Chapter 13 Overview

1
Chapter 13 Overview

• Insight therapies
• Relationship therapies
• Behavior therapies
• Cognitive therapies
• Biomedical therapies
• Evaluating the therapies
• The therapeutic relationship

2
Insight Therapies

• Approaches to psychotherapy based on the notion
  that psychological well-being depends on
  self-understanding

3
What are the basic techniques of psychodynamic
therapies?

• Psychotherapies that attempt to uncover repressed
  childhood experiences that are thought to cause
  the patients current problems
• Psychoanalysis is a technique developed by Freud
• Free association
• Explores the unconscious by having patients
  reveal whatever thoughts, feelings, or images
  come to mind
• Dream analysis
• Areas of emotional concern repressed in waking
  life are sometimes expressed in symbolic form in
  dreams
• Transference
• Emotional reaction that occurs during
  psychoanalysis, in which the patient displays
  feelings and attitudes toward the analyst that
  were present in another significant relationship

4
What are the basic techniques of psychodynamic
therapies?

• Object relations therapy
• Based on idea that early relationships form
  blueprints for future relationships
• Therapist helps clients restructure current
  relationships, changing maladaptive patterns
  formed in early relationships
• Interpersonal therapy
• Brief psychotherapy that helps clients understand
  and cope with four interpersonal problems
  associated with depression
• Severe response to death of a loved one
• Interpersonal role disputes
• Difficulty adjusting to role transitions
• Deficits in interpersonal skills

5
What is the goal of the therapist in
person-centered therapy?

• Humanistic therapies assume that people have the
  ability and freedom to lead rational lives and
  make rational choices
• Founded by Carl Rogers (1951)
• Therapists show empathy and create a climate of
  unconditional positive regard
• Goal is to allow the client to direct the therapy
  session and move toward self-actualization
• The patients realization of his inner potential

6
What is the major emphasis of Gestalt therapy?

• Helps clients fully experience their feelings,
  thoughts, and actions
• Emphasizes clients taking responsibility for
  their behavior, instead of blaming society or
  parents
• Goal is to help the client resolve past
  conflicts, achieve a more integrated self, and
  become more self-accepting
• Gestalt therapy is directive
• Therapist actively directs the therapy session
• Provides answers and suggestions to the client

7
Relationship Therapies

• Therapies that attempt to improve patients
  interpersonal relationships or create new
  relationships to support patients efforts to
  address psychological problems

8
What are the goals of family and couple therapy?

• Family therapy
• Parents and children enter therapy as a group
• Goal is to help family members heal wounds to the
  family, improve communication, and create more
  understanding within the family
• Couple therapy
• Goal is to help partners in an intimate
  relationship communicate and manage conflicts
  more effectively
• May focus on behavioral change or partners
  emotional responses to each other

9
What are some advantages of group therapy?

• A group of clients (usually seven to ten) meets
  regularly with one or more therapists
• Provides client with a sense of belonging and
  opportunity to
• Express feelings
• Get feedback from other group members
• Give and receive emotional support
• Self-help groups
• People with similar problems who meet regularly,
  usually without a professional therapist

10
Behavior Therapies

• A treatment approach that is based on the idea
  that abnormal behavior is learned and that
  applies the principles of operant conditioning,
  classical conditioning, and/or observational
  learning to eliminate inappropriate or
  maladaptive behaviors and replace them with more
  adaptive responses

11
How do behavior therapists modify clients
problematic behavior?

• Uses reinforcement to shape or increase frequency
  of desirable behavior
• e.g., Token economy
• Extinguishes undesirable or maladaptive behavior
  by terminating or withholding reinforcement that
  maintains the behavior
• e.g., Timeout

12
What behavior therapies are based on classical
conditioning and social-cognitive theory?

• Systematic desensitization is behavior therapy
  based on classical conditioning
• Used to treat fears
• Client is trained to relax while being confronted
  with a graduated series of anxiety-producing
  situations
• Eventually, client can stay relaxed while
  confronting even the most feared situation
• Participant modeling is behavior therapy based on
  Albert Banduras principles of observational
  learning
• A model demonstrates appropriate responses to a
  feared stimulus in graduated steps
• Client then imitates the model with encouragement
  of a therapist
• Using this technique, most specific phobias can
  be extinguished in 3 to 4 hours

13
What behavior therapies are based on classical
conditioning and social-cognitive theory?

• Flooding is behavior therapy based on classical
  conditioning
• Used to treat phobias by exposing clients to the
  feared object or event for an extended period,
  until their anxiety decreases
• Exposure and response prevention is behavior
  therapy
• Exposes patients with obsessive-compulsive
  disorder to stimuli that trigger obsessions and
  compulsive rituals, while patients resist
  performing the compulsive rituals for
  progressively longer periods of time
• Aversion therapy is behavior therapy
• An aversive stimulus is paired with a harmful or
  socially undesirable behavior until the behavior
  becomes associated with pain or discomfort

14
Cognitive Therapies

• Therapies that assume maladaptive behavior can
  result from irrational thoughts, beliefs, and
  ideas

15
What is the aim of rational emotive therapy?

• Developed by Albert Ellis
• A directive form of therapy
• Goal is to challenge and modify a clients
  irrational beliefs about themselves and others
• Which are believed to be the causes of personal
  distress

16
How does Becks cognitive therapy help people
overcome depression and panic disorder?

• Cognitive therapy, designed by Aaron Beck, helps
  clients stop their negative thoughts as they
  occur and replace them with more objective
  thoughts
• Depression is treated by brief cognitive therapy,
  usually 10-20 sessions, and is more effective
  than antidepressant drugs
• Panic disorder is treated by teaching clients to
  change the catastrophic interpretations of their
  symptoms to prevent them from escalating into
  panic, usually effective with 3 months of
  treatment

17
Biomedical Therapies

• Therapies (drug, therapy electroconvulsive
  therapy, or psychosurgery) that are based on the
  assumption that psychological disorders are
  symptoms of underlying physical problems

18
What are the advantages and disadvantages of
using drugs to treat psychological disorders?

• Antipsychotic drugs
• Prescribed primarily for schizophrenia
• Used to treat symptoms such as hallucinations,
  delusions, and disorganized behavior
• Work by inhibiting dopamine activity
• Lithium
• Used to treat bipolar disorder
• Reduces both manic and depressive episodes
• Antianxiety drugs
• Benzodiazepines are effective for treating
  generalized anxiety disorder and panic disorder
• This family of minor tranquilizers includes
  Valium and Xanax

19
What are the advantages and disadvantages of
using drugs to treat psychological disorders?

• Antidepressant drugs
• Act as mood elevators for people who are severely
  depressed
• Selective serotonin reuptake inhibitors (SSRIs)
• Block the reuptake of serotonin, increasing its
  availability at the synapses of the brain
• Are effective for treating major depression, OCD,
  social phobia, panic disorder, generalized
  anxiety disorder, and binge eating

20
What are the advantages and disadvantages of
using drugs to treat psychological disorders?

• Drugs can have unpleasant or dangerous side
  effects
• It is difficult to establish proper dosages
• Drugs do not cure psychological disorders
• So relapse is likely if drug therapy is
  discontinued
• Availability of antipsychotic drugs led to a
  trend away from hospitalization, which may have
  increased homelessness among people with
  schizophrenia

21
What is electroconvulsive therapy (ECT) used for?

• Electric current is administered to the right
  cerebral hemisphere
• While patient is under anesthesia
• Usually reserved for severely depressed patients
  who are suicidal
• ECT was misused and overused in the 1940s and
  1950s, leading to a bad reputation
• But it can be a highly effective treatment for
  major depression

22
What is psychosurgery, and for what problems is
it used?

• Brain surgery performed to alleviate serious
  psychological disorders or unbearable chronic
  pain
• Lobotomy
• Severs neural connections between frontal lobes
  and deeper centers involved in emotion
• No longer performed, because it leaves patients
  in permanent deteriorated condition
• Cingulotomy
• Destroys cingulum
• Can help in extreme cases of OCD
• Psychosurgery is controversial, and is considered
  experimental and a last resort
• Because results are unpredictable and permanent

23
Evaluating the Therapies

• Therapies share many similarities. Therapists
  use a core set of techniques no matter which
  perspective of therapy session they adopt, but at
  the same time, each therapeutic approach has
  elements that distinguish it from others.

24
What therapy, if any, is most effective in
treating psychological disorders?

• Smith et al. (1980) analyzed 475 studies with
  25,000 clients
• Found that psychotherapy was better than no
  treatment
• But no one type of psychotherapy was more
  effective than another
• Eysenck (1994) reanalyzed the same studies
• Reported that behavior therapy has a slight
  advantage over other types of therapies

25
What therapy, if any, is most effective in
treating psychological disorders?

• A large survey of psychotherapy clients conducted
  by Consumer Reports found that
• Overall, clients believed that they benefited
  substantially from psychotherapy
• Clients were equally satisfied with therapy
  provided by psychologists, psychiatrists, and
  social workers
• The longer clients stayed in therapy, the more
  they improved
• Clients believed that antidepressant and
  antianxiety drugs helped them but overall
  psychotherapy alone worked as well as
  psychotherapy plus drugs

26
The Therapeutic Relationship

• When establishing a relationship with a
  therapist, it is important to become familiar
  with the various professionals who offer
  therapeutic services.

27
What distinguishes one type of therapist from
another, and what ethical standards are shared by
all types of therapists?

• A Psychologist
• Has an advanced degree, usually a doctorate, in
  psychology
• Clinical psychologists generally diagnose and
  treat psychological disorders
• Counseling psychologists generally provide
  therapy for normal problems of life, such as
  divorce
• A Psychiatrist
• Is a medical doctor
• Can prescribe drug therapy

28
What distinguishes one type of therapist from
another, and what ethical standards are shared by
all types of therapists?

• Therapists are forbidden to engage in any kind of
  intimate relationship with a client or anyone
  close to the client
• They are prohibited from providing therapy to
  former intimate partners
• They are obligated to use tests that are reliable
  and valid
• And they must have appropriate training for all
  tests that are used

29
What are the characteristics of culturally
sensitive therapy?

• An approach to therapy in which knowledge of
  clients cultural backgrounds guides the choice
  of therapeutic interventions
• This approach emphasizes that cultural variables
  may influence the diagnosis and treatment of
  psychological disorders

30
Why is gender-sensitive therapy important?

• An approach to therapy that takes into account
  the effects of gender on both the therapists and
  the clients behavior
• This approach emphasizes how a therapists gender
  biases may affect the techniques that they choose
  and their assessments of clients progress