Transcript EIM8e_Mod35 - Oakton Community College

EXPLORING
PSYCHOLOGY
EIGHTH EDITION IN MODULES
David Myers
PowerPoint Slides
Aneeq Ahmad
Henderson State University
Worth Publishers, © 2011
Therapy
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The Psychological Therapies
Module 35
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Psychoanalysis
 Aims
 Methods
 Psychodynamic Therapy
Humanistic Therapies
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Behavior Therapies
 Classical Conditioning
Techniques
 Operant Conditioning
Cognitive Therapies
 Beck’s Therapy for Depression
 Cognitive-Behavioral Therapy
Group and Family Therapies
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Evaluating Psychotherapies
 Is Psychotherapy Effective?
 The Relative Effectiveness of
Different Therapies
 Evaluating Alternative Therapies
 Commonalities Among
Psychotherapies
 CLOSE-UP: A Consumer’s Guide to
Psychotherapists
 Culture and Values in Psychotherapy
 CLOSE-UP : Preventing
Psychological Disorders
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History of Insane Treatment
Maltreatment of the insane throughout the ages
was the result of irrational views. Many patients
were subjected to strange, debilitating, and
downright dangerous treatments.
The Granger Collection
The Granger Collection
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History of Insane Treatment
Philippe Pinel in France and Dorthea Dix in the
U.S., Canada, and Scotland founded humane
movements to care for the mentally ill.
Culver Pictures
Dorthea Dix
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The Psychological Therapies
Psychotherapy involves an emotionally
charged, confiding interaction between a
trained therapist and a mental patient.
An eclectic approach uses various forms of
healing techniques depending upon the client’s
unique problems.
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Psychoanalysis
The first formal psychotherapy to emerge was
psychoanalysis, developed by Sigmund Freud,
relying on the therapist’s interpretations of the
patient’s free associations, dreams, resistances,
and transferences.
Few therapists today practice as Freud did, but
his work established part of the foundation for
treating psychological disorders.
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Psychoanalysis: Aims
The aim of psychoanalysis is to bring repressed
feelings into conscious awareness where the
patient can deal with them.
When energy devoted to id-ego-superego
conflicts is released, the patient’s anxiety
lessens.
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Psychoanalysis: Methods
Dissatisfied with hypnosis, Freud developed the
method of free association to unravel the
unconscious mind and its conflicts.
The patient lies on a couch and speaks about
whatever comes to his or her mind.
When the patient edits his or her thoughts,
(pausing, joking, or changing the subject) the
analyst interprets this as resistance, hinting that
anxiety lurks.
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Psychoanalysis: Methods
The analyst notes these resistances and
interprets them, offering insight into their
meaning.
Over many sessions the patient may develop
positive or negative feelings (transference)
towards the therapist. By exposing these
feelings, insight is gained into current and past
relationships.
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Psychoanalysis
Few U.S. therapists today practice psychoanalysis
because:
-It cannot be proven or disproven.
- It takes a long time and is very expensive.
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Psychodynamic Therapy
Influenced by Freud, in a face-to-face setting,
psychodynamic therapists understand symptoms
and themes across important relationships in a
patient’s life. Sessions take place once a week for
only a few weeks or months.
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Humanistic Therapies
Psychoanalytic and humanistic therapies are
often referred to as insight therapies because
they aim to help people by reducing inner
conflict and increasing self-understanding.
Humanistic therapists aim to boost selffulfillment by helping people grow in selfawareness and self-acceptance.
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Client-Centered Therapy
Developed by Carl Rogers, client-centered
therapy is the most widely used form of
humanistic therapy.
The therapist listens to the needs of the patient
in an accepting and non-judgmental way,
addressing problems in a productive way and
building his or her self-esteem.
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Humanistic Therapy
The therapist engages in active listening and echoes, restates, and
clarifies the patient’s thinking, acknowledging expressed feelings.
In an environment that provides unconditional positive regard,
people may accept even their worst traits and feel valued.
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Behavior Therapy
Behavioral therapists assume that problem
behaviors are the problem and apply learning
principles to eliminate them.
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Classical Conditioning Techniques
Counterconditioning is a procedure that
conditions new responses to stimuli that trigger
unwanted behaviors.
It is based on classical conditioning and
includes exposure therapy and aversive
conditioning.
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Exposure Therapy
The Far Side © 1986 FARWORKS. Reprinted with Permission. All Rights Reserved.
Expose patients to
things they fear and
avoid. Through
repeated exposures,
anxiety lessens
because they habituate
to the things feared.
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Exposure Therapies
Systematic desensitization is a type of exposure
therapy that associates a pleasant, relaxed state with
gradually increasing anxiety-triggering stimuli
commonly used to treat phobias.
The therapists usually begins with imagined
situations, moving up to actual situations, ,until the
patient no longer experiences anxiety.
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Exposure Therapies
If the anxiety-arousing situation is too, difficult,
expensive, or embarrassing to recreate the therapist
may turn to virtual reality exposure therapy, relying on
computer simulations of feared situations.
• Fig 35.1
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Aversive Conditioning
Aversive conditioning
associates an
unpleasant state with
an unwanted
behavior. With this
technique, temporary
conditioned aversion
to alcohol has been
reported.
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Operant Conditioning
Operant conditioning procedures enable therapists to use
behavior modification, in which desired behaviors are
rewarded and undesired behaviors are either unrewarded
or punished.
In institutional settings, therapists create a token economy
in which patients can earn tokens for exhibiting appropriate
behaviors. Tokens can later be exchanged for priviledges
such as television time, trips, or better living quarters.
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Operant Conditioning
Critics of behavior modification express two
concerns:
-How durable are the behaviors? When the
reinforcers stop, will the behaviors stop as well?
-Is it right to control another person’s behavior?
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Cognitive Therapy
Cognitive therapies
assume that our
thinking colors our
feelings and tries to
teach new, more
constructive ways of
thinking.
• Fig 35.3
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Beck’s Therapy for Depression
Aaron Beck (1979) believed that cognitive
therapy could change depressed patients’
castastrophizing beliefs. He sought to reveal
irrational thinking by gently questioning patients
and then persuading them to change their
thinking.
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Stress Inoculation Training
Meichenbaum (1977, 1985) trained people to
restructure their thinking in stressful situations.
“Relax, the exam may be hard, but it will be
hard for everyone else too. I studied harder
than most people. Besides, I don’t need a perfect
score to get a good grade.”
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Cognitive-Behavior Therapy
Cognitive-behavior therapy aims to alter the
way people act (behavior therapy) and the way
they think (cognitive therapy).
Many studies confirm that it is an effective
therapy for those with anxiety and depression.
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Group & Family Therapies
Group therapy normally consists of 6-9 people
attending a 90-minute session that can help
more people and costs less. A therapist guides
the interactions of the clients and the clients
benefit from knowing others have similar
problems.
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Family Therapy
Family therapy treats the family as a system.
Therapy guides family members toward
positive relationships and improved
communication.
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Comparison of Major
Psychotherapies
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Evaluating Therapies
In 2004 7.4 percent of Americans reported
“undergoing counseling for mental or
emotional problems” a 25% increase from
1991.
With the increasing popularity of therapy, we
need to ask, how effective is it?
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Is Psychotherapy Effective?
It is difficult to gauge the effectiveness of
psychotherapy because there are different levels
upon which its effectiveness can be measured.
1.
2.
3.
Does the patient sense improvement?
Does the therapist feel the patient has improved?
How do friends and family feel about the
patient’s improvement?
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Client’s Perceptions
If you ask clients about their experiences of
getting into therapy, they often overestimate its
effectiveness. Critics however remain skeptical.
1.
2.
3.
Clients enter therapy in crisis, but crisis may
subside over the natural course of time
(regression to normalcy).
Clients may need to believe the therapy was
worth the effort.
Clients generally speak kindly of their therapists.
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Clinician’s Perceptions
Like clients, clinicians believe in therapy’s
success. They believe the client is better off after
therapy than if the client had not taken part in
therapy.
1.
2.
3.
Clinicians are aware of failures, but they believe
failures are the problem of other therapists.
If a client seeks another clinician, the former
therapist is more likely to argue that the client has
developed another psychological problem.
Clinicians are likely to testify to the efficacy of
their therapy regardless of the outcome of
treatment.
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Outcome Research
How can we objectively measure the
effectiveness of psychotherapy?
Meta-analysis of a number of studies suggests
that thousands of patients benefit more from
therapy than those who did not go to therapy.
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The Relative Effectiveness of
Different Therapies
Some forms of therapy are especially effective
at treating particular problems. For example,
behavioral conditioning works well for specific
behavior problems.
Therapy is most effective when there is a clearcut problem.
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The Relative Effectiveness of
Different Therapies
Some clinicians believe in
evidence-based practice,
clinical decision making that
integrates the best available
research with clinical
expertise and patient
characteristics and
preferences, thinking that it
holds mental health
professionals accountable and
protects patients from
pseudotherapies.
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Evaluating Alternative Therapies
57% of those who have had anxiety attacks and
54% who have had depression have used
alternative treatments such as herbal medicines,
massage, and spiritual healing (Kessler &
others, 2001). Do alternative therapies hold up
under scientific scrutiny?
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Eye Movement Desensitization and
Reprocessing (EMDR)
In EMDR therapy, the therapist attempts to
unlock and reprocess previous frozen traumatic
memories by waving a finger in front of the
eyes of the client.
EMDR has not held up under scientific testing.
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Light Exposure Therapy
Courtesy of Christine Brune
Seasonal Affective
Disorder (SAD), a
form of depression,
has been effectively
treated by light
exposure therapy. This
form of therapy has
been scientifically
validated.
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A Consumer’s Guide to
Psychotherapists
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Commonalities Among
Psychotherapies
Three commonalities shared by all forms of
psychotherapies are the following:
1. A hope for
demoralized people.
2. A new perspective.
3. An empathic, trusting
and caring
relationship.
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Culture and Values in Psychotherapy
All therapies offer hope, and nearly all therapists
attempt to enhance their clients’ sensitivity, openness,
personal responsibility, and sense of purpose (Jensen &
Bergin, 1988).
But in matters of culture and values, therapists differ
from one another and from their clients (Delaney et al.,
2007; Kelly, 1990).
A therapist search should include visiting two or more
therapists to judge which one makes the client feel more
comfortable.
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Preventing Psychological
Disorders
Some feel that psychological disorders are
understandable responses to a stressful
environment and that the social context needs
treatment as well as the patient.
Preventative mental health seeks to prevent
problems by identifying and eliminating the
causes. George Albee felt that we should attempt to
alleviate stressful life situations (poverty, racism,
demoralizing work) through support programs.
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