: all methods good if used properly, only looks at averages, not special outlyersb) Population study: test a small sample of a population… really that simple!4) 1990s-present: what works for whom and when?DSM Manual-IV-TR1) 4th edition, TR (text revision)2) Classification of all “legitimized” mental-health related problems3) Necessary, but not uncontroversial part of mental health workUsing the DSM1) Multi-axial or multi-dimensional approach:2) 5 dimensions, symptoms checklists-clinical categoriesAxis 1 Clinical disorders Depression, anxiety, OCDAxis 2 Personality disorders Borderline, histrionic, OCDAxis 3 General medical disorders Problems causing mental symptomsAxis 4 Psychosocial/environmental disordersProblems may cause/contribute to mental symptomsAxis 5 GAF (global assessment functioning)1-100General people: GAF is about 90sAbout to die: teensEthics1) “the client comes first”a) Can be more difficult than you expectb) Mandatory vs aspirational ethics1) Licensing—a) Must abide by uniform ethical codes2) Responsibility on therapist to know nuances of laws within their state3) Ethics help keep this a “professional” field—help us reflect on and improve our practice of counselinga) Working with others during their vulnerable times requires a responsible approachBasic Ethical Principles1) Beneficencea) Focus on doing goodb) Bad: indifference, ill-will, vengefulness or spite2) Non-malfeasancea) Doing no harmb) Bad: using known harmful treatment (false vagina lmao)3) Autonomya) Self-determination, independenceb) Bad: need to be needed, you yourself are co-dependent4) Justicea) Considerations for fair treatment/involvementb) Keep patients for the right reasons5) Fidelitya) Faithfulness, loyalty, support to client and one’s professionb) Client ALWAYS COMES FIRSTClient’s Rights1)