ABNORMAL PSYCHOLOGY SIXTEENTH EDITION James N Butcher Jill

An Overview of Treatment Conviction underlying psychotherapy • People with psychological problems can change

Why Do People Seek Therapy? People seeking therapy may • Be in stressful current life circumstances • Have long-standing problems • Be reluctant and enter therapy at the request of a physician, spouse, or other • Seek personal growth © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Who Provides Psychotherapeutic Services? Members of many different professions provide advice and counsel Physicians

Who Provides Psychotherapeutic Services? • Clergy and physicians generally refer seriously disturbed people to mental health professionals. • Who are these professionals? © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Who Provides Psychotherapeutic Services? Mental health professionals Clinical psychologists Psychiatrists © 2014, 2013, 2010

The Therapeutic Relationship Can you fill in the blanks? The key elements of an effective working alliance between client and therapist include: A sense of working ____ on the problem ____ between patient and therapist about the goals and tasks of therapy. A(n) ____between patient and therapist. © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

The Therapeutic Relationship Client’s motivation to change Other qualities enhancing therapy Client’s expectation of receiving help Protected setting Good match between client and therapist © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Measuring Success in Psychotherapy Estimated gains depend on Therapist’s impression of changes that have occurred Client’s reports of change Reports from the client’s family or friends © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. Comparison of pretreatment and posttreatment scores on personality tests Measures of change in selected overt behaviors

Objectifying and Quantifying Change Measuring change with quantitative methods Beck Depression Inventory Hamilton Depression Inventory © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved. f. MRI

Would Change Occur Anyway? Improvement often occurs without professional intervention Psychotherapy can accelerate improvement Research findings © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Can Therapy Be Harmful? Some clients harmed by encounters with psychotherapists 5 -10% deteriorate during treatment Responsibilities of therapists © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

What Therapeutic Approaches Should Be Used? Evidence-Based Treatment Medication or Psychotherapy? Combined Treatments ©

Evidence-Based Treatment Efficacy Determined via randomized clinical trials in which therapy is compared to placebo Methods Double-blind method is employed Therapies under investigation manualized © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

“Evidence-based” Evidence-Based Treatment “Empirically supported” treatment Efficacy studies determine that a therapy works ©

Advances in psychopharmacology Medication or Psychotherapy? Allow many to remain unhospitalized Include problems with side effects and matching drug and drug dosage to needs of specific patient May reduce symptoms but not cure disorder © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Combined (Medication plus Psychotherapy) Treatments Clinical Practice • Medication and psychotherapy combined used for schizophrenia and bipolar disorder. Effectiveness • Combined treatment often works better for chronic or recurrent depression. © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Psychosocial Approaches to Treatment Psychotherapy fascinates many people The goal of this section is to describe various therapeutic approaches and case studies © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Behavior therapy • Includes direct and active treatment • Recognizes primacy of behavior • Acknowledges role of learning • Includes thorough assessment and evaluation © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Behavior Therapy Exposure therapy Aversion therapy Behavior therapy approaches Modeling Systematic Reinforcement approaches Token economies © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Behavior Therapy Relatively brief Directed towards specific symptoms Characteristics Best used with problems that are not pervasive or vaguely defined Often used with anxiety disorders © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Behavior Therapy Behavioral activation • Relatively new development for treatment of depression • Encourages greater engagement with life © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Cognitive or cognitive-behavioral therapy • Attempts to change behavior by modifying self-statements • Modifying construal of events • Cognitive processes influence emotions, motivation, and behavior © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Cognitive and Cognitive-Behavioral Therapy • Rational Emotive Behavior Therapy • Developed by Albert Ellis • Tries to change a client’s maladaptive thought processes that influence maladaptive emotional responses and behavior. © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Cognitive and Cognitive-Behavioral Therapy Beck’s cognitive therapy • Problems like depression result from clients’ illogical thinking about themselves and the world around them. © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Cognitive and Cognitive-Behavioral Therapy Efficacy of cognitive therapy • Well-documented with depression, anxiety disorders, conduct disorder, and bulimia © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Cognitive and Cognitive-Behavioral Therapy What do you think? Is cognitive change the “active ingredient”

Humanistic-Experiential Therapies Client-centered therapy Humanisticexperimental therapies Gestalt therapy Motivational interviewing © 2014, 2013, 2010

Humanistic-Experiential Therapies Impact on contemporary view of human nature and good psychotherapy Lack of agreed-upon procedures and vagueness of client–therapist relationship Outcome data © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Psychodynamic Therapies Psychodynamic therapy basic forms © 2014, 2013, 2010 by Pearson Education, Inc.

Psychodynamic Therapies Free association Analysis of dreams Elements of Freudian psychoanalysis Analysis of resistance Analysis of transference © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Psychodynamic Therapies Contemporary psychodynamic approaches • Strongly interpersonal focus • Object relations perspective • Attachment-based and selfpsychology perspectives © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Couple and Family Therapy Marital Therapy • Short-term therapy based on social learning model. • Teaches partners caring behaviors and conflict resolution through communication and problem solving. © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Couple and Family Therapy Family Systems Therapy Within-family behavior of any particular family member is influenced by behaviors and communications of other family members. © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Couple and Family Therapy Integrative behavioral couple therapy Structural family therapy • Increasingly replacing traditional behavioral couple therapy • Form of family therapy that emphasizes new organization of family relationships • Requires an active, but non-directive, therapeutic approach • Focuses more on acceptance versus change © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Eclecticism and Integration Electicism • Labels orientation as eclectic, which borrows and combines techniques and concepts from various approaches Interpersonal therapy • Focuses on changing current relationships to reduce depression © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Sociocultural Perspectives Critics Psychotherapy viewed as attempt to get people adjusted to a “sick” society Therapists seen as guardians of status quo © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Social Values and Psychotherapy Therapists’ own value judgments can affect decisions they make about treating clients. Can you think of an example to illustrate this statement? © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Psychotherapy and Cultural Diversity Members of minorities Underrepresented in treatment research studies Underserved by mental health system Affected by different backgrounds than their therapists © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Biological Approaches to Treatment Antipsychotic Drugs Antidepressant Drugs Anti-Anxiety Drugs Lithium and Other Mood-Stabilizing Drugs Electroconvulsive Therapy Neurosurgery © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Antipsychotic Drugs Antipsychotic drugs Atypical antipsychotic drugs • Used to treat psychotic disorders such as schizophrenia and psychotic mood disorders • Have a lower risk of side effects • Treat positive and negative symptoms © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Antidepressant Drugs Most widely prescribed antidepressant drugs • Selective serotonin re-uptake inhibitors Older antidepressants • Monoamine oxidase inhibitors • Tricyclic antidepressants • Trazodone © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Anti-Anxiety Drugs Most widely prescribed anti-anxiety drugs • Benzodiazepines • Buspirone © 2014, 2013,

Lithium and Other Mood-Stabilizing Drugs Lithium Other moodstabilizing drugs • Very effective in treating bipolar mood disorders • Divalproic acid • Carbamazepine © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Electroconvulsive Therapy Used to treat severe mood disorders Safe, effective, and important form of treatment Electroconvulsive therapy Often used after others have failed Kinds: Bilateral ECT, unilateral ECT © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Figure 16. 4: Unilateral and Bilateral Electrode Placement for ECT © 2014, 2013, 2010

Neurosurgery Decreased with use of antipsychotic drugs Effective with debilitating OCD, self-mutilation, or anorexia Includes deep brain stimulation © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Unresolved Issues Managed care companies get financial incentives when patients choose medication over psychotherapy. Has the pharmaceutical industry made questionable claims about biological causes of mental illness for money? Do these medications create more long-term problems for patients? © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.