PsychotherapiesPsychotherapiesTreatment of mental illness by Treatment of mental illness by psychological rather than medical means.psychological rather than medical means.

Types of PsychotherapiesTypes of Psychotherapies

PsychoanalyticPsychoanalytic

HumanisticHumanistic

BehavioralBehavioral

CognitiveCognitive

Types of TherapistsTypes of Therapists

PsychiatristsPsychiatristsMedical doctor + PhD / prescribe medicationMedical doctor + PhD / prescribe medication

Clinical psychologistsClinical psychologistsPH.D.PH.D.

Counseling psychologistCounseling psychologistGraduate degreeGraduate degree

PsychotherapyPsychotherapy

Points to ConsiderPoints to Consider““Patient”Patient”: Biomedical / psychoanalytical: Biomedical / psychoanalytical““Client”: Other therapistsClient”: Other therapists

Insight Therapy: Psychoanalytic and Insight Therapy: Psychoanalytic and HumanisticHumanisticStress importance of patient / client understanding Stress importance of patient / client understanding

their problemstheir problems

Psychoanalytic TherapyPsychoanalytic Therapy

Psychoanalysis: FreudPsychoanalysis: Freud

Psychodynamic: Uncovering the unconsciousPsychodynamic: Uncovering the unconscious

PsychoanalysisPsychoanalysisReview of Key PrinciplesReview of Key PrinciplesUnconscious conflict manifests in outward Unconscious conflict manifests in outward

behavior, thoughtsbehavior, thoughtsFind underlying (unconscious) problemFind underlying (unconscious) problemMethodsMethods

Hypnosis, free association, dream analysisHypnosis, free association, dream analysis

Dream Analysis: Manifest and Latent ContentDream Analysis: Manifest and Latent Content““only true solution”- symptom substitution only true solution”- symptom substitution

other therapies mask it- thus conflict expresses other therapies mask it- thus conflict expresses itself in new formitself in new form

Subjective: based on interpretationSubjective: based on interpretation

PsychoanalysisPsychoanalysisTherapy PrinciplesTherapy Principles

ResistanceResistancePatient objections, natural as uncovering Patient objections, natural as uncovering

disturbing conflicts (resistance as sign of nearing disturbing conflicts (resistance as sign of nearing the conflict)the conflict)

TransferenceTransferencePatients develop strong feelings for therapist Patients develop strong feelings for therapist

(love, parental feelings, or hatred / transferred (love, parental feelings, or hatred / transferred from feelings toward others to therapist)from feelings toward others to therapist)

PsychoanalysisPsychoanalysisPoints of interestPoints of interest

Patient attends treatment 4-5 x a weekPatient attends treatment 4-5 x a weekAnalysts looks for & records repetitions of behavior Analysts looks for & records repetitions of behavior (unconscious)(unconscious)Therapist says little (then interprets at the end of Therapist says little (then interprets at the end of session)session)Dream Analysis (often uses free association to Dream Analysis (often uses free association to analyze parts of a dream)analyze parts of a dream)WeaknessesWeaknesses Not sanctioned by state or federal governmentNot sanctioned by state or federal government Expensive / not covered by insuranceExpensive / not covered by insurance Only 20 psychoanalytic schools in U.S.Only 20 psychoanalytic schools in U.S.

Humanistic TherapiesHumanistic Therapies

Review of Key Principles:Review of Key Principles:

Maslow, RogersMaslow, Rogers

Focus on self-concept (understanding self)Focus on self-concept (understanding self)

Self-Actualization: help support, recognize Self-Actualization: help support, recognize goals = self-fulfillmentgoals = self-fulfillment

Free will (as opposed to determinism)Free will (as opposed to determinism)

Man’s nature as goodMan’s nature as good

Carl Rogers (Humanistic)Carl Rogers (Humanistic)

Client-centered therapyClient-centered therapy (aka person- (aka person-centered: (centered: (genuineness, acceptance, empathy)genuineness, acceptance, empathy)

Unconditional Positive RegardUnconditional Positive RegardEssential for healthy developmentEssential for healthy development

Non-directiveNon-directiveDon’t tell clients what to do, but encourage them Don’t tell clients what to do, but encourage them

to choose course of action for themselvesto choose course of action for themselvesTherapist says little…Therapist says little…

Active listening: “So what I’m hearing you Active listening: “So what I’m hearing you say is….”say is….”

Gestalt (Humanistic)Gestalt (Humanistic)

Fritz PerlsFritz Perls

““Whole is greater than sum of its parts”Whole is greater than sum of its parts”

Get in touch with “whole self”Get in touch with “whole self”

Integrate thoughts, actions, feelings, Integrate thoughts, actions, feelings, talents, goals, body into harmonious whole talents, goals, body into harmonious whole Body as extension of selfBody as extension of self

Healing a fragmented patientHealing a fragmented patient

Behavioral TherapyBehavioral Therapy

Review of Key PrinciplesReview of Key Principles

Pavlov, Watson, SkinnerPavlov, Watson, Skinner

Classical / OperantClassical / Operant

““All behavior is learned”All behavior is learned”

Behavioral Modification, (Behavioral Modification, (oror changing changing maladaptive actions)maladaptive actions)

Behavioral TherapyBehavioral TherapyCounterconditioningCounterconditioning / Mary Cover Jones / Mary Cover JonesClassical conditioningClassical conditioningNegative CR (Conditioned response) is Negative CR (Conditioned response) is

replaced by positive CRreplaced by positive CRExample: Joey cries hysterically every time Example: Joey cries hysterically every time

he goes to the dentist.he goes to the dentist.Candy / toy upon entering dentists = positive CRCandy / toy upon entering dentists = positive CR

Behavioral TherapyBehavioral TherapyCounterconditioningCounterconditioning

Joseph Wolpe / Joseph Wolpe / Systematic DesensitizationSystematic Desensitization Replace anxiety with relaxationReplace anxiety with relaxation Step one: relaxation techniques (breathing / meditation)Step one: relaxation techniques (breathing / meditation) Step two: anxiety hierarchy: rank ordered list of fear Step two: anxiety hierarchy: rank ordered list of fear

(least to most)(least to most) Start with least- incremental move up the ladder- learning Start with least- incremental move up the ladder- learning

to relax at each stepto relax at each step Classical / counterconditioning: more x relaxation paired Classical / counterconditioning: more x relaxation paired

with fear, stronger relaxation response becomeswith fear, stronger relaxation response becomes Feared stimulus is Feared stimulus is imaginedimagined

Implosive TherapyImplosive Therapy: Imagine biggest fear first : Imagine biggest fear first

Behavioral TherapyBehavioral TherapyIn vivo desensitizationIn vivo desensitizationConfronting actual fear (not just imagining it)Confronting actual fear (not just imagining it)Flooding: experiencing one’s peak fear Flooding: experiencing one’s peak fear Idea is to realize irrationality of fear (huge Idea is to realize irrationality of fear (huge

anxiety factor)anxiety factor)

Aversive conditioningAversive conditioningPairing undesired behavior with unpleasant Pairing undesired behavior with unpleasant

stimulus (Baby Albert)stimulus (Baby Albert)

Instrumental Conditioning: Token economiesInstrumental Conditioning: Token economiesModelingModeling: observation and imitation (Role : observation and imitation (Role play)play)

Cognitive TherapyCognitive Therapy((aka cognitive-behavior therapy)aka cognitive-behavior therapy)

Most widely practiced therapyMost widely practiced therapy

Core assumption: Core assumption: Conscious thoughtsConscious thoughts are are most influential to our psychological well-most influential to our psychological well-beingbeing

Changing unhealthy thought patternsChanging unhealthy thought patterns

Combative nature: challenge irrational Combative nature: challenge irrational thinking (negative attributional styles)thinking (negative attributional styles)

Cognitive TherapyCognitive Therapy

Rational Emotive Behavior TherapyRational Emotive Behavior Therapy

(REBT or RET)(REBT or RET)Albert EllisAlbert Ellis

Expose and confront irrational thoughtsExpose and confront irrational thoughts

Example: social phobiaExample: social phobiaQuestion likelihood of occurrence, likely resultQuestion likelihood of occurrence, likely result

Cognitive TherapyCognitive Therapy

Aaron Beck: Cognitive TriadAaron Beck: Cognitive TriadNegative thoughts about self, environment Negative thoughts about self, environment and future result in depressionand future result in depression

Develop positive thoughts for each factorDevelop positive thoughts for each factor

Somatic TherapiesSomatic TherapiesSoma = body (bodily changes)Soma = body (bodily changes)

Biomedical = organic causes of disordersBiomedical = organic causes of disordersNeurotransmitters / hormonesNeurotransmitters / hormones

Structural brain abnormalitiesStructural brain abnormalities

Genetic predispositionsGenetic predispositions

Somatic TherapiesSomatic TherapiesDrug Therapy (psychopharmacology)Drug Therapy (psychopharmacology)Schizophrenia: Schizophrenia:

Antipsychotic drugsAntipsychotic drugsThorazineThorazine: to control positive symptoms such as : to control positive symptoms such as

hallucinations, voices, or paranoiahallucinations, voices, or paranoiaClozapineClozapine: counteracts negative symptoms (Catatonic): counteracts negative symptoms (Catatonic)

Block receptor sites for dopamineBlock receptor sites for dopamine

Tardive dyskinesia: trembling side-effectTardive dyskinesia: trembling side-effect

Mood DisordersMood DisordersAnti-DepressantsAnti-Depressants

Unipolar: Unipolar: Prozac, ZoloftProzac, Zoloft (Clinical depression) (Clinical depression)Bipolar: LBipolar: Lithiumithium (Manic phase: stabilizes Norepinephrine (Manic phase: stabilizes Norepinephrine

production)production)

Somatic TherapySomatic TherapyDrug TherapyDrug TherapyAnxiety DisordersAnxiety Disorders

Librium, ValiumLibrium, Valium

Relaxers, slows Central Nervous SystemRelaxers, slows Central Nervous System

An eclectic approach…An eclectic approach…

Therapists often use…Therapists often use…Multiple perspectives- based on condition / Multiple perspectives- based on condition /

needs of patientneeds of patientIOW: “Different tools for different problems”IOW: “Different tools for different problems”

Somatic TherapySomatic TherapyElectroconvulsive therapy (ECT)Electroconvulsive therapy (ECT)

Bilateral = both hemispheres of brainBilateral = both hemispheres of brain

Unilateral = one hemisphereUnilateral = one hemisphere

Theory: changes brain’s blood flow patternTheory: changes brain’s blood flow pattern

Side effectsSide effectsMemory loss, brief seizure, brief loss of Memory loss, brief seizure, brief loss of

consciousnessconsciousness

Severe depression (last resort)Severe depression (last resort)

Somatic TherapySomatic TherapyPsychosurgeryPsychosurgeryPrefrontal lobotomyPrefrontal lobotomy

Cutting main neurons to the frontal lobeCutting main neurons to the frontal lobe

= mental vegetable= mental vegetable

Therapy SessionsTherapy Sessions

IndividualIndividualGroup therapy sessionsGroup therapy sessionsAdvantages? Examples?Advantages? Examples?Family therapyFamily therapyMarital therapyMarital therapyPlay therapy (for children)Play therapy (for children)Multisystemic therapy (coordinating Multisystemic therapy (coordinating specific environments)specific environments)