Psychotherapies Treatment of mental illness by psychological rather than medical means.

Types of Psychotherapies Psychoanalytic Humanistic Behavioral Cognitive

Types of Therapists Psychiatrists Clinical psychologists Medical doctor + PhD / prescribe medication Clinical psychologists PH.D. (focus is psych disorders) Counseling psychologist Graduate degree

Psychotherapy Points to Consider “Patient”: Biomedical / psychoanalytical “Client”: Other therapists Insight Therapy: Psychoanalytic and Humanistic Stress importance of patient / client understanding their problems

Psychoanalytic Therapy Psychoanalysis: Freudian: (sexual conflict) Psychodynamic: Uncovering the unconscious

Psychoanalysis Review of Key Principles Unconscious conflict manifests in outward behavior, thoughts Find underlying (unconscious) problem Methods Hypnosis, free association, dream analysis Dream Analysis: Manifest and Latent Content “only true solution”- symptom substitution other therapies mask it- thus conflict expresses itself in new form Subjective: based on interpretation

Psychoanalysis Therapy Principles Resistance Transference Patient objections, natural result of getting closer to disturbing conflicts (the closer, the more discomfort and thus more resistance) Transference Patients develop strong feelings for therapist (love, parental feelings, or hatred / transferred from feelings toward others to therapist)

Psychoanalysis Points of interest Patient attends treatment 4-5 x a week Analysts looks for & records repetitions of behavior (unconscious) Therapist says little (then interprets at the end of session) Dream Analysis (often uses free association to analyze parts of a dream) Weaknesses Not sanctioned by state or federal government Expensive / not covered by insurance Only 20 psychoanalytic schools in U.S.

Humanistic Therapies Review of Key Principles: Maslow, Rogers Focus on self-concept (understanding self) Self-Actualization: help support, recognize goals = self-fulfillment Free will (as opposed to determinism) Man’s nature as good

Carl Rogers (Humanistic) Client-centered therapy (aka person-centered: (genuineness, acceptance, empathy) Unconditional Positive Regard Essential for healthy development Non-directive Don’t tell clients what to do, but encourage them to choose course of action for themselves Therapist says little… Active listening: “So what I’m hearing you say is….”

Gestalt (Humanistic) Fritz Perls “Whole is greater than sum of its parts” Get in touch with “whole self” Integrate thoughts, actions, feelings, talents, goals, body into harmonious whole Body as extension of self Healing a fragmented patient

Behavioral Therapy Review of Key Principles Pavlov, Watson, Skinner Classical / Operant “All behavior is learned” Behavioral Modification, (or changing maladaptive actions)

Behavioral Therapy Counterconditioning / Mary Cover Jones Classical conditioning Negative CR (Conditioned response) is replaced by positive CR Example: Joey cries hysterically every time he goes to the dentist. Candy / toy upon entering dentists = positive CR

Behavioral Therapy Counterconditioning Joseph Wolpe / Systematic Desensitization Replace anxiety with relaxation Step one: relaxation techniques (breathing / meditation) Step two: anxiety hierarchy: rank ordered list of fear (least to most) Start with least- incremental move up the ladder- learning to relax at each step Classical / counterconditioning: more x relaxation paired with fear, stronger relaxation response becomes Feared stimulus is imagined Implosive Therapy: Imagine biggest fear first

Behavioral Therapy In vivo desensitization Aversive conditioning Confronting actual fear (not just imagining it) Flooding: experiencing one’s peak fear Idea is to realize irrationality of fear (huge anxiety factor) Aversive conditioning Pairing undesired behavior with unpleasant stimulus (Baby Albert) Instrumental Conditioning: Token economies Modeling: observation and imitation (Role play)

Cognitive Therapy (aka cognitive-behavior therapy) Most widely practiced therapy Core assumption: Conscious thoughts are most influential to our psychological well-being Changing unhealthy thought patterns Combative nature: challenge irrational thinking (negative attributional styles)

Cognitive Therapy Rational Emotive Behavior Therapy (REBT or RET) Albert Ellis Expose and confront irrational thoughts Example: social phobia Question likelihood of occurrence, likely result

Cognitive Therapy Aaron Beck: Cognitive Triad Negative thoughts about self, environment and future result in depression Develop positive thoughts for each factor

Somatic Therapies Soma = body (bodily changes) Biomedical = organic causes of disorders Neurotransmitters / hormones Structural brain abnormalities Genetic predispositions

Somatic Therapies Drug Therapy (psychopharmacology) Schizophrenia: Antipsychotic drugs (Neuroleptics) Thorazine: to control positive symptoms such as hallucinations, voices, or paranoia Clozapine: counteracts negative symptoms (Catatonic) Haldol Block receptor sites for dopamine Tardive dyskinesia: trembling side-effect Mood Disorders Anti-Depressants Unipolar: Prozac, Zoloft, Paxil (Clinical depression) Bipolar: Lithium (Manic phase: stabilizes Norepinephrine production)

Somatic Therapy Drug Therapy Anxiety Disorders Librium, Valium, Xanax Relaxers, slows Central Nervous System

An eclectic approach… Therapists often use… Multiple perspectives- based on condition / needs of patient IOW: “Different tools for different problems”

Somatic Therapy Electroconvulsive therapy (ECT) Bilateral = both hemispheres of brain Unilateral = one hemisphere Theory: changes brain’s blood flow pattern Side effects Memory loss, brief seizure, brief loss of consciousness Severe depression (last resort)

Somatic Therapy Psychosurgery Prefrontal lobotomy Cutting main neurons to the frontal lobe = mental vegetable

Therapy Sessions Individual Group therapy sessions Advantages? Examples? Family therapy Marital therapy Play therapy (for children) Multisystemic therapy (coordinating specific environments)