1. Chapter 12 Methods of Therapy

2. Module 12.1 Types of Psychotherapy

3. Module 12.1 Preview Questions  What is psychotherapy?  What are the major types of mental health professionals?  What are the major types of psychotherapy?  What is eclectic therapy?  What are group, family, and couple therapy?

4. Module 12.1 Preview Questions (Cont’d)  Does psychotherapy work?  What cultural factors do therapists need to consider when working with members of diverse groups?

5. What Is Psychotherapy?  A psychologically based form of treatment used to help people better understand their emotional or behavioral problems and resolve them  Often called “talk therapy” because consists of a series of verbal interactions between therapist and client

6. Major Types of Mental Health Professionals (see Table 12.1 for more details)  Clinical psychologists  Counseling psychologists  Psychiatrists  Clinical or psychiatric social workers  Psychoanalysts  Counselors  Psychiatric nurses

7. Contemporary Approaches to Therapy  Psychological therapies- based on psychological principles Behavioral therapy Behavioral therapy Cognitive therapy Cognitive therapy Psychodynamic approach Psychodynamic approach Humanistic therapy Humanistic therapy  Biomedical therapies- treatments that focus on altering the brain, especially with drugs, psychosurgery, or electroconvulsive therapy

8. Psychodynamic Therapy  Psychological problems are rooted in unconscious psychological conflicts dating from childhood  Gaining insight into conflicts and working through them are the key steps to restoring psychological health  Traditional psychoanalysis developed by Freud

9. Psychoanalytic Techniques  Free association  Dream analysis Latent vs. manifest content Latent vs. manifest content  Use of interpretations to help the client gain insight Interpretation of client’s resistance Interpretation of client’s resistance Analysis of the transference relationship Analysis of the transference relationship Problem of countertransference Problem of countertransference

10. Modern Psychodynamic Approaches (More Ego, Less Id)  Less focus on sexual issues  Focus more on the: Adaptive functioning of ego Adaptive functioning of ego Client’s current relationships Client’s current relationships  Briefer, more direct approach

11. Humanistic Therapy  Humans possess free will and can make conscious choices that enrich their lives  Emphasis on the client’s subjective, conscious experience  Focus is on the here-and-now, not the past

12. Rogers’s Client-Centered Therapy  Psychological problems stem from blocked self-actualization  Focus of therapy is on the person: Therapist strives to create warm, accepting atmosphere for client Therapist strives to create warm, accepting atmosphere for client Nondirective approach Nondirective approach

13. Client-Centered Therapy (Cont’d)  Effective therapists display: Unconditional positive regard Unconditional positive regard Empathy Empathy Genuineness Genuineness

14. Perls’s Gestalt Therapy  Important to help clients blend conflicting parts of personality into an integrated whole or “Gestalt”  Characteristics: Direct, even confrontational, approach Direct, even confrontational, approach Challenging of clients to express feelings Challenging of clients to express feelings Use of role playing, such as empty chair technique Use of role playing, such as empty chair technique

15. Behavior therapies  Classical Conditioning Techniques Systematic desensitization Systematic desensitization Aversion therapy Aversion therapy  Operant Conditioning Approaches Contingency management Contingency management Social Learning Therapy Social Learning Therapy Token Economies Token Economies

16. Behavior Therapy  Application of learning principles to help person make adaptive changes in behavior Assumption that psychological problems are learned Assumption that psychological problems are learned  Focus is on changing problem behaviors, not exploring client’s feelings

17. Behavior Therapy: Fear Reduction  Systematic desensitization Construction of a fear hierarchy Construction of a fear hierarchy  Gradual exposure (in-vivo experience)  Modeling  Virtual reality therapy

18. Behavior Therapy: Aversive Conditioning  Form of classical conditioning  Objects paired with aversive stimuli e.g., electric shock, nausea-inducing drug e.g., electric shock, nausea-inducing drug  Effects often temporary

19. Other Behavior Therapy Methods  Operant Conditioning Methods Reinforcement and punishment Reinforcement and punishment Token economy Token economy  Cognitive-Behavioral Therapy (CBT) Combines behavioral techniques with cognitive techniques Combines behavioral techniques with cognitive techniques

20. Cognitive Therapy  Focus on helping people to change how they think  Assumption that distorted thinking underlies: Emotional problems Emotional problems Self-defeating behaviors Self-defeating behaviors Maladaptive behaviors Maladaptive behaviors  Focus on present, not distant past

21. Ellis’s Rational-Emotive Behavior Therapy (REBT)  Irrational beliefs lead to problems Often take the form of “shoulds” and “musts” Often take the form of “shoulds” and “musts”  Encourages clients to replace irrational beliefs with rational alternatives

22. Beck’s Cognitive Therapy Beck’s Cognitive Therapy  Goal is to help clients identify and correct errors in thinking “Cognitive distortions” “Cognitive distortions”  Clients given homework assignments e.g., Reality testing e.g., Reality testing  Although similar to REBT, differs in therapeutic style

23. Eclectic Therapy  Draws upon principles and techniques representing different schools of therapy  Most widely endorsed theoretical orientation Most widely endorsed theoretical orientation Most widely endorsed theoretical orientation  Some argue that therapeutic integration is neither desirable nor achievable. Continue

24. Group Therapy  People brought together to explore and resolve problems  Advantages: Less costly Less costly Helps with interpersonal problems, social skills Helps with interpersonal problems, social skills Share coping strategies Share coping strategies  Drawbacks: No individual attention No individual attention Reluctance to disclose personal problems to group Reluctance to disclose personal problems to group Feelings of inhibition Feelings of inhibition

25. Family Therapy  Helps troubled families learn to communicate better and resolve their differences  Family, not the individual, is the unit of treatment  Individual problems symptomatic of family system breakdown

26. Couples Therapy  The couple is the unit of the treatment  Goal is to build healthier relationships: Acquire more effective communication and problem-solving skills Acquire more effective communication and problem-solving skills Resolve power struggles Resolve power struggles  Aim is to help open channels of communication between partners

27. Nonspecific Factors Accounting for the Benefits of Psychotherapy  Interpersonal relationship with therapist Therapeutic alliance Therapeutic alliance  Expectation of improvement Self-fulfilling prophecy Self-fulfilling prophecy Placebo or expectancy effects Placebo or expectancy effects

28. Multicultural Issues  Members of ethnic and racial minorities may have different customs, beliefs, and philosophies  Culturally sensitive therapists need to respect and understand the customs, cultures, and values of the people they treat

29. Module 12.2 Biomedical Therapies

30. Module 12.2 Preview Questions  What are the major types of psychotropic or psychiatric drugs?  What are the advantages and disadvantages of psychiatric drugs?  What is ECT, and how is it used?  What is psychosurgery?  What are community-based mental health centers?  How successful is the policy of deinstitutionalization?

31. How Is the Biomedical Approach Used to Treat Mental Disorders?  Biomedical therapies seek to alter the structure of function of the brain through drugs, surgery, or electromagnetic stimulation  Psychopharmacotherapy- treatment of mental disorders with medication  Three major groups of drugs 1. Antipsychotic drugs 2. Antidepressant drugs 3. Antianxiety drugs

32. Drug Therapy: Antianxiety Drugs  Also called minor tranquilizers  Effects: Reduces anxiety Reduces anxiety Produces calmness Produces calmness Reduces muscle tension Reduces muscle tension  Effect on GABA receptors  Examples: Valium, Librium, Xanax Valium, Librium, Xanax

33. Drug Therapy: Antidepressants  Increases availability of neurotransmitters Serotonin, norepinephrine Serotonin, norepinephrine  Major types: Tricyclics (e.g., Elavil) Tricyclics (e.g., Elavil) MAO inhibitors (e.g., Nardil) MAO inhibitors (e.g., Nardil) Selective serotonin-reuptake inhibitors (e.g., Prozac, Zoloft) Selective serotonin-reuptake inhibitors (e.g., Prozac, Zoloft)  Used to treat more than depression (e.g., anxiety, bulimia, phobias, PTSD, OCD)

34. Drug Therapy: Antipsychotics  Sometimes called major tranquilizers  Used to treat schizophrenia and other psychotic disorders  Newer drugs block the action of dopamine at receptor sites in brain

35. Other Psychiatric Drugs  Mood stabilizers to reduce mood swings e.g., Lithium e.g., Lithium  Stimulants used to improve attention spans and reduce disruptive behavior in hyperactive children e.g., Ritalin, Cylert e.g., Ritalin, Cylert

36. Evaluating Psychotropic Drugs  Limitations: May reduce or control symptoms, but not a cure May reduce or control symptoms, but not a cure Does not teach how to resolve problems or develop necessary life skills Does not teach how to resolve problems or develop necessary life skills  Risks of adverse side effects  Some drugs can lead to psychological or physical dependence

37. Evaluating Psychotropic Drugs (Cont’d)  Relapses common when taking drugs is stopped  May be seen as a “quick fix”  Useful for temporary relief Usually used in tandem with psychotherapy Usually used in tandem with psychotherapy

38. Electroconvulsive Therapy (ECT)  Electric current is passed through head  Can produce dramatic relief from severe depression  High rates of relapse in weeks and months following treatment  May produce permanent memory loss  Many view as treatment of last resort

39. Psychosurgery  Involves surgically altering the brain to control deviant or violent behavior  Prefrontal lobotomy a widely practiced form in the past  More sophisticated techniques have been introduced in recent years. But still, procedures rarely used and only as a treatment of last resort But still, procedures rarely used and only as a treatment of last resort

40. Community-Based Care  Social policy of deinstitutionalization Resulted in the back wards of many mental hospitals being vacated Resulted in the back wards of many mental hospitals being vacated  Community-based mental health centers offer a variety of services  Has deinstitutionalization been successful? A work in progress A work in progress

41. Module 12.3 Getting Help

42. Choosing a Therapist  Seek recommendations from respected sources  Seek a referral from a local medical center or local community mental health center  Seek consultation from college counseling center or health services  Contact professional organizations for recommendations

43. Choosing a Therapist (Cont’d)  Use local Yellow Pages, but be careful  Check for proper licensing  Ask about type of therapy being provided  Ask about provider’s background & experience

44. Working with the Therapist  Discuss diagnosis and treatment plan before committing  Ask about costs and insurance  Find out about policies for missed or canceled sessions  If medication is to be prescribed, inquire about delay, side effects

45. Working with Therapist (Cont’d)  Openly discuss concerns about treatment  Request a second opinion if in doubt  Be wary of online therapy services