1. Psychotherapies

2. 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

3. 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.

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

5. 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

6. Psychoanalysis

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

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

9. 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.

10. 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

11. Psychoanalytic Methods

12. 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

13. Resistance
Unconscious attempts to block the revelation of repressed memories and conflicts.

14. 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”

15. Transference
Patient’s transfer to the analyst of emotions linked with other relationships
The patient projects feeling from the past to the therapist.

16. 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

17. Psychoanalytic Influence
Few therapists follow strict Freudian therapy.
Heavily influenced other types of therapy (interpersonal therapy)
Modern approach is the psychodynamic perspective

18. The Psychodynamic Perspective

19. 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

20. Common Features of Short-Term Dynamic Therapies
Most therapies today are shorter-term
Patients’ problems are quickly assessed at the beginning of therapy.
Based on goals that are specific and attainable
Therapists are more directive than traditional psychoanalysis
Therapist uses interpretations to help the patient recognize hidden feelings and transferences that may be occurring in important relationships in her life
Therapy focuses on helping the patient identify psychological resources that she can use to cope with the current difficulty as well as with future problems
Discovering Psy p515

21. Interpersonal Therapy (IPT)
Influential short-term psychodynamic therapy, focuses on current relationships and social interactions and is highly structured
4 categories of personal problems:
unresolved grief
role disputes
role transitions
interpersonal deficits
1st phase of treatment, the therapist identifies the interpersonal problem that is causing difficulties
Next phase, the therapist helps the person understand his or her particular interpersonal problem and develop strategies to resolve it

22. Humanistic Therapies

23. 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

24. 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”

25. 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

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

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

28. 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

29. 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 with dealing with client’s day-to-day concerns but not very successful in treating psychotic patients like those with severe schizophrenia.

31. Gestalt Therapy A type of Humanistic Therapy Developed by Fritz Perls
Believed that people create their own understanding of the world and continue to grow as long as they have insight into their feelings.
More directive and confrontational than client-centered therapy.
Therapist tries to help clients identify inconsistencies between the statements they make about how they see the themselves & how they really interact with the world.

32. Boundaries to the Therapist–Client Relationship

33. Therapist–Client Relationship
Therapy is a collaborative effort between you and the therapist.
Don’t expect your therapist to make decisions for you
Your therapist is not a substitute friend
Therapeutic intimacy does not include sexual intimacy; it is never ethical or appropriate for a therapist to have any form of sexual contact with a client
Expect therapy to challenge how you think and act
Don’t confuse insight with change
Don’t confuse catharsis with change
Don’t expect change to happen overnight

34. Behavior Therapies

35. 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

36. Behavior Therapies: Classical Conditioning Techniques

37. 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
Jones also used social imitation, or observational learning, techniques

38. Systematic Desensitization
Developed by Joseph Wolpe
Based on counter conditioning
Usually used to treat phobias
phobic responses are reduced by pairing relaxation with a series of mental images or real-life situations that the person finds progressively more fear-provoking
Uses three steps:
Progressive relaxation
Development of anxiety hierarchy and control scene
Combination of progressive relaxation with anxiety hierarchy

39. 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

40. Sample Anxiety Hierarchy

41. Systematic Desensitization

42. Systematic Desensitization Variations
Virtual reality--systematic desensitization by way of computerized, anxiety-triggering 3-D stimuli
Combined with models by having the subjects watch someone perform the anxiety-causing behavior
Just as effective as graduated exposure to the actual feared objects or situations

43. 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)

44. Virtual Systematic Desensitization
Play “Virtual Fear” (7:57) Segment #30 from Scientific American Frontiers: Video Collection for Introductory Psychology (2nd edition).

45. Arachnophobia and Virtual Reality
Play “Arachnophobia” (9:31) Segment #31 from Scientific American Frontiers: Video Collection for Introductory Psychology (2nd edition).

46. Bell & Pad Treatment for Bed Wetting
Conditioning arousal from sleep in response to bodily signals of a full bladder.
Pair an alarm (US) that will awaken child (UR).
When moisture hits pad (bladder tension = NS) the Alarm sounds (US) waking the child (UR).
Eventually bladder tension (CR) causes the child to awaken (CR).
It is effective in about 75 percent of school-age children who have difficulties with bedwetting.

47. 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.

48. 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) CS
(alcohol) CR

49. Behavior Therapies: Operant Conditioning Techniques

50. 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

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

53. Cognitive Therapies

54. Cognitive Therapy
Based on the assumption that psychological problems are due to maladaptive patterns of thinking
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

55. 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

56. 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 expose and confront the person’s core irrational beliefs
Effective in the treatment of depression, social phobia, and certain anxiety disorders, and in helping people overcome self-defeating behaviors

59. 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

60. RET – AN EXAMPLE
PROBLEM: Social Phobic concerned they will be publicly embarrassed when giving a class presentation.
SOLUTION: Therapist questions the likelihood of such embarrassment occurring and impact of it.
Therapist’s goal is to show the client that not only is their failure unlikely, but even if it did happen, it would not be a big deal.

61. RET Therapy A = Activating Events B = Irrational Beliefs
C = Inappropriate Consequences
D = Disputing these Beliefs
E = Effects of disputing – Rational beliefs, appropriate feelings, desirable behaviors.

62. 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 distorted thinking and unrealistic beliefs
Schemas – methods for organizing the way we view the world have evolved into a distorted perception
Focuses on changing the client’s unrealistic beliefs
Therapist acts as model and aims for a collaborative therapeutic climate
Therapy includes homework of writing down automatic thoughts or habits

64. Cognitive Therapy: How it Works
CT therapist encourages the client to empirically test the accuracy of his or her assumptions and beliefs
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

65. What’s the Difference Between Ellis’ RET & Beck’s Cognitive Therapy?
RET therapists logically debate and vigorously challenge or dispute the irrationality of a client’s beliefs
Beck’s Cognitive Therapy give the client “homework” to empirically test the accuracy of his or her assumptions and beliefs.

66. 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

68. 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.)
From myers 6e

69. Family and Group Therapies

70. 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.
Couple therapy—relationship therapy that helps with difficulty in marriage or other committed relationships

71. 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.

72. 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

73. 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

74. 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

75. Evaluating Psychotherapy’s Effectiveness

76. 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

77. 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.

78. Evaluating Therapies
Play “Empirically Validated Therapies” (3:29) Segment #41 from Psychology: The Human Experience.

79. 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

80. 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.

81. Are Alternative Therapies Effective?

82. Eye movement desensitization reprocessing (EMDR)
Treatment technique in which patients suffering from traumatic memories visually follow her waving finger while simultaneously holding a mental image of disturbing memories, events, or situations
EMDR is more effective than no treatment at all
EMDR is no more effective than exposure therapy and other standard treatments for anxiety disorders
Several research studies have found no difference in outcome between treatments that incorporated eye movements and “sham” EMDR

83. Therapeutic Touch Therapy
Therapists move their hands above the person’s body to “push energy fields into balance.”
No evidence has been found to support the effectiveness of this therapy

84. Light Exposure Therapy
Therapy for Seasonal Affective Disorder by exposing the patient to artificial light mimicking that of the sun
Research supports a connection between exposure to light and melatonin levels in the blood, which affects levels of alertness

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