Goals and Techniques

Type of psychology: Psychotherapy Field of study: Evaluating psychotherapy

The goals to be reached in psychotherapy and the techniques employed to accomplish them vary according to the needs of the patient and the theoretical orientation of the therapist.

Key concepts

• behavioral therapy

• corrective emotional experience

• desensitization

• eclectic therapy

• humanistic therapy

• interpretation

• psychodynamic therapy

• resistance

• therapeutic alliance

Psychotherapy involves an interpersonal relationship in which clients present themselves to a psychotherapist in order to gain some relief from distress in their lives. It should be noted that although people who seek psychological help are referred to as "clients" by a wide range of psychotherapists, this term is used interchangeably with the term "patients," which is traditionally used more often by psychodynamically and medically trained practitioners. In all forms of psychotherapy, patients must tell the psychotherapist about their distress and reveal intimate information in order for the psychotherapist to be helpful. The psychotherapist must aid patients in the difficult task of admitting difficulties and revealing themselves, because a patient's desire to be liked and to be seen as competent can stand in the way of this work. The patient also wants to find relief from distress at the least possible cost in terms of the effort and personal changes to be made, and, therefore, patients often prevent themselves from making the very changes in which they are interested. This is termed resistance, and much of the work of the psychotherapist involves dealing with such resistance.

The goals of the patient are determined by the type of life problems that are being experienced. Traditionally, psychotherapists make a diagnosis of the psychiatric disorder from which the patient suffers, with certain symptoms to be removed in order for the patient to gain relief. The vast majority of patients suffer from some form of anxiety or depression, or from certain failures in personality development which produce deviant behaviors and rigid patterns of relating to others called personality disorders. Relatively few patients suffer from severe disorders, called psychoses, which are characterized by some degree of loss of contact with reality. Depending on the particular symptoms involved in the patient's disorder, psychotherapeutic goals will be set, although the patient may not be aware of the necessity of these changes at first. In addition, the diagnosis allows the psychotherapist to anticipate the kinds of goals that would be difficult for the patient to attain. Psychotherapists also consider the length of time they will likely work with the patient. Therefore, psychotherapeutic goals depend on the patient's wishes, the type of psychiatric disorder from which the patient suffers, and the limitations of time under which the psychotherapy proceeds.

Another factor that plays a major role in determining psychotherapeutic goals is the psychotherapist's theoretical model for treatment. This model is based on a personality theory that explains people's motivations, how people develop psychologically, and how people differ from one another. It suggests what occurred in life to create the person's problems and what must be achieved to correct these problems. Associated with each theory is a group of techniques that can be applied to accomplish the goals considered to be crucial within the theory used. There are three main models of personality and treatment: psychodynamic therapies, behavioral therapies, and humanistic therapies. Psychodynamic therapists seek to make patients aware of motives, of which they were previously unconscious or unaware, for their actions. By becoming aware of their motives, patients can better control the balance between desires for pleasure and the need to obey one's conscience. Behavioral therapists attempt to increase the frequency of certain behaviors and decrease the frequency of others by reducing anxiety associated with certain behavior, teaching new behavior, and rewarding and punishing certain behaviors. Humanistic therapists try to free patients to use their innate abilities by developing relationships with patients in which patients can be assured of acceptance, making the patients more accepting of themselves and more confident in making decisions and expressing themselves.

Most psychotherapists use a combination of theories, and therefore of goals and techniques, in their practice. These "eclectic" therapists base their decisions about goals and techniques upon the combined theory they have evolved or upon a choice among other theories given what applies best to a patient or diagnosis. It also appears that this eclectic approach has become popular because virtually all psychotherapy cases demand attention to certain common goals associated with the various stages of treatment, and different types of therapy are well suited to certain goals and related techniques at particular stages.

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