Main streams of psychotherapies Behaviour (external) Behaviour (internal) Humanistic views Subjective experience Cognitive therapies Person-centered approach Psychoanalysis Behaviourism

Die „Methode” in der Psychotherapie Theoretischer Hintergrund (Ideologie) Eigener Sprachgebrauch (manchmal esoterisch) Der Kontext (setting) Spezielle kommunikative Techniken und Verhaltensweisen (Ritualen)

Traditionelle Einteilung der Psychotherapien Aufdeckende Methoden Psychoanalyse Kurze dynamische Methoden Imaginationstechniken Logotherapie, Kognitive Therapie Analytische Gruppentherapien Psychodrama Verdeckende Methoden Hypnose Relaxationsverfahren Assertives Training Verhaltenstherapien Körpertherapien Stützende (supportive) Psychotherapie

Ursache im Hintergrund Sigmund Freud Universität Wien 1873 (1856-1939) Facharzt für Neurologie Forschung Keine physikalische Ursache im Hintergrund der Beschwerden 4 4

Philosophischer Hintergrund der Psychoanalyse Der Rationalismus Es gibt „a priori” Kategorien Es gibt „a priori” synthetische Wahrheit Die Wichtigkeit des Subjekts Descartes, Spinoza, Leibniz

Die Theorie von Carl Rogers Humanistische Psychologie Organismus: Das Individuum strebt nach Selbstverwirklichung Selbstbild: selbstbezogene Vorstellungen, Perzeptionen, Emotionen, Werte und Attitüde Selbst-Ideal: die Person zu der das Individuum werden möchte 1902 - 1987

H. J. Eysenck Behaviour Therapy and the Neuroses. Pergamon Press, Oxford. 1960. 1916 - 1997

Philosophischer Hintergrund des Behaviourismus Empirismus (später: Positivismus) Alle Kenntnisse aus der Erfahrung Es gibt keine „a priori” Aussagen Das Subjekt ist kein Gegenstand der wissenschaflichen Erkenntnis (Locke, Berkeley, Hume, Angelsachsen)

Pawlow unter seinen Schülern

Die instrumentelle Konditionierung

Grundmechanismen des Lernens Klassische Konditionierung (Pavlov) Operante Konditionierung (Watson, Thorndike) Lernen durch Nachahmung – Modell- Lernen (Miller, Dollard)

Verhaltenstherapeutische Techniken Systhematische Desensibilisierung Reizüberflutung (flooding) Operante Konditionierung Münzökonomie (Token economy) Negative Rückkopplung (negative feedback) Gedeckte Sensitisierung (Covert sensitisation)

Aaron Beck (1921-)

The cognitive revolution in the history of ideas Positivism Linguistics (Chomsky) Philosophy of languages (Wittgenstein) Existentialism (Heidegger) Philosophical ethics (Moore)

Hierarchical structure of cognitive distortions Ellis: Hot and cold cognitions Beck: Basic and secondary assumptions Tringer: Ontological and epistemological level Central and peripheric

Classification of cognitive schemata Some other analyses make difference between central and peripheral, active and dormant schemata as well. At any case, some cognitive distortions are fast universal, effective in the processing of all external and internal stimuli (like the negative bias), while others action in a more restricted way, influencing the evaluation of informations belonging to certain situations (like being abandoned).

Hierarchy of the cognitive „tetrade” The major groups of cognitive distortions have been named „cognitive triade” by Aaron Beck. On the basis of the analysis of more than 50 sessions of cognitive psychotherapy we found that the majority of distortions concern the interpersonal relatioships. So the setting up of a new category „I and the other” to the detriment of the categories „Self” and „world” seems to be reasonable. (Paraphrasing Beck I proposed the category „cognitive tetrade”). (Tringer, 1988). The Depressive Cognitive Structure (DCS) consists of the above main categories and the basic dispositions under each category (like „worthlessness”, „Special person”, „Being not understood” etc.)

Basic assumtions concerning the Self Worthlessness: The most basic pattern of the deprressional ego-experience. All informations regarding the self is furnished with a negative moment of value, (lack of value). Disease: This is an important basic experience in the clinical practice. The conceptualization of bodily events and proprioceptions take place within the disease-dimension. The mechanism plays a role in the development of panick-attacks. Faults and mistakes of everyday life are also taken as illnesses. Special person: The pattern was described by Raimy (1985). The patiens experiences himself other than or different from other people or just the opposite, he thinks people are different from him. A special emphasis is placed on the common perception of the „differentness” but in the negative sense. This way of perceiving results in a non-differentiated, global perception of the person: in the mirror of differentness everybody seems to be „equally” different. Immobilism:The patient denies the very basic feature of man: the capability of developing and changing. In solving certain problems he/or she does not even realize that he/or she could change, he couldlearn something new. Things are given, they are motionless, there is no growth or development. One of their frequent verbal phrases is: „I don’t know”. And he/she does not even think he/she could find out about it.

I and the other Patient material An unselected population of in- and outpatients has been included in the study, forming a suicidal and a non-suicidal group. The suicidal persons were matched with non-suicidal controls, by six criteria. 1. Age group 2. Sex 3. Education 4. DSM-IV diagnosis 5. Severity of depression (Beck’s Depression Scale) 6. Main MMPI categories (psychotic, neurotic, personality disorder)

The future Basic assumptions can be sub-divided into secondary assumptions. Secondary assumptions have alredy been put into language structures and they can be described in characteristic types of sentences. In these sentences information distortion is even more obvious. The part of the pyramid overlapping the area of secondary assumptions is called epistemological level, as it carries the personal, depressive mechanism of the perception of the realities. The Secondary assumtions can be disintegrated into concrete situational and behavioural elements corresponding to them. This is also the phenomenological level, and the majority of communication between the patient and the therapist is taking place at this level.

Cognitive distortions All or nothing (dichotomous thinking Exaggerated generalisation Mental filter (selective abstraction) Disqualification of the positive Mind reading (early conclusion) Future telling Catastrophising Minimalisation - maximalisation Emotional logic Should statements Labelling Personalisation

Dimensions of cognitive schemata Anerkennung (approval) Liebe (love) Leistung (achievement) Perfektionismus Berechtigung (entitlements) Allmächtigkeit (omnipotence) Autonomie

Der Prozess der kognitiven Therapien Aufbau des Kontakts Ziele und Prioritäten Identifikation der automatischen Gedanken Kontrolle der automatischen Gedanken Identifikation und Modifikation der kognitiven Schemata Korrektion des Selbstbildes

Vermehrung der Zahl der Psychotherapien Harper Parloff Karasu Y=2,07·x1,7+36