Chapter 17 Therapies

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Chapter 17 Therapies
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Quiz

• True or False
• Psychotherapy includes lying on a couch and
  discussing how you feel about your parents
  sexually.
• Behavior therapy includes a heavy emphasis on the
  past and how to affect your behavior in the
  future.
• Therapy placebo affect is when improvement is
  caused by the expectation that therapy will help,
  not by any specific intervention.
• Pharmacotherapy is the use of drugs to alleviate
  the symptoms of emotional disturbance
• A community mental health center is a facility
  offering a wide range of mental health services,
  such as prevention counseling, crisis intervention

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What is Psychotherapy?

• Any psychological technique used to facilitate
  positive changes in an individuals personality,
  behavior, or adjustment
• Can include individual or group therapy

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The dose-improvement relationship in
psychotherapy. This graph shows the percentage of
patients who improved after varying numbers of
therapy sessions. Notice that the most rapid
improvement took place during the first 6 months
of once-a-week sessions.
Fig. 17-6, p. 588
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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
• Goal presumably to relieve pressure or rid the
  person of evil spirits
• 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!

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Primitive treatment for mental disorders
sometimes took the form of boring a hole in the
skull. This example shows signs of healing, which
means the patient survived the treatment. Many
didnt.
Fig. 17-1, p. 571
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Origins of Therapy Continued

• Ergotism Psychotic-like symptoms that come from
  ergot poisoning, a common fungus in Rye fields
• Ergot is a natural source of LSD
• Philippe Pinel French physician who initiated
  humane treatment of mental patients in 1793
• Created the first humane mental hospital by
  unchaining clients

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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 reduce internal
  conflicts that lead to emotional suffering

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Some Key Techniques of Psychoanalysis

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

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Psychoanalysis and Freud Concluded

• Resistance Blockage in flow of ideas topics the
  client resists thinking about or discussing
• Resistances reveal particularly important
  unconscious conflicts
• Transference Tendency to transfer feelings to a
  therapist that match those the patient has for
  important people in his or her past
• The patient might act like the therapist is a
  rejecting father, loving mother, etc.

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Waiting-List Control Group

• People who receive no therapy as a way to test
  the effectiveness of psychotherapy
• Compare control with experimental group if no
  statistically significant difference, then
  something other than therapy caused change or no
  change in conditions

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Psychotherapist Carl Rogers, who originated
client-centered therapy.
Everything previous was unconscious, Rogers found
it more beneficial to focus on the conscious
p. 574
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Four Aspects

• 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
• 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

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Existential Therapy

• An insight therapy that focuses on problems of
  existence, such as meaning, choice, death, and
  responsibility emphasizes making difficult
  choices in life
• Free Will Human ability to make choices
• You can choose to be the person you want to be
• Logotherapy Emphasizes need to find and maintain
  meaning in ones life
• Confrontation Clients are challenged to examine
  their values and choices

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Gestalt Therapy

• Focuses on immediate experience and awareness to
  help clients rebuild thinking, feeling, and
  acting into connected wholes
• Emphasizes integration of fragmented experiences
  (filling in the gaps)
• Clients are taught to accept responsibility for
  their thoughts and actions
• More directive than client-centered or
  existential therapy
• Example
• http//www.youtube.com/watch?vZbOAdMdMLdI

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Cybertherapy and Psychotherapy at a Distance Dr.
Phil, Among Others

• 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!

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Media psychologists have been urged to educate
without actually doing therapy on the air. Some
overstep this boundary, however. Do you think
popular TV psychologist Dr. Phil sometimes goes
too far?
p. 576
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Cybertherapy and Psychotherapy at a Distance
Concluded

• Cybertherapy Internet therapists in chat rooms
  and so on
• Videocameras at both ends so now you can hear AND
  see therapist
• 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

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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
• http//www.youtube.com/watch?vMCyfMFXR-n0

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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
• Example anabuse, putting something foul tasting
  on nails or couches, forcing someone to smoke a
  whole pack
• Rubber bands
• Anyone here used any of these?

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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
• Im with Busy

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A virtual reality system is used to expose people
to feared stimuli. Many patients would rather
face feared stimuli in a virtual environment than
in a real physical environment.
Fig. 17-3a, p. 581
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Fig. 17-3b, p. 581
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Operant Therapies

• Eye Movement Desensitization and Reprocessing
  (EMDR) Reduces fear and anxiety by holding
  upsetting thoughts in your mind while rapidly
  moving your eyes from side to side
• Further research needed

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Aspects of Behavior Modification

• Operant conditioning Learning based on
  consequences of making a response
• Positive Reinforcement Responses that are
  followed by a reward tend to occur more
  frequently
• Punishment If a response is followed by
  discomfort or an undesirable effect, the response
  will decrease/be suppressed (but not necessarily
  extinguished)
• Example How do you train a dog?
• How do you train a child?

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How far can we go with controlling behavior?

• As various therapies are tried, modified, and
  developed, the possibility of controlling
  maladaptive behavior increases. It is possible
  to foresee a time when such techniques will be
  perfected to the point where behavioral change,
  and therefore, behavioral control, will be much
  easier to accomplish and more certain.

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Reinforcement and Token Economies

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

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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

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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

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Medical Therapies

• Pharmacotherapy Use of drugs to alleviate
  emotional disturbance
• Anti-depressants Elevate mood and combat
  depression
• Prozac (fluoxetine) and Zoloft (sertraline) are
  two types
• Anxiolytics Produce relaxation or reduce anxiety
• Valium (diazepam) is one type
• Antipsychotics Tranquilize and also reduce
  hallucinations and delusions in larger dosages
• Haldol (haloperidol) and Thorazine
  (chlorpromazine) are two types
• What are the problems with these?

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Shock

• Electroconvulsive Therapy (ECT) Electric shock
  is passed through the brain inducing a convulsion
  
• Based on belief that seizure alleviates
  depression by altering brain chemistry and
  hormonal balance

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Psychosurgery

• Any surgical alteration of the brain designed to
  bring about desired behavioral or emotional
  changes
• 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

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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)
• All societies find some mechanism for
  facilitating change in others. Compare and
  contrast the therapeutic role of witch-doctors,
  folk-medicine practitioners, and religious
  leaders. What might all these have in common
  that would help at least some people feel better?

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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

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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

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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?
• Do you see a therapist?

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Things Left Unsaid

• Ask students to turn to the person next to them
  and share "things left unsaid" to someone they
  care about. If they could talk to anyone in the
  world to add closure to the relationship, who
  would they call? What would they say?

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How much do you trust someone?

• Randomly pair students and instruct them to walk
  to some point on campus. On the way to the
  chosen point, one student should be blindfolded
  while being guided by the second. On the way
  back, they should reverse roles.

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Behavior Change

• In groups of three work on a plan to change a
  behavior. Each of the three should have a
  behavior to change. The group can work on each
  one. There is an advantage to a group rather
  than an individual working on the problem,
  because it is more likely to get done if the
  group works on it. It also gives support to each
  individual in the planning and executing of the
  change.

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A friend in Need

• Handout

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Insight vs Behaviorism

• Two teams of students prepare a debate reflecting
  the opposing viewpoints of insight therapists and
  behavior therapists. Which should be used or
  under what circumstances, should these
  techniques be used in schools, the military,
  prisons, programs for the mentally disabled,
  mental hospitals, and other institutional
  settings.