Psychotherapy: Lectures
Lecture 1, 17-04-2018
Psychotherapy-schools
- Psychoanalysis, brief psychodynamic
- Client-centered = Rogerian, person-oriented or humanistic
- Directive treatments: CBT, hypnosis, schema-focused therapy, ACT
- Family and systems therapy —> Freud
Louise: panic disorder with agoraphobia —> transpireren, flauwvallen, diarree, paniekerig;
dingen zoeken om te doen, heel erg druk maken; nat van het zweet, praat zichzelf dingen aan,
duizelig/licht in hoofd. Ze wil vluchten naar de buren of de telefoon pakken —> ze doet dit nooit
omdat ze zich schaamt. Ze weet zich geen houding te geven en wil dan graag hulp. Ze is altijd
bang dat iets met haar gaat gebeuren, zoals flauwvallen. Ze zorgt altijd dat ze iets te doen heeft of
een beetje onder de mensen is. Ze probeert zo veel mogelijk te vermijden dat ze alleen is; ze kan
niet langer dan een uur alleen zijn.
She can not explain why she’s having panic attacks, because she’s actually anxious about the
panic attack itself. When you get anxious about panic itself, it’s a panic disorder.
Marit: trichotillomania —> Moeilijk om te stoppen, dit lukt haar soms voor 10 minuten. Ze kan het
even vermijden of uit stellen, maar onbewust gaat ze vervolgens weer verder. Als ze het uitstelt
blijft het verlangen om het toch te doen. Extremiteit is vervolg van bevalling kortgeleden. Als er
veel onrust is, wordt het erger.
A habit can significantly influence your life.
Mental disorders
Experience of feelings, thoughts, behaviour tendencies, bodily sensations as a problem: unwanted,
intolerable, abnormal, uncontrollable, absurd. Fragmented sense of “self”.
Mostly you are visiting a therapist when you can’t change those feelings, thoughts, behaviour
tendencies and/or bodily sensations by yourself. It’s only a disorder when you experience those
things as a problem and they hold you back in daily life. Both video examples showed that patients
feel ashamed and helpless; the problem is an inside experience —> your experiences don’t “work”
like they should. They feel like it’s within themselves and that’s why they don’t know how they can
solve the problem.
Inaccessible, unconscious motives
Freud: constant fight with the ID —> immediate need for gratification, but we learned to postpone
these needs/urges because we also act social; superego. ID & superego are in conflict a lot of the
time. —> There are no actual ID and superego in the brain. Though in a very broad sense/different
way the cortical and subcortical areas are a bit of the same.
- Overwhelming childhood experiences
- Restricted learning experiences
- Inability to acknowledge parts of self
The “me” is not the boss; patterns are very difficult to change and it’s very difficult to control
yourself.
Modern experimental psychology: disorder specific, theories from cognitive psychology and
neuroscience
Psychotherapy: ????
,Gazzaniga
“There is no me, there is no I” —> lots of research supporting this. The “me” & “I” are some sort of
reporters behind screens
telling you what you
experience. Consciousness is
the last to know —> if we
would know things sooner, we
would’ve died ages ago.
Temporary view: brain
FF TERUG KIJKEN DIKKE TROL
MAND!
Man screams —> visual: retina —> thalamus —> primary visual cortex: pattern recognitions —>
information also comes into ear and olfactory cortex —> amygdala: link mental and bodily
processes: do I feel anything? —> hypothalamus: emotion is going to arise: somatosensory —>
hippocampus: connection between things we know in our memory; top-down process: recognition:
milliseconds before consciousness! This comes last!
You don’t need an I or me: English butlers (subprograms) —> always watchful, always there to
help you at the right moment without us consciously knowing he’s doing this —> Changing an
English butler: learning, for example when eating spoiled food. You can learn and change cell
chemistry —> adaptable, influenceable by the environment.
Three ways in which the brain can learn: representations —> interaction with your environment
1. Associative: experience which comes about because you’re repeatedly interacting in a sudden
way with your environment. Example: when your father hits you when you talk too loud, you
learn to not do it. Stimulus —> certain reaction. Implicit system. You can think about nice things
regarding dogs, but if you’re scared of dogs because of a bad experience, the thoughts won’t
change this fear next time you see a dog.
2. Schema: neural network; orange —> we know a lot of things about oranges, but we can’t
describe for example the smell or taste in words. Activation of meanings.
3. Propositional: words and symbols —> difference humans and animals —> when someone is
telling you something, this can change your behaviour. Language is a mixed blessing: people
can tell the truth, or they can lie. Factual, but not based on experience: it’s not typically
emotional, it’s logical: Paris is the capital of France.
, Synaptogenesis
…….
We do not know reality. There is no “I”, there is only a story about yourself. When you change your
view about yourself, you are changing yourself. But it has nothing to do with who you are; it’s a
narrative. A therapist should not change YOU, but your burdens. Whenever reasoning is involved
with the problems you have, then the best way of changing that part of yourself, is offering
information; talking helps. Talking is a way to change propositional representation, but not
associative representation —> you have to exercise; cognitive therapy for example.
Schematic representation: activation of meanings —> large networks of information are connected
and exposed to each other —> activating the meanings cause connections and therefore change.
Conclusions
What is
Psychotherapy is an undertaking aimed at changing subjective reality. “That it is otherwise” has to
be made available.
What are the means?
To active one’s experiences and to add a different context
1. Good therapeutic relationship: acceptance, empathy
4. (Perceived) expertness of the therapist
5. Constant patient involvement
6. Emotions (to a certain degree)
7. Simultaneous activation of meanings (insight)
8. Systematic exercise
, Lecture 2, 24-04-2018
Behaviour therapy and cognitive therapy are 2 of the most effective therapies.
Part 1: Behaviour Therapy (BT)
Classical conditioning
Unconditional stimulus (UCS = food) elicits unconditioned response (UCR = saliva)
After repeated trials:
Conditioned stimulus (CS = bell) elicits conditioned response (CR = saliva): Dog attached
“meaning” to the CS.
—> very quick and easy to learn.
Examples CS - CR:
TTM* CSs: ‘...in the evening when I am tired...’, ‘...TV on...’, ‘...while studying...’, ‘...when I feel
down...’, ‘...while talking on the phone…’
TTM CRs: ‘...I select one hair and start pulling...’, ‘...my mind is empty...’, ‘...I relax…’
Dog phobia CSs: ‘...especially in parks...’, ‘...small dogs also...’, ‘...when the dog is not leashed…’
Dog phobia CRs: ’...then I panic...’, ‘...I always drive to my work...’, ‘...I haven’t visited my aunt
since than…’ —> avoidance behaviour
Panic disorder CRs: ‘...my sister usually accompanies me...’, ‘...I always have my medicine...’,
‘...my heart is beating like hell…’
Social phobia CRs: ‘...I always arrive early so there are only a few people...’, ‘...of course I use
make-up...’, ‘...I never go to parties…’
—> associative learning!
Operant conditioning
Sd: R — S
Given a discriminative stimulus (Sd), certain behaviour (R), results in a situation (S) becoming
(more) positive or negative.
S+ or S- = pleasant or unpleasant
+S or -S = occurs or does not occur (while expected)
So,
+S+ or -S- = positive or negative rewards: R increases
+S- or -S+ = positive or negative punishment: R decreases
Examples:
TTM +S+: ‘...it feels nice, a good moment for myself...’,
+S- ‘...after the hair pulling I feel remorse…’
Dog phobia –S-: ’...I avoid parks...’, ‘...I only go out when there are parking spots nearby…’
Lacking assertiveness –S-: ‘...then I rather shut my mouth...’,
+S-: ‘...later on, I regret ending up with those extra tasks…’
Lecture 1, 17-04-2018
Psychotherapy-schools
- Psychoanalysis, brief psychodynamic
- Client-centered = Rogerian, person-oriented or humanistic
- Directive treatments: CBT, hypnosis, schema-focused therapy, ACT
- Family and systems therapy —> Freud
Louise: panic disorder with agoraphobia —> transpireren, flauwvallen, diarree, paniekerig;
dingen zoeken om te doen, heel erg druk maken; nat van het zweet, praat zichzelf dingen aan,
duizelig/licht in hoofd. Ze wil vluchten naar de buren of de telefoon pakken —> ze doet dit nooit
omdat ze zich schaamt. Ze weet zich geen houding te geven en wil dan graag hulp. Ze is altijd
bang dat iets met haar gaat gebeuren, zoals flauwvallen. Ze zorgt altijd dat ze iets te doen heeft of
een beetje onder de mensen is. Ze probeert zo veel mogelijk te vermijden dat ze alleen is; ze kan
niet langer dan een uur alleen zijn.
She can not explain why she’s having panic attacks, because she’s actually anxious about the
panic attack itself. When you get anxious about panic itself, it’s a panic disorder.
Marit: trichotillomania —> Moeilijk om te stoppen, dit lukt haar soms voor 10 minuten. Ze kan het
even vermijden of uit stellen, maar onbewust gaat ze vervolgens weer verder. Als ze het uitstelt
blijft het verlangen om het toch te doen. Extremiteit is vervolg van bevalling kortgeleden. Als er
veel onrust is, wordt het erger.
A habit can significantly influence your life.
Mental disorders
Experience of feelings, thoughts, behaviour tendencies, bodily sensations as a problem: unwanted,
intolerable, abnormal, uncontrollable, absurd. Fragmented sense of “self”.
Mostly you are visiting a therapist when you can’t change those feelings, thoughts, behaviour
tendencies and/or bodily sensations by yourself. It’s only a disorder when you experience those
things as a problem and they hold you back in daily life. Both video examples showed that patients
feel ashamed and helpless; the problem is an inside experience —> your experiences don’t “work”
like they should. They feel like it’s within themselves and that’s why they don’t know how they can
solve the problem.
Inaccessible, unconscious motives
Freud: constant fight with the ID —> immediate need for gratification, but we learned to postpone
these needs/urges because we also act social; superego. ID & superego are in conflict a lot of the
time. —> There are no actual ID and superego in the brain. Though in a very broad sense/different
way the cortical and subcortical areas are a bit of the same.
- Overwhelming childhood experiences
- Restricted learning experiences
- Inability to acknowledge parts of self
The “me” is not the boss; patterns are very difficult to change and it’s very difficult to control
yourself.
Modern experimental psychology: disorder specific, theories from cognitive psychology and
neuroscience
Psychotherapy: ????
,Gazzaniga
“There is no me, there is no I” —> lots of research supporting this. The “me” & “I” are some sort of
reporters behind screens
telling you what you
experience. Consciousness is
the last to know —> if we
would know things sooner, we
would’ve died ages ago.
Temporary view: brain
FF TERUG KIJKEN DIKKE TROL
MAND!
Man screams —> visual: retina —> thalamus —> primary visual cortex: pattern recognitions —>
information also comes into ear and olfactory cortex —> amygdala: link mental and bodily
processes: do I feel anything? —> hypothalamus: emotion is going to arise: somatosensory —>
hippocampus: connection between things we know in our memory; top-down process: recognition:
milliseconds before consciousness! This comes last!
You don’t need an I or me: English butlers (subprograms) —> always watchful, always there to
help you at the right moment without us consciously knowing he’s doing this —> Changing an
English butler: learning, for example when eating spoiled food. You can learn and change cell
chemistry —> adaptable, influenceable by the environment.
Three ways in which the brain can learn: representations —> interaction with your environment
1. Associative: experience which comes about because you’re repeatedly interacting in a sudden
way with your environment. Example: when your father hits you when you talk too loud, you
learn to not do it. Stimulus —> certain reaction. Implicit system. You can think about nice things
regarding dogs, but if you’re scared of dogs because of a bad experience, the thoughts won’t
change this fear next time you see a dog.
2. Schema: neural network; orange —> we know a lot of things about oranges, but we can’t
describe for example the smell or taste in words. Activation of meanings.
3. Propositional: words and symbols —> difference humans and animals —> when someone is
telling you something, this can change your behaviour. Language is a mixed blessing: people
can tell the truth, or they can lie. Factual, but not based on experience: it’s not typically
emotional, it’s logical: Paris is the capital of France.
, Synaptogenesis
…….
We do not know reality. There is no “I”, there is only a story about yourself. When you change your
view about yourself, you are changing yourself. But it has nothing to do with who you are; it’s a
narrative. A therapist should not change YOU, but your burdens. Whenever reasoning is involved
with the problems you have, then the best way of changing that part of yourself, is offering
information; talking helps. Talking is a way to change propositional representation, but not
associative representation —> you have to exercise; cognitive therapy for example.
Schematic representation: activation of meanings —> large networks of information are connected
and exposed to each other —> activating the meanings cause connections and therefore change.
Conclusions
What is
Psychotherapy is an undertaking aimed at changing subjective reality. “That it is otherwise” has to
be made available.
What are the means?
To active one’s experiences and to add a different context
1. Good therapeutic relationship: acceptance, empathy
4. (Perceived) expertness of the therapist
5. Constant patient involvement
6. Emotions (to a certain degree)
7. Simultaneous activation of meanings (insight)
8. Systematic exercise
, Lecture 2, 24-04-2018
Behaviour therapy and cognitive therapy are 2 of the most effective therapies.
Part 1: Behaviour Therapy (BT)
Classical conditioning
Unconditional stimulus (UCS = food) elicits unconditioned response (UCR = saliva)
After repeated trials:
Conditioned stimulus (CS = bell) elicits conditioned response (CR = saliva): Dog attached
“meaning” to the CS.
—> very quick and easy to learn.
Examples CS - CR:
TTM* CSs: ‘...in the evening when I am tired...’, ‘...TV on...’, ‘...while studying...’, ‘...when I feel
down...’, ‘...while talking on the phone…’
TTM CRs: ‘...I select one hair and start pulling...’, ‘...my mind is empty...’, ‘...I relax…’
Dog phobia CSs: ‘...especially in parks...’, ‘...small dogs also...’, ‘...when the dog is not leashed…’
Dog phobia CRs: ’...then I panic...’, ‘...I always drive to my work...’, ‘...I haven’t visited my aunt
since than…’ —> avoidance behaviour
Panic disorder CRs: ‘...my sister usually accompanies me...’, ‘...I always have my medicine...’,
‘...my heart is beating like hell…’
Social phobia CRs: ‘...I always arrive early so there are only a few people...’, ‘...of course I use
make-up...’, ‘...I never go to parties…’
—> associative learning!
Operant conditioning
Sd: R — S
Given a discriminative stimulus (Sd), certain behaviour (R), results in a situation (S) becoming
(more) positive or negative.
S+ or S- = pleasant or unpleasant
+S or -S = occurs or does not occur (while expected)
So,
+S+ or -S- = positive or negative rewards: R increases
+S- or -S+ = positive or negative punishment: R decreases
Examples:
TTM +S+: ‘...it feels nice, a good moment for myself...’,
+S- ‘...after the hair pulling I feel remorse…’
Dog phobia –S-: ’...I avoid parks...’, ‘...I only go out when there are parking spots nearby…’
Lacking assertiveness –S-: ‘...then I rather shut my mouth...’,
+S-: ‘...later on, I regret ending up with those extra tasks…’
