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

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

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)

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

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

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”

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

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

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.

Behavior Therapy Systematic Desensitization

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

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

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

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?

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…”

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

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?

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

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

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…

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

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??

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)

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

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…

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

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

Types of Therapists

The Relative Effectiveness of Different Therapies Evidence-based practice

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…

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.)

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

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

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

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

Biomedical Therapies: Dramatic rise in antidepressant use:

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

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.

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

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

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?

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

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.