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Lecture Slides 
Chapter Fifteen 
Therapies 
By Glenn Meyer 
Trinity University
Introduction: 
Psychotherapy and 
Biomedical Therapy 
Reasons for Seeking Therapy 
• Psychological disorder—troubling thou...
Two Broad Forms of Therapy 
Biomedical Therapies 
Click here 
Psychotherapy 
Click here 
• Refers to the use of psychologi...
Psychoanalytic Therapy 
Sigmund Freud and Psychoanalysis 
• Psychoanalysis is a form of 
therapy developed by Sigmund 
Fre...
Free association— 
spontaneous report of all 
mental images, thoughts, 
feelings as a way of 
revealing unconscious 
confl...
Short-Term Dynamic Therapies 
Based on psychoanalytic theory, but differs because it 
• is typically time limited–a few mo...
Humanistic Therapy 
• Humanistic perspective emphasizes 
human potential, self-awareness, and free-will 
• Humanistic ther...
Carl Rogers and Client- 
Centered Therapy 
• Therapy is nondirective— 
therapist does not interpret 
thoughts, make sugges...
Motivational Interviewing 
Helping Clients Commit to Change 
• Only one or two sessions; help clients overcome 
reluctance...
Behavior 
Therapy/Behavior 
Modification 
• Uses learning principles 
to directly change 
problem behaviors 
• Assumes tha...
Techniques Based on 
Classical Conditioning 
• Student of Watson’s – worked with 
conditioned emotional responses 
• Devel...
Systematic 
Desensitization 
• Phobic responses are reduced by pairing relaxation with mental 
images or real-life situati...
Aversive Conditioning 
• Relatively ineffective type of therapy that involves 
repeatedly pairing an aversive stimulus wit...
Techniques Based 
on Operant 
Conditioning 
• Uses Skinnerian principles 
such as 
• Shaping (useful with 
patients who ar...
Token Economy 
• System for strengthening desired behaviors through 
positive reinforcement in a very structured environme...
Cognitive Therapies 
• Assumes that the culprit in psychological problems is 
faulty or illogical patterns of thinking 
• ...
Albert Ellis and Rational- 
Emotive Therapy (RET) 
• Key premise of RET is that 
people’s difficulties are 
caused by thei...
Steps in RET 
• Identifying the core irrational beliefs that underlie personal 
distress is the first step 
• Therapist th...
Aaron Beck and Cognitive Therapy 
• Problems due to negative cognitive 
bias that lead to distorted 
perceptions and inter...
Steps in Cognitive Therapy (CT) 
Help client learn to 
recognize and monitor 
automatic thoughts that 
occur without consc...
Cognitive-Behavioral Therapy 
• Integrates cognitive and behavioral techniques 
• Based on the assumption that thoughts, m...
Group and Family Therapy 
• May use many different 
therapeutic approaches 
• Goal of family therapy is 
to alter and impr...
Couple Therapy 
• Relationship therapy that helps with difficulties in 
marriage or other committed relationships 
• Many ...
Self-Help Groups 
Helping Yourself by Helping 
Others 
• Format varies (structured 
and unstructured) 
• Many follow a 12-...
Evaluating the Effectiveness of 
Psychotherapy 
Many people 
just seek 
help and 
support 
from friends 
and family 
Some ...
Findings 
• Psychotherapy is 
significantly more effective 
than no treatment 
• On average, a person who 
completes psych...
Is One Form of Psychotherapy Superior? 
Depression 
Panic disorder, 
obsessive-compulsive 
disorder, and phobias 
Cognitiv...
What Factors 
Contribute to 
Effective 
Psychotherapy? 
Click here 
Therapeutic relationship characterized by mutual respe...
EMDR: Can You 
Wave Your 
Fears Away? 
• Developed by 
Francis Shapiro 
• Useful for relieving 
anxiety and 
traumatic mem...
Cultural Values and Psychotherapy 
Western psychotherapy 
tends to reflect European and North 
American cultural values 
•...
Cultural Values and Psychotherapy 
Collectivistic Cultures 
focus on needs of group, less on internal 
causes, not being a...
Value Clashes 
• Western therapies focus on 
insight, but other cultures 
emphasize avoiding negative 
thinking 
• Many cu...
Biomedical Therapies 
• Medical treatments for 
symptoms of 
psychological disorders 
include medication and 
electroconvu...
Antipsychotic Medications 
• Effective against positive 
symptoms of schizophrenia 
• Also referred to as 
neuroleptics 
•...
Drawbacks of Antipsychotic Medications 
• Do not cure schizophrenia 
• Early antipsychotic medications ineffective with ne...
The Atypical 
Antipsychotics 
Second Generation 
• Clozapine and 
risperidone 
• More recent: 
olanzapine, 
sertindole 
• ...
Antianxiety Medications 
Antianxiety medications 
are prescribed to help people deal with the problems and 
symptoms assoc...
Lithium 
• Used to treat bipolar disorder (manic 
depression), interrupt acute manic attacks, 
and prevent relapse 
• Lith...
Antidepressant 
Medications 
Counteract the symptoms of depression— 
hopelessness, guilt, dejection, suicidal 
thoughts, d...
Antidepressant 
Medications 
Third generation—Selective 
serotonin reuptake inhibitors 
(SSRIs) 
• Fluoxetine—Prozac, Zolo...
Comparing 
Psychotherapy and 
Antidepressant 
Medication 
Results 
• PET scans revealed that patients 
in both groups show...
Electroconvulsive Therapy 
(Electroshock therapy or 
shock therapy) 
• Involves brief burst of electric current to induce ...
Vagus nerve stimulation (VNS) 
Implantation of a device into left 
chest wall 
Uses brief, intermittent electrical 
stimul...
B. F. Skinner 
and the 
Search for 
“Order in 
Behavior” 
What to Expect in Psychotherapy 
1. Strengthen your commitment t...
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  1. 1. Lecture Slides Chapter Fifteen Therapies By Glenn Meyer Trinity University
  2. 2. Introduction: Psychotherapy and Biomedical Therapy Reasons for Seeking Therapy • Psychological disorder—troubling thoughts, feelings, or behaviors that cause psychological discomfort or interfere with a person’s ability to function • Troubled relationships—parent-child conflicts, unhappy marriage • Life transitions—death of a loved one, dissolving marriage, adjustment to retirement
  3. 3. Two Broad Forms of Therapy Biomedical Therapies Click here Psychotherapy Click here • Refers to the use of psychological techniques to treat emotional, behavioral, and interpersonal problems • Designed to encourage understanding of problems and modify troubling feelings, behaviors, • or relationships • Many types of psychotherapy • Assumes psychological factors play a significant role in person’s troubling feelings, behaviors, or relationships • Therapists are now being granted privileges to prescribe medications in some areas, but this is controversial • Involve the use of medication, electroconvulsive therapy, or other medical treatments to treat the symptoms associated with psychological disorder • Use psychotropic medications • Assume symptoms of psychological disorders involve biological factors
  4. 4. Psychoanalytic Therapy Sigmund Freud and Psychoanalysis • Psychoanalysis is a form of therapy developed by Sigmund Freud and is based on his theory of personality • Repressed conflicts continue to influence a person’s thoughts and behaviors, including the dynamics of his relationships with others • Psychoanalysis is designed to help unearth unconscious conflicts so the patient attains insight
  5. 5. Free association— spontaneous report of all mental images, thoughts, feelings as a way of revealing unconscious conflicts; usually done lying on a couch Techniques of Psychoanalysis to Lift Repression Click here Resistance— patient’s unconscious attempt to block revelation of unconscious material; usually sign that patient is close to revealing painful memory Dream interpretation— dreams are the “royal road to the unconscious”; interpretation often reveals unconscious conflicts Transference— process by which emotions originally associated with a significant person, such as a parent, are unconsciously transferred to the therapist • Seen as most important • Therapist remains neutral to produce optimal frustration and bring out unresolved conflicts Traditional psychoanalysis can take years and be very expensive
  6. 6. Short-Term Dynamic Therapies Based on psychoanalytic theory, but differs because it • is typically time limited–a few months • has specific goals • involves an active, rather than neutral, role for therapist Interpersonal Therapy (IPT) Focuses on current rather than past relationships; interpersonal problems seen as core of psychological symptoms Four Categories of Personal Problems • Unresolved grief–death of significant other • Role disputes–conflict with significant others • Role transitions–major life changes • Interpersonal deficits–absent or faulty social skills
  7. 7. Humanistic Therapy • Humanistic perspective emphasizes human potential, self-awareness, and free-will • Humanistic therapies focus on self-perception and individual’s conscious thoughts and perceptions • Most important factor in personality is the individual’s conscious, subjective perception of his or her self • Humanistic therapists see people as being innately good and motivated by the need to grow psychologically
  8. 8. Carl Rogers and Client- Centered Therapy • Therapy is nondirective— therapist does not interpret thoughts, make suggestions, or pass judgment • Therapy focuses on client’s subjective perception of self and environment • Does not speak of “illness” or “cure” • Therapist’s role is to create conditions that allow client to direct focus of therapy Therapeutic conditions that promote self-awareness, psychological growth, and self-directed change: • Genuineness: therapist honestly and openly shares thoughts and feelings with client • Unconditional positive regard: therapist must value, accept, and care for client • Empathic understanding: therapist must communicate and listen actively for personal meaning The goal is self-actualization: a realization his or her unique potentials and talents
  9. 9. Motivational Interviewing Helping Clients Commit to Change • Only one or two sessions; help clients overcome reluctance to change; encourage client’s self-motivating statements • More directive than traditional client-centered therapy • Has been applied to marital counseling, parenting, education, business, and community and international relations
  10. 10. Behavior Therapy/Behavior Modification • Uses learning principles to directly change problem behaviors • Assumes that maladaptive behaviors are learned, just as adaptive behaviors are learned • Basic strategy involves unlearning maladaptive behaviors and learning more adaptive behaviors instead
  11. 11. Techniques Based on Classical Conditioning • Student of Watson’s – worked with conditioned emotional responses • Developed counterconditioning, a behavior therapy technique based on classical conditioning that involves modifying behavior by conditioning a new response that is incompatible with a previously learned responses • Also used observational learning • Successful with Peter who was phobic to rabbits • Rabbit presented while 3-year-old Peter had a favorite snack • Peter observed other children playing with rabbit Mary Cover Jones The First Behavior Therapist
  12. 12. Systematic Desensitization • Phobic responses are reduced by pairing relaxation with mental images or real-life situations that the person finds progressively more fear-provoking • Based on the principle of counterconditioning • Patient learns a new conditioned response (relaxation) that is incompatible with old conditioned responses of fear and anxiety • Three basic steps • Can be combined with observational learning • Can be done using virtual reality – for fear of flying, specific phobias, PTSD • Virtual reality may be preferred over desensitization with actual exposure Patient learns progressive relaxation Patient constructs anxiety hierarchy Process of desensitization
  13. 13. Aversive Conditioning • Relatively ineffective type of therapy that involves repeatedly pairing an aversive stimulus with occurrence of undesirable behaviors or thoughts • Based in part on the Garcia effect Example: The use of Antabuse with alcoholism • Found not to be very effective
  14. 14. Techniques Based on Operant Conditioning • Uses Skinnerian principles such as • Shaping (useful with patients who are mentally disabled with autism, mental retardation, or schizophrenia) • Positive and negative reinforcement • Extinction
  15. 15. Token Economy • System for strengthening desired behaviors through positive reinforcement in a very structured environment • Tokens or points are awarded as positive reinforcers for desirable behaviors, and are withheld or taken away for undesirable behaviors • Tokens can be exchanged for other reinforcers • Used for behavior modification in group settings (prisons, classrooms, hospitals) • Has been successful with severely disturbed people • Difficult to implement and administer Contingency Management Focuses on one of a small set of behaviors Useful for outpatient substance abuse treatment
  16. 16. Cognitive Therapies • Assumes that the culprit in psychological problems is faulty or illogical patterns of thinking • Cognitive therapists zero in on the faulty, irrational patterns of thinking that they believe are causing psychological problems • Treatment techniques focus on recognizing and altering these unhealthy thinking patterns
  17. 17. Albert Ellis and Rational- Emotive Therapy (RET) • Key premise of RET is that people’s difficulties are caused by their faulty expectations and irrational beliefs • Psychological problems are explained by the “ABC” model • Activating event (A) occurs • Beliefs (B) about the event… • Cause emotional consequences (C) • Irrational beliefs lead to self-defeating behaviors, anxiety disorders, depression, etc.
  18. 18. Steps in RET • Identifying the core irrational beliefs that underlie personal distress is the first step • Therapist then disputes the irrational beliefs • Client must admit irrational beliefs and accept fact that they are irrational and unhealthy • Effective in • Depression, social phobia, and certain anxiety disorders • Overcoming self-defeating behaviors
  19. 19. Aaron Beck and Cognitive Therapy • Problems due to negative cognitive bias that lead to distorted perceptions and interpretations of events • Beck believes that depression and other psychological problems are caused by distorted thinking and unrealistic beliefs • Therapist acts as a model and aims for a collaborative therapeutic climate
  20. 20. Steps in Cognitive Therapy (CT) Help client learn to recognize and monitor automatic thoughts that occur without conscious effort or control CT therapist encourages client to empirically test accuracy of his or her assumptions and beliefs CT therapist creates a therapeutic climate of collaboration that encourages client to contribute to the evaluation of logic and the accuracy of automatic thoughts Effective in: Treating and preventing depression Anxiety disorders Borderline personality disorders Eating disorders Post-traumatic stress disorder Relationship problems
  21. 21. Cognitive-Behavioral Therapy • Integrates cognitive and behavioral techniques • Based on the assumption that thoughts, moods, and behaviors are interrelated • The hallmark of cognitive-behavioral therapy is its pragmatic approach
  22. 22. Group and Family Therapy • May use many different therapeutic approaches • Goal of family therapy is to alter and improve the ongoing interactions among family members • Family therapy involves many members of immediate family and important members of the extended family • Enhances effectiveness of individual psychotherapy Group therapy Form of psychotherapy that involves one or more therapists working simultaneously with a small group of clients Click here Family therapy Form of psychotherapy that is based on assumption that the family is a system and treats the family as a unit Click here Advantages • Very cost-effective • Therapist can observe actual interactions with others • Support and encouragement provided by the other group members • Group members may provide one another with helpful, practical advice Self-help groups and support groups are typically conducted by nonprofessionals
  23. 23. Couple Therapy • Relationship therapy that helps with difficulties in marriage or other committed relationships • Many different approaches: for example, behavioral couple therapy based on learning theory • Goals • Improving communication • Reducing negative communication • Increasing intimacy
  24. 24. Self-Help Groups Helping Yourself by Helping Others • Format varies (structured and unstructured) • Many follow a 12-step approach • 12-step attendees who find sponsors and who have a high motivation to change are more likely to stay involved in a program • Have been shown to be very effective (equal to therapists) and cost effective • More research needed about the reasons for effectiveness and the kinds of people and problems that benefit from this approach
  25. 25. Evaluating the Effectiveness of Psychotherapy Many people just seek help and support from friends and family Some people eventually improve simply with the passage of time; spontaneous remission Most people do not seek help with problems Basic strategy for investigating effectiveness Compare people who enter psychotherapy with a carefully selected, matched control group of people who do not receive psychotherapy Researchers use statistical technique called meta-analysis to combine and interpret large numbers of studies
  26. 26. Findings • Psychotherapy is significantly more effective than no treatment • On average, a person who completes psychotherapy is better off than about 80 percent of those in the untreated control group • Gains that people make as a result of psychotherapy also tend to endure long after the therapy has ended • PET scans may show changes equivalent to drug therapies
  27. 27. Is One Form of Psychotherapy Superior? Depression Panic disorder, obsessive-compulsive disorder, and phobias Cognitive therapy and interpersonal therapy Cognitive, cognitive-behavioral, and behavior therapies In some cases, some therapies are more effective for different problems • Insight-oriented therapies are less effective than other therapies in treating severe psychotic symptoms, such as in schizophrenia. • General finding: no differences among the types of empirically based forms of psychotherapy • Beware of untested psychotherapies
  28. 28. What Factors Contribute to Effective Psychotherapy? Click here Therapeutic relationship characterized by mutual respect Therapist characteristics are associated with successful therapy Caring attitude and the ability to listen empathically Warm, sensitive, and responsive Sincere and genuine Sensitivity to cultural differences Important client characteristics Motivated, committed to therapy, and actively involved Stable living situation and supportive family members Good match between client and specific therapeutic technique Personalized approach to therapy is being facilitated by eclecticism, a pragmatic and integrated use of diverse psychotherapy techniques
  29. 29. EMDR: Can You Wave Your Fears Away? • Developed by Francis Shapiro • Useful for relieving anxiety and traumatic memories • Involves visually following a moving finger while holding mental image of disturbing event, situation, or memory, but the mechanism for this being effective has not been supported • Too much pseudoscientific trappings added to basic therapeutic principles • No more effective than other therapies
  30. 30. Cultural Values and Psychotherapy Western psychotherapy tends to reflect European and North American cultural values • Clients are encouraged to become more assertive, more self-sufficient, and less dependent on others in making decisions • Problems are assumed to have an internal cause and are expected to be solved by the client alone
  31. 31. Cultural Values and Psychotherapy Collectivistic Cultures focus on needs of group, less on internal causes, not being a burden on community Latino cultures Click here Native Americans: Network therapy Click here • One person’s problems may be seen as a problem for entire community to resolve • Family members, friends, and community members asked to participate in treatment or healing rituals • Network therapy is conducted in the person’s home and can involve as many as 70 members of the individual’s community • Interdependen ce over independence • Stress the value of familismo—the importance of the extended family network Japanese psychotherapy: Naikan therapy Click here • Being self-absorbed is path to psychological suffering • Naikan therapy: replace focus on self with a sense of gratitude and obligation • Client is asked to meditate on how he or she failed to meet the needs of others
  32. 32. Value Clashes • Western therapies focus on insight, but other cultures emphasize avoiding negative thinking • Many cultures do not value self-disclosure • Western values may clash with cultures that feel women should be subservient
  33. 33. Biomedical Therapies • Medical treatments for symptoms of psychological disorders include medication and electroconvulsive therapy • Past centuries, patients were whirled, soothed, drenched, restrained, and isolated—all in an attempt to alleviate symptoms of psychological disorders • Most common biomedical therapy: Psychotropic medications— prescription drugs that alter mental functions and alleviate psychological symptoms
  34. 34. Antipsychotic Medications • Effective against positive symptoms of schizophrenia • Also referred to as neuroleptics • Reserpine – discovered in India • Chlorpromazine (trade name: Thorazine) • Reduce levels of the neurotransmitter called dopamine • Have dramatically decreased the number of patients in mental hospitals
  35. 35. Drawbacks of Antipsychotic Medications • Do not cure schizophrenia • Early antipsychotic medications ineffective with negative symptoms of schizophrenia • Unwanted side effects • Dry mouth, weight gain, constipation, sleepiness, and poor concentration • Early antipsychotic medications could produce motor-related side effects caused by dopamine involvement in motor systems • Muscle tremors, rigid movements, a shuffling gait, and a masklike facial expression • “Thorazine shuffle” • Long-term use can produce tardive dyskinesia, an irreversible motor disorder characterized by severe, uncontrollable facial tics and grimaces, chewing movements, and other involuntary movements of the lips, jaw, and tongue • “Revolving door” pattern of hospitalization, discharge, and rehospitalization
  36. 36. The Atypical Antipsychotics Second Generation • Clozapine and risperidone • More recent: olanzapine, sertindole • Less likely to cause movement-related dopamine side effects • More effective in treating the negative symptoms of schizophrenia • Lessen revolving door pattern • Problems: weight gain, diabetes, cardiac problems • Do not produce greater improvements than older antipsychotics
  37. 37. Antianxiety Medications Antianxiety medications are prescribed to help people deal with the problems and symptoms associated with pathological anxiety Non-benzodiazepine (Buspar) Click here Benzodiazepines (Valium, Xanax) Click here • Reduce anxiety through increasing level of GABA • Take effect rapidly and after a week or two effectively reduce anxiety levels • Side effects include decreased coordination, reaction time, alertness • Physical addiction and possible life-threatening withdrawal symptoms • Effect intensified if combined with alcohol or over-the-counter drugs like antihistamines • Good for short-term relief • Doesn’t effect GABA, perhaps effects dopamine or serotonin • May take up to two or three weeks to work • Does not reduce alertness or produce cognitive impairment
  38. 38. Lithium • Used to treat bipolar disorder (manic depression), interrupt acute manic attacks, and prevent relapse • Lithium counteracts both manic and depressive symptoms in bipolar patients • Prevents acute manic episodes over the course of a week or two • Lithium level problems • Too low = manic symptoms persist • Too high = lithium poisoning, which causes vomiting, muscle weakness, and reduced muscle coordination • Lithium blood level must be carefully monitored • Action: Lithium affects levels of excitatory neurotransmitter glutamate • Stabilizes glutamate availability within a narrow, normal range, preventing both abnormal highs and abnormal lows
  39. 39. Antidepressant Medications Counteract the symptoms of depression— hopelessness, guilt, dejection, suicidal thoughts, difficulty concentrating, and disruptions in sleep, energy, appetite, and sexual desire. First generation—tricyclics and MAO inhibitors • Effective for about 75% of patients • Increase availability of norepinephrine and serotonin • Can take up to six weeks before symptoms begin to lift Side effects • Serious physiological side effects when taken with common foods: cheese, smoked meats, and red wine • Dangerously high blood pressure, stroke, death • Weight gain, dry mouth, dizziness, sedation
  40. 40. Antidepressant Medications Third generation—Selective serotonin reuptake inhibitors (SSRIs) • Fluoxetine—Prozac, Zoloft, and Paxil • Effect the availability of a single neurotransmitter: serotonin • Milder side effects • Prozac’s: headaches, nervousness, difficulty sleeping, loss of appetite, and sexual dysfunction Dual-action antidepressants: Serzone and Remeron • Affect serotonin levels Dual-reuptake inhibitors: Effexor and Cymbalta • Affect levels of both serotonin and norepinephrine Dopamine-norepinephrine inhibitor: Wellbutrin Second generation • Trazodone and bupropion • No more effective than first generation • Same side effects
  41. 41. Comparing Psychotherapy and Antidepressant Medication Results • PET scans revealed that patients in both groups showed a trend toward more normalized brain functioning • Similar changes in patients with panic disorder, post-traumatic stress disorder, obsessive compulsive disorder, phobias, and other anxiety disorders after psychotherapy treatment PET scan study: Depressed individuals showed increased activity in the prefrontal cortex, caudate nucleus, and thalamus Two groups in study; each group was assigned to either Paxil or interpersonal therapy
  42. 42. Electroconvulsive Therapy (Electroshock therapy or shock therapy) • Involves brief burst of electric current to induce a seizure in the brain • Commonly used to treat depression • Occasionally used to treat mania, schizophrenia • Used after other forms of treatment have failed to help • Antidepressive effects can be short-lived • Half of patients relapse within six months • Not known exactly how it relieves the symptoms of depression • May have cognitive side effects such as memory loss • Controversial because of its early overuse and punitive appearance
  43. 43. Vagus nerve stimulation (VNS) Implantation of a device into left chest wall Uses brief, intermittent electrical stimulation to left vagus nerve Runs through the neck and connects to the brain stem New and Experimental Treatments Click here Deep brain stimulation (DBS) Uses electrodes surgically implanted in the brain Transcranial magnetic stimulation (TMS) Stimulation of certain regions of brain with magnetic pulses
  44. 44. B. F. Skinner and the Search for “Order in Behavior” What to Expect in Psychotherapy 1. Strengthen your commitment to change. Think about the reasons you want to change. 2. Therapy is a collaborative effort. You must actively participate. Therapist can’t do all the work. 3. Don’t confuse catharsis with change. Emotional release alone doesn’t fix the problem. 4. Don’t confuse insight with change. Insight doesn’t automatically translate into healthier behavior and attitudes. 5. Don’t expect your therapist to make decisions for you. You need to decide what to do with the therapist helping you explore decision making. 6. Expect therapy to challenge how you think and act. Therapy can be a painful magnifying glass on your life.

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