 Therapy Chapter 16

 Therapy The Psychological Therapies Psychotherapy – interaction between trained therapist and a person seeking to overcome a psychological disorder or achieve personal growth

 Therapy The Psychological Therapies Psychoanalysis – Sigmund Freud’s therapeutic approach Freud’s “consulting room”

Aims and Methods: Through free association and dream analysis, to uncover repressed thoughts, memories, and feelings, and bring them into conscious awareness to help patient to take responsibility for their own growth.

Criticisms: Interpretations of therapist cannot be proven or disproven; also, psychoanalysis takes a great deal of time (years) and is expensive.

 Therapy The Psychological Therapies Humanistic Therapies – emphasize people’s inherent potential for self-fulfillment; goal to boost self-fulfillment by helping people grow in self-awareness

Client-centered therapy: a humanistic therapy, developed by Carl Rogers, in which the therapist uses techniques such as active listening with a genuine, accepting, empathic environment (a non-directive therapy). Credit: Michael Rougier/Life Magazine

“Hearing has consequences. When I truly hear a person and the meanings that are important to him at the present moment, hearing not simply his words, but him, and when I let him know that I have heard his own private personal meanings, many things happen…” - Carl Rogers Credit: Michael Rougier/Life Magazine

 Therapy The Psychological Therapies Behavior Therapies – therapy that applies learning principles to the elimination of unwanted behaviors

Classical Conditioning Techniques Exposure Therapies: behavior techniques that treats anxiety by exposing people (in imagination or reality) to the things they fear and avoid. Credit: Bob Mahoney/The Image Works

Classical Conditioning Techniques The idea: Just as people can habituate to the sound of a passing train in a new apartment, they can become less anxiously responsive to the things they once feared. Credit: Bob Mahoney/The Image Works

Aversive Conditioning: a behavioral technique that associates an unpleasant state with an unwanted behavior.

Aversive therapy for alcohol dependency: After drinking an alcoholic drink mixed with a drug that produces nausea (antabuse), some people develop conditioned aversion to alcohol.

Operant Conditioning Techniques Token economy: an operant conditioning procedure in which people earn a token of some sort for exhibiting desired behavior and can later exchange the tokens for various privileges or treats.

 Therapy The Psychological Therapies Cognitive Therapies – therapy that teaches people new, more adaptive ways of thinking and acting; based on the assumption that thoughts intervene between events and emotional reactions

A cognitive perspective on psychological disorders: The person’s emotional reactions are produced not directly by the event but by the person’s thoughts in response to the event.

Cognitive-Behavior Therapy CBT – an integrative therapy that aims to alter the way people think (cognitive therapy) and the way they act (behavior therapy). EventsThoughtsBehavior Emotions

 Psychological Disorders and Therapy The Psychological Therapies Family Therapy – therapy that treats the family as a system; views an individual’s unwanted behaviors as influenced by other family members

The therapist helps family members understand how their ways of relating to one another creates problems; the emphasis is not on changing the individual but on changing their relationships. Credit: Michael Newman/PhotoEdit

 Therapy Evaluating Psychotherapies Is Psychotherapy Effective?

Clients’ Perceptions The problem with perceptions: People often enter therapy in crisis, and when the crisis passes, people often attribute improvement to therapy. © Mary Kate Denny/ PhotoEdit, Inc.

Clients’ Perceptions The problem with perceptions: Clients may need to believe the therapy was worth the effort an expense. © Mary Kate Denny/ PhotoEdit, Inc.

Clients’ Perceptions The problem with perceptions: Clients generally speak kindly of their therapists, even if the problems remain. © Mary Kate Denny/ PhotoEdit, Inc.

Clinicians’ Perceptions The problem with perceptions: Clinicians are human, and as such, they remember their successes more than their failures. © Mary Kate Denny/ PhotoEdit, Inc.

Outcome Research Meta analysis – a procedure for statistically combining the results of many different research studies. Above, data from 475 studies showing improvement of untreated people vs. psychotherapy clients.

Outcome Research The bottom-line: Those not undergoing therapy often improve, but those undergoing therapy are more likely to improve.

 Therapy Evaluating Psychotherapies Relative Effectiveness of Different Therapies

There is little connection between outcomes and clinicians’ experience, licensing, etc., but certain therapies are more effective for certain disorders.

There is little connection between outcomes and clinicians’ experience, licensing, etc., but certain therapies are more effective for certain disorders. For example, there is good evidence that light exposure therapy is an effective treatment of SAD. Credit: Christine Brune

DisorderTherapy DepressionBehavior, Cognition, Interpersonal AnxietyCognition, Exposure, Stress Inoculation BulimiaCognitive-behavior PhobiaBehavior Bed WettingBehavior Modification

Evidence-based practice – clinical decision making that integrates the best available evidence with clinical expertise and patient characteristics and preferences

 Therapy The Biomedical Therapies Prescribed medications or medical procedures that act directly on the patient’s nervous system

 Therapy The Biomedical Therapies Drug Procedures

Antipsychotic Drugs Antipsychotic drugs – drugs used to treat schizophrenia and other forms of severe thought disorders

Antianxiety Drugs Antianxiety drugs – drugs used to control anxiety and agitation Credit: Nsaum75

Antidepressant Drugs Antidepressant drugs – drugs used to treat depression (and increasingly prescribed for anxiety). Credit: Tom Varco

SSRI – Selective Serotonin Reuptake Inhibitor

Antidepressant Drugs There is some evidence for effectiveness of SSRIs. Experts agree that people taking SSRIs for a month improve. But some of this is spontaneous recovery. Credit: Tom Varco

 Therapy The Biomedical Therapies Brain Stimulation Credit: Eric S. Lesser

Electroconvulsive Therapy ECT – a treatment for depression that does not respond to drug therapy. There is evidence that it is effective, but no one is quite sure how it works (may calm neural centers where overactivity produces depression).

Alternative Neurostimulation Therapies Repetitive TMS – the application of repeated pulses of magnetic energy to the brain; used to stimulate or suppress brain activity.

 Therapy The Biomedical Therapies Psychosurgery – surgery that removes or destroys brain tissue Credit: Discover Magazine

 Therapy The Biomedical Therapies Therapeutic Life-Style Change 1. Aerobic exercise 2. Adequate sleep 3. Light exposure 4. Social connection 5. Nutritional supplements

 Chapter Review What is psychotherapy? What are major types of psychotherapy? Is psychotherapy effective? What certain approaches are better for certain disorders? What is biomedical therapy? How effective are drugs? Other biomedical treatments?