1. Copyright © 2010 Allyn & Bacon This multimedia product and its contents are protected under copyright law. The following are prohibited by law: any public performance or display, including transmission over any network; preparation of any derivative work, including the extraction, in whole or part, of any images; any rental, lease, or lending of the program. ISBN: 0-205-50294-6 PowerPoint for Abnormal Psychology Fourteenth Edition James N. Butcher Susan Mineka Jill M. Hooley Prepared by Andy Pomerantz Southern Illinois University Edwardsville

2. Copyright © 2010 Allyn & Bacon Chapter 16 Therapy

3. Copyright © 2010 Allyn & Bacon 3 An Overview of Treatment  The belief that people with psychological problems can change is the conviction underlying psychotherapy  Several hundred therapeutic approaches exist, but the efficacy of all of these have not been experimentally demonstrated  The belief that people with psychological problems can change is the conviction underlying psychotherapy  Several hundred therapeutic approaches exist, but the efficacy of all of these have not been experimentally demonstrated

4. Copyright © 2010 Allyn & Bacon Why Do People Seek Therapy?  People seeking therapy may  Be in stressful current life circumstances  Have long-standing problems  Be reluctant and enter therapy at the request of a physician, spouse, or other  Seek personal growth  People seeking therapy may  Be in stressful current life circumstances  Have long-standing problems  Be reluctant and enter therapy at the request of a physician, spouse, or other  Seek personal growth 4

5. Copyright © 2010 Allyn & Bacon Who Provides Psychotherapeutic Services?  Members of many different professions provide advice and counsel including:  Physicians  Clergy  Clergy and physicians generally refer seriously disturbed people to mental health professionals  Members of many different professions provide advice and counsel including:  Physicians  Clergy  Clergy and physicians generally refer seriously disturbed people to mental health professionals 5

6. Copyright © 2010 Allyn & Bacon Who Provides Psychotherapeutic Services?  Mental health professionals include, among others:  Clinical psychologists  Psychiatrists  Psychiatric social workers  Mental health professionals include, among others:  Clinical psychologists  Psychiatrists  Psychiatric social workers 6

7. Copyright © 2010 Allyn & Bacon The Therapeutic Relationship  The key elements of an effective working alliance between client and therapist include:  A sense of working collaboratively on the problem  Agreement between patient and therapist about the goals and tasks of therapy  An affective bond between patient and therapist  The key elements of an effective working alliance between client and therapist include:  A sense of working collaboratively on the problem  Agreement between patient and therapist about the goals and tasks of therapy  An affective bond between patient and therapist 7

8. Copyright © 2010 Allyn & Bacon 8 The Therapeutic Relationship  Other qualities enhancing therapy include:  The client’s motivation to change  A client’s expectation of receiving help  A protected setting  A good match between client and therapist  Other qualities enhancing therapy include:  The client’s motivation to change  A client’s expectation of receiving help  A protected setting  A good match between client and therapist

9. Copyright © 2010 Allyn & Bacon 9 Measuring Success in Psychotherapy  Estimated gains depend on  A therapist’s impression of changes that have occurred  A client’s reports of change  Reports from the client’s family or friends  Comparison of pretreatment and post- treatment scores on personality tests  Measures of change in selected overt behaviors  Estimated gains depend on  A therapist’s impression of changes that have occurred  A client’s reports of change  Reports from the client’s family or friends  Comparison of pretreatment and post- treatment scores on personality tests  Measures of change in selected overt behaviors

10. Copyright © 2010 Allyn & Bacon 10 Objectifying and Quantifying Change  Today the emphasis is on using more quantitative methods of measuring change  Beck Depression Inventory and Hamilton Depression Inventory are objective rating scales used pre- and post-therapy for depressed clients  fMRI can also measure change  Today the emphasis is on using more quantitative methods of measuring change  Beck Depression Inventory and Hamilton Depression Inventory are objective rating scales used pre- and post-therapy for depressed clients  fMRI can also measure change

11. Copyright © 2010 Allyn & Bacon 11 Would Change Occur Anyway?  Improvement often occurs without professional intervention  Psychotherapy can accelerate improvement  50% show clinically significant change after 21 sessions  75% show clinically significant change after 40 sessions  Improvement often occurs without professional intervention  Psychotherapy can accelerate improvement  50% show clinically significant change after 21 sessions  75% show clinically significant change after 40 sessions

12. Copyright © 2010 Allyn & Bacon 12 Can Therapy Be Harmful?  Some clients are actually harmed by their encounters with psychotherapists  5-10% deteriorate during treatment  Borderline personality disorder and OCD have relatively high rates  Therapists should not commit boundary violations or try to work with clients they are not equipped to help  Some clients are actually harmed by their encounters with psychotherapists  5-10% deteriorate during treatment  Borderline personality disorder and OCD have relatively high rates  Therapists should not commit boundary violations or try to work with clients they are not equipped to help

13. Copyright © 2010 Allyn & Bacon What Therapeutic Approaches Should Be Used?  Evidence-Based Treatment  Medication or Psychotherapy?  Combined Treatments  Evidence-Based Treatment  Medication or Psychotherapy?  Combined Treatments 13

14. Copyright © 2010 Allyn & Bacon 14 Evidence-Based Treatment  Efficacy is determined via randomized clinical trials in which therapy is compared to placebo  Usually a double-blind method is employed  Therapies under investigation are typically manualized to control variability between therapists  If efficacy studies determine that a therapy works, it is described as “evidence-based” or “empirically supported”  Efficacy is determined via randomized clinical trials in which therapy is compared to placebo  Usually a double-blind method is employed  Therapies under investigation are typically manualized to control variability between therapists  If efficacy studies determine that a therapy works, it is described as “evidence-based” or “empirically supported”

15. Copyright © 2010 Allyn & Bacon 15 Medication or Psychotherapy?  Advances in psychopharmacology have allowed many to remain unhospitalized  Problems include side effects and inexact selection of medication or dosage  Relapsing can also occur because symptoms are reduced but disorder is not cured  Advances in psychopharmacology have allowed many to remain unhospitalized  Problems include side effects and inexact selection of medication or dosage  Relapsing can also occur because symptoms are reduced but disorder is not cured

16. Copyright © 2010 Allyn & Bacon 16 Combined Treatments  In the past, it was thought that medication and psychotherapy were incompatible  Today, they are frequently combined  Combination exemplifies biopsychosocial approach  In the past, it was thought that medication and psychotherapy were incompatible  Today, they are frequently combined  Combination exemplifies biopsychosocial approach

17. Copyright © 2010 Allyn & Bacon Psychosocial Approaches to Treatment   Psychotherapy fascinates many people   The HBO drama In Treatment illustrates psychoanalytic psychotherapy   The goal of this section is to describe various therapeutic approaches and illustrate them with case studies whenever possible   Psychotherapy fascinates many people   The HBO drama In Treatment illustrates psychoanalytic psychotherapy   The goal of this section is to describe various therapeutic approaches and illustrate them with case studies whenever possible 17

18. Copyright © 2010 Allyn & Bacon Behavior Therapy  Behavior therapy is a direct and active treatment that  Recognizes the primacy of behavior  Acknowledges the role of learning  Includes thorough assessment and evaluation  Behavior therapy is a direct and active treatment that  Recognizes the primacy of behavior  Acknowledges the role of learning  Includes thorough assessment and evaluation 18

19. Copyright © 2010 Allyn & Bacon Behavior Therapy  Behavior therapy approaches include:  Exposure therapy  Aversion therapy  Modeling  Reinforcement approaches  Token economies  Behavior therapy approaches include:  Exposure therapy  Aversion therapy  Modeling  Reinforcement approaches  Token economies 19

20. Copyright © 2010 Allyn & Bacon Behavior Therapy  Tends to be relatively brief  Directed towards specific symptoms  Best with problems that are not pervasive or vaguely defined (e.g., most personality disorders)  Often used with anxiety disorders  Behavioral activation is a relatively new development encouraging greater engagement with life  Tends to be relatively brief  Directed towards specific symptoms  Best with problems that are not pervasive or vaguely defined (e.g., most personality disorders)  Often used with anxiety disorders  Behavioral activation is a relatively new development encouraging greater engagement with life 20

21. Copyright © 2010 Allyn & Bacon 21 Cognitive and Cognitive-Behavioral Therapy  Cognitive or cognitive-behavioral therapy attempts to change a person’s behavior by  Modifying self-statements  Modifying construal of events  Cognitive or cognitive-behavioral therapy attempts to change a person’s behavior by  Modifying self-statements  Modifying construal of events

22. Copyright © 2010 Allyn & Bacon 22 Cognitive and Cognitive-Behavioral Therapy  Rational emotive behavior therapy attempts to change a client’s thought processes  Stress-inoculation therapy is a type of self-instructional training focused on altering the self-statements an individual routinely makes in stressful situations  Rational emotive behavior therapy attempts to change a client’s thought processes  Stress-inoculation therapy is a type of self-instructional training focused on altering the self-statements an individual routinely makes in stressful situations

23. Copyright © 2010 Allyn & Bacon 23 Cognitive and Cognitive-Behavioral Therapy  Beck’s cognitive therapy is based on the assumption that problems like depression result from  Clients’ illogical thinking about themselves  Clients’ illogical thinking about the world around them  Beck’s cognitive therapy is based on the assumption that problems like depression result from  Clients’ illogical thinking about themselves  Clients’ illogical thinking about the world around them

24. Copyright © 2010 Allyn & Bacon 24 Cognitive and Cognitive-Behavioral Therapy  Efficacy of cognitive therapy has been well-documented  Especially with depression, anxiety disorders, and bulimia  Debate about whether cognitive change is the “active ingredient” in cognitive therapy  Efficacy of cognitive therapy has been well-documented  Especially with depression, anxiety disorders, and bulimia  Debate about whether cognitive change is the “active ingredient” in cognitive therapy

25. Copyright © 2010 Allyn & Bacon Humanistic-Experiential Therapies  Humanistic-experimental therapies include:  Client-centered therapy  Gestalt therapy  Process-experiential therapy  Humanistic-experimental therapies include:  Client-centered therapy  Gestalt therapy  Process-experiential therapy 25

26. Copyright © 2010 Allyn & Bacon Humanistic-Experiential Therapies  Have had a major impact on contemporary view of human nature and good psychotherapy  However, have been criticized for lack of agreed-upon procedures and vagueness of method  Increasing outcome data suggests it is beneficial for a variety of problems  Have had a major impact on contemporary view of human nature and good psychotherapy  However, have been criticized for lack of agreed-upon procedures and vagueness of method  Increasing outcome data suggests it is beneficial for a variety of problems 26

27. Copyright © 2010 Allyn & Bacon 27 Psychodynamic Therapies  Psychodynamic therapy is mainly practiced in two basic forms:  Classical psychoanalysis  Psychoanalytically oriented psychotherapy  Psychodynamic therapy is mainly practiced in two basic forms:  Classical psychoanalysis  Psychoanalytically oriented psychotherapy

28. Copyright © 2010 Allyn & Bacon 28 Psychodynamic Therapies  Elements of Freudian psychoanalysis include:  Free association  Analysis of dreams  Analysis of resistance  Analysis of transference  Elements of Freudian psychoanalysis include:  Free association  Analysis of dreams  Analysis of resistance  Analysis of transference

29. Copyright © 2010 Allyn & Bacon 29 Psychodynamic Therapies  Contemporary psychodynamic approaches tend to have  A strongly interpersonal focus  Revisions to the object relations perspective  Revisions to the attachment and self- psychology perspectives  Contemporary psychodynamic approaches tend to have  A strongly interpersonal focus  Revisions to the object relations perspective  Revisions to the attachment and self- psychology perspectives

30. Copyright © 2010 Allyn & Bacon  The focus of marital therapy and family systems therapy is to change the way in which members of the family unit interact 30 Couple and Family Therapy

31. Copyright © 2010 Allyn & Bacon 31 Couple and Family Therapy  Integrative behavioral couple therapy is increasingly replacing traditional behavioral couple therapy  Structural family therapy is one form of family therapy that emphasizes new organization of family relationships  Integrative behavioral couple therapy is increasingly replacing traditional behavioral couple therapy  Structural family therapy is one form of family therapy that emphasizes new organization of family relationships

32. Copyright © 2010 Allyn & Bacon 32 Eclecticism and Integration  Therapists today are more likely to label their orientation as eclectic than to adhere to a single approach  Interpersonal therapy, which focuses on changing current relationships to reduce depression, is an example of an eclectic form of therapy  Therapists today are more likely to label their orientation as eclectic than to adhere to a single approach  Interpersonal therapy, which focuses on changing current relationships to reduce depression, is an example of an eclectic form of therapy

33. Copyright © 2010 Allyn & Bacon  Critics may view psychotherapy as an attempt to get people adjusted to a “sick” society  Therapists can be seen as guardians of the status quo  Critics may view psychotherapy as an attempt to get people adjusted to a “sick” society  Therapists can be seen as guardians of the status quo 33 Sociocultural Perspectives

34. Copyright © 2010 Allyn & Bacon 34 Social Values and Psychotherapy  Therapists’ own value judgments can affect decisions they make about treating clients  Example: A young mother abused by an alcoholic husband shows signs of depression, but who should be treated?  Example: A 15-year-old girl is sexually active but her parents disapprove. What goal should the therapist set?  Therapists’ own value judgments can affect decisions they make about treating clients  Example: A young mother abused by an alcoholic husband shows signs of depression, but who should be treated?  Example: A 15-year-old girl is sexually active but her parents disapprove. What goal should the therapist set?

35. Copyright © 2010 Allyn & Bacon 35 Psychotherapy and Cultural Diversity  Members of minorities  Are underrepresented in treatment research studies  Are underserved by the mental health system  Often have very different backgrounds than their therapists, which can affect therapeutic alliance  Members of minorities  Are underrepresented in treatment research studies  Are underserved by the mental health system  Often have very different backgrounds than their therapists, which can affect therapeutic alliance

36. Copyright © 2010 Allyn & Bacon 36 Biological Approaches to Treatment  Antipsychotic Drugs  Antidepressant Drugs  Anti-Anxiety Drugs  Lithium and Other Mood-Stabilizing Drugs  Electroconvulsive Therapy  Neurosurgery  Antipsychotic Drugs  Antidepressant Drugs  Anti-Anxiety Drugs  Lithium and Other Mood-Stabilizing Drugs  Electroconvulsive Therapy  Neurosurgery

37. Copyright © 2010 Allyn & Bacon Antipsychotic Drugs  Antipsychotic drugs are used to treat psychotic disorders such as:  Schizophrenia  Psychotic mood disorders  One side effect of traditional antipsychotics is tardive dyskinesia  Atypical antipsychotic drugs  Have a lower risk of side effects  Treat positive and negative symptoms  Antipsychotic drugs are used to treat psychotic disorders such as:  Schizophrenia  Psychotic mood disorders  One side effect of traditional antipsychotics is tardive dyskinesia  Atypical antipsychotic drugs  Have a lower risk of side effects  Treat positive and negative symptoms 37

38. Copyright © 2010 Allyn & Bacon Antidepressant Drugs  The most widely prescribed antidepressant drugs are selective serotonin re-uptake inhibitors  Older antidepressants include:  Monoamine oxidase inhibitors  Tricyclic antidepressants  Trazodone  Antidepressants are also widely used in the treatment of various other disorders  The most widely prescribed antidepressant drugs are selective serotonin re-uptake inhibitors  Older antidepressants include:  Monoamine oxidase inhibitors  Tricyclic antidepressants  Trazodone  Antidepressants are also widely used in the treatment of various other disorders 38

39. Copyright © 2010 Allyn & Bacon 39 Figure 16.3: Tricyclic Antidepressants as Reuptake Blockers

40. Copyright © 2010 Allyn & Bacon Anti-Anxiety Drugs  The most widely prescribed anti-anxiety drugs are benzodiazepines  Buspirone also has been shown to be effective  The most widely prescribed anti-anxiety drugs are benzodiazepines  Buspirone also has been shown to be effective 40

41. Copyright © 2010 Allyn & Bacon Lithium and Other Mood-Stabilizing Drugs  Lithium is very effective in treating bipolar mood disorders  Other mood-stabilizing drugs include:  Divalproic acid  Carbamazepine  Lithium is very effective in treating bipolar mood disorders  Other mood-stabilizing drugs include:  Divalproic acid  Carbamazepine 41

42. Copyright © 2010 Allyn & Bacon 42 Electroconvulsive Therapy  Electroconvulsive therapy is now used to treat severe mood disorders  It is a safe, effective, and important form of treatment, often used after others have failed  Anesthetics allow patients to sleep through the procedure  Bilateral ECT appears to be more effective than unilateral ECT  ECT produces some short-term side effects including amnesia  Electroconvulsive therapy is now used to treat severe mood disorders  It is a safe, effective, and important form of treatment, often used after others have failed  Anesthetics allow patients to sleep through the procedure  Bilateral ECT appears to be more effective than unilateral ECT  ECT produces some short-term side effects including amnesia

43. Copyright © 2010 Allyn & Bacon 43 Figure 16.4: Unilateral and Bilateral Electrode Placement for ECT

44. Copyright © 2010 Allyn & Bacon 44 NeurosurgeryNeurosurgery  Antipsychotic drugs have decreased the use of psychosurgery  Psychosurgery appears to be effective with debilitating OCD, self-mutilation, or anorexia  Deep brain stimulation is a more recent surgical approach  Antipsychotic drugs have decreased the use of psychosurgery  Psychosurgery appears to be effective with debilitating OCD, self-mutilation, or anorexia  Deep brain stimulation is a more recent surgical approach

45. Copyright © 2010 Allyn & Bacon Unresolved Issues  Is there bias in the reporting of drug trials?  Researchers may have financial ties to drug companies  Does this represent a conflict of interests when investigating those companies’ products?  Is there bias in the reporting of drug trials?  Researchers may have financial ties to drug companies  Does this represent a conflict of interests when investigating those companies’ products? 45

46. Copyright © 2010 Allyn & Bacon End of Chapter 16