Treatment

1
Treatment

• for
• Psychological Disorders

2
Biological Treatments

• Psychotropic medications
• Psychosurgery-cingulotomy for OCD, lobotomies no
  longer used
• ECT often effective for severe depressions that
  fail to respond to medications
• People with the most severe disorders usually
  need medication and/or ECT.
• Explosion of use. In the early 1990s, Prozac
  outsold every prescription medication.

3
Psychotherapy

• What is psychotherapy?
• The use of psychological techniques and the
  therapist-client relationship to produce
  emotional, cognitive and behavioral changes in
  the client.
• Is it different from what a friend does who
  provides support and encouragement?

4
Many Types (400 or so)

• Psychoanalytic
• Interpersonal (IPT))
• Behavioral
• Cognitive
• Humanistic/Existential
• Gestalt
• Adlerian
• Rational-Emotive Behavior Therapy
• Reality
• And many more

5
Main Approaches

• Psychodynamic
• Behavioral
• Cognitive
• Humanist/Existential
• Most behavioral approaches include cognitive
  techniques and v.v. thus, these two are often
  combined as cognitive-behavioral

6
Eclectic approach

• Many therapists today use a variety of approaches
  with the same client, or
• Different approaches with different disorders
• Most, however, still identify with one of the
  major paradigms
• Many therapists work closely with physicians if
  the client needs medications
• Many therapists also will work with community
  resources

7
Psychodynamic Therapies

• Freudian Psychoanalysis goal Insight
• Techniques hypnosis, free association, dream
  analysis, interpretation, transference, etc.)
• Ego analysis Harry Stack Sullivan, Karen
  Horney, Erik Erikson (focuses on interpersonal
  relationships)
• Short-term psychodynamic psychotherapy-usually
  focuses on 1 emotional issue.
• Interpersonal Therapy (IPT) for depression

8
Cognitive/Behavior Therapy

• Focuses on emotional, cognitive, and behavior
  change in the present, not insight about the
  past.
• Practical. Relies on empirical evaluation.
  Applies experimental psychology.
• Techniques include systematic desensitization, in
  vivo desensitization, flooding, aversion therapy,
  contingency management, token economies, social
  skills training such as role playing and
  assertiveness training.

9
Cognitive Therapies

• Rooted in cognitive psychology
• Aaron Becks Cognitive Therapy for Depression
  (Depression is caused by errors in thinking)
• Albert Elliss Rational-Emotive therapy (RET)
  (Emotional disorders are caused by irrational
  beliefs)
• Cognitive techniques include attribution
  retraining, challenging irrational assumptions,
  homework assignments, hypothesis testing,
  self-instruction training.
• Meichenbaums Stress-Inoculation technique, and
  others

10
Humanist/Existential Approaches

• Humanistic therapists believe that emotional
  distress results from the frustration of human
  existence, particularly from alienation from the
  self and others.
• They argue that each individual is responsible
  for finding meaning in his or her own life.
• Treatment is a way to help individuals make their
  own life choices and resolve their own dilemmas.
• More oriented toward the present than other
  insight therapies
• Therapist/client relationship extremely important

11
Humanist/Existential Therapy (2)

• Carl Rogers Client-centered therapy (or non-
  directive therapy). Techniques include empathy,
  self-disclosure on the part of the therapist,
  demonstrating unconditional positive regard,
  clarifying and reflecting.
• Popular among counselors LPCs
• Eliza computer program
• Gestalt Therapy (Fritz Perls) Confrontational,
  very directive. Being genuine-not phony,
  emotional awareness, living in the here and
  now. Empty chair technique.

12
Does Psychotherapy Work?

• If so, how do we know?
• What is meant by spontaneous remission? What is
  the rate?
• What are some of the difficulties involved in
  doing research on psychotherapy? How do we
  define success?
• Is one type of therapy more effective than
  another?

13
Meta-analyses

• Meta-analyses of hundreds of studies estimate
  that about 2/3 of individuals who are treated
  with psychotherapy improve significantly in the
  short-term. (Most studies do not do long term
  follow-up).
• How many get better without treatment? i.e., what
  is the spontaneous remission rate? 1/3
• Studies use wait-list control groups.

14
Placebos

• What is the appropriate placebo for
  psychotherapy? If a placebo heals through
  psychological means, then it may be active.
• Active ingredient versus inactive or inert
  ingredients.
• Common versus specific factors in therapy?

15
How important are therapist variables to success?

• Social support warmth, genuineness, empathy very
  important to success of psychotherapy
• Social influence a process of
  persuasioninstilling hope. (not value free)

16
Client Variables more important

• There is greater success when the clients are
  involved in therapy, interested in the process,
  highly motivated to get better, cooperative,
  have the ability to introspect, like the
  therapist, share values with the therapist, have
  confidence in the therapist and therapy, trust
  the therapist, have a high expectation of success
  (but not too high), are verbal, intelligent, and
  highly educated.
• Severity matters (the more disturbed do worse)
• Type of problem matters (the anxious improve
  most)

17
What therapy works best with what disorders? (in
general)

• Anxiety Disorders Cognitive-behavior therapy
  works best. Need exposure. Meds helpful if
  severe. Success rate high for most types.
• Unipolar Depression Cognitive-behavior therapy
  or IPT plus antidepressant medications if severe.
  Success rates high. ECT and anti-psychotics if
  profound depression.
• People with mild disorders seem to improve
  significantly by seeing a professional but the
  type of training and type of therapy do not
  matter much. Probably the common factors.

18

• Somatoform disorders hard to treat.
  Combinations of therapy.
• Dissociative disorders. Hard to treat. Hypnosis
  plus psychodynamic-based therapies have been
  successful.
• Meaning of life issues, mild anxiety and
  depression. Humanist/Existential therapies
• Anorexia Hospitalization and combinations
  including Family therapy. Bulimia
  antidepressants plus cognitive behavior therapy.
  IPT also helpful.
• Personality disorders very hard to treat.
  Therapy may not help at all. Not effective for
  antisocial PD.