Chapter 13 Overview Insight therapies Relationship therapies Behavior therapies Cognitive therapies Biomedical therapies Evaluating the therapies The therapeutic relationship

Insight Therapies Approaches to psychotherapy based on the notion that psychological well-being depends on self-understanding

What are the basic techniques of psychodynamic therapies? Psychotherapies that attempt to uncover repressed childhood experiences that are thought to cause the patient’s current problems Psychoanalysis is a technique developed by Freud Free association Explores the unconscious by having patients reveal whatever thoughts, feelings, or images come to mind Dream analysis Areas of emotional concern repressed in waking life are sometimes expressed in symbolic form in dreams Transference Emotional reaction that occurs during psychoanalysis, in which the patient displays feelings and attitudes toward the analyst that were present in another significant relationship

What are the basic techniques of psychodynamic therapies? Object relations therapy Based on idea that early relationships form blueprints for future relationships Therapist helps clients restructure current relationships, changing maladaptive patterns formed in early relationships Interpersonal therapy Brief psychotherapy that helps clients understand and cope with four interpersonal problems associated with depression Severe response to death of a loved one Interpersonal role disputes Difficulty adjusting to role transitions Deficits in interpersonal skills

What is the goal of the therapist in person-centered therapy? Humanistic therapies assume that people have the ability and freedom to lead rational lives and make rational choices Founded by Carl Rogers (1951) Therapists show empathy and create a climate of unconditional positive regard Goal is to allow the client to direct the therapy session and move toward self-actualization The patient’s realization of his inner potential

What is the major emphasis of Gestalt therapy? Helps clients fully experience their feelings, thoughts, and actions Emphasizes clients taking responsibility for their behavior, instead of blaming society or parents Goal is to help the client resolve past conflicts, achieve a more integrated self, and become more self-accepting Gestalt therapy is directive Therapist actively directs the therapy session Provides answers and suggestions to the client

Relationship Therapies Therapies that attempt to improve patients’ interpersonal relationships or create new relationships to support patients’ efforts to address psychological problems

What are the goals of family and couple therapy? Family therapy Parents and children enter therapy as a group Goal is to help family members heal wounds to the family, improve communication, and create more understanding within the family Couple therapy Goal is to help partners in an intimate relationship communicate and manage conflicts more effectively May focus on behavioral change or partners’ emotional responses to each other

What are some advantages of group therapy? A group of clients (usually seven to ten) meets regularly with one or more therapists Provides client with a sense of belonging and opportunity to Express feelings Get feedback from other group members Give and receive emotional support Self-help groups People with similar problems who meet regularly, usually without a professional therapist

Behavior Therapies A treatment approach that is based on the idea that abnormal behavior is learned and that applies the principles of operant conditioning, classical conditioning, and/or observational learning to eliminate inappropriate or maladaptive behaviors and replace them with more adaptive responses

How do behavior therapists modify clients’ problematic behavior? Uses reinforcement to shape or increase frequency of desirable behavior e.g., Token economy Extinguishes undesirable or maladaptive behavior by terminating or withholding reinforcement that maintains the behavior e.g., Timeout

What behavior therapies are based on classical conditioning and social-cognitive theory? Systematic desensitization is behavior therapy based on classical conditioning Used to treat fears Client is trained to relax while being confronted with a graduated series of anxiety-producing situations Eventually, client can stay relaxed while confronting even the most feared situation Participant modeling is behavior therapy based on Albert Bandura’s principles of observational learning A model demonstrates appropriate responses to a feared stimulus in graduated steps Client then imitates the model with encouragement of a therapist Using this technique, most specific phobias can be extinguished in 3 to 4 hours

What behavior therapies are based on classical conditioning and social-cognitive theory? Flooding is behavior therapy based on classical conditioning Used to treat phobias by exposing clients to the feared object or event for an extended period, until their anxiety decreases Exposure and response prevention is behavior therapy Exposes patients with obsessive-compulsive disorder to stimuli that trigger obsessions and compulsive rituals, while patients resist performing the compulsive rituals for progressively longer periods of time Aversion therapy is behavior therapy An aversive stimulus is paired with a harmful or socially undesirable behavior until the behavior becomes associated with pain or discomfort

Cognitive Therapies Therapies that assume maladaptive behavior can result from irrational thoughts, beliefs, and ideas

What is the aim of rational emotive therapy? Developed by Albert Ellis A directive form of therapy Goal is to challenge and modify a client’s irrational beliefs about themselves and others Which are believed to be the causes of personal distress

How does Beck’s cognitive therapy help people overcome depression and panic disorder? Cognitive therapy, designed by Aaron Beck, helps clients stop their negative thoughts as they occur and replace them with more objective thoughts Depression is treated by brief cognitive therapy, usually 10-20 sessions, and is more effective than antidepressant drugs Panic disorder is treated by teaching clients to change the catastrophic interpretations of their symptoms to prevent them from escalating into panic, usually effective with 3 months of treatment

Biomedical Therapies Therapies (drug, therapy electroconvulsive therapy, or psychosurgery) that are based on the assumption that psychological disorders are symptoms of underlying physical problems

What are the advantages and disadvantages of using drugs to treat psychological disorders? Antipsychotic drugs Prescribed primarily for schizophrenia Used to treat symptoms such as hallucinations, delusions, and disorganized behavior Work by inhibiting dopamine activity Lithium Used to treat bipolar disorder Reduces both manic and depressive episodes Antianxiety drugs Benzodiazepines are effective for treating generalized anxiety disorder and panic disorder This family of minor tranquilizers includes Valium and Xanax

What are the advantages and disadvantages of using drugs to treat psychological disorders? Antidepressant drugs Act as mood elevators for people who are severely depressed Selective serotonin reuptake inhibitors (SSRIs) Block the reuptake of serotonin, increasing its availability at the synapses of the brain Are effective for treating major depression, OCD, social phobia, panic disorder, generalized anxiety disorder, and binge eating

What are the advantages and disadvantages of using drugs to treat psychological disorders? Drugs can have unpleasant or dangerous side effects It is difficult to establish proper dosages Drugs do not cure psychological disorders So relapse is likely if drug therapy is discontinued Availability of antipsychotic drugs led to a trend away from hospitalization, which may have increased homelessness among people with schizophrenia

What is electroconvulsive therapy (ECT) used for? Electric current is administered to the right cerebral hemisphere While patient is under anesthesia Usually reserved for severely depressed patients who are suicidal ECT was misused and overused in the 1940s and 1950s, leading to a bad reputation But it can be a highly effective treatment for major depression

What is psychosurgery, and for what problems is it used? Brain surgery performed to alleviate serious psychological disorders or unbearable chronic pain Lobotomy Severs neural connections between frontal lobes and deeper centers involved in emotion No longer performed, because it leaves patients in permanent deteriorated condition Cingulotomy Destroys cingulum Can help in extreme cases of OCD Psychosurgery is controversial, and is considered experimental and a last resort Because results are unpredictable and permanent

Evaluating the Therapies Therapies share many similarities. Therapists use a core set of techniques no matter which perspective of therapy session they adopt, but at the same time, each therapeutic approach has elements that distinguish it from others.

What therapy, if any, is most effective in treating psychological disorders? Smith et al. (1980) analyzed 475 studies with 25,000 clients Found that psychotherapy was better than no treatment But no one type of psychotherapy was more effective than another Eysenck (1994) reanalyzed the same studies Reported that behavior therapy has a slight advantage over other types of therapies

What therapy, if any, is most effective in treating psychological disorders? A large survey of psychotherapy clients conducted by Consumer Reports found that Overall, clients believed that they benefited substantially from psychotherapy Clients were equally satisfied with therapy provided by psychologists, psychiatrists, and social workers The longer clients stayed in therapy, the more they improved Clients believed that antidepressant and antianxiety drugs helped them; but overall psychotherapy alone worked as well as psychotherapy plus drugs

The Therapeutic Relationship When establishing a relationship with a therapist, it is important to become familiar with the various professionals who offer therapeutic services.

What distinguishes one type of therapist from another, and what ethical standards are shared by all types of therapists? A Psychologist Has an advanced degree, usually a doctorate, in psychology Clinical psychologists generally diagnose and treat psychological disorders Counseling psychologists generally provide therapy for normal problems of life, such as divorce A Psychiatrist Is a medical doctor Can prescribe drug therapy

They are prohibited from providing therapy to former intimate partners What distinguishes one type of therapist from another, and what ethical standards are shared by all types of therapists? Therapists are forbidden to engage in any kind of intimate relationship with a client or anyone close to the client They are prohibited from providing therapy to former intimate partners They are obligated to use tests that are reliable and valid And they must have appropriate training for all tests that are used

What are the characteristics of culturally sensitive therapy? An approach to therapy in which knowledge of clients’ cultural backgrounds guides the choice of therapeutic interventions This approach emphasizes that cultural variables may influence the diagnosis and treatment of psychological disorders

Why is gender-sensitive therapy important? An approach to therapy that takes into account the effects of gender on both the therapist’s and the client’s behavior This approach emphasizes how a therapist’s gender biases may affect the techniques that they choose and their assessments of clients’ progress