©2002 prentice hall approaches to treatment and therapy chapter 17
TRANSCRIPT
©2002 Prentice Hall
Approaches to Treatment and Therapy
Chapter 17
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Approaches to Treatment and Therapy Biological treatments. Kinds of psychotherapy. Evaluating psychotherapy.
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Biological Treatments The question of drugs. Surgery and electroshock.
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The Question of Drugs
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Antipsychotic Drugs Many block or reduce sensitivity of brain
receptors that respond to dopamine. Some increase levels of serotonin, a
neurotransmitter that inhibits dopamine activity.
Can relieve positive symptoms of schizophrenia but are ineffective for or even worsen negative symptoms in some patients.
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Antidepressant Drugs Monoamine oxidase inhibitors (MAOIs)
Elevate norepinephrine and serotonin in brain by blocking an enzyme that deactivates these neurotransmitters.
Tricyclic antidepressants Boost norepinephrine and serotonin in brain by
preventing normal reuptake of these substances.
Selective serotonin reuptake inhibitors work same way as tricyclic antidepressants but target
serotonin.
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Tranquilizers Increase the activity of the neurotransmitter
gamma-aminobutyric acid (GABA). Developed for treatment of mild anxiety
and often overprescribed by general physicians for patients who complain of any mood disorder.
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Lithium Carbonate Used to treat bipolar disorder. Moderates levels of norepinephrine or by
protecting cells from being overstimulated by the neurotransmitter, glutamate.
Must be given in right dose and bloodstream levels need to be monitored.
Newer drug treatments for bipolar disorder include Tegetrol and Depakote.
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Cautions About Drug Treatment
Placebo effect High Relapse and dropout rates. Dosage problems. Long-term risks
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Placebo effect The apparent success of a treatment that is
due to the patient’s expectation of hopes rather than to the drug or treatment itself.
Meta-analyses indicates that clinicians considered medication helpful yet patient ratings in treatment groups were no greater than patient ratings in placebo groups.
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High Relapse and Dropout Rate There may be short term success but many
patients (50% to 66%) stop taking medication due to side effects.
Individuals who take antidepressants without learning to cope with problems are more likely to relapse.
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Dosage Problems Finding the therapeutic window or the amount
of medication that is enough but not too much. Drugs may be metabolized differently in:
men and women, old and young, and in different ethnic groups.
Groups may differ in dosages due to variations in metabolic rates, amount of body fat, number or type of drug receptors in the brain, smoking and eating habits.
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Long term risks Antipsychotic drugs can be dangerous,
even fatal if taken for many years. Tardive dyskinesia
Antidepressants are assumed to be same but no long term studies have been conducted.
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Surgery and Electroshock Psychosurgery
Any surgical procedure that destroys selected areas of the brain believed to be involved in emotional disorders or violent, impulsive behavior.
Electroconvulsive Therapy (ECT) A procedure used in cases of prolonged and
severe major depression, in which a brief brain seizure is induced.
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Kinds of Psychotherapy Psychodynamic therapy. Behavioral and Cognitive therapy. Humanist and Existential therapy. Family therapy.
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Psychodynamic Therapy – The Freudian Approach
Goal is exploring the unconscious Free Association
In psychoanalysis, a method of uncovering unconscious conflicts by saying freely whatever comes to mind.
Transference In psychodynamic therapies, a critical step in which
the client transfers unconscious emotions or reactions, such as conflicts about his or her parents, onto the therapist.
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Behavior and Cognitive Therapy
Behavior therapy Systematic desensitization. Aversive conditioning. Exposure treatments. Behavioral records and contracts. Skills training.
Cognitive therapy
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Behavior Therapy A form therapy that applies principles and
techniques of classical and operant conditioning to help people change self defeating or problematic behaviors.
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Systematic Desensitization A step by step process of desensitizing a
client to a feared object or experience, Based on counterconditioning.
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Exposure (Flooding) A technique whereby a person suffering
from an anxiety disorder such as a phobia or panic attack, is taken directly into the feared situation until the anxiety subsides.
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Behavioral Records A method of keeping careful data on the
frequency and consequences of the behavior to be changed.
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Skills Training An effort to teach a client skills he or she
may lack as well as new more constructive behaviors to replace self-defeating ones.
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Cognitive Techniques Examine the evidence for beliefs. Consider other explanations for the
behavior of others. Identify assumptions and biases.
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Humanist Therapy Humanist therapy
Based on the assumption that all people automatically seek self-actualization and self-fulfillment.
Emphasizes people’s free will to change, not past conflicts.
Client-Centered (Nondirective) Therapy Developed by Carl Rogers and emphasizes the
therapist’s empathy with the client, seeing the world as client does, and creating climate of Unconditional Positive Regard.
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Existential Therapy Helps clients explore the meaning of existence
and face with courage the great issues of life such as death, freedom, free will, alienation and loneliness.
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Family and Couples Therapy Problems develop in the context of family, are sustained
by the dynamics of the family and that any changes made will affect all members of the family.
Can look for patterns of behavior across generations and create a family tree of psychologically significant events.
Family-System Perspective Therapy with individuals or families that focuses on
how each member forms part of a larger interacting system.
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One Family’s Genogram
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Primary Goals of Therapies Psychodynamic
Insight into unconscious motives and feelings. Cognitive-Behavioral
Modification of behavior and irrational beliefs. Humanist
Insight; self-acceptance and self-fulfillment. Family
Modification of individual habits and family patterns.
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Primary Methods of Therapies Psychodynamic
Probing the unconscious through dream analysis, free association, transference.
Cognitive-Behavioral Behavioral techniques such as systematic desensitization, flooding;
cognitive exercises to identify and change faulty beliefs. Humanist
Providing a safe, non-judgmental setting in which to discuss life issues.
Family Working with couples, families, and sometimes individuals to
identify and change patterns that perpetuate problems.
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Evaluating Psychotherapy The scientist-practitioner gap. When therapy helps. Which therapy for which problem? When therapy harms.
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The Scientist-Practitioner Gap Some psychotherapists believe that
evaluating therapy using research methods is futile.
Scientists find that therapists who do not keep up with empirical findings are less effective and can do harm to clients.
Economic pressures require empirical assessment of therapies.
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Is More Psychotherapy Better? With additional therapy
sessions, the percentage of people improved increased up to 26 sessions.
Rate of improvement then levels off Based on a summary of 15
studies, 2400 clients (Howard, et al., 1996).
Patients’ sense of improvement slower but more steady.
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Psychotherapy Research Questions What are the common ingredients in
successful therapies? What kinds of therapy are best suited for
which problems? Under what conditions can therapy be
harmful?
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Common Ingredients in Successful Therapies When there is a bond between therapist and
client (a.k.a. Therapeutic Alliance). When participants want to be helped. When therapists distinguish normal cultural
patterns from individual psychological problems.
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Which Therapy for Which Problem? Depression
Cognitive therapy’s greatest success has come in treatment of mood disorders.
Anxiety Disorders Exposure techniques are more effective than
others. Anger and Impulsive Violence
Cognitive therapy is extremely successful.
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Which Therapy for Which Problem? Health Problems
Cognitive and behavior therapies are effective for a wide range of health problems.
Childhood and Adolescent Behavior Problems Behavior therapy is the most effective
treatment.
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Successful Therapy
Psychotherapy outcome depends not only on method of therapy.
Qualities of client and therapist, and their alliance, also determine success.
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When Therapy Harms Sexual intimacies, or other unethical
behavior on the part of the therapist. Prejudice or cultural ignorance on the part
of the therapist. Inappropriate or coercive influence, which
can create new problems for the client. The use of empirically unsupported,
potentially dangerous techniques.