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Therapuetic Approaches - Coggle Diagram
Therapuetic Approaches
"Group Think"
Highlights importance for service user input and diversity experience
Critical Theory
Critical Theory is a social theory that aims to critique and change society as a whole.
Simple Psychology, Critical Theory
Attachement Theory
Cognitive / Behavioural
Cognitive
Model
Assumptions
Mental illness stems from
faulty cognitions
about others, our world and us.
This fault thinking may be through
cognitive deficiencies
(lack of planning) or
cognitive distortions
(processing information inaccurately)
Cognitions cause distortions in the way we see things.
Ellis
Distortions are caused by
irrational thinking
and basic irrational assumptions
e.g. assuming "I'm a failure" if they are not loved by everyone they know, so seeking approval and repeatedly feeling rejected
ABC model (Activating event, Belief, Consequences)
REBT (Rational Emotive Behaviour Therapy) is often highly directive, persuasive and confrontative. Uses different models depending on the personality of the client
Therapist = Teacher. Personal relationship with client is not essential
Aaron
Beck
Identified 3 mechanisms responsible for depression:
2. Negative self-schemas
Negative & pessimistic beliefs and expectations about oneself. May be acquired in childhood as a result as a traumatic event (death, rejection, overprotection, neglect or abuse, bullying, exclusion)
3. Errors in Logic Cognitive
Distortions are self-defeating and can cause great anxiety and depression
1. Cognitive triad
3 forms of negative thinking: negative thoughts about the self, the world, and the future. As these components interact, they interfere with normal cognitive processing, leading to impairments in perception, memory and problem solving with the person becoming obsessed with negative thoughts
Stresses quality of therapeutic relationship
Places more emphasis than Ellis on the client discovering misconceptions for themselves. The method is based upon the particular disorder, no the client's personality.
We interact with the world through out mental representation of it. If our mental representations are innacurate our ways of reasoning are inadequate then our emotions and behaviour become disordered
Aims
To teach clients to how to identify distorted cognitions through a process of evaluation.
For clients to learn to discriminate between their own thoughts and reality
To learn the influence of cognition on feelings, and then recognise observe and monitor their own thoughts
To help clients challenge their unhelpful beliefs and prove them wrong
What is it?
Describes how people's thoughts and perceptions influence the way they feel and behave.
Forms the core of CBT and plays a critical role in helping therapists conceptualise and treat difficulties.
Situation --> Automatic Thoughts --> Reaction (Emotion, Behaviour, Physiological Response)
Strengths
Cost effective
as it tends to result in change occurring quickly when used with certain types of problems and therapeutic (SMART) goals
Evidence-based
: Cognitive theories lend themselves to testing. When experimental subjects are manipulated into adopting unpleasant assumptions or thought they became more anxious and depressed (Rimm & Litvak, 1969). Many people with psychological disorders, particularly depressive, anxiety, and sexual disorders have been found to display maladaptive assumptions and thoughts (Beck et al., 1983). Found very effective in treating depression and moderately effective in treating anxiety.
Model has great
appeal
because it focuses on human thought. Human cognitive abilities have been responsible for our many accomplishments so may also be responsible for our problems. Focuses on what we can
control
Limitations
The precise role of cognitive processes is yet to be determined. It is not clear whether faulty cognitions are a cause of the psychopathology or a consequence of it. Lewinsohn (1981) suggested hopeless and negative thinking may be the result of depression rather than the cause.
The cognitive model is
narrow in scope
- thinking is just one part of human functioning, broader issues need to be addressed. Does not address possible
underlying causes
or the wider problems in
systems
or
families
Ethical issues:
RET
is a directive therapy aimed at changing cognitions sometimes quite
forcefully
. For some, this may be considered an
unethical
approach.
What is it?
Behaviourism
Strengths
Uses
scientific
methods of research because experiments are
objective, measurable and observable
. E.g.
Bandar's bobo doll study of aggression
Has successfully applied classical and operant conditioning to its theories.
Systematic desensitisation
is based on
classical conditioning
and is useful for
treating phobias
Limitations
Assumes people can only learn as a result of their experiences.
Ignores mental processes
involved in learning unlike the cognitive approach.
Less focus on
nature
and
biological elements
What is it?
The theory that human and animal behavior can be explained in terms of conditioning, without appeal to thoughts or feelings, and that psychological disorders are best treated by altering behaviour patterns
Only concerned with observable stimulus-response behaviours, as they can be studied in a systematic and observable matter
Systemic
What is it
Focuses on the relationships between a group of people or
system
(families, orchestras, co-workers, sports teams) rather than solely on an individual's thoughts and feelings
Focuses on interactions and relationships between the group to help them address problems and move on. Gives all members the chance to explore their feelings and say what they think in a
safe, non-judgemental environment
. Work with all members in the system so no one feels isolated or ganged up on.
Took inspiration from thinking of a family as a
feedback loop
where everyone reacts to everyone else.
Uses
circular questioning
- asks about perceptions of the relationship and actions within it - to
identify deeply entrenches patterns
within relationship. This process helps to uncover ays in which members
communicate and behave within a systems
, based on
beliefs about their respective roles
.
Rather than asking 'who is ill?' it asks '
how does the system maintain this problem?
' through alliances, assumptions, interactions, coalitions, conflict, conflict avoidance, splits, enmeshment (co-dependence), etc.
Based on
systems theory
, which has roots in
biological sciences
. Views an individual/group as its own ecosystem with many moving parts that affect one another.
Areas of application
Working through addiction
Transitioning through divorce and / or step-family situation
Co-parenting after separation
Multi-generational issues if non-immediate family members live within the same household
Porcessing individual and/or familial trauma
Assumptions
Solutions
are created and maintained by individuals within the system
changing their communication, interactions with, and responses
to other members of the system
Problems
are caused and maintained in the system through
unhelpful relationship dynamics
and
ongoing interactions
The problem is in that of a
dysfunctional system
, not just the individual. "If part of the system is broken, then the whole system is broken".
Disadvantages
Requires participation of
all
members of the system which can be challenging. Refusal to participate can cause difficulties as homeostasis (even if unhealthy) is thrown out of balance.
Family issues can temporarily intensity as unhealthy patterns become more apparent. Issues tend to get worse before they get better.
Requires deep self-reflection, insight,
and
emotional intelligence
, or the
willingness
to work on these factors
Pyshodynamic
Assumptions
The major causes of behaviour have their origin in the unconscious
. The unconscious mind comprises of mental processes that are inaccessible to consciousness but influence feelings, judgements, and behaviours and these are powerfully influences by our past.
Our behaviour and feelings as adults (including psychological problems) are rotted in our childhood experiences.
Our childhood shapes our personality through different conflicts during psychosexual development and, has great influence on our adult lives
Psychic determinism: all behaviour has a cause / reason.
Causes of behaviour are external to the will. All behaviour has a cause (usually unconscious), even slips of the tongue, which provide insight into the unconscious mind.
Different parts of the unconscious mind are in constant struggle.
Personality is made of three parts (tripartite). Unconscious mind (Id and Superego) are in constant conflict with the conscious part of the mind (Ego). The conflict creates anxiety, which could be dealt with by the ego's use of the defence mechanism
1. Id.
Primitive and instinctive. Consists of inherited (biological) traits including the sex (life) instinct Erois (containing the libido), and the aggressive (death) instinct Thanatos
2. Ego
Develops to mediate between the unrealistic id and the external world. Decision making component of personality.
Superego
incorporates the values and morals of society which are learnt from parents and others
What is it
Draws on
analytical psychology
, helping clients understand and resolve issues by increasing their awareness of their inner world and its influence on relationships
Coined by Jung to describe his "empirical science" of the psyche.
A theory of human personality and thought that takes into account the individual unconscious and its relationship to the collective unconscious
.
Focuses on the role of symbolic experiences in human life. Puts a great focus on previous experiences, but views current circumstances as containing the seeds for future growth and development
Goal: Individuation. The achievement of a greater degree of consciousness regarding the totality of psychological interpersonal and cultural experiences
Archetypes
: Factors outside of consciousness with universal qualities. Form a collective unconscious, shape the moral universal narratives, myths and religious phenomena
Analysts role is to help facilitate the individuation process by providing an informed interpretative environment for understanding the individual's life experiences
Multiple observations are used to build a hypothesis -
triagnulaoiton
Consistency is key to make inferences from transference and countertransference
Helps people understand how
current feelings and behaviour
are
shaped by past experiences
and the
unconscious mind
.
Areas of Application
Gender Role Development
Therapy (Psychoanalysis)
Play Therapy (Anna Freud)
Attachment (Bowlby)
Moral Development (super-ego)
Psychopathology (e.g., Depression)
Aggression (Displacement / Thanatos)
Dream Analysis
Strengths
Emphasises and acknowledges importance of childhood in mental health
Considers both nature and nurture
Considers interpersonal relationship
Empirical findings
have demonstrated the role of unconscious processes in human behaviour. Cognitive psychology has identified unconscious processes (procedural memory & automatic processing) and social psychology has shown the importance of implicit processing.
Limitations
Ignores meditational processes
(e.g. thinking)
Places too little emphasis on biological / genetic factors that influence and controbitue to mental health problems
Deterministic:
Suggests we have no conscious free will over our behaviour
Unfalsifiable:
Cannot be empirically tested. If people behave as is predicted it supports the theory, if they don't they are using defence mechanisms. Tripartite personality cannot be tested.
Subjective:
Concepts central to Freud's theories are subjective. Relies on therapists subjective interpretations of case studies, which cannot be generalised. Most of Freud's participants were middle-aged women from Vienna so may not generalise to the rest of the world.
Reductionistic
(simplifies the human mind into id, ego and superego and five psychosexual stages)
Sexist:
Freud believes females' penis envy made them inferior to males and that females develop weaker superegos to be more prone to anxiety than males
Third-Wave Therapies
What are they
Seek to
blend traditional CBT principles
with concepts new to behavioural psychotherapies such as
mindfulness
,
acceptance
,
compassion
,
metacognition
,
spirituality
, and the
therapeutic relationship
in order to help the more complex client problems
Schema Therapy (ST)
Mindfulness-Based Cognitive Therapy (MBCT)
Compassion-Focused Psychotherapy
Dialectical Behavioural Therapy (DBT)
Metacognitive Therapy (MCT)
Acceptance & Commitment Therapy (ACT)
Behavioural Activation
Cognitive Behavioural Analysis System of Psychotherapy (CBASP)
ACT
(Acceptance & Commitment Therapy)
Assumptions
It is human nature, and thus understandable, that people tend to
avoid negative inner experiences
.
Clarity of
personal values and commitment
are keys to behavior change.
Rather than fighting the feeling attached to a behavior, a person can
observe
having the feeling but still
act
in a way
not directly influenced by the feeling
.
What is it
Mindfulness-based
behavioural therapy that aims to
commit action that improves and enriches your life while accepting what is out of your control
Effective with a diverse range of clinical conditions: depression, OCD, workplace stress, chronic pain, the stress of terminal cancer, anxiety, PTSD, anorexia, heroin abuse, marijuana abuse, and even schizophrenia
Can be used with individuals, couples and groups, both as a brief or long-term therapy
Theory suggests that when attempting to change a behaviour (e.g. substance use) it is important to understand how individuals form
relationships
between their
inner experience
(e.g. thoughts) and the
behaviour
in order to help alter those relationships
Grounded in
behaviourism
, but underpinned by analysis of
cognitive processes
Principles
Cognitive de-fusion
:
Detaching
from inner experiences by interacting or relating to them differently.
Acceptance
: Allowing thoughts and feelings to arise without trying to change their form or frequency.
Mindfulness
: Retain contact with the
present
moment.
Self understanding
: Letting go of concrete and inflexible thoughts or ideas about oneself, and moving to understanding oneself within the
context
of situations.
Values
: Learning what is most important to oneself (family, service, etc.).
Committed action
: Efforts to
empower
behavioral change.
Strengths
Flexibility
&
ease of use
. It can be readily adapted or made short or long as needed.
Quick
&
effective
for cultivating acceptance, mindfulness, and openness to experience
Highly effective
for depression, anxiety disorders, substance abuse, chronic pain, PTSD, anorexia, and schizophrenia
Effective model for life coaching
Focuses on
enriching lives
, rather than fighting negative symptoms
Increases
psychological flexibility
and acknowledges that negative experiences are part of life which is
validating
Limitations
Narrow in scope
- thinking is just one part of human functioning, broader issues need to be addressed. Does not address possible
underlying causes
or the wider problems in
systems
or
families*
Some people put off by focus on mindfulness as it can be linked to "new-age"
Highly structured
and (depending on therapist) therefore not individualised
Calls for
radical acceptance
of the concepts and ideas in order to put them into action. Cannot wait until the client is ready they just have to give it a go.
MBCT
(Mindfulness-Based Cognitive Therapy
What is it
A type of psychotherapy involving a combination of cognitive therapy, meditation, and the cultivation of present-oriented, non-judgemental attitude called "mindfulness"
Aims to increase presence in the moment and being aware of one's body, thoughts, surroundings and feelings
Roots in Buddhist traditions
Strengths
Limitations
Many MBCT studies have a small sample size, lack of control groups or lack of randomisation, so more rigorous studies are needed to evaluate effectiveness
Relatively new treatment, so long-term effects not yet known
CAT
(Cognitive Analytic Therapy)
What is it
Focuses on
patterns of relating, and the way a client's habitual responses to others have
on their relationships and life in general
Based on the idea that our
early life experiences influence
the way we
relate to other people
and how we
treat ourselves
. Sometimes patterns of behaviour, or our expectations of other people's behaviour, can develop into unhealthy or unhelpful repeating patterns
Differs from psychoanalytic therapies in its focus on the description of current problem psychological procedures rather than interpretation
Originated in an attempt to integrate
psychoanalytic
and
cognitive beliefs and methods
. CAT is both interpersonal and intrapsychic.
CAT is rooted in cultural and social process, as opposed to the monadic information processing model in CBT. CAT is both interpersonal and intrapsychic, not one of the other.
Strenghts
Integration
of
interpersonal
and
theoretic coherence
makes up for narrow scope of CBT
Cost-effective
as it is brief (6-8 session)
Viewed as more
collaborative
and less prescriptive, and focuses on therapeutic relationship
Limitations
Current lack of evidence-base
Piecemeal approach may encourage fragmentation and may fail to tackle borderline personality disorder at anything other than a superficial level