1. EXPLORING PSYCHOLOGY EIGHTH EDITION IN MODULES David Myers PowerPoint Slides Aneeq Ahmad Henderson State University Worth Publishers, © 2011

2. 2 Therapy

3. The Psychological Therapies Module 35 3

4. 4 Psychoanalysis  Aims  Methods  Psychodynamic Therapy Humanistic Therapies

5. 5 Behavior Therapies  Classical Conditioning Techniques  Operant Conditioning Cognitive Therapies  Beck’s Therapy for Depression  Cognitive-Behavioral Therapy Group and Family Therapies

6. 6 Evaluating Psychotherapies  Is Psychotherapy Effective?  The Relative Effectiveness of Different Therapies  Evaluating Alternative Therapies  Commonalities Among Psychotherapies  CLOSE-UP: A Consumer’s Guide to Psychotherapists  Culture and Values in Psychotherapy  CLOSE-UP : Preventing Psychological Disorders

7. 7 History of Insane Treatment Maltreatment of the insane throughout the ages was the result of irrational views. Many patients were subjected to strange, debilitating, and downright dangerous treatments. The Granger Collection

8. 8 History of Insane Treatment Philippe Pinel in France and Dorthea Dix in the U.S., Canada, and Scotland founded humane movements to care for the mentally ill. Dorthea Dix Culver Pictures

9. 9 The Psychological Therapies Psychotherapy involves an emotionally charged, confiding interaction between a trained therapist and a mental patient. An eclectic approach uses various forms of healing techniques depending upon the client’s unique problems.

10. 10 Psychoanalysis The first formal psychotherapy to emerge was psychoanalysis, developed by Sigmund Freud, relying on the therapist’s interpretations of the patient’s free associations, dreams, resistances, and transferences. Few therapists today practice as Freud did, but his work established part of the foundation for treating psychological disorders.

11. 11 Psychoanalysis: Aims The aim of psychoanalysis is to bring repressed feelings into conscious awareness where the patient can deal with them. When energy devoted to id-ego-superego conflicts is released, the patient’s anxiety lessens.

12. 12 Psychoanalysis: Methods Dissatisfied with hypnosis, Freud developed the method of free association to unravel the unconscious mind and its conflicts. The patient lies on a couch and speaks about whatever comes to his or her mind. When the patient edits his or her thoughts, (pausing, joking, or changing the subject) the analyst interprets this as resistance, hinting that anxiety lurks.

13. 13 Psychoanalysis: Methods The analyst notes these resistances and interprets them, offering insight into their meaning. Over many sessions the patient may develop positive or negative feelings (transference) towards the therapist. By exposing these feelings, insight is gained into current and past relationships.

14. 14 Psychoanalysis Few U.S. therapists today practice psychoanalysis because: -It cannot be proven or disproven. - It takes a long time and is very expensive.

15. 15 Psychodynamic Therapy Influenced by Freud, in a face-to-face setting, psychodynamic therapists understand symptoms and themes across important relationships in a patient’s life. Sessions take place once a week for only a few weeks or months.

16. 16 Humanistic Therapies Psychoanalytic and humanistic therapies are often referred to as insight therapies because they aim to help people by reducing inner conflict and increasing self-understanding. Humanistic therapists aim to boost self- fulfillment by helping people grow in self- awareness and self-acceptance.

17. 17 Client-Centered Therapy Developed by Carl Rogers, client-centered therapy is the most widely used form of humanistic therapy. The therapist listens to the needs of the patient in an accepting and non-judgmental way, addressing problems in a productive way and building his or her self-esteem.

18. 18 Humanistic Therapy The therapist engages in active listening and echoes, restates, and clarifies the patient’s thinking, acknowledging expressed feelings. In an environment that provides unconditional positive regard, people may accept even their worst traits and feel valued.

19. 19 Behavior Therapy Behavioral therapists assume that problem behaviors are the problem and apply learning principles to eliminate them.

20. 20 Classical Conditioning Techniques Counterconditioning is a procedure that conditions new responses to stimuli that trigger unwanted behaviors. It is based on classical conditioning and includes exposure therapy and aversive conditioning.

21. 21 Exposure Therapy Expose patients to things they fear and avoid. Through repeated exposures, anxiety lessens because they habituate to the things feared. The Far Side © 1986 FARWORKS. Reprinted with Permission. All Rights Reserved.

22. 22 Exposure Therapies Systematic desensitization is a type of exposure therapy that associates a pleasant, relaxed state with gradually increasing anxiety-triggering stimuli commonly used to treat phobias. The therapists usually begins with imagined situations, moving up to actual situations,,until the patient no longer experiences anxiety.

23. Exposure Therapies If the anxiety-arousing situation is too, difficult, expensive, or embarrassing to recreate the therapist may turn to virtual reality exposure therapy, relying on computer simulations of feared situations. Fig 35.1 23

24. 24 Aversive Conditioning Aversive conditioning associates an unpleasant state with an unwanted behavior. With this technique, temporary conditioned aversion to alcohol has been reported.

25. 25 Operant Conditioning Operant conditioning procedures enable therapists to use behavior modification, in which desired behaviors are rewarded and undesired behaviors are either unrewarded or punished. In institutional settings, therapists create a token economy in which patients can earn tokens for exhibiting appropriate behaviors. Tokens can later be exchanged for priviledges such as television time, trips, or better living quarters.

26. 26 Operant Conditioning Critics of behavior modification express two concerns: -How durable are the behaviors? When the reinforcers stop, will the behaviors stop as well? -Is it right to control another person’s behavior?

27. 27 Cognitive Therapy Cognitive therapies assume that our thinking colors our feelings and tries to teach new, more constructive ways of thinking. Fig 35.3

28. 28 Beck’s Therapy for Depression Aaron Beck (1979) believed that cognitive therapy could change depressed patients’ castastrophizing beliefs. He sought to reveal irrational thinking by gently questioning patients and then persuading them to change their thinking.

29. 29 Stress Inoculation Training Meichenbaum (1977, 1985) trained people to restructure their thinking in stressful situations. “Relax, the exam may be hard, but it will be hard for everyone else too. I studied harder than most people. Besides, I don’t need a perfect score to get a good grade.”

30. 30 Cognitive-Behavior Therapy Cognitive-behavior therapy aims to alter the way people act (behavior therapy) and the way they think (cognitive therapy). Many studies confirm that it is an effective therapy for those with anxiety and depression.

31. 31 Group & Family Therapies Group therapy normally consists of 6-9 people attending a 90-minute session that can help more people and costs less. A therapist guides the interactions of the clients and the clients benefit from knowing others have similar problems.

32. 32 Family Therapy Family therapy treats the family as a system. Therapy guides family members toward positive relationships and improved communication.

33. Comparison of Major Psychotherapies 33

34. 34 In 2004 7.4 percent of Americans reported “undergoing counseling for mental or emotional problems” a 25% increase from 1991. With the increasing popularity of therapy, we need to ask, how effective is it? Evaluating Therapies

35. 35 Is Psychotherapy Effective? It is difficult to gauge the effectiveness of psychotherapy because there are different levels upon which its effectiveness can be measured. 1.Does the patient sense improvement? 2.Does the therapist feel the patient has improved? 3.How do friends and family feel about the patient’s improvement?

36. 36 Client’s Perceptions If you ask clients about their experiences of getting into therapy, they often overestimate its effectiveness. Critics however remain skeptical. 1.Clients enter therapy in crisis, but crisis may subside over the natural course of time (regression to normalcy). 2.Clients may need to believe the therapy was worth the effort. 3.Clients generally speak kindly of their therapists.

37. 37 Clinician’s Perceptions Like clients, clinicians believe in therapy’s success. They believe the client is better off after therapy than if the client had not taken part in therapy. 1.Clinicians are aware of failures, but they believe failures are the problem of other therapists. 2.If a client seeks another clinician, the former therapist is more likely to argue that the client has developed another psychological problem. 3.Clinicians are likely to testify to the efficacy of their therapy regardless of the outcome of treatment.

38. 38 Outcome Research How can we objectively measure the effectiveness of psychotherapy? Meta-analysis of a number of studies suggests that thousands of patients benefit more from therapy than those who did not go to therapy.

39. 39 The Relative Effectiveness of Different Therapies Some forms of therapy are especially effective at treating particular problems. For example, behavioral conditioning works well for specific behavior problems. Therapy is most effective when there is a clear- cut problem.

40. Some clinicians believe in evidence-based practice, clinical decision making that integrates the best available research with clinical expertise and patient characteristics and preferences, thinking that it holds mental health professionals accountable and protects patients from pseudotherapies. 40 The Relative Effectiveness of Different Therapies

41. 41 Evaluating Alternative Therapies 57% of those who have had anxiety attacks and 54% who have had depression have used alternative treatments such as herbal medicines, massage, and spiritual healing (Kessler & others, 2001). Do alternative therapies hold up under scientific scrutiny?

42. 42 Eye Movement Desensitization and Reprocessing (EMDR) In EMDR therapy, the therapist attempts to unlock and reprocess previous frozen traumatic memories by waving a finger in front of the eyes of the client. EMDR has not held up under scientific testing.

43. 43 Light Exposure Therapy Seasonal Affective Disorder (SAD), a form of depression, has been effectively treated by light exposure therapy. This form of therapy has been scientifically validated. Courtesy of Christine Brune

44. A Consumer’s Guide to Psychotherapists 44

45. 45 Commonalities Among Psychotherapies Three commonalities shared by all forms of psychotherapies are the following: 1.A hope for demoralized people. 2.A new perspective. 3.An empathic, trusting and caring relationship.

46. 46 Culture and Values in Psychotherapy All therapies offer hope, and nearly all therapists attempt to enhance their clients’ sensitivity, openness, personal responsibility, and sense of purpose (Jensen & Bergin, 1988). But in matters of culture and values, therapists differ from one another and from their clients (Delaney et al., 2007; Kelly, 1990). A therapist search should include visiting two or more therapists to judge which one makes the client feel more comfortable.

47. Preventing Psychological Disorders Some feel that psychological disorders are understandable responses to a stressful environment and that the social context needs treatment as well as the patient. Preventative mental health seeks to prevent problems by identifying and eliminating the causes. George Albee felt that we should attempt to alleviate stressful life situations (poverty, racism, demoralizing work) through support programs. 47