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Chapter 13

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Chapter 13

  1. 1. Chapter 13 Therapies
  2. 2. Chapter 13 Overview  Insight therapies  Relationship therapies  Behavior therapies  Cognitive therapies  Biomedical therapies  Evaluating the therapies  The therapeutic relationship
  3. 3. Insight Therapies  Approaches to psychotherapy based on the notion that psychological well- being depends on self-understanding
  4. 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. 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. 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. 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. 8. Relationship Therapies  Therapies that attempt to improve patients’ interpersonal relationships or create new relationships to support patients’ efforts to address psychological problems
  9. 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. 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. 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. 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. 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. 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. 15. Cognitive Therapies  Therapies that assume maladaptive behavior can result from irrational thoughts, beliefs, and ideas
  16. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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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