Psychotherapy: “Talk Therapy”

• Psychotherapy

  • treatment that use psychological rather than biological means to treat emotional and behavioral disorders

• Insight therapies

  • Approaches to psychotherapy based on the notion that psychological well-being depends on self-understanding and self discovery

Insight therapies: Psychodynamic therapy

• Attempts to uncover repressed childhood experiences that are thought to cause the patient’s current problems

• Psychodynamic = Freud = the unconscious

Insight therapies: Psychoanalysis

• Psychoanalysis

  • first psychodynamic technique

  • developed by Freud

  • Techniques:

    • Free association

      • patient reveals first thoughts, feelings, or images come to mine

      • Explores the unconscious

Psychoanalytic Techniques

• Psychoanalysis

  • techniques

    • dream analysis

      • areas of emotional concern repressed in conscious life are sometimes expressed in symbolic form in dreams.

Object relations: emotional experiences of earlier relationships become blueprints for future relationships. We sometimes act out experiences from past relationships in our current relationships.

• Psychoanalysis

  • techniques

    • transference

      • emotional reaction that occurs during psychoanalysis

      • Patient displays feeling and attitudes toward the analyst present in another significant relationship; i.e. parent, SO, etc…

Insight Therapies: Interpersonal Therapy

• Interpersonal Therapy (ITP)

  • brief psychotherapy: 12-16 sessions (or less due to insurance constraints)

  • effective with depression, bipolar illness and stress form significant life changes

  • These therapies place emphasis on the present rather than on past experiences

Interpersonal Therapy

• Interpersonal therapy (ITP)

  • four common interpersonal problems associated with depression:

    • Severe response to death (or loss) of a loved one

    • Interpersonal role disputes, understanding other’s point of view

    • Difficulty adjusting to role transitions; divorce, career change, etc…

    • Deficits in interpersonal skills

Insight therapies: Humanistic Therapy

• Humanistic therapies: assume that people have the ability and freedom to live rational lives and make rational choices, to exercise free will and develop growth

Humanistic therapy

• Person-Centered Therapy

  • Carl Rogers (1951)

  • Disorder results when the natural tendency toward self-actualization is blocked, re: Maslow

  • The therapist attempts to create an accepting climate based on unconditional positive regard; acceptance, active listening.

  • Non-directive

Insight therapies: Gestalt Therapy

• Developed by Fritz Perls (1969)

• Goal of therapy is to help clients:

  • Achieve a more integrated self

  • Become more authentic and self-accepting, assume personal responsibility

  • Live in the present

  • Address unfinished business

  • In your face, directive therapy

  • The “empty chair” technique

Relationship Therapies

• Relationship Therapies

  • look not only at the individual’s internal struggles but also at his or her interpersonal relationships

  • Working with the couple or family as an organism or unit

  • Examines family structures, dynamics and alliances

Relationship Therapies: Family Therapy

• Family Therapy

  • Parent and children enter therapy as a group

  • The goal is to help family members:

    • Heal wounds to the family

    • Improve communication

    • Create more understanding within the family

    • Examine family structure

    • Establish boundaries

Relationship Therapies: Couples therapy

• Couple Therapy

  • The goal is to help partners in an intimate relationship

    • Examine communication patterns to help encourage and improve communication

    • Manage conflicts more effectivley

    • Assist in problem solving

  • May focus on behavioral change or partners’ emotional responses to each other

Relationship Therapies: Group Therapy

• Seven to ten clients meet regularly with one or more therapists to resolve personal problems

• Provides client with a sense of belonging and the opportunity to:

  • Express feelings

  • Get feedback from other group members

  • Give and receive emotional support

Group Therapy

• Self-Help Groups

• Usually led by a non-professional

  • Alcoholics Anonymous

    • one of the oldest and best-known groups

    • Note: not designed to discover underlying issues contributing to substance abuse, etc…

Behavior therapies

• A treatment approach consistent with the learning perspective (reinforcement, consequences, etc…) on psychological disorders

  • Abnormal behavior is learned

  • the behavior itself IS the disorder

  • use learning principles to eliminate inappropriate or maladaptive behaviors

  • The goal is to change the troublesome behavior

Behavior Modification techniques Based on Operant Conditioning

• Techniques seek to control the consequences of behavior

• Extinction of undesirable behavior by terminating or withholding reinforcement maintaining the behavior

• Assisting client in understanding how maladaptive behaviors develop

• Time Out

  • A behavior modification technique used to eliminate undesirable behavior, especially in children and adolescents, by withdrawing all reinforcers for a period of time.

Therapies Based on Learning theories

• Systematic Desensitization

  • Based on classical conditioning

  • Used to treat fears and phobias

    • Client is trained in deep muscle relaxation

    • Pairs the feared object with relaxation

    • Highly successful treatment for eliminating fears and phobias in a relatively short time

    • Re: Little Albert

Techniques

• Flooding

  • behaviors therapy based on classical conditioning

  • used to treat phobias by exposing clients to the feared object or event for an extended period, until their anxiety decreases

  • Client must be a willing participant

  • Re: Avoidant behavior

• Aversion therapy

  • aversive stimulus paired with a harmful or socially undesirable behavior

    • Behavior becomes associated with pain or discomfort

  • Controversial

    • May bring intentional discomfort to client

Observational learning Therapy

• Participant Modeling

  • Based on Albert Bandura’s principles of Observational Learning

  • A model demonstrates appropriate responses to a feared stimulus in graduated steps

  • The client imitates the model with the encouragement of a therapist

  • Most specific phobias can be extinguished in 3 to 4 hours

Behavior therapies

• Note: behavior therapies are not aimed at discovering unconscious motivation. They are strictly designed to change or eliminate unwanted behaviors

• Question: How do people develop maladaptive behaviors in the first place?

Cognitive Behavior therapies (CBT)

• Assume that maladaptive behavior results from irrational thoughts, beliefs, and ideas

• The approach is effective for treating a wide variety of problems such as: (cognitive) anxiety disorder, psychological drug dependence, psychological drug dependence, mood disorders

• Two Best-known types of CBT

  • Albert Ellis’s rational emotive behavior therapy (REBT)

  • Aaron Beck’s cognitive therapy (CT)

Cognitive Behavior therapies: Albert Ellis’s Rational Emotive Behavior therapy

• ALbert Ellis

  • “ as clients replace irrational beliefs with rational ones, their emotional reactions become more appropriate”

• Based on Ellis’s ABC Theory

  • A= the activation event

  • B = belief about that event

  • C = emotional consequence that follows

• Directive form of therapy

Cognitive Behavior Therapy: Aaron Beck’s Cognitive therapy

• Aaron T. Beck (1976)

• Some misery endured by a person with depression and anxiety can be traced to automatic thoughts

  • unreasonable bu unquestioned ideas that rule a person’s life

• The goal of therapy is to help clients overcome the impact of cognitive errors i.e. catastrophizing

• Note: awareness is key

Cognitive Behavior therapy: Cognitive therapy (CT)

• Clients first become aware of their negative cognitions

• Helps clients stop negative/ dysfunctional thoughts as they occur and replace them with more productive cognitions

• Therapy is breif

  • Seven to ten sessions

  • effective with mild to moderate depression and panic disorder plus other psychological conditions where faulty thinking prevails

Biomedical therapies: Drug and Surgical Therapies

• Also known as biomedical therapies

• Most frequently used biological treatment

• Breakthroughs in drug therapies have been credited with the reduction in the amount of time a patient is hospitalized

Drug therapies: Neuropleptics

• Antipsychotic Drugs

  • Neuroleptics: inhibit activity of dopamine

  • Prescribed primarily of schizophrenia

  • Control hallucinations, delusions, disorganized speech, and behavior

Biomedical Therapies: Atypical Neuroleptics

• Atypical neuroleptics: (clozapine, risperidone) treat both positive and negative symptoms of schizophrenia

  • Target both serotonin and dopamine receptors

• Antipsychotic Drugs: Side effects

  • Tardive dyskinesia

    • severe side effect of long-term drug use

    • twitching and jerking, squirming movements

Biomedical therapies: Antidepressants

• Antidepressant Drugs

  • Improve mood in severe depression

  • Helpful in the treatment of certain anxiety disorders

  • Of the people who are anti depressants, 65 to 75 percent significantly improve; 40 to 50 percent essentially completely recover

Biomedical therapies: Types of Antidepressants

• Anti-depressants (side effects)

  • First-Generation Antidepressants

    • tricyclics (amitrpytyline, imipramine0block reuptake of noepenephrine and serotonin into axon terminals

  • Second-generation Antidepressants

    • Selective serotonin reuptake inhibitors (SSRIs) Prozac

    • Block reuptake of serotonin, increasing its availability at synapses in the brain

  • Serotonin-noepenephrine reuktake inhibitors (SNRIs)

Bi-Polar and Anti-Anxiety Medication

• Bi-polar disorder: lithium reduces depressive episodes as well as manic ones (liver toxicity and other side effects)

• Anti-Anxiety Drugs

  • minor tranquilizers called benzodiazepines include:

    • Valium, librium and Xanax

  • Users may experience moderate to intense withdrawal symptoms, including intense anxiety

  • Highly addictive

Drug therapies

• Disadvantages of Drug Therapy

  • Difficulty in establishing the proper dosages

  • Drugs do not cure psychological disorders!!

  • Maintenance dosages may be required to reduce possibility of recurrence

  • Compliance issues

Biomedical therapies: Electroconvulsive Therapy (ECT)

• Electric current is administered to the right cerebral hemisphere (unilateral ECT)

  • patient is under anesthesia

  • usually reserved for severely depressed patients who are suicidal

• Highly effective treatment for major depression

• Possibly works by changing biochemical balance in the brain

ECT and transcranial Magnetic Stimulation

• Rapid Transcranial Magnetic Stimulation

• (rTMS)

  • newer, magnetic therapy; not invasive

  • no known side effects

  • Most have a success rate b/n 70-80 percent and about 50 percent have complete remission of depression

Biomedical Therapies: Psychosurgery

• Lobotomy: Severs neural connections between frontal lobes and deeper centers involved in emotion

  • no longer performed

  • leaves patients in permanently deteriorated condition

• Cingulotomy: electrodes are used to destroy the cingulum, a small bundle of nerves connecting cortex to emotion centers

Practical. Issues in Psychotherapy: Choosing a Therapist

• Ethical Considerations

  • According to the ethics code of the American Psychological Association (2002), therapists must take reasonable steps to:

    • ensure the well-being and rights of client

    • Avoid causing them any kind of immediate or long-term harm

  • Informed consent

    • Therapists must inform clients of the cost and expected duration of therapy prior to beginning any intervention

  • Therapists are prohibited from providing therapy to former intimate partners

issues in Psychotherapy: Culture and Gender Sensitive therapy

• Knowledge of clients’ cultural backgrounds guides the choice of therapeutic interventions and direction

• Therapists recognize that differences in language, traditions/attitudes between therapists and clients can pose problems

• Take into account the effects of gender on both the therapist’s and the client’s behavior. Therapists must examine their own gender-based prejudices.

Practical Issues in Psychotherapy: Evaluating the Therapies

• Psychotherapy was better than no treatment

  • No one type of psychotherapy was more effective than another

  • A combination of drug therapy and psychotherapy achieved the most favorable results.