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Chapter 13

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  • 1. Chapter 13 Therapies
  • 2. Chapter 13 Overview  Insight therapies  Relationship therapies  Behavior therapies  Cognitive therapies  Biomedical therapies  Evaluating the therapies  The therapeutic relationship
  • 3. Insight Therapies  Approaches to psychotherapy based on the notion that psychological well- being depends on self-understanding
  • 4. What are the basic techniques of psychodynamic therapies?  Psychotherapies that attempt to uncover repressed childhood experiences that are thought to cause the patient’s current problems  Psychoanalysis is a technique developed by Freud – Free association  Explores the unconscious by having patients reveal 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, in which the patient displays feelings and attitudes toward the analyst that were present in another significant relationship
  • 5. What are the basic techniques of psychodynamic therapies?  Object relations therapy – Based on idea that early relationships form blueprints for future relationships – Therapist helps clients restructure current relationships, changing maladaptive patterns formed in early relationships  Interpersonal therapy – Brief psychotherapy that helps clients understand and cope with 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
  • 6. What is the goal of the therapist in person-centered therapy?  Humanistic therapies assume that people have the ability and freedom to lead rational lives and make rational choices – Founded by Carl Rogers (1951)  Therapists show empathy and create a climate of unconditional positive regard – Goal is to allow the client to direct the therapy session and move toward self-actualization  The patient’s realization of his inner potential
  • 7. What is the major emphasis of Gestalt therapy?  Helps clients fully experience their feelings, thoughts, and actions – Emphasizes clients taking responsibility for their behavior, instead of blaming society or parents – Goal is to help the client resolve past conflicts, achieve a more integrated self, and become more self-accepting  Gestalt therapy is directive – Therapist actively directs the therapy session – Provides answers and suggestions to the client
  • 8. Relationship Therapies  Therapies that attempt to improve patients’ interpersonal relationships or create new relationships to support patients’ efforts to address psychological problems
  • 9. What are the goals of family and couple therapy?  Family therapy – Parents and children enter therapy as a group – Goal is to help family members heal wounds to the family, improve communication, and create more understanding within the family  Couple therapy – Goal is to help partners in an intimate relationship communicate and manage conflicts more effectively – May focus on behavioral change or partners’ emotional responses to each other
  • 10. What are some advantages of group therapy?  A group of clients (usually seven to ten) meets regularly with one or more therapists  Provides client with a sense of belonging and opportunity to – Express feelings – Get feedback from other group members – Give and receive emotional support  Self-help groups – People with similar problems who meet regularly, usually without a professional therapist
  • 11. Behavior Therapies  A treatment approach that is based on the idea that abnormal behavior is learned and that applies the principles of operant conditioning, classical conditioning, and/or observational learning to eliminate inappropriate or maladaptive behaviors and replace them with more adaptive responses
  • 12. How do behavior therapists modify clients’ problematic behavior?  Uses reinforcement to shape or increase frequency of desirable behavior – e.g., Token economy  Extinguishes undesirable or maladaptive behavior by terminating or withholding reinforcement that maintains the behavior – e.g., Timeout
  • 13. What behavior therapies are based on classical conditioning and social- cognitive theory?  Systematic desensitization is behavior therapy based on classical conditioning – Used to treat fears  Client is trained to relax while being confronted with a graduated series of anxiety-producing situations  Eventually, client can stay relaxed while confronting even the most feared situation  Participant modeling is behavior therapy based on Albert Bandura’s principles of observational learning – A model demonstrates appropriate responses to a feared stimulus in graduated steps – Client then imitates the model with encouragement of a therapist – Using this technique, most specific phobias can be extinguished in 3 to 4 hours
  • 14. What behavior therapies are based on classical conditioning and social- cognitive theory?  Flooding is 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  Exposure and response prevention is behavior therapy – Exposes patients with obsessive-compulsive disorder to stimuli that trigger obsessions and compulsive rituals, while patients resist performing the compulsive rituals for progressively longer periods of time  Aversion therapy is behavior therapy – An aversive stimulus is paired with a harmful or socially undesirable behavior until the behavior becomes associated with pain or discomfort
  • 15. Cognitive Therapies  Therapies that assume maladaptive behavior can result from irrational thoughts, beliefs, and ideas
  • 16. What is the aim of rational emotive therapy?  Developed by Albert Ellis  A directive form of therapy  Goal is to challenge and modify a client’s irrational beliefs about themselves and others – Which are believed to be the causes of personal distress
  • 17. How does Beck’s cognitive therapy help people overcome depression and panic disorder?  Cognitive therapy, designed by Aaron Beck, helps clients stop their negative thoughts as they occur and replace them with more objective thoughts – Depression is treated by brief cognitive therapy, usually 10-20 sessions, and is more effective than antidepressant drugs – Panic disorder is treated by teaching clients to change the catastrophic interpretations of their symptoms to prevent them from escalating into panic, usually effective with 3 months of treatment
  • 18. Biomedical Therapies  Therapies (drug, therapy electroconvulsive therapy, or psychosurgery) that are based on the assumption that psychological disorders are symptoms of underlying physical problems
  • 19. What are the advantages and disadvantages of using drugs to treat psychological disorders?  Antipsychotic drugs – Prescribed primarily for schizophrenia – Used to treat symptoms such as hallucinations, delusions, and disorganized behavior – Work by inhibiting dopamine activity  Lithium – Used to treat bipolar disorder – Reduces both manic and depressive episodes  Antianxiety drugs – Benzodiazepines are effective for treating generalized anxiety disorder and panic disorder  This family of minor tranquilizers includes Valium and Xanax
  • 20. What are the advantages and disadvantages of using drugs to treat psychological disorders?  Antidepressant drugs – Act as mood elevators for people who are severely depressed – Selective serotonin reuptake inhibitors (SSRIs)  Block the reuptake of serotonin, increasing its availability at the synapses of the brain  Are effective for treating major depression, OCD, social phobia, panic disorder, generalized anxiety disorder, and binge eating
  • 21. What are the advantages and disadvantages of using drugs to treat psychological disorders?  Drugs can have unpleasant or dangerous side effects  It is difficult to establish proper dosages  Drugs do not cure psychological disorders – So relapse is likely if drug therapy is discontinued  Availability of antipsychotic drugs led to a trend away from hospitalization, which may have increased homelessness among people with schizophrenia
  • 22. What is electroconvulsive therapy (ECT) used for?  Electric current is administered to the right cerebral hemisphere – While patient is under anesthesia – Usually reserved for severely depressed patients who are suicidal  ECT was misused and overused in the 1940s and 1950s, leading to a bad reputation  But it can be a highly effective treatment for major depression
  • 23. What is psychosurgery, and for what problems is it used?  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, because it leaves patients in permanent deteriorated condition  Cingulotomy – Destroys cingulum – Can help in extreme cases of OCD  Psychosurgery is controversial, and is considered experimental and a last resort – Because results are unpredictable and permanent
  • 24. Evaluating the Therapies  Therapies share many similarities. Therapists use a core set of techniques no matter which perspective of therapy session they adopt, but at the same time, each therapeutic approach has elements that distinguish it from others.
  • 25. What therapy, if any, is most effective in treating psychological disorders?  Smith et al. (1980) analyzed 475 studies with 25,000 clients – Found that psychotherapy was better than no treatment – But no one type of psychotherapy was more effective than another  Eysenck (1994) reanalyzed the same studies – Reported that behavior therapy has a slight advantage over other types of therapies
  • 26. What therapy, if any, is most effective in treating psychological disorders?  A large survey of psychotherapy clients conducted by Consumer Reports found that – Overall, clients believed that they benefited substantially from psychotherapy – Clients were 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 antianxiety drugs helped them; but overall psychotherapy alone worked as well as psychotherapy plus drugs
  • 27. The Therapeutic Relationship  When establishing a relationship with a therapist, it is important to become familiar with the various professionals who offer therapeutic services.
  • 28. What distinguishes one type of therapist from another, and what ethical standards are shared by all types of therapists?  A Psychologist – Has an advanced degree, usually a doctorate, in psychology – Clinical psychologists generally diagnose and treat psychological disorders – Counseling psychologists generally provide therapy for normal problems of life, such as divorce  A Psychiatrist – Is a medical doctor – Can prescribe drug therapy
  • 29. What distinguishes one type of therapist from another, and what ethical standards are shared by all types of therapists?  Therapists are forbidden to engage in any kind of intimate relationship with a client or anyone close to the client  They are prohibited from providing therapy to former intimate partners  They are obligated to use tests that are reliable and valid – And they must have appropriate training for all tests that are used
  • 30. What are the characteristics of culturally sensitive therapy?  An approach to therapy in which knowledge of clients’ cultural backgrounds guides the choice of therapeutic interventions  This approach emphasizes that cultural variables may influence the diagnosis and treatment of psychological disorders
  • 31. Why is gender-sensitive therapy important?  An approach to therapy that takes into account the effects of gender on both the therapist’s and the client’s behavior  This approach emphasizes how a therapist’s gender biases may affect the techniques that they choose and their assessments of clients’ progress

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