Therapies PowerPoint by Prentice Hall, Inc Therapies PowerPoint by Prentice Hall, Inc., modified by Stephen Landman, Ph.D.

Insight Therapies Insight therapies Provide people with better awareness and understanding of their feelings, motivations, and actions Psychoanalysis Client-Centered Therapy Gestalt Therapy

Freud’s method of psychotherapy Psychoanalysis Hidden feelings and motives are made conscious for better adaptation. Freud’s method of psychotherapy Based on the belief that anxiety and other problems are symptoms of inner conflicts stemming from childhood Free association: A technique encouraging the patient to talk without inhibition about whatever thoughts or fantasies come to mind Transference: transferring feelings toward authority figures from childhood to therapist Insight: becoming aware of what was formerly outside of awareness

Psychoanalysis (continued) Freudian therapist = “psychoanalyst” Symptoms are caused by unconscious conflicts Goal of Psychoanalysis = Insight, which causes symptoms to disappear Task of psychoanalyst is to make timely interpretations Freud interpreted: Free Association – (reason for use of the couch) Dreams Transference Catharsis = “Emotional Insight” (also called “abreaction”)

Client-Centered Therapy (person-centered therapy) Carl Rogers Problems stem from conditional love from parents Calls for unconditional positive regard Conditional positive regard Love and acceptance comes from conforming to what others want Unconditional positive regard True acceptance regardless of actions Nondirective “Reflection of Feeling” Nondirectional form of therapy developed by Carl Rogers that calls for unconditional positive regard of the client by the therapist with the goal of helping the client become fully functioning

Gestalt Therapy To help people be more genuine in day-to-day interactions Focus on here-and-now, and whole person Therapy is active, directive Empty chair technique

Behavior Therapies Focus on behavior change, rather than insight Belief that all behavior is learned. Uses principles of learning for treatment. Maladaptive behaviors themselves are the focus of the therapy; they are not “symptoms” of an underlying problem. Based on the belief that all behavior, normal and abnormal, is learned and that the goal of therapy is to teach people more satisfying ways of behaving For behaviorists, the focus of psychotherapy should be the problem behaviors themselves, not some deeper, underlying conflicts that are presumably causing those behaviors

Behavior Therapy (continued) Examples: Desensitization – uses classical conditioning of Pavlov Token Economy – uses operant conditioning of Skinner Aversive therapy – classical conditioning (Antabuse for alcholism, slap a car to teach dog not to chase cars) Behavioral marriage counseling Behavioral Contracting Modeling Many other applications exist

Cognitive Therapies Changing clients’ perceptions of themselves and the world One method: Rational-emotive therapy Albert Ellis, Ph.D. Irrational ideas, common in society, cause problems. Client needs to understand how the ideas are irrational and what self-talk is associated with them, and then needs to change to using rational self-talk instead. Ellis uses “counterpropaganda” to counter the irrational propaganda the client has been affected by. Cognitive therapies focus not so much on maladaptive behaviors as on maladaptive ways of thinking By changing people's distorted, self-defeating ideas about themselves and the world, cognitive therapists hope to encourage better coping skills and adjustment Stress-inoculation therapy Trains clients to cope with stressful situations by learning a more useful pattern of self-talk Works by turning the client’s own thought patterns into a kind of vaccine against stress-induced anxiety Rational-emotive therapy (RET) A directive therapy based on the idea that clients’ psychological distress is caused by irrational and self-defeating beliefs and the therapist’s job is to challenge such dysfunctional beliefs Irrational/self-defeating beliefs involve absolutes, for example “musts” and “shoulds” that allow no room for mistakes Beck’s cognitive therapy Depends on identifying and changing inappropriately negative and self-critical patterns of thought Therapists try to help clients examine each dysfunctional thought in a supportive but objectively scientific manner

Cognitive-Behavioral Therapy widely used today Combines cognitive therapy and behavior therapy methods – not one specific technique Supported by much research as being effective for wide range of problems (eating disorders, personality disorders, depression, pain disorders) Short term Structured and goal-directed An educational model - Client does homework

Group Therapies Many advantages to group approach Types Family therapy Increased feedback on how a person affects others Modeling Learning from others’ mistakes Laboratory for trying new behaviors Social support Realizing that one is not alone Social skills and communication practice Opportunity to be helpful to others Cost effective Types Family therapy Couple therapy Self-help groups (not technically a therapy group) Advantages Based on the idea that psychological problems are at least partly interpersonal and are therefore best approached in a group Offer a circle of support for clients, shares insights into problems, and provides the opportunity to obtain psychotherapy at a lower cost Family therapy The family is seen as partly responsible for the individual’s problems Family therapy seeks to change all family members’ behaviors to the benefit of the family unit as well as the troubled individual Couple therapy A form of group therapy intended to help troubled partners improve their problems of communication and interaction Empathy training: Each person is taught to share inner feelings and to listen to and understand the partner’s feelings before responding to them Self-help groups As the cost of private psychotherapy has risen, self-help groups have become increasingly popular because of its low cost In such groups, people share their concerns and feelings with others who are experiencing similar problems Alcoholics Anonymous is a very effective self-help group

Effectiveness of Psychotherapy Success rate Eysenck (1952): About two-thirds get better with or without therapy. He was criticizing psychodynamic therapy, claiming behavior therapy to be superior. Smith & Glass (1977) Meta-analysis of psychotherapy outcome studies concludes that therapy is better than no therapy. Most researchers agree that psychotherapy helps about two-thirds of the people treated Although there is some debate over how many untreated people also recover, the consensus is that those who get therapy are generally better off than those who don't Each kind of therapy, however, works better for some problems than for others The general trend in psychotherapy is toward eclecticism, the use of whatever treatment works best for a particular problem Consumer Reports study 180,000 readers, 7,000 responded Most report an improvement No difference between types of therapy Long-term therapy better than short-term (Fig 13-1)

Which Therapy is Best? Truax and Carkhuff (1967) found that characteristics of therapist are crucial. Effective therapists are characterized by warmth, genuiness, and empathy. Most therapists are “eclectic”, drawing form various approaches, rather than strictly following one method.

Which Type of Therapy is Best? No apparent difference in effectiveness Possible explanations: All offer an explanation for problems All offer hope All provide a therapeutic alliance with a therapist

Biological Treatments Drug therapy Major types Antipsychotic drugs Antidepressant drugs Lithium & Other Mood Stabilizers Electroconvulsive therapy Transcranial magnetic stimulation (new treatment for depression) Psychosurgery A group of treatment approaches, such as medication, electroconvulsive therapy, and psychosurgery These treatments are sometimes used to treat psychological disorders in conjunction with, or instead of, psychotherapy Drug therapy The development of several effective drugs; Drug therapies cost less than psychotherapy Critics contend that drugs are used because of our society’s “pill mentality” Drugs are the most common form of biological therapy Antipsychotic drugs are valuable in treating schizophrenia They do not cure the disorder, but they reduce its symptoms, although side effects can be severe Antidepressant drugs alleviate depression, though some also have serious side effects Lithium is a naturally occurring salt that is used to treat bipolar disorder Lithium helps level out the extreme highs of mania and the extreme lows of depression Many other types of medications are used to treat psychological disorders including: Antimanic drugs, Antianxiety drugs, Sedatives, Psychostimultants for children with attention-deficit/hyperactivity disorder ECT A mild electrical current is passed through the brain for a short period, often producing convulsions and temporary coma ECT is used to treat severe, prolonged depression The reason ECT works remains unknown Psychosurgery Brain surgery performed to change a person’s behavior and emotional state, for example prefrontal lobotomy This therapy is rarely used today

Institutionalization In past, institutionalization was most common approach Antipsychotic drugs reduced this practice Deinstitutionalization This approach has own problems Alternative forms of treatment In the past, institutionalization in large mental hospitals was the most common approach to caring for people with serious mental disorders Patients were given shelter and some degree of treatment, but a great many were never able to be released Then, with the advent of antipsychotic drugs, a trend began toward deinstitutionalization, or integrating people with serious mental disorders back into the community Deinstitutionalization The policy of treating people with severe psychological disorders in the community rather than in large public hospitals Problems Community mental-health centers are poorly funded or non-existent Ex-patients are poorly prepared to live in the community Not enough housing available Social stigma of having a mental disorder Large insurance companies discourage outpatient care Alternative forms of treatment Avoiding hospitalization through a number of different types of programs involving skilled workers in different therapy settings Is often effective and less expensive than hospitalization

Prevention Forms of prevention Primary prevention Efforts to reduce new cases of mental disorders Secondary prevention Identifying at-risk groups Tertiary prevention Helping people adjust after hospital release Primary prevention Techniques and programs to improve the social environment so that new cases of mental disorders do not develop Secondary prevention Programs to identify groups that are at high risk for mental disorders and to detect maladaptive behavior in these groups and treat it properly Tertiary prevention Programs to help people adjust to community life after release from a mental hospital

Client Diversity and Treatment Gender and treatment Rates of treatment for females is higher Form of treatment can be gender biased Culture and treatment What constitutes normal can be culture-bound Given that human beings differ as much as they do, it isn't surprising that a one-size-fits-all concept isn't always appropriate in the treatment of psychological problems In recent years the special needs of women and people from other cultures have particularly occupied the attention of mental health professionals Women are more likely than men to be in psychotherapy Psychotherapy is more socially accepted for women than men Traditionally, women have received a disproportionate share of drugs for psychological disorders Because, in traditional therapy, women are often expected to conform to gender stereotypes in order to be pronounced “well,” many women have turned to “feminist therapists” The American Psychological Association has issued guidelines to ensure that women receive treatment that is not tied to traditional ideas about appropriate behavior for the sexes Our ideas of what constitutes normal behavior may not be viewed as normal by another culture Some psychological disorders only occur within a specific culture When the client and therapist come from different cultural backgrounds or belong to different racial or ethnic groups, misunderstandings can arise in therapy The APA has issued guidelines to help psychologists deal more effectively with our ethnically and culturally diverse population Following these guidelines is an important step toward avoiding cultural misunderstandings