The Therapeutic Enterprise

Types of Psychotherapy  Psychodynamic  Behavioral  Cognitive  Cognitive-behavioral  Humanistic and Existential  Group  Cognitive-behavioral group  Family and marital therapy  Psychodrama Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Psychodynamic Therapy  Goal is insight into one’s inner life  Some therapists use hypnosis to uncover repressed material  Transference – Patient displaces affect and feeling about others onto the therapist  Counter transference – Therapists’ emotional responses to patient  Psychoanalysis – Special type of psychodynamic therapy using free association and examination of dreams and fantasies  Interpersonal psychotherapy – A form of brief therapy that focuses on social relationships Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Behavior Therapy  Behavioral modification  Based on classical and operant conditioning theory  Uses reinforcement and shaping  Token economy – Reinforces desired behaviors  Biofeedback – Can help develop control of internal processes  Parent training Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Cognitive Therapy  Goal – Solve emotional problems through cognitive restructuring  Aaron Beck – Focuses on changing automatic thoughts  Albert Ellis – Rational-emotive therapy emphasizes needs to change self-defeating thinking and beliefs  Brief psychotherapies – Often fewer than 12 sessions; specific goals and targets. Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Keys Aspects of Cognitive Therapy  Presentation of therapy rationale to patient  Short-term intervention  Focus on the “here and now”  Patient-therapist collaboration  Questions and homework  Maintain daily records of mood, behavior, and dysfunctional thoughts  Carry out informal experiments to test thoughts, beliefs, and assumptions  Apply newly acquired cognitive schema to real- life situations. Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Cognitive- Behavioral Therapy  Integrates cognitive and behavioral therapies  Relaxation training  Exposure therapy  Flooding  Implosive therapy  Systematic desensitization  In vivo exposure  Modeling  Behavioral rehearsal  Assertiveness training Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Humanistic/ Existential Therapies  Humanistic therapy  Emphasis on people’s desire to achieve self- respect  Carl Rogers’ Client-centered Therapy  Nonjudgmental, nondirective  Atmosphere of unconditional positive regard  Existential therapy  Emphasis on people’s needs to confront questions about meaning and direction of their lives  Combine humanistic and psychodynamic techniques  Gestalt therapy based on view that people need to get in touch with disowned parts of themselves Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Group Therapy  Several people with similar problems  Group membership provides  Acceptance and support  Normative information about behavior/feelings  Learning through modeling and behavioral rehearsal  Cognitive-behavioral group therapy  Goal is development of social skills and comfort in social situations  Family and marital therapy  View marriage and family as a system  Learn how behaviors affect each other  Psychodrama  Group acts out events of emotional significance Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Does Psychotherapy work? Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Does Psychotherapy work?  Conventional wisdom (behind closed doors)  H. Eysenck’s study (1952)  Meta-analysis (Smith and Glass, 1977)  Specific studies- the case of the NIMH collaborative study (1989)  Randomized Clinical Trials methods  The Consumer Reports Study (1998)  Empirically Supported Therapies Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Issues in Psychotherapy Research  Specifying the problem  patient characteristics and the issue of specificity  Specifying the treatment:  Specific and nonspecific elements of therapy  Treatment manuals  Therapist training and fidelity  Research design issues (single case, open trials, and RCTS)  Internal validity issues (e.g. measurement of outcome, sample size, blindness)  External validity issues (e.g., setting, recruitment, flexibility of treatments) Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Concerns about reliance on ESTs  ESTs are limited by the methodology of psychotherapy research (e.g. RCT)  Some therapies are easier to test (e.g. CBT)  Some problems are more difficult to treat and therefore have fewer ESTs  Just because a therapy is not listed as an EST does not mean it could not be  Treatment research might not generalize to clinical settings  ESTs are too restrictive in general clinical practice  There is a need for dissemination research  Third party payers might misuse lists of ESTs Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Nonspecific factors in psychotherapy  Motivation for treatment; desire to change  The release of emotions; catharsis  Fostering insight, awareness and self-understanding  Building competency and mastery  Providing new information; psychoeducation  Developing new skills; assigning tasks  Working with an “expert”  Relationship factors/ therapeutic alliance  Empathy, Genuineness  Unconditional positive regard  Respect and Trust  Collaboration  Positive expectancies of change; hope Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Biological Therapies  Drug therapies  Antipsychotic, Antidepressant, Antianxiety, Stimulant, Antimanic  Electroconvulsive therapy (ECT)  Used for severe depression when drugs and other therapies have failed  Psychosurgery  Rarely performed for DSM-IV problems  Effectiveness of biological therapies  Effective for some disorders  Multi-modal treatment Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Hospitalization  Reasons for hospitalization  Behaviors poses threat to self or others  Behavior intolerable to community  Outpatient treatment failed  Treatment requires controlled setting  Withdrawal from drugs or alcohol  Physical illness complicated by mental disorder requiring continuous care  Legislation exists in all states to hospitalize and treat patients against their will. Abnormal Psychology, 11/e by Sarason & Sarason © 2005

Issues in Hospitalization  Partial hospitalization  When complete hospitalization not required  Day, evening, or weekend care  Day hospitalization  For patients who can live at home but need structure and social interaction  Deinstitutionalization  Movement towards community-based treatment  Initially made possible by discovery of psychoactive drugs  Lack of adequate community care has led to increased homelessness and gaps in treatment for seriously mentally ill Abnormal Psychology, 11/e by Sarason & Sarason © 2005