Therapeutic Approaches Test - 3

‘Trepanning ’involved removing part of the skull bone to allow evil spirits out of the body, and was a practice that endured until the twentieth century. Bloodletting, another outdated ‘technique ’, required a surgical removal of the patient ’s blood –again to let out those evil spirits. A form of psychosurgery, the prefrontal (or ‘ice pick ’) lobotomy involved a sharp piece of metal being inserted under the eyelid and above the eye so that it entered the base of the frontal lobe. Sideways movement severed the connections between the frontal lobe and the rest of the brain, in an attempt to treat the disorder.

While psychotropic drugs are useful for some psychological disorders and have improved the quality of life for many people, there are some obvious limitations to their use, including the first three mentioned above and therefore should be administered in conjunction with other forms of therapy.

The placebo effect is a widely documented phenomenon in the treatment of various diseases from flu to heart disease. It has been shown that up to 70 per cent of patients actually demonstrate some real functional improvement after being treated with an inert substance (a placebo) such as a sugar pill.

Free association, interpretation and analysis of transference are examples of treatment techniques in the psychoanalytic model of psychotherapy. Treatment techniques in the other three models above include:

• in the humanistic model, unconditional positive regard and active listening;
• in the cognitive model, collaborative empiricism and identifying automatic thoughts; and
• in the behavioural model, counter-conditioning and modelling.

CBT has been shown to be most effective for treating recurrent depression in conjunction with drug treatment.

Suicidal patients and psychotic patients may be at greatest risk for self-harm and/or the least receptive to psychotherapy, and thus may benefit by drug treatments first to stabilise symptoms and ensure safety.

Aaron Beck developed one of the most influential cognitive therapies to treat depression. Beck maintains that the depressed person ’s negative view of self, the world and the future (the ‘cognitive triad ’) results from the operation of maladaptive automatic thoughts –the spontaneously generated thoughts associated with specific moods or situations (e.g. ‘Everything I do turns out wrong ’). In depression, these cognitive distortions can take many forms including dichotomous thinking, overgeneralization, arbitrary inference and magnification.
Whatever form the cognitive distortion takes, a primary goal in cognitive therapy is to help the client identify automatic thoughts and evaluate them. The therapist helps the client to do this by asking questions like, ‘What is the evidence for this idea?’, ‘Is there another way to look at the situation?’, ‘Are these facts, or your interpretation of the facts?’The therapist also formulates a hypothesis regarding the automatic thought and invites the client to test the validity of the hypothesis in a systematic way –a process called collaborative empiricism. In taking this approach, ultimately more realistic, accurate interpretations should replace the automatic thoughts, distorted beliefs and assumptions.

In this most influential humanist therapy, Carl Rogers argued that a person ’s natural tendency to grow as a unique individual (self-actualize) is thwarted by judgements imposed on them by other people –what he called conditions of worth. He therefore emphasized the importance of affirming the worth of the client, who typically is not interrupted or questioned by the therapist. This is achieved by the exercise of three therapeutic attitudes:

1. 1. Unconditional positive regard is established by showing the client that she is valued, no matter what.
2. 2. Also essential to the Rogerian therapist is empathy –an emotional understanding of what the client is experiencing by seeing things from his point of view.
3. 3. Finally, congruence between the therapist ’s actions and feelings, sometimes called genuineness, is important in this form of therapy.

The Gestalt therapist may often be quite confrontational in forcing the client to focus on the here and now and deal honestly with his feelings. Indeed, according to one commentator, Perls ‘was often seen as inhumane in application of his technique ’(Cottone, 1992, p. 148).

All of the above have been considered as possible reasons for why patients may deteriorate after psychotherapy.

Research suggests that beneficial effects will appear after about 6 to 8 sessions in 50 percent of clients. After 26 sessions, beneficial effects will appear in 75 percent of clients. 10 to 12 sessions and 1 to 2 sessions have not been demonstrated to be the most critical points for therapeutic effects to appear.