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Chapter 14: Therapies

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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
What Is Psychotherapy?
  • -- *Any psychological technique used to facilitate positive changes in personality, behavior, or adjustment
types of psychotherapy
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
more types of psychotherapy
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
key features of psychotherapy
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
origins of therapy
Origins of Therapy
  • *Trepanning:
    • Patient unlikely to survive
    • To relieve pressure or rid the person of evil spirits
people in therapy
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
freudian techniques psychodynamic psychoanalysis
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
humanistic therapies
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
cybertherapy and psychotherapy at a distance
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.)
cybertherapy and psychotherapy at a distance concluded continued
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
behavior therapy
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
behavior therapy continued
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
behavioral therapies continued
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)
operant therapies
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
  • 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
token economy
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
cognitive therapy
Cognitive Therapy
  • -- Therapy that helps clients change thinking patterns that lead to problematic behaviors or emotions
cognitive therapy19
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
rational emotive behavior therapy rebt
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.”
group therapy
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
family therapy
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
group awareness training
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
basic counseling skills
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
medical somatic therapies
*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
problems with drug therapy
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
electroconvulsive therapy
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
  • 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
  • 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
half way houses
Half-Way Houses
  • Short-term group living facilities for individuals making the transition from an institution (mental hospital, prison, etc.) to independent living
community mental health centers
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
other therapy options
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”)
evaluating a therapist danger signals
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
evaluating a therapist questions to be answered during the initial meeting
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?