Transcript Ch 13 Notes Therapies

AP Psychology
Therapists are trained
professionals who know
the art of establishing a
helping relationship
and know how to apply
the knowledge of
psychology to an
individual struggling
with problems and
choices.
We often hear that
someone was in
therapy, but what is
therapy?
There are many
stereotypes about
therapy, like the
picture of a bearded
therapist taking notes
while a patient lies on
a couch and spills his
or her guts. This is a
very Freudian image.
Therapy is a term used for any treatment
process; in psychology and psychiatry, therapy
refers to a variety of techniques used to deal
with mental disorders or cope with problems of
living.
There are endless reasons why people go to see a
therapist or counselor including making
difficult decisions, dealing with academic
problems, coping with the loss of a loved one,
or dealing with an unhappy relationship.
There are a variety of techniques and methods
therapists and counselors use, but all center on
developing a strong, supportive relationship with the
patient.
Another similarity amongst all therapy techniques is
their end goal of changing a person’s functioning in
some way.
In addition to developing a strong
relationship between client/patient and
counselor, the therapeutic process generally
involves some or all of the following
processes:
Identifying the problem
2. Identifying the cause of the problem or the
current conditions that maintain the problem
3. Deciding on and carrying out some form of
treatment
1.
Professional
Title
Specialty and common work setting
Credential and
qualifications
Counseling
Psychologist
Provides help in dealing with the common
problems of normal living-relationships, child
rearing, school problems. Typically counselors in
schools clinics or other institutions
Depends on the state;
minimum master’s in
counseling, but most
commonly a PhD
Clinical
Psychologist
Trained primarily to work with those who have
more severe disorders, but may also work with
clients having less severe problems. Usually
private practice
Usually required to hold a
PhD and state certificate
Psychiatrist
A specialty of medicine; deals with sever mental
problems-most often prescribes drugs. May be
private practice or employed by clinics and
mental hospitals
MD; licensed by medical
board
Psychoanalyst
Practitioners of Freudian therapy. Usually in
private practice
MD
Psychiatric Nurse
Practitioner
A nursing specialty; licensed to prescribe drugs
for mental disorders. May work in private practice
or in clinics and hospitals
Requires RN credential plus
specialty training
Clinical or
Psychiatric Social
Worker
Social workers with a specialty in dealing with
mental disorders, especially from the viewpoint of
social and environmental contexts
MSW-Masters of Social Work
Pastoral
A member of a religious order or ministry who
Varies
The world of psychology is constantly changing.
One of the current movements is clinical
psychologists who are seeking to obtain the
privilege to give prescriptions to clients.
New Mexico became the first state to allow this,
putting psychologists through a rigorous program,
including 850 hours of of course work and a
supervised internship.
Not surprisingly this is hotly contested in the
medical profession.
Much like the history of psychology itself and
psychological disorders, therapy has had its fair
share of misguided theories.
In medieval Europe, people often thought mental
disorders were the work of the devil and other
demons. The job the therapists was to perform
exorcisms.
One of the most well known asylums was that of
Bethlehem Hospital in London. On the weekend, a
person could pay a few pence to go sightseeing and
watch the inmates who often put on a noisy and
wild show. As a result, “Bedlam,” the shortened
term Londoners used for Bethlehem, became a
word used to describe any noisy, chaotic place
(Zimbardo et al.)
In the medieval asylums, patients, at most only
custodial care; at worst, they were neglected and put in
cruel restraints such as cages and straightjackets.
Some received other forms of torture like beatings and
cold showers.
There are two main modern approaches:
Psychological therapies (psychotherapy)
focus on changing disordered thoughts, feelings
and behaviors using psychological techniques.
They come in two main forms:
 Insight therapy: focuses on helping people understand their
problems and change their thoughts, motives or feelings.
 Behavior therapy: focuses primarily on changing behavior.
Biomedical therapies focus on treating mental
problems by changing the underlying biology of the
brain. To do so, a physician or nurse practitioner can
use a variety of drugs, including antidepressants,
tranquilizers and stimulants.
The way a disorder is treated relies on the way it is
viewed. The way it is viewed is heavily dependent on the
culture it is being treated in.
Individualistic Western views generally regard
psychological disorders to be a result of disease process,
abnormal genetics, disordered thinking, unhealthy
environments or stressors.
Collectivist cultures often think of mental disorders as
a disconnect between the person and the group. In such
cultures, treating mentally disturbed people by
removing them from society is unthinkable.
Treatment of disorders falls into one of the two
categories we just discussed. Insight therapies were the
first truly psychological treatments used. In recent
years, behavioral therapies have also become common
and effective.
Insight therapies attempt to change people on the
inside-changing the way they think and feel. These are
sometimes called think therapies. These therapies
share the assumption that distressed persons need to
develop an understanding of the disordered thoughts,
emotions and motives that underline their mental
difficulties.
In the classical Freudian view, psychological
problems arise from tension in the unconscious
mind by forbidden impulses and threatening
memories.
Psychoanalysis, therefore, probes the
unconscious in an attempt to bring these issues
into the “light of day” or into consciousness.
The major goal of psychoanalysis, then, is to
reveal and interpret the contents of the
unconscious mind.
In the final stages of psychoanalysis, patients learn
how their relationship with the therapist mirrors
the unresolved issues they have with their parents.
This is referred to as analysis of transference.
According to this theory, people will recover when
they are finally released from the repressive mental
restraints established in the relationship with their
parents during early childhood.
These therapies were developed by
psychologists why embraced some of Freud’s
ideas, but disagreed with others.
While they follow many of the same
techniques, their emphasis is on the conscious,
rather than the unconscious, mind. Basically
they spend less time probing for hidden
conflicts and repressed memories.
Psychotherapy
Insight
Therapies
Psychodynamic
Therapies
Humanistic
Therapies
Freudian
Psychoanalysis
Neo-Freudian
Therapies
Behavior
Therapies
Cognitive
Therapies
Therapies based
on Operant
Conditioning
Therapies Based
On Observational
Learning
Therapies Based
on Classical
Conditioning
Many people struggle with the problems of
everyday existence. These are commonly called
existential crises.
This term underscores the idea that many
problems deal with questions about the
meaning and purpose of one’s existence.
Humanistic psychology developed theories to
specifically address these problems
Humanistic psychology believes that people are
generally motivated by healthy needs for
growth and psychological well being. Problems
only occur when conditions interfere with
normal development and produce low self
esteem.
These therapies, then, try to help clients
confront their problems by recognizing their
own freedom, enhancing their self-esteem and
realizing their fullest potential.
This therapy assumes that people all have a
need to realize their fullest potential (self
actualization). But, development can be
hindered by a conflict between one’s desire for a
positive self image and criticism by self and
others.
One therapy technique called “reflection of
feeling,” or reflective listening, is where the
therapist paraphrases the clients words, making
sure to capture the emotional tone, so the client
can see and hear themselves.
 Element of client –centered created by Carl Rogers
 Blanket acceptance and support of a person regardless
of what the person says or does
In stark contrast to psychoanalysis, humanistic
therapists assume that people are generally good
and healthy, but can be negatively effected by
pressure from oneself and society.
Humanistic therapists accomplish treatment
through genuineness, empathy, and unconditional
regard and acceptance for their clients.
Cognitive Therapies see rational thinking as the key to
therapeutic change. The assumption is that
psychological problems arise from erroneous thinking.
Cognitive therapists help the individuals confront the
destructive thoughts that support depression.
 Fritz Perls
 Importance of the whole and encourages their clients
to be in touch with the whole self
 Explore feelings of which they are not aware of
 Importance of body position
 Clients integrate their actions, feelings and thoughts
into a harmonious whole
Behavior therapy, or behavior modification, is
based on the assumption that undesirable
behaviors have been learned, and therefore, can be
unlearned.
Behavior therapist focus on the problem behaviors
rather than inner thoughts, motives or emotions.
Their goal is to determine how these behaviors
were learned and see if they can eliminate them.
One behavioral technique to extinguish anxiety is
systematic desensitization. In this, a patient is exposed
to an anxiety producing stimulus gradually. Over time,
the anxiety will become extinguised.
For a fear of public speaking:
1.
2.
3.
4.
5.
6.
7.
8.
Seeing a picture of a person giving a speech
Watching another person give a speech
Preparing a speech to give
Having to introduce oneself to a large group
Waiting to be called upon to speak at a meeting.
Being introduced as a speaker to a group
Walking to the podium to make a speech
Making a speech to a large group
Aversion therapy takes on the psychological
problems with a conditioning procedure designed
to make tempting stimulus less provocative by
pairing them with an unpleasant (aversive)
stimuli.
In time, the negative reaction (UCR) associated
with the averse stimuli come to be associated with
the conditioned stimuli.
This is usually a last resort type of therapy, though
it has been shown to be successful.
These therapies rely on the tools of operant
conditioning: reward and punishment.
Contingency Management: An approach to
changing behavior by changing the consequences
associated with a behavior.
Token Economy: A technique involving the
distribution of “tokens” or indicators of
reinforcement contingent on desired behaviors
This therapy combines a cognitive emphasis on
thoughts and attitudes with the behavioral strategies.
This approach assumes that an irrational selfstatement often underlies maladaptive behavior.
In this form of treatment, therapist and client work
together to modify irrational self-talk, set attainable
behavioral goals and develop realistic strategies for
attaining them.
In this way, people change the way they approach
problems and gradually develop new skills and a sense
of self-efficacy.
Biomedical therapies seek to treat psychological
disorders by changing the brain’s chemistry with
drugs, its circuitry with surgery or its patterns of
activity with pulses of electricity or magnetic fields.
The first psychological drugs were administered in
1953 with the antipsychotic drugs.
In 1955, over ½ a million Americans were living in
mental institutions, each staying an average of a
few years. Then, with the introduction of
tranquilizers, the number declined. By 1965, the
number of patients was down to ¼ million, with
most patients staying for only a few months.
Antipsychotic drugs are used to treat the
symptoms of psychosis: delusions, hallucinations,
social withdrawal and agitation.
Most work by reducing the activity of the
neurotransmitter dopamine. Although the exact
reason why this has an antipsychotic effect, these
drugs have proven to be quite effective.
While these drugs reduce the overall brain activity,
they do not simply put the patient in a trance.
Instead they simply reduce the “positive”
symptoms of psychosis.
Unfortunately, long-term use can cause problems
like tardive dyskinesia, which produces an
uncontrollable disturbance of motor control,
especially in the facial muscles.
Often times, researchers now simply characterize
symptoms of schizophrenia into positive and
negative categories.
Positive symptoms refer to active process such as
delusions, and hallucinations while negative
symptoms refer to passive processes like social
withdrawal.
There are three major classes of antidepressant
drugs, and all three work by “turning up the
volume” on messages transmitted over certain
brain pathways, especially those using
norepinephrine and serotonin.
The major downside of these drugs is that it often
takes a few weeks for them to have an effect. In
some cases, time is not a luxury a mentally ill
patient has.
Antianxiety drugs most commonly fall into two
categories: barbiturates and benzodiazepines.
Barbiturates act as a central nervous system
depressant, so they have a relaxing effect.
Benzodiazepines work by increasing the activity of
certain neurotransmitters.
Stimulants is a broad category that includes
everything from caffeine to nicotine to amphetamines
to cocaine-they are any drugs that produce excitement
or hyperactivity.
These drugs are prescribed for a variety of disorders
including narcolepsy and ADHD.
 Cannot cure any mental illness
 Can alter the brain to suppress some symptoms
 Can have negative long term effects
 Can be habit forming
 Often over prescribed
Psychosurgery is the general term given for any
surgical intervention in the brain to treat a
psychological disorder.
These surgeries were far more common in the past,
and today have become a method of last resort.
Electroconvulsive Therapy (ECT)A treatment used primarily for depression that
involves the application of an electric current to
head, producing a generalized seizure.
Transcranial Magnetic Stimulation (TMS)A treatment that involves magnetic stimulation of
specific regions of the brain, but unlike ECT, it
does not produce a seizure.