Therapy Chapter 16. Therapy The Psychological Therapies Psychotherapy – interaction between...

Therapy

Chapter 16

Therapy

The Psychological Therapies

Psychotherapy – interaction between trained therapist and a person seeking to overcome a psychological disorder or achieve personal growth

Therapy


Psychoanalysis – Sigmund Freud’s therapeutic approach

Freud’s “consulting room”

Aims and Methods: Through free association and dream analysis, to uncover repressed thoughts, memories, and feelings, and bring them into conscious awareness to help patient to take responsibility for their own growth.

Criticisms: Interpretations of therapist cannot be proven or disproven; also, psychoanalysis takes a great deal of time (years) and is expensive.

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Humanistic Therapies – emphasize people’s inherent potential for self-fulfillment; goal to boost self-fulfillment by helping people grow in self-awareness

Client-centered therapy: a humanistic therapy, developed by Carl Rogers, in which the therapist uses techniques such as active listening with a genuine, accepting, empathic environment (a non-directive therapy).

Credit: Michael Rougier/Life Magazine

“Hearing has consequences. When I truly hear a person and the meanings that are important to him at the present moment, hearing not simply his words, but him, and when I let him know that I have heard his own private personal meanings, many things happen…” - Carl Rogers

Credit: Michael Rougier/Life Magazine

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Behavior Therapies – therapy that applies learning principles to the elimination of unwanted behaviors

Classical Conditioning Techniques

Exposure Therapies: behavior techniques that treats anxiety by exposing people (in imagination or reality) to the things they fear and avoid.

Credit: Bob Mahoney/The Image Works

Classical Conditioning Techniques

The idea: Just as people can habituate to the sound of a passing train in a new apartment, they can become less anxiously responsive to the things they once feared.

Credit: Bob Mahoney/The Image Works

Aversive Conditioning: a behavioral technique that associates an unpleasant state with an unwanted behavior.

Aversive therapy for alcohol dependency: After drinking an alcoholic drink mixed with a drug that produces nausea (antabuse), some people develop conditioned aversion to alcohol.

Operant Conditioning Techniques

Token economy: an operant conditioning procedure in which people earn a token of some sort for exhibiting desired behavior and can later exchange the tokens for various privileges or treats.

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Cognitive Therapies – therapy that teaches people new, more

adaptive ways of thinking and acting; based on the assumption that thoughts intervene between events and emotional reactions

A cognitive perspective on psychological disorders: The person’s emotional reactions are produced not directly by the event but by the person’s thoughts in response to the event.

Cognitive-Behavior Therapy

CBT – an integrative therapy that aims to alter the way people think (cognitive therapy) and the way they act (behavior therapy).

Events Thoughts Behavior

Emotions

Psychological Disorders and Therapy


Family Therapy – therapy that treats the family as a system; views

an individual’s unwanted behaviors as influenced by other family members

The therapist helps family members understand how their ways of relating to one another creates problems; the emphasis is not on changing the individual but on changing their relationships.

Credit: Michael Newman/PhotoEdit

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Evaluating Psychotherapies

Is Psychotherapy Effective?

Clients’ Perceptions

The problem with perceptions: People often enter therapy in crisis, and when the crisis passes, people often attribute improvement to therapy.

© M

ary Kate D

enny/ PhotoEdit, Inc.


The problem with perceptions: Clients may need to believe the therapy was worth the effort an expense.

© M

ary Kate D



The problem with perceptions: Clients generally speak kindly of their therapists, even if the problems remain.

© M

ary Kate D


Clinicians’ Perceptions

The problem with perceptions: Clinicians are human, and as such, they remember their successes more than their failures.

© M

ary Kate D


Outcome Research

Meta analysis – a procedure for statistically combining the results of many different research studies. Above, data from 475 studies showing improvement of untreated people vs. psychotherapy clients.

Outcome Research

The bottom-line: Those not undergoing therapy often improve, but those undergoing therapy are more likely to improve.

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Evaluating Psychotherapies

Relative Effectiveness of Different Therapies

There is little connection between outcomes and clinicians’ experience, licensing, etc., but certain therapies are more effective for certain disorders.

There is little connection between outcomes and clinicians’ experience, licensing, etc., but certain therapies are more effective for certain disorders. For example, there is good evidence that light exposure therapy is an effective treatment of SAD.

Credit: Christine Brune

Disorder Therapy

Depression Behavior, Cognition, Interpersonal

Anxiety Cognition, Exposure, Stress Inoculation

Bulimia Cognitive-behavior

Phobia Behavior

Bed Wetting

Behavior Modification

Evidence-based practice – clinical decision making that integrates the best available evidence with clinical expertise and patient characteristics and preferences

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The Biomedical Therapies

Prescribed medications or medical procedures that act directly on the patient’s nervous system

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Drug Procedures

Antipsychotic Drugs

Antipsychotic drugs – drugs used to treat schizophrenia and other forms of severe thought disorders

Antianxiety Drugs

Antianxiety drugs – drugs used to control anxiety and agitation

Credit: Nsaum75

Antidepressant Drugs

Antidepressant drugs – drugs used to treat depression (and increasingly prescribed for anxiety).

Credit: Tom Varco

SSRI – Selective Serotonin Reuptake Inhibitor

Antidepressant Drugs

There is some evidence for effectiveness of SSRIs. Experts agree that people taking SSRIs for a month improve. But some of this is spontaneous recovery.

Credit: Tom Varco

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Brain Stimulation

Credit: Eric S. Lesser

Electroconvulsive Therapy

ECT – a treatment for depression that does not respond to drug therapy. There is evidence that it is effective, but no one is quite sure how it works (may calm neural centers where overactivity produces depression).

Alternative Neurostimulation Therapies

Repetitive TMS – the application of repeated pulses of magnetic energy to the brain; used to stimulate or suppress brain activity.

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Psychosurgery – surgery that removes or destroys brain tissue

Credit: Discover Magazine

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Therapeutic Life-Style Change

1. Aerobic exercise

2. Adequate sleep

3. Light exposure

4. Social connection

5. Nutritional supplements

Chapter Review

What is psychotherapy? What are major types of psychotherapy?

Is psychotherapy effective? What certain approaches are better for certain disorders?

What is biomedical therapy? How effective are drugs? Other biomedical treatments?

Therapy Chapter 16. Therapy The Psychological Therapies Psychotherapy – interaction between...

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