1. Copyright © Allyn & Bacon 2006 by Pearson Education. Reproduced by permission of the publisher. Further reproduction is prohibited without written permission from the publisher. This multimedia product and its contents are protected under copyright law. The following are prohibited by law: Any public performance or display, including transmission of any image over a network; Preparation of any derivative work, including the extraction, in whole or in part, of any images; Any rental, lease, or lending of the program. Therapy www.ablongman.com/lefton9e

2. Copyright © Allyn & Bacon 2006 What is Psychotherapy, and What Types Are Available? A. Is Psychotherapy Necessary and Effective? 1. Placebo Effects Controlled with double-blind studies –Reduce demand characteristics Such studies show psychotherapy is effective 2. Effectiveness of Psychotherapy Psychotherapy patients are better off than 80% of untreated patients Most therapies are equally effective

3. Copyright © Allyn & Bacon 2006 What is Psychotherapy, and What Types Are Available? B. Which Therapy, Which Therapist? –Eclectic approaches –Systematic psychotherapeutic approaches Psychodynamically based therapies Humanistic therapy Behavior therapy Cognitive therapy

4. Copyright © Allyn & Bacon 2006 What is Psychotherapy, and What Types Are Available? C. Are There Common Factors Among Therapists? –Expectations of change –Attention from the therapist –Therapist characteristics –Rapport between therapist and client –Initiative from client –Adherence to ethical guidelines

5. Copyright © Allyn & Bacon 2006 Psychotherapy Effectiveness Therapist and client should form an alliance to work on problems The client should be motivated to make changes There should be rapport (connection and mutual understanding) between therapist and client

6. Copyright © Allyn & Bacon 2006 Mental Health Practitioners Clinical Psychologist Ph.D. or Psy.D. trained to diagnose, treat, and conduct research on psychological and behavioral disorders Psychiatrist M.D. Social Worker M.S.W. Psychiatric Nurse M.S.N. Counselor M.A.

7. Copyright © Allyn & Bacon 2006 What Roles Do Culture and Gender Play in Therapy? --All therapy occurs in a cultural context –Multiculturalism Acceptance and celebration of all cultures –Transculturalism Recognition of the interaction of multiple cultural influences on an individual

8. Copyright © Allyn & Bacon 2006 What Roles Do Culture and Gender Play in Therapy? Therapists’ ethnicity affects how they are viewed by clients Clients’ ethnicity affects how they respond to treatment Therapists must respect culture without stereotyping clients Gender –Women seek therapy more than men –Women and men often communicate differently (rapport talk Vs. report talk) –Effects of gender biases and gender roles

9. Copyright © Allyn & Bacon 2006 How Do Psychodynamic Therapies Work? A. Goals of Psychoanalysis –Understanding and awareness of unconscious conflicts B. Techniques of Psychoanalysis –Exploration of early experiences –Free association –Dream analysis –Interpretation –Use of resistance –Transference –Working through

10. Copyright © Allyn & Bacon 2006 How Do Psychodynamic Therapies Work? C. Criticisms of Psychoanalysis –Unscientific –Ignores free will –Based on an untestable theory –Sexist –No more effective than other therapies –Time-consuming and expensive

11. Copyright © Allyn & Bacon 2006 What Do Humanistic Therapies Emphasize? Carl Rogers: Techniques of Client- Centered Therapy –Essential techniques Unconditional positive regard Congruence Empathy Paraphrasing Reflecting

12. Copyright © Allyn & Bacon 2006 What Do Humanistic Therapies Emphasize? Criticisms of Client-Centered Therapy –Emphasis on therapeutic relationship may not be enough to bring long-lasting change –Focuses on hard-to-define concepts, like self-actualization

13. Copyright © Allyn & Bacon 2006 What Are the Methods of Behavior Therapy? Assumptions and Goals of Behavior Therapy –Behavior modification –Uses learning principles to change overt behavior

14. Copyright © Allyn & Bacon 2006 Assumptions and Goals of Behavior Therapy Does not interpret past events Behaviorists criticize insight-oriented therapies because –They use concepts that can’t be defined or measured –Patients improve without these treatments –Being labeled “abnormal” may lead to more abnormal behavior

15. Copyright © Allyn & Bacon 2006 Assumptions and Goals of Behavior Therapy Insight-oriented therapists criticize behaviorists because –Treat symptoms, not the underlying problems –May lead to symptom substitution Research shows behavior therapy is as, if not more, effective than insight-oriented therapies

16. Copyright © Allyn & Bacon 2006 What Are the Methods of Behavior Therapy? Operant Conditioning in Behavior Therapy 1. Token Economies Receive tokens for desirable behaviors Exchange tokens for desired items or privileges Used effectively in schools and hospitals to modify behavior in social settings

17. Copyright © Allyn & Bacon 2006 Operant Conditioning in Behavior Therapy 2. Extinction 3. Punishment –Usually combined with reinforcement of a desirable replacement behavior –May lead to aggression 4. Time-Out

18. Copyright © Allyn & Bacon 2006 What Are the Methods of Behavior Therapy? C. Counterconditioning in Behavior Therapy –Based on principles of classical conditioning –Systematic desensitization Learn to relax Once relaxed, imagines increasingly vivid scenes of anxiety-arousing stimulus Based on the principle that a person cannot be afraid and relaxed at the same time

19. Copyright © Allyn & Bacon 2006 Counterconditioning in Behavior Therapy Aversive Counterconditioning –Pairs an unpleasant stimulus with a stimulus that prompts inappropriate behavior E.g., Give an alcoholic drink laced with a drug that induces nausea Eventually, even the thought of alcohol will make the person feel sick –Not widely used

20. Copyright © Allyn & Bacon 2006 What Are the Methods of Behavior Therapy? D. Modeling in Behavior Therapy –According to Bandura, modeling is most effective for Teaching new behaviors Eliminating fears Enhancing already existing behaviors –Unfortunately, people may learn from inappropriate models, too

21. Copyright © Allyn & Bacon 2006 Why is Cognitive Therapy So Popular? A. Assumptions of Cognitive Therapy –Three basic assumptions: Thinking affects behavior Cognitive activity can be monitored Behavior changes can be affected through cognitive changes –Cognitive behavior therapists –Cognitive restructuring modifies faulty thought patterns

22. Copyright © Allyn & Bacon 2006 Why is Cognitive Therapy So Popular? B. Types of Cognitive Therapy 1. Rational–Emotive Therapy Albert Ellis Faulty and irrational thinking causes irrational behavior

23. Copyright © Allyn & Bacon 2006 Types of Cognitive Therapy 2. Beck’s Approach –Focuses on negative views about self, the world, and the future –Four stages: Awareness of thoughts Recognize when faulty Substitute accurate thoughts Feedback about whether correct

24. Copyright © Allyn & Bacon 2006 How Does Therapy Work In A Group? A. Techniques of Group Therapy –Varies for each therapist and each group –In general, groups consist of 6–12 unrelated people –Allows members to share problems and learn from each other –Members can role-play new behaviors

25. Copyright © Allyn & Bacon 2006 How Does Therapy Work In A Group? B. Family Therapy –Special form of group therapy in which two or more people have a special relationship and are committed to each other –Focus on the family’s structure and organization Relationship therapy Family systems approach –Codependence (being enmeshed) –As, if not more, effective than individual therapy

26. Copyright © Allyn & Bacon 2006 How Do Biologically Based Therapies Create Change? A. Drugs and the Therapeutic Process –Increasingly used –Correct dosages are crucial –Long-term use may not be advisable –Can not permanently cure most problems –Some psychologists lobbying for prescription privileges –Various types of psychotropic drugs

27. Copyright © Allyn & Bacon 2006 Drugs and the Therapeutic Process 1. Antianxiety Drugs –Tranquilizers or anxiolytics Xanax, Librium, Valium 2. Antidepressant Drugs –Selective serotonin reuptake inhibitors (SSRIs) Block reuptake of serotonin E.g., Prozac, Zoloft, Paxil, Celexa Effects usually seen within about 4 weeks

28. Copyright © Allyn & Bacon 2006 Antidepressant Drugs Tricyclics Also block reuptake of neurotransmitters E.g., imipramine (Tofranil), amitriptyline (Elavil) c. Monoamine Oxidase (MAO) inhibitors Inhibts MAO, an enzyme that breaks down neurotransmitters Can have serious side effects

29. Copyright © Allyn & Bacon 2006 Antidepressant Drugs All antidepressant drugs have some side effects in some people Research evidence for effectiveness is mixed Most appropriate for serious and / or chronic depression Also appropriate when talk therapy isn’t working or is refused

30. Copyright © Allyn & Bacon 2006 Drugs and the Therapeutic Process 3. Antimania Drugs –E.g., Lithium carbonate –Used to treat bipolar disorder 4. Antipsychotic Drugs –Neuroleptics –Used to treat schizophrenia Phenothiazines (e.g., Thorazine) Atypical antipsychotics (e.g., Clozaril) Newer drugs (e.g., Risperdal)

31. Copyright © Allyn & Bacon 2006 Antipsychotic Drugs Newer drugs have fewer side effects Especially effective for treating hallucinations and delusions Long-term use associated with significant problems –Tardive dyskinesia

32. Copyright © Allyn & Bacon 2006 How Do Biologically Based Therapies Create Change? B. Psychosurgery and Electroconvulsive Therapy –Psychosurgery (brain surgery) Prefrontal lobotomy –Very rare today »Drugs more effective »Questionable long-term effects »Irreversible

33. Copyright © Allyn & Bacon 2006 Psychosurgery and Electroconvulsive Therapy Electroconvulsive therapy (ECT) –Electrical current applied to the head to produce a seizure –Overused in the 1940s and 1950s –Effective in short-term treatment of severe depression –Drug treatment and talk therapy needed to maintain long-term change

34. Copyright © Allyn & Bacon 2006 How Do Biologically Based Therapies Create Change? C. Alternative Therapies –Very little controlled, scientific evidence for their effectiveness D. The Debate Over Hospitalization –Hospitalization occurs when patients are at a risk of harming themselves or others –Deinstitutionalization: Transition from inpatient hospitalization to outpatient treatment Cheaper than hospitalization Large numbers of the homeless are deinstitutionalized