Transcript Chapter 17: Therapies

Chapter 17
Therapies
Quiz
True or False:
1. Psychotherapy includes lying on a couch and
discussing how you feel about your parents
sexually.
2. Behavior therapy includes a heavy emphasis on
the past and how to affect your behavior in the
future.
3. Therapy placebo affect is when improvement is
caused by the expectation that therapy will help,
not by any specific intervention.
4. Pharmacotherapy is the use of drugs to
alleviate the symptoms of emotional disturbance
5. A community mental health center is a facility
offering a wide range of mental health services,
such as prevention counseling, crisis
intervention
What is Psychotherapy?
• Any psychological technique used to facilitate
positive changes in an individual’s
personality, behavior, or adjustment
• Can include individual or group therapy
The dose-improvement
relationship in psychotherapy.
This graph shows the percentage
of patients who improved after
varying numbers of therapy
sessions. Notice that the most
rapid improvement took place
during the first 6 months of oncea-week sessions.
Fig. 17-6, p. 588
Origins of Therapy
Trepanning: For primitive “therapists,” refers to
boring, chipping, or bashing holes into a
patient’s head; for modern usage, refers to
any surgical procedure in which a hole is
bored into the skull
– Goal presumably to relieve pressure or rid
the person of evil spirits
Demonology
• Study of demons and people beset by spirits
– People were possessed, and they needed
an exorcism to be cured
• Exorcism: Practice of driving off an “evil
spirit”; still practiced today!
Primitive “treatment”
for mental disorders
sometimes took the
form of boring a hole in
the skull. This example
shows signs of healing,
which means the
patient survived the
treatment. Many didn’t.
Fig. 17-1, p. 571
Origins of Therapy Continued
• Ergotism: Psychotic-like symptoms that come
from ergot poisoning, a common fungus in
Rye fields
– Ergot is a natural source of LSD
• Philippe Pinel: French physician who initiated
humane treatment of mental patients in 1793
– Created the first humane mental hospital
by unchaining clients
Psychoanalysis: Freud
• Hysteria: Physical symptoms (like paralysis or
numbness) occur without physiological
causes
– Now known as somatoform disorders
• Freud became convinced that hysterias were
caused by deeply hidden unconscious
conflicts
• Main Goal of Psychoanalysis: To reduce
internal conflicts that lead to emotional
suffering
Some Key Techniques of
Psychoanalysis
• Free Association: Saying whatever comes to
mind, regardless of how embarrassing or
unimportant it may seem
– By doing so without censorship and
censure, unconscious material can emerge
Psychoanalysis and Freud Concluded
• Resistance: Blockage in flow of ideas; topics
the client resists thinking about or discussing
– Resistances reveal particularly important
unconscious conflicts
• Transference: Tendency to transfer feelings
to a therapist that match those the patient has
for important people in his or her past
– The patient might act like the therapist is a
rejecting father, loving mother, etc.
Waiting-List Control Group
• People who receive no therapy as a way to
test the effectiveness of psychotherapy
– Compare control with experimental group;
if no statistically significant difference, then
something other than therapy caused
change or no change in conditions
Psychotherapist Carl Rogers,
who originated client-centered
therapy.
Everything previous
was unconscious,
Rogers found it more
beneficial to focus on
the conscious
p. 574
Four Aspects:
• Unconditional Positive Regard: Unshakable
acceptance of another person, regardless of
what they tell the therapist or how they feel
• Empathy: Ability to feel what another person
is feeling; capacity to take another person’s
point of view
• Authenticity: Ability of a therapist to be
genuine and honest about his or her feelings
• Reflection: Rephrasing or repeating thoughts
and feelings of the clients’; helps clients
become aware of what they are saying
Existential Therapy
• An insight therapy that focuses on problems
of existence, such as meaning, choice, death,
and responsibility; emphasizes making
difficult choices in life
• Free Will: Human ability to make choices
– You can choose to be the person you want
to be
• Logotherapy: Emphasizes need to find and
maintain meaning in one’s life
• Confrontation: Clients are challenged to
examine their values and choices
Gestalt Therapy
• Focuses on immediate experience and
awareness to help clients rebuild thinking,
feeling, and acting into connected wholes
– Emphasizes integration of fragmented
experiences (filling in the gaps)
– Clients are taught to accept responsibility
for their thoughts and actions
– More directive than client-centered or
existential therapy
– Example:
– http://www.youtube.com/watch?v=ZbOAdM
dMLdI
Cybertherapy and Psychotherapy at a
Distance: Dr. Phil, Among Others
• Media Psychologists: Radio, newspaper, and
television psychologists; often give advice,
information, and social support
– Most helpful when referrals and information
are given
• Telephone Therapists: 900 number therapists
– Caution: Many “therapists” may be nothing
more than telephone operators who have
never even taken a psychology course!
Media psychologists
have been urged to
educate without
actually doing therapy
on the air. Some
overstep this boundary,
however. Do you think
popular TV
psychologist Dr. Phil
sometimes goes too
far?
p. 576
Cybertherapy and Psychotherapy at a
Distance Concluded
• Cybertherapy: Internet therapists in chat
rooms and so on
• Videocameras at both ends so now you can
hear AND see therapist
• Patient/client can remain anonymous
• May be wave of future for those who cannot
drive a distance to a therapist or cannot leave
the house (e.g., Paula can’t leave the house
because of agoraphobia, so Robert the
therapist comes to her via Internet!)
• Cheaper than traditional psychotherapy
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
http://www.youtube.com/watch?v=MCyfMFX
R-n0
Aversion Therapy
• 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
• Example: anabuse, putting something foul
tasting on nails or couches, forcing someone
to smoke a whole pack
• Rubber bands
• Anyone here used any of these?
Systematic Desensitization
• Guided reduction in fear, anxiety, or aversion;
attained by approaching a feared stimulus
gradually while maintaining relaxation
– Best used to treat phobias: intense,
unrealistic fears
– “I’m with Busy”
A virtual reality
system is used to
expose people to
feared stimuli. Many
patients would
rather face feared
stimuli in a virtual
environment than in
a real physical
environment.
Fig. 17-3a, p. 581
Fig. 17-3b, p. 581
Operant Therapies
• Eye Movement Desensitization and
Reprocessing (EMDR): Reduces fear and
anxiety by holding upsetting thoughts in your
mind while rapidly moving your eyes from
side to side
• Further research needed
Aspects of Behavior Modification
• Operant conditioning: Learning based on
consequences of making a response
• Positive Reinforcement: Responses that are
followed by a reward tend to occur more
frequently
• Punishment: If a response is followed by
discomfort or an undesirable effect, the
response will decrease/be suppressed (but
not necessarily extinguished)
• Example: How do you train a dog?
• How do you “train” a child?
How far can we go with controlling
behavior?
• As various therapies are tried, modified, and
developed, the possibility of controlling
maladaptive behavior increases. It is
possible to foresee a time when such
techniques will be perfected to the point
where behavioral change, and therefore,
behavioral control, will be much easier to
accomplish and more certain.
Reinforcement and Token Economies
• Tokens: Symbolic rewards like poker chips or
gold stars that can be exchanged for real
rewards
– Can be used to reinforce positive
responses immediately
– Effective in psychiatric hospitals and
sheltered care facilities
• Target Behaviors: Actions or other behaviors
a therapist seeks to change
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
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
Medical Therapies
• Pharmacotherapy: Use of drugs to alleviate
emotional disturbance
• Anti-depressants: Elevate mood and combat
depression
– Prozac (fluoxetine) and Zoloft (sertraline) are two
types
• Anxiolytics: Produce relaxation or reduce anxiety
• Valium (diazepam) is one type
• Antipsychotics: Tranquilize and also reduce
hallucinations and delusions in larger dosages
– Haldol (haloperidol) and Thorazine
(chlorpromazine) are two types
– What are the problems with these?
Shock
• Electroconvulsive Therapy (ECT): Electric
shock is passed through the brain inducing a
convulsion
– Based on belief that seizure alleviates
depression by altering brain chemistry and
hormonal balance
Psychosurgery
• Any surgical alteration of the brain designed
to bring about desired behavioral or
emotional changes
• 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
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”)
• All societies find some mechanism for facilitating
change in others. Compare and contrast the
therapeutic role of witch-doctors, folk-medicine
practitioners, and religious leaders. What might all
these have in common that would help at least some
people feel better?
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
More Danger Signals
• 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
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?
• Do you see a therapist?
Things Left Unsaid
• Ask students to turn to the person next to
them and share "things left unsaid" to
someone they care about. If they could talk
to anyone in the world to add closure to the
relationship, who would they call? What
would they say?
How much do you trust someone?
• Randomly pair students and instruct them to
walk to some point on campus. On the way
to the chosen point, one student should be
blindfolded while being guided by the second.
On the way back, they should reverse roles.
Behavior Change
• In groups of three: work on a plan to change
a behavior. Each of the three should have a
behavior to change. The group can work on
each one. There is an advantage to a group
rather than an individual working on the
problem, because it is more likely to get done
if the group works on it. It also gives support
to each individual in the planning and
executing of the change.
A friend in Need
• Handout
Insight vs Behaviorism
• Two teams of students prepare a debate
reflecting the opposing viewpoints of insight
therapists and behavior therapists. Which
should be used or under what circumstances,
should these techniques be used in schools,
the military, prisons, programs for the
mentally disabled, mental hospitals, and other
institutional settings.