top of page

Growth and Change Training Notes.


button image for text Theory of Change
Growth and Change Study notes
.pdf
Download PDF • 420KB

Growth and Change Training Notes

The training relates to UKCP Postgraduate Master programme of study for Integrative Psychotherapy

Contents - not included here, the pdf includes contents sections links

 

Aspects of Change

From Experience:

Who was responsible for what

Who played what role?

How was change facilitated

How was change resisted

Categories of Change

Predictable Change:

occurs at points in our lives

birth, puberty, adulthood, marriage, childbirth, menopause, retirement, death.

Unpredictable Change:

illness, accident, job losses, wars and natural disasters.

External Change

Internal Change:

Ownership and Responsibilities for Change

NOT

what do you want to change

RATHER

what is going on that ‘you think/feel you want/need to change’

What are you changing for?

Who are you changing for?

Who wants you to change?

What is ‘wrong’ with not changing?

Change Cycle

What makes change so difficult for us is that in order for the new to come, the old must decay, crumble or die, sometimes with violent suddenness.

Change always carries a component of loss even when it is change for the better

Change of . . .

SELF

There are many different theories and definitions of "self" among professional psychologists, but many agree that the "self" consists of

a person's conscious and unconscious aspects, their personality, cognitions or thoughts and feelings.

All these traits or aspects combine together into the person's core identity.

Other synonyms for "self" are

soul, ego, personality, or individual

Maybe the Self is . . .defined as a totality of . . .

a complex, dynamic, and organized system of learned beliefs that an individual holds to be true about his or her personal existence. It is this self that provides consistency to the human personality and allows the individual to maintain a reference point for antecedents and consequences of perceptions and behaviours.

Self in Contact

the self lives, and survives, in contact; by making meaning, identifying and accepting or rejecting and alienating with all that it is not-self.  In noticing what presents as different the self responds with assimilation or rejection, thus maintaining, and making, the self through this contact.

This growth is: the Self in contact, in the moment.

“the self (is) the function of contacting the actual transient present”.   (Perls et al, 1951 p371)

Perls F, Hefferline, R, Goodman P. (1951:1984) Gestalt Therapy Excitement and Growth in the Human Personality, Souvenir Press, New York.

Growth and Change Resist and Defend

Functional, not dysfunctional

Resistance to change is functional when not carried to extremes. In other words, the energy we put into resisting change also permits us to preserve balance in our lives by relegating habitual responses to the unconscious.

Resistance is a force that slows or stops movement. It is a natural and expected part of any change.

Working with Resistance

Resistance is an emotional process. Behind the resistance are certain feelings.

The basic strategy is to help the resistance blow itself out, like a storm, and not to fight the resistance head-on

The above… yes, and no.  The resistance blows (itself) out when there is no longer anything to resist.  The resistance itself serves a purpose, like the protective brother, or father, or friend who ultimately needs to recognise that  the support or protection is not required at this time…

Resistance to change is functional when not carried to extremes. In other words, the energy we put into resisting change also permits us to preserve balance in our lives by relegating habitual responses to the unconscious

Resistance is a force that slows or stops movement. It is a natural and expected part of any change

Pressure to Change

According to some models pressing for change tends to threaten stability and thus increases the power of forces maintaining the system. So, the most effective way to bring about change is to reduce the forces of resistance

Preservation

At the heart of

Resistance

is our fear of loss.

Of change

  • Fear of the unknown

  • Suspicion and mistrust

  • Ambiguity about what the change will mean (for individual job/role)

  • Loss of status and/or job security.

  • Peer pressure

Of losing what has been preserved

Gestalt Therapy Theory of Change

Gestalt Adaption

Gestalt Theory was formulated by Fritz Perls, an experienced psychoanalysis.  In terms of defences Gestalt Theory adapted from psychoanalysis and formulated defences in terms resistances to being in contact – in the relational setting.  The formulation of resistances within Gestalt Theory is in conjunction with its view of the Self in Contact

Defence Mechanisms Gestalt

RESISTANCE TO CONTACT – the defenses we develop to prevent us from experiencing the present fully


Five major channels of resistance:

Deflection

Introjection

Projection

Confluence

Retroflection


david forrest image Gestalt Cycle showing interruptions to contact


Deflection

To avoid becoming aware of what is perceived to be damaging or negative experiences the person will seek to turn away direct contact with another person. This avoidance ensures criticism is not heard and therefore does not upset or damage the person. However in turning this unwelcome criticism away the person will also turn away the positive

" you look nice today" "Oh I don't think so, I haven't shaved today!"

"This is a good piece of writing!" "Uh, it's just a few notes jotted down"

Rather than accept (welcome) attention, meaning bringing awareness to a situation the person deflects, or side steps from the situation, avoiding being aware; avoiding contact. The effect is to avoid your surroundings, your environment; and to miss the positiveness coming to you

Introjection

Rather than mobilising the body and mind to the opportunities surrounding this new awareness the person switches to how he 'should' react in the predefined manner which seems appropriate to the situation. More energy would seem to go into deciding what is the action should be than would be spent in exploring the breadth and depth of the experience.

Whilst the learning process in the younger years requires social behaviour to apply rules - should do this, should not do that the person also needs to be allowed to break out and decide which 'shoulds' need to apply, and when.

The person may lack an inner feeling of self, of direction and thus be unable to differentiate in varying situations.

Projection

"It takes one to know one" ; "he reminds me of me"

The speaker is aware of his qualities and is seeing them in another. Projection would be when the speaker sees the qualities (or flaws) he possesses BUT only in another, not in himself.

Projection may be described as seeing in someone else the qualities you are not acknowledging in yourself. A trait, attitude or feeling which is seen as being directed towards you but actually has stemmed from you. For example you may see that people are difficult and reject your friendship, actually you are difficult and will not allow a friendship.

Retroflection

Retroflection may specifically interrupt the final contact phase. The person is not able to receive or assimilate with his environment and so resorts to retroflection.

This behaviour is learnt, reinforced, in development when feelings and thoughts are not validated in the family group, or when expressed feelings or thoughts are punished without validation.

There are two types of retroflection:

(i) You would do to yourself that which you want done TO the other

(ii) you do to yourself that which you want done BY the other

Note the difference - To and By.

In the first type instead of the person expressing their opinion, anger, frustration, on the other person it is turned inwards. This leads to a critical self, and the ultimate criticism of self is suicide; being the retroflective form of homicide

In the second type of retroflection the person will express or behave how they would wish to be treated. For example in the context of a difficult situation the person may stroke the back of the hand in comfort, this being what they would have wanted from their loved one.

In viewing the two types it would seem

'TO me instead of the other' action is hostile to the self

'BY me instead of the other' action is comforting the self.

Confluence

Confluence may be seen in individuals whose self becomes as much a part of their job or past time. So the computer programmer who lives to code, to socialise only through bits and bytes; the sport enthusiast whose whole happiness seems determined by whether or not there is a win on Saturday, or by how well the sporting idol performs on the field.

Confluence, merging, with another person or with a situation or the surroundings leads to loss of self, to lack of satisfaction and to the dulling of the receptiveness to sensation.  Confluence is the lack of differentiation between the self and other. In the context of the disturbance at the withdrawal stage the individual clings to the gestalt, is unable to appreciate the letting go will allow a further new enriching experience to come forward.

Just Cause

Defensiveness and resistance has – or had – just cause

Rather than the defence or resistance changing it is the cause that needs to be understood / changed, or be removed.

From: Yontef, G., (1993) Awareness Dialogue & Process Essays on Gestalt Therapy, Gestalt Journal Press, New York

Awareness Dialogue & Process Chapter 5 Gestalt Therapy

Children swallow whole (introject) ideas and behavior. This results in an enforced morality rather than an organismically compatible morality. As a result, people frequently feel guilt when they behave in accordance with their wants as opposed to their shoulds. Some people invest an enormous amount of energy in maintaining the split between shoulds and wants  - the resolution of which requires a recognition of their own morality as opposed to an introjected one. Shoulds sabotage such people, and the more they push to be what they are not, the more resistance is set up, and no change occurs.

Beisser advanced the theory that change does not happen through a "coercive attempt by the individual or by another person to change him," but does happen if the person puts in the time and effort to be "what he is," "to be fully in his current position" (1970, p. 70). When the therapist rejects the change agent role, change that is orderly and also meaningful is possible.

The Gestalt therapy notion is that awareness (including owning, choice, and responsibility) and contact bring natural and sponta­neous change. Forced change is an attempt to actualize an image rather than to actualize the self. With awareness self-acceptance, and the right to exist as is, the organism can grow. Forced inter­vention retards this process.

The Gestalt psychology principle of Pragnanz states that the field will form itself into the best Gestalt that global conditions will allow. So, too, Gestalt therapists believe that people have an innate drive to health. This propensity is found in nature, and people are part of nature. Awareness of the obvious, the awareness contin­uum, is a tool that a person can deliberately use to channel this spontaneous drive for health. (Yontef 1993, p142)

Clinical Phenomenology The Paradoxical Theory of Change.

Chapter 6 Gestalt Therapy:

The GT theory of change (The Paradoxical Theory of Change. Beisser, 1970) states:

... that change occurs when one becomes what he is, not when he tries to become what he is not. Change does not take place through a coercive attempt by the individual or by another person to change him, but it does take place if one takes the time and effort to be what he is — to be fully invested in his current positions. By rejecting the role of change agent, we make meaningful and orderly change possible.

The Gestalt therapist rejects the role of "changer," for his strategy is to encourage, even insist, that the patient be where and what he is. He believes change does not take place by "trying," coercion, or persuasion, or by insight, interpretation or any other such means. Rather, change can occur when the patient abandons, at least for the moment, what he would like to become and attempts to be what he is. The premise is that one must stand in one place in order to have firm footing to move and that it is difficult or impossible to move without that footing.

The person seeking change by coming to therapy is in conflict with at least two warring intrapsychic factions. He is constantly moving between what he "should be" and what he thinks he "is," never fully identifying with either. The Gestalt therapist asks the person to invest himself fully in his roles, one at a time. Whichever role he begins with, the patient soon shifts to another. The Gestalt therapist asks simply that he be what he is at the moment.

The patient comes to the therapist because he wishes to be changed. Many therapies accept this as a legitimate objective and set out through various means to try to change him, establishing what Perls calls the "top-dog/under-dog" dichotomy. A therapist who seeks to help a patient has left the egalitarian position and become the knowing expert, with the patient playing the helpless (p185begins) person, yet his goal is that he and the patient should become equals. The Gestalt therapist believes that the top-dog/under-dog dichotomy already exists within the patient, with one part trying to change the other, and that the therapist must avoid becoming locked into one of these roles. He tries to avoid this trap by encouraging the patient to accept both of them, one at a time, as his own.

If the patient abandons trying to be what he is not, even for a moment, he can experience what he is. To invest in and explore what one is, to endure the reality of one's way of being in the world, gives one the centering and support for growth through Awareness and choice. Awareness develops through contact and experimentation based on: wanting to know what one needs, a willingness to stay with the confusion, conflict and doubt that accompanies the search for the given, and a willingness to take the responsibility for finding or creating new solutions. "Man transcends himself only via his true nature, not through ambition and artificial goals" (Perls, 1973, p. 49.).   (Yontef 1993, p184 -185)

When therapists act the role of change agent or rescuer they play one side of the internal battle of the patient and therby lose the possibility of really aiding the patient to integrate the split.  (Yontef 1993, p211)

Shame and the Paradoxical Theory of Change

Chapter 15 Shame, and the Paradoxical Theory of Change

Shame includes a sense of defect or inferiority and a sense of being unlovable and unworthy of respect as a person with that defect.  Shame usually carries the belief or sentiment that with such a defect one does not truly belong in human company. People experiencing this sense of shame often describe themselves as: alien, not human, toxic, untouchable, "yucky".  Some ideal self would be worthy of love and respect, but not the self as is. This is an area where the Gestalt therapy paradoxical theory of change is valuable, since identification with one's state is the heart of that change theory.  (Yontef 1993 p493)

References

Beisser, A., (1970). The paradoxical theory of change. In J. Fagan & I. Shepherd (Eds). Gestalt Therapy Now. Pp77-80.  Harper: New York

Perls F. (1973) The Gestalt Approach.  Science and Behavior Books. Palo Alto

Growth: Relational Needs - Erskine et al

Security

To be who we really are

More than verbal reassurances

The visceral experience of having one’s vulnerabilities respected and protected

Need to know the therapist will continue

eg, client seeks reassurance when repeating a traumatic experience

To provide the hold, rather than being held

eg, different for client to receive: to hold the client’s hand rather than the client holding your hand

Valuing

Being understood and valued in this

eg, values the intent as much as the action; that what is presented is respected and valued

Validation

De-centre, normalise, respectful curiosity

Acceptance

Acceptance wrapped in a strong and stable and protective therapist

Allow the client to have this from the ‘parent’

Allow and provide for idealisation

Mutuality

Understands what the client is experiencing

Thus empathic

The thread of similarity is what is important

Sometimes the client needs to know your experience

Challenge is to be keeping the client’s need to the fore

Self Definition

The need to be different

Special, unique

Support expressions of identity

Encouragement to express their qualities

Listen for questions rather than statement that shift responsibility, or avoid ownership

A significant aspect is saying ‘no’

Negativity, disagreement, resistance

Making an Impact

To have an influence

The therapist must be capable of being impacted by the client

A paradox, to be impacted, share authentically, yet only for the client’s well being

Be impacted, be stirred by the client, care

Be willing to let go, to review, to be wrong

Have the Other Initiate

Reaching out in a way that acknowledges and validates the client’s importance to you.

To be active, to take the lead

Underscores the reciprocal nature of the therapeutic relationship

Counterbalance to a client script

Therapist must sense the client’s foreground need and respond to it.

Know when to initiate and doing so appropriately

Transferential consideration needed; may be considered as an experiment (Gestalt).

To Express Love

A therapy of contact-in-relationship creates one of the most intimate of all human connections.

Natural (that a client is) feeling love and affection for someone … who continues to respect care and attend to and care about.

Take expression at face value

A competent and ethical therapist accepts expressions of love… with equanimity, understanding. With respect and humility


Growth and Change Life Script

Life scripts may form at any developmental age

Tenacious life scripts are formed from a composite of

implicit experiential conclusions

Survival reactions

Introjections

These (implicit memories are not available in the explicit memory or narrative of early life

Life scripts are a desperate and creative attempt to self-regulate while managing and adjusting to the failures that occurred in significant and dependent relationships throughout life (p22)

Implicit conclusions

are revealed through

Bodily reactions

Pre-reflective relational patterns

Transference in the therapeutic relationship

Transference of everyday life

Unconscious transference of early emotional memory

in the present examples are

Hurt and anger with family or friends

Fearfully anticipated reactions of coworkers

Disregard for own health or general wellbeing

Habitual worry

Repetitive fantasies

Obessions

Often necessary to construct a narrative of early emotional and relational experiences to gain understanding and resolution

Co-construct client meaning of the experience

Attend to

Cognitive, Developmental and Current needs

Everyday transferences,

behaviour and fantasy,

Physiological reactions and health maintenance

Psychological functioning

Adopting a relational stance and phenomenological inquiry

Enquire into client’s phenomenological experience

of each developmentally dependent relationship

Influence of parents, family members, teachers and peers

The purpose is to construct the client’s relational patterns and scrip beliefs

You are required to sustain attunement to the client’s affect, rhythm, developmental level, cognitive style and relational needs

Internally script

is essentially a self narrative process that organises the mind, life experiences, and sense of identity

Externally script

 is concerned with unconscious relational patterns

Implications for therapy and the therapist

Script is an embodied self-narrative constructed out of early interactions

Less emphasis on what parents tell children, more on how the child’s experience is reflected

Focus on learning how to think and feel, less on what the client is thinking or feeling

Script is embedded in the body

Cognitive challenges to beliefs about self, other, and life are unlikely to produce lasting change.

Focus on: (both client and therapist)

Bodily sensations

Sensorimotor communication

Identifying feelings and shifts in affect

Script: the end of the story…

The conclusion of the script can be negative or positive

There are four destination

Getting better (positive)

Homicide (negative)

Suicide (negative)

Psychosis (negative)

The last three are (in TA) escape hatches – the (tragic) way out!

The tragic way out, is the ‘child’ scripting: destruction is a fair price to pay for retaining approval and protection of the internalised parent

These are the ways out that the individual will follow if thigs get bad enough

At some point the client will consciously and maturely invoke their decision to enact the negative escape hatch

Change the Ending

Potency is the power to create and support change

Essential aspects of a person’s ability to change:

How a person is empowered or disempowered

How a person becomes powerful or impotent

The therapist is in a role of permission, and protection, giver

Personality Adaptations (Doors to Therapy)

Paul Ware, 1983 Personality Adaptations (Doors to Therapy), Transactional Analysis Journal, Vol13, No1, January  pp11-19

Paul Ware conceptualized thoughts, feelings, and behaviors as being sequential.  He showed the clinical value in determining this order in a patient, matching the strongest of these three in order to make initial contact with the patient (the Open Door), then focus on the probable growth potential area (the Target Door), avoiding the last area (the Trap Door).

One way of understanding how people get to be the way they are and function as they do is to examine the basic personality types in the context of the TA framework. Contact with the client is facilitated by learning her personality characteristics and adaptational patterns; a process which helps clarify the therapeutic task. Since each personality type has its own pattern the therapist must understand the area in which each client invests the most energy, whether it be primarily in feelings, thinking or in behavior as first introduced by (Richard) Erskine. This article presents the concept of personality adaptations and their respective "doors" which enable the therapist to make effective initial contact and to "go with the resistance." In essence, it suggests the direction the therapist should take in relating to and treating the client.

 

Paul Ware spoke of doors of feelings, thoughts, and behaviors, identifying these in ‘areas in which each clients invests energy


Paul Ware Doors to Therapy

 

Personality Adaptations (Doors to Therapy)

Each personality type (DSM IVR) invests energy in either thinking, feeling, or behaviour

 

The OPEN door

is where the individual invests their energy. Use this to establish contact

The TARGET (accessible) door

is to move the client without resistance.

The TRAP door

becomes the final goal in therapy; where there has been most resistance

Personality Types and Contact (Open) Door

Each personality type (DSM IVR) invests energy in either thinking, feeling, or behaviour

Table of Adaptations for Personality Types

Adaptation

Characteristics

Description

Drivers

Injunctions

Schizoid

Withdrawn Passivity

Daydreaming

Avoidance

Detachment

Shy

Overly Sensitive

Eccentric

Be Strong

Try Harder

Please Others

Don't Make It

Don't Belong

Dont' Enjoy

Don't Be Sane

Don't Grow Up

Don't Feel (Love, Sex, Joy)

Don't Think

Hysterical

Excitability

Emotional

Instability

Over Reactivity

Dramatic

Attention-Getting

Seductive

Immature

Self-Centered

Vain

Dependent

Please Me

Try Harder

Hurry Up

Don't Grow Up

Don't Be Important

Don't Think

Obsessive -Compulsive

Conformity

Conscientiousness

Perfectionist

Overly Inhibited

Overly Conscientious

Overly Dutiful

Tense 

Be Strong

Be Perfect

Don't Be A Child

Don't Feel (Joy, and Sex

Don't Be Close

Don't Enjoy

Paranoid

Rigidity of Thought

Grandiosity

Projection

Hypersensitive

Suspicious

Jealous

Envious

Be Strong Be Perfect

Don't Be a Child

Don't Be Close

Don't Feel

Don't Enjoy

Antisocial

Conflict with Society

Low Frustration

Tolerance

Need for Excitement and Drama

Selfishness

Callousness

Irresponsibility

Be Strong

Please Others

Don't Make It

Don't Be Close

Don't Be a Child

Don't Feel

Passive Aggressive

Aggressive Personality

Resentment

Obstructive

Stubborn

Try hard

Be Strong

Don't Feel

Don't Be Close

Don't Enjoy

Don't Make It

 

Table of Personality Types and Doors for Therapy

Adaptations

Doors



 

Contact Door

Target Door

Trap Door

Schizoid

Behavior (WP)

Thinking

Feeling

Anti-Social

Behavior (AA)

Feeling

Thinking

Paranoid

Thinking

Feeling

Behavior

Hysterical

Feeling

Thinking

Behavior

Obsessive-Compulsive

Thinking

Feeling

Behavior

Passive-Aggressive

Behavior (AP)

Feeling

Thinking

 (WP) Withdrawn Passivity. 

(AP) Active Passivity. 

 (AA) Active Assertion


 

Person Centred Approach - Process of Change

Person Centred: Why therapy

According to Rogers (1961)

The fully functioning person is open to experience – where as a person who is troubled & seeking help is engaged in denying or distorting their awareness of self & others in order to avoid unacceptable or frightening areas of feelings or experiencing.

Person Centred: progress

Therapeutic progress follows from the client experiencing being empathically understood without judgement

The client experiences the therapist as one who is acceptant of the client’s experience & meaning system

The therapeutic relationship is therefore a healing encounter

Person Centred: Interventions

It is non- directive

No goals for the client       

Therapist does not interpret

Instead focus on maintaining an attitude of:

Empathic, non-judgemental understanding & acceptance

 

Bozarth (1990) has argued that the central task in person centred therapy is, ‘going with the client’s direction, at the client’s pace & with the client’s way of being’.

Person Centred: Stages of Change

Rogers (1961) conceptualized the process of counselling as a series of stages where the client becomes more involved with his/her inner world – a self exploration:

Seven Stages of Change . . .

Communication is about external events

Expression begins to flow more freely

Describes personal reactions to external events

Descriptions of feelings & personal experience

Present feelings are expressed

Sense of ‘inner referent,’ or flow of feeling

A series of felt senses connecting the different aspects

Person Centred: Stage 1 and 2

Communication is about external events.

Feelings and personal meaning are not ‘owned’.

Close relationships are construed as dangerous.

Does not use first person pronouns.

Expression begins to flow more freely in respect of non-self topics.

Feelings may be described but not owned.

Intellectualization.

Describes behaviour rather than inner feelings.

May show more interest & participation in therapy.

Person Centred: Stage 3 and 4

Describes personal reactions to external events.

Limited amount of self- description.

Communication about past feelings.

Beginning to recognise contradictions in experience. 

Descriptions of feelings & personal experience.

Beginning to experience current feelings, but fear and distrust of this when it happens.

The ‘inner life’ is presented & listed or described, but not purposefully explored.

Person Centred: Stage 5 and 6

Present feelings are expressed.

Increasing ownership of feelings.

More exactness in the differentiation of feelings & meanings. 

Intentional exploration of problems in a personal way, based in processing of feelings rather than reasoning.

Sense of ‘inner referent,’ or flow of feeling that has a life of its own.

‘Psychological loosening’, such as moistness of the eyes, tears, sighs, or muscular relaxation, accompanies the open expression of feelings.

Speaks in present tense or offers vivid representation of past.

Person Centred: Stage 7

A series of felt senses connecting the different aspects of an issue.

Basic trust in own inner processes.

Feelings experienced with immediacy & richness of detail.

Speaks fluently in present tense.

At this stage the person owns their own feelings, and trusts their own inner feelings. 

Cognitive Behaviour Therapy Process of Change

CBT: Change

Behavioural change is more likely to occur if it is well defined or concrete rather than vague .It is more likely to occur if it is  attempted in small manageable steps.

Change is related to an improvement in behaviour & symptom reduction

Long lasting change is seen to result from modification of the person’s underlying distorted beliefs

Change is related to an improvement in behaviour & symptom reduction

Although it may be obvious that change has occurred measurements are taken

Long lasting change is seen to result from modification of the person’s underlying distorted beliefs

CBT: Methodology of Change

Therapy begins with a well planned rationale:

 Initially educating the client about the CBT model –the role of thought ,emotion & behaviour

The client is provided with an explanation/formulation of their problem linked to the CBT model.

Goals are set.

CBT: Process of Change

CBT uses a variety of skills & strategies to bring about change – they are central to this approach.

They are used to help the client to  identify, examine  & reality test , to modify automatic thoughts, errors in information processing & schema.

Independent use of skills

Therapy encourages the client to attribute his improvements in mood more to his own increased skilfulness than to the therapist endeavours.

If the client sees the improvement in his mood as a product of his/her own change in thinking habits & behaviour & can continue using these skills, the therapist will be able to terminate therapy

CBT: Uses techniques to bring about change

Techniques are chosen on the basis of case formulation & in collaboration with the client. They include:

socratic questioning – a form of challenging dialogue,

cost-benefit-analysis – looking at  advantages& disadvantages of having a particular belief,

challenging negative automatic thoughts – looking for evidence for & against a thought,

cognitive rehearsal – role play, graded exposure, relaxation techniques

CBT – advocates homework assignments to encourage clients to practise their newly learned skills to enhance the therapeutic process.

CBT: What When Where:

The What

Stevens[1996] suggests that most people when they seek to change some aspects of their behaviour or thoughts, will have to construct a plan…The components of a CBT plan usually consist of the ‘what’ ‘when’ & ‘where’ sections.

For example, a behavioural ‘what’ could be:

Keeping a written record of anxiety attacks.

Going into a specific feared situation.

Planning a schedule of daily activities

Doing a relaxation exercise.

The When

When are the ‘what’s’ going to be  carried out? For example, the ‘when’ could be:

Every day, until the next therapy session

Every time the client finds him/herself in a particular situation

The Where

Where are the ‘what’s’ planned to happen? For example

At home

In a café where the client will not be interrupted by family members.

Growth and Change Psychoanalysis

The Process of Change

Aim

The health & well-being of the person depends upon the ‘ego’ to resolve psychic conflict generated by the interaction between the id/ super-ego/ external reality. 

For instance: anxiety is often seen as a conscious signal of  internal danger.

Goal

Develop strength of the ego so that it is capable of handling the opposing demands of id/super-ego/external reality.

Psychoanalysis: Id  Ego  Superego

Id [wild]

– instinctual/innate force of behaviour, driving all behaviour in the direction of immediate gratification of the individuals biological needs: hunger, thirst, sex & so on.

Ego [ rational]

– maintains the individual as a whole, whilst at the same time adapting to external reality. It compromise between the outside world, the id, & the demands of the super-ego.

Super-ego [too moral]

– represents the internalization of demands normally generated outside the individual by culture/society. This is initially communicated to the child by words & deeds of parents- it is the source of the child conscience –[as if the parents are inside head].

Psychoanalysis: psychological apparatus

Freud suggested the notion of the ‘psychological apparatus of the mind’

It is an abstract concept – involving the ‘id’ ‘ego’ & ‘super-ego’

Id – instinctual/innate force of behaviour,  driving all behaviour in the direction of immediate gratification of the individuals biological needs: hunger, thirst, sex & so on.

Psychoanalysis: Change - how

Pre- therapy the ego defends itself using defence mechanisms 

The therapist forms an alliance with the patients ego, to help him control the id impulse & the unreasonable demands of the super- ego

The transformation of the ego is brought about in 3 stages;

           1- defence mechanisms identified

           2 – repressed conflict brought into consciousness- using techniques

           3 – patient helped to cope with conflict in a more realistic way.

These stages are repeated many times for each conflict that is identified – the repressed is expressed – it is worked through.

The patient learns that the therapist does not condemn her/him & expresses thought & desires freely.

The patient’s ego has an opportunity to face situations that it could not handle in the childhood [when the ego was weak] in a new setting, with a person who does not react as did the parent. 

Result- patient realises inappropriateness of behaviour –is an intellectual insight  & a corrective emotional experience .

The experience is the central therapeutic agent in the process of change.

Resistance and other Rs 

The "Four R's" are barriers associated with the Prochaska and DiClemente Transtheoretical Model of Change:

Reluctance

The person is not fully conscious of the behaviour's impact on him or herself or upon others

Rebellion

The person may rebel against behaviour change because of fear.

Resignation

The person may have a lack of energy to change

Rationalization

The person may often make excuses for his or her behaviour.

Defence MechanismsPsychoanalytic

Sometimes the id desires something that conflicts with the ego or superego.

This results in anxiety

and also the need for psychological defence mechanisms which deal with the anxiety (the forbidden desired thing and the pain which is associated with the conflict).

Defence mechanisms keep all these out of conscious awareness.

Many of the concepts developed by Freud have found their way into  common usage in psychodynamic and other psychotherapies.

Defences:

super ego

conscience/ego ideal

Ego

conscious self mediates between the id and the ‘reality principle’            

Id

primitive desires/wishes in unconscious / instinctual self

  • Denial

  • Repression

  • Reaction Formation

  • Projection

  • Rationalisation

  • Intellectualisation

  • Regression

  • Displacement

  • Deflection

Denial

Denial  probably has an early developmental origin. (Imagine the small child closing his eyes in order to ‘disappear’ the painful and unwanted experience, or the man still setting the table for two even though his wife has died and he says he is feeling OK)

Denial is a defence mechanism that disavows or denies thoughts, feelings,

      needs and wishes which cause anxiety. It is an unconscious psychological mechanism  that functions to ‘deny’ the thing that cannot be dealt with consciously. 

Repression

Freud first used the term in Studies in Hysteria (1895), which he co-authored with Breuer. The term was used to describe the process whereby feelings which are unacceptable, are banished from conscious thought. As a concept it helped to explain the strange phenomenon of hysteria.

Later Freud wrote another paper entitled

     ‘Repression’ (1915) to describe every blocking of ideas and feelings which are unacceptable to the conscious mind.

An important part of Freud’s theory is that repression does not de-activate these unconscious desire or wishes, but that they continue to have an influence and make their appearance in symbolic form in dreams, jokes and slips of the tongue

     

Reaction Formation and Projection

Reaction formation describes the replacement of negative feelings with their opposite.

Casement (1985) cites the case of a therapist  being infinitely patient with a client and being out of touch with her irritation until she forgot the client’s session.

Projection is the process of ascribing an unwanted impulse to someone else. There is an accompanying denial that one has these feelings or tendencies, whilst seeing them in others.

      Both of theses defences were developed initially by Freud.

Rationalization and Intellectualization

This means finding a rational explanation for something that was confusing or irrational.

      In psychodynamic theory it carries the further connotation

      that the rationalization also serves to conceal the real motivations for an action, thought or feeling. For example, Fred believes he did not lose his job because he was lazy and uncooperative, but because his boss is unsympathetic, unnecessarily critical and difficult.

Intellectualization is the cutting off of the painful feelings about something and replacing them with remote intellectual analysis; for example, the woman who cannot face the fact that her husband is terminally, and instead, becomes the expert on his illness.

Regression

Regression means the reverting back to earlier more primitive or more childlike ways of behaving. It has the implication that stress or anxiety may cause the individual to flee from adult reality into an infantile state at which we are fixated.

Balint (Hungarian psychoanalyst 1920s) distinguishes between ‘benign’ and ‘malign’ regression.

     In the former, the therapeutic relationship, leads to a new beginning in which the client can acknowledge their infantile needs and wishes and make appropriate changes based on their new understanding. In the latter, a spiral of demands may set in as a hysterical response to anxiety and need.

      Balint also suggest that in the latter the client is deeply afraid of emotional contact and is not seeking relationship, but ‘gratification’ of childlike fantasies (Gomez, 1997).

Displacement and  Deflection

Displacement is the moving of an impulse from one object to another. It involves the transferral of feelings, desires or wishes. For example, the man who is angry with his boss, comes home and kicks the cat, shouts at his wife and in turn his wife shouts at the children.

Deflection diverts attention or awareness from the object or situation which arouses anxiety onto something with much less emotional valency. For example, the client who comes because she has some serious emotional difficulties, who, every time you ask how she feels, begins to talk about the weather.

 


 

Tables are reproduced here to allow an easy print option and to show the complete page on a single page

Appendix 1 Table of Personality Types and Doors for Therapy

 

<

Adaptations

Doors



 

Contact Door

Target Door

Trap Door

Schizoid

Behavior (WP)

Thinking

Feeling

Anti-Social

Behavior (AA)

Feeling

Thinking

Paranoid

Thinking

Feeling

Behavior

Hysterical

Feeling

Thinking

Behavior

Obsessive-Compulsive

Thinking