Therapy and Change

1. Therapy and Change • Goals • Diagnosis • Etiology (causes) • Prognosis • Starting treatment

2. Therapies • Biomedical • Alter brain functioning with chemical or physical intervention • Drug therapy, surgery, electroconvulsive therapy

3. Therapies • Psychotherapies • Focus on changing faulty behaviors, thought, perceptions and emotions that may be associated with specific disorders

4. Therapies • Psychodynamic • Inner conflict (unconscious) • “talk therapy”

5. Psychodynamic • http://www.youtube.com/watch?v=j1FGaCNN1aw&feature=PlayList&p=AA9116F724F0DD74&playnext=1&playnext_from=PL&index=25

6. Therapies • Behavioral • Treats external • Changing surroundings • No internal

7. Therapies • Cognitive • Attempts to change way one thinks • Alter the way one views themselves

8. Therapies • Existential/Humanistic • Self actualization, psychological growth, development of more meaningful relationships

9. Therapist • Counseling Psychologist • Provide guidance in areas such as vocational selection, school problems, drug abuse and marital conflict

10. Therapist • Clinical social worker • Considers social context of problems • Collaborates with other professionals • Works in family or work setting

11. Therapist • Pastoral counselor • Religious person who specializes in the treatment of psychological disorders often combining spirituality with practical problem solving

12. Therapist • Clinical psychologist (PHD or PSYD) • Trained in assessment and treatment of psychological problem solving

13. Therapist • Psychiatrist • Prescribes medications for the treatment of psychological disorder

14. Therapist • Psychoanalyst • Specialized post grad training in Freudian approach

15. Attendee • Client • One who is being treated for a psychological disorder not a mental illness • Humanistic approach • Patient • One who is using the biomedical approach

16. History • Phillippe Pinel (1801) • Mentally ill are sick and need treatment not warehousing • Clifford Beers (1900’s) • Mental hygiene movement • Rehabilitation goal • 1960’s • Deinstitutionalize mentally ill • Remove wharehousing

17. Cultural • US/Western • Individualizes • Takes person out and fixes them • Other cultures • Use their own social groups/families

18. Cultural • Shamanism • Spiritual tradition that involves both healing and gaining contact with the spirit world • Mental illness is being powerless • Need to personalize to regain power

19. Cultural • Ritual healing • Ceremonies that infuse special emotional intensity and meaning into the healing process

20. Psychodynamic Approach • Psychoanalysis • Freud • An intensive prolonged technique for exploring the unconscious motivations and conflicts in neurotic, anxiety ridden individuals

21. Psychoanalysis • Id, Ego, Superego issue • Repression understanding • Gain insight(therapy) • Therapist guides a patient toward discovering insights between present symptoms and past organs • Work with long standing unconscious issues

22. Psychoanalysis • Free association • Patient gives a running account of thoughts, wishes, physical sensations and mental issues that occur • Freud would say they were predetermined not random • Significant patters

23. Psychoanalysis • Catharsis • Process of expressing strongly felt but usually repressed emotions

24. Psychoanalysis • Resistance • Inability or unwillingness of a patient in psychoanalysis to discuss certain ideas, desires or experiences

25. Psychoanalysis • Dream analysis • Royal road to the unconscious • Manifest (open visible) • Latent (hidden) • Psychoanalytic interpretation of dreams used to gain insight into a person’s unconscious motives or conflict

26. Psychoanalysis • Transference • Attachment to a therapist feelings formerly held toward some significant person who figured in a past emotional conflict • Positive or negative

27. Psychoanalysis • Counter Transference • Therapist develops personal feelings about a client due to similarities to someone in the therapists life

28. Neo-Freudian Therapies • Placed more emphasis on patient’s current social environment • Continuing influences of life experiences • Role of social motivation, interpersonal relationships • Importance of ego function, development of the self concept

29. Neo-Freudian Therapies • Harry Stack Sullivan (1953) • Stressed social relationships and patient’s needs for acceptance, respect and love • Not only internal but current societal and interpersonal relationship

30. Neo-Freudian Therapies • Melanie Klein (1975) • Issues with Oedipus conflict (age 4-5) • Earlier superego • Death instinct greater than sex instinct • Love unites and aggression splits the psyche • Object relations theory • Building blocks of how people experience the world emerge from their relations to loved and hated objects (people)

31. Neo-Freudian Therapies • Heinz Kohut (1977) • Emphasis on self • Objective relations • How various aspects of the self require self objects, supportive people and significant things everyone needs to maintain optimal personality functioning.

32. Behavioral Therapies • Behavior Modification • Systematic use of principles of learning to increase the frequency of desired behaviors and or decrease the frequency of problem behaviors

33. Behavioral Therapies • Symptom Substitution • Treating external will lead to this according to psychodynamics • New psychological problem

34. Behavioral Therapies • Counterconditioning • Substitute a new response for a maladaptive one by means of conditioning procedures

35. Behavioral Therapies • Systematic desensitization • Client is taught to prevent the arousal they feared, while being taught to relax

36. Behavioral Therapies • Implosion therapy (opposite of system desensitization) • Client exposed to anxiety-provoking stimuli, through their imagination, in an attempt to extinguish the anxiety with the stimuli

37. Behavioral Therapies • Flooding • Therapy for phobias in which clients are exposed, with permission, to the stimuli most frightening to them

38. Behavioral Therapies • Keys to systematic desensitization, implosion, flooding • exposure

39. Behavioral Therapies • Aversion therapy • Therapy to stop people who are attracted to harmful stimuli • Attractive (but bad) stimulus is paired w/ a noxious stimulus in order to elicit a negative reaction to the target stimulus • I.e. shock with smoking

40. Behavioral Therapies • Contingency Management • Skinner • Extinction strategies • Removing unseen reinforcements that cause unwanted behaviors • Changing behavior by modifying its consequences • Positive reinforcement • Rewards given • Shaping • Token economies

41. Social-Learning • Client observes model’s desirable behaviors being reinforced • Albert Bandura (1986)

42. Social-Learning • Participant Modeling • Therapist demonstrates desired behavior and client is aided through supportive encouragement to imitate the modeled behavior

43. Social-Learning • Social Skills • Responsibilities that allow one to achieve their social goals • What to say, how and when

44. Social-Learning • Behavioral Rehearsal • Establish and strengthen basic skills • Rehearse skills with therapist

45. Cognitive Therapies • Attempt to change feelings and behaviors by changing the way a client thinks about or perceives life experiences

46. Cognitive Therapies • Cognitive behavior modification • Role of thoughts and attitudes influencing motivations and responses with the behavioral emphasis on changing performance through modifications of reinforcement contingencies • Unacceptable behaviors changed into positive coping ones • Increase self-efficacy • Belief that one can perform adequately in a particular situation • Also behavioral and cognitive efficiency

47. Cognitive Therapies • Changing false beliefs • Unreasonable attitudes (being perfect) • False premises (do what others want) • Rigid rules (obey, always do the same)

48. Cognitive Therapies • Aaron Beck (1976) • Uses with depression • Depression due to the lack of awareness to negative, automatic thought • How therapy works • Challenge client’s basic assumption about functioning • Evaluate evidence for and against these thoughts • Reattribute blame to situational factor • Discuss alternate solution

49. Cognitive Therapies • Rational Emotive Therapy • Albert Ellis (1962) • Comprehensive system of personality change based on changing irrational beliefs that cause undesirable, highly charged emotional reactions such as severe anxiety • How to recognize the “shoulds, oughts, and musts” • Get rid of system of faulty beliefs

50. Existential-Humanistic Therapies • Freedom to choose leads to a burden of responsibility • Guilt over lost opportunities to achieve full potential