Power Point for Abnormal Psychology Fourteenth Edition James

Power. Point for Abnormal Psychology Fourteenth Edition James N. Butcher Susan Mineka Jill M. Hooley Prepared by Andy Pomerantz Southern Illinois University Edwardsville This multimedia product and its contents are protected under copyright law. The following are prohibited by law: • any public performance or display, including transmission over any network; • preparation of any derivative work, including the extraction, in whole or part, of any images; • any rental, lease, or lending of the program. ISBN: 0 -205 -50294 -6 Copyright © 2010 Allyn & Bacon

Chapter 16 Therapy Copyright © 2010 Allyn & Bacon

An Overview of Treatment The belief that people with psychological problems can change is the conviction underlying psychotherapy Several hundred therapeutic approaches exist, but the efficacy of all of these have not been experimentally demonstrated Copyright © 2010 Allyn & Bacon 3

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 Copyright © 2010 Allyn & Bacon 4

Who Provides Psychotherapeutic Services? Members of many different professions provide advice and counsel including: Physicians Clergy and physicians generally refer seriously disturbed people to mental health professionals Copyright © 2010 Allyn & Bacon 5

Who Provides Psychotherapeutic Services? Mental health professionals include, among others: Clinical psychologists Psychiatric social

The Therapeutic Relationship The key elements of an effective working alliance between client and therapist include: A sense of working collaboratively on the problem Agreement between patient and therapist about the goals and tasks of therapy An affective bond between patient and therapist Copyright © 2010 Allyn & Bacon 7

The Therapeutic Relationship Other qualities enhancing therapy include: The client’s motivation to change A client’s expectation of receiving help A protected setting A good match between client and therapist Copyright © 2010 Allyn & Bacon 8

Measuring Success in Psychotherapy Estimated gains depend on A therapist’s impression of changes that have occurred A client’s reports of change Reports from the client’s family or friends Comparison of pretreatment and posttreatment scores on personality tests Measures of change in selected overt behaviors Copyright © 2010 Allyn & Bacon 9

Objectifying and Quantifying Change Today the emphasis is on using more quantitative methods of measuring change Beck Depression Inventory and Hamilton Depression Inventory are objective rating scales used pre- and post-therapy for depressed clients f. MRI can also measure change Copyright © 2010 Allyn & Bacon 10

Would Change Occur Anyway? Improvement often occurs without professional intervention Psychotherapy can accelerate improvement 50% show clinically significant change after 21 sessions 75% show clinically significant change after 40 sessions Copyright © 2010 Allyn & Bacon 11

Can Therapy Be Harmful? Some clients are actually harmed by their encounters with psychotherapists 5 -10% deteriorate during treatment Borderline personality disorder and OCD have relatively high rates Therapists should not commit boundary violations or try to work with clients they are not equipped to help Copyright © 2010 Allyn & Bacon 12

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

Evidence-Based Treatment Efficacy is determined via randomized clinical trials in which therapy is compared to placebo Usually a double-blind method is employed Therapies under investigation are typically manualized to control variability between therapists If efficacy studies determine that a therapy works, it is described as “evidence-based” or “empirically supported” Copyright © 2010 Allyn & Bacon 14

Medication or Psychotherapy? Advances in psychopharmacology have allowed many to remain unhospitalized Problems include side effects and inexact selection of medication or dosage Relapsing can also occur because symptoms are reduced but disorder is not cured Copyright © 2010 Allyn & Bacon 15

Combined Treatments In the past, it was thought that medication and psychotherapy were incompatible Today, they are frequently combined Combination exemplifies biopsychosocial approach Copyright © 2010 Allyn & Bacon 16

Psychosocial Approaches to Treatment Psychotherapy fascinates many people The HBO drama In Treatment illustrates psychoanalytic psychotherapy The goal of this section is to describe various therapeutic approaches and illustrate them with case studies whenever possible Copyright © 2010 Allyn & Bacon 17

Behavior Therapy Behavior therapy is a direct and active treatment that Recognizes the primacy of behavior Acknowledges the role of learning Includes thorough assessment and evaluation Copyright © 2010 Allyn & Bacon 18

Behavior Therapy Behavior therapy approaches include: Exposure therapy Aversion therapy Modeling Reinforcement approaches Token

Behavior Therapy Tends to be relatively brief Directed towards specific symptoms Best with problems that are not pervasive or vaguely defined (e. g. , most personality disorders) Often used with anxiety disorders Behavioral activation is a relatively new development encouraging greater engagement with life Copyright © 2010 Allyn & Bacon 20

Cognitive and Cognitive-Behavioral Therapy Cognitive or cognitive-behavioral therapy attempts to change a person’s behavior by Modifying self-statements Modifying construal of events Copyright © 2010 Allyn & Bacon 21

Cognitive and Cognitive-Behavioral Therapy Rational emotive behavior therapy attempts to change a client’s thought processes Stress-inoculation therapy is a type of self -instructional training focused on altering the self-statements an individual routinely makes in stressful situations Copyright © 2010 Allyn & Bacon 22

Cognitive and Cognitive-Behavioral Therapy Beck’s cognitive therapy is based on the assumption that problems like depression result from Clients’ illogical thinking about themselves Clients’ illogical thinking about the world around them Copyright © 2010 Allyn & Bacon 23

Cognitive and Cognitive-Behavioral Therapy Efficacy of cognitive therapy has been well-documented Especially with depression, anxiety disorders, and bulimia Debate about whether cognitive change is the “active ingredient” in cognitive therapy Copyright © 2010 Allyn & Bacon 24

Humanistic-Experiential Therapies Humanistic-experimental therapies include: Client-centered therapy Gestalt therapy Process-experiential therapy Copyright © 2010

Humanistic-Experiential Therapies Have had a major impact on contemporary view of human nature and good psychotherapy However, have been criticized for lack of agreed-upon procedures and vagueness of method Increasing outcome data suggests it is beneficial for a variety of problems Copyright © 2010 Allyn & Bacon 26

Psychodynamic Therapies Psychodynamic therapy is mainly practiced in two basic forms: Classical psychoanalysis Psychoanalytically

Psychodynamic Therapies Elements of Freudian psychoanalysis include: Free association Analysis of dreams Analysis of

Psychodynamic Therapies Contemporary psychodynamic approaches tend to have A strongly interpersonal focus Revisions to the object relations perspective Revisions to the attachment and selfpsychology perspectives Copyright © 2010 Allyn & Bacon 29

Couple and Family Therapy The focus of marital therapy and family systems therapy is

Couple and Family Therapy Integrative behavioral couple therapy is increasingly replacing traditional behavioral couple therapy Structural family therapy is one form of family therapy that emphasizes new organization of family relationships Copyright © 2010 Allyn & Bacon 31

Eclecticism and Integration Therapists today are more likely to label their orientation as eclectic than to adhere to a single approach Interpersonal therapy, which focuses on changing current relationships to reduce depression, is an example of an eclectic form of therapy Copyright © 2010 Allyn & Bacon 32

Sociocultural Perspectives Critics may view psychotherapy as an attempt to get people adjusted to a “sick” society Therapists can be seen as guardians of the status quo Copyright © 2010 Allyn & Bacon 33

Social Values and Psychotherapy Therapists’ own value judgments can affect decisions they make about treating clients Example: A young mother abused by an alcoholic husband shows signs of depression, but who should be treated? Example: A 15 -year-old girl is sexually active but her parents disapprove. What goal should therapist set? Copyright © 2010 Allyn & Bacon 34

Psychotherapy and Cultural Diversity Members of minorities Are underrepresented in treatment research studies Are underserved by the mental health system Often have very different backgrounds than their therapists, which can affect therapeutic alliance Copyright © 2010 Allyn & Bacon 35

Biological Approaches to Treatment Antipsychotic Drugs Antidepressant Drugs Anti-Anxiety Drugs Lithium and Other Mood-Stabilizing Drugs Electroconvulsive Therapy Neurosurgery Copyright © 2010 Allyn & Bacon 36

Antipsychotic Drugs Antipsychotic drugs are used to treat psychotic disorders such as: Schizophrenia Psychotic mood disorders One side effect of traditional antipsychotics is tardive dyskinesia Atypical antipsychotic drugs Have a lower risk of side effects Treat positive and negative symptoms Copyright © 2010 Allyn & Bacon 37

Antidepressant Drugs The most widely prescribed antidepressant drugs are selective serotonin re-uptake inhibitors Older antidepressants include: Monoamine oxidase inhibitors Tricyclic antidepressants Trazodone Antidepressants are also widely used in the treatment of various other disorders Copyright © 2010 Allyn & Bacon 38

Figure 16. 3: Tricyclic Antidepressants as Reuptake Blockers Copyright © 2010 Allyn & Bacon

Anti-Anxiety Drugs The most widely prescribed anti-anxiety drugs are benzodiazepines Buspirone also has been

Lithium and Other Mood-Stabilizing Drugs Lithium is very effective in treating bipolar mood disorders Other mood-stabilizing drugs include: Divalproic acid Carbamazepine Copyright © 2010 Allyn & Bacon 41

Electroconvulsive Therapy Electroconvulsive therapy is now used to treat severe mood disorders It is a safe, effective, and important form of treatment, often used after others have failed Anesthetics allow patients to sleep through the procedure Bilateral ECT appears to be more effective than unilateral ECT produces some short-term side effects including amnesia Copyright © 2010 Allyn & Bacon 42

Figure 16. 4: Unilateral and Bilateral Electrode Placement for ECT Copyright © 2010 Allyn

Neurosurgery Antipsychotic drugs have decreased the use of psychosurgery Psychosurgery appears to be effective with debilitating OCD, self-mutilation, or anorexia Deep brain stimulation is a more recent surgical approach Copyright © 2010 Allyn & Bacon 44

Unresolved Issues Is there bias in the reporting of drug trials? Researchers may have financial ties to drug companies Does this represent a conflict of interests when investigating those companies’ products? Copyright © 2010 Allyn & Bacon 45