Chapter 16 Therapies

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Chapter 16 Therapies

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Psychotherapy

• Psychotherapy
• is an umbrella term.
• includes diverse therapies treatments. 
• reflects diverse theories/orientations.
• addresses widely ranging problems issues.

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Psychotherapy

• Commonly defined by three elements
• 1. A helping relationship
• 2. A helping professional
•  
• 3. One in need of the intervention, or
• the client

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Four major CLASSIFICATIONS of therapy

• 1. Insight Therapies- verbal interactions
  intended to enhance clients self-knowledge as a
  way of promoting healthy changes in behavior or
  personality
• 2. Behavior Therapies- apply principles of
  learning in order to direct efforts to change
  clients maladaptive behaviors

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Four major CLASSIFICATIONS of therapy

• 3. Cognitive therapies- based on cognitive
  perspective assume maladaptive behaviors can
  result from irrational thoughts, beliefs, and
  ideas which therapist tries to change
• 4. Biomedical therapies- physiological
  interventions intended to reduce symptoms
  associated with psychological disorders

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Who are the clients?

• 15 of the U.S. population
• Most common presenting problems
• Half seeking services have no specific disorder
• Those who seek therapy show trends

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Who are the professionally-trained providers?

• Clinical psychologists (PhD)
• Counseling psychologists (PhD)
• Psychiatrists
• Psychiatric Social Workers
• Psychiatric Nurses
• Counselors

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 Involve verbal interactions geared toward
increasing clients self-awareness toward
producing healthy changes in personality and
behavior
Insight Therapies

•  The Insight Therapies Psychoanalysis Client-Ce
  ntered Therapy Interpersonal Therapy
• Group Therapy

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Psychoanalysis

• Proponent Sigmund Freud
• Emphasis Recovery of unconscious conflicts,
  motives defenses
• Techniques Free Association, Dream Analysis,
  Transference
• Primary Problems Treated by Freud
• Neuroses, anxiety disorders,
• Revealing ones defense mechanisms

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Psychoanalytic Techniques

• Free Association
• Dream Analysis
• Symbolism in dreams interpreted
• Believed to be most direct access to the
  unconscious clients current problems
• Interpretation of Dreams

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Psychoanalysis

• Resistance
•  Transference
• Countertransference

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Problems with psychoanalysis

• Quality and extent of the interpretive skills of
  therapistpsychoanalysis requires vast
  interpretation
• Long-term treatment plan (e.g. 3-5 years)
• Often NOT in keeping with Managed Care
• Deals with
• the symbolic interplay between the client
  therapist the interpretation of transference

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Client-Centered Therapy AKA Person-Centered
Therapy

• Proponent Carl Rogers
• Emphases
• Supportive emotional climate for clients
  insight and client direction
• Client(s) establish pace and direction of therapy
• Pathology arises from clients incongruence,
• Goal Self-acceptance personal growth

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Client-Centered Therapy AKA Person-Centered
Therapy

• Client-Centered Climate
• Client-Centered Process
• Clients clarification of their own feelings
• Insight into their own behavior and acceptable
  behavioral choices

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Group Therapy
Several clients in group of 5-10 clients
Common goals, often theme-based groups
Therapist acts as facilitator e.g. AA-
Alcoholics Anonymous Advantages
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Cognitive Therapy

• Proponents
• Aaron Beck, Albert Ellis
• Elliss RET - Rational Emotive Therapy
• Directive and confrontational
• Challenges and modifies irrational beliefs
  thought to cause personal distress
• A warm therapeutic relationship only helps
  patients feel better not get better
• Becks Cognitive Therapy
• Misery of depression and anxiety traced to
  automatic thoughts
• Help patients change maladaptive behavior by
  changing their thoughts
• Effective in treating panic disorders and
  generalized anxiety

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Cognitive Therapy

• Originated in treatment for Depression
• To address
• Therapeutic Goal

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Goals of Cognitive Therapy Changing the way
clients think! Identify negative
thinking Become more realistic, i.e. Get Real!
Group therapy compatible
COMPARE CONTRAST

• Goals of Behavior Therapy
• Changing overt behavior
• Techniques
• Homework assignments
• Combines with Cognitive Therapy well
• More DIRECTIVE than client-centered

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Behavior Therapy

• The application of principles of learning to
  directly change clients overt behaviors
• Basic premise
• Thus, behavior can be unlearned or changed.
• AKA Behavior Modification
• Systematic application of learning principles to
  eliminate and replace maladaptive behavior
  adaptive behavior
• Goal of Behavior Therapy
• Process reduce vague complaints to specific
  behaviors, target those to change, employ
  modification plan

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--Behavioral therapy focuses on changing
specific actions
--uses several techniques to decrease or
stop unwanted behavior (e.g., systematic
desensitization
Behavioral Therapy Treatment Issues
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Behavior Therapy

• Systematic Desensitization
• Used to reduce anxiety through counterconditioning
  
• Proponent Joseph Wolpe
• Three steps

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Behavior Therapy

• Aversion Therapy
• Social Skills Training
• Efficacy of Behavior Therapies
• Measuring outcomes is a focus of the treatment
  paradigm.
• Result Empirical support of effectiveness
• Behavior vs. Insight Therapies
• Slightly favors the behavioral

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Biomedical Therapies

• Physiological interventions to reduce symptoms of
  psychological disorders,
• e.g. Drug Therapy AKA psychopharmacology
• -Treatment with Drugs
•  

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Biomedical Therapies

• Anti-anxiety Medications
• Relieve tension, anxiety, apprehensions, etc.
• e.g. benzodiazepines (valium, xanax)
• Common side effects
• Antipsychotic Drugs
• produces a gradual reduction in psychotic
  symptoms of physical agitation, mental confusion,
  hallucinations, delusions, etc. 

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Biomedical Therapies

• Biomedical Therapies for Mood Disorders
• Antidepressants AKA Mood elevators
• 3 classes Tricyclics, MAO Inhibitors, SSRIs
• Mechanisms of action differ across these three,
  as do side effects, and efficacy.
• Lithium control of mood swings in Bipolar
  Disorder

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Biomedical Therapies

• Biomedical Efficacy
• Varies with individuals but positive response for
  most
• Potential problems with Drug Therapy
• Positive effects of Drug Therapy
• effective relief of symptoms can free clients to
  pursue and effect social, emotional, behavioral
  changes
• For some disorders, medications are necessary for
  recovery maintenance.

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Biomedical Therapies

• Electroconvulsive Shock Therapy (ECT)
  Electrical shock
  produces cortical seizures convulsions
• Greatest use in 1940s 1950s with marked
  decline in 60s 70s controversy continues
• Effectiveness recently documented, especially
  for intractable depressio
• Risks

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Comparison of Therapies