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Explore the historical origins and key techniques of psychotherapy, including psychoanalysis and client-centered therapy.
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True or False: • Psychotherapy includes lying on a couch and discussing how you feel about your parents sexually. • Behavior therapy includes a heavy emphasis on the past and how to affect your behavior in the future. • Therapy placebo affect is when improvement is caused by the expectation that therapy will help, not by any specific intervention. • Pharmacotherapy is the use of drugs to alleviate the symptoms of emotional disturbance • A community mental health center is a facility offering a wide range of mental health services, such as prevention counseling, crisis intervention Quiz
What is Psychotherapy? • Any psychological technique used to facilitate positive changes in an individual’s personality, behavior, or adjustment • Can include individual or group therapy
The dose-improvement relationship in psychotherapy. This graph shows the percentage of patients who improved after varying numbers of therapy sessions. Notice that the most rapid improvement took place during the first 6 months of once-a-week sessions. Fig. 17-6, p. 588
Origins of Therapy Trepanning: For primitive “therapists,” refers to boring, chipping, or bashing holes into a patient’s head; for modern usage, refers to any surgical procedure in which a hole is bored into the skull • Goal presumably to relieve pressure or rid the person of evil spirits Demonology • Study of demons and people beset by spirits • People were possessed, and they needed an exorcism to be cured • Exorcism: Practice of driving off an “evil spirit”; still practiced today!
Primitive “treatment” for mental disorders sometimes took the form of boring a hole in the skull. This example shows signs of healing, which means the patient survived the treatment. Many didn’t. Fig. 17-1, p. 571
Origins of Therapy Continued • Ergotism: Psychotic-like symptoms that come from ergot poisoning, a common fungus in Rye fields • Ergot is a natural source of LSD • Philippe Pinel: French physician who initiated humane treatment of mental patients in 1793 • Created the first humane mental hospital by unchaining clients
Psychoanalysis: Freud • Hysteria: Physical symptoms (like paralysis or numbness) occur without physiological causes • Now known as somatoform disorders • Freud became convinced that hysterias were caused by deeply hidden unconscious conflicts • Main Goal of Psychoanalysis: To reduce internal conflicts that lead to emotional suffering
Some Key Techniques of Psychoanalysis • Free Association: Saying whatever comes to mind, regardless of how embarrassing or unimportant it may seem • By doing so without censorship and censure, unconscious material can emerge
Psychoanalysis and Freud Concluded • Resistance: Blockage in flow of ideas; topics the client resists thinking about or discussing • Resistances reveal particularly important unconscious conflicts • Transference: Tendency to transfer feelings to a therapist that match those the patient has for important people in his or her past • The patient might act like the therapist is a rejecting father, loving mother, etc.
Waiting-List Control Group • People who receive no therapy as a way to test the effectiveness of psychotherapy • Compare control with experimental group; if no statistically significant difference, then something other than therapy caused change or no change in conditions
Psychotherapist Carl Rogers, who originated client-centered therapy. Everything previous was unconscious, Rogers found it more beneficial to focus on the conscious p. 574
Four Aspects: • Unconditional Positive Regard: Unshakable acceptance of another person, regardless of what they tell the therapist or how they feel • Empathy: Ability to feel what another person is feeling; capacity to take another person’s point of view • Authenticity: Ability of a therapist to be genuine and honest about his or her feelings • Reflection: Rephrasing or repeating thoughts and feelings of the clients’; helps clients become aware of what they are saying
Existential Therapy • An insight therapy that focuses on problems of existence, such as meaning, choice, death, and responsibility; emphasizes making difficult choices in life • Free Will: Human ability to make choices • You can choose to be the person you want to be • Logotherapy: Emphasizes need to find and maintain meaning in one’s life • Confrontation: Clients are challenged to examine their values and choices
Gestalt Therapy • Focuses on immediate experience and awareness to help clients rebuild thinking, feeling, and acting into connected wholes • Emphasizes integration of fragmented experiences (filling in the gaps) • Clients are taught to accept responsibility for their thoughts and actions • More directive than client-centered or existential therapy • Example: • http://www.youtube.com/watch?v=ZbOAdMdMLdI
Cybertherapy and Psychotherapy at a Distance: Dr. Phil, Among Others • Media Psychologists: Radio, newspaper, and television psychologists; often give advice, information, and social support • Most helpful when referrals and information are given • Telephone Therapists: 900 number therapists • Caution: Many “therapists” may be nothing more than telephone operators who have never even taken a psychology course!
Media psychologists have been urged to educate without actually doing therapy on the air. Some overstep this boundary, however. Do you think popular TV psychologist Dr. Phil sometimes goes too far? p. 576
Cybertherapy and Psychotherapy at a Distance Concluded • Cybertherapy: Internet therapists in chat rooms and so on • Videocameras at both ends so now you can hear AND see therapist • Patient/client can remain anonymous • May be wave of future for those who cannot drive a distance to a therapist or cannot leave the house (e.g., Paula can’t leave the house because of agoraphobia, so Robert the therapist comes to her via Internet!) • Cheaper than traditional psychotherapy
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 http://www.youtube.com/watch?v=MCyfMFXR-n0
Aversion Therapy • 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 • Example: anabuse, putting something foul tasting on nails or couches, forcing someone to smoke a whole pack • Rubber bands • Anyone here used any of these?
Systematic Desensitization • Guided reduction in fear, anxiety, or aversion; attained by approaching a feared stimulus gradually while maintaining relaxation • Best used to treat phobias: intense, unrealistic fears • “I’m with Busy”
A virtual reality system is used to expose people to feared stimuli. Many patients would rather face feared stimuli in a virtual environment than in a real physical environment. Fig. 17-3a, p. 581
Operant Therapies • Eye Movement Desensitization and Reprocessing (EMDR): Reduces fear and anxiety by holding upsetting thoughts in your mind while rapidly moving your eyes from side to side • Further research needed
Aspects of Behavior Modification • Operant conditioning: Learning based on consequences of making a response • Positive Reinforcement: Responses that are followed by a reward tend to occur more frequently • Punishment: If a response is followed by discomfort or an undesirable effect, the response will decrease/be suppressed (but not necessarily extinguished) • Example: How do you train a dog? • How do you “train” a child?
How far can we go with controlling behavior? • As various therapies are tried, modified, and developed, the possibility of controlling maladaptive behavior increases. It is possible to foresee a time when such techniques will be perfected to the point where behavioral change, and therefore, behavioral control, will be much easier to accomplish and more certain.
Reinforcement and Token Economies • Tokens: Symbolic rewards like poker chips or gold stars that can be exchanged for real rewards • Can be used to reinforce positive responses immediately • Effective in psychiatric hospitals and sheltered care facilities • Target Behaviors: Actions or other behaviors a therapist seeks to change
Psychodrama (Moreno) • Clients act out 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
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
Medical Therapies • Pharmacotherapy: Use of drugs to alleviate emotional disturbance • Anti-depressants: Elevate mood and combat depression • Prozac (fluoxetine) and Zoloft (sertraline) are two types • Anxiolytics: Produce relaxation or reduce anxiety • Valium (diazepam) is one type • Antipsychotics: Tranquilize and also reduce hallucinations and delusions in larger dosages • Haldol (haloperidol) and Thorazine (chlorpromazine) are two types • What are the problems with these?
Shock • Electroconvulsive Therapy (ECT): Electric shock is passed through the brain inducing a convulsion • Based on belief that seizure alleviates depression by altering brain chemistry and hormonal balance
Psychosurgery • Any surgical alteration of the brain designed to bring about desired behavioral or emotional changes • 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
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”) • All societies find some mechanism for facilitating change in others. Compare and contrast the therapeutic role of witch-doctors, folk-medicine practitioners, and religious leaders. What might all these have in common that would help at least some people feel better?
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
More Danger Signals • 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
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? • Do you see a therapist?
Things Left Unsaid • Ask students to turn to the person next to them and share "things left unsaid" to someone they care about. If they could talk to anyone in the world to add closure to the relationship, who would they call? What would they say?
How much do you trust someone? • Randomly pair students and instruct them to walk to some point on campus. On the way to the chosen point, one student should be blindfolded while being guided by the second. On the way back, they should reverse roles.
Behavior Change • In groups of three: work on a plan to change a behavior. Each of the three should have a behavior to change. The group can work on each one. There is an advantage to a group rather than an individual working on the problem, because it is more likely to get done if the group works on it. It also gives support to each individual in the planning and executing of the change.
A friend in Need • Handout
Insight vs Behaviorism • Two teams of students prepare a debate reflecting the opposing viewpoints of insight therapists and behavior therapists. Which should be used or under what circumstances, should these techniques be used in schools, the military, prisons, programs for the mentally disabled, mental hospitals, and other institutional settings.
