Psychotherapies

1. Psychotherapies

2. 2 Types of Therapy • Psychotherapy—use of psychological techniques to treat emotional, behavioral, and interpersonal problems • Biomedical—use of medications and other medical therapies to treat the symptoms associated with psychological disorders

3. Psychotherapy • A planned, emotionally charged, confiding interaction between a trained therapist and someone who suffers from psychological difficulties • There are over 250 different types of therapy.

4. Four Types of Psychotherapy • Most therapies can be divided into: • Psychoanalytic • Humanistic • Behavioral • Cognitive

5. Eclectic Approach • An approach to psychotherapy that, depending on the person’s problems, uses techniques from multiple forms of therapy • Carefully tailor the therapy approach to the problems and characteristics of the person seeking help

6. Psychoanalysis

7. Psychoanalysis Developed by Sigmund Freud based on his theory of personality Freud’s Office

8. Psychoanalysis • Freud’s therapeutic technique that attributes one’s thoughts and actions to unconscious motives and conflicts

9. Psychoanalysis Assumptions • Psychological problems are the result of repressed conflicts and impulses from childhood. • The therapist must bring the repressed problems into the conscious mind to help patients have an insight about the original cause of the problem.

10. Causes of Psychological Problems • Undesirable urges and conflicts are “repressed” or pushed to the unconscious • Unconscious conflicts exert influence on behaviors, emotions, and interpersonal dynamics • Understanding and insight into repressed conflicts leads to recognition and resolution

11. Psychoanalytic Methods

12. Free Association • Freudian technique of discovering the unconscious mind--where the patient relaxes and says whatever comes to mind, no matter how trivial or embarrassing • A way of revealing unconscious thoughts and emotions

13. Resistance • Client’s unwillingness to discuss issues raised during free association. • Unconsciousattempts to block the revelation of repressed memories and conflicts.

14. Interpretation • A technique in which the psychoanalyst offers a carefully timed explanation of the unconscious meaning of the patient’s behavior, thoughts, feelings, or dreams to facilitate the recognition of unconscious conflicts or motivations • Dream Interpretation - Manifest content of dreams is analyzed for disguised or symbolic wishes, meanings, and motivations (latent content) • Freud considered dreams to be the “royal road to the unconscious”

15. Transference • Patient’s transfer to the analyst of emotions linked with other relationships • The patient projects feeling from the past to the therapist. • Once these are feelings are opened up the therapist can help the client work through them.

16. Using Psychoanalysis • All these psychoanalytic techniques are designed to help the patient achieve insight into how past conflicts influence her current behavior and relationships and then replace maladaptive behavior patterns with adaptive ones. • On average, the traditional psychoanalyst sees the patient four or five times a week over the course of four years or longer

17. Psychoanalytic Influence • Few therapists follow strict Freudian therapy. • Most feel it emphasizes sex and aggression too much • Works well with anxiety and mild depression.

18. The Psychodynamic Perspective

19. Psychodynamic Approach • A more modern view that retains some aspects of Freudian theory but rejects other aspects • Retains the importance of the unconscious mind • Less emphasis on unresolved childhood conflicts • Does not require meeting with therapist as often as traditional psychoanalytic therapy.

20. Humanistic Therapies

21. Humanistic Therapies • Humanistic perspective emphasizes human potential, self-awareness, and free-will • Humanistic therapies focus on self-perception and individual’s conscious thoughts and perceptions • Client-centered (or person-centered) therapy is the most common form of humanistic therapy • Carl Rogers (1902–1987)—developed this technique

22. Nondirective Client-Centered Therapy • Therapist listens without interpreting and does not direct the client (patient) to any particular insight. • Therapist must not make decisions for the client, offer solutions, or pass judgment on the client’s thoughts or feelings. • Rogers deliberately used the word client rather than patient to avoid the idea that the person was “sick” and could be “cured”

23. Client-Centered Therapy • Therapist uses techniques such as active listening within a genuine, accepting, empathic environment to facilitate the client’s growth. The therapy stresses: • Empathy • Acceptance • Genuineness

24. Therapeutic Conditions • Genuineness—therapist openly shares thoughts without defensiveness • Unconditional positive regard for client—no conditions on acceptance of person • Empathic understanding—creates a psychological mirror reflecting clients thoughts and feelings

25. Active Listening • Empathic listening in which the listener echoes, restates and clarifies.

26. Active Listening Characteristics • Active listening entails: • Paraphrasing: uses the words of the client to summarize the conversation • Clarifying: encouraging the client to say more by asking leading questions • Reflecting feelings: mirrors the feelings of the client

27. The Results of Good Humanistic Therapy • Rogers thought if clients are treated with unconditional positive regard, empathy, & genuineness, the client will explore their feelings & thoughts. • Exploring their thoughts & feelings in an accepting environment will lead the client to change their attitudes & behavior. • This approach very successful in dealing with mild depression and anxiety but not very successful in treating psychotic patients like those with severe schizophrenia.

29. Behavior Therapies

30. Behavior Therapy • Behavioristic perspective emphasizes that behavior (normal and abnormal) is learned • Applies classical and operant conditioning to the elimination of unwanted behaviors • Primary concern is to eliminate the disorder’s behavior, not find the cause of the disorder • Often called behavior modification

31. Behavior Therapies:Classical Conditioning Techniques

32. Mary Cover Jones: The First Behavior Therapist • Demonstrated that conditioning could be used to remove fears. • Treated three-year-old Peter’s fear of rabbits, using counterconditioning • Involves modifying behavior by conditioning a new response that is incompatible with a previously learned response (paired rabbit with a cookie) • Rabbit + Cookie = Happy/Not Scared • Rabbit = Happy/Not Scared CS UCS UCR CS CR

33. Systematic Desensitization Process • Establish a hierarchy of the anxiety- triggering stimuli • Learning relaxation methods (progressive relaxation) • Slowly think through the hierarchy from least anxiety-provoking to most anxiety-provoking , working to relax whenever anxiety is felt • Once you can maintain complete relaxation, you move on to the next scene, and so on

34. Sample Anxiety Hierarchy

35. Flooding • Method of extinction usually used to rid a patient of phobias (Exposure Therapy) • The patient is inundated with repeated exposures to what they fear until they realize they can remain calm in the presence of the feared object. (view video of this process for phobias – 2 min)

36. Aversive Conditioning • A type of counterconditioning that associates an unpleasant state (such as nausea) with an unwanted behavior • The person is replacing a positive but harmful response with a negative response • Example with alcoholism: Lace a drink with a drug that makes the person becomes sick • Aversive conditioning is not very effective, and its use has declined in recent years.

37. UCS (drug) UCR (nausea) CS (alcohol) UCS (drug) UCR (nausea) CS (alcohol) CR (nausea) Aversion Therapy for Alcoholism • Relatively ineffective, does not generalize very well beyond therapy • Pairs and aversive stimulus with the undesired behavior

38. Behavior Therapies: Operant Conditioning Techniques

39. Operant Conditioning • Behavior therapists have developed a variety of techniques based on B. F. Skinner’s operant conditioning model of learning • Shaping involves reinforcing successive approximations of a desired behavior • Positive reinforcement is used to increase the incidence of desired behaviors • Extinction, or nonreinforcement, is used to reduce the occurrence of undesired behaviors

40. Token Economy • An operant conditioning procedure that attempts to modify behavior by giving tokens (rewards) for desired behavior. • The tokens can be exchanged for various privileges or treats • Use for behavior modification in group settings (prisons, classrooms, hospitals) • Form of secondary reinforcement • Proven to be especially effective in the outpatient treatment of substance abuse and dependence and with severely disturbed people

41. Successive Approximations • Series of behaviors that gradually become more similar to a target behavior. • Each time the behavior is closer to the desired behavior it gets rewarded. • Good for learning proper social behaviors.

42. Evaluating Behavior Therapy • Effective short-term therapy for well-defined problems like phobias, PTSD and compulsions. • Also effective with addictions and helping those living in institutions. • Not as effective with schizophrenics and depressed patients.

44. Cognitive Therapies

45. Cognitive Therapy • Based on the idea that people have irrational beliefs, thoughts and attitudes that distort their behaviors • Thoughts intervene between events and our emotional reactions • Therapy focuses on recognition and alteration of unhealthy thinking patterns • Teaches people new, more adaptive ways of thinking and acting

46. Self-Serving Bias • Tendency to judge oneself favorably • Severely depressed patients tend to not have a self-serving bias and tend to blame themselves for problems and credit the environment for successes

47. Rational Emotive Therapy • Developed by Albert Ellis • People’s difficulties are caused by their faulty expectations and irrational beliefs • ABC model • Activating Event • Beliefs • Consequences • When an Activating event (A) occurs, it is the person’s Beliefs (B) about the event that cause emotional Consequences (C) • Goal of therapy is identification and elimination of core irrational beliefs • Effective in the treatment of depression, social phobia, and certain anxiety disorders, and in helping people overcome self-defeating behaviors

50. How RET Works • Step 1: Identify the core irrational beliefs or self talk that underlie personal distress • Step 2: Vigorously dispute and challenge the irrational beliefs. Therapist acts as a teacher to show patient how to do this. • Rational-emotive therapists tend to be very direct and even confrontational • From the client’s perspective, rational-emotive therapy requires considerable effort • person must admit her irrational beliefs and accept the fact that those beliefs are irrational and unhealthy • client must radically change her way of interpreting and responding to stressful events