Issues in Psychotherapy

What are Repressed Memories?

• Holly and Gary Ramona– Holly’s bulimia and accusation– Gary’s lawsuit

• Dad awarded $500,000.00 from therapist!

Freud and Repression

• Unpleasant thoughts, experiences, memories get pushed way down into unconsciousness

• These repressed items sneak out through slips of the tongue, symbolic behaviors, or psychologically abnormal behaviors

Validity & Frequency

• Clinical cases have been substantiated

• Different researchers found that 18%, 32%, and 59% of adult clients with a history of sexual abuse said that they had forgotten or recently uncovered repressed memories of sexual abuse

Elizabeth Loftus

• Increased occurrence in 1990s has been partly blamed on the practices of some therapists

The Therapist’s Role

• Therapists who treat survivors of incest and other traumatic situations maintain that repressed memories are so completely blocked that it may take deliberate suggestion and effort to release them

Can False Memories be Implanted?

• Loftus contacted the families of her students, found out whether they had ever been lost.

• Those who had not were subjects in an experiment.

Lost in a Mall Experiment, Loftus, 1996

• Ss. told story that at about 5 years of age, they were lost in a mall, complete with details of the local mall from where they lived at age 5.

Lost in a Mall Experiment, Loftus, 1996

• Ss. are asked questions about having been lost in the mall.

• 75% of what they remember were true facts about the mall, etc.

• 25% of what they remember is totally created based on what they had been told, falsely, had happened to them.

• A significant minority of people (in research) will believe the created memories actually did occur, even when presented with explanation.

Do photos enhance the creation of false memories?

• Garry and Gerrie, 2005• Instead of narratives of

being “lost in a mall”, Ss. are shown 4 photos, three are real childhood pictures, but the fourth is a ‘doctored’ photo of them and at least one other family member taking a hot-air-balloon ride.

Do photos enhance the creation of false memories?

• After Ss. reviewed each photo three times over a maximum of 2 weeks,

• 50% remembered something about the ride

• Descriptions were rich in detail

• When told the photo was a fake, many were genuinely surprised

Which is more effective at creating false memories, photos or narratives?

• Garry and Wade, 2005 combined the “lost in a mall” and “hot-air-balloon” experiments– Half of the Ss. saw a doctored photo of them in a

balloon, the other half read a detailed story about their balloon ride

– When interviewed about their memory of the ride, 50% of photo-viewers claimed it happened, but 80% of narrative-readers believed it had happened!

Why are made-up stories better than doctored photos?

• One theory is that photo forced a concrete visual memory, whereas narrative allowed them to generate their own details, expending more mental involvement, and thus making it more likely to believe our own story (invented though it may be).

A clinical case of false memories

• Dr. Diane Humenansky sued by a patient for medical malpractice– Client came in with Generalized Anxiety Disorder– 10 months later, Humenansky diagnosed Dissociative

Identity Disorder with over 100 alter personalities– Patient awarded $2,671,000.00

• $2 mill for pain/suffering, $461,000 for future damages, husband awarded $210,000 for loss of partnership

– A second patient came forward, sued and received $2,500,00.00

Loftus investigates techniques of rogue doctors• Therapist and patient

accounts• Sworn statements• Taped sessions• Artifacts - books & articles

doctor is reading/writing, etc.• Undercover patients• Surveys of therapists about

techniques commonly used• 75% did not use

questionable techniques

Humenansky used. . .

• Hypnosis• Sodium amytal (truth serum)• Group therapy (memory poker)• Age regression• Guided imagery related to abuse situations

So, does therapy work?

• What, and how, to measure?– Compare different

styles of therapy– How do we measure

improvement?

• Is psychotherapy more effective than no treatment at all?– “Spontaneous

remission”

• Improvement for people in weekly psychotherapy and people who did not receive psychotherapy.

• After 8 weekly sessions more than 50% receiving therapy were significantly improved compared to 4% of those not receiving therapy

• Clearly, psychotherapy accelerates both the rate and the degree of improvement for those experiencing psychological problems. SOURCE: McNeilly & Howard, 1991.

More Evidence of Psychotherapy’s Effectiveness

• PET scans of Obsessive Compulsive Disorder patients’ brains before and after 10 weeks of psychotherapy– Scans showed changes in the actual

structure and functioning of their brains similar to the changes that accompany patients who receive only drug therapy

Burlingame & Barlow, 1988

• Eight experimental therapy groups met for 15 weekly sessions– 4 groups run by

therapists– 4 groups run by

nonprofessionals

• 6 months out - non-expert group had deteriorated, pros did not!

What about relapse rates?

• Comparing those who received:

1. a placebo drug treatment;

2. a placebo and counseling;

3. drugs and counseling;

4. drugs only.

Is one form of psychotherapy better?

• Answer 1: No -- in general there is little or no difference in the effectiveness of different empirically supported psychotherapies

• Answer 2: Yes -- in some cases one type of therapy is more effective than another for treating a particular problem– E.g.,

• Depression -- – cognitive therapy

• Panic disorder, OCD, phobias– cognitive, behaviorist, CBT > insight oriented therapies

• Disorders with severe psychotic symptoms (e.g., schizophrenia)

– insight oriented therapies < other therapies

Daily Affirmations

Stuart Smalley

Jessica's Affirmations

Eclecticism• A good match between person and type of therapy

is important• Current trend in psychotherapy is Eclecticism--

pragmatic and integrated use of techniques from different psychotherapies.

• Today therapists identify themselves as eclectic more than any other orientation

• Eclectic psychotherapists carefully tailor the therapy approach to the problems and characteristics of the person seeking help.

What makes psychotherapy effective?

• A strong therapeutic relationship

• Personal characteristics of the therapist

• Personal characteristics of the client

• External circumstances– Family– Finances– Employer & co-workers