Transcript Psychological Therapies - School District of Cambridge

Mental Health Treatment
Today
Q: How many therapists
does it take to change a
light bulb?
Psychotherapy
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Psychotherapy: refers to a broad range of
techniques designed to address problems of
psychological functioning and improve an individual’s
personal and social adjustment.
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It involves an interaction between a trained therapist and
someone suffering from psychological difficulties.
There are several different types of
psychotherapy, based on different theories of
human nature:
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Psychoanalysis/Psychodynamic Therapy
Behavioral Therapies
Cognitive Therapies
Humanistic Therapies
Group, Family, or Couples Therapy
Eclectic Approach
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The most popular form of therapy – it’s
basically a smorgasbord where the therapist
combines techniques from different schools
of psychology.
Psychoanalytic/Psychodynamic
Therapy
Emphasizes the recovery
of __________ conflicts,
motives, and defenses
through a variety of
techniques.
Psychoanalysis/Psychodynamic
Therapy
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This is an example of an insight therapy – insight therapies
involve verbal interactions intended to enhance clients’ selfknowledge and thus promote healthful changes in
personality and behavior.
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With psychoanalysis or psychodynamic
therapy, treatment is designed to help
the patient bring unconscious
material to awareness, where it can be
dealt with.
Similarities
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Both psychoanalysis and psychodynamic therapies:
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Use free association, which encourages the patient to talk
without focusing on the analyst’s reaction. Patients report
whatever thoughts, memories, or images come to mind,
with as little censorship as possible. In the course of free
association, unconscious or repressed feelings, thoughts,
and memories should surface. It is the analyst’s job to
look for these clues about what is going on in the
unconscious.
May involve transference, where the patients
unconsciously start relating to their therapist in ways
that mimic critical relationships in their lives. When the
analyst points it out, it can provide valuable information for
the patient’s self-understanding.
Similarities, cont.
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Use dream analysis, which involves the therapist
interpreting the symbolic meaning (latent content) of the
client’s dreams. Freud called dreams the “royal road to the
unconscious.“
May involve resistance, which refers to the largely
unconscious defensive maneuvers intended to hinder the
progress of therapy.
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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.
Use interpretation, which refers to the therapist’s
attempts to explain the inner significance of the client’s
thoughts, feelings, memories, and behaviors in order to
bring the unconscious thoughts or feelings to a
conscious level.
Differences
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Psychoanalysis:
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Not commonly practiced
Meet with patient 4-5 times a week for 2 years or more;
therefore, it is costly and impractical for most
Patient lies on a couch, not looking at the analyst
Psychodynamic Therapy:
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More common
Meet with patient much less often – once or twice a week
sessions for a few months
The therapist may not use the “couch” (often face-to-face)
They focus more on current issues instead of simply what
happened in the past. (Although, they do still place focus on
learning about a patient’s childhood experiences, unconscious
drives, and unresolved conflicts).
Behavioral Therapy
Classical Conditioning (Exposure
Therapy, Aversive Conditioning)
and
Operant Conditioning (Behavior
Modification and Token
Economies)
Behavioral Therapies
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Behavior therapy applies learning principles
(classical conditioning and operant conditioning) to
the elimination of unwanted behaviors.
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Instead of trying to trace a fear of dogs to some unresolved
childhood conflict (like a psychoanalyst)
A behaviorist would instead focus on the present by
attempting to replace your fearful thoughts and related
behaviors with constructive, relaxing thoughts and
actions.
The behaviors are the problems, so we
must change the behaviors.
Psychoanalytic Therapist vs.
Behavioral Therapist
Classical Conditioning Techniques
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Remember, classical conditioning is a type of
learning in which we associate two things that
occur together (remember John B. Watson?)
So if we can learn fears, can we unlearn them?
In some cases, yes – through
counterconditioning (a behavioral therapy that
conditions new responses to stimuli that
trigger unwanted behaviors).
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There are two commonly used types of
counterconditioning: exposure therapy and aversive
conditioning.
Exposure therapy with
an elevator phobia
Exposure Therapy
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Expose patients to things they
fear and avoid.
Through repeated exposures,
anxiety lessens because they
habituate to the things feared. If
they’re no longer allowed to
avoid the stimulus, they will
gradually become desensitized
to it.
If the client learns to tolerate the
feared object or situation through
exposure to a high level of that
stimulus, it is termed flooding.
Systematic Desensitization
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Joseph Wolpe (1958) pioneered this specific type of
exposure therapy.
Systematic desensitization associates a pleasant,
relaxed state (called progressive relaxation) with
gradually increasing, anxiety-triggering stimuli.
If you can repeatedly relax when faced with
higher and higher levels of the anxiety-producing
stimulus, you will gradually overcome your
problem.
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The basic idea is that you cannot be anxious and relaxed
at the same time.
Research shows that this technique is very effective in
treating phobias.
Example of Systematic Desensitization
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Fear of flying:
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Write down a hierarchy of anxiety-triggering flying
situations. The ideas about flying that cause you the most
anxiety are at the top of the list, and they gradually
decrease as you move down the list.
Practice progressive relaxation – start with the bottom item
on your list, and try to maintain a sense of relaxation while
thinking about this scenario. You continue the process until
you can think about it and still maintain your relaxed state.
Next, you move on to the next item on your hierarchy, and
continue until you reach the top of your list.
After several therapy sessions, thoughts and photos are
replaced by experience, beginning with somewhat easy
tasks like watching planes land. Eventually, you move to
more difficult tasks (like boarding the plane) until your fear is
gone.
Systematic Desensitization
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Instructor’s Notes
Copyright © Houghton Mifflin Company. All rights reserved.
Aversive Conditioning
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Aversion therapy is the most controversial
of the behavior therapies.
Purposefully associates an unpleasant
state (such as a bitter-tasting nail polish)
with an unwanted behavior (such as biting
one’s nails).
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This process is the opposite of systematic
desensitization. Here, you replace a positive
response to a harmful experience with a negative
(aversive) response.
Examples of Aversive
Conditioning
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Alcoholism:
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Antabuse is a drug therapy for alcoholics. Here,
the addict can drink anything he wants, but every
time, a tasteless, odorless drug is mixed in with it
that causes severe nausea and vomiting.
Over time, the addict will associate this negative
response with the alcohol, and stop wanting it.
In one study, 63% of people treated with this
method were still abstaining from alcohol one
year later. Unfortunately, only 33% of them were
successfully abstaining from alcohol after 3 years.
Why might that be?
Examples of Aversive Conditioning
(cont.)
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Read the ABC News article “’Shocking’
School Takes on Severe Autism: A Painful
Treatment Inspires Controversy”
(http://abcnews.go.com/Primetime/Story?id=
2887677&page=1)
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What do you think about aversive conditioning
being used in this sense?
Operant Conditioning Techniques
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This technique uses the idea of rewarding desired
behaviors, and withholding rewards for
unwanted behaviors or punishing them.
Therapists shape behavior by reinforcing small
steps in the right direction.
Treatments aim to encourage patients to voluntarily
reduce their maladaptive behaviors and replace
them with more constructive and healthy ones.
Two types of operant conditioning techniques are
behavior modification and token economy.
Behavior Modification
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Involves identifying one or more specific
target behaviors that need to be increased
or eliminated and providing reinforcers
accordingly.
Eventually, as the behavior becomes
habitual, the reinforcers are decreased in
frequency.
Example of Behavior Modification
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In one two year study, 19 uncommunicative,
withdrawn 3-year-olds with autism underwent
behavior modification techniques.
Parents worked 40 hours a week
reinforcing appropriate or desired
behavior while ignoring or punishing selfabusive and aggressive behaviors.
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9 of the 19 became successfully functioning first
graders with normal intelligence.
Token Economy
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It is called a token economy because it rewards
desired behaviors with some kind of token.
Patients (or inmates) earn the tokens by
behaving appropriately, then exchange them
for simple things like candy, or privileges like
watching TV.
This has been successful with day-care centers,
delinquent teens, schools, hospitals, and even
private homes.
What are the downsides to operant
conditioning techniques?
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What happens after a person is no longer
reinforced for proper behavior?
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People who leave an institution will not receive tokens
for getting out of bed on time.
Doctors remedy this by trying to gradually shift
patients away from external rewards to internal
ones (satisfaction, pride, etc.)
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Is this ethical?
Is it right to deprive someone of a privilege, television,
or dessert in order to obtain a desired behavior?
Or is this process too controlling?
Cognitive Therapy
Rational-Emotive
Therapy and CognitiveBehavior Therapy
Cognitive Therapies
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Cognition is _________, and cognitive
therapies are designed to change the
patient’s thoughts.
The underlying theory here is that it is the
way a person thinks about the situation,
not the actual situation, that is the main
cause of poor adjustment and distress.
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The two major types of cognitive therapies are
Rational-emotive therapy (RET) and Cognitivebehavior therapy (CBT).
Rational-emotive therapy (RET)
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This was developed in the 1950s by Albert Ellis.
He believed that irrational thoughts lead to
negative emotions and that controlling and
changing such thoughts is the key to better
mental health.
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Patient identifies unrealistic and self-defeating
thoughts.
Therapist uses suggestions, logic, and
encouragement to help the client replace such
thoughts with more realistic and beneficial ones.
Example of rationalemotive therapy
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Before RET:
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“I lost my job because I’m worthless. I’m awful at
everything I do and I’ll never be successful.”
After RET:
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“I lost my job because they had to make budget
cuts as a result of the bad economy. I was a hard
worker and I did my best. Employers will
recognize my efforts and I will find a new job –
probably even a better one than the one I lost.”
Aaron Beck’s Theory
of Depression
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In 1976, Aaron Beck proposed that depression and
other mood disorders result primarily from
negative self-talk and the distorted perceptions
of self that result from it.
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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.
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Used cognitive therapy get people to take off the “dark
sunglasses” in which they view their surroundings
Cognitive-behavior therapy
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CBT, another insight therapy, combines cognitive
therapy (changing self-defeating thoughts) with
behavior therapy (changing inappropriate
behaviors).
With this therapy, people become aware of their
irrationally negative thoughts, and are taught to
practice a better everyday approach by changing
those thoughts and letting the new thoughts
guide their behavior.
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Patients are also given behavioral “homework
assignments” that focus on changing overt behaviors.
Example of cognitive-behavior therapy
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Before CBT:
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Changing thoughts:
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“I may not be able to do everything, but I can still help out
around the house in a worthwhile way.”
“Homework” assignment from therapist:
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“I’m no good around the house.”
Tasks such as cleaning out the basement, getting advice on
hanging a picture, or cutting the grass.
After CBT:
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Success at accomplishing even one of the homework tasks
provides concrete evidence to challenge a false belief,
thus helping to reduce it.
Humanistic Therapy
Humanistic
Therapies
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To a humanistic therapist, the potential for
self-fulfillment already exists in each one
of us.
This therapy promotes self-fulfillment by
increasing self-acceptance and selfawareness.
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Carl Rogers developed the most famous form of
humanistic therapy, sometimes referred to as
“client-centered therapy.”
Client-Centered
Therapy
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Client-centered therapy is an insight therapy that emphasizes
providing a supportive emotional climate for clients, who
play a major role in determining the pace and direction of their
therapy.
Rogers maintained that most personal distress is due to
incongruence between a person’s self-concept and reality.
The goal of therapy involves helping people restructure their
self-concept to correspond better to reality.
Rogers held that there are 3 main elements to creating this
atmosphere:
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Genuineness, or the therapist being completely honest and
spontaneous with the client
Unconditional positive regard, or a complete nonjudgmental
acceptance of the client as a person
Empathy, an understanding of the client’s point of view.
Characteristics of Humanistic Therapy
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Treatment is an encounter between equals, fostering
growth; not a “cure” given by an expert. This is why
“patient” is often changed to “client” by humanistic
therapists.
Focuses of people’s potential for self-fulfillment (selfactualization).
Focus is on the present and future instead of the past.
Take responsibility for your actions, instead of blaming
childhood anxieties.
Use of nondirective methods – therapists listen without
interpreting and do not direct clients to any particular
insight.
The client should feel unconditional positive regard: a
feeling of being accepted by the therapist, not depending on
any specific behaviors.
Characteristics of Humanistic Therapy,
cont.
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Uses active listening:
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Paraphrasing – uses the words of the
client to summarize the conversation.
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Clarifying – encourage clients to say
more by asking questions like:
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“Could you give me an example of what
you’re saying?”
Reflecting feelings – The therapist
mirrors the feelings of the client with
statements like
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“That must really be frustrating.”
Group, Family, and Couples
Therapy
Group, Family, and Couples Therapy
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The one-to-one methods
of psychodynamic,
humanistic, and
behavioral treatment we
have discussed are often
adapted for use with
groups of clients or
family units.
Group therapy
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Many groups are organized around:
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one type of problem (such as alcoholism)
one type of client (such as adolescents)
In most cases, 6-12 clients meet with their
therapist at least once a week for about 2
hours.
All members of the group agree to hold
confidential everything that occurs within
group sessions.
Benefits to group
therapy
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Allows the therapists to observe the clients interacting with
one another.
Groups encourage the members to talk about themselves
and explore their feelings.
It can help more people and costs less to the client/patient.
Clients feel less alone because they realize that other people
are struggling with difficulties at least as severe as their own.
Group members can boost one another’s self-confidence and
self-acceptance as they come to trust and value one
another.
Clients learn from one another by sharing ideas for
improvement and giving honest feedback.
Allows clients to try out new skills in a supportive
environment.
Family therapy
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Involves treatment of two or more individuals
from the same family.
This format gives the psychologist an excellent view
of how the initially identified client interacts with
others, thus providing a basis for discussion of topics
important to each family member.
The goal of family therapy is not just to ease the
identified client’s problems, but to create greater
balance and harmony within the family by
helping each member understand family
interaction patterns and the problems they
create.
Couples therapy
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Discussion typically focuses on identifying
and improving the miscommunication or
lack of communication that is interfering
with the couples’ happiness and intimacy.
Therapy helps the couple to express their
emotions more honestly and to be more
accepting of one another.
Sometimes it offers preventive treatment to
couples who are at risk for relationship
problems.
What kind of therapy do most
psychologists use?
Recap
Table 15.1
Myers: Psychology, Ninth Edition
Copyright © 2010 by Worth Publishers