C hapter Fifteen Therapy © 2012 John Wiley & Sons, Inc. All rights reserved.

Psychotherapy Techniques employed to improve psychological functioning and promote adjustment to life © 2012 John Wiley & Sons, Inc. All rights reserved.

Myths About Therapy There is one best therapy Therapists can read your mind People who go to therapists are crazy or weak Only the rich can afford therapy If I am taking meds, I don’t need therapy © 2012 John Wiley & Sons, Inc. All rights reserved.

Major Approaches to Therapy © 2012 John Wiley & Sons, Inc. All rights reserved. ANIMATION Cognitive Behavior Therapy

INSIGHT THERAPIES © 2012 John Wiley & Sons, Inc. All rights reserved.

Insight Therapies Definition Variety of therapies seeking to improve psychological functioning by increasing awareness of underlying motives and improvement in thoughts, feelings, and/or behavior Types Psychoanalysis/Psychodyna- mic therapies Cognitive therapy Humanistic therapy Group, family, and marital therapies © 2012 John Wiley & Sons, Inc. All rights reserved.

Psychoanalysis Freudian therapy designed to bring unconscious conflicts into conscious awareness © 2012 John Wiley & Sons, Inc. All rights reserved.

Psychoanalysis Major Criticisms Limited applicability Lack of scientific credibility © 2012 John Wiley & Sons, Inc. All rights reserved.

Modern Psychodynamic Therapy A briefer, more directive, and more modern form of psychoanalysis focusing more on conscious processes and current problems © 2012 John Wiley & Sons, Inc. All rights reserved.

Cognitive Therapies Cognitive Therapy Therapy that treats problem behaviors and mental processes by focusing on faulty thought processes and beliefs Self-Talk Internal dialogue; the things people say to themselves when they interpret events © 2012 John Wiley & Sons, Inc. All rights reserved.

Cognitive Therapies Cognitive Restructuring Process in cognitive therapy to change destructive thoughts or inappropriate interpretations Cognitive-Behavior Therapy Combines cognitive therapy (changing faulty thinking) with behavior therapy (changing faulty behaviors) © 2012 John Wiley & Sons, Inc. All rights reserved.

Cognitive Restructuring © 2012 John Wiley & Sons, Inc. All rights reserved.

Rational-Emotive Behavior Therapy (REBT) Cognitive therapy to eliminate emotional problems through rational examination of irrational beliefs (e.g. “musts” and “shoulds”) Albert Ellis © 2012 John Wiley & Sons, Inc. All rights reserved.

Rational-Emotive Behavior Therapy (REBT) © 2012 John Wiley & Sons, Inc. All rights reserved.

Rational-Emotive Behavior Therapy (REBT) Overcoming Irrational Misconceptions 1.Identify and confront your belief system 2.Evaluate consequences 3.Practice effective ways of thinking and behaving © 2012 John Wiley & Sons, Inc. All rights reserved.

Beck’s Cognitive Therapy Distorted Thinking Patterns 1.Selective perception—focus on negative events 2.Overgeneralization 3.Magnification—exaggerating undesirables and shortcomings 4.All-or-nothing thinking—seeing things in black or white Recognize and track thoughts, then test these thoughts against reality © 2012 John Wiley & Sons, Inc. All rights reserved. ANIMATION Cognitive Behavior Therapy

Evaluating Cognitive Therapies Highly effective for: Depression Anxiety disorders Bulimia nervosa Anger management Addiction Procrastination Some forms of schizophrenia Insomnia Criticisms Ignoring unconscious processes Overemphasis on rationality Minimizing the importance of the past Uses behavior techniques rather than changing cognitive structure © 2012 John Wiley & Sons, Inc. All rights reserved.

Humanistic Therapies Therapy that focuses on removing obstacles that block personal growth and potential Client-Centered Therapy Rogers’s therapy emphasizing the client’s natural tendency to become healthy and productive. Clients (not “patients”) are in charge. © 2012 John Wiley & Sons, Inc. All rights reserved.

Client-Centered Therapy Therapeutic Qualities of Communication 1.Empathy—insightful awareness and ability to share another’s inner experience 2.Unconditional Positive Regard—love and acceptance with no contingencies 3.Genuineness/Authenticity 4.Active Listening—involves reflecting, paraphrasing, and clarifying © 2012 John Wiley & Sons, Inc. All rights reserved.

Evaluating Humanistic Therapies Support Evidence for efficacy of client-centered therapy Criticisms Core concepts are difficult to empirically test Data on outcomes rely on self-reports of clients Mixed results on specific therapeutic techniques © 2012 John Wiley & Sons, Inc. All rights reserved.

Group, Family, and Marital Therapies Group Therapy A number of people meet together to work toward therapeutic goals; guided by a therapist Self-Help Group Leaderless or nonprofessionally guided groups in which members assist one another with a specific problem © 2012 John Wiley & Sons, Inc. All rights reserved.

Group Therapy Advantages 1.Less expense 2.Group support 3.Insight and information 4.Behavior rehearsal Can supplement individual therapy © 2012 John Wiley & Sons, Inc. All rights reserved.

Family and Marital Therapies Goal is to change maladaptive family interaction patterns Most useful for treatment of marital infidelity, anger management, adolescent drug abuse, schizophrenia © 2012 John Wiley & Sons, Inc. All rights reserved.

Informal “Counseling” Skills Active listening Acceptance Avoid advice © 2012 John Wiley & Sons, Inc. All rights reserved.

BEHAVIOR THERAPIES © 2012 John Wiley & Sons, Inc. All rights reserved.

Behavior Therapies Group of techniques based on learning principles used to change maladaptive behaviors Focus on problem behavior rather than underlying causes Classical conditioning Operant conditioning Observational learning © 2012 John Wiley & Sons, Inc. All rights reserved. ANIMATION Classical Conditioning

Classical Conditioning Systematic Desensitization Gradual process of extinguishing a learned fear (phobia) by working through a hierarchy of fear-evoking stimuli while staying deeply relaxed; replace anxiety with relaxation Aversion Therapy Pairing an aversive (unpleasant) stimulus with a maladaptive behavior; learn negative associations © 2012 John Wiley & Sons, Inc. All rights reserved.

Systematic Desensitization © 2012 John Wiley & Sons, Inc. All rights reserved.

Aversion Therapy © 2012 John Wiley & Sons, Inc. All rights reserved.

Operant Conditioning Increase desired behaviors through reinforcement and shaping; may use tokens May use some punishment and extinction to eliminate undesired behavior Role playing/behavior rehearsal © 2012 John Wiley & Sons, Inc. All rights reserved. WILEY VIDEO Exercise and Depression

Observational Learning Modeling therapy—watching and imitating models that demonstrate desirable behaviors Useful for treating phobias and training in social skills and assertiveness © 2012 John Wiley & Sons, Inc. All rights reserved.

Evaluating Behavior Therapies Support for use in Phobias Obsessive-compulsive disorder Eating disorders Autism Intellectual disabilities Delinquency Criticisms Generalizability—to the “real world” outside of therapy Ethics—related to control © 2012 John Wiley & Sons, Inc. All rights reserved.

BIOMEDICAL THERAPIES © 2012 John Wiley & Sons, Inc. All rights reserved.

Biomedical Therapies Using biological interventions to treat psychological disorders Drugs Electroconvulsive therapy Psychosurgery Based on the premise that chemical imbalances or disturbed nervous system function are involved in mental health problems © 2012 John Wiley & Sons, Inc. All rights reserved. WILEY VIDEO Imaging Antidepressant Accuracy WILEY VIDEO Buzzed Brain

Psychopharmacology Study of drug effects on brain and behavior Four major categories: Antianxiety Antipsychotic Mood stabilizer Antidepressant © 2012 John Wiley & Sons, Inc. All rights reserved. WILEY VIDEO Placebo Effect WILEY VIDEO Brain Viagra

Drug Treatments © 2012 John Wiley & Sons, Inc. All rights reserved. WILEY VIDEO Post-Trauma Drugs

Drug Treatments © 2012 John Wiley & Sons, Inc. All rights reserved. WILEY VIDEO Antidepressant Suicide Genes

Electroconvulsive Therapy (ECT) Biomedical therapy based on passing electrical current through the brain Used almost exclusively to treat serious depression when drug therapy fails Likely affects mood controlling neurotransmitters © 2012 John Wiley & Sons, Inc. All rights reserved.

Psychosurgery Surgical alteration of the brain to bring about desirable behavioral, cognitive, or emotional changes Generally used when patients have not responded to other forms of treatment Lobotomy—outmoded medical procedure for mental disorders that involved cutting nerve pathways between the frontal lobes and the thalamus and hypothalamus © 2012 John Wiley & Sons, Inc. All rights reserved.

Evaluating Biomedical Therapies Psychopharmacology May provide relief but not a cure Physical dependence Side and long-term effects Tardivedyskinesia—movement disorder involving facial muscles, tongue, and limbs; possible side effect of long-term use of antipsychotic medications Overuse © 2012 John Wiley & Sons, Inc. All rights reserved.

Evaluating Biomedical Therapi es ECT and Psychosurgery ECT is controversial; seizures, memory loss Repetitive Transcranial Magnetic Stimulation (rTMS) may replace ECT Psychosurgery is controversial, with potentially serious or fatal side effects and complications © 2012 John Wiley & Sons, Inc. All rights reserved.

THERAPY ESSENTIALS © 2012 John Wiley & Sons, Inc. All rights reserved.

Common Goals of Therapy © 2012 John Wiley & Sons, Inc. All rights reserved.

Eclectic Approach Combining techniques from various theories to find the most appropriate treatment © 2012 John Wiley & Sons, Inc. All rights reserved.

Mental Health Professional s © 2012 John Wiley & Sons, Inc. All rights reserved.

Institutionalization Involuntary Commitment Generally can occur if people are believed to be: of danger to themselves or others in serious need of treatment or if there is no reasonable, less restrictive alternative Deinstitutionalization Discharging patients from mental hospitals as soon as possible and discouraging admissions © 2012 John Wiley & Sons, Inc. All rights reserved.

Evaluating Therapy Controlled research and meta-analyses 40 to 80% of those who receive treatment are better off than those who do not Short-term treatments can be as effective as long-term treatments Combination of therapy with medication is more effective than drugs alone Some therapies more effective for specific problems © 2012 John Wiley & Sons, Inc. All rights reserved.

Finding Therapy Critical/Urgent Need Hospital emergency services Hotlines Have time to search Ask for referrals University/college counseling center Seek therapist best suited to your goals © 2012 John Wiley & Sons, Inc. All rights reserved.

Culture and Therapy Similarities Naming the problem Qualities of the therapist Therapist credibility Familiar framework Techniques that bring relief Special time and place Differences Emphasis on self or interdependence Types of therapies Perceptions of the therapist © 2012 John Wiley & Sons, Inc. All rights reserved.

Gender and Therapy Unique concerns Rates of diagnosis and treatment of mental disorders Stresses of poverty Stresses of aging Violence against women Stresses of multiple roles © 2012 John Wiley & Sons, Inc. All rights reserved. WILEY VIDEO Smoking, Stress, and Gender