1. Chapter 14: Therapies

2. What Is Psychotherapy? -- *Any psychological technique used to facilitate positive changes in personality, behavior, or adjustment

3. Types of Psychotherapy -- *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

4. More Types of Psychotherapy Insight: Goal is for clients to gain deeper understanding of their thoughts, emotions, and behaviors -- *Directive: Therapist provides strong guidance (vs. *non-directive) Time-Limited: Any therapy that limits number of sessions –Partial response to managed care and to ever-increasing caseloads Caseload: Number of clients a therapist actively sees

5. Key Features of Psychotherapy 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

6. Origins of Therapy *Trepanning: –Patient unlikely to survive –To relieve pressure or rid the person of evil spirits

7. People in Therapy -- *Phillippe Pinel: French physician who initiated humane treatment of mental patients in 1793 –Created the first mental hospital Freud: –Hysteria (--somatoform disorders) caused by deeply hidden unconscious conflicts –Goal of Psychoanalysis: To resolve internal conflicts that lead to emotional suffering

8. Freudian techniques (Psychodynamic/psychoanalysis) -- *Free Association: saying whatever comes to mind, regardless of how embarrassing it is. –Allows unconscious material to emerge -- *Dream Analysis: –*Latent content –*Manifest content –Symbols Directive Brief psychodynamic therapy: designed to produce insights more quickly; uses direct questioning to reveal unconscious conflicts

9. Humanistic Therapies -- *Client-Centered Therapy (Carl Rogers) --Nondirective and based on insights from conscious thoughts and feelings; accept one’s true self (optimistic!) –*Unconditional Positive Regard: Unshakable acceptance of another person. –Empathy: Ability to feel what another person is feeling –Authenticity: Therapist is genuine and honest about his or her feelings –Reflection: Rephrasing or repeating thoughts and feelings of the clients

10. Cybertherapy and Psychotherapy at a Distance -- * Media Psychologists: Radio, newspaper, and television psychologists; give advice, information, and social support, e.g., Dr. Phil (OK), Dr. Laura (bad) Telephone Therapists: 900 number therapists –May be nothing more than telephone operators who have never even taken a psychology course! (True in practice, too.)

11. Cybertherapy and Psychotherapy at a Distance Concluded (Continued) Cybertherapy: Internet therapists in chat rooms. –Patient/client can remain anonymous –Good if client can not drive a distance to a therapist or cannot leave the house (agoraphobic) –Cheaper than traditional psychotherapy

12. Behavior Therapy 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 Positive/negative Reinforcement and punishment

13. Behavior Therapy (Continued) 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 –E.g., Rapid Smoking: Prolonged smoking at a forced pace –Designed to cause aversion to smoking Response-Contingent Consequences –Reinforcement, punishment, or other consequences that are applied only when a certain response is made

14. Behavioral Therapies (Continued) -- *Systematic Desensitization –Hierarchy: Rank-ordered series of steps, amounts, levels, or degrees –Uses reciprocal Inhibition: One emotional state is used to block another (e.g., impossible to be anxious and relaxed at the same time)

15. Operant Therapies *Operant Conditioning: Learning based on consequences of making a response –-- *Shaping: Rewarding actions that are closer and closer approximations to a desired response –Stimulus Control: Controlling responses in the situation in which they occur –Time Out: Removing individual from a situation in which reinforcement occurs

16. Tokens Tokens: Symbolic rewards like poker chips or gold stars that can be exchanged for real rewards –Can be used to immediately reinforce positive responses –Effective in psychiatric hospitals and sheltered care facilities Target Behaviors: Actions or other behaviors a therapist seeks to change

17. Token Economy Patients get tokens for many socially desirable or productive behaviors; they can exchange tokens for tangible rewards and must pay tokens for undesirable behaviors

18. Cognitive Therapy -- Therapy that helps clients change thinking patterns that lead to problematic behaviors or emotions

19. Cognitive Therapy Therapy that helps clients change thinking patterns that lead to problematic behaviors or emotions Beck: Three Major Distortions in Thinking: –Selective Perception: Perceiving only certain stimuli in a larger array of possibilities –Overgeneralization: Blowing a single event out of proportion by extending it to a large number of unrelated situations –All-or-Nothing Thinking: Seeing objects and events as absolutely right or wrong, good or bad, and so on

20. Rational Emotive Behavior Therapy (REBT) 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.”

21. Group Therapy Psychodrama (Moreno): Clients act out personal conflicts and feelings with others who play supporting roles –Role Playing: Re-enacting significant life events –Role Reversal: Taking the part of another person to learn how he or she feels –Mirror Technique: Client observes another person re-enacting the client’s behavior

22. Family Therapy Family Therapy: All family members work as a group to resolve the problems of each family member –Tends to be brief and focuses on specific problems (e.g., specific fights) –Modality views problems experienced by one family member are the entire family’s problem

23. Group Awareness Training Sensitivity Groups: Group experience consisting of exercises designed to increase self-awareness and sensitivity to others Encounter Groups: Emphasize honest expression of feelings Large-Group Awareness Training: Increases self-awareness and facilitates constructive personal change -- Therapy Placebo Effect: Improvement is based on client’s belief that therapy will help

24. Basic Counseling Skills Active listening Clarify the problem Focus on feelings Avoid giving advice Accept the client’s frame of reference 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 14.3

26. *Medical (Somatic) Therapies Pharmacotherapy: Use of drugs to alleviate emotional disturbance; three classes: –Anxiolytics (Antianxiety): 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

27. Problems 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

28. Electroconvulsive Therapy -- *Electroconvulsive Therapy (ECT): Electric shock is passed through the brain inducing a convulsion; treatment for severe depression –Based on belief that seizure alleviates depression by altering brain chemistry Produces only temporary improvement Causes permanent memory loss in some patients Should only be used as a last resort Should be followed by antidepressant medications to further prevent relapse

29. *Psychosurgery 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

30. Hospitalization Mental Hospitalization: Involves placing a person in a protected, therapeutic environment staffed by mental health professionals Partial Hospitalization: Patients spend only part of their time in the hospital and go home at night Deinstitutionalization: Reduced use of full- time commitment to mental institutions

31. Half-Way Houses Short-term group living facilities for individuals making the transition from an institution (mental hospital, prison, etc.) to independent living

32. Community Mental Health Centers Offer many health services like prevention, education, therapy, and crisis intervention –Crisis Intervention: Skilled management of a psychological emergency Paraprofessional: Individual who works in a near-professional capacity under supervision of a more highly trained person

33. Other Therapy Options 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”)

34. Evaluating a Therapist: Danger Signals 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

35. Evaluating a Therapist: Questions to be Answered During the Initial Meeting Will the information I reveal in therapy remain confidential? What risks do I face if I begin therapy? How long do you expect treatment to last? What form of treatment do you expect to use? Are there alternatives to therapy that might help as much or more?