Chapter 13: Methods of Therapy

Learning Outcomes Define psychotherapy and describe the history of treatment of psychological disorders Describe traditional psychoanalysis and short- term psychodynamic therapies

Learning Outcomes Define humanistic therapy and contrast its two main approaches Define behavior therapy and identify various behavioral approaches to therapy

Learning Outcomes Define cognitive therapy and describe Beck’s approach and REBT Identify various types of group therapy and discuss their advantages and disadvantages

Learning Outcomes Explain whether psychotherapy works and who benefits from it Describe methods of biological therapy - their benefits and side effects

What is Psychotherapy?

Psychotherapy Systematic interaction between client and therapist Based on psychological principles Influences clients’ thoughts, feelings, and behavior Clients use it for psychological disorders, adjustment problems, and/or personal growth

History of Therapies Asylums Mental Hospitals Community Mental Health Movement

The Unchaining of the Patients at La Salpêtrière

Truth or Fiction? Residents of London used to visit the local insane asylum for a fun night out on the town.

Truth or Fiction? Residents of London used to visit the local insane asylum for a fun night out on the town. TRUE!

Psychodynamic Therapies

Traditional Psychoanalysis Insight Catharsis Free Association Resistance Transference Dream Analysis – Wish Fulfillment

Freud’s Consulting Room

Modern Psychodynamic Approaches Briefer, less intense, usually directive Ego analysis – More focus on ego, less on the id

Humanistic Therapies

Client-Centered Therapy Carl Rogers Provide insight into parts of us we have disowned so we may feel whole Warm, therapeutic atmosphere – Unconditional positive regard – Empathy – Genuineness

Truth or Fiction? Some psychotherapists let their clients take the lead in psychotherapy.

Truth or Fiction? Some psychotherapists let their clients take the lead in psychotherapy. TRUE!

Gestalt Therapy Fritz Perls Integrate conflicting parts of the personality Directive, focused on the here and now

Behavior Therapy

Apply principles of learning to directly promote desired behavioral changes – Conditioning and observational learning – Discontinue self-defeating behaviors

Truth or Fiction? Some psychotherapists tell their clients exactly what to do.

Truth or Fiction? Some psychotherapists tell their clients exactly what to do. TRUE!

Fear-Reduction Methods Systematic desensitization – Confront hierarchy of stimuli – Counterconditioning Virtual Therapy Modeling – Observational learning

A Program Containing Images of the World Trade Center Intended to Help People with PTSD

Truth or Fiction? Lying in a reclining chair and fantasizing can be an effective way of confronting fears.

Truth or Fiction? Lying in a reclining chair and fantasizing can be an effective way of confronting fears. TRUE!

Eye-Movement Desensitization and Reprocessing EMDR – used to treat stress disorders Research does not explain why it works – Are the eye movements necessary? – May have to do with relationship with therapist and exposure to trauma while believing it can be managed

Aversive Conditioning Pair an aversive stimuli with the unwanted impulse – Used to eliminate unwanted habits and antisocial behaviors

Truth or Fiction? Smoking cigarettes can be an effective method for helping people stop smoking cigarettes.

Truth or Fiction? Smoking cigarettes can be an effective method for helping people stop smoking cigarettes. TRUE!

Aversive Conditioning

Operant Conditioning Token economy Successive approximation Biofeedback training

Social Skills Training Decrease social anxiety and build social skills through operant conditioning techniques – Self-monitoring, behavior rehearsal, and feedback

Cognitive Therapies

Cognitive Therapy Changing beliefs, attitudes, and automatic types of thinking that create and compound problems – Awareness of current cognitions

Aaron Beck’s Cognitive Therapy Client confronts feelings and beliefs that make no sense Become aware of cognitive errors

Rational Emotive Behavior Therapy Albert Ellis Challenge irrational beliefs – Need for love and approval of others – Need to prove oneself to be thoroughly competent, adequate, achieving

Cognitive-Behavioral Therapy Integration of behavioral and cognitive therapies

Group Therapies

Advantages – Economical – More experiences for client to draw upon – Social support of the group – Affiliation with people with similar problems – Improvement provides hope for others – Practice social skills in safe environment Disadvantages – Unable to express feelings to group

Group Therapies Couple therapy – Improve communication and manage conflict – Cognitive behavioral approach Family therapy – Systems approach Self-help and support groups – Alcoholics Anonymous (AA)

Does Psychotherapy Work?

Truth or Fiction? There is no scientific evidence that psychotherapy helps people with psychological disorders.

Truth or Fiction? There is no scientific evidence that psychotherapy helps people with psychological disorders. FICTION!

Effectiveness of Psychotherapy Meta-analysis – People who obtain psychotherapy of client- centered therapies fare better than those who do not – Must consider type of therapy; type of problem; and type of patient

Effectiveness of Psychotherapy Cognitive therapies – Best used for anxiety and depression – Also used with personality disorders

Evidence –Based Practices Use of random controlled experiments (RCEs) – May favor cognitive-behavioral therapies – May not capture the complexity of clients in community settings

Examples of Evidence-Based Practices

Ethnicity and Psychotherapy Ethnic minority groups in US less likely than European Americans to seek therapy – Not aware of helpfulness of therapy – Lack of information on services – Distrust of professionals – Language barriers

Ethnicity and Psychotherapy Ethnic minority groups in US less likely than European Americans to seek therapy – Reluctance to open up to strangers – Cultural inclinations toward other approaches – Negative experiences

Ethnicity and Psychotherapy African Americans – reluctant to seek help; suspicious of therapist Asian Americans – stigmatize people with disorders therefore deny problems Latino/Latina Americans – value of family interdependence conflicts with goal for self- reliance Native Americans – Disruption of traditional culture

Biological Therapies

Drug Therapy Antianxiety Drugs – Rebound anxiety Antipsychotic Drugs Antidepressants – Selective serotonin-reuptake inhibitors Mood stabilizers

Other Biological Therapies Electroconvulsive Therapy – Side effects include memory problems Psychosurgery – Prefrontal lobotomy – Pioneered by Antonio Egas Moniz

Electroconvulsive Therapy

Truth or Fiction? The originator of a surgical technique to reduce violence learned that it was not always successful when one of his patients shot him.

Truth or Fiction? The originator of a surgical technique to reduce violence learned that it was not always successful when one of his patients shot him. TRUE!

Does Biological Therapy Work? Drug therapies have been effective – Must consider side effects Psychotherapy and pharmacotherapy – Depression – Schizophrenia ECT as last resort