Types of Therapy / Treatment

Insight TherapyBehavioral TherapyCognitive TherapyGroup TherapyBiological Treatments

Insight Therapies

Psychoanalysis

Client-Centered Therapy

Gestalt Therapy

Short-term psychodynamic

Virtual therapy

Psychoanalysis Designed to bring repressed feelings and

thoughts to conscious awareness Free association

Patient talks about whatever comes to mind Transference

Client’s feelings about authority figures, both positive and negative, transferred to therapist

Insight Awareness of previously unconscious

feelings and memories and how they influence present behavior

Client-Centered Therapy

Developed by Carl Rogers Goal is to help clients become fully

functioning Therapist expresses unconditional

positive regard Therapy is nondirective Therapist reflects clients’ statements

Gestalt Therapy

Outgrowth of the work of Fritz Perls Emphasizes the wholeness of

personality Attempts to reawaken people to their

emotions and sensations in the here-and-now

Encourages confrontation with issues Therapist is active and directive

Recent Developments

Short-term psychodynamic psychotherapyFocused on trying to help people

correct the immediate problems in their lives

Virtual therapyTherapy delivered online

Behavior Therapies

Based on the belief that all behavior is learned

Objective of therapy is to teach people new ways of behaving

Examples:

•Classical Conditioning

•Operant Conditioning

•Modeling

Using Classical Conditioning Techniques Systematic desensitization

Gradually associating relaxation with what was feared

Extinction Ending of old fears or reactions

Flooding Full-intensity exposure to feared object

Aversive conditioning Eliminate undesirable behavior by associating it

with pain and discomfort

Operant Conditioning

Behavior contractingClient and therapist set behavioral goals

and agree on reinforcements the person will receive

Token economyClients earn tokens for desired behaviors

and exchange them for desired items or privileges

Often used in schools and hospitals

Modeling

Person learns new behaviors by watching others perform those behaviors

Sometimes used in conjunction with operant conditioning

Cognitive Therapies

•Stress Inoculation

•RET

•Beck’s Cognitive Therapy

Stress-Inoculation Therapy

Type of cognitive therapy that trains people to cope with stressful situations by learning a more useful patterns of self-talk

Taught to suppress negative and anxiety-provoking thoughts in times of stress

Particularly effective for treating anxiety disorders

Rational-Emotive Therapy (RET)

A directive therapy based on the idea that psychological distress is caused by irrational and self-defeating beliefs

Core problem is belief in “musts” and “shoulds” that leave no room for making mistakes

Therapist’s job is to challenge client’s irrational beliefs

Beck’s Cognitive Therapy

Aimed at identifying and changing inappropriately negative and self-critical patterns of thought

Good treatment for depression

Group Therapies•Family

•Couple

•Self-help

Family Therapy

Form of group therapy that sees the family as at least partly responsible for the individual’s problems

Seeks to change all family members’ behavior to the benefit of the family and the individual

Couple Therapy

A form of group therapy intended to help troubled partners improve their communication and interaction

Empathy trainingPartners taught to share feelings and

listen to and understand partner’s feelings

Self-Help Groups

Small, local gatherings of people who share common problems and provide mutual assistance at very low cost

Alcoholics Anonymous is an example

Effectiveness of Psychotherapy Does Psychotherapy Work?

Psychotherapy helps about 2/3rd of people treated

Approximately 1/3 would improve without therapy

Which Type of Therapy is Best for Which Disorder? No one type of therapy is better Key is to match the problem with the

appropriate therapy

Biological Treatments

•Drug therapy

Anti-psychotic, Anti-depressant, Psycho-stimulants, Anti-anxiety

•Electroconvulsive

•Psychosurgery

Drug Therapies

Major reasons for widespread use of drugsDrugs are effective at treating

disordersDrug therapies are often less

expensive that psychotherapy

Antipsychotic Drugs

Used for schizophrenia or psychosis All antipsychotics block dopamine

receptors in the brain Phenothiazines (Thorazine)

Antidepressant Drugs

Tricyclics and MAO inhibitors Most common antidepressants prior to late

1980s Work by increasing amount of the

neurotransmitters serotonin and norepinephrine Effective, but have serious side effects

Selective Serotonin Reuptake Inhibitors (SSRIs) Work by blocking the reuptake of serotonin Prozac, Paxil, Zoloft, Effexor

Action of SSRIs

Lithium

A naturally occurring salt that is used to treat bipolar disorder (manic depression)

Nobody knows how lithium works to alleviate symptoms

Problem with people stopping medication when symptoms ease

Other Medications

PsychostimulantsUse to treat disorders such as AD/HDConcern that psychostimulants are being

overused Antianxiety medications

Use to treat anxiety disordersProduce a feeling of calm and mild

euphoriaValium is a common antianxiety medication

Electroconvulsive Therapy

Commonly known as “shock therapy” Used as a treatment for severe

depression Causes brief convulsions and

temporary loss of consciousness Memory loss is a side-effect Newer techniques minimize effects on

memory

Psychosurgery

Brain surgery performed to change a person’s behavior or emotional state

A prefrontal lobotomy is an example Psychosurgery is rarely used today

Institutionalization and Its Alternatives

Institutions offer:

•Shelter

•Care

•Therapy / Treatment / Counseling

•Transition training and preparation for real world

living

•Relief for family members

Deinstitutionalization

Releasing people with severe psychological disorders into the community

Can cause problems Some people are ill-prepared to deal with life

outside of a hospital Up to 40% of homeless are mentally ill Alternative forms of treatment (many)

Half-way houses Family-crisis interventions Day-care

Prevention

Primary prevention Improve the social environment so that new

cases of mental disorders do not develop• Family planning• Genetic counseling

Secondary prevention Interventions with high risk groups (e.g.,

suicide hot-line) Tertiary prevention

Help people adjust after they are released from the hospital in order to help prevent a relapse

Gender Differences in Treatment

More women admit problems and go to therapy

Women are more likely to take medication

Psychotherapy is seen as more acceptable for women

Recent increases in number of males seeking psychotherapy

Cultural Difference in Treatment Eye contact and body language varies

across cultures and may be misinterpreted as symptomatic of a disorder

Another challenge is treating post-traumatic stress disorder in refugees

There may be disorders in other cultures that do not appear in U.S.

The main goal of insight therapies is to give clients a better understanding and awareness of their feelings, motivations,

and actions in the hope that this will lead to better adjustment. Behavior therapies are based on the belief that all behavior, normal and abnormal, is learned, and that the objective of

therapy is to teach people more satisfying ways of behaving. Cognitive therapies aim at changing clients' maladaptive ways of thinking about themselves and the world. Group therapy is

based on the idea that psychological problems are at least partly interpersonal problems and are therefore best

approached in an interpersonal setting. Group therapy provides social support and is less costly than individual

therapy.

Review

Psychoanalysis is a therapy based on the belief that psychological problems stem from feelings and conflicts repressed during childhood. One way to uncover what has been repressed is through free association, a process in which the client discloses whatever thoughts or fantasies come to mind without editing or otherwise inhibiting them. In classical psychoanalysis, the patient comes to transfer feelings held toward authority figures from childhood to the analyst, a process known as transference. The goal of psychoanalysis is insight, or awareness of feelings, memories, and actions from the past that were unconscious but were exerting a strong influence on the patient's present feelings and behavior.

Client-centered (or person-centered) therapy, founded by Carl Rogers, is built on the idea that therapy should be based on the client's view of the world rather than the therapist's and on the client's responsibility for change. The therapist's most important task is to provide unconditional positive regard for clients so that they will learn to accept themselves. Gestalt therapy grew out of the work of Fritz Perls and is designed to help people become more aware of their feelings and more genuine in their day-to-day interactions. The emphasis in therapy is on making the person whole and complete.

Behavior therapies are based on the belief that all behavior, normal and abnormal, is learned, and that the objective of therapy is to teach people more satisfying ways of behaving. Classical conditioning therapies attempt to evoke

a new conditioned response to old stimuli. For example, systematic desensitization is a method for gradually reducing irrational fears by imagining---or confronting in real life---increasingly fearful situations while maintaining a relaxed state. Eventually, relaxation replaces fear as a response, perhaps as a result of extinction. Flooding, which subjects the person to feared situations at full intensity and for a prolonged time, is a somewhat harsh but highly effective method of desensitization. Aversive conditioning has the opposite goal: it conditions a negative rather than a positive response to a stimulus such as the sight or taste of alcohol. Its purpose is to eliminate undesirable behaviors by associating them with pain and discomfort. Operant conditioning techniques work by reinforcing new behaviors and ignoring or punishing old ones. In one such technique, called behavior contracting, client and therapist agree on certain behavioral goals and on the reinforcement the client will receive upon reaching those goals. In another technique, called the token economy, tokens that can be cashed in for "rewards" are used to positively reinforce many different kinds of desired behavior. In modeling, a person learns new behaviors by watching others perform those behaviors.

Stress-inoculation therapy teaches clients new and positive patterns of self-talk they can use to support themselves through stressful situations. Rational-emotive therapy (RET) is based on the idea that people's emotional problems derive from a set of irrational and self-defeating beliefs they hold about themselves and the world. The therapist vigorously challenges these beliefs until the client comes to see just how irrational and dysfunctional they are. Aaron Beck believes that depression results from negative patterns of thought that are strongly and inappropriately self-critical. His cognitive therapy tries to help clients think more positively about themselves and the world.

Group therapy is based on the idea that psychological problems are at least partly interpersonal problems and are therefore best approached in an interpersonal setting. Group therapy provides social support and is less costly than individual therapy. Family therapy is based on the idea that an individual's psychological problems are to some extent family problems. Therefore, the therapist treats the family unit rather than the isolated individual, with the goal of improving communication and empathy among family members and reducing intrafamily conflict. Couple therapy concentrates on improving patterns of communication and interaction.

Most researchers agree that psychotherapy helps about two-thirds of the people treated. Most kinds of therapy are more effective than no treatment at all, but researchers have found few major differences in the effectiveness of various forms of therapy. The general trend in psychotherapy is toward eclecticism, the use of a broad treatment package rather than one single form of therapy.

Biological treatments, including medication, electroconvulsive therapy, and psychosurgery, are sometimes used when psychotherapy does not work or when a client has a disorder for which biological treatment is known to be safe and effective. Medication, especially, is very often used in conjunction with psychotherapy

Drugs are the most common biological therapies. Antipsychotic drugs are valuable in the treatment of schizophrenia; they do not cure the disorder, but they do reduce its symptoms. Side effects can be severe, however. Antidepressant drugs alleviate depression, though some have serious side effects. Often the effectiveness of antidepressants such as Prozac seems to be due to the patient's belief that the drug will work (the placebo effect). Many other types of medication are used to treat psychological disorders, including antianxiety drugs, sedatives, and psychostimultants for children with attention-deficit/hyperactivity disorder.

Electroconvulsive therapy (ECT) is used for cases of severe depression that do not respond to other treatments. An electric current briefly passed through the brain of the patient produces convulsions and temporary coma.

Psychosurgery is brain surgery performed to change a person's behavior and emotional state. It is rarely done today, and then only as a last desperate measure on patients with intractable psychoses.

Large mental hospitals offer people with severe mental disorders shelter and a degree of care, but a number of problems are linked with institutionalization, including inadequate care and the tendency of patients to become lethargic and accept a permanent "sick role." With the advent of antipsychotic drugs in the 1950s, many patients were released from large public hospitals to be cared for in a community setting, in the policy of deinstitutionalization. But community mental-health centers and other support services proved inadequate to the task. As a result, many former patients stopped taking their medication, became homeless, and ended up suffering from psychosis and living on the street.

Alternatives to hospitalization range from living in the family home, with training to cope with daily activities for the mentally ill individual and crisis therapy for the family, to small homelike facilities in which residents and staff share responsibilities. Most alternative treatments involve some medication of the troubled individual and skillful preparation of the family/community. The majority of studies have found more positive outcomes for alternative treatments than for hospitalization.

Prevention refers to efforts to reduce the incidence of mental illness. Primary prevention refers to improving the social environment through assistance to parents, education, and family planning. Secondary prevention refers to identifying high-risk groups and directing service to them. The object of tertiary prevention is to help hospitalized patients return to the community.

Reference:

Psychology, an Introduction, 12th ed. ; Morris, Charles & Maisto, Albert

Pearson Publishers, 2010 (chapter 14)

Psychology, a Journey, 2nd ed.; Coon, Dennis

Thomson/Wadsworth Publishers, 2005 (chapter 13)

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