Lecture Outline: Therapy

Here we will identify the most common types of therapy used in the field of psychology

Objectives:
1.    Describe the different types of psychological therapies  
2.    Explain the biomedical therapies of antidepressants, antipsychotics, and antianxiety medications

PSYCHOTHERAPY is the application of specialized techniques to the treatment of mental disorders or to the problems of everyday adjustment.  All types of psychotherapy involve close communication between the therapist and client.  The client is encouraged to discuss his or her anxieties and most intimate experiences without moral judgment or criticism on the part of the psychotherapist.  The therapist, in turn, exhibits a warm understanding attitude toward the client in order to encourage freedom of expression and to minimize embarrassment.  The goal of psychotherapy is the modification of the client's behavior to bring about a more effective adjustment to his or her environment.
The most influential types of therapy include PSYCHODYNAMIC, HUMANISTIC, BEHAVIORAL, and COGNITIVE therapies, with a more recent focus on the BIOMEDICAL therapies.

PSYCHODYNAMIC THERAPY

Remember that the father of psychoanalysis is Sigmund Freud.  The basis of psychoanalysis is that all psychological disorders or everyday problems are caused by unresolved childhood issues.  These childhood experiences that are causing current problems are repressed, meaning they are not in our conscious awareness.  The psychoanalyst tries to tap into the repressed feelings to help the client work through them and improve current functioning.  The methods used include free association: saying whatever comes to mind after being asked a question about early experiences or after a specific word and any block in the flow signals resistance.  The therapist then interprets these resistances in treatment and helps the client explore their unconscious motives. 

HUMANISTIC THERAPY

The focus of humanistic therapy is the present and future instead of the past and on conscious thoughts.  Humanistic therapists emphasize personal growth and taking responsibility for your thoughts and actions.  The therapist centers on the person's true potential and focuses on self-acceptance and approval.  A specific type of humanistic therapy is called person-centered therapy where the therapist listens and focuses on the client's feelings and opinions about themselves.  The therapist engages in active listening without interruption to validate the client and provide a reflection.   Humanistic therapists exercise a great deal of acceptance and empathy to help clients reach their fullest potential.

BEHAVIORAL THERAPY

Behavioral therapists do not feel that self-awareness and self-perceptions are causing the problems, rather the problem behavior IS THE PROBLEM.  The focus is on ridding the person of the problem behavior and the problem (phobia, habit, sexual disorder) goes away.  The classic procedures of behavioral therapy include systematic desensitization, aversion therapy, and behavior modification. 

Systematic desensitization is a counterconditioning procedure where we "unlearn" behavior.  For example, a client has a severe snake phobia and would like to eliminate the fear and anxiety associated with snakes.  Using systematic desensitization, the therapist will pair the anxiety response with an incompatible response like relaxation and deep breathing.  By associating a relaxed state with gradually increasing anxiety-provoking stimuli, eventually the snake phobia will be eliminated.

Aversion therapy is the practice of replacing a positive feeling associated with a problem behavior with a negative feeling.  For example, showing a child molester photos of nude children while sending a powerful electrical shock to each of his legs might create a negative association and thereby eliminate the problem behavior.  Another example would be to give an alcoholic a drug that would produce a violent physical reaction (nausea and vomiting) if alcohol is consumed.  The idea here is that if the person drinks alcohol, they will get sick and then have a conditioned taste aversion to alcohol and will stop drinking.

Behavior modification is part of operant conditioning where behavior is increased through the processes of positive or negative reinforcement or decreased through punishment. 

All of these behavior therapies require a high level of client motivation and will not succeed without it.

COGNITIVE THERAPY

Cognitive therapy focuses on feelings and thoughts and how these influence our behavior.  We may perpetuate our undesirable feelings and emotions through negative self-talk.  The cognitive therapist teaches people new, more constructive ways of thinking.  A specific type of cognitive therapy is called  rational emotive therapy and is somewhat confrontational in pointing out how unrealistic negative statements are and to try and get the client to think differently.

BIOMEDICAL THERAPY

These therapies include one of the most successful therapies: drug therapy, as well as electroconvulsive therapy (ECT) and psychosurgery. 

Psychopharmacology is the study of the effects of drugs on behavior and has revolutionized the treatment of severely disordered people.  Three major classes of psychotherapeutic drugs are:
1) antidepressants (treat depression) - SSRIs, tricyclics, and MAOIs
2) antipsychotics (treat psychosis, like symptoms of schizophrenia)
3) antianxiety medications (reduce anxiety) - benzodiazepines (Valium and Xanax)

Electroconvulsive therapy (ECT) aka shock treatment is a biomedical therapy for severely depressed patients in which a brief electrical current is passed into the brain to produce a seizure.  It is not understood why a seizure may help reduce symptoms of depression, but it works in patients who have not responded to traditional oral medications.