1. Copyright © Houghton Mifflin Company. All rights reserved. 14–1 Chapter Fourteen Methods of Therapy

2. Copyright © Houghton Mifflin Company. All rights reserved. 14–2 Did You Know That… Sigmund Freud believed that clients bring into the therapeutic relationship the conflicts they have had with important persons in their lives? Gestalt therapists have their clients talk to an empty chair? Behavior therapists have used virtual reality to help people overcome fear of heights?

3. Copyright © Houghton Mifflin Company. All rights reserved. 14–3 Did You Know That… (cont.) Cognitive therapists believe that emotional problems, such as anxiety and depression, are caused not directly by troubling events we experience but by the ways in which we interpret these events? Antidepressant drugs have been used to treat not only depression but other disorders as well, such as panic disorder and even bulimia?

4. Copyright © Houghton Mifflin Company. All rights reserved. 14–4 Did You Know That… (cont.) Stimulant drugs are widely used to improve attention spans and reduce disruptive behavior of hyperactive children and adolescents? Sending jolts of electricity through a person’s head can relieve severe depression? In many states, anyone can practice psychotherapy?

5. Copyright © Houghton Mifflin Company. All rights reserved. 14–5 Module 14.1 Pathways to the Present: A Brief History of Therapy

6. Copyright © Houghton Mifflin Company. All rights reserved. 14–6 Module 14.1 Preview Questions How has the treatment of people with disturbed behavior changed over time? What are community-based health centers? How successful is the policy of deinstitutionalization?

7. Copyright © Houghton Mifflin Company. All rights reserved. 14–7 Moral Therapy Philosophy that mentally disturbed people should be treated with compassion and humane care. –Reaction against prevailing view that deranged people were threats to society. Leading proponents –Jean-Baptiste Pussin & Philippe Pinel –Dorothea Dix Fell out of favor during later half of 19 th century.

8. Copyright © Houghton Mifflin Company. All rights reserved. 14–8 Community-Based Care Community mental health system began in 1960s in response to poor conditions in mental hospitals. –Provided alternatives to long-term hospitalization. Deinstitutionalization: The social policy that redirected care from state mental hospitals toward community-based treatment settings.

9. Copyright © Houghton Mifflin Company. All rights reserved. 14–9 Community-Based Care (cont.) Variety of services offer include: –Outpatient care –Day treatment –Crisis intervention Has deinstitutionalization reintegrated mental patients into their communities? –Mixed results

10. Copyright © Houghton Mifflin Company. All rights reserved. 14–10 Module 14.2 Types of Psychotherapy

11. Copyright © Houghton Mifflin Company. All rights reserved. 14–11 Module 14.2 Preview Questions What is psychotherapy? What are the major types of mental health professionals? What are the major forms of psychotherapy? Is psychotherapy effective? What cultural factors do therapists need to consider when working with members of diverse groups?

12. Copyright © Houghton Mifflin Company. All rights reserved. 14–12 What Is Psychotherapy? A psychologically based form of treatment used to help people better understand their emotional or behavioral problems and resolve them. Called “talk therapy” because consists of a series of verbal interactions between therapist and client.

13. Copyright © Houghton Mifflin Company. All rights reserved. 14–13 Mental Health Professionals Clinical psychologists –Doctoral degree in psychology, licensing exam –Psychological testing, diagnosing mental disorders, psychotherapy Counseling psychologists –Doctoral degree in psychology, licensing exam –Counseling for milder range of problems

14. Copyright © Houghton Mifflin Company. All rights reserved. 14–14 Mental Health Professionals Psychiatrists –Medical degree, residency –Physicians specializing in diagnosis and treatment of mental illness –May prescribe psychiatric drugs or practice psychotherapy

15. Copyright © Houghton Mifflin Company. All rights reserved. 14–15 Mental Health Professionals Clinical or psychiatric social workers –Master’s degree in social work –Help individuals with severe mental illness to receive services from community agencies and organizations Psychoanalysts –Psychologist or psychiatrist with additional training in psychoanalysis

16. Copyright © Houghton Mifflin Company. All rights reserved. 14–16 Mental Health Professionals Counselors –Master’s degree in counseling field –Varied settings and types of counseling Psychiatric nurses –R.N. with master’s degree in psychiatric nursing –Working with people who have severe psychological disorders

17. Copyright © Houghton Mifflin Company. All rights reserved. 14–17 Psychodynamic Therapy Based on belief that psychological problems are rooted in unconscious psychological conflicts dating from childhood. Assumption that gaining insight into conflicts and working through them are key steps to restoring psychological health. Traditional psychoanalysis developed by Freud.

18. Copyright © Houghton Mifflin Company. All rights reserved. 14–18 Traditional Psychoanalytic Techniques Free association Dream analysis –Latent versus manifest content Interpretation of: –Resistance –Transference relationship –Countertransference

19. Copyright © Houghton Mifflin Company. All rights reserved. 14–19 Modern Psychodynamic Approaches Less focus on sexual issues More focus on –Adaptive functioning of ego –Client’s current relationships Briefer, more direct approach

20. Copyright © Houghton Mifflin Company. All rights reserved. 14–20 Humanistic Therapy Based on belief that humans possess free will and ability to make conscious choices. Emphasis on the client’s subjective, conscious experience. Focus is on the here-and-now, not the past.

21. Copyright © Houghton Mifflin Company. All rights reserved. 14–21 Rogers’ Client-Centered Therapy Based on belief that psychological problems stem from blocked self-actualization. Focus of therapy is on the person. –Therapist strives to create warm, accepting atmosphere for client. –Nondirective approach. Necessary qualities of an effective therapist: –Unconditional positive regard –Empathy –Genuineness

22. Copyright © Houghton Mifflin Company. All rights reserved. 14–22 Perls’ Gestalt Therapy Important to help clients blend conflicting parts of personality into an integrated whole or “Gestalt.” Characteristics –Direct, confrontational approach –Identifying feelings –Use of role playing, such as empty chair technique

23. Copyright © Houghton Mifflin Company. All rights reserved. 14–23 Behavior Therapy Behavior therapy or behavior modification Application of principles of learning to help person make adaptive changes in behavior. –Assumption that psychological problems are learned. Focus is on the present situation.

24. Copyright © Houghton Mifflin Company. All rights reserved. 14–24 Behavior Therapy: Fear Reduction Systematic desensitization –Construction of a fear hierarchy Gradual exposure (or “in-vivo exposure”) Modeling Virtual therapy

25. Copyright © Houghton Mifflin Company. All rights reserved. 14–25 Behavior Therapy: Aversive Conditioning Form of classical conditioning Objects paired with aversive stimuli –Electric shock, nausea-inducing drug Effects often temporary.

26. Copyright © Houghton Mifflin Company. All rights reserved. 14–26 Figure 14.1: Model of Aversive Conditioning

27. Copyright © Houghton Mifflin Company. All rights reserved. 14–27 Other Behavior Therapy Methods Operant Conditioning Methods –Reinforcement and punishment –Token economy Cognitive-Behavioral Therapy (CBT) –Combines behavioral techniques with cognitive techniques.

28. Copyright © Houghton Mifflin Company. All rights reserved. 14–28 Cognitive Therapy Focus on helping people change how they think. Assumption that distorted thinking underlies: –Emotional problems –Self-defeating behaviors –Maladaptive behaviors

29. Copyright © Houghton Mifflin Company. All rights reserved. 14–29 Ellis’ Rational-Emotive Behavior Therapy (REBT) Irrational beliefs lead to problems –Often take the form of “shoulds” and “musts” ABC approach: –Activating events  Beliefs  Consequences Goal is to recognize irrational beliefs and replace them with more logical, self- enhancing beliefs.

30. Copyright © Houghton Mifflin Company. All rights reserved. 14–30

31. Copyright © Houghton Mifflin Company. All rights reserved. 14–31 Figure 14.2: The Ellis “ABC” Model

32. Copyright © Houghton Mifflin Company. All rights reserved. 14–32 Beck’s Cognitive Therapy Goal is to help clients identify and correct errors in thinking. –“Cognitive distortions” Clients given homework assignments. –E.g., Reality testing Although similar to REBT, differs in therapeutic style.

33. Copyright © Houghton Mifflin Company. All rights reserved. 14–33 Eclectic Therapy Draws upon principles and techniques representing different schools of therapy. Most widely endorsed theoretical orientation. Some argue that therapeutic integration is neither desirable nor achievable.

34. Copyright © Houghton Mifflin Company. All rights reserved. 14–34 Figure 14.3: Clinical and Counseling Psychologists Identifying with each theoretical orientation

35. Copyright © Houghton Mifflin Company. All rights reserved. 14–35 Group Therapy People brought together to explore and resolve problems. Advantages over individual therapy –Less costly –Helps with interpersonal problems, social skills –Share coping strategies Drawbacks –No one-on-one attention –Reluctance to disclose –Feelings of inhibition

36. Copyright © Houghton Mifflin Company. All rights reserved. 14–36 Family Therapy Helps troubled families learn to communicate better and resolve their differences. Family, not individual is the unit of treatment. Individual problems symptomatic of family system breakdown.

37. Copyright © Houghton Mifflin Company. All rights reserved. 14–37 Couples Therapy Often called marital therapy. The couple is the unit of the treatment. Goal is to build healthier relationships. –Acquire more effective communication and problem-solving skills. –Resolve power struggles. Typically focus on disturbed role relationships.

38. Copyright © Houghton Mifflin Company. All rights reserved. 14–38 Figure 14.4: Effectiveness of Psychotherapy

39. Copyright © Houghton Mifflin Company. All rights reserved. 14–39

40. Copyright © Houghton Mifflin Company. All rights reserved. 14–40 Which Therapy Is Best? Little difference between kinds of therapy overall. Effectiveness may rely on matching problem to therapy.

41. Copyright © Houghton Mifflin Company. All rights reserved. 14–41 What Accounts for the Benefits of Psychotherapy? Interpersonal relationship with therapist –Therapeutic alliance Expectation of improvement –Self-fulfilling prophecy –Placebo or expectancy effects

42. Copyright © Houghton Mifflin Company. All rights reserved. 14–42 Multicultural Issues African Americans Asian Americans Hispanic Americans Native Americans

43. Copyright © Houghton Mifflin Company. All rights reserved. 14–43 Module 14.3 Biomedical Therapies

44. Copyright © Houghton Mifflin Company. All rights reserved. 14–44 Module 14.3 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?

45. Copyright © Houghton Mifflin Company. All rights reserved. 14–45 Antianxiety Drugs Also called minor tranquilizers Effects –Reduces anxiety –Produces calmness –Reduces muscle tension Effect on GABA receptors Examples –Valium, Librium, Xanax

46. Copyright © Houghton Mifflin Company. All rights reserved. 14–46 Antidepressants Increases availability of neurotransmitters –Serotonin, norepinephrine Major types –Tricyclics –MAO inhibitors –Selective serotonin-reuptake inhibitors (SSRIs) Therapeutic benefits for both depression and anxiety disorders.

47. Copyright © Houghton Mifflin Company. All rights reserved. 14–47 Antipsychotics Sometimes called major tranquilizers Treatment for schizophrenia, other psychotic disorders Blocks action of dopamine at receptor sites in brain

48. Copyright © Houghton Mifflin Company. All rights reserved. 14–48 Other Psychiatric Drugs Mood stabilizers to reduce mood swings –E.g., Lithium Stimulants used to improve attention spans and reduce disruptive behavior in hyperactive children. –E.g., Ritalin, Cylert

49. Copyright © Houghton Mifflin Company. All rights reserved. 14–49 Evaluating Psychotropic Drugs Limitations –May reduce or control symptoms, but not a cure. –Does not teach how to resolve problems or develop necessary life skills. Risks of adverse side effects –E.g., tardive dyskinesia with antipsychotics Can lead to psychological or physical dependence.

50. Copyright © Houghton Mifflin Company. All rights reserved. 14–50 Evaluating Psychotropic Drugs (cont.) Relapses common when stop taking drugs. –15-20% of schizophrenics relapse even when reliably taking medication. May be seen as a “quick fix” Useful for temporary relief –Usually used in tandem with psychotherapy.

51. Copyright © Houghton Mifflin Company. All rights reserved. 14–51 Other Biomedical Therapies Electroconvulsive therapy (ECT) can produce dramatic relief from severe depression. Psychosurgery involves surgically altering the brain to control deviant or violent behavior. –Prefrontal lobotomy –Newer more specified techniques rarely used as a last resort.

52. Copyright © Houghton Mifflin Company. All rights reserved. 14–52 Module 14.4 Application: Getting Help

53. Copyright © Houghton Mifflin Company. All rights reserved. 14–53 Module 14.4 Preview Question What steps can people take to find qualified mental health professionals?

54. Copyright © Houghton Mifflin Company. All rights reserved. 14–54 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.

55. Copyright © Houghton Mifflin Company. All rights reserved. 14–55 Choosing a Therapist (cont.) Use Yellow Pages, but be wary. Check for proper licensing Ask about type of therapy being provided. Ask about provider’s background and experience.

56. Copyright © Houghton Mifflin Company. All rights reserved. 14–56 Working with Therapist Discuss diagnosis and treatment plan before committing. Ask about costs and insurance. Find out about late/missed session policy. If medication is to be prescribed, inquire about delay, side effects.

57. Copyright © Houghton Mifflin Company. All rights reserved. 14–57 Working with Therapist (cont.) Openly discuss concerns about treatment. Request a second opinion if in doubt. Be wary of online therapy services.