Lecture Ch 16 3v4856

Therapy Chapter 16

OVERVIEW  Psychotherapy  Evaluating

Therapeutic Outcome  Types of Therapy  Psychoanalytic  Humanistic  Behavioural  Cognitive  Biological

Therapy Comes in Many Forms LOBJ 16.1

 Many forms of treatment are available for

people experiencing psychological difficulties 2 Broad Types of Therapy:  Somatic therapy (biological) –  Drugs  ECT  Psychosurgery

 Psychotherapy  Various techniques of “talk” therapy

Video Clip from Abn Psy

Psychotherapy: Four Areas of Emphasis  Distorted

thoughts

 Disturbed

emotions (Inner Conflicts)

 Maladaptive

behaviours

 Interpersonal

and life situation difficulties

Common Themes Among Psychotherapies  Emotional

defusing

 Interpersonal

learning

 Self-knowledge  Therapy

as a step-by-step process

 Therapy

as socially accepted healing

Evaluating Therapeutic Outcome: Does

Placebo Effects  A placebo effect is a therapeutic change

that occurs as a result of a person’s expectations of change rather than as a result of any specific treatment.  Some patients in psychotherapy may

show relief from their symptoms simply because they are in therapy and may expect change

DOES PSYCHOTHERAPY WORK?  In a 1952 paper, Hans

Eysenck challenged the effectiveness of psychotherapy

 Eysenck claimed that

psychotherapy produced no greater change in maladjustment than natural life experiences

 He was WRONG!

Meta-Analyses of Therapy Outcome LOBJ 16.2  Meta-analysis

 Smith,

–

Glass, & Miller (1980) conducted the most comprehensive meta-analysis of psychotherapy outcome research

Types of Therapy Psychoanalysis/psychodynamic Behavioural Group Biological

Humanistic Cognitive

Psychoanalysis & Psychodynamic Therapies

Psychodynamic Therapies 



Psychoanalysis 

Developed by Freud



Insight oriented therapy



Uses free association, dream analysis, and transference



Considerable time/financial investment



Not commonly used today

Psychodynamically based therapies 

Insight oriented



Use techniques derived from Freud



Reject or modify parts of Freud’s theory



More common than psychoanalysis

Psychodynamic Therapies LOBJ 16.6

Assumptions of insight therapies: 

Becoming aware of your motivations will help you change and adapt  Unresolved conflict results in maladjustment 

Childhood



Sexual feelings



Aggression

Psychodynamic Therapies: Goal  Psychoanalytic

therapies attempt to help patients understand the unconscious motivations that direct their behavior

 Change

your perspective = better mental health

Psychodynamic Therapies: Techniques LOBJ 16.7…  free

association

 the

patient is asked to report whatever comes to mind, no matter how disorganized or trivial

Free association I feel like crying when … If I were rich … My mother… I feel happy…

Psychoanalytic Therapies: Techniques Dream analysis  Based

on idea that dreams are unconscious drives seeking expression

 “Dreams

are the royal road to the unconscious.” -- Sigmund Freud

Psychoanalytic Therapies: Techniques  Interpretation

context , meaning, or cause of a specific idea, feeling, set of behaviors  Defense

Mechanisms – signal areas that need to be explored

Psychoanalytic Therapies: Processes  Resistance

is unwillingness to cooperate on the part of the patient  Belligerence  Missing

appointments

 Refusal

to pay

It means you have hit on something big

Psychoanalytic Therapies: Processes 

Transference occurs when the therapist becomes the object of a patient’s emotional attitudes about an important person in the patient’s life * E.g. parent figure, spouse, boss



Countertransference refers to personal issues the therapist brings to professional issues with clients

Humanistic Therapies

Humanistic Therapies 

Goal is to remove constraints upon self-fulfillment



Emphasize the ability to reflect on conscious experience



Assume that humans have free will and are motivated to fulfill themselves



Focus on present and future

Client-Centered Therapy  Developed by Carl Rogers  The Role of the Therapist:

Video Clip of Rogers

 Description: insight therapy

that helps people evaluate the world and themselves from their own perspective

Client-Centered Therapy: Techniques 

The goal of clientcentered therapy is to help people discover the ideal self



In client-centered therapy, the therapist guides clients to help them find what they feel is right for themselves

Client-Centered Therapy: Techniques The therapist must demonstrate:  Unconditional positive regard

- be an accepting person who projects positive feelings towards client  Congruence

-being real or genuine; honest and aware of own feelings  Empathic listening

- sense how the client feels and communicate these feelings to the client

Behaviour Therapy Operant Conditioning Counterconditioning Modelling

Behaviour Therapy: Goals  Behaviour

therapy focuses on changing overt behaviour by using learning principles to help people replace maladaptive behaviours with more effective behaviours

Behaviour Therapy: A Criticism  Most insight therapists believe that if

only overt behaviour is treated, symptom substitution will occur  In symptom substitution, the client

substitutes a new symptom to replace the treated one  E.g. I did have an nervous twitch, now I

clear my throat constantly.  Research does show that behaviour

therapy is at least as effective as insight therapies

Not necessarily True.

Behaviour Therapy: Procedures 

Behaviour therapy involves three general procedures: 1) Examining the problem behavior and its frequency

2) Developing an individually tailored strategy

treatment

3) Continually assessing whether or not the behaviour has changed.

Behavior Therapy: Operant Conditioning  Uses reinforcers to establish

desired behaviours

 Reinforcer =

something that INCREASES the likelihood of a target behavior

Operant Conditioning: Examples 

Token economy A system based on positive reinforcement in which people who display appropriate behaviours receive tokens

 Time-out

- removal from source of reinforcement - Use it with positive reinforcers

Counterconditioning  Counterconditioning:  Based

on classical conditioning

 Person

is taught a new, more adaptive response to a stimulus

 Two

types of counterconditioning:  Systematic  Aversive

desensitization

e.g., replace anxiety with Relaxation in response to The provoking stimulus/

Systematic Desensitization  Gradually replacing an

undesirable response (e.g. anxiety) with a desirable one (e.g. relaxation)

 Client is taught relaxation

strategies, and once relaxed is exposed to progressively stronger anxiety-provoking stimuli.

 Two phases:  In imagination  In vivo

Aversive Conditioning A

noxious stimulus is paired with a stimulus that elicits an undesirable behaviour

COGNITIVE THERAPY Rational-Emotive Therapy Approach

Beck’s

Cognitive Therapy Assumption: Wrong, distorted, or underdeveloped ideas and thoughts may prevent a person from developing effective coping skills. Focus: Changing thoughts and perceptions will change behavior.

Cognitive Therapy

Cognitive Therapy Propositions: 1. Cognitions affect behaviour 2.

Cognitions can be monitored

3.

By changing cognitions, we can change behaviour

Rational Emotive Therapy 

best known cognitive therapy developed by Albert Ellis



emphasizes the importance of logical, rational thought processes



assumed abnormal behaviour is caused by faulty and irrational thinking patterns



“What disturbs people’s minds is not events but their judgements on events”….Epictectus, 100 A.D.

Table 16.4, pg.598

Biological Therapies Pharmaceutical

Drug Therapy  No

drug will permanently cure the maladjustment of people who are not coping well

 Psychotropic

drugs: drugs given to relieve mental problems

Drug Therapy

Antianxiety Drugs  Anxiolytics  Mood-altering

 e.g.

–

reduce stress, increase calm, induce sleep  neurotransmitter

(GABA)

Librium, Xanax, and Valium:

 Long-term

use without adjunct therapy illadvised

Antidepressants 

Thymoleptics



Elevate mood, alter levels of brain chemicals



Common Side Effects: headache, nausea, weight gain, decreased sex drive



Types: Selective Serotonin Reuptake Inhibitors – SSRI’s (e.g. Prozac, Zoloft, Paxil) & SNRI’s (Effexor)

Antimania Drugs 

Lithium carbonate has long been used as an effective antimania drug



Thymoleptic



Importance of dosage – too much has negative side effects; too little = no effect



Side Effects

Antipsychotic Drugs  neuroleptics

 Phenothiazine

(e.g. Thorazine)  Treat

Schizophrenia

 Issues:

not helpful for all symptoms, side effects

 Reduce

hostility, aggression, and delusions

 Neurotransmitter

Dopamine

 Tardive

-

dyskinesia

Psychosurgery  Psychosurgery:

brain surgery

 Prefrontal

Lobotomy: removal of parts of the brain’s frontal lobes thought to alleviate symptoms of mental disorders done in the 1940s and 50s

 Prefrontal

lobotomies made some people become unnaturally calm and completely unemotional

Electroconvulsive Therapy Electroconvulsive therapy (ECT) o

An electric current is briefly applied to the head to produce a generalized seizure (convulsion)

 was

once widely employed with depressed people

 Today,

ECT is not a widely used therapy