psychological therapies

PSYCHOLOGYPSYCHOLOGYAN EXPLORATIONAN EXPLORATION

PSYCHOLOGYPSYCHOLOGYAN EXPLORATIONAN EXPLORATION

CHAPTER

Second EditionSecond Edition

Psychology: An Exploration, Second EditionSaundra K. Ciccarelli • J. Noland White

psychological therapies

13


why study therapies for psychological disorders?There are almost as many therapy methods as there are disorders. Correctly matching the type of therapy to the disorder can mean the differ- ence between a cure or a crisis. It is important to know the choices available for treatment and how they relate to the different kinds of disorders so that an informed decision can be made and the best possible outcome can be achieved for mental health and wellness.


Learning Objective Menu

• LO 13.1Two ways modern ways to treat psychological disorders• LO 13.2Elements of Freud’s psychoanalysis and psychoanalysis to

day• LO 13.3Basic elements Humanistic therapies• LO 13.4Behavior therapists’ use of classical and operant conditioni

ng• LO 13.5Goals of cognitive therapies• LO 13.6Types of group therapy• LO 13.7Effectiveness of psychotherapy• LO 13.8Types of drugs used to treat psychological disorders• LO 13.9Modern electroconvulsive therapy and psychosurgery• LO 13.10How might computers be used in psychotherapy


Two Kinds of Therapy

• Therapy – Treatment with goal of improved mood

and functioning

• Psychotherapy – Treats mental disorders

LO 13.1 Two modern ways to treat psychological disorders



• Psychotherapy – Talk with a psychological professional

Insight therapy – Gain insight about behavior, thoughts, and

feelings Action therapy

– Change behavior directly




• Biomedical therapy – Treatment with biological or medical

methods to relieve symptoms Includes drugs, surgical methods,

electroconvulsive treatment

– Medication alone not sufficient Treats symptoms of disorder Psychotherapy builds coping strategies,

aids in adjustment



Treatment in the Past

• Early efforts to treat mentally ill – 1500’s Bethlehem Hospital converted to

asylum– Treatments included beatings

bloodletting, ice baths



Treatment in the Past

• Philippe Pinel’s Reforms – Unchained inmates

La Bicêtre Asylum, Paris 1793

– Treated mentally ill with kindness– Advocated “moral” therapy



In this famous painting by French artist Robert Fleury, French psychiatrist Dr. Philippe Pinel orders the chains removed from patients at a Paris asylum for insane women. Pinel was one of the first psychiatrists to recommend humane treatment of the mentally ill.


Freud’s Psychoanalysis

• Insight therapy– Emphasizes revealing unconscious

conflicts

LO 13.2 Elements of Freud’s psychoanalysis and psychoanalysis today



• Two techniques for accessing unconscious:– Dream interpretation

Manifest content – Actual dream and it’s events

Latent content – Symbolic or hidden meaning of dreams




• Two techniques for accessing unconscious:– Free association

Patient free to say anything that came to mind

No fear of negative evaluation




• Resistance – Patient reluctant to talk about certain

topics Changes subject or becomes silent




• Transference – Therapist becomes a symbol of parental

authority figure from the past Countertransference

– Therapist has transference reaction to the patient



Evaluation of Psychoanalysis andPsychodynamic Approaches

• Criticisms– Lack of scientific methodology– Over-emphasis on sexual problems



Evaluation of Psychoanalysis andPsychodynamic Approaches

• Modern Psychodynamic therapy– Client sits face-to-face with therapist– Therapist is more directive

Asks questions, suggests helpful behavior, and gives opinions

Therapy not useful for clients with psychoses



Interpersonal Psychotherapy

• Developed to treat depression• Insight-oriented therapy• Focus on relationships• Psychodynamic origins

– More eclectic– Combines elements of

humanistic and cognitive behavioral therapies

• Effectiveness supported by research



Psychotherapy often takes place one-on-one, with a client and therapist exploring various issues together to achieve deeper insights or to change undesirable behavior.


Roger’s Person-Centered Therapy

• Non-directive insight therapy • Based on the work of Carl Rogers • Client talks and the therapist listens

LO 13.3 Basic elements of Humanistic therapies



• Four Elements:– Reflection

Therapist restates client’s talk No interpretation of statements

– Unconditional positive regard Accepting atmosphere created by

therapist

– Empathy Therapist understands client feelings




• Four Elements:– Authenticity

Genuine, open, and honest response of therapist



A Rogerian person-centered therapist listens with calm acceptance to anything the client says. A sense of empathy with the client’s feelings is also important.


Gestalt Therapy

• Founded by Fritz Perls• People hide parts of self behind false

“mask” – Mask is socially acceptable behavior– Inner self not matching mask causes

conflict



Gestalt Therapy

• Therapist is confrontational and directive– Lead clients through exercises

• Attention to body language• Focus on “denied parts” not hidden

past of psychoanalysis



In Gestalt therapy, it is not unusual to find a client talking to an empty chair. The chair represents some person from the past with whom the client has unresolved issues, and this is the opportunity to deal with those issues.


Evaluation of Humanistic Therapy

• Little experimental research to support ideas– Theories built around case studies

• Clients need to be intelligent, highly verbal– Not a good choice for seriously mentally

ill



Behavioral Therapy and Classical Conditioning

• Action-based rather than insight-based therapy

• Change behavior through learning new responses– Learning created problem– New learning corrects problem

LO 13.4 Behavior therapists’ use of classical and operant conditioning


Therapies Based on Classical Conditioning

• Through classical conditioning:– Old and undesirable automatic

responses can be replaced by desirable ones

• Techniques originally called Behavior Modification




• Applied behavior analysis– Newer term– Highlights need for a functional analysis

of behavior– Analysis followed by conditioning




• Systematic desensitization – Used to treat phobias– Client is first taught deep muscle

relaxation– Next creates a list of ordered fears

Hierarchy of fears

– Pairs relaxation with fears– Computer generated simulations used




• Aversion therapy– Undesirable behavior is paired

with aversive stimulus– Reduces frequency of behavior



This device allows the delivery of high levels of nicotine to the smoker in a process known as rapid smoking. Rapid smoking is an aversive technique for helping people to quit smoking and is based on the classical conditioning principle of counterconditioning.



• Flooding – Technique for treating phobias, stress

disorders – Person is intensely exposed to fear-

provoking situation – Prevented from making avoidance or

escape response




• Techniques include reinforcement, extinction, shaping, and modeling – Change the frequency of voluntary

behavior– Results quick and practical




• Modeling – Learning through observation, imitation

of a model– Participant modeling

Model demonstrates the desired behavior in a step-by-step process

Client is encouraged to imitate




• Reinforcement – Strengthening of response by following

it with: A pleasurable consequence (positive

reinforcement) Removal of an unpleasant stimulus

(negative reinforcement)




• Reinforcement – Token economy

Tokens to reinforce behavior Can be accumulated and exchanged for

desired items or privileges Used effectively to modify behavior of

disturbed institutionalized individuals




• Contingency contract – Formal, written agreement between the

therapist and client – Goals for behavioral change,

reinforcements, and penalties are clearly stated

– Useful in treating problems such as drug addiction




• Extinction – Removal of a reinforcer – Reduces frequency of behavior– Time-out

Extinction process Person is removed from situation

reinforcing an undesirable behavior Placed away from attention and

reinforcement opportunities



This boy is sitting in the “time-out” corner at his school. By removing the attention that he found rewarding, the teacher is attempting to extinguish the behavior that earned the boy a time-out. Do you see anything in this time-out corner that might make it less effective?


Evaluation of Behavioral Therapies

• Effective in treating specific problems– Bedwetting, drug addictions, phobias

• More serious psychological disorders do not respond as well to behavioral treatments

• Overall behavior therapies are: – Relatively quick and efficient – Eliminate or greatly reduce symptoms



Cognitive Therapy

• Focus on:– Helping clients recognize distortions in

thinking – Replace distorted, unrealistic beliefs

with realistic thoughts

• Is critical thinking applied to one’s own beliefs

LO 13.5 Goals of cognitive therapy


Cognitive Therapy

• Beck– Identified five common distortions– Arbitrary inference

Jumping to conclusions Drawing conclusions not based on

evidence



Beck's Cognitive Therapy

• Selective thinking – Focusing on one aspect of a situation – Ignoring all other relevant aspects

• Overgeneralization– Drawing sweeping conclusions based on

only one incident – Applying conclusions to events

unrelated to original



Beck's Cognitive Therapy

• Magnification and minimization – Negative event blown out of proportion

to its importance (magnification) – Ignore relevant positive events

(minimization)

• Personalization – Taking responsibility for events

unconnected to the person



Cognitive-Behavioral Therapy

• Assumes disorders come from illogical, irrational cognitions

• Is an action therapy – Learning to think more rationally and

logically



Cognitive-Behavioral Therapy

• Three goals: – Relieve the symptoms and solve the

problems– Develop strategies for solving future

problems– Help change irrational, distorted

thinking



Rational-Emotive Behavior Therapy

• A cognitive-behavioral therapy • Clients are directly challenged on

irrational beliefs • Restructures thinking into rational belief

statements• Therapists are directive

– Provide homework assignments– Challenge “my way or nothing”

statements



Success of CBT

• CBT has seemed successful in treating– Depression, stress disorders, and

anxiety

• Criticized for focusing on symptoms, not causes of disordered behavior



Table 13.1 Characteristics of Psychotherapies


Group Therapies

• Therapist may use one of many approaches or a combination– Insight, cognitive-behavioral,

person-centered, behavioral– Share problems, provide support

LO 13.6 Types of group therapy


Group Therapies

• Family counseling – Family members meet together with

a counselor– Discover and resolve unhealthy patterns

of relating– Open lines of communication – Resolve problems that affect the entire

family



Group Therapies

• Self-help groups – People with similar problems meet

together without a therapist or counselor

– Purpose is discussion, problem solving, emotional support



In family therapy, all family members participate in therapy sessions, with the therapist guiding them through open communication. Although it appears that the young boy in the corner is the focus of this session, all family members are encouraged to see how their own behavior may contribute to the problem behavior.


Advantages of Group Therapy

• Lower cost• Exposure to way other persons view

and handle the same kinds of problems• Opportunity for therapist and client to

see interaction with others• Social and emotional support from

people with similar problems



In group therapy, several people who share similar problems gather with a therapist to discuss their feelings and concerns. The presence of others who are going through the same kind of emotional difficulties can be comforting as well as provide the opportunity for insights into one’s own problems by hearing about the problems of others.


Disadvantages of Group Therapy

• Need to share therapist’s time with others in the group

• Lack of a private setting in which to reveal concerns

• Possibility that shy people will not be able to speak up within a group setting

• Inability of people with severe disorders to tolerate being in a group



Does Psychotherapy Really Work?

• Psychotherapy is more effective than no treatment at all.

• 75 to 90 percent of people who receive therapy improve – Longer a person stays in therapy the

better the improvement– Psychotherapy works as well alone as

with drugs

LO 13.7 Effectiveness of psychotherapy


Does Psychotherapy Really Work?

• Some types of psychotherapy are more effective for certain types of problems– No one psychotherapy method is

effective for all problems



Characteristics of Effectiveness Psychotherapy

• Common factors approach – Modern approach to eclecticism – Focuses on factors common to

successful outcomes in therapy



Characteristics of Effectiveness Psychotherapy

• Therapeutic Alliance– Relationship between client and

therapist

• Protected setting– Privacy, safety for client

• Opportunity for catharsis• Learning and practice of new behavior



Culture, Ethnic and Gender Concerns

• Differences between therapist and client– Difficult for the therapist to understand

concerns– Misunderstandings and

misinterpretations can occur



Culture, Ethnic and Gender Concerns

• Four barriers to effective psychotherapy– Language– Culture-bound values– Class-bound values– Nonverbal communication



Cybertherapy

• Psychotherapy offered on the Internet• Offers advantages of low or no cost,

accessible, anonymous• No guarantee cybertherapist has

credentials or training in psychotherapy• Difficult for cybertherapist to assess

client’s body language or emotional state



Biomedical Therapies

• Therapies directly affecting the biological functioning of body and brain

• Psychopharmacology – The use of drugs to control or relieve the

symptoms of psychological disorders

LO 13.8 Types of drugs used to treat psychological disorders



• Psychopharmacology – Anti-psychotic drugs

Used to treat psychotic symptoms– Delusions, hallucinations, and other

bizarre behavior

– Anti-anxiety drugs Include anti-anxiety and antidepressant

drugs




• Psychopharmacology– Anti-manic drugs

Used to treat bipolar disorder Include lithium and anticonvulsant drugs

– Antidepressant drugs Used to treat depression and anxiety Include MAOIs, tricyclics, SSRIs



Table 13.2 Types of Drugs Used in Psychopharmacology


Electroconvulsive Therapy

• Treats severe depression – Electrodes are placed on one or both

sides of the head – Bilateral ECT

Electrodes are placed on both sides of the head

– Unilateral ECT Electrodes are placed on only one side of

the head and forehead

LO 13.9 Modern electroconvulsive therapy and psychosurgery


Electroconvulsive therapy consists of applying an electric shock to one or both sides of the head. The result is rapid improvement in mood. It has been shown to be most effective in treating severe depression that has not responded to medication or where medication side effects cannot be tolerated.


Electroconvulsive Therapy

• Treats severe depression – An electric current is passed through the

electrodes – Strong enough to cause a seizure or

convulsion



Psychosurgery

• Surgery performed on brain tissue to relieve or control severe psychological disorders– Prefrontal lobotomy

Connections between prefrontal cortex to other brain areas are severed



Psychosurgery

• Surgery performed on brain tissue to relieve or control severe psychological disorders– Bilateral cingulotomy

MRI used to guide electrode to area in brain

Electrode is inserted into the cingulate gyrus



Psychosurgery

• Surgery performed on brain tissue to relieve or control severe psychological disorders– Bilateral cingulotomy

Small current run to electrode to destroy small area of cells– Referred to as deep lesioning– Effective in ⅓ to ½ cases of major

depression, bipolar and OCD



Emerging Techniques

• Repetitivetranscranial magnetic stimulation (rTMS)– Magnetic pulses are applied to the

cortex

• Transcranial direct current stimulation (tDCS)– Scalp electrodes used to pass low

amplitude currents to the brain



Repetitive transcranial magnetic stimulation (rTMS) uses a pulsating magnetic field to activate specific parts of the brain’s surface. As seen above, by placing an electromagnet on the scalp, TMS can be used to stimulate small areas of the cortex and is being evaluated as a way to control some psychological symptoms, such as those related to depression and PTSD. Photo courtesy of Martijn Arns, http://www.brainclinics.com


Virtual Realities

• Software-generated, three-dimensional simulated environment

• Useful with exposure therapy• Vivid and realistic imagery possible

– Particularly helpful for clients that do not visualize well

• Post-traumatic stress disorder (PTSD) – Benefits from the use of VR

psychotherapy

LO 13.10 How might computers be used in psychotherapy


Some behavioral therapists now use virtual reality to expose patients to phobic objects and situations—like the cabin of an airplane. As part of systematic desensitization, this patient receives exposure to anxiety-provoking visual displays through a virtual reality headset. Credit: Charles Undermost, Delft University of Technology.

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psychological therapies