1. Table of Contents Exit Therapies

2. Table of Contents Exit  Any psychological technique used to facilitate positive changes in personality, behavior, or adjustment; some types of psychotherapy:  However, it’s NOT a major overhaul in personality and therapists are not miracle workers ◦ Individual: Involves only one client and one therapist  Client: Patient; the one who participates in psychotherapy  Rogers used “client” to equalize therapist-client relationship and de-emphasize doctor-patient concept ◦ Group: Several clients participate at the same time

3. Table of Contents Exit ◦ Directive: Therapist provides strong guidance ◦ Insight: Goal is for clients to gain deeper understanding of their thoughts, emotions, and behaviors ◦ Also, therapists offer support, understanding and empathy

4. Table of Contents Exit  Trepanning: For primitive “therapists,” refers to boring, chipping, or bashing holes into a patient’s head; for modern usage, refers to any surgical procedure in which a hole is bored into the skull ◦ In primitive times it was unlikely the patient would survive; this may have been a goal ◦ Goal presumably to relieve pressure or rid the person of evil spirits  Demonology: Study of demons and people beset by spirits ◦ People were possessed, and they needed an exorcism to be cured  Exorcism: Practice of driving off an “evil spirit”; still practiced today!

5. Table of Contents Exit Fig. 17.1 Primitive “treatment” for mental disorders sometimes took the form of boring a hole in the skull. This example shows signs of healing, which means the patient survived the treatment. Many didn’t. © Daniella Pellagrini/Photo Researchers

6. Table of Contents Exit  Hysteria: Physical symptoms (like paralysis or numbness) occur without physiological causes ◦ Now known as somatoform disorders  Freud became convinced that hysterias were caused by deeply hidden unconscious conflicts  Main Goal of Psychoanalysis: To resolve internal conflicts that lead to emotional suffering

7. Table of Contents Exit  Free Association: Saying whatever comes to mind, regardless of how embarrassing it is ◦ By doing so without censorship and censure, unconscious material can emerge  Dream Analysis: Dreams express forbidden desires and unconscious feelings ◦ Latent Content: Hidden, symbolic meaning of dreams ◦ Manifest Content: Obvious, visible meaning of dreams ◦ Dream Symbols: Images in dreams that have personal or emotional meanings ◦ However, dreams can mean anything you want them to mean so it’s not exact

8. Table of Contents Exit  Resistance: Blockage in flow of ideas; topics the client resists thinking about or discussing ◦ Resistances reveal particularly important unconscious conflicts  Transference: Tendency to transfer feelings to a therapist that match those the patient has for important people in his or her past ◦ The patient might act like the therapist is a rejecting father, loving mother, etc. ◦ What Freudians aspire to in therapy

9. Table of Contents Exit  Client-Centered Therapy (Rogers): Nondirective and based on insights from conscious thoughts and feelings  Effective therapist must have four basic conditions ◦ Unconditional Positive Regard: Unshakable acceptance of another person, regardless of what they tell the therapist or how they feel ◦ Empathy: Ability to feel what another person is feeling; capacity to take another person’s point of view ◦ Authenticity: Ability of a therapist to be genuine and honest about his or her feelings ◦ Reflection: Rephrasing or repeating thoughts and feelings of the clients’; helps clients become aware of what they are saying

10. Table of Contents Exit  An insight therapy that focuses on problems of existence, such as meaning, choice, and responsibility; emphasizes making difficult choices in life ◦ Therapy focuses on death, freedom, isolation, and meaninglessness  Free Will: Human ability to make choices ◦ You can choose to be the person you want to be  Logotherapy: Emphasizes need to find and maintain meaning in one’s life/victor frankyl concentration camps  When you have a why for living you can endure any how  Confrontation: Clients are challenged to examine their values and choices

11. Table of Contents Exit  Media Psychologists: Radio, newspaper, and television psychologists; often give advice, information, and social support ◦ Most helpful when referrals and information are given/Can be more educational than therapeutic, sometimes entertaining  Telephone Therapists: 900 number therapists ◦ Caution: Many “therapists” may be nothing more than telephone operators who have never even taken a psychology course! CSUN hotline for example

12. Table of Contents Exit  Cybertherapy: Internet therapists in chat rooms and so on/also communicating my email ◦ Videocameras at both ends so now you can hear AND see therapist ◦ Patient/client can remain anonymous ◦ May be wave of future for those who cannot drive a distance to a therapist or cannot leave the house (e.g., Paula can’t leave the house because of agoraphobia, so Robert the therapist comes to her via Internet!) ◦ Cheaper than traditional psychotherapy

13. Table of Contents Exit  Use of learning principles to make constructive changes in behavior  Behavior Modification: Using any classical or operant conditioning principles to directly change human behavior ◦ Deep insight is often not necessary ◦ Focus on the present; cannot change the past, and no reason to alter that which has yet to occur

14. Table of Contents Exit  Conditioned Aversion: Learned dislike or negative emotional response to a stimulus  Aversion Therapy: Associate a strong aversion to an undesirable habit like smoking, overeating, drinking alcohol, or gambling/shocks administered at the bar  Rapid Smoking: Prolonged smoking at a forced pace ◦ Designed to cause aversion to smoking ◦ Or eat twinkies until you become ill…that will make you stop eating twinkies

15. Table of Contents Exit  Hierarchy: Rank-ordered series of steps, amounts, or degrees  Reciprocal Inhibition: One emotional state is used to block another (e.g., impossible to be anxious and relaxed at the same time)  Systematic Desensitization: Guided reduction in fear, anxiety, or aversion; attained by approaching a feared stimulus gradually while maintaining relaxation ◦ Best used to treat phobias: intense, unrealistic fears

16. Table of Contents Exit  Model: Live or filmed person who serves as an example for observational learning or vicarious conditioning  Vicarious Desensitization: Reduction in fear that takes place secondhand when a client watches models perform the feared behavior  Virtual Reality Exposure: Presents computerized fear stimuli to patients in a controlled fashion

17. Table of Contents Exit Fig. 17.2 Treatment of a snake phobia by vicarious desensitization. The photographs show models interacting with snakes. To overcome their own fears, phobic subjects observed the models. (Bandura et al., 1969. Photos courtesy of Albert Bandura.)

18. Table of Contents Exit Fig. 17.3 (left) Dr. Barbara Rothbaum and Dr. Larry Hodges show how a virtual reality system is used to expose people to feared stimuli. Many patients say that they would rather face exposure to feared stimuli in a virtual environment than in a real physical environment. (right) A computer image from a virtual elevator. Over an 8-week period, patients who suffered from acrophobia “rode” in the elevator. Each session took them to greater heights. (Image courtesy of Larry Hodges, Thomas Meyer, and Rob Kooper.)

19. Table of Contents Exit  Learning based on consequences of making a response ◦ Positive Reinforcement: Responses that are followed by a reward tend to occur more frequently /studying and getting an A on the exam ◦ Nonreinforcement: A response that is not followed by a reward will occur less frequently/working hard and getting no recognition ◦ Extinction: If response is NOT followed by a reward after it has been repeated many times, it will go away/for example not getting attention when acting up in class ◦ Punishment: If a response is followed by discomfort or an undesirable effect, the response will decrease/be suppressed (but not necessarily extinguished)/an F grade for shoddy work

20. Table of Contents Exit  Therapy that helps clients change thinking patterns that lead to problematic behaviors or emotions  Selective Perception: Perceiving only certain stimuli in a larger group of possibilities/for example, focusing on ONLY the negative things that happened to you today  Overgeneralization: Allowing upsetting events to affect unrelated situations/Gee I got an F on my exam, I will be stupid forever  All-or-Nothing Thinking: Seeing objects and events as absolutely right or wrong, good or bad, and so on/Everyone must like me, I must be perfect  Cognitive therapy is VERY effective in treating depression, shyness, and stress

21. Table of Contents Exit  Attempts to change irrational beliefs that cause emotional problems ◦ Theory created by Albert Ellis ◦ For example, Anya thinks, “I must be liked by everyone; if not, I’m a rotten person.”

22. Table of Contents Exit  Therapeutic Alliance: Caring relationship between the client and therapist  Therapy offers a protected setting where emotional catharsis (release) can occur  All the therapies offer some explanation or rationale for the client’s suffering  Provides clients with a new perspective about themselves or their situations and a chance to practice new behaviors

23. Table of Contents Exit  Active listening  Clarify the problem  Focus on feelings  Avoid giving advice  Accept the client’s frame of reference

24. Table of Contents Exit  Reflect thoughts and feelings  Silence: Know when to use  Questions ◦ Open: Open-ended reply ◦ Closed: Can be answered “Yes” or “No”  Maintain confidentiality

25. Table of Contents Exit  Pharmacotherapy: Use of drugs to alleviate emotional disturbance; three classes: ◦ Anti-anxiety drugs: Like Valium; produce relaxation or reduce anxiety ◦ Antidepressants: Elevate mood and combat depression ◦ Antipsychotics (Major Tranquilizers): Tranquilize and also reduce hallucinations and delusions in larger dosages  One Problem With Drug Therapy: ◦ Clozaril (clozapine): Relieves schizophrenic symptoms; however, two out of one hundred patients may suffer from a potentially fatal white blood cell disease

26. Table of Contents Exit  Electroconvulsive Therapy (ECT): Electric shock is passed through the brain inducing a convulsion ◦ Based on belief that seizure alleviates depression by altering brain chemistry and hormonal balance  ECT Views ◦ Produces only temporary improvement ◦ Causes permanent memory loss in many patients ◦ Should only be used as a last resort

27. Table of Contents Exit  Any surgical alteration of the brain  Prefrontal Lobotomy: Frontal lobes in brain are surgically cut from other brain areas ◦ Supposed to calm people who did not respond to other forms of treatment ◦ Was not very successful  Deep Lesioning: Small target areas in the brain are destroyed by using an electrode

28. Table of Contents Exit  Covert Sensitization: Aversive imagery is used to reduce occurrence of an undesired response/The Dali Lama says imagine excrement coming out of your mouth before slandering against someone/Or flab around your waist after eating chocolate  Thought Stopping: Aversive stimuli are used to interrupt or prevent upsetting thoughts/Say stop! In your mind  Covert Reinforcement: Using positive imagery to reinforce desired behavior/Think of how good you’re going to feel when you graduate

29. Table of Contents Exit  Peer Counselor: Nonprofessional person who has learned basic counseling skills  Self-Help Group: Group of people who share a particular type of problem and provide mutual support to each other (e.g., “Alcoholics Anonymous”)

30. Table of Contents Exit  Therapist makes sexual advances  Therapist makes repeated verbal threats or is physically aggressive  Therapist is excessively hostile, controlling, blaming, or belittling  Therapist talks repeatedly about his/her own problems  Therapist encourages prolonged dependence on him/her  Therapist demands absolute trust or tells client not to discuss therapy with anyone else  End of lecture