Chapter 16 Both psychoanalytic and humanistic therapies are

Chapter 16

§ Both psychoanalytic and humanistic therapies are insight therapies—they attempt to improve functioning by increasing clients’ awareness of motives and defenses. § therapies are not insight therapies. Their goal is to apply learning principles to modify problem behaviors.

The History of Treatment § Visitors to eighteenth-century mental hospitals paid to gawk at patients, as though they were viewing zoo animals. William Hogarth’s (1697– 1764) painting captured one of these visits to London’s St. Mary of Bethlehem hospital (commonly called Bedlam).

§ Psychotherapy § Involves psychological techniques derived from psychological perspectives; trained therapist uses psychological techniques to assist someone seeking to overcome difficulties or achieve personal growth § Biomedical therapy § Involves treatment with medical procedures; trained therapist, most often a medical doctor, offers medications and other biological treatments § Eclectic approach § Approach to psychotherapy that uses techniques from various forms of therapy

Psychoanalysis § Goals: To bring patients’ repressed feelings into conscious awareness; to help patients release energy devoted to id-egosuperego conflicts so they may achieve healthier, less anxious lives. § Techniques: Historical reconstruction, initially through hypnosis and later through free association; interpretation of resistance, transference

Psychoanalysis Interpretation § Sigmund Freud’s therapeutic § In psychoanalysis, the analyst’s noting technique. Freud believed the patient’s free associations, resistances, dreams, and transferences—and therapist’s interpretations of them—released previously repressed feelings, allowing the patient to gain self - insight. Resistance § In psychoanalysis, the blocking from consciousness of anxiety- laden material. supposed dream meanings, resistances, and other significant behaviors and events in order to promote insight. Transference § In psychoanalysis, the patient’s transfer to the analyst of emotions linked with other relationships (such as love or hatred for a parent).

Psychodynamic Therapy Goals: To help people understand current symptoms; to explore and gain perspective on defended-against thoughts and feelings Techniques: Client-centered face-toface 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 the client find relief from 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 Therapy § Rogers § Person-centered therapy focuses on person’s conscious self-perceptions; non-directive; active listening. § unconditional positive regard § Accepting someone no matter what § Most people possess resources for growth § Therapists foster growth by exhibiting genuineness, acceptance, and empathy ACTIVE LISTENING Carl Rogers (right) empathized with a client during this group therapy session. Strengthening communication: Rogers Paraphrase Invite clarification Reflect feelings

Behavior therapies § 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 imagination or actual situations) to the things they fear and avoid § Systematic desensitization: Associates a pleasant, relaxed state with gradually increasing, anxiety-triggering stimuli

Systematic desensitization

§ Aversive conditioning § Goal: Substituting negative response for a positive response to a harmful stimulus; conditioning 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 all other situations can limit treatment effectiveness

§ Operant conditioning therapy: Consequences drive behavior: voluntary behaviors are strongly influenced by their consequences § Behavior modification: Desired behavior reinforced; undesired behavior not reinforced, sometimes punished § Token economy: People earn a token for exhibiting a desired behavior and can later exchange the tokens for privileges or treats Token Economy

§ Critics of behavior therapy maintain § Techniques such as those used in token economies may produce behavior changes that disappear when rewards end. § Deciding which behaviors should change is authoritarian and unethical. § Proponents argue § Treatment with positive rewards is more humane than punishing people or institutionalizing them for undesired behaviors.

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

§ Cognitive-behavioral therapy (CBT) § Is integrative therapy that combines cognitive therapy (changing self-defeating thinking) with behavior therapy (changing behavior) § Aims to alter the way they act AND they way they think § Helps people learn to make more realistic appraisals

§ Group therapy § Conducted with groups rather than individuals, providing benefits from group interaction § Often used when client problems involve interactions with others § Group therapy benefits § Saves therapists’ time and clients’ money § Encourages exploration of social behaviors and social skill development § Enables people to see that others share their problems § Provides feedback as clients try out new ways of behaving

§ Family therapy § Attempts to open up communication within the family and help family members to discover and use conflict resolution strategies § Treats the family as a system § Views an individual’s unwanted behaviors as influenced by, or directed at, other family members • The therapist helps family members understand how their ways of relating to one another create problems. • The treatment’s emphasis is not on changing the individuals, but on changing their relationships and interactions.

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 not undergoing treatment often improve, but those undergoing psychotherapy are more likely to improve more quickly, and with less chance of relapse.

§ Using meta-analyses to statistically combine the results of hundreds of randomized psychotherapy outcome studies, researchers have found that those not undergoing treatment often improve, but those undergoing psychotherapy are more likely to improve more quickly, and with less chance of relapse.

Treatment vs No Treatment These two normal distribution curves based on data from 475 studies show the improvement of untreated people and psychotherapy clients. The outcome for the average therapy client surpassed the outcome for 80 percent of the untreated people. (Data from Smith et al. , 1980. )

§ Some forms of psychotherapy work best for particular problems. § Behavior therapies: Bed-wetting, phobias, compulsions, marital problems, and sexual dysfunctions § Psychodynamic therapy: Depression and anxiety § Cognitive therapies: Anxiety, depression, and posttraumatic stress disorder § Evidence-based practice: Integration of best available research with clinicians’ expertise and patients’ characteristics, preferences, and circumstances

Alternative therapies § Abnormal states often return to normal and the placebo effect can mislead effectiveness evaluation § Eye movement desensitization and reprocessing (EMDR) § Some effectiveness shown—not from the eye movement but rather from the exposure therapy nature of the treatments § Light exposure therapy § Relief from depression symptoms for those with a seasonal pattern of major depressive disorder by activating a brain region that influences arousal and hormones § Used to treat SAD (seasonal affective disorder)

§ Three basic benefits for all psychotherapies § Hope for demoralized people § New perspective for oneself and the world § Empathic, trusting, caring relationship (therapeutic alliance) § 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 therapist.

The Biomedical Therapies and Preventing Psychological Disorders § Psychopharmacology § Includes study of drug effects on mind and behavior, has helped make drug therapy the most widely used biomedical therapy § Drug therapies § Are most widely used biomedical treatments § Include prescribed antidepressants for 27 million Americans § Involve placebo and double-blind techniques to evaluate drug effectiveness

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

§ Antipsychotic drugs § Antianxiety drugs § Treat schizophrenia § Mimic certain neurotransmitters § Treats anxiety § Depress CNS activity; Xanax (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 or Ativan § Used in combination with psychological therapy § May reduce symptoms without resolving underlying problems; withdrawal linked to increased anxiety and insomnia

§ 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: Controlling manic episodes § Lithium: Levels emotional highs and lows of bipolar disorder

§ 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

§ Alternative neurostimulation therapies § Vagus nerve stimulation: Stimulates neck nerve that sends signal to limbic system; increases available serotonin by increasing firing rate of some neurons § Deep brain stimulation: Manipulates depressed brain via pacemaker; stimulates inhibition activity related to negative emotions and thoughts § Repetitive transcranial magnetic stimulation (r. TMS): Sends magnetic energy to brain surface through coiled wire held close to brain; fewer side effects; modest effectiveness

§ Psychosurgery § Involves surgery that removes or destroys brain tissue in an effort to change behavior § Is irreversible; least used biomedical therapy § Lobotomy § Psychosurgical procedure once used to calm uncontrollably emotional or violent patients § Procedure cut the nerves connecting the frontal lobes to the emotion-controlling centers of the inner brain (Moniz) § Today, less invasive techniques used; MRIguided surgery in severe disorders

Lifestyle changes § Training seminars § Human brains and bodies were designed for physical activity and social engagement § Ancestors hunted, gathered, and built in groups with little evidence of disabling depression § Goals § Aerobic exercise, adequate sleep, light exposure, social connection, antirumination, nutritional supplements

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, self-confidence § Resilience § Involves personal strength that helps most people cope with stress and recover from adversity and trauma § Can be seen in New Yorkers after 9/11, spinal cord injury patients, Holocaust survivors, and others