Therapy Chapter 16 OVERVIEW Psychotherapy l Evaluating Therapeutic

Therapy Chapter 16

OVERVIEW Psychotherapy l Evaluating Therapeutic Outcome l Types of Therapy l Psychoanalytic l Humanistic l Behavioural l Cognitive l Biological l

Therapy Comes in Many Forms LOBJ 16. 1 l Many forms of treatment are available for people experiencing psychological difficulties 2 Broad Types of Therapy: l Somatic therapy (biological) – l Drugs l ECT l Psychosurgery l Psychotherapy l Various techniques of “talk” therapy Video Clip from Abn Psy

Psychotherapy: Four Areas of Emphasis l Distorted thoughts l Disturbed emotions (Inner Conflicts) l Maladaptive behaviours l Interpersonal and life situation difficulties

Common Themes Among Psychotherapies l Emotional defusing l Interpersonal learning l Self-knowledge l Therapy as a step-by-step process l Therapy as socially accepted healing

Evaluating Therapeutic Outcome: Does Psychotherapy Work?

Placebo Effects l A placebo effect is a therapeutic change that occurs as a result of a person’s expectations of change rather than as a result of any specific treatment. l Some patients in psychotherapy may show relief from their symptoms simply because they are in therapy and may expect change

DOES PSYCHOTHERAPY WORK? l In a 1952 paper, Hans Eysenck challenged the effectiveness of psychotherapy l Eysenck claimed that psychotherapy produced no greater change in maladjustment than natural life experiences l He was WRONG!

Meta-Analyses of Therapy Outcome LOBJ 16. 2 l Meta-analysis – l Smith, Glass, & Miller (1980) conducted the most comprehensive metaanalysis of psychotherapy outcome research

Types of Therapy Psychoanalysis/psychodynamic Humanistic Behavioural Cognitive Group Biological

Psychoanalysis & Psychodynamic Therapies

Psychodynamic Therapies l Psychoanalysis l Developed by Freud l Insight oriented therapy l Uses free association, dream analysis, and transference l Considerable time/financial investment l Not commonly used today l Psychodynamically based therapies l Insight oriented l Use techniques derived from Freud l Reject or modify parts of Freud’s theory l More common than psychoanalysis

Psychodynamic Therapies LOBJ 16. 6 Assumptions of insight therapies: l Becoming aware of your motivations will help you change and adapt l Unresolved conflict results in maladjustment l Childhood l Sexual feelings l Aggression

Psychodynamic Therapies: Goal l Psychoanalytic therapies attempt to help patients understand the unconscious motivations that direct their behavior l Change your perspective = better mental health

Psychodynamic Therapies: Techniques LOBJ 16. 7… l free association l the patient is asked to report whatever comes to mind, no matter how disorganized or trivial

Free association I feel like crying when … If I were rich … My mother… I feel happy…

Psychoanalytic Therapies: Techniques Dream analysis l Based on idea that dreams are unconscious drives seeking expression l “Dreams are the royal road to the unconscious. ” -- Sigmund Freud

Psychoanalytic Therapies: Techniques l Interpretation - context , meaning, or cause of a specific idea, feeling, set of behaviors l Defense Mechanisms – signal areas that need to be explored

Psychoanalytic Therapies: Processes l Resistance is unwillingness to cooperate on the part of the patient l Belligerence l Missing appointments l Refusal to pay It means you have hit on something big

Psychoanalytic Therapies: Processes Transference occurs when therapist becomes the object of a patient’s emotional attitudes about an important person in the patient’s life * E. g. parent figure, spouse, boss l Countertransference refers to personal issues therapist brings to professional issues with clients l

Humanistic Therapies

Humanistic Therapies l Goal is to remove constraints upon self-fulfillment l Emphasize the ability to reflect on conscious experience l Assume that humans have free will and are motivated to fulfill themselves l Focus on present and future

Client-Centered Therapy l Developed by Carl Rogers l The Role of the Therapist: Video Clip of Rogers l Description: insight therapy that helps people evaluate the world and themselves from their own perspective

Client-Centered Therapy: Techniques l The goal of client-centered therapy is to help people discover the ideal self l In client-centered therapy, therapist guides clients to help them find what they feel is right for themselves

Client-Centered Therapy: Techniques The therapist must demonstrate: l Unconditional positive regard - be an accepting person who projects positive feelings towards client l Congruence -being real or genuine; honest and aware of own feelings l Empathic listening - sense how the client feels and communicate these feelings to the client

Behaviour Therapy Operant Conditioning Counterconditioning Modelling

Behaviour Therapy: Goals l Behaviour therapy focuses on changing overt behaviour by using learning principles to help people replace maladaptive behaviours with more effective behaviours

Behaviour Therapy: A Criticism l Most insight therapists believe that if only overt behaviour is treated, symptom substitution will occur l In symptom substitution, the client substitutes a new symptom to replace the treated one l E. g. I did have an nervous twitch, now I clear my throat constantly. l Research does show that behaviour therapy is at least as effective as insight therapies Not necessarily True.

Behaviour Therapy: Procedures l Behaviour therapy involves three general procedures: 1) Examining the problem behavior and its frequency 2) Developing an individually tailored treatment strategy 3) Continually assessing whether or not the behaviour has changed.

Behavior Therapy: Operant Conditioning l Uses reinforcers to establish desired behaviours l Reinforcer = something that INCREASES the likelihood of a target behavior

Operant Conditioning: Examples l Token economy A system based on positive reinforcement in which people who display appropriate behaviours receive tokens l Time-out - removal from source of reinforcement - Use it with positive reinforcers

Counterconditioning l Counterconditioning: l Based on classical conditioning l Person is taught a new, more adaptive response to a stimulus l Two types of counterconditioning: l Systematic desensitization l Aversive e. g. , replace anxiety with Relaxation in response to The provoking stimulus/

Systematic Desensitization l Gradually replacing an undesirable response (e. g. anxiety) with a desirable one (e. g. relaxation) l Client is taught relaxation strategies, and once relaxed is exposed to progressively stronger anxiety-provoking stimuli. l Two phases: l In imagination l In vivo

Aversive Conditioning l A noxious stimulus is paired with a stimulus that elicits an undesirable behaviour

COGNITIVE THERAPY Rational-Emotive Therapy Beck’s Approach Meichenbaum’s Approach

Cognitive Therapy Assumption: Wrong, distorted, or underdeveloped ideas and thoughts may prevent a person from developing effective coping skills. Focus: Changing thoughts and perceptions will change behavior.

Cognitive Therapy

Cognitive Therapy Propositions: 1. Cognitions affect behaviour 2. Cognitions can be monitored 3. By changing cognitions, we can change behaviour

Rational Emotive Therapy l best known cognitive therapy developed by Albert Ellis l emphasizes the importance of logical, rational thought processes l assumed abnormal behaviour is caused by faulty and irrational thinking patterns l “What disturbs people’s minds is not events but their judgements on events”…. Epictectus, 100 A. D. Table 16. 4, pg. 598

Biological Therapies Pharmaceutical Psychosurgery/ECT

Drug Therapy l No drug will permanently cure the maladjustment of people who are not coping well l Psychotropic drugs: drugs given to relieve mental problems

Drug Therapy

Antianxiety Drugs l Anxiolytics l Mood-altering – reduce stress, increase calm, induce sleep l neurotransmitter (GABA) l e. g. Librium, Xanax, and Valium: l Long-term use without adjunct therapy ill-advised

Antidepressants l Thymoleptics l Elevate mood, alter levels of brain chemicals l Common Side Effects: headache, nausea, weight gain, decreased sex drive l Types: Selective Serotonin Reuptake Inhibitors – SSRI’s (e. g. Prozac, Zoloft, Paxil) & SNRI’s (Effexor)

Antimania Drugs l Lithium carbonate has long been used as an effective antimania drug l Thymoleptic l Importance of dosage – too much has negative side effects; too little = no effect l Side Effects

Antipsychotic Drugs l neuroleptics l Treat Schizophrenia l l Reduce hostility, aggression, and delusions Neurotransmitter Dopamine l Phenothiazine (e. g. Thorazine) l Issues: not helpful for all symptoms, side effects l Tardive dyskinesia

Psychosurgery l Psychosurgery: brain surgery l Prefrontal Lobotomy: removal of parts of the brain’s frontal lobes thought to alleviate symptoms of mental disorders done in the 1940 s and 50 s l Prefrontal lobotomies made some people become unnaturally calm and completely unemotional

Electroconvulsive Therapy Electroconvulsive therapy (ECT) o An electric current is briefly applied to the head to produce a generalized seizure (convulsion) l was once widely employed with depressed people l Today, ECT is not a widely used therapy