Psychotherapy
Therapy Comes in Many Forms <ul><li>Many sources and types of treatment are available </li></ul><ul><li>There are two broa...
<ul><ul><li>Psychotherapy   </li></ul></ul><ul><ul><ul><li>Treatment of psychological problems through psychological techn...
Is Psychotherapy Necessary and Effective? <ul><li>Does psychotherapy simply create placebo effect? </li></ul><ul><ul><li>A...
Is Psychotherapy Effective? <ul><ul><li>Researchers must determine if improvements are due to expectations or real benefit...
Is Psychotherapy Effective? <ul><ul><li>The   double-blind eliminates any potential bias by reducing demand characteristic...
<ul><li>The double-blind eliminates any potential bias by reducing demand characteristics </li></ul><ul><ul><li>Demand cha...
<ul><li>Demand characteristics distort the results of a study </li></ul><ul><li>Research studies that compare psychotherap...
Research on Psychotherapy <ul><li>In a 1952 paper, Hans Eysenck challenged the effectiveness of psychotherapy </li></ul><u...
 
Research on Psychotherapy <ul><li>These studies, and analyses using sophisticated statistical techniques, found psychother...
Research on Psychotherapy <ul><li>If most therapies are effective, there must be a common underlying component making them...
Which Therapy, Which Therapist? <ul><li>There are hundreds of types of therapy </li></ul><ul><ul><li>Some focus on individ...
Which Therapy? <ul><li>Community psychologists  focus on whole communities </li></ul><ul><li>They try to develop action-or...
Which Therapy? <ul><li>A number of specific psychotherapeutic approaches are in use today </li></ul><ul><ul><li>Psychodyna...
<ul><ul><li>Humanistic approaches  assume people are essentially good </li></ul></ul><ul><ul><ul><li>Humanistic approaches...
<ul><ul><li>Cognitive therapy  focuses on changing a client’s behavior by changing thoughts and perceptions </li></ul></ul...
<ul><li>The effectiveness of different kinds of therapy depends on  two things, the disorder treated and the goals of the ...
Which Therapy? <ul><ul><li>These include ethnicity, personality, level of experience, and degree of empathy </li></ul></ul...
Which Therapy? <ul><ul><li>Good therapists communicate interest, understanding, respect, tact, and maturity </li></ul></ul...
Which Therapy? <ul><li>Good therapists use suggestions, interpretation, encouragement, and perhaps rewards to help clients...
Culture and Therapy <ul><li>The therapy process and its outcome are effected by the client’s ethnicity </li></ul><ul><ul><...
Culture and Therapy <ul><li>At a minimum, the therapist must respect multiculturalism </li></ul><ul><ul><li>The acceptance...
Culture and Therapy <ul><li>Therapists must see individuals as made up of a confluence of different influences </li></ul><...
Culture and Therapy <ul><li>Therapists need to be well about clients’ backgrounds </li></ul><ul><ul><li>They should provid...
Culture and Therapy <ul><li>Some cultures have prohibitions against self-disclosure, or toward control </li></ul><ul><li>S...
Culture and Therapy <ul><li>Cultural mistrust of therapy situations is common among African-Americans </li></ul><ul><li>By...
Culture and Therapy <ul><li>Latino, African-American, and Asian-American therapists are viewed differently than European-A...
Culture and Therapy <ul><li>Therapists must recognize that members of other groups may not share their own cultural values...
Gender and Therapy <ul><li>Not only is ethnicity important, gender is also a significant factor in therapy </li></ul><ul><...
Gender and Therapy <ul><ul><li>Clients may also experience gender bias in their families that affects their gender assumpt...
Gender and Therapy <ul><ul><li>Gay men and lesbians bring still another view to gender roles in the therapeutic situation ...
Gender and Therapy <ul><li>Therapists must also understand how their own gender socialization affects therapy </li></ul><u...
Managed Care and Psychology <ul><li>“ Managed care” emphasizes active coordination and arrangement of health care services...
Managed Care and Psychology <ul><li>The aim of managed care is to control costs </li></ul><ul><li>There are two major diff...
Managed Care <ul><li>Insurance companies limit who a client can see </li></ul><ul><li>Many HMOs require re-approval of the...
Managed Care <ul><li>Edwards (1999) believes that these factors compromise the practitioner/client alliance </li></ul><ul>...
Managed Care <ul><li>One objective of brief therapy is saving clients time and money </li></ul><ul><li>Clients may remain ...
Brief Therapy <ul><li>Practitioners of brief therapy think in terms of  planned  short-term treatments </li></ul><ul><ul><...
Brief Therapy <ul><li>The operational diagnosis answers the question “Why is the client here today?” </li></ul><ul><li>The...
Brief Therapy <ul><ul><li>Especially when tailored to the clients needs and time </li></ul></ul><ul><ul><li>Brief therapy ...
Brief Therapy <ul><li>Brief therapy is highly effective with couples and when combined with cognitive restructuring </li><...
Managed Care <ul><ul><li>They also fear it is managed by people with little or no training who never meet patients </li></...
Choosing a Therapist <ul><li>The best way to choose a therapist is to ask around </li></ul><ul><ul><li>Ask family and frie...
Choosing a Therapist <ul><li>Doctors can suggest someone they know to be effective </li></ul><ul><li>Consult the psycholog...
Choosing a Therapist <ul><li>Once one has a list of several practitioners, find out if they are licensed </li></ul><ul><li...
Psychoanalysis And Psychodynamic Therapies www.ablongman.com/lefton8e
Psychoanalysis <ul><li>Psychoanalysis  is a lengthy insight therapy developed by Freud </li></ul><ul><ul><li>It aims at un...
<ul><li>Psychodynamically based therapies  use techniques derived from Freud, but reject or modify parts of his theory </l...
<ul><ul><li>Second, the causes of maladjustment are unresolved conflicts </li></ul></ul><ul><ul><ul><li>The person is unaw...
Goal of Psychoanalysis <ul><li>The goal is to help patients understand the unconscious motivations that direct their behav...
Copyright © Allyn & Bacon 2003
Techniques of Psychoanalysis <ul><li>Psychoanalysis is geared toward the exploration of early experiences </li></ul><ul><l...
Techniques of Psychoanalysis <ul><li>In  free association , the patient is asked to report whatever comes to mind, no matt...
Techniques of Psychoanalysis <ul><li>In  dream analysis , patients are asked to describe their dreams in detail </li></ul>...
<ul><li>Both free association and dream analysis involve the therapist’s interpretations </li></ul><ul><li>Interpretation ...
Techniques of Psychoanalysis <ul><li>Defense mechanisms may point to areas that need to be explored </li></ul><ul><li>Two ...
<ul><li>Resistance shows one of two things </li></ul><ul><ul><li>The patient wishes to avoid talking about a topic </li></...
<ul><li>To minimize resistance, analysts try to accept a patient’s behavior </li></ul><ul><li>During  transference , the t...
<ul><li>The therapist can also guide the person to explore repressed ideas </li></ul><ul><li>Examining previously unaccept...
<ul><li>Examining previously unacceptable thoughts and feelings helps patients identify underlying conflicts </li></ul><ul...
Techniques of Psychoanalysis <ul><li>The patient also develops mature ways of dealing with anxiety and guilt </li></ul><ul...
Ego Analysis <ul><li>Ego analysts  are psychoanalysts who assume the ego has greater control over behavior than Freud sugg...
Ego Analysis <ul><li>A major disagreement between “traditional” and “ego” analysts has to do with the role of the id and t...
Ego Analysis <ul><li>The ego is assumed to control memory and perception, and is not in constant conflict with the id </li...
<ul><li>Ego analysts begin by trying to strengthen the ego </li></ul><ul><li>They may ask a client to be assertive and tak...
Criticisms of Psychoanalysis <ul><li>Critics of psychoanalysis contend it is unscientific, imprecise, and subjective </li>...
Criticisms of Psychoanalysis <ul><li>These critics object to the notion that we are bundles of energy caught in conflict <...
Criticisms of Psychoanalysis <ul><ul><li>In general, it can be  as  effective as other therapies, but not  more  effective...
Criticisms of Psychoanalysis <ul><li>Psychoanalysis has certain inherent disadvantages </li></ul><ul><ul><li>The patient m...
Humanistic Therapies Focusing on the Present www.ablongman.com/lefton8e
Humanistic Therapies <ul><li>Humanistic therapies emphasize the ability to reflect on conscious experience </li></ul><ul><...
Humanistic Therapies <ul><li>To some extent, humanistic therapies are insight therapies </li></ul><ul><ul><li>They focus o...
Client-Centered Therapy <ul><li>Client-centered therapy   is also known as  person-centered therapy </li></ul><ul><ul><li>...
Copyright © Allyn & Bacon 2003
Techniques of Client-Centered Therapy <ul><li>The goal of client-centered therapy is to help people discover their ideal s...
<ul><li>First, the therapist must show  unconditional positive regard </li></ul><ul><ul><li>Be an accepting person who pro...
<ul><ul><li>Therapists are honest and aware of their own feelings </li></ul></ul><ul><ul><li>Counselors’ congruence allows...
Techniques <ul><li>The final ingredient is  empathic listening </li></ul><ul><ul><li>Therapists must sense how their clien...
Techniques <ul><li>Therapists help their clients organize their thoughts and ideas </li></ul><ul><ul><li>Three techniques ...
Techniques <ul><ul><li>They are defensive, and show disorganized behavior </li></ul></ul><ul><ul><li>Over time, the client...
Techniques <ul><li>Over time, the client begins to use her or his own ideas as standards for self-evaluation </li></ul><ul...
Criticisms of Client-Centered Therapy <ul><li>No other therapy makes clients feel so warm, accepted, and safe </li></ul><u...
Behavior Therapy From the Behavioral Perspective
Behavior Therapy <ul><li>Behavior therapy has become especially popular in the last 30 years </li></ul><ul><ul><li>This ha...
Goals of Behavior Therapy <ul><li>Behavior therapy  focuses on changing overt behavior </li></ul><ul><ul><li>It is also ca...
Goals of Behavior Therapy <ul><li>Behavior therapists assume changes in the environment affect people’s responses </li></u...
Goals of Behavior Therapy <ul><li>Behavior therapists try to help people unlearn faulty behaviors and learn more effective...
Goals of Behavior Therapy <ul><li>If behavior therapists see the problem is associated with another situation, they may tr...
Goals of Behavior Therapy <ul><li>Second, some studies show that people who do not receive those therapies improve anyway ...
Goals of Behavior Therapy <ul><li>Once a person is labeled “abnormal”, the label itself may lead to maladaptive behavior <...
Behavior Therapy: A Criticism <ul><li>Most insight therapists believe that if only overt behavior is treated, symptom subs...
Techniques of Behavior Therapy <ul><li>The techniques of behavior therapy include operant conditioning, modeling, and coun...
Techniques of Behavior Therapy <ul><li>Behavior therapy usually involves three general procedures: </li></ul><ul><ul><li>F...
Operant Conditioning <ul><li>Operant conditioning to establish a new behavior often depends on a  reinforcer </li></ul><ul...
Token Economies <ul><li>In a token economy people who display appropriate behaviors receive tokens </li></ul><ul><ul><li>T...
Token Economies <ul><li>Token economies are used to modify behavior in social settings </li></ul><ul><li>The aim is to str...
Extinction <ul><li>Extinction occurs when reinforcers are withheld </li></ul><ul><ul><li>This eventually leads a previousl...
Punishment <ul><li>Another way to stop an undesirable behavior is to use punishment </li></ul><ul><ul><li>This often invol...
Punishment <ul><li>Punishment does not establish new, desired behaviors </li></ul><ul><li>Thus, it is often combined with ...
Punishment <ul><li>Punishment can be harmful </li></ul><ul><li>People (especially young people) sometimes imitate aggressi...
Time-Out <ul><li>Time-out  is the removal of a person from sources of reinforcement </li></ul><ul><ul><li>It is used to de...
Counterconditioning <ul><li>In  Counterconditioning , a person is taught a new, more adaptive response to a stimulus </li>...
Counterconditioning <ul><li>Wolpe used counterconditioning to inhibit anxiety as a response </li></ul><ul><li>Therapy usin...
Systematic Desensitization <ul><li>Systematic desensitization  is a three-stage counterconditioning procedure </li></ul><u...
Systematic Desensitization <ul><ul><li>With each successive experience, the client learns relaxation rather than fear as a...
Systematic Desensitization <ul><li>With each successive experience, the client learns relaxation rather than fear as a res...
Aversive Conditioning <ul><li>Another method using counterconditioning is  aversive conditioning </li></ul><ul><ul><li>A n...
Modeling <ul><li>Bandura (1997) believes modeling can be used effectively for: </li></ul><ul><ul><li>Teaching a new behavi...
Cognitive Therapy An Outgrowth of Behavior Therapy www.ablongman.com/lefton8e
Cognitive Therapy <ul><li>Cognitive therapists assume that distorted, undeveloped ideas prevent people from establishing e...
Cognitive Therapy <ul><li>Cognitive therapy is derived from three propositions: </li></ul><ul><ul><li>Cognitive activity a...
Cognitive Therapy <ul><ul><li>Cognitive therapy is also known as  cognitive restructuring </li></ul></ul><ul><ul><li>Cogni...
Cognitive Therapy <ul><li>Cognitive therapy focuses on current behaviors and thoughts </li></ul><ul><ul><li>It is not espe...
Rational Emotive Therapy <ul><li>The best known cognitive therapy is  rational emotive therapy </li></ul><ul><ul><li>It em...
Rational Emotive Therapy <ul><li>Ellis assumed abnormal behavior is caused by faulty and irrational thinking patterns </li...
Beck’s Approach <ul><li>Aaron Beck developed another cognitive therapy </li></ul><ul><ul><li>Beck assumes depression is ca...
Copyright © Allyn & Bacon 2003
Beck’s Approach <ul><li>A goal of Beck’s therapy is to help people develop realistic appraisals of situations </li></ul><u...
Beck’s Approach <ul><li>Beck says a successful client passes through four stages in moving toward mental health </li></ul>...
Meichenbaum’s Approach <ul><li>Meichenbaum developed a third cognitive therapy </li></ul><ul><ul><li>He believes that what...
Meichenbaum’s Approach <ul><li>The therapist must change the client’s appraisal of situations and the client’s use of self...
Meichenbaum’s Approach <ul><ul><li>They may learn to organize their responses to specific situations in orderly steps </li...
Cognitive Therapy <ul><li>Cognitive therapy is influencing an increasing number of therapists who conduct long-term, as we...
Cognitive Therapy <ul><li>Cognitive therapy in its many forms has been used with adults and children </li></ul><ul><li>It ...
Group Therapy
Group Therapy <ul><li>In  group therapy , several people meet together with a therapist to receive treatment </li></ul><ul...
Group Therapy <ul><li>Group therapy can also be more effective than individual therapy </li></ul><ul><ul><li>The social pr...
Techniques and Formats of Group Therapy <ul><li>The techniques used are determined by the nature of the group </li></ul><u...
Techniques and Formats <ul><li>In traditional group therapy, 6 to 12 clients meet once a week </li></ul><ul><ul><li>Member...
Techniques and Formats <ul><li>The format of traditional group therapy varies </li></ul><ul><ul><li>Generally, each member...
Techniques and Formats <ul><li>Thus, each member expresses their fears and anxieties to people who are accepting </li></ul...
Family Therapy <ul><li>A  family  is a group of people who are committed to one another’s well-being, preferably for life ...
Family Therapy <ul><ul><li>Therapists assume there are multiple sources of psychological influence </li></ul></ul><ul><ul>...
Family Therapy <ul><li>Family interactions affect individuals </li></ul><ul><li>Sometimes family therapy is called  relati...
Family Therapy <ul><li>An issue in family therapy is how all members of a family may become enmeshed in one member’s probl...
Family Therapy <ul><ul><li>A family member may be alcoholic, but codependence may be an additional adjustment problem </li...
Family Therapy <ul><li>Codependents are often plagued by feelings of shame, fear, anger, and pain </li></ul><ul><li>Howeve...
Family Therapy <ul><li>In some cases, people  need  the person to stay disordered </li></ul><ul><li>This allows them to ma...
Family Therapy: Assessment <ul><li>Some researchers believe family therapy to be as effective as individual therapy </li><...
Family Therapy: Assessment <ul><li>Outcomes are not as good when depression is involved </li></ul><ul><li>If family member...
Biologically Based Therapies Medical Therapies www.ablongman.com/lefton8e
Biologically Based Therapy <ul><li>The usual approach to a psychological problem is “talking therapy” </li></ul><ul><ul><l...
Biologically Based Therapy <ul><ul><ul><li>These therapies often involve medication, or hospitalization </li></ul></ul></u...
Biologically Based Therapy <ul><li>Biological therapies are often used in combination with traditional psychotherapy </li>...
Drug Therapy <ul><li>Clinicians who use drug therapy must be aware of several key issues </li></ul><ul><ul><li>Dosages are...
Drug Therapy <ul><li>Psychotropic drugs are grouped into four categories </li></ul><ul><li>No drug will permanently cure t...
Drug Therapy <ul><ul><li>Antianxiety drugs </li></ul></ul><ul><ul><li>Antimania drugs </li></ul></ul><ul><ul><li>Antipsych...
Antianxiety Drugs <ul><li>Librium, Xanax, and Valium are trade names of widely prescribed antianxiety drugs </li></ul><ul>...
Antidepressant Drugs <ul><li>Antidepressants ( thymoleptics ) work by altering levels of brain chemicals </li></ul><ul><ul...
Antidepressant Drugs <ul><li>Depression is believed to occur when serotonin does not bind to receptors on the next neuron ...
Antidepressant Drugs <ul><li>SSRIs allow serotonin to remain in the synapse so it can be effective </li></ul><ul><li>Proza...
Tricyclics and MAO Inhibitors <ul><li>Tricyclics block neurotransmitter reuptake </li></ul><ul><li>MAO inhibitors break do...
Tricyclics and MAO Inhibitors <ul><li>Tricyclics pose less of a danger of complications than MAO inhibitors </li></ul><ul>...
Prozac <ul><li>About 31 million people have taken the SSRI Prozac since its introduction in 1987 </li></ul><ul><ul><li>Yea...
Prozac <ul><ul><li>However, Prozac does not help everyone </li></ul></ul><ul><ul><li>Psychologists worry that Prozac is so...
Prozac <ul><li>Psychologists worry that Prozac is so effective that the original problems leading to depression may be ove...
Antidepressants: Research <ul><li>Research on the effectiveness of antidepressants is contradictory </li></ul><ul><li>Some...
Antimania Drugs <ul><li>Lithium carbonate has long been used as an effective antimania drug </li></ul><ul><li>The dosage i...
Antipsychotic Drugs <ul><li>Schizophrenia is treated using antipsychotics </li></ul><ul><ul><li>Technically called  neurol...
Antipsychotic Drugs <ul><li>Clozapine (Clozaril) is one of these new drugs </li></ul><ul><ul><li>It is effective, but has ...
Antipsychotic Drugs <ul><li>Antipsychotics are less effective at reducing other symptoms, such as problems of emotions </l...
Antipsychotic Drugs <ul><li>Antipsychotics are less effective at reducing other symptoms, such as problems of emotions </l...
Antipsychotic Drugs <ul><li>One problem with antipsychotics is  tardive dyskinesia </li></ul><ul><ul><li>A nervous system ...
Psychosurgery <ul><li>Psychosurgery  is brain surgery </li></ul><ul><ul><li>In the 1940s and 50s, a common type was the  p...
Psychosurgery <ul><li>Prefrontal lobotomies made some people become unnaturally calm and completely unemotional </li></ul>...
Psychosurgery <ul><li>Most important, psychosurgery is irreversible </li></ul><ul><li>Therefore, it is morally objectionab...
Electroconvulsive Therapy <ul><li>Electroconvulsive therapy  (ECT) was once widely employed with depressed people </li></u...
Electroconvulsive Therapy <ul><li>In the 1940s and 50s, ECT was routinely given to severely disturbed patients in mental h...
Electroconvulsive Therapy <ul><li>Today, ECT is not a widely used treatment </li></ul><ul><li>In the 1940s and 50s, ECT wa...
Electroconvulsive Therapy <ul><li>Today, ECT is not a widely used treatment </li></ul><ul><li>ECT is effective in short-te...
Electroconvulsive Therapy <ul><li>The effects of ECT are temporary </li></ul><ul><li>Use of ECT should be followed by psyc...
Electroconvulsive Therapy <ul><li>Risk of death due to ECT is low </li></ul><ul><li>However, it may cause memory loss </li...
Upcoming SlideShare
Loading in...5
×

Psychotherapy

3,951

Published on

0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
3,951
On Slideshare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
255
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

Psychotherapy

  1. 1. Psychotherapy
  2. 2. Therapy Comes in Many Forms <ul><li>Many sources and types of treatment are available </li></ul><ul><li>There are two broad categories of therapy </li></ul><ul><ul><li>Somatic therapy </li></ul></ul><ul><ul><ul><li>Treating psychological disorders by treating the body </li></ul></ul></ul><ul><ul><ul><li>Somatic therapy often involves methods that affect hormone levels and brain chemistry </li></ul></ul></ul>
  3. 3. <ul><ul><li>Psychotherapy </li></ul></ul><ul><ul><ul><li>Treatment of psychological problems through psychological techniques </li></ul></ul></ul><ul><ul><ul><li>It is a change-oriented process </li></ul></ul></ul><ul><ul><ul><li>Its goal is to teach people to cope better and lead more fulfilling lives </li></ul></ul></ul><ul><ul><ul><li>It does so by teaching people to relieve stress, improve interpersonal communication, understand previous life events, and/or modify their thinking </li></ul></ul></ul>Therapy Comes in Many Forms
  4. 4. Is Psychotherapy Necessary and Effective? <ul><li>Does psychotherapy simply create placebo effect? </li></ul><ul><ul><li>A placebo effect is a nonspecific improvement as a result of a person’s expectations of change </li></ul></ul><ul><ul><ul><li>It is not a result of a therapeutic treatment </li></ul></ul></ul><ul><ul><ul><li>Some patients in psychotherapy may show relief from their symptoms simply because they are in therapy and may expect change </li></ul></ul></ul>
  5. 5. Is Psychotherapy Effective? <ul><ul><li>Researchers must determine if improvements are due to expectations or real benefits of therapy </li></ul></ul><ul><ul><li>The double-blind technique helps distinguish between improvements due to expectations or therapy </li></ul></ul><ul><li>Some patients in psychotherapy may show relief from their symptoms simply because they are in therapy and may expect change </li></ul><ul><li>The placebo effect complicates research on therapy effectiveness </li></ul>
  6. 6. Is Psychotherapy Effective? <ul><ul><li>The double-blind eliminates any potential bias by reducing demand characteristics </li></ul></ul><ul><li>The double-blind technique helps distinguish between improvements due to expectations or therapy </li></ul><ul><ul><li>In the double-blind technique neither the experimenter nor participants know who is in the experimental or control groups </li></ul></ul>
  7. 7. <ul><li>The double-blind eliminates any potential bias by reducing demand characteristics </li></ul><ul><ul><li>Demand characteristics are elements of an experiment that might bias the participant to act in a certain way </li></ul></ul><ul><ul><ul><li>By perceiving the situation in a certain way, or becoming aware of the purpose of the study </li></ul></ul></ul><ul><ul><ul><li>Demand characteristics distort the results of a study </li></ul></ul></ul>Is Psychotherapy Effective?
  8. 8. <ul><li>Demand characteristics distort the results of a study </li></ul><ul><li>Research studies that compare psychotherapy and placebo treatment show the therapies are consistently more effective </li></ul>Is Psychotherapy Effective?
  9. 9. Research on Psychotherapy <ul><li>In a 1952 paper, Hans Eysenck challenged the effectiveness of psychotherapy </li></ul><ul><ul><li>He claimed that it produced no greater change in maladjustment than natural life experiences </li></ul></ul><ul><ul><li>Thousands of studies investigating the effectiveness of therapy followed </li></ul></ul><ul><ul><li>These studies, and analyses using sophisticated statistical techniques, found psychotherapy to be effective </li></ul></ul>
  10. 11. Research on Psychotherapy <ul><li>These studies, and analyses using sophisticated statistical techniques, found psychotherapy to be effective </li></ul><ul><li>Effectiveness and the client’s speed of response vary with the type of problem </li></ul><ul><li>Is one type of therapy more effective? </li></ul><ul><ul><li>Many researchers contend that most psychotherapies are equally effective </li></ul></ul><ul><ul><li>If most therapies are effective, there must be a common underlying component making them successful </li></ul></ul>
  11. 12. Research on Psychotherapy <ul><li>If most therapies are effective, there must be a common underlying component making them successful </li></ul><ul><ul><li>Researchers are seeking to systematize research strategies to investigate the effectiveness of therapies </li></ul></ul><ul><ul><li>This research will lead to a clearer picture of which approaches are best for certain disorders and clients of various ages and ethnic groups </li></ul></ul>
  12. 13. Which Therapy, Which Therapist? <ul><li>There are hundreds of types of therapy </li></ul><ul><ul><li>Some focus on individuals, some on groups (group therapy) and others on families (family therapy) </li></ul></ul><ul><ul><li>Community psychologists focus on whole communities </li></ul></ul>
  13. 14. Which Therapy? <ul><li>Community psychologists focus on whole communities </li></ul><ul><li>They try to develop action-oriented approaches to individual and social problems </li></ul><ul><li>A therapist’s training usually determines the approach taken </li></ul><ul><li>Many therapists take an eclectic approach , combining different techniques </li></ul>
  14. 15. Which Therapy? <ul><li>A number of specific psychotherapeutic approaches are in use today </li></ul><ul><ul><li>Psychodynamically based approaches are based on Freud’s ideas </li></ul></ul><ul><ul><ul><li>Psychodynamic approaches aim to help patients understand the motivations underlying their behavior </li></ul></ul></ul><ul><ul><ul><li>They assume abnormal behavior occurs when people do not understand themselves </li></ul></ul></ul>
  15. 16. <ul><ul><li>Humanistic approaches assume people are essentially good </li></ul></ul><ul><ul><ul><li>Humanistic approaches try to help people realize their full potential and find meaning in life </li></ul></ul></ul><ul><ul><li>Behavior therapy is based on the assumption most behaviors are learned </li></ul></ul><ul><ul><ul><li>Behavior therapists encourage clients to learn new adaptive behaviors </li></ul></ul></ul>Which Therapy?
  16. 17. <ul><ul><li>Cognitive therapy focuses on changing a client’s behavior by changing thoughts and perceptions </li></ul></ul><ul><li>A new approach, psychotherapy integration , is now emerging </li></ul><ul><ul><li>It is more than an eclectic approach, because the goal is to integrate theories into a new approach </li></ul></ul><ul><ul><li>Research on psychotherapy integration is relatively scarce </li></ul></ul>Which Therapy?
  17. 18. <ul><li>The effectiveness of different kinds of therapy depends on two things, the disorder treated and the goals of the client </li></ul><ul><li>Research to discover the best treatment usually focuses on specific disorders </li></ul><ul><li>Research on psychotherapy integration is relatively scarce </li></ul><ul><li>This is because it is difficult to generate hypotheses based on the new points of view it creates </li></ul>Which Therapy?
  18. 19. Which Therapy? <ul><ul><li>These include ethnicity, personality, level of experience, and degree of empathy </li></ul></ul><ul><ul><li>While there are differences among therapists, there are also commonalities </li></ul></ul><ul><li>Research to discover the best treatment usually focuses on specific disorders </li></ul><ul><li>Besides therapeutic approaches, some characteristics of the therapist affect treatment </li></ul>
  19. 20. Which Therapy? <ul><ul><li>Good therapists communicate interest, understanding, respect, tact, and maturity </li></ul></ul><ul><ul><li>Good therapists use suggestions, interpretation, encouragement, and perhaps rewards to help clients change </li></ul></ul><ul><li>While there are differences among therapists, there are also commonalities </li></ul><ul><ul><li>Clients receive attention, which helps them maintain a positive attitude </li></ul></ul>
  20. 21. Which Therapy? <ul><li>Good therapists use suggestions, interpretation, encouragement, and perhaps rewards to help clients change </li></ul><ul><li>But clients must be willing to make some changes in their lifestyles and ideas </li></ul><ul><li>The therapist and client must form an alliance to work together purposefully </li></ul>
  21. 22. Culture and Therapy <ul><li>The therapy process and its outcome are effected by the client’s ethnicity </li></ul><ul><ul><li>Care must be taken to be culturally congruent </li></ul></ul><ul><ul><ul><li>Have a match between therapist and client </li></ul></ul></ul><ul><ul><ul><li>At a minimum, the therapist must respect multiculturalism </li></ul></ul></ul>
  22. 23. Culture and Therapy <ul><li>At a minimum, the therapist must respect multiculturalism </li></ul><ul><ul><li>The acceptance of and celebration of distinct cultural heritages </li></ul></ul><ul><ul><li>Therapists must also see beyond the distinct margins of a specific culture </li></ul></ul><ul><ul><li>Therapists must see individuals as made up of a confluence of different influences </li></ul></ul>
  23. 24. Culture and Therapy <ul><li>Therapists must see individuals as made up of a confluence of different influences </li></ul><ul><ul><li>This view is called transculturalism </li></ul></ul><ul><ul><ul><li>This view reflects changes that have occurred in the world through globalization, mobility, improved communication, and intermarriage </li></ul></ul></ul><ul><ul><ul><li>Therapists need to be well informed about clients’ backgrounds </li></ul></ul></ul>
  24. 25. Culture and Therapy <ul><li>Therapists need to be well about clients’ backgrounds </li></ul><ul><ul><li>They should provide interventions based upon and using cultural symbols and rituals meaningful to the client </li></ul></ul><ul><ul><ul><li>Asian culture reflects family and roles in the family, so they must be taken into account </li></ul></ul></ul><ul><ul><ul><li>Some cultures have prohibitions against self-disclosure, or toward control </li></ul></ul></ul>
  25. 26. Culture and Therapy <ul><li>Some cultures have prohibitions against self-disclosure, or toward control </li></ul><ul><li>Some Arab cultures resist emotional exploration </li></ul><ul><li>Such cultures are more likely to value and adapt to cognitive therapies </li></ul><ul><li>Cultural mistrust of therapy situations is common among African-Americans </li></ul>
  26. 27. Culture and Therapy <ul><li>Cultural mistrust of therapy situations is common among African-Americans </li></ul><ul><li>By contrast, many Hispanic cultures have a high regard for experts like therapists </li></ul><ul><li>The therapists ethnicity is also important </li></ul><ul><li>Latino, African-American, and Asian-American therapists are viewed differently than European-American therapists </li></ul>
  27. 28. Culture and Therapy <ul><li>Latino, African-American, and Asian-American therapists are viewed differently than European-American therapists </li></ul><ul><li>It must be remembered that culture is dynamic, contextual, and even political </li></ul><ul><li>Stereotypes and oversimplifications also abound </li></ul><ul><li>Therapists must recognize that members of other groups may not share their own cultural values </li></ul>
  28. 29. Culture and Therapy <ul><li>Therapists must recognize that members of other groups may not share their own cultural values </li></ul><ul><li>They must also realize that their preconceived ideas can affect the outcome of therapy </li></ul><ul><ul><li>They may be oppressive to their clients </li></ul></ul><ul><ul><li>This may constrain their effectiveness as therapists </li></ul></ul>
  29. 30. Gender and Therapy <ul><li>Not only is ethnicity important, gender is also a significant factor in therapy </li></ul><ul><ul><li>Women seek out therapy more often than men </li></ul></ul><ul><ul><li>They also respond differently to therapy, and to drug therapy </li></ul></ul><ul><ul><li>Communication differences may also affect therapy (Tannen, 2001) </li></ul></ul>
  30. 31. Gender and Therapy <ul><ul><li>Clients may also experience gender bias in their families that affects their gender assumptions </li></ul></ul><ul><ul><li>Gender differences can be compounded by ethnicity </li></ul></ul><ul><li>Communication differences may also affect therapy </li></ul><ul><ul><li>Men tend to give reports while women try to establish rapport </li></ul></ul>
  31. 32. Gender and Therapy <ul><ul><li>Gay men and lesbians bring still another view to gender roles in the therapeutic situation </li></ul></ul><ul><ul><li>Therapists must also understand how their own gender socialization affects therapy </li></ul></ul><ul><li>Gender differences can be compounded by ethnicity </li></ul><ul><ul><li>People from different cultural backgrounds may view masculinity differently </li></ul></ul>
  32. 33. Gender and Therapy <ul><li>Therapists must also understand how their own gender socialization affects therapy </li></ul><ul><li>They must avoid gender stereotypes, and recognize the diversity of men’s and women’s experiences </li></ul>
  33. 34. Managed Care and Psychology <ul><li>“ Managed care” emphasizes active coordination and arrangement of health care services </li></ul><ul><ul><li>It usually involves three components: </li></ul></ul><ul><ul><ul><li>Oversight of the care given </li></ul></ul></ul><ul><ul><ul><li>Contractual relationships with, and organization of, the providers giving care </li></ul></ul></ul><ul><ul><ul><li>Determines the covered benefits </li></ul></ul></ul>
  34. 35. Managed Care and Psychology <ul><li>The aim of managed care is to control costs </li></ul><ul><li>There are two major difficulties with managed care </li></ul><ul><ul><li>First, insurance companies seek to limit the time or type of psychotherapy a person may access </li></ul></ul><ul><ul><li>The second problem is that insurance companies limit who a client can see </li></ul></ul><ul><li>Both deal with access to timely and effective treatment </li></ul>
  35. 36. Managed Care <ul><li>Insurance companies limit who a client can see </li></ul><ul><li>Many HMOs require re-approval of therapy every six sessions </li></ul><ul><li>This tends to make therapy shorter </li></ul><ul><li>It also means the therapist must continually justify a person’s treatment </li></ul><ul><li>Edwards (1999) believes that these factors compromise the practitioner/client alliance </li></ul>
  36. 37. Managed Care <ul><li>Edwards (1999) believes that these factors compromise the practitioner/client alliance </li></ul><ul><li>Managed care has led to brief therapy </li></ul><ul><ul><li>Six weeks is common, and 16 is considered lengthy </li></ul></ul><ul><ul><li>One objective of brief therapy is saving clients time and money </li></ul></ul>
  37. 38. Managed Care <ul><li>One objective of brief therapy is saving clients time and money </li></ul><ul><li>Clients may remain in therapy longer if they feel it is needed and can continue to pay </li></ul><ul><li>Clients can also return to therapy if they feel they need it in the future </li></ul>
  38. 39. Brief Therapy <ul><li>Practitioners of brief therapy think in terms of planned short-term treatments </li></ul><ul><ul><li>They make sure treatment begins in the first session </li></ul></ul><ul><ul><ul><li>An operational diagnosis is made </li></ul></ul></ul><ul><ul><ul><li>The operational diagnosis answers the question “Why is the client here today?” </li></ul></ul></ul>
  39. 40. Brief Therapy <ul><li>The operational diagnosis answers the question “Why is the client here today?” </li></ul><ul><li>The answer helps pinpoint the specific problem for which the client is seeking help </li></ul><ul><li>During the first session, the client also makes a “therapeutic contract” with the therapists </li></ul><ul><li>The therapeutic contract establishes precise goals for the therapy </li></ul>
  40. 41. Brief Therapy <ul><ul><li>Especially when tailored to the clients needs and time </li></ul></ul><ul><ul><li>Brief therapy is highly effective with couples and when combined with cognitive restructuring </li></ul></ul><ul><li>The therapeutic contract establishes precise goals for the therapy </li></ul><ul><li>Research on brief therapy suggests that it is effective and has long-lasting effects </li></ul>
  41. 42. Brief Therapy <ul><li>Brief therapy is highly effective with couples and when combined with cognitive restructuring </li></ul><ul><li>However, research has been limited to relatively few clients and a narrow range of problems </li></ul><ul><li>Further research on brief therapy is being conducted </li></ul><ul><li>But, it is inaccurate and misleading to say no one gets appropriate care from managed care </li></ul>
  42. 43. Managed Care <ul><ul><li>They also fear it is managed by people with little or no training who never meet patients </li></ul></ul><ul><ul><li>It poses a social policy question whether our society wants to provide psychotherapy for those in need </li></ul></ul><ul><li>It is inaccurate and misleading to say no one gets appropriate care from managed care </li></ul><ul><li>Still, many practitioners worry that care is terminated too quickly </li></ul>
  43. 44. Choosing a Therapist <ul><li>The best way to choose a therapist is to ask around </li></ul><ul><ul><li>Ask family and friends </li></ul></ul><ul><ul><li>Talk to one’s doctor </li></ul></ul><ul><ul><ul><li>Many doctors work with a team of health care providers, including psychotherapists </li></ul></ul></ul><ul><ul><ul><li>Doctors can suggest someone they know to be effective </li></ul></ul></ul>
  44. 45. Choosing a Therapist <ul><li>Doctors can suggest someone they know to be effective </li></ul><ul><li>Consult the psychology department of local colleges or the staff of community health care centers </li></ul><ul><li>Once one has a list of several practitioners, find out if they are licensed </li></ul>
  45. 46. Choosing a Therapist <ul><li>Once one has a list of several practitioners, find out if they are licensed </li></ul><ul><li>Ask what kind of treatment procedures they use </li></ul><ul><li>Find out if they have a specialty </li></ul><ul><ul><li>Such as working with children or teens </li></ul></ul><ul><ul><li>Working with eating disorders </li></ul></ul><ul><li>In the end, one must choose a therapist with whom one is comfortable </li></ul>
  46. 47. Psychoanalysis And Psychodynamic Therapies www.ablongman.com/lefton8e
  47. 48. Psychoanalysis <ul><li>Psychoanalysis is a lengthy insight therapy developed by Freud </li></ul><ul><ul><li>It aims at uncovering unconscious conflicts </li></ul></ul><ul><ul><li>It uses techniques such as free association and dream analysis </li></ul></ul><ul><li>Psychodynamically based therapies use techniques derived from Freud, but reject or modify parts of his theory </li></ul>
  48. 49. <ul><li>Psychodynamically based therapies use techniques derived from Freud, but reject or modify parts of his theory </li></ul><ul><li>Freud’s therapy is an insight therapy </li></ul><ul><ul><li>It attempts to discover relationships between unconscious motivation and abnormal behavior </li></ul></ul><ul><ul><li>Any insight therapy has two basic assumptions </li></ul></ul>Psychoanalysis
  49. 50. <ul><ul><li>Second, the causes of maladjustment are unresolved conflicts </li></ul></ul><ul><ul><ul><li>The person is unaware of these conflicts, and therefore cannot deal with them </li></ul></ul></ul><ul><li>Any insight therapy has two basic assumptions: </li></ul><ul><ul><li>First, becoming aware of one’s motivations helps one change and become more adaptive </li></ul></ul>Psychoanalysis
  50. 51. Goal of Psychoanalysis <ul><li>The goal is to help patients understand the unconscious motivations that direct their behaviors </li></ul><ul><ul><li>Only by becoming aware of these motivations can they choose behaviors that lead to more fulfilling lives </li></ul></ul><ul><ul><li>During analysis, patients are encouraged to express healthy impulses, strengthen day-to-day functioning based on reality, and perceive the world as a positive place </li></ul></ul>
  51. 52. Copyright © Allyn & Bacon 2003
  52. 53. Techniques of Psychoanalysis <ul><li>Psychoanalysis is geared toward the exploration of early experiences </li></ul><ul><li>Two major techniques are free association and dream analysis </li></ul><ul><li>In free association , the patient is asked to report whatever comes to mind, no matter how disorganized or trivial </li></ul>
  53. 54. Techniques of Psychoanalysis <ul><li>In free association , the patient is asked to report whatever comes to mind, no matter how disorganized or trivial </li></ul><ul><ul><li>One purpose is to help patients recognize connections and patterns among their thoughts </li></ul></ul><ul><ul><li>It also allows free expression of the unconscious </li></ul></ul><ul><li>In dream analysis , patients are asked to describe their dreams in detail </li></ul>
  54. 55. Techniques of Psychoanalysis <ul><li>In dream analysis , patients are asked to describe their dreams in detail </li></ul><ul><ul><li>The dreams are interpreted to provide insight into unconscious motivation </li></ul></ul><ul><ul><li>Freud believed dreams represent some element of the unconscious seeking expression </li></ul></ul><ul><li>Both free association and dream analysis involve the therapist’s interpretations </li></ul>
  55. 56. <ul><li>Both free association and dream analysis involve the therapist’s interpretations </li></ul><ul><li>Interpretation involves providing a context, meaning, or cause, for an idea, feeling, or set of behaviors </li></ul><ul><ul><li>The therapist attempts to find a common thread in a patient’s behaviors and thoughts </li></ul></ul><ul><ul><li>Patients’ use of defense mechanisms may point to areas that need to be explored </li></ul></ul>Techniques of Psychoanalysis
  56. 57. Techniques of Psychoanalysis <ul><li>Defense mechanisms may point to areas that need to be explored </li></ul><ul><li>Two processes in psychoanalysis are resistance and transference </li></ul><ul><ul><li>Resistance is an unwillingness to cooperate </li></ul></ul><ul><ul><li>In resistance, the patient may be unwilling to provide information, or help in interpretation </li></ul></ul>
  57. 58. <ul><li>Resistance shows one of two things </li></ul><ul><ul><li>The patient wishes to avoid talking about a topic </li></ul></ul><ul><ul><li>Or, a difficult stage of therapy has been reached </li></ul></ul><ul><li>To minimize resistance, analysts try to accept a patient’s behavior </li></ul><ul><li>In resistance, the patient may be unwilling to provide information, or help in interpretation </li></ul><ul><li>Resistance may sometimes reach the point of belligerence </li></ul>Techniques of Psychoanalysis
  58. 59. <ul><li>To minimize resistance, analysts try to accept a patient’s behavior </li></ul><ul><li>During transference , the therapist becomes the object of a patient’s emotional attitudes about an important person in the patient’s life </li></ul><ul><ul><li>The importance of transference is that the therapist will respond differently than the important person </li></ul></ul><ul><ul><li>This allows the patient to experience conflict differently </li></ul></ul>Techniques of Psychoanalysis
  59. 60. <ul><li>The therapist can also guide the person to explore repressed ideas </li></ul><ul><li>Examining previously unacceptable thoughts and feelings helps patients identify underlying conflicts </li></ul><ul><li>This allows the patient to experience conflict differently </li></ul><ul><li>This gives patients a new opportunity to explore their feelings </li></ul>Techniques of Psychoanalysis
  60. 61. <ul><li>Examining previously unacceptable thoughts and feelings helps patients identify underlying conflicts </li></ul><ul><li>Psychoanalysis involves slowly gaining insights into the unconscious </li></ul><ul><li>These insights allow the patient to learn new ways of coping with instinctual urges </li></ul><ul><li>The patient also develops mature ways of dealing with anxiety and guilt </li></ul>Techniques of Psychoanalysis
  61. 62. Techniques of Psychoanalysis <ul><li>The patient also develops mature ways of dealing with anxiety and guilt </li></ul><ul><li>The cycle of interpretation, resistance, and transference occurs repeatedly during psychoanalysis </li></ul><ul><li>It is sometimes referred to as working through </li></ul>
  62. 63. Ego Analysis <ul><li>Ego analysts are psychoanalysts who assume the ego has greater control over behavior than Freud suggested </li></ul><ul><ul><li>They focus more on a person’s reality testing and control over the environment </li></ul></ul><ul><ul><li>They place less emphasis on unconscious motivation and processes </li></ul></ul><ul><li>A major disagreement between “traditional” and “ego” analysts has to do with the role of the id and the ego </li></ul>
  63. 64. Ego Analysis <ul><li>A major disagreement between “traditional” and “ego” analysts has to do with the role of the id and the ego </li></ul><ul><li>Traditional analysts feels the ego grows out of the id and is controlled by it </li></ul><ul><li>An ego analyst asserts the ego is independent of the id </li></ul><ul><li>The ego is assumed to control memory and perception, and is not in constant conflict with the id </li></ul>
  64. 65. Ego Analysis <ul><li>The ego is assumed to control memory and perception, and is not in constant conflict with the id </li></ul><ul><li>Traditional analysis focuses on unconscious material in the id before trying to increase a person’s ego control </li></ul><ul><li>Ego analysts begin by trying to strengthen the ego </li></ul>
  65. 66. <ul><li>Ego analysts begin by trying to strengthen the ego </li></ul><ul><li>They may ask a client to be assertive and take control of a situation </li></ul><ul><li>A weak ego is seen to cause maladjustment as it fails to perceive, understand, and control the id </li></ul><ul><li>By learning to master and develop their ego, people gain greater control of their lives </li></ul>Ego Analysis
  66. 67. Criticisms of Psychoanalysis <ul><li>Critics of psychoanalysis contend it is unscientific, imprecise, and subjective </li></ul><ul><ul><li>They assert concepts such as id, ego, and superego are not linked to reality </li></ul></ul><ul><ul><li>Other critics object to Freud’s biologically oriented approach </li></ul></ul><ul><ul><li>These critics object to the notion that we are bundles of energy caught in conflict </li></ul></ul>
  67. 68. Criticisms of Psychoanalysis <ul><li>These critics object to the notion that we are bundles of energy caught in conflict </li></ul><ul><li>They also object to the idea we are driven toward hedonistic goals </li></ul><ul><li>Freud’s ideas have been criticized as sexist </li></ul><ul><li>The effectiveness of psychoanalysis is open to question </li></ul>
  68. 69. Criticisms of Psychoanalysis <ul><ul><li>In general, it can be as effective as other therapies, but not more effective </li></ul></ul><ul><li>Psychoanalysis has certain inherent disadvantages </li></ul><ul><li>The effectiveness of psychoanalysis is open to question </li></ul><ul><ul><li>It is more effective for some people than others </li></ul></ul>
  69. 70. Criticisms of Psychoanalysis <ul><li>Psychoanalysis has certain inherent disadvantages </li></ul><ul><ul><li>The patient must be highly motivated and articulate </li></ul></ul><ul><ul><li>It is also typically extremely expensive </li></ul></ul><ul><ul><li>Many people cannot afford the time or money for this type of treatment </li></ul></ul>
  70. 71. Humanistic Therapies Focusing on the Present www.ablongman.com/lefton8e
  71. 72. Humanistic Therapies <ul><li>Humanistic therapies emphasize the ability to reflect on conscious experience </li></ul><ul><li>They also emphasize that humans have free will </li></ul><ul><li>Unlike psychoanalysis, humanistic therapies tend to focus on the present and future </li></ul>
  72. 73. Humanistic Therapies <ul><li>To some extent, humanistic therapies are insight therapies </li></ul><ul><ul><li>They focus on helping people see the causes of their behavior </li></ul></ul><ul><ul><li>Client-centered therapy is a major humanistic therapy </li></ul></ul><ul><li>Unlike psychoanalysis, humanistic therapies tend to focus on the present and future </li></ul><ul><li>They also assert that people are creative and born with a desire to fulfill themselves </li></ul>
  73. 74. Client-Centered Therapy <ul><li>Client-centered therapy is also known as person-centered therapy </li></ul><ul><ul><li>It is an insight therapy </li></ul></ul><ul><ul><ul><li>It helps people evaluate the world and themselves from their own perspective </li></ul></ul></ul><ul><ul><ul><li>Client-centered therapy was developed by Carl Rogers (1902 – 1987) </li></ul></ul></ul><ul><li>Rogerian therapists hold that problems occur when a person is kept from developing his or her unique potential </li></ul>
  74. 75. Copyright © Allyn & Bacon 2003
  75. 76. Techniques of Client-Centered Therapy <ul><li>The goal of client-centered therapy is to help people discover their ideal selves </li></ul><ul><ul><li>This is then reconciled with their real selves </li></ul></ul><ul><ul><li>The word client rather than patient is important in Roger’s form of therapy </li></ul></ul><ul><ul><ul><li>In psychoanalysis, the analyst directs a patient toward a “cure” </li></ul></ul></ul><ul><ul><ul><li>In client-centered therapy, the therapist guides clients to help them find what they feel is right for themselves </li></ul></ul></ul>
  76. 77. <ul><li>First, the therapist must show unconditional positive regard </li></ul><ul><ul><li>Be an accepting person who projects positive feelings </li></ul></ul><ul><ul><li>Unconditional positive regard counteracts a client’s negative encounters with unaccepting people </li></ul></ul><ul><li>In client-centered therapy, the therapist guides clients to help them find what they feel is right for themselves </li></ul><ul><li>Rogers felt a therapist must have certain characteristics in order for therapy to be successful </li></ul>Techniques
  77. 78. <ul><ul><li>Therapists are honest and aware of their own feelings </li></ul></ul><ul><ul><li>Counselors’ congruence allows them to communicate more effectively and help clients be more aware and open </li></ul></ul><ul><li>Congruence is another component </li></ul>Techniques
  78. 79. Techniques <ul><li>The final ingredient is empathic listening </li></ul><ul><ul><li>Therapists must sense how their client feels and communicate these feelings to the client </li></ul></ul><ul><ul><li>Therapists help their clients organize their thoughts and ideas </li></ul></ul>
  79. 80. Techniques <ul><li>Therapists help their clients organize their thoughts and ideas </li></ul><ul><ul><li>Three techniques can be used to do this: </li></ul></ul><ul><ul><ul><li>The therapist can paraphrase a client’s ideas </li></ul></ul></ul><ul><ul><ul><li>The client can be asked to rephrase an idea or feeling </li></ul></ul></ul><ul><ul><ul><li>The client can reflect back what they had said </li></ul></ul></ul>
  80. 81. Techniques <ul><ul><li>They are defensive, and show disorganized behavior </li></ul></ul><ul><ul><li>Over time, the client begins to use her or his own ideas as standards for self-evaluation </li></ul></ul><ul><li>The client can reflect back what they had said </li></ul><ul><li>At the beginning of therapy, clients tend to express attitudes adopted from other people </li></ul>
  81. 82. Techniques <ul><li>Over time, the client begins to use her or his own ideas as standards for self-evaluation </li></ul><ul><ul><li>Two things may occur as a result </li></ul></ul><ul><ul><ul><li>The client may adjust the ideal self so it is in line with his or her own goals, rather than those of others </li></ul></ul></ul><ul><ul><ul><li>Behavior may change so it is more adaptive and positive </li></ul></ul></ul>
  82. 83. Criticisms of Client-Centered Therapy <ul><li>No other therapy makes clients feel so warm, accepted, and safe </li></ul><ul><ul><li>Critics argue this may not be enough to bring about long-lasting change </li></ul></ul><ul><ul><li>Critics also argue that lengthy discussions about problems do not necessarily help people with present difficulties </li></ul></ul><ul><ul><li>It is also said that client-centered therapy focuses on concepts that are hard to define, such as self-actualization </li></ul></ul>
  83. 84. Behavior Therapy From the Behavioral Perspective
  84. 85. Behavior Therapy <ul><li>Behavior therapy has become especially popular in the last 30 years </li></ul><ul><ul><li>This has occurred for three reasons: </li></ul></ul><ul><ul><ul><li>People sometimes have problems that may not require insights or in-depth discussions of feelings </li></ul></ul></ul><ul><ul><ul><li>Managed care organizations see it as quicker and less expensive than other approaches </li></ul></ul></ul><ul><ul><ul><li>Finally, behavior therapy can be highly effective </li></ul></ul></ul>
  85. 86. Goals of Behavior Therapy <ul><li>Behavior therapy focuses on changing overt behavior </li></ul><ul><ul><li>It is also called behavior modification </li></ul></ul><ul><ul><ul><li>It uses learning principles to help people replace maladaptive behaviors with more effective ones </li></ul></ul></ul><ul><ul><ul><li>Behavior therapists assume changes in the environment affect people’s responses </li></ul></ul></ul>
  86. 87. Goals of Behavior Therapy <ul><li>Behavior therapists assume changes in the environment affect people’s responses </li></ul><ul><li>Unlike psychoanalysis, behavior therapy does not try to discover the origins of behavior </li></ul><ul><ul><li>It only tries to alter behavior </li></ul></ul><ul><ul><li>Behavior therapists try to help people unlearn faulty behaviors and learn more effective ones </li></ul></ul>
  87. 88. Goals of Behavior Therapy <ul><li>Behavior therapists try to help people unlearn faulty behaviors and learn more effective ones </li></ul><ul><li>They do not always focus on the problem leading the client to seek therapy </li></ul><ul><li>If behavior therapists see the problem is associated with another situation, they may try to change that situation </li></ul>
  88. 89. Goals of Behavior Therapy <ul><li>If behavior therapists see the problem is associated with another situation, they may try to change that situation </li></ul><ul><li>Unlike psychodynamic and humanistic therapies, behavior therapy does not encourage clients to interpret past events </li></ul><ul><li>Behavior therapists are dissatisfied with psychodynamic and humanistic therapies for three basic reasons </li></ul>
  89. 90. Goals of Behavior Therapy <ul><li>Second, some studies show that people who do not receive those therapies improve anyway </li></ul><ul><li>Finally, once a person is labeled “abnormal” the label itself may lead to maladaptive behavior </li></ul><ul><li>Behavior therapists are dissatisfied with psychodynamic and humanistic therapies for three basic reasons </li></ul><ul><li>First, those therapies use concepts difficult to define and measure </li></ul>
  90. 91. Goals of Behavior Therapy <ul><li>Once a person is labeled “abnormal”, the label itself may lead to maladaptive behavior </li></ul><ul><li>Behavior therapists assume people do not display maladaptive behavior because they are “abnormal” </li></ul><ul><ul><li>They display maladaptive behavior because they are having trouble adjusting to the environment </li></ul></ul><ul><ul><li>If they are taught how to cope, maladjustment will disappear </li></ul></ul>
  91. 92. Behavior Therapy: A Criticism <ul><li>Most insight therapists believe that if only overt behavior is treated, symptom substitution will occur </li></ul><ul><ul><li>In symptom substitution , a new overt symptom appears to replace one eliminated by treatment </li></ul></ul><ul><ul><li>Research does show, however, that behavior therapy is at least as effective as insight therapies </li></ul></ul>
  92. 93. Techniques of Behavior Therapy <ul><li>The techniques of behavior therapy include operant conditioning, modeling, and counterconditioning </li></ul><ul><ul><li>A therapist will use whatever combination of techniques is needed to help a client </li></ul></ul><ul><ul><li>Behavior therapy usually involves three general procedures </li></ul></ul>
  93. 94. Techniques of Behavior Therapy <ul><li>Behavior therapy usually involves three general procedures: </li></ul><ul><ul><li>First, the problem behavior and its frequency is examined </li></ul></ul><ul><ul><li>Next, a treatment strategy is used, individually tailored to the client </li></ul></ul><ul><ul><li>Finally, there is continual assessment as to whether behavior has changed </li></ul></ul>
  94. 95. Operant Conditioning <ul><li>Operant conditioning to establish a new behavior often depends on a reinforcer </li></ul><ul><ul><li>An event or circumstance that increases the probability a response will occur </li></ul></ul><ul><ul><li>One method of rewarding adaptive behavior is through a token economy </li></ul></ul>
  95. 96. Token Economies <ul><li>In a token economy people who display appropriate behaviors receive tokens </li></ul><ul><ul><li>These can be exchanged for desirable items and activities </li></ul></ul><ul><ul><li>Token economies are used to modify behavior in social settings </li></ul></ul>
  96. 97. Token Economies <ul><li>Token economies are used to modify behavior in social settings </li></ul><ul><li>The aim is to strengthen behaviors compatible with norms </li></ul><ul><li>They have been used successfully in schools and hospital settings </li></ul><ul><li>Other operant techniques include extinction, punishment, and time out </li></ul>
  97. 98. Extinction <ul><li>Extinction occurs when reinforcers are withheld </li></ul><ul><ul><li>This eventually leads a previously reinforced behavior to stop </li></ul></ul><ul><ul><li>It can be used in conjunction with a token economy, or separately, to stop an undesirable behavior </li></ul></ul>
  98. 99. Punishment <ul><li>Another way to stop an undesirable behavior is to use punishment </li></ul><ul><ul><li>This often involves the presentation of an aversive stimulus </li></ul></ul><ul><ul><ul><li>It only suppresses a behavior </li></ul></ul></ul><ul><ul><ul><li>Punishment does not establish new, desired behaviors </li></ul></ul></ul>
  99. 100. Punishment <ul><li>Punishment does not establish new, desired behaviors </li></ul><ul><li>Thus, it is often combined with positive reinforcement for desirable behaviors </li></ul><ul><li>Punishment has other drawbacks </li></ul><ul><li>People (especially young people) sometimes imitate aggression </li></ul>
  100. 101. Punishment <ul><li>Punishment can be harmful </li></ul><ul><li>People (especially young people) sometimes imitate aggression </li></ul><ul><li>Punishment can lead to generalized aggression </li></ul>
  101. 102. Time-Out <ul><li>Time-out is the removal of a person from sources of reinforcement </li></ul><ul><ul><li>It is used to decrease behavior </li></ul></ul><ul><ul><li>Time-out is principally used with children </li></ul></ul><ul><ul><li>It is especially effective when combined with positive reinforcers for appropriate behavior </li></ul></ul>
  102. 103. Counterconditioning <ul><li>In Counterconditioning , a person is taught a new, more adaptive response to a stimulus </li></ul><ul><ul><li>It is a process of reconditioning </li></ul></ul><ul><ul><li>Joseph Wolpe (1915 – 1997) was one of the original proponents of counterconditioning </li></ul></ul><ul><ul><li>Wolpe used counterconditioning to inhibit anxiety as a response </li></ul></ul>
  103. 104. Counterconditioning <ul><li>Wolpe used counterconditioning to inhibit anxiety as a response </li></ul><ul><li>Therapy using the technique begins with a specific stimulus (S1) that elicits a specific response (R1) </li></ul><ul><li>After therapy, S1 should elicit a new response (R2) </li></ul><ul><li>Two approaches use counterconditioning: </li></ul><ul><ul><li>Systematic desensitization </li></ul></ul><ul><ul><li>Aversive conditioning </li></ul></ul>
  104. 105. Systematic Desensitization <ul><li>Systematic desensitization is a three-stage counterconditioning procedure </li></ul><ul><ul><li>The client is first taught to relax </li></ul></ul><ul><ul><ul><li>The client then describes the specific situations that arouse anxiety </li></ul></ul></ul><ul><ul><ul><li>While deeply relaxed, the client imagines increasingly vivid scenes of the situations causing anxiety </li></ul></ul></ul>
  105. 106. Systematic Desensitization <ul><ul><li>With each successive experience, the client learns relaxation rather than fear as a response </li></ul></ul><ul><li>While deeply relaxed, the client imagines increasingly vivid scenes of the situations causing anxiety </li></ul><ul><ul><li>This gradually exposes the client to the source of the anxiety </li></ul></ul>
  106. 107. Systematic Desensitization <ul><li>With each successive experience, the client learns relaxation rather than fear as a response </li></ul><ul><li>Systematic desensitization is most successful for people with two types of problems </li></ul><ul><ul><li>Problems with impulse control </li></ul></ul><ul><ul><li>Particular forms of anxiety such as phobias </li></ul></ul><ul><li>It is not effective for people with psychotic symptoms, or situations of interpersonal conflict </li></ul>
  107. 108. Aversive Conditioning <ul><li>Another method using counterconditioning is aversive conditioning </li></ul><ul><ul><li>A noxious stimulus is paired with a stimulus that elicits an undesirable behavior </li></ul></ul><ul><ul><ul><li>This will cause the undesirable behavior to stop </li></ul></ul></ul><ul><ul><ul><li>The goal is to teach a new response to the aversive stimulus </li></ul></ul></ul>
  108. 109. Modeling <ul><li>Bandura (1997) believes modeling can be used effectively for: </li></ul><ul><ul><li>Teaching a new behavior </li></ul></ul><ul><ul><li>Helping eliminate fears </li></ul></ul><ul><ul><li>Enhancing already existing behavior </li></ul></ul><ul><li>One problem is that people may imitate the behavior of inappropriate models </li></ul>
  109. 110. Cognitive Therapy An Outgrowth of Behavior Therapy www.ablongman.com/lefton8e
  110. 111. Cognitive Therapy <ul><li>Cognitive therapists assume that distorted, undeveloped ideas prevent people from establishing effective coping behaviors </li></ul><ul><li>Cognitive therapy focuses on changing client behavior by changing the person’s thoughts or perceptions </li></ul><ul><li>Cognitive therapy is derived from three propositions </li></ul>
  111. 112. Cognitive Therapy <ul><li>Cognitive therapy is derived from three propositions: </li></ul><ul><ul><li>Cognitive activity affects behavior </li></ul></ul><ul><ul><li>Cognitive activity can be monitored </li></ul></ul><ul><ul><li>Behavior can be changed by altering cognitive patterns </li></ul></ul>
  112. 113. Cognitive Therapy <ul><ul><li>Cognitive therapy is also known as cognitive restructuring </li></ul></ul><ul><ul><li>Cognitive therapy is effective for people who have attached narrow or inappropriate labels to certain behaviors or situations </li></ul></ul><ul><li>Many behavior therapists currently incorporate thought processes into treatment </li></ul><ul><ul><li>This is called cognitive behavior therapy </li></ul></ul>
  113. 114. Cognitive Therapy <ul><li>Cognitive therapy focuses on current behaviors and thoughts </li></ul><ul><ul><li>It is not especially concerned with uncovering childhood experiences </li></ul></ul><ul><ul><li>It is especially effective if combined with techniques such as use of reinforcement </li></ul></ul>
  114. 115. Rational Emotive Therapy <ul><li>The best known cognitive therapy is rational emotive therapy </li></ul><ul><ul><li>It emphasizes the importance of logical, rational, thought processes </li></ul></ul><ul><ul><ul><li>It was developed by Albert Ellis over 30 years ago </li></ul></ul></ul><ul><ul><ul><li>Ellis assumed abnormal behavior is caused by faulty and irrational thinking patterns </li></ul></ul></ul>
  115. 116. Rational Emotive Therapy <ul><li>Ellis assumed abnormal behavior is caused by faulty and irrational thinking patterns </li></ul><ul><li>A major goal is to help people examine past events that produce irrational beliefs </li></ul><ul><ul><li>Clients adopt different behavior patterns based on more rational thought processes </li></ul></ul><ul><ul><li>Research supports the effectiveness of the approach </li></ul></ul>
  116. 117. Beck’s Approach <ul><li>Aaron Beck developed another cognitive therapy </li></ul><ul><ul><li>Beck assumes depression is caused by people’s distorted thoughts about reality </li></ul></ul><ul><ul><ul><li>These lead to negative views of the world, the self, and the future </li></ul></ul></ul><ul><ul><ul><li>A goal of Beck’s therapy is to help people develop realistic appraisals of situations </li></ul></ul></ul>
  117. 118. Copyright © Allyn & Bacon 2003
  118. 119. Beck’s Approach <ul><li>A goal of Beck’s therapy is to help people develop realistic appraisals of situations </li></ul><ul><li>The therapist acts as a trainer and coinvestigator </li></ul><ul><ul><li>Providing data to be examined </li></ul></ul><ul><ul><li>The therapist also guides the client in understanding how cognitions influence behavior </li></ul></ul>
  119. 120. Beck’s Approach <ul><li>Beck says a successful client passes through four stages in moving toward mental health </li></ul><ul><ul><li>First the client becomes aware of her/his thoughts </li></ul></ul><ul><ul><li>The client recognizes what thoughts are awry </li></ul></ul><ul><ul><li>Accurate judgments then need to be substituted for inaccurate ones </li></ul></ul><ul><ul><li>Finally, the client needs feedback as to whether the changes are correct </li></ul></ul>
  120. 121. Meichenbaum’s Approach <ul><li>Meichenbaum developed a third cognitive therapy </li></ul><ul><ul><li>He believes that what people say to themselves determines what they do </li></ul></ul><ul><ul><ul><li>A goal of his therapy is to change what people say to themselves </li></ul></ul></ul><ul><ul><ul><li>The therapist must change the client’s appraisal of situations and the client’s use of self-instructions </li></ul></ul></ul>
  121. 122. Meichenbaum’s Approach <ul><li>The therapist must change the client’s appraisal of situations and the client’s use of self-instructions </li></ul><ul><li>A strength of the approach is that it can be used in many settings for many problems </li></ul><ul><li>No attempt is made to change irrational beliefs </li></ul><ul><li>Clients learn a repertoire of activities they can use to make their behavior more adaptive </li></ul>
  122. 123. Meichenbaum’s Approach <ul><ul><li>They may learn to organize their responses to specific situations in orderly steps </li></ul></ul><ul><li>Clients learn a repertoire of activities they can use to make their behavior more adaptive </li></ul><ul><ul><li>They may learn to conduct a private monologue in which they work out adaptive ways of coping </li></ul></ul>
  123. 124. Cognitive Therapy <ul><li>Cognitive therapy is influencing an increasing number of therapists who conduct long-term, as well as brief, therapy </li></ul><ul><li>It can be applied to a variety of problems including anxiety, depression, marital difficulties, and chronic pain </li></ul><ul><li>Cognitive therapy in its many forms has been used with adults and children </li></ul>
  124. 125. Cognitive Therapy <ul><li>Cognitive therapy in its many forms has been used with adults and children </li></ul><ul><li>It can be used with groups having particular characteristics </li></ul>
  125. 126. Group Therapy
  126. 127. Group Therapy <ul><li>In group therapy , several people meet together with a therapist to receive treatment </li></ul><ul><ul><li>This allows a therapist to see more clients </li></ul></ul><ul><ul><li>Since fees are shared, it is also less expensive </li></ul></ul><ul><ul><li>Group therapy can also be more effective than individual therapy </li></ul></ul>
  127. 128. Group Therapy <ul><li>Group therapy can also be more effective than individual therapy </li></ul><ul><ul><li>The social pressure in the group can help shape members’ behavior </li></ul></ul><ul><ul><li>Group members can also act as useful models </li></ul></ul><ul><ul><li>Mutual reinforcement and support can also be provided </li></ul></ul>
  128. 129. Techniques and Formats of Group Therapy <ul><li>The techniques used are determined by the nature of the group </li></ul><ul><li>It is also determined by the theoretical orientation of the therapist </li></ul><ul><li>In traditional group therapy, 6 to 12 clients meet once a week </li></ul>
  129. 130. Techniques and Formats <ul><li>In traditional group therapy, 6 to 12 clients meet once a week </li></ul><ul><ul><li>Members are chosen on the basis of what they can gain from and offer to the group </li></ul></ul><ul><ul><li>The aim is to construct a group whose members are compatible in terms of age, needs, and problems </li></ul></ul>
  130. 131. Techniques and Formats <ul><li>The format of traditional group therapy varies </li></ul><ul><ul><li>Generally, each member describes his or her problems to the other members </li></ul></ul><ul><ul><ul><li>The other members relate their experiences with similar problems, and how they coped </li></ul></ul></ul><ul><ul><ul><li>Thus, each member expresses their fears and anxieties to people who are accepting </li></ul></ul></ul>
  131. 132. Techniques and Formats <ul><li>Thus, each member expresses their fears and anxieties to people who are accepting </li></ul><ul><li>Group members have an opportunity to role play new behaviors in a safe environment </li></ul><ul><li>Sometimes the therapist is directive in helping to address problems </li></ul><ul><li>At other times, the therapist has the group resolve a problem independently </li></ul>
  132. 133. Family Therapy <ul><li>A family is a group of people who are committed to one another’s well-being, preferably for life </li></ul><ul><ul><li>In family therapy , two or more people who are committed to each other’s well-being are treated together </li></ul></ul><ul><ul><li>Family therapists often attempt to change family systems </li></ul></ul>
  133. 134. Family Therapy <ul><ul><li>Therapists assume there are multiple sources of psychological influence </li></ul></ul><ul><ul><ul><li>Individuals in a family affect family interactions </li></ul></ul></ul><ul><ul><ul><li>Family interactions affect individuals </li></ul></ul></ul><ul><li>Family therapists often attempt to change family systems </li></ul><ul><ul><li>Treatment takes place within the dynamic social system of the marriage or family </li></ul></ul>
  134. 135. Family Therapy <ul><li>Family interactions affect individuals </li></ul><ul><li>Sometimes family therapy is called relationship therapy , because relationships are a focus of intervention </li></ul><ul><li>A useful technique is to restructure the family’s interactions </li></ul><ul><li>For example, a son may be responding passively to a domineering mother </li></ul>
  135. 136. Family Therapy <ul><li>An issue in family therapy is how all members of a family may become enmeshed in one member’s problems </li></ul><ul><li>A son may be responding passively to a domineering mother </li></ul><ul><li>The therapist may suggest he only be assigned chores by his father </li></ul>
  136. 137. Family Therapy <ul><ul><li>A family member may be alcoholic, but codependence may be an additional adjustment problem </li></ul></ul><ul><ul><li>Codependents are often plagued by feelings of shame, fear, anger, and pain </li></ul></ul><ul><li>An issue in family therapy is how all members of a family may become enmeshed in one member’s problems </li></ul><ul><ul><li>This problem is called codependence </li></ul></ul>
  137. 138. Family Therapy <ul><li>Codependents are often plagued by feelings of shame, fear, anger, and pain </li></ul><ul><li>However, they feel obligated to care for the person with the disorder or addiction </li></ul><ul><li>This prevents them from expressing their feelings </li></ul><ul><li>In some cases, people need the person to stay disordered </li></ul>
  138. 139. Family Therapy <ul><li>In some cases, people need the person to stay disordered </li></ul><ul><li>This allows them to maintain a controlling position </li></ul>
  139. 140. Family Therapy: Assessment <ul><li>Some researchers believe family therapy to be as effective as individual therapy </li></ul><ul><ul><li>In some situations they say it is more effective </li></ul></ul><ul><ul><li>However, not all families profit equally </li></ul></ul><ul><ul><ul><li>It is difficult with families that are disorganized </li></ul></ul></ul><ul><ul><ul><li>Outcomes are not as good when depression is involved </li></ul></ul></ul>
  140. 141. Family Therapy: Assessment <ul><li>Outcomes are not as good when depression is involved </li></ul><ul><li>If family members drop out or refuse to participate, the outcome is almost always negative </li></ul><ul><li>Younger couples seem to have better outcomes </li></ul><ul><li>There is no one solution to family problems </li></ul>
  141. 142. Biologically Based Therapies Medical Therapies www.ablongman.com/lefton8e
  142. 143. Biologically Based Therapy <ul><li>The usual approach to a psychological problem is “talking therapy” </li></ul><ul><ul><li>For some patients, this is not enough </li></ul></ul><ul><ul><ul><li>They may be exhibiting symptoms of bipolar disorder or schizophrenia </li></ul></ul></ul><ul><ul><ul><li>Some people may be suicidal </li></ul></ul></ul>
  143. 144. Biologically Based Therapy <ul><ul><ul><li>These therapies often involve medication, or hospitalization </li></ul></ul></ul><ul><ul><ul><li>Biological therapies are often used in combination with traditional psychotherapy </li></ul></ul></ul><ul><li>Some people may be suicidal </li></ul><ul><ul><li>These are cases where biologically based therapies come into play </li></ul></ul>
  144. 145. Biologically Based Therapy <ul><li>Biological therapies are often used in combination with traditional psychotherapy </li></ul><ul><li>Most practitioners and theoreticians believe the most effective treatment is drugs in combination with psychotherapy </li></ul>
  145. 146. Drug Therapy <ul><li>Clinicians who use drug therapy must be aware of several key issues </li></ul><ul><ul><li>Dosages are important and must be monitored </li></ul></ul><ul><ul><li>Long-term use of many drugs is ill advised </li></ul></ul><ul><ul><li>No drug will permanently cure the maladjustment of people who are not coping well </li></ul></ul>
  146. 147. Drug Therapy <ul><li>Psychotropic drugs are grouped into four categories </li></ul><ul><li>No drug will permanently cure the maladjustment of people who are not coping well </li></ul><ul><li>Drugs for the relief of mental problems are sometimes called psychotropic drugs </li></ul>
  147. 148. Drug Therapy <ul><ul><li>Antianxiety drugs </li></ul></ul><ul><ul><li>Antimania drugs </li></ul></ul><ul><ul><li>Antipsychotic drugs </li></ul></ul><ul><li>Psychotropic drugs are grouped into four categories </li></ul><ul><ul><li>Antidepressant drugs </li></ul></ul>
  148. 149. Antianxiety Drugs <ul><li>Librium, Xanax, and Valium are trade names of widely prescribed antianxiety drugs </li></ul><ul><ul><li>They are also known as tranquilizers </li></ul></ul><ul><ul><li>They reduce feelings of stress, and have a calming effect </li></ul></ul><ul><ul><li>Abuse and overreliance can be a problem with antianxiety drugs </li></ul></ul>
  149. 150. Antidepressant Drugs <ul><li>Antidepressants ( thymoleptics ) work by altering levels of brain chemicals </li></ul><ul><ul><li>Selective serotonin reuptake inhibitors (SSRIs) relieve depression by affecting the neurotransmitter serotonin </li></ul></ul><ul><ul><li>Depression is believed to occur when serotonin does not bind to receptors on the next neuron </li></ul></ul>
  150. 151. Antidepressant Drugs <ul><li>Depression is believed to occur when serotonin does not bind to receptors on the next neuron </li></ul><ul><li>After release, neurotransmitters are neutralized, or re-uptake occurs </li></ul><ul><li>SSRIs prevent the neutralization or reuptake of serotonin </li></ul><ul><li>SSRIs thus allow serotonin to remain in the synapse so it can be effective </li></ul>
  151. 152. Antidepressant Drugs <ul><li>SSRIs allow serotonin to remain in the synapse so it can be effective </li></ul><ul><li>Prozac, Zoloft, and Paxil are SSRIs </li></ul><ul><li>Two other categories of antidepressants are: </li></ul><ul><ul><li>Tricyclics </li></ul></ul><ul><ul><li>Monoamine oxidase (MAO) inhibitors </li></ul></ul>
  152. 153. Tricyclics and MAO Inhibitors <ul><li>Tricyclics block neurotransmitter reuptake </li></ul><ul><li>MAO inhibitors break down monoamine oxidase (MAO) </li></ul><ul><ul><li>MAO is an enzyme that destroys neurotransmitters </li></ul></ul><ul><ul><li>Tricyclics pose less of a danger of complications than MAO inhibitors </li></ul></ul>
  153. 154. Tricyclics and MAO Inhibitors <ul><li>Tricyclics pose less of a danger of complications than MAO inhibitors </li></ul><ul><li>Therefore, they are used more frequently </li></ul>
  154. 155. Prozac <ul><li>About 31 million people have taken the SSRI Prozac since its introduction in 1987 </li></ul><ul><ul><li>Yearly sales of Prozac and other SSRIs such as Zoloft and Paxil amount to more than $4 billion </li></ul></ul><ul><ul><li>Earlier antidepressants could cause increased heart rate and blood pressure, nausea, and sleeplessness </li></ul></ul>
  155. 156. Prozac <ul><ul><li>However, Prozac does not help everyone </li></ul></ul><ul><ul><li>Psychologists worry that Prozac is so effective that the original problems leading to depression may be overlooked </li></ul></ul><ul><li>Earlier antidepressants could cause increased heart rate and blood pressure, nausea, and sleeplessness </li></ul><ul><li>Prozac has fewer side effects </li></ul>
  156. 157. Prozac <ul><li>Psychologists worry that Prozac is so effective that the original problems leading to depression may be overlooked </li></ul><ul><li>Most psychologists feel SSRIs should be part of a full treatment program that also includes psychotherapy </li></ul>
  157. 158. Antidepressants: Research <ul><li>Research on the effectiveness of antidepressants is contradictory </li></ul><ul><li>Some studies show strong effects, others report only modest help from the drugs </li></ul>
  158. 159. Antimania Drugs <ul><li>Lithium carbonate has long been used as an effective antimania drug </li></ul><ul><li>The dosage is vital </li></ul><ul><ul><li>Too much produces noxious side effects </li></ul></ul><ul><ul><li>Too little has no effect </li></ul></ul>
  159. 160. Antipsychotic Drugs <ul><li>Schizophrenia is treated using antipsychotics </li></ul><ul><ul><li>Technically called neuroleptics </li></ul></ul><ul><ul><ul><li>The most common are the phenothiazines </li></ul></ul></ul><ul><ul><ul><li>Chlorpromazine (Thorazine) is the most common phenothiazine </li></ul></ul></ul>
  160. 161. Antipsychotic Drugs <ul><li>Clozapine (Clozaril) is one of these new drugs </li></ul><ul><ul><li>It is effective, but has severe side effects </li></ul></ul><ul><ul><li>Newer drugs such as Risperidone (Risperdal) may be as effective with fewer side effects </li></ul></ul><ul><li>Chlorpromazine (Thorazine) is the most common phenothiazine </li></ul><ul><li>Other drugs, called “atypical antipsychotics,” have been introduced in the last decade </li></ul>
  161. 162. Antipsychotic Drugs <ul><li>Antipsychotics are less effective at reducing other symptoms, such as problems of emotions </li></ul><ul><li>Newer drugs such as Risperidone (Risperdal) may be as effective with fewer side effects </li></ul><ul><li>Antipsychotics are often very effective at treating hallucinations and delusions </li></ul>
  162. 163. Antipsychotic Drugs <ul><li>Antipsychotics are less effective at reducing other symptoms, such as problems of emotions </li></ul><ul><li>As with other drugs, dosages are crucial </li></ul><ul><li>If patients are maintained on antipsychotics for too long, problems may emerge </li></ul><ul><li>One problem with antipsychotics is tardive dyskinesia </li></ul>
  163. 164. Antipsychotic Drugs <ul><li>One problem with antipsychotics is tardive dyskinesia </li></ul><ul><ul><li>A nervous system disorder </li></ul></ul><ul><ul><li>It involves involuntary, spasmodic movements of the upper body, especially the face and fingers </li></ul></ul>
  164. 165. Psychosurgery <ul><li>Psychosurgery is brain surgery </li></ul><ul><ul><li>In the 1940s and 50s, a common type was the prefrontal lobotomy </li></ul></ul><ul><ul><ul><li>Removal of parts of the brain’s frontal lobes would alleviate symptoms of mental disorders </li></ul></ul></ul><ul><ul><ul><li>However, prefrontal lobotomies made some people become unnaturally calm and completely unemotional </li></ul></ul></ul>
  165. 166. Psychosurgery <ul><li>Prefrontal lobotomies made some people become unnaturally calm and completely unemotional </li></ul><ul><li>Others became unable to control their impulses </li></ul><ul><li>Today, despite advances, psychosurgery is rare </li></ul><ul><li>Drug therapy has proven more effective than surgical procedures </li></ul>
  166. 167. Psychosurgery <ul><li>Most important, psychosurgery is irreversible </li></ul><ul><li>Therefore, it is morally objectionable to many patients and their families </li></ul><ul><li>Drug therapy has proven more effective than surgical procedures </li></ul><ul><li>The long-term effects of psychosurgery are also questionable </li></ul>
  167. 168. Electroconvulsive Therapy <ul><li>Electroconvulsive therapy (ECT) was once widely employed with depressed people </li></ul><ul><ul><li>It is a treatment for severe mental illness </li></ul></ul><ul><ul><li>An electric current is briefly applied to the head to produce a generalized seizure (convulsion) </li></ul></ul><ul><ul><li>The duration of the shock is less than a second </li></ul></ul>
  168. 169. Electroconvulsive Therapy <ul><li>In the 1940s and 50s, ECT was routinely given to severely disturbed patients in mental hospitals </li></ul><ul><li>The duration of the shock is less than a second </li></ul><ul><li>Patients are treated in 3 to 12 sessions over several weeks </li></ul>
  169. 170. Electroconvulsive Therapy <ul><li>Today, ECT is not a widely used treatment </li></ul><ul><li>In the 1940s and 50s, ECT was routinely given to severely disturbed patients in mental hospitals </li></ul><ul><li>Unfortunately, it was often used with patients who did not need it, or as a means of control </li></ul>
  170. 171. Electroconvulsive Therapy <ul><li>Today, ECT is not a widely used treatment </li></ul><ul><li>ECT is effective in short-term management of severe depression </li></ul><ul><li>It is sometimes used when there is a risk of suicide </li></ul><ul><li>However, the effects of ECT are temporary </li></ul>
  171. 172. Electroconvulsive Therapy <ul><li>The effects of ECT are temporary </li></ul><ul><li>Use of ECT should be followed by psychotherapy and drug therapy </li></ul><ul><li>ECT should also be used only as a last option </li></ul>
  172. 173. Electroconvulsive Therapy <ul><li>Risk of death due to ECT is low </li></ul><ul><li>However, it may cause memory loss </li></ul><ul><li>Law requires that the patient be given the option to refuse ECT treatment, as is true for any treatment </li></ul><ul><li>ECT is not appropriate for treating schizophrenia </li></ul><ul><li>It is also inappropriate for managing unruly behavior </li></ul>
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×