Psychotherapies

1
Psychotherapies
2
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

3
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.

4
Four Types of Psychotherapy

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

5
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

6
Psychoanalysis
7
Psychoanalysis

• Developed by Sigmund Freud based on his theory of
  personality

Freuds Office
8
Psychoanalysis

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

9
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.

10
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

11
Psychoanalytic Methods
12
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

13
Resistance

• Unconscious attempts to block the revelation of
  repressed memories and conflicts.

14
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

15
Transference

• Patients transfer to the analyst of emotions
  linked with other relationships
• The patient projects feeling from the past to the
  therapist.

16
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

17
Psychoanalytic Influence

• Few therapists follow strict Freudian therapy.
• Heavily influenced other types of therapy
  (interpersonal therapy)
• Modern approach is the psychodynamic perspective

18
The Psychodynamic Perspective
19
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

20
Common Features of Short-Term Dynamic Therapies

• Most therapies today are shorter-term
• Patients problems are quickly assessed at the
  beginning of therapy.
• Based on goals that are specific and attainable
• Therapists are more directive than traditional
  psychoanalysis
• Therapist uses interpretations to help the
  patient recognize hidden feelings and
  transferences that may be occurring in important
  relationships in her life
• Therapy focuses on helping the patient identify
  psychological resources that she can use to cope
  with the current difficulty as well as with
  future problems

21
Interpersonal Therapy (IPT)

• Influential short-term psychodynamic therapy,
  focuses on current relationships and social
  interactions and is highly structured
• 4 categories of personal problems
• unresolved grief
• role disputes
• role transitions
• interpersonal deficits
• 1st phase of treatment, the therapist identifies
  the interpersonal problem that is causing
  difficulties
• Next phase, the therapist helps the person
  understand his or her particular interpersonal
  problem and develop strategies to resolve it

22
Humanistic Therapies
23
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

24
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

25
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

26
Therapeutic Conditions

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

27
Active Listening

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

28
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

29
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 with dealing with
  clients day-to-day concerns but not very
  successful in treating psychotic patients like
  those with severe schizophrenia.

30
(No Transcript)
31
Gestalt Therapy

• A type of Humanistic Therapy
• Developed by Fritz Perls
• Believed that people create their own
  understanding of the world and continue to grow
  as long as they have insight into their feelings.
• More directive and confrontational than
  client-centered therapy.
• Therapist tries to help clients identify
  inconsistencies between the statements they make
  about how they see the themselves how they
  really interact with the world.

32
Boundaries to the TherapistClient Relationship
33
TherapistClient Relationship

• Therapy is a collaborative effort between you and
  the therapist.
• Dont expect your therapist to make decisions for
  you
• Your therapist is not a substitute friend
• Therapeutic intimacy does not include sexual
  intimacy it is never ethical or appropriate for
  a therapist to have any form of sexual contact
  with a client
• Expect therapy to challenge how you think and act
  
• Dont confuse insight with change
• Dont confuse catharsis with change
• Dont expect change to happen overnight

34
Behavior Therapies
35
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

36
Behavior TherapiesClassical Conditioning
Techniques
37
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
• Jones also used social imitation, or
  observational learning, techniques

38
Systematic Desensitization

• Developed by Joseph Wolpe
• Based on counter conditioning
• Usually used to treat phobias
• phobic responses are reduced by pairing
  relaxation with a series of mental images or
  real-life situations that the person finds
  progressively more fear-provoking
• Uses three steps
• Progressive relaxation
• Development of anxiety hierarchy and control
  scene
• Combination of progressive relaxation with
  anxiety hierarchy

39
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

40
Sample Anxiety Hierarchy
41
Systematic Desensitization
42
Systematic Desensitization Variations

• Virtual reality--systematic desensitization by
  way of computerized, anxiety-triggering 3-D
  stimuli
• Combined with models by having the subjects watch
  someone perform the anxiety-causing behavior
• Just as effective as graduated exposure to the
  actual feared objects or situations

43
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)

44
Virtual Systematic Desensitization

• Play Virtual Fear (757) Segment 30 from
  Scientific American Frontiers Video Collection
  for Introductory Psychology (2nd edition).

45
Arachnophobia and Virtual Reality

• Play Arachnophobia (931) Segment 31 from
  Scientific American Frontiers Video Collection
  for Introductory Psychology (2nd edition).

46
Bell Pad Treatment for Bed Wetting

• Conditioning arousal from sleep in response to
  bodily signals of a full bladder.
• Pair an alarm (US) that will awaken child (UR).
• When moisture hits pad (bladder tension NS) the
  Alarm sounds (US) waking the child (UR).
• Eventually bladder tension (CR) causes the child
  to awaken (CR).
• It is effective in about 75 percent of school-age
  children who have difficulties with bedwetting.

47
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.

48
Aversion Therapy for Alcoholism

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

49
Behavior Therapies Operant Conditioning
Techniques
50
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

51
Token Economy

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

52
(No Transcript)
53
Cognitive Therapies
54
Cognitive Therapy

• Based on the assumption that psychological
  problems are due to maladaptive patterns of
  thinking
• 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

55
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

56
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 expose and confront the
  persons core irrational beliefs
• Effective in the treatment of depression, social
  phobia, and certain anxiety disorders, and in
  helping people overcome self-defeating behaviors

57
(No Transcript)
58
(No Transcript)
59
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

60
RET AN EXAMPLE

• PROBLEM Social Phobic concerned they will be
  publicly embarrassed when giving a class
  presentation.
• SOLUTION Therapist questions the likelihood of
  such embarrassment occurring and impact of it.
• Therapists goal is to show the client that not
  only is their failure unlikely, but even if it
  did happen, it would not be a big deal.

61
RET Therapy

• A Activating Events
• B Irrational Beliefs
• C Inappropriate Consequences
• D Disputing these Beliefs
• E Effects of disputing Rational beliefs,
  appropriate feelings, desirable behaviors.

62
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 distorted
  thinking and unrealistic beliefs
• Schemas methods for organizing the way we view
  the world have evolved into a distorted
  perception
• Focuses on changing the clients unrealistic
  beliefs
• Therapist acts as model and aims for a
  collaborative therapeutic climate
• Therapy includes homework of writing down
  automatic thoughts or habits

63
(No Transcript)
64
Cognitive Therapy How it Works

• CT therapist encourages the client to empirically
  test the accuracy of his or her assumptions and
  beliefs
• 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

65
Whats the Difference Between Ellis RET
Becks Cognitive Therapy?

• RET therapists logically debate and vigorously
  challenge or dispute the irrationality of a
  clients beliefs
• Becks Cognitive Therapy give the client
  homework to empirically test the accuracy of
  his or her assumptions and beliefs.

66
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

67
(No Transcript)
68
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.)
69
Family and Group Therapies
70
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.
• Couple therapyrelationship therapy that helps
  with difficulty in marriage or other committed
  relationships

71
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.

72
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

73
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

74
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

75
Evaluating Psychotherapys Effectiveness
76
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

77
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.

78
Evaluating Therapies

• Play Empirically Validated Therapies (329)
  Segment 41 from Psychology The Human
  Experience.

79
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

80
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.
81
Are Alternative Therapies Effective?
82
Eye movement desensitization reprocessing (EMDR)

• Treatment technique in which patients suffering
  from traumatic memories visually follow her
  waving finger while simultaneously holding a
  mental image of disturbing memories, events, or
  situations
• EMDR is more effective than no treatment at all
• EMDR is no more effective than exposure therapy
  and other standard treatments for anxiety
  disorders
• Several research studies have found no difference
  in outcome between treatments that incorporated
  eye movements and sham EMDR

83
Therapeutic Touch Therapy

• Therapists move their hands above the persons
  body to push energy fields into balance.
• No evidence has been found to support the
  effectiveness of this therapy

84
Light Exposure Therapy

• Therapy for Seasonal Affective Disorder by
  exposing the patient to artificial light
  mimicking that of the sun
• Research supports a connection between exposure
  to light and melatonin levels in the blood, which
  affects levels of alertness

85
Expectation Effect

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