INTRODUCTION TO PSYCHOLOGY Chapter 16: Therapy & Treatment

THERAPEUTIC OPTIONS Psychotherapy: Any of a group of therapies that focuses on changing environmental contingencies, behaviors, thoughts, perceptions, and emotions (sees clients) Psychoanalysis Behavioral Cognitive Humanistic Biomedical therapies: treatment for psychological disorders that alters brain and neural functioning with chemical or physical interventions (treats patients) Surgery Pharmaceuticals Electroconvulsive therapy Transcranial Magnetic Stimulation

THERAPISTS Clinical Psychologist (Ph.D. or Psy.D.): trained in the assessment and treatment of psychological problems Counseling Psychologists (Ph.D. or Ed.D): trained in treating everyday adjustment problems, often found in a university clinic Psychiatrist (M.D. with postdoctoral specialty): treats patients with the medical model, can prescribe medication Psychoanalyst (Ph.D. or M.D.): specializes in Freudian-style psychotherapy Behavior Analyst (M.S. or Ph.D.): specializes is Skinnerian behaviorism; focuses on changing behavior/environment contingencies Clinical Social Worker: a mental health professional who specializes in recognizing and addressing the social context of people’s problems

THERAPY & CONFIDENTIALITY Almost everything discussed with a therapist is confidential  Exceptions: Immanent future harm to self or others, self-neglect, child or elder abuse (if the client was a victim and the perpetrator is still out there)  Baker Act (Florida)  Requires:  Ideation  Plan  Intent

HISTORY OF MENTAL INSTITUTIONS Large scale deinstitutionalization occurred in the U.S. starting in the 1960’s & 70’s as a part of JFK’s legislation  Advent of antipsychotic drugs, such as Thorazine  Criticism of mental health institutions Deinstitutionalization: the process of moving people from psychiatric institutions to other venues for treatment  Imprisonment  Homelessness  ER

PSYCHODYNAMIC (FREUDIAN) THERAPY Not considered evidence- based practice  Insurance will not cover Freudian-style psychotherapy  People are in psychotherapy almost indefinitely  Very few people specialize in psychodynamic therapy today

PSYCHODYNAMIC THERAPY Based on uncovering unconscious motivations and unresolved conflicts in neurotic, anxious individuals Focus on early childhood experiences Insight therapy: the therapist guides the client toward discovering the relationship between their current neurosis and past experiences Free Association: principal tool of psychoanalysis; have the patient talks freely about their thoughts and feelings in a relaxed environment Dream Analysis: Dream content is analyzed for Manifest (actual) and Latent (hidden, metaphorical) content.

PSYCHODYNAMIC THERAPY

Transference: the transfer of feelings to a psychoanalyst of love or anger that had originally been directed to a patient’s parents or other authority figure Resistance: unconscious defensive maneuvers intended to hinder the progress of therapy

BEHAVIOR THERAPY / BEHAVIOR ANALYSIS Behavior modification: the systematic use of principles of conditioning to alter the probability of behaviors Counter conditioning (DRO): replacing an undesired behavior with one that is neutral or desired Exposure therapy: used in the treatment of phobias; the stimulus is presented without anything aversive Systematic desensitization Aversion therapy: used in clients that are attracted to harmful stimuli; pairs that stimulus with something aversive Pedophiles Contingency management: changing behavior by changing the consequences Extinction SuperNanny

BEHAVIOR THERAPY / BEHAVIOR ANALYSIS Behavior Analysis is effective and (relatively) quick at altering behaviors Primarily used in the treatment of  Children  Individuals with developmental disorders  Anxiety Disorders  Phobias  Compulsive behaviors in OCD Behavior Analysis focuses on the observable behaviors and the environmental contingencies that control them  “under the skin” feelings, emotions, or neurological happenings are not measured or manipulated directly, but may be changed as behavior changes

COGNITIVE THERAPIES Cognitive Therapy: attempts to change the problem feelings by changing the way the client thinks about experiences  Can be combined with behavioral techniques:  Cognitive-Behavioral Therapy (CBT) is effective for the treatment of depression, addiction, OCD, and is considered effective practice for a variety of disorders.  Combines changing someone’s thoughts and attributions while making it more likely for desirable behaviors to be reinforced in the environment  Addiction

COGNITIVE THERAPIES Rational-emotive behavior therapy: A form a therapy that attempts to restructure a person’s belief system into one that is more realistic, rational, and logical A-B-C model of rational-emotive behavior therapy

COGNITIVE THERAPIES Changing false beliefs for the treatment of depression:  Challenges the client’s basic assumptions of their functioning  Evaluating evidence that client has for and against the accuracy of automatic thoughts  Reattributes blame to external environmental factors  Discussing alternative solutions to complex tasks that would have a higher probability of success

HUMANISTIC THERAPIES Positive Psychology: uses theory and research to understand the positive, adaptive, creative, and fulfilling aspects of human existence Human-potential movement: encompasses all practices and methods that would release the potential of the client to be the best they could be and have a rich life Client-centered therapy: focuses on the healthy psychological growth of the client based on the assumption that all people strive for self-actualization Unconditional Positive Regard

HUMANISTIC THERAPY

PSYCHOTHERAPY: DOES IT WORK? Most agree that any form of therapy is better than no therapy Exactly what kind of psychotherapy works best depends on the individual and the factors contributing to their particular issue Most forms of therapy share basic similar characteristics  Positive relationship with a therapist  Explanation or interpretation of symptoms  Confrontation of negative emotions or behaviors

BIOMEDICAL THERAPIES Psychopharmaceuticals (drugs) Antipsychotics: treats hallucinations, delusions, irrational thoughts, and agitation by way of reducing dopamine Thorazine (“lobotomy in a bottle”) Haldol Antidepressants: elevates mood by increasing levels of serotonin and/or norepinephrine SSRI’s Wellbutrin Zoloft Anxiety Medications: reduces anxiety by increasing GABA neurotransmitters Benzodiazapines Xanax Vallium

THORAZINE Antipsychotic medications were widely marketed as a cure-all during the 1950s

BIOMEDICAL THERAPIES Psychosurgery  Prefrontal lobotomy: severs the nerve fibers connected to the frontal lobe of the brain   Permanent  The patient becomes child-like, has no coherent sense of self, has little or no executive control, cannot plan or create  The use of lobotomies have generally ceased since the introduction of antipsychotic drugs

BIOMEDICAL THERAPIES Electroconvulsive Therapy: the use of eclectic shock applied to the brain to treat psychiatric disorders Most prevalent for the treatment of severe depression, but also for schizophrenia and mania Repeated Transcrainial Magnetic Stimulation: use of magnets to target and interfere with specific brain regions Effective at treating major depression as well as antidepressant drugs, without the side effects Deep Brain Stimulation (DBS): “pacemaker for the brain”

ECLECTICISM Eclecticism: therapy that involves multiple perspectives