Therapy

Chapter 15

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Psychological Therapies

1. Psychoanalytic theory2. Humanistic theory3. Behavioral theory4. Cognitive theory

Psychoanalytic Therapy

• Goal: to bring unconscious conflicts, traumas, worries into the conscious so they can be faced and resolved

Psychoanalytic Therapy

• Psychoanalysis: Freud’s Therapy• Free association • Dream interpretation• Transference • http://www.youtube.com/watch?v=oS_L8efaJ-E

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Psychoanalysis: Criticisms

1. cannot be proven or disproven.2. takes a long time and is very

expensive– http://www.youtube.com/watch?

v=Ss8fYIKlRdo

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Psychoanalytic Therapies

Interpersonal psychotherapy•effective in treating depression•focuses on symptom relief here and now•Relationships the patient has

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Humanistic Therapies

•client-centered therapy –Carl Rogers–Provide unconditional acceptance and high regard–Increase self-esteem–http://www.youtube.com/watch?v=m30jsZx_Ngs&feature=related

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Humanistic Therapy

active listening - echoes, restates, and clarifies the patient’s thinking,

acknowledging expressed feelings

Michael Rougier/ Life M

agazine © Tim

e Warner, Inc.

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Behavior Therapy

Therapy that applies learning principles to the elimination of unwanted behaviors.

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Behavioral Therapy

•Counterconditioning

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Exposure Therapy

The Far Side © 1986 FARW

ORKS. Reprinted w

ith Permission. All Rights Reserved.

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Systematic Desensitization

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Aversive Conditioning

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Operant Conditioning

•behavior modification –desired behaviors are rewarded and undesired behaviors are either unrewarded or punished–Successful in treating uncommunicative patients

•Autistic children

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Token Economy

•patients exchange a token of some sort, earned for exhibiting the desired behavior, for various privileges or treats.–institutional settings–schizophrenic patients

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Cognitive Therapy

Cognitive Therapy

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Cognitive Therapy

Stress Inoculation TrainingMeichenbaum (1977, 1985) trained people to restructure their thinking in stressful situations.

“Relax, the exam may be hard, but it will be hard for everyone else too. I studied harder than most people. Besides, I don’t need a perfect score to get a good grade.”

Cognitive Therapy

• Cognitive-Behavioral Therapy (CBT)– Therapists attempt to change the way people

think as well as their behavior – Highly structured and focused on concrete

problems– Clients have specific therapy goals– Clients are given “homework”

Group Therapy, Family Therapy• Group Therapy

– Several unrelated people meet with a therapist to discuss some aspect of their psychological functioning

– Often centers on a common difficulty– Help people realize that others have the same problem– People with the same problem exchange advice about how to deal with

things

© M

ary Kate Denny/ PhotoEdit, Inc.

Group Therapy, Family Therapy

• Family Therapy– Involves two or more family members, one (or more) of

whose problems led to treatment• Family is viewed as a unit so if one person has psychological issues,

the entire family needs therapy to improve the situation

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Who do people turn to for help with psychological difficulties?

Evaluating Therapies

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Is Psychotherapy Effective?

It is difficult to gauge the effectiveness of psychotherapy because there are

different levels upon which its effectiveness can be measured.

1. Does the patient sense improvement?2. Does the therapist feel the patient has improved?3. How do friends and family feel about the patient’s

improvement?

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Client’s Perceptions

1. Clients enter therapy in crisis, but crisis may subside over the natural course of time (regression to normalcy).

2. Clients may need to believe the therapy was worth the effort.

3. Clients generally speak kindly of their therapists.

Choosing the Right Therapist

• You should feel comfortable with your therapist• Therapists should have appropriate training and

credentials and should be licensed by appropriate state and local agencies

• You should feel that you are making progress after therapy has begun, despite occasional setbacks

• The therapist should be monitoring your progress and making sure that you are improving, adjusting treatment accordingly

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Clinician’s Perceptions

1. Clinicians are aware of failures, but they believe failures are the problem of other therapists.

2. If a client seeks another clinician, the former therapist is more likely to argue that the client has developed another psychological problem.

3. Clinicians are likely to testify to the efficacy of their therapy regardless of the outcome of treatment.

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Outcome Research

Research shows that treated patients were 80% better than untreated ones.

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The Relative Effectiveness of Different Therapies

Which psychotherapy would be most effective for treating a particular

problem?Disorder Therapy

Depression Behavior, Cognition, Interpersonal

Anxiety Cognition, Exposure, Stress Inoculation

Bulimia Cognitive-behavior

Phobia Behavior

Bed Wetting

Behavior Modification

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Eye Movement Desensitization and Reprocessing (EMDR)

In EMDR therapy, the therapist attempts to unlock and reprocess previous frozen

traumatic memories by waving a finger in front of the eyes of the client.

EMDR has not held up under scientific testing.

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Light Exposure Therapy

Seasonal Affective Disorder (SAD), a

form of depression, has been effectively

treated by light exposure therapy.

This form of therapy has been

scientifically validated.

Courtesy of Christine Brune

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Commonalities Among Psychotherapies

Three commonalities shared by all forms of psychotherapies are the following:

1. A hope for demoralized people.

2. A new perspective.3. An empathic, trusting

and caring relationship.

© M

ary Kate Denny/ PhotoEdit, Inc.

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The Biomedical Therapies

1. Drug Therapies2. Brain Stimulation3. Psychosurgery

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Drug Therapies

With the advent of drugs, hospitalization in mental institutions has rapidly declined.

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Double-Blind Procedures

To test the effectiveness of a drug, patients are tested with the drug and a placebo. Two groups of patients and medical health professionals are unaware of who is taking the drug and who is taking the placebo.

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Antipsychotic Drugs

Classical antipsychotics [chlorpromazine (Thorazine)]: Remove a number of positive symptoms associated with schizophrenia such as agitation,

delusions, and hallucinatioAtypical antipsychotics [clozapine (Clozaril)]: Remove

negative symptoms associated with schizophrenia such as apathy, jumbled thoughts, concentration

difficulties, and difficulties in interacting with others.ns.

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Atypical Antipsychotic

Clozapine (Clozaril) blocks receptors for dopamine and serotonin to remove the negative symptoms of schizophrenia.

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Antianxiety Drugs

Antianxiety drugs (Xanax and Ativan) depress the central nervous system and reduce anxiety

and tension by elevating the levels of the Gamma-aminobutyric acid (GABA)

neurotransmitter.

Drug Therapy

• Antidepressant Drugs– Medications used in cases of severe depression to

improve the moods of patients • Work by changing the concentration of specific

neurotransmitters in the brain– Tricyclic drugs– MAO inhibitors– Selective serotonin reuptake inhibitors (SSRIs)

» Prozac

How Prozac Works

Effectiveness of Drug in Treating Mood Disorders

• Results are about the same with MAOIs, tricyclics, and SSRIs– About 50% improve, compared to 25% of controls

• do not prevent future episodes

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Antidepressant Drugs

Antidepressant drugs like Prozac, Zoloft, and Paxil are Selective Serotonin Reuptake

Inhibitors (SSRIs) that improve the mood by elevating levels of serotonin by inhibiting

reuptake.

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Mood-Stabilizing Medications

For Bipolar DisorderLithium Carbonate, a common salt, It moderates the levels of norepinephrine and glutamate neurotransmitters.

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Brain Stimulation

Electroconvulsive Therapy (ECT)

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Alternatives to ECT

Repetitive Transcranial

Magnetic Stimulation (rTMS)

http://www.pbs.org/wgbh/nova/body/george-uses-tms.html

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Psychosurgery