1
Hoorcolleges Psychotherapy
Lecture 1 – Psychotherapeutic change: introduction
7 april 2026
Psychotherapy = YO
To put things in perspective: some data
Of adults in the Netherlands (18-75 years) in 2023: hugely common!!
- 26% (3.3 million) had a mental disorder in the previous 12 months (of these: anxiety disorder
29%, depression 25%, substance abuse 17%)
- 9% (1.5 million) seek help in mental health care, the others consult GP, social work, local or
online support, or do nothing at all
Typically, between 5 and 16 sessions, but > 50 is possible. In many countries there is no mental health
care, or you are not insured (sometimes, in Obama care, there are 5 sessions insured but then you
must pay yourself). Basic mental health care stops at 10 sessions in holland. You also have specialized
mental health care.
All mental disorders have a huge impact on quality of life
One praises and several concerns
- Strong effects for disorder-specific treatments, when you compare YO with doing nothing
- Little theoretical integration across psychotherapy schools missed
- (Huge) Gap: academic psychology and clinical practice: Small impact of research findings; at
uni you are taught that a disorder is like a broken leg. When you do your internship, you see
that you have to look at the person. Uni talks about an ideal situation that is not the case.
Mental disorders
Experience of
- persisting or recurrent feelings, thoughts, behaviour tendencies, or bodily sensations
- as a problem: unwanted, intolerable, abnormal, uncontrollable, absurd
- ‘I am not in charge’ it’s a process inside of them, they can’t control it, you can’t just stop
being afraid if you think logically
Fragmented sense of ‘self’
,2
What is the goal of psychotherapy (YO)
- Correct: change unwanted patters of subjective experiences, not about trying to understand
the way things are (because we just don’t know)
OR – viewed from medical model – reduce agreed-upon symptoms, disorders, etc.
- Wrong: make patients happy (again) of help patients understand reality; it isn’t enjoyable to
be in therapy. Changing the pattern!! Are we always happy? What is happy? Might be an
ultimate result in life.
1. Mechanisms of change in YO: change by reasoning, arguments and explanations?
- Conceptual, symbolic, logical, semantical use of language (propositional
representations), is not going to help a person. (P: ‘I can’t do anything’; T: ‘can you
drive a car?’; P: yes; T: so, you can do something!! this is meaningless). Although
we must use words, there is this large restriction that words are not experienced
based and therefore it is difficult to use words to help people.
You always have to ask the patient for examples or experiences, you don’t need to
come up with your own ideas of life and the world, the patient is just listening and it
doesn’t help or change the patient.
- Change is rather easy: provide information, reason, persuade, f.i. psychoeducation
- Problems: (1) patient is too passive; (2) persuasion has transient of no effect: it taps
too little into experience level. It’s just restricting the goal.
2. Mechanisms of change in YO: discover who you are?
- Classical assumption: talking-cure, still layman’s-view
- Of course, you learn a bit about ‘yourself’, but in so far ‘identity’ is concerned. Two
problems:
1) Too propositional (again), too much model, too many concepts, too
intellectual and philosophical; pub talk doesn’t help. Although … changing
one’s narrative may be moderately helpful. Healthy people have more
positive stories about himself.
2) Unsupported by academic psychology: our mental processes hardly
accessible; fragmented sense of self. Instead ‘English butlers’ (automated
processes who regulate posture and word choosing etc.) we cannot know
what we think or what we choose.
3. Mechanisms of change in YO: change dominant schemas
(holistic representations)?
Neuroscientists would argue that you cannot change these
schemas, but maybe when you
1. Distracting the dominant schematic representation
(autobiographical memories) from oneself
2. Build up new (or reuse) salient experiences
then they are connected and you activate both schemas.
Eg. Induce emotions: connect past, present, future, images and previous experiences
Experiential techniques: chair technique, imagery rescripting
Problem: typically, you have to activate this within sessions, at home isn’t possible
,3
4. Mechanisms of change in YO: systematic exercise?
- Change associative representations when you have a fear for dogs and you see a
dog, there is an immediate reaction of fear. Saying that the dog is nice, doesn’t help.
Exposure offers experiences where you learn you can endure the dog and then the
fear will go down. Associative representation response is immediatly there, you
dan’t have to think about it or do something
- Core business in directive forms of YO (CT, BT)
- E.g., exposure, systematically challenging negative automatic thoughts, behavioural
rehearsal, assertiveness training, role playing, communication skills
- A lot of evidence for effectiveness
- Problem: patients have to participate
5. Mechanisms of change in YO: patient activation and involvement?
- Without involvement no change in the way we experience things
- Preferably in and between sessions excercises for at home
- E.g. clients’ disclosure, emotional experiences, training, etc.
- When you understand the patiënt and offer your understanding, you have the power
to change the person
6. Mechanisms of change in YO: high quality therapeutic alliende
- Core ingredient in client-centered therapy and psychoanalysis
- Used (needed) for motivation and involvement in directive forms of YO (CT,BT)
- Consistently (bot moderately strong not the same as a successful treatment)
related to YO results
- Problem: fussy and untested theories in clinical psychology. But sound theories from
social psychology and communication sciende about (resistance to) social influence
explaining why the therapeutic allience is so important, rather than the therories
in clinical psychology, because those theories mostly are ‘You need the therapeutic
allience because Freud said so’, but is is not so simple.
7. Mechanisms of change in YO: rearranging environment and social interactions
- E.g. spouse and family support; increase social or daily activities; reduce
stress (e.g., moving); job-related interventions
- Also, informal or formal care plan including long-lasting help of others,
outreaching, sheltered housing
- Strong (and last resort) treatment packages for severe psychiatric disorders
treatment will maybe work better when you change the environment of the
patient instead of the patient itself in order to help overcome the problems of the
patient
, 4
Conclusions:
YO: undertaking aimed at changing unwanted patterns of sxperience: ‘That things are otherwise’ has
to be made available
Means:
1. Patients’ involvement
2. High quality therapeutic relationship
3. Providing information (propositional)
4. Systematic exercise (associative)
5. Induce new (or reuse) salient experiences
For severe psychiatric disorders
6. Rearranging environment
Lastly, ‘that it can be otherwise’ implies that the power of new experiences or behaviours consists of
letting go the older ones.
New schema gets somebody out of the groove with the bad schema, because that one was
destructive.
Hoorcolleges Psychotherapy
Lecture 1 – Psychotherapeutic change: introduction
7 april 2026
Psychotherapy = YO
To put things in perspective: some data
Of adults in the Netherlands (18-75 years) in 2023: hugely common!!
- 26% (3.3 million) had a mental disorder in the previous 12 months (of these: anxiety disorder
29%, depression 25%, substance abuse 17%)
- 9% (1.5 million) seek help in mental health care, the others consult GP, social work, local or
online support, or do nothing at all
Typically, between 5 and 16 sessions, but > 50 is possible. In many countries there is no mental health
care, or you are not insured (sometimes, in Obama care, there are 5 sessions insured but then you
must pay yourself). Basic mental health care stops at 10 sessions in holland. You also have specialized
mental health care.
All mental disorders have a huge impact on quality of life
One praises and several concerns
- Strong effects for disorder-specific treatments, when you compare YO with doing nothing
- Little theoretical integration across psychotherapy schools missed
- (Huge) Gap: academic psychology and clinical practice: Small impact of research findings; at
uni you are taught that a disorder is like a broken leg. When you do your internship, you see
that you have to look at the person. Uni talks about an ideal situation that is not the case.
Mental disorders
Experience of
- persisting or recurrent feelings, thoughts, behaviour tendencies, or bodily sensations
- as a problem: unwanted, intolerable, abnormal, uncontrollable, absurd
- ‘I am not in charge’ it’s a process inside of them, they can’t control it, you can’t just stop
being afraid if you think logically
Fragmented sense of ‘self’
,2
What is the goal of psychotherapy (YO)
- Correct: change unwanted patters of subjective experiences, not about trying to understand
the way things are (because we just don’t know)
OR – viewed from medical model – reduce agreed-upon symptoms, disorders, etc.
- Wrong: make patients happy (again) of help patients understand reality; it isn’t enjoyable to
be in therapy. Changing the pattern!! Are we always happy? What is happy? Might be an
ultimate result in life.
1. Mechanisms of change in YO: change by reasoning, arguments and explanations?
- Conceptual, symbolic, logical, semantical use of language (propositional
representations), is not going to help a person. (P: ‘I can’t do anything’; T: ‘can you
drive a car?’; P: yes; T: so, you can do something!! this is meaningless). Although
we must use words, there is this large restriction that words are not experienced
based and therefore it is difficult to use words to help people.
You always have to ask the patient for examples or experiences, you don’t need to
come up with your own ideas of life and the world, the patient is just listening and it
doesn’t help or change the patient.
- Change is rather easy: provide information, reason, persuade, f.i. psychoeducation
- Problems: (1) patient is too passive; (2) persuasion has transient of no effect: it taps
too little into experience level. It’s just restricting the goal.
2. Mechanisms of change in YO: discover who you are?
- Classical assumption: talking-cure, still layman’s-view
- Of course, you learn a bit about ‘yourself’, but in so far ‘identity’ is concerned. Two
problems:
1) Too propositional (again), too much model, too many concepts, too
intellectual and philosophical; pub talk doesn’t help. Although … changing
one’s narrative may be moderately helpful. Healthy people have more
positive stories about himself.
2) Unsupported by academic psychology: our mental processes hardly
accessible; fragmented sense of self. Instead ‘English butlers’ (automated
processes who regulate posture and word choosing etc.) we cannot know
what we think or what we choose.
3. Mechanisms of change in YO: change dominant schemas
(holistic representations)?
Neuroscientists would argue that you cannot change these
schemas, but maybe when you
1. Distracting the dominant schematic representation
(autobiographical memories) from oneself
2. Build up new (or reuse) salient experiences
then they are connected and you activate both schemas.
Eg. Induce emotions: connect past, present, future, images and previous experiences
Experiential techniques: chair technique, imagery rescripting
Problem: typically, you have to activate this within sessions, at home isn’t possible
,3
4. Mechanisms of change in YO: systematic exercise?
- Change associative representations when you have a fear for dogs and you see a
dog, there is an immediate reaction of fear. Saying that the dog is nice, doesn’t help.
Exposure offers experiences where you learn you can endure the dog and then the
fear will go down. Associative representation response is immediatly there, you
dan’t have to think about it or do something
- Core business in directive forms of YO (CT, BT)
- E.g., exposure, systematically challenging negative automatic thoughts, behavioural
rehearsal, assertiveness training, role playing, communication skills
- A lot of evidence for effectiveness
- Problem: patients have to participate
5. Mechanisms of change in YO: patient activation and involvement?
- Without involvement no change in the way we experience things
- Preferably in and between sessions excercises for at home
- E.g. clients’ disclosure, emotional experiences, training, etc.
- When you understand the patiënt and offer your understanding, you have the power
to change the person
6. Mechanisms of change in YO: high quality therapeutic alliende
- Core ingredient in client-centered therapy and psychoanalysis
- Used (needed) for motivation and involvement in directive forms of YO (CT,BT)
- Consistently (bot moderately strong not the same as a successful treatment)
related to YO results
- Problem: fussy and untested theories in clinical psychology. But sound theories from
social psychology and communication sciende about (resistance to) social influence
explaining why the therapeutic allience is so important, rather than the therories
in clinical psychology, because those theories mostly are ‘You need the therapeutic
allience because Freud said so’, but is is not so simple.
7. Mechanisms of change in YO: rearranging environment and social interactions
- E.g. spouse and family support; increase social or daily activities; reduce
stress (e.g., moving); job-related interventions
- Also, informal or formal care plan including long-lasting help of others,
outreaching, sheltered housing
- Strong (and last resort) treatment packages for severe psychiatric disorders
treatment will maybe work better when you change the environment of the
patient instead of the patient itself in order to help overcome the problems of the
patient
, 4
Conclusions:
YO: undertaking aimed at changing unwanted patterns of sxperience: ‘That things are otherwise’ has
to be made available
Means:
1. Patients’ involvement
2. High quality therapeutic relationship
3. Providing information (propositional)
4. Systematic exercise (associative)
5. Induce new (or reuse) salient experiences
For severe psychiatric disorders
6. Rearranging environment
Lastly, ‘that it can be otherwise’ implies that the power of new experiences or behaviours consists of
letting go the older ones.
New schema gets somebody out of the groove with the bad schema, because that one was
destructive.
