Therapeutic Approaches in Psychotherapy: Choices, Techniques, Evaluation

1. CHAPTER 16 THE THERAPEUTIC ENTERPRISE: CHOICES, TECHNIQUES, EVALUATION

2. PSYCHOTHERAPY • Psychodynamic • Humanistic and Existential • Behavioral • Cognitive • Cognitive-behavioral • Group • Cognitive-behavioral group • Family and marital therapy • Psychodrama

3. PSYCHODYNAMIC THERAPY • Goal is insight into one’s inner life • Transference – Patient displaces affect and feeling about others onto the therapist • Counter transference – Therapists’ emotional responses to patient • Psychoanalysis – Special type of psychodynamic therapy using free association and examination of dreams and fantasies • Some use hypnosis to uncover repressed material

4. HUMANISTIC AND EXISTENTIAL THERAPIES • Humanistic • Emphasis on people’s desire to achieve self-respect • Cark Rogers’ client-centered therapy • Nonjudgmental, nondirective • Atmosphere of unconditional positive regard • Existential • Emphasis on people’s needs to confront questions about meaning and direction of their lives • Combine humanistic and psychodynamic techniques • Gestalt therapy based on view that people need to get in touch with disowned parts of themselves

5. COGNITIVE PSYCHOTHERAPY • Goal – Solve emotional problems through cognitive restructuring • Aaron Beck – Focuses on changing automatic thoughts • Albert Ellis – Rational-emotive therapy emphasizes needs to change self-defeating thinking and beliefs • Brief psychotherapies – Fewer than 12 sessions; specific goals and targets. • Interpersonal psychotherapy – A form of brief therapy that focuses on social relationships

6. PRINCIPAL ELEMENTS OF COGNITIVE THERAPY • Presentation of cognitive rationale to patient • Short-term intervention • Focus on the “here and now” • Patient-therapist collaboration • Questions and homework • Maintain daily records of mood, behavior, and dysfunctional thoughts • Carry out informal experiments to test thoughts, beliefs, and assumptions • Apply newly acquired cognitive schema to real-life situations.

7. BEHAVIOR THERAPY • Forerunner of cognitive-behavioral therapy • Behavioral modification • Based on operant conditioning • Uses reinforcement and shaping • Token economy – Reinforces desired behaviors • Biofeedback – Can help develop control of internal processes

8. COGNITIVE-BEHAVIOR THERAPY • Integrates cognitive and behavioral elements • Relaxation training • Exposure therapy • Flooding • Implosive therapy • Systematic desensitization • In vivo exposure • Modeling • Behavioral rehearsal • Assertiveness training

9. FACTORS IN SUCCESSFUL USE OF RELAXATION TRAINING • The individual’s problems do not have an organic basis. • The individual is not psychotic, depressed, or subject to panic attacks. • The individual is able to assume responsibility for active participation in treatment, with special emphasis on home practice. • Family members are cooperative with and supportive of the individual’s treatment. • The individual has reasonable expectations of the training’s effectiveness.

10. GROUP THERAPY • Several people with similar problems • Group membership provides • Acceptance and support • Normative information about behavior/feelings • Learning through modeling and behavioral rehearsal • Cognitive-behavioral group therapy • Goal is development of social skills and comfort in social situations • Family and marital therapy • View marriage and family as a system • Learn how behaviors affect each other • Psychodrama • Group acts out events of emotional significance

11. RESEARCH ON PSYCHLOGICAL THERAPIES • Important to distinguish between unique and common features among therapies • Important to determine therapeutic outcomes • No one form of therapy is superior than the other overall • Research needs to determine extent to which cultural and ethnic factors play a role in processes and outcomes of therapeutic interventions

12. BIOLOGICAL THERAPIES • Electroconvulsive therapy (ECT) • Used for severe depression when drugs and other therapies have failed • Drug therapies • Antipsychotic • Antimanic • Antidepressant • Antianxiety • Effectiveness of biological therapies • Effective for particular disorders • Multimodal treatment • Medication and psychotherapy is possibly more effective than either intervention alone.

13. HOSPITALIZATION • Reasons for hospitalization • Behaviors poses threat to self or others • Behavior intolerable to community • Outpatient treatment failed • Treatment requires controlled setting • Withdrawal from drugs or alcohol • Physical illness complicated by mental disorder requiring continuous care

14. HOSPITALIZATION • Partial hospitalization • When complete hospitalization not required • Day, evening, or weekend care • Day hospitalization • For patients who can live at home but need structure and social interaction • Deinstitutionalization • Movement in the 1960s to return hospitalized patients to the community for community-based treatment • Made possible by discovery of psychoactive drugs • Lack of adequate community care has led to increased homelessness and gaps in treatment for seriously mentally ill