Psychotherapies

1. Psychotherapies • Treatment of mental illness by psychological rather than medical means.

2. Types of Psychotherapies • Psychoanalytic • Humanistic • Behavioral • Cognitive

3. Types of Therapists • Psychiatrists • Medical doctor + PhD / prescribe medication • Clinical psychologists • PH.D. • Counseling psychologist • Graduate degree

4. Psychotherapy Points to Consider • “Patient”: Biomedical / psychoanalytical • “Client”: Other therapists • Insight Therapy: Psychoanalytic and Humanistic • Stress importance of patient / client understanding their problems

5. Psychoanalytic Therapy • Psychoanalysis: Freud • Psychodynamic: Uncovering the unconscious

6. Psychoanalysis • Review of Key Principles • Unconscious conflict manifests in outward behavior, thoughts • Find underlying (unconscious) problem • Methods • Hypnosis, free association, dream analysis • Dream Analysis: Manifest and Latent Content • “only true solution”- symptom substitution • other therapies mask it- thus conflict expresses itself in new form • Subjective: based on interpretation

7. Psychoanalysis • Therapy Principles • Resistance • Patient objections, natural as uncovering disturbing conflicts (resistance as sign of nearing the conflict) • Transference • Patients develop strong feelings for therapist (love, parental feelings, or hatred / transferred from feelings toward others to therapist)

8. Psychoanalysis Points of interest • Patient attends treatment 4-5 x a week • Analysts looks for & records repetitions of behavior (unconscious) • Therapist says little (then interprets at the end of session) • Dream Analysis (often uses free association to analyze parts of a dream) • Weaknesses • Not sanctioned by state or federal government • Expensive / not covered by insurance • Only 20 psychoanalytic schools in U.S.

9. Humanistic Therapies • Review of Key Principles: • Maslow, Rogers • Focus on self-concept (understanding self) • Self-Actualization: help support, recognize goals = self-fulfillment • Free will (as opposed to determinism) • Man’s nature as good

10. Carl Rogers (Humanistic) • Client-centered therapy (aka person-centered: (genuineness, acceptance, empathy) • Unconditional Positive Regard • Essential for healthy development • Non-directive • Don’t tell clients what to do, but encourage them to choose course of action for themselves • Therapist says little… • Active listening: “So what I’m hearing you say is….”

11. Gestalt (Humanistic) • Fritz Perls • “Whole is greater than sum of its parts” • Get in touch with “whole self” • Integrate thoughts, actions, feelings, talents, goals, body into harmonious whole • Body as extension of self • Healing a fragmented patient

12. Behavioral Therapy • Review of Key Principles • Pavlov, Watson, Skinner • Classical / Operant • “All behavior is learned” • Behavioral Modification, (or changing maladaptive actions)

13. Behavioral Therapy • Counterconditioning / Mary Cover Jones • Classical conditioning • Negative CR (Conditioned response) is replaced by positive CR • Example: Joey cries hysterically every time he goes to the dentist. • Candy / toy upon entering dentists = positive CR

14. Behavioral Therapy • Counterconditioning • Joseph Wolpe / Systematic Desensitization • Replace anxiety with relaxation • Step one: relaxation techniques (breathing / meditation) • Step two: anxiety hierarchy: rank ordered list of fear (least to most) • Start with least- incremental move up the ladder- learning to relax at each step • Classical / counterconditioning: more x relaxation paired with fear, stronger relaxation response becomes • Feared stimulus is imagined • Implosive Therapy: Imagine biggest fear first

15. Behavioral Therapy • In vivo desensitization • Confronting actual fear (not just imagining it) • Flooding: experiencing one’s peak fear • Idea is to realize irrationality of fear (huge anxiety factor) • Aversive conditioning • Pairing undesired behavior with unpleasant stimulus (Baby Albert) • Instrumental Conditioning: Token economies • Modeling: observation and imitation (Role play)

16. Cognitive Therapy(aka cognitive-behavior therapy) • Most widely practiced therapy • Core assumption: Conscious thoughts are most influential to our psychological well-being • Changing unhealthy thought patterns • Combative nature: challenge irrational thinking (negative attributional styles)

17. Cognitive Therapy Rational Emotive Behavior Therapy (REBT or RET) • Albert Ellis • Expose and confront irrational thoughts • Example: social phobia • Question likelihood of occurrence, likely result

18. Cognitive Therapy • Aaron Beck: Cognitive Triad • Negative thoughts about self, environment and future result in depression • Develop positive thoughts for each factor

19. Somatic Therapies • Soma = body (bodily changes) • Biomedical = organic causes of disorders • Neurotransmitters / hormones • Structural brain abnormalities • Genetic predispositions

20. Somatic Therapies • Drug Therapy (psychopharmacology) • Schizophrenia: • Antipsychotic drugs • Thorazine: to control positive symptoms such as hallucinations, voices, or paranoia • Clozapine: counteracts negative symptoms (Catatonic) • Block receptor sites for dopamine • Tardive dyskinesia: trembling side-effect • Mood Disorders • Anti-Depressants • Unipolar: Prozac, Zoloft (Clinical depression) • Bipolar: Lithium (Manic phase: stabilizes Norepinephrine production)

21. Somatic Therapy • Drug Therapy • Anxiety Disorders • Librium, Valium • Relaxers, slows Central Nervous System

22. An eclectic approach… • Therapists often use… • Multiple perspectives- based on condition / needs of patient • IOW: “Different tools for different problems”

23. Somatic Therapy Electroconvulsive therapy (ECT) • Bilateral = both hemispheres of brain • Unilateral = one hemisphere • Theory: changes brain’s blood flow pattern • Side effects • Memory loss, brief seizure, brief loss of consciousness • Severe depression (last resort)

24. Somatic Therapy • Psychosurgery • Prefrontal lobotomy • Cutting main neurons to the frontal lobe • = mental vegetable

25. Therapy Sessions • Individual • Group therapy sessions • Advantages? Examples? • Family therapy • Marital therapy • Play therapy (for children) • Multisystemic therapy (coordinating specific environments)