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ATC Psychology. Chapter 16 Treatment of Personality Disorders. Psychotherapy. Is used by those who take a psychodynamic, phenomenological, or behavioral approach to treatment of psychological disorders. Psychotherapy.
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ATC Psychology Chapter 16 Treatment of Personality Disorders
Psychotherapy • Is used by those who take a psychodynamic, phenomenological, or behavioral approach to treatment of psychological disorders.
Psychotherapy • It involves treating disorders with psychological methods, such as analyzing problems, talking about possible solutions, and encouraging more adaptive ways of feeling, thinking, and acting.
Psychotherapy • The biological approach uses drugs and other physical treatments. • Most psychologists consider themselves to be eclectic—that is, they draw on one more of the approaches in helping any given client.
Basic Features of Treatment • All methods of treatment share certain basic features, including a client or patient seeking relief from problems; a person who is socially accepted as one who can help the client because of training or experience; a special social relationship between client and therapist, which helps ease the client’s problems; a theoretical explanation of those problems; a set of procedures for dealing with them.
Basic Features of Treatment • Clients can be categorized as inpatients, outpatients, or those seeking personal growth.
Basic Features of Treatment • Psychiatrists are medical doctors who specialize in the treatment of mental disorders and can prescribe medications.
Basic Features of Treatment • Psychologists who do psychotherapy usually have a doctoral degree in clinical or counseling psychology, but currently cannot prescribe drugs.
Basic Features of Treatment • The main goal of psychotherapists is to help people change their thinking, feeling, and behavior so that they will be happier and more productive.
Psychodynamic Psychotherapy • Freud’s method of treatment, psychoanalysis, attempts to help the patient understand unconscious conflicts and wishes and work through their implications for everyday life.
Classical Psychoanalysis • Free association consists of asking a client to verbalize all thoughts, feelings, and memories that come to mind. • The content and pattern of associations contain clues to unconscious material.
Classical Psychoanalysis • In the interpretation of dreams, a patient reports the manifest content (the surface story) of a dream and works to understand its latent content (the unconscious meaning), as represented by the dreams symbols.
Classical Psychoanalysis • The psychoanalyst looks for evidence that the feelings, reactions, and conflicts the client experiences toward others have been transferred on the therapists. • Transference may help the client reenact and gain insight into old conflicts.
Contemporary Variations on Psychoanalysis • Psychoanalysis requires much time, money, verbal skill, and abstract thinking ability; these requirements limit its use. • Variations on psychoanalytic treatments, such as ego analysis, deemphasized the past and focus on helping the client use the ego to solve problems.
Contemporary Variations on Psychoanalysis • Object relations therapy is a contemporary psychodynamic approach to psychotherapy. • Therapists using this approach believe that personality and the arising conflict that cause problems stem from the need for supportive human relationships, such as the mother-child bond.
Contemporary Variations on Psychoanalysis • Object Relations • The therapist takes an active role in therapy and tries to establish a supportive and nurturing relationship with the client so that she or he can experience what may have been missed as an infant.
Contemporary Variations on Psychoanalysis • Other variations on psychoanalysis include psychoanalytically oriented psychotherapy, and time-limited dynamic psychotherapy.
Phenomenological Psychotherapy • Phenomenologists, or humanistic psychologists, believe that behavior is shaped by an innate drive toward growth that is guided by an individual’s interpretation of the world.
Phenomenological Psychotherapy • Phenomenological treatment is based on the following assumptions: • Treatment is a human encounter between equals, not a cure. • Clients will improve on their own, given the right conditions • An accepting and supportive relationship will support clients’ growth • Clients must remain responsible for choosing how to feel and think.
Client Centered Therapy • Carl Rogers’s client-centered, or person centered, therapy is based on creating a relationship characterized by unconditional positive regard, empathy and congruence.
Client Centered Therapy • Unconditional Positive Regard—The therapist must show that he or she genuinely cares about and accepts the client as a person and trusts the client’s ability to change.
Client Centered Therapy • Empathy—the therapist must appreciate how the world looks form the client’s point of view. • Empathy is communicated through a technique called reflection.
Client Centered Therapy • Congruence—the way the therapist feels is consistent with the way he or she acts toward the client. • The therapist’s unconditional positive regard and empathy are real, not manufactured.
Gestalt Therapy • The goal of Frederick S. Perls’s Gestalt therapy is to help clients become more self-aware and self-accepting so that they can begin growing again in their own unique, consciously guided direction.
Gestalt Therapy • Gestalt therapists encourage clients to become aware of real feelings that they have denied, and to discard foreign feelings, ideas, and values.
Gestalt Therapy • Therapists are directive in helping clients focus on present, not past, feelings. • Role play and imaginary dialogues are two facets of this therapy.
Behavior Therapy • Therapists who use behavior assume that problems are learned patterns of thinking and behaving that can be changed without looking for the meanings behind them.
Behavior Therapy • Treatments that utilize classical conditioning principles are referred to as behavior therapy
Behavior Therapy • Those utilizing operant conditioning are called behavior modification.
Behavior Therapy • Therapies that focus on changing thinking patterns as well as overt behavior are called cognitive-behavior therapy.
Behavior Therapy • Basic features of behavior therapy include: • The development of a good client-therapist relationship • A list of behaviors and thoughts to be changed • A therapist who acts as a teacher by setting and implementing specific treatment plans, and ongoing evaluation of the effects of therapy.
Techniques for Modifying Behavior • Systematic Desensitization • A client practices progressive relaxation while imagining fear- provoking situations for an anxiety hierarchy. • The process of remaining calm while thinking about something feared weakens the learned association between anxiety and the feared object
Techniques for Modifying Behavior • Modeling • A client can learn about or get comfortable displaying desirable behaviors. • The therapist demonstrates desirable behaviors, and the client gradually practices them. • The clients can learn to be more appropriately self-expressive and more comfortable in social situation through assertiveness and social skills training.
Techniques for Modifying Behavior • Positive Reinforcement • A therapist systematically uses positive reinforcement to alter problematic behavior. • The receipt of rewards or tokens is dependent upon a client’s display of desirable behaviors. • In institutions, behavior therapists sometimes establish a token economy.
Techniques for Modifying Behavior • Extinction • Behavior can be modified by removing reinforcers that normally follow a particular response. • A procedure called flooding, which extinguishes a classically conditioned fear response, keeps a patient in a feared but harmless situation. • As a result, the client who is deprived of the normally rewarding escape pattern has not reason for continued anxiety.
Techniques for Modifying Behavior • Aversive Conditioning • This technique uses classical conditioning to reduce undesirable behavior by associating it with some psychological or physical discomfort.
Techniques for Modifying Behavior • Punishment • To eliminate a dangerous or disruptive behavior, an unpleasant stimulus is presented after the behavior, which reduces its occurrence.
Cognitive-Behavior Therapy • Cognitive-behavior therapy can help people change negative thoughts, which can induce depression, anger, or anxiety.
Rational-Emotive Therapy and Cognitive Restructuring • RET tried to eliminate learned problem-causing thoughts. • Cognitive restructuring and stress inoculation training can teach a client new and calming thoughts to help her cope with stressful or anxiety-provoking situations.
Beck’s Cognitive Therapy • Cognitive therapy rests on the assumption that a client has formed negative thoughts about the self and the world. • Treatment involves demonstrating the inaccuracy of these thoughts by testing them.
Group, Family, and Couples Therapy • Group therapy is the simultaneous treatment of several clients by one therapist. • There is not predominant theoretical approach to group therapy.
Group Therapy • Groups are organized around either one type of problem or one type of client. • Advantages: • The therapist can observe clients’ personal interactions • Clients realize that they aren’t the only people with a particular problem • Clients support one another, which increases self-esteem • Clients learn from one another
Family Therapy • Based in part on the psychodynamic theory that a patients problems stem from early relationships and problems, that patients released from mental hospitals often relapse, and that problems are multifaceted and must be dealt with in the setting in which they are maintained.
Family Therapy • The entire family is the “client” and the therapist attempts to create harmony within the family by facilitating each member’s understanding of the family’s intentions and how they relate to problems.
Couples Therapy • Focuses on communication between partners. • Therapists and clients often set “rules for talking” to improve communication skills.
Evaluating Psychotherapy • Focus on Research Methods: Meta-Analysis • Psychotherapy is often more helpful than placebos or no treatment at all, and the benefits tend to be long lasting. • Whether benefits are durable in daily life has not been demonstrated. • Only a small percentage of clients become worse after therapy. • Research needs to focus on measuring the magnitude of both positive and negative effects.
Evaluating Psychotherapy • Addressing the “Ultimate Question” • The client-therapist relationship, an “approach-free” factor, is extremely important in the success of any therapy. • When choosing a type of therapy, a person should give careful consideration to what approach he or she finds appealing, the therapist’s “track record”, and the potential for forming a productive client-therapist relationship.
Cultural Factors in Psychotherapy • Cultural differences may lead a client and therapist to have different expectations and goals about the outcome of therapy and the approach and methods used.
Cultural Factors in Psychotherapy • Psychologists are working to align cultural influence and choice of specific treatment. • Mental health training programs are trying to recruit more students from varying cultures, and clinicians are being trained to recognize and understand cultural differences in verbal and nonverbal communication.
Rules and Rights in the Therapeutic Relationship • The ethical standards of the APA forbids a sexual relationship between therapist and client. • A therapist must also hold whatever the client says in complete confidentiality.
