Transcript Therapy - White Plains Public Schools

Therapy
Psychodynamic
Therapy
Psychodynamic Therapy
• Used for unfocused anxiety/depression
• Psychoanalysis- pioneered by Freud
intensive technique for exploring the
unconscious
- Freud believed that anxiety disorders
are inabilities to resolve inner conflicts
(they become repressed) in the
unconscious between the id and the
superego
Psychodynamic Therapy
• GOAL of Psychoanalysis:
- make unconscious conflict
 conscious
- repressed material can
then be dealt with
- ego can be strengthened &
defense mechanisms do
not need to be used
Job of the Therapist
• Main job: help a
patient bring
repressed thoughts
into consciousness &
gain insight into the
relationship between
current symptoms &
the repressed conflict
Job of the Therapist
• Therapy succeeds when patients are
released from the repression
established in early childhood
- often through catharsis (AKA insight
therapy) – expressing strong felt, but
usually repressed emotions; a
healing emotional release
Job of the Therapist
• It is an attempt to reconstruct longstanding repressed memories & work
through painful feelings to an
effective resolution
• This takes years, requires
introspective patients who are highly
motivated, verbally fluent & have $ to
continue the therapy
Techniques Used
1. Free Association- say whatever
comes to mind regardless of
painful or irrelevant thoughts
- therapist will note patterns that
lie beneath the words (the
surface)
2. Catharsis- see notes
Free Association
• Start with a recent experience,
memory, or dream and write every
image or idea that enters your
awareness
• Don’t self-edit OR refrain from logic
Techniques Used
3. Dream Analysis- examines content
of a person’s dreams to discover
motivations, life experiences,
desires
- 2 kinds of content:
a) manifest- people remember
upon awakening
b) latent- hidden, deeper content
Techniques Used
4. Analysis of Transferencetransferring of feelings about a
person in the past to the therapist
due to unfinished business
- positive- feeling of love/admiration
- negative- feeling of anger/hostility
- therapist provides a stage for reenacting unresolved conflicts
Techniques Used
5. Analysis of Countertransference- therapist begins to view client as
someone in therapists life &
projects feeling toward the client
- can provide useful material to look
at with client, but must be careful
- become mirrors for one another
Techniques Used
6. Analysis of Resistance
- individuals put up
barriers to free association
- resisting to “work” with
the therapist
- therapist’s job is to break
down areas the client does
not want to discuss
Techniques Used
• Projective Techniques- help access
unconscious, esp. in children
- Rorschach, TAT, incomplete
sentences, draw a picture
Behavioral Therapy
Behavioral Therapy
• Abnormal behaviors are acquired
through a learning process that follows
basic principles of conditioning &
learning
• Therapy includes applying principles of
conditioning & reinforcement to
increase frequency of desired behaviors
or decrease frequency of problem
behaviors
Behavioral Therapy
• Problems that generally
use behavior
modification/therapy:
- fears/phobias,
compulsions,
depression, addictions,
aggression, &
delinquent behavior
Behavioral Therapy
• When people can’t
cope effectively, their
maladaptive
reactions can be
overcome by therapy
based on learning or
relearning
Behavioral Therapy
• 3 Types of Behavioral Therapy:
1. Counter-Conditioning- a new response is conditioned to
replace or “counter” a maladaptive
response
ex. Child afraid of the dark  have
child listen to their favorite song
while sitting in the dark
Behavioral Therapy
- Techniques Used:
a) systematic desensitization- client is
taught to prevent the arousal of
anxiety by confronting the feared
stimulus & using relaxation
techniques; used for social phobias
(The King’s Speech);
Behavioral Therapy
b) implosion- opposite; exposes a
client to anxiety, provoking the
stimuli (most frightening is the
imagination) but in a safe setting;
person cannot run away; “tough love”
c) flooding- client is placed in or
exposed to the phobic situation; used
for agoraphobia
Behavioral Therapy
*all 3 have in common  exposure
through imagery, contact, or virtual
reality; all are exposed to object
feared
Behavioral Therapy
d) aversion therapy- used for patients
attracted to harmful stimuli (drug
addictions, violent behavior); an
attractive stimuli is paired with shock
or drugs (noxious stimuli) to get the
patient to pair the noxious stimuli
with the harmful behavior
Behavioral Therapy
2. Contingency Management- Skinner;
changing behavior by modifying
consequences (operant cond.)
- Techniques Used:
a) token economy- positive
reinforcement; desired behaviors are
defined & token payoffs are given when
behavior is performed (gold stars); can
later be exchanged for rewards, etc.
Behavioral Therapy
3. Social Learning Theory- clients
observe models’ desirable
behaviors being reinforced b/c
people learn via observation
- used to overcome phobias & to
build social skills
- based on Bandura’s research
Behavioral Therapy
- Techniques Used:
a) Participant Modeling- therapist
demonstrates desired behavior &
client is helped to imitate behavior
with support & encouragement
b) Behavioral Rehearsal- visual; how
one should behave in a situation 
helps strengthen social skills
Behavioral Therapy
Most common problem: lack of
assertiveness
 often in children (have deficits in
social skills that may lead to
problems later)
 pre-schools, elem. schools look
to build skills in withdrawn, isolated
children
Cognitive Therapy
Cognitive Therapy
• Attempts to change
the feelings &
behaviors by changing
the way a client thinks
about or perceives
significant life events
Cognitive Therapy
• Abnormal behavior
patterns start with
problems in what people
think & how they think
(cognitive process)
• Therapy will focus on
changing how people think
Cognitive Therapy
Cognitive Therapy
• 2 Types of Cognitive Therapy:
1. Cognitive Behavior Modification- Combines thoughts w/ focus on
reinforcement contingencies in
modifying performance
- Unacceptable behavior patterns are
changed/modified by cognitive
restructuring
Cognitive Therapy
- Change the person’s negative self
statement into constructive coping
statements
- Ex. I am boring, no one will invite
me to another party.
Change this thought to  next time
I’ll tell a joke, be proactive, or more
responsive to other’s stories
Cognitive Therapy
- Step 1: figure out
together the kind of
thinking that is leading to
dysfunctional behavior
- Step 2: develop new selfstatements that minimize
negative thoughts that
elicit anxiety or lower
self-esteem
Cognitive Therapy
- Step 3: set goals
- Step 4: develop strategies for meeting
them  develop self-efficacy
- Step 5: evaluate feedback
Cognitive Therapy
- Changing False Beliefs- cognitive
therapy for depression (Aaron Beck)
- depression arises when people
are unaware of their negative
automatic thoughts & faulty
thinking
Cognitive Therapy
- often emotional stress is caused
by cognitive misunderstanding and
failure to distinguish between
reality & one’s expectations
 MUST challenge patient’s basic
assumptions
Cognitive Therapy
2. Rational Emotive Therapy
(RET)- based on the
transformation/changing of
irrational beliefs that cause
severe emotional reactions
(ex. Anxiety)
- Ellis
Cognitive Therapy
- teach the client to
recognize the “shoulds,
oughts, haves, &
musts” that control
their actions & prevent
them from choosing
the life they want
Cognitive Therapy
- through rational confrontation,
client can dispute & examine
alternative reasons for their
thoughts/actions
- this is followed up by replacing
dogmatic thinking w/ rational,
situationally appropriate ideas
Cognitive Therapy
- it aims to increase individual’s
self-worth by getting rid of faulty
beliefs that block personal
growth
Group Therapy
Group Therapy
• Can sometimes be more effective
1. Less Expensive- small # of mental
health personnel can help more
people
2. Power of Groups- less threatening,
provides opportunities to practice
interpersonal skills and observe
others
Group Therapy
Allows for corrective
emotional experiences
to take place in a
“family-like” atmosphere
Helps people realize
they are not alone
Provides social support
outside of therapy
Group Therapy
• Different Types:
1. Marital & Family- each
member is treated as a
member of a system of
relationships
- therapist helps to
understand what the
problems are in the family
Group Therapy
- seeks to help communication,
understand communication styles &
how to express themselves
- therapist acts as interpreter,
clarifier, mediator, & referee when
helping to resolve dysfunctional
elements
Group Therapy
2. Community Support Groups
- 10+ million Americans participate in
self-help groups
- pioneered by women’s groups & AA
- 4 Main Groups:
Group Therapy
a) Addictive behavior
b) Physical/mental disorder
c) Life transition or other crises
d) Traumas experienced by friends or
relatives w/ serious problems
Group Therapy
• Many groups popping up on the
Internet
 providing social support, hope
& control for problems; people
dispense info about disorders &
treatments
Humanistic &
Bio-Medical Theory
Humanistic Therapy
• Started in 1960s, goes along with
theory that a human is a whole
person who is constantly changing
and growing
- environment and heredity place
some restrictions, but people are
always free to choose what they will
become
Humanistic Therapy
• Therapists attempt to help clients
define their own freedom, cultivate
their individuality, & discover ways
to reach their fullest potential (selfactualization)
Humanistic Therapy
1. Client-Centered Therapy (Carl Rogers)
- major assumption: people can selfactualize (realize their potential)
- problems arise when there is conflict
between positive self-image &
negative external criticisms  anxiety
Humanistic Therapy
- The counselor acts as a mirror
- Client is in the role of
exploring thoughts, feelings,
& behaviors
- GOAL: help people become
more confident, fully
functioning, able to counsel
themselves
Humanistic Therapy
• Techniques:
1. Active listening (no
advice, solutions,
criticisms)
- listen, reflect, rephrase
2. Respectful, unconditional
positive regard, empathetic
Biomedical Therapy
• Treat mental disorders as problems in
the brain
• 3 Approaches:
1. Psychosurgery- considered method
of last resort; not practiced
anymore; most famous is lobotomy
- severed connections between
prefrontal cortex & rest of brain
Biomedical Therapy
2. Electroconvulsive Therapy (ECT)use of shock to treat psychiatric
disorders such as: schizophrenia,
mania, & depression
- generally used to treat depression
that has not worked with drugs
- apply weak electrical current after
patient has had a muscle relaxant
Biomedical Therapy
- A last resort as well- been proved
effective for severe depression,
acute psychotic states & mania
- Side effects: memory loss,
confusions (sometimes a little,
sometimes permanent)
Biomedical Therapy
3. Drug Therapy: 3 typesA. Anti-Psychotic- dopamine blockers,
mood stabilizers (Thorazine, Haldol,
Clozapine)
- try to reduce hallucinations,
delusions, & paranoia
- too much dopamine = hallucinations
- too little dopamine= flat emotional
response
Biomedical Therapy
B. Anti-Depressants (SSRI’s & MAO’s)
- SSRI’s- used for depression, anxiety
(panic, OCD, eating disorder), & some
personality disorders
- prozac, celexa, lexapro, paxil,
zoloft
Biomedical Therapy
- MAO’s- not used as much, can cause
toxic reaction
- enzyme breaks down
norepinephrine & serotonin
Biomedical Therapy
C. Anti-Anxiety- benzodiazepine
(Valium, Xanax, Ativan, Klonopin)
- need to be careful  can form a
dependence; has a calming effect and
can cause sedation affecting the CNS
Biomedical Therapy
4. Lithium- takes time to
work; helps with manic
highs & lows of bipolar
disorder
- anticonvulsant- used
for immediate treatment
of manic episodes