Chapter 15:

1. Human AdjustmentJohn W. Santrock Chapter 15: Therapies McGraw-Hill © 2006 by The McGraw-Hill Companies, Inc. All rights reserved.

2. Chapter Outline Biological Therapies Psychotherapies Sociocultural Approaches and Issues in Treatment Evaluating Therapy ©2006 by the McGraw-Hill Companies, Inc. All rights reserved.

3. Learning Goals 1. Describe the biological therapies 2. Characterize four types of psychotherapy 3. Explain sociocultural approaches and issues in treatment 4. Evaluate the effectiveness of therapy ©2006 by the McGraw-Hill Companies, Inc. All rights reserved.

4. BIOLOGICAL THERAPIES Drug therapy Electroconvulsive Therapy Psychosurgery ©2006 by the McGraw-Hill Companies, Inc. All rights reserved.

5. Therapy Biological therapy = treatment to reduce or eliminate symptoms of psychological disorders by altering the way an individual’s body functions Psychotherapy = process used by mental health professionals to help individuals recognize, define, an overcome psychological and interpersonal difficulties ©2006 by the McGraw-Hill Companies, Inc. All rights reserved.

6. Drug Therapy - Antianxiety Drugs Antianxiety drugs = commonly known as tranquilizers; drugs that reduce anxiety by making individuals calmer and less excitable ©2006 by the McGraw-Hill Companies, Inc. All rights reserved.

7. Drug Therapy - Antianxiety Drugs • Benzodiazepines - relieve anxiety symptoms by binding to receptor sites of neurotransmitters that become overactive during anxiety • Most frequently prescribed benzodiazepines include Xanax, Valium, Librium • Side-effects of benzodiazepines include addiction, drowsiness, loss of coordination, fatigue ©2006 by the McGraw-Hill Companies, Inc. All rights reserved.

8. Drug Therapy - Antidepressant Drugs Antidepressant drugs = drugs that regulate mood ©2006 by the McGraw-Hill Companies, Inc. All rights reserved.

9. Drug Therapy - Antidepressant Drugs • Three main classes of antidepressant drugs: • tricyclics (Elavil) - increase norepinephrine and serotonin • MAO inhibitors (Nardil) - not as widely used because of interactions • SSRI drugs (Prozac, Paxil, Zoloft) - inhibit reabsorption of serotonin (selective serotonin reuptake inhibitors) ©2006 by the McGraw-Hill Companies, Inc. All rights reserved.

10. Figure 15.1 How the Antidepressant Prozac Works ©2006 by the McGraw-Hill Companies, Inc. All rights reserved.

11. Drug Therapy - Lithium • Lithium helps reduce mood swings Lithium = drug used to treat bipolar disorder ©2006 by the McGraw-Hill Companies, Inc. All rights reserved.

12. Drug Therapy - Antipsychotic Drugs Antipsychotic drugs = drugs that diminish agitated behavior, reduce tension, decrease hallucinations, improve social behavior, and produce better sleep patterns in individuals who have a severe psychological disorder, especially schizophrenia ©2006 by the McGraw-Hill Companies, Inc. All rights reserved.

13. Drug Therapy - Antipsychotic Drugs • Neuroleptics are the most widely used antipsychotic drugs • reduce level of the neurotransmitter dopamine in the brain • Atypical antipsychotic drugs block reuptake of serotonin • Two atypical antipsychotic drugs include Clozaril and Risperdal ©2006 by the McGraw-Hill Companies, Inc. All rights reserved.

14. Electroconvulsive Therapy (ECT) • Patient is given anesthesia and muscle relaxants before treatment, so patient has no memory of it • ECT is effective for these who do not respond to other therapies Electroconvulsive therapy = treatment used to treat severely depressed individuals; treatment causes seizure in the brain ©2006 by the McGraw-Hill Companies, Inc. All rights reserved.

15. Psychosurgery Psychosurgery = biological therapy that involves removal of brain tissue to improve individual’s adjustment ©2006 by the McGraw-Hill Companies, Inc. All rights reserved.

16. Review - Learning Goal 1 • What types of drugs are most often used to treat anxiety disorders, mood disorders, and schizophrenia? • What is electroconvulsive therapy and when is it used? • What is psychosurgery? ©2006 by the McGraw-Hill Companies, Inc. All rights reserved.

17. PSYCHOTHERAPIES Psychodynamic Therapies Humanistic Therapies Behavior Therapies Cognitive Therapies Integrative Therapy ©2006 by the McGraw-Hill Companies, Inc. All rights reserved.

18. Psychodynamic Therapies • Goal of psychodynamic therapies is to help individuals recognize maladaptive ways of coping and the sources of their unconscious conflicts Psychodynamic therapies = therapies that stress importance of unconscious mind, extensive interpretation by the therapist, and the role of early childhood years ©2006 by the McGraw-Hill Companies, Inc. All rights reserved.

19. Freud’s Psychoanalysis • Client’s current problems can be traced to early childhood experiences involving conflicts • Interpretation important - therapist searches for symbolic, hidden meaning Psychoanalysis = Freud’s psychotherapeutic technique for analyzing an individual’s unconscious thoughts ©2006 by the McGraw-Hill Companies, Inc. All rights reserved.

20. Freud’s Psychoanalysis • Free association - psychoanalytic technique of having individuals say aloud whatever comes to mind • Catharsis - release of emotional tension when reliving emotionally charged and conflict-filled experience • Dream analysis - psychotherapeutic technique used by psychoanalysts to interpret a dream • Psychoanalysts believe dreams contain information about individual’s unconscious thoughts and conflicts ©2006 by the McGraw-Hill Companies, Inc. All rights reserved.

21. Figure 15.4 Freudian Interpretation of Sexual Symbolism in Dreams ©2006 by the McGraw-Hill Companies, Inc. All rights reserved.

22. Freud’s Psychoanalysis • Resistance - psychoanalytic term for person’s unconscious defense strategies that prevent analyst from understanding the person’s problems • Resistance occurs because it is painful to bring conflicts into conscious awareness ©2006 by the McGraw-Hill Companies, Inc. All rights reserved.

23. Freud’s Psychoanalysis • Transference - psychoanalytic term for person’s relation to the analyst in ways that relive important relationships in the person’s life • Transference can reveal how individuals relate to important people in their lives ©2006 by the McGraw-Hill Companies, Inc. All rights reserved.

24. Contemporary Psychodynamic Therapies • Today, individuals in psychodynamic therapy: • face the therapist • have weekly appointments • undergo therapy for a shorter period of time ©2006 by the McGraw-Hill Companies, Inc. All rights reserved.

25. Contemporary Psychodynamic Therapies • Currently, psychodynamic therapists emphasize (in addition to the unconscious mind): • the conscious mind • relationships • social contexts ©2006 by the McGraw-Hill Companies, Inc. All rights reserved.

26. Adjustment Strategies Based on Psychodynamic Therapies 1. Recognize that the reasons for your good or poor adjustment are likely beyond conscious awareness 2. Examine your childhood experiences in your family 3. Explore whether you are relying too heavily on defense mechanisms 4. Realize that different psychodynamic therapies offer different approaches to adjustment ©2006 by the McGraw-Hill Companies, Inc. All rights reserved.

27. Humanistic Therapies Insight therapy = therapy that encourages insight and self-awareness; includes both psychodynamic and humanistic therapies ©2006 by the McGraw-Hill Companies, Inc. All rights reserved.

28. Humanistic Therapies • Humanistic therapies emphasize: • conscious rather than unconscious thought • the present rather than the past • growth and self-fulfillment rather than illness Humanistic therapies = insight therapies that encourage people to understand themselves and to grow personally ©2006 by the McGraw-Hill Companies, Inc. All rights reserved.

29. Client-Centered Therapy • Developed by Carl Rogers (1961) Client-centered therapy = Rogers’ humanistic therapy in which the therapist provides a warm, supportive atmosphere to improve the client’s self-concept and encourage the client to gain insight about problems ©2006 by the McGraw-Hill Companies, Inc. All rights reserved.

30. Client-Centered Therapy • Unconditional positive regard - therapist creates a warm and caring environment and never disapproves of the client • Therapist’s role is nondirective • In addition to unconditional positive regard, client-centered therapy involves: • genuineness - let client know therapist’s feelings • active listening - give total attention to what person says ©2006 by the McGraw-Hill Companies, Inc. All rights reserved.

31. Gestalt Therapy • Developed by Fritz Perls (1969) • Therapist pushes clients to decide whether they will continue to allow the past to control their future Gestalt therapy = Perl’s humanistic therapy in which the therapist challenges the client to help them become aware of their feelings and to face their problems ©2006 by the McGraw-Hill Companies, Inc. All rights reserved.

32. Gestalt Therapy • Gestalt therapists encourage clients to: • be open about their feelings • develop self-awareness • be themselves • develop a sense of freedom • look at what they are doing with their lives • To stimulate change, therapist often openly confronts client ©2006 by the McGraw-Hill Companies, Inc. All rights reserved.

33. Behavior Therapies • Behavior therapists offer action-oriented strategies to help people change what they are doing • The maladaptive symptoms are the problem Behavior therapies = use principles of learning to reduce or eliminate maladaptive behavior ©2006 by the McGraw-Hill Companies, Inc. All rights reserved.

34. Applications of Classical Conditioning • Systematic desensitization steps include: • develop a hierarchy of least fearful to most fearful situation to teach the individual how to relax • start at the lower end of the hierarchy and work your way up Systematic Desensitization = treats anxiety by getting the person to associate deep relaxation with increasingly intense anxiety-producing situations ©2006 by the McGraw-Hill Companies, Inc. All rights reserved.

35. Applications of Classical Conditioning • Aversive conditioning - used to teach people to avoid behaviors such as smoking, eating, and drinking Aversive conditioning = repeated pairings of an undesirable behavior with aversive stimuli to decrease the behavior’s rewards ©2006 by the McGraw-Hill Companies, Inc. All rights reserved.

36. Figure 15.6 Classical Conditioning: the Backbone of Aversive Conditioning ©2006 by the McGraw-Hill Companies, Inc. All rights reserved.

37. Applications of Operant Conditioning Behavior modification = application of operant conditioning principles to change human behaviors, especially to replace unacceptable, maladaptive behavior with acceptable adaptive behaviors ©2006 by the McGraw-Hill Companies, Inc. All rights reserved.

38. Applications of Operant Conditioning • Token economy - system in which desired behaviors are reinforced with tokens that later can be exchanged for desired rewards • Token economies are used in: • classrooms • institutions for the mentally retarded ©2006 by the McGraw-Hill Companies, Inc. All rights reserved.

39. Cognitive Therapies • Cognitive therapies: • focus more on overt symptoms • provide structure to individual’s thoughts • are less concerned about origin of problem Cognitive therapies = emphasize that the individual’s cognitions are the main source of abnormal behavior and psychological problems ©2006 by the McGraw-Hill Companies, Inc. All rights reserved.

40. Cognitive Therapies • Cognitive therapists: • aim for cognitive restructuring (changing a pattern of thought) • guide individuals to identify irrational and self-defeating thoughts • use techniques to help clients: -challenge these thoughts -consider different, more positive ways of thinking ©2006 by the McGraw-Hill Companies, Inc. All rights reserved.

41. Rational-Emotive Behavior Therapy • Goal of REBT is to get person to eliminate self-defeating beliefs by rationally examining them Rational-emotive behavior therapy (REBT) = based on Albert Ellis’ assertion that individuals develop a psychological disorder because of their beliefs, especially those that are irrational and self-defeating ©2006 by the McGraw-Hill Companies, Inc. All rights reserved.

42. Beck’s Cognitive Therapy • Aaron Beck’s (1976)cognitive therapy resembles an open-ended dialogue in which the therapist helps individuals to: • reflect on personal issues • discover their own misconceptions • try out unbiased experiments that reveal the inaccuracies of their beliefs ©2006 by the McGraw-Hill Companies, Inc. All rights reserved.

43. Beck’s Cognitive Therapy • Illogical thinking can lead an individual to errors: • perceive world as harmful • overgeneralize on the basis of limited examples • Magnify the importance of undesirable events • engage in absolutist thinking ©2006 by the McGraw-Hill Companies, Inc. All rights reserved.

44. Adjustment Strategies Based on Beck’s Cognitive Therapy 1. Keep records of thoughts and emotional reactions 2. Engage in thought stopping 3. Examine options and alternatives 4. Question the evidence 5. Become positively distracted 6. Decatastrophize 7. Fantasize consequences 8. Turn adversity into advantage ©2006 by the McGraw-Hill Companies, Inc. All rights reserved.

45. Cognitive Behavior Therapy • Self-efficacy is an important goal of cognitive behavior therapy Cognitive behavior therapy = consists of a combination of cognitive therapy and behavior therapy ©2006 by the McGraw-Hill Companies, Inc. All rights reserved.

46. Adjustment Strategies Self-Instructional Methods 1. Preparing for stress or anxiety 2. Confronting and handling anxiety or stress 3. Coping with feelings at critical moments 4. Reinforcing self-statements ©2006 by the McGraw-Hill Companies, Inc. All rights reserved.

47. Integrative Therapy Integrative therapy = combination of techniques from different therapies based on the therapist’s judgment of which particular techniques will provide the greatest benefit for the client ©2006 by the McGraw-Hill Companies, Inc. All rights reserved.

48. Integrative Therapy • Move toward integrative therapy includes factors such as: • proliferation of therapies • inadequacy of a single therapy to be relevant to all clients and all problems • lack of evidence that one therapy is better than others • recognition that therapy commonalities play an important role in therapy outcomes ©2006 by the McGraw-Hill Companies, Inc. All rights reserved.

49. Review - Learning Goal 2 • What is psychodynamic therapy? • How do the humanistic therapies of Rogers and Perls differ? • How are classical conditioning and operant conditioning applied in behavior therapies? • What are the characteristics of RMBT, Beck’s cognitive therapy, and cognitive-behavior therapy? • What is integrative therapy? ©2006 by the McGraw-Hill Companies, Inc. All rights reserved.

50. SOCIOCULTURAL APPROACHES AND ISSUES IN TREATMENT Group Therapy Family and Couple Therapy Self-Help Support Groups Community Mental Health Cultural Perspectives ©2006 by the McGraw-Hill Companies, Inc. All rights reserved.