Introduction to Clinical Psychology

3PsyB | PSE102

Introduction to Psychological Interventions The Dodo Bird Verdict & Common Factors

Psychotherapy is one of the most common and effective The Dodo Bird Verdict
treatments for mental health issues. It involves various
techniques and approaches aimed at helping individuals The Dodo Bird Verdict is a hypothesis suggesting that all
manage and cope with emotional, cognitive, and behavioral therapeutic approaches are equally effective due to shared
challenges. This handout provides a deeper understanding of common factors. This theory proposes that elements such as
the theories, practices, and ethical considerations involved in the therapeutic relationship, empathy, and client expectations
therapy. play a more significant role in therapy outcomes than the specific
treatment method used.
Key Areas of Focus:
Common Factors
o Theoretical Foundations. The theories that guide different
therapeutic approaches. Common factors are universal elements across all therapeutic
approaches that contribute to positive treatment outcomes.
o Efficacy vs. Effectiveness. The differences between how These include:
therapies perform in controlled settings versus in real-world
practice. o Empathy. The therapist’s ability to understand and share the
client’s feelings.
o Therapeutic Relationship. The central role of the client-
therapist relationship in therapy. o Rapport. A trusting and collaborative relationship between
therapist and client.
o Ethical Considerations. The importance of ethics in
ensuring the success and integrity of psychotherapy. o Therapeutic Alliance. The working relationship between
the therapist and client, which includes mutual respect and
o Alternative Service Delivery. Emerging methods of shared goals.
delivering psychotherapy in a modern context.
Exploring the Therapeutic Relationship
Does Psychotherapy Work?
Importance of the Therapeutic Relationship
The question of whether psychotherapy works is fundamental to
the practice of clinical psychology. It requires us to distinguish The therapeutic relationship is often considered the most
between efficacy and effectiveness. significant factor in determining the success of psychotherapy. It
is the foundation of the therapeutic process and has been shown
o Efficacy. Efficacy refers to the success of psychotherapy in to play a crucial role in facilitating change.
controlled research settings, often assessed through well-
structured studies such as randomized controlled trials Ethical Considerations in the Therapeutic Relationship
(RCTs). These studies aim to assess whether a particular
therapy can produce positive outcomes under ideal Therapists are ethically required to maintain boundaries, provide
conditions. Efficacy research is valuable for identifying which informed consent, and ensure confidentiality. Ethical practice
therapies work for specific disorders and establishing also includes being culturally competent and respecting client
treatment guidelines. autonomy during therapy.

o Effectiveness. Effectiveness refers to how well Key Terms:

psychotherapy works in real world clinical settings. It focuses
on whether therapy produces positive results when applied o Informed Consent. Ensuring clients understand the nature
in clinical practice, considering factors such as client of therapy and its potential risks and benefits before starting.
engagement, therapist expertise, and societal influences.
Effectiveness research evaluates how therapies perform in o Confidentiality. The ethical obligation to keep client
less controlled environments and assesses the external information private unless there is a risk of harm.
validity of therapeutic techniques.
Understanding Different Types of Psychotherapy
Bridging the Gap Between Research and Practice
Major Theoretical Approaches
Psychotherapy research provides valuable insights into which
therapies are effective, but these findings must be adapted to Psychotherapy can be categorized into several major
real-world settings. The challenge is translating efficacy findings approaches, each grounded in different theories of human
into practical, everyday therapeutic practices. behavior and development.

Evidence-Based Practice 1. Cognitive Behavioral Therapy (CBT)

Evidence-based practice refers to integrating scientific research o Focus: Identifying and changing negative thought patterns
with clinical expertise and client preferences. Therapists use and behaviors.
evidence-based approaches to ensure that their treatments are
grounded in research while adapting to the unique needs of each o Common Use: Treating anxiety, depression, and other
client. mood disorders.

Key Point: o Effectiveness: Supported by research showing its high

efficacy in treating various mental health issues.
o The transition from research efficacy to clinical effectiveness
often requires therapists to adjust treatment methods to 2. Psychodynamic Therapy
accommodate client needs, preferences, and external
factors. o Focus: Exploring unconscious processes and past
experiences to understand current behavior.

o Common Use: Treating personality disorders and complex

trauma.

Reference: PSE102 Handouts - Alicia Clarita G. De Vergara

Introduction to Clinical Psychology
3PsyB | PSE102

o Effectiveness: Often used for long-term issues requiring The Ethics of Intervention
exploration of early life experiences.
Ethical principles are fundamental to the practice of
3. Humanistic Therapy psychotherapy. These include maintaining client confidentiality,
obtaining informed consent, ensuring the competence of the
o Focus: Personal growth, self-actualization, and the client’s therapist, and respecting client autonomy. Ethical
capacity for change. considerations guide therapists in providing effective,
responsible care while protecting client rights and ensuring safe
o Common Use: Helping clients with self-esteem issues and practice.
emotional struggles.
Seeking Psychological Treatment
o Effectiveness: Emphasizes the importance of empathy,
unconditional positive regard, and authenticity in therapy. Understanding the process of seeking therapy is crucial.
Barriers to seeking treatment can include stigma, financial
4. Integrative Therapy concerns, lack of access, and cultural barriers. Addressing these
barriers is a significant challenge for both clinicians and the
o Focus: Combining techniques from different therapy models mental health field as a whole.
to address the unique needs of the client.
The Duration and Impact of Psychotherapy
o Effectiveness: Flexible and adaptable, integrative therapy
is used when clients require more personalized care based The duration of therapy varies greatly depending on the
on a blend of different approaches. individual's needs, the complexity of the issues, and the
therapeutic approach used. The long-term impact of
Key Term: psychotherapy can be assessed through follow-up studies and
client outcomes over time, including improved emotional
o Eclectic Therapy. An approach where therapists draw from regulation, coping skills, and better overall well-being.
multiple therapeutic models depending on the client’s needs.
Psychodynamic Therapy
Eclectic & Integrative Approaches in Therapy
Psychodynamic therapy, rooted in Freud’s work, aims to
Integrative Therapy uncover unconscious processes shaped by early relationships
and childhood experiences. Though less prominent today, it
Integrative therapy combines elements from various therapeutic remains important for understanding deep emotional conflicts
modalities to create a personalized treatment plan. This and personality structure.
approach is grounded in the idea that no single therapeutic
model can address all client needs. Defining Psychodynamic Therapy

Psychodynamic therapy is a family of therapeutic approaches

Example: Integrative therapy is particularly effective for that aims to uncover and work through unconscious conflicts,
clients with complex issues, such as comorbid conditions thereby improving mental health. It is unified by one primary
(e.g., depression and anxiety), who may benefit from more goal:
than one therapeutic technique.
To make the unconscious conscious, facilitating insight into
maladaptive patterns and unresolved emotional issues
Alternative Modes of Service Delivery (Pomerantz, 2020).

Emerging Service Delivery Models Theoretical Foundations

In recent years, the field of psychotherapy has seen the Freud’s Structural Model of the Mind
emergence of alternative modes of service delivery. These
innovations increase access to mental health services and adapt o Id. Drives based on pleasure, instincts, and immediate
to the evolving needs of modern society. gratification

1. Telepsychology. Therapy delivered via video calls or phone, o Superego. Internalized moral standards from authority
providing greater accessibility for clients in remote areas or with figures
limited mobility.
o Ego. Mediator between the id and superego, based on
o Considerations: Ethical concerns regarding confidentiality, reality
client safety, and the quality of therapeutic interactions in
virtual settings. Intra-psychic conflict among these forces leads to anxiety and
psychological defenses.
2. Walk-and-Talk Therapy. Therapy conducted while walking
outdoors, allowing clients to engage in physical activity while Core Techniques
discussing their concerns.
Psychodynamic therapists use indirect techniques to uncover
3. Mobile-Based Interventions. Digital platforms and apps that unconscious material:
provide therapy, support, and mental health tools directly to
clients, often providing self-guided interventions or virtual o Free Association. Speaking without censorship to reveal
therapy. underlying thoughts

Key Term: o Dream Interpretation. Distinguishing latent (hidden)

content from manifest (surface) content
o Telepsychology. Remote therapy conducted using
technology to facilitate therapy sessions, ensuring increased o Freudian Slips. Verbal or behavioral mistakes revealing
accessibility. unconscious desires

o Resistance Analysis. Identifying avoidance of meaningful

material

Reference: PSE102 Handouts - Alicia Clarita G. De Vergara

Introduction to Clinical Psychology
3PsyB | PSE102

o Transference Analysis. Observing how the client’s early draws from psychodynamic theory but is structured around
relationships are replayed with the therapist improving the client’s interpersonal functioning.

o Interpretation. Therapist offers explanatory insights to Core Assumption:

promote understanding and change
Psychological symptoms (especially mood-related) occur within
Defense Mechanisms the context of current and past interpersonal difficulties. By
improving relational functioning, emotional symptoms can
Defense mechanisms are unconscious processes used by the improve as well.
ego to manage inner conflict and anxiety. All are protective, but
some are more adaptive than others. Key Characteristics:

o Sublimation. Channeling impulses into socially constructive o Duration: 12–20 sessions

activities
o Focus: Present-day relational issues, not the distant past
o Humor. Using humor to express distressing thoughts or
feelings o Theoretical Background: Interpersonal school of
psychodynamics (e.g., Harry Stack Sullivan)
o Suppression. Conscious decision to delay addressing
uncomfortable thoughts o Techniques: Clarifying emotional responses, role play,
communication analysis, psychoeducation
o Denial. Refusal to acknowledge external reality
o Evidence Base: Strong, especially for depression,
o Projection. Attributing one’s unacceptable impulses to postpartum depression, eating disorders
others
Four Major Interpersonal Problem Areas in IPT:
o Repression. Keeping distressing thoughts completely out of
awareness o Grief (e.g., unresolved loss)
o Interpersonal role disputes (e.g., marital conflict)
o Displacement. Redirecting feelings toward a safer o Role transitions (e.g., job loss, parenthood)
substitute target o Interpersonal deficits (e.g., social isolation)

Psychodynamic therapists help clients become aware of their 2. Time-Limited Dynamic Psychotherapy (TLDP). TLDP is a
habitual defenses and gradually replace immature mechanisms brief psychodynamic therapy that focuses on current
with mature ones. interpersonal patterns, particularly those that emerge within the
therapeutic relationship. It emphasizes emotional experience
Psychosexual Stages and Fixation and in-session interaction rather than historical interpretation.

Stage Core Issue Fixation Consequences Core Assumption:

Oral Dependency Overdependence or extreme Clients tend to repeat maladaptive relational patterns across
distrust relationships, including with the therapist. These patterns can be
modified when the therapist identifies and challenges them as
they occur in real time.
Anal Control Obsessive neatness or
disorganization Key Characteristics:

o Duration: Approximately 20–25 sessions

Phallic Self-wort Arrogance or insecurity
o Focus: Maladaptive relational “scripts” and emotional
experiences in the therapeutic relationship
Fixation often results from too much or too little parental
responsiveness during that developmental period. o Theoretical Background: Based on the concept of
corrective emotional experiences (Alexander & French,
Transference and Countertransference 1946)

o Transference. The client unconsciously projects feelings o Techniques: Interpretation, pattern identification, emotional
about a significant person onto the therapist. exploration, relational feedback

o Countertransference. The therapist’s emotional reaction to Core Model – Cyclical Maladaptive Pattern (CMP):
the client, shaped by their own past experiences.
1. Acts of the Self. How the client behaves with others
These dynamics are essential for understanding relational
patterns and offer a corrective emotional experience when 2. Expectations of Others’ Reactions. Often unconscious
explored appropriately. assumptions

Contemporary Forms of Psychodynamic Therapy 3. Acts of Others. Actual or perceived responses

As psychodynamic therapy has evolved, many newer models 4. Acts of the Self Toward the Self. Self-directed feelings or
have emerged to adapt its foundational principles to modern behaviors
clinical demands. These contemporary approaches are more
structured, time-limited, and often empirically supported, yet Clinical Application Guidance
they preserve core psychodynamic features like transference,
insight, and unconscious relational patterns. o Choose IPT when the client's symptoms clearly stem from a
recent interpersonal stressor (e.g., loss, divorce, role
1. Interpersonal Therapy (IPT). Interpersonal Therapy (IPT) is change) and they need practical skills to cope with
a manualized, time-limited psychodynamic therapy originally transitions.
developed for the treatment of major depressive disorder. It

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Introduction to Clinical Psychology
3PsyB | PSE102

o Choose TLDP when the client demonstrates enduring Humanistic Psychotherapy

relational difficulties, particularly with trust, boundaries, or
intimacy, and needs to re pattern their interactions through Humanistic psychotherapy focuses on personal growth, self-
relational awareness and experience. awareness, and individuals' innate potential. It emerged as a
response to psychoanalysis and behaviorism, emphasizing that
Cultural Considerations in Psychodynamic Therapy people are inherently good and can thrive in a supportive
therapeutic environment.
Psychodynamic therapy traditionally emphasizes the therapist
as a "blank screen"—offering minimal personal disclosure to Core Goal of Humanistic Therapy
allow transference to emerge unfiltered. However, this can
conflict with cultural expectations. The central goal of humanistic therapy is self-actualization—
helping individuals live in congruence with their true self, free
Cultural Considerations: from imposed conditions of worth. It focuses on authenticity,
autonomy, and emotional openness as pathways to healing.
Clients from collectivist, non-Western, or marginalized cultures Psychological distress is believed to result from a misalignment
may prefer more relational, transparent therapist roles (e.g., between the real self and the ideal self, often caused by
advisor, advocate). conditions of worth developed in early relationships.

Rigid adherence to the blank screen approach may be alienating The Three Core Therapeutic Conditions (Carl Rogers)
or misaligned with client expectations.
1. Empathy. Deep, accurate understanding of the client's
Adaptation is critical: culturally attuned psychodynamic experiences from their perspective.
therapists may balance neutrality with appropriate self-
disclosure to build trust and relevance. 2. Unconditional Positive Regard (UPR). Accepting and
valuing the client without judgment or expectation.
Clinical Reflection: In what ways can you maintain clinical
neutrality while respecting cultural relational norms? 3. Genuineness (Congruence). The therapist’s authenticity
and transparency in the therapeutic relationship. These
Effectiveness and Research Support conditions are believed to be both necessary and sufficient for
meaningful psychological change.
Psychodynamic therapy is empirically supported for depression,
anxiety, personality disorders, and eating disorders. Mechanism of Change:

Meta-analyses show significant improvements, often The Therapeutic Relationship Therapeutic change arises not
comparable to CBT, especially for complex cases. through techniques or interpretation, but through the quality of
the therapist client relationship. When clients feel genuinely
Challenges: understood, unconditionally accepted, and safe with an
authentic therapist, they can reconnect with their real self and
o Difficulty in manualization and quantification reduce internal incongruence.

o Allegiance effects (therapist/researcher bias toward their Reflection as Technique

preferred modality)
Reflection of feeling is a central technique in humanistic therapy.
Despite critiques, the depth and durability of change offered by It involves rephrasing the emotional essence of the client’s
psychodynamic therapy remain key strengths. statements to validate their experience and promote self-
exploration. The goal is not to analyze but to clarify and affirm
1. Why might a client resist talking about a certain topic? emotional experience.

o Resistance signals unconscious conflict or anxiety Contemporary Humanistic Approaches

associated with that material.
Modern applications of humanistic therapy have evolved into
2. How do different cultures shape clients’ expectations of structured and evidence-supported interventions while retaining
their therapist? their original values—empathy, authenticity, client-
centeredness, and the belief in the individual's capacity to grow
o Cultural norms may favor direct advice or relational warmth, and heal.
conflicting with the “blank screen” ideal.
1. Motivational Interviewing (MI). Motivational Interviewing is
3. What distinguishes a mature defense from an immature a collaborative, goal-oriented method of communication
one? developed by William Miller and Stephen Rollnick. It is designed
to strengthen a person’s own motivation and commitment to
o Mature defenses are adaptive and socially constructive; change by exploring and resolving ambivalence.
immature defenses distort or avoid reality.
Best For: Addiction, health behavior change
4. What benefits come from exploring transference in
therapy? Core Humanistic Principles in MI:

o It reveals deep-seated patterns and enables corrective o Respects client autonomy

relational experiences.
o Builds a strong therapeutic alliance through empathy
5. How can therapists manage their own
countertransference ethically? o Views the client as the expert in their own life

o Through supervision, training, and self-awareness. o Avoids confrontation and persuasion

Key Techniques in MI:

o OARS. Open-ended questions, Affirmations, Reflective

listening, Summarizing

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Introduction to Clinical Psychology
3PsyB | PSE102

o Change talk. Highlighting the client’s own reasons and Clinical Uses:
desire for change
o Depression and low self-esteem
o Rolling with resistance. Accepting client hesitancy without
argument o Burnout and life transitions

Common Clinical Applications: o Enhancing life satisfaction and well-being

o Substance use and addiction recovery o Schools, career counseling, trauma recovery

o Health behavior change (e.g., diet, exercise, medication Cultural Considerations

adherence)
While humanistic therapy assumes universal psychological
o Treatment noncompliance needs (e.g., acceptance, growth), cultural differences shape
how these are experienced.
o Pre-contemplation in therapy engagement
o Clients from collectivist or non-Western cultures may expect
2. Emotionally Focused Therapy (EFT). Developed by Dr. Sue more directive guidance from therapists.
Johnson, EFT is a short-term, structured therapy rooted in
attachment theory and humanistic principles. It is primarily used o Cultural humility is critical; therapists must remain open,
for couples but also applicable to individuals and families. The curious, and responsive to the client's worldview.
goal is to enhance emotional bonding, increase security, and
restructure negative cycles of interaction. o Empathy and authenticity should be expressed in ways that
are culturally appropriate and respectful.
Best For: Couples in distress, attachment trauma
Strengths and Critiques
Core Humanistic Elements in EFT:
Strengths Critiques
o Empathy and attunement to emotional experience
Emphasizes personal Lacks structured, directive
o Respect for vulnerability and safety growth, not just symptom interventions
relief
o Support for authentic emotional expression

Therapeutic Process: Strong therapeutic alliance Less suitable for crisis or

foundation severe psychopathology
1. Identify negative interaction cycles (e.g., blame withdraw)

2. Access primary emotions (fear, sadness, longing) hidden Applicable across diverse Difficult to measure and
beneath reactive responses client presentations research empirically

3. Promote new emotional experiences and secure connections

through vulnerability Influenced many integrative May be perceived as vague
and evidence-based models or overly idealistic
Evidence Base: EFT is strongly supported by research in
relationship satisfaction, reduction of conflict, and long-term
emotional connection. Psychotherapy- Behavioral Perspectives
3. Strength-Based Counseling / Positive Psychology. This Behavior therapy is a form of psychological treatment that
approach draws from humanistic psychology and the positive applies the principles of learning theory to modify maladaptive
psychology movement (Seligman, 1998), which focuses on behaviors. It is distinguished by its focus on observable
enhancing well-being rather than just alleviating distress. It behaviors and the empirical methods used to assess and treat
emphasizes clients’ internal strengths, values, and capacities for these behaviors, as opposed to psychodynamic or humanistic
resilience, shifting focus from what’s “wrong” to what’s “strong.” approaches, which focus more on the internal mental states that
cannot be directly observed. In behavior therapy, the objective
Best For: Depression, burnout, self esteem is to change maladaptive behaviors through the application of
principles like classical conditioning and operant conditioning.
Foundational Concepts:
Key Features:
o Personal strengths (e.g., kindness, perseverance, creativity)
o Focuses on observable and measurable behaviors.
o Meaning-making and purpose
o Uses empirical research to test hypotheses and refine
o Hope, optimism, and gratitude treatment methods.
Common Interventions: o Rejects the notion of uncovering unconscious mental states
or emotions; instead, it focuses on changing the external
o Strengths assessment (e.g., VIA Character Strengths) behaviors that are causing the client's distress.
o Gratitude journaling Origins of Behavior Therapy

o Visualization of best possible self The development of behavior therapy is grounded in the
principles of learning theory and the works of foundational
o Values clarification and goal-setting psychologists.
o Savoring positive experiences 1. Ivan Pavlov (Classical Conditioning). Pavlov’s work on
classical conditioning with dogs demonstrated how a neutral
stimulus (e.g., a bell) could be associated with an unconditioned
stimulus (e.g., food) to produce a conditioned response (e.g.,
Reference: PSE102 Handouts - Alicia Clarita G. De Vergara
Introduction to Clinical Psychology
3PsyB | PSE102

salivation). This process led to the understanding of associative o Hypothesize: Based on these observations, the therapist
learning. formulates hypotheses about how the behaviors developed.

o Test and Revise: The therapist tests these hypotheses

Example: Pavlov's dogs salivated not just at the food but also using controlled interventions and revises the treatment plan
at the sound of the bell after it was repeatedly paired with as needed based on the client's response.
food. This process, where a neutral stimulus becomes
associated with a natural reflex, laid the groundwork for 2. Defining Problems Behaviorally. Problems are defined as
classical conditioning used in therapy today. specific behaviors rather than vague or broad mental states.
This helps to ensure clarity and makes it easier to measure
progress.
2. John B. Watson. Watson extended Pavlov’s findings to
humans. He argued that psychology should focus only on
observable behaviors and not delve into unobservable mental Example: Instead of diagnosing a client with "depression,"
processes, rejecting the focus on introspection in favor of behavior therapists would target specific behaviors such as
empirical, external observation. excessive sleeping, crying, social withdrawal, and avoiding
work. These behaviors are then observed, and interventions
are aimed directly at changing them.
Example: In his famous Little Albert experiment, Watson
conditioned a young child, Albert, to fear white rats by pairing
the rat with a loud, frightening noise. Eventually, Albert began 3. Measuring Change Observably. Success in therapy is
to fear not only the rat but also other white, furry objects, determined by observable behavioral change. This approach
demonstrating generalization in classical conditioning. avoids relying on subjective interpretations of internal mental
states (such as feelings of "insight" or "self-actualization").
Objective measurements are used to track progress.
3. Edward Thorndike (Law of Effect). Thorndike’s Law of
Effect proposed that behaviors followed by satisfying
consequences are likely to be repeated, while those followed by Example: A therapist may measure a reduction in compulsive
discomforting consequences are less likely to recur. behaviors (e.g., hand-washing) or an increase in social
participation (e.g., attending social events).

Example: A cat in a puzzle box would learn to escape faster

over time when rewarded with food for successfully escaping, Types of Conditioning
reinforcing the behavior of figuring out the puzzle box
mechanism. Behavior therapy relies heavily on the principles of classical
conditioning and operant conditioning, both of which involve
learning through association or consequences.
4. B.F. Skinner (Operant Conditioning). Skinner expanded on
Thorndike’s Law of Effect, introducing the concept of operant 1. Classical Conditioning (Pavlovian Conditioning):
conditioning, where behavior is shaped by reinforcements and
punishments. o UCS (Unconditioned Stimulus). A stimulus that naturally
and automatically triggers a response (e.g., food).

Example: Skinner's work with rats and pigeons in the Skinner o UCR (Unconditioned Response). A natural, automatic
box demonstrated that behavior could be reinforced by response to the UCS (e.g., salivation).
rewarding the organism when it performed a desired action
(e.g., pressing a lever for food). Skinner showed that behavior o CS (Conditioned Stimulus). A previously neutral stimulus
could be controlled by manipulating the consequences that that, after being paired with the UCS, comes to trigger the
followed it. response (e.g., bell).

o CR (Conditioned Response). A learned response to the CS

Goal of Behavior Therapy (e.g., salivation at the bell).

The primary goal of behavior therapy is to modify observable

behavior rather than address internal mental or emotional Example: A person who develops a fear of dogs after being
issues. The treatment process aims to: bitten is demonstrating classical conditioning. The bite
(UCS) naturally causes pain and fear (UCR), while the sight
o Identify maladaptive behaviors. of dogs (CS) becomes associated with fear (CR).

o Replace them with more adaptive, functional behaviors.

2. Operant Conditioning (Skinnerian Conditioning):
o Increase behaviors that are beneficial and decrease
behaviors that are harmful or disruptive. o Behavior is modified through its consequences:

Key Concept: Behavior therapists do not focus on uncovering - Reinforcement (Positive or Negative). Increases the
the psychodynamic causes of symptoms but instead look at the likelihood of a behavior.
environmental factors (stimuli and consequences) that influence
behavior. - Punishment (Positive or Negative). Decreases the
likelihood of a behavior.
Core Principles of Behavior Therapy
o Positive Reinforcement. Adding something pleasant to
1. Empiricism. Behavior therapy is scientifically grounded. increase a behavior (e.g., praise for completing a task).
Therapists operate like scientists:
o Negative Reinforcement. Removing something unpleasant
o Observe: The therapist observes and measures the client’s to increase behavior (e.g., stopping nagging once a task is
behaviors. completed).

o Positive Punishment. Adding something unpleasant to

decrease behavior (e.g., extra chores for misbehavior).
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Introduction to Clinical Psychology
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o Negative Punishment. Removing something pleasant to 4. Shaping. Shaping reinforces successive approximations of a
decrease behavior (e.g., taking away a child’s favorite toy for desired behavior. This technique is used when a behavior is
bad behavior). complex and cannot be directly taught in one step.

Behavior Therapy Techniques Based on Classical

Conditioning Example: A client, Dina, gradually increases social
interactions by setting small, achievable goals such as
1. Exposure Therapy. Exposure therapy helps individuals making a phone call to a friend or attending a social event.
confront their fears gradually or intensely to reduce anxiety
responses. This process involves extinguishing the conditioned
fear response by presenting the feared object without the 5. Behavioral Activation. Behavioral activation is used to treat
negative outcome. depression by encouraging the client to engage in positive,
reinforcing activities to break the cycle of depression, which is
o Graded Exposure. The client is gradually exposed to the often characterized by a lack of motivation and avoidance.
feared stimulus in increasing intensity.

o Flooding (Implosion). The client is exposed to the feared Example: A client who feels depressed is encouraged to plan
stimulus in its most intense form immediately. enjoyable, goal-oriented activities (e.g., going for walks,
meeting friends) to increase positive reinforcement in their
life.
Example: Wayne, who has a fear of dogs after being bitten,
undergoes graded exposure starting with pictures of dogs
and eventually progressing to petting dogs. Alternative Applications of Behavior Therapy

1. Behavioral Consultation. A therapist works with a consultee

(e.g., teacher, manager) to implement behavior management
2. Systematic Desensitization. This technique pairs strategies to modify the client’s behavior.
relaxation exercises with exposure to a feared object, thereby
replacing the fear response with a relaxation response.
Example: A teacher uses reinforcement techniques to
improve a student's classroom behavior.
Example: A student with test anxiety learns relaxation
techniques and practices them while imagining sitting for an
exam. Over time, relaxation replaces the anxiety. 2. Parent and Teacher Training. Parents and teachers are
trained to use reinforcement and punishment techniques
effectively to manage children’s behavior.
Behavior Therapy Techniques Based on Operant
Conditioning
Example: A parent uses a sticker chart to encourage their
1. Contingency Management. This involves altering the child’s good behavior and manage their tantrums.
reinforcement or punishment that follows a behavior. By
changing the consequences of behavior, therapists can
increase or decrease the likelihood of that behavior occurring Effectiveness of Behavior Therapy
again.
Behavior therapy has demonstrated strong empirical support
o Positive Reinforcement: Rewarding desired behaviors. across various conditions such as:

o Negative Reinforcement: Removing unpleasant stimuli to o Anxiety disorders

increase desired behaviors. o Phobias
o Depression
o Positive Punishment: Adding unpleasant consequences to o Obsessive-compulsive disorder (OCD)
decrease unwanted behaviors. o Behavioral issues in children

o Negative Punishment: Removing positive reinforcements to Behavior therapy is adaptable to different cultural contexts and
decrease unwanted behaviors. can be modified to accommodate individualistic or collectivist
values.
2. Extinction. The process of removing reinforcement for a
behavior to decrease its occurrence. Initially, the behavior may Psychotherapy- Cognitive-Behavioral Perspectives
temporarily increase (extinction burst), but it will eventually
decrease once reinforcement is consistently withheld. Cognitive therapy (CT), developed by Aaron Beck in the 1960s,
is a structured and goal-oriented form of psychotherapy aimed
at changing negative patterns of thinking. It is rooted in the belief
Example: Wendy, a child who throws tantrums to get junk that our thoughts, rather than external events, play a primary role
food at dinner, has her tantrums extinguished when her in shaping our emotions and behaviors. Cognitive therapy has
parents consistently refuse to provide the food after her been proven effective in treating a variety of psychological
outbursts. disorders, including depression, anxiety, and stress, and has
become one of the most widely practiced therapeutic
approaches in clinical psychology.
3. Token Economies. Clients earn tokens for desired behaviors
that can be exchanged for tangible rewards. This technique is Core Concepts and Definitions
especially useful in institutional settings (e.g., hospitals, prisons,
schools). To fully understand cognitive therapy, it’s essential to define and
clarify some key terms that serve as the foundation of this
therapeutic approach.
Example: A classroom rewards students with tokens for
positive behaviors, such as completing assignments on time, 1. Cognition. Cognition refers to the mental processes involved
which they can later exchange for privileges or rewards. in thinking, perceiving, remembering, and making decisions. In
cognitive therapy, it refers to the thoughts, beliefs, assumptions,
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Introduction to Clinical Psychology
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and interpretations we make about ourselves, the world, and clients identify and change negative thought patterns, as well as
others. modifying behaviors that reinforce these thoughts.

Importance: Cognitive therapists believe that the way we

interpret events influences how we feel and behave. For Example: A person with social anxiety might learn to
example, if someone interprets an event as a failure, they may recognize and challenge irrational beliefs about being judged
feel sad or anxious, even if the event itself is not inherently by others, while also engaging in gradual exposure to social
negative. situations to reduce anxiety.

2. Automatic Thoughts. Automatic thoughts are immediate,

often subconscious thoughts that occur in response to a Cognitive Restructuring. Cognitive restructuring refers to the
situation. These thoughts can be positive, neutral, or negative, process of identifying and challenging irrational or maladaptive
but in cognitive therapy, the focus is on identifying and thoughts, and replacing them with more balanced, rational ones.
challenging the negative or irrational ones.

Example: A person who thinks, "I’ll never find a job," might

Example: A person might receive a critical comment and restructure that thought to, "Finding a job is challenging, but I
immediately think, “I’m not good enough,” which can lead to have the skills and can continue applying to opportunities."
feelings of shame or inadequacy.

Goal of Cognitive Therapy

3. Cognitive Distortions. Cognitive distortions are patterns of
thinking that consistently reinforce negative emotional states. The primary goal of cognitive therapy is to help individuals
These distorted ways of thinking often arise automatically and identify and correct cognitive distortions that contribute to
contribute to psychological distress. emotional distress. This process involves altering illogical or
unhelpful thought patterns, which in turn leads to healthier
Common Cognitive Distortions: emotional responses and more adaptive behaviors. The overall
aim is to teach clients to think in ways that are more aligned with
a) All-or-Nothing Thinking. Viewing things in extremes, without reality, ultimately helping them lead more fulfilling and balanced
recognizing the middle ground. lives.

Example: "If I’m not perfect, I’m a failure." Example: If someone believes, “I must always be successful,”
cognitive therapy would help them recognize that this belief
is unrealistic and help them replace it with the thought,
b) Catastrophizing. Expecting the worst possible outcome, “Success is important, but I don’t need to be perfect all the
even when it’s highly unlikely. time.”

Example: "If I fail this test, my life will be ruined." The Importance of Cognition

Cognitive therapists emphasize that it’s not the events

c) Mental Filtering. Focusing only on the negative aspects and themselves that determine how we feel, but rather the way we
ignoring any positive ones. interpret and think about those events. This view contrasts with
traditional perspectives that suggest events directly cause
emotions.
Example: "I made a mistake in my presentation, so the whole
presentation was a disaster."
Example: Two students might receive a low grade on the
same exam, but one might interpret it as a sign of failure
d) Overgeneralization. Making broad conclusions based on a (leading to feelings of depression), while the other might see
single event. it as an opportunity to learn and improve (leading to a more
constructive emotional response).

Example: "I failed one test, so I’ll never succeed in school."

This understanding of the connection between thoughts,
feelings, and behavior is central to cognitive therapy and guides
e) Personalization. Blaming yourself for events outside your how clients learn to change their thinking patterns.
control.
Revising Cognitions

Example: "It rained during my event. It’s my fault." The process of revising cognitions is at the heart of cognitive
therapy. Once negative automatic thoughts are identified, the
next step is to challenge their validity and replace them with
f) Mind Reading. Assuming you know what others are thinking more realistic and balanced thoughts. Cognitive therapists use
without any evidence. a variety of techniques to help clients revise their thought
patterns:

Example: "My professor must think I’m incompetent because 1. Identifying Illogical Thoughts: This involves noticing
I stumbled during my presentation." automatic thoughts and recognizing when they are irrational or
distorted.

Cognitive Behavioral Therapy (CBT) 2. Challenging the Thoughts: Clients are encouraged to
critically evaluate the evidence for and against their thoughts.
CBT is a combination of cognitive therapy and behavioral For example, they may ask themselves, “What proof do I have
therapy. It addresses both the mental and behavioral that this thought is true?”
components of psychological issues. CBT focuses on helping

Reference: PSE102 Handouts - Alicia Clarita G. De Vergara

Introduction to Clinical Psychology
3PsyB | PSE102

3. Replacing with Logical Thoughts: After challenging the dispute their irrational beliefs (D) and replace them with more
irrational thought, the therapist helps the client come up with a effective beliefs (E).
more balanced and rational thought that better aligns with
reality.
Example: "I must always succeed" (irrational belief) would be
challenged and replaced with "Success is important, but I can
Example: If a person thinks, “I’m always going to fail,” handle failure" (rational belief).
cognitive therapy would help them recognize that this is an
overgeneralization and replace it with the thought, “I have
failed in the past, but I’ve also succeeded, and I can improve.” 2. Aaron Beck and Cognitive Therapy (CT)

o Focus: Beck’s approach is centered on identifying and

Teaching as a Therapy Tool changing negative cognitive schemas, particularly those that
contribute to depression and anxiety.
In cognitive therapy, therapists often function as teachers. They
educate clients about how their thoughts influence their o Dysfunctional Thought Record (DTR): Beck uses a tool
emotions and behaviors, and teach them strategies to identify called the Dysfunctional Thought Record to help clients track
and challenge distorted thinking. This education is a crucial their automatic thoughts and identify cognitive distortions.
component of therapy, as it empowers clients to become more
self-sufficient in managing their thoughts and emotions.
Example: A client may write down a negative thought like, “I’m
worthless,” and work with their therapist to challenge this
Example: A therapist might use educational materials to thought and replace it with a more balanced belief.
explain the difference between rational and irrational beliefs
and provide examples to help the client better understand the
cognitive model. Recent Applications of Cognitive Therapy

Cognitive therapy has expanded beyond its original focus on

Homework in Cognitive Therapy depression and is now used to treat a wide range of disorders,
including anxiety, PTSD, eating disorders, and personality
Homework is an essential part of cognitive therapy. Clients are disorders. It is also applied to medical problems, such as chronic
typically asked to complete assignments between sessions, pain and insomnia.
which helps them practice the skills they learn in therapy and
apply them to real-life situations. Homework assignments may The Third Wave: Mindfulness- and Acceptance-Based
include: Therapies

1. Tracking Thoughts: Clients may be asked to record their Third-wave therapies, such as Mindfulness-Based Cognitive
automatic thoughts and the emotions that arise from them. Therapy (MBCT), Acceptance and Commitment Therapy (ACT),
and Dialectical Behavior Therapy (DBT), integrate mindfulness
2. Behavioral Experiments: Clients are encouraged to test and acceptance strategies with cognitive therapy. These
their beliefs in real-world scenarios, such as speaking in public therapies help clients relate to their thoughts in a more
if they fear rejection. accepting, nonjudgmental way, reducing the impact of negative
thinking.
3. Cognitive Restructuring Exercises: Clients may practice
identifying and challenging their cognitive distortions outside of Cognitive Therapy for Medical Problems
therapy.
Cognitive therapy has also been shown to be effective in treating
A Brief, Structured, Focused Approach medical conditions. By addressing irrational beliefs about illness
and treatment, cognitive therapy can help patients cope better
Cognitive therapy is often brief (usually 12-16 sessions), with chronic pain, medical procedures, and long-term illness.
structured, and focused on specific goals. Each session follows
a clear agenda, which includes reviewing progress, discussing Schema Therapy
homework, and setting goals for the next session. This
structured approach helps clients stay focused on their Schema Therapy focuses on deep-seated cognitive patterns or
immediate concerns and makes therapy more efficient. "schemas" that are often developed in childhood and continue
to affect the way we think about ourselves and the world. It’s
especially effective for treating personality disorders.
Example: In a typical session, the therapist might begin by
asking the client to share updates on their homework, Group Therapy and Family Therapy
followed by a discussion of any negative thoughts they
encountered. Then, the therapist and client would work Group therapy is a form of psychotherapy where a small group
together to challenge those thoughts and develop more of people (typically 5-10) meet regularly under the guidance of
rational alternatives. one or more therapists. Group members share common
psychological concerns or challenges, and the therapy process
encourages them to interact with each other, share their
Two Approaches to Cognitive Therapy thoughts and feelings, and learn from one another. It is based
on the idea that interpersonal relationships and group
There are two main pioneers of cognitive therapy, each with a interactions can facilitate healing and personal growth.
slightly different approach:
Unlike individual therapy, which focuses on the one-on-one
1. Albert Ellis and Rational Emotive Behavior Therapy relationship between the therapist and client, group therapy
(REBT) emphasizes the social and interpersonal dynamics between
group members. This approach is rooted in the belief that
o Focus: REBT focuses on identifying and changing irrational interpersonal issues play a significant role in many psychological
beliefs that lead to emotional and behavioral problems. conditions.

o ABC Model: In Ellis’s ABC model, A represents the

activating event, B represents the belief about the event, and
C represents the emotional consequence. Clients learn to
Reference: PSE102 Handouts - Alicia Clarita G. De Vergara
Introduction to Clinical Psychology
3PsyB | PSE102

1. Interpersonal Focus in Group Therapy: d) Catharsis:

Group therapy is distinguished from individual therapy by its Catharsis is the emotional release that often occurs when clients
emphasis on interpersonal interactions. Group therapy allows express their pent-up feelings in the group. This release of
clients to develop and practice social skills, improve their ability emotions is essential for healing and personal growth.
to communicate, and gain insights into their interpersonal
behaviors through feedback from fellow group members.
Example: A client who has repressed feelings of anger
Group therapy is particularly beneficial because it provides a towards a parent may finally be able to express that anger
microcosm of the outside world, allowing clients to experiment within the group, which can lead to emotional relief and a
with new behaviors and learn to apply them outside the therapy deeper understanding of their feelings.
session.

3. Stages of Group Therapy:

Example: A client who struggles with social anxiety may find
group therapy particularly useful. By interacting with others in Like individual therapy, group therapy often progresses through
a controlled environment, the client has the opportunity to a series of stages. Each stage offers unique challenges and
practice speaking up, making eye contact, and engaging in opportunities for clients.
conversations—all of which may be difficult in real life.
a) Initial Stage (Cautiousness):

2. Yalom’s Therapeutic Factors in Group Therapy: In the first stage, group members are typically cautious and
hesitant. They may feel insecure about revealing personal
Irvin Yalom, a pioneer in group therapy, outlined several information and worry about being judged by others. This stage
therapeutic factors that explain why group therapy is effective. is characterized by polite, surface-level conversations, and
These factors shape the group therapy experience and help members often try to assess whether the group is a safe space.
clients improve their emotional and psychological well-being.

Key Therapeutic Factors: Example: A new group member may stay quiet in the first few
sessions, unsure about how much to reveal or whether they
a) Universality: will be accepted by others.

One of the most powerful aspects of group therapy is the sense

of universality, where clients realize that their struggles are b) Second Stage (Conflict and Competition):
shared by others. This helps to reduce feelings of isolation,
shame, and loneliness. The second stage is often marked by a rise in conflict and
competition among members. As members begin to feel more
comfortable, they may start to assert their own opinions,
Example: A client dealing with addiction may feel isolated and sometimes leading to disagreements. This stage can be difficult
believe they are the only one struggling. When they hear but is crucial for establishing group dynamics.
others in the group share similar experiences, it normalizes
their feelings and helps them feel less alone.
Example: A member may challenge the group leader’s
approach or disagree with another member’s opinion, which
b) Group Cohesiveness: can lead to tensions but also promotes deeper self-reflection
and group cohesion.
Group cohesiveness refers to the emotional bonds that form
between group members. A cohesive group creates a
supportive and trusting environment where clients feel safe to c) Third Stage (Cohesion and Productive Interactions):
share their deepest feelings. The emotional warmth and
acceptance within the group are essential for therapeutic By the third stage, the group typically becomes more cohesive.
progress. Members feel more comfortable with one another and are willing
to engage in more meaningful and vulnerable interactions. This
stage is where therapeutic progress is most evident.
Example: When a group member shares a vulnerable
experience, the group’s supportive response fosters a sense
of belonging and acceptance, which can significantly improve Example: Members begin to share more personal
the individual’s self-esteem. experiences and provide constructive feedback to one
another, leading to emotional breakthroughs and a stronger
sense of community within the group.
c) Interpersonal Learning:

Interpersonal learning occurs when clients gain insight into their 4. Co-therapy in Group Therapy:
interpersonal behaviors by interacting with others in the group.
Group therapy offers a unique environment where clients can Co-therapy involves having two therapists lead a group therapy
practice new social skills and receive feedback from others. session together. This approach has several advantages:

a) Multiple Perspectives:
Example: A client who struggles with being overly aggressive
in personal relationships may practice more assertive, yet Having two therapists allows for more thorough observation of
respectful communication in the group. Feedback from the group dynamics. The therapists can offer different viewpoints
group can help them refine their approach and develop and respond to the group’s needs in real-time.
healthier relationship skills.
b) Modeling Healthy Relationships:

Co-therapists can model effective collaboration and

communication for the group members, showing how to work
together in a respectful and productive way.
Reference: PSE102 Handouts - Alicia Clarita G. De Vergara
Introduction to Clinical Psychology
3PsyB | PSE102

Core Concepts in Family Therapy

Example: In a session led by two therapists, the group may
observe one therapist’s nurturing approach and the other’s 1. Family Structure:
more directive style. This variety in therapy style can help
clients see how different approaches can work together to Family structure refers to the implicit rules and roles that govern
create a balanced therapeutic environment. family interactions. A dysfunctional family structure may involve
rigid rules, poor boundaries, or enmeshment (where family
members are overly involved in each other’s lives).
Family Therapy
Family therapists work to restructure the family system by
Family therapy is a form of psychotherapy that focuses on the improving boundaries, clarifying roles, and promoting healthier
dynamics and relationships within the family system. It operates ways of interacting.
on the premise that psychological problems are often symptoms
of dysfunctional family interactions, rather than solely individual
issues. By addressing these patterns of interaction, family Example: A family may have poor boundaries, where children
therapy helps improve communication, resolve conflicts, and are expected to act as emotional caregivers for their parents.
foster healthier relationships. In therapy, the therapist works to establish more appropriate
roles and boundaries, allowing family members to function in
1. Systemic Approach in Family Therapy: healthier ways.

Family therapy is grounded in the idea that the family operates

as a system, where the behaviors of one family member 2. Differentiation of Self:
influence and are influenced by the behaviors of others. The
problem is seen not as something inherent within the individual, This concept, introduced by Murray Bowen, emphasizes the
but as part of the system as a whole. ability of family members to maintain their individuality while
remaining emotionally connected to the family. When
The therapist’s goal is to identify and address dysfunctional differentiation is low, family members may become enmeshed,
patterns within the system, helping family members meaning they lose their individuality and become overly involved
communicate more effectively and support each other’s growth. in each other’s emotional lives.

In therapy, family members are encouraged to balance

Example: A teenage girl may begin acting out in school emotional closeness with personal independence.
because of tension between her parents. Family therapy
helps uncover how the parents' communication issues are
affecting their daughter’s behavior, and the therapy works to Example: In a highly enmeshed family, a child may feel
resolve those issues at the family level. responsible for their parents’ emotional well-being, which can
lead to stress and identity confusion. Therapy helps the child
develop independence while maintaining healthy family
2. Circular Causality: relationships.

Circular causality contrasts with linear causality. In linear

causality, one event directly causes another, whereas circular 3. Triangles:
causality suggests that behaviors and events influence one
another in a continuous, reciprocal way. In family therapy, this A triangle occurs when two family members in conflict pull a third
concept helps explain how family members’ actions perpetuate person into the dispute, often causing them to take sides. This
dysfunctional behaviors. creates unhealthy dynamics, as the third person is forced into a
position where they feel they must align with one party or the
other.
Example: A mother’s anxiety about her son’s behavior may
cause her to be overprotective. Her overprotectiveness, in
turn, causes the son to feel suffocated, which leads to further Example: In a divorce, one parent might ask the child to take
rebellious behavior, thus creating a cycle of anxiety and sides, creating emotional turmoil for the child and
resistance. perpetuating the conflict between the parents. Family therapy
aims to reduce such triangulation and encourage direct
communication between the conflicting parties.
3. Genograms in Family Therapy:

A genogram is a family tree that maps out family relationships

over multiple generations. It helps therapists visualize the
family’s structure and identify patterns of behavior, including
emotional relationships, conflicts, and significant events.

Genograms can reveal generational patterns, such as addiction,

mental health issues, or communication breakdowns, which may
influence current family dynamics.

Example: A genogram might reveal that a family has a long

history of conflict between mothers and daughters. This
insight could help the therapist explore how this pattern
affects current relationships within the family.

Reference: PSE102 Handouts - Alicia Clarita G. De Vergara