THE%20THERAPEUTIC%20ENTERPRISE:

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CHAPTER 16

• THE THERAPEUTIC ENTERPRISE
• CHOICES, TECHNIQUES, EVALUATION

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PSYCHOTHERAPY

• Psychodynamic
• Humanistic and Existential
• Behavioral
• Cognitive
• Cognitive-behavioral
• Group
• Cognitive-behavioral group
• Family and marital therapy
• Psychodrama

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PSYCHODYNAMIC THERAPY

• Goal is insight into ones inner life
• Transference Patient displaces affect and
  feeling about others onto the therapist
• Counter transference Therapists emotional
  responses to patient
• Psychoanalysis Special type of psychodynamic
  therapy using free association and examination of
  dreams and fantasies
• Some use hypnosis to uncover repressed material

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HUMANISTIC AND EXISTENTIAL THERAPIES

• Humanistic
• Emphasis on peoples desire to achieve
  self-respect
• Cark Rogers client-centered therapy
• Nonjudgmental, nondirective
• Atmosphere of unconditional positive regard
• Existential
• Emphasis on peoples needs to confront questions
  about meaning and direction of their lives
• Combine humanistic and psychodynamic techniques
• Gestalt therapy based on view that people need to
  get in touch with disowned parts of themselves

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COGNITIVE PSYCHOTHERAPY

• Goal Solve emotional problems through cognitive
  restructuring
• Aaron Beck Focuses on changing automatic
  thoughts
• Albert Ellis Rational-emotive therapy
  emphasizes needs to change self-defeating
  thinking and beliefs
• Brief psychotherapies Fewer than 12 sessions
  specific goals and targets.
• Interpersonal psychotherapy A form of brief
  therapy that focuses on social relationships

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PRINCIPAL ELEMENTS OF COGNITIVE THERAPY

• Presentation of cognitive rationale to patient
• Short-term intervention
• Focus on the here and now
• Patient-therapist collaboration
• Questions and homework
• Maintain daily records of mood, behavior, and
  dysfunctional thoughts
• Carry out informal experiments to test thoughts,
  beliefs, and assumptions
• Apply newly acquired cognitive schema to
  real-life situations.

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BEHAVIOR THERAPY

• Forerunner of cognitive-behavioral therapy
• Behavioral modification
• Based on operant conditioning
• Uses reinforcement and shaping
• Token economy Reinforces desired behaviors
• Biofeedback Can help develop control of
  internal processes

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COGNITIVE-BEHAVIOR THERAPY

• Integrates cognitive and behavioral elements
• Relaxation training
• Exposure therapy
• Flooding
• Implosive therapy
• Systematic desensitization
• In vivo exposure
• Modeling
• Behavioral rehearsal
• Assertiveness training

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FACTORS IN SUCCESSFUL USE OF RELAXATION TRAINING

• The individuals problems do not have an organic
  basis.
• The individual is not psychotic, depressed, or
  subject to panic attacks.
• The individual is able to assume responsibility
  for active participation in treatment, with
  special emphasis on home practice.
• Family members are cooperative with and
  supportive of the individuals treatment.
• The individual has reasonable expectations of the
  trainings effectiveness.

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GROUP THERAPY

• Several people with similar problems
• Group membership provides
• Acceptance and support
• Normative information about behavior/feelings
• Learning through modeling and behavioral
  rehearsal
• Cognitive-behavioral group therapy
• Goal is development of social skills and comfort
  in social situations
• Family and marital therapy
• View marriage and family as a system
• Learn how behaviors affect each other
• Psychodrama
• Group acts out events of emotional significance

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RESEARCH ON PSYCHLOGICAL THERAPIES

• Important to distinguish between unique and
  common features among therapies
• Important to determine therapeutic outcomes
• No one form of therapy is superior than the other
  overall
• Research needs to determine extent to which
  cultural and ethnic factors play a role in
  processes and outcomes of therapeutic
  interventions

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BIOLOGICAL THERAPIES

• Electroconvulsive therapy (ECT)
• Used for severe depression when drugs and other
  therapies have failed
• Drug therapies
• Antipsychotic
• Antimanic
• Antidepressant
• Antianxiety
• Effectiveness of biological therapies
• Effective for particular disorders
• Multimodal treatment
• Medication and psychotherapy is possibly more
  effective than either intervention alone.

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HOSPITALIZATION

• Reasons for hospitalization
• Behaviors poses threat to self or others
• Behavior intolerable to community
• Outpatient treatment failed
• Treatment requires controlled setting
• Withdrawal from drugs or alcohol
• Physical illness complicated by mental disorder
  requiring continuous care

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HOSPITALIZATION

• Partial hospitalization
• When complete hospitalization not required
• Day, evening, or weekend care
• Day hospitalization
• For patients who can live at home but need
  structure and social interaction
• Deinstitutionalization
• Movement in the 1960s to return hospitalized
  patients to the community for community-based
  treatment
• Made possible by discovery of psychoactive drugs
• Lack of adequate community care has led to
  increased homelessness and gaps in treatment for
  seriously mentally ill