THE THERAPEUTIC ENTERPRISE: CHOICES, TECHNIQUES, EVALUATION CHAPTER 16 THE THERAPEUTIC ENTERPRISE: CHOICES, TECHNIQUES, EVALUATION

PSYCHOTHERAPY Psychodynamic Humanistic and Existential Behavioral Cognitive Cognitive-behavioral Group Cognitive-behavioral group Family and marital therapy Psychodrama

PSYCHODYNAMIC THERAPY Goal is insight into one’s inner life Transference – Patient displaces affect and feeling about others onto the therapist Counter transference – Therapists’ emotional responses to patient Psychoanalysis – Special type of psychodynamic therapy using free association and examination of dreams and fantasies Some use hypnosis to uncover repressed material

HUMANISTIC AND EXISTENTIAL THERAPIES Emphasis on people’s desire to achieve self-respect Cark Rogers’ client-centered therapy Nonjudgmental, nondirective Atmosphere of unconditional positive regard Existential Emphasis on people’s needs to confront questions about meaning and direction of their lives Combine humanistic and psychodynamic techniques Gestalt therapy based on view that people need to get in touch with disowned parts of themselves

COGNITIVE PSYCHOTHERAPY Goal – Solve emotional problems through cognitive restructuring Aaron Beck – Focuses on changing automatic thoughts Albert Ellis – Rational-emotive therapy emphasizes needs to change self-defeating thinking and beliefs Brief psychotherapies – Fewer than 12 sessions; specific goals and targets. Interpersonal psychotherapy – A form of brief therapy that focuses on social relationships

PRINCIPAL ELEMENTS OF COGNITIVE THERAPY Presentation of cognitive rationale to patient Short-term intervention Focus on the “here and now” Patient-therapist collaboration Questions and homework Maintain daily records of mood, behavior, and dysfunctional thoughts Carry out informal experiments to test thoughts, beliefs, and assumptions Apply newly acquired cognitive schema to real-life situations.

BEHAVIOR THERAPY Forerunner of cognitive-behavioral therapy Behavioral modification Based on operant conditioning Uses reinforcement and shaping Token economy – Reinforces desired behaviors Biofeedback – Can help develop control of internal processes

COGNITIVE-BEHAVIOR THERAPY Integrates cognitive and behavioral elements Relaxation training Exposure therapy Flooding Implosive therapy Systematic desensitization In vivo exposure Modeling Behavioral rehearsal Assertiveness training

FACTORS IN SUCCESSFUL USE OF RELAXATION TRAINING The individual’s problems do not have an organic basis. The individual is not psychotic, depressed, or subject to panic attacks. The individual is able to assume responsibility for active participation in treatment, with special emphasis on home practice. Family members are cooperative with and supportive of the individual’s treatment. The individual has reasonable expectations of the training’s effectiveness.

GROUP THERAPY Several people with similar problems Group membership provides Acceptance and support Normative information about behavior/feelings Learning through modeling and behavioral rehearsal Cognitive-behavioral group therapy Goal is development of social skills and comfort in social situations Family and marital therapy View marriage and family as a system Learn how behaviors affect each other Psychodrama Group acts out events of emotional significance

RESEARCH ON PSYCHLOGICAL THERAPIES Important to distinguish between unique and common features among therapies Important to determine therapeutic outcomes No one form of therapy is superior than the other overall Research needs to determine extent to which cultural and ethnic factors play a role in processes and outcomes of therapeutic interventions

BIOLOGICAL THERAPIES Electroconvulsive therapy (ECT) Drug therapies Used for severe depression when drugs and other therapies have failed Drug therapies Antipsychotic Antimanic Antidepressant Antianxiety Effectiveness of biological therapies Effective for particular disorders Multimodal treatment Medication and psychotherapy is possibly more effective than either intervention alone.

HOSPITALIZATION Reasons for hospitalization Behaviors poses threat to self or others Behavior intolerable to community Outpatient treatment failed Treatment requires controlled setting Withdrawal from drugs or alcohol Physical illness complicated by mental disorder requiring continuous care

HOSPITALIZATION Partial hospitalization Day hospitalization When complete hospitalization not required Day, evening, or weekend care Day hospitalization For patients who can live at home but need structure and social interaction Deinstitutionalization Movement in the 1960s to return hospitalized patients to the community for community-based treatment Made possible by discovery of psychoactive drugs Lack of adequate community care has led to increased homelessness and gaps in treatment for seriously mentally ill