Psychological Perspectives on Human Behavior:

1. Psychological Perspectives on Human Behavior: THERAPY

2. The History of Therapy: • Historically, people with psychological disorders were subjected to such techniques as “skull-holes”, “restoring body humors,” and “placement in insane asylums.” • Only in recent historical times have people received decent, effect therapy for their psychological problems and disorders.

3. The Definition of Therapy: • Psychotherapyis the process in which a client and a professional attempt to treat and to remedy the client’s psychological difficulties. • Psychotherapy is defined as the establishment of a helping relationship between a patient and a trained professional who applies psychological principles to the treatment of emotional or behavioral problems. • Psychotherapy involves the treatment of: (1) disturbed thoughts; (2) disturbed emotions; (3) disturbed behaviors; (4) interpersonal and life situation difficulties; and (5) biomedical disturbances.

4. Types of Therapists: • Clinical Psychologists: • Most are psychologists with PhDs or PsyDs and expertise in research, assessment, and therapy. • Usually have a supervised internship. • About half work in agencies and institutions; half in private practice. • Psychiatrists: • Psychiatrists are physicians who specialize in the treatment of psychological disorders. • As MDs, they can prescribe medications. • They tend to see clients with the most serious problems. • Many have private practice.

5. Types of Therapists: • Psychiatric Social Workers: • Professionals with a master’s degree and specialized training in treating people in home and community. • Social workers offer psychotherapy, mostly to people with everyday personal and family problems. • Counseling Psychologists: • Marriage and family counselors specialize in problems arising from family relations. • Pastoral counselors are certified by the American Association of Pastoral counselors. • Abuse counselors work with substance abusers, spouse and child abusers, and their victims.

6. Types of Therapists: • Psychoanalyst: • Either an MD or a psychologist who specializes in psychoanalysis, the treatment technique first developed by Freud. • Psychiatric Nurses: • Professionals who are trained nurses, usually with at least a BS and a MS. • Obtain additional specialized training in psychiatric problems. • Usually administer psychiatric drugs at in-patient and out-patient facilities.

7. Types of Therapy • There are 4 main types of therapy: • Psychodynamic. • Humanistic. • Behavioral-Learning. • Cognitive.

8. The Psychodynamic Approachto Therapy: • Psychodynamic Therapy: emphasizes the role of unconscious conflict. • Therapy Focus: bring the conflict to consciousness. • Source of the problem: childhood problems and unconscious conflicts. • Techniques of therapy: psychoanalysis, free association, and dream analysis. • Psychological component emphasized: emotions.

9. The Behavioral-Learning Approachto Therapy: • Behavioral-Learning Therapy: emphasizes the role of inappropriate learning. • Therapy Focus: identify and correct specific undesirable behaviors. • Source of the problem: inappropriate learning. • Techniques of therapy: systematic desensitization and behavior modification. • Psychological component emphasized: behaviors.

10. The Humanistic Approachto Therapy: • Humanistic Therapy: emphasizes the importance of being aware of one's emotions and feeling free to express them. • Therapy Focus: discover true emotions and personal goals. • Source of the problem: blocking of full development due to restricted growth potential. • Techniques of therapy: conversations, largely guided by the client. • Types of humanistic therapies: (1) Person-Centered Therapy; (2) Gestalt Therapy; and (3) Existential Therapy.

11. The Cognitive Approachto Therapy: • Cognitive Therapy: emphasizes the role of maladaptive and dysfunctional thinking. • Therapy Focus: restructure/change maladaptive and dysfunctional thinking. • Source of the problem: maladaptive thinking. • Techniques of therapy: client conducts self-statement modification; stress-inoculation. • Psychological component emphasized: thoughts.

12. Psychoanalytic Therapy :Sigmund Freud • The Psychoanalytic Orientation to Therapy: After hearing Joseph Breuer's report of the benefits of catharsis in the case of Anna O., Sigmund Freud turned from a career in medicine and eventually developed psychoanalysis. • The Nature of Psychoanalysis: Traditional psychoanalysis takes place with the client reclining on a couch and the therapist sitting nearby, just out of sight. • Psychoanalysis: involves frequent sessions and often lasts for many years.

13. Psychoanalysis: History • Breuer’s Treatment of Anna O. involved catharsis: • Talking led to emotional release. • Relieved symptoms of conversion hysteria. • Freud’s Development of Psychoanalysis: • Childhood conflicts repressed in the unconscious lead to psychological symptoms. • Used the ‘talking cure’to encourageinsight. • Insight leads to catharsis and change.

14. Techniques of Psychoanalysis • Interpretation: • Making suggestions about possible meaning of things to help the client break through defenses. • Therapist clarifies the importance of patient’s experience. • “The man you dreamt about has some of your father’s characteristics.” • Free Associations: • Patient says whatever comes to mind, regardless of how trivial or irrelevant it seems. • Clues about the content of the unconscious will eventually be revealed.

15. Techniques of Psychoanalysis • Resistance: • Patient’s reluctance to focus on certain experiences or emotions. • Unconscious defense strategies designed to keep the therapist from understanding the client’s problems. • Dreams: • The latent or unconscious meaning of dreams is revealed. • Versus the manifest dream content.

16. Techniques of Psychoanalysis • Transference: • The patient reacts to the therapist in the same way that he/she reacts to other important people. • The Analysis of Transference: • Strong feelings toward the therapist which are transferred from childhood reactions are used in therapy to help the patient resolve conflicts.

17. Humanistic Therapies:Carl Rogers • Person-Centered Therapy (Client-centered Therapy) by Carl Rogers: This form of therapy uses reflection, genuineness, and accurate empathy to help clients come up with their own solutions to their problems and to help promote self understanding and acceptance.

18. Humanistic Therapies:Carl Rogers • Empathy: • Looks at life from the client’s perspective. • Active involvement in the client’s world by imagining what it would be like to be the client. • Genuineness: • Shows honesty with client. • Requires therapists to let their inner feelings appear open and honest during therapy. • Unconditional positive regard: • Shows warmth and caring for the client. • Caring acceptance of the client’s individuality regardless of what the client says or does. • Reflection: mirroring back of client’s emotions.

19. Humanistic Therapies:Carl Rogers • Person-Centered Therapy provides a safe therapeutic climate, reflection and clarification of what the client says. In contrast to the psychodynamic therapist, the client-centered therapist does little to interpret, direct, or advise the client. • The basic premise of person-centered therapy is that the social values (conditions of worth) imposed on the individual by society underlie self-actualization.

20. Humanistic Therapies:Gestalt Therapy • Gestalt Therapy: This form of therapy is more directive than person-centered therapy and challenges clients to face their true feelings and to act on them. • Gestalt Therapy: • Developed by Fritz Perls. • Encourages direct expression of emotionby client (can be confrontational). • Focus on the present rather than past or future.

21. Humanistic Therapies:Gestalt Therapy • Gestalt Therapy: emphasizes the importance of increasing an accurate perception of reality. • When perceptions become abnormally inaccurate, they can lead to psychopathology. • Therapist examples: therapist sets example for client by being an open and aware person. • Role play: therapist and/or client engages in role play to help the client manage feelings. • Nonverbal-behavior congruence: therapist encourages client to be in touch with whether verbal behavior matches nonverbal behavior.

22. Humanistic Therapies: Existential Therapy • Existential Therapy: Existential therapists assume that emotional and behavioral problems stem from an inability to cope with the ultimate issues of life. • Existential therapists try to make their clients aware of the importance of free choice and the fact that they have the ultimate responsibility form making their own choices about their lives.

23. The Behavioral-LearningOrientation to Therapy • The behavioral orientation to therapy places more emphasis on changing maladaptive behaviors rather than on providing insight into unconscious conflicts. • All behavior therapies are based on the fundamental principles that normal and abnormal behavior is learned, and therefore treatment is based on processes designed to change behavior. • 3 types of Behavioral-Learning approaches: • Classical Conditioning Therapies. • Operant Conditioning Therapies. • Social Learning Therapies.

24. Behavioral (Learning) Approachesto Therapy: Classical Conditioning Therapies: 1. Systematic Desensitization: This approach uses progressive relaxation, the construction of an anxiety hierarchy, andcounterconditioning. 2. Aversion Therapy: The goal of aversion therapy is to make a formerly pleasurable, but maladaptive, behavior become unpleasant.

25. Behavior (Learning) Therapies:Abnormal behaviors canbeunlearned. (1) Systematic Desensitization: A relaxation response is repeatedly paired with a stimulus that evokes anxiety in the hope that the anxiety will be alleviated. • Client relaxes while thinking aboutincreasingly more threatening images of phobic object. • Dog phobic remains relaxed while imagining a dog in the room, licking her hand, in her lap. (2) Aversion Therapy: Pair an unpleasant stimulus with an object that causes an inappropriate response. • Show a pedophile pictures of a child while delivering a shock.

26. Behavioral (Learning) Approachesto Therapy (continued): Operant Conditioning Therapies: 1. Positive Reinforcement: One of the main uses of positive reinforcement is the token economy, used often in institutional settings. 2. Punishment: The use of punishment is effective in eliminating inappropriate or dangerous behaviors, such as self-injurious behavior in autistic children. 3. Extinction: Both imaginal flooding and invivo flooding are techniques used to extinguish maladaptive behavior.

27. Behavioral (Learning) Approachesto Therapy (continued): Social Learning Therapies: Social learning theory has contributed participant modeling as a way to overcome phobias.

28. Behavioral (Learning) Approachesto Therapy: Social Skills Training • Clients learns to be more outgoing or assertive in social settings. • Role Play: • Therapist and client practice difficult social interactions. • Job interviews, asking for a date, refusing to pay for shoddy repairs. • Through shaping and positive reinforcement, client gradually improves social skills.

29. The Cognitive Orientation to Therapy: • The cognitive orientation to therapy assumes that the interpretation of events, rather than the events themselves, causes psychological problems. • The cognitive approaches focus on the thought processes or cognitions that underlie and maintain behavior. • The basic premise is that changes in behavior should follow from changes in underlying cognitions.

30. The Cognitive Orientation to Therapy: • Three types of Cognitive Therapy: • Stress-Inoculation therapy. • Rational-Emotive Behavior Therapy. • Cognitive Therapy.

31. Cognitive Therapies:Stress-Inoculation Therapy • Stress-Inoculation therapy, developed by Meichenbaum, uses inoculation training to help people think optimistically when in stressful situations. • Rational-Emotive Behavior Therapy: • Developed by Meichenbaum. • Inoculation Training:

32. Cognitive Therapies:Rational-Emotive Behavior Therapy • Rational-Emotive Behavior Therapy: In Albert Ellis's rational-emotive behavior therapy, the client learns to challenge and change dysfunctional-irrational thinking and, ultimately, behavior. • Ellis focuses on restructuring cognitions that are based on dysfunctional-irrational beliefs. • Challenge dysfunctional-irrational beliefs: “I must be perfect or no one will love me!” “I must be thoroughly competent, adequate, and successful in all possible respects if I am to be worthwhile.” “It is horrible when things do not turn out the way I want them to.”

33. Cognitive Therapies:Cognitive Behavior Therapy • Cognitive Behavior Therapy: • Developed by Aaron Beck. • Replacenegative or maladaptive thoughtswith less harsh thoughts. • For example, change “I never do anything right!”to “Just like everyone else, I do some things well.” • According to Beck, perceptual and thought processes cause depression. • The types of cognitions that are targeted for change involve self-devaluation and pessimism about the future.

34. Cognitive Behavior Therapy: Examples of Maladaptive Cognitions • Overgeneralization: • One person rejects your request for a date and you conclude that anyone you approach will also reject you. • Magnification/minimization: • You miss exercising for two days and you tell yourself, “I’ll never get in shape”. • Arbitrary Inference: • Your girlfriend is late picking you up and you suspect she wants to break up with you.

35. Group Therapies: • Therapy in which people discuss problems with a group. • Psychotherapy with 4 - 8 clients. • Some advantages over individual therapy: • Experience interacting with other group members. • Discovering that others experience similar problems. • Receiving support and advice from other members.

36. Group Therapies:The Social Relations Orientation to Therapy The social relations orientation assumes that many psychological problems involve interpersonal relationships; thus, people cannot be therapeutically treated as individuals. 3 Types of Social Relations Therapy: 1. Psychoanalytic Group Therapies: Psychodrama and transactional analysis are two types of group therapy derived from the psychoanalytic approach. 2. Behavioral Group Therapies: Social skills training and assertiveness training are two group therapy techniques derived from the behavioral approach. 3.Humanistic Group Therapies: Sensitivity groups and encounter groups are two types of group therapy derived from the humanistic approach.

37. Group Therapies:Transactional Analysis • Transactional Analysis (TA) focuses on the transactions (i.e., interactions) that people perform within themselves and with other people. • Transactional Analysis emphasizes the roles of “parent,” “adult,” and “child.” • People sometimes try to act toward others “as if they are that person’s parent or child.” • Goal of TA therapy: help people to relate to others as adults. • Interpersonal games and scripts are other processes emphasized in Transactional Analysis.

38. Feminist Psychotherapy: • Therapeutic change involves becoming aware of and challenging society’s views of women. • Assumption: Society’s expectations for women emphasize roles of dependency. • Women are encouraged to value themselves as highly as they value others (partners, children). • Anger towards institutions which oppress women should be constructively used to change society.

39. Family Therapy • In family therapy, the family system as a whole--not just one family member identified as having the “problem”--is treated. • Family therapy deals with problems involving family structure and family interaction patterns. • Many family therapists assume that family members fall into rigid roles, with one person acting as the scapegoat (i.e., as the “disturbed” family member).

40. Family Therapy (continued): • In family therapy, the main goals are the constructive expression of feelings and the establishment of rules that family members agree to follow. • Family members learn to express their emotions and to provide feedback to each other. • Virginia Satir's conjoint family therapy and Salvador Minuchin's structured family therapy. • Family therapy has been used to increase marital intimacy, to treat adolescent drug abusers, and anorexics.

41. Marital - Couples Therapy • Marital - Couples Therapy: couples learn about compromises and expectations. • Compromises: Couples learn how about the give-and-take of intimate relationships. • Expectations: Couples learn that they sometimes have unconscious/conscious expectations about how they expect their partners to behave: • expect males to: car care, lawn care, etc. • expect females to: clean house, child care, etc.

42. The BiopsychologicalOrientation to Therapy: • The biopsychological approach uses medical procedures to treat psychological disorders. • This approach is based on the assumption that rather than focusing on a patient’s psychological conflicts, past traumas, or environmental variables that may support abnormal behavior, it is more appropriate to directly treat brain chemistry and other neurological factors. • 3 types of biopsychological approaches to therapy: (1). Psychosurgery; (2). ECT; and (3). Drugs.

43. Drug Approaches to Therapy: • Drug Therapy: Since its introduction in the 1950s, drug therapy has become the most widely used form of medical therapy. • Four types of Drug Therapy: • Anti-anxiety drugs. • Anti-depression drugs. • Anti-mania drugs. • Anti-psychotic drugs.

44. Drug Approaches to Therapy: 1. Anti-anxiety Drugs (tranquilizers): • The most widely prescribed antianxiety drugs are the benzodiazepines (e.g.,Xanax,Valium, and Librium). • Do tranquilizers treat symptoms or problem cause? 2. Anti-depressant Drugs (improve mood): (a) The tricyclic antidepressants work by increasing the levels of serotonin and norepinephrine in the brain and by preventing their reuptake. (b) Recently, drugs known as serotonin-reuptake inhibitors (e.g., Prozac, Zoloft and Paxil) have become widely used.

45. Drug Approaches to Therapy (continued): 3. Anti-mania Drugs: • The drug lithium carbonate is frequently prescribed to prevent the extreme mood swings of bipolar disorder.

46. Drug Approaches to Therapy (continued):4. Anti-psychotic Drugs: • Commonly used anti-psychotic drugs (e.g., the phenothiazines) work by blocking brain receptor sites for the neurotransmitter dopamine. • Phenothiazines, particularly Thorazine, have been effective in making schizophrenics less agitated and aggressive and in reducing delusions and hallucinations. • A new drug, clozapine, produces fewer side effects than traditionally prescribed anti-psychotic drugs. • Anti-psychotic drugs have been a significant factor in the reduction of mental hospital populations over the last few decades. • These anti-psychotic agents are also known as neuroleptics.

47. Biopsychological Treatments:Psychiatric Drugs

48. Psychosurgery:Approach to Therapy • Although psychosurgery was once considered a humane alternative to locking agitated patients in rooms, its contemporary use has declined markedly. • Psychosurgery involves operating on the human brain. • Psychosurgery is rarely used today.

49. Biopsychological Treatments:Psychosurgery • Destroy brain tissue to alter behavior. • Used with violent or agitated patients. • Prefrontal lobotomy: • Separate parts of the frontal lobes from hypothalamus. • Side effects: • Apathy, withdrawal, seizures. • Lack of goal directed behavior. • Cingulotomy: • Cingulate cortex partially destroyed. • Effective for treatment resistant OCD.

50. Electroconvulsive Therapy (ECT): • While Electroconvulsive Therapy was originally used for treating agitated patients, it proved more successful in elevating the mood of severely depressed patients who failed to respond to drug therapy. • Electroconvulsive Therapy involves the administration of electrical shock to the human brain.