Transcript Chapter 17

PSYCHOLOGY
(8th Edition)
David Myers
PowerPoint Slides
Aneeq Ahmad
Henderson State University
Worth Publishers, © 2006
1
Therapy
Chapter 17
2
Therapy
The Psychological Therapies
 Psychoanalysis
 Humanistic Therapies
 Behavior Therapies
 Cognitive Therapies
 Group and Family Therapies
3
Therapy
Evaluating Psychotherapies
 The Effectiveness of Psychotherapy
 The Relative Effectiveness of
Different Therapies
 Alternative Therapies Evaluated
 Commonalities Among
Psychotherapies
 Culture and Values in
Psychotherapies
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Therapy
The Biomedical Therapies
 Drug Therapies
 Brain Stimulation Psychosurgery
Preventing Psychological
Disorders
5
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
6
History of Insane Treatment
Philippe Pinel in France and Dorthea Dix in
America founded humane movements to care
for the mentally sick.
Culver Pictures
http://wwwihm.nlm.nih.gov
Philippe Pinel (1745-1826)
Dorthea Dix (1745-1826)
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Therapies
Psychotherapy involves an emotionally
charged, confiding interaction between a
trained therapist and a mental patient.
Biomedical therapy uses drugs or other
procedures that act on the patient’s nervous
system, curing him or her of psychological
disorders.
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An eclectic approach uses various forms of healing
techniques depending upon the client’s unique
problems.
Psychotherapy integration combines a selection of
assorted techniques into a single, coherent system.
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Psychological Therapies
We will look at four major forms of
psychotherapies based on different theories of
human nature:
1.
2.
3.
4.
Psychoanalytical theory
Humanistic theory
Behavioral theory
Cognitive theory
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Psychoanalysis
The first formal psychotherapy to emerge was
psychoanalysis, developed by Sigmund Freud.
Edmund Engleman
Sigmund Freud's famous couch
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Psychoanalysis: Aims
Since psychological problems originate from
childhood repressed impulses and conflicts, 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 (1) 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.
http://www.english.upenn.edu
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Psychoanalysis: Methods
During free association, the patient edits his
thoughts, resisting his or her feelings to express
emotions. Such (2) resistance, the defensive
blocking from awareness of anxiety-laden material,
becomes important in the analysis of conflictdriven anxiety.
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Eventually the patient opens up and reveals his or her
innermost private thoughts, developing positive or
negative feelings (transference) towards the therapist.
When (3) transference occurs the patient is
transferring onto the therapist a long-repressed
feeling from earlier relationships with family
members or other important people
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(4) Interpretation – when the therapists translates
latent content of dreams in order to gain insight into
the client’s problem and its source:
verbalizing/determining the true meaning of the
dream
Freud also believed that the latent content of
dreams was another clue to unconscious conflicts.
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Psychoanalysis: Criticisms
1. Psychoanalysis is hard to refute because it
cannot be proven or disproven.
2. Psychoanalysis takes a long time and is very
expensive.
Psychoanalysis is criticized because its
interpretations are hard to prove or disprove
and because it is time-consuming and
costly. The recent challenge to repressed
memories, on which much of psychoanalysis is
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built, is also provoking intense debate.
Psychodynamic Therapies
Influenced by Freud, psychodynamic therapists
understand symptoms and themes across
important relationships in a patient’s life.
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Today, there are relatively few
traditional psychoanalysts.
Most have been replaced by therapists who make
psychodynamic therapists.
Those that make psychodynamic assumptions, that
is, those who try to understand patients’ current
symptoms by exploring their childhood experiences
and by exploring the therapist-patient relationship.
They may also help the person explore defendedagainst thoughts and feelings. However, they talk
with the patient face-to-face, once a week, and for
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only a few weeks or months.
Psychodynamic Therapies
Interpersonal psychotherapy, a brief alternative to
psychodynamic therapy, emphasizes symptom relief
in the present, not overall personality change.
Interpersonal Therapy is used on depressed patients.
This therapy aims to help people gain insight into their
difficulties- it focuses on current relationships rather
than past hurts.
The therapist also focuses on current relationships and
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the mastery of relationships skills.
Humanistic Therapies
Humanistic therapists aim to boost selffulfillment by helping people grow in selfawareness and self-acceptance.
Humanistic therapists focus on clients’ current
conscious feelings and on their taking
responsibility for their own growth.
In emphasizing people’s inherent potential for
self-fulfillment, they aim to promote growth
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rather than to cure illness.
Person-Centered Therapy
Developed by Carl Rogers, person-centered
therapy is a 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 (1) active listening and
echoes, restates, and clarifies the patient’s
thinking, acknowledging expressed feelings.
Michael Rougier/ Life Magazine © Time Warner, Inc.
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Humanistic Therapy
In his client-centered therapy, Rogers expresses
genuineness, acceptance, and empathy.
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Client Centered therapy is a non-directive therapy
because the therapist does not
interpret the person’s problems.
This technique, he believed, would help clients to
increase their self-understanding & self-acceptance.
The therapist interrupts only to restate and confirm
the client’s feelings, to accept what the client is
expressing, or to seek clarification. This is active
listening.
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Three tips for listening more actively in your own
relationships are to: paraphrase, invite clarification,
and reflect feelings.
The client-centered counselor
seeks to provide a
psychological mirror that
helps clients see themselves
more clearly.
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How is Humanistic Therapy different from
Psychoanalysis?
* Humanistic focuses on the present not the past.
* Humanistic has the client become aware of their
feelings as they occur instead of looking for origins in
childhood.
* Humanistic works with the conscious thinking not
unconscious.
*Humanistic therapy promotes growth and fulfillment
instead of curing an illness.
*Humanistic focuses on the client to take immediate
responsibility for their feelings and actions rather than
on uncovering the obstacles to doing so.
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The difference between behavior therapies and
psychoanalysis and humanistic therapy.
*Psychoanalysis & Humanistic therapies assume the problems
diminish as self-awareness grows.
*Behavior Therapists doubt that self-awareness is the key.
*Behavior Therapists are not looking for the inner cause.
*Behavior Therapists apply learning principles to directly attack
the unwanted behavior itself.
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The therapies we have considered thus far assume
that many psychological problems
diminish as self-awareness grows.
Traditional psychoanalysts attempt to help people
gain insight into their
unresolved and unconscious conflicts.
Humanistic therapists help clients
to get in touch with their feelings.
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In contrast, behavior therapists question the
therapeutic power of increased self-awareness.
They assume problem behaviors are the problems
and thus do not look for inner causes.
Instead, they apply learning principles
to eliminate a troubling behavior.
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Behavior Therapy
Therapy that applies learning principles to the
elimination of unwanted behaviors.
To treat phobias or sexual disorders, behavior
therapists do not delve deeply below the
surface looking for inner causes.
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Classical Conditioning Techniques
Counterconditioning is a procedure that
conditions new responses to stimuli that trigger
unwanted behaviors.
Examples: Chronic bed-wetter’s or fear of elevators
one might unlearn the fear by counter-conditioning
the fear response.
It is based on classical conditioning and
includes exposure therapy and aversive
conditioning.
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Two specific counter conditioning techniques:
Exposure Therapy & Aversive Conditioning
1) Exposure therapies treat anxieties by exposing
people to the things they fear and avoid.
Ex. Fear of snakes- place the snake across the room
while the subject was engaged in a pleasurable
relaxing behavior such as a massage. Each time the
snake is placed a little closer until the subject is
holding the snake. The fear has been countered or
replaced by the relaxed feeling that cannot occur at
the same time.
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1) 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 Therapy
Exposure therapy involves exposing people to
fear-driving objects in real or virtual
environments.
Both Photos: Bob Mahoney/ The Image Works
N. Rown/ The Image Works
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In systematic desensitization,
a prime example of exposure therapy,
a pleasant, relaxed state is associated with
gradually increasing anxiety-triggering stimuli.
This procedure is commonly used to treat phobias.
Step 1- construction of a hierarchy of anxiety-arousing
stimuli
Step 2- training in progressive relaxation
Step 3- trained to associate the relaxed state with the
anxiety-arousing stimuli
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Systematic Desensitization
A type of exposure therapy that associates a
pleasant, relaxed state with gradually increasing
anxiety-triggering stimuli commonly used to
treat phobias.
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2) Aversive Conditioning
A type of
counterconditioning
that 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.
A number of withdrawn, uncommunicative
3-year-old autistic children have been
successfully trained by giving and withdrawing
reinforcements for desired and undesired
behaviors.
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Token Economy
In institutional settings therapists may create a
token economy in which patients exchange a
token of some sort, earned for exhibiting the
desired behavior, for various privileges or
treats.
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Criticisms and Positives
of Behavior Modification
First, what happens when the reinforcers stop?
Might the person have become so dependent upon the
extrinsic rewards that the appropriate behaviors
quickly disappear?
Second, is it ethical for one person to control another’s
behavior?
Proponents of Behavior Modification:
First, some clients may request this therapy
Second, control already exists.
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Cognitive Therapy
Cognitive therapists assume that our thinking colors
our feelings, and so they try to teach people who suffer
psychological disorders new, more constructive ways
of thinking.
Cognitive-behavior therapists combine the reversal of
self-defeating thinking with efforts to modify behavior.
They aim to make people aware of their irrational
negative thinking, to replace it with new ways of
thinking and talking, and to practice the more positive
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approach in everyday settings.
Cognitive Therapy
Teaches people adaptive ways of thinking and
acting based on the assumption that thoughts
intervene between events and our emotional
reactions.
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Cognitive Therapy for Depression
Aaron Beck (1979) suggests that depressed
patients believe that they can never be happy
(thinking) and thus associate minor failings (e.g.
failing a test [event]) in life as major causes for
their depression.
Beck believes that cognitions such as
“I can never be happy” need to change in order
for depressed patients to recover.
This change is brought about by gently
questioning patients.
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Cognitive Therapy for Depression
Rabin et al., (1986)
trained depressed
patients to record
positive events each day,
and relate how they
contributed to these
events. Compared to
other depressed patients,
trained patients showed
lower depression scores.
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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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In stress inoculation training, people suffering
depression learn to dispute their negative thoughts
and to restructure their thinking in stressful
situations.
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Cognitive-Behavior Therapy
Cognitive therapists often combine the reversal
of self-defeated thinking with efforts to modify
behavior.
Cognitive-behavior therapy aims to alter the
way people act (behavior therapy) and alter the
way they think (cognitive therapy).
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So these therapists teach depressed adults to interpret
life events as non-depressed people do, for example,
to take credit for their successes.
So cognitive therapists often combine the reversal of
self-defeating thinking with efforts to modify
behavior.
Thus this integrated therapy is called cognitivebehavior therapy which aims to alter the way people
act (behavior therapy) and to alter the way they thing
(cognitive therapy).
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Group Therapy
Group therapy normally consists of 6-9 people
attending a 90-minute session that can help
more people and costs less. Clients benefit from
knowing others have similar problems.
© Mary Kate Denny/ PhotoEdit, Inc.
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Group therapy does not provide the same degree of
therapist’s involvement with each client; however it
saves therapists’ time and clients’ money- and often
is no less effective than individual therapy.
The social context provided by group therapy allows
people to discover that others have problems similar
to their own and to try out new ways of behaving.
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Group therapy can help you:
*Discover that you're not alone in your struggles, thoughts,
and feelings
*Learn from other students facing similar problems
*Gain multiple perspectives on your concerns
*Feel more connected to others as group cohesion develops
*Become more aware of yourself through genuine feedback
from others
*Pick up new interpersonal skills that you can use in your
daily life
*Internalize the lessons you've learned by helping others in
the group
*Develop effective ways of building and maintaining
relationships
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Group therapy is very diverse.
Psychologists with different theoretical
training will use group therapy for many
different types of psychological problems
and concerns.
Receiving honest
feedback can be very
helpful, and it can be
reassuring to find that
you are not alone.
Group therapy has been effective in
addressing many types of problems
including, but not limited to:
*feelings of isolation
*depression and anxiety
*difficulties with interpersonal relationships
*aging
*medical illness and physical problems
*addictive disorders
*sexual problems
*death and other losses
*lifestyle issues within a traditional culture
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Many participate in self-help and support groups—
for divorced people, the addicted, the bereaved, and
those simply seeking personal growth.
Self-help groups may exist separately or as part of larger
organizations. They may operate informally or according to a
format or program. The groups usually meet locally, in
members’ homes or in community rooms in schools, churches,
or other centers.
In self-help groups, specific modes of social support emerge.
Through self-disclosure, members share their stories, stresses,
feelings, issues, and recoveries. They learn that they are not
alone; they are not the only ones facing the problem. This
lessens the isolation that many people, especially those with
disabilities, experience.
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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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In an effort to heal
relationships,
therapists help family
members discover the
role they play within
the family’s social
system
They also attempt to open up
communication within the family
or to help family members
discover new ways of preventing
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or resolving conflicts.
Evaluating Therapies
Who do people turn to for help with
psychological difficulties?
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Evaluating Psychotherapies
Within psychotherapies cognitive therapies are
most widely used, followed by psychoanalytic
and family/group therapies.
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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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Two phenomena that contribute to perceived value in
ineffective therapies are the:
1) Placebo effect (the belief a treatment will work)
2) Regression toward the mean (the tendency for
extremes of unusual scores to fall back toward the
average)
Feeling low tends to be followed by our return to a
more normal state and anything we tried in the
interim may seem effective.
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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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Outcome Research
Research shows that treated patients were 80%
better than untreated ones.
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Research that includes use of
meta-analysis reveals that:
(1) People who remain untreated often improve
(2)Those who receive psychotherapy are more likely
to improve
(3)When people seek psychological treatment, their
search for other medical treatment declines,
compared with their counterparts on waiting lists.
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The Relative Effectiveness of
Different Therapies
Which psychotherapy would be most effective
for treating a particular problem?
Disorder
Therapy
Depression
Behavior, Cognition, Interpersonal
Anxiety
Cognition, Exposure, Stress Inoculation
Bulimia
Cognitive-behavior
Phobia
Behavior
Bed Wetting
Behavior Modification
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Evaluating Alternative Therapies
Lilienfeld (1998) suggests comparing scientific
therapies against popular therapies through
electronic means. The results of such a search
are below:
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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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EMDR created by Francine Shapiro (1989) was walking
in the park one day and observed that anxious
thoughts vanished as her eyes spontaneously darted
about.
Does it work? For 84 to 100% of single-trauma victim’s
participants in four recent studies, the answer is yes,
reports Shapiro.
When EMDR did not work, Shapiro argued that the
therapists were not properly trained.
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In other research what skeptics suspect is that the eye
movements are not the therapeutic ingredient but
possibly the combination of exposure therapyrepeatedly reliving traumatic memories in a safe and
reassuring context- and robust placebo effect.
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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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Commonalities Among
Psychotherapies
Three commonalities shared by all forms of
psychotherapies are the following:
© Mary Kate Denny/ PhotoEdit, Inc.
1. A hope for
demoralized people.
2. A new perspective.
3. An empathic, trusting
and caring
relationship.
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In short, all therapies offer hope for demoralized
people, a new perspective on oneself and the world,
and an empathic, trusting, caring relationship.
The most effective therapists are those who are
perceived as the most empathetic and caring and who
established the closest therapeutic bonds with their
clients.
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No matter what therapeutic technique, the striking
finding was how similar the therapists were during
the parts of their sessions they considered most
significant.
At key moments, the empathetic therapists of both
persuasions would help clients evaluate themselves,
link one aspect of their life with another, and gain
insight into their interactions with others.
The emotional bond between
therapist and client-the therapeutic allianceis a key aspect of effective therapy.
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What about treatment offered by lay people?
(friendly professors, people who have a few hours of
training in empathetic listening)
The result? These paraprofessionals typically
proved as effective as the professionals.
So to recap, those who seek help usually improve, so
do many that do not undergo psychotherapy, and
that is a tribute to our human resourcefulness and our
capacity to care for one another.
People with clear cut,
specific problems
tend to improve the most.
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Culture and Values in Psychotherapy
Psychotherapists’ personal beliefs and values
influence their therapy. While nearly all agree on
the importance of encouraging clients’ sensitivity,
openness, and personal responsibility, they differ
sharply on the pursuit of self-gratification, selfsacrifice, and interpersonal commitment.
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Value differences also become important when a client
from one culture meets a therapist from another.
For example, clients from a collectivist culture may
have difficulty with a therapist who requires them to
think independently.
Such differences may help explain the reluctance of
some minorities to use mental health services.
A therapist search should include visiting two or more
therapists to judge which one makes the client feel
more comfortable.
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Therapists & Their Training
Clinical psychologists: They have PhDs mostly.
They are experts in research, assessment, and
therapy, all of which is verified through a
supervised internship.
Clinical or Psychiatric Social Worker: They have
a Masters of Social Work. Postgraduate
supervision prepares some social workers to
offer psychotherapy, mostly to people with
everyday personal and family problems.
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Therapists & Their Training
Counselors: Pastoral counselors or abuse
counselors work with problems arising from
family relations, spouse and child abusers and
their victims, and substance abusers.
Psychiatrists: They are physicians who
specialize in the treatment of psychological
disorders. Not all psychiatrists have extensive
training in psychotherapy, but as MDs they can
prescribe medications.
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The Biomedical Therapies
These include physical, medicinal, and other
forms of biological therapies.
1. Drug Treatments
2. Surgery
3. Electric-shock therapy
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Drug Therapies
Psychopharmacology is the study of drug effects
on mind and behavior.
With the advent of drugs, hospitalization in mental
institutions has rapidly declined.
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Drug Therapies
However, many patients are left homeless on the
streets due to their ill-preparedness to cope
independently outside in society.
Les Snider/ The Image Works
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Double-Blind Procedures
To test the effectiveness of a drug, patients are
tested with the drug and a placebo. Two groups of
patients and medical health professionals are
unaware of who is taking the drug and who is
taking the placebo.
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To evaluate the effects of any new drug, researchers used
the double-blind technique, in which half the patients
receive the drug while the other half receives a placebo.
Because neither staff nor patients know who gets which,
this research strategy eliminates bias that results from
therapists’ and patients’ expectations of improvement.
Using this approach, several types of drugs have proven
effective in treating psychological disorders.
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Schizophrenia Symptoms
Inappropriate symptoms
present (positive
symptoms)
Appropriate symptoms
absent (negative
symptoms)
Hallucinations,
disorganized thinking,
deluded ways.
Apathy, expressionless
faces, rigid bodies.
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Antipsychotic Drugs
Classical antipsychotics [Chlorpromazine
(Thorazine)]: Remove a number of positive
symptoms associated with schizophrenia such
as agitation, delusions, and hallucinations.
Thorazine works by
. dampening their
responsiveness to irrelevant stimuli. Thus
found very useful from those suffering from
schizophrenia.
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Antipsychotic Drugs
Atypical antipsychotics [Clozapine (Clozaril)]:
Remove negative symptoms associated with
schizophrenia such as apathy, jumbled thoughts,
concentration difficulties, and difficulties in
interacting with others.
Long term use of the first gerenration drugs (e.g.,
Thorazine) block D@ dopamine receptors and can
produce tardive dyskinesia, which is marked by
involuntary movements of facial muslces, tongue,
and limbs.
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New generation antipsychotics (e.g., clozapine) target
D1 dopamine receptors and seem to increase the risk
of obesity and diabetes.
Another complication with both generations of these
medications is that one person’s effective does may be
another person’s overdose or underdose. Only with
careful monitoring can this fine line be walked.
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Atypical Antipsychotic
Clozapine (Clozaril) blocks receptors for
dopamine and serotonin to remove the negative
symptoms of schizophrenia.
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Antianxiety Drugs
Antianxiety drugs (Xanax and Ativan) depress the
central nervous system and reduce anxiety and tension
by elevating the levels of the Gamma-aminobutyric acid
(GABA) neurotransmitter.
Used in
combination with
other therapy,
they can help
people cope with
frightening
stimuli.
Should not be
used in
combination with
alcohol.
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The complaint made about behavior therapies can
also be made about antianxiety drugs, the underlying
problem has not been solved.
Antianxiety drugs can be both psychologically and
physically addictive. When heavy users stop taking
them, they may experience withdrawal symptoms,
such as increased anxiety and insomnia.
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Antidepressant Drugs
Antidepressant drugs like Prozac, Zoloft, and Paxil are
Selective Serotonin Reuptake Inhibitors (SSRIs) that
improve the mood by elevating levels of serotonin by
inhibiting reuptake.
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Fluoxetine (Prozac) blocks the reabsorption and
removal of serotonin from the synapses.
Prozac and its cousins Zoloft and Paxil, are called
selective-serotonin-reuptake-inhibitors (SSRI’s)
because they slow the synaptic vacuuming up of
serotonin.
Other dual action antidepressants work by blocking
the reabsorption or breakdown of both
norepinephrine and serotonin.
Although no less effective, these dual action drugs
have more potential side effects, such as dry mouth,
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weight gain, hypertension, or dizzy spells.
Antidepressants influence neurotransmitter systems
almost immediately; their full psychological effects
may take weeks.
Antidepressant drugs are not the only way to give
the body a lift. Aerobic exercise, which helps calm
people who feel anxious and energize those who feel
depressed, does about as much good for some people
with mild to moderate depression, and has
additional positive side effects.
94
Placebos have been found to be nearly as effective as
the drugs themselves, especially when they also
mimic similar side effects. Our expectations have
surprisingly powerful effects not only on our
perception and our responses but on our biology
and well being.
The risk of suicide for those taking these drugs has
probably been overestimated. What has been noticed
is that children and adults are at a temporary
heightened risk of suicide just after beginning drug
treatment. One explanation is that the drugs reduce
one’s lethargy before they life one’s feelings, thus
giving formerly inert people enough energy to act on
95
their depression.
Over the past two decades, the use of antidepressants
has skyrocketed. One in 10 Americans now takes an
antidepressant medication; among women in their
40s and 50s, the figure is one in four.
Experts have offered numerous reasons. Depression
is common, and economic struggles have added to
our stress and anxiety. Television ads promote
antidepressants, and insurance plans usually cover
them, even while limiting talk therapy.
But a recent study suggests another explanation: that
the condition is being over diagnosed on a
remarkable scale.
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Mood-Stabilizing Medications
Lithium Carbonate, a common salt, has been used
to stabilize manic episodes in bipolar disorders. It
moderates the levels of norepinephrine and
glutamate neurotransmitters.
Preclinical studies have
shown that lithium
alters sodium transport
in nerve and muscle
cells and effects a shift
toward intraneuronal
metabolism of
catecholamines,
but the specific
biochemical
mechanism of
lithium action in
mania is unknown.
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Brain Stimulation
Electroconvulsive Therapy
(ECT)
ECT is used for severely
depressed patients who do
not respond to drugs. The
patient is anesthetized and
given a muscle relaxant.
Patients usually get a 100
volt shock that relieves
them of depression.
Reduce the stigma of ECT
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Although ECT is credited with saving many from
suicide, no one knows for sure how it works.
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Alternatives to ECT
Transcranial Magnetic
Stimulation (TMS)
In TMS, a pulsating
magnetic coil is placed
over prefrontal regions
of the brain to treat
depression with
minimal side effects.
100
Repetitive trans-cranial magnetic stimulation (rTMS)
is performed on wide awake patients. When a
repeated pulse surges through a magnetic coil held
close to a person’s skull the depressed mood seems
to improve.
The magnetic energy penetrated only to
the brain’s surface and this procedure is
40 minutes five days a week for 4 to 6
weeks. rTMS procedure produces
no seizures, memory loss, or other side effects.
101
rTMS has been shown to produce changes in neuronal
activity in regions of the brain implicated in mood
regulation, such as the prefrontal cortex. As each
magnetic pulse passes through the skull and into the
brain, this induces brief activity of brain cells
underlying the treatment coil.
The frequency of pulse delivery also influences whether
brain activity is increased or decreased by a session of
rTMS.
Recent studies also suggest that stimulation over the
left and right sides of the brain can have opposite
effects on mood regulation.
102
Psychosurgery
http://www.epub.org.br
Psychosurgery was
popular even in
Neolithic times.
Although used sparingly
today, about
200 such operations do
take place in the US
alone.
103
Psychosurgery
Psychosurgery is used as a last resort in
alleviating psychological disturbances.
Psychosurgery is irreversible. Removal of brain
tissue changes the mind.
104
Psychosurgery
http://www.epub.org.br
Modern methods use
stereotactic
neurosurgery and
radiosurgery (Laksell,
1951) that refine older
methods of
psychosurgery.
http://www.epub.org.br
105
Lobotomy
Lobotomies were once used to claim uncontrollably
emotional or violent patients.
The nerves that connect the frontal lobes to the
emotion-controlling centers of the inner brain are cut.
Inside the mind of Roman Fritz
The lobotomy usually produced a permanently
lethargic, immature, impulsive personality. Because of
the effects and the introduction of drug treatments in
the 1950’s, the procedure has been abandoned. 106
Other psychosurgery is used only in extreme cases.
For example, for patients who suffer uncontrollable
seizures, surgeons may deactivate the specific nerve
clusters that cause or transmit the convulsions.
MRI-guided precision surgery may also be used to
cut the circuits involved in severe obsessivecompulsive disorder. Because this procedure is
irreversible it is performed only as la last resort.
107
Preventing Psychological Disorders
“It is better to prevent than cure.”
Peruvian Folk Wisdom
Preventing psychological disorders means
removing the factors that affect society. Those
factors may be poverty, meaningless work,
constant criticism, unemployment, racism, and
sexism.
108
Psychotherapies and biomedical therapies tend to
locate the cause of the psychological disorders within
the persona with the disorder.
We infer that people who act “crazy” must be “sick”.
We then try to treat people who have been labeled
from the normal ‘folks’ by giving them insight into
their problems, by changing their thinking, and or by
helping them gain control with drugs.
109
There is an alternative viewpoint: We
could interpret many psychological
disorders as understandable responses
to a disturbing and distressing society.
According to this viewpoint, it is not just
the person who needs treatment, but
also the person’s social context.
110
Preventive Mental Health
Preventive mental health experts view many
psychological disorders as an understandable
response to a disturbing and stressful society. It seeks
to prevent psychological causalities by identifying
and alleviating the conditions that cause them.
111
George Albee believes there is an abundant evidence
that poverty, meaningless work, constant criticism,
unemployment, racism, and sexism undermine
people’s sense of competence, personal control, and
self-esteem. Such stresses increase their risk of
depression, alcoholism, and suicide. Albee suggests
that in order to help people we need to support
programs to alleviate these societal factors.
Thus, the aim of preventive mental health programs
is to change oppressive, esteem-destroying
environments into more benevolent, nurturing
environments that foster individual growth and self112
confidence.
Psychological Disorders are
Biopsychosocial in Nature
113
Clearly, a human being is an
integrated biopsychosocial
system.
For example, stress affects body
chemistry and health.
114
Effective treatment
requires treating
biological, psychological,
and social-cultural
factors.
115