Existential and Behavioral Therapy

By: Jacqueline Heler and Siofra Sharpe

The case of Miriam…

Miriam (Pg. 361)• Abused as a child “…terrifying and degrading

childhood abuse,” (Corsini, 361)• Speaks in a flat voice seemingly disconnected

from her feelings• Self-critical• Terrified of other people/relationships• Can’t “feel”• When she dared to move into contact with

therapist, she would suddenly shrink back in shame

EXISTENTIAL THERAPY

Key Theorists

• Kierkegaard (1813–55): believed that truth could ultimately only be discovered subjectively by the individual in action

• Nietzsche (1844–1900): encouraged people to choose their own standards and live by their own free will

• Heidegger (1889–1976): interpretation seeks to understand how the person himself subjectively experiences something

Key Points

• there is no such thing as psychological dysfunction or being ill, every way of being is merely an expression of how one chooses to live one's life

• accepting feelings rather than trying to change them • generally not concerned with the client's past; instead,

the emphasis is on the choices to be made in the present and future

• 4 “givens” of human existence: death, freedom, isolation, and meaningless

• depending on how we confront these themes, we determine the design and quality of our lives

4 Dimensions “Worlds”

In an Existential Psychotherapy Session…

• Authentic the therapeutic relationship• Encourage clients to personalize their

dialogue• Providing examples, speaking in the first

person, taking responsibility for perceptions about self and world

• Grounding exercise: “embodied meditation”

Role of the Therapist

• Psychotherapist functions as a guide, accompanist, and symbol… “wisdom teacher”

• Provides clear, humble demonstration of what is possible

• Provides support and guidance, but the search is the CLIENT’S

• Authentic relationship…awakening to what is real, immediate, and personal. HERE AND NOW

Pros and Cons

• Cross-cultural applications; both Eastern and Western civilizations can relate

• There is no system or design to existential therapy

• Handling mental illness?• Present and future oriented• Emphasizes personal responsibility

Existential References (beyond the Corsini textbook)

• Yalom, Irvin D.; Existential Psychotherapy; Basic Books, 1980.

• Yalom, Irvin D.; The Gift of Therapy; Piatkus Books, 2001.

• Ryckman, Richard M.; Theories of Personality; Wadsworth Publishing Company, 1999.

BEHAVIOR THERAPY

“What is causing this person to behave in this way right now, and what can we do right now

to change that behavior?”

Approach

• A primary focus of both cognitive and behavioral techniques is to change the cognitive processes viewed as essential to therapeutic success

• Both cognitive and behavioral methods are used to modify faulty perceptions and interpretations of important life events

• For this reason, it is now common to refer to “Cognitive Behavior Therapy”(CBT), instead of Behavior Therapy

History

•Emerged in the late 1950’s as a systematic approach to the assessment and treatment of psychological disorders•In its early stages, Behavior therapy was defined as the application of modern learning theory to the treatment of clinical problems•Modern learning theory referred to the principles and procedures of classical and operant conditioning•Behavior therapy was seen as the logical extension of behaviorism to complex forms of human activities•Key theorists: Pavlov, Skinner,Wolpe, Bandura

Key Theorists• Pavlov (1849-1936): Established the foundations of classical conditioning• Skinner (1904-1990): Radical behaviorism has had significant impact on

BT as well as on psychology in general• Wolpe (1915-1997): anxiety as causal agent in all neurotic reactions,

defined as a persistent response of the automatic nervous system, acquired through classical conditioning

• developed specific techniques such as systematic desensitization, one of the most widely used methods of BT

• Bandura (1925-present) His Social Cognitive theory has influenced many areas of inquiry: Education, Health Sciences, Social Policy and Psychotherapy among others

• Concepts: analysis of personal efficacy and social roots of moral behavior

Basic concepts

Three main approaches have been identified:

1. Applied Behavior Analysis - focuses exclusively on observable behavior and rejects all cognitive mediating processes

2. Neobehavioristic Mediational Stimulus-Response (S-R) Model

3. Social-Cognitive Theory - relies heavily on cognitive theories

These approaches differ in the extent to which they use cognitive concepts and procedures.

Common Core of Basic Concepts:• Many types of abnormal behavior formerly regarded as illnesses

are now construed as nonpathalogical “problems of living”• Most abnormal behavior is assumed to be acquired and

maintained in the same way as normal behavior• Assessment focuses on current determinants rather than on

analysis of possible historical antecedents• Specificity the hallmark of behavioral assessment and treatment

(person best understood and described by what the person does in a particular situation)

• Understanding the origins of a psychological problem not essential for producing behavior change

• Behavior therapy involves a commitment to the scientific method. This includes an explicit, testable conceptual framework.

Techniques used in psychotherapy

• Imagery-based techniques• Cognitive Restructuring• Assertiveness and Social Skills Training• Self-Control Procedures• Real-Life Performance-Based Techniques

Current Developments

• Most recent developments, emerging in the 1990s and gaining momentum, have been labeled the “third wave” (Hayes, Follette and Linehan)

• First wave: focused on modifying overt behavior• Second wave: emphasis on cognitive factors, resulting in what is

known as CBT• The Third wave: A group of therapeutic approaches with overlapping

conceptual and technical foundations. The two most prominent forms of these developments are Dialectical Behavior Therapy (DBT) and Acceptance and Commitment Therapy (ACT)

• Cognitive defusion - seperating thoughts from their referents and differentiating the thinker from the thoughts

• Mindfulness is taught in both systems and the goal of acceptance is essentially the same in ACT as in DBT

Dialectical Behavior Therapy (DBT)

• Defining feature: its focus on balancing the traditional emphasis on behavior change with the value of acceptance, and the importance of the relationship between the two

• Mindfulness: DBT uses typical BT techniques and strategies but a distinctive and seminal therapeutic strategy in DBT is to use mindfulness training

Acceptance and Commitment Therapy (ACT)

• Designed to help clients learn that experiential avoidance does not work and that it is part of the problem and not the solution• Patients need to accept the thoughts and feelings they have been trying to get rid of• Commitment - ACT is all about action. Making mindful decisions about what is important in life and what you are going to do in order to live a valued life•The goal of acceptance is essentially the same in ACT as DBT, and mindfulness is taught in both systems

• Today, there is increasing recognition of the importance of biological factors and brain mechanisms in many of the disorders commonly treated with behavioral methods

(Example: D Cycloserine, combined with behavior treatment such as exposure has proven to be very effective in the extinction of fear responses located in the brain)