محاضرة د.ضبيع 24\6\2012

1. AHMAD DOBEA M.D.

4. psychotherapy is indeed effective
Psychotherapy alone did not differ in effectiveness from medication plus
psychotherapy.
No specific modality of psychotherapy did better than any other for any
disorder .
Psychologists, psychiatrists, and social workers did not differ in their
effectiveness as treaters; and all did better than marriage counselors and
long-term family doctoring
Long-term treatment did considerably better than short-term treatment ..

5. the type of treatment is not a factor.
the theoretical bases of the techniques used, and the strictness of
adherence to those techniques are both not factors,
the therapist's strength of belief in the efficacy of the technique is a
factor.
the personality of the therapist is a significant factor,
the alliance between the patient and the therapist (meaning affectionate
and trusting feelings toward the therapist, motivation and collaboration
of the client, and empathic response of the therapist) is a key factor

6. Effect size: the difference between treatment and control groups,
expressed in standard deviation units.
An effect size of 1.0 means that the average treated patient is one
standard deviation healthier on the normal distribution or bell curve
than the average untreated patient.
0.8 is a large effect
0.5 is a moderate effect
0.2 is a small effect (Cohen, 1988).

7. Abbass et al. (2006) 0.97 12 studies
Leichsenring et al. (2004) 1.17 7 studies
Anderson & Lambert (1995) 0.85 9 studies
Abbass et al. (2009) 0.69 8 studies
Messer & Abbass (in press) 0.91 7 studies
Leichsenring & Leibing (2003) 1.46 14 studies
Leichsenring & Rabung (2008) 1.8 7 studies
de Maat et al. (2009) 0.78 10 studies

8. General psychotherapy
Smith et al. (1980) 0.85 475 studies
Lipsey & Wilson (1993) 0.75 18 meta-analyses
Robinson et al. (1990) 0.73 37 studies
Antidepressant medication
Turner et al. (2008) 0.31 74 studies
Moncrieff et al. (2004) 0.17 9 studies

9. Lipsey & Wilson (1993) 0.62 23 meta-analyses
Haby et al. (2006) 0.68 33 studies
Churchill et al. (2001) 1.0 20 studies
Cuijpers et al. (2007) 0.87 16 studies
Öst , (2008) 0.58 13 studies

12. Verbal Psychotherapies
Individual
Couple
Family
Group

13. INDIVIDUAL PSYCHOTHERAPIES
DYNAMIC
COGNITIVE
HUMANISTIC
INTEGRATIVE

15. Doesn’t remember your name and/or doesn’t
remember your issues from one session to the
next
Does not pay attention or demonstrate he or she
is listening and understanding you.
Habitually late, cancels, or changes
appointments
Insufficient and specific training or supervision
Makes guarantees and/or promises.
Unlicensed or has many complaints. -
Critical of your behavior, lifestyle, or problems.
Tries to push spirituality or religion on to you.

16. “looks down” at you or treats you as inferior.
Blames your family, friends, or partner, or
encourages you to blame them
Focusing on him/herself instead of you.
Tries to be your friend.
Initiates touch, romance, or sex relation.
Reveals identities of his or her other clients.
Cannot accept feedback or admit mistakes.

17. Talks too much or not at all
Psychobabble” that leaves you confused.
Acts as if she or he has all the answers and keeps
telling you how to best fix things.
Encourages your dependency by allowing you to get
your emotional needs met from the therapist. Therapist
“feeds you fish, rather than helping you to fish for
yourself.”
Tries to keep you in therapy against your will.
Ridicules other approaches to therapy.
Tries to get you to use control over your impulses
without appreciating or attempting to resolve
underlying conflicts .

18. Pushes you or constantly avoids highly
vulnerable feelings or memories.
Overly emotional, affected, or triggered by
your feelings or issues.
Does not empathize or empathizes too
much.

19. THE PLACE, ROOM, OFFICE,
FURNATURE.
TIME AND DATE.
FEE, WHY

20. Emotions
Past Defense
experiences focus resistance
Recurring
themes

21. Motivation
Past &
current
Personality
type focus relations
& with
therapist
Fantasy life

23. hysterical schizoid depressive obsessive

24. HYSTERICAL

27. Ego
Id

28. Conscious
subconscious
Un-Conscious

29. Stimulus
Conscious
subconscious
Ego Un-Conscious
Impulse Id

30. defenses Stimulus
Anxiety Conscious
subconscious
Ego Un-Conscious
Impulse Id

31. In life we experience conflicts with others.
When conflicts occur, we experience feelings.
These feelings tell us what we want and mobilize us to act on
our desires.
However, most patients seek therapy because they cannot
channel their feelings into effective action.
Instead, they become anxious and use defenses.
These defenses create the presenting problems and symptoms
from which our patients suffer.

32. FEELINGS ,
EMOTIONS &
TRANSFERENCE
DEFENSES &
Anxiety
RESISTANCE

33. Thank you

34. • What is therapeutic relationship?
• Is a key factor.
• Why it is important?
• What are its ingredients?
•

35. • Drop out = 47% (why)
• The first 7 sessions
• Co-creating therapeutic relationship (alliance=
collaborative relation = not kind warm supportive or
empathic relation but it is a relationship designed to
accomplish a specific task)

36. • 1--THE PROBLEM
• -DEFENSES D,P, V, IND
• 2--A SPECIFIC EXAMPLE
• -DEFENSES R, RR, REG,
• 3--FEELINGS AT THAT TIME
• -DEFENSES F, DISP, RAT conflict triangle
• 4--THE IMPACT OF FEELING ON BODY
• -DEFENSES

37. FEELINGS ,
EMOTIONS &
TRANSFERENCE
DEFENSES &
Anxiety
RESISTANCE

39. •
•
• You will be faced with the:
• 1- the real problem
•

40. 2-anxiety
a)striated: H.R, R.R, B.P.,
clinch, bruxism etc
b) smooth: migraine, vomiting, diarrhea etc
c) cognitive perceptual disruption: dizzy,
concentration, blurring, ear, dissociation etc

41. • Tactical, vagueness, sarcasm, arguing, laughing, crossing legs
or arms, changing topic.
• Repressive, intellectualization, rationalization, minimization,
displacement, reaction formation
• Regressive, splitting, projection, somatization, acting out,
• Character, identification,

42. •
• Is this a defense, feeling or anxiety?
• What is the name of this defense? (………)
• Yes, so, you need to see, clarify, round about, block defense,
and focus again upon the problem (pressure).
•
•
• Never explore this way

43. •
• Is this defense, feeling or anxiety?
• What is the name of this defense?
• Yes,
• so, you need to see, clarify, round about, block defense.
and focus again upon the problem (pressure).
•

44. (……………………….) •
.. ..!. •

45. • SPECIFIC EXAMPLE
• YOU WILL BE FACED BY DEFENSES
• DETAILED EXAMPLE (file)
• WHY
• HOW
• WHEN

46. Awareness of
Stimulus from body
environment activation
A person appears feelings
Body
mobilization
Dog barks or
licks face

47. Stimulus
leads to Defensively Habitually
emotion conceals used in
current
FEELINGS emotions relations
Child & Fear of loss of
caretaker
(anxiety attachment
provoking (adaptive
st) survival of self
and other)

48. 1) A cognitive label: “I am sad.”
2) Awareness of physiological arousal: heaviness in the chest and tears
3) The motoric impulse: crying
Let’s look at another feeling.
1) A cognitive label: “I am angry.”
2) Awareness of physiological arousal: sensation of
heat rising from the solar plexus.
3) The motoric impulse: hands clenched and arms are
raised.

49. • AGAIN YOU WILL BE FACED WITH SOME OTHER DEFENSES
• Such as denial through fantasy
• Displacement
• Self abandon , dismissal

50. •
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51. Pressure
Face the
Challenge
DEFENSES

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56. Ludwig Binswanger, Freud once wrote that
“psychoanalysis is a cure through love.” Through our
constant attention to the patient’s inner life and by blocking
the defenses that strangle it.
Through our constant moment to moment attention to the
patient’s feelings we actively demonstrate our concern for
his/her right to be free from those inhibiting defenses that
have perpetuated his/her suffering. For, as Frieda Fromm-
Reichmann said,
“To redeem one person is to redeem the world.”