第十九章
心理治療
第十九章 心理治療(Psychotherapy)
國立中正大學心理系所
作者：心理學研究所 陳冠銘
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Psychotherapy:
An intervention that uses the principles of psychology to try to improve the life of a person who is unhappy or disturbed.
Joseph Weizenbaum(1966) created a program "ELIZA" to stimulate nondirective psychotherapy.
一、心理治療的歷史
a.Middge Ages, deamon, torture techniques(施以苦刑)
b.15th-16th centuries, asylums, St Mary of Bethlehem (commonly known as "Bedlam", King Henry VIII, 1547)
c.Phillipe Pinel(1745-1826): first physician to treat patients in human method.
d.18th-19th centuries, Jean Martin Charcot used hypnosis to cure hysteria;
Josef Breuer(1842-1925), a Viennese physician, also used hypnosis to treat hysterical patients
catharsis, cathartic method: if hyponotized patients can talk about their problems, especially the originf of their difficulties,
the patients seemed to improve.
e. Charcot's student Sigmund Freud began working with Breuer.....
二、診斷與評估變態行為
1.Diagnostic Systemes:
a. ICD-10
b. DSM-IV
2. Three questions for a clinician:
a. Does the client have a problem?
b. If so, what is it?
c. Once the problem is diagnosed, how should it be treated?
3. Techniques for answering three questions
a. Clinical Interviews
(1) structured interview vs. unstructured interview:
-In the former method, the interviewer conscientously follwos a specific list of questions and rarely departs from the structured sequences of questions.
WHY? The advantages and disadvantages of both methods ?
-The ideal os a cp,nomatopm pf tje twp techniques: Therapists have some standard questions that they make sure to ask, yet they freely pursue particular issues that appear to be important for a given client.
-Exactly how a clinician conducts an interview depends not only on the type of client and presenting symptoms, but also on the clinician's theoretical orientation.
(a). Psychodynamically oriented:
(b). Behaviorally oriented:
(c). Cognitive oriented:
(d). Humanistic oriented:
-How clients say something? Behavior observation !
-In making a diagnosis, clinicians needs to be sensitive not only to what clients are saying, but also to how the clients' relationship with them may be affecting the content of the interview.
-Clinicians need to recognize that both the clinical syndrome itself and the clients' personal motivations affet what clients say and how they say it.
b. Psychological Testing
(1) Personality tests: TAT, Rorschach tests, MMPI
(2)Neuropsychological tests: Halstead-Reitan Battery, Luria-Nebraska Battery, Benda Test, CASI
(3) Psychophysiological measurements:
a. knee-jerk reflex, pupillary reflex, HR, BP, GSR....
b. CT, PET, MRI, fMRI, MEG
(for details, see APA monitors March, 2000, http://www.apa.org/monitor)
三、心理治療的取向
1. Psychodynamic Therapies
a. free association : Freud's couch, resistance
b. the analysis of dream: manifest content, latent content
*transference, the patient projects her or his feelings and internal conflicts onto the therapist, often also projecting onto the threapist-pateint relationship many aspects of the patient's early childhood relationships.
*counter-transference, the therapist projects onto the patient the therapist's own feelings.
*Movie: The Prince of Tide(潮浪王子, Robert Redford and Babara Straitsen?)
c. Neo-Freudians: Carl Jung, Erik Erikson, Karen Horney...
-time-limited psychotherapy
2. Humanistic / Client-Centered Therapies
(1) "patients" vs. "client", (2) free will
Client-Center Therapy (Carl Rogers, 1961): (1) nondirective, (2) try to understand their client's view of the world.
Three keys to successful therapy: (1) genuineness onthe part of the therapist, (2) the therapist to provide the client with unconditional positive regard, (3) the therapist to experience accurate empathic understanding of the client.
3. Behavior Therapies
-Five characteristics of behavior therapy (p.644-5)
-counterconditioning :
(a) aversion therapy: e.g pedophiliac
(b) systematic desensitization: Joseph Wolpe(1958)
-Extinction :
(a) flooding: e.g. snake phobia
(b) implosion therapyz
-Operant Conditioning
(a) Token Economy, five features of token economy
-Behavioral Contracting
-Modeling: Bandura(1969)
4. Cognitive Therapies
-Rational-Emotive Therapy (RET) Albert Ellis(1962)
-Beck's Cognitive Theorapy(1976)
5. Biological Therapies
-Electroconvulsive therapy(ECT)
-Psychosurgery: e.g. Phneas Gage and Prefrontal Lobotomy
-Drug Therapy: psychotropic drugs( includes antipsychotics/neuroleptics, antidepressant, antianxiety/ anxiolitics )
(1)antipsycotics: chlorpromazine, haloperidol, extrapyramidal syndrome, clozapine
(2)antidepressants: tricyclics(e.g. imipramine), MAOI (e.g. phenelzine), SSRI (e.g. Prozac), lithium
-spontaneous recovery?
-Anxioletics:
(1) barbiturates, muscle relaxants, bendodiazepines,
(2) Lithium
***Psychotherapy in a cultural perspective
-five basic components of psychotherapy
四、個別心理治療之外
1.Group therapy: advantages and dissavantages, e.g. Alcoholics Anonymous(AA)
2. Couples and Family Therapy:
-even individual problems often have roots in he family system, and to treat the problem, the whole family should be part of the solution.
-couple therapy emphasizes communication and mutual empathy.
進階閱讀：熱鍋上的家庭(張老師文化)、家庭會傷人--自我重生的契機(張老師文化) Virginia Sapir
3. Community Psychology:
a. Primary Prevention, is amied at preventing disorders befor they happen.
b. Secondary Prevention, is targeted toward detecting disorders early, before they become major problems.
c. Tertiary Prevention, essentially treates disorders once they have developed more fully, and it can be considered preventive only in the sense that the continuation of the disorders may be prevented.
-for more information, please contact 周雅容老師 or 政大心理系陳嘉鳳老師
4. Self-Help:
-書店裡面標榜「可自行進行心理治療」的書是否真的有效？請說明理由!
五、Effectiveness of Psychotherapy
接受psychotherapy是有效的嗎？ 那些psychoterapy是最好的？是不是最好的psychotherapy是因人而異？最好的psychotherapy會不會因文化而異？會不會因病況的不同,有不同的最佳療法？Psychotherapy之間可不可以互補？
eclectic therapy(折衷療法) describe a strategy for therapy that intergrates several approches. Indeed, many therapist today take an eclectic approach.
it is important to compare the effectiveness of a fiven treatment not only against alternative treatments, but against no therapy at all. 為什麼要與no therapy比較？
the length of treatment dramatically afects therapeutic outcomes. Reseachers should consider not only the length of treatment, in general, but also the length of treatment for specific disorders.
Seligman(1995) has reported that patients who received long-term treatment did substantially better than those who received only short-term treatment, and that pateients who received both medication and psychotherpay did no better than those who received just psychotherapy. No specific type of psychotherapy was, on average, bettern than any other for any disorder.
the positive outcomes of therapy seem to occur regardless of the type of therapy implmented.
the paradox : equivalent therapeutic outcome despite profoundly different therapeutic techniques and theoretical approches. The reasons for this paradox are
a) inadequate distinctions among disorders,
b) common characteristics across therapists,
c) common characteristics across clients,
d) common characteristics of the therapetic alliance between therapist and client.
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最後更新日期：02-06-01 04:09.（香港時間）