Therapy Most Psychotherapy is now done by psychologists, clinical social workers, pastoral and school counselors, not psychiatrists. Only psychiatrists can prescribe medicine and see the most disturbed clients.

Therapy: How effective? Using Meta-analysis, studying many studies: Therapy works better than no therapy, but about 50% on non psychotic, untreated patients improve on their own. About 80% of treated patients improve.

THERAPY In general people who have a clear-cut problem--phobias, sexual dysfunction, unassertiveness, depression--do best with therapy. One group of mildly depressed college girls were tested against a control, a group using cognitive therapy and one doing aerobics. The aerobic group blew them away.

Types: Psychoanalysis Freudian: designed to uncover repressed feelings and issues from childhood through talk and free association and dream interpretation (latent content). When free associating a block called resistance indicates a repressed feeling.Patient may attach feelings on therapist called transference.

Humanistic Client-Centered therapy (Carl Rogers): therapist acts as mirror but client guides process. Focuses on active-listening by the therapists to help client understand their feelings, with conscious thought, focusing on future growth, not past causes. Therapy is non-directive.

Humanistic Object is to give client unconditional positive regard, so they may accept even their worst traits in a positive context. Emphasize taking ownership of feelings. Active listening: paraphrase, clarify, reflect feeling.

Gestalt Therapy Combines the exploration of the causes with the idea of taking ownership of feelings. They may use I messages (remember your favorite activity I am…..) and role-playing.

Similarities between Psychoanalytic and Humanistic Therapies  Both believe that awareness of the cause of a problem, insight, aids in solving the problem.  Humanistic techniques like “active listening” and reflection are often used by counselors, who may not subscribe to all the humanists’ theories. Combining perspectives makes you eclectic.

Behavioral Therapies Designed to change behaviors, causes and self- awareness are not addressed, not that to matter in treatment of symptoms. Behaviorists use counterconditioning: pairing the problem feeling with a positive reinforcer to change the feeling. Most effective with specific problems like phobias.

Behavioral Therapy: Systematic Desensitization: slowly moving the person closer to a fearful situation until symptoms subside and are replaced by pleasure relaxation. Then the person is moved even closer to object of discomfort. Predicated on the belief that you cannot be simultaneously anxious and relaxed.

Behavioral Techniques Systematic cont: first begin with establishing a hierarchy of anxiety and moving you up that hierarchy. May use progressive relaxation..

Aversive (getting away from) Techniques: couples an undesirable behavior with an immediate negative outcome. Alcohol with nausea for instance. Problem is that cognition can override learning: if you know the alcohol is spiked the technique doesn’t work.

Behavioral Therapies Operant conditioning: using a combination of rewards and punishment to shape desired behaviors. Token economies: giving Papalien bucks for desired behaviors that can be turned in for rewards.

Social learning/observational learning (Bandura) Exposes patient to others handling the source of their anxiety in hopes they will imitate that behavior. Flooding: exposing patient repeatedly to the source of their fear until they adapt to it and the fear extinguishes.

Criticism of behaviorism: Remember overjustification effect. If one is extrinsically rewarded, they tend to lose intrinsic motivation. And is it brainwashing?

Cognitive Therapy Designed to alter negative internal sentences and thoughts. Rational-emotive therapy (Albert Ellis): in-your-face challenges to irrational thought processes. Depression is linked with negative self-talk, often irrational. Depressed people are immune from self- serving bias.

Cognitive Therapy Is effective, and also reduces relapse once the therapy stops. Patients are trained to use more positive thought process as habits, which feed upon themselves.

Therapies: Groups and Family therapies No less effective than individual and are cheaper. Allows patient to see others have the same problems and benefit by them. Family: treats the systems of dysfunction, changing the environment.

Benefits of Psychotherapy Hope has a placebo effect on patients. Offer people a cause and alternative ways of looking at themselves. Those who seek help usually improve, although no type is proven superior to another-even empathetic, compassionate non-professionals have success rates comparable to trained therapists.

Psychopharmacology-the study of drug effects on mind and behavior Anti-psychotics: work on dopamine systems--Thorazine, clozapine. Blocks activity. Anti-anxiety: Valium librium, tranquilizers.

Antidepressants: Prozac, Paxil, Luvox, Zoloft, block serotonin, norepinephrine reuptake. Used with Lithium (a common salt, mood stabilizer) for treatment of bipolar disorder.

Radical Strategies: Electroconvulsive Therapy: very effective for extreme depression, lasting several months. Psychosurgery: rarely used- lobotomy where the frontal lobe is disconnected from the limbic system.

Today’s focus is shifting toward prevention by altering environment and teaching stress management.