The Psychological Therapies

Psychological therapy or psychotherapy:

a planned, emotionally charged, confiding interaction between a trained therapist and someone who suffers from psychological
difficulties.

Most common therapeutic mentalities:

• Psychoanalytic Perspective

• Humanistic Perspective

• Psychodynamic Perspective

• Behavioral Perspective

• Cognitive Perspective

• Cognitive Behavioral Perspective (CBT)

• Positive Psychology

Psychoanalysis:

Developed by Sigmund Freud in the 1900’s. Though a century ago, still influence many psychotherapies today.

Freud assumed our psychological problems are fueled by childhood repressed conflicts stored in the unconscious.

It is the psychoanalyst’s job to bring these repressed feelings into conscious awareness where patients can deal with them.

As a result, patients develop more adaptive emotions and patterns of behavior when they achieve insight and resolve the unconscious
conflicts that were maintaining maladaptive emotions and behavior.

Techniques in psychoanalysis include:

• free association: the patient spontaneously reports all her thoughts, mental images, and feelings while lying on a couch.

• dream analysis (interpretation): explanations of the unconscious meaning of the patient’s behavior, thoughts,
  feelings or dreams.

What is free association in psychoanalysis?

Free association is a technique where the patient spontaneously reports all her thoughts, mental images, and feelings while lying on a couch while the psychoanalyst usually sits out of view and asks questions to encourage flow of associations.

Blocks in free association, such as sudden silence or abrupt change of topic were thought to be signs of resistance.

What is dream analysis (interpretation) in psychoanalysis?

Dream analysis (interpretation) involves explaining the unconscious meaning of the patient’s behavior, thoughts, feelings, or dreams.

Defensive responses increase resistance.

Resistance:

the patient’s conscious or unconscious attempts to block the process of revealing repressed memories and conflicts.

Transference:

the patient transfer’s emotions and desires originally associated with significant persons in the patient’s life unconsciously onto the psychoanalyst.

The therapist purposely remains neutral to
produce “ ? ” in the patient, so
they transfer and project unresolved conflicts
onto the psychoanalyst.

optimal frustration

Traditional psychoanalysis:

a slow therapeutic process that may last for years, and the traditional form is still used today. However, most people are not seeking a
personality overhaul and are expecting help with specific problems and want much quicker results. (weeks or months, not years)

Short-term psychodynamic therapies:

type of psychotherapy that is based on psychoanalytic theory but differs in that it is typically time- limited/short term, has specific goals, and involves an active, rather than neutral, role of the therapist.

Problems are quickly assessed in the beginning,
therapist and patient agree on goals.

Interpersonal therapy (IPT):

A type of psychodynamic psychotherapy that focuses on current relationships and is based on the assumption that symptoms are caused and
maintained by interpersonal problems.

Brief or long-term, highly structured, and
specifically identifies the interpersonal problem.

Used to treat eating disorders, major depressive
disorder, and interpersonal conflicts.

IPT focuses on 4 categories of personal problems:

1. Unresolved grief: problems dealing with the
death of significant others.
2. Role disputes: repetitive conflicts with
significant others. (spouse, family, coworker)
3. Role transitions: problems involving major life
changes (marriage, divorce, retirement)
4. Role transitions: absent or faulty social skills that limit the ability to start or maintain healthy
relationships with others.

Humanistic Therapies:

emphasizes people’s potential for self fulfillment. Focus is on the present, conscious, and taking immediate responsibility.

Client Centered Therapy:

focuses on the person’s conscious self-perceptions rather than on the therapist’s interpretations.

According to Carl Rogers’ Humanistic approach,
the client centered therapist ideally should
demonstrate:

Active listening with genuineness, unconditional
acceptance, and empathy.

Humanists emphasize the importance of self-
awareness and self-acceptance.

Behavior Therapies:

applies learning principles to eliminate a troubling behavior.

Often use systematic desensitization and virtual reality exposure to treat disorders.

Doubt the power of self awareness and assume
problem behaviors are the problem.

Focus on Classical and Operant methods of
learning.

Pavlov’s Classical Conditioning:

learning where neutral stimuli signal an unconditioned response and later produces responses that are anticipated and prepares us for the unconditioned stimulus, referred to as
conditioning.

Counterconditioning:

a procedure that conditions new responses to stimuli that trigger unwanted behaviors.

Two types of counterconditioning:

1. Exposure therapy: expose people to what
they normally avoid, eventually will become
less anxiously responsive to things that once
petrified them.
Common form: Systematic desensitization

2. Aversive Conditioning: the goal is substituting
a negative response for a positive one to
harmful stimuli.

Systematic Desensitization:

Widely used type of exposure therapy was developed by South African psychiatrist Joseph Wolpe in the 1950’s.

Based on the same premise as counterconditioning, involves learning a new
conditioned response (relaxation) that is
incompatible with or inhibits the old conditioned response (fear and anxiety).

3 steps to systematic desensitization:

1. Progressive relaxation: involves successively
relaxing one muscle group after another until
a deep state of relaxation is achieved.

2. The behavior therapist helps the patient
construct an anxiety hierarchy: list of anxiety-
provoking images associated with the feared
situation arranged in a hierarchy from least
to most anxiety-producing.

3. The actual process of desensitization through
exposure to feared experiences.

Skinner’s Operant Conditioning:

learning in which behavior is strengthened if followed by a reinforcer or diminished if followed by a punisher.

Cognitive Therapy (CT):

approach is to teach people new, more constructive ways of thinking.

Emphasize that emotional disturbances result
from consistent pessimistic ways of experiencing
personal situations.

Problems are in the result of negative ways of looking at things.

Goal is to change self-defeating beliefs. (Distorted thinking and unrealistic beliefs.)

Who developed Cognitive Therapy (CT)?

Developed by Aaron T. Beck (initially a
psychoanalyst) while researching depression.

Who developed Rational-emotive behavior therapy (REBT)?

Albert Ellis.

What do Cognitive Therapy (CT) and Rational-emotive behavior Therapy (REBT) have in common?

Both believe what people think creates their moods and emotions, not the result of the event themselves.

What is the difference between Cognitive Therapy (CT) and Rational-emotive behavior Therapy (REBT)?

Ellis’s emphasis on “irrational” thinking in REBT and Becks focus on distorted thinking and unrealistic beliefs in CT. So instead of arguing what’s irrational, Beck tests the accuracy of the assumptions and beliefs.

Cognitive-behavioral therapy (CBT):

uses a pragmatic approach and involves a treatment plan that integrates behavior modification techniques and cognitive therapy techniques. Aims to modify both self-defeating thinking and maladaptive actions. (unhealthy behavior)

What does CBT stand for?

Cognitive Behavior Therapy

What does CT stand for?

Cognitive Therapy

What does REBT stand for?

Rational-emotive behavior Therapy

Family therapy:

treats the family as a system.

Group therapy:

people feel less alone, members vent in a safe and supportive environment, and therapists can observe how a clients interact with others.

3 benefits attributed to all psychotherapies:

1. Hope. (placebo)
2. A new perspective
3. An empathetic, trusting and caring relationship.

Research indicates that clients are generally
? with the effectiveness of therapy.

satisfied.

Controlled research studies evaluate the
effectiveness of psychotherapy by comparing
people who enter psychotherapy with a
matched control group of people who do not.
Result: The gains that people make as a result of
psychotherapy, including brief forms of
psychotherapy, tend to be long lasting.

To say that a psychotherapy treatment is
empirically supported means it meets the
following criteria:

• is based on known psychological principles

• has demonstrated its effectiveness

• has been subjected to controlled scientific trials

True or False:
Research indicates the vast majority of
people who experience the symptoms of a
psychological disorder do not seek the help
of a mental health professional.

TRUE

True or False:
Research shows therapy works but revealed no
one type of psychotherapy as being superior and
there is little or no difference in the
effectiveness of different psychotherapies.

TRUE

Eclecticism:

A therapist (an eclectic therapist) integrates use of techniques from different psychotherapies. Will depend on the client and symptoms.

Recent research on psychotherapy effectiveness:

In recent years, hundreds of studies have evaluated the effectiveness of major forms of psychotherapy. Research varies in terms of the types of psychotherapy compared, the disorders studied, and how improvement is measured.

Spontaneous remission:

refers to the improvement of symptoms that sometimes occur simply over the passage of time.

Psychiatrist:

holds a medical degree, can prescribe medication, and specializes in the treatment of psychological disorders.

Psychologist:

holds an academic doctorate (PhD or PsyD) and specializes in psychotherapy.

Clinical psychologist:

expertise in research and assessment of psychological disorders and the practice of psychotherapy. Academic doctorate.

Counseling psychologist:

licensed to practice, has extensive training in assessing and treating mental, emotional and behavioral disorders. Treats less severe disorders in less restrictive environments. Academic doctorate.

Biomedical therapy:

often used to treat serious disorders by physically changing the brain’s functioning by altering its chemistry with drugs or medical procedures that act directly on the patient’s nervous system.

Most widely used biomedical therapy today is…

drug therapy, the use of psychotropic
medications

Psychopharmacology:

the study of drug effects on the mind and behavior.

Antipsychotic medications:

prescription drugs that are used to reduce psychotic symptoms by blocking receptor sites for dopamine.

What type of medications are used to dampen responsiveness to irrelevant stimuli and decreases positive symptoms in schizophrenia patients by decreasing brain levels of the neurotransmitter dopamine?

Antipsychotic Medications.

Also referred to as neuroleptics.

Reserpine and chlorpromazine (Thorazine)
1950’s.

Antianxiety drugs:

depress central nervous system activity and calm the symptoms of anxiety.

Best known antianxiety drugs are…

Benzodiazepines medications which go by the name “tranquilizers” because they calm jittery feelings, relax muscles and promote sleep.

Types of Benzodiazepines:

Valium, Xanax, Klonopin

What do Benzodiazepines do?

Increase the level of GABA, a neurotransmitter that inhibits the transmission of nerve impulses in the brain and slows brain activity.

Antidepressant drugs:

increases neurotransmitters that elevate arousal and mood which are scarce during depression.

What are SSRI’s (selective-serotonin-reuptake-
inhibitors) and what do they do?

Antidepressant drugs that increase serotonin levels.

Examples:
- fluoxetine (Prozac)
- Zoloft
- Paxil

Mood-stabilizing drugs:

regulate neurotransmitters to level out mood.

Most common are Lithium and Depakote.

Electroconvulsive Therapy (ECT):

biomedical therapy used primarily in the treatment for severely depressed patients (major depressive disorder) in which a brief electric current is sent through the brain of an anesthetized patient to electrically induce a brief brain seizure.

Also called electroshock therapy.

What does ECT stand for?

Electroconvulsive Therapy

Electroconvulsive Therapy (ECT) is also known as:

electroshock therapy

Repetitive Transcranial Magnetic Stimulation
(rTMS):

pulses of magnetic energy to the brain through a coil held close to the person’s skull used to stimulate or suppress brain activity.

Deep-brain stimulation (DBS):

a battery powered neurostimulator is surgically implanted in the chest and connected to electrodes surgically implanted in the brain via wires under the skin, sends electrical signals to the brain of a person with major depressive disorder.

New experimental treatment and does not
involve seizures.

What does DBS stand for?

Deep-brain stimulation

What does rTMS stand for?

Repetitive Transcranial Magnetic Stimulation

Psychosurgery:

surgery that removes or destroys
brain tissue in an effort to change behavior.

Lobotomy:

psychosurgical procedure once used
to calm uncontrollable emotional or violent
patients. (Not used for mood disorders.)

MRI-guided precision surgery:

was occasionally done to cut the brain circuits involved in severe cases of obsessive-compulsive disorder.

What does SSRI stand for?

selective-serotonin-reuptake-inhibitors

Which type of medications goes by the name tranquilizers?

Benzodiazepines

What are Antipsychotic Medications also referred to?

neuroleptics