1. ©2002 Prentice Hall Approaches to Treatment and Therapy Chapter 17

2. ©2002 Prentice Hall Approaches to Treatment and Therapy Biological treatments. Kinds of psychotherapy. Evaluating psychotherapy.

3. ©2002 Prentice Hall Biological Treatments The question of drugs. Surgery and electroshock.

4. ©2002 Prentice Hall The Question of Drugs

5. ©2002 Prentice Hall Antipsychotic Drugs Many block or reduce sensitivity of brain receptors that respond to dopamine. Some increase levels of serotonin, a neurotransmitter that inhibits dopamine activity. Can relieve positive symptoms of schizophrenia but are ineffective for or even worsen negative symptoms in some patients.

6. ©2002 Prentice Hall Antidepressant Drugs Monoamine oxidase inhibitors (MAOIs) Elevate norepinephrine and serotonin in brain by blocking an enzyme that deactivates these neurotransmitters. Tricyclic antidepressants Boost norepinephrine and serotonin in brain by preventing normal reuptake of these substances. Selective serotonin reuptake inhibitors work same way as tricyclic antidepressants but target serotonin.

7. ©2002 Prentice Hall Tranquilizers Increase the activity of the neurotransmitter gamma-aminobutyric acid (GABA). Developed for treatment of mild anxiety and often overprescribed by general physicians for patients who complain of any mood disorder.

8. ©2002 Prentice Hall Lithium Carbonate Used to treat bipolar disorder. Moderates levels of norepinephrine or by protecting cells from being overstimulated by the neurotransmitter, glutamate. Must be given in right dose and bloodstream levels need to be monitored. Newer drug treatments for bipolar disorder include Tegetrol and Depakote.

9. ©2002 Prentice Hall Cautions About Drug Treatment Placebo effect High Relapse and dropout rates. Dosage problems. Long-term risks

10. ©2002 Prentice Hall Placebo effect The apparent success of a treatment that is due to the patient’s expectation of hopes rather than to the drug or treatment itself. Meta-analyses indicates that clinicians considered medication helpful yet patient ratings in treatment groups were no greater than patient ratings in placebo groups.

11. ©2002 Prentice Hall High Relapse and Dropout Rate There may be short term success but many patients (50% to 66%) stop taking medication due to side effects. Individuals who take antidepressants without learning to cope with problems are more likely to relapse.

12. ©2002 Prentice Hall Dosage Problems Finding the therapeutic window or the amount of medication that is enough but not too much. Drugs may be metabolized differently in: men and women, old and young, and in different ethnic groups. Groups may differ in dosages due to variations in metabolic rates, amount of body fat, number or type of drug receptors in the brain, smoking and eating habits.

13. ©2002 Prentice Hall Long term risks Antipsychotic drugs can be dangerous, even fatal if taken for many years. Tardive dyskinesia Antidepressants are assumed to be same but no long term studies have been conducted.

14. ©2002 Prentice Hall 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.

15. ©2002 Prentice Hall Kinds of Psychotherapy Psychodynamic therapy. Behavioral and Cognitive therapy. Humanist and Existential therapy. Family therapy.

16. ©2002 Prentice Hall Psychodynamic Therapy – The Freudian Approach Goal is exploring the unconscious 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.

17. ©2002 Prentice Hall Behavior and Cognitive Therapy Behavior therapy Systematic desensitization. Aversive conditioning. Exposure treatments. Behavioral records and contracts. Skills training. Cognitive therapy

18. ©2002 Prentice Hall Behavior Therapy A form therapy that applies principles and techniques of classical and operant conditioning to help people change self defeating or problematic behaviors.

19. ©2002 Prentice Hall Systematic Desensitization A step by step process of desensitizing a client to a feared object or experience, Based on counterconditioning.

20. ©2002 Prentice Hall Exposure (Flooding) A technique whereby a person suffering from an anxiety disorder such as a phobia or panic attack, is taken directly into the feared situation until the anxiety subsides.

21. ©2002 Prentice Hall Behavioral Records A method of keeping careful data on the frequency and consequences of the behavior to be changed.

22. ©2002 Prentice Hall Skills Training An effort to teach a client skills he or she may lack as well as new more constructive behaviors to replace self-defeating ones.

23. ©2002 Prentice Hall Cognitive Techniques Examine the evidence for beliefs. Consider other explanations for the behavior of others. Identify assumptions and biases.

24. ©2002 Prentice Hall Humanist Therapy Humanist therapy Based on the assumption that all people automatically seek self-actualization and self- fulfillment. Emphasizes people’s free will to change, not past conflicts. Client-Centered (Nondirective) Therapy Developed by Carl Rogers and emphasizes the therapist’s empathy with the client, seeing the world as client does, and creating climate of Unconditional Positive Regard.

25. ©2002 Prentice Hall Existential Therapy Helps clients explore the meaning of existence and face with courage the great issues of life such as death, freedom, free will, alienation and loneliness.

26. ©2002 Prentice Hall Family and Couples Therapy Problems develop in the context of family, are sustained by the dynamics of the family and that any changes made will affect all members of the family. Can look for patterns of behavior across generations and create a family tree of psychologically significant events. Family-System Perspective Therapy with individuals or families that focuses on how each member forms part of a larger interacting system.

27. ©2002 Prentice Hall One Family’s Genogram

28. ©2002 Prentice Hall Primary Goals of Therapies Psychodynamic Insight into unconscious motives and feelings. Cognitive-Behavioral Modification of behavior and irrational beliefs. Humanist Insight; self-acceptance and self-fulfillment. Family Modification of individual habits and family patterns.

29. ©2002 Prentice Hall 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. 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.

30. ©2002 Prentice Hall Evaluating Psychotherapy The scientist-practitioner gap. When therapy helps. Which therapy for which problem? When therapy harms.

31. ©2002 Prentice Hall 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.

32. ©2002 Prentice Hall 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.

33. ©2002 Prentice Hall Psychotherapy Research 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?

34. ©2002 Prentice Hall Common Ingredients in Successful Therapies When there is a bond between therapist and client (a.k.a. Therapeutic Alliance). When participants want to be helped. When therapists distinguish normal cultural patterns from individual psychological problems.

35. ©2002 Prentice Hall 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.

36. ©2002 Prentice Hall 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.

37. ©2002 Prentice Hall Successful Therapy Psychotherapy outcome depends not only on method of therapy. Qualities of client and therapist, and their alliance, also determine success.

38. ©2002 Prentice Hall When Therapy Harms Sexual intimacies, or other unethical behavior on the part of the therapist. Prejudice or cultural ignorance on the part of the therapist. Inappropriate or coercive influence, which can create new problems for the client. The use of empirically unsupported, potentially dangerous techniques.