Psychotherapy

PsychotherapyPsychotherapy

Therapy Comes in Many FormsTherapy Comes in Many Forms

Many sources and types of treatment are Many sources and types of treatment are availableavailable

There are two broad categories of therapyThere are two broad categories of therapy

• Somatic therapySomatic therapy

Treating psychological disorders by treating the Treating psychological disorders by treating the bodybody

Somatic therapy often involves methods that Somatic therapy often involves methods that affect hormone levels and brain chemistryaffect hormone levels and brain chemistry

• PsychotherapyPsychotherapy

Treatment of psychological problems Treatment of psychological problems through psychological techniquesthrough psychological techniques

It is a change-oriented processIt is a change-oriented process

Its goal is to teach people to cope better Its goal is to teach people to cope better and lead more fulfilling livesand lead more fulfilling lives

It does so by teaching people to relieve It does so by teaching people to relieve stress, improve interpersonal stress, improve interpersonal communication, understand previous life communication, understand previous life events, and/or modify their thinkingevents, and/or modify their thinking

Therapy Comes in Many Forms

Is Psychotherapy Necessary and Is Psychotherapy Necessary and Effective?Effective?

Does psychotherapy simply create Does psychotherapy simply create placebo effect?placebo effect?

• A A placebo effectplacebo effect is a nonspecific is a nonspecific improvement as a result of a person’s improvement as a result of a person’s expectations of changeexpectations of change

It is not a result of a therapeutic treatmentIt is not a result of a therapeutic treatment

Some patients in psychotherapy may show Some patients in psychotherapy may show relief from their symptoms simply because relief from their symptoms simply because they are in therapy and may expect changethey are in therapy and may expect change

Is Psychotherapy Effective?Is Psychotherapy Effective?

• Researchers must determine if Researchers must determine if improvements are due to expectations or improvements are due to expectations or real benefits of therapyreal benefits of therapy

• The double-blind technique helps The double-blind technique helps distinguish between improvements due to distinguish between improvements due to expectations or therapyexpectations or therapy

Some patients in psychotherapy may show Some patients in psychotherapy may show relief from their symptoms simply because relief from their symptoms simply because they are in therapy and may expect changethey are in therapy and may expect change

The placebo effect complicates research on The placebo effect complicates research on therapy effectivenesstherapy effectiveness

Is Psychotherapy Effective?Is Psychotherapy Effective?

• TheThe double-blind eliminates any potential double-blind eliminates any potential bias by reducing demand characteristicsbias by reducing demand characteristics

The double-blind technique helps distinguish between improvements due to expectations or therapy

In the double-blind technique neither the experimenter nor participants know who is in the experimental or control groups

The double-blind eliminates any potential The double-blind eliminates any potential bias by reducing demand characteristicsbias by reducing demand characteristics

• Demand characteristicsDemand characteristics are elements of an are elements of an experiment that might bias the participant experiment that might bias the participant to act in a certain wayto act in a certain way

By perceiving the situation in a certain way, or By perceiving the situation in a certain way, or becoming aware of the purpose of the studybecoming aware of the purpose of the study

Demand characteristics distort the results of a Demand characteristics distort the results of a studystudy

Is Psychotherapy Effective?

Is Psychotherapy Effective?

Demand characteristics distort the Demand characteristics distort the results of a studyresults of a study

Research studies that compare Research studies that compare psychotherapy and placebo psychotherapy and placebo treatment show the therapies are treatment show the therapies are consistently more effectiveconsistently more effective

Research on PsychotherapyResearch on Psychotherapy

In a 1952 paper, Hans Eysenck challenged In a 1952 paper, Hans Eysenck challenged the effectiveness of psychotherapythe effectiveness of psychotherapy

• He claimed that it produced no greater change He claimed that it produced no greater change in maladjustment than natural life experiencesin maladjustment than natural life experiences

• Thousands of studies investigating the Thousands of studies investigating the effectiveness of therapy followedeffectiveness of therapy followed

• These studies, and analyses using sophisticated These studies, and analyses using sophisticated statistical techniques, found psychotherapy to statistical techniques, found psychotherapy to be effectivebe effective


These studies, and These studies, and analyses using analyses using sophisticated sophisticated statistical statistical techniques, found techniques, found psychotherapy to be psychotherapy to be effectiveeffective

Effectiveness and Effectiveness and the client’s speed of the client’s speed of response vary with response vary with the type of problemthe type of problem

Is one type of therapy Is one type of therapy more effective?more effective?

• Many researchers Many researchers contend that most contend that most psychotherapies are psychotherapies are equally effectiveequally effective

• If most therapies are If most therapies are effective, there must effective, there must be a common be a common underlying underlying component making component making them successfulthem successful


If most therapies are effective, there must If most therapies are effective, there must be a common underlying component be a common underlying component making them successfulmaking them successful

• Researchers are seeking to systematize Researchers are seeking to systematize research strategies to investigate the research strategies to investigate the effectiveness of therapieseffectiveness of therapies

• This research will lead to a clearer picture of This research will lead to a clearer picture of which approaches are best for certain disorders which approaches are best for certain disorders and clients of various ages and ethnic groupsand clients of various ages and ethnic groups

Which Therapy, Which Therapist?Which Therapy, Which Therapist?

There are hundreds of types of There are hundreds of types of therapytherapy

• Some focus on individuals, some on Some focus on individuals, some on groups (group therapy) and others on groups (group therapy) and others on families (family therapy)families (family therapy)

• Community psychologistsCommunity psychologists focus on focus on whole communitieswhole communities

Which Therapy?Which Therapy?

Community Community psychologistspsychologists focus on whole focus on whole communitiescommunities

They try to They try to develop action-develop action-oriented oriented approaches to approaches to individual and individual and social problemssocial problems

A therapist’s A therapist’s training usually training usually determines the determines the approach takenapproach taken

Many therapists Many therapists take an take an eclectic eclectic approachapproach, , combining different combining different techniquestechniques


A number of specific psychotherapeutic A number of specific psychotherapeutic approaches are in use todayapproaches are in use today

• Psychodynamically based approaches Psychodynamically based approaches are based on are based on Freud’s ideasFreud’s ideas

Psychodynamic approaches aim to help patients Psychodynamic approaches aim to help patients understand the motivations underlying their behaviorunderstand the motivations underlying their behavior

They assume abnormal behavior occurs when people They assume abnormal behavior occurs when people do not understand themselves do not understand themselves

• Humanistic approachesHumanistic approaches assume assume people are essentially goodpeople are essentially good

Humanistic approaches try to help Humanistic approaches try to help people realize their full potential and people realize their full potential and find meaning in lifefind meaning in life

• Behavior therapyBehavior therapy is based on the is based on the assumption most behaviors are assumption most behaviors are learnedlearned

Behavior therapists encourage clients Behavior therapists encourage clients to learn new adaptive behaviorsto learn new adaptive behaviors

Which Therapy?

• Cognitive therapyCognitive therapy focuses on changing a focuses on changing a client’s behavior by changing thoughts client’s behavior by changing thoughts and perceptionsand perceptions

A new approach, A new approach, psychotherapy psychotherapy integrationintegration, is now emerging, is now emerging

• It is more than an eclectic approach, because It is more than an eclectic approach, because the goal is to integrate theories into a new the goal is to integrate theories into a new approachapproach

• Research on psychotherapy integration is Research on psychotherapy integration is relatively scarcerelatively scarce

Which Therapy?

The effectiveness of The effectiveness of different kinds of different kinds of therapy depends on therapy depends on two things, the two things, the disorder treated and disorder treated and the goals of the the goals of the clientclient

Research to discover Research to discover the best treatment the best treatment usually focuses on usually focuses on specific disordersspecific disorders

Research on Research on psychotherapy psychotherapy integration is integration is relatively scarcerelatively scarce

This is because it is This is because it is difficult to generate difficult to generate hypotheses based on hypotheses based on the new points of the new points of view it createsview it creates

Which Therapy?


• These include ethnicity, personality, level of These include ethnicity, personality, level of experience, and degree of empathyexperience, and degree of empathy

• While there are differences among therapists, While there are differences among therapists, there are also commonalitiesthere are also commonalities

Research to discover the best treatment Research to discover the best treatment usually focuses on specific disordersusually focuses on specific disorders

Besides therapeutic approaches, some Besides therapeutic approaches, some characteristics of the therapist affect characteristics of the therapist affect treatmenttreatment


• Good therapists communicate interest, Good therapists communicate interest, understanding, respect, tact, and maturityunderstanding, respect, tact, and maturity

• Good therapists use suggestions, Good therapists use suggestions, interpretation, encouragement, and interpretation, encouragement, and perhaps rewards to help clients changeperhaps rewards to help clients change

While there are differences among While there are differences among therapists, there are also commonalitiestherapists, there are also commonalities

• Clients receive attention, which helps them Clients receive attention, which helps them maintain a positive attitudemaintain a positive attitude


Good therapists use suggestions, Good therapists use suggestions, interpretation, encouragement, and interpretation, encouragement, and perhaps rewards to help clients changeperhaps rewards to help clients change

But clients must be willing to make some But clients must be willing to make some changes in their lifestyles and ideaschanges in their lifestyles and ideas

The therapist and client must form an The therapist and client must form an alliance to work together purposefullyalliance to work together purposefully

Culture and TherapyCulture and Therapy

The therapy process and its outcome are The therapy process and its outcome are effected by the client’s ethnicityeffected by the client’s ethnicity

• Care must be taken to be culturally Care must be taken to be culturally congruentcongruent

Have a match between therapist and clientHave a match between therapist and client

At a minimum, the therapist must respect At a minimum, the therapist must respect multiculturalismmulticulturalism

Culture and TherapyCulture and Therapy At a minimum, the therapist must respect At a minimum, the therapist must respect

multiculturalismmulticulturalism

• The acceptance of and celebration of distinct The acceptance of and celebration of distinct cultural heritagescultural heritages

• Therapists must also see beyond the Therapists must also see beyond the distinct margins of a specific culturedistinct margins of a specific culture

• Therapists must see individuals as made up Therapists must see individuals as made up of a confluence of different influencesof a confluence of different influences


Therapists must see individuals as made Therapists must see individuals as made up of a confluence of different influencesup of a confluence of different influences

• This view is called This view is called transculturalismtransculturalism

This view reflects changes that have This view reflects changes that have occurred in the world through occurred in the world through globalization, mobility, improved globalization, mobility, improved communication, and intermarriagecommunication, and intermarriage

Therapists need to be well informed Therapists need to be well informed about clients’ backgroundsabout clients’ backgrounds


Therapists need to be well about clients’ Therapists need to be well about clients’ backgroundsbackgrounds

• They should provide interventions based They should provide interventions based upon and using cultural symbols and upon and using cultural symbols and rituals meaningful to the clientrituals meaningful to the client

Asian culture reflects family and roles in Asian culture reflects family and roles in the family, so they must be taken into the family, so they must be taken into accountaccount

Some cultures have prohibitions against Some cultures have prohibitions against self-disclosure, or toward controlself-disclosure, or toward control


Some cultures have prohibitions Some cultures have prohibitions against self-disclosure, or toward against self-disclosure, or toward controlcontrol

Some Arab cultures resist emotional Some Arab cultures resist emotional explorationexploration

Such cultures are more likely to value Such cultures are more likely to value and adapt to cognitive therapiesand adapt to cognitive therapies

Cultural mistrust of therapy situations Cultural mistrust of therapy situations is common among African-Americansis common among African-Americans


Cultural mistrust of therapy situations is Cultural mistrust of therapy situations is common among African-Americanscommon among African-Americans

By contrast, many Hispanic cultures have By contrast, many Hispanic cultures have a high regard for experts like therapistsa high regard for experts like therapists

The therapists ethnicity is also importantThe therapists ethnicity is also important

Latino, African-American, and Asian-Latino, African-American, and Asian-American therapists are viewed differently American therapists are viewed differently than European-American therapiststhan European-American therapists


Latino, African-American, and Asian-Latino, African-American, and Asian-American therapists are viewed differently American therapists are viewed differently than European-American therapiststhan European-American therapists

It must be remembered that culture is It must be remembered that culture is dynamic, contextual, and even politicaldynamic, contextual, and even political

Stereotypes and oversimplifications also Stereotypes and oversimplifications also aboundabound

Therapists must recognize that members of Therapists must recognize that members of other groups may not share their own cultural other groups may not share their own cultural valuesvalues


Therapists must recognize that members of Therapists must recognize that members of other groups may not share their own other groups may not share their own cultural valuescultural values

They must also realize that their They must also realize that their preconceived ideas can affect the outcome preconceived ideas can affect the outcome of therapyof therapy

• They may be oppressive to their clientsThey may be oppressive to their clients

• This may constrain their effectiveness as This may constrain their effectiveness as therapiststherapists

Gender and TherapyGender and Therapy

Not only is ethnicity important, gender is Not only is ethnicity important, gender is also a significant factor in therapyalso a significant factor in therapy

• Women seek out therapy more often than menWomen seek out therapy more often than men

• They also respond differently to therapy, and They also respond differently to therapy, and to drug therapyto drug therapy

• Communication differences may also affect Communication differences may also affect therapy (Tannen, 2001)therapy (Tannen, 2001)


• Clients may also experience gender bias in their Clients may also experience gender bias in their families that affects their gender assumptionsfamilies that affects their gender assumptions

• Gender differences can be compounded by Gender differences can be compounded by ethnicityethnicity

Communication differences may also Communication differences may also affect therapyaffect therapy

• Men tend to give Men tend to give reportsreports while women try to while women try to establish establish rapportrapport


• Gay men and lesbians bring still another Gay men and lesbians bring still another view to gender roles in the therapeutic view to gender roles in the therapeutic situationsituation

• Therapists must also understand how their Therapists must also understand how their own gender socialization affects therapyown gender socialization affects therapy

Gender differences can be compounded by Gender differences can be compounded by ethnicityethnicity

• People from different cultural backgrounds People from different cultural backgrounds may view masculinity differentlymay view masculinity differently


Therapists must also understand Therapists must also understand how their own gender socialization how their own gender socialization affects therapyaffects therapy

They must avoid gender They must avoid gender stereotypes, and recognize the stereotypes, and recognize the diversity of men’s and women’s diversity of men’s and women’s experiencesexperiences

Managed Care and PsychologyManaged Care and Psychology

““Managed care” emphasizes active Managed care” emphasizes active coordination and arrangement of health care coordination and arrangement of health care servicesservices

• It usually involves three components:It usually involves three components:

Oversight of the care givenOversight of the care given

Contractual relationships with, and Contractual relationships with, and organization of, the providers giving careorganization of, the providers giving care

Determines the covered benefitsDetermines the covered benefits

Managed Care and PsychologyManaged Care and Psychology

The aim of managed care is to control costsThe aim of managed care is to control costs

There are two major difficulties with managed careThere are two major difficulties with managed care

• First, insurance companies seek to limit the time or First, insurance companies seek to limit the time or type of psychotherapy a person may accesstype of psychotherapy a person may access

• The second problem is that insurance companies limit The second problem is that insurance companies limit who a client can seewho a client can see

Both deal with access to timely and effective Both deal with access to timely and effective treatmenttreatment

Managed CareManaged Care

Insurance Insurance companies limit who companies limit who a client can seea client can see

Many HMOs require Many HMOs require re-approval of re-approval of therapy every six therapy every six sessionssessions

This tends to make This tends to make therapy shortertherapy shorter

It also means the It also means the therapist must therapist must continually justify a continually justify a person’s treatmentperson’s treatment

Edwards (1999) Edwards (1999) believes that these believes that these factors compromise factors compromise the the practitioner/client practitioner/client alliancealliance


Edwards (1999) believes that these factors Edwards (1999) believes that these factors compromise the practitioner/client alliancecompromise the practitioner/client alliance

Managed care has led to Managed care has led to brief therapybrief therapy

• Six weeks is common, and 16 is considered Six weeks is common, and 16 is considered lengthylengthy

• One objective of brief therapy is saving clients One objective of brief therapy is saving clients time and moneytime and money


One objective of One objective of brief therapy is brief therapy is saving clients time saving clients time and moneyand money

Clients may remain Clients may remain in therapy longer if in therapy longer if they feel it is they feel it is needed and can needed and can continue to paycontinue to pay

Clients can also Clients can also return to therapy if return to therapy if they feel they need they feel they need it in the futureit in the future

Brief TherapyBrief Therapy

Practitioners of brief therapy think in Practitioners of brief therapy think in terms of terms of plannedplanned short-term treatments short-term treatments

• They make sure treatment begins in the They make sure treatment begins in the first sessionfirst session

An An operational diagnosisoperational diagnosis is made is made

The operational diagnosis answers the The operational diagnosis answers the question “Why is the client here today?”question “Why is the client here today?”


The operational The operational diagnosis answers diagnosis answers the question “Why the question “Why is the client here is the client here today?”today?”

The answer helps The answer helps pinpoint the pinpoint the specific problem specific problem for which the client for which the client is seeking helpis seeking help

During the first During the first session, the client session, the client also makes a also makes a “therapeutic “therapeutic contract” with the contract” with the therapiststherapists

The therapeutic The therapeutic contract establishes contract establishes precise goals for the precise goals for the therapytherapy


• Especially when tailored to the clients needs and Especially when tailored to the clients needs and timetime

• Brief therapy is highly effective with couples and Brief therapy is highly effective with couples and when combined with cognitive restructuringwhen combined with cognitive restructuring

The therapeutic contract establishes The therapeutic contract establishes precise goals for the therapyprecise goals for the therapy

Research on brief therapy suggests that it Research on brief therapy suggests that it is effective and has long-lasting effectsis effective and has long-lasting effects


Brief therapy is highly Brief therapy is highly effective with couples effective with couples and when combined and when combined with cognitive with cognitive restructuringrestructuring

However, research However, research has been limited to has been limited to relatively few clients relatively few clients and a narrow range and a narrow range of problemsof problems

Further research Further research on brief therapy is on brief therapy is being conductedbeing conducted

But, it is inaccurate But, it is inaccurate and misleading to and misleading to say no one gets say no one gets appropriate care appropriate care from managed from managed carecare


• They also fear it is managed by people with little or They also fear it is managed by people with little or no training who never meet patientsno training who never meet patients

• It poses a social policy question whether our society It poses a social policy question whether our society wants to provide psychotherapy for those in needwants to provide psychotherapy for those in need

It is inaccurate and misleading to say no one It is inaccurate and misleading to say no one gets appropriate care from managed caregets appropriate care from managed care

Still, many practitioners worry that care is Still, many practitioners worry that care is terminated too quicklyterminated too quickly

Choosing a TherapistChoosing a Therapist The best way to choose a therapist is to The best way to choose a therapist is to

ask aroundask around

• Ask family and friendsAsk family and friends

• Talk to one’s doctorTalk to one’s doctor

Many doctors work with a team of health Many doctors work with a team of health care providers, including psychotherapistscare providers, including psychotherapists

Doctors can suggest someone they know to Doctors can suggest someone they know to be effectivebe effective

Choosing a TherapistChoosing a Therapist

Doctors can suggest someone they Doctors can suggest someone they know to be effectiveknow to be effective

Consult the psychology department of Consult the psychology department of local colleges or the staff of community local colleges or the staff of community health care centershealth care centers

Once one has a list of several Once one has a list of several practitioners, find out if they are licensedpractitioners, find out if they are licensed

Choosing a TherapistChoosing a Therapist

Once one has a list Once one has a list of several of several practitioners, find practitioners, find out if they are out if they are licensedlicensed

Ask what kind of Ask what kind of treatment treatment procedures they procedures they useuse

Find out if they have a Find out if they have a specialty specialty

• Such as working with Such as working with children or teenschildren or teens

• Working with eating Working with eating disordersdisorders

In the end, one must In the end, one must choose a therapist with choose a therapist with whom one is whom one is comfortablecomfortable

PsychoanalysisPsychoanalysis

And Psychodynamic TherapiesAnd Psychodynamic Therapies

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PsychoanalysisPsychoanalysis

PsychoanalysisPsychoanalysis is a lengthy insight is a lengthy insight therapy developed by Freudtherapy developed by Freud

• It aims at uncovering unconscious conflictsIt aims at uncovering unconscious conflicts

• It uses techniques such as free association It uses techniques such as free association and dream analysisand dream analysis

Psychodynamically based therapiesPsychodynamically based therapies use use techniques derived from Freud, but techniques derived from Freud, but reject or modify parts of his theoryreject or modify parts of his theory

Psychodynamically based therapiesPsychodynamically based therapies use use techniques derived from Freud, but techniques derived from Freud, but reject or modify parts of his theoryreject or modify parts of his theory

Freud’s therapy is an Freud’s therapy is an insight therapyinsight therapy

• It attempts to discover relationships between It attempts to discover relationships between unconscious motivation and abnormal behaviorunconscious motivation and abnormal behavior

• Any insight therapy has two basic assumptionsAny insight therapy has two basic assumptions

Psychoanalysis

• Second, the causes of maladjustment are Second, the causes of maladjustment are unresolved conflictsunresolved conflicts

The person is unaware of these conflicts, The person is unaware of these conflicts, and therefore cannot deal with themand therefore cannot deal with them

Any insight therapy has two basic Any insight therapy has two basic assumptions:assumptions:

• First, becoming aware of one’s motivations First, becoming aware of one’s motivations helps one change and become more helps one change and become more adaptiveadaptive

Psychoanalysis

Goal of PsychoanalysisGoal of Psychoanalysis The goal is to help patients understand the The goal is to help patients understand the

unconscious motivations that direct their unconscious motivations that direct their behaviorsbehaviors

• Only by becoming aware of these motivations Only by becoming aware of these motivations can they choose behaviors that lead to more can they choose behaviors that lead to more fulfilling livesfulfilling lives

• During analysis, patients are encouraged to During analysis, patients are encouraged to express healthy impulses, strengthen day-to-express healthy impulses, strengthen day-to-day functioning based on reality, and perceive day functioning based on reality, and perceive the world as a positive placethe world as a positive place

Copyright © Allyn & Bacon 2003

Techniques of PsychoanalysisTechniques of Psychoanalysis Psychoanalysis is geared toward the Psychoanalysis is geared toward the

exploration of early experiencesexploration of early experiences

Two major techniques are free association Two major techniques are free association and dream analysisand dream analysis

In In free associationfree association, the patient is asked to , the patient is asked to report whatever comes to mind, no matter report whatever comes to mind, no matter how disorganized or trivialhow disorganized or trivial

Techniques of PsychoanalysisTechniques of Psychoanalysis In In free associationfree association, the patient is asked to report , the patient is asked to report

whatever comes to mind, no matter how whatever comes to mind, no matter how disorganized or trivialdisorganized or trivial

• One purpose is to help patients recognize connections One purpose is to help patients recognize connections and patterns among their thoughtsand patterns among their thoughts

• It also allows free expression of the unconsciousIt also allows free expression of the unconscious

In In dream analysisdream analysis, patients are asked to , patients are asked to describe their dreams in detaildescribe their dreams in detail

Techniques of PsychoanalysisTechniques of Psychoanalysis

In In dream analysisdream analysis, patients are asked to , patients are asked to describe their dreams in detaildescribe their dreams in detail

• The dreams are interpreted to provide insight The dreams are interpreted to provide insight into unconscious motivationinto unconscious motivation

• Freud believed dreams represent some element Freud believed dreams represent some element of the unconscious seeking expressionof the unconscious seeking expression

Both free association and dream analysis Both free association and dream analysis involve the therapist’s interpretationsinvolve the therapist’s interpretations

Both free association and dream analysis Both free association and dream analysis involve the therapist’s interpretationsinvolve the therapist’s interpretations

InterpretationInterpretation involves providing a context, involves providing a context, meaning, or cause, for an idea, feeling, or meaning, or cause, for an idea, feeling, or set of behaviorsset of behaviors

• The therapist attempts to find a common thread in a The therapist attempts to find a common thread in a patient’s behaviors and thoughtspatient’s behaviors and thoughts

• Patients’ use of defense mechanisms may point to areas Patients’ use of defense mechanisms may point to areas that need to be exploredthat need to be explored

Techniques of Psychoanalysis

Techniques of PsychoanalysisTechniques of Psychoanalysis

Defense mechanisms may point to areas Defense mechanisms may point to areas that need to be exploredthat need to be explored

Two processes in psychoanalysis are Two processes in psychoanalysis are resistance and transferenceresistance and transference

• ResistanceResistance is an unwillingness to cooperate is an unwillingness to cooperate

• In resistance, the patient may be unwilling In resistance, the patient may be unwilling to provide information, or help in to provide information, or help in interpretationinterpretation

Resistance shows one of Resistance shows one of two thingstwo things

• The patient wishes to The patient wishes to avoid talking about a avoid talking about a topictopic

• Or, a difficult stage of Or, a difficult stage of therapy has been therapy has been reachedreached

To minimize resistance, To minimize resistance, analysts try to accept a analysts try to accept a patient’s behaviorpatient’s behavior

In resistance, the In resistance, the patient may be patient may be unwilling to provide unwilling to provide information, or help information, or help in interpretationin interpretation

Resistance may Resistance may sometimes reach sometimes reach the point of the point of belligerencebelligerence


To minimize resistance, analysts try to accept To minimize resistance, analysts try to accept a patient’s behaviora patient’s behavior

During During transferencetransference, the therapist becomes , the therapist becomes the object of a patient’s emotional attitudes the object of a patient’s emotional attitudes about an important person in the patient’s lifeabout an important person in the patient’s life

• The importance of transference is that the therapist will The importance of transference is that the therapist will respond differently than the important personrespond differently than the important person

• This allows the patient to experience conflict differentlyThis allows the patient to experience conflict differently


The therapist can The therapist can also guide the person also guide the person to explore repressed to explore repressed ideasideas

Examining previously Examining previously unacceptable unacceptable thoughts and thoughts and feelings helps feelings helps patients identify patients identify underlying conflictsunderlying conflicts

This allows the This allows the patient to patient to experience conflict experience conflict differentlydifferently

This gives patients This gives patients a new opportunity a new opportunity to explore their to explore their feelingsfeelings


Examining previously Examining previously unacceptable unacceptable thoughts and feelings thoughts and feelings helps patients identify helps patients identify underlying conflictsunderlying conflicts

Psychoanalysis Psychoanalysis involves slowly involves slowly gaining insights into gaining insights into the unconsciousthe unconscious

These insights allow These insights allow the patient to learn the patient to learn new ways of coping new ways of coping with instinctual with instinctual urgesurges

The patient also The patient also develops mature develops mature ways of dealing ways of dealing with anxiety and with anxiety and guiltguilt


Techniques of PsychoanalysisTechniques of Psychoanalysis The patient also develops mature ways of dealing The patient also develops mature ways of dealing

with anxiety and guiltwith anxiety and guilt

The cycle of interpretation, resistance, and The cycle of interpretation, resistance, and transference occurs repeatedly during transference occurs repeatedly during psychoanalysispsychoanalysis

It is sometimes referred to as It is sometimes referred to as working working throughthrough

Ego AnalysisEgo Analysis Ego analystsEgo analysts are psychoanalysts who are psychoanalysts who

assume the ego has greater control over assume the ego has greater control over behavior than Freud suggestedbehavior than Freud suggested

• They focus more on a person’s reality testing They focus more on a person’s reality testing and control over the environmentand control over the environment

• They place less emphasis on unconscious They place less emphasis on unconscious motivation and processesmotivation and processes

A major disagreement between A major disagreement between “traditional” and “ego” analysts has to “traditional” and “ego” analysts has to do with the role of the id and the egodo with the role of the id and the ego

Ego AnalysisEgo Analysis A major disagreement A major disagreement

between “traditional” between “traditional” and “ego” analysts and “ego” analysts has to do with the role has to do with the role of the id and the egoof the id and the ego

Traditional analysts Traditional analysts feels the ego grows feels the ego grows out of the id and is out of the id and is controlled by itcontrolled by it

An ego analyst An ego analyst asserts the ego is asserts the ego is independent of the independent of the idid

The ego is assumed The ego is assumed to control memory to control memory and perception, and and perception, and is not in constant is not in constant conflict with the idconflict with the id

Ego AnalysisEgo Analysis The ego is assumed to control memory and The ego is assumed to control memory and

perception, and is not in constant conflict with the perception, and is not in constant conflict with the idid

Traditional analysis focuses on unconscious Traditional analysis focuses on unconscious material in the id before trying to increase a material in the id before trying to increase a person’s ego controlperson’s ego control

Ego analysts begin by trying to strengthen Ego analysts begin by trying to strengthen the egothe ego

Ego analysts begin Ego analysts begin by trying to by trying to strengthen the egostrengthen the ego

They may ask a They may ask a client to be client to be assertive and take assertive and take control of a control of a situationsituation

A weak ego is seen A weak ego is seen to cause to cause maladjustment as maladjustment as it fails to perceive, it fails to perceive, understand, and understand, and control the idcontrol the id

By learning to By learning to master and master and develop their ego, develop their ego, people gain greater people gain greater control of their control of their liveslives

Ego Analysis

Criticisms of PsychoanalysisCriticisms of Psychoanalysis

Critics of psychoanalysis contend it is Critics of psychoanalysis contend it is unscientific, imprecise, and subjectiveunscientific, imprecise, and subjective

• They assert concepts such as id, ego, and They assert concepts such as id, ego, and superego are not linked to realitysuperego are not linked to reality

• Other critics object to Freud’s biologically Other critics object to Freud’s biologically oriented approach oriented approach

• These critics object to the notion that we are These critics object to the notion that we are bundles of energy caught in conflictbundles of energy caught in conflict


These critics These critics object to the object to the notion that we are notion that we are bundles of energy bundles of energy caught in conflictcaught in conflict

They also object to They also object to the idea we are the idea we are driven toward driven toward hedonistic goalshedonistic goals

Freud’s ideas Freud’s ideas have been have been criticized as sexistcriticized as sexist

The effectiveness The effectiveness of psychoanalysis of psychoanalysis is open to is open to questionquestion


• In general, it can be In general, it can be asas effective as other effective as other therapies, but not therapies, but not moremore effective effective

Psychoanalysis has certain inherent Psychoanalysis has certain inherent disadvantagesdisadvantages

The effectiveness of psychoanalysis is The effectiveness of psychoanalysis is open to questionopen to question

• It is more effective for some people than It is more effective for some people than othersothers


Psychoanalysis has certain inherent Psychoanalysis has certain inherent disadvantagesdisadvantages

• The patient must be highly motivated The patient must be highly motivated and articulateand articulate

• It is also typically extremely expensiveIt is also typically extremely expensive

• Many people cannot afford the time or Many people cannot afford the time or money for this type of treatmentmoney for this type of treatment

Humanistic TherapiesHumanistic Therapies

Focusing on the PresentFocusing on the Present




Humanistic TherapiesHumanistic Therapies

Humanistic therapies emphasize the Humanistic therapies emphasize the ability to reflect on conscious experienceability to reflect on conscious experience

They also emphasize that humans have They also emphasize that humans have free willfree will

Unlike psychoanalysis, humanistic Unlike psychoanalysis, humanistic therapies tend to focus on the present and therapies tend to focus on the present and futurefuture

Humanistic TherapiesHumanistic Therapies To some extent, To some extent,

humanistic humanistic therapies are therapies are insight therapiesinsight therapies

• They focus on They focus on helping people see helping people see the causes of their the causes of their behaviorbehavior

• Client-centered Client-centered therapy is a major therapy is a major humanistic therapyhumanistic therapy

Unlike psychoanalysis, Unlike psychoanalysis, humanistic therapies humanistic therapies tend to focus on the tend to focus on the present and futurepresent and future

They also assert that They also assert that people are creative people are creative and born with a desire and born with a desire to fulfill themselvesto fulfill themselves

Client-Centered TherapyClient-Centered Therapy Client-centered therapyClient-centered therapy is also known as is also known as

person-centered therapyperson-centered therapy

• It is an insight therapyIt is an insight therapy

It helps people evaluate the world and It helps people evaluate the world and themselves from their own perspectivethemselves from their own perspective

Client-centered therapy was developed by Carl Client-centered therapy was developed by Carl Rogers (1902 – 1987)Rogers (1902 – 1987)

Rogerian therapists hold that problems occur Rogerian therapists hold that problems occur when a person is kept from developing his or when a person is kept from developing his or her unique potentialher unique potential


Techniques of Client-Centered Techniques of Client-Centered TherapyTherapy

The goal of client-centered therapy is to The goal of client-centered therapy is to help people discover their ideal selveshelp people discover their ideal selves

• This is then reconciled with their real selvesThis is then reconciled with their real selves

• The word The word clientclient rather than rather than patientpatient is is important in Roger’s form of therapyimportant in Roger’s form of therapy

In psychoanalysis, the analyst In psychoanalysis, the analyst directsdirects a a patient toward a “cure”patient toward a “cure”

In client-centered therapy, the therapist In client-centered therapy, the therapist guidesguides clients to help them find what they feel clients to help them find what they feel is right for themselvesis right for themselves

First, the therapist First, the therapist must show must show unconditional positive unconditional positive regardregard

• Be an accepting Be an accepting person who projects person who projects positive feelingspositive feelings

• Unconditional positive Unconditional positive regard counteracts a regard counteracts a client’s negative client’s negative encounters with encounters with unaccepting peopleunaccepting people

In client-centered In client-centered therapy, the therapist therapy, the therapist guidesguides clients to help clients to help them find what they them find what they feel is right for feel is right for themselvesthemselves

Rogers felt a therapist Rogers felt a therapist must have certain must have certain characteristics in characteristics in order for therapy to order for therapy to be successfulbe successful

Techniques

• Therapists are honest and aware of their own feelingsTherapists are honest and aware of their own feelings

• Counselors’ congruence allows them to communicate Counselors’ congruence allows them to communicate more effectively and help clients be more aware and more effectively and help clients be more aware and openopen

CongruenceCongruence is another component is another component

Techniques

TechniquesTechniques

The final ingredient is The final ingredient is empathic empathic listeninglistening

• Therapists must sense how their client feels and Therapists must sense how their client feels and communicate these feelings to the clientcommunicate these feelings to the client

• Therapists help their clients organize their thoughts and Therapists help their clients organize their thoughts and ideasideas

TechniquesTechniques Therapists help their clients organize Therapists help their clients organize

their thoughts and ideastheir thoughts and ideas

• Three techniques can be used to do this:Three techniques can be used to do this:

The therapist can The therapist can paraphraseparaphrase a client’s ideas a client’s ideas

The client can be asked to The client can be asked to rephraserephrase an idea or an idea or feelingfeeling

The client can The client can reflectreflect back what they had said back what they had said


• They are defensive, and show disorganized behaviorThey are defensive, and show disorganized behavior

• Over time, the client begins to use her or his own Over time, the client begins to use her or his own ideas as standards for self-evaluationideas as standards for self-evaluation

The client can The client can reflectreflect back what they had said back what they had said

At the beginning of therapy, clients tend to At the beginning of therapy, clients tend to express attitudes adopted from other peopleexpress attitudes adopted from other people


Over time, the client begins to use her or his Over time, the client begins to use her or his own ideas as standards for self-evaluationown ideas as standards for self-evaluation

• Two things may occur as a resultTwo things may occur as a result

The client may adjust the ideal self so it is in line The client may adjust the ideal self so it is in line with his or her own goals, rather than those of with his or her own goals, rather than those of othersothers

Behavior may change so it is more adaptive and Behavior may change so it is more adaptive and positivepositive

Criticisms of Client-Centered TherapyCriticisms of Client-Centered Therapy

No other therapy makes clients feel so No other therapy makes clients feel so warm, accepted, and safewarm, accepted, and safe

• Critics argue this may not be enough to bring Critics argue this may not be enough to bring about long-lasting changeabout long-lasting change

• Critics also argue that lengthy discussions Critics also argue that lengthy discussions about problems do not necessarily help about problems do not necessarily help people with present difficultiespeople with present difficulties

• It is also said that client-centered therapy It is also said that client-centered therapy focuses on concepts that are hard to define, focuses on concepts that are hard to define, such as self-actualizationsuch as self-actualization

Behavior TherapyBehavior Therapy

From the Behavioral From the Behavioral PerspectivePerspective

Behavior TherapyBehavior Therapy Behavior therapy has become especially Behavior therapy has become especially

popular in the last 30 yearspopular in the last 30 years

• This has occurred for three reasons:This has occurred for three reasons:

People sometimes have problems that may not People sometimes have problems that may not require insights or in-depth discussions of feelingsrequire insights or in-depth discussions of feelings

Managed care organizations see it as quicker and Managed care organizations see it as quicker and less expensive than other approachesless expensive than other approaches

Finally, behavior therapy can be highly effectiveFinally, behavior therapy can be highly effective

Goals of Behavior TherapyGoals of Behavior Therapy

Behavior therapyBehavior therapy focuses on focuses on changing overt behaviorchanging overt behavior

• It is also called It is also called behavior modificationbehavior modification

It uses learning principles to help people It uses learning principles to help people replace maladaptive behaviors with more replace maladaptive behaviors with more effective oneseffective ones

Behavior therapists assume changes in the Behavior therapists assume changes in the environment affect people’s responsesenvironment affect people’s responses


Behavior therapists assume changes in the Behavior therapists assume changes in the environment affect people’s responsesenvironment affect people’s responses

Unlike psychoanalysis, behavior therapy Unlike psychoanalysis, behavior therapy does not try to discover the origins of does not try to discover the origins of behaviorbehavior

• It only tries to alter behaviorIt only tries to alter behavior

• Behavior therapists try to help people unlearn Behavior therapists try to help people unlearn faulty behaviors and learn more effective onesfaulty behaviors and learn more effective ones


Behavior therapists try to help people unlearn Behavior therapists try to help people unlearn faulty behaviors and learn more effective onesfaulty behaviors and learn more effective ones

They do not always focus on the problem leading They do not always focus on the problem leading the client to seek therapythe client to seek therapy

If behavior therapists see the problem is If behavior therapists see the problem is associated with another situation, they associated with another situation, they may try to change that situationmay try to change that situation

Goals of Behavior TherapyGoals of Behavior Therapy If behavior therapists see the problem is If behavior therapists see the problem is

associated with another situation, they may associated with another situation, they may try to change that situationtry to change that situation

Unlike psychodynamic and humanistic Unlike psychodynamic and humanistic therapies, behavior therapy does not therapies, behavior therapy does not encourage clients to interpret past eventsencourage clients to interpret past events

Behavior therapists are dissatisfied with Behavior therapists are dissatisfied with psychodynamic and humanistic therapies psychodynamic and humanistic therapies for three basic reasonsfor three basic reasons

Goals of Behavior TherapyGoals of Behavior Therapy Second, some studies Second, some studies

show that people show that people who do not receive who do not receive those therapies those therapies improve anywayimprove anyway

Finally, once a person Finally, once a person is labeled “abnormal” is labeled “abnormal” the label itself may the label itself may lead to maladaptive lead to maladaptive behaviorbehavior

Behavior therapists Behavior therapists are dissatisfied with are dissatisfied with psychodynamic and psychodynamic and humanistic humanistic therapies for three therapies for three basic reasonsbasic reasons

First, those First, those therapies use therapies use concepts difficult to concepts difficult to define and measuredefine and measure

Goals of Behavior TherapyGoals of Behavior Therapy Once a person is labeled “abnormal”, the Once a person is labeled “abnormal”, the

label itself may lead to maladaptive behaviorlabel itself may lead to maladaptive behavior

Behavior therapists assume people do not Behavior therapists assume people do not display maladaptive behavior because they display maladaptive behavior because they are “abnormal”are “abnormal”

• They display maladaptive behavior because they They display maladaptive behavior because they are having trouble adjusting to the environmentare having trouble adjusting to the environment

• If they are taught how to cope, maladjustment If they are taught how to cope, maladjustment will disappearwill disappear

Behavior Therapy: A CriticismBehavior Therapy: A Criticism

Most insight therapists believe that if only Most insight therapists believe that if only overt behavior is treated, symptom overt behavior is treated, symptom substitution will occursubstitution will occur

• In In symptom substitutionsymptom substitution, a new overt symptom , a new overt symptom appears to replace one eliminated by appears to replace one eliminated by treatmenttreatment

• Research does show, however, that behavior Research does show, however, that behavior therapy is at least as effective as insight therapy is at least as effective as insight therapiestherapies

Techniques of Behavior TherapyTechniques of Behavior Therapy

The techniques of behavior therapy The techniques of behavior therapy include operant conditioning, modeling, include operant conditioning, modeling, and counterconditioningand counterconditioning

• A therapist will use whatever combination of A therapist will use whatever combination of techniques is needed to help a clienttechniques is needed to help a client

• Behavior therapy usually involves three Behavior therapy usually involves three general proceduresgeneral procedures

Techniques of Behavior TherapyTechniques of Behavior Therapy

Behavior therapy usually involves Behavior therapy usually involves three general procedures:three general procedures:

• First, the problem behavior and its First, the problem behavior and its frequency is examinedfrequency is examined

• Next, a treatment strategy is used, Next, a treatment strategy is used, individually tailored to the clientindividually tailored to the client

• Finally, there is continual assessment Finally, there is continual assessment as to whether behavior has changedas to whether behavior has changed

Operant ConditioningOperant Conditioning

Operant conditioning to establish a new Operant conditioning to establish a new behavior often depends on a behavior often depends on a reinforcerreinforcer

• An event or circumstance that increases the An event or circumstance that increases the probability a response will occurprobability a response will occur

• One method of rewarding adaptive behavior One method of rewarding adaptive behavior is through a is through a token economytoken economy

Token EconomiesToken Economies

In a token economy people who In a token economy people who display appropriate behaviors display appropriate behaviors receive tokensreceive tokens

• These can be exchanged for desirable These can be exchanged for desirable items and activitiesitems and activities

• Token economies are used to modify Token economies are used to modify behavior in social settingsbehavior in social settings

Token EconomiesToken Economies

Token economies Token economies are used to modify are used to modify behavior in social behavior in social settingssettings

The aim is to The aim is to strengthen strengthen behaviors behaviors compatible with compatible with normsnorms

They have been They have been used successfully in used successfully in schools and hospital schools and hospital settingssettings

Other operant Other operant techniques include techniques include extinction, extinction, punishment, and punishment, and time outtime out

ExtinctionExtinction

Extinction occurs when reinforcers are Extinction occurs when reinforcers are withheldwithheld

• This eventually leads a previously reinforced This eventually leads a previously reinforced behavior to stopbehavior to stop

• It can be used in conjunction with a token It can be used in conjunction with a token economy, or separately, to stop an economy, or separately, to stop an undesirable behaviorundesirable behavior

PunishmentPunishment

Another way to stop an undesirable Another way to stop an undesirable behavior is to use punishmentbehavior is to use punishment

• This often involves the presentation of an This often involves the presentation of an aversive stimulusaversive stimulus

It only suppresses a behaviorIt only suppresses a behavior

Punishment does not establish new, desired Punishment does not establish new, desired behaviorsbehaviors


Punishment does not establish new, Punishment does not establish new, desired behaviorsdesired behaviors

Thus, it is often combined with positive Thus, it is often combined with positive reinforcement for desirable behaviorsreinforcement for desirable behaviors

Punishment has other drawbacksPunishment has other drawbacks

People (especially young people) People (especially young people) sometimes imitate aggressionsometimes imitate aggression


Punishment can be harmfulPunishment can be harmful

People (especially young people) sometimes People (especially young people) sometimes imitate aggressionimitate aggression

Punishment can lead to generalized aggressionPunishment can lead to generalized aggression

Time-OutTime-Out

Time-outTime-out is the removal of a person from is the removal of a person from sources of reinforcementsources of reinforcement

• It is used to decrease behaviorIt is used to decrease behavior

• Time-out is principally used with childrenTime-out is principally used with children

• It is especially effective when combined with It is especially effective when combined with positive reinforcers for appropriate behaviorpositive reinforcers for appropriate behavior

CounterconditioningCounterconditioning

In In CounterconditioningCounterconditioning, a person is taught , a person is taught a new, more adaptive response to a a new, more adaptive response to a stimulusstimulus

• It is a process of reconditioningIt is a process of reconditioning

• Joseph Wolpe (1915 – 1997) was one of the Joseph Wolpe (1915 – 1997) was one of the original proponents of counterconditioningoriginal proponents of counterconditioning

• Wolpe used counterconditioning to inhibit Wolpe used counterconditioning to inhibit anxiety as a responseanxiety as a response

CounterconditioningCounterconditioning Wolpe used Wolpe used

counterconditionincounterconditioning to inhibit anxiety g to inhibit anxiety as a responseas a response

Therapy using the Therapy using the technique begins technique begins with a specific with a specific stimulus (S1) that stimulus (S1) that elicits a specific elicits a specific response (R1)response (R1)

After therapy, S1 After therapy, S1 should elicit a new should elicit a new response (R2)response (R2)

Two approaches use Two approaches use counterconditioning:counterconditioning:

• Systematic Systematic desensitizationdesensitization

• Aversive conditioningAversive conditioning

Systematic DesensitizationSystematic Desensitization

Systematic desensitizationSystematic desensitization is a three-stage is a three-stage counterconditioning procedurecounterconditioning procedure

• The client is first taught to relaxThe client is first taught to relax

The client then describes the specific The client then describes the specific situations that arouse anxietysituations that arouse anxiety

While deeply relaxed, the client imagines While deeply relaxed, the client imagines increasingly vivid scenes of the situations increasingly vivid scenes of the situations causing anxietycausing anxiety

Systematic DesensitizationSystematic Desensitization

• With each successive experience, the client With each successive experience, the client learns relaxation rather than fear as a learns relaxation rather than fear as a responseresponse

While deeply relaxed, the client imagines While deeply relaxed, the client imagines increasingly vivid scenes of the situations increasingly vivid scenes of the situations causing anxietycausing anxiety

• This gradually exposes the client to the This gradually exposes the client to the source of the anxietysource of the anxiety

Systematic DesensitizationSystematic Desensitization With each successive experience, the client With each successive experience, the client

learns relaxation rather than fear as a responselearns relaxation rather than fear as a response

Systematic desensitization is most successful for Systematic desensitization is most successful for people with two types of problemspeople with two types of problems

• Problems with impulse controlProblems with impulse control

• Particular forms of anxiety such as phobiasParticular forms of anxiety such as phobias

It is not effective for people with psychotic It is not effective for people with psychotic symptoms, or situations of interpersonal conflictsymptoms, or situations of interpersonal conflict

Aversive ConditioningAversive Conditioning

Another method using counterconditioning Another method using counterconditioning is is aversive conditioningaversive conditioning

• A noxious stimulus is paired with a stimulus A noxious stimulus is paired with a stimulus that elicits an undesirable behaviorthat elicits an undesirable behavior

This will cause the undesirable behavior to This will cause the undesirable behavior to stopstop

The goal is to teach a new response to the The goal is to teach a new response to the aversive stimulusaversive stimulus

ModelingModeling

Bandura (1997) believes modeling can be Bandura (1997) believes modeling can be used effectively for:used effectively for:

• Teaching a new behaviorTeaching a new behavior

• Helping eliminate fearsHelping eliminate fears

• Enhancing already existing behaviorEnhancing already existing behavior

One problem is that people may imitate One problem is that people may imitate the behavior of inappropriate modelsthe behavior of inappropriate models

Cognitive TherapyCognitive Therapy

An Outgrowth of Behavior An Outgrowth of Behavior TherapyTherapy





Cognitive therapists assume that Cognitive therapists assume that distorted, undeveloped ideas prevent distorted, undeveloped ideas prevent people from establishing effective coping people from establishing effective coping behaviorsbehaviors

Cognitive therapy focuses on changing Cognitive therapy focuses on changing client behavior by changing the person’s client behavior by changing the person’s thoughts or perceptionsthoughts or perceptions

Cognitive therapy is derived from three Cognitive therapy is derived from three propositionspropositions


Cognitive therapy is derived from Cognitive therapy is derived from three propositions:three propositions:

• Cognitive activity affects behaviorCognitive activity affects behavior

• Cognitive activity can be monitoredCognitive activity can be monitored

• Behavior can be changed by altering Behavior can be changed by altering cognitive patternscognitive patterns


• Cognitive therapy is also known as Cognitive therapy is also known as cognitive cognitive restructuringrestructuring

• Cognitive therapy is effective for people who Cognitive therapy is effective for people who have attached narrow or inappropriate labels have attached narrow or inappropriate labels to certain behaviors or situationsto certain behaviors or situations

Many behavior therapists currently Many behavior therapists currently incorporate thought processes into incorporate thought processes into treatmenttreatment

• This is called This is called cognitive behavior therapycognitive behavior therapy


Cognitive therapy focuses on Cognitive therapy focuses on current behaviors and thoughtscurrent behaviors and thoughts

• It is not especially concerned with uncovering childhood It is not especially concerned with uncovering childhood experiencesexperiences

• It is especially effective if combined with techniques such It is especially effective if combined with techniques such as use of reinforcementas use of reinforcement

Rational Emotive TherapyRational Emotive Therapy The best known cognitive therapy is The best known cognitive therapy is

rational emotive therapyrational emotive therapy

• It emphasizes the importance of logical, It emphasizes the importance of logical, rational, thought processesrational, thought processes

It was developed by Albert Ellis over 30 It was developed by Albert Ellis over 30 years agoyears ago

Ellis assumed abnormal behavior is caused Ellis assumed abnormal behavior is caused by faulty and irrational thinking patternsby faulty and irrational thinking patterns

Rational Emotive TherapyRational Emotive Therapy

Ellis assumed abnormal behavior is caused Ellis assumed abnormal behavior is caused by faulty and irrational thinking patternsby faulty and irrational thinking patterns

A major goal is to help people examine A major goal is to help people examine past events that produce irrational beliefspast events that produce irrational beliefs

• Clients adopt different behavior patterns based on more Clients adopt different behavior patterns based on more rational thought processesrational thought processes

• Research supports the effectiveness of the approachResearch supports the effectiveness of the approach

Beck’s ApproachBeck’s Approach

Aaron Beck developed another cognitive Aaron Beck developed another cognitive therapytherapy

• Beck assumes depression is caused by Beck assumes depression is caused by people’s distorted thoughts about realitypeople’s distorted thoughts about reality

These lead to negative views of the world, These lead to negative views of the world, the self, and the futurethe self, and the future

A goal of Beck’s therapy is to help people A goal of Beck’s therapy is to help people develop realistic appraisals of situationsdevelop realistic appraisals of situations



A goal of Beck’s therapy is to help people A goal of Beck’s therapy is to help people develop realistic appraisals of situationsdevelop realistic appraisals of situations

The therapist acts as a trainer and The therapist acts as a trainer and coinvestigatorcoinvestigator

• Providing data to be examinedProviding data to be examined

• The therapist also guides the client in The therapist also guides the client in understanding how cognitions influence behaviorunderstanding how cognitions influence behavior


Beck says a successful client passes through Beck says a successful client passes through four stages in moving toward mental healthfour stages in moving toward mental health

• First the client becomes aware of her/his thoughtsFirst the client becomes aware of her/his thoughts

• The client recognizes what thoughts are awryThe client recognizes what thoughts are awry

• Accurate judgments then need to be substituted for inaccurate Accurate judgments then need to be substituted for inaccurate onesones

• Finally, the client needs feedback as to whether the changes are Finally, the client needs feedback as to whether the changes are correctcorrect

Meichenbaum’s ApproachMeichenbaum’s Approach

Meichenbaum developed a third Meichenbaum developed a third cognitive therapycognitive therapy

• He believes that what people say to He believes that what people say to themselves determines what they dothemselves determines what they do

A goal of his therapy is to change what A goal of his therapy is to change what people say to themselvespeople say to themselves

The therapist must change the client’s The therapist must change the client’s appraisal of situations and the client’s use of appraisal of situations and the client’s use of self-instructionsself-instructions


The therapist must The therapist must change the client’s change the client’s appraisal of situations appraisal of situations and the client’s use and the client’s use of self-instructionsof self-instructions

A strength of the A strength of the approach is that it approach is that it can be used in many can be used in many settings for many settings for many problemsproblems

No attempt is No attempt is made to change made to change irrational beliefsirrational beliefs

Clients learn a Clients learn a repertoire of repertoire of activities they can activities they can use to make their use to make their behavior more behavior more adaptiveadaptive


• They may learn to organize their responses They may learn to organize their responses to specific situations in orderly stepsto specific situations in orderly steps

Clients learn a repertoire of activities they can Clients learn a repertoire of activities they can use to make their behavior more adaptiveuse to make their behavior more adaptive

• They may learn to conduct a private monologue in They may learn to conduct a private monologue in which they work out adaptive ways of copingwhich they work out adaptive ways of coping


Cognitive therapy is influencing an Cognitive therapy is influencing an increasing number of therapists who increasing number of therapists who conduct long-term, as well as brief, therapyconduct long-term, as well as brief, therapy

It can be applied to a variety of problems It can be applied to a variety of problems including anxiety, depression, marital including anxiety, depression, marital difficulties, and chronic paindifficulties, and chronic pain

Cognitive therapy in its many forms has Cognitive therapy in its many forms has been used with adults and childrenbeen used with adults and children


Cognitive therapy in its many Cognitive therapy in its many forms has been used with adults forms has been used with adults and childrenand children

It can be used with groups having It can be used with groups having particular characteristicsparticular characteristics

Group TherapyGroup Therapy


In In group therapygroup therapy, several people meet , several people meet together with a therapist to receive together with a therapist to receive treatmenttreatment

• This allows a therapist to see more clientsThis allows a therapist to see more clients

• Since fees are shared, it is also less expensiveSince fees are shared, it is also less expensive

• Group therapy can also be more effective than Group therapy can also be more effective than individual therapyindividual therapy


Group therapy can also be more effective Group therapy can also be more effective than individual therapythan individual therapy

• The social pressure in the group can help The social pressure in the group can help shape members’ behaviorshape members’ behavior

• Group members can also act as useful modelsGroup members can also act as useful models

• Mutual reinforcement and support can also be Mutual reinforcement and support can also be providedprovided

Techniques and Formats of Techniques and Formats of Group TherapyGroup Therapy

The techniques used are determined by The techniques used are determined by the nature of the groupthe nature of the group

It is also determined by the theoretical It is also determined by the theoretical orientation of the therapistorientation of the therapist

In traditional group therapy, 6 to 12 In traditional group therapy, 6 to 12 clients meet once a weekclients meet once a week

Techniques and FormatsTechniques and Formats

In traditional group therapy, 6 to 12 In traditional group therapy, 6 to 12 clients meet once a weekclients meet once a week

• Members are chosen on the basis of what they Members are chosen on the basis of what they can gain from and offer to the groupcan gain from and offer to the group

• The aim is to construct a group whose The aim is to construct a group whose members are compatible in terms of age, members are compatible in terms of age, needs, and problemsneeds, and problems


The format of traditional group therapy The format of traditional group therapy variesvaries

• Generally, each member describes his or her Generally, each member describes his or her problems to the other membersproblems to the other members

The other members relate their experiences The other members relate their experiences with similar problems, and how they copedwith similar problems, and how they coped

Thus, each member expresses their fears and Thus, each member expresses their fears and anxieties to people who are acceptinganxieties to people who are accepting


Thus, each member expresses their fears Thus, each member expresses their fears and anxieties to people who are acceptingand anxieties to people who are accepting

Group members have an opportunity to role Group members have an opportunity to role play new behaviors in a safe environmentplay new behaviors in a safe environment

Sometimes the therapist is directive in helping to Sometimes the therapist is directive in helping to address problemsaddress problems

At other times, the therapist has the group At other times, the therapist has the group resolve a problem independentlyresolve a problem independently

Family TherapyFamily Therapy

A A familyfamily is a group of people who are is a group of people who are committed to one another’s well-committed to one another’s well-being, preferably for lifebeing, preferably for life

• In In family therapyfamily therapy, two or more people , two or more people who are committed to each other’s well-who are committed to each other’s well-being are treated togetherbeing are treated together

• Family therapists often attempt to Family therapists often attempt to change change family systemsfamily systems


• Therapists assume there are multiple sources of Therapists assume there are multiple sources of psychological influencepsychological influence

Individuals in a family affect family interactionsIndividuals in a family affect family interactions

Family interactions affect individualsFamily interactions affect individuals

Family therapists often attempt to change Family therapists often attempt to change family systemsfamily systems

• Treatment takes place within the dynamic Treatment takes place within the dynamic social system of the marriage or familysocial system of the marriage or family


Family interactions Family interactions affect individualsaffect individuals

Sometimes family Sometimes family therapy is called therapy is called relationship relationship therapytherapy, because , because relationships are a relationships are a focus of focus of interventionintervention

A useful technique A useful technique is to is to restructurerestructure the family’s the family’s interactionsinteractions

For example, a son For example, a son may be responding may be responding passively to a passively to a domineering domineering mothermother


An issue in family therapy is how all An issue in family therapy is how all members of a family may become members of a family may become enmeshed in one member’s problemsenmeshed in one member’s problems

A son may be responding passively to a A son may be responding passively to a domineering motherdomineering mother

The therapist may suggest he only be The therapist may suggest he only be assigned chores by his fatherassigned chores by his father


• A family member may be alcoholic, but A family member may be alcoholic, but codependence may be an additional codependence may be an additional adjustment problemadjustment problem

• Codependents are often plagued by feelings Codependents are often plagued by feelings of shame, fear, anger, and painof shame, fear, anger, and pain

An issue in family therapy is how all An issue in family therapy is how all members of a family may become members of a family may become enmeshed in one member’s problemsenmeshed in one member’s problems

• This problem is called This problem is called codependencecodependence


Codependents are Codependents are often plagued by often plagued by feelings of shame, feelings of shame, fear, anger, and fear, anger, and painpain

However, they feel However, they feel obligated to care obligated to care for the person with for the person with the disorder or the disorder or addictionaddiction

This prevents them This prevents them from expressing from expressing their feelingstheir feelings

In some cases, In some cases, people people need need the the person to stay person to stay disordereddisordered


In some cases, people In some cases, people need need the the person to stay disorderedperson to stay disordered

This allows them to maintain a This allows them to maintain a controlling positioncontrolling position

Family Therapy: AssessmentFamily Therapy: Assessment

Some researchers believe family therapy to Some researchers believe family therapy to be as effective as individual therapybe as effective as individual therapy

• In some situations they say it is more effectiveIn some situations they say it is more effective

• However, not all families profit equallyHowever, not all families profit equally

It is difficult with families that are disorganizedIt is difficult with families that are disorganized

Outcomes are not as good when depression is Outcomes are not as good when depression is involvedinvolved

Family Therapy: AssessmentFamily Therapy: Assessment

Outcomes are not Outcomes are not as good when as good when depression is depression is involvedinvolved

If family members If family members drop out or refuse drop out or refuse to participate, the to participate, the outcome is almost outcome is almost always negativealways negative

Younger couples Younger couples seem to have seem to have better outcomesbetter outcomes

There is no There is no one one solution to family solution to family problemsproblems

Biologically Based Biologically Based TherapiesTherapies

Medical TherapiesMedical Therapies


Biologically Based TherapyBiologically Based Therapy

The usual approach to a The usual approach to a psychological problem is “talking psychological problem is “talking therapy”therapy”

• For some patients, this is not enoughFor some patients, this is not enough

They may be exhibiting symptoms of bipolar They may be exhibiting symptoms of bipolar disorder or schizophreniadisorder or schizophrenia

Some people may be suicidalSome people may be suicidal


These therapies often involve medication, or These therapies often involve medication, or hospitalizationhospitalization

Biological therapies are often used in Biological therapies are often used in combination with traditional psychotherapycombination with traditional psychotherapy

Some people may be suicidalSome people may be suicidal

• These are cases where biologically These are cases where biologically based therapies come into playbased therapies come into play


Biological therapies are often used in Biological therapies are often used in combination with traditional combination with traditional psychotherapypsychotherapy

Most practitioners and theoreticians Most practitioners and theoreticians believe the most effective treatment believe the most effective treatment is drugs in combination with is drugs in combination with psychotherapypsychotherapy

Drug TherapyDrug Therapy

Clinicians who use drug therapy must be Clinicians who use drug therapy must be aware of several key issuesaware of several key issues

• Dosages are important and must be monitoredDosages are important and must be monitored

• Long-term use of many drugs is ill advisedLong-term use of many drugs is ill advised

• No drug will permanently cure the No drug will permanently cure the maladjustment of people who are not coping maladjustment of people who are not coping wellwell


Psychotropic drugs are grouped into four Psychotropic drugs are grouped into four categoriescategories

No drug will permanently cure the No drug will permanently cure the maladjustment of people who are not maladjustment of people who are not coping wellcoping well

Drugs for the relief of mental problems Drugs for the relief of mental problems are sometimes called are sometimes called psychotropic drugspsychotropic drugs


• Antianxiety drugsAntianxiety drugs

• Antimania drugsAntimania drugs

• Antipsychotic drugsAntipsychotic drugs

Psychotropic drugs are grouped Psychotropic drugs are grouped into four categoriesinto four categories

• Antidepressant drugsAntidepressant drugs

Antianxiety DrugsAntianxiety Drugs Librium, Xanax, and Valium are trade Librium, Xanax, and Valium are trade

names of widely prescribed antianxiety names of widely prescribed antianxiety drugsdrugs

• They are also known as tranquilizersThey are also known as tranquilizers

• They reduce feelings of stress, and have a They reduce feelings of stress, and have a calming effectcalming effect

• Abuse and overreliance can be a problem Abuse and overreliance can be a problem with antianxiety drugswith antianxiety drugs

Antidepressant DrugsAntidepressant Drugs

Antidepressants (Antidepressants (thymolepticsthymoleptics) ) work by altering levels of brain work by altering levels of brain chemicalschemicals

• Selective serotonin reuptake inhibitors Selective serotonin reuptake inhibitors (SSRIs) relieve depression by affecting (SSRIs) relieve depression by affecting the neurotransmitter serotoninthe neurotransmitter serotonin

• Depression is believed to occur when Depression is believed to occur when serotonin does not bind to receptors on serotonin does not bind to receptors on the next neuronthe next neuron

Antidepressant DrugsAntidepressant Drugs Depression is Depression is

believed to occur believed to occur when serotonin when serotonin does not bind to does not bind to receptors on the receptors on the next neuronnext neuron

After release, After release, neurotransmitters neurotransmitters are neutralized, or are neutralized, or re-uptake occursre-uptake occurs

SSRIs prevent the SSRIs prevent the neutralization or neutralization or reuptake of reuptake of serotoninserotonin

SSRIs thus allow SSRIs thus allow serotonin to serotonin to remain in the remain in the synapse so it can synapse so it can be effectivebe effective

Antidepressant DrugsAntidepressant Drugs

SSRIs allow SSRIs allow serotonin to remain serotonin to remain in the synapse so it in the synapse so it can be effectivecan be effective

Prozac, Zoloft, and Prozac, Zoloft, and Paxil are SSRIsPaxil are SSRIs

Two other Two other categories of categories of antidepressants antidepressants are:are:

• TricyclicsTricyclics

• Monoamine oxidase Monoamine oxidase (MAO) inhibitors(MAO) inhibitors

Tricyclics and MAO InhibitorsTricyclics and MAO Inhibitors

Tricyclics block neurotransmitter Tricyclics block neurotransmitter reuptakereuptake

MAO inhibitors break down monoamine MAO inhibitors break down monoamine oxidase (MAO)oxidase (MAO)

• MAO is an enzyme that destroys MAO is an enzyme that destroys neurotransmittersneurotransmitters

• Tricyclics pose less of a danger of Tricyclics pose less of a danger of complications than MAO inhibitorscomplications than MAO inhibitors

Tricyclics and MAO InhibitorsTricyclics and MAO Inhibitors

Tricyclics pose less of a danger of Tricyclics pose less of a danger of complications than MAO inhibitorscomplications than MAO inhibitors

Therefore, they are used more Therefore, they are used more frequentlyfrequently

ProzacProzac

About 31 million people have taken the About 31 million people have taken the SSRI Prozac since its introduction in 1987SSRI Prozac since its introduction in 1987

• Yearly sales of Prozac and other SSRIs such Yearly sales of Prozac and other SSRIs such as Zoloft and Paxil amount to more than $4 as Zoloft and Paxil amount to more than $4 billionbillion

• Earlier antidepressants could cause increased Earlier antidepressants could cause increased heart rate and blood pressure, nausea, and heart rate and blood pressure, nausea, and sleeplessnesssleeplessness

ProzacProzac

• However, Prozac does not help everyoneHowever, Prozac does not help everyone

• Psychologists worry that Prozac is so Psychologists worry that Prozac is so effective that the original problems leading effective that the original problems leading to depression may be overlookedto depression may be overlooked

Earlier antidepressants could cause Earlier antidepressants could cause increased heart rate and blood pressure, increased heart rate and blood pressure, nausea, and sleeplessnessnausea, and sleeplessness

Prozac has fewer side effectsProzac has fewer side effects

ProzacProzac

Psychologists worry that Prozac is so Psychologists worry that Prozac is so effective that the original problems effective that the original problems leading to depression may be leading to depression may be overlookedoverlooked

Most psychologists feel SSRIs should Most psychologists feel SSRIs should be part of a full treatment program be part of a full treatment program that also includes psychotherapythat also includes psychotherapy

Antidepressants: ResearchAntidepressants: Research

Research on the effectiveness of Research on the effectiveness of antidepressants is contradictoryantidepressants is contradictory

Some studies show strong effects, Some studies show strong effects, others report only modest help others report only modest help from the drugsfrom the drugs

Antimania DrugsAntimania Drugs

Lithium carbonate has long been Lithium carbonate has long been used as an effective antimania drugused as an effective antimania drug

The dosage is vitalThe dosage is vital

• Too much produces noxious side effectsToo much produces noxious side effects

• Too little has no effectToo little has no effect

Antipsychotic DrugsAntipsychotic Drugs

Schizophrenia is treated using Schizophrenia is treated using antipsychoticsantipsychotics

• Technically called Technically called neurolepticsneuroleptics

The most common are the The most common are the phenothiazinesphenothiazines

Chlorpromazine (Thorazine) is the most Chlorpromazine (Thorazine) is the most common phenothiazinecommon phenothiazine

Antipsychotic DrugsAntipsychotic Drugs Clozapine (Clozaril) Clozapine (Clozaril)

is one of these new is one of these new drugsdrugs

• It is effective, but It is effective, but has severe side has severe side effectseffects

• Newer drugs such Newer drugs such as Risperidone as Risperidone (Risperdal) may be (Risperdal) may be as effective with as effective with fewer side effectsfewer side effects

Chlorpromazine Chlorpromazine (Thorazine) is the (Thorazine) is the most common most common phenothiazinephenothiazine

Other drugs, Other drugs, called “atypical called “atypical antipsychotics,” antipsychotics,” have been have been introduced in the introduced in the last decadelast decade


Antipsychotics are less effective at Antipsychotics are less effective at reducing other symptoms, such as reducing other symptoms, such as problems of emotionsproblems of emotions

Newer drugs such as Risperidone (Risperdal) Newer drugs such as Risperidone (Risperdal) may be as effective with fewer side effects may be as effective with fewer side effects

Antipsychotics are often very effective at Antipsychotics are often very effective at treating hallucinations and delusionstreating hallucinations and delusions


Antipsychotics are Antipsychotics are less effective at less effective at reducing other reducing other symptoms, such as symptoms, such as problems of problems of emotionsemotions

As with other drugs, As with other drugs, dosages are crucialdosages are crucial

If patients are If patients are maintained on maintained on antipsychotics for antipsychotics for too long, problems too long, problems may emergemay emerge

One problem with One problem with antipsychotics is antipsychotics is tardive dyskinesiatardive dyskinesia


One problem with antipsychotics is One problem with antipsychotics is tardive dyskinesiatardive dyskinesia

• A nervous system disorderA nervous system disorder

• It involves involuntary, spasmodic It involves involuntary, spasmodic movements of the upper body, movements of the upper body, especially the face and fingersespecially the face and fingers

PsychosurgeryPsychosurgery

PsychosurgeryPsychosurgery is brain surgery is brain surgery

• In the 1940s and 50s, a common type In the 1940s and 50s, a common type was the was the prefrontal lobotomyprefrontal lobotomy

Removal of parts of the brain’s frontal lobes Removal of parts of the brain’s frontal lobes would alleviate symptoms of mental would alleviate symptoms of mental disordersdisorders

However, prefrontal lobotomies made some However, prefrontal lobotomies made some people become unnaturally calm and people become unnaturally calm and completely unemotionalcompletely unemotional


Prefrontal lobotomies Prefrontal lobotomies made some people made some people become unnaturally become unnaturally calm and completely calm and completely unemotionalunemotional

Others became Others became unable to control unable to control their impulsestheir impulses

Today, despite Today, despite advances, advances, psychosurgery is psychosurgery is rarerare

Drug therapy has Drug therapy has proven more proven more effective than effective than surgical proceduressurgical procedures


Most important, Most important, psychosurgery is psychosurgery is irreversibleirreversible

Therefore, it is Therefore, it is morally morally objectionable to objectionable to many patients and many patients and their familiestheir families

Drug therapy has Drug therapy has proven more proven more effective than effective than surgical surgical proceduresprocedures

The long-term The long-term effects of effects of psychosurgery psychosurgery are also are also questionablequestionable

Electroconvulsive TherapyElectroconvulsive Therapy

Electroconvulsive therapyElectroconvulsive therapy (ECT) was once (ECT) was once widely employed with depressed peoplewidely employed with depressed people

• It is a treatment for severe mental illnessIt is a treatment for severe mental illness

• An electric current is briefly applied to the head An electric current is briefly applied to the head to produce a generalized seizure (convulsion)to produce a generalized seizure (convulsion)

• The duration of the shock is less than a secondThe duration of the shock is less than a second


In the 1940s and 50s, ECT was routinely In the 1940s and 50s, ECT was routinely given to severely disturbed patients in given to severely disturbed patients in mental hospitalsmental hospitals

The duration of the shock is less than a secondThe duration of the shock is less than a second

Patients are treated in 3 to 12 sessions over Patients are treated in 3 to 12 sessions over several weeksseveral weeks


Today, ECT is not a widely used Today, ECT is not a widely used treatmenttreatment

In the 1940s and 50s, ECT was routinely In the 1940s and 50s, ECT was routinely given to severely disturbed patients in given to severely disturbed patients in mental hospitalsmental hospitals

Unfortunately, it was often used with Unfortunately, it was often used with patients who did not need it, or as a means patients who did not need it, or as a means of controlof control


Today, ECT is not a Today, ECT is not a widely used widely used treatmenttreatment

ECT is effective in ECT is effective in short-term short-term management of management of severe depressionsevere depression

It is sometimes It is sometimes used when there used when there is a risk of suicideis a risk of suicide

However, the However, the effects of ECT are effects of ECT are temporarytemporary


The effects of ECT are temporaryThe effects of ECT are temporary

Use of ECT should be followed by Use of ECT should be followed by psychotherapy and drug therapypsychotherapy and drug therapy

ECT should also be used only as a ECT should also be used only as a last optionlast option

Electroconvulsive TherapyElectroconvulsive Therapy Risk of death due to Risk of death due to

ECT is lowECT is low

However, it may However, it may cause memory losscause memory loss

Law requires that the Law requires that the patient be given the patient be given the option to refuse ECT option to refuse ECT treatment, as is true treatment, as is true for any treatmentfor any treatment

ECT is not ECT is not appropriate for appropriate for treating treating schizophreniaschizophrenia

It is also It is also inappropriate for inappropriate for managing unruly managing unruly behaviorbehavior

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Psychotherapy