Transcript Models in Psychopathology

The
Therapeutic
Enterprise
Types of Psychotherapy
 Psychodynamic
 Behavioral
 Cognitive
 Cognitive-behavioral
 Humanistic and Existential
 Group
Cognitive-behavioral group
Family and marital therapy
Psychodrama
Abnormal Psychology, 11/e
by Sarason & Sarason © 2005
Psychodynamic Therapy
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Goal is insight into one’s inner life
Some therapists use hypnosis to uncover repressed
material
Transference – Patient displaces affect and feeling
about others onto the therapist
Counter transference – Therapists’ emotional
responses to patient
Psychoanalysis – Special type of psychodynamic
therapy using free association and examination of
dreams and fantasies
Interpersonal psychotherapy – A form of brief therapy
that focuses on social relationships
Abnormal Psychology, 11/e
by Sarason & Sarason © 2005
Behavior Therapy
 Behavioral modification
 Based on classical and operant
conditioning theory
 Uses reinforcement and shaping
 Token economy – Reinforces desired
behaviors
 Biofeedback – Can help develop control of
internal processes
 Parent training
Abnormal Psychology, 11/e
by Sarason & Sarason © 2005
Cognitive Therapy
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Goal – Solve emotional problems through cognitive
restructuring
Aaron Beck – Focuses on changing automatic
thoughts
Albert Ellis – Rational-emotive therapy emphasizes
needs to change self-defeating thinking and beliefs
Brief psychotherapies – Often fewer than 12
sessions; specific goals and targets.
Abnormal Psychology, 11/e
by Sarason & Sarason © 2005
Keys Aspects of Cognitive Therapy
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Presentation of therapy rationale to patient
Short-term intervention
Focus on the “here and now”
Patient-therapist collaboration
Questions and homework
 Maintain daily records of mood, behavior, and
dysfunctional thoughts
 Carry out informal experiments to test thoughts,
beliefs, and assumptions
 Apply newly acquired cognitive schema to reallife situations.
Abnormal Psychology, 11/e
by Sarason & Sarason © 2005
Cognitive- Behavioral Therapy
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Integrates cognitive and behavioral therapies
Relaxation training
Exposure therapy
Flooding
Implosive therapy
Systematic desensitization
In vivo exposure
Modeling
Behavioral rehearsal
Assertiveness training
Abnormal Psychology, 11/e
by Sarason & Sarason © 2005
Humanistic/ Existential Therapies
 Humanistic therapy
 Emphasis on people’s desire to achieve selfrespect
 Carl Rogers’ Client-centered Therapy
 Nonjudgmental, nondirective
 Atmosphere of unconditional positive regard
 Existential therapy
 Emphasis on people’s needs to confront questions
about meaning and direction of their lives
 Combine humanistic and psychodynamic
techniques
 Gestalt therapy based on view that people need to
get in touch with disowned parts of themselves
Abnormal Psychology, 11/e
by Sarason & Sarason © 2005
Group Therapy
 Several people with similar problems
 Group membership provides
 Acceptance and support
 Normative information about behavior/feelings
 Learning through modeling and behavioral rehearsal
 Cognitive-behavioral group therapy
 Goal is development of social skills and comfort in social
situations
 Family and marital therapy
 View marriage and family as a system
 Learn how behaviors affect each other
 Psychodrama
 Group acts out events of emotional significance
Abnormal Psychology, 11/e
by Sarason & Sarason © 2005
Does
Psychotherapy
work?
Abnormal Psychology, 11/e
by Sarason & Sarason © 2005
Does Psychotherapy work?
 Conventional wisdom (behind closed doors)
 H. Eysenck’s study (1952)
 Meta-analysis (Smith and Glass, 1977)
 Specific studies- the case of the NIMH
collaborative study (1989)
 Randomized Clinical Trials methods
 The Consumer Reports Study (1998)
 Empirically Supported Therapies
Abnormal Psychology, 11/e
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Issues in Psychotherapy Research
 Specifying the problem
 patient characteristics and the issue of specificity
 Specifying the treatment:
 Specific and nonspecific elements of therapy
 Treatment manuals
 Therapist training and fidelity
 Research design issues (single case, open trials, and
RCTS)
 Internal validity issues (e.g. measurement of outcome,
sample size, blindness)
 External validity issues (e.g., setting, recruitment,
flexibility of treatments)
Abnormal Psychology, 11/e
by Sarason & Sarason © 2005
Abnormal Psychology, 11/e
by Sarason & Sarason © 2005
Abnormal Psychology, 11/e
by Sarason & Sarason © 2005
Concerns about reliance on ESTs
 ESTs are limited by the methodology of psychotherapy
research (e.g. RCT)
Some therapies are easier to test (e.g. CBT)
 Some problems are more difficult to treat and therefore
have fewer ESTs
Just because a therapy is not listed as an EST does not
mean it could not be
 Treatment research might not generalize to clinical
settings
 ESTs are too restrictive in general clinical practice
 There is a need for dissemination research
 Third party payers might misuse lists of ESTs
Abnormal Psychology, 11/e
by Sarason & Sarason © 2005
Nonspecific factors in psychotherapy
 Motivation for treatment; desire to change
 The release of emotions; catharsis
 Fostering insight, awareness and self-understanding
 Building competency and mastery
 Providing new information; psychoeducation
 Developing new skills; assigning tasks
 Working with an “expert”
 Relationship factors/ therapeutic alliance
 Empathy, Genuineness
 Unconditional positive regard
 Respect and Trust
 Collaboration
 Positive expectancies of change; hope
Abnormal Psychology, 11/e
by Sarason & Sarason © 2005
Biological Therapies
 Drug therapies
 Antipsychotic, Antidepressant, Antianxiety,
Stimulant, Antimanic
 Electroconvulsive therapy (ECT)
 Used for severe depression when drugs and
other therapies have failed
 Psychosurgery
 Rarely performed for DSM-IV problems
 Effectiveness of biological therapies
 Effective for some disorders
 Multi-modal treatment
Abnormal Psychology, 11/e
by Sarason & Sarason © 2005
Hospitalization
 Reasons for hospitalization
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Behaviors poses threat to self or others
Behavior intolerable to community
Outpatient treatment failed
Treatment requires controlled setting
Withdrawal from drugs or alcohol
Physical illness complicated by mental disorder requiring
continuous care
 Legislation exists in all states to hospitalize
and treat patients against their will.
Abnormal Psychology, 11/e
by Sarason & Sarason © 2005
Issues in Hospitalization
 Partial hospitalization
 When complete hospitalization not required
 Day, evening, or weekend care
 Day hospitalization
 For patients who can live at home but need
structure and social interaction
 Deinstitutionalization
 Movement towards community-based treatment
 Initially made possible by discovery of psychoactive
drugs
 Lack of adequate community care has led to
increased homelessness and gaps in treatment for
seriously mentally ill
Abnormal Psychology, 11/e
by Sarason & Sarason © 2005