Lecture # 210:
Psychotherapy (Continued)

copyright 2008 Cheryl K. Hosken, BSN, MS Psych.


Humanistic Techniques

There are many different types of humanistic therapy. What does this term mean? You should not confuse it with the philosophy of humanism, which excludes God from the universe and is totally human-centered. The basic meaning of humanistic therapy is that the individual or self should be the central concern of psychology. That is, the person has the ability to choose his own destiny and that biological, instinctive, and environmental influences can be overcome. This is compatible with the Christian idea that man has a free will and therefore is a morally responsible being. The emphasis in humanistic therapy is on making the person whole or healed. The goal of these therapies is not merely to uncover deep-seated conflicts, but to foster psychological growth and change. Our goal in rehabilitation is not merely to talk endlessly with a client about his problems, but to help him return to work and become a more whole and productive member of society.

Below are brief summaries of these therapies:

Client-centered Therapy - This is also called Rogerian after its founder, Carl Rogers. As the name suggests, the client is the center of the therapeutic interaction. Rogers did not want to call his clients "patients," but rather persons. The purpose of the therapy is self-discovery and learning about himself and his strengths.

The characteristics of this therapy are:

  1. focus on the present, not childhood;
  2. focus on feelings, not beliefs or thoughts, meaning that the therapist will ask questions such as, "How do you feel about that?";
  3. the therapist will reflect what the person is feeling and not interpret what a person is feeling, using such statements as "You seem angry" or "Does that make you feel sad?"

Assessing and reflecting the person's feelings is not easy to do. The therapist must be an active listener and able to understand and share the essence of another's feelings.

Unconditional positive regard is used by the therapist is an expression of being accepting and non-critical. The therapist wants the person to express himself, and anything the person says is alright if he is being honest with himself. As the person expresses himself, he is able to understand how and why he thinks as he does. This process of self-discovery helps him to grow emotionally.

Meditate Word By Word On These Verses:
Matthew 18:10-14
.

Gestalt Therapy
The goal of Gestalt therapy is to assist a person to integrate his thoughts, feelings, and actions so that he accepts himself, understands himself, and grows. Therapy is aimed at helping the person become aware of his whole self, even the problems and conflicts he may have. He then begins to find ways to deal with the conflicts and problems.

Question:
1. Do you think Christians can use these therapy techniques? Why or why not?

 


 

What is meant by this therapy is that one "touches one's own feelings" and acknowledges them as valid and then tries to progress in maturity. This therapy is often done in small groups where the clients act out how they feel in a certain situation and then act out how they wish they could respond. Role-playing is a central part of this therapy.

2. Is there a place in these therapies for acknowledging God, asking forgiveness of sin and being healed?
yes / no.

 


 

3. Did Jesus ever use techniques similar to these? If so, can you give an example? If not, what techniques did He use?

 


 

Behavioral Techniques

There is no one behavior therapy. It is a collection of several techniques. The techniques are methods of psychotherapeutic change based on learning principles as researched in the laboratory. This means that the main assumption of behavior therapy is that maladaptive behaviors are learned, and these behaviors need to be unlearned. There are many principles of learning that can be used for healing many psychological disorders. We will list a few types of learning principles and how they help persons with psychological problems.

Question:
4. What is the basic assumption of behavior therapy?
(Select the best answer.)
Psychotherapeutic change is based on learning principles as researched in the laboratory.
Maladaptive behaviors are learned, and they need to be unlearned.
Behavior therapy is a collection of several techniques.

 


 

Systematic Desensitization is using classical conditioning to alleviate feelings of anxiety, especially phobic disorders. This therapy is a matter of teaching a person to first relax totally then remain relaxed as ever-increasing levels of stimuli that produce the anxiety. For example, if a person is afraid of small, furry animals and wants to rid himself of that fear, he is taught to relax and then a real or fake furry animal is brought nearer and nearer him. If the person can remain relaxed, that relaxation can replace the anxious fear response previously associated with a furry animal. This is also done for persons who are afraid of flying in airplanes. They are taken to an airplane first to simply see it, then sit in it, then gradually progressing to taking a short trip in a plane.

Question:
5. How would you help someone who is afraid of riding the subway?

 


 

Contracting is used for changing behavior as well. If a person exhibits the behaviors he wants, he will get certain rewards. We often do this with children - "if you eat all your vegetables, you may have dessert". This technique is often used in institutions where there is control over the environment of the learner. However, this technique can also be used with an adult person. For example, if he wants to heal his broken bone, he must do a certain number of exercises per day. The rehabilitation specialist can check the person's own record of how many exercises he does every day and visually see if his function improves.

Some phobias can be overcome by modeling, which is learning an appropriate response through the imitation of a model. For example, if a child is afraid of dogs, he may profit by watching another child being with a dog. Modeling is also part of what is called assertiveness training which helps persons stand for their rights and that their feelings and opinions can be expressed. Through this training, persons learn appropriate ways to express how they feel and what they think in social situations.

Question:
6. Who is the best role model for Christians?
(Only one of the following answers is correct.)
Vladimir Putin
Donald Trump
Jesus Christ

 


 

Cognitive Techniques

Psychotherapists who use these techniques believe what matters most of all is what a person believes, his thoughts and attitudes about himself and the world he lives in. The major principle of this therapy is to help a person change how he feels and acts. The goal of treatment is to produce a change in the way a person thinks and to teach the client how the changes were achieved. The goal is not to provide a cure, but to develop a strategy that can be applied to many aspects of life.

Question:
7. What is the basic assumption of cognitive therapy?

 


 

There are several types of cognitive therapy:

Rational-Emotive Therapy
The basic premise of this therapy is that psychological problems happen when people interpret what happens in the world based on irrational beliefs. The person puts his incorrect perceptions, preferences and desires into dogmatic musts and commands for himself and everyone else in the world.

RET is directive for the psychologically disturbed person. The idea that a therapy which helps a person feel better without giving him useful strategies to make him remain better is not best for coping with the rest of his life. The therapist takes an active role in interpreting the client's belief system and encourages active change from the client. Therapists often are role models and make homework assignments that help clients bring their expectations and perceptions more realistic.

Some irrational beliefs that people can form, and which lead to psychological problems, are:

  1. One must always do tasks well and have a great desire to do them well;
  2. One must always have the approval of others due to a strong need for approval;
  3. One must be loved by everyone for everything he does;
  4. One must always maintain perfect self-control;
  5. It is better to avoid problems than to face them.

Cognitive Restructuring Therapy
The goals of cognitive restructuring therapy are similar to rational emotive therapy but are less confrontational. Aaron Beck who first used this therapy, believed that people with disorders, (particularly those related to depression) arise from a few misguided beliefs. Beck also believed that these people share a few certain characteristics, for example:

  1. They have very negative self-images. They do not value themselves or what they do.
  2. They have a negative view of life experiences.
  3. They over-generalize. For example, if a student fails a test in college, he comes to believe that there is no way that he can do college work and he leaves college. He looks for a job, even though he believes that no one would offer a job to someone who is a failure and a college dropout.
  4. They actually seek out experiences that reinforce their negative expectations. The student in the above example may seek out a high level job. However, he does not have the experience for such a job and will not be offered the job, therefore, he is worthless.
  5. The future for these people is dismal.
  6. They do not see the bright side of any experience.

Question:
8. Are there any verses in the Bible you could use with these two types of therapy that would help a person understand his own worth to God and others? If so, which verses?
yes / no.

 


 

In this therapy, the client is given opportunities to test or demonstrate his beliefs. The client and the therapist make up a list of hypotheses based on the assumptions and beliefs of the client and then the therapist and the client actually test out these hypotheses. Given the hypothesis that "Nobody cares about me", the therapist need only find one person to refute that hypothesis. This approach of leading a person to self-discovery has been successful in treatment of depression. This is because the client begins to understand that negative attitudes directed toward oneself are defeating his own success as a person.

Question:
9. If someone said to you, "Nobody likes me!" How would you try to help them using these two types of therapy?

 


 

Group Therapy

Group therapy is used in various situations for people with various problems for resolution of problems. This method of treatment is used for people with alcohol addictions, depression, or recovery from a traumatic experience. There is usually a group leader or therapist who may provide some basic educational instruction and assist the members of the group to talk with one another. The members of the group share their experiences and feelings. Most groups are informal, and no particular form of therapy is dominant.

There are benefits that can be derived from group therapy. Perhaps foremost is that individuals realize they are "not the only one with a problem." There is also a sense of support from the group, which may be greater than just the support of the therapist. There is a logic that says: "these other people really know from experience what a hell I am going through." Then members of the groups get involved in helping someone else and that in itself is a therapeutic process. Another advantage of the group therapy setting is that a person can learn effective ways of presenting new behaviors to someone else.

Family therapy is a popular group approach. It focuses on the roles, interdependence, and communication skills of the family. Family therapy is usually started after one person of a family group begins psychotherapy. After discussing the problems of the individual family member, the remaining members are invited to join therapy. There is evidence that family therapy is useful for such problems as agoraphobia, depression, and schizophrenia.

Question:
10. Who is the authority for how family members should act toward one another?
(One or more of the following answers may be correct.)
Jesus Christ.
The father of the family.
The mother of the family.
Mahatma Gandi.

 


 

There are two assumptions that underlie the family approach. One is that each person in the family is part of a small system and the person's thoughts, feelings, and behaviors affect the other family members. Bringing about change in one family member without involving all the other family members will not be successful. This is particularly true if the initial problem appears in an adolescent or child. If the parents refuse to assist in the healing of the child, the effectiveness of the therapist is lost.

Question:
11. What is the standard for behavior among family members?
(Select the best answer.)
Authority.
Force.
Agape-love.

 


 

The second assumption is that family problems arise out of improper methods of communicating between its members. Individuals can develop false beliefs about the feelings and needs of the other family members. The goal then is to help persons in the family to openly express their needs and feelings. For example, it is very helpful for an adolescent to learn that his parents are upset and anxious about work-related stress and financial affairs. The adolescent may have assumed that her parents yelled at her and at one another because of something she was doing. Also, the parents did not want to share their concerns over money with the adolescent because it may have upset her.

Question:
12. What are some of the advantages of group therapy?

 


 

Evaluation of Psychotherapy

Evaluating psychotherapy is difficult. Is psychotherapy effective? In comparison to what? Is one type of therapy better than another? These are important questions, but we know only partial answers. We know that it is better than no treatment at all. And more treatment seems better than less treatment. However, there are limits to how long a person or family can be treated. Often time-limited therapy accomplishes as much as an unlimited number of treatment sessions. Most therapy these days is time-limited since patients and insurance companies want results from treatment. Research also shows that the earlier treatment begins, the better the prognosis. There is also evidence that one therapist can be more effective than others, no matter what type of therapy is used.

Question:
13. As a Christian, what is your attitude toward these therapies? Can you use some of these strategies and if so, when?

 


 

What are some of the problems encountered when doing research on the effectiveness of therapy? First, there is often little data on how people might have responded without treatment. We do not have a baseline for comparison. We know that sometimes people suddenly get better without treatment. To believe that any person can get better without treatment is seldom true. There are many factors than can improve one's mental health. Perhaps the source of stress is removed, that is, a nagging parent moves away, an aggravating boss gets transferred, or an interpersonal relationship begins that gives support.

Secondly, that psychotherapists cannot agree on what is meant by recovery or cure. These terms take on different meaning depending on the goal of therapy. For some persons, the goal is absence of symptoms for a specific period of time. For others, the goal is something different - perhaps "feeling better", personal understanding, permanent change in behavior, or insight into deep conflicts. These are just some of the problems psychologists have in determining if therapy actually helps a person. However, studies done that focus on just one technique show very positive results.

Question:
14. Some people have called these therapies "mind-changers" and give them a negative connotation. Is this true, and why?
true / false.

 


 

Remember that in our introductory semester we had four lectures on how to deal with "Functional Limitations." This is very important! Our goal in rehabilitation is not merely to help people feel good about themselves, but to help them overcome their limitations and become functional, productive members of society. What about comparing psychotherapy methods? Is there any one therapy that gives better results than another? One of the most active areas of research is to find which therapy is best suited for which disorder. Each type of therapy has strengths and weaknesses. Psychoanalytic therapy is time-consuming and expensive. Client-centered approaches require an introspective, nondependent client to be most useful.

Group approaches cannot be used for a person who needs personal attention. Behavioral methods work well for phobias and cognitive approaches seem effective for persons with depression. A combination of behavioral and cognitive approaches is well suited for persons with obsessive-compulsive disorders. No variety of psychotherapy is effective for persons with bipolar disorder or schizophrenia. Medication, social skills training, and cognitive training seem to help most schizophrenics. Marital and family group therapy studies show good effects on the members of the group.

Question:
15. What is the "right" way to live in society for everyone? What is our standard as Christians? How does that come into conflict with others who do not believe in God?