1. Therapy

2. OA Who was Philippe Pinel and Dorothea Dix? (605)
Describe the following professions: (627)
Counselors
Social Workers
Clinical Psychologists
Psychiatrist

3. History of Therapy
Philippe Pinel: France Dorothea Dix: US/CA founded humane movements to care for the mentally sick.

4. Therapists & Their Training
Clinical psychologists: They have PhDs mostly. They are experts in research, assessment, and therapy, all of which is verified through a supervised internship.
Clinical or Psychiatric Social Worker: They have a Masters of Social Work. Postgraduate supervision prepares some social workers to offer psychotherapy, mostly to people with everyday personal and family problems.

5. Therapists & Their Training
Counselors: Pastoral counselors or abuse counselors work with problems arising from family relations, spouse and child abusers and their victims, and substance abusers.
Psychiatrists: They are physicians who specialize in the treatment of psychological disorders. Not all psychiatrists have extensive training in psychotherapy, but as MDs they can prescribe medications.

6. Therapies
I. Psychotherapy involves an emotionally charged, confiding interaction between a trained therapist and a mental patient.
II. Biomedical therapy uses drugs or other procedures that act on the patient’s nervous system, treating his or her psychological disorders.
III. An Eclectic approach uses various forms of healing techniques depending upon the client’s unique problems.

7. Freudian psychoanalysis Neo-Freudian therapies
Insight Therapies
Insight therapies – Psychotherapies in which the therapist helps patients/clients understand (gain insight into) their problems
A therapist and client work together with the goal of identifying the problem and reaching a possible solution
Freudian psychoanalysis
Neo-Freudian therapies
Humanistic therapies
Cognitive therapies
Group therapies
Copyright © Allyn & Bacon 2007

8. The Psychological Therapies
Psychoanalysis
Humanist
Cognitive
Behavioral
Group

9. Psychoanalysis
Psychoanalysis Sigmund Freud’s therapeutic technique. Freud believed the patient’s free associations, resistances, dreams, & transferences – & the therapist’s interpretations of them – released previously repressed feelings, allowing the patient to gain self-insight.
When energy devoted to id-ego-superego conflicts is released, the patient’s anxiety lessens.
Aims of therapy
Childhood impulses & conflicts

10. Psychoanalysis Methods
Free association--The patient lies down, out of sight, and starts talking about anything, randomly reporting any feelings or thoughts.
Resistance in psychoanalysis, the blocking from consciousness of anxiety-laden material
Interpretation in psychoanalysis, analyst’s noting supposed dream meanings, resistances, & other significant behaviors & events in order to promote insight of the meaning
People are going to avoid or become defensive about sensitive topics.
You might see them become anxious, or pause or evade the topics. These are all examples of resistance.

12. Psychoanalysis: Methods at work
During free association, the patient edits his thoughts, resisting his or her feelings to express emotions. Such resistance becomes important in the analysis of conflict-driven anxiety.
Eventually the patient opens up & reveals his or her innermost private thoughts, developing positive or negative feelings (transference) towards the therapist.
Aggressive Transference – anger and hostility towards therapist
Sexual Transference – sexual attraction to your therapist
As a psychoanalytic therapist, it is important that you keep distance from your patients.

13. Humanistic Therapies focus more on: the present rather than the past
conscious rather than the unconscious
taking immediate responsibility
promoting growth instead of curing

14. Humanistic Therapies
Client-centered therapy (AKA person-centered therapy.) Humanistic therapy, developed by Carl Rogers, the therapist uses techniques such as active listening within a genuine, accepting, empathic environment to facilitate client’s growth.
Nondirective therapy: no interpretation. No insight.
Genuineness, acceptance, & empathy
Active listening empathic listening in which the listener echoes, restates, & clarifies.
Paraphrase
Invite clarification
Reflect feelings
Ex: School Councilors
Unconditional positive regard: is basic acceptance and support of a person regardless of what the person says or does
Instead of a therapist telling you what is wrong with you or what they interpret,
It is about team work, collaboration in understanding the client’s self. Instead of telling, they are going to be “listening.”
You allow the patient to correct or clarify what is being heard and understood.

15. Behavior Therapies
Behavior Therapy- therapy that applies learning principles to the elimination of unwanted behaviors.
Focus: the ACTION, not the thought patterns associated with the behavior, doesn’t look for the “inner cause”
Classical conditioning techniques
We learn various behaviors & emotions via classical conditioning
Operant conditioning techniques
Behavior modification – reinforces desired behaviors & withholding reinforcement for undesired behaviors or punishments

16. Behavior Therapies I. Classical Conditioning Therapies
Counterconditioning The patient comes in with a stimuli that triggers unwanted behaviors. This procedure tries to condition new responses to the stimuli
Very effective with phobias
1. Exposure Therapies: behavior therapy procedure that uses classical conditioning to evoke new responses to stimuli that are triggering unwanted behaviors; Includes
Systematic desensitization
Virtual reality exposure therapy
2. Intensive Exposure therapy
3. Aversive conditioning

17. 1. Exposure Therapy
Expose patients to things they fear and avoid. Through repeated exposures, anxiety lessens because they habituate to the things feared.
Can be in real or virtual environments.
Virtual reality Exposure Therapy
Virtual reality exposure therapy uses virtual simulations to progressively expose people to anxiety provoking stimuli
Flying or height
Anxiety disorders (such as phobias)
N. Rown/ The Image Works

18. Systematic Desensitization
A method in exposure therapy that associates a pleasant, relaxed state with gradually increasing anxiety-triggering stimuli commonly used to treat phobias.
Fear Hierarchy

19. 2. Intensive Exposure Therapy (Flooding)
Expose patients to things they fear and avoid. Through repeated exposures, anxiety lessens because they habituate to the things feared.
The Far Side © 1986 FARWORKS. Reprinted with Permission. All Rights Reserved.
Not gradual process! Expose them to the negative stimuli right away!

20. 3. Aversive Conditioning
A type of counterconditioning that associates an unpleasant state with an unwanted behavior. With this technique, temporary conditioned aversion to alcohol has been reported.
The behavior therapies—specifically aversive conditioning—
will have some students conjuring up images
of George Orwell’s 1984 and Stanley Kubrick’s A
Clockwork Orange. In the latter, Alex, a young hoodlum,
is apprehended by police after a series of sexual
and violent crimes. While in prison he volunteers for
the “Ludoveck Treatment,” which presumably cures
criminals in a few weeks. Alex is injected with a drug
that makes him violently ill; while under its influence,
he is forced to view films that graphically portray sexual
and aggressive actions. After repeated pairings of the
conditioned stimulus (sexual and violent images) with
the unconditioned stimulus (nausea-producing drug),
sexual and violent thoughts come to make Alex
extremely ill.
Two points are worth making in regard to this fictional
example. First, psychologists do not use aversive
conditioning in this way. Typically, the client knows all
about the procedure and consents to it. Moreover, its
aim—for example, in the treatment of smoking or
drinking—is toward increased self-control rather than
control by others. Second, Kubrick’s account is simplistic.
It overlooks the influences of cognition. After treatment,
Alex would know that sexual and violent actions
would not induce illness. In short, people’s feelings and
behavior cannot be so easily controlled as A Clockwork
Orange implies.

21. Behavior Therapies II. Operant Conditioning
Behavior modification- reinforce desired behaviors withholding reinforcement for undesired behavior or punishment. Can work b/c a behavior strongly influenced by consequences. (effective with autism, retardation, schizophrenia).
Rewards used to modify behavior vary from praise, to attention to more concrete rewards, food.
Raises ethical Questions
1. Token economy operant conditioning procedure. People earn a token of some sort for exhibiting a desired behavior & can later exchange tokens for various privileges/treats. Successful in various settings, cultures, & many mental disorders.

22. Token Economy

23. 2. Behavior Contracting
Therapist and the client agree on behavior goals and on the reinforcement usually in the form of a contract with punishments and rewards. (Example behavior plans in school)

24. Cognitive Therapies
Cognitive therapy that teaches people new, more adaptive ways of thinking & acting; based on the assumption that thoughts intervene between events & our emotional reactions
RUMINATION -- compulsively focused attention on the symptoms of one's distress, and on its possible causes and consequences, as opposed to its solutions.

25. Cognitive Therapy Aaron Beck’s Therapy for Depression
Aaron Beck (1979) suggests that depressed patients believe that they can never be happy (thinking) and thus associate minor failings (e.g. failing a test [event]) in life as major causes for their depression.
Beck believes that cognitions such as “I can never be happy” need to change in order for depressed patients to recover. This change is brought about by gently questioning patients.

26. Cognitive Therapy Aaron Beck’s therapy for depression
Catastrophizing beliefs- recurring negative themes of loss, rejection, abandonment, self-blaming & over generalizing that perpetuate existing feelings of depression
Cognitive-behavioral therapy popular integrative therapy that combines:
cognitive therapy (changing self-defeating thinking)
behavior therapy (changing behavior).
Seeks to restructure thinking (retrain) people to restructure negative thinking

27. Cognitive Therapy Albert Ellis
Rational Emotive Behavior Therapy (REBT)
Directly confronting patients about their irrational thinking and irrational beliefs.
ABCDE Model
Activating events (what activates the negative thought)
Beliefs (Negative beliefs about ourselves or others)
Consequences (Emotional and behavioral reactions)
Disputing irrational beliefs (Confront irrational beliefs)
Effective new beliefs (Positive beliefs)
Anxiety disorders and mood disorders

28. Cognitive Therapy
Teaches people adaptive ways of thinking & acting based on the assumption that thoughts intervene between events & our emotional reactions.
Preview Question 4: What are the goals and techniques of the cognitive therapies?

29. The Relative Effectiveness of Different Therapies
Which psychotherapy would be most effective for treating a particular problem?
Disorder
Therapy
Depression
Behavior, Cognition, Interpersonal
Anxiety
Cognition, Exposure, Stress Inoculation
Bulimia
Cognitive-behavior
Phobia
Behavior
Bed Wetting
Behavior Modification
OBJECTIVE 14| Summarize the findings on which psychotherapies are most effective for specific disorders.

30. Group Therapy
Group therapy normally consists of 6-9 people attending a 90-minute session
If the problems are interpersonal then why not broaden the therapy?
Positives:
behaviors towards others show up quickly in a group setting
client social support, not only one with this problem,
learn new behaviors
seeing others will help insight,
Clients benefit from knowing others have similar problems.
OBJECTIVE 10| Discuss the rationale and benefits of group therapy, including family therapy.

31. Family Therapy
Goal: To change all family members’ behavior to the benefit of the family unit as well as the troubled individual.
Method:
If one person is having problems, then it is likely the whole family is.
Must improve communication, empathy, responsibility, and reduce conflict.
Requires that all family members see the benefits.
Focus on changing self not others.
Concerns: Key person won’t come or monopolizes the sessions.

32. Couple Therapy
Goal: To improve a couple’s problems in communication, interaction, and mutual expectations.
Method:
Empathy Training – each is taught to share the inner feelings and to listen to and understand the partner’s feelings before responding.
Behavioral Techniques – schedule for caring actions
Cognitive Techniques – tries to dispel the cognitive distortions that disrupt communication
Concerns: Much more affective when it is two instead of one (56% vs. 29%)

33. Self-Help Groups
Goal: Low cost support and social network for a disorder
Method:
Since 40 million Americans suffer from some form of psychological disorder there are not enough psychologists to go around and they are expensive.
These small local gatherings of people share a common problem and provide mutual assistance at a very low cost.
AA is the best known.

34. Evaluating Psychotherapies
Within psychotherapies cognitive therapies are most widely used, followed by psychoanalytic and family/group therapies.

35. The Biomedical Therapies
These include physical, medicinal, and other forms of biological therapies.
Drug Treatments
Surgery
Electric-shock therapy
Used if:
The client is too agitated, disoriented, or unresponsive for psychotherapy.
The disorder has a strong biological component.
Dangerous to themselves or others.

36. I. Antipsychotic Drugs
Classical antipsychotics [Thorazine (Chlorpromazine)]: Remove a number of positive symptoms associated with schizophrenia such as agitation, delusions, and hallucinations.
Atypical antipsychotics [Clozapine (Clozaril)]: Remove negative symptoms associated with schizophrenia such as apathy, jumbled thoughts, concentration difficulties, and difficulties in interacting with others.
They block dopamine production or receptors

37. Atypical Antipsychotic
Clozapine (Clozaril) blocks receptors for dopamine and serotonin to remove the negative symptoms of schizophrenia.

38. tardive dyskinesia
side effect for long-term use of antipsychotic drugs that target D2 dopamine receptors.
involuntary movements of the facial muscles, tongue, and limbs

39. Antianxiety drugs (Xanax and Valium)
II. Antianxiety Drugs
Antianxiety drugs (Xanax and Valium)
depress the central nervous system and reduce anxiety and tension by elevating the levels of the Gamma-aminobutyric acid (GABA) neurotransmitter. GABA is the chief inhibitory neurotransmitter in the CNS
OBJECTIVE 20| Describe the characteristics of antianxiety drugs, and discuss their use in treating specific disorders.

40. III. Antidepressant Drugs
Antidepressant drugs like Prozac, Zoloft, and Paxil are Selective Serotonin Reuptake Inhibitors (SSRIs) that improve the mood by elevating levels of serotonin by inhibiting reuptake. MAO Inhibitors increase the concentration of serotonin
OBJECTIVE 21| Describe the characteristics of antidepressant drugs, and discuss their use in treating specific disorders.

41. IV. Mood-Stabilizing Medications
Lithium Carbonate, a common salt, has been used to stabilize manic episodes in bipolar disorders. It moderates the levels of norepinephrine and glutamate neurotransmitters.
OBJECTIVE 22| Describe the use and effects of mood-stabilizing medications.

43. Electroconvulsive Therapy (ECT)
Brain Stimulation
Electroconvulsive Therapy (ECT)
ECT is used for severely depressed patients who do not respond to drugs. The patient is anesthetized and given a muscle relaxant. Patients usually get a 100 volt shock that relieves them of depression.
OBJECTIVE 23| Describe the use of electroconvulsive therapy (ECT) in treating severe depression, and describe some possible alternatives to ECT.

44. Brain Stimulation Alternative Neurostimulation Therapies
Magnetic Stimulation
Repetitive transcranial magnetic stimulations (rTMS) - the application of repeated pulses of magnetic energy to the prefrontal regions brain; used to stimulate or suppress brain activity
Deep-Brain Stimulation

45. Brain Stimulation Alternative Neurostimulation Therapies

46. Psychosurgery
Psychosurgery was popular even in Neolithic times. Although used sparingly today, about
200 such operations do take place in the US alone.
OBJECTIVE 24| Summarize the history of the psychosurgical procedure known as lobotomy, and discuss the use of psychosurgery today.

47. Psychosurgery
Psychosurgery is used as a last resort in alleviating psychological disturbances.
Psychosurgery is irreversible. Removal of brain tissue changes the mind.
Preview Question 14: How, by caring for their bodies with a healthy lifestyle, might people find some relief from depression?

48. Psychosurgery
Psychosurgery surgery that removes or destroys brain tissue in an effort to change behavior
Lobotomy a now-rare psychosurgical procedure once used to calm uncontrollably emotional or violent patients. The procedure cut the nerves connecting the frontal lobes to the emotion-controlling centers of the inner brain
History
Procedure
Side effects
Use today

49. Psychosurgery
Modern methods use stereotactic neurosurgery and radiosurgery (Laksell, 1951) that refine older methods of psychosurgery.

50. Psychological Disorders are Biopsychosocial in Nature