ABNORMAL PSYCHOLOGY, SIXTEENTH EDITION James N. Butcher/ Jill M. Hooley/ Susan Mineka Chapter 16 Therapy © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

An Overview of Treatment Conviction underlying psychotherapy People with psychological problems can change © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Why Do People Seek Therapy? People seeking therapy may Be in stressful current life circumstances Have long-standing problems Be reluctant and enter therapy at the request of a physician, spouse, or other Seek personal growth © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Who Provides Psychotherapeutic Services? Members of many different professions provide advice and counsel Physicians Clergy © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Who Provides Psychotherapeutic Services? Clergy and physicians generally refer seriously disturbed people to mental health professionals. Who are these professionals? © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Who Provides Psychotherapeutic Services? Mental health professionals Clinical psychologists Psychiatrists Psychiatric social workers © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

The Therapeutic Relationship Can you fill in the blanks? The key elements of an effective working alliance between client and therapist include: A sense of working ________ on the problem ________ between patient and therapist about the goals and tasks of therapy. A(n) ________between patient and therapist. © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

The Therapeutic Relationship Other qualities enhancing therapy Client’s motivation to change Client’s expectation of receiving help Protected setting Good match between client and therapist © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Measuring Success in Psychotherapy Estimated gains depend on Therapist’s impression of changes that have occurred Client’s reports of change Reports from the client’s family or friends Comparison of pretreatment and post- treatment scores on personality tests Measures of change in selected overt behaviors © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Objectifying and Quantifying Change Measuring change with quantitative methods Beck Depression Inventory Hamilton Depression Inventory fMRI © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Would Change Occur Anyway? Improvement often occurs without professional intervention Psychotherapy can accelerate improvement Research findings © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Can Therapy Be Harmful? Some clients harmed by encounters with psychotherapists 5-10% deteriorate during treatment Responsibilities of therapists © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

What Therapeutic Approaches Should Be Used? © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Evidence-Based Treatment Efficacy Determined via randomized clinical trials in which therapy is compared to placebo Methods Double-blind method is employed Therapies under investigation manualized © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Evidence-Based Treatment “Evidence-based” “Empirically supported” treatment Efficacy studies determine that a therapy works © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Medication or Psychotherapy? Advances in psychopharmacology Allow many to remain unhospitalized Include problems with side effects and matching drug and drug dosage to needs of specific patient May reduce symptoms but not cure disorder © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Combined (Medication plus Psychotherapy) Treatments Clinical Practice Medication and psychotherapy combined used for schizophrenia and bipolar disorder. Effectiveness Combined treatment often works better for chronic or recurrent depression. © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Psychosocial Approaches to Treatment

Behavior therapy Includes direct and active treatment Recognizes primacy of behavior Acknowledges role of learning Includes thorough assessment and evaluation © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Behavior Therapy Behavior therapy approaches Exposure therapy Aversion therapy Modeling Systematic Reinforcement approaches Token economies © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Behavior Therapy Characteristics Relatively brief Directed towards specific symptoms Best used with problems that are not pervasive or vaguely defined Often used with anxiety disorders © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Behavior Therapy Behavioral activation Relatively new development for treatment of depression Encourages greater engagement with life © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Cognitive or cognitive-behavioral therapy Attempts to change behavior by modifying self-statements Modifying construal of events Cognitive processes influence emotions, motivation, and behavior © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Cognitive and Cognitive-Behavioral Therapy Rational Emotive Behavior Therapy Developed by Albert Ellis Tries to change a client’s maladaptive thought processes that influence maladaptive emotional responses and behavior. © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Cognitive and Cognitive-Behavioral Therapy Beck’s cognitive therapy Problems like depression result from clients’ illogical thinking about themselves and the world around them. © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Cognitive and Cognitive-Behavioral Therapy Efficacy of cognitive therapy Well-documented with depression, anxiety disorders, conduct disorder, and bulimia © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Cognitive and Cognitive-Behavioral Therapy What do you think? Is cognitive change the “active ingredient” in cognitive therapy? © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Humanistic-Experiential Therapies Humanistic- experimental therapies Client- centered therapy Gestalt therapy Motivational interviewing © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Humanistic-Experiential Therapies © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Psychodynamic Therapies Psychodynamic therapy basic forms Classical psychoanalysis Psychoanalytically oriented psychotherapy © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Psychodynamic Therapies Elements of Freudian psychoanalysis Free associationAnalysis of dreamsAnalysis of resistanceAnalysis of transference © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Psychodynamic Therapies Contemporary psychodynamic approaches Strongly interpersonal focus Object relations perspective Attachment-based and self- psychology perspectives © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Couple and Family Therapy Marital Therapy Short-term therapy based on social learning model. Teaches partners caring behaviors and conflict resolution through communication and problem solving. © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Couple and Family Therapy Family Systems Therapy Within-family behavior of any particular family member is influenced by behaviors and communications of other family members. © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Couple and Family Therapy Integrative behavioral couple therapy Increasingly replacing traditional behavioral couple therapy Focuses more on acceptance versus change Structural family therapy Form of family therapy that emphasizes new organization of family relationships Requires an active, but non-directive, therapeutic approach © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Eclecticism and Integration Electicism Labels orientation as eclectic, which borrows and combines techniques and concepts from various approaches Interpersonal therapy Focuses on changing current relationships to reduce depression © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Sociocultural Perspectives Critics Psychotherapy viewed as attempt to get people adjusted to a “sick” society Therapists seen as guardians of status quo © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Social Values and Psychotherapy Therapists’ own value judgments can affect decisions they make about treating clients. Can you think of an example to illustrate this statement? © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Psychotherapy and Cultural Diversity Members of minorities Underrepresented in treatment research studies Underserved by mental health system Affected by different backgrounds than their therapists © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Biological Approaches to Treatment © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Antipsychotic Drugs Antipsychotic drugs Used to treat psychotic disorders such as schizophrenia and psychotic mood disorders Atypical antipsychotic drugs Have a lower risk of side effects Treat positive and negative symptoms © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Antidepressant Drugs Most widely prescribed antidepressant drugs Selective serotonin re-uptake inhibitors Older antidepressants Monoamine oxidase inhibitors Tricyclic antidepressants Trazodone © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Anti-Anxiety Drugs Most widely prescribed anti-anxiety drugs Benzodiazepines Buspirone © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Lithium and Other Mood-Stabilizing Drugs Lithium Very effective in treating bipolar mood disorders Other mood- stabilizing drugs Divalproic acid Carbamazepine © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Electroconvulsive Therapy Electroconvulsive therapy Used to treat severe mood disorders Safe, effective, and important form of treatment Often used after others have failedKinds: Bilateral ECT, unilateral ECT © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Figure 16.4: Unilateral and Bilateral Electrode Placement for ECT © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Neurosurgery Decreased with use of antipsychotic drugs Effective with debilitating OCD, self- mutilation, or anorexia Includes deep brain stimulation © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Unresolved Issues Managed care companies get financial incentives when patients choose medication over psychotherapy. Has the pharmaceutical industry made questionable claims about biological causes of mental illness for money? Do these medications create more long-term problems for patients? © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.