Psychotherapies

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Psychotherapies
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2 Types of Therapy

• Psychotherapyuse of psychological techniques to
  treat emotional, behavioral, and interpersonal
  problems
• Biomedicaluse of medications and other medical
  therapies to treat the symptoms associated with
  psychological disorders

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Psychotherapy

• A planned, emotionally charged, confiding
  interaction between a trained therapist and
  someone who suffers from psychological
  difficulties
• There are over 250 different types of therapy.

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Four Types of Psychotherapy

• Most therapies can be divided into
• Psychoanalytic
• Humanistic
• Behavioral
• Cognitive

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Eclectic Approach

• An approach to psychotherapy that, depending on
  the persons problems, uses techniques from
  multiple forms of therapy
• Carefully tailor the therapy approach to the
  problems and characteristics of the person
  seeking help

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Psychoanalysis
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Psychoanalysis

• Developed by Sigmund Freud based on his theory of
  personality

Freuds Office
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Psychoanalysis

• Freuds therapeutic technique that attributes
  ones thoughts and actions to unconscious motives
  and conflicts

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Psychoanalysis Assumptions

• Psychological problems are the result of
  repressed conflicts and impulses from childhood.
• The therapist must bring the repressed problems
  into the conscious mind to help patients have an
  insight about the original cause of the problem.

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Causes of Psychological Problems

• Undesirable urges and conflicts are repressed
  or pushed to the unconscious
• Unconscious conflicts exert influence on
  behaviors, emotions, and interpersonal dynamics
• Understanding and insight into repressed
  conflicts leads to recognition and resolution

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Psychoanalytic Methods
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Free Association

• Freudian technique of discovering the unconscious
  mind--where the patient relaxes and says whatever
  comes to mind, no matter how trivial or
  embarrassing
• A way of revealing unconscious thoughts and
  emotions

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Resistance

• Clients unwillingness to discuss issues raised
  during free association.
• Unconscious attempts to block the revelation of
  repressed memories and conflicts.

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Interpretation

• A technique in which the psychoanalyst offers a
  carefully timed explanation of the unconscious
  meaning of the patients behavior, thoughts,
  feelings, or dreams to facilitate the recognition
  of unconscious conflicts or motivations
• Dream Interpretation - Manifest content of dreams
  is analyzed for disguised or symbolic wishes,
  meanings, and motivations (latent content)
• Freud considered dreams to be the royal road to
  the unconscious

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Transference

• Patients transfer to the analyst of emotions
  linked with other relationships
• The patient projects feeling from the past to the
  therapist.
• Once these are feelings are opened up the
  therapist can help the client work through them.

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Using Psychoanalysis

• All these psychoanalytic techniques are designed
  to help the patient achieve insight into how past
  conflicts influence her current behavior and
  relationships and then replace maladaptive
  behavior patterns with adaptive ones.
• On average, the traditional psychoanalyst sees
  the patient four or five times a week over the
  course of four years or longer

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Psychoanalytic Influence

• Few therapists follow strict Freudian therapy.
• Most feel it emphasizes sex and aggression too
  much
• Works well with anxiety and mild depression.

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The Psychodynamic Perspective
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Psychodynamic Approach

• A more modern view that retains some aspects of
  Freudian theory but rejects other aspects
• Retains the importance of the unconscious mind
• Less emphasis on unresolved childhood conflicts
• Does not require meeting with therapist as often
  as traditional psychoanalytic therapy.

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Humanistic Therapies
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Humanistic Therapies

• Humanistic perspective emphasizes human
  potential, self-awareness, and free-will
• Humanistic therapies focus on self-perception and
  individuals conscious thoughts and perceptions
• Client-centered (or person-centered) therapy is
  the most common form of humanistic therapy
• Carl Rogers (19021987)developed this technique

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Nondirective Client-Centered Therapy

• Therapist listens without interpreting and does
  not direct the client (patient) to any particular
  insight.
• Therapist must not make decisions for the client,
  offer solutions, or pass judgment on the clients
  thoughts or feelings.
• Rogers deliberately used the word client rather
  than patient to avoid the idea that the person
  was sick and could be cured

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Client-Centered Therapy

• Therapist uses techniques such as active
  listening within a genuine, accepting, empathic
  environment to facilitate the clients growth.
  The therapy stresses
• Empathy
• Acceptance
• Genuineness

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Therapeutic Conditions

• Genuinenesstherapist openly shares thoughts
  without defensiveness
• Unconditional positive regard for clientno
  conditions on acceptance of person
• Empathic understandingcreates a psychological
  mirror reflecting clients thoughts and feelings

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Active Listening

• Empathic listening in which the listener echoes,
  restates and clarifies.

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Active Listening Characteristics

• Active listening entails
• Paraphrasing uses the words of the client to
  summarize the conversation
• Clarifying encouraging the client to say more by
  asking leading questions
• Reflecting feelings mirrors the feelings of the
  client

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The Results of Good Humanistic Therapy

• Rogers thought if clients are treated with
  unconditional positive regard, empathy,
  genuineness, the client will explore their
  feelings thoughts.
• Exploring their thoughts feelings in an
  accepting environment will lead the client to
  change their attitudes behavior.
• This approach very successful in dealing with
  mild depression and anxiety but not very
  successful in treating psychotic patients like
  those with severe schizophrenia.

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Behavior Therapies
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Behavior Therapy

• Behavioristic perspective emphasizes that
  behavior (normal and abnormal) is learned
• Applies classical and operant conditioning to the
  elimination of unwanted behaviors
• Primary concern is to eliminate the disorders
  behavior, not find the cause of the disorder
• Often called behavior modification

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Behavior TherapiesClassical Conditioning
Techniques
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Mary Cover Jones The First Behavior Therapist

• Demonstrated that conditioning could be used to
  remove fears.
• Treated three-year-old Peters fear of rabbits,
  using counterconditioning
• Involves modifying behavior by conditioning a new
  response that is incompatible with a previously
  learned response (paired rabbit with a cookie)
• Rabbit Cookie Happy/Not Scared
• Rabbit Happy/Not Scared

UCS
CS
UCR
CS
CR
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Systematic Desensitization Process

• Establish a hierarchy of the anxiety- triggering
  stimuli
• Learning relaxation methods (progressive
  relaxation)
• Slowly think through the hierarchy from least
  anxiety-provoking to most anxiety-provoking ,
  working to relax whenever anxiety is felt
• Once you can maintain complete relaxation, you
  move on to the next scene, and so on

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Sample Anxiety Hierarchy
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Flooding

• Method of extinction usually used to rid a
  patient of phobias (Exposure Therapy)
• The patient is inundated with repeated exposures
  to what they fear until they realize they can
  remain calm in the presence of the feared object.
  (view video of this process for phobias 2 min)

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Aversive Conditioning

• A type of counterconditioning that associates an
  unpleasant state (such as nausea) with an
  unwanted behavior
• The person is replacing a positive but harmful
  response with a negative response
• Example with alcoholism Lace a drink with a drug
  that makes the person becomes sick
• Aversive conditioning is not very effective, and
  its use has declined in recent years.

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Aversion Therapy for Alcoholism

• Relatively ineffective, does not generalize very
  well beyond therapy
• Pairs and aversive stimulus with the undesired
  behavior

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Behavior Therapies Operant Conditioning
Techniques
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Operant Conditioning

• Behavior therapists have developed a variety of
  techniques based on B. F. Skinners operant
  conditioning model of learning
• Shaping involves reinforcing successive
  approximations of a desired behavior
• Positive reinforcement is used to increase the
  incidence of desired behaviors
• Extinction, or nonreinforcement, is used to
  reduce the occurrence of undesired behaviors

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Token Economy

• An operant conditioning procedure that attempts
  to modify behavior by giving tokens (rewards) for
  desired behavior.
• The tokens can be exchanged for various
  privileges or treats
• Use for behavior modification in group settings
  (prisons, classrooms, hospitals)
• Form of secondary reinforcement
• Proven to be especially effective in the
  outpatient treatment of substance abuse and
  dependence and with severely disturbed people

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Successive Approximations

• Series of behaviors that gradually become more
  similar to a target behavior.
• Each time the behavior is closer to the desired
  behavior it gets rewarded.
• Good for learning proper social behaviors.

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Evaluating Behavior Therapy

• Effective short-term therapy for well-defined
  problems like phobias, PTSD and compulsions.
• Also effective with addictions and helping those
  living in institutions.
• Not as effective with schizophrenics and
  depressed patients.

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Cognitive Therapies
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Cognitive Therapy

• Based on the idea that people have irrational
  beliefs, thoughts and attitudes that distort
  their behaviors
• Thoughts intervene between events and our
  emotional reactions
• Therapy focuses on recognition and alteration of
  unhealthy thinking patterns
• Teaches people new, more adaptive ways of
  thinking and acting

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Self-Serving Bias

• Tendency to judge oneself favorably
• Severely depressed patients tend to not have a
  self-serving bias and tend to blame themselves
  for problems and credit the environment for
  successes

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Rational Emotive Therapy

• Developed by Albert Ellis
• Peoples difficulties are caused by their faulty
  expectations and irrational beliefs
• ABC model
• Activating Event
• Beliefs
• Consequences

• When an Activating event (A) occurs, it is the
  persons Beliefs (B) about the event that cause
  emotional Consequences (C)
• Goal of therapy is identification and elimination
  of core irrational beliefs
• Effective in the treatment of depression, social
  phobia, and certain anxiety disorders, and in
  helping people overcome self-defeating behaviors

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How RET Works

• Step 1 Identify the core irrational beliefs or
  self talk that underlie personal distress
• Step 2 Vigorously dispute and challenge the
  irrational beliefs. Therapist acts as a teacher
  to show patient how to do this.
• Rational-emotive therapists tend to be very
  direct and even confrontational
• From the clients perspective, rational-emotive
  therapy requires considerable effort
• person must admit her irrational beliefs and
  accept the fact that those beliefs are irrational
  and unhealthy
• client must radically change her way of
  interpreting and responding to stressful events

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Aaron Becks Cognitive Therapy

• Based on the assumption that thoughts, moods, and
  behaviors are interrelated
• Beck believes that depression and other
  psychological problems are caused by illogical
  thoughts
• Schemas methods for organizing the way we view
  the world have evolved into a distorted
  perception
• Focuses on changing the clients unrealistic
  thoughts
• Therapist acts as model and aims for a
  collaborative therapeutic climate
• Therapy includes homework of writing down
  automatic thoughts or habits

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Cognitive Therapy How it Works

• CT therapist encourages the client to empirically
  test the accuracy of his or her assumptions
• The client learns to recognize and monitor the
  automatic thoughts that occur without conscious
  effort or control
• The client learns how to empirically test the
  reality of the automatic thoughts that are so
  upsetting
• CT is very effective in treating depression,
  anxiety disorders, eating disorders, PTSD, and
  relationship problems. It may also help prevent
  depression from recurring

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Whats the Difference Between Ellis RET
Becks Cognitive Therapy?

• Ellis says faulty assumptions or beliefs to blame
• Beck says illogical thought processes to blame
• RET therapists logically debate and vigorously
  challenge or dispute the irrationality of a
  clients beliefs
• Ellis Cognitive Therapy gently guides clients to
  observe and record their thoughts in response to
  everyday life. Later therapist helps them sort
  out the illogical thought processes.

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Cognitive Behavioral Therapy

• An integrated therapy that combines cognitive
  therapy (changing self-defeating thinking) with
  behavior therapy (changing inappropriate
  behaviors)
• Based on the assumption that cognitions,
  behaviors, and emotional responses are
  interrelated
• Cognitive-behavioral therapists challenge
  maladaptive beliefs and substitute more adaptive
  cognitions
• They use behavior modification, shaping,
  reinforcement, and modeling to teach problem
  solving and change unhealthy behavior patterns

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Prevalence of Cognitive Therapy
Half of all faculty in accredited clinical
psychology doctoral programs now align themselves
with a cognitive or cognitive-behavior therapy
orientation. (Data from Mayne others, 1994.
Note Some faculty identify with more than one
perspective.)
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Family and Group Therapies
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Group and Family Therapy

• Group therapyone or more therapists working with
  several people at the same time.
• Family therapybased on the assumption that the
  family is a system and treats the family as a
  unit.

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Group Therapy

• Having a therapist work with a number of patients
  at one time
• Groups usually consist of 6 to 10 people
• Cognitive, behavior, and humanistic therapists
  all can lead group therapies.

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Advantage of Group Therapy

• Therapists can help more than one person at a
  time.
• Overall session cost is lower.
• Patients interact with others having the same
  problems as they have.
• Builds a sense of community

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Self-help groups Helping yourself by helping
others

• Self-help groups and support groups are typically
  organized and led by nonprofessionals
• The groups are either free or charge nominal fees
  to cover the cost of materials.
• Typically, members have a common problem and meet
  for the purpose of exchanging support
• The format of such groups varies enormously, but
  many follow a 12-step approach
• Self-help groups can be as effective as therapy
• More research is needed on why self-help groups
  are effective and on the kinds of people and
  problems that are most likely to benefit from
  them

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Family Therapy

• Therapy that treats the family as a system
• Views the patients problems as influenced by or
  directed at family members
• Every family has certain unspoken rules of
  interaction and communication.
• As such, issues are explored, and unhealthy
  patterns of family interaction can be identified
  and replaced with new rules that promote the
  psychological health of the family
• Attempts to guide the family toward positive
  relationships and improved communication

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Evaluating Psychotherapys Effectiveness
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Are Psychotherapies Effective?

• Most people do not seek help with problems
• Spontaneous Remission - Some people improve with
  nothing more than the passage of time
• Meta-analysis used to combine and interpret the
  results of large numbers of studies has found
• On average, the person who completes treatment is
  better off than about 80 percent of those in the
  untreated control group.
• Benefits are usually apparent in a relatively
  short period of time
• Gains that people make tend to endure
• Brain-imaging technologies show that
  psychotherapy alone produces distinct
  physiological changes in the brain that are
  associated with a reduction in symptoms

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Studies on Psychotherapy

• Studies researching the effectiveness of
  psychotherapy have found
• Clients believe therapy is effective.
• Clinicians believe therapy is effective.
• Researchers are still debating psychotherapys
  effectiveness.
• The more clear cut the problem, the more
  effective the therapy is.
• No one therapy is absolutely more effective than
  the others.

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Factors in Successful Therapy

• Therapeutic relationshipcaring and mutually
  respectful
• Therapist characteristicscaring attitude,
  ability to listen, sensitive
• Client characteristicsmotivated, actively
  involved, emotionally and socially mature
• External circumstancesa stable living situation
  and supportive family members

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The rates of improvement for more than 2,000
people in weekly psychotherapy and for 500 people
who did not receive psychotherapy. Clearly,
psychotherapy accelerates both the rate and the
degree of improvement for those experiencing
psychological problems. SOURCE McNeilly
Howard, 1991.
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Expectation Effect

• Person feels better after therapy because they
  thought or expected to become better