Psychotherapy

An Overview of psychotherapy Models and
Techniques
12/29/2022 Bizu_T_tfmariam@gmail.com_251-920276533 1
Unit1:introduction to PP
12/29/2022 2
Bizu T. BED,BSC and MSC
Presentation outline
• Introduction to psychotherapy
• Key concepts in psychoanalysis
• The therapeutic process in psychoanalysis
• Therapeutic techniques in psychoanalysis
• Scientific critics about psychoanalysis
• Summary
12/29/2022 Bizuneh T. BED,BSC,MSC 3
session objectives
At the end of this session students will be able to:
• Define concepts in psychoanalysis such as
transference, counter transference, free
association, dream analysis and defense
mechanism
• Evaluate the psychoanalysis view of human
nature
Cont…
• Define psychoanalysis psychotherapy

• Differentiate the difference between psychoanalysis
and psychodynamic psychotherapy
• Describe therapeutic relationship
• Analyze therapeutic techniques and procedures

• Make a scientific critic

Introduction
 Brain Storming
 Which treatment modality is more effective?;
psychotherapy or pharmacotherapy or combination
of them, in the treatment of psychiatric disorders;
and how?
 2’ for thinking
 2’ for sharing
cont…
Efficacy study : Psycho Vs Pharmacotherapy
• A meta analysis done on 67 published journals of 5,993 subjects
show different efficacy.
• Pharma>>>dysthymic disorder
• Psychotherapy>>>OCD
• Pharma>>non directive therapy
• Psychotherapy>>> TCAS in depression

Cont…
• How many types of psychotherapy do you know so far?
• List them and describe their assumptions

• 1.
• 2.
2’ for rehearsal
2’ for reflection

Cont…
 Before the 1950s, we know only few therapy
techniques:-
 Corsini (2001) summarized 69 therapies
 Most of them derived from the psychoanalysis
 However, currently, we have more than 400 kind of
therapy (Corsini, 2008).

Psychotherapy and counseling
 Are Psychotherapy and Counseling have the same

meaning?
Evaluate them based on:
• The setting
• The severity of disease to be managed
• Training orientation
• Duration and therapeutic relationship
3’ for pair discussion

The meaning of psychotherapy
Interpersonal, relational intervention by trained

therapists to aid someone in life problems
 Goal: increase sense of well-being, reduce
discomfort
Cont…
 Some therapies focus on changing current behavior

patterns
 Others emphasize understanding past issues
 Some other therapies use combination of techniques
 Can be short-term with few meetings, or with many

sessions over years

Cont…
 Can be conducted with individual, couple, family or

group of unrelated members who share common
issues
 Also known as talk therapy, counseling,

psychosocial therapy or, simply, therapy
 Can be combined with other types of treatment,

such as medications
How does therapy works?
 Research: quality of therapist/client relationship
effects outcome more than specific therapy
 Lambert (1992) estimates 40% client changes due
to motivation or severity of problem; 30% to quality
of therapeutic relationship; 15% to expectancy
(placebo) effects, and 15% to specific techniques.

Unit one
• Introduction to pp

The View of Human Behavior/ assumption?
• The Freudian view of human nature is basically deterministic.
• What is determinism?
• Take 3 minutes
• Form a group of two
• List out the determining factors of human behavior based on

Freudian theory of psychoanalysis
• And reflect in 2 minutes

Cont…
 Our behavior is basically determined by:-

 Irrational forces
 Unconscious motivations
 Biological and instinctual drives and
 Early childhood experience.
• Freud stresses the inborn derives/sexual/ in determining

later personality development
Cont…
 These evolve through key psychosexual stages in
the first 6 years of life?
 List psychosexual stages with the specific personality

developments and characterize these terms, fixations and
complexes
• Are these terms important for therapy?, how?

Cont…
 Instincts are central to the Freudian approach.
 The term libido refers to sexual energy at particular, but
broadened up to energy of all the life instincts.
 These instincts serve for survival of human race; they are
oriented toward growth, development, and creativity.

Cont…
• Freud includes all pleasurable acts in his

concept as the life instincts (Eros)
• He also believed the goal of our life as

gaining pleasure and avoiding pain.
• What is your life goal? Is it inline with Fraud's claim?

Cont…
• Freud also postulates death instincts (thanatos),

which account for the aggressive drive.
• Can be self destructive or aggressive on others
• People manifest through their behavior an

unconscious wish to die or to hurt themselves or
others.

Cont.…
For instance, the two instincts are
• Love and hate between marriage partners
• Eating; chewing and biting
• Solders and socially condone fighting

• Sports provide an outlet for physical aggression.
• Often libido and aggressive drives are expressed without an
individual’s awareness.

Cont..
 Managing this aggressive drive is a major

challenge to the human race.
 Both sexual and aggressive drives are powerful

determinants our actions.
“Why we do what we do”

The unconscious motivation/Structure of Personality
• Id(pleasure)------- Anxiety types, based on
• Ego(reality)------- psychoanalysis
• Super ego(conscience )-------
• Neurotic anxiety
• These are systems working as a whole
• Reality anxiety
• Moral anxiety

Topography of Mind
• Sigmund Freud is an Archeologist of human mind
• Conscious
• preconscious and
• the Unconscious mind

The conscious mind
 Topography of mind is one of the greatest work of S.

Freud .
 The conscious mind is the smallest slice of it.
 This includes sensations and immediate experiences
that the person is aware of at any point in time,
awareness of being warm or cold.

The Preconscious mind
• The preconscious includes memories of events and
experiences that can easily be retrieved with little
effort.

The unconscious mind
• The concept of unconscious is the

keys to understand behavior and the
problems of personality.
• But the unconscious cannot be

studied directly but is inferred from
behavior.

Cont….
The unconscious mind stores all experiences,
memories, and repressed material.
 Needs and motivations are outside the sphere of

conscious control.
 Most psychological functioning exists out of

awareness.

Cont…
• The unconscious is central to understand

psychoanalytic model of behavior.
• It possesses the root of all forms of neurotic

symptoms and behaviors.

Clinical evidences postulating the unconscious
• Dreams: are symbolic representations of unconscious
needs, wishes, and conflicts.
• Slips of the tongue and forgetting
• Post-hypnotic suggestions

Clinical evidence…
 Material derived from free-association
techniques
 Material derived from projective techniques and
 The symbolic content of psychotic symptoms

The aim of psychoanalysis psychotherapy
• We have only two important aims here
* Reveal the unconscious motives, wishes,

memories and to conscious.
* And strengthening “ego”

Cont…
• So what is cure in psychiatry and psychoanalysis therapy
• ---------------------------------------------------------?
• From psychoanalytic perspective, a “cure” is based on
uncovering the meaning of symptoms, the causes of behavior,
and the repressed materials that interfere with healthy
functioning
• From psychiatry perspective --------------------------?

Meaning of Anxiety in psychoanalysis
• Anxiety is a feeling of worry results from

repressed feelings, memories, desires, and
experience that emerge to the surface of
awareness.
• It develops out of a conflict among the id,

ego, and superego over control of the
available psychic energy.
Cont…
The three anxieties : reality, neurotic, and moral.
• Reality anxiety is the fear of danger from the

external world.
• Neurotic and moral anxieties are evoked by

threats to the “balance of power” within the
person.

Cont…
• The two instincts signal to the ego that unless

appropriate measures are taken the danger may
increase until the ego is overthrown.
• Neurotic anxiety is the fear that the instincts

will get out of hand and cause one to do
something for which one will be punished.

Cont…
• Moral anxiety is the fear of one’s own conscience.

People with a well-developed conscience tend to feel
guilty when they do something contrary to their moral
code.
• When the ego cannot control anxiety by rational and

direct methods, it relies on indirect ones—namely, ego-
defense behavior.

Freud’s reason people come for counseling
• First is the oral stage, which deals with the
inability to trust oneself and others, resulting in
the fear of loving and forming close relationships
and low self-esteem.

Freud's reason…
• Second, is the anal stage, which deals with the
inability to recognize and express anger, leading
to the denial of one’s own power as a person
and the lack of a sense of autonomy.

Freud's view …
• The third, is the phallic stage, which deals with the
inability to fully accept one’s sexuality and sexual
feelings, and also to difficulty in accepting oneself as a
man or woman.
• Sexuality and Gender issues??

Freud's view
• The three areas of personal and social development—
love and trust, dealing with negative feelings, and
developing a positive acceptance of sexuality—are
all grounded in the first 6 years of life.

Freud's view …
• These periods are the foundation on which later

personality development is built.
• When our needs are not adequately met during these

stages, we become ﬁxated and behave in
psychologically immature ways

The Therapeutic Process
Therapeutic Goals
Freudian therapy has two goals
 to uncover unconscious materials to

conscious and
 to strengthen the ego so that behavior is

based more on reality and less on instinctual
drives or irrational guilt.

Cont…
• Therapeutic methods are used to bring

out unconscious material and childhood
experiences ; then reconstructed,
discussed, interpreted, and analyzed.

Cont…
• This process is not limited to solving problems and

learning new behaviors.
• Rather, there is a deeper inquiring into the past to

develop self-understanding.
• Do you know your self well( thought, feeling

and action) and are you happy on your self?

Cont…
• Psychoanalysis therapy is oriented towards
achieving insight, essentially the feelings and
memories associated with self-understanding.

Indications and Contraindications
• All psychoneuroses; anxiety disorders, OCD, conversion
disorder, sexual dysfunction, depressive states, and
other non psychotic illness, such as PDs.
• N.B: significant suffering must be present

Cont…
• Must have a genuine wish to understand themselves,
not for symptomatic relief.
• withstand frustration, anxiety.
• Reasonable and mature superego.
• Average intelligence
• Psychologically minded about the unconscious

meanings of their behavior.

Therapeutic relationship
• Based on classical and cotemporary psychoanalysis:
* In classical psychoanalysis, therapy relationship

is to be blank screen approach
• However, in cotemporary psychoanalysis: the therapeutic

relationship considered as a therapeutic factor in bringing
about change (Ainslie, 2007).

Transference
• The unconscious shifting of past feelings from
significant others to therapist.
• It reflects the deep patterning of old experiences in

relationships.
• An interactive process between the client and the

therapist.
• Reactions to a therapist, can be positive and negative

Transference…
• Transference takes place when clients raise the dead issues
from their early life, intense conflicts relating to love,
sexuality, hostility, anxiety, and resentment; bring them
into the present; re-experience them; and attach them to
the analyst.

Transference…
• For example, clients may transfer unresolved feelings

toward a harsh and unloving father to the analyst.
• Angry feelings are the product of negative transference.
• Clients may also develop a positive transference ; they

fall in love with the analyst.

Cont…
• If therapy is to produce change, the transference
relationship must be worked through
• Working through: the process consists of an

exploration of unconscious material and defenses,
most of which originated in early childhood.

Cont…
• It is achieved by repeated interpretations and by

exploring forms of resistance.
• It results in a resolution of old patterns and allows

clients to make new choices.

Cont…
• A major function of interpretation is to

accelerate the process of uncovering unconscious
material.
• The analyst listens for gaps and

inconsistencies in the client’s story.
• Infers the meaning of dreams and free

associations
Cont…
• Remains sensitive to clues concerning the client’s

feelings toward the analyst
• Effective therapy requires that the client develop a

relationship with the analyst in the present

Cont…
• By experiencing a therapist who is

engaged, caring, and reliable, clients can
be changed in profound ways, which can
lead to new experiences of human
relationships (Ainslie, 2007).

Cont…
• All feelings of clients toward therapists

are not manifestations of negative or
positive transference.
• Many of these reactions may have a

reality base.

Counter-transference
• Counter transference involves the therapist’s total

emotional response to a client.
• Hayes (2004) refers to counter transference as the

therapist’s reactions to clients that are based on his
or her unresolved conflicts.
• “Therapists must aware of their counter

transference”

Psychoanalytic technique
• The most important techniques are:-

• Maintaining the analytic framework
• Free association
• Interpretation
• Dream analysis
• Analysis of resistance and
• Analysis of transference

Main critics
• Needs highly qualified therapists
• Costly and time consuming
• Needs clients ego strength and average intelligence
• Difficult to assure with scientific methods
• Was experimented with few sample in single area
• Masculine oriented
• highly sexualized

Summary
• Freudian psychoanalysis theory is basically

deterministic
• Freud’s contribution in therapy is enormous
• The instinctual drive, structure of personality, topography

of mind, dream analysis and defense mechanism are
important concepts of psychoanalysis.

Cont…
• Death instinct and life instincts(thanatos and eros).
• The unconscious can be evaluate indirectly by dream, free

association, projective thinking, posthypnotic suggestion,
symbolic contents of psychotic symptoms and slip of
tongue and forgetting.
• Therapy techniques are like maintaining the analytic

framework, free association, interpretation, dream
analysis, analysis of resistance and, analysis of
transference

Seminar presentation
• Topic
• Ego psychology
• Object relation psychology
• Self psychology
• Relational psychoanalysis
• Expectation : this seminar presentation entitled neo-Fruedian theory
• Analysis the view of human behavior /normal or abnormal/ and the
focus of therapy in each model ( the important points from these
theories will appear in your second test)

Quiz #1
1. write two aims of psychoanalysis therapy
2. what is the view of psychoanalytic theory to the human
behavior ?
3. what are the differences between neurotic anxiety, reality
anxiety and moral anxiety
4. What is the cause of anxiety based on psychoanalysis
5. Describe the clinical evidences postulating the unconscious
6. List three indication for psychoanalysis

Adlerian Therapy
“Lifestyle can be conceived as a personal mythology”
12/29/2022 Bizu.t (BED and BSc, msc Clinical psychology 67

Presentation Outline
•ADLER’S THEORY OF PERSONALITY

Style of Life
Social Interest
Inferiority and Superiority
Birth Order
Cont.…
• ADLERIAN THEORY OF THERAPY

 Goals of Therapy
 The Therapeutic Relationship
 Early recollections
 Adlerian therapy techniques

Objectives
• At the end of this session students will be able
to:
Describe life style, social interest, inferiority and
superiority and birth order
Demonstrate Adlerian therapy techniques

Introduction
• Alfred Adler: is the forefather

 He grew up in a Vienna family of six boys and two girls.
 His early childhood was not a happy time.
 And very much aware of death.
 At age 4 he almost died of pneumonia

 Pampered by his mother
 “Dethroned” by a younger brother

Cont..
 His Early childhood experiences had an impact
 He was extremely jealous of his older brother,.

 Struggling to overcome illnesses and feelings of inferiority.
 Determined to compensate for his physical limitation.
 Adler’s early childhood experiences had an impact on the
formation of his theory and he was an example of a person who

shaped his own life as opposed to having it determined by instinctual
fate.
Adler’s Theory of Personality
 Emphasized the importance of the individual’s interaction

with the rest of society.
 Adler’s view of the individual as a creative and goal-

directed who are responsible for her own fate (griffith &
graham, 2004; sweeney, 2009).
 Closely examined the striving for perfection or

superiority.
Cont…
• Alfred Adler was similar to Freud’s belief in some

respect that personalities are formed in early years
• However, Adlerian theory emphasizes the social

nature of the individual

Cont…
 According to Adler, humans are motivated primarily by social

relatedness than by sexual urges
 Behavior is purposeful and goal-directed; and
 Consciousness, more than unconsciousness.
 Unlike Freud, Adler stressed choice and responsibility, meaning

in life, and the striving for success, completion, and
perfection.

Q#1
 Compare and contras the theories of personality development
•By S. Freud with Adler
• Make a group of three

• Take 10 minutes
• 5 for discussion
• 5 for reflection

Adlerian Concepts
 Style of life
 Social interest
 Inferiority and superiority
 And birth order.

1. Style of Life
 It is away of adapting obstacles and ways in which a man
creates solutions and means of achieving goals
The term style of life reflects the individual's unique,
unconscious, and repetitive way of responding to (or avoiding)
the main tasks of living: friendship, love, and work.

Cont…
 This is developed in early childhood (Ansbacher & Ansbacher,
1956, p. 186),allowing to strive for perfection or
superiority.
 Established by the age 4 or 5, so that it would be difficult to
change one’s lifestyle.
 It was based on overcoming a series of inferiorities.

Cont…
• Choice of occupation can be seen as a way of expressing one’s
lifestyle (Sharf, 2010).
• For example, the individual who felt intimidated as a child

may express her lifestyle as an insurance salesperson,
persuading and convincing other.
• Lifestyle also has its expression in how individuals deal with
friends and acquaintances as well as love.

Cont..
• How can we understand style of life ?

by observing individual’s approach to five major interrelated
tasks:
1. Self-development
2. Spiritual development
3. Occupation
4. Society
5. And love
Reading assignment
• Read about the life styles of :
• 1. Martin Luter King junior
• 2.the three holocaust survivors
• 3. Bing drunker of college students

• References: best 2
• Page: 127-128

2. Social interest
Social interest is the hallmark concept of Adlerian theory.
Adler theorized social interest as “a feeling of community, an orientation to live
cooperatively with others, and a lifestyle that values the common good above one's
own interests and desires” (Guzick, Dorman, Groff, Altermatt, & Forsyth, 2004; p.
362)
Social interest evolves in three stages:

 Aptitude
 Ability
 and secondary dynamic characteristics

Con’t….
 We have an innate ability or aptitude for social living.

 After the aptitude has been developed, we develop abilities
to express social cooperation in various activities.
 As these abilities are developed, secondary dynamic
characteristics express themselves as attitudes and interests
 Is an innate concept but the parent–child relationship
was highly instrumental.

Con’t…
• Where is the origin of the first social interest?

 In the mother–child bond.
 Mother’s task is developing a sense of cooperation and
friendship.
 The mother communicates a model of caring to the child.
 Her care for her husband,child’s siblings, and other
friends and relatives becomes a model of social interest
Con’t…
• Adler believed that an individual’s “psychological

health can be measured by the contribution that
individuals make to their community and to
society” (Sharf, 2002, p.119).

Adler describes 4 types of people
 Socially useful type – high social interest and high degree of

activity (amount of energy an individual displays for dealing with
problems)
 Ruling type–low social-interest–yet ruling i.e. thieves, drug addicts
 Getting type–low social interest–looks to receive rather than give
 Avoiding type –low social interest–low activity levels–may be

looked upon as shy, lonely

3.Inferiority and Superiority
• Throughout life, a child strives to become more

independent and self-sufficient–from inferiority to
superiority.
• Three factors can hinder human development :

physical disabilities, pampering, and
neglect.

Con’t…
• If an individual does not overcome feelings of

inferiority, a person may develop inferiority
complex.
• Adler described how individuals try to overcome this

“less than” feeling by actually “inflating one’s self-
importance in order to overcome these inferiority
feelings.”
4.Birth order
 Adler believed that the place the child was in the family
determined how the individual would develop a style of life and
social interest.
 Exact birth order was not necessary, but the perceived role in
the family was more important.
The Adlerian approach is unique in giving special attention to the

relationships between siblings and the psychological birth position in
one’s family.

Con’t…
 He identified five psychological positions, from

which children tend to view life: oldest, second of
only two, middle, youngest, and only.
 Birth order is not a deterministic concept.

#1.Oldest child
• Receives a good deal of attention
• typically somewhat spoiled as the center of attention.
• dependable and hard working and strives to keep ahead.
• When a new brother or sister arrives on the scene, however, she finds
herself ousted from her favored position.
• She is no longer unique or special and the intruder will rob her of the
love to which she is accustomed.

#2. Second of only two
• The typical second child behaves as if she were in a race and is

generally under full steam at all times.
• The younger child develops a ability for finding
out the elder child’s weak spots and proceeds to win praise from both
parents and teachers by achieving successes.
• The second-born is often opposite to the firstborn.

#3. Middle
• The middle child often feels squeezed out.
• Convinced of the unfairness of life and feel cheated.
• This person may assume a “poor me "attitude and can become a

problem child.
• However, especially in families characterized by conflict, the middle child

may become the switchboard and the peacemaker, the person who
holds things together.

#4. Youngest
 The youngest child is always the baby of the family and

tends to be the most pampered one. He has a special role to
play, for all the other children are ahead of him.
 Youngest children tend to go their own way. They often

develop in ways no others in the family have thought about.

#5. Only
• The only child has a problem of her own.
• She will learn to deal with adults well, as they make up her original familial
world.
• Often, the only child is pampered by her parents and may become
dependently tied to one or both of them.
• She may want to have center stage all of the time, and if her position is
challenged, she will feel it is unfair.

Adler’s Goals in Therapy
• Fostering social interest
 Helping clients overcome feelings of discouragement and inferiority

• Modifying clients’ views and goals that is, changing their
lifestyle
• Changing faulty motivation
• Encouraging the individual to recognize equality among people
• Helping people to become contributing members of society

Basic Mistakes is Adlerian therapy
• Adler believed that these flaws in thinking are

due to some earlier events or experiences.

Five Basic Mistakes
• 1. Overgeneralizations- “all”, “should”, “always”
• 2. False or impossible goals of security.
• 3. Misperceptions of life’s demands- “Life’s too hard.”
• 4. Minimization or denial of one’s worth.
• 5. Faulty Values “I have to steal because I have no money”.

Insight and Interpretation
• Adler believed that it wasn’t useful to point out psychological

problems to the client (such as a lack of confidence).
• He believed rather in asking questions for the client to think

about their confidence.
• This way, the client would not become defensive or offended.
• Questions such as “Have you thought of..” or “Is it

possible..?”

Therapeutic technique
• Acting “as if”
• Catching Oneself
• Spitting in the client’s soup
• Avoiding the tar baby
• Push-Button technique
• Paradoxical intention

Behavioral therapy
Outline
• Introduction
• Historical background
• four areas of development
• Key concepts
• View of Human Nature; basic characteristics and Assumptions
• The Therapeutic Process
• Therapeutic Goals
• Therapist’s Function and Role
• Relationship Between Therapist and Client

Outline…
Therapeutic Techniques and Procedures
• Applied Behavioral Analysis: Operant Conditioning
Techniques
• Relaxation Training
• Systematic Desensitization
• In Vivo Exposure and Flooding
• Eye Movement Desensitization and Reprocessing

Bizuneh T. BED,BSC,MSC
12/29/2022 105
Outline…
• Stress inoculation
• Multimodal Therapy: Clinical Behavior Therapy
• Social Skills Training
• Mindfulness and Acceptance-based Cognitive Behavior
Therapy

Objectives
• Define behavioral therapy
• Describe key concepts in behaviorism
• Describe the assumptions of behavior therapy
• Describe four areas of behavioral therapy
• Evaluate the roles of therapist
• Define therapeutic goals and relationships
• Evaluate behavioral therapy techniques

Introduction
Who are the Key figures?

• Pavlov : classical conditioning
• BF. Skinner: operant conditioning
• Albert Bandura : social learning
Theory
Describe the assumption of each theory?

Cont..
• Behavioral therapy is a set of clinical
procedures relying on experimental findings
• It works based on principles of learning
• What are learning principles?

Cont…
• Began in the 1950s in US, South Africa and UK
• Albert Bandura developed social learning theory, which
combined classical and operant conditioning with
observational learning.

Cont…
Behavior therapy practitioners focus on

• Observable behavior
• Current determinants of behavior
• Learning experiences that promote change
• Tailoring treatment strategies to individual clients, and
• Rigorous assessment and evaluation (kazdin,
2001; wilson, 2008).

Key concepts
#1. View of human nature
 Behaviorists believed, man is both the producer and the product of his ev’t.
 Behavior therapy aims to increase people’s skills so that they have more
options for responding.
“Blank slate”

Con’t…
#2. Basic Characteristics and Assumptions
• We have Six key characteristics
 Procedures are tested empirically, and revised continually.
 Deals with current problems and factors influencing them
 Clients assume having an active role/ assignment
 Assumes that change can take place without insight
 The focus is on assessing overt and covert behavior directly
 Treatment interventions are individually tailored to specific problems

Four theories of Behavior Therapy
1. Classical Conditioning
In classical conditioning respondent’s behaviors, such as salivation, is
elicited from a passive organism
• UCS-------------> UCR; meat ------->salivation
• CS--------------->CR; bell ring------> salivation
• High order learning
• CS-----CR;BELL +LIGHT--------SALIVATION
• Cs-----CR;LIGHT------------------SALIVATION

Con’t….
#2. Operant Conditioning
 Focuses on actions that operate on the environment to produce consequences
(behavior)
 If behavior is reinforced, the chances are strengthened and will occur again
 If no reinforcement, the chances are lessened and it will disappear

Con’t…
3. Social Learning theory
• Gives prominence to the triadic
reciprocal interactions between
an individual’s behavior, personal
factors and the environment

Con’t
#4. cognitive behavior theory
• Cognitive behavior theory and social learning theory

now represent the mainstream of contemporary
behavior therapy
• A good example of this more integrative approach is
multimodal therapy
• What is MMT?

Con’t
• Multimodal therapy is a form of psychotherapy developed by

Arnold Lazarus.
• It focuses on reducing psychological suffering and promoting

personal growth as rapidly as possible.
• Multimodal therapy is based on the idea that humans are biological

beings that think, feel, act, sense, imagine, and interact.

Con’t
• THE BASIC I.D.
• The essence of Lazarus’s MMT is the premise that the complex personality of
human beings can be divided into seven major areas of functioning:
• B = behavior
• A = affective responses
• S = sensations
• I = images
• C = cognitions
• I = interpersonal relationships; and
• D = drugs, biological functions, nutrition, and exercise

Therapeutic Goals
• Has very specific goals for each problem
• The two most important goals:

• To increase personal choice/ skills
• To create new conditions for leaning

Therapist’s Function & Role
What are the roles of behavior therapist? Compare with
psychoanalysis therapist
• Active & directive

• Consultants & problem-solvers
• Pay attention to clues presented by client/ thorough asst.
• Follow the clinical Sx/Sx

Treatment techniques
• Systematic Desensitization
• Relaxation
• Flooding
• In Vivo/vitro exposure Therapies

Cont…
o Virtual Reality Therapy
o Modeling Techniques
• Live modeling
• Symbolic modeling
• Role playing
• Participant modeling
• Covert modeling

cont…
o Eye-Movement Desensitization and Reprocessing/PTSD
o Acceptance and Commitment Therapy
o Dialectical Behavior Therapy(borderline PD)
o exposure and ritual prevention therapy/ OCD

Systematic Desensitization
• Developed by Joseph Wolpe (1958)

• Designed to treat patients with extreme anxiety or fear
• The basic assumption is to replace anxious feelings with
relaxation.

Procedure
• First, teach the client about relaxation responses.
• Second, the events that make the client anxious are assessed
and arranged by degrees of anxiety/SUDS/.
• The third step is to have the client imagine anxiety-evoking
situations while being relaxed.

CON’T…
 Repeat gradually, so that relaxation is paired with
thoughts of events that had previously evoked anxiety
 The client is systematically desensitized to situations
that had previously created anxiety.

CON’T…
. Basically it involves tensing and relaxing muscle groups
• . Wolpe (1990) would ask patients to devote 10 to 15

minutes twice a day.
• He often used five or six sessions to teach relaxation
• Finally, state of relaxation could be paired with

imagined anxious situations.

Anxiety hierarchies
• Obtaining detailed and highly specific information about events

that cause a client to become anxious is the essence of
constructing an anxiety hierarchy.
• Clients list problems in order from least anxiety evoking to most

(0 to 100) to each event.
• This is called subjective units of discomfort scale (SUDs)

scenario #1
SUDS IN THE CASE OF ARACHNOPHOBIA

Indication
• Although commonly used with anxiety, desensitization has
also been used in working with anger, asthmatic attacks,
insomnia, nightmares, problem drinking, speech disorders,
and other problems (Spiegler & Guevremont, 2010).
• N.B. Some therapists have used pleasant thoughts as a substitute for deep muscle
relaxation.

Imaginal flooding/ vitro exposure
• In imaginal flooding, the client is exposed to the mental image of a
frightening or anxiety-producing object.
• Continues to experience the image of the event until the anxiety
gradually diminishes.
 The exposure is not to the actual situation but to an image of a frightening
situation

In vivo therapy
 In vivo exposure: Directly facing a feared object,
situation or activity in real life.
 For example, someone with a fear of snakes might be
instructed to handle a snake, or someone with social
anxiety might be instructed to give a speech in front of
an audience.

Virtual reality therapy
• First started in the 1980s and 1990s
• virtual reality therapy is therapy that takes place in a

computer-generated environment (Wiederhold, 2005).
• In this way, a client could “walk” or “drive” a car in a

simulated manner.
• NB. Costly

Modeling technique
• The therapeutic use of modeling is based chiefly on

the work of A. Bandura
• Modeling as a therapeutic technique occurs when a

client observes the behavior of another person and
makes use of that observation.

Con’t
• Bandura (1977, 1997) states that reinforcement is not

sufficient to explain learning and personality development.
• He believes that much learning takes place through

observing and modeling.
• For example, children may learn by watching parents,

friends,television, or movies, or by reading.

Con’t
• In the process of learning, behavioral processes are

important, as are cognitive processes that symbolically
code observations and memories (Bandura, 1986, 1989a).
• Bandura describes observational learning as having

four basic functions:
• Attention,retention(V/I coding), , motor

reproduction, and motivation

Modeling …
• The five basic functions of modeling are:

• Teaching
• Prompting
• Motivating
• Reducing anxiety, and
• Discouraging

Modeling …
• These five functions are combined to varying degrees in live,

symbolic, participant, and covert modeling.
• Live :basically live modeling refers to watching a model, sometimes

the therapist
• Symbolic : Common examples of symbolic modeling are films or

videotapes of appropriate behavior

Modeling …
• Self modeling: Sometimes it is helpful to

videotape a client performing the target behavior
in a desired way
 Filming a child interacting in a socially appropriate way

Modeling …
• Participant modeling: Sometimes it is helpful for the

therapist to model a behavior for the client and then guide
the client in using the behavior–participant modeling.
• Eg, If a client is afraid of climbing ladders, the therapist can model the behavior by
first climbing the ladder

Modeling…
• Covert modeling: Sometimes, when a model cannot

be observed, it may be helpful to have a client visualize
a model’s behavior.
• In this process, covert modeling, the therapist

describes a situation for the patient to imagine.

Modeling …
• Krop and Burgess (1993) give an example of covert modeling with a 7-year-old
deaf girl who was sexually abused by her stepfather.
• As a result of the abuse, the girl was inappropriately touching males (in the
crotch area), engaging in other inappropriate sexual behavior, and having
tantrums. In using covert modeling, Krop and Burgess had the girl imagine
another little girl named Sara who felt good about making decisions not to
throw tantrums and instead to interact appropriately with other children.
Several scenes involved taking constructive action rather than acting out in a
negative way.

Stress inoculation
• Just as a vaccine inoculation to prevent measles,

stress inoculation allows people to tolerate stronger
fears or anxieties.
• People changing their beliefs about the behaviors

and the statements they make to themselves.

Con’t…
• How it can be done ?
• Stress inoculation can done by information giving, relaxation

training, cognitive restructuring, problem solving, behavioral
rehearsals, and other cognitive and behavioral techniques.

Eye-Movement Desensitization and
Reprocessing/EMDR/
• Relatively new model

• Developed by Francine Shapiro in 1987
• It was first designed for individuals with PTSD , but it
has been applied more broadly since then.
• This method uses a combination of cognitive and
behavioral techniques.
HOW IT WORKS
 First a behavioral assessment is done

 Then imaginal flooding is used, and
 cognitive restructuring is followed.

Con’t…
• Shapiro describes eight phases in EMDR.
• The first three phases are an introduction to BA.

• First, take Hx. and tries to determine clients stress tolerance about EMDR.
• Second, explains how EMDR works.
• Third, gathers baseline data before desensitizing.
• Typically, the client is asked to select a memory of the traumatic event

and to assign SUDS

Con’t…
 The fourth is the desensitization phase, which is the longest one.
 The therapist asks the client to think of the traumatic image/

imaginal flooding/ and to notice feelings attached to it as the
therapist moves her hand.
 The client concentrates on the image and feelings as the

therapist moves her hand right and left as rapidly as possible.

Con’t….
 The fifth phase is to increase the positive cognition.
 This stage is called installation because a new positive thought is

installed.
 Positive cognition is linked to the original memory by asking the

individual to focus on the positive cognition and the desired target
behavior. At this point, eye movements are done to enhance the connection.

Con’t…
 The six phase is body scan
 Here, the client scans his body from head to toe,

trying to find any tension or discomfort.
 If discomfort is located, it is targeted with successive

sets of eye movements until the tension is diminished.

Con’t…
• In the last two phases, the client returns to an emotional

equilibrium.
• Between sessions, the client is asked to maintain a log of distressing

thoughts, images, or dreams.
• If they occur, the client is told to apply the self-soothing or relaxation

exercises learned. Then the entire process is re-evaluated.
• Typically EMDR takes 4-6 sessions
• sessions usually run 90 to 120 minutes.

Acceptance & Commitment Therapy
 A relatively new approach,(act)
 Uses behavioral techniques in combination with

clients’ use of language to alleviate client distress.
 Assumption: many emotional problems develop

as clients use ineffective methods, such as
avoidance.

Con’t…
 Strategy: rather than having clients focus on

avoiding a feeling, help clients accept a feeling,
events, or situations.
Help clients clarify values and commit to behaviors

that fit with these values.

Con’t
• ACT is a therapy approach that uses Acceptance,

Mindfulness processes and Commitment to
produce greater psychological flexibility”
And “Psychological flexibility is the ability to

contact the present moment more fully.

Social Skills Training
• Social skills training deals with an individual’s ability to interact

effectively with others.
• It is used to correct deficits in interpersonal competencies

(spiegler, 2008).
• Individuals who experience psychosocial problems caused by interpersonal
difficulties are good candidates.

Con’t
 Psychoeducation  Behavioral rehearsal
 Assertion training  Anger management
 Modeling  Role playing, and
 Reinforcement  Feedback

Assertiveness training
• The basic assumption underlying assertion training is that

people have the right (but not the obligation) to express
themselves.
• One goal of assertion training is to increase people’s

behavioral repertoire so that they can make the choice of
whether to behave assertively in certain situations

Con’t
• Most assertion training programs focus on clients’
negative self-statements, self defeating beliefs,
and faulty thinking.
• ‘It isn't what we say, it’s the way that we say it.’

Con’t…
Can be useful for those
• Who cannot express anger or irritation
• Who have difficulty “saying no”
• Who are overly polite & allow others to take advantage of them

Con’t
• Who find it difficult to express affection

• Who feel they do not have a right to express their
thoughts, beliefs, & feelings
• Who have social phobia

Con’t
• Exercise: 1. think of a situation in your life where you behave unassertively.
2. What are the pay-offs for you in behaving in this way in this situation?
3. What are the disadvantages?
4. Identify what you may gain by being assertive in the situation.
• Consider the following possibilities:
— independence — self-respect
— being true to yourself — honesty in relationships
— inner peace — clarity.

Assertiveness…
• Home take Exercise

1. Write a list of five things or more you love about yourself;
include abilities, skills, qualities, achievements.
2. Read the list to yourself once a day at night.
3. Each day, notice something positive that you do. And
congratulate yourself.

Contributions of BT
• Apply wide variety of specific therapy and

assessment techniques
• Emphasis on research based assessment and
treatment techniques
• The behavioral techniques have been subjected to
the most empirical research

Contributions …
 Both effective and brief
 Evidence-based therapies (EBT) are a hallmark
 Address ethical issues by stating that therapy is basically

an education process.

Limitations & Criticisms
May change behaviors, but does not feelings

Ignores the important relational factors in therapy
Does not provide insight
Treats only symptoms than causes
Involves control & manipulation by therapist
Most experiments are tested in lab. Animals???

?
Summary
• Behavior therapy is an evidence based therapy help

patients in reducing dysfunctional behavior and to
improve quality of life with specific methodology
• Behaviorism argues that man is both a product

and producer of his own evt.
• We call it the ABC model

Con’t
• Triadic reciprocal interaction system

• This involving the interactions among the
environment; personal factors(memories,
beliefs, preferences, predictions,
anticipations, and self-perceptions); and
behavioral actions (Martin, 2004).

Con’t
The four aspects of behavioral models

• classical conditioning….Pavlov
• operant condition……….BF. Skinner
• Social learning approach….Albert Bandura
• Cognitive behavioral therapy…Albert
Bandura

I thank you!!
….TAKE CARE …

Psychotherapy

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Psychotherapy

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An Overview of psychotherapy Models and

• Key concepts in psychoanalysis

• The therapeutic process in psychoanalysis

• Therapeutic techniques in psychoanalysis

• Scientific critics about psychoanalysis

• Define concepts in psychoanalysis such as

transference, counter transference, free

association, dream analysis and defense

• Define psychoanalysis psychotherapy

• Analyze therapeutic techniques and procedures

12/29/2022 Bizuneh T. BED,BSC,MSC 5

 Which treatment modality is more effective?;

psychotherapy or pharmacotherapy or combination

of them, in the treatment of psychiatric disorders;

Efficacy study : Psycho Vs Pharmacotherapy

• A meta analysis done on 67 published journals of 5,993 subjects

show different efficacy.

• Pharma>>non directive therapy

• Psychotherapy>>> TCAS in depression

12/29/2022 Bizuneh T. BED,BSC,MSC 7

• How many types of psychotherapy do you know so far?

• List them and describe their assumptions

12/29/2022 Bizuneh T. BED,BSC,MSC 8

 Before the 1950s, we know only few therapy

 Corsini (2001) summarized 69 therapies

 Most of them derived from the psychoanalysis

 However, currently, we have more than 400 kind of

therapy (Corsini, 2008).

 Are Psychotherapy and Counseling have the same

Evaluate them based on:

• The severity of disease to be managed

• Duration and therapeutic relationship

3’ for pair discussion

12/29/2022 Bizuneh T. BED,BSC,MSC 10

Interpersonal, relational intervention by trained

 Some therapies focus on changing current behavior

 Others emphasize understanding past issues

 Some other therapies use combination of techniques

 Can be short-term with few meetings, or with many

12/29/2022 Bizuneh T. BED,BSC,MSC 12

 Can be conducted with individual, couple, family or

 Also known as talk therapy, counseling,

 Can be combined with other types of treatment,

 Research: quality of therapist/client relationship

effects outcome more than specific therapy

 Lambert (1992) estimates 40% client changes due

to motivation or severity of problem; 30% to quality

of therapeutic relationship; 15% to expectancy

(placebo) effects, and 15% to specific techniques.

12/29/2022 Bizuneh T. BED,BSC,MSC 14

12/29/2022 Bizuneh T. BED,BSC,MSC 15

• The Freudian view of human nature is basically deterministic.

• Form a group of two

• List out the determining factors of human behavior based on

• And reflect in 2 minutes

12/29/2022 Bizuneh T. BED,BSC,MSC 16

 Our behavior is basically determined by:-

• Freud stresses the inborn derives/sexual/ in determining

the first 6 years of life?

 List psychosexual stages with the specific personality

• Are these terms important for therapy?, how?

12/29/2022 Bizuneh T. BED,BSC,MSC 18

 Instincts are central to the Freudian approach.