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Issues in Psychotherapy

Issues in Psychotherapy. What are Repressed Memories?. Holly and Gary Ramona Holly ’ s bulimia and accusation Gary ’ s lawsuit Dad awarded $500,000.00 from therapist!. Freud and Repression. Unpleasant thoughts, experiences, memories get pushed way down into unconsciousness

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Issues in Psychotherapy

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  1. Issues in Psychotherapy

  2. What are Repressed Memories? • Holly and Gary Ramona • Holly’s bulimia and accusation • Gary’s lawsuit • Dad awarded $500,000.00 from therapist!

  3. Freud and Repression • Unpleasant thoughts, experiences, memories get pushed way down into unconsciousness • These repressed items sneak out through slips of the tongue, symbolic behaviors, or psychologically abnormal behaviors

  4. Validity & Frequency • Clinical cases have been substantiated • Different researchers found that 18%, 32%, and 59% of adult clients with a history of sexual abuse said that they had forgotten or recently uncovered repressed memories of sexual abuse

  5. Elizabeth Loftus • Increased occurrence in 1990s has been partly blamed on the practices of some therapists

  6. The Therapist’s Role • Therapists’ defense - repressed memories blocked, takes deliberate suggestion and effort to release them

  7. Can False Memories be Implanted? • Loftus contacted families of students, had they ever been lost. • Those who had not were subjects in an experiment.

  8. Lost in a Mall Experiment, Loftus, 1996 • Ss. told story that at about 5 years of age, they were lost in a mall, complete with details of the local mall from where they lived at age 5.

  9. Lost in a Mall Experiment, Loftus, 1996 • Ss. are asked questions about having been lost in the mall. • 75% of what they remember were true facts about the mall, etc. • 25% of what they remember is totally created based on what they had been told, falsely, had happened to them. • A significant minority of people (in research) will believe the created memories actually did occur, even when presented with explanation.

  10. Do photos enhance the creation of false memories? • Garry and Gerrie, 2005 • Instead of narratives of being “lost in a mall”, Ss. are shown 4 photos, three are real childhood pictures, but the fourth is a ‘doctored’ photo of them and at least one other family member taking a hot-air-balloon ride.

  11. Do photos enhance the creation of false memories? • Ss. reviewed each photo three times over a maximum of 2 weeks, • 50% remembered something about the ride • Descriptions were rich in detail • When told the photo was a fake, many were genuinely surprised

  12. Which is more effective at creating false memories, photos or narratives? • Garry and Wade, 2005 combined the “lost in a mall” and “hot-air-balloon” experiments • Half of the Ss. saw a doctored photo of them in a balloon, the other half read a detailed story about their balloon ride • When interviewed about their memory of the ride, 50% of photo-viewers claimed it happened, but 80% of narrative-readers believed it had happened!

  13. Why are made-up stories better than doctored photos? • photo forced a concrete visual memory • narrative allowed them to generate their own details, expending more mental involvement, and thus making it more likely to believe our own story (invented though it may be).

  14. A clinical case of false memories • Dr. Diane Humenansky sued by a patient for medical malpractice • Client came in with Generalized Anxiety Disorder • 10 months later, Humenansky diagnosed Dissociative Identity Disorder with over 100 alter personalities • Patient awarded $2,671,000.00 • $2 mill for pain/suffering, $461,000 for future damages, husband awarded $210,000 for loss of partnership • A second patient came forward, sued and received $2,500,00.00

  15. Loftus investigates techniques of rogue doctors • Therapist and patient accounts • Sworn statements • Taped sessions • Artifacts - books & articles doctor is reading/writing, etc. • Undercover patients • Surveys of therapists about techniques commonly used • 75% did not use questionable techniques

  16. Humenansky used. . . • Hypnosis • Sodium amytal (truth serum) • Group therapy (memory poker) • Age regression • Guided imagery related to abuse situations

  17. So, does therapy work? • What, and how, to measure? • Compare different styles of therapy • How do we measure improvement? • Is psychotherapy more effective than no treatment at all? • “Spontaneous remission”

  18. Improvement for people in weekly psychotherapy and people who did not receive psychotherapy. • After 8 weekly sessions more than 50% receiving therapy were significantly improved compared to 4% of those not receiving therapy • Clearly, psychotherapy accelerates both the rate and the degree of improvement for those experiencing psychological problems. SOURCE: McNeilly & Howard, 1991.

  19. More Evidence of Psychotherapy’s Effectiveness • PET scans of Obsessive Compulsive Disorder patients’ brains before and after 10 weeks of psychotherapy • Scans showed changes in the actual structure and functioning of their brains similar to the changes that accompany patients who receive only drug therapy

  20. Burlingame & Barlow, 1988 • Eight experimental therapy groups met for 15 weekly sessions • 4 groups run by therapists • 4 groups run by nonprofessionals • 6 months out - non-expert group had deteriorated, pros did not!

  21. What about relapse rates? • Comparing those who received: 1. a placebo drug treatment; 2. a placebo and counseling; 3. drugs and counseling; 4. drugs only.

  22. Is one form of psychotherapy better? • Answer 1: No -- in general there is little or no difference in the effectiveness of different empirically supported psychotherapies • Answer 2: Yes -- in some cases one type of therapy is more effective than another for treating a particular problem • E.g., • Depression -- • cognitive therapy • Panic disorder, OCD, phobias • cognitive, behaviorist, CBT > insight oriented therapies • Disorders with severe psychotic symptoms (e.g., schizophrenia) • insight oriented therapies < other therapies

  23. Daily Affirmations Stuart Smalley Jessica's Affirmations

  24. Eclecticism • A good match between person and type of therapy is important • Current trend in psychotherapy is Eclecticism--pragmatic and integrated use of techniques from different psychotherapies. • Today therapists identify themselves as eclectic more than any other orientation • Eclectic psychotherapists carefully tailor the therapy approach to the problems and characteristics of the person seeking help.

  25. What makes psychotherapy effective? • A strong therapeutic relationship • Personal characteristics of the therapist • Personal characteristics of the client • External circumstances • Family • Finances • Employer & co-workers

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