PSYC

Therapy

PSYCHOLOGY David G. Myers C. Nathan DeWall Twelfth Edition

Chapter 16

Chapter Overview

 Introduction to Therapy and the Psychological Therapies

 Evaluating Psychotherapies  The Biomedical Therapies and Preventing

Psychological Disorders

The History of Treatment

Approach Differences  Psychotherapy  Psychological techniques derived from psychological

perspectives  Trained therapist uses psychological techniques to assist

someone overcome difficulties or achieve personal growth  Biomedical therapy  Treatment with medical procedures  Trained therapist, most often a medical doctor, offers

medications and other biological treatments  Eclectic approach  Uses techniques from various forms of therapy

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Psychoanalysis

 Goals: To bring patients’ repressed feelings into conscious awareness; to help patients release energy devoted to internal conflicts so they may achieve healthier, less anxious lives.

 Techniques: Historical reconstruction, initially through hypnosis and later through free association; interpretation of resistance, transference

Psychodynamic Therapy

 Goals: Help people understand current symptoms; explore and gain perspective on defended-against thoughts and feelings

 Techniques: Client-centered face-to-face meetings; exploration of past relationship troubles to understand origins of current difficulties

Psychoanalysis and Psychodynamic Therapies  Psychodynamic therapy

 Influenced by traditional psychoanalysis but differs from it in many ways

 Differences  Lack of belief in id, ego, and superego  Briefer, less expensive, and more focused on helping clients find

relief from their current symptoms  Helps clients understand how past relationships create themes

that may be acted out in present relationships

 Interpersonal therapy  Brief 12- to 16-session form of psychodynamic therapy that has

been effective in treating depression

Humanistic Therapies (part 1)

 Humanistic perspective  Theme: Emphasis on people’s potential for self-

fulfillment; to give people new insights  Goals: Reduce inner conflicts that interfere with

natural development and growth; help clients grow in self-awareness and self-acceptance promoting personal growth

 Techniques: Client-centered therapy; focus on taking responsibility for feelings and actions, and on present and future rather than past

Understanding Differences

 Both psychodynamic and humanistic therapies are insight therapies.  They attempt to improve functioning by increasing

clients’ awareness of motives and defenses.

 Behavior therapies are not insight therapies.  Their goal is to apply learning principles to modify

problem behaviors.

Humanistic Therapies (part 2)

 Rogers  Person-centered therapy

that focuses on person’s conscious self- perceptions; non-directive; active listening; unconditional positive regard

 Most people possess resources for growth.

 Therapists foster growth by exhibiting genuineness, acceptance, and empathy.

Behavior Therapies (part 1)

 Classical conditioning techniques  Counterconditioning: Uses classical conditioning to

evoke new responses to stimuli that are triggering unwanted behaviors

 Exposure therapies: Treat anxieties by exposing people (in imaginary or actual situations) to the things they fear and avoid

 Systematic desensitization: Associates a pleasant, relaxed state with gradually increasing, anxiety- triggering stimuli

Virtual Reality Exposure Therapy

 Treats anxiety by creative electronic simulations in which people can safely face their greatest fears, such as airplane flying, spiders, or public speaking

Behavior Therapies (part 2)

 Aversive conditioning  Goals:

 Substitute a negative response for a positive response to a harmful stimulus

 Condition an aversion to something the person should avoid

 Techniques:  Unwanted behavior is associated with unpleasant feelings

 Ability to discriminate between aversive conditioning situation in therapy and other situations can limit treatment effectiveness

Aversion Therapy for Alcohol Abuse

Behavior Therapies (part 3)

 Operant conditioning therapy: Consequences drive behavior; voluntary behaviors are strongly influenced by their consequences.

 Behavior modification: Desired behavior is reinforced; undesired behavior is not reinforced, and sometimes punished.

 Token economy: People earn a token for exhibiting a desired behavior and can later exchange the tokens for privileges or treats.

Behavior Therapies (part 4)

 Critics:  How durable are the behaviors? Will people become

so dependent on extrinsic rewards that the desired behaviors will stop when reinforcers stop?

 Is it right for one human to control another’s behavior?

 Proponents:  Treatment with positive rewards is more humane than

punishing people or institutionalizing them for undesired behaviors.

 Teaches people new, more adaptive ways of thinking; based on the assumption that thoughts intervene between events and our emotional reactions

 Beck’s therapy for depression  Gentle questioning seeks to reveal irrational thinking and

then to persuade people to change their perceptions of their own and others’ actions as dark, negative, and pessimistic

 People trained to recognize and modify negative self-talk

Cognitive Therapies

The person’s emotional reactions are produced not directly by the event but by the person’s thoughts in response to the event.

A COGNITIVE PERSPECTIVE ON PSYCHOLOGICAL DISORDERS

Cognitive Therapies

 Integrative therapy that combines cognitive therapy (changing self-defeating thinking) with behavior therapy (changing behavior)

 Aims to alter the way one acts AND they way one thinks

 Helps people learn to make more realistic appraisals

Cognitive Therapies

Cognitive-behavioral therapy (CBT)

 Conducted with groups, rather than individuals

 Benefits:  Saves therapists’ time and clients’

money  Offers a social laboratory for

exploring social behaviors and developing social skills

 Enables clients to see that others share their problems

 Provides feedback as clients try out new ways of behaving

Group Therapy

 Treats the family as a system

 Views an individual’s unwanted behaviors as influenced by, or directed at, other family members

 Acts as a preventive mental health strategy

Family Therapy

 Changes the brain’s chemistry with drugs

 Affects the brain’s circuitry with electrical stimulation, magnetic impulses, or psychosurgery

 Influences the brain’s responses with lifestyle changes

Myers/DeWall, Psychology in Everyday Life, 4e, © 2017 Worth Publishers

Biomedical Therapy

Comparing Modern Psychotherapies Therapy Presumed Problem Therapy Aim Therapy Technique

Psychodynamic Unconscious conflicts from childhood experiences

Reduce anxiety through self- insight.

Interpret patients’ memories and feelings.

Client-centered Barriers to self- understanding and self- acceptance

Enable growth via unconditional positive regard, acceptance, genuineness, and empathy.

Listen actively and reflect clients’ feelings.

Behavior Dysfunctional behaviors Learn adaptive behaviors; extinguish problem ones.

Use classical conditioning (via exposure or aversion therapy) or operant conditioning (as in token economies).

Cognitive Negative, self-defeating thinking

Promote healthier thinking and self-talk.

Train people to dispute negative thoughts and attributions.

Cognitive- behavioral

Self-harmful thoughts and behaviors

Promote healthier thinking and adaptive behaviors.

Train people to counter self-harmful thoughts and to act out their new ways of thinking.

Group and family Stressful relationships Heal relationships. Develop an understanding of family and other social systems, explore roles, and improve communication.

Is Psychotherapy Effective?

 Clients’ and therapists’ positive testimonials cannot prove that psychotherapy is actually effective.

 The placebo effect makes it difficult to judge whether improvement occurred because of the treatment.

 Research indicates that those persons who do not undergo treatment often improve, but those undergoing psychotherapy are more likely to improve more quickly, and with less chance of relapse.

Treatment Versus No Treatment

Which Psychotherapies Work Best?

 Some forms of psychotherapy work best for particular problems.  Cognitive and cognitive-behavioral therapies:

anxiety, depression, and posttraumatic stress disorder

 Behavioral conditioning therapies: bed-wetting, phobias, compulsions, marital problems, and sexual dysfunctions

 Psychodynamic therapy: depression and anxiety  Nondirective (client-centered) counseling: mild to

moderate depression

Culture and Values in Psychotherapy

 Psychotherapists’ personal beliefs and values influence their practice.

 Differences in cultural and moral diversity and religious values can create a mismatch.

Finding a Mental Health Professional

 A person seeking therapy is encouraged to ask about  Treatment approach  Values  Credentials  Fees

 An important consideration is whether the potential client feels comfortable and able to establish a bond with the therapist.

Therapists and Their Training

Type Therapy Description

Clinical psychologists Most are psychologists with a Ph.D. (includes research training) or Psy.D. (focuses on therapy) supplemented by a supervised internship and, often, post-doctoral training. About half work in agencies and institutions, half in private practice.

Psychiatrists Psychiatrists are physicians who specialize in the treatment of psychological disorders. Not all psychiatrists have had extensive training in psychotherapy, but as M.D.s or D.O.s they can prescribe medications. Thus, they tend to see those with the most serious problems. Many have their own private practice.

Clinical or psychiatric social workers

A two-year master of social work graduate program plus postgraduate supervision prepares some social workers to offer psychotherapy, mostly to people with everyday personal and family problems. About half have earned the National Association of Social Workers’ designation of clinical social worker.

Counselors Marriage and family counselors specialize in problems arising from family relations. Clergy provide counseling to countless people. Abuse counselors work with substance abusers and with spouse and child abusers and their victims. Mental health and other counselors may be required to have a two-year master’s degree.

The Biomedical Therapies and Preventing Psychological Disorders

 Psychopharmacology  Study of drug effects on mind and behavior  Has helped make drug therapy the most widely used

biomedical therapy

 Drug therapies  The most widely used biomedical treatments  27 million Americans take prescribed antidepressants  Placebo and double-blind techniques are used to

evaluate drug effectiveness

The Biomedical Therapies

 Most common drug treatments for psychological disorders  Antipsychotic drugs  Antianxiety drugs  Antidepressant drugs  Mood-stabilizing medications

Let’s take a closer look at each of these.

Drug Therapies (part 1)

 Antipsychotic drugs  Mimic certain neurotransmitters (e.g., block or increase activity of

dopamine); reduce overreaction to irrelevant stimuli  May produce sluggishness, tremors, twitches, and tardive

dyskinesia; Thorazine  Successfully used with life-skills programs and family support to

treat schizophrenia

 Antianxiety drugs  Depress CNS activity; Xanax, Ativan  Used in combination with psychological therapy  May reduce symptoms without resolving underlying problems;

withdrawal linked to increased anxiety and insomnia

Drug Therapies (part 2)

 Antidepressant drugs  Increase availability of norepinephrine or serotonin;

promote birth of new brain cells  Slow synaptic vacuuming up of serotonin (SSRIs)  Effectiveness sometimes questioned due to spontaneous

recovery and placebo effect

 Mood-stabilizing medications  Depakote: Controls manic episodes  Lithium: Levels out the emotional highs and lows of bipolar

disorder

Biology of Antidepressants

 Electroconvulsive therapy (ECT)  Manipulates brain by shocking it  Involves administration of general

anesthetic and muscle relaxation to prevent convulsions

 Causes less memory disruption than earlier versions

 AMA concluded that ECT methods among most positive treatment effects; reduces suicidal thoughts

 Involves several theories about reason for effectiveness

 Deep Brain Stimulation

Brain Stimulation

Preventing Psychological Disorders and Building Resilience  Preventive mental health programs work to build

resilience.  Based on the idea that many psychological disorders could

be prevented by changing oppressive, esteem-destroying environments into more benevolent, nurturing environments that foster growth and self-confidence

 Resilience  Personal strength that helps most people cope with stress

and recover from adversity and trauma  Can be seen in New Yorkers after 9/11, patients who

experience spinal cord injury, and Holocaust survivors, among others