Psychological Therapies Ch.15 

• Therapy- treatment methods to help people feel better and function more effectively
• Psychotherapy- patients discuss issues and events that have impacted their lives; therapist assists them in understanding how these events have affected them

1. Insight therapies- helping patients achieve a clearer understanding of their motives and actions
2. Action therapy- changing disordered or inappropriate behavior directly
3. Biomedical- therapies for mental disorders in which a person with a problem is treated with biological or medical methods to relieve symptoms

Treatment in Past

• Mentally ill confined to institutions called asylums; mid-1500s
• Philippe Pinel- mentally ill to be treated with support and kindness (France)
• Psychoanalysis- emphasizing the revealing of unconscious conflicts, urges, and desires believed to be the causes of disordered emotions and behavior
• Free association- patient talks about anything that comes to mind

Dream Analysis

• Manifest content- the actual dream and its events
• Latent content- hidden, symbolic meaning of those events

Classical Psychoanalysis

• Resistance- reluctance as patient becomes increasingly aware of an unconscious conflict
• Transference- patient projects positive or negative feelings for important people from the past onto the therapist

-Insight-oriented emphasis

Contemporary Psychoanalysis

• Psychodynamic therapy- term for therapies based on psychoanalysis with an emphasis on transference, shorter treatment times, and a more direct therapeutic approach
• Interpersonal psychotherapy (IPT)- for depression that incorporates multiple approaches and focuses on interpersonal problems
• Directive- therapist actively gives interpretations of a patient’s statements and suggest certain behavior
• Non-directive- therapist remains relatively neutral and does not interpret or take direct actions with regard to the client, instead remaining a calm, non judgemental listener while the client talks

Roger’s Person-Centered Therapy (1961)

• Person-centered therapy- nondirective insight therapy in which the client does most of the talking and therapist listens

Four Elements:

1. Reflection- restates what client says rather than interpreting those statements
2. Unconditional positive regard- accepting atmosphere created by the therapist for the client
3. Empathy- acknowledge and understand what the client is feeling and experiencing
4. Authenticity- genuine, open response of therapist to client

Primary goal of this therapy is positivity

Motivational Interviewing (MI) Miller & Rollnick, 2002

• A variation of person-centered therapy
• Has goals to reduce ambivalence about change and to increase intrinsic motivation 

1. Focusing on the goals and direction of counseling
2. Evoking and eliciting client’s motivation to change
3. Planning how to implement change
4. Differentiating sustain talk, conversations reinforcing no change, from change talk, conversations leading to improvement

• Effective for addictive disorders, anxiety treatment, and mood disorders

Fritz Perls’s Gestalt Therapy

• Emphasizes the importance of the choices made by individuals and the potential to change one’s behaviors
• Gestalt Therapy- form of directive insight in which the therapist helps clients to accept all parts of their feelings and subjective experiences, using leading questions and planned experiences such as role-playing
• Based in humanism
• Helps clients become aware of their feelings and take responsibility for their own actions
• Focuses on denied past

Behavior Therapy

• Behavioral therapies- action therapies based on classical, operant, and observational learning; emphasis on current behavior
• Modification- use of learning techniques to reduce undesirable behavior

Behavior Therapy & Classical Conditioning

• Systematic desensitization- used to treat phobias

1. Client makes a list of ordered fears from least to greatest
2. Taught to relax while imaging each fear in the hierarchy
3. Counterconditioning- replacing past undesirable conditioned response with a new desirable one; anxiety replaced by relaxation

• Flooding- for treating phobias and stress disorders; a person is rapidly and intensely exposed to the fear-provoking situation or object and prevented from making the usual response
• Aversion therapy- counterconditioning technique where undesirable behavior is paired with an aversive stimulus
• Excessive smoke inhalation/nausea to reduce the behavior’s frequency
• Antabuse to reduce alcohol intake

Behavior Therapy & Operant Conditioning

• Reinforcement- strengthening a desired response by following it with either:
• Pleasurable consequence
• Removal of an unpleasant stimulus
• Token economy- objects called tokens are exchanged for rewards (used for schizophrenic, depressed, ADHD)
• Extinction- removal of reinforcer to reduce undesirable behavior (time-out)
• Modeling- learned through observation and imitation (client encouraged to imitate therapist petting a dog)
• Cognitive therapy- identifying and changing distorted thinking and unrealistic beliefs (by Beck)
• Cognitive distortions-

1. Arbitrary inference- “jumping to conclusions” without any evidence
2. Selective thinking- focuses on one aspect of a situation, leaving out other relative facts
3. Overgeneralization- drawing sweeping conclusions from one incident
4. Magnification & Minimization- blowing bad things out of proportion while not emphasizing the good things
5. Personalization- individual takes responsibility or blame for events that they aren’t connected to

Goals of cognitive-behavioral therapy

1. Relieve the symptoms and help clients resolve the problems
2. Help clients develop strategies to cope with future problems
3. Help clients change the way they think

• Rational emotional behavior therapy (REBT)- clients are directly challenged in their irrational beliefs and helped to restructure their thinking into more rational belief statements

Types of Group Therapy

• Family
• Self-help Groups

Advantages of group therapy:

• Low cost
• Exposure to others with similar issues
• Social and emotional support

Psychotherapy

• 75-90% of people improve
• Majority improve in first 20 sessions
• The longer a person stays in therapy, the greater the improvement
• Barriers to effective psychotherapy:

1. Culture-bound values
2. Class-bound values
3. Language
4. “American” cultural assumptions
5. Communication style

Biomedical Treatment

• Biomedical Treatment- directly effects biological function, especially brain function
• Psychopharmacology- drugs to relieve symptoms
• Antipsychotic- treats delusions, hallucinations, and other bizarre behavior
• Antianxiety- to treat and calm anxiety, minor tranquilizers
• Antimanic
• Antidepression- treat depression and chronic anxiety
• Psychostimulants- treat ADHD