Transcript Chapter 13 - Bakersfield College

PSYCHOLOGY
AN EXPLORATION
Second Edition
CHAPTER
13
psychological
therapies
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
why study therapies for psychological disorders?
There are almost as many therapy methods as there
are disorders. Correctly matching the type of therapy
to the disorder can mean the differ- ence between a
cure or a crisis. It is important to know the choices
available for treatment and how they relate to the
different kinds of disorders so that an informed
decision can be made and the best possible outcome
can be achieved for mental health and wellness.
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Learning Objective Menu
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LO 13.1 Two ways modern ways to treat psychological disorders
LO 13.2 Elements of Freud’s psychoanalysis and psychoanalysis
today
LO 13.3 Basic elements Humanistic therapies
LO 13.4 Behavior therapists’ use of classical and operant
conditioning
LO 13.5 Goals of cognitive therapies
LO 13.6 Types of group therapy
LO 13.7 Effectiveness of psychotherapy
LO 13.8 Types of drugs used to treat psychological disorders
LO 13.9 Modern electroconvulsive therapy and psychosurgery
LO 13.10 How might computers be used in psychotherapy
Psychology: An Exploration, Second Edition
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Two Kinds of Therapy
LO 13.1 Two modern ways to treat psychological disorders
• Therapy
– Treatment with goal of improved mood
and functioning
• Psychotherapy
– Treats mental disorders
Psychology: An Exploration, Second Edition
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Two Kinds of Therapy
LO 13.1 Two modern ways to treat psychological disorders
• Psychotherapy
– Talk with a psychological professional
 Insight therapy
– Gain insight about behavior, thoughts, and
feelings
 Action therapy
– Change behavior directly
Psychology: An Exploration, Second Edition
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Two Kinds of Therapy
LO 13.1 Two modern ways to treat psychological disorders
• Biomedical therapy
– Treatment with biological or medical
methods to relieve symptoms
 Includes drugs, surgical methods,
electroconvulsive treatment
– Medication alone not sufficient
 Treats symptoms of disorder
 Psychotherapy builds coping strategies,
aids in adjustment
Psychology: An Exploration, Second Edition
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Treatment in the Past
LO 13.1 Two modern ways to treat psychological disorders
• Early efforts to treat mentally ill
– 1500’s Bethlehem Hospital converted to
asylum
– Treatments included beatings
bloodletting, ice baths
Psychology: An Exploration, Second Edition
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Treatment in the Past
LO 13.1 Two modern ways to treat psychological disorders
• Philippe Pinel’s Reforms
– Unchained inmates
 La Bicêtre Asylum, Paris 1793
– Treated mentally ill with kindness
– Advocated “moral” therapy
Psychology: An Exploration, Second Edition
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In this famous painting by French artist Robert Fleury, French psychiatrist Dr. Philippe Pinel orders the chains
removed from patients at a Paris asylum for insane women. Pinel was one of the first psychiatrists to recommend
humane treatment of the mentally ill.
Psychology: An Exploration, Second Edition
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Freud’s Psychoanalysis
LO 13.2 Elements of Freud’s psychoanalysis and psychoanalysis today
• Insight therapy
– Emphasizes revealing unconscious
conflicts
Psychology: An Exploration, Second Edition
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Freud’s Psychoanalysis
LO 13.2 Elements of Freud’s psychoanalysis and psychoanalysis today
• Two techniques for accessing
unconscious:
– Dream interpretation
 Manifest content
– Actual dream and it’s events
 Latent content
– Symbolic or hidden meaning of dreams
Psychology: An Exploration, Second Edition
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Freud’s Psychoanalysis
LO 13.2 Elements of Freud’s psychoanalysis and psychoanalysis today
• Two techniques for accessing
unconscious:
– Free association
 Patient free to say anything that came to
mind
 No fear of negative evaluation
Psychology: An Exploration, Second Edition
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Freud’s Psychoanalysis
LO 13.2 Elements of Freud’s psychoanalysis and psychoanalysis today
• Resistance
– Patient reluctant to talk about certain
topics
 Changes subject or becomes silent
Psychology: An Exploration, Second Edition
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Freud’s Psychoanalysis
LO 13.2 Elements of Freud’s psychoanalysis and psychoanalysis today
• Transference
– Therapist becomes a symbol of parental
authority figure from the past
 Countertransference
– Therapist has transference reaction to the
patient
Psychology: An Exploration, Second Edition
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Evaluation of Psychoanalysis and
Psychodynamic Approaches
LO 13.2 Elements of Freud’s psychoanalysis and psychoanalysis today
• Criticisms
– Lack of scientific methodology
– Over-emphasis on sexual problems
Psychology: An Exploration, Second Edition
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Evaluation of Psychoanalysis and
Psychodynamic Approaches
LO 13.2 Elements of Freud’s psychoanalysis and psychoanalysis today
• Modern Psychodynamic therapy
– Client sits face-to-face with therapist
– Therapist is more directive
 Asks questions, suggests helpful
behavior, and gives opinions
 Therapy not useful for clients with
psychoses
Psychology: An Exploration, Second Edition
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Interpersonal Psychotherapy
LO 13.2 Elements of Freud’s psychoanalysis and psychoanalysis today
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Developed to treat depression
Insight-oriented therapy
Focus on relationships
Psychodynamic origins
– More eclectic
– Combines elements of
humanistic and cognitive
behavioral therapies
• Effectiveness supported by research
Psychology: An Exploration, Second Edition
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Psychotherapy often takes place one-on-one, with a client and therapist exploring various issues together to
achieve deeper insights or to change undesirable behavior.
Psychology: An Exploration, Second Edition
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Roger’s Person-Centered Therapy
LO 13.3
Basic elements of Humanistic therapies
• Non-directive insight therapy
• Based on the work of Carl Rogers
• Client talks and the therapist listens
Psychology: An Exploration, Second Edition
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Roger’s Person-Centered Therapy
LO 13.3
Basic elements of Humanistic therapies
• Four Elements:
– Reflection
 Therapist restates client’s talk
 No interpretation of statements
– Unconditional positive regard
 Accepting atmosphere created by
therapist
– Empathy
 Therapist understands client feelings
Psychology: An Exploration, Second Edition
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Roger’s Person-Centered Therapy
LO 13.3
Basic elements of Humanistic therapies
• Four Elements:
– Authenticity
 Genuine, open, and honest response of
therapist
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
A Rogerian person-centered therapist listens with calm acceptance to anything the client says. A sense of
empathy with the client’s feelings is also important.
Psychology: An Exploration, Second Edition
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Gestalt Therapy
LO 13.3
Basic elements of Humanistic therapies
• Founded by Fritz Perls
• People hide parts of self behind false
“mask”
– Mask is socially acceptable behavior
– Inner self not matching mask causes
conflict
Psychology: An Exploration, Second Edition
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Gestalt Therapy
LO 13.3
Basic elements of Humanistic therapies
• Therapist is confrontational and
directive
– Lead clients through exercises
• Attention to body language
• Focus on “denied parts” not hidden past
of psychoanalysis
Psychology: An Exploration, Second Edition
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In Gestalt therapy, it is not unusual to find a client talking to an empty chair. The chair represents some person
from the past with whom the client has unresolved issues, and this is the opportunity to deal with those issues.
Psychology: An Exploration, Second Edition
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Evaluation of Humanistic Therapy
LO 13.3
Basic elements of Humanistic therapies
• Little experimental research to support
ideas
– Theories built around case studies
• Clients need to be intelligent, highly
verbal
– Not a good choice for seriously mentally
ill
Psychology: An Exploration, Second Edition
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Behavioral Therapy and Classical Conditioning
LO 13.4
Behavior therapists’ use of classical and operant conditioning
• Action-based rather than insight-based
therapy
• Change behavior through learning new
responses
– Learning created problem
– New learning corrects problem
Psychology: An Exploration, Second Edition
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Therapies Based on Classical Conditioning
LO 13.4
Behavior therapists’ use of classical and operant conditioning
• Through classical conditioning:
– Old and undesirable automatic
responses can be replaced by desirable
ones
• Techniques originally called Behavior
Modification
Psychology: An Exploration, Second Edition
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Therapies Based on Classical Conditioning
LO 13.4
Behavior therapists’ use of classical and operant conditioning
• Applied behavior analysis
– Newer term
– Highlights need for a functional analysis
of behavior
– Analysis followed by conditioning
Psychology: An Exploration, Second Edition
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Therapies Based on Classical Conditioning
LO 13.4
Behavior therapists’ use of classical and operant conditioning
• Systematic desensitization
– Used to treat phobias
– Client is first taught deep muscle
relaxation
– Next creates a list of ordered fears
 Hierarchy of fears
– Pairs relaxation with fears
– Computer generated simulations used
Psychology: An Exploration, Second Edition
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Therapies Based on Classical Conditioning
LO 13.4
Behavior therapists’ use of classical and operant conditioning
• Aversion therapy
– Undesirable behavior is paired
with aversive stimulus
– Reduces frequency of behavior
Psychology: An Exploration, Second Edition
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This device allows the delivery of high levels of nicotine to the smoker in a process known as rapid smoking.
Rapid smoking is an aversive technique for helping people to quit smoking and is based on the classical
conditioning principle of counterconditioning.
Psychology: An Exploration, Second Edition
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Therapies Based on Classical Conditioning
LO 13.4
Behavior therapists’ use of classical and operant conditioning
• Flooding
– Technique for treating phobias, stress
disorders
– Person is intensely exposed to fearprovoking situation
– Prevented from making avoidance or
escape response
Psychology: An Exploration, Second Edition
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Therapies Based on Classical Conditioning
LO 13.4
Behavior therapists’ use of classical and operant conditioning
• Techniques include reinforcement,
extinction, shaping, and modeling
– Change the frequency of voluntary
behavior
– Results quick and practical
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Therapies Based on Classical Conditioning
LO 13.4
Behavior therapists’ use of classical and operant conditioning
• Modeling
– Learning through observation, imitation
of a model
– Participant modeling
 Model demonstrates the desired behavior
in a step-by-step process
 Client is encouraged to imitate
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Therapies Based on Classical Conditioning
LO 13.4
Behavior therapists’ use of classical and operant conditioning
• Reinforcement
– Strengthening of response by following
it with:
 A pleasurable consequence (positive
reinforcement)
 Removal of an unpleasant stimulus
(negative reinforcement)
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Therapies Based on Classical Conditioning
LO 13.4
Behavior therapists’ use of classical and operant conditioning
• Reinforcement
– Token economy
 Tokens to reinforce behavior
 Can be accumulated and exchanged for
desired items or privileges
 Used effectively to modify behavior of
disturbed institutionalized individuals
Psychology: An Exploration, Second Edition
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Therapies Based on Classical Conditioning
LO 13.4
Behavior therapists’ use of classical and operant conditioning
• Contingency contract
– Formal, written agreement between the
therapist and client
– Goals for behavioral change,
reinforcements, and penalties are
clearly stated
– Useful in treating problems such as drug
addiction
Psychology: An Exploration, Second Edition
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Therapies Based on Classical Conditioning
LO 13.4
Behavior therapists’ use of classical and operant conditioning
• Extinction
– Removal of a reinforcer
– Reduces frequency of behavior
– Time-out
 Extinction process
 Person is removed from situation
reinforcing an undesirable behavior
 Placed away from attention and
reinforcement opportunities
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
This boy is sitting in the “time-out” corner at his school. By removing the attention that he found rewarding, the
teacher is attempting to extinguish the behavior that earned the boy a time-out. Do you see anything in this
time-out corner that might make it less effective?
Psychology: An Exploration, Second Edition
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Evaluation of Behavioral Therapies
LO 13.4
Behavior therapists’ use of classical and operant conditioning
• Effective in treating specific problems
– Bedwetting, drug addictions, phobias
• More serious psychological disorders do
not respond as well to behavioral
treatments
• Overall behavior therapies are:
– Relatively quick and efficient
– Eliminate or greatly reduce symptoms
Psychology: An Exploration, Second Edition
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Cognitive Therapy
LO 13.5 Goals of cognitive therapy
• Focus on:
– Helping clients recognize distortions in
thinking
– Replace distorted, unrealistic beliefs
with realistic thoughts
• Is critical thinking applied to one’s own
beliefs
Psychology: An Exploration, Second Edition
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Cognitive Therapy
LO 13.5 Goals of cognitive therapy
• Beck
– Identified five common distortions
– Arbitrary inference
 Jumping to conclusions
 Drawing conclusions not based on
evidence
Psychology: An Exploration, Second Edition
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Beck's Cognitive Therapy
LO 13.5 Goals of cognitive therapy
• Selective thinking
– Focusing on one aspect of a situation
– Ignoring all other relevant aspects
• Overgeneralization
– Drawing sweeping conclusions based on
only one incident
– Applying conclusions to events
unrelated to original
Psychology: An Exploration, Second Edition
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Beck's Cognitive Therapy
LO 13.5 Goals of cognitive therapy
• Magnification and minimization
– Negative event blown out of proportion
to its importance (magnification)
– Ignore relevant positive events
(minimization)
• Personalization
– Taking responsibility for events
unconnected to the person
Psychology: An Exploration, Second Edition
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Cognitive-Behavioral Therapy
LO 13.5 Goals of cognitive therapy
• Assumes disorders come from illogical,
irrational cognitions
• Is an action therapy
– Learning to think more rationally and
logically
Psychology: An Exploration, Second Edition
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Cognitive-Behavioral Therapy
LO 13.5 Goals of cognitive therapy
• Three goals:
– Relieve the symptoms and solve the
problems
– Develop strategies for solving future
problems
– Help change irrational, distorted
thinking
Psychology: An Exploration, Second Edition
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Rational-Emotive Behavior Therapy
LO 13.5 Goals of cognitive therapy
• A cognitive-behavioral therapy
• Clients are directly challenged on
irrational beliefs
• Restructures thinking into rational
belief statements
• Therapists are directive
– Provide homework assignments
– Challenge “my way or nothing”
statements
Psychology: An Exploration, Second Edition
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Success of CBT
LO 13.5 Goals of cognitive therapy
• CBT has seemed successful in treating
– Depression, stress disorders, and
anxiety
• Criticized for focusing on symptoms,
not causes of disordered behavior
Psychology: An Exploration, Second Edition
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Table 13.1
Characteristics of Psychotherapies
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Group Therapies
LO 13.6 Types of group therapy
• Therapist may use one of many
approaches or a combination
– Insight, cognitive-behavioral,
person-centered, behavioral
– Share problems, provide support
Psychology: An Exploration, Second Edition
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Group Therapies
LO 13.6 Types of group therapy
• Family counseling
– Family members meet together with
a counselor
– Discover and resolve unhealthy patterns
of relating
– Open lines of communication
– Resolve problems that affect the entire
family
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
Group Therapies
LO 13.6 Types of group therapy
• Self-help groups
– People with similar problems meet
together without a therapist or
counselor
– Purpose is discussion, problem solving,
emotional support
Psychology: An Exploration, Second Edition
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In family therapy, all family members participate in therapy sessions, with the therapist guiding them through
open communication. Although it appears that the young boy in the corner is the focus of this session, all family
members are encouraged to see how their own behavior may contribute to the problem behavior.
Psychology: An Exploration, Second Edition
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Advantages of Group Therapy
LO 13.6 Types of group therapy
• Lower cost
• Exposure to way other persons view
and handle the same kinds of problems
• Opportunity for therapist and client to
see interaction with others
• Social and emotional support from
people with similar problems
Psychology: An Exploration, Second Edition
Saundra K. Ciccarelli • J. Noland White
In group therapy, several people who share similar problems gather with a therapist to discuss their feelings and
concerns. The presence of others who are going through the same kind of emotional difficulties can be comforting
as well as provide the opportunity for insights into one’s own problems by hearing about the problems of others.
Psychology: An Exploration, Second Edition
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Disadvantages of Group Therapy
LO 13.6 Types of group therapy
• Need to share therapist’s time with
others in the group
• Lack of a private setting in which to
reveal concerns
• Possibility that shy people will not be
able to speak up within a group setting
• Inability of people with severe disorders
to tolerate being in a group
Psychology: An Exploration, Second Edition
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Does Psychotherapy Really Work?
LO 13.7 Effectiveness of psychotherapy
• Psychotherapy is more effective than
no treatment at all.
• 75 to 90 percent of people who receive
therapy improve
– Longer a person stays in therapy the
better the improvement
– Psychotherapy works as well alone as
with drugs
Psychology: An Exploration, Second Edition
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Does Psychotherapy Really Work?
LO 13.7 Effectiveness of psychotherapy
• Some types of psychotherapy are more
effective for certain types of problems
– No one psychotherapy method is
effective for all problems
Psychology: An Exploration, Second Edition
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Characteristics of Effectiveness Psychotherapy
LO 13.7 Effectiveness of psychotherapy
• Common factors approach
– Modern approach to eclecticism
– Focuses on factors common to
successful outcomes in therapy
Psychology: An Exploration, Second Edition
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Characteristics of Effectiveness Psychotherapy
LO 13.7 Effectiveness of psychotherapy
• Therapeutic Alliance
– Relationship between client and
therapist
• Protected setting
– Privacy, safety for client
• Opportunity for catharsis
• Learning and practice of new behavior
Psychology: An Exploration, Second Edition
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Culture, Ethnic and Gender Concerns
LO 13.7 Effectiveness of psychotherapy
• Differences between therapist and
client
– Difficult for the therapist to understand
concerns
– Misunderstandings and
misinterpretations can occur
Psychology: An Exploration, Second Edition
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Culture, Ethnic and Gender Concerns
LO 13.7 Effectiveness of psychotherapy
• Four barriers to effective psychotherapy
– Language
– Culture-bound values
– Class-bound values
– Nonverbal communication
Psychology: An Exploration, Second Edition
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Cybertherapy
LO 13.7 Effectiveness of psychotherapy
• Psychotherapy offered on the Internet
• Offers advantages of low or no cost,
accessible, anonymous
• No guarantee cybertherapist has
credentials or training in psychotherapy
• Difficult for cybertherapist to assess
client’s body language or emotional
state
Psychology: An Exploration, Second Edition
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Biomedical Therapies
LO 13.8
Types of drugs used to treat psychological disorders
• Therapies directly affecting the
biological functioning of body and brain
• Psychopharmacology
– The use of drugs to control or relieve
the symptoms of psychological disorders
Psychology: An Exploration, Second Edition
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Biomedical Therapies
LO 13.8
Types of drugs used to treat psychological disorders
• Psychopharmacology
– Anti-psychotic drugs
 Used to treat psychotic symptoms
– Delusions, hallucinations, and other
bizarre behavior
– Anti-anxiety drugs
 Include anti-anxiety and antidepressant
drugs
Psychology: An Exploration, Second Edition
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Biomedical Therapies
LO 13.8
Types of drugs used to treat psychological disorders
• Psychopharmacology
– Anti-manic drugs
 Used to treat bipolar disorder
 Include lithium and anticonvulsant drugs
– Antidepressant drugs
 Used to treat depression and anxiety
 Include MAOIs, tricyclics, SSRIs
Psychology: An Exploration, Second Edition
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Table 13.2 Types of Drugs Used in
Psychopharmacology
Psychology: An Exploration, Second Edition
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Electroconvulsive Therapy
LO 13.9
Modern electroconvulsive therapy and psychosurgery
• Treats severe depression
– Electrodes are placed on one or both
sides of the head
– Bilateral ECT
 Electrodes are placed on both sides of
the head
– Unilateral ECT
 Electrodes are placed on only one side of
the head and forehead
Psychology: An Exploration, Second Edition
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Electroconvulsive therapy consists of applying an electric shock to one or both sides of the head. The result is
rapid improvement in mood. It has been shown to be most effective in treating severe depression that has not
responded to medication or where medication side effects cannot be tolerated.
Psychology: An Exploration, Second Edition
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Electroconvulsive Therapy
LO 13.9
Modern electroconvulsive therapy and psychosurgery
• Treats severe depression
– An electric current is passed through the
electrodes
– Strong enough to cause a seizure or
convulsion
Psychology: An Exploration, Second Edition
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Psychosurgery
LO 13.9
Modern electroconvulsive therapy and psychosurgery
• Surgery performed on brain tissue to
relieve or control severe psychological
disorders
– Prefrontal lobotomy
 Connections between prefrontal cortex to
other brain areas are severed
Psychology: An Exploration, Second Edition
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Psychosurgery
LO 13.9
Modern electroconvulsive therapy and psychosurgery
• Surgery performed on brain tissue to
relieve or control severe psychological
disorders
– Bilateral cingulotomy
 MRI used to guide electrode to area in
brain
 Electrode is inserted into the cingulate
gyrus
Psychology: An Exploration, Second Edition
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Psychosurgery
LO 13.9
Modern electroconvulsive therapy and psychosurgery
• Surgery performed on brain tissue to
relieve or control severe psychological
disorders
– Bilateral cingulotomy
 Small current run to electrode to destroy
small area of cells
– Referred to as deep lesioning
– Effective in ⅓ to ½ cases of major
depression, bipolar and OCD
Psychology: An Exploration, Second Edition
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Emerging Techniques
LO 13.9
Modern electroconvulsive therapy and psychosurgery
• Repetitivetranscranial magnetic
stimulation (rTMS)
– Magnetic pulses are applied to the
cortex
• Transcranial direct current stimulation
(tDCS)
– Scalp electrodes used to pass low
amplitude currents to the brain
Psychology: An Exploration, Second Edition
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Repetitive transcranial magnetic stimulation (rTMS) uses a pulsating magnetic field to activate specific parts of
the brain’s surface. As seen above, by placing an electromagnet on the scalp, TMS can be used to stimulate small
areas of the cortex and is being evaluated as a way to control some psychological symptoms, such as those
related to depression and PTSD. Photo courtesy of Martijn Arns, http://www.brainclinics.com
Psychology: An Exploration, Second Edition
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Virtual Realities
LO 13.10 How might computers be used in psychotherapy
• Software-generated, three-dimensional
simulated environment
• Useful with exposure therapy
• Vivid and realistic imagery possible
– Particularly helpful for clients that do
not visualize well
• Post-traumatic stress disorder (PTSD)
– Benefits from the use of VR
psychotherapy
Psychology: An Exploration, Second Edition
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Some behavioral therapists now use virtual reality to expose patients to phobic objects and situations—like the
cabin of an airplane. As part of systematic desensitization, this patient receives exposure to anxiety-provoking
visual displays through a virtual reality headset. Credit: Charles Undermost, Delft University of Technology.
Psychology: An Exploration, Second Edition
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