Chapter 14: Therapies

1. Chapter 14: Therapies

2. What Is Psychotherapy? • -- *Any psychological technique used to facilitate positive changes in personality, behavior, or adjustment

3. Types of Psychotherapy • -- *Individual: Involves only one client and one therapist • Client: Patient; the one who participates in psychotherapy • Rogers used “client” to equalize therapist-client relationship and de-emphasize doctor-patient concept • -- *Group: Several clients participate at the same time

4. More Types of Psychotherapy • Insight: Goal is for clients to gain deeper understanding of their thoughts, emotions, and behaviors • -- *Directive: Therapist provides strong guidance (vs. *non-directive) • Time-Limited: Any therapy that limits number of sessions • Partial response to managed care and to ever-increasing caseloads • Caseload: Number of clients a therapist actively sees

5. Key Features of Psychotherapy • Therapeutic Alliance: Caring relationship between the client and therapist • Therapy offers a protected setting where emotional catharsis (release) can occur • All the therapies offer some explanation or rationale for the client’s suffering • Provides clients with a new perspective about themselves or their situations and a chance to practice new behaviors

6. Origins of Therapy • *Trepanning: • Patient unlikely to survive • To relieve pressure or rid the person of evil spirits

7. People in Therapy • -- *Phillippe Pinel: French physician who initiated humane treatment of mental patients in 1793 • Created the first mental hospital • Freud: • Hysteria (--somatoform disorders) • caused by deeply hidden unconscious conflicts • Goal of Psychoanalysis: To resolve internal conflicts that lead to emotional suffering

8. Freudian techniques (Psychodynamic/psychoanalysis) • -- *Free Association: saying whatever comes to mind, regardless of how embarrassing it is. • Allows unconscious material to emerge • -- *Dream Analysis: • *Latent content • *Manifest content • Symbols • Directive • Brief psychodynamic therapy: designed to produce insights more quickly; uses direct questioning to reveal unconscious conflicts

9. Humanistic Therapies • -- *Client-Centered Therapy (Carl Rogers) --Nondirective and based on insights from conscious thoughts and feelings; accept one’s true self (optimistic!) • *Unconditional Positive Regard: Unshakable acceptance of another person. • Empathy: Ability to feel what another person is feeling • Authenticity: Therapist is genuine and honest about his or her feelings • Reflection: Rephrasing or repeating thoughts and feelings of the clients

10. Cybertherapy and Psychotherapy at a Distance • -- *Media Psychologists: Radio, • newspaper, and television • psychologists; give advice, • information, and social support, e.g., Dr. Phil (OK), Dr. Laura (bad) • Telephone Therapists: 900 number therapists • May be nothing more than telephone operators who have never even taken a psychology course! (True in practice, too.)

11. Cybertherapy and Psychotherapy at a Distance Concluded (Continued) • Cybertherapy: Internet therapists in chat rooms. • Patient/client can remain anonymous • Good if client can not drive a distance to a therapist or cannot leave the house (agoraphobic) • Cheaper than traditional psychotherapy

12. Behavior Therapy • Use of learning principles to make constructive changes in behavior • -- *Behavior Modification: Using any classical or operant conditioning principles to directly change human behavior • Deep insight is often not necessary • Focus on the present; cannot change the past, and no reason to alter that which has yet to occur • Positive/negative Reinforcement and punishment

13. Behavior Therapy (Continued) • Conditioned Aversion: Learned dislike or negative emotional response to a stimulus • -- *Aversion Therapy • Associate a strong aversion to an undesirable habit like smoking, overeating, drinking alcohol, or gambling • E.g., Rapid Smoking: Prolonged smoking at a forced pace • Designed to cause aversion to smoking • Response-Contingent Consequences • Reinforcement, punishment, or other consequences that are applied only when a certain response is made

14. Behavioral Therapies (Continued) • -- *Systematic Desensitization • Hierarchy: Rank-ordered series of steps, amounts, levels, or degrees • Uses reciprocal Inhibition: One emotional state is used to block another (e.g., impossible to be anxious and relaxed at the same time)

15. Operant Therapies • *Operant Conditioning: Learning based on consequences of making a response • -- *Shaping: Rewarding actions that are closer and closer approximations to a desired response • Stimulus Control: Controlling responses in the situation in which they occur • Time Out: Removing individual from a situation in which reinforcement occurs

16. Tokens • Tokens: Symbolic rewards like poker chips or gold stars that can be exchanged for real rewards • Can be used to immediately reinforce positive responses • Effective in psychiatric hospitals and sheltered care facilities • Target Behaviors: Actions or other behaviors a therapist seeks to change

17. Token Economy • Patients get tokens for many socially desirable or productive behaviors; they can exchange tokens for tangible rewards and must pay tokens for undesirable behaviors

18. Cognitive Therapy • -- Therapy that helps clients change thinking patterns that lead to problematic behaviors or emotions

19. Cognitive Therapy • Therapy that helps clients change thinking patterns that lead to problematic behaviors or emotions • Beck: Three Major Distortions in Thinking: • Selective Perception: Perceiving only certain stimuli in a larger array of possibilities • Overgeneralization: Blowing a single event out of proportion by extending it to a large number of unrelated situations • All-or-Nothing Thinking: Seeing objects and events as absolutely right or wrong, good or bad, and so on

20. Rational Emotive Behavior Therapy (REBT) • Attempts to change irrational beliefs that cause emotional problems • Theory created by Albert Ellis • For example, Anya thinks, “I must be liked by everyone; if not, I’m a rotten person.”

21. Group Therapy • Psychodrama (Moreno): Clients actout personal conflicts and feelings with others who play supporting roles • Role Playing: Re-enacting significant life events • Role Reversal: Taking the part of another person to learn how he or she feels • Mirror Technique: Client observes another person re-enacting the client’s behavior

22. Family Therapy • Family Therapy: All family members work as a group to resolve the problems of each family member • Tends to be brief and focuses on specific problems (e.g., specific fights) • Modality views problems experienced by one family member are the entire family’s problem

23. Group Awareness Training • Sensitivity Groups: Group experience consisting of exercises designed to increase self-awareness and sensitivity to others • Encounter Groups: Emphasize honest expression of feelings • Large-Group Awareness Training: Increases self-awareness and facilitates constructive personal change • -- Therapy Placebo Effect: Improvement is based on client’s belief that therapy will help

24. Basic Counseling Skills • Active listening • Clarify the problem • Focus on feelings • Avoid giving advice • Accept the client’s frame of reference • Reflect thoughts and feelings • Silence: Know when to use • Questions • Open: Open-ended reply • Closed: Can be answered “Yes” or “No” • Maintain confidentiality

25. Table 14.3

26. *Medical (Somatic) Therapies • Pharmacotherapy: Use of drugs to alleviate emotional disturbance; three classes: • Anxiolytics (Antianxiety): Like Valium; produce relaxation or reduce anxiety • Antidepressants: Elevate mood and combat depression • Antipsychotics (Major Tranquilizers): Tranquilize and also reduce hallucinations and delusions in larger dosages

27. Problems with Drug Therapy • *Clozaril (clozapine): Relieves schizophrenic symptoms; however, two out of one hundred patients may suffer from a potentially fatal white blood cell disease

28. Electroconvulsive Therapy • -- *Electroconvulsive Therapy (ECT): Electric shock is passed through the brain inducing a convulsion; treatment for severe depression • Based on belief that seizure alleviates depression by altering brain chemistry • Produces only temporary improvement • Causes permanent memory loss in some patients • Should only be used as a last resort • Should be followed by antidepressant medications to further prevent relapse

29. *Psychosurgery • Any surgical alteration of the brain • Prefrontal Lobotomy: Frontal lobes in brain are surgically cut from other brain areas • Supposed to calm people who did not respond to other forms of treatment • Was not very successful • Deep Lesioning: Small target areas in the brain are destroyed by using an electrode

30. Hospitalization • Mental Hospitalization: Involves placing a person in a protected, therapeutic environment staffed by mental health professionals • Partial Hospitalization: Patients spend only part of their time in the hospital and go home at night • Deinstitutionalization: Reduced use of full-time commitment to mental institutions

31. Half-Way Houses • Short-term group living facilities for individuals making the transition from an institution (mental hospital, prison, etc.) to independent living

32. Community Mental Health Centers • Offer many health services like prevention, education, therapy, and crisis intervention • Crisis Intervention: Skilled management of a psychological emergency • Paraprofessional: Individual who works in a near-professional capacity under supervision of a more highly trained person

33. Other Therapy Options • Peer Counselor: Nonprofessional person who has learned basic counseling skills • Self-Help Group: Group of people who share a particular type of problem and provide mutual support to each other (e.g., “Alcoholics Anonymous”)

34. Evaluating a Therapist: Danger Signals • Therapist makes sexual advances • Therapist makes repeated verbal threats or is physically aggressive • Therapist is excessively hostile, controlling, blaming, or belittling • Therapist talks repeatedly about his/her own problems • Therapist encourages prolonged dependence on him/her • Therapist demands absolute trust or tells client not to discuss therapy with anyone else

35. Evaluating a Therapist: Questions to be Answered During the Initial Meeting • Will the information I reveal in therapy remain confidential? • What risks do I face if I begin therapy? • How long do you expect treatment to last? • What form of treatment do you expect to use? • Are there alternatives to therapy that might help as much or more?