Therapeutic Intervention 2008 / 9 Peter Reddy A brief dip into a vast area * This is a ten-week academic course - by contrast the DClinPsy clinical qualifying course is three years long with practical, personal development and experiential as well as academic elements * Modest aims; no supervised practical experience, no skills development training or personal development groups * But we will introduce some key academic themes in counselling and clinical psychology The module * Uses a variety of texts and journals (mostly available electronically) – so you need good library skills * Seminar programme as well as lectures – contribute your view and talk about what you have read * Main focus is on the outcome of therapy * Does therapy work? How well? * Is therapy care or cure? * What therapies work best or are they all the same? * Can therapies be matched to clients and conditions? * How do therapies work, are there general or specific mechanisms? * What is the evidence base for all this & how good is it? * What sort of evidence is appropriate? * Is evidence of outcome for ‘cure’ the same as for ‘care’ * How do you do therapy? Can it be trained? How are therapists trained? Key Journals * There is a wealth of material available on PsycArticles www.psycinfo.com/library/ and you should consult recent editions of these and other journals: * Journal of Consulting and Clinical Psychology * Journal of Counselling Psychology * Psychological Bulletin * British Medical Journal * American Psychologist Key Texts * McLeod, J. (2003). An Introduction to Counselling (3rd edn.) Buckingham. Open University Press. * Bergin, A.E., Garfield, S. L. and Lambert, M.J. (2004). Bergin and Garfield's Handbook of Psychotherapy and Behavior Change. (5th edn.) New York, Wiley. * Feltham, C. (ed.) (2002). Controversies in Counselling and Psychotherapy. London: Sage. * Feltham, C. (ed.) (2002). What’s The Good of Counselling and Psychotherapy? London: Sage. * Dryden W. (ed). (2002). Handbook of individual therapy. (4th. Edn.) London. Sage. * Dryden W. and Feltham C., (eds). (1992). Psychotherapy and its discontents. Buckingham. Open University Press * As well as Amazon and ebay, try abebooks for second hand copies: www.abebooks.co.uk The context of therapy in Britain – where are we coming from? * 19^th Century: moral treatment, phrenology * Impact of war: psychoanalysis & shellshock * Post-war: welfarism, drug revolution and optimism, rise of clinical psychology * 70’s - 80’s: anti-psychiatry, community care, disillusion with drugs, pessimism * 90’s to present: privatisation, quasi-markets, consumerism, evidence based practice Context of therapy: Growth * Growth in different approaches to therapy * hyper-inflation in theoretical diversity * Over 400 distinct models (Karasu 1986) * Growth in participation * Growth in demand - part of private health care, * raised expectations? * Growth in criticism - consumerism Context: changing funding/political climate * Demand for social goods is rising faster than for consumer goods * Why? What are social goods? * Governments supply social goods * Political pressure for lower taxes * = privatisation and/or pressure to raise productivity * So research into clinical utility or (cost) effectiveness rather than efficacy * Dose-effect curve * Managed care * Evidence-based practice Barkham et al 1996 JC & CP * Dose-effect curves Dose effect curve Hansen, Lambert & Foreman (2002) Clinical Psychology: Science and Practice Aims of therapy / counselling - put into our own order of importance * Acquisition of social skills * Behaviour change * Cognitive change * Empowerment * Generativity and social action * Insight * Problem solving * Psychological education * Restitution * Relating to others * Self acceptance * Self actualisation or individuation * Self awareness * Systemic change * Adapted from McLeod 2003, pages 12-13 The first talking cure; Freudian roots of the Psychodynamic approach * therapeutic model * historical context * image of the person * conceptions of disturbance and health * acquisition/perpetuation of disturbance/change * goals of therapy …continued * selection * qualities of effective therapists * therapeutic relationship and style * strategies and techniques * change process * limitations * case example Other theoretical models * Object relations & Kleinian Psychodynamic therapies * Behavioural therapy * Humanistic person-centred therapy * R.E.T. and other cognitive therapies * These are the four core approaches in individual therapy * Many other therapies, can be thought of as drawing on the same theoretical roots, some have alternative focus, eg. Systemic therapy, narrative therapy Psychoanalysis in the UK * Ernest Jones, Strachey translated into English * Impact of WW1 – Shell shock, army psychiatry, W.H.Rivers at Craiglockhart * Melanie Klein & other refugees * Divergent strands * WW2, foundation of NHS * Anna Freud, Melanie Klein, the middle group Object relations & Kleinian Psychodynamic therapies * 3 versions of how we absorb the social world and create the internal world of subjective experience * Freudian, Kleinian models instinct based drive to seek others * Object relations models (Winnicott, Fairbairn) about relating to others Melanie Klein * Internal world densely populated with polarised versions of people * represent innate drives & unconscious phantasies rather than real others * defences of splitting & projection * potentially fragmented model of self * depressive position * paranoid-schizoid position Object relations * Relating drives social life * self and internal world made from internalised versions of others & relationships with others * shift in theory towards real experiences with real people - we seek emotional contact with people (Fairbairn) * schizoid tendencies - withdrawn, isolated, low affect, fearful of intimacy Evaluation * Depends on your epistemological position * Vague, intuitive, unvalidated from a strictly positivist standpoint * Primarily about understanding & treating neurosis, not a scientific theory * Remains useful and therefore influential in clinical practice * Decline in authority of positivism has given it a new lease of life? Why has psychoanalysis been so influential? * Seems to offer an ability to see behind the mask of self-presentation * a way to reach below the surface to deeper meaning, truth, reality. * Influential in theatre (Hamlet, Ibsen), literature, anthropology, classics, marketing and much else * Its language now permeates society What survives? * 3 sets of concepts: * Related to practice; * free association, transference, resistance, identification, interpretation * Related to mental structure; * defence, splitting, unconscious mental processes * Concerned with early development; * infantile sexuality, fixation, regression, Oedipus complex Further reading * See chapter in Dryden or McLeod. Also; * Entries by Zangwill and Padel in: Gregory, R.A. (Ed.) (1987) The Oxford Companion to the mind. Oxford. Oxford University Press * Thomas, K. (1996) ‘The defensive self: a psychodynamic perspective’. In: Stevens, R. (ed) Understanding the self. London. Sage / OU * Thomas, K. (1996) ‘The psychodynamics of relating’ In: Miell, D. and Dallos, R. (eds) Social interaction and personal relationships. London. Sage / OU