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Chapter 14: Therapies

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Title: Chapter 14: Therapies


1
Chapter 14 Therapies
2
What Is Psychotherapy?
  • Any psychological technique used to facilitate
    positive changes in personality, behavior, or
    adjustment

3
Types of Psychotherapy
  • Individual Involves only one client and one
    therapist
  • Client Patient the one who participates in
    psychotherapy
  • Rogers used client to equalize therapist-client
    relationship and de-emphasize doctor-patient
    concept
  • Group Several clients participate at the same
    time

4
More Types of Psychotherapy
  • Insight Goal is for clients to gain deeper
    understanding of their thoughts, emotions, and
    behaviors
  • Directive Therapist provides strong guidance
  • Time-Limited Any therapy that limits number of
    sessions
  • Partial response to managed care and to
    ever-increasing caseloads
  • Caseload Number of clients a therapist actively
    sees

5
Positive Therapy
  • Techniques designed to enhance personal
    strengths, rather than fix weaknesses

6
Figure 14.6
7
Table 14.1
8
Origins of Therapy
  • Trepanning For primitive therapists, refers to
    boring, chipping, or bashing holes into a
    patients head for modern usage, refers to any
    surgical procedure in which a hole is bored into
    the skull
  • In primitive times it was unlikely the patient
    would survive this may have been a goal
  • Goal presumably to relieve pressure or rid the
    person of evil spirits

9
Demonology
  • Study of demons and people beset by spirits
  • People were possessed, and they needed an
    exorcism to be cured
  • Exorcism Practice of driving off an evil
    spirit still practiced today!

10
Psychoanalysis Freud
  • Hysteria Physical symptoms (like paralysis or
    numbness) occur without physiological causes
  • Now known as somatoform disorders
  • Freud became convinced that hysterias were caused
    by deeply hidden unconscious conflicts
  • Main Goal of Psychoanalysis To resolve internal
    conflicts that lead to emotional suffering

11
Free Association
  • Saying whatever comes to mind, regardless of how
    embarrassing it is
  • By doing so without censorship and censure,
    unconscious material can emerge

12
Resistance
  • Blockage in flow of ideas topics the client
    resists thinking about or discussing
  • Resistances reveal particularly important
    unconscious conflicts

13
Modern Psychoanalysis
  • Brief Psychodynamic Therapy Based on
    psychoanalytic theory but designed to produce
    insights more quickly uses direct questioning to
    reveal unconscious conflicts
  • Spontaneous Remission Improvement of a
    psychological condition due to time passing
    without therapy

14
Humanistic Therapies
  • Client-Centered Therapy (Rogers) Nondirective
    and based on insights from conscious thoughts and
    feelings accept ones true self

15
Rogers Key Conditions for an Effective Therapist
  • Unconditional Positive Regard Unshakable
    acceptance of another person, regardless of what
    they tell the therapist or how they feel
  • Empathy Ability to feel what another person is
    feeling capacity to take another persons point
    of view

16
Rogers Key Conditions for an Effective Therapist
Concluded
  • Authenticity Ability of a therapist to be
    genuine and honest about his or her feelings
  • Reflection Rephrasing or repeating thoughts and
    feelings of the clients helps clients become
    aware of what they are saying

17
Existential Therapy
  • An insight therapy that focuses on problems of
    existence, such as meaning, choice, death, and
    responsibility emphasizes making difficult
    choices in life
  • Therapy focuses on death, freedom, isolation, and
    meaninglessness
  • Confrontation Clients are challenged to examine
    their values and choices

18
Gestalt Therapy (Perls)
  • Focuses on immediate awareness and experience to
    help clients rebuild thinking, feeling, and
    acting into connected wholes
  • Emphasizes integration of various experiences
    (filling in the gaps)
  • Clients are taught to accept responsibility for
    their thoughts and actions
  • More directive than client-centered or
    existential therapy

19
Cybertherapy and Psychotherapy at a Distance
  • Media Psychologists Radio, newspaper, and
    television psychologists often give advice,
    information, and social support
  • Most helpful when referrals and information are
    given
  • Telephone Therapists 900 number therapists
  • Caution Many therapists may be nothing more
    than telephone operators who have never even
    taken a psychology course!

20
Cybertherapy and Psychotherapy at a Distance
Concluded
  • Cybertherapy Internet therapists in chat rooms
    and so on
  • Patient/client can remain anonymous
  • May be wave of future for those who cannot drive
    a distance to a therapist or cannot leave the
    house (e.g., Paula cant leave the house because
    of agoraphobia, so Robert the therapist comes to
    her via Internet!)
  • Cheaper than traditional psychotherapy

21
Telehealth
  • Psychotherapy via teleconferencing

22
Behavior Therapy
  • Use of learning principles to make constructive
    changes in behavior
  • Behavior Modification Using any classical or
    operant conditioning principles to directly
    change human behavior
  • Deep insight is often not necessary
  • Focus on the present cannot change the past, and
    no reason to alter that which has yet to occur

23
Aversion Therapy
  • Conditioned Aversion Learned dislike or negative
    emotional response to a stimulus
  • Aversion Therapy Associate a strong aversion to
    an undesirable habit like smoking, overeating,
    drinking alcohol, or gambling
  • Rapid Smoking Prolonged smoking at a forced pace
  • Designed to cause aversion to smoking

24
Response-Contingent Consequences
  • Reinforcement, punishment, or other consequences
    that are applied only when a certain response is
    made

25
Desensitization
  • Hierarchy Rank-ordered series of steps, amounts,
    levels, or degrees
  • Reciprocal Inhibition One emotional state is
    used to block another (e.g., impossible to be
    anxious and relaxed at the same time)

26
Systematic Desensitization
  • Guided reduction in fear, anxiety, or aversion
    attained by approaching a feared stimulus
    gradually while maintaining relaxation
  • Best used to treat phobias intense, unrealistic
    fears

27
Desensitization (cont.)
  • Tension-Release Method Procedure for
    systematically achieving deep relaxation of the
    body
  • Model Live or filmed person who serves as an
    example for observational learning
  • Vicarious Desensitization Reduction in fear or
    anxiety that takes place secondhand when a client
    watches models perform the feared behavior

28
Virtual Reality Exposure
  • Presents computerized fear stimuli to patients in
    a realistic, yet carefully controlled fashion

29
Operant Conditioning
  • Learning based on consequences of making a
    response

30
Positive Reinforcement
  • Responses that are followed by a reward tend to
    occur more frequently

31
Nonreinforcement
  • A response that is not followed by a reward will
    occur less frequently

32
Punishment
  • If a response is followed by discomfort or an
    undesirable effect, the response will decrease/be
    suppressed (but not necessarily extinguished)

33
Extinction
  • If response is NOT followed by reward after it
    has been repeated many times, it will go away

34
Operant Therapies
  • Shaping Rewarding actions that are closer and
    closer approximations to a desired response
  • Stimulus Control Controlling responses in the
    situation in which they occur
  • Time Out Removing individual from a situation in
    which reinforcement occurs

35
Tokens
  • Tokens Symbolic rewards like poker chips or gold
    stars that can be exchanged for real rewards
  • Can be used to immediately reinforce positive
    responses
  • Effective in psychiatric hospitals and sheltered
    care facilities
  • Target Behaviors Actions or other behaviors a
    therapist seeks to change

36
Token Economy
  • Patients get tokens for many socially desirable
    or productive behaviors they can exchange tokens
    for tangible rewards and must pay tokens for
    undesirable behaviors

37
Figure 14.5
38
Cognitive Therapy
  • Therapy that helps clients change thinking
    patterns that lead to problematic behaviors or
    emotions

39
Cognitive Therapy for Depression (Beck)
  • Three Major Distortions in Thinking
  • Selective Perception Perceiving only certain
    stimuli in a larger array of possibilities
  • Overgeneralization Blowing a single event out of
    proportion by extending it to a large number of
    unrelated situations
  • All-or-Nothing Thinking Seeing objects and
    events as absolutely right or wrong, good or bad,
    and so on

40
Rational Emotive Behavior Therapy (REBT)
  • Attempts to change irrational beliefs that cause
    emotional problems
  • Theory created by Albert Ellis
  • For example, Anya thinks, I must be liked by
    everyone if not, Im a rotten person.

41
Ellis ABC Concept
  • A Activating experience, which person presumes
    to be the cause of C
  • C Emotional Consequences
  • B Persons irrational and unrealistic beliefs

42
Group Therapy
  • Psychodrama (Moreno) Clients act out personal
    conflicts and feelings with others who play
    supporting roles
  • Role Playing Re-enacting significant life events
  • Role Reversal Taking the part of another person
    to learn how he or she feels
  • Mirror Technique Client observes another person
    re-enacting the clients behavior

43
Family Therapy
  • Family Therapy All family members work as a
    group to resolve the problems of each family
    member
  • Tends to be brief and focuses on specific
    problems (e.g., specific fights)
  • Modality views problems experienced by one family
    member are the entire familys problem

44
Group Awareness Training
  • Sensitivity Groups Group experience consisting
    of exercises designed to increase self-awareness
    and sensitivity to others
  • Encounter Groups Emphasize honest expression of
    feelings
  • Large-Group Awareness Training Increases
    self-awareness and facilitates constructive
    personal change
  • Therapy Placebo Effect Improvement is based on
    clients belief that therapy will help

45
Table 14.2
46
Key Features of Psychotherapy
  • Therapeutic Alliance Caring relationship between
    the client and therapist
  • Therapy offers a protected setting where
    emotional catharsis (release) can occur
  • All the therapies offer some explanation or
    rationale for the clients suffering
  • Provides clients with a new perspective about
    themselves or their situations and a chance to
    practice new behaviors

47
Basic Counseling Skills
  • Active listening
  • Clarify the problem
  • Focus on feelings
  • Avoid giving advice
  • Accept the clients frame of reference

48
Basic Counseling Skills (cont.)
  • Reflect thoughts and feelings
  • Silence Know when to use
  • Questions
  • Open Open-ended reply
  • Closed Can be answered Yes or No
  • Maintain confidentiality

49
Table 14.3
50
Medical (Somatic) Therapies
  • Pharmacotherapy Use of drugs to alleviate
    emotional disturbance three classes
  • Anxiolytics (Antianxiety) Like Valium produce
    relaxation or reduce anxiety
  • Antidepressants Elevate mood and combat
    depression
  • Antipsychotics (Major Tranquilizers) Tranquilize
    and also reduce hallucinations and delusions in
    larger dosages

51
Problems with Drug Therapy
  • Clozaril (clozapine) Relieves schizophrenic
    symptoms however, two out of one hundred
    patients may suffer from a potentially fatal
    white blood cell disease

52
Shock
  • Electroconvulsive Therapy (ECT) Electric shock
    is passed through the brain inducing a
    convulsion treatment for severe depression
  • Based on belief that seizure alleviates
    depression by altering brain chemistry

53
ECT Views
  • Produces only temporary improvement
  • Causes permanent memory loss in some patients
  • Should only be used as a last resort
  • Should be followed by antidepressant medications
    to further prevent relapse

54
Psychosurgery
  • Any surgical alteration of the brain
  • Prefrontal Lobotomy Frontal lobes in brain are
    surgically cut from other brain areas
  • Supposed to calm people who did not respond to
    other forms of treatment
  • Was not very successful
  • Deep Lesioning Small target areas in the brain
    are destroyed by using an electrode

55
Hospitalization
  • Mental Hospitalization Involves placing a person
    in a protected, therapeutic environment staffed
    by mental health professionals
  • Partial Hospitalization Patients spend only part
    of their time in the hospital and go home at
    night
  • Deinstitutionalization Reduced use of full-time
    commitment to mental institutions

56
Half-Way Houses
  • Short-term group living facilities for
    individuals making the transition from an
    institution (mental hospital, prison, etc.) to
    independent living

57
Community Mental Health Centers
  • Offer many health services like prevention,
    education, therapy, and crisis intervention
  • Crisis Intervention Skilled management of a
    psychological emergency
  • Paraprofessional Individual who works in a
    near-professional capacity under supervision of a
    more highly trained person

58
Self-Management
  • Covert Sensitization Aversive imagery is used to
    reduce occurrence of an undesired response
  • Thought Stopping Aversive stimuli are used to
    interrupt or prevent upsetting thoughts
  • Covert Reinforcement Using positive imagery to
    reinforce desired behavior

59
Other Therapy Options
  • Peer Counselor Nonprofessional person who has
    learned basic counseling skills
  • Self-Help Group Group of people who share a
    particular type of problem and provide mutual
    support to each other (e.g., Alcoholics
    Anonymous)

60
Table 14.5
61
Evaluating a Therapist Danger Signals
  • Therapist makes sexual advances
  • Therapist makes repeated verbal threats or is
    physically aggressive
  • Therapist is excessively hostile, controlling,
    blaming, or belittling

62
Evaluating a Therapist More Danger Signals
  • Therapist talks repeatedly about his/her own
    problems
  • Therapist encourages prolonged dependence on
    him/her
  • Therapist demands absolute trust or tells client
    not to discuss therapy with anyone else

63
Evaluating a Therapist Questions to be Answered
During the Initial Meeting
  • Will the information I reveal in therapy remain
    confidential?
  • What risks do I face if I begin therapy?
  • How long do you expect treatment to last?
  • What form of treatment do you expect to use?
  • Are there alternatives to therapy that might help
    as much or more?
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