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
Insight therapies- helping patients achieve a clearer understanding of their motives and actions
Action therapy- changing disordered or inappropriate behavior directly
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:
Reflection- restates what client says rather than interpreting those statements
Unconditional positive regard- accepting atmosphere created by the therapist for the client
Empathy- acknowledge and understand what the client is feeling and experiencing
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
Focusing on the goals and direction of counseling
Evoking and eliciting client’s motivation to change
Planning how to implement change
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
Client makes a list of ordered fears from least to greatest
Taught to relax while imaging each fear in the hierarchy
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-
Arbitrary inference- “jumping to conclusions” without any evidence
Selective thinking- focuses on one aspect of a situation, leaving out other relative facts
Overgeneralization- drawing sweeping conclusions from one incident
Magnification & Minimization- blowing bad things out of proportion while not emphasizing the good things
Personalization- individual takes responsibility or blame for events that they aren’t connected to
Goals of cognitive-behavioral therapy
Relieve the symptoms and help clients resolve the problems
Help clients develop strategies to cope with future problems
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:
Culture-bound values
Class-bound values
Language
“American” cultural assumptions
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
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
Insight therapies- helping patients achieve a clearer understanding of their motives and actions
Action therapy- changing disordered or inappropriate behavior directly
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:
Reflection- restates what client says rather than interpreting those statements
Unconditional positive regard- accepting atmosphere created by the therapist for the client
Empathy- acknowledge and understand what the client is feeling and experiencing
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
Focusing on the goals and direction of counseling
Evoking and eliciting client’s motivation to change
Planning how to implement change
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
Client makes a list of ordered fears from least to greatest
Taught to relax while imaging each fear in the hierarchy
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-
Arbitrary inference- “jumping to conclusions” without any evidence
Selective thinking- focuses on one aspect of a situation, leaving out other relative facts
Overgeneralization- drawing sweeping conclusions from one incident
Magnification & Minimization- blowing bad things out of proportion while not emphasizing the good things
Personalization- individual takes responsibility or blame for events that they aren’t connected to
Goals of cognitive-behavioral therapy
Relieve the symptoms and help clients resolve the problems
Help clients develop strategies to cope with future problems
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:
Culture-bound values
Class-bound values
Language
“American” cultural assumptions
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