Chapter 15: Psychotherapy

CENGAGE Learning in the 21st Century: Psychology Adjustment Applied to Modern Life

Chapter 15: Psychotherapy

Elements of the Treatment Process

  • Learning Objectives:

    • Identify the three major categories of therapy, and discuss patterns of treatment seeking.

    • Distinguish among the various types of mental health professionals involved in the provision of therapy.

The Treatment Process

  1. Types of Treatments

    • All psychotherapies involve “a helping relationship (the treatment) between a professional (the therapist) and another person in need of help (the client)."

    • Three main categories of therapy:

      • Insight therapies

      • Behavior therapies

      • Biomedical therapies

Medication and Psychotherapy Trends

  • Statistics on treatment types:

    • Percent of patients treated according to type from 1998 to 2007:

    • Medication only

    • Psychotherapy (insight or behavioral) and medication

    • Psychotherapy (insight or behavioral) only

Client Demographics and Therapy Seeking

  1. Who Seeks Therapy?

    • Clients in treatment may not have an identifiable psychological disorder.

    • People often seek treatment for milder problems, such as career decisions.

    • Common psychological disorders prompting treatment include excessive anxiety and depression.

    • Demographics more likely to seek treatment:

      • Women

      • Individuals with medical insurance

      • People with greater education.

    • Barriers to Seeking Treatment:

      • Lack of health insurance

      • Stigma associated with receiving mental health services.

Types of Therapists

  1. Who Provides Treatment?

    • Common Providers of Treatment:

      • Psychologists and psychiatrists

      • Also provided by:

      • Psychiatric social workers

      • Psychiatric nurses

      • Counselors.

  2. Roles of Different Mental Health Professionals:

    • Clinical Psychologists and Counseling Psychologists:

      • Specialize in the diagnosis and treatment of psychological disorders and behavioral issues.

      • Require a doctoral degree (Ph.D., Psy.D., or Ed.D).

      • Typically utilize behavioral methods more than psychoanalysis.

      • Conduct psychological testing and research.

  3. Psychiatrists:

    • Definition: Physicians specializing in the treatment of psychological disorders, focusing on severe disorders such as schizophrenia.

    • Education: MD, emphasizing drug therapies (unlike psychologists who cannot prescribe medication).

    • More likely to employ psychoanalysis techniques.

  4. Other Mental Health Professionals:

    • Psychiatric Social Workers:

      • Work as part of a treatment team with psychologists/psychiatrists.

      • Hold a master’s degree and assist patients in community reintegration.

    • Psychiatric Nurses:

      • Hold a bachelor’s or master’s degree, typically work with hospitalized patients.

Insight Therapies

  • Learning Objectives:

    • Understand psychoanalysis logic and techniques to probe the unconscious.

    • Discuss therapeutic climate and process in client-centered therapy.

    • Describe group, couples, and family therapy conduct.

    • Assess the efficacy of insight therapies and the importance of common factors.

  1. Definition of Insight Therapies:

    • Verbal interactions aimed at enhancing self-knowledge and effecting healthful changes in personality and behavior.

    • Include:

      • Psychoanalysis

      • Client-centered therapy

      • Group therapy.

Psychoanalysis

  1. Psychoanalysis Overview:

    • Developed by Sigmund Freud, emphasizes resolving unconscious conflicts through:

      • Free association

      • Dream analysis

      • Transference.

    • Methods:

      • Free Association: Clients express thoughts and feelings spontaneously with little censorship.

      • Dream Analysis: Involves interpreting the symbolic meaning of dreams to uncover unconscious conflicts.

  2. Therapist Techniques:

    • Interpretation: Explaining the significance of thoughts, feelings, and behaviors.

    • Resistance: Unconscious defenses that hinder therapy progress (e.g., forgetting appointments).

    • Transference: Relating to therapists in ways that echo critical personal relationships.

Client-Centered Therapy

  1. Definition:

    • Emphasizes a supportive emotional climate where clients influence their therapy’s pace and direction.

    • Rooted in humanistic psychology (Carl Rogers).

    • Focus on enhancing clients' self-concepts.

  2. Therapeutic Climate:

    • Required elements for a positive change:

      • Genuineness (open communication)

      • Unconditional positive regard (acceptance and support)

      • Empathy (understanding the client’s perspective).

  3. Therapeutic Process:

    • Client-centric where therapist clarifies client statements for better understanding.

    • Goal: To help clients become aware of and accept their “genuine selves.”

Group, Couples, and Family Therapy

  1. Group Therapy:

    • Simultaneous treatment of multiple clients.

    • Participants act as “therapists” for each other, offering emotional support.

    • Advantages:

      • Realizing shared problems

      • Opportunities to practice social skills.

  2. Couples and Family Therapy:

    • Couples therapy treats both partners in a relationship.

    • Family therapy involves addressing dynamics and communication within the family unit.

Efficacy of Insight Therapies

  1. Efficacy Assessment:

    • Comparison of therapies complicated by the allegiance effect (researchers favoring their approaches).

    • Studies typically show insight therapy is more effective than placebo, yielding durable results.

    • General consensus: Therapy is beneficial for many.

  2. Common Factors for Effectiveness:

    • Building a professional alliance

    • Providing emotional support and empathy

    • Cultivating hope and positive expectations

    • Offering rationale and methods for addressing problems

    • Facilitating expression and confrontation of feelings.

Behavior Therapies

  • Learning Objectives:

    • Outline goals/procedures of systematic desensitization and exposure therapies.

    • Describe social skills training and its uses.

    • Understand cognitive therapy's logic, goals, and techniques.

    • Assess evidence on behavior therapies' efficacy.

  1. Insight vs. Behavior Therapies:

    • Insight therapists view behaviors as symptoms of deeper issues; behavior therapists see them as the primary problem.

    • Definition of Behavior Therapies: Application of learning principles to modify maladaptive behaviors.

  2. Assumptions of Behavior Therapy:

    • Behavior results from learning; learned behavior can be unlearned.

    • Concrete goals are established for vague complaints.

  3. Systematic Desensitization:

    • Behavior therapy that reduces anxiety responses through counterconditioning.

    • Goal: Disassociate the fear-triggering stimulus from the anxiety response.

    • Steps involve creating an anxiety hierarchy and training in relaxation techniques followed by pairing them with fear responses.

  4. Social Skills Training:

    • Focuses on enhancing interpersonal skills via modeling, rehearsal, and shaping.

    • Process: Clients observe skilled individuals, practice through role-play, and gradually handle more complex situations.

  5. Cognitive-behavioral Treatments:

    • Blend verbal/cognitive strategies and behavioral interventions.

    • Focuses on correcting habitual cognitive errors.

    • Cohen theory states depression arises from negative thinking patterns.

  6. Cognitive Therapy Goals:

    • Help clients identify negative automatic thoughts and adopt more rational evaluations.

    • Therapists lead the process, determining the pace of treatment.

  7. Evaluating Behavior/Cognitive Therapies:

    • Highly effective, especially for:

      • Depression

      • Anxiety issues

      • Phobias

      • Obsessive-compulsive disorder

      • Schizophrenia

      • Eating disorders

      • Drug-related problems.

Biomedical Therapies

  • Learning Objectives:

    • Outline principal drug therapies for psychological disorders and their efficacy.

    • Identify problems with drug therapies and research.

    • Describe Electroconvulsive Therapy (ECT), including efficacy and risks.

  1. Definition of Biomedical Therapies:

    • Physiological interventions aimed at reducing symptoms of psychological disorders.

    • Prominent forms:

      • Drug therapy

      • Electroconvulsive Therapy (ECT).

  2. Psychopharmacotherapy:

    • Drug therapy for mental disorders.

    • Four main categories:

      • Antianxiety drugs

      • Antipsychotic drugs

      • Antidepressants

      • Mood stabilizers.

  3. Antianxiety Drugs:

    • Used to relieve tension and anxiety (e.g., Valium, Xanax).

    • Fast-acting but can carry risks of abuse and dependency.

  4. Antipsychotic Drugs:

    • Reduce psychotic symptoms, enable treatment of schizophrenia.

    • Traditional examples: Thorazine, Mellaril, Haldol, which take 1-3 weeks to effect.

    • Side effects include cotton mouth and drowsiness; severe cases may lead to tardive dyskinesia.

  5. Antidepressant Drugs:

    • Increase mood, common in the U.S. treatment courses (SSRIs like Zoloft).

    • Side effects: Weight gain, insomnia, sexual dysfunction.

    • Increased suicide risk monitoring is required.

  6. Mood Stabilizers:

    • Control mood swings, especially in bipolar disorders (e.g., Lithium).

    • Lithium potentially harmful at high doses; newer alternatives may have fewer side effects.

  7. Evaluating Drug Therapies:

    • Benefits: Provide relief for severe disorders.

    • Critics highlight potential overprescription and that drugs treat symptoms, not causes.

  8. Electroconvulsive Therapy (ECT):

    • Involves electric shock to induce a seizure, primarily for treatment-resistant depression.

    • Requires anesthetics and muscle relaxants, typically done in 2-7 weeks with various treatments.

  9. ECT Effectiveness and Risks:

    • Advocates claim efficacy for non-responsive depression; critics cite high relapse and possible serious cognitive side effects.

Current Trends and Issues in Treatment

  • Learning Objectives:

    • Discuss the benefits of blending therapeutic approaches.

    • Understand why therapy is underutilized in ethnic minorities and examine solutions.

    • Explain technological enhancements in accessing clinical services.

  1. Blending Approaches:

    • Eclectic therapy practices involve integrating various strategies tailored to individual needs.

    • Evidently beneficial according to studies.

  2. Multicultural Sensitivity in Treatment:

    • Minority groups face barriers in accessing therapy: familial reliance, distrust of medical institutions, and cultural communication gaps.

    • Factors for addressing underutilization include training minority therapists and researching adaptable approaches for cultural compatibility.

  3. Where to Seek Therapy:

    • Majority of therapists work in institutional settings rather than private practice, such as community mental health centers, hospitals, and agencies.

  4. Therapist Choice Considerations:

    • Assessing the therapist’s profession and gender can influence efficacy; empirical links are weak.

    • Therapy cost may be mitigated by utilizing non-private providers or insurance.

  5. Expectations in Therapy:

    • Recognizing that therapy is often a slow, challenging process, requiring significant client engagement and personal change for improvement.