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Assessment and Therapy Major methods of clinical assessment ¢ Therapeutic approaches 1. Psychoanalysis 2. Assessment and Therapy Major methods of clinical assessment ¢ Therapeutic approaches 1. Psychoanalysis 2. Cognitive Behavioural Therapy 3. Gestalt Therapy 4. Solution-focussed Therapy ¢

Major methods of clinical assessment ¢ ¢ Clinical interview l Unstructured l Structured or Major methods of clinical assessment ¢ ¢ Clinical interview l Unstructured l Structured or semi-structured, e. g. for OCD, Anxiety Disorders, Pervasive Developmental Disorders Psychological tests l Self-report e. g. personality inventories (MMPI), depression, selfesteem etc. l Clinician administered, e. g. intelligence tests, neuropsychological tests, projective tests (Rohrschach, TAT) Observation = direct observation of behaviour; structured or unstructured Biological and Physiological testing, e. g. physiological indicators (GSR, heart rate) or neurological mapping (MRI, PET & CT etc. )

Major Research Methods Case Studies ¢ Epidemiological Research ¢ Correlational Studies ¢ Experimental studies: Major Research Methods Case Studies ¢ Epidemiological Research ¢ Correlational Studies ¢ Experimental studies: vary with regard the amount of control and randomisation ¢ Single-case experimental design ¢

Psychoanalysis (Freud & others) ¢ ¢ Personality is an organised system of drives or Psychoanalysis (Freud & others) ¢ ¢ Personality is an organised system of drives or instincts which must be regulated. Pleasure Principle: Individuals are driven to seek pleasure and avoid pain Personality/behaviour is guided by the conflict between life instincts (Eros) and death instincts (Thanatos) ANXIETY arises out of the tension between the id, ego and superego. This tension motivates us to do something. l Three types of anxiety according to Freud: • Reality – anxiety is realistic and appropriate to the situation • Neurotic – fear of uncontrollable instincts • Moral – fear of violating one’s own conscience (built on the standards of parents or society).

Defence Mechanisms: ¢ ¢ ¢ ¢ ¢ Repression Denial Reaction Formation Projection Displacement Sublimation Defence Mechanisms: ¢ ¢ ¢ ¢ ¢ Repression Denial Reaction Formation Projection Displacement Sublimation Rationalisation Regression Identification Intellectualisation

Assessment: Projective techniques ¢ ¢ ¢ Rorschach (1921) - 10 cards with ambiguous material Assessment: Projective techniques ¢ ¢ ¢ Rorschach (1921) - 10 cards with ambiguous material (ink blots) presented and clients project feelings and motivations Thematic Apperception Test (Morgan & Murray, 1935) - Series of 31 drawings and clients make up a story about what is occurring in the drawing Research conducted by Craig and Horowitz (1990) TAT and Rorschach top 4 tests commonly used

Goals of Therapy: ¢ Make the unconscious, conscious l l l ¢ Awareness of Goals of Therapy: ¢ Make the unconscious, conscious l l l ¢ Awareness of past experiences Acknowledgment of anxiety and threat Gain insight into patterns of behaviour Strengthen the ego l l l Behaviour in tune with reality Able to withstand impulses of ID & Superego No need for reliance on defence mechanisms

Therapeutic Process Goals are achieved through analysis of childhood experiences. These experiences are: ¢ Therapeutic Process Goals are achieved through analysis of childhood experiences. These experiences are: ¢ Reconstructed ¢ Interpreted ¢ Analysed

Analyst - Therapist-client relationship is key ¢ Neutrality (blank screen) and empathy ¢ Allows Analyst - Therapist-client relationship is key ¢ Neutrality (blank screen) and empathy ¢ Allows free expression of thoughts, images, feelings without distortion or censorship ¢ Attitude is non judgemental with ‘benign curiosity’ ¢ Encourages client to reflect upon significance and to make connections ¢ Transference is central to therapy ¢

Transference ¢ ¢ Transference occurs when clients earlier relationships contribute to their distorting of Transference ¢ ¢ Transference occurs when clients earlier relationships contribute to their distorting of the present. Clients react to therapist as they did to some other, significant person. Analysis of transference assists to distinguish reality from fantasy, past from present, and bring aspects of unconscious into consciousness Therapist listens for gaps, inconsistencies and draws meaning from associations and dreams Therapist examines relationships and motivations occurring before age 5 that affect current functioning

Techniques and Procedures ¢ Free association: relate everything they are aware and this allows Techniques and Procedures ¢ Free association: relate everything they are aware and this allows for unconscious material to arise • • • ¢ slips of the tongue meanings disruptions omitted material interpreting behaviour and material presented Dream Analysis: • Dreams are the “royal road to a knowledge of the unconscious activities of the mind” (Freud, 1900). • Dreams can reveal wishes, needs, and fears • Representation of content (manifest and latent) unacceptable to the ego

¢ Interpretation: • Analysts present material to client arising during sessions • Analysts attend ¢ Interpretation: • Analysts present material to client arising during sessions • Analysts attend to content of material and process of conveying material to client • Clients may resist therapy at times and this may be interpreted ¢ Encouragement of Regression: • Returning to an earlier way of reducing threat, anxiety or pain

Cognitive Therapy ¢ ¢ In the 1950 s behavioural theory and therapy (Skinner etc. Cognitive Therapy ¢ ¢ In the 1950 s behavioural theory and therapy (Skinner etc. ) was prominent In the 1960 s other theorists (esp. Aaron Beck) proposed the importance of thoughts/cognitions Albert Ellis added the emotional dimension and the “rationalisation” of thoughts and feelings Since then, many other theorists and models

The Main Elements in Cognitive Theory Negative Automatic Thoughts ¢ Negative schemas/negative schema content The Main Elements in Cognitive Theory Negative Automatic Thoughts ¢ Negative schemas/negative schema content ¢ Leads to process of logical errors/cognitive distortions ¢ Content negative with respect to ¢ Self l World l Future l

Automatic Thoughts ¢ ¢ ¢ ¢ Are transient phenomena; quick but can be “caught” Automatic Thoughts ¢ ¢ ¢ ¢ Are transient phenomena; quick but can be “caught” (like a spoken sentence) Occur in the stream of consciousness They are short and specific. They occur extremely rapidly, immediately after the event. They do not occur in sentences, but may consist of a few key words or images. They do not arise from careful thought. They do not occur in a logical series of steps such as in problem solving. They seem to happen just by reflex

Schemas ¢ ¢ Are permanent entities/scripts stored somewhere in your brain Long term reference Schemas ¢ ¢ Are permanent entities/scripts stored somewhere in your brain Long term reference material about things in the world A schema is like a box that contains the results of previous experiences as interpreted by the person The content of the schema can be positive or negative or a mixture EXPECTATIONS MEMORIES ASSOCIATED EMOTIONS ACTION TENDENCIES (Behaviours)

STREAM OF CONSCIOUSNESS (Includes awareness of sensations) AUTOMATIC THOUGHTS ACTIVATING EVENT Emotional Response SCHEMAS STREAM OF CONSCIOUSNESS (Includes awareness of sensations) AUTOMATIC THOUGHTS ACTIVATING EVENT Emotional Response SCHEMAS Behavioural Response

Logical Errors in making conclusions from sensory input ¢ Also known as “cognitive distortions” Logical Errors in making conclusions from sensory input ¢ Also known as “cognitive distortions” ¢ Not errors in perception, but errors in interpretation ¢ Misinterpretation or non-objective interpretation ¢

Types of Logical Errors ¢ ¢ ¢ Catastrophisation l More dire than justified l Types of Logical Errors ¢ ¢ ¢ Catastrophisation l More dire than justified l Unjustified negative prediction Overgeneralisation Personalisation l Invalid assumption of responsibility l Mindreading ¢ ¢ Selective Abstraction l Biased weighting l Not considering all the facts l Black & White thinking l False Absolutes Arbitrary Thinking l (Shoulds) l Emotional Reasoning

Which Logical Error? Activating event Belief or thought Referee awards Penalty He’s useless - Which Logical Error? Activating event Belief or thought Referee awards Penalty He’s useless - Invalid allocation of responsibility - Overgeneralisation - Biased Weighting Emotional onsequence C Anger - Must or Should Emotional Reasoning

Which Logical Error? Emotional onsequence Activating event Belief or thought C Bike Smash My Which Logical Error? Emotional onsequence Activating event Belief or thought C Bike Smash My career is over, this is the end Depression Catastrophisation - More dire than justified - Unjustified negative prediction - Overgeneralisation (External attribution)

Which Logical Error? Activating event Going to a party Belief or thought I’ll probably Which Logical Error? Activating event Going to a party Belief or thought I’ll probably embarrass myself Catastrophisation - Biased Weighting - More dire than justified - Unjustified Negative Prediction Emotional onsequence C Anxious

Common negative schema content Nature of self: I am no good ¢ Integrity of Common negative schema content Nature of self: I am no good ¢ Integrity of self: I am unsafe/will come to harm ¢ Nature of social world: I am or will be alone ¢ Nature of the world: The world is bad/against me ¢ Nature of others: Other people are bad/against me ¢

Which Schema Theme? Activating event Belief or thought Referee awards Penalty Emotional onsequence He’s Which Schema Theme? Activating event Belief or thought Referee awards Penalty Emotional onsequence He’s useless C Nature of self: I am no good Integrity of self: I am unsafe Nature of social world: I am or will be alone Nature of the world: The world is bad/against me Nature of others: Others are bad/against me Anger

Which Schema Theme? Emotional onsequence Activating event Belief or thought C Bike Smash My Which Schema Theme? Emotional onsequence Activating event Belief or thought C Bike Smash My career is over, this is the end Depression Nature of self: I am no good Integrity of self: I am unsafe Nature of social world: I am or will be alone Nature of the world: The world is bad/against me Nature of others: Others are bad/against me

Which Schema Theme? Activating event Going to a party Belief or thought I’ll probably Which Schema Theme? Activating event Going to a party Belief or thought I’ll probably embarrass myself Nature of self: I am no good Integrity of self: I am unsafe Nature of social world: I am or will be alone Nature of the world: The world is bad/against me Nature of others: Others are bad/against me Emotional onsequence C Anxious

What goes Wrong? We make logical errors in our childhood ¢ We develop Early What goes Wrong? We make logical errors in our childhood ¢ We develop Early Maladaptive Schemas ¢ We make logical errors after Activating (Critical) Events ¢ Activate negative emotion from an EMS l Have frequent negative automatic thoughts l ¢ We believe in and use dysfunctional strategies

Which counterproductive strategy? ¢ ¢ ¢ Avoidance? Surrender? Overcompensation? Cognitive Behavioural Therapy: adds a Which counterproductive strategy? ¢ ¢ ¢ Avoidance? Surrender? Overcompensation? Cognitive Behavioural Therapy: adds a behavioural or ‘change to strategy’ element

Goals of Therapy In the Moment ¢ Change logical errors to appropriate logic ¢ Goals of Therapy In the Moment ¢ Change logical errors to appropriate logic ¢ Reduce the frequency of automatic thoughts ¢ Change the balance of schema content from negative to positive ¢ Help the client change their behaviour Later in Therapy ¢ Change logical errors to appropriate logic in more pervasive way ¢ Change schema content ¢ Build new schema content ¢ Revise memories ¢ Change meta-cognitions regarding behavioural strategies

Therapeutic process ¢ ¢ ¢ Summarizing and questioning can lead to change in beliefs Therapeutic process ¢ ¢ ¢ Summarizing and questioning can lead to change in beliefs l Making your questioning specific can make the logical errors apparent l Summarising Comparing incompatible information or values Funnelling BROAD your Psychoeducation questions Investigation leads to automatic Experiment thoughts SPECIFIC

Gestalt Therapy ¢ Gestalt - German word meaning “pattern” or “whole” ¢ Fritz Perl’s Gestalt Therapy ¢ Gestalt - German word meaning “pattern” or “whole” ¢ Fritz Perl’s Gestalt Prayer I do my thing, and you do your thing I am not in this world to live up to your expectations And you are not in this world to live up to mine. You are you, and I am I, And if by chance we find each other, it’s beautiful If not, it can’t be helped. (Source: Fritz Perls, as quoted in Shepard, 1975, p. 3. )

Personality - Five Layers Cliché layer (Phony) Implosive layer Role playing layer (Phobic) Impasse Personality - Five Layers Cliché layer (Phony) Implosive layer Role playing layer (Phobic) Impasse layer Explosive layer Genuine personality

Key concepts ¢ Gestalt - exists through the inter relation of parts. l ¢ Key concepts ¢ Gestalt - exists through the inter relation of parts. l ¢ Healthy functioning: parts form a meaningful whole Awareness: contact within self and with others. Ability to focus on what exists in the now. l Becoming aware of : • • Sensations - senses: seeing, hearing, touching etc. . Feelings - emotional and physical Future events - wants and desires Values - social, spiritual, and relationship issues

Key concepts cont. . . ¢ Unfinished business- unexpressed feelings from the past ¢ Key concepts cont. . . ¢ Unfinished business- unexpressed feelings from the past ¢ The Now- present focus- incorporating bodily and sensing systems ¢ Responsibility- core of Gestalt Therapy. ¢ Holism

Assessment ¢ Focus is on “moments in therapy” ¢ Gestalt contact style questionnaire (how Assessment ¢ Focus is on “moments in therapy” ¢ Gestalt contact style questionnaire (how the “I” comes into contact with others and the world in terms of body, values, emotional expression etc. )

Goals of Therapy ¢ Increase awareness • body, feeling, environment, experiences, needs, skills, senses, Goals of Therapy ¢ Increase awareness • body, feeling, environment, experiences, needs, skills, senses, power to care for oneself, actions and consequences, fantasies Accept responsibility ¢ Increase personal growth and autonomy ¢

Therapeutic change “Change occurs when one becomes what one is, not when one tries Therapeutic change “Change occurs when one becomes what one is, not when one tries to become what one is not” (Beisser, 1970) ¢ 3 stage sequence of integration (Polster, 1987) Discovery l Accommodation l Assimilation l

Gestalt Techniques The dialogue exercise ¢ Playing the projection ¢ I take responsibility for Gestalt Techniques The dialogue exercise ¢ Playing the projection ¢ I take responsibility for ¢ May I feed you a sentence ¢ The rehearsal exercise ¢ Experiments ¢

Solution Focussed Therapy Overview of Philosophical Approach Serious optimism l Client as expert l Solution Focussed Therapy Overview of Philosophical Approach Serious optimism l Client as expert l Collaborative l Customers and complaints l Power of language l No absolute truths l Constructivist l

Assumptions of solution focussed therapies (O’Hanlon & Weiner- Davis (1989) ¢ ¢ ¢ ¢ Assumptions of solution focussed therapies (O’Hanlon & Weiner- Davis (1989) ¢ ¢ ¢ ¢ ¢ Clients have resources and strengths to solve complaints Change is constant The SF therapist’s job is to identify and amplify change It is usually unnecessary to know a great deal about the complaint to resolve it It is not necessary to know the cause or function of a complaint to resolve it A small change is all that is necessary; a change in one part of the system can effect change in another part of the system Clients define the goal Rapid change or resolution of problems is possible There is no one “right” way to view things; different views may be just as valid and may fit the facts just as well Focus on what is possible and changeable rather than what is impossible and intractable

Central constructs ¢ ¢ Exceptions l regardless of the severity of a problem, there Central constructs ¢ ¢ Exceptions l regardless of the severity of a problem, there always times when the problem does not happen l helps consumers see they are already successful l Work to find ways to increase exceptions Change talk Strengths and resources Solutions l Focus is on what would be perceived as acceptable solutions – “a difference that would make a difference”

Therapy ¢ Roles Client is expert on the problem l Therapist expert on change Therapy ¢ Roles Client is expert on the problem l Therapist expert on change and solutions l ¢ Assessment Traditional assessment belongs in the medical, problem focused models l Focus is on interviewing for solutions l • How were you hoping I could help you? • Have you tried anything to solve this? • What do you notice when it isn’t happening?

Therapy continued… ¢ Goals Need to be specific, attainable, observable and concrete l Good Therapy continued… ¢ Goals Need to be specific, attainable, observable and concrete l Good goals: l • • Change the doing of the problem Change the viewing of the situation Evoke resources, strengths and solutions The best goals are those that specify what replaces unwanted behaviours

Therapeutic techniques ¢ Questions Heavily relied upon l Special tactic: The pre suppositional question Therapeutic techniques ¢ Questions Heavily relied upon l Special tactic: The pre suppositional question l • When the problem is not present, how are things different? • Assumes that success already occurs

Some solution focused questions (Hudson, OHanlon & Weinrer-Davis, 1989) 1. 2. 3. 4. 5. Some solution focused questions (Hudson, OHanlon & Weinrer-Davis, 1989) 1. 2. 3. 4. 5. 6. What is different about the times when (the exception) happens? How did you get that to happen? How does it make your day go differently when (the exception) happens? How did you get her/him to stop? How is it different from the way you might have handled it (one week, one month etc. . ) ago? Have you ever had this difficulty in the past? What did you do to resolve it then? What would you need to do to get that to happen again?

Techniques continued… ¢ Externalisation of the complaint The person is not the problem l Techniques continued… ¢ Externalisation of the complaint The person is not the problem l The problem is not the person l The problem is labelled as the complaint (or given a name) l Questions asked about the impact of the complaint l The complaint is broken down into small and specific components l The complaint is reframed as habits l

¢ Normalising the problem l ¢ SFT may ask the client something like “How ¢ Normalising the problem l ¢ SFT may ask the client something like “How can you tell the difference between (stated complaint) and (normalised explanation)? Compliments Drawing out personal qualities that can be useful in resolving current difficulties l Not motivated to be kind to clients l Used to reinforce what is of importance to a client l ¢ The miracle question l Help identify goals without focusing on problems and causes

The Miracle question Set the scene: I’m going to ask you a question, it The Miracle question Set the scene: I’m going to ask you a question, it may seem a little weird, but I think it may be really helpful. Are you ready? The Miracle question (de Shazer, 1988): “Suppose that while you are sleeping tonight and the entire house is quiet, a miracle happens. The miracle is that the problem which brought you here today is solved. However, because you are sleeping, you don’t know what the miracle has happened. So, when you wake up tomorrow morning, what will be different that will tell you a miracle has happened and the problem which brought you here is solved?

Techniques continued…. ¢ Scaling questions “On a scale from 0 – 10, with 0 Techniques continued…. ¢ Scaling questions “On a scale from 0 – 10, with 0 being the worst the problem has ever been and 10 being the problem is completely solved, where are you today? ” l “What one or two things could you do this week to being you up one or two points? ” l

¢ Altering the complaint l Changing when the complaint is performed l Changing the ¢ Altering the complaint l Changing when the complaint is performed l Changing the duration of the complaint l Changing the location of the complaint l Adding at least one new element to the complaint pattern l Linking the complaint to some burdensome activity l Changing the context of the complaint ¢ Surprise task l Do one or two things that will surprise (partner, parents) don’t tell them what it is, (Partner or parents) job is to find out what it is. Don’t compare notes, we will do that at next session

¢ ¢ Write, read and burn l Write about a problem on even numbered ¢ ¢ Write, read and burn l Write about a problem on even numbered days for specific time periods and odd numbered days read notes and burn them. Structured fight l Changing the pattern • Flip a coin to decide who goes first then winner has 10 minutes uninterrupted time to bitch. The other then gets 10 minutes. There must be 10 minutes of silence before flipping the coin again. ¢ Do something different l Aim to disrupt the more of the same routine