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THERAPY AND
TREATMENT
AP Psychology
Myers – Chapter 17
Types of Therapy
■ The type of therapy used depends on the problem!
Psychotherapy
Social interaction between a
trained therapist and someone
who suffers from psychological
difficulties
Ex: Using behavior therapies
to treat a phobia that
psychologically learned
Eclectic Approach
an approach that depending on
the client’s problems, uses
techniques from various forms of
psychotherapy
Ex: using cognitive and
behavioral therapies to treat
disorders that require
changes in thinking and
behaviors
Biomedical Therapy
Prescribed medications or
medical procedures that act
directly on the patient’s brain
and/or nervous system.
EX: treating schizophrenia
with medication because it
is biologically rooted in the
brain
PSYCHOTHERAPIES
Psychoanalysis
Humanistic
Behavioral
Cognitive
Group Therapies
PSYCHOANALYSIS
“Look into the depths of your own soul and learn first to know yourself, then
you will understand why this illness was bound to come upon you and
perhaps you will thenceforth avoid falling ill.”
- Sigmund Freud
Psychoanalysis
■ Based upon the ideas of Freud
Goal
Try to help patients
gain insight into the
unconscious origins
and roots of their
disorders and work
through anxiety-ridden
feelings.
Techniques
•Free association - patient relaxes
and starts talking about anything
•Dream interpretation
•Interpretation – the analyst’s
noting of supposed meanings of
dreams, free association,
projective tests, etc in order to
promote insight into the
subconscious
Criticisms
•Interpretations cannot be
proven or disproven;
psychoanalysts say that
psychoanalysis is therapy,
not a science
•Time consuming – years
long
•Expensive – several
sessions a week
Psychoanalytic Phenomena
■ Resistance –the blocking
from consciousness of
anxiety-laden material
– Hints that anxiety exists
and you are defending
against sensitive
material
■ Transference –the
patient’s transfer to the
analysts of emotions
linked with other
relationships
– such as love or hatred
for a parent
•Example Psychoanalytic
Session
•What About Bob Trailer
Psychodynamic Therapy
■ Influenced by Freud, but not
the same as psychoanalysis
Goal
Techniques
Try to understand a
patient’s current
symptoms by focusing on
themes across important
relationships
•Face-to-face conversation
•Once a week for a few weeks/months
•Look for patterns in
behaviors/relationships
HUMANISTIC
THERAPY
“We have two ears and one mouth that we may listen that more an talk
the less.”
- Zeno. 335-263 BC
Humanistic Therapy
■ Emphasis on self-actualization and self-fulfillment
■ Developed largely by Carl Rogers
Goal
Aim to boost selffulfillment by
helping people
grow in selfawareness and
self-acceptance
Techniques
•Focusing on the future instead of the past
•Focusing on conscious rather than
unconscious thoughts
•“Clients” rather than “patients”  clientcentered therapy in which the client feels
unconditional positive regard and the
therapist is nondirective (refrains from
offering personal interpretations).
•Active listening – therapist echoes, restates,
and clarifies
Active Listening Example
Criticisms
•Not scientific enough
With a neighbor…
■
■
■
Think of the last thing recently that:
–
Made you angry
–
Made you sad
–
Made you anxious/nervous
For 2-3 minutes, talk about the event and feelings. The active
listener should:
–
Use Active Listening Tips sheet
–
Paraphrase – check your understanding by summarizing the
speaker’s words in your own words and ask if you are correct.
–
Invite clarification – “What might be an example of that?” may
encourage the speaker to say more.
–
Reflect feelings – “It sounds frustrating” might mirror what
you’re sensing from the speaker’s body language and intensity.
–
Remain unbiased and nonjudgmental
Did you notice any differences when you were active listening
compared to how you listen everyday?
BEHAVIORAL
THERAPIES
Behavioral Therapy
■ Behavioral therapists do not emphasize the mental root of a
disorder as they assume that the problem behaviors are the
problems
Goal
Techniques
Applies learning
principles to the
elimination of
unwanted behaviors
(useful for phobias)
•Counter-conditioning - conditions new
responses to stimuli that trigger
unwanted behaviors, based on classical
conditioning.
•Exposure therapy (systematic
desensitization)
•Aversion therapy
•Behavior modification - reinforcing
desired behaviors and withholding
reinforcement or using punishment for
undesired behaviors
•Token economy
Criticisms
•Doesn’t address mental
processes behind
disorders
•When reinforcement
disappears/stops,
behaviors may come back.
•Is it right for one human
to control another’s
behavior?
•Is punishment unethical?
Counter-conditioning
■ Systematic Desensitization (exposure
therapy) - associates a pleasant relaxed
state with gradually increasing anxietytriggering stimuli
– commonly used to treat phobias.
■ Ex: fear of public speaking.
– 1. Ranked list (high to low anxiety)
– 2. Relaxed state
– 3. Induce mild anxiety and indicate
too much
– 4. Return to relaxation
– 5. Repeat the pairing until the
anxiety is replaced by relaxed
feelings
– 6. Move up the anxiety list
implementing desensitization each
time.
– 7. Move from imagined situations to
real situation.
Counter-conditioning
■ Aversion therapy - associates an
unpleasant state with an
unwanted behavior
–
■
■
Commonly used to treat
addictions
Ex: quitting smoking
–
1. Therapist shocks a patient
when a drag is inhaled
–
2. Patient smokes rapidly,
inducing many shocks
–
3. Pair together several times
–
4. Patient associates pain of
shock with smoking
–
5. Quit smoking
Highly successful in the short-run,
but has mixed results in the longrun.
Behavior Modification
■ Behaviors are influenced by
their consequences
– operant conditioning –
reinforcement and
punishment
■ Token economy –earn a
token of some sort for
exhibiting a desired behavior
and can later exchange the
tokens for various privileges
or treats.
– Used to help autistic
children become more
social.
– Can teach
schizophrenic sufferers
or the mentally
retarded to care for
themselves.
Behavioral Therapy
■ Behavioral therapists do not emphasize the mental root of a
disorder as they assume that the problem behaviors are the
problems
Goal
Techniques
Applies learning
principles to the
elimination of
unwanted behaviors
(useful for phobias)
•Counter-conditioning - conditions new
responses to stimuli that trigger
unwanted behaviors, based on classical
conditioning.
•Exposure therapy (systematic
desensitization)
•Aversion therapy
•Behavior modification - reinforcing
desired behaviors and withholding
reinforcement or using punishment for
undesired behaviors
•Token economy
Criticisms
•Doesn’t address mental
processes behind
disorders
•When reinforcement
disappears/stops,
behaviors may come back.
•Is it right for one human
to control another’s
behavior?
•Is punishment unethical?
COGNITIVE THERAPY
“Life does not consist mainly, or even largely, of facts and happenings. It
consists mainly of the storm of thoughts that are forever blowing through
one’s mind.”
- Mark Twain
Cognitive Therapy
■ Best for disorders in which the roots are unclear, like generalized
anxiety disorder and major depressive disorder
Goal
Tries to change unhealthy
or maladaptive patterns
in thinking by teaching
new healthier ways of
thinking
Techniques
Depressed people do not exhibit the self-serving bias
common in nondepressed people.
Instead they attribute their failure to themselves and
attribute their successes to external circumstances. 
must change that pattern of thinking
•Ex: a depressed person writes 3 positive things that
happened that day and how they contributed to them
•Ex: a person with test-anxiety repeats positive things to
themselves before an exam
Cognitive-Behavioral Therapy
■ Useful for disorders that involve maladaptive mental and
behavioral elements
Goal
Techniques
Combines changes in thinking Rational-emotive behavior therapy – proposes
(cognitive) and changes in
that unrealistic and irrational beliefs cause
behaviors (behavioral)
maladaptive behaviors; focuses on changing
thinking patterns.
1. Identify the underlying irrational thought
patterns/beliefs
2. Challenge the irrational beliefs
3. Gain insight and recognize irrationality
Best for OCD, eating disorders, etc (any
disorder with cognitive/behavior roots)
Other examples of CBT
■ EX: OCD sufferers – changing thinking patterns concerning
obsessive thoughts and changing behaviors concerning
compulsions
■ EX: Anorexia nervosa – changing thinking patterns concerning
depression and negative body image and changing behaviors
concerning eating.
GROUP THERAPIES
“The feeling of having shared in a common peril is one element in the
powerful cement that binds us.”
- Alcoholics Anonymous member
Group Therapy and Support
Groups
■
Except for psychoanalytic therapies, psychotherapy techniques can
be used in therapist-led small groups.
■
Group therapy does not allow for the same degree of individual
attention, but it is time and cost effective and has often been found
no less effective than individual therapy.
■
The social context of group therapy often allows client to feel as if
they are not alone in their problems. It can be a relief to find that
others share your problems and feelings.
■
EX: AA, cancer or AIDS support groups, online support groups
■
Rent – “Will I” – AIDS support group
■
Go On Trailer
Family Therapy
■ Treats the family as a system in which undesirable behaviors
are influenced by and affect other members
– tries to foster healthier relationships within the family.
■ Ex: A family might attend therapy if one member is addicted to
drugs/medication during which the therapist would evaluate
relationships in the family that could contribute to conflict and
possible drug abuse.
Crash Course - Psychotherapy
EVALUATING
PSYCHOTHERAPIES
Is Therapy Effective?
Clients…
Clinicians…
■ YES
■ YES
■ Self-justification – rationalize the
time and money spent.
■ More aware of the failures of
other therapists.
– The same person with the
same recurring problems
could be considered a
“success story” for several
therapists.
■ Confirmation bias and selective
recall
■ Enter therapy in troubled state,
when we return to a “normal”
state, we attribute this to
whatever we have done in the
interim.
– Placebo effect?
■ Although treatments have varied
widely, every generation of
therapists view its own approach
as the most enlightened and
effective.
– Self-serving bias
Outcome Research
■ Controlled experiments!
■ Outcome studies are randomized clinical trials
in which people on a waiting list receive therapy
or no therapy.
■ Meta-analysis – a procedure for statistically
combining the results of many different
research studies
– People who remain untreated often improve (2/3)
– People who receive psychotherapy are more likely
to improve.
– People who receive psychological treatment spend
less time and money later seeking other medical
treatments, compared with those on the waiting
list.
EVALUATING
PSEUDOTHERAPIES
As critical thinkers, exploring and evaluating pseudotherapies requires a
scientific attitude -- being skeptical but not cynical, and open to surprise
but not gullible.
Pseudotherapies
■ Every therapy, based on testimonials, will seem effective for some
people.
– Placebo effect? Regression toward the mean?
■ For many pseudotherapies, little/no scientific evidence about the
effectiveness exists (uncontrolled exp., unreliable results)
– Hypnotherapy
– Anger-release therapists
– Reflexologists
– Aromatherapists
– Massage therapy
– Herbal medicines
Eye Movement Desensitization
and Reprocessing (EMDR)
■ A therapist attempts to unlock
and reprocess previously frozen
traumatic memories by waving a
finger/flashing a light in front of
the eyes of a person imagining a
traumatic scene.
■ EDMR has its believers and also
its critics.
■ Combination of exposure therapy
(repeatedly reliving traumatic
memories in a safe and
reassuring context) and the
placebo effect?
EMDR
Light Exposure Therapy
■ Light exposure therapy –
exposure to daily timed doses of
light that mimics outdoor light.
–
–
Seasonal affective disorder –
(SAD) a form of depression
linked to periods of decreased
sunlight.
Light comes out of
manufactured light boxes that
can be bought or rented from
health supply and lighting
stores.
■ Research and controlled
experiments suggest that light
exposure therapy diminishes
symptoms associated with SAD.
RELATIVE
EFFECTIVENESS OF
DIFFERENT THERAPIES
Is there a “best” therapy?
Relative Effectiveness
■ Consumer Reports readers reported being
equally satisfied…
– Regardless of therapy type
– Regardless of training level of therapist
(psychiatrist, psychologist, or social worker)
– With both group vs. individual sessions
Relative Effectiveness
■ Therapy is most effective when the problem is
clear-cut and specific.
– Phobias or panic can hope for improvement.
– Less-focused problems, such as depression and
anxiety, usually benefit in the short-run but often
relapse later.
– Those who have chronic schizophrenia or who wish
to change their personality are unlikely to benefit
from psychotherapy alone.
Effective Therapy Depends on
the Problem
Psycho- Humanisitc/ Behavioral
dynamic CCT Therapy Therapies
Depression
X
X
X
Anxiety
X
X
Phobias
OCD
Reducing
suicide risk
X
X
X
X
Cognitive
Therapy
X
X
X
X
When Should You Consider
Therapy?
■ The APA suggests considering seeking a
mental health profession if you display:
Feelings of
hopelessness
Deep and lasting Self-destructive
depression
behaviors
Disruptive fears
Sudden mood
shifts
Compulsive
rituals
Thoughts of
suicide
THE BIOMEDICAL
THERAPIES
“Medicine, the only profession that labors incessantly to destroy the
reason for its existence,”
- James Bryce
Biomedical Therapies
■ Physically change the brain’s functioning…
– Altering chemistry with medication
– Overloading its circuits with electroconvulsive shock
– Using magnetic impulses to stimulate or dampen activity
– Altering its circuits through psychosurgery
Psychopharmacology
■ The study of the effects of drugs on mental processes
and behaviors.
– Led to more independent lives for sufferers of psychological
disorders
– Reduced hospitalization of many people
■ To evaluate the effectiveness of new drugs,
researchers use the double-blind experimental
technique to reduce researcher bias.
Antipsychotic Drugs
Goal
Lessen
responsiveness to
random stimuli by
blocking dopamine
receptors
Useful for…
Schizophrenia
(regulates
dopamine by
blocking it at the
synapse)
Dopamine hypothesis Lessens positive
- schizophrenia is
symptoms
related to overactivity
of dopamine.
= Dopamine
= Antipsychotic
drug
Examples
Thorazine
Clozapine
Risperdal
Zyprexa
AKA Neuroleptics
Tardive Dyskenesia
Negative Effects
Tardive dyskenesia –
involuntary mov’ts of
facial muscles, tongue,
and limbs
Increased risk of obesity
and diabetes
Anti-anxiety Drugs
Goal
Depress central
nervous system
reactivity
Useful for…
Anxiety
Phobias
Examples
Xanax
Ativan
Can help a person learn
to cope with frightening
situations and feartriggering stimuli.
Negative Effects
Can be used as a
crutch, without
actually solving the
root of the anxiety.
Users can become
tolerant, addicted,
and dependent on
the medication.
Anti-depressant Drugs
Goal
Regulate levels of
neurotransmitters
in the brain
(serotonin and
norepinephrine)
that can elevate
mood
Useful for…
Depression
Anxiety
Examples
Selective-serotoninreuptake-inhibitors
(SSRIs) – slow/block
the reabsorption or
reuptake of serotonin
Zoloft
Prozac
Paxil
Negative Effects
Full effects take 4
weeks – high
suicide risk when
starting medication
Mood Stabilizing Drugs
Goal
Stabilize
fluctuating
moods
Useful for…
Bipolar
Disorder
Examples
Lithium
Unclear how it works –
maybe strengthens nerve
connections in brain that
regulate mood?
Negative Effects
Increased thirst
Headaches
Memory loss
Some tremors or
twitches
Brain Stimulation
Goal
“Shock” Trailer
Useful for…
Examples
Send an electric
current through the
brain while the
patient is
anesthetized
Severe
depression that
does not
respond to
meds
Electroconvulsive therapy (ECT)
repeated pulses of
magnetic energy to
the brain
Severe
depression that
does not
respond to
meds
Repetitive transcranial
magnetic stimulation (rTMS) used to stimulate or suppress
brain activity
Alternative to
ECT
Not exactly sure how it works –
maybe calms the area of the
brain that is over active and
causing depression?
•Does not penetrate surface of
brain
•Painless, wide-awake
•No memory loss
•No seizures
Negative Effects
•Memory loss
•Stigmatized (bad
reputation)
Psychosurgery
Goal
Useful for…
Remove or destroy Epilepsy
brain tissue to
change behavior
Examples
Cutting the corpus callosum
Negative Effects
Irreversible – least used
therapy
Lobotomy – NOT performed
anymore
■ Lobotomy – a now-rare psychosurgical procedure that
cut the nerves that connect the frontal lobes to the
emotion-controlling centers of the inner brain.
– Developed in the 1930s
– Shock the patient into a coma
– Hammer an ice pick-like instrument
through each eye socket into the
brain, then wiggle it to sever
connections running up to
the frontal lobes.
Lobotomies
■ Crude but easy and inexpensive
(10 minutes)
■ Tens of thousands of severely
disturbed people were
lobotomized during the 1940s-50s
■ The lobotomy usually produced a
permanently lethargic, immature,
impulsive personality.
■ In the 1950s, calming drugs were
introduced and lobotomized fell
out of favor in the US.
■ Other early therapies
■ Crash Course – Biomedical
Therapies