Therapies

Chapter 9

What is Psychotherapy?

Systematic interaction psychological principles Explores and influences

thoughts, feelings, and behavior to help that client overcome abnormal behavior or adjust to problems in living.

Psychodynamic Therapy

Psychodynamic theories are based on the thinking of Sigmund Freud, the founder of psychodynamic theory.

Focus upon the conflict amongst the three psychic structures (id, ego and superego).

Freud’s method of therapy, psychoanalysis, was the first psychodynamic therapy.

Psychoanalysis

Psychoanalysis seeks to help people develop insight into the dynamic struggles occurring within the psyche between the three psychic structures.

The goal is to bring conflicts between the psychic structures into conscious awareness and “work through” them.

Activity for free association.

Psychoanalysis Terms and Techniques

Free Association: In psychoanalysis, the uncensored uttering of all thoughts that come to mind.

Resistance: The tendency to block the free expression of impulses and primitive ideas—a reflection of the defense mechanism of repression.

Interpretation: An explanation of a client’s remarks according to psychoanalytic theory.

Psychoanalysis Terms and Techniques

Transference: Responding to one person in a way that is similar to the way one responded to another person in childhood. (ex. Displace feelings of father onto male therapist)

Dream Analysis: unconscious impulses tend to be expressed in dreams as a form of wish fulfillment. Dreams consist of both manifest content and latent content.

Activity

“Think of your partner or close friend. Think about some aspect of their personality that you have a strong reaction to, either positive or negative.

Now write that down on a scratch piece of paper.

Describe what that aspect of their personality is like, and how you react in your thoughts, feelings, and behavior toward that part of their personality.

Activity:

Here are several possibilities of how transference may play out.

You see the other in the same way as you believed your parent to have been (simple transference).

You see the other as being like what you WISH your parent COULD have been like

You see the OTHER AS YOU were as a child and you act like your parent did

You see the other as you were as a child and you act like you WISHED your parent could have acted.

Client-Centered Therapy

Carl Rogers’s emphasizes the creation of a warm,

therapeutic atmosphere that frees clients to engage in self-exploration and self-expression.

Frame of Reference: One’s unique patterning of perceptions and attitudes, according to which one evaluates events.

3 main qualities: Unconditional positive regard Empathic understanding Genuineness

Gestalt Therapy

Fritz Perls’s attempts to integrate conflicting parts

of the personality through directive methods designed to help clients perceive their whole selves.

Gestalt exercises include: The dialogue “I take responsibility” Playing the projection The empty chair Body language

Reflection Activity I need one volunteer to do a scripted role play

with me. Reflection: can be applied as a versatile and

powerful lens for helping a client uncover and clarify extremely important intrapsychic issues

Part 2: Listen to role play of client with problem (video). http://www.aetv.com/obsessed/episode-guide/?bcpid=30881450001&bctid=28981312001

On scratch piece of paper, write down EXACTLY what you would reflect back to the client based on what you heard (word for word).

Sharing of reflections.

Behavior Therapy

Behavior Therapy: Systematic application of the principles of learning to the direct modification of a client’s problem behaviors.

Behavior therapists draw upon the principles of classical and operant conditioning as well as observational learning.

Behavior Therapy (Fear Reduction Methods)

Flooding: A person is exposed for prolonged intervals to a fear-evoking but harmless stimulus until fear is extinguished.

Gradual exposure: Similar to flooding, but works upward in a hierarchy of progressively more fearful stimuli.

Systematic Desensitization: Wolpe’s method for reducing fears by associating a hierarchy of images of fear-evoking stimuli with deep muscle relaxation.

Modeling: A technique in which a client observes and imitates a person who approaches and copes with feared objects or situations.

Behavior Therapy (Aversive Conditioning)

Aversive Conditioning: A behavior therapy technique in which stimuli associated with undesired responses become aversive by pairing noxious stimuli with them.

Rapid Smoking: An aversive conditioning method for quitting smoking in which the smoker inhales every 6 seconds, thus rendering once-desirable cigarette smoke undesireable.

Behavior Therapy (Operant Conditioning Principles)

The Token Economy: A controlled environment in which people are reinforced for desired behaviors with tokens (such as poker chips) that may be exchanged for later privileges (Ex. Incentive plan).

Social Skills Training: Behavior therapists help people alleviate social anxiety and build social skills through having participants rehearse social behaviors in a group setting.

Biofeedback Training: The systematic feeding back to an organism of information about a bodily function so that the organism can gain control of that function.

Example of Behavioral Therapy

Video with example of Behavioral Therapy - gradual exposure.

From A&E show, “Obsessed”. http://www.aetv.com/obsessed/video/

index.jsp?bcpid=45697868001&bclid=23151005001&bctid=25714299001&baseURL=/bcconfig/Player/3Tier/Obsessed_ws/config-xml/&baseDIR=/bcplayers/Player/3Tier_ws/baseDIR/

Cognitive Therapies

Cognitive therapists focus on helping people change the beliefs, attitudes and automatic types of thinking that are believed to underlie psychological problems such as anxiety and depression.

The two most common cognitive therapies are Aaron Beck’s cognitive therapy and Albert Ellis’s rational-emotive behavior therapy.

Cognitive Therapies

Beck’s Cognitive Therapy: A form of therapy that focuses on how clients’ cognitions (expectations, attitudes, beliefs, etc.) lead to distress and may be modified to relieve distress and promote adaptive behavior.

Ellis’s Rational-Emotive Behavior Therapy (REBT): A form of therapy that encourages clients to challenge and correct irrational expectations and maladaptive behaviors.

Activity: “The Way I Think” Answer the following questions on a

separate piece of paper. 1) I often worry that I _____________. 2) If this worry of yours was indeed true,

what does it mean to you and why does it bother you so much?

2b) If what you JUST wrote was indeed true, what does it mean to you and why does it bother you so much?

2c) if what you JUST wrote was indeed true, what does it mean to you and why does it bother you so much?

Activity: “The Way I Think” (cont’) 3) What’s the worst thing that could

possibly happen? What do you fear most of all?

4) When you think of the worst thing that could happen, do you really think that it’s likely to happen? If so, how could you learn to cope with it?

5) What do I (perhaps “secretly”) get out of thinking like this? How does it work to my advantage?

Activity: “The Way I Think” (cont’) 6) Letter to your friend.

Pretend your friend has some of the same worrisome beliefs that you do.

Pick out one of the statements from questions 1-3 and write it down.

Write a compassionate, rational, and realistic response to your friend’s statement

Next line: Have your friend reply. Next line: respond again to your friend…try to

keep the conversation going for 10 lines or so.

Activity: “The Way I think” (cont’) 7) Positive imagery antedotes

Select 3 positive images (real or imaginary) related to: 1) confidence and strength in your life, 2) safety and peacefulness in your life, 3) love in your life

8) I accept myself even though I _____________. Now write this down 10 times!!

Convergence of Approaches

Today, many therapists don’t adhere to a single approach.

Many therapists utilize an eclectic approach.

These therapists tend to be older and/or more experienced.

Group Therapy Group therapy has several advantages:

It’s economical. Therapists can work with several clients at once.

It can provide more information and life experience for clients to draw upon.

Appropriate behavior receives support from the group.

Affiliating with people with similar problems is reassuring that we’re not alone.

Group members who improve provide hope for other group members,.

Group therapy can help those who are seeking therapy because of problems in relating to other people.

Couples Therapy

Couples therapy focuses on helping distressed couples resolve their conflicts and improve their communication skills.

Couples therapy helps correct power imbalances in the relationship so that partners can explore alternative ways of relating to one another.

The leading contemporary approach to couples therapy is based on cognitive-behavioral principles.

Family Therapy

A form of therapy in which the family unit is treated as the client.

In a systems approach to family therapy, the therapist helps the family change the system by which the family functions in order to enhance growth of individual family members and of the family as a whole.

Effectiveness of Psychotherapy

There are several problems that researchers must address when evaluating the effectiveness of psychotherapy. These problems include comparing different forms of psychotherapy, measuring outcomes of therapy and determining whether effectiveness is due to nonspecific factors or the therapeutic alliance. However…

Meta-analyses by Smith and Glass (1977) and Shadish (2000) have found that psychotherapy is effective.

Smith and Glass: Those who receive psychodynamic therapy showed better results, on average, than 70-75% of those who did not receive treatment. Similarly, nearly 75% of those who received client-centered therapy were better off than control groups.

Psychotherapy and Human Diversity

In general: Psychotherapists must attend to and respect their client’s sociocultural and individual differences. Therapists must also recognize their own ethical responsibilities if they are not comfortable with, or lack the skills to work with, a particular client.

Biomedical Therapies

Biomedical therapies are administered by doctors, such as psychiatrists. The three primary forms of biomedical therapy are drug therapy, electroconvulsive therapy and psychosurgery.

Drug Therapy

Psychotropic Drugs: Prescription drugs that are widely used to help relieve disturbing emotional states, such as anxiety or depression, or to control symptoms of severe disorders.

There are three major classes of psychotropic drugs: antianxiety, antipsychotic, and antidepressants.

Drug Therapy

Antianxiety: Most antianxiety drugs belong to the chemical class known as benzodiazapenes. Common drugs include Valium and Xanax. These drugs depress the activity of the central nervous system. Many people quickly develop a tolerance to antianxiety drugs.

Antipsychotic: Are a group of drugs that help relieve psychotic symptoms. These drugs are believed to act by blocking dopamine receptors in the brain.

Antidepressants: A group of drugs that primarily help relieve depression, but also are used to treat obsessive-compulsive disorder, bulimia and panic disorder amongst others. Three major classes include Monoamine Oxidase (MAO) inhibitors (such as Nardil), Tricyclics (such as Tofranil) and Selective Serotonin-Reuptake Inhibitors (SSRIs) such as Prozac and Zoloft.

Electroconvulsive Therapy (ECT)

Treats disorders like major depression by passing an electric current (that causes a convulsion) through the head.

People usually receive ECT in a series of 6 to 12 treatments spread over several weeks.

Problems with ECT include potential memory loss and high relapse rates.

Evaluating Biomedical Therapies

The introduction of antipsychotic drugs made it possible for hundreds of thousands of mental hospital patients to return home.

However, psychiatric drugs are not a cure all. They can have troubling side effects.

Also, psychotherapy has been found to be as effective (if not more so) than drug therapies for certain disorders (such as depression).

Ultimately, a combination of psychotherapy and biomedical treatment may be the best course of action.

Coping with Anxiety and Fear

1. Define the feared object or situation.

2. List specific behaviors that make up a gradual approach of the target.

3. Create a hierarchy of fears.

4. Utilize gradual exposure, starting with the least threatening item of your hierarchy.

5. Pay attention to your cognitions.

Managing Anger

Monitor your reactions in angering situations. Stop and think Practice competing responses and competing

thoughts. Practice self-relaxation. Don’t impose unrealistic expectations on others. Replace anger with empathy. Depersonalize the situation. Keep your voice down. Act assertively, not aggressively. Express positive feelings. Give yourself a pat on the back for keeping your

cool.

Lifting your Mood

Engage in pleasant activities: Utilizing the list in your book, engage in at least three of these events each day. Record your activities in a diary and toward the end of each day, rate your response to each activity. After a week or so, check the items in your diary that received positive ratings and repeat successful activities while experimenting with new ones.

Think Rationally: Recognize and change distorted thoughts into rational thoughts.

Exercise: Exercise can enhance psychological well-being and help us cope with depression.

Homework

Journal #5