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psychological therapies

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Title: psychological therapies


1
13
psychological therapies
2
why study therapies for psychological
disorders?There are almost as many therapy
methods as there are disorders. Correctly
matching the type of therapy to the disorder can
mean the differ- ence between a cure or a crisis.
It is important to know the choices available for
treatment and how they relate to the different
kinds of disorders so that an informed decision
can be made and the best possible outcome can be
achieved for mental health and wellness.
3
Learning Objective Menu
  • LO 13.1 Two ways modern ways to treat
    psychological disorders
  • LO 13.2 Elements of Freuds psychoanalysis and
    psychoanalysis today
  • LO 13.3 Basic elements Humanistic therapies
  • LO 13.4 Behavior therapists use of classical and
    operant conditioning
  • LO 13.5 Goals of cognitive therapies
  • LO 13.6 Types of group therapy
  • LO 13.7 Effectiveness of psychotherapy
  • LO 13.8 Types of drugs used to treat
    psychological disorders
  • LO 13.9 Modern electroconvulsive therapy and
    psychosurgery
  • LO 13.10 How might computers be used in
    psychotherapy

4
Two Kinds of Therapy
LO 13.1 Two modern ways to treat psychological
disorders
  • Therapy
  • Treatment with goal of improved mood and
    functioning
  • Psychotherapy
  • Treats mental disorders

5
Two Kinds of Therapy
LO 13.1 Two modern ways to treat psychological
disorders
  • Psychotherapy
  • Talk with a psychological professional
  • Insight therapy
  • Gain insight about behavior, thoughts, and
    feelings
  • Action therapy
  • Change behavior directly

6
Two Kinds of Therapy
LO 13.1 Two modern ways to treat psychological
disorders
  • Biomedical therapy
  • Treatment with biological or medical methods to
    relieve symptoms
  • Includes drugs, surgical methods,
    electroconvulsive treatment
  • Medication alone not sufficient
  • Treats symptoms of disorder
  • Psychotherapy builds coping strategies, aids in
    adjustment

7
Treatment in the Past
LO 13.1 Two modern ways to treat psychological
disorders
  • Early efforts to treat mentally ill
  • 1500s Bethlehem Hospital converted to asylum
  • Treatments included beatings bloodletting, ice
    baths

8
Treatment in the Past
LO 13.1 Two modern ways to treat psychological
disorders
  • Philippe Pinels Reforms
  • Unchained inmates
  • La Bicêtre Asylum, Paris 1793
  • Treated mentally ill with kindness
  • Advocated moral therapy

9
In this famous painting by French artist Robert
Fleury, French psychiatrist Dr. Philippe Pinel
orders the chains removed from patients at a
Paris asylum for insane women. Pinel was one of
the first psychiatrists to recommend humane
treatment of the mentally ill.
10
Freuds Psychoanalysis
LO 13.2 Elements of Freuds psychoanalysis and
psychoanalysis today
  • Insight therapy
  • Emphasizes revealing unconscious conflicts

11
Freuds Psychoanalysis
LO 13.2 Elements of Freuds psychoanalysis and
psychoanalysis today
  • Two techniques for accessing unconscious
  • Dream interpretation
  • Manifest content
  • Actual dream and its events
  • Latent content
  • Symbolic or hidden meaning of dreams

12
Freuds Psychoanalysis
LO 13.2 Elements of Freuds psychoanalysis and
psychoanalysis today
  • Two techniques for accessing unconscious
  • Free association
  • Patient free to say anything that came to mind
  • No fear of negative evaluation

13
Freuds Psychoanalysis
LO 13.2 Elements of Freuds psychoanalysis and
psychoanalysis today
  • Resistance
  • Patient reluctant to talk about certain topics
  • Changes subject or becomes silent

14
Freuds Psychoanalysis
LO 13.2 Elements of Freuds psychoanalysis and
psychoanalysis today
  • Transference
  • Therapist becomes a symbol of parental authority
    figure from the past
  • Countertransference
  • Therapist has transference reaction to the patient

15
Evaluation of Psychoanalysis andPsychodynamic
Approaches
LO 13.2 Elements of Freuds psychoanalysis and
psychoanalysis today
  • Criticisms
  • Lack of scientific methodology
  • Over-emphasis on sexual problems

16
Evaluation of Psychoanalysis andPsychodynamic
Approaches
LO 13.2 Elements of Freuds psychoanalysis and
psychoanalysis today
  • Modern Psychodynamic therapy
  • Client sits face-to-face with therapist
  • Therapist is more directive
  • Asks questions, suggests helpful behavior, and
    gives opinions
  • Therapy not useful for clients with psychoses

17
Interpersonal Psychotherapy
LO 13.2 Elements of Freuds psychoanalysis and
psychoanalysis today
  • Developed to treat depression
  • Insight-oriented therapy
  • Focus on relationships
  • Psychodynamic origins
  • More eclectic
  • Combines elements of humanistic and cognitive
    behavioral therapies
  • Effectiveness supported by research

18
Psychotherapy often takes place one-on-one, with
a client and therapist exploring various issues
together to achieve deeper insights or to change
undesirable behavior.
19
Rogers Person-Centered Therapy
LO 13.3 Basic elements of Humanistic therapies
  • Non-directive insight therapy
  • Based on the work of Carl Rogers
  • Client talks and the therapist listens

20
Rogers Person-Centered Therapy
LO 13.3 Basic elements of Humanistic therapies
  • Four Elements
  • Reflection
  • Therapist restates clients talk
  • No interpretation of statements
  • Unconditional positive regard
  • Accepting atmosphere created by therapist
  • Empathy
  • Therapist understands client feelings

21
Rogers Person-Centered Therapy
LO 13.3 Basic elements of Humanistic therapies
  • Four Elements
  • Authenticity
  • Genuine, open, and honest response of therapist

22
A Rogerian person-centered therapist listens with
calm acceptance to anything the client says. A
sense of empathy with the clients feelings is
also important.
23
Gestalt Therapy
LO 13.3 Basic elements of Humanistic therapies
  • Founded by Fritz Perls
  • People hide parts of self behind false mask
  • Mask is socially acceptable behavior
  • Inner self not matching mask causes conflict

24
Gestalt Therapy
LO 13.3 Basic elements of Humanistic therapies
  • Therapist is confrontational and directive
  • Lead clients through exercises
  • Attention to body language
  • Focus on denied parts not hidden past of
    psychoanalysis

25
In Gestalt therapy, it is not unusual to find a
client talking to an empty chair. The chair
represents some person from the past with whom
the client has unresolved issues, and this is the
opportunity to deal with those issues.
26
Evaluation of Humanistic Therapy
LO 13.3 Basic elements of Humanistic therapies
  • Little experimental research to support ideas
  • Theories built around case studies
  • Clients need to be intelligent, highly verbal
  • Not a good choice for seriously mentally ill

27
Behavioral Therapy and Classical Conditioning
LO 13.4 Behavior therapists use of classical
and operant conditioning
  • Action-based rather than insight-based therapy
  • Change behavior through learning new responses
  • Learning created problem
  • New learning corrects problem

28
Therapies Based on Classical Conditioning
LO 13.4 Behavior therapists use of classical
and operant conditioning
  • Through classical conditioning
  • Old and undesirable automatic responses can be
    replaced by desirable ones
  • Techniques originally called Behavior
    Modification

29
Therapies Based on Classical Conditioning
LO 13.4 Behavior therapists use of classical
and operant conditioning
  • Applied behavior analysis
  • Newer term
  • Highlights need for a functional analysis of
    behavior
  • Analysis followed by conditioning

30
Therapies Based on Classical Conditioning
LO 13.4 Behavior therapists use of classical
and operant conditioning
  • Systematic desensitization
  • Used to treat phobias
  • Client is first taught deep muscle relaxation
  • Next creates a list of ordered fears
  • Hierarchy of fears
  • Pairs relaxation with fears
  • Computer generated simulations used

31
Therapies Based on Classical Conditioning
LO 13.4 Behavior therapists use of classical
and operant conditioning
  • Aversion therapy
  • Undesirable behavior is paired with aversive
    stimulus
  • Reduces frequency of behavior

32
This device allows the delivery of high levels of
nicotine to the smoker in a process known as
rapid smoking. Rapid smoking is an aversive
technique for helping people to quit smoking and
is based on the classical conditioning principle
of counterconditioning.
33
Therapies Based on Classical Conditioning
LO 13.4 Behavior therapists use of classical
and operant conditioning
  • Flooding
  • Technique for treating phobias, stress disorders
  • Person is intensely exposed to fear-provoking
    situation
  • Prevented from making avoidance or escape response

34
Therapies Based on Classical Conditioning
LO 13.4 Behavior therapists use of classical
and operant conditioning
  • Techniques include reinforcement, extinction,
    shaping, and modeling
  • Change the frequency of voluntary behavior
  • Results quick and practical

35
Therapies Based on Classical Conditioning
LO 13.4 Behavior therapists use of classical
and operant conditioning
  • Modeling
  • Learning through observation, imitation of a
    model
  • Participant modeling
  • Model demonstrates the desired behavior in a
    step-by-step process
  • Client is encouraged to imitate

36
Therapies Based on Classical Conditioning
LO 13.4 Behavior therapists use of classical
and operant conditioning
  • Reinforcement
  • Strengthening of response by following it with
  • A pleasurable consequence (positive
    reinforcement)
  • Removal of an unpleasant stimulus (negative
    reinforcement)

37
Therapies Based on Classical Conditioning
LO 13.4 Behavior therapists use of classical
and operant conditioning
  • Reinforcement
  • Token economy
  • Tokens to reinforce behavior
  • Can be accumulated and exchanged for desired
    items or privileges
  • Used effectively to modify behavior of disturbed
    institutionalized individuals

38
Therapies Based on Classical Conditioning
LO 13.4 Behavior therapists use of classical
and operant conditioning
  • Contingency contract
  • Formal, written agreement between the therapist
    and client
  • Goals for behavioral change, reinforcements, and
    penalties are clearly stated
  • Useful in treating problems such as drug addiction

39
Therapies Based on Classical Conditioning
LO 13.4 Behavior therapists use of classical
and operant conditioning
  • Extinction
  • Removal of a reinforcer
  • Reduces frequency of behavior
  • Time-out
  • Extinction process
  • Person is removed from situation reinforcing an
    undesirable behavior
  • Placed away from attention and reinforcement
    opportunities

40
This boy is sitting in the time-out corner at
his school. By removing the attention that he
found rewarding, the teacher is attempting to
extinguish the behavior that earned the boy a
time-out. Do you see anything in this time-out
corner that might make it less effective?
41
Evaluation of Behavioral Therapies
LO 13.4 Behavior therapists use of classical
and operant conditioning
  • Effective in treating specific problems
  • Bedwetting, drug addictions, phobias
  • More serious psychological disorders do not
    respond as well to behavioral treatments
  • Overall behavior therapies are
  • Relatively quick and efficient
  • Eliminate or greatly reduce symptoms

42
Cognitive Therapy
LO 13.5 Goals of cognitive therapy
  • Focus on
  • Helping clients recognize distortions in thinking
  • Replace distorted, unrealistic beliefs with
    realistic thoughts
  • Is critical thinking applied to ones own beliefs

43
Cognitive Therapy
LO 13.5 Goals of cognitive therapy
  • Beck
  • Identified five common distortions
  • Arbitrary inference
  • Jumping to conclusions
  • Drawing conclusions not based on evidence

44
Beck's Cognitive Therapy
LO 13.5 Goals of cognitive therapy
  • Selective thinking
  • Focusing on one aspect of a situation
  • Ignoring all other relevant aspects
  • Overgeneralization
  • Drawing sweeping conclusions based on only one
    incident
  • Applying conclusions to events unrelated to
    original

45
Beck's Cognitive Therapy
LO 13.5 Goals of cognitive therapy
  • Magnification and minimization
  • Negative event blown out of proportion to its
    importance (magnification)
  • Ignore relevant positive events (minimization)
  • Personalization
  • Taking responsibility for events unconnected to
    the person

46
Cognitive-Behavioral Therapy
LO 13.5 Goals of cognitive therapy
  • Assumes disorders come from illogical, irrational
    cognitions
  • Is an action therapy
  • Learning to think more rationally and logically

47
Cognitive-Behavioral Therapy
LO 13.5 Goals of cognitive therapy
  • Three goals
  • Relieve the symptoms and solve the problems
  • Develop strategies for solving future problems
  • Help change irrational, distorted thinking

48
Rational-Emotive Behavior Therapy
LO 13.5 Goals of cognitive therapy
  • A cognitive-behavioral therapy
  • Clients are directly challenged on irrational
    beliefs
  • Restructures thinking into rational belief
    statements
  • Therapists are directive
  • Provide homework assignments
  • Challenge my way or nothing statements

49
Success of CBT
LO 13.5 Goals of cognitive therapy
  • CBT has seemed successful in treating
  • Depression, stress disorders, and anxiety
  • Criticized for focusing on symptoms, not causes
    of disordered behavior

50
Table 13.1 Characteristics of Psychotherapies
51
Group Therapies
LO 13.6 Types of group therapy
  • Therapist may use one of many approaches or a
    combination
  • Insight, cognitive-behavioral, person-centered,
    behavioral
  • Share problems, provide support

52
Group Therapies
LO 13.6 Types of group therapy
  • Family counseling
  • Family members meet together with a counselor
  • Discover and resolve unhealthy patterns of
    relating
  • Open lines of communication
  • Resolve problems that affect the entire family

53
Group Therapies
LO 13.6 Types of group therapy
  • Self-help groups
  • People with similar problems meet together
    without a therapist or counselor
  • Purpose is discussion, problem solving, emotional
    support

54
In family therapy, all family members participate
in therapy sessions, with the therapist guiding
them through open communication. Although it
appears that the young boy in the corner is the
focus of this session, all family members are
encouraged to see how their own behavior may
contribute to the problem behavior.
55
Advantages of Group Therapy
LO 13.6 Types of group therapy
  • Lower cost
  • Exposure to way other persons view and handle the
    same kinds of problems
  • Opportunity for therapist and client to see
    interaction with others
  • Social and emotional support from people with
    similar problems

56
In group therapy, several people who share
similar problems gather with a therapist to
discuss their feelings and concerns. The presence
of others who are going through the same kind of
emotional difficulties can be comforting as well
as provide the opportunity for insights into
ones own problems by hearing about the problems
of others.
57
Disadvantages of Group Therapy
LO 13.6 Types of group therapy
  • Need to share therapists time with others in the
    group
  • Lack of a private setting in which to reveal
    concerns
  • Possibility that shy people will not be able to
    speak up within a group setting
  • Inability of people with severe disorders to
    tolerate being in a group

58
Does Psychotherapy Really Work?
LO 13.7 Effectiveness of psychotherapy
  • Psychotherapy is more effective than no treatment
    at all.
  • 75 to 90 percent of people who receive therapy
    improve
  • Longer a person stays in therapy the better the
    improvement
  • Psychotherapy works as well alone as with drugs

59
Does Psychotherapy Really Work?
LO 13.7 Effectiveness of psychotherapy
  • Some types of psychotherapy are more effective
    for certain types of problems
  • No one psychotherapy method is effective for all
    problems

60
Characteristics of Effectiveness Psychotherapy
LO 13.7 Effectiveness of psychotherapy
  • Common factors approach
  • Modern approach to eclecticism
  • Focuses on factors common to successful outcomes
    in therapy

61
Characteristics of Effectiveness Psychotherapy
LO 13.7 Effectiveness of psychotherapy
  • Therapeutic Alliance
  • Relationship between client and therapist
  • Protected setting
  • Privacy, safety for client
  • Opportunity for catharsis
  • Learning and practice of new behavior

62
Culture, Ethnic and Gender Concerns
LO 13.7 Effectiveness of psychotherapy
  • Differences between therapist and client
  • Difficult for the therapist to understand
    concerns
  • Misunderstandings and misinterpretations can occur

63
Culture, Ethnic and Gender Concerns
LO 13.7 Effectiveness of psychotherapy
  • Four barriers to effective psychotherapy
  • Language
  • Culture-bound values
  • Class-bound values
  • Nonverbal communication

64
Cybertherapy
LO 13.7 Effectiveness of psychotherapy
  • Psychotherapy offered on the Internet
  • Offers advantages of low or no cost, accessible,
    anonymous
  • No guarantee cybertherapist has credentials or
    training in psychotherapy
  • Difficult for cybertherapist to assess clients
    body language or emotional state

65
Biomedical Therapies
LO 13.8 Types of drugs used to treat
psychological disorders
  • Therapies directly affecting the biological
    functioning of body and brain
  • Psychopharmacology
  • The use of drugs to control or relieve the
    symptoms of psychological disorders

66
Biomedical Therapies
LO 13.8 Types of drugs used to treat
psychological disorders
  • Psychopharmacology
  • Anti-psychotic drugs
  • Used to treat psychotic symptoms
  • Delusions, hallucinations, and other bizarre
    behavior
  • Anti-anxiety drugs
  • Include anti-anxiety and antidepressant drugs

67
Biomedical Therapies
LO 13.8 Types of drugs used to treat
psychological disorders
  • Psychopharmacology
  • Anti-manic drugs
  • Used to treat bipolar disorder
  • Include lithium and anticonvulsant drugs
  • Antidepressant drugs
  • Used to treat depression and anxiety
  • Include MAOIs, tricyclics, SSRIs

68
Table 13.2 Types of Drugs Used in
Psychopharmacology
69
Electroconvulsive Therapy
LO 13.9 Modern electroconvulsive therapy and
psychosurgery
  • Treats severe depression
  • Electrodes are placed on one or both sides of the
    head
  • Bilateral ECT
  • Electrodes are placed on both sides of the head
  • Unilateral ECT
  • Electrodes are placed on only one side of the
    head and forehead

70
Electroconvulsive therapy consists of applying an
electric shock to one or both sides of the head.
The result is rapid improvement in mood. It has
been shown to be most effective in treating
severe depression that has not responded to
medication or where medication side effects
cannot be tolerated.
71
Electroconvulsive Therapy
LO 13.9 Modern electroconvulsive therapy and
psychosurgery
  • Treats severe depression
  • An electric current is passed through the
    electrodes
  • Strong enough to cause a seizure or convulsion

72
Psychosurgery
LO 13.9 Modern electroconvulsive therapy and
psychosurgery
  • Surgery performed on brain tissue to relieve or
    control severe psychological disorders
  • Prefrontal lobotomy
  • Connections between prefrontal cortex to other
    brain areas are severed

73
Psychosurgery
LO 13.9 Modern electroconvulsive therapy and
psychosurgery
  • Surgery performed on brain tissue to relieve or
    control severe psychological disorders
  • Bilateral cingulotomy
  • MRI used to guide electrode to area in brain
  • Electrode is inserted into the cingulate gyrus

74
Psychosurgery
LO 13.9 Modern electroconvulsive therapy and
psychosurgery
  • Surgery performed on brain tissue to relieve or
    control severe psychological disorders
  • Bilateral cingulotomy
  • Small current run to electrode to destroy small
    area of cells
  • Referred to as deep lesioning
  • Effective in ? to ½ cases of major depression,
    bipolar and OCD

75
Emerging Techniques
LO 13.9 Modern electroconvulsive therapy and
psychosurgery
  • Repetitivetranscranial magnetic stimulation
    (rTMS)
  • Magnetic pulses are applied to the cortex
  • Transcranial direct current stimulation (tDCS)
  • Scalp electrodes used to pass low amplitude
    currents to the brain

76
Repetitive transcranial magnetic stimulation
(rTMS) uses a pulsating magnetic field to
activate specific parts of the brains surface.
As seen above, by placing an electromagnet on the
scalp, TMS can be used to stimulate small areas
of the cortex and is being evaluated as a way to
control some psychological symptoms, such as
those related to depression and PTSD. Photo
courtesy of Martijn Arns, http//www.brainclinics.
com
77
Virtual Realities
LO 13.10 How might computers be used in
psychotherapy
  • Software-generated, three-dimensional simulated
    environment
  • Useful with exposure therapy
  • Vivid and realistic imagery possible
  • Particularly helpful for clients that do not
    visualize well
  • Post-traumatic stress disorder (PTSD)
  • Benefits from the use of VR psychotherapy

78
Some behavioral therapists now use virtual
reality to expose patients to phobic objects and
situationslike the cabin of an airplane. As part
of systematic desensitization, this patient
receives exposure to anxiety-provoking visual
displays through a virtual reality headset.
Credit Charles Undermost, Delft University of
Technology.
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