I N T E R V E N T I O N PSYCHOLOGICAL

I N T E R V E N T I O N PSYCHOLOGICAL

Henny regina salve

INTERVENTION PSYCHOLOGICAL

• Kata intervensi, berasal dr bhs Latin → intervening, yg berarti ”coming between” (yg datang di antara) mengacu pd usaha utk mengubah khdpn yg sdng b’jln dgn cara2 ttt

• intervensi psikologis mrp metode utk mengubah seseorang baik dr pikiran, perasaan, atau pun perilakunya.

• Psikoterapi melibatkan hubungan yg profesional antaraterapis dgn klien.

• Wolberg (1967) mendefiniskan terapi adl bentuk treatment untuk masalah yg bersifat emosional. Di mana seseorang yg terlatih scra sengaja membina hub profesional dgn seorg klien, dgn tujuan menghilangkan, mengubah atau memperlambat simtomp utk mengantarai pola perilaku terganggu & meningkatkan pertumbuhan & perkembangan pribadi yg positif.

• Does psikoterapi help ? → The efficacy of treatment and effectiveness treatment

Features Common to Many Therapy

• Lambert & Ogles (2004) note, one implication of therapeutic equivalence is that the positive changes effected by psychological treatment may be the result of a set of common factors that cuts across various theoritical & therapeutic boundaries.

1. The expert role - Terapis yg memiliki skill, pengetahuan, & pengalaman, akan sgt mbantu terapis dlm mnyelesaikn permasalahn klien. 2. The release of emotions / Catharsis - Mrp hal yg pnting di dlm psikoterapi. - Dlm hal ini klien mengekspresikan berbagai emosinya, namun terapis jg hrs siap utk brhadapan dgn hal tsb & m’gunakannya utk ke arah perubahan. 3. Relationship / therapeutic alliance - Relasi yg t’cipta antara terapis dgn klien mrp hal penting dlm keberlangsungan & keberhasilan psikoterapi - Terapis mampu bersikap profesional, tanpa penilaian, & dapat menunjukkan sikap hangat & memahami.

Lanjutan Features Common to Many Therapy ...4. Anxiety Reduction / Release of tension - The essential conditions of psychotherapy-including the nature of the

relationship, the qualifications of the therapists, confosentiality, & privacy-combine to provide a reassurance & a sense of security that can lower the patient’s anxiety and permit the patient to contemplate his or her esperiences systematically.

- In instances in which the anxiety level is extremely high, some patients may require, on medical advice, antianxiety medications to help to deal with the situation.

5. Interpretation / insight - Is a very common component of psychotherapy - Insight may be seen as a facilitator of psychological growth &

improvement but not as something that by it self will inevitably bring about such changes

6. Building competence / mastery - Those persons who experience a sense of mastery-who feel confident,

expect to do well, or just feel good about themselves-are more likely to function in an effective fashion.

7. Nonspesific factors - Call it faith, believe, hope, or expectations for incereased competence,

succesfull therapy tends to bee associated with such nonspesific factors

Nature of Spesific Therapeutic Variables• A number of factors involving the nature of the patient, the therapist, & the patient-

therapist affect the process of therapy in important ways :

1. The patient / Client - The reason is that the outcomes of therapy are exceedingly complex events that are not shaped by patient characteristic alone. - They are also determined by therapist qualities & skills, the kinds of therapeutic procedures employed, the circumstances & environment of patient, & so on. 2. The degree of the patient’s distress 3. Intelligence - In general, psychotherapy requires a reasonable level of intelligence. - The several reason is : a. Psychotherapy is verbal process. b. Psychotherapy requires patients to establish connections among events. c. To enable connections among events to be made, psychotherapy requires a degree of introspection. 4. Age - In any events, the notion that younger persons do better in therapy is quite prevalent among clinician. - It is best to consider not age alone, but rather the spesific characteristic of the prospective patient.

5. Motivation

6. Openness

7. Gender

8. Race, ethnicity, & social class

9. Therapis’ reaction to patient

Therapist

• Contribute of charactheristic therapist to therapy outcome has become an important research area.

1. Age, sex, ethnicity

2. personality

3. Emphaty, warmth, & genuineness

4. Emotional well-being

5. Experience & professional identification

Lanjutan Nature of Spesific Therapeutic Variables …

Course of Clinical Intervention• They are so many forms of intervention, along with so many different kinds

of problems & it’s imposible to to describe with precision a sequence of procedures that will apply equally will to every case. However, a general description of the typical sequence describes most forms of psychological treatment.

1. Initial contact 2. Assessment 3. The goals of treatment 4. Implementing treatment 5. Termination, evaluatin, & follow-up

Stage of change 1. Precontemplation 2. Contemplation 3. preparation 4. Action 5. Maintenance 6. Termination

PSYCHOTERAPY : THE PSYCHODYNAMIC PERSPECTIVE

• Pendekatan psikodinamika pada terapi, berfokus pada motif ketidaksadaran dan akar konflik dari perilaku.

• Awal mulanya psikoanalisa : - Freud yang terpesona dengan cara kerja Josef Breur’s ketika menangani pasien histeria yang bernama Anna O.

• Pandangan Freud : - Asumsi dasar dari teori Freudian adalah “psyhic determinism, yang menunjukkan bahwa apa pun yang dilakukan oleh seseorang pasti memiliki makna dan tujuan, dan merupakan sasaran langsung (goal directed).

• Untuk mengetahui berbagai aspek dari pelaku manusia, Freud juga mengemukakan tentang adanya motivasi ketidaksadaran.

Instink Struktur Kepribadian

Tahap Psi. sex

Kecemasan Pertahanan Ego

1. Instink kehidupan

(The life instincts /

Eros)

- Ex : Sex, hunger, thirsty

1. Id- Pleasure principle- Primary process

1. Tahap oral (0-6 bln)

1. Kecemasan realitas (Reality anxiety) - Sumber : ego

1. Represi

2. Regresi

3. Fiksasi

4. Proyeksi

2. Ego- Reality principle- The secondary process

2. Tahap anal (6 bln -3 thn)

2. Kecemasan neurotis (Neurotic anxiety)- Sumber : id

5. Rasio- nalisasi

3. Tahap phalic (3-7 thn)

6. Reaksi formasi

2. Instink kematian (The death

instink)

- Ex : Aggression

4. Tahap laten (5-12 thn)

3. Kecemasan moral (Moral anxiety)- Sumb : super ego

7. Denial

3. Superego- ideal & value society- Self / ego ideal

5. Tahap genital (12 )

8. Sublimasi

9. Displace- ment

Pandangan Freud

Techniques of Psychodynamic Psychotherapy

Asosiasi Bebas

(Free Association)

Analisis Mimpi

(Analysis of Dreams)

(Resistance) (Transference) Interpretation

-Klien diminta utk mengatakan semua hal dr pikirannya.

- Tuj : katarsis

- Posisi : terapis duduk di belakang klien & klien dlm posisi berbaring

-Mnyingkap hal2 yg tak disadari oleh klien melalui mimpi, yg biasanya muncul dgn simbol2 ttt.

-2 taraf mimpi :1. Manifest content 2. Latent content

- Tuj : utk mencegah material2 yg m’ancam yg akan memasuki ke kesadaran klien, dgn cara mencegah klien m’ungkapkan hal2 yg tdk disadarinya.

- kunci / inti terapi Psikoanalisis.-

-Pd akhirnya, klien diminta utk m’kmbangkan neurosis transferensi yg b’sumber pd 5 thn prtama khdpnnya, shg terapis pnya ksmpatn utk m’intrpretasi transference.

- Terapis tdk mbrikn saran.

-Mrp dasar landasan hampir setiap psikoterapi dinamik.

- Mrp cara utama bagi klien utk m’p’oleh kesadaran (insight).

Ego analysis

- Gerakan analisis ego, dimulai dari kerangka psikoanalisis tradisional.

- Psikoanalisis tradisional lebih menekankan ketidaksadaran dan instink (dorongan) yang menentukan proses ego secara keseluruhan.

- Mereka meyakini bhw ego berperan utk menengahi konflik antara id dgn dunia nyata.

- Mereka jg meyakini bhw ego turut menunjukan fungsi penting lainnya.

- Tokoh : Hartmann, Anna Freud, Kris, Erikson, dan Rapaport.- Pendekatan analisis ego juga cenderung menekankan pd

pentingnya membangun kepercayaan klien yg “reparenting” pada suatu relasi terapi.

PSYCHOTERAPY : Phenomenological & Humanistic − Exixtential

Prespective

● Client Centerd Therapy - Tokoh : Carl Rogers - Rogers mengembangkan konsep “self”. Mnrt Rogers, individu adl sumber informasi terbaik mengenai

dirinya sendiri. Hal ini dikarenakan individu adl pusat dr berbagai pengalaman yang dialaminya. - Berdasarkan pengalaman, ada 3 hal yg mgkn dialami seseorang, yaitu : 1. Pengalaman dpt brupa simbol / diatur ke dalam beberapa hubungan ke dalam self. 2. Pengalaman dapat diabaikan karena berkaitan dengan diri, bukan di rasa. 3. Pengalamn dpt mjd simbol yg disangkal / menyimpang karena tidak serupa dengan struktur self.

Lanjutan Client Centerd Therapy …

• 3 tipe karakter terapis mnrt Rogers

1. Accurate, emphatic understanding

2. Unconditional positive regards

3. Genuineness or congruence

1. Emphaty

- Terapis berusaha memahami secara peka (baik kebutuhannya,

perasaan, maupun keadaan) si klien.

Dlm hal ini, empati memerlukan lbh dr sekedar refleksi perasaan.

- Tujuannya adalah utk m’dorong klien agar lebih dekat dgn dirinya

2. Unconditional positive regards

- Terapis perlu memberikan perhatian yg tulus & mendalam kpd

klien serta menghargai klien sbg manusia.

- Tanpa syarat

3. Congruence

- Terapi dpt menunjukkan sikap, perilaku & perasaannya dlm hubungannya dgn klien

- Jika terapis memiliki hubungan yg selaras dgn klien, maka proses

terapeutik bs berlangsung.

▪ Attitude VS Technique

- Scr luas, client centered therapy adl keadaan pikiran, dan tidak hanya sekumpulan teknik (p’gunaan teknik tdk diutamakan).

- Rogers melihat mns sbg yang memiliki kekuatan membangun untuk mencapai kesehatan dan pemenuhan diri yang seutuhnya.

- Rogers turut menyatakan bhw inner experience merupakan

data yg paling tertinggi.

Lanjutan Client Centerd Therapy …

Proses Terapi Client Centerd Therapy

1. Tahap I : Enggan utk m’ungkapkan diri; tdk m’kenali perasaannya sndiri; konsep yg kaku; merasa berbahaya jk memiliki hubungn yg dkt.

2. Tahap II : T’kadang m’gambarkan prasaan, namun org tsb msh ttp jauh dari pengalamn pribadi; msh berat keadaannya, tp mulai menunjukkan bbrpa pengenalan thd mslh & konflik yg ada.

3. Tahap III : M’deskripsikn prsaan yg lalu yg tdk dpt diterima oleh klien; ekspresi diri yg mengalir bebas, mulai menanyakan kebenaran akan konsep dirinya; permulaan pengenalan bg individu utk lebih melihat mslh ke dalam dari pada ke luar diri.

4. Tahap IV : Bebas m’deskripsikan dirinya sbg pemilik dirinya sndiri; adanya pandangan suram thd perasaan lama yg disangkalnya mulai memasuki keadaan yg skrng ; kebebasan pribadi ; sejmlh ekspresi sbg tanggung jwb pribadi ; di mulai dgn hubungan yg beresiko dgn org lain yg brdsrkn pd perasaan.

5. Tahap V : Bebas m’ekspresikan prsaan dan penerimaan diri scr penuh ; sblm menyangkal perasaan2 nya ; walaupun yg menakutkan ; kesadaran yg nyata ; mengenali konflik di antara emosi dgn intelektual ; menerima tanggung jawab pribadi atas masalah ; hasrat utk mnjd seseorang .

Lanjutan Proses Terapi Client Centerd Therapy …

6. Tahap VI : Menerima perasaan tanpa adanya penolakan; hidup : melepaskan rasa atas pengalaman yg dialami ; kemauan utk m’ambil resiko sndiri dlm hubungannya dgn org lain ; mempercayai org lain utk dpt lbh diterima

7. Tahap VII : Individu tsb kini merasa nyaman dengan pengalamannya sndiri ; mengalami perasaan yg br : sedikit keseleo lidah “slips of tonge , sedikit ketidaksesuaian ; Kemampuan utk mengecek pengalamn yg benar.

• Diagnosis - Scr umum, diagnosis / assessment adl menekankan pd client centered therapy. - Mnrt Rogerian, apabila memposisikan terapis sbg superior, peran yg autoritative, dpt m’halangi perkemabangan kemandirian & aktualisasi diri. - Sebaliknya, assessment dgn kondisi bebas memperlihatkan bhw metode client centered therapy begitu potensial & efektif jika digunakan kpd slrh klien yg memiliki mslh atau dlm kndisi ttt utk menemukan dirinya yg sesungguhnya.

Kesimpulan Client Centred Therapy

• (+) Positif - dlm krjnya, bfokus pd self determination & inner directedness - Lebih utama, menekankan hub antara terapis dgn klien, dibandingkan teknik. - Bentuk terapi yg dilakukan lbh singkat jk dibandingkan psikoanalisa.

• (-) Negatif - Terapis menyederhanakn sejmlh sikap2 sentral dr posisi client centered therapy. - Terlalu berpusat pd client centered therapy

The Humanistic-Exixtensial Movement

♣ Humanism - Memandang mns sbg pribadi yg memiliki potensi dan dpt m’aktualisasikan diri.

♣ Exixtensial therapy - Tokoh : Biswanger, Boss, Gendlin, Frankl, May and Laing. - The goals of therapy : To help the individual reach a point at which awareness and decision making can be exercised responsibly. It means, the individual must learn to accepts responsibility for one’s own decisions and to tolerate the anxiety that accumulates as one moves toward change. - Technique : The emphasize is on understanding & on experiencing the client as a unique essence.

Lanjutan The Humanitsic-Exixtensial Movement …♣ Logotherapy - Tokoh : Frankl - About searching for meaning - Technique : Encourage the client to find meaning in what appears to be a callous, uncaring, & meaningless world. - 2 technique describe by Frankl : 1. Paradoxial intention Fear is thus replaced by a paradoxial wish. 2. De-reflection Instructs the client to ignore a troublesome behavior or symptom.

♣ Gestalt therapy - Tokoh : Frederick Perls - Fokus pd : awareness, experience, now & responsibility. - Tuj : Membantu klien mengalami keberadaannya scr penuh “di sini” & “skrng” atas tindakannya yg m’cegah dirinya utk m’alami keadaan di sini & skrng shg dpt menemukan makna2 nya sndiri.

- Non verbal behavior By paying attention to nonverbal cues, the therapist was able to cut right

through to a significant experience, then use that to get feelings that existed now & helped the client get in touch with them.

- Dreams Dlm terapi ini, klien diminta utk mencari “inner self” dgn mengkonfrontasi

pengalamn mimpi yg dialaminya scr lgsung, lalu. klien diminta utk mlepaskan mimpinya skrng di dlm ruang terapi (b’beda dgn psikoanalisa, di mana interpretasi hnya diperoleh scr kesadran intelektual).

- Topdog-Underdog When conflics involve opposing aspects of the personality, the patient may

be asked to take each part in dialogue. Spt psikoanalisa, the topdog is the superego & contains the introjected “shoulds” of the personality. The underdog is the id. It’s primitive & constantly distrups the efforts of the topdog.

- The defense Tuj : agr klien menyadari hal2 yg membuatnya memiliki kecemasan, phobia,

& rasa malu.

- Responsibility Agar si klien menerima tanggung jwb atas perasaan & tindakannya.

Lanjutan The Humanistic-Exixtensial Movement …

- The rules 6 rules of gestalt therapy : 1. Communication is in the present tense 2. Communication is between equals (one talks with, not at). 3. One uses “I” languange rathen than “it” languange (to encourage the acceptance of responsibility). 4. The client continually focuses on immediate experience. 5. There is no gossip (talking about someone else). 6. Questions are discourage Because questions are often quiet ways of stating opinions rather than seeking information.

• Gestalt games• Moral precepts Ada 9, yaitu : 1. Live now 2. Live here . 3. Stop imagining 4. Stop unnecessary thinking 5. Express directly 6. Be aware of both the pleasant & the unpleasant 7. Rejecty all “should” & “oughts” that are not your own 8. Take complete responsibility for your actions, 9. Surrender to being what you really are.

Lanjutan The Humanistic-Exixtensial Movement …

• Mengintegrasikan antara psikoterapi client centered therapy dgn gestalt.

• The therapist provides a safe & supportive environment such that the client become more aware of different aspevt of him or herself, can access & explore emotional states, & can learn to better regulate these emotional states.

Strength• Experience• Choice• The present• The relationship• Growth

Process-Exoriential Therapy

Criticisms

1. Prejudicial languange

2. Emphasis on feelings & emotions

3. Phenomenal field

4. Assessment

5. Technique-centered

6. Lack of research

7. Obscure languange

Psychotherapy : Behavioral & Cognitive-Behavioral Perspective

• Sejarah - Watson & Rayner (1920) → Kasus Albert kecil yg ketakutan setiap kali m’dengar suara krs, shg ia kemudian takut melihat tikus. → Menunjukkan bgm “neuorosis” dpt berkmbang pd anak. - Mary Cover Jones (1924) → M’perlihatkan bgm rasa takut bs dipindahkan - Pavlov → Melakukan p’cobaan dgn anjing - Joseph Wolpe & Arnold Lazarus → Menemukan teknik disentisisasi sistematis - Skinner dan rekan2 nya → Menunjukkan percobaan dgn pastient psikotik yg di modifikasi mll prosedur operan. - Julian Rotter (1954) → Mempublikasikan buku Social learning & clinical Psychology - Albert Bandura → Kontribusinya dlm memodifikasi perilaku dgn social learning

Technique of Behavioral Therapy1. Systematic disensitization - Dikembangkan oleh Joseph Wolpe - Terapi ini digunakan org2 yg memiliki kecemasan, ketakutan, phobia & penghindar. - Technique & procedure : → Klien diminta utk mbuat hirarki ketakutan / kecemasan (dr taraf rendah-tinggi) → The problem is explained to the patient & following the rationale for systemic disentisization. → Klien mempelajari & melakukn teknik relaksasi, maka dilakukan pula hierarki kecemasan.2. Exposure therapy - Teknik ini utk m’hilangkan / mengurangi pl menyimpang yg bkaitan dgn kecemasan. - Si klien lgsng dihadapkan pd stimulus / situasi yg mbuatnya takut / menjauh. - Terapi “exposure” bs dilakukan dlm khdpn nyata (in vivo) / dibayangkan (in imagino)

3. Behavior rehearsal - Mnrt Goldfried & Davidson (1994) ada 4 tahap behavioral rehearsal : a. The First stage : To prepare the patient by explaining the necessity for acquiring new behaviors, getting the patient to accept behavior rehearsal as a useful device, & reducing any initial anxiety over the prospect of role-playing. b. The second stage Involves the selection of target situation. c. The third stage Is the actual behavior rehearsal. d. The final stage Is the patient’s actual utilization of newly acquired skills in real life situation. 4. Assertiveness training - A treatment for persons whose anxiety seemed to stem from their timid

mode of coping with situation. - A variety of assertiveness training pograms have been developes

spesifically for individuals seeking to overcome destructive passivity, also treating sexual problems, depression, & marital conflicts.

Lanjutan Technique of Behavioral Therapy …

5. Contigency management

- A variety of Skinnerian or operant techniques are all referred to as

contigency management procedures.

- They share the common goal of controling behavior by manipulating its

consequences

- Techniques :

a. Shaping c. Contigency contacting

b. Time-out d. “Grandma’s rule”

6. Token ekonomies

- Token ekonomies are used to promote desired behavior through the control of reinforcement.

- Biasa digunakan di kelas normal (mis :Tk), sekolah utk anak2 khusus (MR), penjara, tmpt rehabilitasi (narkoba, alkohol), dll.

Lanjutan Technique of Behavioral Therapy …

7. Aversion therapy

- Mrp terapi yg paling kontroversi.

- These therapies are based on the apparently simple principle that when a response is followed by an unpleasant consequence (punishment / pain), it’s strength will diminish.

- Terapi ini sering digunakan utk membantu klien mengontrol diri, sebagai coping masalah trhdp obesitas, merokok, alkohol, dan sexual deviations.

- Bbrp teknik aversion therapy :

a. Aversive agents c. Other techniques

b. Covert sensitization d. Second thougts

Lanjutan Technique of Behavioral Therapy …

Cognitive Behavioral Therapy• CBT seeks to modify or change patterns of thinking that are believed to

contribute to a patient’s problems.

1. The role social learning - In particularm Rotter;s social learning theory helped bridge the chasm between traditional psychodynamic clinical practice & learning theory. - The presence of such a social learning theory had a least two effects on the development of behavior therapy : a. It produced a number of clinicians (and influences other) who were ready to accept newer behavioral techniques & wee equipped with a theoritical point of view that could facilitate the modification of those techniques along more cognitive lines. b. The theory, being both cognitive and motivational, was capable of blending the older psychodynamically derived therapeutic procedures with the newer behavioral & cognitive approaches. - Rotter & Bandura and others highlighted the idea that learning is an

active, not a passive, process.

2. Modelling

- Mrp teknik yg paling mudah & efisien

- Dilakukan dgn cara mengamati perilaku orang lain dgn

tujuan untuk mengurangi / menghilangkan rasa takut /

kecemasn.

- Thorpe & Olson has note, observational learning is best

and most efficient when the following four conditions are

met :

a. Patients attend to the model

b. Patients retain the information provided by the model

c. Patient must perform the modeled behavior.

d. Patient must be moivated to use the behavior that is

modeled.

Lanjutan Cognitive Behavioral Therapy ..

3. Rational structuring - To facilitate this rational restructureing of events, the therapist may sometimes use argument / discussion in a attempt to get patients to see the irrationality of their beliefs. - Ex : RET (Rational Emotive Therapy) by Ellis’s → RET aims to change behavior by altering the way the aptients thinks about things. → RET, memiliki konsep ABC - A (situations), B (beliefs), C (Consequences) → Basic goal of RET is to make people confront their own ollogical thinking.

4. Stress Inoculation training (SIT) - Use self talk-self instuction to modify client behavior. - Its designed to hep individuals develop new coping skills and make full use of the coping stategies that are already in place. - Meichenbaum m’ungkapkan 3 proses dalam overlapping phases, yaitu : a. Conceptualization phase b. Skil acquisition and rehearsal phase c. Application phase - SIT has been used for the treatment of several clinical problems, including rape & assault trauma, posttarumatic stress disorder, & anger discontrol

Lanjutan Cognitive Behavioral Therapy ..

5. Beck’s cognitive therapy

- Tokoh : Aaron Becks

- Cocok untuk mentreatment individu yg m’alami depresi

6. Dialectical behavior therapy (DBT)

- Tokoh : Linehan

- Treatment for borderline personality disorder & related conditions involving emotional dysregulation & impulsivity.

- DBT developed based on her clinical experience with woman diagnosed with BPD who engaged in suicidal behavior.

- DBT involves skils training in problem-solving techniques, emotional

regulation, & interpersonal skills.

- Clients in DBT cycle twice through four skills training modules :

a. Mindfullness

b. Emotional regulation

c. Distress tolerance

d. Interpersonal effectiveness

Lanjutan Cognitive Behavioral Therapy ..

An Evaluation of Behavior Therapy

☻ Strength

1. Efficiency

2. An array of empirically supported techniques

3. Symptom substitution

4. Breadth of application

5. Scientist-practitioner and clinical

☻ Critisisms 1. Linking practice to science

2. Dehumanizing

3. Inner growth

4. Nonspesific problem

5. Mental process

6. Manipulation & control

7. Generalization

8. Lack of a unifying theory