Therapy approaches

Any psychological (non physical) therapeutic intervention. Typically refers to psychoanalytic therapy.

Focus on psychological, social and cultural factors. i.e. believes things are multiply determined.

• Believes the unconscious mind has great influence on the conscious.
• Mental disorders are a result of unconscious conflicts.
• Aim: reduce defences (denial, repression, projection, etc) and gain insight into hidden intrapsychic conflicts. Insight itself leads to improvement.
• Uses free association and dream analysis to reveal the unconscious mind.
• Looks at transference and counter-transference.
• Therapy is long term and intensive.
• BUT: based primarily on case studies rather than quantitative, experimental studies (unscienetific). Therapy is reductionist and simplistic (reduces everything to sexual urges). Unfalsifiable. Few well-controlled randomised trials.

• Reaction against psychoanalysis - minimal therapist interpretation, non-directive, no diagnosis.
• Aim: elimination unrealistic conditions of worth, allow self-actualisation.
• Therapist shows empathic understanding, unconditional positive regard, congruence/genuineness/integration.
• Relationships were the most positive influence in facilitating growth.
• BUT: difficult to research. Greatest application among individuals without psychological disorders.

• Symptoms in one member treated as an indicator of family dysfunction.
• Recommends changes on basis of altering patterns of interrelationships and dynamics in groups.
• Focus on communication, interpretation, working to create helpful patterns of relating and responding to problems.
• Therapist recommends changes to break dysfunctional patterns.

• Reaction against psychoanalysis.
• Suggests problems are due to faulty learning (classical conditioning and generalisation).
• Aim: to change overt, observable, maladaptive behaviour.
• Take presenting problem seriously.
• Time limited, directive, clearly defined goals.
• Application of classical and operant conditioning to disorders.
• Client is an active participant (homework). Therapist relationship is not sufficient.
• Specific techniques: systematic desensitisation, flooding, graded exposure, operant conditioning behaviour modification (shaping), social learning (observational learning, modelling, social skills training), relaxation techniques.
• Empirical research based and evaluated.
• Strong evidence for efficacy.
• BUT: no room for biology, doesn't account for development across lifespan.

• Relativel less emphasis on "observable" than in behavioural therapy, but the aim is still to change overt behaviour.
• Assumes disorders are based on dysfunctional attitudes, beliefs (cognitive schema).
• Supported by evidence of cognitive bias in many disorders.
• Present focused, time limited, specific, directive, empirical research based.
• Verbal therapy plus "behavioural experiments" to teach clients to identify and test validity of their automatic thoughts.
• Cognitive restructuring
• Rational emotive therapy: emotional disturbance caused by cognitive structures that lead an individual to misinterpret how they see the world. Activating event, Belief/interpretation, Consequence/emotional response (ABC).
• Beck: goal of CT is the development of rational, adaptive thought patterns.
• Substantial research supports effectiveness.

• Combination of cognitive and behavioural techniques.
• Based on recognition that cognitive change is often best achieved by experience/action rather than by talking.
• Most widely used and well-validated treatment to date.
• Strong evidence for effectiveness.
• Techniques: imaginal exposure, behavioural experiments.

• Sensitive to the context and functions of psychological phenomena, not just form.
• Emphasise contextual and experiential change strategies in addition to more direct ones.
• Focus on: mindfulness, acceptance, values in life, relationships, client-therapist relationship.
• E.g. acceptance and commitment therapy (ACT), dialectic behaviour therapy, functional analytic psychotherapy, integrative behavioural couple therapy, mindfulness based cognitive therapy for depression, metacognitive therapy.
• ACT: teaches individual to notice and accept private events without attempting to change them. Views the core of problems as Fusion with thoughts, Evaluation of experience, Avoidance of experience, Reason for giving your behaviour (FEAR). Train people to Accept reactions to be present, Choose a valued direction, Take action (ACT).
• Found moderate effect sizes for ACT. But scientific rigour of studies was less than for CBT and not yet meeting criteria for empirically supported treatments.