©John Wiley & Sons, Inc Huffman: Psychology in Action (8e) Psychology in Action (8e) by Karen Huffman PowerPoint  Lecture Notes Presentation Chapter 12: Therapy Karen Huffman, Palomar College

©John Wiley & Sons, Inc Huffman: Psychology in Action (8e) Lecture Overview Insight Therapies Behavior Therapies Biomedical Therapies Therapy and Critical Thinking

©John Wiley & Sons, Inc Huffman: Psychology in Action (8e) Psychotherapy: techniques employed to improve psychological functioning and promote adjustment to life Three Major Approaches to Therapy:  Insight (personal understanding)  Behavior (maladaptive behaviors)  Biomedical (mental illness and medical treatments, such as drugs) Introductory Definitions

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Four Major Forms of Insight Therapy Psychoanalysis/ psychodynamic Cognitive Humanistic Group, Family, and Marital

©John Wiley & Sons, Inc Huffman: Psychology in Action (8e) Insight Therapies: Psychoanalysis/Psychodynamic Psychoanalysis: Freudian therapy designed to bring unconscious conflicts into consciousness

©John Wiley & Sons, Inc Huffman: Psychology in Action (8e) Insight Therapies: Psychoanalyis/Psychodynamic Five Major Techniques of Psychoanalysis: 1. Free association 2. Dream analysis 3. Analyzing resistance 4. Analyzing transference 5. Interpretation

©John Wiley & Sons, Inc Huffman: Psychology in Action (8e) Insight Therapies: Psychoanalysis/Psychodynamic Evaluation of psychoanalysis: Limited applicability and lack of scientific credibility Psychodynamic Therapy: briefer, more directive, and more modern form of psychoanalysis that focuses on conscious processes and current problems

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Insight Therapies: Cognitive Cognitive Therapy: focuses on faulty thinking and beliefs  Improvement comes from insight into negative self-talk (unrealistic things a person has been telling himself or herself)  Cognitive Restructuring (process of changing destructive thoughts or inappropriate interpretations)

©John Wiley & Sons, Inc Huffman: Psychology in Action (8e) Insight Therapies: Cognitive (Continued) Two Major Cognitive Therapies: 1. Albert Ellis’s Rational-Emotive Behavior Therapy (REBT) 2. Aaron Beck’s Cognitive-Behavior Therapy

©John Wiley & Sons, Inc Huffman: Psychology in Action (8e) Insight Therapies: Cognitive (Continued) Ellis’s Rational-Emotive Behavior Therapy (REBT): eliminates self-defeating beliefs through rational examination

©John Wiley & Sons, Inc Huffman: Psychology in Action (8e) Beck’s Cognitive-Behavior Therapy: confronts and changes behaviors associated with destructive cognitions Depressive Thinking Patterns:  selective perception  overgeneralization  magnification  all-or-nothing thinking Insight Therapies: Cognitive (Continued)

©John Wiley & Sons, Inc Huffman: Psychology in Action (8e) Insight Therapies: Cognitive (Continued) Evaluation of cognitive therapy: Pro: Considerable success with a range of problems Con: Criticized for overemphasizing rationality, ignoring unconscious dynamics, minimizing importance of the past, etc.

©John Wiley & Sons, Inc Huffman: Psychology in Action (8e) Insight Therapies: Humanistic Humanistic therapy: Maximizes personal growth through affective restructuring (emotional readjustment) Key assumption: People with problems are suffering from a blockage or disruption of their normal growth potential, which leads to a defective self-concept.

©John Wiley & Sons, Inc Huffman: Psychology in Action (8e) Rogers’s Client-Centered Therapy: emphasizes client’s natural tendency to become healthy and productive Techniques include:  Empathy  Unconditional positive regard  Genuineness  Active listening Insight Therapies: Humanistic (Cont.)

©John Wiley & Sons, Inc Huffman: Psychology in Action (8e) Insight Therapies: Humanistic (Continued) Evaluation of humanistic therapy: Pro: Evidence for success Con: Basic tenets, such as self- actualization, difficult to test scientifically

©John Wiley & Sons, Inc Huffman: Psychology in Action (8e) Insight Therapies: Group, Family, and Marital Therapies Group Therapy: a number of people meet together to work toward therapeutic goals Family and Marital Therapies: work to change maladaptive family and couple interaction patterns

©John Wiley & Sons, Inc Huffman: Psychology in Action (8e) Behavior Therapies Behavior Therapy: group of techniques based on learning principles used to change maladaptive behaviors Three foundations of behavior therapy:  Classical conditioning  Operant conditioning  Observational learning

©John Wiley & Sons, Inc Huffman: Psychology in Action (8e) Behavior Therapies: Classical Conditioning Systematic Desensitization: gradual process of extinguishing a learned fear (or phobia) by working through a hierarchy of fearful stimuli while remaining relaxed

©John Wiley & Sons, Inc Huffman: Psychology in Action (8e) Behavior Therapies: Classical Conditioning

©John Wiley & Sons, Inc Huffman: Psychology in Action (8e) Behavior Therapies: Classical Conditioning  Aversion Therapy: pairing an aversive (unpleasant) stimulus with a maladaptive behavior

©John Wiley & Sons, Inc Huffman: Psychology in Action (8e) Behavior Therapies: Operant Conditioning Operant Conditioning Techniques Used to INCREASE Adaptive Behaviors: Shaping--successive approximations of target behavior are rewarded (includes role-playing, behavior rehearsal, assertiveness training) Tokens: symbolic rewards used to immediately reinforce desired behavior

©John Wiley & Sons, Inc Huffman: Psychology in Action (8e) Behavior Therapies: Operant Conditioning Operant Conditioning Techniques Used to DECREASE Maladaptive Behaviors: Extinction: withdrawal of attention Punishment: adding or taking away something (e.g., time-out)

©John Wiley & Sons, Inc Huffman: Psychology in Action (8e) Behavior Therapies: Observational Learning Modeling: watching and imitating models that demonstrate desirable behaviors Participant Modeling: combining live modeling with direct and gradual practice

©John Wiley & Sons, Inc Huffman: Psychology in Action (8e) Behavior Therapies (Continued) Evaluation of behavior therapies: Pro: Strong evidence for success with a wide range of problems Con: Questioned and criticized for generalizability and ethics

©John Wiley & Sons, Inc Huffman: Psychology in Action (8e) Biomedical Therapies Biomedical Therapy: uses physiological interventions, such as drugs, to reduce or alleviate symptoms of psychological disorders Three forms of biomedical therapy:  Psychopharmacology  Electroconvulsive therapy (ECT)  Psychosurgery

©John Wiley & Sons, Inc Huffman: Psychology in Action (8e) Biomedical Therapies: Psychopharmacology Four major categories of drugs: Antianxiety (increases relaxation, reduces anxiety and muscle tension) Antipsychotic (treats hallucinations and other symptoms of psychosis) Mood Stabilizer (treats manic episodes and depression) Antidepressant (treats symptoms of depression)

©John Wiley & Sons, Inc Huffman: Psychology in Action (8e) Biomedical Therapies: Psychopharmacology

©John Wiley & Sons, Inc Huffman: Psychology in Action (8e) Psychopharmacology— How Antidepressants Work

©John Wiley & Sons, Inc Huffman: Psychology in Action (8e) Biomedical Therapies (Continued) Electroconvulsive Therapy: based on passing electrical current through the brain and used when other methods have not been successful Psychosurgery: operative procedures on the brain designed to relieve severe mental symptoms that have not responded to other forms of treatment

©John Wiley & Sons, Inc Huffman: Psychology in Action (8e) Therapy and Critical Thinking Therapy Essentials--Five Common Goals

©John Wiley & Sons, Inc Huffman: Psychology in Action (8e) Therapy and Critical Thinking

©John Wiley & Sons, Inc Huffman: Psychology in Action (8e) Therapy and Critical Thinking: Gender and Cultural Diversity Cultural Similarities in Therapy: naming a problem qualities of the therapist establishing credibility placing the problems in a familiar framework applying techniques to bring relief a special time and place

©John Wiley & Sons, Inc Huffman: Psychology in Action (8e) Cultural Differences:  Therapies in individualistic cultures emphasize independence, the self, and control over one’s life.  Therapies in collectivist cultures emphasize interdependence. Therapy and Critical Thinking: Gender and Cultural Diversity (Cont.)

©John Wiley & Sons, Inc Huffman: Psychology in Action (8e) Key considerations for women and therapy: 1. Higher rate of diagnosis and treatment of mental disorders 2. Stresses of poverty 3. Stresses of multiple roles 4. Stresses of aging 5. Violence against women Therapy and Critical Thinking: Gender and Cultural Diversity (Cont.)

©John Wiley & Sons, Inc Huffman: Psychology in Action (8e) Institutionalization— Criteria for involuntary commitment: – Dangerous to self or others – Believed to be in serious need of treatment – No reasonable alternatives Therapy and Critical Thinking: Institutionalization

©John Wiley & Sons, Inc Huffman: Psychology in Action (8e) Deinstitutionalization: discharging as many people as possible from state hospitals and discouraging admissions Community services such as community mental health (CMH) centers work to cope with the problems of deinstitutionalization. Therapy and Critical Thinking: Institutionalization (Continued)

©John Wiley & Sons, Inc Huffman: Psychology in Action (8e) Therapy and Critical Thinking: Evaluating and Finding Therapy Forty to 90 % who receive therapy are better off than people who do not. Guidelines for Finding a Therapist: Take time to “shop around.” If in a crisis, call 24-hour hotlines or college counseling centers. If others’ problems affect you, get help yourself.

40 Overestimating the Effectiveness of Psychotherapy. Clients tend to overestimate the effectiveness of psychotherapy because they enter therapy in crisis. With the normal ebb and flow of events, the crisis passes and people attribute their improvement to the therapy. Clients may also need to believe that the investment of time and money has been worth it.

41 Overestimating the Effectiveness of Psychotherapy. Finally, clients generally speak positively of therapists who have been very understanding and who have helped them gain a new perspective. Research has generally not supported clients’ estimates of therapy’s effectiveness.

42 Overestimating the Effectiveness of Psychotherapy. Clients enter therapy when they are extremely unhappy, usually leave when they are less extremely unhappy, and stay in touch only if satisfied. Thus, therapists, like most clients, testify to therapy’s success. Clinicians are mostly aware of other therapists’ failures as clients seek new therapists for their recurring problems.

43 Overestimating the Effectiveness of Psychotherapy. Two phenomena that contribute to perceived value in ineffective therapies are the 1. placebo effect (the belief a treatment will work) and 2. regression toward the mean (the tendency for extremes of unusual scores to fall back toward the average). Feeling low tends to be followed by our return to a more normal state and anything we tried in the interim may seem effective.

44 Overestimating the Effectiveness of Psychotherapy. A common error made by clinicians involves illusory correlations (perceived expected associations) Hindsight bias Overconfidence Client’s induced to give information that fulfills clinician’s expectations- self-fulfilling prophecy

45 Outcome Studies Randomized clinical trials assign people on a waiting list to therapy or no therapy. Research that includes use of meta-analysis reveals that (1) people who remain untreated often improve; (2) those who receive psychotherapy are more likely to improve, and (3) when people seek psychological treatment, their search for other medical treatment declines, compared with their counterparts on waiting lists.

46 Clients who expressed greatest satisfaction with their care and who had the best outcomes were more likely to: Research their problem before seeking help. Interview with more than one professional. Ask therapists if they had experience treating their problem. Bring a friend or family member along to an office visit. Keep a written record of their treatment and emotional state. Deliberately apply what they were learning in treatment to their daily lives.

47 Effective Therapies No one therapy has been shown to be best in all cases, nor is there any relationship between clinicians’ experience, training, supervision, and licensing and their clients’ outcomes.

48 Effective Therapies Some therapies are, however, well suited to particular disorders such as: cognitive, interpersonal, and behavior therapies for depression; cognitive, exposure, and stress inoculation therapies for anxiety; cognitive-behavior therapy for bulimia; behavior modification for bedwetting.

49 Effective Therapies In addition, behavioral conditioning therapies achieve especially favorable results in treating phobias, compulsions, marital problems, and sexual disorders. Therapy is most effective when the problem is clear-cut.

50 Effective Therapies In contrast, the light exposure therapies (exposure to daily doses of light that mimics outdoor light) have proven effective in treating people with seasonal affective disorder, a form of depression linked to periods of decreased sunlight.

51 Effective Therapies Writing About Emotional Experience the mere act of disclosure may be a powerful therapeutic agent. Research indicates that writing about personally upsetting experiences produces consistent and significant health benefits. Talking and writing about emotional experiences are both superior to writing about superficial topics. Most interesting is the finding that social feedback seems unnecessary to produce beneficial results.

52 Effective Therapies To the degree that a problem has biological underpinnings because it is predisposed or heritable, it will be harder to change. To the degree it is a learned habit, it is easier to change.

53 Three Benefits of the Therapies 1. They all offer the expectation that, with commitment from the patient, things can and will get better. 2. Every therapy offers people a plausible explanation of their symptoms and an alternative way of looking at themselves and responding to their worlds.

54 Three Benefits of the Therapies 3. Regardless of their therapeutic technique, effective therapists are  empathic people who seek to understand another’s experience,  who care and have concern about how the client feels, and  Who demonstrate respectful listening, reassurance, and advice earn the client’s trust and respect. In short, all therapies offer hope for demoralized people, a new perspective on oneself and the world, and an empathic, trusting, caring relationship.

55 Values and Cultural Differences Psychotherapists’ personal beliefs and values influence their therapy. While nearly all agree on the importance of encouraging clients’ sensitivity, openness, and personal responsibility, they differ sharply on the pursuit of self-gratification, self-sacrifice, and interpersonal commitment.

©John Wiley & Sons, Inc Huffman: Psychology in Action (8e) Psychology in Action (8e) by Karen Huffman PowerPoint  Lecture Notes Presentation End of Chapter 15: Therapy Karen Huffman, Palomar College