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Chapter 16.doc.doc.doc


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Chapter 16.doc.doc.doc

  1. 1. Prof. Millie Roqueta CHAPTER 16 SUMMARY .Chapter 16 PSYCHOTHERAPY LEARNING OBJECTIVES 1. Identify the three major categories of therapy. 2. Describe the various types of mental health professionals involved in the provision of therapy. 3. Explain the logic of psychoanalysis and describe the techniques used to probe the unconscious. 4. Explain the logic of client-centered therapy. 5. Describe therapeutic climate and process in client-centered therapy. 6. Discuss the logic, goals, and techniques of cognitive therapy. 7. Describe how group therapy is generally conducted. 8. Identify some advantages of group therapy. 9. Summarize the general approach and principles of behavior therapies. 10.Describe the three steps in systematic desensitization and the logic underlying the treatment. 11.Describe the use of aversion therapy and social skills training. 12.Discuss the merits of blending approaches to therapy. The Elements of the Treatment Process Treatments: How Many Types are There? Types and approaches are numerous and varied, however, there are 3 major categories: 1. Insight therapies, or "talk therapy" in tradition of Freud’s psychoanalysis. 2. Behavior therapies, based on principles of learning and conditioning. 3. Biomedical therapies, which focus on biological interventions. Therapists: Who Provides Professional Treatment? 1. Psychologists a. Clinical psychologists and counseling psychologists specialize in the diagnosis and treatment of psychological disorders and everyday behavioral problems. b. Much overlap in training, skills, clientele c. Both must earn doctoral degree. d. Use either insight or behavioral approaches. 2. Psychiatrists a. Psychiatrists are physicians who specialize in the treatment of psychological disorders. b. Devote more time to relatively severe disorders. Page 1
  2. 2. Prof. Millie Roqueta c. Have M.D. degree d. Tend to emphasize biomedical treatments. 3. Other mental health professionals a. Psychiatric social workers, psychiatric nurses often work as part of treatment team with psychologist or psychiatrist. b. Counselors also provide therapeutic services. In Florida, there are three types of licensed mental health professionals (see Florida Statute 491.005): 1) Mental Health Counselors – Master’s Degree in psychology or related field and 2 years supervised field placement (internship) which was part of the applicant's advanced concentration in direct practice, during which the applicant provided clinical services directly to clients. Must pass a theory and practice examination provided by State of Florida (a licensing exam). 2) Marriage and Family Therapists – Master’s Degree in psychology or related field, 2 years supervised field placement, and licensing exam. 3) Clinical Social Workers - Master’s Degree in psychology or related field, 2 years supervised field placement, and licensing exam. Insight Therapies Psychoanalysis Insight therapies (involve verbal interactions intended to enhance clients' self-knowledge and thus promote healthful changes in personality and behavior). 1. Psychoanalysis is an insight therapy that emphasizes the recovery of unconscious conflicts, motives, and defenses through techniques such as free association, dream analysis, and transference. 2. Developed by Sigmund Freud 3. Dominance has eroded in recent decades, but diverse array of psychoanalytic approaches continue to remain influential. 4. Probing the unconscious a. Free association: clients spontaneously express their thoughts and feelings exactly as they occur, with as little censorship as possible. b. Dream analysis: the therapist interprets the symbolic meaning of the client's dreams. Page 2
  3. 3. Prof. Millie Roqueta 5. Interpretation involves the therapist's attempt to explain the inner significance of the client's thoughts, feelings, memories, and behaviors. 6. Resistance involves largely unconscious defensive maneuvers intended to hinder the progress of therapy. 7. Transference occurs when clients start relating to their therapist in ways that mimic critical relationships in their lives. a. In a sense, clients transfer conflicting feeling about important people onto therapist. b. Psychoanalysts often encourage transference as a way to bring repressed feelings, conflicts to the surface. c. Undergoing psychoanalysis can be slow, painful process of self-examination. d. Classical psychoanalysis, as done by Freud, is not widely practiced anymore. Client-Centered Therapy Client-centered therapy (an insight therapy that emphasizes providing a supportive emotional climate for clients, who play a major role in determining the pace and direction of their therapy) 1. Stimulated by work of Carl Rogers, who took a humanistic perspective. 2. Therapeutic climate a. Climate is more important than process. b. Therapist must provide three conditions: 1) Genuineness 2) Unconditional positive regard 3) Empathy 3. Therapeutic process a. Client, therapist work together as equals. b. Therapist's key role is clarification of client's true feelings. Cognitive Therapy Cognitive therapy (an insight therapy that emphasizes recognizing and changing negative thoughts and maladaptive beliefs) 1. Exemplified by work of Aaron Beck, Albert Ellis 2. Goals and techniques a. Goal is to change way clients think, to help them use more reasonable standards of evaluation. b. Therapist is actively involved, looking for unrealistic assumptions that underlie client's negative thinking. Page 3
  4. 4. Prof. Millie Roqueta 3. Kinship with behavior therapy (see Cognitive-Behavioral therapies section below) a. Cognitive therapists often use "homework assignments" that focus on patterns of behavior. b. A blend of "talk therapy" and behavior therapy c. Was originally designed for treatment with individuals, but has been adapted for use with groups. Group Therapy Group therapy (the simultaneous treatment of several or more clients in a group) 1. Participants' roles a. Therapist usually screens participants, excluding potentially disruptive people. b. Clients and therapist are on much more equal footing with groups than with individual therapy. c. Clients functions as therapists for each other. 2. Advantages of the group experience a. Can save time and money. b. Participants often realize that their misery is not unique. c. Provides opportunities for clients to work on social skills in safe environment. d. Certain kinds of problems especially well suited to group treatment (e.g., drug groups, Alcoholics Anonymous). Behavior Therapies General Principles Behavior therapies (involve the application of the principles of learning to direct efforts to change clients' maladaptive behaviors). 1. General principles a. Assumed that behavior is a product of learning b. Assumed that what has been learned can be unlearned. c. Behavior therapies are close cousins of self- modification procedures (described in Chapter 4 Application) Page 4
  5. 5. Prof. Millie Roqueta Systematic Desensitization Systematic desensitization: a behavior therapy used to reduce clients' anxiety responses through counterconditioning. 1. Devised by Joseph Wolpe 2. Involves three steps 1) Therapist helps client build an anxiety hierarchy. 2) Therapist trains client in deep muscle relaxation 3) Client tries to work through hierarchy, learning to remain relaxed while imagining each stimulus. 3. Desensitization to imagined stimuli generally followed by exposure to real anxiety-arousing stimuli. 4. Goal is to counter-condition new response (relaxation) to original stimulus (object of anxiety). 5. Has been effective in eliminating specific anxieties. Aversion Therapy Aversion therapy is a behavior therapy in which an aversive stimulus is paired with a stimulus that elicits an undesirable response 1. Most controversial of behavior therapies. a. Used only as treatment of last resort. b. Client has to endure unpleasant stimuli (e.g., shock, drug-induced nausea) 2. Behaviors treated successfully include drug abuse, sexual deviance, gambling, etc. Social Skills Training Social skills training is a behavior therapy designed to improve interpersonal skills that emphasizes shaping, modeling, and behavioral rehearsal 1. Many psychological problems grow out of interpersonal difficulties. 2. Has yielded promising results in treatment of depression, shyness, social anxiety, even schizophrenia. 3. Can be conducted with individual clients or in groups. 4. Depends on principles of operant conditioning, observational learning a. Modeling - such as encouraging clients to watch socially skilled friends, colleagues b. Behavioral rehearsal - client practices social techniques in role-playing exercises. c. Shaping- clients gradually handle more complicated and delicate social situations. Page 5
  6. 6. Prof. Millie Roqueta Cognitive-Behavioral Therapies Cognitive- Behavioral Therapies What is Cognitive-Behavioral Therapy? According to the National Association of Cognitive Behavioral Therapists, Cognitive-Behavioral Therapy (CBT) is a form of psychotherapy that emphasizes the important role of thinking in how we feel and what we do. Therapists with this orientation believe that when our brains are healthy, it is our thinking that causes us to feel and act the way we do. As a result, it follows that if we are experiencing unwanted feelings and behaviors, our thinking is what causes those feelings and behaviors. The purpose of CBT is to identify the thinking that is causing the unwanted feelings and behaviors and to learn how to replace this thinking with thoughts that lead to more desirable reactions. There are several approaches to cognitive-behavioral therapy, including Rational Emotive Behavior Therapy, Rational Behavior Therapy, Rational Living Therapy, Cognitive Therapy, and Dialectic Behavior Therapy. However, most cognitive-behavioral therapies have the following characteristics: 1. CBT is based on the Cognitive Model of Emotional Response which maintains that it is our thoughts that cause our feelings and behaviors, not external things, like people, situations, and events. The truly beneficial aspect of this orientation is that we can change the way we think in order to feel and act better even if the situation has not changed. 2. CBT is short term and time-limited – most therapy using this model lasts between 3 to 16 sessions. This makes CBT one of the forms of therapy covered by medical insurance. 3. CBT is structured and directive - Cognitive-behavioral therapists have a specific agenda for each session. Specific techniques and concepts are taught during each session. CBT focuses on helping the client achieve the goals they have set. CBT therapists do not tell their clients what to do -- rather, they teach their clients how to do. 4. CBT is based on an educational model – the underlying assumption is that most emotional and behavioral reactions are learned and can therefore be unlearned. The goal of CBT is to help clients unlearn their unwanted reactions and to learn a new way of reacting. This is accomplished with the aid of homework and in structured sessions. Page 6
  7. 7. Prof. Millie Roqueta Discussion Questions 1. If you or someone close to you were going to seek therapy, which type of mental health professional would you seek out (e.g., psychologist, psychiatrist, or other mental health professional)? Why? 2. If you thought you could benefit from therapy but were reluctant to seek it, who would you talk to? Parents? Friends? Clergy? 3. Do you think, as Freud did, that our unconscious conflicts and motives can be uncovered through dream analysis? If so, why do you think these motives and feelings are presented in the form of symbols in our dreams, rather than in a more obvious form that would be easier to interpret? 4. Do you think it's possible that the resistance that psychoanalysts believe is an important element of the therapy process is simply a reluctance to engage in a process (i.e., therapy) that has been stigmatized to a degree by our society? 5. According to your textbook, psychoanalysts often encourage transference such that clients begin to reenact relations with crucial people in the context of therapy. What do you see as the main advantages of this approach? What are the drawbacks? 6. Which of the main approaches to insight therapy (psychoanalysis, client- centered, cognitive, group therapy) do you think is the most reasonable way to deal with psychological problems? Why? 7. If you had a close friend or relative who had a serious problem with anxiety, which of the insight approaches to therapy (psychoanalysis, client-centered, cognitive, group therapy) would you recommend? Why? 8. One of the main assumptions of behavior therapies is that behavior is a product of learning. On the surface, this seems like a straightforward and reasonable assumption, but do you think that some psychological disorders may develop as a result of genetic factors rather than learning? Why or why not? Chapter Summary References: Adapted by Roqueta, M. (2002), from Weiten, W., & Lloyd, M. A. (2003), Psychology applied to modern life: Adjustment in the 21st Century. Belmont, CA: Wadsworth/Thomson Learning. Table References: Tables and PowerPoint Slides adapted by Roqueta, M. (2002) from Hutchens PowerPoint Series for Weiten, W., & Lloyd, M. A. (2003), Psychology applied to modern life: Adjustment in the 21st Century. Belmont, CA: Wadsworth/Thomson Learning. Websites:  This site contains Dr. R. Richmond’s “Guide to Psychology and its Practice,” which provides information on numerous aspects of psychotherapy.  AmoebaWeb Psychology: Therapies This site contains AmoebaWeb’s links to numerous sites with information on psychotherapy.  The home page of the American Psychological Association.  The home page of the American Psychoanalytic Association. Page 7
  8. 8. Prof. Millie Roqueta  The home page of the Association for the Advancement of Behavior Therapy.  The home page of the National Association of Cognitive Behavioral Therapists.  The home page of the Existential- Humanistic Therapy Institute.  This page has a comprehensive list of resources related to Humanistic Psychotherapy. Page 8