1. Myers’ PSYCHOLOGY (7th Ed)
Chapter 17
Therapy
James A. McCubbin, PhD
Clemson University
Worth Publishers

2. History of Treatment: Changed w/ Philippe Pinel in Paris (1793) released patients from chains..)

3. Ch. 17: Therapy….terms, types of therapy:
Psychotherapy
an emotionally charged, confiding interaction between a trained therapist and someone who suffers from psychological difficulties
Eclectic Approach
an approach to psychotherapy that, depending on the client’s problems, uses techniques from various forms of therapy… some of this…some of that…
Psychoanalysis: Freud’s system…
Freud believed the patient’s free associations, resistances, dreams, and transferences – and the therapist’s interpretations of them – released previously repressed feelings, allowing the patient to gain self-insight
use has rapidly decreased in recent years partly b/c of the time involved…& the $$ involved (insurance)

4. Therapy- Psychoanalysis: (Freud, et al.)
Resistance: “I don’t want to know!”
blocking from consciousness of anxiety-laden material…refusing to accept therapist’s interpretations
Interpretation
the analyst’s noting supposed dream meanings, resistances, and other significant behaviors in order to promote insight…stuff therapist notes
Patient uses defense mechanisms; therapist ID’s these
Free association, dream analysis, hypnosis = routes to unconscious
Transference: patient transfers to the analyst of emotions linked w/ other relationships:
EX: love or hatred for a parent is aimed at therapist

5. Humanistic Therapy: Carl Rogers
Client-Centered Therapy: humanistic therapy was developed by C. Rogers
therapist uses techniques such as active listening within a genuine, accepting, empathic environment to facilitate clients’ growth.. partners in therapy
Unconditional Positive Regard: Like parents, therapist should view clients this way, accepting the way that person is…
Active Listening- empathic listening in which the listener a) echoes b) restates c) clarifies client’s words
Therapist should be “like a mirror,” reflecting the person’s thoughts & ideas so they can see self clearly

6. Both psychoanalytic & humanistic = “insight therapies”
The major differences: Humanists focus more on…
…the present & future instead of the past. Don’t try to look for childhood origin of feelings
…conscious rather than unconscious thoughts
…taking immediate responsibility for our feelings & actions, not looking for hidden reasons…
…promoting growth instead of “curing illness”…so they are “clients” not “patients…
..H. =
“Brief
therapy”

7. Counter-conditioning (Mary Cover Jones)
Behavior Therapy: therapy that applies learning principles to the elimination of unwanted behaviors
Counter-conditioning (Mary Cover Jones)
procedure that conditions new responses to stimuli that trigger unwanted behaviors
based on classical conditioning
includes systematic desensitization & aversive conditioning
Systematic Desensitization (Joseph Wolpe)
type of counter-conditioning
associates a pleasant, relaxed state with gradually increasing anxiety-triggering stimuli
commonly used to treat phobias
Aversive Conditioning
type of counter-conditioning that associates an unpleasant state with an unwanted behavior
nausea ---> alcohol

8. Behavior Therapy
Exposure Therapy
(also…Virtual reality Exposure Therapy)
treat anxieties by exposing people (in imagination or reality) to the things they fear and avoid

9. Types of exposure therapy:
Critical difference: rate/type of exposure. Flooding is a type of exposure, such as dropping you into the snake pit if you are scared of snakes and you come out alive (hopefully) and realize that your fear was not so rational. Systematic desensitization is a kinder gentler way of exposure in gradual increasing degrees of difficulty (picture of a snake, touching a snake, holding a snake, etc) up a hierarchy. Aversion: Classically condition to cause someone to avoid something.

10. Behavior Therapy
Systematic Desensitization

11. Behavior Therapy Aversion therapy for alcoholics
Anabuse: drug that creates nausea in anyone who drinks w/in 1-2 weeks of ingesting

12. Behavior Therapy: Know the various methods
Systematic desensensitization
Aversive therapy
Token Economy
an operant conditioning procedure that rewards desired behavior
patient exchanges a token of some sort, earned for exhibiting the desired behavior, for various privileges or treats

13. Cognitive Therapy
teaches people new, more adaptive ways of thinking & acting (“retrains” thinking)
based on the assumption that thoughts intervene between events and our emotional reactions
Think calm thoughts = calm person
Aaron Beck, originally a Freudian, was a major force in this, especially in treating depression (late 70’s)
R.E.B.T.(aka R.B.T.): Rational Emotive Behavioral Therapy:
Albert Ellis: designed to help ppl focus on a rational, logical way to look at dealing with problems & disappointments

14. Cognitive Therapy: Often combined w/ drug therapy and/or behavioral therapy
The Cognitive
Revolution:
Which
psychologist
began this
type of
therapy?
An associate of his
developed a
related therapy—
Who?
What therapy?

15. Cognitive Therapy A cognitive perspective on psychological disorders:
The way ppl tend to view a situation as…..
Stable…
”It’ll stay the same…& never get better…”
Global:
“….it’s everything…”
Internal:
“…And it is all my fault…”

16. Cognitive Therapy: Evaluating the effectiveness of cognitive therapy:
Effectiveness of Beck’s Cognitive therapy for depression

17. Cognitive-Behavioral Therapy (CBT)
A very popular integrated therapy that combines cognitive therapy (changing self-defeating thinking) w/ behavior therapy (changing behavior)
Especially helpful for anxiety disorders & for mood disorders
Also can be coupled w/ chemotherapy (drug-therapy)
WHAT do you call this…when you use a variety of methods in treatments…instead of one single technique?

18. Group & Family Therapies
Group therapy: individuals who share same types of disorders & who interact w/ each other to help come up w/ solutions to each others issues
-groups are led by a trained therapist (usually psychologist)
Not the same thing as a “support group” in which people share a problem such as a specific disease, divorce, grief, etc.; these are not always led by trained therapists
--can be less expensive than individual therapy
Family therapy: often led by psychological counselors, not clinical psychologists
treats the family as a system
views an individual’s unwanted behaviors as influenced by or directed at other family members
attempts to guide family members toward positive relationships and improved communication

19. Evaluating Psychotherapies: Any difference. PATIENTS VS CLIENTS
Evaluating Psychotherapies: Any difference? PATIENTS VS CLIENTS?? Which call ppl “patients?” Which “clients?”
To whom do people turn for help for psychological difficulties?
Med. doctors are often the 1st person someone will turn to for help with mental disorders
They will often then refer to MHS if needed

20. Evaluating Psychotherapies: How good is it?
How ppl respond when asked “Does therapy help?”
Remember that psy’s try to be cautious in accepting date too quickly…They try to evaluate scientifically:
Regression toward the mean (avg.) (ch. 1)
tendency for extremes of unusual scores to fall back (regress) toward their average
Basically, things average out…& hi’s & lo’s blend…
Placebo effect:
Ppl’s tendency to justify therapy: Clients/patients’ want to feel their therapist has helped.. “It was NOT a waste of time!”
Regression toward the mean can confuse this b/c extreme behaviors tend to drift back to the mid-point anyway…

21. Evaluating Therapies: Meta-analysis: procedure for statistically combining the results of many different research studies… -look at a lot of studies & come up w/ basic finding from these With this, we can see a better pic RE: what helps…
Poor outcome
Good outcome
Average
untreated
person
psychotherapy
client
Number of
persons
80% of untreated people have poorer
outcomes than average treated person

22. Evaluating Alternative Therapies vs
Evaluating Alternative Therapies vs. a more “valid” behavioral therapy: What’s in scientific journal articles…& what’s mainly just on the Web??

23. Therapists, mental health workers, & their Training
Clinical = working in a clinic, seeing clients/patients (generally out-patient)
Clinical or Psychiatric Social Worker
A two-year Master of Social Work graduate program + postgrad. supervision prepares some social workers to offer psychotherapy, mostly to people with everyday personal and family problems
About half have earned the National Association of Social Workers’ designation of clinical social worker
Clinical psychologists
Most are psychologists with a Ph.D. & expertise in research, assessment, & therapy, supplemented by a supervised internship
About half work in agencies & institutions, half in private practice (EX: Beckman; Cornerstone)

24. Psychotherapists & their Training
Counselors: Have or working toward MS
Marriage & family counselors specialize in problems arising from family relations
“Pastoral counselors” provide counseling to people,
but tend to have a more religious perspective
Abuse counselors work with (usually MS)
--substance abusers (substance abuse disorder)
--spouse & child abusers
--the victims of spousal abuse or child abuse

25. Psychiatrists
Physicians (M.D.) who specialize in the treatment of psychological disorders
Not all psychiatrists have had extensive training in psychotherapy, but as M.D.s they can prescribe medications.
Thus, they tend to see those with the most serious problems
(they see more “in-patients”)
Many have a private practice
Some psychiatrists today do use interpersonal psychodynamic therapy: from Freud…but is a brief psychotherapy: targets problems more, childhood issues “hidden desires” less…

26. A newer therapy that shows promise: Light exposure therapy: Using a special type if light, having client sit under the light for specified amts. of time Has been tested at varying times of day: Results: Morning light 61% improved w/ AM light vs. 50% PM light 32% placebo (“hissing negative ion generator”) So does show “statistical significance” (i.e., seems to indicate that it helps) Disorders that this has helped: SAD (Seasonal Affective Disorder: Depression related to seasons, specifically winter…Lack of light? ALSO: Newer: PTSD (an anxiety disorder): indications are it helps especially if paired with antidepressants

27. Commonalities Among Psychotherapies
Hope for demoralized people
A new perspective
An empathic, trusting, caring relationship
But… could it be
Psychotherapy
& CONFIRMATION
BIAS?

28. Types of Therapists

29. The Relative Effectiveness of Different Therapies
Evidence-based practice

30. Biomedical Therapies
Diagnostic labeling: Using the DSM-IV-TR to diagnose a patient …in order to proceed w/ possible therapy (or therapies)
But does this “labeling” cause client & others to see him/her
that way?
Psychopharmacology
study of effects of drugs on mind & behavior
New & more effective drugs therapies have been added
schiz., depression, anxiety, all are treated now more effectively w/ drugs
Anti-anxiety drugs: Used to treat anxiety disorders
EX’s: Xanax, Valium, Tranzene (used to be barbiturates…)
now use benzodiazepines
These treat SYMPTOMS after they occur…don’t keep the anxiety from occuring…unless taken all the time, which can interfere with functioning…

31. Used to treat depression
Anti-depressants:
Used to treat depression
**SSRI’s EX’s: Prozac, Celexa, Wellbutrin, Paxil, Zoloft, etc
SSRI’s: Selective Serotonin Re-uptake inhibitor:
-recycles, cleans up “spilled” serotonin at receptor sites &
helps use it all more effectively
**tricyclics: EX: Elavil (still used, but has not shown results
as strong as antidepressants)
**MAO inhibitors: not used much anymore (due to major
side-effects—interactions w/ some aged cheeses, red wines, etc.)

32. Anti-psychotic drugs: -used to treat schizophrenia but also helpful for some symptoms of bipolar, etc. EX: old: Thorazine was a standard; -could cause tics, jerks, strange facial contortions (known as Tardive’s Dyskinesia) Newer anti-psyc. drugs (less side effects): Clozapine, Zyprexa

33. Treating Bipolar Disorder
Lithium
chemical that provides an effective drug therapy for the mood swings of bipolar (manic-depressive) disorders
Hard to prescribe b/c you must be very careful RE: amounts
--too little will not help much
--too much can be life threatening…
Newer: Depakote…very effective...and Abilify

34. Biomedical Therapies The emptying of U.S. mental hospitals
Many ended up homeless “street-people” b/c of their inability to function well, but no $$ for hospitalization

35. Biomedical Therapies: SSRI’s… serotonin selective re-uptake inhibitors

36. Biomedical Therapies: Dramatic rise in antidepressant use:

37. Biomedical Therapies Psychosurgery Electroconvulsive Therapy (ECT)
therapy for almost exclusively for severely depressed patients in which a brief electric current is sent through the brain of an anesthetized patient
a.k.a. “shock therapy”
Has negative effect on memory, but NOT major
Used as last ditch effort to control major depr.
Psychosurgery
Lobotomy (prefrontal lob.)
surgery that removes or destroys brain tissue in an effort to change behavior
now-rare psychosurgical procedure once used to calm uncontrollably emotional or violent patients

38. Brain Stimulation Alternative Neurostimulation Therapies
Magnetic Stimulation: repetitive transcranial magnetic stimulation (rTMS) has been tested as a treatment tool for various neurological & psychiatric disorders including migraines, strokes, Parkinson's disease, tinnitus, depression, and auditory hallucinations.

39. Deep Brain Stimulation: A psychosurgery…
Planting an electrode into brain to treat extreme, debilitating OCD

40. Electro- convulsive Therapy: Used to use major shocks Now very mild Used for depression when other things have not worked…

41. Mind-Body Interaction: mind  body  mind  etc…  Relates to the biopsychosocial view Ex: experiencing an attack…you begin to think of it over & over…& you have an overactive fear response (from what part of the body?)…This could cause which disorder?

42. Therapeutic Life-Style Change
Integrated biopsychosocial system
Therapeutic life-style change
Aerobic exercise
Adequate sleep
Light exposure
Social connection
Anti-rumination
Nutritional supplements

43. Stroke: S-T-R + tongue! S- Ask him/her to SMILE. T -Ask him to TALK &
speak a clear
Sentence
R –Ask him to
RAISE
both arms
Trouble with ANY 1
of these ? call 911
Immediately &
describe symptoms
NOTE: A newer 'sign':
“stick out his tongue.”
'crooked', if it
goes to one side
or the other can be
a stroke.