Transcript Psychotherapies - Grand Haven Area Public Schools

Psychotherapies
2 Types of Therapy
• Psychotherapy—use of psychological
techniques to treat emotional, behavioral,
and interpersonal problems
• Biomedical—use of medications and other
medical therapies to treat the symptoms
associated with psychological disorders
Psychotherapy
• A planned, emotionally charged,
confiding interaction between a
trained therapist and someone who
suffers from psychological difficulties
• There are over 250 different types of
therapy.
Four Types of Psychotherapy
• Most therapies can be divided into:
– Psychoanalytic
– Humanistic
– Behavioral
– Cognitive
Eclectic Approach
• An approach to psychotherapy that,
depending on the person’s problems,
uses techniques from multiple forms
of therapy
• Carefully tailor the therapy
approach to the problems and
characteristics of the person
seeking help
Psychoanalysis
Psychoanalysis
Developed by Sigmund Freud based on his
theory of personality
Freud’s Office
Psychoanalysis
• Freud’s therapeutic
technique that
attributes one’s
thoughts and actions
to unconscious
motives and conflicts
Psychoanalysis Assumptions
• Psychological problems are the result
of repressed conflicts and impulses
from childhood.
• The therapist must bring the repressed
problems into the conscious mind to
help patients have an insight about the
original cause of the problem.
Causes of Psychological Problems
• Undesirable urges and conflicts are
“repressed” or pushed to the unconscious
• Unconscious conflicts exert influence on
behaviors, emotions, and interpersonal
dynamics
• Understanding and insight into repressed
conflicts leads to recognition and resolution
Psychoanalytic
Methods
Free Association
• Freudian technique of discovering the
unconscious mind--where the patient
relaxes and says whatever comes to
mind, no matter how trivial or
embarrassing
• A way of revealing unconscious
thoughts and emotions
Resistance
• Unconscious attempts to block the
revelation of repressed memories
and conflicts.
Interpretation
• A technique in which the psychoanalyst
offers a carefully timed explanation of
the unconscious meaning of the
patient’s behavior, thoughts, feelings, or
dreams to facilitate the recognition of
unconscious conflicts or motivations
• Dream Interpretation - Manifest content
of dreams is analyzed for disguised or
symbolic wishes, meanings, and
motivations (latent content)
– Freud considered dreams to be the “royal road
to the unconscious”
Transference
• Patient’s transfer to the analyst of
emotions linked with other
relationships
• The patient projects feeling from the
past to the therapist.
Using Psychoanalysis
• All these psychoanalytic techniques are
designed to help the patient achieve
insight into how past conflicts influence
her current behavior and relationships
and then replace maladaptive behavior
patterns with adaptive ones.
• On average, the traditional
psychoanalyst sees the patient four or
five times a week over the course of
Psychoanalytic Influence
• Few therapists follow strict Freudian
therapy.
• Heavily influenced other types of
therapy (interpersonal therapy)
• Modern approach is the
psychodynamic perspective
The Psychodynamic
Perspective
Psychodynamic Approach
• A more modern view that retains some
aspects of Freudian theory but rejects
other aspects
• Retains the importance of the
unconscious mind
• Less emphasis on unresolved
childhood conflicts
Common Features of Short-Term
Dynamic Therapies
• Most therapies today are shorter-term
• Patients’ problems are quickly assessed at the
beginning of therapy.
• Based on goals that are specific and attainable
• Therapists are more directive than traditional
psychoanalysis
• Therapist uses interpretations to help the patient
recognize hidden feelings and transferences that
may be occurring in important relationships in her
life
• Therapy focuses on helping the patient identify
psychological resources that she can use to cope
with the current difficulty as well as with future
Interpersonal Therapy (IPT)
• Influential short-term psychodynamic therapy,
focuses on current relationships and social
interactions and is highly structured
• 4 categories of personal problems:
–
–
–
–
unresolved grief
role disputes
role transitions
interpersonal deficits
• 1st phase of treatment, the therapist identifies the
interpersonal problem that is causing difficulties
• Next phase, the therapist helps the person
understand his or her particular interpersonal
problem and develop strategies to resolve it
Humanistic Therapies
Humanistic Therapies
• Humanistic perspective emphasizes
human potential, self-awareness, and freewill
• Humanistic therapies focus on selfperception and individual’s conscious
thoughts and perceptions
• Client-centered (or person-centered)
therapy is the most common form of
humanistic therapy
• Carl Rogers (1902–1987)—developed this
technique
Nondirective Client-Centered Therapy
• Therapist listens without interpreting and
does not direct the client (patient) to any
particular insight.
• Therapist must not make decisions for
the client, offer solutions, or pass
judgment on the client’s thoughts or
feelings.
• Rogers deliberately used the word
client rather than patient to avoid the
idea that the person was “sick” and
could be “cured”
Client-Centered Therapy
• Therapist uses techniques such as active
listening within a genuine, accepting,
empathic environment to facilitate the
client’s growth. The therapy stresses:
– Empathy
– Acceptance
– Genuineness
Therapeutic Conditions
• Genuineness—therapist openly shares
thoughts without defensiveness
• Unconditional positive regard for client—
no conditions on acceptance of person
• Empathetic understanding—creates a
psychological mirror reflecting clients
thoughts and feelings
Active Listening
• Empathic listening in which the
listener echoes, restates and clarifies.
Active Listening Characteristics
• Active listening entails:
– Paraphrasing: uses the words of the
client to summarize the conversation
– Clarifying: encouraging the client to say
more by asking leading questions
– Reflecting feelings: mirrors the feelings
of the client
The Results of Good Humanistic
Therapy
• Rogers thought if clients are treated with
unconditional positive regard, empathy, &
genuineness, the client will explore their feelings &
thoughts.
• Exploring their thoughts & feelings in an accepting
environment will lead the client to change their
attitudes & behavior.
• This approach very successful with dealing with
client’s day-to-day concerns but not very successful
in treating psychotic patients like those with severe
schizophrenia.
Gestalt Therapy
• A type of Humanistic Therapy
• Developed by Fritz Perls
• Believed that people create their own understanding of
the world and continue to grow as long as they have
insight into their feelings.
• More directive and confrontational than client-centered
therapy.
• Therapist tries to help clients identify inconsistencies
between the statements they make about how they see
the themselves & how they really interact with the
world.
Boundaries to the
Therapist–Client
Relationship
Therapist–Client Relationship
• Therapy is a collaborative effort between you and the
therapist.
• Don’t expect your therapist to make decisions for you
• Your therapist is not a substitute friend
• Therapeutic intimacy does not include sexual
intimacy; it is never ethical or appropriate for a
therapist to have any form of sexual contact with a
client
• Expect therapy to challenge how you think and act
• Don’t confuse insight with change
• Don’t confuse catharsis with change
• Don’t expect change to happen overnight
Behavior Therapies
Behavior Therapy
• Behavioristic perspective emphasizes
that behavior (normal and abnormal) is
learned
• Applies classical and operant
conditioning to the elimination of
unwanted behaviors
• Primary concern is to eliminate the
disorder’s behavior, not find the cause of
the disorder
• Often called behavior modification
Behavior Therapies:
Classical Conditioning
Techniques
Mary Cover Jones:
The First Behavior Therapist
• Demonstrated that conditioning could be
used to remove fears.
• Treated three-year-old Peter’s fear of
rabbits, using counterconditioning
• Involves modifying behavior by conditioning
a new response that is incompatible with a
previously learned response
• Jones also used social imitation, or
observational learning, techniques
Systematic Desensitization
•
•
•
•
Developed by Joseph Wolpe
Based on counter conditioning
Usually used to treat phobias
phobic responses are reduced by pairing
relaxation with a series of mental images or
real-life situations that the person finds
progressively more fear-provoking
• Uses three steps:
– Progressive relaxation
– Development of anxiety hierarchy and control scene
– Combination of progressive relaxation with anxiety
hierarchy
Systematic Desensitization Process
• Establish a hierarchy of the anxiety- triggering
stimuli
• Learning relaxation methods (progressive
relaxation)
• Slowly think through the hierarchy from least
anxiety-provoking to most anxiety-provoking
, working to relax whenever anxiety is felt
• Once you can maintain complete relaxation,
you move on to the next scene, and so on
Sample Anxiety Hierarchy
Systematic Desensitization
Systematic Desensitization Variations
• Virtual reality--systematic desensitization
by way of computerized, anxietytriggering 3-D stimuli
• Combined with models by having the
subjects watch someone perform the
anxiety-causing behavior
• Just as effective as graduated
exposure to the actual feared objects
or situations
Flooding
• Method of extinction usually used to rid a
patient of phobias (Exposure Therapy)
• The patient is inundated with repeated
exposures to what they fear until they
realize they can remain calm in the presence
of the feared object. (view video of this
process for phobias – 2 min)
Virtual Systematic
Desensitization
• Play “Virtual Fear” (7:57) Segment
#30 from Scientific American
Frontiers: Video Collection for
Introductory Psychology (2nd edition).
Arachnophobia and Virtual
Reality
• Play “Arachnophobia” (9:31)
Segment #31 from Scientific
American Frontiers: Video Collection
for Introductory Psychology (2nd
edition).
Bell & Pad Treatment for
Bed Wetting
• Conditioning arousal from sleep in response
to bodily signals of a full bladder.
• Pair an alarm (US) that will awaken child
(UR).
• When moisture hits pad (bladder tension =
NS) the Alarm sounds (US) waking the child
(UR).
• Eventually bladder tension (CR) causes the
child to awaken (CR).
• It is effective in about 75 percent of school-
Aversive Conditioning
• A type of counterconditioning that associates an
unpleasant state (such as nausea) with an
unwanted behavior
• The person is replacing a positive but harmful
response with a negative response
• Example with alcoholism: Lace a drink with a
drug that makes the person becomes sick
• Aversive conditioning is not very effective,
and its use has declined in recent years.
Aversion Therapy for Alcoholism
• Relatively
ineffective, does
not generalize
very well
beyond therapy
• Pairs and
aversive
stimulus with
the undesired
behavior
UCS
(drug)
UCR
(nausea)
CS
(alcohol)
UCS
(drug)
UCR
(nausea)
CS
(alcohol)
CR
(nausea)
Behavior Therapies:
Operant Conditioning
Techniques
Operant Conditioning
• Behavior therapists have developed a
variety of techniques based on B. F.
Skinner’s operant conditioning model of
learning
– Shaping involves reinforcing successive
approximations of a desired behavior
– Positive reinforcement is used to increase
the incidence of desired behaviors
– Extinction, or nonreinforcement, is used to
reduce the occurrence of undesired
behaviors
Token Economy
• An operant conditioning procedure that attempts to
modify behavior by giving tokens (rewards) for
desired behavior.
• Use for behavior modification in group settings
(prisons, classrooms, hospitals)
• The tokens can be exchanged for various privileges
or treats
• Form of secondary reinforcement
• Proven to be especially effective in the
outpatient treatment of substance abuse and
dependence and with severely disturbed people
Cognitive Therapies
Cognitive Therapy
• Based on the assumption that psychological
problems are due to maladaptive patterns of
thinking
– Thoughts intervene between events and our
emotional reactions
• Therapy focuses on recognition and alteration
of unhealthy thinking patterns
– Teaches people new, more adaptive ways of
thinking and acting
Self-Serving Bias
• Tendency to judge oneself favorably
• Severely depressed patients tend to
not have a self-serving bias and tend
to blame themselves for problems and
credit the environment for successes
Rational Emotive Therapy
• Developed by Albert Ellis
• People’s difficulties are caused by their
faulty expectations and irrational beliefs
• ABC model
– Activating Event
– Beliefs
– Consequences
•When an Activating event (A) occurs, it is the person’s Beliefs (B)
about the event that cause emotional Consequences (C)
•Goal of therapy is expose and confront the person’s core irrational
beliefs
•Effective in the treatment of depression, social phobia, and
certain anxiety disorders, and in helping people overcome selfdefeating behaviors
How RET Works
• Step 1: Identify the core irrational beliefs or self
talk that underlie personal distress
• Step 2: Vigorously dispute and challenge the
irrational beliefs. Therapist acts as a teacher to
show patient how to do this.
• Rational-emotive therapists tend to be very
direct and even confrontational
• From the client’s perspective, rational-emotive
therapy requires considerable effort
– person must admit her irrational beliefs and accept
the fact that those beliefs are irrational and unhealthy
– client must radically change her way of interpreting
and responding to stressful events
RET – AN EXAMPLE
• PROBLEM: Social Phobic concerned they will
be publicly embarrassed when giving a class
presentation.
• SOLUTION: Therapist questions the likelihood
of such embarrassment occurring and impact of
it.
• Therapist’s goal is to show the client that not
only is their failure unlikely, but even if it did
happen, it would not be a big deal.
RET Therapy
•
•
•
•
•
A = Activating Events
B = Irrational Beliefs
C = Inappropriate Consequences
D = Disputing these Beliefs
E = Effects of disputing – Rational beliefs,
appropriate feelings, desirable behaviors.
Aaron Beck’s Cognitive Therapy
• Based on the assumption that thoughts,
moods, and behaviors are interrelated
• Beck believes that depression and
other psychological problems are
caused by distorted thinking and
unrealistic beliefs
• Schemas – methods for organizing the
way we view the world have evolved
into a distorted perception
• Focuses on changing the client’s
unrealistic beliefs
• Therapist acts as model and aims for a
collaborative therapeutic climate
• Therapy includes homework of writing
down automatic thoughts or habits
Cognitive Therapy: How it Works
• CT therapist encourages the client to
empirically test the accuracy of his or her
assumptions and beliefs
– The client learns to recognize and monitor the
automatic thoughts that occur without conscious
effort or control
– The client learns how to empirically test the reality
of the automatic thoughts that are so upsetting
• CT is very effective in treating depression,
anxiety disorders, eating disorders, PTSD,
and relationship problems. It may also help
prevent depression from recurring
What’s the Difference Between
Ellis’ RET &
Beck’s Cognitive Therapy?
• RET therapists logically debate and vigorously
challenge or dispute the irrationality of a client’s
beliefs
• Beck’s Cognitive Therapy give the client
“homework” to empirically test the accuracy of
his or her assumptions and beliefs.
Cognitive Behavioral Therapy
• An integrated therapy that combines cognitive
therapy (changing self-defeating thinking) with
behavior therapy (changing inappropriate behaviors)
• Based on the assumption that cognitions,
behaviors, and emotional responses are
interrelated
• Cognitive-behavioral therapists challenge
maladaptive beliefs and substitute more
adaptive cognitions
• They use behavior modification, shaping,
reinforcement, and modeling to teach problem
solving and change unhealthy behavior patterns
Prevalence of Cognitive Therapy
Half of all faculty in
accredited clinical
psychology doctoral
programs now align
themselves with a
cognitive or cognitivebehavior therapy
orientation. (Data from
Mayne & others, 1994.
Note: Some faculty
identify with more
than one perspective.)
Family and Group
Therapies
Group and Family Therapy
• Group therapy—one or more therapists working
with several people at the same time.
• Family therapy—based on the assumption that
the family is a system and treats the family as a
unit.
• Couple therapy—relationship therapy that helps
with difficulty in marriage or other committed
relationships
Group Therapy
• Having a therapist work with a
number of patients at one time
• Groups usually consist of 6 to 10
people
• Cognitive, behavior, and humanistic
therapists all can lead group therapies.
Advantage of Group Therapy
• Therapists can help more than one
person at a time.
• Overall session cost is lower.
• Patients interact with others having
the same problems as they have.
• Builds a sense of community
Self-help groups: Helping yourself
by helping others
• Self-help groups and support groups are typically
organized and led by nonprofessionals
• The groups are either free or charge nominal fees to
cover the cost of materials.
• Typically, members have a common problem and
meet for the purpose of exchanging support
• The format of such groups varies enormously, but
many follow a 12-step approach
• Self-help groups can be as effective as therapy
• More research is needed on why self-help groups are
effective and on the kinds of people and problems that
are most likely to benefit from them
Family Therapy
• Therapy that treats the family as a system
• Views the patient’s problems as influenced by
or directed at family members
• Every family has certain unspoken “rules”
of interaction and communication.
• As such, issues are explored, and
unhealthy patterns of family interaction can
be identified and replaced with new “rules”
that promote the psychological health of
the family
• Attempts to guide the family toward positive
relationships and improved communication
Evaluating
Psychotherapy’s
Effectiveness
Are Psychotherapies Effective?
• Most people do not seek help with problems
• Spontaneous Remission - Some people improve with
nothing more than the passage of time
• Meta-analysis used to combine and interpret the
results of large numbers of studies has found:
– On average, the person who completes treatment is better
off than about 80 percent of those in the untreated control
group.
– Benefits are usually apparent in a relatively short period of
time
– Gains that people make tend to endure
– Brain-imaging technologies show that psychotherapy alone
produces distinct physiological changes in the brain that are
Studies on Psychotherapy
• Studies researching the effectiveness of
psychotherapy have found:
– Clients believe therapy is effective.
– Clinicians believe therapy is effective.
– Researchers are still debating
psychotherapy’s effectiveness.
– The more clear cut the problem, the more
effective the therapy is.
– No one therapy is absolutely more effective
than the others.
Evaluating Therapies
• Play “Empirically Validated
Therapies” (3:29) Segment #41 from
Psychology: The Human Experience.
Factors in Successful Therapy
• Therapeutic relationship—caring and
mutually respectful
• Therapist characteristics—caring attitude,
ability to listen, sensitive
• Client characteristics—motivated, actively
involved, emotionally and socially mature
• External circumstances—a stable living
situation and supportive family
members
The rates of improvement for
more than 2,000 people in
weekly psychotherapy and
for 500 people who did not
receive psychotherapy.
Clearly, psychotherapy
accelerates both the rate and
the degree of improvement
for those experiencing
psychological problems.
SOURCE: McNeilly &
Howard, 1991.
Are Alternative
Therapies Effective?
Eye movement desensitization
reprocessing (EMDR)
• Treatment technique in which patients suffering
from traumatic memories visually follow her
waving finger while simultaneously holding a
mental image of disturbing memories, events, or
situations
• EMDR is more effective than no treatment at all
• EMDR is no more effective than exposure therapy
and other standard treatments for anxiety
disorders
• Several research studies have found no
difference in outcome between treatments that
Therapeutic Touch Therapy
• Therapists move their hands above
the person’s body to “push energy
fields into balance.”
• No evidence has been found to
support the effectiveness of this
therapy
Light Exposure Therapy
• Therapy for Seasonal Affective Disorder
by exposing the patient to artificial light
mimicking that of the sun
• Research supports a connection between
exposure to light and melatonin levels in
the blood, which affects levels of alertness
Expectation Effect
• Person feels better after therapy
because they thought or expected to
become better