The Psychological Therapies
Psychological therapy or psychotherapy: is 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 and dream analysis:
Free association: the patient spontaneously reports all her thoughts, mental images, and feelings while lying on a couch.
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.
Resistance: the patient’s conscious or unconscious attempts to block the process of revealing repressed memories and conflicts.
Dream Interpretation (another important psychanalytic technique)
Interpretations: explanations of the unconscious meaning of the patient’s behavior, thoughts, feelings or dreams.
Defensive responses increase resistance.
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 “optimal frustration” in the patient, so they transfer and project unresolved conflicts onto the psychoanalyst.
Traditional psychoanalysis is 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)
As a result, the development of psychodynamic therapies.
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.
Unresolved grief: problems dealing with the death of significant others.
Role disputes: repetitive conflicts with significant others. (spouse, family, coworker)
Role transitions: problems involving major life changes (marriage, divorce, retirement)
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.
Carl Rogers
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:
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:
Progressive relaxation: involves successively relaxing one muscle group after another until a deep state of relaxation is achieved.
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.
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.
Developed by Aaron T. Beck (initially a psychoanalyst) while researching depression.
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.)
Beck’s Cognitive therapy (CT) has much in common with Albert Ellis’s Rational-emotive behavior therapy (REBT).
Both believe what people think creates their moods and emotions, not the result of the event themselves.
Difference: Ellis’s emphasis on “irrational” thinking and Becks focus on distorted thinking and unrealistic beliefs. 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)
Group and Family Therapies
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.
Evaluating Psychotherapies
Research indicates that clients are generally satisfied with the effectiveness of therapy.
3 benefits attributed to all psychotherapies:
Hope. (placebo)
new perspective
empathetic, trusting and caring relationship.
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.
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
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.
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.
Eclecticism: A therapist (an eclectic therapist) integrates use of techniques from different psychotherapies. Will depend on the client and symptoms.
In recent years 100’s of studies have evaluated the effectiveness of the major forms of psychotherapy.
Research varies in terms of the types of psychotherapy compared and 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
The Biomedical Therapies
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.
Used to dampen responsiveness to irrelevant stimuli and decreases positive symptoms in schizophrenia patients by decreasing brain levels of the neurotransmitter dopamine.
Reserpine and chlorpromazine (Thorazine) 1950’s.
Also referred to as neuroleptics.
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.
Valium, Xanax. Increases 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.
Called SSRI’s (selective-serotonin-reuptake-inhibitors) Increase serotonin levels.
First SSRI, fluoxetine (Prozac) then Zoloft and Paxil.
Mood-stabilizing drugs: regulate neurotransmitters to level out mood. Most common, Lithium, and Depakote.
Brain Stimulation
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.
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.
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.