Module 47 Notes: Therapy & Psychological Therapies

Historical Context of Psychological Treatment

• Historically, treatments for psychological disorders ranged from harsh (e.g., cutting holes in the head, restraints, bleeding) to gentle (e.g., warm baths, massages, serene environments).
• Treatments have included both drugs and talk therapies addressing childhood experiences, feelings, thoughts, and behaviors.
• Dorothea Dix (1802-1887) and Philippe Pinel (1745-1826) advocated for humane treatment and psychiatric hospitals.
• The introduction of effective drug therapies and community-based treatment in the 1950s led to deinstitutionalization, but also increased homelessness and incarceration.

Modern Therapies

• Modern Western therapies include psychotherapy and biomedical therapy.

Psychotherapy

• Involves a trained therapist using psychological techniques to help clients overcome difficulties and achieve personal growth.
• Therapists may explore early relationships, encourage new ways of thinking, or coach clients to replace old behaviors.

Biomedical Therapy

• Involves medication or biological treatments like electroconvulsive shock therapy (ECT) or deep brain stimulation.
• Psychotherapy and medication are often combined.
• Choice of treatment depends on the care provider's training, expertise, and the specific disorder.
• 1 in 5 Americans receive outpatient mental health therapy (Alson et al., 2019).

Influential Psychotherapy Options

• Based on major psychological theories: psychodynamic, humanistic, behavioral, and cognitive.
• Techniques can be used one-on-one or in groups, in person or online.
• Many therapists use an eclectic approach, blending therapies.

Psychoanalysis and Psychodynamic Therapies

Psychoanalysis

• Developed by Sigmund Freud and serves as a foundation for treating psychological disorders.
• Aims to achieve healthier living by releasing energy devoted to id-ego-superego conflicts.
• Freud believed people are not fully aware of themselves and repress threatening things.
• Psychoanalysis brings repressed feelings into conscious awareness, reclaiming unconscious thoughts and feelings, and providing insight into the origins of disorders.
• The therapist (analyst) helps reduce growth-impeding inner conflicts.

Techniques of Psychoanalysis

• Emphasizes the power of childhood experiences.
• Aims to unearth the past, loosening its bonds on the present.
• Uses free association, where patients relax and say aloud whatever comes to mind.
• Mental blocks indicate resistance, hinting at anxiety and defense against sensitive material.
• Analysts interpret the meaning of resistance, providing insight into underlying wishes, feelings, and conflicts.
• Analysis of dream content is utilized.
• Transference: Patients may transfer feelings from earlier relationships onto the analyst, providing insight into current relationships.
• Modern psychoanalysis is less common due to lack of scientific support, unproven interpretations, time, and cost.

Psychodynamic Therapy

• Influenced by Freud but doesn't focus on id-ego-superego conflicts.
• Helps people understand current symptoms by focusing on important relationships and events, including childhood experiences & client/therapist relationship.
• Addresses conflicting feelings toward the same person and desires mixed with fears (Schedler, 2009).
• Meetings occur once or twice a week for a few weeks or months.
• Clients meet face-to-face with the therapist.
• May involve antidepressant drugs (Dreeson et al., 2020).
• Aims to restore awareness of own wishes, feelings, and reactions against those feelings (Shapiro, 1990).

Humanistic Therapies

• Emphasizes people's potential for self-fulfillment.
• Aims to reduce inner conflicts that interfere with natural development and growth.
• Seeks new insights.
• Focuses on helping people grow in self-awareness and self-acceptance.
• Therapy focuses on exploring feelings as they occur rather than on achieving insight into the childhood origins of those feelings.
• Conscious thoughts are more important than unconscious thoughts.

Person-Centered Therapy

• Developed by Carl Rogers.
• Nondirective therapy: The client leads the discussion.
• The therapist listens without judging or interpreting and refrains from directing the client towards certain insights.
• Therapists foster growth by exhibiting acceptance, genuineness, and empathy (Rogers, 1961, 1980).

Active Listening

• Therapist echoes, restates, and seeks clarification of what the client expresses verbally or nonverbally.
• Involves attentive listening, restating and confirming feelings, accepting what was said, and checking understanding.

Communication Improvement

• Paraphrase: Summarize the person's words out loud.
• Invite clarification: Encourage the person to say more.
• Reflect feelings: Mirror what you're sensing from the person's body language and intensity.

Freud's Personality Theory

• Freud’s ideas are based on the psychodynamic approach to personality.
• Every person possesses a dynamic unconscious, an active collection of a lifetime of hidden memories, a person's deepest instincts and desires, and the struggles to contain these forces.
• The mind is composed of the id, ego, and superego.

Id

• The most basic system, the id, is the part of the mind containing our deepest instinctual drives, our bodily needs and desires, particularly our sexual and aggressive impulses.
• It seeks immediate gratification of any impulse.

Ego

• The part of one's personality that allows us to deal with things practically.
• Helps us resist impulses and live life according to reality.

Superego

• The superego incorporates rules of society and internal standards by which to live our lives.
• Some call it the conscience.

Defense Mechanisms (Freud)

• Projection
• Reaction formation
• Rationalization
• Regression
• Repression
• Displacement

Psychosexual Stages of Development (Freud)

• Oral
• Anal
• Phallic
• Latency
• Genital
• People have desires that have a sexual nature that are present in childhood.

Behavior Therapies

• Doubts the healing power of self-awareness.
• Assumes that problem behaviors are the problems.
• Replaces maladaptive symptoms with new constructive behaviors.

Classical Conditioning Techniques

• Classical conditioning used to unlearn fear responses.
• Mower's conditioning therapy for chronic bed-wetting: using a liquid-sensitive pad connected to an alarm. (\frac{3}{4}) cases had success.

Counter conditioning

• Pairs the trigger stimulus with a new response, relaxation, that is incompatible with fear.
• Exposure therapies: Changes people's reactions by repeatedly exposing them to stimuli that trigger unwanted reactions.

Systematic Desensitization

• • The trick is to proceed gradually.
• Construct an anxiety hierarchy, a kind of ladder of speaking situations that trigger increasing levels of anxiety.
• Learn to release tension in one muscle group after another until you achieve a comfortable, complete state of relaxation.
• Train in progressive relaxation

Virtual Reality Exposure Therapy

• Therapist may recommend virtual reality exposure therapy if anxiety-arousing situations, such as flying, heights, particular animals, and public speaking are too expensive, difficult, or embarrassing to recreate.

Aversive Conditioning

• Creates a negative, aversive response to a harmful stimulus such as alcohol.
• Associates the unwanted behavior with unpleasant feelings.
• To treat compulsive nail biting, the therapist may suggest painting the fingernails with a nasty testing nail polish. (Vaskeind, 1997).
• US: unconditioned stimulus.
• UR: unconditioned response.
• NS: neutral stimulus.
• CS: conditioned stimulus.
• CR: conditioned response.

Operant Conditioning Techniques

• Reinforce desirable behaviors and fail to reinforce or sometimes punish undesirable behaviors.
• Can apply behavior modification

Effectiveness

• Children with intellectual disabilities have been taught to care for themselves.
• Socially withdrawn children with autism spectrum disorder, ASD have learned to interact.
• People with schizophrenia have been helped to behave more rationally.

Token economy

• When people display a desired behavior, such as getting out of bed, washing, dressing, eating, talking meaningfully, cleaning their rooms, or playing cooperatively, they receive a token or plastic coin.

Cognitive Therapies

• Assumes that our thinking colors our feelings.

Cognitive therapy for depression

• Challenge people's automatic negative thoughts could be therapeutic, and thus was born his cognitive therapy (Spiegel, 2015).

Stress inoculation training

• Cognitive therapists have offered stress inoculation training, teaching people to restructure their thinking in stressful situations. (Meechinbaum, 1977, 1985).
• Technique:
  • Reveal beliefs
  • Test beliefs
  • Change beliefs

Cognitive Behavioral Therapy (CBT)

• Takes a combined approach to treating depressive and other disorders.
• Alters not only the way people think, but also the way they act.
• Trains people to practice the more positive approach in everyday settings.