1. THE THERAPEUTIC ENTERPRISE: CHOICES, TECHNIQUES, EVALUATION
CHAPTER 16
THE THERAPEUTIC ENTERPRISE:
CHOICES, TECHNIQUES, EVALUATION

2. PSYCHOTHERAPY Psychodynamic Humanistic and Existential Behavioral
Cognitive
Cognitive-behavioral
Group
Cognitive-behavioral group
Family and marital therapy
Psychodrama

3. PSYCHODYNAMIC THERAPY
Goal is insight into one’s inner life
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
Some use hypnosis to uncover repressed material

4. HUMANISTIC AND EXISTENTIAL THERAPIES
Emphasis on people’s desire to achieve self-respect
Cark Rogers’ client-centered therapy
Nonjudgmental, nondirective
Atmosphere of unconditional positive regard
Existential
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

5. COGNITIVE PSYCHOTHERAPY
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 – Fewer than 12 sessions; specific goals and targets.
Interpersonal psychotherapy – A form of brief therapy that focuses on social relationships

6. PRINCIPAL ELEMENTS OF COGNITIVE THERAPY
Presentation of cognitive 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.

7. BEHAVIOR THERAPY Forerunner of cognitive-behavioral therapy
Behavioral modification
Based on operant conditioning
Uses reinforcement and shaping
Token economy – Reinforces desired behaviors
Biofeedback – Can help develop control of internal processes

8. COGNITIVE-BEHAVIOR THERAPY
Integrates cognitive and behavioral elements
Relaxation training
Exposure therapy
Flooding
Implosive therapy
Systematic desensitization
In vivo exposure
Modeling
Behavioral rehearsal
Assertiveness training

9. FACTORS IN SUCCESSFUL USE OF RELAXATION TRAINING
The individual’s problems do not have an organic basis.
The individual is not psychotic, depressed, or subject to panic attacks.
The individual is able to assume responsibility for active participation in treatment, with special emphasis on home practice.
Family members are cooperative with and supportive of the individual’s treatment.
The individual has reasonable expectations of the training’s effectiveness.

10. 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

11. RESEARCH ON PSYCHLOGICAL THERAPIES
Important to distinguish between unique and common features among therapies
Important to determine therapeutic outcomes
No one form of therapy is superior than the other overall
Research needs to determine extent to which cultural and ethnic factors play a role in processes and outcomes of therapeutic interventions

12. BIOLOGICAL THERAPIES Electroconvulsive therapy (ECT) Drug therapies
Used for severe depression when drugs and other therapies have failed
Drug therapies
Antipsychotic
Antimanic
Antidepressant
Antianxiety
Effectiveness of biological therapies
Effective for particular disorders
Multimodal treatment
Medication and psychotherapy is possibly more effective than either intervention alone.

13. 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

14. HOSPITALIZATION Partial hospitalization Day 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 in the 1960s to return hospitalized patients to the community for community-based treatment
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