Ch- 16 psychological and biological treatments

PSYCHOTHERAPY

a psychological intervention designed to help people resolve emotional, behavioral, and interpersonal problems and improve the quality of their lives

factors that dont predict treatment outcomes

socioeconomic status, gender, age, and ethnicity

Licensed professionals vs paraprofessionals

licensed professionals have professional training and have degrees and can operate within the system and choose more effective treatments

paraprofessionals have no professional trainings who provide mental health services, obtain agency-specific training and attend workshops that enhance their education

(little to no difference in effectiveness between experienced and novice therapists

determinants of a therapist’s effectiveness

-warm and direct

-selecting important topics to discuss

-not contradicting patients

-the ability to establish positive relationships

-match treatments to needs of clients

Who seeks and benefits?

• 20% of americans have received psychotherapy at some point in their lives

• females go more than males, caucasians more than minority groups

• research shows therapy can benefit all these groups equally

main people that practices psychotherapy

clinical psychologists, psychiatrists, counsellors, and social workers

non-advance degree in psychology

social services agencies, crisis intervention centres

clinical psychologist

private practice, hospitals, schools, community agencies, medical settings, academic

psychiatrists

physicians, private practice, hospitals, medical centers, schools, academic

counselling psychologists

university clinics, mental health centres; treat people with less severe psychological problems

psychiatric nurse

manage medications, with advanced degrees can diagnose and treat mental patients

insight therapies

form of psychotherapy where the goal is to expand awareness or insight, encompasses psychodynamic, humanistic, and group approaches

ex: Robert says that he despises Claire's nagging about being late and that it makes him so angry and irritated that he actually becomes less motivated to try to be on time. The therapist delves into Claire and Robert's past experiences and upbringing regarding the issue of timeliness.

Psychodynamic therapy (central beliefs)

• causes of abnormal behaviours stem from traumatic or adverse childhood experiences

• analyze avoided thoughts and feelings, wishes, fantasies, and significant past events

• when clients achieve insight into unconscious material, the causes and significance of symptoms become evident

• this insight then often causes symptoms to disappear

ex: When her husband gets home, he asks where the cake is and Jennifer realizes she forgot to get it. Based on the psychoanalytical/psychodynamic perspective, Jennifer would react to her forgetfulness in the same way that she used to react when her father would ask her to do something and she forgot to do it.

psychoanalysis

• developed by freud, one of the first forms of therapy

• goal is to decrease guilt and frustration by bringing the unconscious into the conscious

• try to bring to awareness previously repressed impulses, conflicts, and memories

key aspects of psychoanalysis

• free association (technique in which clients express themselves without censorship of any sort

• interpretation

• dream analysis

• resistance (attempts to avoid confrontation and anxiety associated with uncovering previously repressed thoughts, emotions, and impulses)

• transference (projecting intense, unrealistic feelings)

• working through

neo-freudian tradition

• more concerned with conscious aspects of the client’s functioning

• more optimistic, emphasize needs for power, love, status (not just sex and aggression)

• emphasize the impact of cultural and interpersonal influences on behaviour

interpersonal therapy

• sullivan influenced this development

• treatment that strengthens social skills and targets

interpersonal problems, conflicts and life transitions

• short term treatment (12-16 sessions) originally developed for depression

• also effective at treatment of substance abuse and eating disorders

For example, a person going through a breakup might notice that their depression developed after the breakup. The therapist will also develop an “interpersonal inventory” that reviews the client's pattern of behavior in relationships and evaluation of current relationships.

psychodynamic therapy

• research shows that insight is not necessary to relieve stress

• weak support for repressed memories

• many concepts are difficult to falsify

• many are questionable from a scientific standpoint, difficult to research

• brief psychodynamic treatment is better than none but less effective than cognitive-behavioural therapy

• not effective for psychotic disorders

Psychodynamic therapy focuses on building the client's internal resources to be able to deal with problems going forward without the aid of the therapist. For example, a client with depression may learn how to explore how reactions to present-day circumstances may be influenced by past events.

humanistic psychotherapy

• emphasizes the development of human potential and the belief that human nature is basically positive

• stress the importance of assuming responsibility for our lives and living in the present

• more effective than no treatment but mixed results compared to other therapies

• For example, you might explore the belief that your opinions don't matter to your partner. Therapists help create the “here and now” atmosphere by asking what you're currently aware of or how certain emotions make you feel. You might use a range of techniques to do this, including: role-playing.

person-centred therapy

• developed by carl rogers, centers on the client’s goals and ways of solving problems

• therapist does not focus on diagnosis

• patient structure the session

• tries to increase awareness and heightened self-acceptance

• intended to cause people to think more realistically, become more tolerant of others and engage in more adaptive behaviours

for example, having problems in the family and just venting to the therapist about it, The therapist will not actively direct conversation in sessions, or judge or interpret what you say, but they may restate your words in an effort to fully understand your thoughts and feelings (and to help you do the same)

gestalt therapy

• aim to integrate differing and sometimes opposing aspects of our personality into a unified sense of self

• recognizes the importance of awareness, acceptance, and expression of feelings

For example, a client might be tapping their feet on the ground. The therapist may say “Become your leg and give it a voice?” This creates awareness of the client's physical sensations and emotions. Locating emotions in the body: Gestalt Therapists may ask clients where they are experiencing the emotion in their body.

group therapies

• therapies that treat more than one person at a time

• range from 3-20 people, efficient, time-saving, and less costly than individual

• effective for a wide range of problems and about as helpful as individual treatments

Alcoholics anonymous

• composed of peers with similar problems, often no professional therapists

AA alternatives

• relapse prevention treatment assumes people will slip up and plans accordingly

• controlled drinking programs encourage people to set limits and drink moderately

family therapies

• most psychological problems as rooted in a dysfunctional family system

• focus on interactions among family members

strategic family interventions

designed to remove barriers to effective communication

An example would be helping a family to create a structure of rules and consequences for children or adolescents. Also, interventions can be centered around improving the interactions and communication among family members.

structural family therapy

has the therapist immerse themselves in the family to make changes

For example, if after observing the family's interactions, a structural family therapist will develop a hypothesis that the mother and her teenage son are enmeshed and the father is disengaged, the interventions will be aimed at modifying the family structure by helping the couple get emotionally closer to each other

behavioural therapists

focus on specific problem behaviours and the variables that maintain them

ecological momentary assessment

assessment of thoughts, emotions, and behaviours that arise at the moment in situations in which they occur in everyday life

exposure therapies

confront clients with what they fear with the goal of reducing the fear

systemic desensitization

developed by joseph wolpe

• gradually exposes clients to anxiety-producing situations through the use of imagined scenes

• anxiety-producing stimulus is repeatedly paired with a relaxation response

• relaxation is incompatible with anxiety; eventually the anxiety-producing stimulus stops producing anxiety

• very effective for phobias, speech disorders, insomnia and more

• this approach led to the development of flooding

ex: Suppose you're afraid of birds. Your therapist might ask you to talk about birds in detail. As you feel more at ease with the topic, they may ask you to look at photos of birds while you focus on breathing deeply or practicing another relaxation technique.

flooding

• repeated exposure to feared stimuli for long periods in a safe environment

• without aversive consequences, extinction of the fear can occur

• key component is response prevention (patient cannot use normal anxiety-reducing behaviours during the exposure period)

ex: If you live with claustrophobia, a flooding session might involve sitting in an extremely small, crowded room for several hours. This might even involve an elevator or a closet. A proper flooding session would require that you stay in the room until your panic response has fully subsided.

participant therapy

the therapist:

• models a calm encounter with the client’s feared object or situation

• guides the client through the steps of the encounter until she can cope unassisted

• used in assertion and social skills training and behavioural rehearsal

token economies

rewards client for desirable behaviours with tokens to exchange for items

aversion therapies

treatment that uses punishment to decrease the frequency of undesirable behaviours

cognitive-behavioural therapies (1st wave of cbt)

• treatments that attempt to replace maladaptive or irrational cognitions with more adaptive and rational cognitions

• three core assumptions:

  • cognitions are identifiable and measurable

  • cognitions are key in both healthy and unhealthy psychological functioning

  • irrational beliefs or thinking can be replaced by more rational and adaptive cognitions

• For example, with a client who is dreading an interview, the therapist takes on the role of the interviewer. By analyzing his/ her responses after enacting the mock-scene, the client can see what s/he tends to do.

Rational emotive behaviour therapy

• developed by albert ellis

• emphasizes changing how we think but also how we act

• how we feel about the consequences of an event is determined by our beliefs or opinions

• ABC model:

  • Activating event (getting exam grade back)

  • Beliefs (thinking you did well but got bad grade/ thinking you did bad but got a good grade)

  • Consequences (feeling sad and thinking you’ll never succeed/feeling great and thinking you can do better now)

• was later added D and E, Dispute the beliefs and adopt more effective ones

cognitive therapy by aaron beck (2nd wave of cbt)

• focuses on identifying and then modifying disorted thoughts and long long-held core beliefs

• works best for depression

ex: Beck's negative triad holds that depressed people have negative thoughts about themselves, their experiences in the world, and the future. For instance, a depressed person might think, "I didn't get the job because I'm terrible at interviews.

3rd wave of cbt

• acceptance and commitment therapy

• dialectical behaviour therapy

effectiveness of psychotherapy

80% of treated people have better outcomes than the average untreated person

some potentially harmful therapies

• facilitated communication

• scared straight programs

• crisis debriefing

• dare programs

• coercive restraint therapies

psychopharmacotherapy

use of medication to directly alter the brain’s chemistry or physiology to treat psychological disorders

• almost 7% of the population are on antidepressants

electroconvulsive therapy

• patients receiving brief electrical pulses to the brain that produces a seizure

• used to treat severe problems (intractable depression and schizophrenia) as a last resort

psychosurgery

• brain surgery to treat psychological disorders

• used as an absolute last resort (severe ocd, depression, bipolar disorders)