Chapter 14: Therapies

What Is Psychotherapy?

• -- *Any psychological technique used to facilitate positive changes in personality, behavior, or adjustment

Types of Psychotherapy

• -- *Individual: Involves only one client and one therapist– Client: Patient; the one who participates in

psychotherapy– Rogers used “client” to equalize therapist-

client relationship and de-emphasize doctor-patient concept

• -- *Group: Several clients participate at the same time

More Types of Psychotherapy

• Insight: Goal is for clients to gain deeper understanding of their thoughts, emotions, and behaviors

• -- *Directive: Therapist provides strong guidance (vs. *non-directive)

• Time-Limited: Any therapy that limits number of sessions– Partial response to managed care and to

ever-increasing caseloads• Caseload: Number of clients a therapist

actively sees

Key Features of Psychotherapy

• Therapeutic Alliance: Caring relationship between the client and therapist

• Therapy offers a protected setting where emotional catharsis (release) can occur

• All the therapies offer some explanation or rationale for the client’s suffering

• Provides clients with a new perspective about themselves or their situations and a chance to practice new behaviors

Origins of Therapy

• *Trepanning:

– Patient unlikely to survive

– To relieve pressure or rid the person of evil spirits

People in Therapy

• -- *Phillippe Pinel: French physician who initiated humane treatment of mental patients in 1793– Created the first mental hospital

• Freud: – Hysteria (--somatoform disorders)

• caused by deeply hidden unconscious conflicts

– Goal of Psychoanalysis: To resolve internal conflicts that lead to emotional suffering

Freudian techniques (Psychodynamic/psychoanalysis)

• -- *Free Association: saying whatever comes to mind, regardless of how embarrassing it is.– Allows unconscious material to emerge

• -- *Dream Analysis: – *Latent content– *Manifest content– Symbols

• Directive• Brief psychodynamic therapy: designed to

produce insights more quickly; uses direct questioning to reveal unconscious conflicts

Humanistic Therapies

• -- *Client-Centered Therapy (Carl Rogers)--Nondirective and based on insights from conscious thoughts and feelings; accept one’s true self (optimistic!)

– *Unconditional Positive Regard: Unshakable acceptance of another person.

– Empathy: Ability to feel what another person is feeling

– Authenticity: Therapist is genuine and honest about his or her feelings

– Reflection: Rephrasing or repeating thoughts and feelings of the clients

Cybertherapy and Psychotherapy at a Distance

• -- *Media Psychologists: Radio, • newspaper, and television • psychologists; give advice, • information, and social support, e.g., Dr. Phil (OK), Dr.

Laura (bad)• Telephone Therapists: 900 number therapists

– May be nothing more than telephone operators who have never even taken a psychology course! (True in practice, too.)

Cybertherapy and Psychotherapy at a Distance Concluded (Continued)

• Cybertherapy: Internet therapists in chat rooms. – Patient/client can remain anonymous– Good if client can not drive a distance to a

therapist or cannot leave the house (agoraphobic)

– Cheaper than traditional psychotherapy

Behavior Therapy

• Use of learning principles to make constructive changes in behavior

• -- *Behavior Modification: Using any classical or operant conditioning principles to directly change human behavior– Deep insight is often not necessary– Focus on the present; cannot change the past, and

no reason to alter that which has yet to occur

• Positive/negative Reinforcement and punishment

Behavior Therapy (Continued)

• Conditioned Aversion: Learned dislike or negative emotional response to a stimulus

• -- *Aversion Therapy– Associate a strong aversion to an undesirable

habit like smoking, overeating, drinking alcohol, or gambling

– E.g., Rapid Smoking: Prolonged smoking at a forced pace

– Designed to cause aversion to smoking

• Response-Contingent Consequences– Reinforcement, punishment, or other

consequences that are applied only when a certain response is made

Behavioral Therapies (Continued)

• -- *Systematic Desensitization

– Hierarchy: Rank-ordered series of steps, amounts, levels, or degrees

– Uses reciprocal Inhibition: One emotional state is used to block another (e.g., impossible to be anxious and relaxed at the same time)

Operant Therapies

• *Operant Conditioning: Learning based on consequences of making a response– -- *Shaping: Rewarding actions that are

closer and closer approximations to a desired response

– Stimulus Control: Controlling responses in the situation in which they occur

– Time Out: Removing individual from a situation in which reinforcement occurs

Tokens

• Tokens: Symbolic rewards like poker chips or gold stars that can be exchanged for real rewards– Can be used to immediately reinforce

positive responses– Effective in psychiatric hospitals and

sheltered care facilities• Target Behaviors: Actions or other behaviors

a therapist seeks to change

Token Economy

• Patients get tokens for many socially desirable or productive behaviors; they can exchange tokens for tangible rewards and must pay tokens for undesirable behaviors

Cognitive Therapy

• -- Therapy that helps clients change thinking patterns that lead to problematic behaviors or emotions

Cognitive Therapy

• Therapy that helps clients change thinking patterns that lead to problematic behaviors or emotions

• Beck: Three Major Distortions in Thinking:– Selective Perception: Perceiving only certain

stimuli in a larger array of possibilities– Overgeneralization: Blowing a single event out of

proportion by extending it to a large number of unrelated situations

– All-or-Nothing Thinking: Seeing objects and events as absolutely right or wrong, good or bad, and so on

Rational Emotive Behavior Therapy (REBT)

• Attempts to change irrational beliefs that cause emotional problems– Theory created by Albert Ellis– For example, Anya thinks, “I must be liked

by everyone; if not, I’m a rotten person.”

Group Therapy

• Psychodrama (Moreno): Clients act out personal conflicts and feelings with others who play supporting roles– Role Playing: Re-enacting significant life

events– Role Reversal: Taking the part of another

person to learn how he or she feels– Mirror Technique: Client observes another

person re-enacting the client’s behavior

Family Therapy

• Family Therapy: All family members work as a group to resolve the problems of each family member– Tends to be brief and focuses on specific

problems (e.g., specific fights)– Modality views problems experienced by

one family member are the entire family’s problem

Group Awareness Training

• Sensitivity Groups: Group experience consisting of exercises designed to increase self-awareness and sensitivity to others

• Encounter Groups: Emphasize honest expression of feelings

• Large-Group Awareness Training: Increases self-awareness and facilitates constructive personal change

• -- Therapy Placebo Effect: Improvement is based on client’s belief that therapy will help

Basic Counseling Skills

• Active listening• Clarify the problem• Focus on feelings• Avoid giving advice• Accept the client’s frame of reference • Reflect thoughts and feelings• Silence: Know when to use• Questions

– Open: Open-ended reply– Closed: Can be answered “Yes” or “No”

• Maintain confidentiality

Table 14.3

*Medical (Somatic) Therapies

• Pharmacotherapy: Use of drugs to alleviate emotional disturbance; three classes:– Anxiolytics (Antianxiety): Like Valium;

produce relaxation or reduce anxiety– Antidepressants: Elevate mood and

combat depression– Antipsychotics (Major Tranquilizers):

Tranquilize and also reduce hallucinations and delusions in larger dosages

Problems with Drug Therapy

• *Clozaril (clozapine): Relieves schizophrenic symptoms; however, two out of one hundred patients may suffer from a potentially fatal white blood cell disease

Electroconvulsive Therapy

• -- *Electroconvulsive Therapy (ECT): Electric shock is passed through the brain inducing a convulsion; treatment for severe depression – Based on belief that seizure alleviates

depression by altering brain chemistry• Produces only temporary improvement• Causes permanent memory loss in

some patients• Should only be used as a last resort• Should be followed by antidepressant

medications to further prevent relapse

*Psychosurgery

• Any surgical alteration of the brain• Prefrontal Lobotomy: Frontal lobes in brain

are surgically cut from other brain areas– Supposed to calm people who did not

respond to other forms of treatment– Was not very successful

• Deep Lesioning: Small target areas in the brain are destroyed by using an electrode

Hospitalization

• Mental Hospitalization: Involves placing a person in a protected, therapeutic environment staffed by mental health professionals

• Partial Hospitalization: Patients spend only part of their time in the hospital and go home at night

• Deinstitutionalization: Reduced use of full-time commitment to mental institutions

Half-Way Houses

• Short-term group living facilities for individuals making the transition from an institution (mental hospital, prison, etc.) to independent living

Community Mental Health Centers

• Offer many health services like prevention, education, therapy, and crisis intervention– Crisis Intervention: Skilled management of

a psychological emergency• Paraprofessional: Individual who works in a

near-professional capacity under supervision of a more highly trained person

Other Therapy Options

• Peer Counselor: Nonprofessional person who has learned basic counseling skills

• Self-Help Group: Group of people who share a particular type of problem and provide mutual support to each other (e.g., “Alcoholics Anonymous”)

Evaluating a Therapist: Danger Signals

• Therapist makes sexual advances • Therapist makes repeated verbal threats or is

physically aggressive• Therapist is excessively hostile, controlling,

blaming, or belittling• Therapist talks repeatedly about his/her own

problems• Therapist encourages prolonged dependence

on him/her• Therapist demands absolute trust or tells

client not to discuss therapy with anyone else

Evaluating a Therapist: Questions to be Answered During the Initial Meeting

• Will the information I reveal in therapy remain confidential?

• What risks do I face if I begin therapy?• How long do you expect treatment to last?• What form of treatment do you expect to use?• Are there alternatives to therapy that might

help as much or more?