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Therapies OverviewInsight TherapiesWhat are the basic techniques of psychoanalysis, and how are they used to help patients?What are the role and the goal of the therapist in person-centered therapy?What is the major emphasis of Gestalt therapy?

Relationship TherapiesWhat problems commonly associated with major depression does interpersonal therapy focus on?What is the goal of family therapy?What are some advantages of group therapy?

Therapies OverviewBehavior TherapiesHow do behavior therapist modify clients problematic behavior?What behavior therapies are based on classical conditioning?How does participant modeling help people overcome their fears?

Cognitive TherapiesWhat is the aim of rational-emotive therapy?How does Becks cognitive therapy help people overcome depression and panic disorder?

Therapies OverviewBiological TherapiesWhat are the advantages and disadvantages of using drugs to treat psychological disorders?What is electroconvulsive therapy (ECT) used for?What is psychosurgery, and for what problem is it used?Evaluating TherapiesWhat therapy, if any, is most effective in treating psychological disorders?Culturally and Gender-Sensitive TherapyWhat characterizes culturally sensitive and gender-sensitive therapy?

PsychotherapyAny type of approach that uses psychological rather than biological means to treat psychological disordersInsight TherapiesApproaches to psychotherapy based on the notion that psychological well-being depends on self-understandingOf ones own thoughts, emotions, motives, behavior, and coping mechanismsPsychodynamic TherapiesAttempt to uncover childhood experiences that are thought to explain a patients current difficultiesPsychoanalysisFreuds first psychodynamic therapyUses free association, dream analysis, and transference

Psychodynamic TherapiesFree AssociationA technique used to explore the unconscious by having patients reveal whatever thoughts, feelings, or images come to mindThe analyst pieces together the free-flowing associations, explaining their meaningsHelps the patient gain insight into troubling thoughts and behaviorsResistanceWhen a patient avoids revealing certain painful or embarrassing thoughtsHalting speech, forgetting appointments, or arriving lateDream AnalysisAreas of repressed emotional concerns expressed symbolically in dreams

Psychodynamic TherapiesTransferenceAn emotional reaction that occurs during psychoanalysisThe patient displays feelings and attitudes toward the analyst that were present in another significant relationshipFreud believed it an essential part of therapyPatient could relive troubling experiences from the past with the analyst as a parent substituteAids in resolving any hidden conflictsBrief Psychodynamic therapyPatient and therapist agree beforehand what issues to work on rather than wait for them to emergeTherapist assumes active role and emphasizes the present rather than the pastFound to be as effective as other therapiesEffective with patients with out multiple psychological disorders

Humanistic TherapiesAssumes people have the ability and freedom to lead rational lives and make rational choicesPerson-Centered TherapyA nondirective, humanistic therapy developed by Carl RogersThe therapist creates an accepting climate and shows empathyUnconditional Positive RegardFrees clients to be themselves and releasing their natural tendency toward self-actualizationPsychological disorders result when a persons natural tendency towards self-actualization is blocked by oneself or othersTherapist empathizes with clients concerns and emotionsReflecting listening used to respond allowing the client to control the direction of the sessions.Also called nondirective therapyRogers rejects all forms of therapy that cast the therapist as an expert who prescribes something to cure the problem

Gestalt TherapyOriginated by Fritz Perls emphasizes the importance of clients fully experiencing, in the present moment, their feelings, thoughts, and actions then taking responsibility for themGoal of Gestalt therapyHelp clients achieve a more integrated self and become more authentic and self-acceptingLearn to assume personal responsibility for their behavior rather than blaming society, past experiences, parents, or others.Directive TherapyAny type of therapy in which the therapist takes an active role in determining the course of therapy sessions and provides answers and suggestions to the patientGetting in touch with your feelings a major objectiveThose in need of therapy carry around unfinished businessEmpty Chair technique role plays past relationships

Relationship TherapiesAttempt to improve patients interpersonal relationships or create new relationships to support patients efforts to address psychological problemsInterpersonal TherapyDesigned to help depressed people better understand and cope with problems relating to their interpersonal relationshipsHelps Identify and cope with 4 types of interpersonal problems associated with depression:Unusual or Severe Responses to The Death of a Loved OneInterpersonal Role DisputesDifficulty Adjusting to Role TransitionsDivorce, career change, and retirementDeficits in Interpersonal SkillsBrief therapy with 12 to 16 weekly sessionsEffective for severe depression and low dropout rateLonger period with out depression relapse with monthly sessions

Family and Couples TherapyInvolves entire familyGoal of helping family members reach agreement on changes that will help heal the family unitImprove communicationCreate understandingEnhance harmony within the groupDynamics of the family unit How family members communicate How they act towards and view each otherPositively Effect Treating Disorders and Clinical ProblemsSexual dysfunctionsSchizophrenia when it accompanies medicationReduces relapse by reducing criticism, hostility, or emotional over-involvementAdolescent drug abuse

Therapists working with couples pay attention to the dynamics between the two people how they communicate act toward each other, and view each other.

Group TherapySeveral clients (7-10 usually) meet regularly with one or more therapists to resolve personal problemsLess expensive than regular therapyProvides individuals aSense of belonging Opportunity to express feelingsGet feedback from other membersGive and receive help and emotional supportSelf-Help GroupUsually are not led by a professional therapistsProvide people who share a common problem to meet and get supportMost focus on a single problem (drug abuse or depression)Alcoholics Anonymous The oldest and best known with 1.5 million members world wideDerivatives include Gamblers Anonymous, Overeaters Anonymous, Narcotics Anonymous, Sex addicts Anonymous

Group therapy can give individuals a sense of belonging and receive emotional opportunity to give and receive emotional support

Behavior TherapyBased on the idea that abnormal idea is learned Not a sign of an underlying disorderIf afraid to fly then fear of flying is the problemapplies the principles of operant and classical conditioning, or observational learningTo eliminate inappropriate or maladaptive behaviors and replace them with more adaptive responsesNot change the individuals personality structure or search for the origin of the problemBehavior ModificationUses learning principles to eliminate inappropriate or maladaptive behaviors and replace them with more adaptive responses

Behavior Modification TherapyBased on Operant ConditioningSeek to control the consequences of behaviorExtinction of undesirable behaviors accomplished byTerminating or withholding the reinforcement Seek to reinforce desirable behavior to increase its frequencyBest done in hospitals, prisons, and schools classroomsToken EconomiesRewards appropriate behavior with tokens Poker chips, coupons, play money, stars, stickers, etc.later exchanged for desired goods and/or privilegesWeekend passes, candy, gum, TV time, etc.Undesirable behaviors can be fined a certain number of tokens

Behavior Modification TherapyBased on Operant ConditioningTime OutUsed to eliminate undesirable behavior by withdrawing all reinforcers for a period of timeWorks well with children and adolescentsChildren are told in advance of rulesIf they do undesirable behaviors they will be removed from the situation for a period of timeNo more than 15 minutesIn a place containing no reinforcersNo toys, friends, television, books, etc.The undesirable behavior will stop if it is no longer reinforced Also works for breaking bad habits or developing good habitsDevise a reward system for desirable behaviorsReward gradual changes in the direction of the ultimate goal

Behavior Modification TherapyBased on Classical ConditioningSystematic DesensitizationUsed to treat fears by training clients in deep muscle relaxation Then confront a hierarchy of anxiety producing situations (real or imagined)Until they remain relaxed even in the most feared situation.Highly successfully treatment for eliminating fears and phobias in a short period of timeFloodingUsed to treat phobias by exposing clients to feared object or event for an extended period of time until anxiety decreasesFear of heights may stand on roof of high building until anxiety subsidesSessions do not end until patients are markedly less afraidIn vivo flooding (real life) works faster up to 6 sessions

A Possible Hierarchy of FearsUse what you have learned about systematic desensitization to create a step-by-step approach to help someone overcome a fear of taking tests. The persons hierarchy of fears begins with reading in the syllabus that a test will be given and culminates in actually taking the test. Fill in successive steps, according to a possible hierarchy of fears, that will lead to the final step.

Behavior Modification TherapyBased on Classical ConditioningExposure and Response PreventionExposes patients with obsessive-compulsive disorder to stimuli that trigger obsessions and compulsive ritualsTouching a door knob, piece of unwashed fruit, or garbage binPatients resist performing the compulsive rituals for progressively longer periods of timeWashing hands, bathing, etc.Therapist identifies trigger thoughts, objects, or situations Typically 10 treatment sessions over 3-7 weeks bring improvement in 60-70% of patientsLess relapse than those treated with drugs aloneAlso useful in treatment of posttraumatic stress disorder

Behavior Modification TherapyBased on Classical ConditioningAversion TherapyAn aversive stimulus is paired with a painful, sickening, or otherwise aversive stimulus until the behavior becomes associated with pain or discomfortElectric shock, emetics (causes nausea and vomiting), antabuseAntabuse reacts violently with alcohol causing a person to retch and vomit until the stomach is emptyPainting fingernails with bitter tasting coating to stop nail chewingParticipant ModelingAppropriate response to a feared stimulus is modeled in graduated steps Client attempts to imitate the model step by step while the therapist gives encouragement and supportMost phobias can be extinguished in only 3 or 4 hours

Approaches to Therapy

Approaches to Therapy Continued

Cognitive TherapiesAssume maladaptive behavior can result from irrational thoughts, beliefs, and ideasOften called Cognitive-Behavioral Approach Combine cognitive insight with methodological behavioral approachTherapists seek to change the way clients think determine effectiveness by assessing changes in the clients behaviorEffective in treatment of anxiety disorders hypochondriasis psychological drug dependence pathological gambling

Cognitive TherapiesRational Emotive Therapy a directive form of psychotherapy designed to challenge clients irrational beliefs about themselves and others. Based on Ellis ABC TheoryA = activating eventB = persons belief about the eventC = emotional consequence that followEllis claims it is not the event itself that causes the emotional consequence, rather it is the persons belief about the eventA does not cause C, B causes CIf the belief is irrational, then the emotional consequence can be extreme distress

The ABCs o f Rational-Emotive Therapy

Cognitive TherapiesRational Emotive Therapy Ellis believes clients do not benefit from warm, supportive therapeutic approaches that do not address the irrational thoughts that underlie the problemAs irrational beliefs are replaced emotional reactions become appropriate, less distressing, and lead to constructive behaviorsClients are taught they can not control demands of others but can control their emotional reactionsRelaxation techniques often taught to control emotional reactionsRET equally effective with systematic desensitization

Cognitive TherapiesBecks Cognitive TherapyHelp patients stop negative thoughts as they occur and replace them with more objective or positive thoughts. Automatic thoughts cause misery of depression and anxiety:To be happy I must be liked by everyoneIf people disagree with me, it means they dont like meDepressed people hold a negative view of the present, past, and future experiences It has never worked and I cant make it happenNotice only negative unpleasant things Fail to recognize positive events and feelingsJump to the wrong conclusionsNo one likes me

Cognitive TherapiesBecks Cognitive TherapyTherapist identifies and challenging irrational thoughts sets up a plan and guides the client so life experiences become evidence to refute false beliefsHomework assignments given to track automatic thoughts, feelings evoked by them, and writing substitute rational thoughtsBrief, lasting 10-20 sessionsExtensive research demonstrates high success rate with mild to moderate depressionPanic disorderGeneralized Anxiety disorderCocaine addiction, insomnia, and bulimiaNegative and positive symptoms of schizophreniaLess likely to relapse than those treated with antidepressant drugs

Becks Cognitive Therapy

Biological TherapiesTherapy based on the assumption that psychological disorders are symptoms of underlying physical problemsIncludes: drug therapy, electroconvulsive therapy, or psychosurgeryMillions of people take medications for psychological problemsDrug TherapyAntipsychotic drugsDrugs used to control severe psychotic symptomsDelusions, hallucinations, disorganized speech and behaviorBy inhibiting dopamine activityAlso known as neurolepticsThorazine, Stelazine, Compazine, Mellaril50% of patients have a good responseLong term use may lead to tardive dyskinesiaAlmost continual twitching and jerking of face and tongue and squirming movements of the hands and trunk

Biological TherapiesAntipsychotic drugsAtypical Neuroleptics (newer drugs) Clozapine, Risperidone, OlanzipineTarget both dopamine and serotoninMarked improvement in quality of life tardive dyskinesia is rareTreat both positive and negative effects of schizophrenia

Antidepressant DrugsAct as mood elevators for severely depressed people and are also prescribed to treat some anxiety disorders65-75% of patients report significant improvement40-50% report complete recoveryPlacebo studies demonstrate almost equal effectivenessResponses to antidepressants a combination of physiological effects on the brain and the patients confidence in effectiveness of treatmentTricyclics first generation of antidepressantsBlock reuptake of norepinephrine and serotonin into axon terminalsEnhancing the action of these neurotransmitters in the synapsesSide effects includeSedation, fatigue, dizziness, nervousness, dry mouth, forgetfulness, and weight gainWeight gain #1 reason (20 or more pounds) main reason people stop taking them despite benefit

Antidepressant DrugsSecond Generation AntidepressantsSelective serotonin reuptake inhibitors block the reuptake of serotonin increasing availability at the brain synapses Fewer side effects and safer in case of overdoseEffective in treatingObsessive-compulsive disorderSocial phobiaPanic disorderGeneralized anxiety disorderBinge eatingSide EffectsSexual dysfunctionReturns to normal when drug is discontinuedIncrease in suicide risk not substantiated

Antidepressant DrugsMonoamine Oxidase Inhibitors (MOA)Block the action of an enzyme that breaks down norepinephrine and serotonin in the synapsesIncrease the availability of norepinephrine and serotoninUsually prescribed to patients who do not respond to other antidepressantsSimilar side effects to tricyclic antidepressants plus patients must avoid certain foods to reduce the risk of strokeLithiumA naturally occurring salt used to treat bipolar disorderEffectiveness in treating depression and bipolar is unmatched40-60% of patients experience a recurrenceMonitoring blood level necessary to prevent nervous system damage

Antidepressant DrugsBenzodiazepinesValium, Librium, and XanaxPrescribed more often than any other classEffective in treating panic disorder and anxietyXanaxWorks fast and has few side effectsRelapse is likely if discontinuedWithdrawal symptoms include intense anxietyUnpleasant Side Effects of Drug TherapyDifficulty establishing proper dosagesHelp with symptoms but do not cure psychological disordersMaintenance doses are required to prevent relapseIncrease in homeless population

Electroconvulsive TherapyAn electric current is passed through the right hemisphere of the brain Usually reserved for severely depressed patients who are suicidal and dont respond to other treatmentsHighly effective for major depressionUnilateral ECT used today instead of bilateral ECTEqually effective with milder cognitive side-effectsPatients are given anesthesia, controlled oxygenation, and a muscle relaxantWhen Effective ECTChanges the biochemical balance in the brainCerebral blood flow in the prefrontal cortex is reduced Delta waves occurNo structural brain damage demonstrated by MRI or CT scans

PsychosurgeryBrain surgery performed to alleviate serious psychological disorders or unbearable chronic painSevere depression, anxiety, or obsessionsLobotomyThe first surgery severing neural connections between the frontal lobes and the deeper brain centers involved in emotionsInitially a tremendous contribution however treatment left patients in a severely deteriorated conditionModern PsychosurgeryResults in less intellectual impairmentSurgeons deliver electrical currents through electrodes to destroy smaller, localized areas of brain tissueHelpful with obsessive-compulsive disorderResults still not predictable and consequences are irreversibleTreatment is considered experimental and an absolute last resort

Evaluating the TherapiesVarious therapeutic approaches share many similaritiesSeveral help clients reflect on their own thoughts and/or emotionsMost therapists use a set of core techniques regardless of perspectiveSpecific element distinguish therapeutic approaches apartOverall:Psychotherapy is better than receiving no treatmentNo one type of treatment is more effective than the anotherBehavioral therapies show slight overall advantageCognitive and interpersonal therapies show advantage for depression Patients View of Effectiveness (Seligman & Consumer Reports 1995)Believe they benefit substantial from psychotherapyEqually satisfied with psychologist, psychiatrist, or social workerThe longer a patient was in therapy the more they improved (6 months+)Patients taking Prozac or Xanax believed it helped themPsychotherapy seemed to work as well as psychotherapy plus drugs

Culturally Sensitive TherapyAwareness of considering cultural variable in diagnosing and treating psychological disorders is growingAPA published guidelines The meaning of symptoms, outcomes, and responses to therapy within a cultural contextCultural difference may affect the therapeutic allianceLanguage differences can pose problemsPatients more fluent in Spanish but speak both Spanish and English may exhibit symptoms causing therapist to misdiagnoseHesitationsBacktrackingDelayed responses to questionsAffect results on standardized testsNeed to consider immigration experiences on thoughts and emotions

Culturally Sensitive TherapyWhen a therapist and client have the same racial or ethnic background, they are more likely to share cultural values and communication styles, which can facilitate the therapeutic process.

Culturally Sensitive TherapyCultural models should be included with interventionsNative American Healing CirclesPromote physical, mental, emotional, and spiritual well beingMay also include discussion, meditation, and prayerAddress group differences that can affect therapy resultsAfrican Americans are less likely to follow medication instructionsCompliance increased by understanding the importance of kinship and community relationships within the cultureHave the patient participate in a support group of members with the same disorder, medication and same cultureDiscuss racial perspectives prior to beginning therapy

Gender-Sensitive TherapyTakes into account the effects of gender on both the therapists and the clients behaviorTherapist must examine own gender-based prejudicesAssuming men are more logical and women more emotionalKnowledge of real differences between sexes is importantEmotional expression interventions may be less effective for men due to gender-role socializationMen may see therapy as a sign of weakness or threat to masculinityTherapist should avoid creating defensiveness in male clientsAvoid using research findings as a basis for stereotypingMore variation within each gender than across gendersConsider each man or woman as an individualPlacing too much emphasis on sensitivity and misinterpret clients problemsMay consider problems arise from gender-role conflict incorrectly

Is E-therapy Right for You?Typically involves the exchange of email messages over a period of hours or days but can also include video-conferencing and telephone sessions.Advantages of E-therapyLess inhibited than face-to-face sessionsLess expensiveDo not have to be in the same place at the same timeRandom scheduleLive in remote areasTherapist can keep accurate records of interactionsThey are good at expressing their thoughts and feelings in writing.

Is E-therapy Right for You?Disadvantages of E-therapyImposters can pose as therapistsNo present system for regulating or licensing e-therapistsEthical problems Possible breaches of confidentialityNo visual or auditory input limits possible feedback and responding to manifest symptoms.Finding an E-therapistVerify credentials via a third party (licensing or certification board)Get real-world contact information (address and phone number)Verify that you will receive personal replies to messagesFind out in advance how much the therapist charges.

Review QuestionsInsight TherapiesWhat are the basic techniques of psychoanalysis, and how are they used to help patients?What are the role and the goal of the therapist in person-centered therapy?What is the major emphasis of Gestalt therapy?Relationship TherapiesWhat problems commonly associated with major depression does interpersonal therapy focus on?What is the goal of family therapy?What are some advantages of group therapy?

Review QuestionsBehavior TherapiesHow do behavior therapists modify clients problematic behavior?What behavior therapies are based on classical conditioning?How does participant modeling help people overcome their fears?Cognitive TherapiesWhat is the aim of Rational-Emotive therapy?How does Becks cognitive therapy help people overcome depression and panic disorder?

Review QuestionsBiological TherapiesWhat are the advantages and disadvantages of using drugs to treat psychological disorders?What is electroconvulsive therapy (ECT) used for?What is psychosurgery, and for what problems is it used?Evaluating the TherapiesWhat therapy, if any, is most effective in treating psychological disorders?Culturally and Gender Sensitive TherapyWhat characterizes culturally and gender sensitive therapy?