1. ABNORMAL PSYCHOLOGY, SIXTEENTH EDITION James N. Butcher/ Jill M
ABNORMAL PSYCHOLOGY, SIXTEENTH EDITION James N. Butcher/ Jill M. Hooley/ Susan Mineka
Chapter 16
Therapy
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2. An Overview of Treatment
Conviction underlying psychotherapy
People with psychological problems can change
Several hundred therapeutic approaches exist, but the efficacy of all of these have not been experimentally demonstrated
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3. Several hundred therapeutic approaches exist, but the efficacy of all of these have not been experimentally demonstrated
Myths
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4. 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
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5. Who Provides Psychotherapeutic Services?
Members of many different professions provide advice and counsel
Physicians
Clergy
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6. Who Provides Psychotherapeutic Services?
Clergy and physicians generally refer seriously disturbed people to mental health professionals.
Who are these professionals?
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7. Who Provides Psychotherapeutic Services?
Mental health professionals
Clinical psychologists
Psychiatrists
Psychiatric social workers
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8. The Therapeutic Relationship
Can you fill in the blanks?
The key elements of an effective working alliance between client and therapist include:
A sense of working ________ on the problem
________ between patient and therapist about the goals and tasks of therapy.
A(n) ________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
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9. The Therapeutic Relationship
Other qualities enhancing therapy
Client’s motivation to change
Client’s expectation of receiving help
Protected setting
Good match between client and therapist
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10. Measuring Success in Psychotherapy
Estimated gains depend on
Therapist’s impression of changes that have occurred
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
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11. Objectifying and Quantifying Change
Measuring change with quantitative methods
Beck Depression Inventory
Hamilton Depression Inventory
fMRI
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
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12. 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
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13. Would Change Occur Anyway?
Improvement often occurs without professional intervention
Psychotherapy can accelerate improvement
Research findings
50% show clinically significant change after 21 sessions
75% show clinically significant change after 40 sessions
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14. 50% show clinically significant change after 21 sessions
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15. Can Therapy Be Harmful?
Some clients harmed by encounters with psychotherapists
5-10% deteriorate during treatment
Responsibilities of therapists
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
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16. 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. Marrying your client?
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17. What Therapeutic Approaches Should Be Used?
Combined Treatments
Medication or Psychotherapy?
Evidence-Based Treatment
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18. Evidence-Based Treatment
Efficacy
Determined via randomized clinical trials in which therapy is compared to placebo
Methods
Double-blind method is employed
Therapies under investigation manualized
Therapies under investigation are typically manualized to control variability between therapists
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19. Evidence-Based Treatment
“Empirically supported” treatment
Efficacy studies determine that a therapy works
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20. Medication or Psychotherapy?
Advances in psychopharmacology
Allow many to remain unhospitalized
Include problems with side effects and matching drug and drug dosage to needs of specific patient
May reduce symptoms but not cure disorder, resulting in relapse
Relapsing can also occur because symptoms are reduced but disorder is not cured
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21. Combined (Medication plus Psychotherapy) Treatments
Clinical Practice
Medication and psychotherapy combined used for schizophrenia and bipolar disorder.
Effectiveness
Combined treatment often works better for chronic or recurrent depression.
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22. Psychosocial Approaches to Treatment
The goal of this section is to describe various therapeutic approaches and case studies
Psychotherapy fascinates many people
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23. Includes direct and active treatment Recognizes primacy of behavior
Behavior therapy
Includes direct and active treatment
Recognizes primacy of behavior
Acknowledges role of learning
Includes thorough assessment and evaluation
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24. Behavior Therapy Exposure therapy Aversion therapy
Behavior therapy approaches
Exposure therapy
Aversion therapy
Modeling
Systematic Reinforcement approaches
Token economies
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25. Behavior Therapy Relatively brief Directed towards specific symptoms
Characteristics
Relatively brief
Directed towards specific symptoms
Best used with problems that are not pervasive or vaguely defined
Often used with anxiety disorders
Best used with problems that are not pervasive or vaguely defined (e.g., most personality disorders)
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26. Behavioral activation
Behavior Therapy
Behavioral activation
Relatively new development for treatment of depression
Encourages greater engagement with life
Best used with problems that are not pervasive or vaguely defined (e.g., most personality disorders)
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27. cognitive-behavioral therapy
Cognitive or
cognitive-behavioral therapy
Attempts to change behavior by modifying self-statements
Modifying construal of events
Cognitive processes influence emotions, motivation, and behavior
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28. Cognitive and Cognitive-Behavioral Therapy
Rational Emotive Behavior Therapy
Developed by Albert Ellis
Tries to change a client’s maladaptive thought processes that influence maladaptive emotional responses and behavior.
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29. Cognitive and Cognitive-Behavioral Therapy
Beck’s cognitive therapy
Problems like depression result from clients’ illogical thinking about themselves and the world around them.
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30. Cognitive and Cognitive-Behavioral Therapy
Efficacy of cognitive therapy
Well-documented with depression, anxiety disorders, conduct disorder, and bulimia
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31. Cognitive and Cognitive-Behavioral Therapy
What do you think?
Is cognitive change the “active ingredient” in cognitive therapy?
Opinion question
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32. Humanistic-Experiential Therapies
Humanistic-experimental therapies
Client-centered therapy
Gestalt therapy
Motivational interviewing
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33. Humanistic-Experiential Therapies
Outcome data: beneficial for a variety of problems
Lack of agreed-upon procedures and vagueness of client–therapist relationship
Impact on contemporary view of human nature and good psychotherapy
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
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34. Psychodynamic Therapies
Psychodynamic therapy basic forms
Classical psychoanalysis
Psychoanalytically oriented psychotherapy
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35. Psychodynamic Therapies
Elements of Freudian psychoanalysis
Free association
Analysis of dreams
Analysis of resistance
Analysis of transference
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36. Psychodynamic Therapies
Contemporary psychodynamic approaches
Strongly interpersonal focus
Object relations perspective
Attachment-based and self-psychology perspectives
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37. Couple and Family Therapy
Marital Therapy
Short-term therapy based on social learning model.
Teaches partners caring behaviors and conflict resolution through communication and problem solving.
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38. Couple and Family Therapy
Family Systems Therapy
Within-family behavior of any particular family member is influenced by behaviors and communications of other family members.
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39. Couple and Family Therapy
Integrative behavioral couple therapy
Increasingly replacing traditional behavioral couple therapy
Focuses more on acceptance versus change
Structural family therapy
Form of family therapy that emphasizes new organization of family relationships
Requires an active, but non-directive, therapeutic approach
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40. Eclecticism and Integration
Electicism
Labels orientation as eclectic, which borrows and combines techniques and concepts from various approaches
Interpersonal therapy
Focuses on changing current relationships to reduce depression. 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
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41. Sociocultural Perspectives
Critics
Psychotherapy viewed as attempt to get people adjusted to a “sick” society
Therapists seen as guardians of status quo
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42. Social Values and Psychotherapy
Therapists’ own value judgments can affect decisions they make about treating clients. Can you think of an example to illustrate this statement?
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?
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43. Psychotherapy and Cultural Diversity
Members of minorities
Underrepresented in treatment research studies
Underserved by mental health system
Affected by different backgrounds than their therapists
Often have very different backgrounds than their therapists, which can affect therapeutic alliance
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44. Biological Approaches to Treatment
Neurosurgery
Electroconvulsive Therapy
Lithium and Other Mood-Stabilizing Drugs
Anti-Anxiety Drugs
Antidepressant Drugs
Antipsychotic Drugs
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45. Atypical antipsychotic drugs
Used to treat psychotic disorders such as schizophrenia and psychotic mood disorders
Atypical antipsychotic drugs
Have a lower risk of side effects: Tardive Dyskinesia
Treat positive and negative symptoms
One side effect of traditional antipsychotics is tardive dyskinesia
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46. Antidepressant Drugs Most widely prescribed antidepressant drugs
Selective serotonin re-uptake inhibitors
Older antidepressants
Monoamine oxidase inhibitors
Tricyclic antidepressants
Trazodone
Antidepressants are also widely used in the treatment of various other disorders
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47. Most widely prescribed anti-anxiety drugs
Benzodiazepines
Buspirone
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48. Lithium and Other Mood-Stabilizing Drugs
Very effective in treating bipolar mood disorders
Other mood-stabilizing drugs
Divalproic acid
Carbamazepine
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49. Electroconvulsive Therapy
Used to treat severe mood disorders
Safe, effective, and important form of treatment
Often used after others have failed
Kinds: Bilateral ECT, unilateral ECT
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
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50. 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
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51. Figure 16.4: Unilateral and Bilateral Electrode Placement for ECT
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52. Neurosurgery Neurosurgery Decreased with use of antipsychotic drugs
Effective with debilitating OCD, self-mutilation, or anorexia
Includes deep brain stimulation
Deep brain stimulation is a more recent surgical approach
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53. Unresolved Issues
Managed care companies get financial incentives when patients choose medication over psychotherapy.
Has the pharmaceutical industry made questionable claims about biological causes of mental illness for money?
Do these medications create more long-term problems for patients?
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