Therapy 101.

Therapy 101

Psychotherapy Treatment of the Psyche
Literally: Treatment of the Psyche Minds or personalities in distress

Psychotherapy is a process by which you examine your thoughts, feelings, actions and relationships, evaluate where problems exist, and learn how to make whatever changes are necessary to achieve better life adjustment and satisfaction

Therapeutic Relationship
Varies with approaches Objective Ethical Confidential Professional

Patient/Therapist Relationship
Terminology: Patient vs. Client How well patients relate to therapists and vice versa is important to the progress that they make in therapy. According to much of the research on psychotherapy, a positive therapeutic relationship may even be more important for recovery than the type of therapy used.

Elements of Counseling Relationship
Rapport-the patient and therapist seem to "click with one another." Trust-the patient views the therapeutic relationship as helpful and the therapist finds the patient interested in changing. Confidentiality- a therapist keeps what is said in therapy between himself and the patient except when the patient or others are in danger.

Empathy- an empathic therapist tries to understand the situations and feelings through the patient 's eyes. Insight- the patient is able to understand how his/her illness, attitudes and behaviors affect his/her life, (i.e. self-understanding). Motivation-the patient has a desire to feel better and improve his/her situation.

Therapeutic Goals Fostering Insight Encouragement
Reducing emotional discomfort Providing new information Facilitating change

Continuum of Care Consultation Outpatient Intensive outpatient
Day Treatment Residential Supervised living Inpatient Hospitalization

Individual Therapy One on one delivery of services focused on theoretical perspective and client need Brief, solution focused therapy Supportive therapy Match client needs with orientation

Group Therapy Simultaneous treatment of serveral individuals
Yalom’s theory of group therapy Therapist’s training Screening of candidates Group composition Open, closed, size, other considerations

Family Therapy Identifying and changing patterns of family interaction “Identified client” Systems view Structural, strategic view Virginia Satir

Family Therapy Family therapy focuses on change within the family, and recognizes than family relationships all have an impact on the feelings and behavior of each of the members of a family. Instead of meeting with an individual, all or most family members are involved in the therapy process.

Occasionally, the non-custodial parents are also involved in family therapy, but this depends on the potential for divorced parents working together to help their children resolve psychological problems. Family therapy is most frequently used when a child or adolescent is identified as having a psychological problem For example, a teen with chronic depression or substance abuse problems might benefit from family therapy to address the impact of their problem on family relationships, while also receiving individual psychotherapy to directly address their personal change issues.

Marital Therapy Relationship counseling, couple therapy Focus on interaction, communication Dynamics Legal issues Problem solving Therapist’s mine field !

Relationship Counseling Couple Therapy (Marriage Counseling)
Couple therapy is often seen as somehow different from psychotherapy because one individual is not identified as having a specific psychological problem. All psychological problems involve both individual symptoms and changes in interpersonal relationships. Couple therapy focuses on the problems existing in the relationship between two people.

These relationship problems always involve individual symptoms and problems, as well as relationship conflicts. Changes may be different ways of interacting within the relationship, or may be individual changes related to other psychological problems. Couple therapy involves learning how to communicate more effectively, and how to listen more closely.

Couples must learn how to avoid competing with each other, and need to identify common life goals and how to share responsibilities within their relationship. Sometimes the process is very similar to individual psychotherapy, sometimes like mediation, and sometimes educational. The combination of the three is what makes it effective.

Who’s Who in Mental Health?
Psychiatrist (MD) College, four years of medical school, four years of a psychiatry residency. Diagnose and treat patients with medication and/or therapy. Oversee patient care.

Clinical Psychologist (Ph.D./PsyD)
College, five to seven years of graduate study, a written dissertation on a specialized topic, specialized clinical training. Diagnosis, psychological testing, and therapy. May refer people for medication but do not prescribe medication.

Counselor/Therapist (MA/MS)
College, two year graduate study in psychology or counseling. Counseling or therapy, psychological testing.May refer people for medication but do not prescribe medication.

Psychiatric Nurse (RN/BSN) RN: Two or three year hospital or community college program. BSN: college degree in nursing. Psychiatric nurse certification: specialty training in medication management and group therapy . Works in inpatient and outpatient settings. Plans, implements, and evaluates patient care; monitors medications;and provides individual and/or group therapy

Social Worker (MSW) College, two years of graduate study which includes clinical training. Usually works in outpatient settings. Diagnosis, therapy, and medication management under the supervision of a physician.

Therapist Orientations
(APA Data, 1989)

Therapy Types Insight Therapies Behavioral Therapies
Cognitive Therapies Biological Therapies

Not All Psychotherapy Is Psychoanalysis
Many people have misconceptions about what psychotherapy is. Some people think psychotherapy involves laying on a couch and talking with a psychoanalyst who just says "tell me more.". Most therapies focus on reducing symptoms quickly and returning the patient to a relatively normal level of functioning.

Insight Therapies Psychodynamic Person-centered Therapy
Gestalt Therapy Existential Therapy

Comparing Major Therapies
Perceived Cause of Disorder Goals of Therapy Methods used

Psychodynamic Unconscious sexual and aggressive urges/conflicts
Cause Goals Methods Unconscious sexual and aggressive urges/conflicts Fixations Bring repressed information into conscious mind Dream Interpretation Free Association

Psychodynamic Usually lengthy Free Association and Dream Analysis Barriers: Resistance, Transference Exploring unconscious

Psychodynamic Free association Analysis of Resistance Dream analysis
Analysis of Transference

Psychodynamic Minimizes patient responsibility
Neglects conscious motives and the present Fairly costly

Psychoanalytic Orientation
The Nature of Psychoanalysis Techniques in psychoanalysis: Analysis of free associations Analysis of resistances Analysis of dreams Analysis of transference Offshoots of psychoanalysis 33

Freud’s Psychoanalysis
Psychoanalysis - an insight therapy based on the theory of Freud, emphasizing the revealing of unconscious conflicts. Dream interpretation Manifest content – the actual content of one’s dream. Latent content – the symbolic or hidden meaning of dreams. Free association – Freudian technique in which a patient was encouraged to talk about anything that came to mind without fear of negative evaluations.

Freud’s Psychoanalysis
Resistance - occurring when a patient becomes reluctant to talk about a certain topic, either changing the subject or becoming silent. Transference - in psychoanalysis, the tendency for a patient or client to project positive or negative feelings for important people from the past onto the therapist.

Psychoanalysis Today Psychodynamic therapy - a newer and more general term for therapies based on psychoanalysis, with an emphasis on transference, shorter treatment times, and a more direct therapeutic approach. Nondirective - therapy style in which the therapist remains relatively neutral and does not interpret or take direct actions with regard to the client, instead remaining a calm, nonjudgmental listener while the client talks. Directive - therapy in which the therapist actively gives interpretations of a client’s statements and may suggest certain behavior or actions. Psychoanalysis today is more directive.

_______________ formed a large part of Freud’s psychoanalytic method
_______________ formed a large part of Freud’s psychoanalytic method. a) Reflection b) Empathy c) Dream interpretation d) Unconditional positive regard

Humanism Only the client can judge if he or she is better
No way to independently verify success

Person Centered Causes Goals Methods Incongruence between real and desired self. Overdependence on positive regard from others Increase self acceptance and self understanding Enhance personal growth Empathy, unconditional Positive regard Reflection of feelings

Person-Centered Therapy
A Humanistic therapy Founded by Rogers Uses mirroring & unconditional positive regard to promote self actualization Therapist must genuinely like the client Therapist must have empathy for the client

Person Centered (Nondirective)
Warm, supportive environment Unconditional positive regard Reveal true feelings to achieve self-growth Understand past conditions of worth Need for therapist to identify with client (empathy)

Gestalt Therapy Founded by Perls
Therapist directs client to get in touch with feelings, resolve unfinished business

Gestalt Challenge with questions, activities designed to challenge clients to increase self-awareness Role playing Confrontation, but encouraging, supportive

Today’s View of Humanistic Therapy
Humanistic therapies are not based in experimental research and work best with intelligent, highly verbal persons.

Humanistic Orientation
Person-Centered Therapy; Carl Rogers Reflection of feelings main technique Unconditional positive regard Gestalt Therapy; Perls 46

Roger’s Person-Centered Therapy
Person-centered therapy - a nondirective insight therapy based on the work of Carl Rogers in which the client does all the talking and the therapist listens. Four Elements: Reflection - therapy technique in which the therapist restates what the client says rather than interpreting those statements. Unconditional positive regard - referring to the warmth, respect, and accepting atmosphere created by the therapist for the client in person-centered therapy. Empathy - the ability of the therapist to understand the feelings of the client. Authenticity - the genuine, open, and honest response of the therapist to the client.

What did Carl Rogers view as a cause of most personal problems and unhappiness? a) reinforcement of maladaptive behavior patterns b) unrealistic modes of thought employed by many people c) mismatch between an individual’s ideal self and real self d) unresolved unconscious conflicts occurring between the id and superego

Gestalt Therapy form of directive insight therapy in which the therapist helps clients to accept all parts of their feelings and subjective experiences, using leading questions and planned experiences such as role-playing. Try to help clients deal with things in their past that they have denied and will use body language and other nonverbal cues to understand what clients are really saying.

Which of the following is a key component of Rogers’s person-centered therapy? a) cognition b) resistance c) dream interpretation d) unconditional positive regard

Behavioral Causes Goals Methods Learning maladaptive behaviors, failure to learn appropriate behaviors Help acquire needed social skills, Extinguish maladaptive behaviors, Replace with Positive behaviors Based on classical and operant conditioning: Exposure, Reinforcement Flooding Modeling

Use learning principles to reduce or eliminate maladaptive behaviors
Behavioral Use learning principles to reduce or eliminate maladaptive behaviors Ignores unconscious conflicts Systematic desensitization, flooding, modeling, token economy, aversive conditioning

Behavioral Therapy Problems arise from failure to learn adaptive behavior or learning of maladaptive behavior Change through operant and classical conditioning techniques

Systematic Desensitization
Teach relaxation Create a hierarchy ranging from least to most feared stimulus Work through hierarchy while maintaining calm

Exposure & Response Prevention
Exposing the person to the situation producing anxiety Preventing the person from performing their rituals

Modeling Providing a role model lacking the anxiety
Participant modeling works best

Behavioral Therapy and Classical Conditioning
Behavior therapies - action therapies based on the principles of classical and operant conditioning and aimed at changing disordered behavior without concern for the original causes of such behavior. Behavior modification or applied behavior analysis – the use of learning techniques to modify or change undesirable behavior and increase desirable behavior.

Systematic desensitization - behavior technique used to treat phobias, in which a client is asked to make a list of ordered fears and taught to relax while concentrating on those fears. Counterconditioning - replacing an old conditioned response with a new one by changing the unconditioned stimulus.

Aversion therapy - form of behavioral therapy in which an undesirable behavior is paired with an aversive stimulus to reduce the frequency of the behavior. Flooding - technique for treating phobias and other stress disorders in which the person is rapidly and intensely exposed to the fear-provoking situation or object and prevented from making the usual avoidance or escape response.

LO 15.8 Behavior therapists’ use of classical conditioning
Menu

Modeling - learning through the observation and imitation of others.
Participant modeling - technique in which a model demonstrates the desired behavior in a step-by-step, gradual process while the client is encouraged to imitate the model. Reinforcement - the strengthening of a response by following it with a pleasurable consequence or the removal of an unpleasant stimulus.

Token economy - the use of objects called tokens to reinforce behavior in which the tokens can be accumulated and exchanged for desired items or privileges. Contingency contract – a formal, written agreement between the therapist and client (or teacher and student) in which goals for behavioral change, reinforcements, and penalties are clearly stated.

Extinction – the removal of a reinforcer to reduce the frequency of a behavior.
Time-out - an extinction process in which a person is removed from the situation that provides reinforcement for undesirable behavior, usually by being placed in a quiet corner or room away from possible attention and reinforcement opportunities.

Effectiveness of Behavioral Therapy
Behavior therapies can be effective in treating specific problems, such as bedwetting, drug addictions, and phobias. Can help improve some of the more troubling behavioral symptoms associated with more severe disorders.

Cognitive Causes Goals Methods Irrational, negative assumptions and ideas about self and others Change faulty, irrational, negative thinking Identify negative thoughts and replace with rational thinking

Cognitive Therapies Rational Emotive Therapy (Ellis)
Beck's cognitive therapy

Cognitive Uses learning principles to challenge irrational thoughts
Cognitive distortions: overgeneralization, black/white thinking, mind reading Rational Emotive Self defeating behaviors/thoughts Substitute more positive

Rational Emotive Therapy
Attempts to modify the irrational beliefs that cause distress Confrontational and directive

Common Irrational Beliefs
I must be perfect Everyone must love me The past determines the future It is catastrophic when things don't go as planned

Common Irrational Beliefs
I have no control over my happiness Perfect solutions must be found for life's problems Happiness just happens

Beck’s Cognitive Therapy
Automatic Thoughts: Thoughts people have about life and the self that may be unreasonable but are accepted as accurate Automatic thoughts create depression and anxiety Goal: teach patients to stop the thoughts

Beck’s Cognitive Therapy
Also involves negative views of past, present, and future experiences Highly effective treatment for depression & anxiety

Cognitive Orientation
Rational-Emotive Therapy: Albert Ellis Goal is changing irrational beliefs A-B-C Theory of Emotion Cognitive Therapy Goal is changing negative beliefs about the world, the self and the future 75

The A-B-C Theory of Emotion

Cognitive Therapy Cognitive therapy - therapy in which the focus is on helping clients recognize distortions in their thinking and replace distorted, unrealistic beliefs with more realistic, helpful thoughts. Cognitive Distortions based on Beck’s Cognitive Therapy: Arbitrary inference – distortion of thinking in which a person draws a conclusion that is not based on any evidence. Selective thinking - distortion of thinking in which a person focuses on only one aspect of a situation while ignoring all other relevant aspects.

Cognitive Distortions:
Overgeneralization - distortion of thinking in which a person draws sweeping conclusions based on only one incident or event and applies those conclusions to events that are unrelated to the original. Magnification and minimization - distortions of thinking in which a person blows a negative event out of proportion to its importance (magnification) while ignoring relevant positive events (minimization). Personalization - distortion of thinking in which a person takes responsibility or blame for events that are unconnected to the person.

Cognitive-behavioral therapy (CBT) - action therapy in which the goal is to help clients overcome problems by learning to think more rationally and logically. Three goals: Relieve the symptoms and solve the problems. To develop strategies for solving future problems. To help change irrational, distorted thinking.

Rational-Emotive Therapy
Rational-emotive behavior therapy (REBT) - cognitive-behavioral therapy in which clients are directly challenged in their irrational beliefs and helped to restructure their thinking into more rational belief statements.

Success of CBT CBT has seemed successful in treating depression, stress disorders, and anxiety. Criticized for focusing on the symptoms and not the causes of disordered behavior.

Biomedical Genetic inheritance,
Causes Goals Methods Genetic inheritance, Biochemical abnormality within the brain Eliminate or control biological causes. Restore balance of neurotransmitters Medication, Psychosurgery ECT

Biomedical Drug therapies Antianxiety agents Antipsychotic agents
Antidepressants Electro convulsive therapy (ECT) Psychosurgery

Mental Hospital Population
Biological Therapies Psychoactive drugs highly successful in reducing in-patient population Mental Hospital Population

Antipsychotic Drugs Neuroleptics -- phenothiazine, butyrophenones
Neuroleptics may cause Tardive dyskinesia Clozapine and risperidone Clozapine has a risk of producing blood clots

Antidepressants Tricyclics Serotonin Selective Reuptake Inhibitors
SSRIs (Prozac, Anafranil) have fewer side effects MAO inhibitors MAO inhibitors can't be taken with certain foods

Antimania Drugs Lithium Carbonate evens out the mood swings of bipolar patients Must be carefully monitored

Tranquilizers Benzodiazapines (Librium, Valium, Xanax)
Xanax more effective but somewhat addictive

Electroconvulsive Therapy
An effective treatment for depression & mania not responsive to drugs May cause temporary memory loss Works by altering neurotransmitter balance

Psychosurgery Lobotomies done from 1935-1955
Cingulotomies and other microsurgeries sometimes done today

Lobotomy Site Portions of the frontal lobe
are separated from the thalamus

Psychosurgery Negatives: Results are unpredictable
Consequences are irreversible

Biopsychological Orientation
Psychosurgery Prefrontal lobotomy Electroconvulsive Therapy Brief electric current induces brain seizures Produces retrograde amnesia 93

Drug Therapy Antianxiety Drugs e.g., Valium, Xanax
Work by stimulating GABA Antidepressant Drugs e.g., tricyclic antidepressants and SSRIs Antimania drugs e.g., lithium Can produce dangerous side effects Antipsychotic drugs e.g., thorazine Motor side effects 94

Drug Treatments Biomedical therapies – therapies that directly affect the biological functioning of the body and brain. Psychopharmacology - the use of drugs to control or relieve the symptoms of psychological disorders. Antipsychotic drugs - drugs used to treat psychotic symptoms such as delusions, hallucinations, and other bizarre behavior.

Antianxiety drugs - drugs used to treat and calm anxiety reactions, typically minor tranquilizers.
Antimanic drugs - used to treat bipolar disorder and include lithium and certain anticonvulsant drugs. Antidepressant drugs - drugs used to treat depression and anxiety.

Electroconvulsive Therapy
Electroconvulsive therapy (ECT) - form of biomedical therapy to treat severe depression in which electrodes are placed on either one or both sides of a person’s head and an electric current is passed through the electrodes that is strong enough to cause a seizure or convulsion. Bilateral ECT - electroconvulsive therapy in which the electrodes are placed on both sides of the head. Unilateral ECT - electroconvulsive therapy in which the electrodes are placed on only one side of the head and the forehead.

Psychosurgery Psychosurgery - surgery performed on brain tissue to relieve or control severe psychological disorders. Prefrontal lobotomy - psychosurgery in which the connections of the prefrontal lobes of the brain to the rear portions are severed. Bilateral cingulotomy - psychosurgical technique in which an electrode wire is inserted into the cingulated gyrus area of the brain with the guidance of a magnetic resonance imaging machine for the purpose of destroying that area of brain tissue with an electric current.

Danger of Treating Children with Antidepressants
All but one antidepressant drug has been associated with an increased risk of suicide when used to treat depression in children and adolescents. Prozac, the one safe antidepressant for children and adolescents, has been found to be more effective when combined with psychotherapy.

Clicker Review Therapy

Lulu sees a professional once a month to manage the medication she is taking to help alleviate the symptoms of her anxiety disorder. The type of therapy Lulu is undergoing is called ______________. a) psychotherapy b) biomedical therapy c) physical therapy d) electroconvulsive shock therapy

The psychoanalytic patient who lets her thoughts flow without interruption or fear of negative criticism from her therapist is using ______. a) dream interpretation b) positive transference c) regression d) free association

The therapist’s feeling of respect and affection for the client that exists without any strings attached, no matter what the client may say or do, is called __________. a) conditions of worth b) empathy c) catharsis d) unconditional positive regard

56. What do behavior therapists see as the cause of abnormal or undesirable behaviors? a) learning b) unconscious conflicts c) distortions in thinking d) discrepancy between the real self and ideal self

67. Every time Jarrad opens his cigarette case or uses his lighter, he gets a painful electric shock. Jarrad’s friends and family have been asked not to give him any cigarettes or light any cigarettes for him, so he must use his own lighter if he wants to smoke. Eventually, Jarrad loses his desire to smoke, thanks to ______. a) negative transference b) behavioral contracting c) systematic desensitization d) aversion conditioning

61. Which method of treating phobias involves progressive relaxation and exposure to the feared object? a) extinction b) punishment c) token economy d) systematic desensitization

Estella is afraid of cats
Estella is afraid of cats. To help her overcome her fear, her mother calmly pets and strokes a cat while Estella is watching. Her mother encourages her to imitate her behavior. Estella’s mother is using_________. a) reinforcement b) token economy c) modeling d) punishment

Which of the following is one of the criticisms of behavior therapy
Which of the following is one of the criticisms of behavior therapy? a) It focuses on the underlying cause of behavior and not the symptoms. b) Therapy typically lasts for several years and is very expensive. c) It focuses too much on the past. d) It only relieves some symptoms but does not treat the overall disorder.

Therapy that depends on identifying and changing distorted thinking and unrealistic beliefs is ______ therapy. a) cognitive b) psychoanalytic c) behavior d) person-centered

Which of the following is a basic goal of cognitive-behavioral therapy
Which of the following is a basic goal of cognitive-behavioral therapy? a) to help clients uncover unconscious conflicts and sexual urges b) to help clients develop a closer match between real and ideal selves c) to help clients change irrational thoughts to rational thoughts d) to help clients complete unfinished business and become whole

Which of the following is an advantage of cognitive and cognitive-behavioral therapies? a) Clients do not need to be verbal. b) They treat the underlying cause of the problem. c) They are less expensive and short term than typical insight therapies. d) The therapist decides which of the client’s beliefs are rational and which are irrational.

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Therapy 101.

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