Treatments of

Psychological

Disorders

Therapy Types

• Insight Therapies

• Behavioral Therapies

• Cognitive Therapies

• Biological Therapies

Therapist Orientations

(APA Data, 1989)

Approaches to Psychotherapy in the 21st

Century

Insight Therapies

• Psychodynamic (Psychoanalytic;

Object Relations; Self Psychology)

• Person-centered Therapy

(Humanistic)

• Gestalt Therapy

• Existential Therapy

Psychodynamic Therapists

Psychodynamic Psychotherapy

• The assumption is that personality and

behavior reflect the efforts of the ego

to referee conflicts, usually unconscious,

among various components of personality

• Psychoanalysis seeks to help clients gain

insight by recognizing and understanding

unconscious thoughts and emotions

Classical Psychoanalysis

• Developed out of Freud’s medical practice

– Only partially and temporarily successful treating

“hysterical” ailments with hypnotic suggestions

– More success using process of “free association”

• Results of this “talking cure” led Freud

to conclude that hysterical symptoms

developed out of conflicts about one’s

unconscious impulses and fantasies

Classical Psychoanalysis (cont.)

• Treatment involves use of free association,

dream analysis, and analysis of the way the

client reacts to therapist (transference and

resistance.)

• Insight into problems is gained by recognizing

unconscious thoughts and emotions

– Clients then work through the ways in which those

unconscious elements affect their daily lives

Neo-Freudian Therapies

• Emphasis placed on the role of social

relationships in clients’ problems and how

the power of the ego could be harnessed

to solve them

– e.g., ego analysis, interpersonal therapy, and

individual analysis

Contemporary Variations

on Psychoanalysis

• Goal of short-term dynamic psychotherapy is to provide benefits in less time than required by classical psychoanalysis

• The focus in object relations therapy is on the powerful need for human contact and support

– The therapist focuses on developing a nurturing relationship with the client

– Through this relationship, some of the consequences of maladaptive early attachment patterns can be counteracted

Contemporary Variations

on Psychoanalysis (cont.)

• Psychoanalytically oriented psychotherapy

and time-limited dynamic psychotherapy

employ classical psychoanalytic methods in a

more flexible manner – Goal of treatment can range from giving psychological support to

achieving basic personality changes

– Clients are encouraged to focus on concrete, specific goals

• Interpersonal psychotherapy (IPT): a form of psychotherapy that focuses on helping clients improve current relationships – Focus on grief, role disputes, role transitions, interpersonal deficits

Humanistic Psychotherapy

• Assumptions

– Treatment is a human encounter between equals,

not a “cure” given by an expert

– Clients will improve on their own, given the conditions

– Ideal conditions in therapy can be established

through a special therapeutic relationship of complete

acceptance and support

– Clients must remain responsible for choosing how

they will think and behave

Client-Centered Therapy

• Developed by Carl Rogers, who was dissatisfied with psychodynamic therapy

• Focus is on the creation of a relationship that reflects three intertwined therapist attitudes

– Unconditional positive regard: Treatment of the client as a valued person

– Empathy: Emotional understanding of what the client may be thinking and feeling

– Congruence: Consistency between the therapist’s feelings and actions

Gestalt Therapy

• Developed by Frederick Perls who believed:

– People create their own versions of reality

– People’s natural psychology growth continues only

as long as they perceive, remain aware of, and act

on their true feelings

– Growth stops and symptoms of mental disorder

appear when people are not aware of all aspects

of themselves

Gestalt Therapy (cont.)

• Gestalt therapy seeks to create conditions

in which clients can become more unified,

self-aware, and self-accepting so they are

ready to grow again

• Two-chair technique:

– Gestalt therapists prod clients to:

• Become aware of disowned feelings and impulses

• Discard feelings, ideas, and values that are not really

their own

Behavior Therapy

• Emphasis is on helping clients view psychological problems as learned behaviors

– Therefore, these behaviors can be changed without searching for hidden meanings or unconscious causes

• The careful listing of the behaviors and thoughts to be changed

• Learning-based treatments provided by the therapist

• Continuous monitoring and evaluation of treatment with constant adjustments to procedures that do not seem to be effective

• Goal of therapy is to understand the learning principles maintaining the undesired behaviors and learn new responses in those situations

Techniques for Modifying Behavior

• Systematic desensitization: The client

visualizes a series of anxiety-provoking

stimuli while remaining relaxed

• Modeling: The client learns desirable

behaviors by watching the therapist or other

people demonstrate those behaviors

Cognitive Therapies

• Rational Emotive Therapy (Albert Ellis)

• Beck's Cognitive Therapy

• Cognitive-Behavioral Therapy

Cognitive and Cognitive

Behavioral Therapy

• Cognitive therapy: involves helping a client identify and correct any distorted thinking about self, others, or the world – Cognitive restructuring: a therapeutic approach that teaches

clients to question the automatic beliefs, assumptions, and predictions that often lead to negative thinking with more realistic and positive beliefs

– Mindfulness meditation: teaches an individual to be fully present in each moment; to be aware of his or her thoughts, feelings, and sensations; and to detect symptoms before they become a problem

• Cognitive Behavioral Therapy (CBT): a blend of cognitive and behavioral therapeutic strategies

Common Irrational Beliefs

• I must be perfect

• Everyone must love me

• The past determines the future

• It is catastrophic when things don't

go as planned

Common Irrational Beliefs

• I have no control over my

happiness

• Perfect solutions must be found for

life's problems

• Happiness just happens

Beck’s Cognitive Therapy

• Automatic Thoughts: Thoughts people have

about life and the self that may be

unreasonable but are accepted as accurate

• Automatic thoughts create depression and

anxiety

• Goal: teach patients to stop the thoughts

Beck’s Cognitive Therapy

• Also involves negative views of

past, present, and future

• Originated as a treatment for

depression & anxiety

Family and Couples Therapy

• Family therapy involves the treatment

of two or more individuals from the same

“family system”

– Structural family therapy concentrates on family

communication patterns

• Couples therapy focuses on improving

communication between partners

Community Psychology

• Community Psychology is a

movement with the following goals:

– Treat people in the home community

– Work for social and environmental changes

that would minimize or prevent

psychological disorders

Does Psychotherapy Work?

• Most psychotherapists and their clients believe in its effectiveness

• Hans Eysenck was first to widely question the value of psychotherapy

• Today’s studies show the typical psychotherapy client is better off than three quarters of untreated individuals

• Problems in assessing psychotherapy’s effectiveness – How should improvement be measured?

– There are a broad range of clients, therapists, and treatments associated with psychotherapy

Figure 16.3 An Analysis

of Psychotherapy’s Effects

Treatment Studies

• Outcome studies are designed whether

treatment works (often in comparison to

another treatment or control).

• Process studies are designed to answer

questions why a treatment works or under

what conditions.

• In double-blind experiments, both the

patient and the researcher/therapist are

uninformed about which treatment the

patient is receiving.

Choosing a therapist:

• Before choosing a therapist and treatment

approach, clients should carefully

consider:

– What treatment approach, method, and goals

are most comfortable and appealing

– Information about the therapist’s “track record” of

clinically significant success treating the client’s

problems

– The likelihood of forming a productive

relationship with the therapist

Rules and Rights

in the Therapeutic Relationship

• Professional ethics and common sense

require the therapist to ensure that the client

is not harmed by the therapeutic relationship

• Issues of confidentiality are vital to the

development of a successful therapeutic

relationship

– Information revealed in therapy is legally

considered to be privileged communication

Biological Treatments

• Electroconvulsive Therapy (ECT):

A brief shock is administered to the brain

– Usually used to reduce depression that does not

respond to drug treatments

• Psychosurgery: The destruction of brain

tissue for the purpose of treating mental disorder

– e.g., prefrontal lobotomy

Lobotomy Site

Portions of the

frontal lobe

are separated

from the

thalamus

Antidepressants and Mood

Stabilizers

• Antidepressants: a class of drugs that help lift people’s mood – Monoamine oxidase inhibitor (MAOI), tricyclic

antidepressants, selective serotonin reuptake inhibitor (SSRI), serotonin and norepinephrine reuptake inhibitor (SNRI), norepinephrine and dopamine reuptake inhibitor

• Mood stabilizers used to treat bipolar disorder; used to suppress swings between mania and depression

Figure 15.2

Antidepressant Drug Actions

Combining Medication and

Psychotherapy

• A combination of treatment which is most

effective depends on the individual and his

or her disorder symptoms.

• Research has shown that both therapy

and medication affect brain regions

associated with reaction to threat.

• Coordination of both forms of treatment

may require cooperation between

psychologists and psychiatrists.

Evaluating Psychoactive

Drug Treatments

• Potential problems

– The drug may being masking the problem without curing it

– Abuse of some drugs can result in physical or

psychological dependence

– Side effects can range from merely annoying to serious

• But, research on psychoactive drugs holds promise

of creating better drugs, a fuller understanding of the

origin and nature of some disorders and more

informed prescription practices

Drugs and Psychotherapy

• Which is better?

– Overall, neither form of therapy is clearly superior

for treating problems such as anxiety disorders

and major depressive disorders

• Is combining drugs and psychotherapy

effective?

– It depends on the disorder