2 What Is Psychotherapy?Any psychological technique used to facilitate positive changes in personality, behavior, or adjustment; some types of psychotherapy:Individual: Involves only one client and one therapistClient: Patient; the one who participates in psychotherapyRogers used “client” to equalize therapist-client relationship and de-emphasize doctor-patient conceptGroup: Several clients participate at the same time
3 More Types of Psychotherapy Directive: Therapist provides strong guidanceInsight: Goal is for clients to gain deeper understanding of their thoughts, emotions, and behaviorsTime-Limited: Any therapy that limits number of sessionsPartial response to managed care and to ever-increasing caseloadsCaseload: Number of clients a therapist actively sees
4 Origins of TherapyTrepanning: For primitive “therapists,” refers to boring, chipping, or bashing holes into a patient’s head; for modern usage, refers to any surgical procedure in which a hole is bored into the skullIn primitive times it was unlikely the patient would survive; this may have been a goalGoal presumably to relieve pressure or rid the person of evil spirits
5 Demonology Study of demons and people beset by spirits People were possessed, and they needed an exorcism to be curedExorcism: Practice of driving off an “evil spirit”; still practiced today!
6 Origins of Therapy (cont'd) Ergotism: Psychotic-like symptoms that come from ergot poisoningErgot is a natural source of LSDErgot occurs with ryePhillippe Pinel: French physician who initiated humane treatment of mental patients in 1793Created the first mental hospital
7 Psychoanalysis: Freud Hysteria: Physical symptoms (like paralysis or numbness) occur without physiological causesNow known as somatoform disordersFreud became convinced that hysterias were caused by deeply hidden unconscious conflictsMain Goal of Psychoanalysis: To resolve internal conflicts that lead to emotional suffering
8 Some Key Techniques of Psychoanalysis Free Association: Saying whatever comes to mind, regardless of how embarrassing it is or how unimportant it may seemBy doing so without censorship and censure, unconscious material can emergeDream Analysis: Dreams express forbidden desires and unconscious feelingsLatent Content: Hidden, symbolic meaning of dreamsManifest Content: Obvious, visible meaning of dreamsDream Symbols: Images in dreams that have personal or emotional meanings
9 Psychoanalysis and Freud Concluded Resistance: Blockage in flow of ideas; topics the client resists thinking about or discussingResistances reveal particularly important unconscious conflictsTransference: Tendency to transfer feelings to a therapist that match those the patient had for important people in his or her pastThe patient might act like the therapist is a rejecting father, loving mother, etc.What Freudians aspire to in therapy
10 Modern Psychoanalysis Brief Psychodynamic Therapy: Based on psychoanalytic theory but designed to produce insights more quickly; uses direct questioning to reveal unconscious conflictsSpontaneous Remission: Improvement of a psychological condition due to time passing without therapyWaiting-List Control Group: People who receive no therapy as a way to test the effectiveness of psychotherapyCompare control with experimental group; if no statistically significant difference, then something other than therapy caused change or no change in conditions
11 Humanistic TherapiesClient-Centered Therapy (Rogers; also known as Person-Centered): Nondirective and based on insights from conscious thoughts and feelings
12 Four Basic Rogerian Conditions Therapist must have four basic conditionsUnconditional Positive Regard: Unshakable acceptance of another person, regardless of what they tell the therapist or how they feelEmpathy: Ability to feel what another person is feeling; capacity to take another person’s point of viewAuthenticity: Ability of a therapist to be genuine and honest about his or her feelingsReflection: Rephrasing or repeating thoughts and feelings of the clients’; helps clients become aware of what they are saying
13 Existential TherapyAn insight therapy that focuses on problems of existence, such as meaning, choice, and responsibility; emphasizes making difficult choices in lifeTherapy focuses on death, freedom, isolation, and meaninglessnessFree Will: Human ability to make choicesYou can choose to be the person you want to beConfrontation: Clients are challenged to examine their values and choices
14 Gestalt Therapy (Perls) Focuses on immediate awareness to help clients rebuild thinking, feeling, and acting into connected wholesEmphasizes integration of various experiences (filling in the gaps)Clients are taught to accept responsibility for their thoughts and actionsMore directive than client-centered or existential therapy
15 Cybertherapy and Psychotherapy at a Distance: Paging Dr. Phil! Media Psychologists: Radio and newspaper and television psychologists; often give advice, information, and social supportMost helpful when general support and information are givenTelephone Therapists: 900 number therapistsCaution: Many “therapists” may be nothing more than telephone operators who have never even taken a psychology course!
16 Cybertherapy and Psychotherapy at a Distance (cont'd) Cybertherapy: Internet therapists in chat rooms and so onVideocameras at both ends so now you can hear AND see therapistPatient/client can remain anonymousMay be wave of future for those who cannot drive a distance to a therapist or cannot leave the house (e.g., Paula can’t leave the house because of agoraphobia, so Robert the therapist comes to her via Internet!)Cheaper than traditional psychotherapy
17 Behavior TherapyUse of learning principles to make constructive changes in behaviorBehavior Modification: Using any classical or operant conditioning principles to directly change human behaviorDeep insight is often not necessaryFocus on the present; cannot change the past, and no reason to alter that which has yet to occur
18 Aversion TherapyConditioned Aversion: Learned dislike or negative emotional response to a stimulusAversion Therapy: Associate a strong aversion to an undesirable habit like smoking, overeating, drinking alcoholResponse-Contingent Consequences: Reinforcement, punishment, or other consequences that are applied only when a certain response is madeRapid Smoking: Prolonged smoking at a rapid paceDesigned to cause aversion to smoking
19 DesensitizationHierarchy: Rank-ordered series of steps, amounts, or degreesReciprocal Inhibition: One emotional state is used to block another (e.g., impossible to be anxious and relaxed at the same time)Systematic Desensitization: Guided reduction in fear, anxiety, or aversion; attained by approaching a feared stimulus gradually while maintaining relaxationBest used to treat phobias: intense, unrealistic fears
20 Desensitization (cont'd) Model: Live or filmed person who serves as an example for observational learningVicarious Desensitization: Reduction in fear that takes place secondhand when a client watches models perform the feared behaviorVirtual Reality Exposure: Presents computerized fear stimuli to patients in a controlled fashion
21 Eye Movement Desensitization and Reprocessing (EMDR) Reduces fear and anxiety by holding upsetting thoughts in your mind while rapidly moving your eyes from side to side
22 Operant ConditioningPositive Reinforcement: Responses that are followed by a reward tend to occur more frequentlyNonreinforcement: A response that is not followed by a reward will occur less frequentlyExtinction: If response is NOT followed by reward after it has been repeated many times, it will go awayPunishment: If a response is followed by discomfort or an undesirable effect, the response will decrease/be suppressed (but not necessarily extinguished)
23 Figure 13.4FIGURE 13.4 This graph shows extinction of self-destructive behavior in two autistic boys. Before extinction began, the boys received attention and concern from adults for injuring themselves. During extinction, the adults were taught to ignore the boys’ self-damaging behavior. As you can see, the number of times that the boys tried to injure themselves declined rapidly.
24 More Operant Principles Shaping: Rewarding actions that are closer and closer approximations to a desired responseStimulus Control: Controlling responses in the situation in which they occurTime Out: Removing individual from a situation in which reinforcement occurs
25 Reinforcement and Token Economies Tokens: Symbolic rewards like poker chips, gold stars, or stamps that can be exchanged for real rewardsCan be used to reinforce positive responses immediatelyEffective in psychiatric hospitals and sheltered care facilitiesTarget Behaviors: Actions or other behaviors a therapist seeks to changeToken Economy: Patients get tokens for many socially desirable or productive behaviors; they can pay tokens for tangible rewards and for undesirable behaviors
26 Figure 13.5FIGURE 13.5 Shown here is a token used in one token economy system. In this instance the token is a card that records the number of credits eared by a patient. Also pictured is a list of credit values for various activities. Tokens may be exchanged for items or for privileges listed on the board. (After photographs by Robert P. Liberman.)
27 Cognitive TherapyTherapy that helps clients change thinking patterns that lead to problematic behaviors or emotionsSelective Perception: Perceiving only certain stimuli in a larger group of possibilitiesOvergeneralization: Allowing upsetting events to affect unrelated situationsAll-or-Nothing Thinking: Seeing objects and events as absolutely right or wrong, good or bad, and so onCognitive therapy is VERY effective in treating depression, shyness, and stress
28 Rational Emotive Behavior Therapy (REBT) Attempts to change irrational beliefs that cause emotional problemsTheory created by Albert EllisFor example, Anya thinks, “I must be liked by everyone; if not, I’m a rotten person.”
29 Group TherapyPsychodrama (Moreno): Clients act out personal conflicts and feelings with others who play supporting rolesRole Playing: Re-enacting significant life eventsRole Reversal: Taking the part of another person to learn how he or she feelsMirror Technique: Client observes another person re-enacting his/her behavior
30 Family TherapyFamily Therapy: All family members work as a group to resolve the problems of each family memberTends to be brief and focuses on specific problems (e.g., specific fights)
31 Group Awareness Training Sensitivity Groups: Increase self-awareness and sensitivity to othersEncounter Groups: Emphasize honest expression of feelingsLarge-Group Awareness Training: Increase self-awareness and facilitate constructive personal changeTherapy Placebo Effect: Improvement is based on client’s belief that therapy will help
32 Key Features of Psychotherapy Therapeutic Alliance: Caring relationship between the client and therapist; work to “solve” client’s problemsTherapy offers a protected setting where emotional catharsis (release) can occurAll the therapies offer some explanation or rationale for the client’s sufferingProvides clients with a new perspective about themselves or their situations and a chance to practice new behaviors
33 Figure 13.6FIGURE 13.6 The dose-improvement relationship in psychotherapy. This graph shows the percentage of patients who improved after varying numbers of therapy sessions. Notice that the most rapid improvement took place during the first 6 months of once-a-week sessions.
34 Basic Counseling Skills Active listeningClarify the problemFocus on feelingsAvoid giving adviceAccept the client’s frame of reference
35 Basic Counseling Skills (cont'd) Reflect thoughts and feelingsSilence: Know when to useQuestionsOpen: Open-ended replyClosed: Can be answered “Yes” or “No”Maintain confidentiality
36 Medical (Somatic) Therapies Pharmacotherapy: Use of drugs to alleviate emotional disturbance; three classes:Anxiolytics: Like Valium; produce relaxation or reduce anxietyAntidepressants: Elevate mood and combat depressionAntipsychotics: Tranquilize and also reduce hallucinations and delusions in larger dosages
37 One Potential Problem 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
38 ShockElectroconvulsive Therapy (ECT): 150 volt electric shock is passed through the brain for about one second, inducing a convulsionBased on belief that seizure alleviates depression by altering brain chemistryECT ViewsProduces only temporary improvementCauses memory loss in many patientsShould only be used as a last resort
39 Psychosurgery Any surgical alteration of the brain Prefrontal Lobotomy: Frontal lobes in brain are surgically cut from other brain areasSupposed to calm people who did not respond to other forms of treatmentWas not very successfulDeep Lesioning: Small target areas in the brain are destroyed by using an electrode
40 HospitalizationMental Hospitalization: Involves placing a person in a protected, therapeutic environment staffed by mental health professionalsPartial Hospitalization: Patients spend only part of their time in the hospitalDeinstitutionalization: Reduced use of full-time commitment to mental institutionsHalf-way Houses: Short-term group living facilities for individuals making the transition from an institution (mental hospital, prison, etc.) to independent living
41 Community Mental Health Centers Offer many health services like prevention, education, therapy, and crisis interventionCrisis Intervention: Skilled management of a psychological emergencyParaprofessional: Individual who works in a near-professional capacity under supervision of a more highly trained person
42 Other Therapy OptionsPeer Counselor: Nonprofessional person who has learned basic counseling skillsSelf-Help Group: Group of people who share a particular type of problem and provide mutual support to each other (e.g., “Alcoholics Anonymous”)
43 Evaluating a Therapist: Ask 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?
44 Evaluating a Therapist: Danger Signals Therapist makes sexual advancesTherapist makes repeated verbal threats or is physically aggressiveTherapist is excessively hostile, controlling, blaming, or belittlingTherapist talks repeatedly about his/her own problemsTherapist encourages prolonged dependence on him/herTherapist demands absolute trust or tells client not to discuss therapy with anyone else
45 Self-ManagementCovert Sensitization: Aversive imagery is used to reduce occurrence of an undesired responseThought Stopping: Aversive stimuli are used to interrupt or prevent upsetting thoughtsCovert Reinforcement: Using positive imagery to reinforce desired behaviorTension Release Method: Procedure of deep relaxation
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