Approaches to Treatment and Therapy

Biological Treatments Kinds of Psychotherapy Evaluating Psychotherapy

Biological Treatments The Question of Drugs Surgery and Electroshock

The Question of Drugs

Cautions About Drug Treatment Placebo Effect High Relapse and Dropout Rates Dosage Problems Long-Term Risks

Surgery and Electroshock Psychosurgery: –Any surgical procedure that destroys selected areas of the brain believed to be involved in emotional disorders or violent, impulsive behavior. Electroconvulsive Therapy (ECT): –A procedure used in cases of prolonged and severe major depression, in which a brief brain seizure is induced.

Kinds of Psychotherapy Psychodynamic Therapy Behavioral and Cognitive Therapy Humanist and Existential Therapy Family Therapy Psychotherapy in Practice

Psychodynamic Therapy Free Association: –In psychoanalysis, a method of uncovering unconscious conflicts by saying freely whatever comes to mind. Transference: –In psychodynamic therapies, a critical step in which the client transfers unconscious emotions or reactions, such as conflicts about his or her parents, onto the therapist.

Behavioral and Cognitive Therapy Systematic Desensitization Aversive Conditioning Exposure Treatments Behavioral Records and Contracts Skills Training

Cognitive Techniques Examine the evidence for beliefs. Consider other explanations for the behavior of others. Identify assumptions and biases.

Humanist and Existential Therapy Client-Centered Therapy : –Developed by Carl Rogers; therapist tries to create climate of Unconditional Positive Regard to allow clients to seek self- actualization and self-fulfillment. –a.k.a., “Nondirective Therapy” Existential Therapy: –Helps clients explore the meaning of existence and face with courage the great issues of life.

One Family’s Genogram

Systemic Therapy Salvador Minuchin (structural family therapy) –All individuals belong to a system. –Systems have structure. –Structure is defined by rules and boundaries. –Rules and boundaries define interaction patterns. –A family system consists of three smaller subsystems Spousal Parental Sibling –Treatment focus is on fixing the systems structural problem and not on the individual or identified patient.

Primary Goals of Therapies Psychodynamic: –Insight into unconscious motives and feelings. Cognitive-Behavioral: –Modification of behavior and irrational beliefs.

Primary Goals of Therapies Humanist: –Insight; self-acceptance and self-fulfillment. Family: –Modification of individual habits and family patterns.

Primary Methods of Therapies Psychodynamic: –Probing the unconscious through dream analysis, free association, transference. Cognitive-Behavioral: –Behavioral techniques such as systematic desensitization, flooding; cognitive exercises to identify and change faulty beliefs.

Primary Methods of Therapies Humanist: –Providing a safe, non-judgmental setting in which to discuss life issues. Family: –Working with couples, families, and sometimes individuals to identify and change patterns that perpetuate problems.

Evaluating Psychotherapy The Scientist-Practitioner Gap When Therapy Helps Which Therapy for Which Problem? When Therapy Harms

The Scientist-Practitioner Gap Some psychotherapists believe that evaluating therapy using research methods is futile. Scientists find that therapists who do not keep up with empirical findings are less effective and can do harm to clients. Economic pressures require empirical assessment of therapies.

Is More Psychotherapy Better? With additional therapy sessions, the percentage of people improved increased up to 26 sessions. Rate of improvement then levels off. –Based on a summary of 15 studies, 2400 clients (Howard, et al., 1996) Patients’ sense of improvement slower but more steady.

Psychotherapy Research: Three Questions What are the common ingredients in successful therapies? What kinds of therapy are best suited for which problems? Under what conditions can therapy be harmful?

When Therapy Helps Therapeutic Alliance: –The bond of confidence and mutual understanding established between therapist and client, which allows them to work together to solve the client’s problems.

Which Therapy for Which Problem? Depression: –Cognitive therapy’s greatest success has come in treatment of mood disorders. Anxiety Disorders: –Exposure techniques are more effective than others. Anger and Impulsive Violence: –Cognitive therapy is extremely successful.

Which Therapy for Which Problem? Health Problems: –Cognitive and behavior therapies are effective for a wide range of health problems. Childhood and Adolescent Behavior Problems: –Behavior therapy is the most effective treatment.

Cognitive Inoculation Against Depression Children at risk for depression split into two groups Cognitive intervention with one group lowered depression risk Effects of intervention seem to grow over time

Successful Therapy Psychotherapy outcome depends not only on method of therapy. Qualities of client and therapist, and their alliance, also determine success.

When Therapy Harms Animosity or biased treatment on the part of the therapist. Coercion to adopt the therapist’s advice, sexual intimacies, or other unethical behavior.

When Therapy Harms Therapist-induced disorders resulting from inadvertent suggestions or influence. Although suggestive techniques may result in false memories, one third of licensed psychotherapists use these methods.