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 • 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. Positive Therapy • Techniques designed to enhance personal strengths, rather than “fix” weaknesses

6. Figure 14.6

7. Table 14.1

8. 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 • In primitive times it was unlikely the patient would survive; this may have been a goal • Goal presumably to relieve pressure or rid the person of evil spirits

9. 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!

10. Origins of Therapy (cont.) • Ergotism: Psychotic-like condition that comes from ergot poisoning • Ergot is a natural source of LSD • Ergot occurs with rye • Phillippe Pinel: French physician who initiated humane treatment of mental patients in 1793 • Created the first mental hospital

11. 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 resolve internal conflicts that lead to emotional suffering

12. Free Association • Saying whatever comes to mind, regardless of how embarrassing it is • By doing so without censorship and censure, unconscious material can emerge

13. Dream Analysis • Dreams express forbidden desires and unconscious feelings • Latent Content: Hidden, symbolic meaning of dreams • Manifest Content: Obvious, visible meaning of dreams • Dream Symbols: Images in dreams that have personal or emotional meanings

14. Resistance • Blockage in flow of ideas; topics the client resists thinking about or discussing • Resistances reveal particularly important unconscious conflicts

15. 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. • What Freudians aspire to in therapy

16. Modern Psychoanalysis • Brief Psychodynamic Therapy: Based on psychoanalytic theory but designed to produce insights more quickly; uses direct questioning to reveal unconscious conflicts • Spontaneous Remission: Improvement of a psychological condition due to time passing without therapy

17. One Method to Measure Psychotherapy’s Effectiveness • Waiting-List Control Group: People who receive no therapy as a way to test the effectiveness of psychotherapy • Compare control with experimental group (group in therapy); if no statistically significant difference, then something other than therapy caused change or no change in conditions

18. Humanistic Therapies • Client-Centered Therapy (Rogers): Nondirective and based on insights from conscious thoughts and feelings; accept one’s true self

19. Rogers’ Key Conditions for an Effective Therapist • 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

20. Roger’s Key Conditions for an Effective Therapist Concluded • 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

21. Existential Therapy • An insight therapy that focuses on problems of existence, such as meaning, choice, death, and responsibility; emphasizes making difficult choices in life • Therapy focuses on death, freedom, isolation, and meaninglessness • Confrontation: Clients are challenged to examine their values and choices

22. Gestalt Therapy (Perls) • Focuses on immediate awareness and experience to help clients rebuild thinking, feeling, and acting into connected wholes • Emphasizes integration of various experiences (filling in the gaps) • Clients are taught to accept responsibility for their thoughts and actions • More directive than client-centered or existential therapy

23. Cybertherapy and Psychotherapy at a Distance • 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!

24. Cybertherapy and Psychotherapy at a Distance Concluded • Cybertherapy: Internet therapists in chat rooms and so on • 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

25. Telehealth • Psychotherapy via teleconferencing

26. 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

27. 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 • Rapid Smoking: Prolonged smoking at a forced pace • Designed to cause aversion to smoking

28. Response-Contingent Consequences • Reinforcement, punishment, or other consequences that are applied only when a certain response is made

29. Desensitization • Hierarchy: Rank-ordered series of steps, amounts, levels, or degrees • Reciprocal Inhibition: One emotional state is used to block another (e.g., impossible to be anxious and relaxed at the same time)

30. 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

31. Behavioral Treatment of Phobias

32. Desensitization (cont.) • Tension-Release Method: Procedure for systematically achieving deep relaxation of the body • Model: Live or filmed person who serves as an example for observational learning • Vicarious Desensitization: Reduction in fear or anxiety that takes place secondhand when a client watches models perform the feared behavior

33. Virtual Reality Exposure • Presents computerized fear stimuli to patients in a realistic, yet carefully controlled fashion

34. 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

35. Operant Conditioning • Learning based on consequences of making a response

36. Positive Reinforcement • Responses that are followed by a reward tend to occur more frequently

37. Nonreinforcement • A response that is not followed by a reward will occur less frequently

38. Punishment • If a response is followed by discomfort or an undesirable effect, the response will decrease/be suppressed (but not necessarily extinguished)

39. Extinction • If response is NOTfollowed by reward after it has been repeated many times, it will go away

40. Operant Therapies • 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

41. 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

42. 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

43. Figure 14.5

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

45. Cognitive Therapy for Depression (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

46. 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.”

47. Ellis’ ABC Concept • A: Activating experience, which person presumes to be the cause of “C” • C: Emotional Consequences • B: Person’s irrational and unrealistic beliefs

48. 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

49. 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

50. 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