chapter 13

Therapies

PowerPoint by Prentice Hall, Inc., modified by Stephen Landman, Ph.D.

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Insight TherapiesInsight therapies

Provide people with better awareness and understanding of their feelings, motivations, and actions•Psychoanalysis •Client-Centered Therapy•Gestalt Therapy

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PsychoanalysisHidden feelings and motives are made conscious for better adaptation.

Freud’s method of psychotherapy

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Psychoanalysis (continued)

Freudian therapist = “psychoanalyst”

Symptoms are caused by unconscious conflicts

Goal of Psychoanalysis = Insight, which causes symptoms to disappear

Task of psychoanalyst is to make timely interpretations

Freud interpreted:1.Free Association – (reason for use of the couch)2.Dreams3.Transference

Catharsis = “Emotional Insight” (also called “abreaction”)

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Client-Centered Therapy

(person-centered therapy)Carl RogersProblems stem from conditional love from

parentsCalls for unconditional positive regard

•Conditional positive regard–Love and acceptance comes from conforming to what others want

•Unconditional positive regard–True acceptance regardless of actions

Nondirective“Reflection of Feeling”

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Gestalt TherapyTo help people be more genuine in day-to-day interactions

Focus on here-and-now, and whole person

Therapy is active, directive

Empty chair technique

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Behavior TherapiesFocus on behavior change, rather than insight

Belief that all behavior is learned. Uses principles of learning for treatment.

Maladaptive behaviors themselves are the focus of the therapy; they are not “symptoms” of an underlying problem.

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Behavior Therapy (continued)

Examples:• Desensitization – uses classical conditioning of Pavlov• Token Economy – uses operant conditioning of Skinner• Aversive therapy – classical conditioning (Antabuse for alcholism, slap a car to teach dog not to chase cars)• Behavioral marriage counseling• Behavioral Contracting• Modeling

Many other applications exist

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Cognitive Therapies

Changing clients’ perceptions of themselves and the world

One method: Rational-emotive therapy Albert Ellis, Ph.D.

• Irrational ideas, common in society, cause problems.

• Client needs to understand how the ideas are irrational and what self-talk is associated with them, and then needs to change to using rational self-talk instead.

• Ellis uses “counterpropaganda” to counter the irrational propaganda the client has been affected by.

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Cognitive-Behavioral Therapy widely used today

•Combines cognitive therapy and behavior therapy methods – not one specific technique•Supported by much research as being effective for wide range of problems (eating disorders, personality disorders, depression, pain disorders)•Short term•Structured and goal-directed•An educational model - Client does homework

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Group TherapiesMany advantages to group approach

Increased feedback on how a person affects others

Modeling

Learning from others’ mistakes

Laboratory for trying new behaviors

Social support

Realizing that one is not alone

Social skills and communication practice

Opportunity to be helpful to others

Cost effective

TypesFamily therapy

Couple therapy

Self-help groups (not technically a therapy group)

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Effectiveness of Psychotherapy

Success rate

Eysenck (1952): About two-thirds get better with or without therapy. He was criticizing psychodynamic therapy, claiming behavior therapy to be superior.

Smith & Glass (1977) Meta-analysis of psychotherapy outcome studies concludes that therapy is better than no therapy.

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Which Therapy is Best?

Truax and Carkhuff (1967) found that characteristics of therapist are crucial. Effective therapists are characterized by warmth, genuiness, and empathy.

Most therapists are “eclectic”, drawing form various approaches, rather than strictly following one method.

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Which Type of Therapy is Best?

No apparent difference in effectiveness

Possible explanations:

All offer an explanation for problems

All offer hope

All provide a therapeutic alliance with a therapist

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Biological Treatments

Drug therapyMajor types

•Antipsychotic drugs•Antidepressant drugs•Lithium & Other Mood Stabilizers

Electroconvulsive therapyTranscranial magnetic stimulation (new treatment for depression)Psychosurgery

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Institutionalization

In past, institutionalization was most common approach

Antipsychotic drugs reduced this practice

Deinstitutionalization

This approach has own problems

Alternative forms of treatment

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PreventionForms of preventionPrimary prevention

•Efforts to reduce new cases of mental disorders

Secondary prevention•Identifying at-risk groups

Tertiary prevention•Helping people adjust after hospital release

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Client Diversity and Treatment

Gender and treatment

Rates of treatment for females is higher

Form of treatment can be gender biased

Culture and treatment

What constitutes normal can be culture-bound