Transcript Therapy

Myers’ PSYCHOLOGY
(7th Ed)
Chapter 17
Therapy
James A. McCubbin, PhD
Clemson University
Worth Publishers
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History of Treatment: Changed w/ Philippe
Pinel in Paris (1793) released patients from
chains..)
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Ch. 17:
Therapy….terms, types of therapy:
 Psychotherapy
 an emotionally charged, confiding interaction
between a trained therapist and someone who
suffers from psychological difficulties
 Eclectic Approach
 an approach to psychotherapy that, depending on
the client’s problems, uses techniques from various
forms of therapy… some of this…some of that…
Psychoanalysis: Freud’s system…
 Freud believed the patient’s free associations,
resistances, dreams, and transferences – and the
therapist’s interpretations of them – released
previously repressed feelings, allowing the patient to
gain self-insight
 use has rapidly decreased in recent years partly b/c
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of the time involved…& the $$ involved (insurance)
Therapy- Psychoanalysis: (Freud, et al.)
 Resistance: “I don’t want to know!”
 blocking from consciousness of anxiety-laden
material…refusing to accept therapist’s
interpretations
 Interpretation
 the analyst’s noting supposed dream meanings,
resistances, and other significant behaviors in order
to promote insight…stuff therapist notes
 Patient uses defense mechanisms; therapist ID’s these
 Free association, dream analysis, hypnosis = routes to
unconscious
 Transference: patient transfers to the analyst of
emotions linked w/ other relationships:
EX: love or hatred for a parent is aimed at therapist4
Humanistic Therapy: Carl Rogers
Client-Centered Therapy: humanistic therapy was
developed by C. Rogers
 therapist uses techniques such as active listening
within a genuine, accepting, empathic environment
to facilitate clients’ growth.. partners in therapy
Unconditional Positive Regard: Like parents, therapist
should view clients this way, accepting the way that
person is…
Active Listening- empathic listening in which the
listener a) echoes b) restates c) clarifies client’s
words
Therapist should be “like a mirror,” reflecting the person’s
thoughts & ideas so they can see self clearly
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Both psychoanalytic & humanistic = “insight therapies”
The major differences: Humanists focus more on…
 …the present & future instead of the past. Don’t try to look for
childhood origin of feelings
 …conscious rather than unconscious thoughts
 …taking immediate responsibility for our feelings & actions, not
looking for hidden reasons…
 …promoting growth instead of “curing illness”…so they are
“clients” not “patients…
 ..H. =
“Brief
therapy”
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Behavior Therapy: therapy that applies learning
principles to the elimination of unwanted behaviors
Counter-conditioning (Mary Cover Jones)
 procedure that conditions new responses to stimuli
that trigger unwanted behaviors
 based on classical conditioning
 includes systematic desensitization & aversive
conditioning
 Systematic Desensitization (Joseph Wolpe)
 type of counter-conditioning
 associates a pleasant, relaxed state with gradually
increasing anxiety-triggering stimuli
 commonly used to treat phobias
 Aversive Conditioning
 type of counter-conditioning that associates an
unpleasant state with an unwanted behavior
 nausea ---> alcohol
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Behavior Therapy
Exposure Therapy
(also…Virtual reality Exposure Therapy)
 treat anxieties by exposing people (in imagination
or reality) to the things they fear and avoid
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Types of exposure therapy:
Critical difference: rate/type of exposure.
Flooding is a type of exposure, such as dropping you
into the snake pit if you are scared of snakes and you
come out alive (hopefully) and realize that your fear
was not so rational.
Systematic desensitization is a kinder gentler way of
exposure in gradual increasing degrees of difficulty
(picture of a snake, touching a snake, holding a snake,
etc) up a hierarchy.
Aversion: Classically condition to cause someone to
avoid something.
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Behavior Therapy
 Systematic Desensitization
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Behavior Therapy
 Aversion
therapy for
alcoholics
 Anabuse:
drug that
creates
nausea in
anyone who
drinks w/in
1-2 weeks
of ingesting
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Behavior Therapy:
Know the various methods
 Systematic desensensitization
 Aversive therapy
 Token Economy
 an operant conditioning procedure that
rewards desired behavior
 patient exchanges a token of some sort, earned for
exhibiting the desired behavior, for various
privileges or treats
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Cognitive Therapy
 teaches people new, more adaptive ways of thinking &
acting (“retrains” thinking)
 based on the assumption that thoughts intervene
between events and our emotional reactions
 Think calm thoughts = calm person
 Aaron Beck, originally a Freudian, was a major force in
this, especially in treating depression (late 70’s)
 R.E.B.T.(aka R.B.T.): Rational Emotive Behavioral
Therapy:
Albert Ellis: designed to help ppl focus on a rational,
logical way to look at dealing with problems &
disappointments
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Cognitive Therapy: Often combined w/
drug therapy and/or behavioral therapy
The Cognitive
Revolution:
Which
psychologist
began this
type of
therapy?
An associate of his
developed a
related therapy—
Who?
What therapy?
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Cognitive Therapy
 A cognitive
perspective on
psychological
disorders:
The way ppl tend
to view a
situation as…..
 Stable…
”It’ll stay the
same…& never
get better…”
 Global:
“….it’s
everything…”
 Internal:
“…And it is all my
fault…”
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Cognitive Therapy:
Evaluating the effectiveness of cognitive therapy:
 Effectiveness
of Beck’s
Cognitive
therapy for
depression
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 Cognitive-Behavioral Therapy (CBT)
 A very popular integrated therapy that combines
cognitive therapy (changing self-defeating thinking) w/
behavior therapy (changing behavior)
 Especially helpful for anxiety disorders & for mood
disorders
 Also can be coupled w/ chemotherapy (drug-therapy)
WHAT do you call this…when you use a variety of
methods in treatments…instead of one single
technique?
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Group & Family Therapies
 Group therapy: individuals who share same types of
disorders & who interact w/ each other to help come up
w/ solutions to each others issues
-groups are led by a trained therapist (usually psychologist)
Not the same thing as a “support group” in which people
share a problem such as a specific disease, divorce,
grief, etc.; these are not always led by trained
therapists
--can be less expensive than individual therapy
 Family therapy: often led by psychological
counselors, not clinical psychologists
 treats the family as a system
 views an individual’s unwanted behaviors as
influenced by or directed at other family members
 attempts to guide family members toward positive
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relationships and improved communication
Evaluating Psychotherapies:
Any difference? PATIENTS VS CLIENTS??
Which call ppl “patients?” Which “clients?”
 To whom do
people turn for
help for
psychological
difficulties?
 Med. doctors are
often the 1st
person someone
will turn to for help
with mental
disorders
 They will often
then refer to MHS
if needed
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Evaluating Psychotherapies: How good is it?
How ppl respond when asked “Does therapy help?”
Remember that psy’s try to be cautious in accepting date too
quickly…They try to evaluate scientifically:
 Regression toward the mean (avg.) (ch. 1)
 tendency for extremes of unusual scores to fall back
(regress) toward their average
 Basically, things average out…& hi’s & lo’s blend…
 Placebo effect:
Ppl’s tendency to justify therapy: Clients/patients’ want to
feel their therapist has helped.. “It was NOT a waste of time!”
Regression toward the mean can confuse this b/c extreme
behaviors tend to drift back to the mid-point anyway…
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Evaluating Therapies:
Meta-analysis: procedure for statistically combining the
results of many different research studies…
-look at a lot of studies & come up w/ basic finding from these
With this, we can see a better pic RE: what helps…
Number of
persons
Average
untreated
person
Poor outcome
80% of untreated people have poorer
outcomes than average treated person
Average
psychotherapy
client
Good outcome
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Evaluating Alternative Therapies vs. a more
“valid” behavioral therapy:
What’s in scientific journal articles…& what’s
mainly just on the Web??
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Therapists, mental health workers, & their Training
 Clinical = working in a clinic, seeing clients/patients (generally
out-patient)
 Clinical or Psychiatric Social Worker
 A two-year Master of Social Work graduate program +
postgrad. supervision prepares some social workers to offer
psychotherapy, mostly to people with everyday personal and
family problems
 About half have earned the National Association of Social
Workers’ designation of clinical social worker
 Clinical psychologists
 Most are psychologists with a Ph.D. & expertise in research,
assessment, & therapy, supplemented by a supervised internship
 About half work in agencies & institutions, half in private practice
(EX: Beckman; Cornerstone)
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Psychotherapists & their Training
 Counselors: Have or working toward MS
 Marriage & family counselors specialize in problems arising from
family relations
“Pastoral counselors” provide counseling to people,
but tend to have a more religious perspective
 Abuse counselors work with (usually MS)
--substance abusers (substance abuse disorder)
--spouse & child abusers
--the victims of spousal abuse or child abuse
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 Psychiatrists
 Physicians (M.D.) who specialize in the treatment of
psychological disorders
 Not all psychiatrists have had extensive training in
psychotherapy, but as M.D.s they can prescribe
medications.
Thus, they tend to see those with the most serious
problems
(they see more “in-patients”)
 Many have a private practice
Some psychiatrists today do use interpersonal
psychodynamic therapy: from Freud…but is a brief
psychotherapy: targets problems more, childhood
issues “hidden desires” less…
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A newer therapy that shows promise:
Light exposure therapy: Using a special type if light, having client
sit under the light for specified amts. of time
Has been tested at varying times of day:
Results:
Morning light 61% improved w/ AM light vs. 50% PM light
32% placebo (“hissing negative ion generator”)
So does show “statistical significance” (i.e., seems to indicate that it
helps)
Disorders that this has helped:
SAD (Seasonal Affective Disorder: Depression related to
seasons, specifically winter…Lack of light?
ALSO: Newer: PTSD (an anxiety disorder): indications are it
helps especially if paired with antidepressants
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Commonalities Among Psychotherapies
Hope for demoralized people
A new perspective
An empathic,
caring relationship
But… could it be
Psychotherapy
& CONFIRMATION
BIAS?
trusting,
Types of Therapists
The Relative Effectiveness of Different
Therapies
Evidence-based practice
Biomedical Therapies
 Diagnostic labeling: Using the DSM-IV-TR to diagnose a
patient …in order to proceed w/ possible therapy (or therapies)
But does this “labeling” cause client & others to see him/her
that way?
 Psychopharmacology
 study of effects of drugs on mind & behavior
 New & more effective drugs therapies have been added
 schiz., depression, anxiety, all are treated now more
effectively w/ drugs
Anti-anxiety drugs: Used to treat anxiety disorders
EX’s: Xanax, Valium, Tranzene (used to be barbiturates…)
now use benzodiazepines
These treat SYMPTOMS after they occur…don’t keep the
anxiety from occuring…unless taken all the time, which can
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interfere with functioning…
Anti-depressants:
Used to treat depression
**SSRI’s EX’s: Prozac, Celexa, Wellbutrin, Paxil, Zoloft, etc
SSRI’s: Selective Serotonin Re-uptake inhibitor:
-recycles, cleans up “spilled” serotonin at receptor sites &
helps use it all more effectively
**tricyclics: EX: Elavil (still used, but has not shown results
as strong as antidepressants)
**MAO inhibitors: not used much anymore (due to major
side-effects—interactions w/ some aged cheeses, red wines, etc.)
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Anti-psychotic drugs:
-used to treat schizophrenia but also helpful for some
symptoms of bipolar, etc.
EX: old: Thorazine was a standard;
-could cause tics, jerks, strange facial contortions
(known as Tardive’s Dyskinesia)
Newer anti-psyc. drugs (less side effects): Clozapine,
Zyprexa
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Treating Bipolar Disorder
Lithium
 chemical that provides an effective drug therapy for
the mood swings of bipolar (manic-depressive)
disorders
 Hard to prescribe b/c you must be very careful RE:
amounts
--too little will not help much
--too much can be life threatening…
Newer: Depakote…very effective...and Abilify
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Biomedical Therapies The emptying
of U.S. mental hospitals
 Many ended up homeless “street-people” b/c of their
inability to function well, but no $$ for hospitalization
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Biomedical Therapies: SSRI’s… serotonin
selective re-uptake inhibitors
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Biomedical Therapies: Dramatic rise
in antidepressant use:
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Biomedical Therapies
 Electroconvulsive Therapy (ECT)
 therapy for almost exclusively for severely depressed patients in which a
brief electric current is sent through the brain of an anesthetized patient
 a.k.a. “shock therapy”
 Has negative effect on memory, but NOT major
 Used as last ditch effort to control major depr.
Psychosurgery
 Lobotomy (prefrontal lob.)
 surgery that removes or destroys brain tissue in an effort to change
behavior
 now-rare psychosurgical procedure once used to calm
uncontrollably emotional or violent patients
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Brain Stimulation
Alternative
Neurostimulation Therapies
Magnetic Stimulation:
repetitive transcranial
magnetic stimulation
(rTMS) has been tested
as a treatment tool for
various neurological &
psychiatric disorders
including migraines,
strokes, Parkinson's
disease, tinnitus,
depression, and auditory
hallucinations.
Deep Brain Stimulation: A psychosurgery…
Planting an electrode into brain to treat extreme, debilitating OCD
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Electroconvulsive
Therapy:
Used to use major
shocks
Now very mild
Used for
depression when
other things have
not worked…
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Mind-Body Interaction:
mind  body  mind  etc…
 Relates to the biopsychosocial view
Ex: experiencing an attack…you begin to think of it over &
over…& you have an overactive fear response (from what
part of the body?)…This could cause which disorder?
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Therapeutic Life-Style Change
Integrated biopsychosocial system
Therapeutic life-style change
Aerobic exercise
Adequate sleep
Light exposure
Social connection
Anti-rumination
Nutritional supplements
Stroke: S-T-R + tongue!
S- Ask him/her to SMILE.
T -Ask him to TALK &
speak a clear
Sentence
R –Ask him to
RAISE
both arms
Trouble with ANY 1
of these ? call 911
Immediately &
describe symptoms
NOTE: A newer 'sign':
“stick out his tongue.”
'crooked', if it
goes to one side
or the other can be
a stroke.
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