THERAPY

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THERAPY
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HISTORY OF THERAPY

• Trephining
• Bloodletting
• Insane asylums
• Philipe Pinel (1745-1826)
• Moral therapy
• Benjamin Rush (1745-1813)
• Dorothea Dix (1802-1887)

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• Psychotherapy
• The treatment of psychological disorders through
  psychological means generally involving verbal
  interaction with a professional therapist
• Eclectic orientation

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THE PSYCHOANALYTIC ORIENTATION

• The Nature of Psychoanalysis
• Psychoanalysis
• A type of psychotherapy, developed by Sigmund
  Freud, aimed at uncovering the unconscious causes
  of psychological disorders.

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• Techniques in Psychoanalysis
• Analysis of free associations
• therapist interprets the underlying meaning of
  the clients uncensored reports of anything that
  comes to mind
• Analysis of resistances
• therapist interprets client behaviors that
  interfere with therapeutic progress toward
  uncovering unconscious conflicts
• Analysis of dreams
• therapist interprets the symbolic, manifest
  content of dreams to reveal their true, latent
  content to the client

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• Analysis of transference
• therapist interprets the feelings expressed by
  the client toward the therapist as being
  indicative of the feelings typically expressed by
  the client toward important people in his or her
  personal life.
• Positive transference
• Client expresses feelings of approval and
  affection toward the therapist
• Negative transference
• Client expresses feelings of disapproval and
  rejection towards therapist

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THE BEHAVIORAL ORIENTATION

• Behavior therapy
• The therapeutic application of the principles of
  learning to change maladaptive behaviors

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Classical Conditioning Therapies

• Counterconditioning
• Technique that applies the principles of
  classical conditioning to replace unpleasant
  emotional responses to stimuli with more pleasant
  ones

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• Systematic desensitization (Joseph Wolpe 1958)
• A form of counterconditioning that trains the
  client to maintain a state of relaxation in the
  presence of imagined anxiety-inducing stimuli.
• In vivo desensitization
• A form of counterconditioning that trains the
  client to maintain a state of relaxation in the
  presence of anxiety-inducing stimuli

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• Aversion therapy
• A form of behavior therapy that inhibits
  maladaptive behavior by pairing a stimulus that
  normally elicits a maladaptive response with an
  unpleasant stimulus

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Operant-Conditioning Therapies

• Positive Reinforcement
• Token economy
• Uses tokens as positive reinforcers in programs
  designed to promote desirable behaviors, with the
  tokens later used to purchase desired items or
  privileges.

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• Punishment
• Extinction
• Flooding
• An extinction procedure in which a phobic client
  is exposed to a stimulus that evokes intense
  anxiety
• Imaginal flooding
• Hold in mind image of feared object
• In vivo flooding
• Placed in actual feared situation

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Social-Learning Therapies

• Participant modeling
• Client learns to perform more adaptive behaviors
  by first observing the therapist model the
  desired behaviors.

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THE COGNITIVE ORIENTATION

• Changes in thinking, produces changes in
  maladaptive emotions and behaviors
• Aka cognitive-behavior therapies

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• Rational-Emotive Behavior Therapy (R-E-B-T)
• Developed by Albert Ellis, treats psychological
  disorders by forcing the client to give up
  irrational beliefs
• A-B-C theory of emotion
• A activating event
• B irrational belief
• C emotional consequences

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• Cognitive Therapy
• Developed by Aaron Beck, aims at eliminating
  exaggerated negative beliefs about oneself, the
  world, or the future.
• Socratic technique

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HUMANISTIC ORIENTATION

• Stresses present not the past
• Conscious not unconscious
• Subjective mental experience not objective
  environmental circumstances
• Expression of emotion rather than control

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• Person-Centered Therapy
• Developed by Carl Rogers, helps clients find
  their own answers to their problems
• Non-directive
• Facilitate self-actualization
• Providing climate in which clients can be
  themselves
• Humanistic assumptions
• Accepting their true feelings

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• Tools of the trade
• Reflection of feelings
• Active listener, therapeutic mirror
• Genuine
• Concerned, open, sincere
• Accurate empathy
• Words and actions indicate true understanding
• Unconditional positive regard
• Warm accepting manner, non-judgmental

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THE BIOPSYCHOLOGICAL ORIENTATION

• Psychosurgery
• The treatment of psychological disorders by
  destroying brain tissue.
• 1935, Portuguese neurologist Egas Moniz
• Almeida Lima
• Prefrontal leucotomy
• Walter Freeman and James Watts 1936
• Transorbital leucotomy
• 1979, 35,000 mental patients in United States
• Rarely used today
• Unpredictable effects
• Advent of drug therapy

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• Electroconvulsive Therapy
• Uses brief electrical currents to induce brain
  seizures in victims of major depression
• Benjamin Rush and shock therapy
• Ladislas von Meduna and Manfred Sakel
• camphor
• Insulin overdoses
• 1938, Ugo Cerletti
• Treatment of choice for people for depressed
  people in imminent danger of committing suicide.
• Stimulates norepinephrine
• Causes retrograde anmesia

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• Drug Therapy
• Antianxiety Drugs (anxiolytics)
• Used to treat anxiety disorders
• Tranquilizers
• Benzodiazepines
• Xanax (alprazolam)
• Valium (diazepam)
• Stimulating receptors in the brain that enhance
  the effects of the neurotransmitter GABA
  (inhibits brain activity)
• Drowsiness, depression and dependence
• BuSpar (buspirone)
• not as many side effects, increases serotonin
  levels in the brain
• Take everyday

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• Antidepressant Drugs
• Psychoactive drugs that are used to treat major
  depression
• MAO inhibitors Nardil
• Used to treat tuberculosis
• Blocking enzymes that breakdown neurotransmitters
  such as serotonin and norepinephrine
• Causes high blood pressure

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• Tricyclic antidepressants
• Elavil (amitriptyline), Tofranil (imipramine) and
  Anafranil (clomipramine)
• Preventing reuptake
• 2-4 weeks to have an effect

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• Selective serotonin reuptake inhibitors (SSRIs)
• Prevents reuptake as well
• Zoloft (sertraline), Paxil (paroxetine) and
  Prozac (fluoxetine)
• Less side effects than tricyclic
• Recovery rates for serious cases of depression
  higher with combined therapy
• Nausea, diarrhea, anxiety, insomnia and loss of
  sexual desire and response

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• Atypical antidepressants
• Wellbutrin (bupropion), Effexor (venlafaxine),
  Serzone (nefazodone), Lexapro (escitalopram) and
  Cymbalta (duloxetine)
• Dopamine and norepinephrine systems
• Heightened sexual interest and response
• Curbs nicotine cravings
• Also used for adult ADD
• No effect if not depressed
• Works on a variety of disorders

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• Antimania Drugs
• Used to treat bipolar disorder
• Lithium carbonate
• 1940s, John Cade
• 50 relapse within 3 months when taken off drug
• Seizures, brain damage and irregular heart
  rhythms
• Tegretol, Depakote (divalproex), Topamax, and
  Lamictal (lamotrigine)
• Effects calcium on neuronal membranes
• Work on serotonin

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• Antipsychotic Drugs (neuroleptics)
• Used to treat schizophrenia
• Snakeroot plant in India
• Reserpine
• Caused depression and low blood pressure
• 1950s phenothiazines
• Thorazine (chlorpromazine)
• Haldol (haloperidol)
• Block receptor sites for the neurotransmitter
  dopamine

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• Tardive dyskinesia
• Grimacing, lip smacking, tongue thrusting and
  limb flailing.
• Atypical neuroleptics
• Clozaril (clozapine), Risperdal (risperidone),
  Zyprexa (olanzapine), Seroquel (quetiapine),
  Geodon (ziprasidone) and Abilify (aripiprazole)
• Agranulocytosis Loss of white blood cells
• Alterations in serotonin transmissions
• Work on subsets of dopamine neurons

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THE SOCIAL-RELATIONS ORIENTATION

• Group Therapy
• 1905 Joseph Pratt Boston physician
• Jacob Moreno
• More people, less time, less cost
• Encouragement from others with similar problems
• Try out new behaviors
• Allows therapist to see clients interactions

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• Social Skills Training
• Behavioral group therapy that improves the
  clients social relationships by enhancing her or
  his interpersonal skills
• Assertiveness training
• Teaches clients to express their feelings
  constructively
• Self-Help Groups
• 1950s Carl Rogers and encounter groups
• Alcoholics Anonymous

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• Family therapy
• Treatment of two or more individuals from the
  same family
• Various approaches
• For example
• Couples therapy
• Improving communication between partners
• Various approaches
• For example

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