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Insight Therapies Relationship Therapies Behavior Therapies Cognitive Behavior Therapies Biomedical Therapies Practical Issues in Psychotherapy Copyright 2011 Pearson Education, Inc. All Rights Reserved

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Psychotherapy treatments that use psychological rather than biological means to treat emotional and behavioral disorders Insight Therapies approaches to psychotherapy based on the notion that psychological well-being depends on self-understanding Copyright 2011 Pearson Education, Inc. All Rights Reserved

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Attempts to uncover repressed childhood experiences that are thought to cause the patients current problems Psychoanalysis first psychodynamic technique developed by Freud techniques: free association explores the unconscious Patient reveals whatever thoughts, feelings, or images come to mind. dream analysis Areas of emotional concern repressed in waking life are sometimes expressed in symbolic form in dreams. transference emotional reaction that occurs during psychoanalysis Patient displays feelings and attitudes toward the analyst present in another significant relationship. Copyright 2011 Pearson Education, Inc. All Rights Reserved

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Object Relations Therapy The main goal of the personality is to forge functional links between the self and others in the environment. Early relationships form blueprints for future relationships. Therapists help clients restructure current relationships, changing maladaptive patterns formed in early relationships. Interpersonal Therapy (ITP) brief psychotherapy: 12 to 16 sessions effective with depression and bipolar illness four interpersonal problems associated with depression: Severe response to death of a loved one Interpersonal role disputes Difficulty adjusting to role transitions Deficits in interpersonal skills Copyright 2011 Pearson Education, Inc. All Rights Reserved

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Therapies assume that people have the ability and freedom to lead rational lives and make rational choices. Person-Centered Therapy Carl Rogers (1951) Disorder results when the natural tendency toward self- actualization is blocked. The therapist attempts to create an accepting climate based on unconditional positive regard. non-directive therapy The therapist allows the direction of the therapy sessions to be controlled by the client. The goal is to allow the client to direct the therapy session and move toward self-actualization. realization of inner potential Copyright 2011 Pearson Education, Inc. All Rights Reserved

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Developed by Fritz Perls (1969) Goal of therapy is to: Help clients achieve a more integrated self Allow clients to become more authentic and self- accepting Gestalt therapy is directive. The therapist actively directs the therapy session. provides answers and suggestions to the client Getting in touch with your feelings is a major objective. Copyright 2011 Pearson Education, Inc. All Rights Reserved

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Relationship Therapies look not only at the individuals internal struggles but also at his or her interpersonal relationships Family Therapy Parents and children enter therapy as a group. The goal is to help family members. Heal wounds to the family Improve communication Create more understanding within the family Couple Therapy The goal is to help partners in an intimate relationship. Communicate Manage conflicts more effectively may focus on behavioral change or partners emotional responses to each other Copyright 2011 Pearson Education, Inc. All Rights Reserved

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Seven to ten clients meet regularly with one or more therapists to resolve personal problems. Provides client with a sense of belonging and the opportunity to: Express feelings Get feedback from other group members Give and receive emotional support Self-Help Groups usually not led by professional therapists groups of people who share a common problem and meet to give and receive support Alcoholics Anonymous one of the oldest and best-known groups Copyright 2011 Pearson Education, Inc. All Rights Reserved

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A treatment approach consistent with the learning perspective on psychological disorders Abnormal behavior is learned. the behavior itself as the disorder use learning principles to eliminate inappropriate or maladaptive behaviors The goal is to change the troublesome behavior. Copyright 2011 Pearson Education, Inc. All Rights Reserved

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Techniques seek to control the consequences of behavior. Extinction of undesirable behavior by terminating or withholding reinforcement maintaining the behavior Institutional settings are well-suited for behavior modification. Consequences of behavior can be controlled. token economy rewards appropriate behavior with poker chips, play money, points Therapies are effective in modifying the behaviors of seriously disturbed people. Copyright 2011 Pearson Education, Inc. All Rights Reserved

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Systematic Desensitization based on classical conditioning used to treat fears Client is trained in deep muscle relaxation. confront hierarchy of fears highly successful treatment for eliminating fears and phobias in a relatively short time Flooding behavior therapy based on classical conditioning used to treat phobias by exposing clients to the feared object or event for an extended period, until their anxiety decreases Copyright 2011 Pearson Education, Inc. All Rights Reserved

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Exposure and Response Prevention successful with obsessive-compulsive disorder two components: exposure exposing clients to objects or situations that trigger obsessions and compulsive rituals response prevention The client agrees to resist performing compulsive rituals for longer and longer periods of time. Treatment can bring about considerable improvement in 60 to 70 percent of patients. Copyright 2011 Pearson Education, Inc. All Rights Reserved

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Aversion Therapy aversive stimulus paired with a harmful or socially undesirable behavior Behavior becomes associated with pain or discomfort. controversial brings intentional discomfort to client Participant Modeling based on Albert Banduras principles of observational learning A model demonstrates appropriate responses to a feared stimulus in graduated steps. The client imitates the model with the encouragement of a therapist. Most specific phobias can be extinguished in 3 to 4 hours. Copyright 2011 Pearson Education, Inc. All Rights Reserved

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Assume that maladaptive behavior results from irrational thoughts, beliefs, and ideas The therapist tries to change these (Dowd, Clen, & Arnold, 2010). The approach is effective for treating a wide variety of problems. anxiety disorders (Kellett et al., 2004), psychological drug dependence (Babor, 2004), and mood disorders (Totterdell & Kellett, 2008) Two Best-Known Types of CBT Albert Elliss rational emotive behavior therapy (REBT) Aaron Becks cognitive therapy (CT) Copyright 2011 Pearson Education, Inc. All Rights Reserved

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Albert Ellis developed the technique as a way of addressing his own problems with incapacitating anxiety (Ellis, 2004a) Based on Ellis ABC Theory A = the activating event B = belief about the event C = emotional consequence that follows Directive form of therapy The goal is to challenge and modify a clients irrational beliefs about the self and others. Individuals receiving REBT do better than those receiving no treatment or a placebo (Browne, Dowd, & Freeman, 2010). Copyright 2011 Pearson Education, Inc. All Rights Reserved

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Aaron T. Beck (1976) Some misery endured by a person with depression and anxiety can be traced to automatic thoughts. unreasonable but unquestioned ideas that rule the persons life The goal of therapy is to help clients overcome the impact of cognitive errors. Helps clients stop negative thoughts as they occur and replace them with more objective thoughts. Therapy is brief. ten to twenty sessions effective with mild to moderate depression and panic disorder Copyright 2011 Pearson Education, Inc. All Rights Reserved

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Most frequently used biological treatment Breakthroughs in drug therapies have been credited with the reduction in the amount of time a patient is hospitalized. Copyright 2011 Pearson Education, Inc. All Rights Reserved

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Antipsychotic Drugs known as neuroleptics prescribed primarily for schizophrenia control hallucinations, delusions, disorganized speech, and behavior Fifty percent of patients have a good response to antipsychotics. tardive dyskinesia severe side effect of long-term drug use twitching and jerking, squirming movements Newer antipsychotic drugs atypical neuroleptics (clozapine, risperidone, olanzipine) treat positive and negative symptoms of schizophrenia Copyright 2011 Pearson Education, Inc. All Rights Reserved

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Antidepressant Drugs mood elevators for severe depression helpful in the treatment of certain anxiety disorders Of the people who take antidepressants, 65 to 75 percent significantly improve; 40 to 50 percent essentially completely recover. Responses to antidepressant drugs result from a combination of: Physiological effects of these medications on the brain Confidence in the effectiveness of drug treatment Copyright 2011 Pearson Education, Inc. All Rights Reserved

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Types of Anti-Depressant Drugs First-Generation Antidepressants tricyclics (amitriptyline, imipramine) block reuptake of norepinephrine and serotonin into axon terminals Second-Generation Antidepressants selective serotonin reuptake inhibitors (SSRIs) block reuptake of serotonin, increasing its availability at synapses in the brain Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) appear more effective than the SSRIs; produce fewer side effects Monoamine Oxidase (MAO) Inhibitors block action of enzyme that breaks down norepinephrine and serotonin in the synapses Copyright 2011 Pearson Education, Inc. All Rights Reserved

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Lithium and Anticonvulsant Drugs The clinical effectiveness of lithium for treating depression and bipolar disorder is unmatched. A naturally occurring salt, lithium is effective for 40 to 50 percent of people who have bipolar disorder. anticonvulsant drugs may be just as effective for managing bipolar symptoms as lithium Anti-Anxiety Drugs minor tranquilizers called benzodiazepines include: Valium, Librium and Xanax Users may experience moderate to intense withdrawal symptoms, including intense anxiety. Copyright 2011 Pearson Education, Inc. All Rights Reserved

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Disadvantages of Drug Therapy difficulty in establishing the proper dosages Drugs do not cure psychological disorders. Drug therapy often prevents people with psychological disorders from being advised of other forms of therapy that may reduce or eliminate the need for psychiatric drugs. Copyright 2011 Pearson Education, Inc. All Rights Reserved

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Electric current is administered to the right cerebral hemisphere (unilateral ECT). Patient is under anesthesia. usually reserved for severely depressed patients who are suicidal ECT was misused and overused in the 1940s and 1950s, leaving it with a bad reputation. Highly effective treatment for major depression Possibly works by changing biochemical balance in the brain Rapid Transcranial Magnetic Stimulation (rTMS) newer, magnetic therapy; not invasive no known side effects Copyright 2011 Pearson Education, Inc. All Rights Reserved

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Brain surgery performed to alleviate serious psychological disorders or unbearable chronic pain Lobotomy severs neural connections between frontal lobes and deeper centers involved in emotion no longer performed leaves patients in permanently deteriorated condition Cingulotomy destroys cingulum can help in extreme cases of OCD Psychosurgery is controversial. considered experimental and a last resort Results are unpredictable and permanent. Copyright 2011 Pearson Education, Inc. All Rights Reserved

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Psychologist has an advanced degreeusually a doctoratein psychology clinical psychologists generally diagnose and treat psychological disorders counseling psychologists generally provide therapy for normal problems of life, such as divorce Psychiatrist is a medical doctor can prescribe drug therapy Copyright 2011 Pearson Education, Inc. All Rights Reserved

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Ethical Considerations According to the ethics code of the American Psychological Association (2002),therapists must take reasonable steps to: Ensure the well-being and rights of client Avoid causing them any kind of immediate or long-term harm informed consent Therapists must inform clients of the cost and expected duration of therapy prior to beginning any intervention. Therapists are prohibited from providing therapy to former intimate partners. Therapists are also obligated to use tests that are reliable and valid. must have appropriate training for all tests that are used Copyright 2011 Pearson Education, Inc. All Rights Reserved

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Knowledge of clients cultural backgrounds guides the choice of therapeutic interventions. Culturally sensitive therapists recognize that language differences between therapists and clients can pose problems. With recent immigrants, culturally sensitive therapists will take into account the impact of the immigration experience on clients thoughts and emotions. Cultural practices can be used as models for therapeutic interventions. example: American Indian healing circle Therapists attempt to address group differences that can affect the results of therapy. Copyright 2011 Pearson Education, Inc. All Rights Reserved

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An approach that takes into account the effects of gender on both the therapists and the clients behavior Therapists must examine their own gender-based prejudices. Knowledge of real differences between the sexes is important to the practice of gender-sensitive therapy. Therapist may place too much emphasis on gender issues and misinterpret clients problems (Addis & Mahalik, 2003). Copyright 2011 Pearson Education, Inc. All Rights Reserved

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Smith et al. (1980) analyzed 475 studies with 25,000 clients. Psychotherapy was better than no treatment. No one type of psychotherapy was more effective than another. Eysenck (1994) showed a slight advantage for behavior therapies over other types. Socioeconomic status and other variables interact with clients problems. Interactions influence therapeutic outcomes (Falconnier, 2009). Most important determinant of effectiveness: Appropriateness for a given clients problems Circumstances of the clients life (Crits-Christoph et al., 2008) Copyright 2011 Pearson Education, Inc. All Rights Reserved

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According to a Consumer Reports survey: Clients believe they benefit from psychotherapy. Clients are equally satisfied with therapy provided by psychologists, psychiatrists, and social workers. The longer clients stayed in therapy, the more they improved. Clients believed that antidepressant and anti-anxiety drugs helped them. Psychotherapy alone worked as well as psychotherapy plus drugs. Copyright 2011 Pearson Education, Inc. All Rights Reserved