Insight, acceptance and the relationship

Transcript

RyanThe OpenStax psychology textbook tells us about Crystal. She has been seeing a psychoanalyst for years. Over that time, she comes to see her analyst as a father figure, and she transfers onto him her feelings about her own father.

SoheeMaybe hoping to get the love and attention she didn't get from him. Freud had a name for this, and it's one of the first terms the exam checks.

RyanWelcome to EPPP Prep, the podcast. I'm Ryan.

SoheeI'm Sohee. Last time we covered the learning and thinking therapies. Today it's the other big families: psychodynamic, humanistic, and two models you'll see constantly, interpersonal therapy and dialectical behavior therapy.

RyanLet's begin where therapy began. The textbook says psychoanalysis was developed by Sigmund Freud and was the first form of psychotherapy. It dominated in the early twentieth century, and it has since waned significantly in popularity.

SoheeFreud believed most psychological problems come from repressed impulses and trauma experienced in childhood. Psychoanalysis aims to uncover those long-buried feelings.

RyanHis tools. Free association: the patient relaxes and says whatever comes to mind. Dream analysis: the therapist interprets the underlying meaning of dreams.

SoheeAnd resistance. Freud felt the ego would sometimes try to block, or repress, unacceptable urges or painful conflicts during free association. So the patient resists recalling them.

RyanAnd transference, which is Crystal. The patient transfers the positive or negative emotions from their other relationships onto the analyst.

SoheeThe textbook adds that psychoanalysis typically takes years. Today, Freud's perspective has been expanded into the psychodynamic approach, still centered on internal drives and forces, but less intensive than his original model.

RyanSo on the exam, if a vignette mentions the unconscious, childhood conflicts, interpreting resistance, or feelings toward the therapist that echo other relationships, you're in psychodynamic territory.

SoheeNow humanistic therapy. The textbook says humanistic psychology focuses on helping people achieve their potential. The goal of humanistic therapy is to help people become more self-aware and accepting of themselves.

RyanAnd two contrasts with psychoanalysis. Humanistic therapists focus on conscious rather than unconscious thoughts. And they emphasize the present and future, as opposed to exploring the past.

SoheeThe big name is Carl Rogers, with client-centered therapy, sometimes called Rogerian therapy. Rogers changed the word patient to client, because he felt patient suggested someone sick looking for a cure.

RyanClient-centered therapy is a form of nondirective therapy. The textbook defines that as an approach in which the therapist does not give advice or provide interpretations, but helps the person identify conflicts and understand feelings.

SoheeThat's a key exam line. A therapist who interprets a dream or tells the client what to do isn't being client-centered.

RyanThe Rogerian toolkit. Active listening: the therapist acknowledges, restates, and clarifies what the client expresses. Unconditional positive regard: not judging the client, accepting them for who they are. And Rogers felt therapists should show genuineness, empathy, and acceptance.

SoheeWhy? Because those help people become more accepting of themselves, which results in personal growth.

RyanPause and think. A client says: I yelled at my sister again, I'm a terrible person. The therapist responds: you're feeling really ashamed about how that went. Which orientation, and which technique?

SoheeClient-centered. It's active listening, restating and clarifying the feeling, without judging or interpreting. A psychodynamic answer might link the anger to childhood conflicts. A cognitive answer might challenge the label terrible person. Both are reasonable therapies, but they're not this one.

RyanNext, play therapy, because children aren't likely to sit on a couch and recall their dreams. The textbook quotes O'Connor: play therapy uses a therapeutic process of play to help clients prevent or resolve psychosocial difficulties and achieve optimal growth.

SoheeAnd there's a directive and nondirective split here too. In nondirective play therapy, children work through problems by playing freely while the therapist observes. In directive play therapy, the therapist provides more structure, suggesting topics, asking questions, even playing with the child.

RyanThe textbook also says play therapy can help a therapist make a diagnosis, by watching how the child interacts with toys.

SoheeOne version you may see named is sandplay, or sandtray therapy. The textbook describes children setting up a three-dimensional world with figures and objects that correspond to their inner state.

RyanAnd notice that the word nondirective now shows up twice: Rogers' client-centered therapy, and nondirective play therapy. In both, the therapist follows rather than leads. If a question asks which approach avoids advice and interpretation, that shared idea is your clue.

SoheeThere's a handy summary table in the textbook, too. For psychodynamic therapy, the example is a patient who talks about their past. For humanistic therapy, a patient who learns to articulate thoughts that keep them from achieving their goals. Past versus present and future, in one glance. Okay, now two models that the National Institute of Mental Health, NIMH, names often. Interpersonal therapy, or IPT, first.

RyanNIMH lists IPT, alongside CBT, as an evidence-based therapy for depression. IPT focuses on interpersonal and life events that impact mood, and vice versa. It aims to help people improve communication skills within relationships, form social support networks, and develop realistic expectations for dealing with crises.

SoheeSo the focus is current relationships and life events. Not the unconscious, not distorted thoughts as such. If the vignette centers on relationships and life events, like a conflict, a loss, or a big change, think IPT.

RyanAnd dialectical behavior therapy, DBT. NIMH says it was developed specifically for people with borderline personality disorder.

SoheeDBT uses concepts of mindfulness, awareness of one's present situation and emotional state. And it teaches skills to help people control intense emotions, reduce self-destructive behaviors, and improve relationships.

RyanMindfulness turns up across modern therapy. NIMH lists applying mindfulness and relaxation techniques, like meditation and breathing exercises, among the elements of psychotherapy. And it says recent advances in CBT for depression include adding mindfulness principles.

SoheeNow the evidence. Do insight and relationship therapies hold up next to CBT?

RyanThe OpenStax text cites a meta-analysis by Shedler, from 2010, which found psychodynamic therapy was as effective as CBT for these types of problems. And NIMH says that using other forms of psychotherapy, such as psychodynamic therapy, for a limited time also may help some people with depression.

SoheeNotice how careful that NIMH wording is. May help some people. For a limited time. Don't stretch it into a ranking either way.

RyanRogers gets support from an unexpected place, the common factors research. Bruce Wampold's review in World Psychiatry pools studies correlating therapist qualities with outcome.

SoheeEmpathy, across fifty-nine studies, showed a relatively large effect, d equals 0.63. Positive regard and affirmation, d equals 0.56. Congruence or genuineness, d equals 0.49.

RyanThose are Rogers' conditions, almost word for word. Wampold is careful that these are correlations, and that, for example, it's easier to be warm toward a cooperative patient who would do well anyway. But he concludes the evidence supports common factors as important.

SoheeAnd here's a nuance that cuts the other way. A meta-analysis by Pim Cuijpers and colleagues compared psychotherapy directly with antidepressant medication. Across all the disorders, the overall difference wasn't statistically significant. But medication was significantly more efficacious than non-directive counseling, with g equal to 0.33. That comparison rests on six studies of non-directive counseling.

RyanSo the qualities Rogers named matter in every therapy. But that study found non-directive counseling, as a stand-alone treatment, did less well than medication in direct comparisons. Both things can be true.

SoheePause and think. A vignette: a client grieving her mother is fighting with her siblings about the estate, and her mood has dropped. The therapist focuses on the sibling conflict and the life change, and helps her rebuild support. Which therapy?

RyanInterpersonal therapy. Life events and relationships linked to mood, communication skills, and social support. If the therapist instead explored her childhood relationship with her mother and the feelings she's bringing to therapy, that would point psychodynamic.

SoheeLet's recap. Psychoanalysis: Freud, the first psychotherapy. Free association, dream analysis, resistance, transference. It takes years. Psychodynamic therapy keeps the focus on internal drives but is less intensive.

RyanHumanistic therapy: self-awareness and self-acceptance, conscious thoughts, present and future. Rogers' client-centered therapy is nondirective: active listening, unconditional positive regard, genuineness and empathy.

SoheePlay therapy can be nondirective or directive, and can aid diagnosis.

RyanIPT: relationships and life events and their link to mood. DBT: developed for borderline personality disorder, mindfulness plus skills for emotions, self-destructive behavior, and relationships.

SoheeEvidence: one meta-analysis found psychodynamic therapy as effective as CBT. Empathy, positive regard and genuineness relate to outcome in Wampold's review. And in Cuijpers' direct comparisons, medication outperformed non-directive counseling.

RyanIf you've been at this a while, you might notice something. Every one of these therapies cares about how a person treats themselves. Be a little client-centered with yourself tonight. Notice the effort, without the judgment.

SoheeThanks for listening to EPPP Prep.

Loading the read-along timings…