psy diss
1
Therapies
Tiffany Daniels, M.S.
Who seeks therapy?
• Women > Men • Divorced/separated > Married/Single • Highly Educated > Low Education
• Why do you think that might be?
Types of Therapists Profession Degree Years of
Education Beyond Bachelor’s
Typical roles/activities
Clinical psychologist
PhD or PsyD 5-7 years Psychological testing, diagnosis, treatment w/insight or behavior therapy
Counseling psychologist
PhD, PsyD, or EdD
5-7 years Similar to clinical, more focus on work, career, and adjustment
Psychiatrist MD 8 years Diagnosis & Treatment, primarily with biomedical, but also insight therapies
Clinical social worker
MSW, DSW 2-5 years Insight & behavior therapy, often help inpatients with return to community
Psychiatric nurse RN, MA, or PhD
0-5 years Inpatient care, insight & behavior therapy
Counselor BA or MA 0-2 years Vocational counseling, drug counseling, rehab counseling
Marriage & family therapist
MA or PhD 2-5 years Marital/couples therapy, family therapy
Treatment Categories
• Includes: • Biological/Biomedical Therapies • Psychotherapy (Psychodynamic,
Psychoanalysis, Insight, Humanistic, Behavior, Cognitive)
Biological Therapy • Biomedical (biological) approaches-
drug therapy, ECT, biofeedback, psychosurgery
• Drug therapy usually involves the prescriptions of antianxiety drugs like Valium, antidepressants like selective serotonin reuptake inhibitors (SSRIs such as Prozac), or antipsychotics like Haldol, depending on the diagnosis.
Drug Therapy • Antianxiety drugs – commonly known as
tranquilizers; reduce anxiety by making the individual calmer and less excitable
• They work by binding to the receptor sites of neurotransmitters that become overactive during anxiety.
• Includes Xanax, Valium, Librium • Used to treat generalized anxiety disorder,
panic disorder, agoraphobia, and specific phobias
2
Drug Therapy • Antidepressant drugs – regulate mood by
allowing the individual’s brain to increase or maintain its level of certain important neurotransmitters, especially serotonin & norepinephrine
• Includes tricyclics, tetracyclics, MAO inhibitors, and SSRIs (selective serotonin reuptake inhibitors)
Drug Therapy
• Antidepressants are used to treat depressive disorders and bipolar disorder
• Lithium, the lightest of the solid elements in the periodic table of elements, is the most common mood stabilizer used to treat bipolar disorder
• Lithium is also the title of two great songs by Nirvana (1991) and Evanescence (2007)
Drug Therapy
• Antipsychotic drugs – diminish agitated behavior, reduce tension, improve social behavior, decrease hallucinations, produce better sleep patterns
• Used to treat schizophrenia • Includes neuroleptics, atypical antipsychotic
medications
ECT • Electroconvulsive therapy (ECT)- see the
special section in your book on this. • Main point: Today, ECT is rarely used, and only on
a voluntary basis with patients for whom neither therapy nor multiple types of drug treatments have had any benefit. Many practitioners opt for deep brain stimulation instead of a full-on shock to create a seizure
Biofeedback • Biofeedback - commonly used in treating
patients who experience physical symptoms to help train them to learn to control their bodies’ response to stressors like chronic pain, etc….
Psychosurgery
• Biological therapy that involves removal or destruction of brain tissue to improve an individual’s adjustment
• Ex: prefrontal lobotomy • Not commonly performed today due to
the considerable damage it can inflict upon the brain
3
Psychotherapy Psychotherapy
• Psychotherapy – Nonmedical process that helps individuals with psychological disorders recognize and overcome their problems
• Includes: Psychodynamic/psychoanalytic, Insight, Humanistic, Behavior, Cognitive
Psychodynamic therapies
• Psychodynamic therapies – includes treatments that stress the importance of the unconscious mind, extensive interpretation by the therapist, and the role of early childhood experiences in the development of an individual’s problem
Psychoanalysis • Psychoanalysis - Freud used this technique
to analyze an individual’s unconscious thoughts.
• The theory here is that the clients current problems are the result of childhood experiences, many of which involved conflicts about sexuality.
Psychoanalysis Today
• Psychoanalysis of this sort is extremely rare in modern psychological practice.
• Only a small minority of practicing psychologists today would list psychoanalysis/psychoanalytic theory as their primary theoretical orientation.
Psychoanalysis - Key Terms • Free association - psychoanalytic
technique of having individuals say aloud whatever comes to mind
• The theory here is that we can understand a lot about a person’s personality and unconscious conflicts through this technique
• Another example: The Keyword Method
4
Psychoanalysis - Key Terms
• Dream analysis - psychotherapeutic technique used to interpret one’s dreams. The theory here is that dreams contain information about unconscious thoughts/conflicts.
Dream Analysis
Psychoanalysis - Key Terms
• Resistance- largely unconscious defensive maneuvers intended to hinder the progress of therapy (think about areas in your life where you might be unconsciously resistant)
• Interpretation – the psychoanalyst’s search for symbolic, hidden meanings in what the client says and does during therapy
Psychoanalysis - Key Terms
• Transference- occurs when clients start relating to their therapists in ways that mimic critical relationships in their lives.
• Countertransference- occurs when therapists start relating to their clients in ways that mimic critical relationships in their lives.
Insight Therapy
• Insight Therapies- “talk therapy” in the tradition of psychoanalysis.
• In insight therapy, clients engage in complex, often lengthy interactions with the goal of pursuing increased insight into the nature of their difficulties and discussing solutions.
Humanistic Therapy
• Humanistic therapies include treatments, unique in their emphasis on people’s self- healing capacities, that encourage clients to understand themselves and to grow personally.
• Includes client-centered therapy, gestalt therapy
5
Client-centered Therapy • Client-centered therapy- an insight therapy
(developed by Carl Rogers) that emphasizes providing a supportive emotional climate for clients, who play a major role in determining the pace and direction of their therapy.
• Encourages personal growth, and self-healing • Often involves reflective speech - therapist
mirrors the client’s own feelings back to the client
Client-centered therapy
• Therapist needs to have unconditional positive regard, empathy/authenticity, and to be nondirective
<---Carl Rogers, not to be confused with Mr. Rogers, although their approach is very similar--->
Gestalt Therapy
• Humanistic therapy developed by Fritz Perls
• The therapist challenges clients in order to help them become more aware of their feelings and face their problems
• Common technique: the chair exercise
Behavior Therapy • Behavior Therapies- based on principles
of learning. • Instead of emphasizing personal insights,
therapists make direct efforts to alter problematic responses (phobias, for instance) and maladaptive habits.
• Includes systematic desensitization, flooding, aversion therapy, behavior modification, token economy
Systematic Desensitization • Systematic Desensitization- a behavior
therapy used to reduce phobic responses. • Example: Treatment of
Arachnophobia…Start with a hierarchy of fear and work your way through it gradually…pictures of spiders, then a spider in a box in the room. Once that’s tolerable, then a spider in the box next to the client…then the spider out of the box in the therapists hand…then eventually on the clients arm, etc….
Flooding • Flooding – Instead of taking it one step at a
time as in systematic desensitization, flooding involves jumping in 100%.
• In the case of arachnophobia, flooding techniques would involve immediately placing the spider in the client’s hand as opposed to “baby stepping it.” Sort of like cannon-balling into the swimming pool vs. gradually getting your feet wet.
• Flooding is a little more traumatic
6
Aversion Therapy
• Aversion therapy- uses classical conditioning to create a negative response to a stimulus that has elicited problematic behavior.
• Example: Alcoholics given drugs that, when mixed with alcohol, cause SEVERE nausea. Client quickly begins to associate alcohol with nausea in Classical Conditioning form and avoids alcohol.
Aversion Therapy • Malcolm McDowell’s character Alex from
Clockwork Orange underwent an extreme form of Aversion therapy in the movie A Clockwork Orange In A Clockwork Orange, a sociopathic rapist is exposed to violent images while being administered drugs that made him sick…
Behavior Modification
• Behavior Modification - the application of operant conditioning principles to change human behavior
• Goal: replace unacceptable, maladaptive behaviors with acceptable, adaptive ones
Token Economy
• One example of behavior therapy is a token economy, where desired behaviors are reinforced with tokens that can later be redeemed for a desired reward.
**Doesn’t always work once the tokens are no longer given.
Cognitive Therapy
• Cognitive therapy- uses specific strategies to correct habitual thinking errors that underlie various types of disorders.
• **Thoughts are the main source of psychological problems and abnormal behavior
• Includes: REBT and CBT
REBT
• Rational-emotive behavior therapy (REBT) - Albert Ellis’s therapy
• The theory here is that individuals develop psychological disorders because of their beliefs, especially those that are irrational & self-defeating.
• Goal is to help clients eliminate self- defeating beliefs and catastrophic thinking by using rational thought to explain events.
7
Cognitive-Behavioral Therapy (CBT)
• Use combinations of verbal interventions and behavior modification techniques (e.g., “homework,” “journaling”) to help clients change maladaptive patterns of thinking.
• One of the most commonly utilized forms of therapy.
• Self-efficacy is key. If you believe you can master a situation and produce positive outcomes, most likely, you will!
Sociocultural Approaches/Issues in
Treatment • Includes group therapy, family/couples
therapy, self-help support groups, and community mental health.
Group Therapy
• Group therapy helps individuals in many ways • It is comforting to know that you are not the only
one with the problem • Others can share their insights & provide you
with valuable feedback • Empathy and sympathy can help us feel
accepted as we are • Interactions in groups help develop social skills
and give us practice for interactions outside of group
Group Therapy - a couple of examples ;)
• http://www.youtube.com/watch?v=jMIDpJ8H7 H0
• http://www.youtube.com/watch?v=Hj2twApba pU
• Warning: some “F” bombs dropped in the above clip
Family/Couples Therapy
• A lot of the same benefits as group therapy • Goals: understand entrenched patterns of
interactions that produce distress, improve communication to move towards healthier patterns of interaction
Self-help/Support Groups • Groups such as Alcoholics
Anonymous, Weight Watchers, LGBT support groups, etc
• Can provide comfort, unity, acceptance, etc…
8
Community Mental Health
• Deinstitutionalization - Refers to transferring the treatment of mental illness from inpatient institutions to community-based facilities that emphasize outpatient care.
• Sadly, deinstitutionalization has caused many severely mentally ill patients who received benefit from inpatient life in mental hospitals to now be on the streets, and homeless.
Community Mental Health
• Primary prevention - programs that aim to reduce the number of new cases of psychological disorders
• Secondary prevention - programs promoting screening for early detection/early intervention
• Tertiary prevention - focuses on treating disorders that were not prevented early
Cultural Perspectives
• Some cultures place great emphasis on the individual; others are collectivist (great emphasis on the group)
• The most effective therapists are those who understand an individual’s life experiences and circumstances (ethnic/racial background, gender, religion, sexual orientation, socio-economic status, etc.) and acknowledge the impact that these factors may have.
The Effectiveness of Psychotherapy
• Research has shown that it’s not really the type of therapy that matters.
• According to the famous Dodo bird analogy, “Everybody has won, and all must have prizes.”
• Integrative therapy - combines techniques from different therapies based on the therapist’s judgment of which techniques will provide the greatest benefit for the client
The Effectiveness of Psychotherapy
• Factors that contribute to successful treatment:
• Therapeutic alliance (the relationship between therapist and client) needs to be trusting, interactive, healing
• Therapist needs to be empathic, objective, properly trained, open-minded, and of course, not on crystal meth ;)
THE END L THANK YOU
ALL FOR SUCH A GREAT CLASS!
GOOD LUCK AND I’ll MISS YOU!