Evolution of Psychological Therapies: From Brutality to Compassionate Care

1. Unit 13 Psychological Therapies

2. History • Used to be very brutal with how disorders were handled • Beating/bleeding disorders out of people • Isolation • Locked in Cages • Laughed at • Phillipe Pinel and Dorthea Dix started movts. to treat with care and compassion

3. Psychotherapy • Techniques involving a trained therapist and someone looking to overcome a disorder or achieve personal growth • Childhood repression of impulses that still impact behavior or feeling • Historical reconstruction through free association • Good for learning related disorders (phobias)

4. Psychoanalysis • Freud’s process of free association • Not editing anything, letting everything out – no matter how trivial • Normally blocks would infer resistance • Resistances are noted and interpreted by analyst • Analyst interprets responses • Dream analysis – latent content (what you remember, censored content of the dream) • Transfer of feelings towards therapist • Takes a long time/expensive

5. Psychodynamic Therapy • Influenced by Freud • Try to understand current feelings/symptoms based on childhood experiences • Help the patient gain understanding and perspective • Talk face to face (unlike psychotherapy) • Shorter time working together

6. Humanistic Therapies • Realizing potential for self fulfillment and self awareness/acceptance • Insight Therapies • Focuses on present and future more than the past • Conscious rather than unconscious thoughts • Taking immediate responsibility for actions, rather than looking for hidden causes • Promoting growth instead of curing illness • Clients, not patients

7. Humanistic • Carl Rogers • Client Centered Therapy • Focus on person’s conscious self perceptions • Nondirective • Listening without judging or interpreting • Therapists encouraged to exhibit genuineness, acceptance and empathy – no facades • Respond with honesty • Deepens self acceptance

8. Carl Rogers - • Active Listening • Echoing, restating and seeking clarification • Unconditional Positive Regard • A way to give non judgemental responses to a patient • 3 techniques used • 1. Paraphrase – summarize what was said in your own words, rather than say “I know how you feel” • 2. Invite Clarification – ask for examples • 3. Reflect Feelings – “That sounds frustrating” • Mirror feelings to get better understanding

9. Behavior Therapies • Healing power of self awareness • Learning principles can eliminate certain problems • Learned behaviors (like phobias and some forms of anxiety) are learned responses • These can be conditioned away and replaced • Classical Conditioning Techniques • Bedwetting • Counterconditioning • Taking the trigger stimulus and pairing it with a new response • Exposure therapy and aversion therapy

10. Behavior Therapy • Exposure therapy • Exposing people to things they normally avoid • Systematic Desensitization • Wolpe • You cant be anxious and relaxed at the same time • Proceed gradually • Progressive relaxation • Fear can be replaced • Virtual reality being used today

11. Behavioral Therapy • Aversion therapy • Getting a negative response or unpleasant feeling when in the presence of a stimulus • Alcohol and smoking, chewing nails • Getting rid of an unwanted behavior by using a negative stimulus

12. Behavioral Therapy • Operant Conditioning • Behaviors are strongly influenced by their consequences • Reinforce the desired behaviors, withhold rewards or enforce punishments for those that are unwanted • Step by step manner of rewards • Token economy – rewards given for behaviors that can be cashed in for privileges or treats • How likely will they continue the behavior when the rewards stop? • Is it ethical to control behavior like this?

13. Cognitive Therapy • Thinking influences our feelings • Change the way we think and we can change our feelings • Beck’s Theory for Depression • Patients constantly recalling and reliving their failures • Catastrophizing themselves – looking through dark glasses

14. Cognitive Behavioral Therapy • Change the way people think and act • Labeling behaviors • Compulsive thoughts labeled and realized

15. Group and Family Therapy • Group • Cheaper • Still effective • Social awareness that patients are not alone • AA • Family • No person is an island, disorders will have an impact on everyone • Sometimes can be caused by others, and they may be unaware

16. Evaluating Psychotherapy • How can you really measure effectiveness • Can symptoms be cured or just treated? • Client perspective • Why is it effective? • 1. People enter therapy in crisis • 2. May want to believe that it was worth the effort • 3. Usually speak kindly of therapists

17. Evaluating Psychotherapy • Clinician Perspective • Since most individuals are so unhappy when they enter therapy and leave happy, clinicians think it is very important • Bias • How can we really tell? • Meta analysis – stat analysis using large numbers of studies • Most people will improve over time, those who get treatment improved more over time

18. Which treatments are best? • Cant really say – too many variables • Alternative therapies • Energy therapy • Recovered memories • Rebirthing therapy • Crisis debriefing • EMDR – Eye Movement Desensitization and Reprocessing • Light Exposure Therapy

19. Biomedical Therapy • Physically changing the brain’s functioning by altering its chemistry with drugs, electricity, magnetic impulses, or surgery • Psychopharmacology • Antipsychotic drugs – dampen responses • Side effects – tardive dyskinesia • Antianxiety drugs - reduce symptoms , but don’t solve problems • Antidepressants - Blocking neurotransmitters

20. Biomedical Therapy • Brain stimulation • Electroconvulsive Therapy (ECT) • Introduced in the 1930s • No memory of treatment • Repetitive Transcranial Magnetic Stimulation (rTMS) • No amnesia • Deep brain stimulation • Implanted electrodes with a type of pacemaker

21. Psychosurgery • Surgery that removes or destroys brain tissue • Lobotomy • Egas Moniz • Sever nerves in the brain will stop emotions in frontal lobes • Nobel Prize winner

22. Lifestyle changes • Sometimes simple changes can have huge impacts • Increasing aerobic exercise • Sleeping more • Light exposure – Seasonal Affective Disorder • Social Connections • Anti rumination – enhancing positive thoughts • Diet and nutritional supplements