Psychotherapies

2 Types of Therapy Psychotherapy—use of psychological techniques to treat emotional, behavioral, and interpersonal problems Biomedical—use of medications and other medical therapies to treat the symptoms associated with psychological disorders

Psychotherapy A planned, emotionally charged, confiding interaction between a trained therapist and someone who suffers from psychological difficulties There are over 250 different types of therapy.

Four Types of Psychotherapy Most therapies can be divided into: –Psychoanalytic –Humanistic –Behavioral –Cognitive

Eclectic Approach An approach to psychotherapy that, depending on the person’s problems, uses techniques from multiple forms of therapy Carefully tailor the therapy approach to the problems and characteristics of the person seeking help

Psychoanalysis

Developed by Sigmund Freud based on his theory of personality Freud’s Office

Psychoanalysis Freud’s therapeutic technique that attributes one’s thoughts and actions to unconscious motives and conflicts

Psychoanalysis Assumptions Psychological problems are the result of repressed conflicts and impulses from childhood. The therapist must bring the repressed problems into the conscious mind to help patients have an insight about the original cause of the problem.

Causes of Psychological Problems Undesirable urges and conflicts are “repressed” or pushed to the unconscious Unconscious conflicts exert influence on behaviors, emotions, and interpersonal dynamics Understanding and insight into repressed conflicts leads to recognition and resolution

Psychoanalytic Methods

Free Association Freudian technique of discovering the unconscious mind--where the patient relaxes and says whatever comes to mind, no matter how trivial or embarrassing A way of revealing unconscious thoughts and emotions

Resistance Client’s unwillingness to discuss issues raised during free association. Unconscious attempts to block the revelation of repressed memories and conflicts.

Interpretation A technique in which the psychoanalyst offers a carefully timed explanation of the unconscious meaning of the patient’s behavior, thoughts, feelings, or dreams to facilitate the recognition of unconscious conflicts or motivations Dream Interpretation - Manifest content of dreams is analyzed for disguised or symbolic wishes, meanings, and motivations (latent content) –Freud considered dreams to be the “royal road to the unconscious”

Transference Patient’s transfer to the analyst of emotions linked with other relationships The patient projects feeling from the past to the therapist. Once these are feelings are opened up the therapist can help the client work through them.

Using Psychoanalysis All these psychoanalytic techniques are designed to help the patient achieve insight into how past conflicts influence her current behavior and relationships and then replace maladaptive behavior patterns with adaptive ones. On average, the traditional psychoanalyst sees the patient four or five times a week over the course of four years or longer

Psychoanalytic Influence Few therapists follow strict Freudian therapy. Most feel it emphasizes sex and aggression too much Works well with anxiety and mild depression.

The Psychodynamic Perspective

Psychodynamic Approach A more modern view that retains some aspects of Freudian theory but rejects other aspects Retains the importance of the unconscious mind Less emphasis on unresolved childhood conflicts Does not require meeting with therapist as often as traditional psychoanalytic therapy.

Humanistic Therapies

Humanistic perspective emphasizes human potential, self-awareness, and free- will Humanistic therapies focus on self- perception and individual’s conscious thoughts and perceptions Client-centered (or person-centered) therapy is the most common form of humanistic therapy Carl Rogers (1902–1987)—developed this technique

Nondirective Client-Centered Therapy Therapist listens without interpreting and does not direct the client (patient) to any particular insight. Therapist must not make decisions for the client, offer solutions, or pass judgment on the client’s thoughts or feelings. Rogers deliberately used the word client rather than patient to avoid the idea that the person was “sick” and could be “cured”

Client-Centered Therapy Therapist uses techniques such as active listening within a genuine, accepting, empathic environment to facilitate the client’s growth. The therapy stresses: –Empathy –Acceptance –Genuineness

Therapeutic Conditions Genuineness—therapist openly shares thoughts without defensiveness Unconditional positive regard for client— no conditions on acceptance of person Empathic understanding—creates a psychological mirror reflecting clients thoughts and feelings

Active Listening Empathic listening in which the listener echoes, restates and clarifies.

Active Listening Characteristics Active listening entails: –Paraphrasing: uses the words of the client to summarize the conversation –Clarifying: encouraging the client to say more by asking leading questions –Reflecting feelings: mirrors the feelings of the client

The Results of Good Humanistic Therapy Rogers thought if clients are treated with unconditional positive regard, empathy, & genuineness, the client will explore their feelings & thoughts. Exploring their thoughts & feelings in an accepting environment will lead the client to change their attitudes & behavior. This approach very successful in dealing with mild depression and anxiety but not very successful in treating psychotic patients like those with severe schizophrenia.

Behavior Therapies

Behavior Therapy Behavioristic perspective emphasizes that behavior (normal and abnormal) is learned Applies classical and operant conditioning to the elimination of unwanted behaviors Primary concern is to eliminate the disorder’s behavior, not find the cause of the disorder Often called behavior modification

Behavior Therapies: Classical Conditioning Techniques

Mary Cover Jones: The First Behavior Therapist Demonstrated that conditioning could be used to remove fears. Treated three-year-old Peter’s fear of rabbits, using counterconditioning Involves modifying behavior by conditioning a new response that is incompatible with a previously learned response (paired rabbit with a cookie) Rabbit + Cookie = Happy/Not Scared Rabbit = Happy/Not Scared UCSCSUCR CSCR

Systematic Desensitization Process Establish a hierarchy of the anxiety- triggering stimuli Learning relaxation methods (progressive relaxation) Slowly think through the hierarchy from least anxiety-provoking to most anxiety-provoking, working to relax whenever anxiety is felt Once you can maintain complete relaxation, you move on to the next scene, and so on

Sample Anxiety Hierarchy

Flooding Method of extinction usually used to rid a patient of phobias (Exposure Therapy) The patient is inundated with repeated exposures to what they fear until they realize they can remain calm in the presence of the feared object. (view video of this process for phobias – 2 min)view video of this process for phobias – 2 min

Aversive Conditioning A type of counterconditioning that associates an unpleasant state (such as nausea) with an unwanted behavior The person is replacing a positive but harmful response with a negative response Example with alcoholism: Lace a drink with a drug that makes the person becomes sick Aversive conditioning is not very effective, and its use has declined in recent years.

Aversion Therapy for Alcoholism Relatively ineffective, does not generalize very well beyond therapy Pairs and aversive stimulus with the undesired behavior UCS (drug) UCR (nausea) UCS (drug) UCR (nausea) CS (alcohol) CS (alcohol) CR (nausea)

Behavior Therapies: Operant Conditioning Techniques

Operant Conditioning Behavior therapists have developed a variety of techniques based on B. F. Skinner’s operant conditioning model of learning – Shaping involves reinforcing successive approximations of a desired behavior – Positive reinforcement is used to increase the incidence of desired behaviors – Extinction, or nonreinforcement, is used to reduce the occurrence of undesired behaviors

Token Economy An operant conditioning procedure that attempts to modify behavior by giving tokens (rewards) for desired behavior. The tokens can be exchanged for various privileges or treats Use for behavior modification in group settings (prisons, classrooms, hospitals) Form of secondary reinforcement Proven to be especially effective in the outpatient treatment of substance abuse and dependence and with severely disturbed people

Successive Approximations Series of behaviors that gradually become more similar to a target behavior. Each time the behavior is closer to the desired behavior it gets rewarded. Good for learning proper social behaviors.

Evaluating Behavior Therapy Effective short-term therapy for well- defined problems like phobias, PTSD and compulsions. Also effective with addictions and helping those living in institutions. Not as effective with schizophrenics and depressed patients.

Cognitive Therapies

Cognitive Therapy Based on the idea that people have irrational beliefs, thoughts and attitudes that distort their behaviors –Thoughts intervene between events and our emotional reactions Therapy focuses on recognition and alteration of unhealthy thinking patterns –Teaches people new, more adaptive ways of thinking and acting

Self-Serving Bias Tendency to judge oneself favorably Severely depressed patients tend to not have a self-serving bias and tend to blame themselves for problems and credit the environment for successes

Rational Emotive Therapy Developed by Albert Ellis People’s difficulties are caused by their faulty expectations and irrational beliefs ABC model –Activating Event –Beliefs –Consequences When an Activating event (A) occurs, it is the person’s Beliefs (B) about the event that cause emotional Consequences (C) Goal of therapy is identification and elimination of core irrational beliefs Effective in the treatment of depression, social phobia, and certain anxiety disorders, and in helping people overcome self- defeating behaviors

How RET Works Step 1: Identify the core irrational beliefs or self talk that underlie personal distress Step 2: Vigorously dispute and challenge the irrational beliefs. Therapist acts as a teacher to show patient how to do this. Rational-emotive therapists tend to be very direct and even confrontational From the client’s perspective, rational-emotive therapy requires considerable effort – person must admit her irrational beliefs and accept the fact that those beliefs are irrational and unhealthy – client must radically change her way of interpreting and responding to stressful events

Aaron Beck’s Cognitive Therapy Based on the assumption that thoughts, moods, and behaviors are interrelated Beck believes that depression and other psychological problems are caused by illogical thoughts Schemas – methods for organizing the way we view the world have evolved into a distorted perception Focuses on changing the client’s unrealistic thoughts Therapist acts as model and aims for a collaborative therapeutic climate Therapy includes homework of writing down automatic thoughts or habits

Cognitive Therapy: How it Works CT therapist encourages the client to empirically test the accuracy of his or her assumptions – The client learns to recognize and monitor the automatic thoughts that occur without conscious effort or control – The client learns how to empirically test the reality of the automatic thoughts that are so upsetting CT is very effective in treating depression, anxiety disorders, eating disorders, PTSD, and relationship problems. It may also help prevent depression from recurring

What’s the Difference Between Ellis’ RET & Beck’s Cognitive Therapy? Ellis says faulty assumptions or beliefs to blame Beck says illogical thought processes to blame RET therapists logically debate and vigorously challenge or dispute the irrationality of a client’s beliefs Ellis’ Cognitive Therapy gently guides clients to observe and record their thoughts in response to everyday life. Later therapist helps them sort out the illogical thought processes.

Cognitive Behavioral Therapy An integrated therapy that combines cognitive therapy (changing self-defeating thinking) with behavior therapy (changing inappropriate behaviors) Based on the assumption that cognitions, behaviors, and emotional responses are interrelated Cognitive-behavioral therapists challenge maladaptive beliefs and substitute more adaptive cognitions They use behavior modification, shaping, reinforcement, and modeling to teach problem solving and change unhealthy behavior patterns

Prevalence of Cognitive Therapy Half of all faculty in accredited clinical psychology doctoral programs now align themselves with a cognitive or cognitive- behavior therapy orientation. (Data from Mayne & others, Note: Some faculty identify with more than one perspective.)

Family and Group Therapies

Group and Family Therapy Group therapy—one or more therapists working with several people at the same time. Family therapy—based on the assumption that the family is a system and treats the family as a unit.

Group Therapy Having a therapist work with a number of patients at one time Groups usually consist of 6 to 10 people Cognitive, behavior, and humanistic therapists all can lead group therapies.

Advantage of Group Therapy Therapists can help more than one person at a time. Overall session cost is lower. Patients interact with others having the same problems as they have. Builds a sense of community

Self-help groups: Helping yourself by helping others Self-help groups and support groups are typically organized and led by nonprofessionals The groups are either free or charge nominal fees to cover the cost of materials. Typically, members have a common problem and meet for the purpose of exchanging support The format of such groups varies enormously, but many follow a 12-step approach Self-help groups can be as effective as therapy More research is needed on why self-help groups are effective and on the kinds of people and problems that are most likely to benefit from them

Family Therapy Therapy that treats the family as a system Views the patient’s problems as influenced by or directed at family members Every family has certain unspoken “rules” of interaction and communication. As such, issues are explored, and unhealthy patterns of family interaction can be identified and replaced with new “rules” that promote the psychological health of the family Attempts to guide the family toward positive relationships and improved communication

Evaluating Psychotherapy’s Effectiveness

Are Psychotherapies Effective? Most people do not seek help with problems Spontaneous Remission - Some people improve with nothing more than the passage of time Meta-analysis used to combine and interpret the results of large numbers of studies has found: – On average, the person who completes treatment is better off than about 80 percent of those in the untreated control group. – Benefits are usually apparent in a relatively short period of time – Gains that people make tend to endure – Brain-imaging technologies show that psychotherapy alone produces distinct physiological changes in the brain that are associated with a reduction in symptoms

Studies on Psychotherapy Studies researching the effectiveness of psychotherapy have found: –Clients believe therapy is effective. –Clinicians believe therapy is effective. –Researchers are still debating psychotherapy’s effectiveness. –The more clear cut the problem, the more effective the therapy is. –No one therapy is absolutely more effective than the others.

Factors in Successful Therapy Therapeutic relationship—caring and mutually respectful Therapist characteristics—caring attitude, ability to listen, sensitive Client characteristics—motivated, actively involved, emotionally and socially mature External circumstances—a stable living situation and supportive family members

The rates of improvement for more than 2,000 people in weekly psychotherapy and for 500 people who did not receive psychotherapy. Clearly, psychotherapy accelerates both the rate and the degree of improvement for those experiencing psychological problems. SOURCE: McNeilly & Howard, 1991.

Expectation Effect Person feels better after therapy because they thought or expected to become better