Therapy

1. Therapy

2. AP EXAM Treatment of Abnormal Behavior (5–7%) • This section of the course provides students with an understanding of empirically based treatments of psychological disorders. The topic emphasizes descriptions of treatment modalities based on various orientations in psychology. AP students in psychology should be able to do the following: • Describe the central characteristics of psychotherapeutic intervention • Describe major treatment orientations used in therapy (e.g., behavioral, cognitive, humanistic) and how those orientations influence therapeutic planning. • Compare and contrast different treatment formats (e.g., individual, group). • Summarize effectiveness of specific treatments used to address specific problems. • Discuss how cultural and ethnic context influence choice and success of treatment (e.g., factors that lead to premature termination of treatment). • Describe prevention strategies that build resilience and promote competence. • Identify major figures in psychological treatment (e.g., Aaron Beck, Albert Ellis, Sigmund Freud, Mary Cover Jones, Carl Rogers, B. F. Skinner, Joseph Wolpe).

3. What are Therapists • Professionals who know the art of establishing a helping relationship • Know how to apply the knowledge of psychology to an individual struggling with problems and choices.

4. Therapy • We often hear that someone was in therapy, but what is therapy? • There are many stereotypes about therapy like the picture of a bearded therapist taking notes while a patient lies on a couch and spills his or her guts. • This is a very Freudian image.

5. Therapy Therapy is a term used for any treatment process; in psychology and psychiatry, therapy refers to a variety of techniques used to deal with mental disorders or cope with problems of living. There are endless reasons why people go to see a therapist or counselor: • making difficult decisions • dealing with academic problems • coping with the loss of a loved one • dealing with an unhappy relationship.

6. History of Therapy Much like the history of psychology itself and psychological disorders, therapy has had its fair share of misguided theories. In medieval Europe, people often thought mental disorders were the work of the devil and other demons. The job the therapists was to perform exorcisms.

7. Bedlam and its Origins • One of the most well known asylums was that of Bethlehem Hospital in London. • On the weekend, a person could pay a few pence to go sightseeing and watch the inmates who often put on a noisy and wild show. • As a result, “Bedlam,” the shortened term Londoners used for Bethlehem, became a word used to describe any noisy, chaotic place (Zimbardo et al.) Video: http://topdocumentaryfilms.com/bedlam-the-history-of-bethlem-hospital/

8. Medieval Asylums In the medieval asylums • patients, at most only custodial care • they were neglected • put in cruel restraints such as cages and straightjackets. Some received other forms of torture like beatings and cold showers.

9. Modern Therapy There are a variety of techniques and methods therapists and counselors use but all center on developing a strong, supportive relationship with the patient. Another similarity amongst all therapy techniques is their end goal of changing a person’s functioning in some way. Psychologists may use an eclectic approach which is like a buffet table; they select various techniques to help individuals

10. Components of Therapy In addition to developing a strong relationship between client/patient and counselor, the therapeutic process generally involves some or all of the following processes: • Identifying the problem • Identifying the cause of the problem or the current conditions that maintain the problem • Deciding on and carrying out some form of treatment

11. 7 Main Types of Professional Help

12. Who Does Therapy? (Drug therapy)

13. Therapy Gentler treatment brought about by: Philipe Pinel (FRANCE) Dorothea Dis (US, CANADA, SCOTLAND) Creation of mental hospitals Mid 1950s creation of psychotropic drugs empty hospitals Psychotherapy an emotionally charged, confiding interaction between a trained therapist and someone who suffers from psychological difficulties. E.g. psychoanalysis, CBT, insight therapy etc. Biomedical Approach Medication or medical procedures to act on nervous system Eclectic Approach an approach to psychotherapy that, depending on the client’s problems, uses techniques from various forms of therapy

14. Freudian Psychoanalysis Freudian view; psychological problems arise from: • Tension in the unconscious mind by forbidden impulses and threatening memories. Psychoanalysis • Probes the unconscious • attempt to bring these issues into the “light of day” or into consciousness. • The major goal of psychoanalysis • reveal and interpret the contents of the unconscious mind.

15. Therapy - Psychoanalysis Psychoanalysis – involving psychological techniques Interactions b/w trained therapist & patient First therapy available Aims Disorders fueled by childhood residue or repressed impulses/conflicts Patients work through buried feelings & take responsibility for growth

16. Therapy - Psychoanalysis Methods Historical reconstruction Uses past to unmask present Free Association Resistance Blocking from consciousness of anxiety-laden material Interpretation The analyst’s noting supposed dream meanings, resistances, and other significant behaviors in order to promote insight

17. Therapy - Psychoanalysis Latent content important to underlying censored meaning Transference the patient’s transfer to the analyst of emotions linked with other relationships e.g. love or hatred for a parent Traditional Psychoanalysis Takes time – several sessions a week for years Can be expensive (usually $100/HR) In USA, most take insurance

18. Psychoanalysis According to this theory, people will recover when they are finally released from the repressive mental restraints established in the relationship with their parents during early childhood.

19. Neo-Freudian Psychodynamic Therapies These therapies were developed by psychologists why embraced some of Freud’s ideas, but disagreed with others. While they follow many of the same techniques, their emphasis is on the conscious, rather than the unconscious, mind. • Basically they spend less time probing for hidden conflicts and repressed memories.

20. Therapy – Psychodynamic Understand current symptoms by focusing on themes across important relationships Help explore & gain perspective on defended-against thoughts/feelings Face-to-face once a week for only a few months Interpersonal Therapy – Brief variation of psychodynamic Help gain insight into roots of difficulties Goal – become symptom free in the present not in overall personality change Focusing on current relationships/relationship skills

21. Insight Therapies Attempts to change people on the inside-changing the way they think and feel. • think therapies • distressed persons need to develop an understanding of the disordered thoughts, emotions and motives that underline their mental difficulties.

22. Humanistic Therapies • Generally motivated by healthy needs for growth and psychological well being. • Problems only occur when conditions interfere with normal development and produce low self esteem. • Help clients confront their problems by recognizing their own freedom, enhancing their self-esteem and realizing their fullest potential.

23. Humanistic Therapy Aims to boost self-fulfillment by growing self-awareness & self-acceptance Referred to as Insight Therapies Aim to improve psychological functioning awareness of underlying motives & defenses Different than psychoanalytic Present & future focus Consciousness Immediate responsibility for own feelings Promoting growth instead of cure Clients rather than patients

24. Humanistic Therapy Client-Centered Therapy Developed by Carl Rogers Uses techniques such as active listening within a genuine, accepting, empathic environment to facilitate clients’ growth Nondirective therapy Therapist listens No judgment Refrain from directing towards insights Carl Rogers with his client Gloria

25. Humanistic Therapy Active Listening Empathic listening in which the listener echoes, restates, and clarifies Unconditional positive regard Accept worst traits & feel valued & whole Psychological problems decrease as self-awareness grows

26. Behavior Therapies • Based on the assumption that undesirable behaviors have been learned, and therefore, can be unlearned. • Behavior therapist focus on the problem behaviors rather than inner thoughts, motives or emotions. • Their goal is to determine how these behaviors were learned and see if they can eliminate them.

27. Behavior Therapy Behavior Therapy Therapy that applies learning principles to the elimination of unwanted behaviors Derived from Pavlov’s ideas Learned behaviors/emotions cause psychological issues Counterconditioning Procedure that conditions new responses to stimuli that trigger unwanted behaviors Based on classical conditioning Includes systematic desensitization and aversive conditioning

28. Behavior – Exposure Therapies Exposure Therapies Exposure to stimuli that is normally avoided Progressive Relaxation Relax 1 muscle group after another until one reaches complete relaxation Systematic Desensitization Type of counterconditioning Associates a pleasant, relaxed state with gradually increasing anxiety-triggering stimuli Commonly used to treat phobias

29. Steps of Systematic Desensitization For a fear of public speaking: • Seeing a picture of a person giving a speech • Watching another person give a speech • Preparing a speech to give • Having to introduce oneself to a large group • Waiting to be called upon to speak at a meeting. • Being introduced as a speaker to a group • Walking to the podium to make a speech • Making a speech to a large group

30. Systematic Desensitization Mary Covers Jones – Desensitization • used to cure phobias. • A patient may be desensitized through the repeated introduction of a series of stimuli that approximate the phobia. • Her study of the removal a fear of rabbits through conditioning, on a three-year-old named Peter. • Jones treated Peter’s fear of a white rabbit by “direct conditioning,” in which a pleasant stimulus (food) was associated with the rabbit. • As the rabbit was gradually brought closer to him in the presence of his favorite food, Peter grew more tolerant, and was able to touch it without fear.

31. Systematic Desensitization • John Wolpe – Hierarchical of Anxiety • Cannot be both relaxed and anxious at the same time. • Client and the therapist create a hierarchy of anxieties • (i.e. list of all the things that produce anxiety in all its different forms) starting with what produces the lowest level of anxiety to what produces the most anxiety. • Client needs to be fully relaxed while imaging the anxiety producing stimulus. • Depending on what their reaction is, whether they feel no anxiety or a great amount of anxiety, the stimulus will then be changed to a stronger or weaker one. NOTE: Systematic desensitization, though successful, has flaws as well. • The patient may give misleading hierarchies, have trouble relaxing, or not be able to adequately imagine the scenarios. Despite this possible flaw, it seems to be most successful

32. Behavior Therapy Systematic Desensitization

33. Exposure Therapies Virtual Reality Exposure Therapy Progressive exposure to simulations of fears Aversive Conditioning type of counterconditioning associates an unpleasant state with an unwanted behavior nausea ---> alcohol

34. Virtual Technology Exposure Therapy

35. Aversion Therapy • Aversion therapy takes on the psychological problems with a conditioning procedure designed to make tempting stimulus less provocative by pairing them with an unpleasant (aversive) stimuli. • In time, the negative reaction (UCR) associated with the averse stimuli come to be associated with the conditioned stimuli. • This is usually a last resort type of therapy, though it has been shown to be successful. • Clockwork Orange • https://www.youtube.com/watch?v=Jv1Bmne20l4

36. Aversion therapy for alcoholics

38. Operant Conditioning Therapy Behavior Modification Reinforcing desired behaviors & withholding reinforcement for undesired behaviors Token Economy an operant conditioning procedure that rewards desired behavior patient exchanges a token of some sort, earned for exhibiting the desired behavior, for various privileges or treats Contingency Management: An approach to changing behavior by changing the consequences associated with a behavior.

39. Cognitive Therapy Teaches people new, more adaptive ways of thinking and acting Based on the assumption that thoughts intervene between events and our emotional reactions

40. Cognitive Therapy The Cognitive Revolution

41. Lost job Internal beliefs: I’m worthless. It’s hopeless. Depression Lost job Internal beliefs: My boss is a jerk. I deserve something better. No depression Cognitive Therapy A cognitive perspective on psychological disorders

42. Cognitive Therapy Cognitive-Behavioral Therapy a popular integrated therapy that combines cognitive therapy (changing self-defeating thinking) with behavior therapy (changing behavior) Aims to alter the way patient thinks & act

43. Cognitive-Behavioral Therapy This approach assumes that an irrational self-statement often underlies maladaptive behavior.

44. Cognitive-Behavioral Therapy In this form of treatment, therapist and client work together to: • modify irrational self-talk, • set attainable behavioral goals • develop realistic strategies for attaining them. In this way, people change the way they approach problems and gradually develop new skills and a sense of self-efficacy.

45. Group/Family Therapies Group Therapy Benefit = social context allows people to discover others have similar problems & give feedback to each other Family Therapy treats the family as a system views an individual’s unwanted behaviors as influenced by or directed at other family members attempts to guide family members toward positive relationships and improved communication

46. Group/Family Therapies Most focus on hard-to-discuss or stigmatized illness AIDS patients high amongst group therapy The worse the illness, the more people actually attend groups

47. Number of persons Average untreated person Average psychotherapy client Poor outcome Good outcome 80% of untreated people have poorer outcomes than average treated person Does Therapy Work? Meta-analysis Procedure for statistically combining the results of many different research studies

48. Does Therapy Actually Work? In 1952, Hans Eysenck shook the psychology world by releasing a study that suggested 2/3 of all people with non- psychotic problems recovered within two years if the onset of the problem, whether they received therapy or not. Essentially he was arguing that therapy was worthless, and is no better than having any treatment at all.

49. Response to Eysenck As you can imagine, this set off a fire storm of studies on this subject. Overall (375 studies) research supports two major conclusions: • Therapy is more effective than non-therapy. • Eysenck overestimated the improvement rate in no-therapy control groups.

50. Biomedical Approach Changing the brain’s chemistry with drugs, its circuitry with surgery or its patterns of activity with pulses of electricity or magnetic fields.