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Chapter 14: Therapies. What Is Psychotherapy? . -- *Any psychological technique used to facilitate positive changes in personality, behavior, or adjustment. Types of Psychotherapy. -- *Individual : Involves only one client and one therapist

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What is psychotherapy l.jpg
What Is Psychotherapy?

  • -- *Any psychological technique used to facilitate positive changes in personality, behavior, or adjustment

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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

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More Types of Psychotherapy

  • Insight: Goal is for clients to gain deeper understanding of their thoughts, emotions, and behaviors

  • -- *Directive: Therapist provides strong guidance (vs. *non-directive)

  • 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

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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 client’s suffering

  • Provides clients with a new perspective about themselves or their situations and a chance to practice new behaviors

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Origins of Therapy

  • *Trepanning:

    • Patient unlikely to survive

    • To relieve pressure or rid the person of evil spirits

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People in Therapy

  • -- *Phillippe Pinel: French physician who initiated humane treatment of mental patients in 1793

    • Created the first mental hospital

  • Freud:

    • Hysteria (--somatoform disorders)

      • caused by deeply hidden unconscious conflicts

    • Goal of Psychoanalysis: To resolve internal conflicts that lead to emotional suffering

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Freudian techniques (Psychodynamic/psychoanalysis)

  • -- *Free Association: saying whatever comes to mind, regardless of how embarrassing it is.

    • Allows unconscious material to emerge

  • -- *Dream Analysis:

    • *Latent content

    • *Manifest content

    • Symbols

  • Directive

  • Brief psychodynamic therapy: designed to produce insights more quickly; uses direct questioning to reveal unconscious conflicts

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Humanistic Therapies

  • -- *Client-Centered Therapy (Carl Rogers)

    --Nondirective and based on insights

    from conscious thoughts and feelings;

    accept one’s true self (optimistic!)

    • *Unconditional Positive Regard: Unshakable acceptance of another person.

    • Empathy: Ability to feel what another person is feeling

    • Authenticity: Therapist is genuine and honest about his or her feelings

    • Reflection: Rephrasing or repeating thoughts and feelings of the clients

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Cybertherapy and Psychotherapy at a Distance

  • -- *Media Psychologists: Radio,

  • newspaper, and television

  • psychologists; give advice,

  • information, and social support, e.g., Dr. Phil (OK), Dr. Laura (bad)

  • Telephone Therapists: 900 number therapists

    • May be nothing more than telephone operators who have never even taken a psychology course! (True in practice, too.)

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Cybertherapy and Psychotherapy at a Distance Concluded (Continued)

  • Cybertherapy: Internet therapists in chat rooms.

    • Patient/client can remain anonymous

    • Good if client can not drive a distance to a therapist or cannot leave the house (agoraphobic)

    • 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


    • 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

  • Positive/negative Reinforcement and punishment

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Behavior Therapy (Continued)

  • 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

    • E.g., Rapid Smoking: Prolonged smoking at a forced pace

    • Designed to cause aversion to smoking

  • Response-Contingent Consequences

    • Reinforcement, punishment, or other consequences that are applied only when a certain response is made

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Behavioral Therapies (Continued)

  • -- *Systematic Desensitization

    • Hierarchy: Rank-ordered series of steps, amounts, levels, or degrees

    • Uses reciprocal Inhibition: One emotional state is used to block another (e.g., impossible to be anxious and relaxed at the same time)

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Operant Therapies

  • *Operant Conditioning: Learning based on consequences of making a response

    • -- *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

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  • 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

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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

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Cognitive Therapy

  • -- Therapy that helps clients change thinking patterns that lead to problematic behaviors or emotions

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Cognitive Therapy

  • Therapy that helps clients change thinking patterns that lead to problematic behaviors or emotions

  • 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

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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, I’m a rotten person.”

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Group Therapy

  • Psychodrama (Moreno): Clients actout 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 client’s behavior

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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 family’s problem

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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 client’s belief that therapy will help

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Basic Counseling Skills

  • Active listening

  • Clarify the problem

  • Focus on feelings

  • Avoid giving advice

  • Accept the client’s frame of reference

  • Reflect thoughts and feelings

  • Silence: Know when to use

  • Questions

    • Open: Open-ended reply

    • Closed: Can be answered “Yes” or “No”

  • Maintain confidentiality

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*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

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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

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Electroconvulsive Therapy

  • -- *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

      • 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

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  • 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

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  • 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

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Half-Way Houses

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

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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

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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”)

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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

  • 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?