Therapy Psychodynamic Therapy Psychodynamic Therapy Used for unfocused

Therapy

Psychodynamic Therapy

Psychodynamic Therapy • Used for unfocused anxiety/depression • Psychoanalysis- pioneered by Freud intensive technique for exploring the unconscious - Freud believed that anxiety disorders are inabilities to resolve inner conflicts (they become repressed) in the unconscious between the id and the superego

Psychodynamic Therapy • GOAL of Psychoanalysis: - make unconscious conflict conscious - repressed material can then be dealt with - ego can be strengthened & defense mechanisms do not need to be used

Job of the Therapist • Main job: help a patient bring repressed thoughts into consciousness & gain insight into the relationship between current symptoms & the repressed conflict

Job of the Therapist • Therapy succeeds when patients are released from the repression established in early childhood - often through catharsis (AKA insight therapy) – expressing strong felt, but usually repressed emotions; a healing emotional release

Job of the Therapist • It is an attempt to reconstruct longstanding repressed memories & work through painful feelings to an effective resolution • This takes years, requires introspective patients who are highly motivated, verbally fluent & have $ to continue therapy

Techniques Used 1. Free Association- say whatever comes to mind regardless of painful or irrelevant thoughts - therapist will note patterns that lie beneath the words (the surface) 2. Catharsis- see notes

Free Association • Start with a recent experience, memory, or dream and write every image or idea that enters your awareness • Don’t self-edit OR refrain from logic

Techniques Used 3. Dream Analysis- examines content of a person’s dreams to discover motivations, life experiences, desires - 2 kinds of content: a) manifest- people remember upon awakening b) latent- hidden, deeper content

Techniques Used 4. Analysis of Transferencetransferring of feelings about a person in the past to therapist due to unfinished business - positive- feeling of love/admiration - negative- feeling of anger/hostility - therapist provides a stage for reenacting unresolved conflicts

Techniques Used 5. Analysis of Countertransference- therapist begins to view client as someone in therapists life & projects feeling toward the client - can provide useful material to look at with client, but must be careful - become mirrors for one another

Techniques Used 6. Analysis of Resistance - individuals put up barriers to free association - resisting to “work” with therapist - therapist’s job is to break down areas the client does not want to discuss

Techniques Used • Projective Techniques- help access unconscious, esp. in children - Rorschach, TAT, incomplete sentences, draw a picture

Behavioral Therapy

Behavioral Therapy • Abnormal behaviors are acquired through a learning process that follows basic principles of conditioning & learning • Therapy includes applying principles of conditioning & reinforcement to increase frequency of desired behaviors or decrease frequency of problem behaviors

Behavioral Therapy • Problems that generally use behavior modification/therapy: - fears/phobias, compulsions, depression, addictions, aggression, & delinquent behavior

Behavioral Therapy • When people can’t cope effectively, their maladaptive reactions can be overcome by therapy based on learning or relearning

Behavioral Therapy • 3 Types of Behavioral Therapy: 1. Counter-Conditioning- a new response is conditioned to replace or “counter” a maladaptive response ex. Child afraid of the dark have child listen to their favorite song while sitting in the dark

Behavioral Therapy - Techniques Used: a) systematic desensitization- client is taught to prevent the arousal of anxiety by confronting the feared stimulus & using relaxation techniques; used for social phobias (The King’s Speech);

Behavioral Therapy b) implosion- opposite; exposes a client to anxiety, provoking the stimuli (most frightening is the imagination) but in a safe setting; person cannot run away; “tough love” c) flooding- client is placed in or exposed to the phobic situation; used for agoraphobia

Behavioral Therapy *all 3 have in common exposure through imagery, contact, or virtual reality; all are exposed to object feared

Behavioral Therapy d) aversion therapy- used for patients attracted to harmful stimuli (drug addictions, violent behavior); an attractive stimuli is paired with shock or drugs (noxious stimuli) to get the patient to pair the noxious stimuli with the harmful behavior

Behavioral Therapy 2. Contingency Management- Skinner; changing behavior by modifying consequences (operant cond. ) - Techniques Used: a) token economy- positive reinforcement; desired behaviors are defined & token payoffs are given when behavior is performed (gold stars); can later be exchanged for rewards, etc.

Behavioral Therapy 3. Social Learning Theory- clients observe models’ desirable behaviors being reinforced b/c people learn via observation - used to overcome phobias & to build social skills - based on Bandura’s research

Behavioral Therapy - Techniques Used: a) Participant Modeling- therapist demonstrates desired behavior & client is helped to imitate behavior with support & encouragement b) Behavioral Rehearsal- visual; how one should behave in a situation helps strengthen social skills

Behavioral Therapy Most common problem: lack of assertiveness often in children (have deficits in social skills that may lead to problems later) pre-schools, elem. schools look to build skills in withdrawn, isolated children

Cognitive Therapy

Cognitive Therapy • Attempts to change the feelings & behaviors by changing the way a client thinks about or perceives significant life events

Cognitive Therapy • Abnormal behavior patterns start with problems in what people think & how they think (cognitive process) • Therapy will focus on changing how people think

Cognitive Therapy

Cognitive Therapy • 2 Types of Cognitive Therapy: 1. Cognitive Behavior Modification- Combines thoughts w/ focus on reinforcement contingencies in modifying performance - Unacceptable behavior patterns are changed/modified by cognitive restructuring

Cognitive Therapy - Change the person’s negative self statement into constructive coping statements - Ex. I am boring, no one will invite me to another party. Change this thought to next time I’ll tell a joke, be proactive, or more responsive to other’s stories

Cognitive Therapy - Step 1: figure out together the kind of thinking that is leading to dysfunctional behavior - Step 2: develop new selfstatements that minimize negative thoughts that elicit anxiety or lower self -esteem

Cognitive Therapy - Step 3: set goals - Step 4: develop strategies for meeting them develop self-efficacy - Step 5: evaluate feedback

Cognitive Therapy - Changing False Beliefs- cognitive therapy for depression (Aaron Beck) - depression arises when people are unaware of their negative automatic thoughts & faulty thinking

Cognitive Therapy - often emotional stress is caused by cognitive misunderstanding and failure to distinguish between reality & one’s expectations MUST challenge patient’s basic assumptions

Cognitive Therapy 2. Rational Emotive Therapy (RET)- based on the transformation/changing of irrational beliefs that cause severe emotional reactions (ex. Anxiety) - Ellis

Cognitive Therapy - teach the client to recognize the “shoulds, oughts, haves, & musts” that control their actions & prevent them from choosing the life they want

Cognitive Therapy - through rational confrontation, client can dispute & examine alternative reasons for their thoughts/actions - this is followed up by replacing dogmatic thinking w/ rational, situationally appropriate ideas

Cognitive Therapy - it aims to increase individual’s self-worth by getting rid of faulty beliefs that block personal growth

Group Therapy

Group Therapy • Can sometimes be more effective 1. Less Expensive- small # of mental health personnel can help more people 2. Power of Groups- less threatening, provides opportunities to practice interpersonal skills and observe others

Group Therapy Allows for corrective emotional experiences to take place in a “family -like” atmosphere Helps people realize they are not alone Provides social support outside of therapy

Group Therapy • Different Types: 1. Marital & Family- each member is treated as a member of a system of relationships - therapist helps to understand what the problems are in the family

Group Therapy - seeks to help communication, understand communication styles & how to express themselves - therapist acts as interpreter, clarifier, mediator, & referee when helping to resolve dysfunctional elements

Group Therapy 2. Community Support Groups - 10+ million Americans participate in self-help groups - pioneered by women’s groups & AA - 4 Main Groups:

Group Therapy a) Addictive behavior b) Physical/mental disorder c) Life transition or other crises d) Traumas experienced by friends or relatives w/ serious problems

Group Therapy • Many groups popping up on the Internet providing social support, hope & control for problems; people dispense info about disorders & treatments

Humanistic & Bio-Medical Theory

Humanistic Therapy • Started in 1960 s, goes along with theory that a human is a whole person who is constantly changing and growing - environment and heredity place some restrictions, but people are always free to choose what they will become

Humanistic Therapy • Therapists attempt to help clients define their own freedom, cultivate their individuality, & discover ways to reach their fullest potential (selfactualization)

Humanistic Therapy 1. Client-Centered Therapy (Carl Rogers) - major assumption: people can selfactualize (realize their potential) - problems arise when there is conflict between positive self-image & negative external criticisms anxiety

Humanistic Therapy - The counselor acts as a mirror - Client is in the role of exploring thoughts, feelings, & behaviors - GOAL: help people become more confident, fully functioning, able to counsel themselves

Humanistic Therapy • Techniques: 1. Active listening (no advice, solutions, criticisms) - listen, reflect, rephrase 2. Respectful, unconditional positive regard, empathetic

Biomedical Therapy • Treat mental disorders as problems in the brain • 3 Approaches: 1. Psychosurgery- considered method of last resort; not practiced anymore; most famous is lobotomy - severed connections between prefrontal cortex & rest of brain

Biomedical Therapy 2. Electroconvulsive Therapy (ECT)use of shock to treat psychiatric disorders such as: schizophrenia, mania, & depression - generally used to treat depression that has not worked with drugs - apply weak electrical current after patient has had a muscle relaxant

Biomedical Therapy - A last resort as well- been proved effective for severe depression, acute psychotic states & mania - Side effects: memory loss, confusions (sometimes a little, sometimes permanent)

Biomedical Therapy 3. Drug Therapy: 3 types. A. Anti-Psychotic- dopamine blockers, mood stabilizers (Thorazine, Haldol, Clozapine) - try to reduce hallucinations, delusions, & paranoia - too much dopamine = hallucinations - too little dopamine= flat emotional response

Biomedical Therapy B. Anti-Depressants (SSRI’s & MAO’s) - SSRI’s- used for depression, anxiety (panic, OCD, eating disorder), & some personality disorders - prozac, celexa, lexapro, paxil, zoloft

Biomedical Therapy - MAO’s- not used as much, can cause toxic reaction - enzyme breaks down norepinephrine & serotonin

Biomedical Therapy C. Anti-Anxiety- benzodiazepine (Valium, Xanax, Ativan, Klonopin) - need to be careful can form a dependence; has a calming effect and can cause sedation affecting the CNS

Biomedical Therapy 4. Lithium- takes time to work; helps with manic highs & lows of bipolar disorder - anticonvulsant- used for immediate treatment of manic episodes