Download client-centered therapy

Chapter 14
Treating
Psychological
Disorders
Christina
Graham, Ph.D.
Outline: Therapy
 Does
Therapy Work?
 Approaches
 Psychoanalytic Therapy
 Humanistic Therapy
 Cognitive-Behavioral Therapy


Treatment for Mood Disorders
Treatment for Anxiety Disorders
Outline: Therapy
 Does
Therapy Work?
 Approaches
 Psychoanalytic Therapy
 Humanistic Therapy
 Cognitive-Behavioral Therapy


Treatment for Mood Disorders
Treatment for Anxiety Disorders
Psychotherapy Effectiveness
 Q:
Does
psychotherapy work?
 A: Yes.*
 *Need
to think
critically about why
studies say it works,
and how effectiveness
is measured
Effectiveness: Key Points
 Most
problems usually get better on their
own…but they’re likely to improve faster
with psychotherapy.
 Two key ingredients of successful
psychotherapy are:


 In
Quality of relationship with the therapist
The client’s belief that s/he will improve
general, no particular therapeutic
approach is superior
 However, certain therapies work much
better for specific problems
Outline: Therapy
 Does
Therapy Work?
 Approaches
 Psychoanalytic Therapy
 Humanistic Therapy
 Cognitive-Behavioral Therapy


Treatment for Mood Disorders
Treatment for Anxiety Disorders
Approaches
 Q:
How should we treat psychological
disorders?
 A: Depends on our assumptions about
etiology (what causes the disorders)
Approaches:
Theoretical Perspectives
 What
 Is





causes psychological disorders?
it…
…unconscious conflicts stemming from
childhood relationships with parents
(psychodynamic perspective)?
…not living to one’s full potential (humanistic)?
…learned behaviors and responses (behavioral)?
…thinking a certain way (cognitive)?
…neurochemistry and biology (biological)?
Outline: Therapy
 Does
Therapy Work?
 Approaches
 Psychoanalytic Therapy
 Humanistic Therapy
 Cognitive-Behavioral Therapy


Treatment for Mood Disorders
Treatment for Anxiety Disorders
Psychoanalytic therapy
(psychoanalysis)



Assumes conflicts are
unconscious
Free association = allowing the
client to verbalize everything
that comes to mind without
censoring anything
Sessions are often frequent over
a long period of time

Expensive!
Psychoanalytic therapy
(psychoanalysis) cont’d



Therapist looks for signs of
transference (client acts toward
the therapist in ways suggestive
of unconscious conflicts)
http://www.youtube.com/watch?
v=yTHM2o3dvao
Countertransference is also an
issue

A therapist’s own conflicts can
change how s/he acts toward
the client
Outline: Therapy
 Does
Therapy Work?
 Approaches
 Psychoanalytic Therapy
 Humanistic Therapy
 Cognitive-Behavioral Therapy


Treatment for Mood Disorders
Treatment for Anxiety Disorders
Humanistic Therapy





Sometimes called clientcentered therapy
Therapist provides
unconditional positive
regard
Therapist is empathic
Encourages client to be
genuine
Most therapists – regardless
of orientation – employ
these humanistic principles
Carl Rogers (1902-1987)
Outline: Therapy
 Does
Therapy Work?
 Approaches
 Psychoanalytic Therapy
 Humanistic Therapy
 Cognitive-Behavioral Therapy


Treatment for Mood Disorders
Treatment for Anxiety Disorders
Cognitive-Behavioral Therapy
(CBT)
 Integrates
assumptions from both the
behavioral and cognitive perspectives
 Basic model:
Cognitions
Behaviors
Emotions
Using a CBT model, how might
a therapist treat depression?
CBT model of depression
“I’m no fun…nobody
wants to hang out
with me.”
Cognitions
“If I go out I won’t
have a good
time...people will
think I’m such a jerk”
Avoiding
friends,
avoiding
social events,
staying home
alone
Behaviors
Emotions
Feeling lonely, depressed
Treatment for depression:
Changing attribution styles
 Depressed
people tend to attribute
events in ways that are inaccurate and
maladaptive (Beck’s Cognitive Triad of
Depression)



Beliefs about the self – negative events are
attributed to internal causes
Beliefs about the world – negative events
are seen as having global effects
Beliefs about the future – negative events
are seen as stable and unchanging
Treatment for depression:
Changing attribution styles
Depressive
Non-Depressive
Internal
External
“It’s all my fault”
“That was just bad luck”
Global
Specific
“Everything is going
wrong”
Stable
“Things will always be
lousy”
“This is just one lousy
situation”
Unstable
“This won’t last forever”
Some Maladaptive Cognitions
 Overgeneralization
= arbitrarily concluding that an
event will happen to you over and over again
 All-or-nothing thinking = tendency to evaluate
personal qualities in black/white categories
 Mind-reading = assuming you know what others
are thinking of you (inaccurately)
 Mental filter = dwelling on the negative and
ignoring the positive
 Magnification = exaggerating the importance of a
negative action
Using a CBT model, how might
a therapist treat a Specific
Phobia?
Treatment of phobias:
Systematic Desensitization
 Feeling
relaxed is incompatible with
feeling anxious
 The therapist helps the client construct a
‘fear hierarchy’
 The client is asked to practice coping by
using relaxation strategies in the presence
of fearful stimuli
 Exposure to the feared stimulus lasts until
the fear level drops to a very low level
Sample fear hierarchy
 Sitting
on Santa’s lap – 10
 Touching Santa’s beard – 9
 Talking to Santa 5 ft away – 8
 Hearing Santa say “Ho Ho Ho!” – 6
 Seeing a red Santa suit on a hanger – 4
 Touching a toy Santa - 4
 Seeing a chubby man with a bushy white
beard – 3
 Hearing “Jingle Bells” - 2
Using a CBT model, how might
a therapist treat OCD?
Treatment of OCD:
Exposure and Response Prevention
 Compulsions
(behaviors) are negatively
reinforcing because they decrease anxiety
 Client with OCD is exposed to a situation that
triggers obsessions (thoughts) and is
prevented from performing compulsions
 Client learns that anxiety will eventually
decrease over time without performing the
compulsion

Client is negatively reinforced for doing other
things, like distracting self or relaxing)
Stress Inoculation
 Combination
of systematic desensitization
(classically conditioning relaxation response
with anxiety-provoking stimuli) with cognitive
responses
 Use of self-talk to facilitate relaxation and
coping (“I can get through this OK”, “Just one
step at a time”, “Fear is natural, it won’t always
be this bad and I can get through this.”)
 Coping skills (self-talk and relaxation) are
practiced prior to encountering the stressors
Questions?