Myers 53: Therapy and Psychological Therapies=

(skip section 53.7)

Intro

1. What historical treatments were employed for psychological disorders before the push for more humane methods?

• historical methods for treating psychological disorders included harsh practices such as cutting holes in people's heads, physical restraints, bloodletting, and attempting to "beat the devil" out of patients.

• These methods often involved extreme and sometimes violent approaches to managing mental illness.

2. Who were Philippe Pinel and Dorothea Dix, and what contributions did they make to the reform of mental health treatment?

Philippe Pinel and Dorothea Dix were reformers who advocated for more humane treatment of individuals with mental illness.

• Pinel, a French physician, advocated for the removal of chains and restraints from patients in psychiatric hospitals and emphasized the importance of compassionate care.

• Dix, an American activist, campaigned for the construction of psychiatric hospitals and improved conditions for mentally ill individuals. Their efforts led to significant reforms in mental health treatment and the establishment of more humane care facilities.

3. What changes in mental health treatment occurred since the 1950s, and what are some consequences of these changes?

• Since the 1950s, the introduction of effective drug therapies and community-based treatment programs has transformed mental health treatment.

• This period saw the deinstitutionalization of psychiatric hospitals, with many patients transitioning to outpatient care.

• However, this shift has also led to increased homelessness and incarceration rates among individuals with mental illness, highlighting the ongoing challenges in mental health care.

4. How did visitors to eighteenth-century psychiatric hospitals view patients?

• Visitors to eighteenth-century psychiatric hospitals often viewed patients as objects of curiosity, paying to observe them as though they were zoo animals.

53.1: Treating Psychological Disorders

1. What are the main differences between psychotherapy and biomedical therapies?

Psychotherapy (talk therapy)

• use of psychological techniques by a trained therapist to help individuals overcome difficulties and achieve personal growth.

• This may involve exploring early relationships, changing thought patterns, or modifying behaviors.

Biomedical therapy (medication therapy)

• utilizes medications and other biological treatments, such as electroconvulsive shock therapy (ECT) or deep brain stimulation, to address mental health issues.

2. What are the main categories of modern Western therapies? Define an eclectic approach.

Can be categorized into two main categories:

1. psychotherapy (talk therapy)

2. biomedical therapy. (medicated therapy)

Eclectic Approach

• The two categories on therapies can also be combined for some patients (usually with server mental health problems)

• using a blend of therapies.

3. How do therapists typically approach psychotherapy sessions?

Typically use various psychological techniques to assist individuals in overcoming difficulties and achieving personal growth. — Talk Therapy

• This may involve exploring early relationships, challenging maladaptive thought patterns, or teaching coping strategies to manage behaviors.

53.2: Psychoanalysis and Psychodynamic Therapies

What were the goals of psychoanalysis according to Sigmund Freud?

Freud believed that the goal of psychoanalysis was to help individuals achieve healthier, less anxious living by releasing the energy previously devoted to conflicts between the id, ego, and superego.

• He aimed to assist people in bringing repressed feelings and thoughts from unconscious into conscious awareness, thereby reducing inner conflicts that impede personal growth.

• assumed that we do not fully know ourselves (we have things we repress)

Define Psychoanalysis

• Freud believed the patient’s free associations, resistances, dreams, and transferences—and the analyst’s interpretations of them—releases previously repressed feelings, allowing the patient to gain self-insight.

• It helped form the foundation for treating psychological disorders,

• psychoanalysis is historical reconstruction.

• focuses on exploring the unconscious mind.

• unconscious as a repository of thoughts, wishes, feelings, and memories that influence behavior and experience without conscious awareness — bring them consciousness

Describe the techniques used in psychoanalysis.

Techniques

• Free association (after discarding hypnosis)

  • where patients relax and say aloud whatever comes to mind without censoring their thoughts.

  • analyst interprets the patient's mental blocks or resistance

  • indicates anxiety and defense mechanisms.

• Dream analysis

  • also a part of psychoanalysis

  • dreams are seen as a window into the unconscious mind.

• Transference

  • where patients transfer feelings from past relationships onto the analyst,

  • providing insight into their current relationships and emotional patterns.

How does free association contribute to the psychoanalytic process?

Free association allows patients to speak freely without censorship, revealing unconscious thoughts and feelings.

• The therapist analyzes the patient's associations, noting any mental blocks or resistance, which indicate areas of anxiety and defense mechanisms.

• By exploring these resistances and interpreting their underlying meaning, the therapist helps the patient gain insight into their unconscious conflicts and emotional patterns.

What is transference, and how does it contribute to the therapeutic process in psychoanalysis?

Transference occurs when patients transfer feelings and attitudes from past relationships onto the therapist.

• provides insight into the patient's current relationships and emotional patterns, as well as unresolved conflicts from the past.

• By exploring transference, the therapist helps the patient gain awareness of their unconscious processes and how they affect their interactions with others.

How does modern psychodynamic therapy differ from traditional psychoanalysis, and what is its focus?

Psychoanalysis, the more intensive of the two, involves multiple sessions per week and can span several years. It delves deeply into unconscious conflicts, often focusing on childhood experiences and the patient's relationships with caregivers. The psychoanalyst typically adopts a neutral stance, allowing the patient to freely associate and explore their thoughts and feelings without much intervention. The goal is to gain insight into unconscious dynamics, which may lead to long-term personality change and psychological growth.

In contrast, psychodynamic therapy, while still drawing from Freudian principles, is typically less intensive and more accessible. It may involve fewer sessions per week and can be shorter in duration. Psychodynamic therapists may take a more interactive role, offering interpretations and insights to help the patient understand their unconscious conflicts and patterns of behavior. While insight remains a central focus, psychodynamic therapy also emphasizes symptom relief and the development of healthier coping mechanisms. This approach makes psychodynamic therapy more adaptable to different formats and more suitable for a broader range of clients, offering a blend of insight-oriented exploration and practical strategies for managing psychological challenges.

What are some key features of psychodynamic therapy sessions?

• Psychodynamic therapy sessions typically occur once or twice a week, often for only a few weeks or months.

• Unlike traditional psychoanalysis where clients lie on a couch out of the therapist's line of vision, clients in psychodynamic therapy meet with their therapist face-to-face or online.

• The therapist helps clients explore defended-against thoughts and feelings to gain perspective on their internal conflicts.

• don’t talk much about id-ego-superego conflicts. Instead they try to help people understand their current symptoms by focusing on important relationships and events, including childhood experiences and the therapist-client relationship.

53.3: Humanistic Therapies

What are the basic themes of humanistic therapy, and how do they differ from psychodynamic therapies?

• emphasizes people's innate potential for self-fulfillment and growth, aiming to reduce inner conflicts that interfere with natural development.

• Self concept

Humanistic VS Psychodynamic

• Unlike psychodynamic therapies, humanistic therapies focus on promoting self-awareness, self-acceptance, and personal growth rather than curing illness.

• Humanistic therapists prioritize immediate responsibility for feelings and actions, conscious thoughts over unconscious thoughts, and the present and future over the past.

What are the goals and techniques of Carl Rogers' person-centered approach?

• Goals:

  • The primary goal of Carl Rogers' person-centered therapy is to boost clients' self-fulfillment by fostering growth in self-awareness and self-acceptance.

  • Therapy aims to facilitate clients' exploration of their feelings and experiences as they occur, rather than focusing on childhood origins.

• Techniques:

  • Nondirective Approach: In person-centered therapy, the client leads the discussion, while the therapist listens without judgment or interpretation.

  • Exhibiting Acceptance, Genuineness, and Empathy: Rogers encouraged therapists to demonstrate acceptance, genuineness, and empathy to create a supportive therapeutic environment.

  • Active Listening: Therapists practice active listening by echoing, restating, and seeking clarification of the client's expressions, both verbally and nonverbally.

  • Reflective Responses: Therapists provide reflective responses to help clients gain deeper self-understanding and self-acceptance by acknowledging and validating their feelings.

Define Insight Therapies

• therapies that aim to improve psychological functioning by increasing a person’s awareness of underlying motives and defenses.

• psychodynamic and humanistic therapies are often referred to as insight therapies.

Can a therapist be a perfect mirror without selecting and interpreting what is reflected?

NO, according to Carl Rogers, a therapist cannot be a perfect mirror without any selection or interpretation of what is reflected. (one cannot be totally nondirective)

Perfect mirror meaning = the idea of the therapist reflecting back to the client their thoughts, feelings, and experiences without distortion or judgment

• While striving for non-directiveness, Rogers acknowledged that complete non interpretation is impossible

  • He recognized that therapists inevitably bring their own biases, interpretations, and limitations to the therapeutic process, which may influence how they reflect back the client's experiences.

• However, he emphasized that the therapist's most significant contribution is to accept and understand the client unconditionally (to not judge)

How does a nonjudgmental and accepting environment contribute to personal growth in therapy? How is this characterized?

In a nonjudgmental and accepting environment, characterized by unconditional positive regard

unconditional positive regard = showing complete support and acceptance of a person no matter what that person says or does.

• This acceptance fosters a sense of safety and encourages individuals to explore and accept even their worst traits. As a result, they may experience personal growth and a greater sense of wholeness.

• Given a nonjudgmental, grace-filled environment

How can we improve communication in our own relationships through active listening? (3 ways)

1. Paraphrase:

   • summarizing the other person's words in one's own words to check understanding

2. Invite Clarification:

   • asking open-ended questions, encouraging the person to provide more info

3. Reflect Feelings:

   • mirroring the emotions conveyed by the other person, based on their body language and intensity

53.4: Behaviour Therapies

How does the basic assumption of behavior therapy differ from the assumptions of psychodynamic and humanistic therapies?

Behavior therapy differs from psychodynamic and humanistic therapies in its basic assumption regarding the source of psychological problems.

While psychodynamic and humanistic therapies emphasize self-awareness and insight into unresolved tensions or feelings, behavior therapy focuses on problem behaviors as the primary concern.

Behavior therapists doubt the healing power of self-awareness and instead address problem behaviors directly.

Classical VS Operant Conditioning

Skinner's theory of behaviorism focuses on how our actions are shaped by what follows them. Focuses on the relationship between behavior and its consequences

• If we do something and it leads to a good outcome, we're more likely to repeat that action. Conversely, if our actions lead to a negative outcome, we're less likely to repeat them. It's all about learning from consequences

Pavlov's theory of classical conditioning is about how we learn to associate one thing with another through experience. Emphasizes the role of associative learning in shaping behavior.

• For instance, if a certain sound always comes before something we like or dislike, we start to automatically link that sound with the feeling we get afterward. It's about learning through association.

What classical conditioning techniques are used in exposure therapies and aversive conditioning?

Exposure Therapy

• Through repeated exposure to the feared stimulus in a controlled and safe environment, individuals learn to associate the stimulus with relaxation instead of fear.

• Exposure to resolve it = associate with the stimulus that is not fearful anymore, through repetition with it in a safe enviroment

• Creating a Positive Association

Aversive Conditioning

• pairing a maladaptive behavior with an unpleasant stimulus to reduce or eliminate the behavior.

• the undesirable behavior becomes associated with discomfort or aversive consequences, leading to a decrease in its occurrence.

• Creating a Negative Association

What is Counter Conditioning. When is it used?

• Exposure therapy utilizes this to treat phobias by pairing the feared stimulus with a new response that is incompatible with fear.

• Through repeated exposure to the feared stimulus in a controlled and gradual manner, individuals learn to replace their fear response with a more adaptive or neutral reaction.

• This process, known as counterconditioning, helps individuals unlearn their fear responses and reduces the impact of phobias.

Exposure Therapy

1. What is the historical background of exposure therapies, and how did they originate?

• Trace their roots back to the work of behavioral psychologist Mary Cover Jones, who used counterconditioning techniques to treat Peter, a child with a phobia of rabbits.

• Joseph Wolpe later refined Jones' techniques, leading to the development of exposure therapies as they are used today.

2. What is systematic desensitization, and how does it treat specific phobias?

Systematic desensitization is a type of exposure therapy used to treat specific phobias.

• gradually exposing individuals to anxiety-provoking stimuli while pairing each exposure with relaxation techniques.

• begins with constructing an anxiety hierarchy, followed by training in progressive relaxation

• then they imagine anxiety-provoking situations while maintaining relaxation, gradually desensitizing themselves to fear-inducing stimuli.

3. How does virtual reality exposure therapy work, and what are its benefits?

Virtual reality exposure therapy involves using immersive virtual environments to simulate anxiety-inducing situations tailored to an individual's specific fear.

• allows individuals to confront their fears in a controlled and safe environment, gradually reducing anxiety.

• can effectively alleviate real-life fears and social anxiety.

Aversive Conditioning

What is aversive conditioning, and how does it differ from exposure therapy?

Aversive conditioning is a therapeutic technique that associates an unwanted behavior with unpleasant feelings, aiming to create a negative (aversive) response to a harmful stimulus.

• Unlike exposure therapy, which fosters a positive response to previously feared stimuli, aversive conditioning aims to discourage specific behaviors by making them unpleasant or aversive.

Can aversive conditioning change human reactions to alcohol. Is this conditioning change something that lasts? — The Wiens & Menustik's study

• Yes, aversive conditioning can alter human reactions to alcohol, at least in the short term.

  • aversion therapy programs for alcohol use disorder can lead to significant reductions in alcohol consumption. (around 63%)

• However, the long-term effectiveness of aversive conditioning may diminish over time, with only 33% remaining alcohol-free after three years.

How does cognition influence the effectiveness of aversive conditioning?

People undergoing aversion therapy often recognize that the unpleasant consequences of a behavior only occur within the therapy setting.

• This ability to discriminate between therapy situations and real-life scenarios can limit the lasting impact of aversive conditioning.

53.5: Operant Conditioning Techniques

1. What is the main premise of behavior therapy based on operant conditioning principles?

Main premise of behavior therapy based on operant conditioning principles is that consequences strongly influence voluntary behaviors.

• Therapists use operant conditioning techniques to reinforce desirable behaviors and fail to reinforce or sometimes punish undesirable behaviors.

• behavior modification

4. What are token economies, and how are they implemented in behavior modification?

Token economies involve rewarding desired behaviors with tokens or plastic coins, which can later be exchanged for concrete rewards for privileges or treats.(an operant conditioning procedure)

• This system is commonly used in institutional settings to reinforce behaviours like getting out of bed, dressing, or talking coherently. — Positive Reinforcement

5. What are the concerns expressed by critics of behavior modification, and how do advocates respond to these concerns?

Critics

• express concerns about the durability of behaviours (wont last) and the ethical implications of controlling others' behavior.

Advocates

• behaviors can endure if individuals are gradually weaned from extrinsic rewards and guided toward intrinsic rewards like social approval.

• using positive reinforcement is more humane than institutionalizing or punishing

53.6: Cognitive Therapy

1. What are the goals of cognitive therapies?

• to help individuals change their patterns of thinking and perception that contribute to psychological distress (more adaptive ways of thinking)

• aim to identify and challenge negative thought patterns and replace them with more constructive and adaptive ways of thinking.

2. How do cognitive therapies view the relationship between thoughts and emotions?

• view emotions as being influenced by individuals' thoughts and interpretations of events, rather than directly by the events themselves.

• assume that our thinking colors our feelings

4. What is the main premise of cognitive-behavioral therapy (CBT)?

The main premise of (CBT)

• thoughts, emotions, and behaviours are interconnected, changing one of these, can lead to changes in the others.

• CBT combines cognitive therapy techniques with behavioural strategies to target both cognitive distortions and maladaptive behaviours.

5. How does CBT differ from traditional cognitive therapies?

• CBT differs from traditional cognitive therapies by incorporating behavioural techniques alongside cognitive restructuring.

• While traditional cognitive therapies focus primarily on changing thought patterns, CBT also addresses behavioral patterns that contribute to psychological distress. This integrated approach allows for a comprehensive treatment of cognitive and behavioral aspects of psychological disorders.

Beck’s Therapy for Depression

1. What led to the development of cognitive therapy by Aaron Beck?

• Aaron Beck developed cognitive therapy after realizing the therapeutic potential of challenging automatic negative thoughts in a woman who felt disconnected and disliked by others at a party.

• This incident led Beck to explore the role of negative thinking in psychological distress, particularly in depression.

2. What is the main premise of Beck’s cognitive therapy for depression?

• Based on the premise that changing people's negative thinking patterns can lead to improvements in their emotional functioning.

• It focuses on identifying and challenging irrational thoughts and beliefs that contribute to depressive symptoms.

• Depressed people, Beck found, often reported dreams with negative themes of loss, rejection, and abandonment.

• We often think in words. Therefore, getting people to change what they say to themselves is an effective way to change their thinking.

3. How does Beck’s therapy aim to reverse clients’ negativity about themselves, their situations, and their futures?

• by gently questioning and challenging irrational thoughts.

• Therapists work to uncover the underlying assumptions and beliefs that contribute to negative thinking, and then encourage clients to reevaluate and modify these beliefs to adopt a more realistic and adaptive perspective.

4. What are some techniques used in Beck’s cognitive therapy to change negative thought patterns?

Questioning interpretations: Encouraging clients to question the accuracy and validity of their negative interpretations of events.

Ranking thoughts and emotions: Helping clients gain perspective by ranking their thoughts and emotions based on their level of distress.

Testing beliefs: Examining the consequences of negative thoughts and challenging faulty reasoning.

Decatastrophizing thinking: Working through worst-case scenarios to show that situations are often not as bad as imagined.

Changing beliefs: Challenging total self-blame and negative thinking and replacing maladaptive beliefs with more balanced and realistic ones.

5. How does cognitive therapy differ from traditional therapy approaches?

• Cognitive therapy differs from traditional therapy approaches by focusing on changing thought patterns rather than delving into past experiences or unconscious conflicts.

6. How can cognitive therapy techniques be applied outside of therapy sessions?

• can be applied outside of therapy sessions through practices such as stress inoculation training and positive self-talk.

• teaching people to restructure their thinking in stressful situations

Cognitive-Behavioral Therapy (CBT)

1. What is cognitive-behavioral therapy (CBT) and how does it differ from traditional therapy approaches?

Integrative therapy approach that aims to alter both negative thinking patterns and maladaptive behaviors.

• CBT emphasizes practical strategies for changing thoughts and actions to alleviate psychological distress.

• practiced integrative therapy aims to alter not only the way people think but also the way they act

• seeks to make people aware of their irrational negative thinking and to replace it with new ways of thinking.

2. How does CBT address the common problem of unhealthy emotion regulation in anxiety, depressive, and bipolar disorders?

CBT addresses the problem of unhealthy emotion regulation by training individuals to replace catastrophizing thinking with more realistic appraisals and by encouraging them to engage in behaviors that are incompatible with their problems. This approach helps individuals develop healthier coping skills and emotional responses.

3. Provide examples of how CBT techniques are applied in the treatment of specific disorders. (OCD, ED, GAD)

Obsessive-Compulsive Disorder (OCD)In CBT for OCD, individuals learn to prevent compulsive behaviors by relabeling obsessive thoughts and engaging in alternative, enjoyable activities to shift attention away from the urges.

Eating Disorders: CBT for eating disorders involves guiding individuals to adopt new ways of interpreting their food-related experiences through journaling and recording positive events.

Generalized Anxiety Disorder (GAD): Individuals with GAD may learn to restrain negative thoughts surrounding social anxiety and practice approaching social situations as part of their CBT treatment.

4. How effective is CBT in treating various psychological disorders, and what are some advantages of online CBT programs?

• CBT has been found effective in treating a wide range of psychological disorders, including anxiety, depression, eating disorders, ADHD, and substance use disorders.

• Online CBT programs offer flexible, affordable, and effective treatment options, particularly for individuals who may face barriers to attending traditional face-to-face therapy sessions, such as rural location, low income, or embarrassment.

5. What is dialectical behavior therapy (DBT) and how does it address harmful behavior patterns?

Dialectical behavior therapy (DBT) is a variation of CBT that helps change harmful behavior patterns, including suicidal behaviors.

• DBT aims to make peace between opposing forces of acceptance and change by creating an accepting and encouraging therapeutic environment.

• Dialectical means “opposing,”

• Clients learn new ways of thinking, emotional regulation skills, social skills, and mindfulness meditation techniques to tolerate distress and regulate emotions effectively.

• offer them constructive feedback and guidance.

• Individual and Group training sessions provide additional opportunities for skill practice in a supportive social context.

RETRIEVAL PRACTICE

RP-1 In psychoanalysis, when patients experience strong feelings for their therapist, this is called . Patients are said to demonstrate anxiety when they put up mental blocks around sensitive memories, indicating . The therapist will attempt to provide insight into the underlying anxiety by offering a(n) of the mental blocks

• RP-1 transference; resistance; interpretation.

RP-2 What might a psychodynamic therapist say about Mowrer’s therapy for bed-wetting? How might a behavior therapist defend it?

• RP-2 A psychodynamic therapist might be more interested in helping the child develop insight about the underlying problems that have caused the bed-wetting response. A behavior therapist would be more likely to agree with Mowrer that the bed-wetting symptom is the problem, and that counterconditioning the unwanted behavior would indeed bring emotional relief.

RP-3 What are the insight therapies, and how do they differ from behavior therapies?

• RP-3 The insight therapies—psychodynamic and humanistic therapies—seek to relieve problems by providing an understanding of their origins. Behavior therapies assume the problem behavior is the problem and treat it directly, paying less attention to its origins.

RP-4 Some maladaptive behaviors are learned. What hope does this fact provide?

• RP-4 If a behavior can be learned, it can be unlearned and replaced by other, more adaptive responses.

RP-5 Exposure therapies and aversive conditioning are applications of conditioning. Token economies are an application of conditioning.

• RP-5 classical; operant.

RP-6 How do the humanistic and cognitive therapies differ?

• RP-6 By reflecting people’s feelings in a nondirective setting, the humanistic therapies attempt to foster personal growth by helping people become more self-aware and self-accepting. By making people aware of self-defeating patterns of thinking, cognitive therapies guide them toward more adaptive ways of thinking about themselves and their world.

RP-7 A critical attribute of the developed by Aaron Beck focuses on the belief that changing people’s thinking can change their functioning.

• RP-7 cognitive therapy.

RP-8 What is cognitive-behavioral therapy, and what sorts of problems does this therapy best address?

• RP-8 This integrative therapy helps people change self-defeating thinking and behavior. It has been shown to be effective for those with anxiety disorders, obsessive-compulsive and related disorders, depressive disorders, bipolar disorders, ADHD, eating disorders, and alcohol or other substance use disorder