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Therapy
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1. Who was Philippe Pinel and Dorothea Dix? (605)
2. Describe the following professions: (627)
1.
2.
3.
4.
Counselors
Social Workers
Clinical Psychologists
Psychiatrist
History of Therapy
Philippe Pinel: France
Dorothea Dix: US/CA
founded humane movements to care for the
mentally sick.
Therapists & Their Training
Clinical psychologists: They have PhDs mostly.
They are experts in research, assessment, and
therapy, all of which is verified through a
supervised internship.
Clinical or Psychiatric Social Worker: They have
a Masters of Social Work. Postgraduate supervision
prepares some social workers to offer psychotherapy,
mostly to people with everyday personal and family
problems.
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Therapists & Their Training
Counselors: Pastoral counselors or abuse
counselors work with problems arising from
family relations, spouse and child abusers and
their victims, and substance abusers.
Psychiatrists: They are physicians who specialize in
the treatment of psychological disorders. Not all
psychiatrists have extensive training in psychotherapy,
but as MDs they can prescribe medications.
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Therapies
I. Psychotherapy involves an emotionally charged,
confiding interaction between a trained therapist
and a mental patient.
II. Biomedical therapy uses drugs or other
procedures that act on the patient’s nervous
system, treating his or her psychological disorders.
III. An Eclectic approach uses various forms of
healing techniques depending upon the client’s
unique problems.
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Insight Therapies
• Insight therapies –
Psychotherapies in which the therapist helps
patients/clients understand (gain insight into)
their problems
• A therapist and client work together with the
goal of identifying the problem and reaching a
possible solution
Freudian psychoanalysis
Neo-Freudian therapies
Humanistic therapies
Cognitive therapies
Group therapies
Copyright © Allyn & Bacon 2007
The Psychological Therapies
Psychoanalysis
Humanist
Cognitive
Behavioral
Group
Psychoanalysis
• Psychoanalysis
Sigmund Freud’s therapeutic
technique. Freud believed the patient’s free
associations, resistances, dreams, & transferences –
& the therapist’s interpretations of them – released
previously repressed feelings, allowing the patient to
gain self-insight.
• When energy devoted to id-ego-superego conflicts is
released, the patient’s anxiety lessens.
• Aims of therapy
– Childhood impulses & conflicts
Psychoanalysis
Methods
– Free association--The patient lies down, out of
sight, and starts talking about anything,
randomly reporting any feelings or thoughts.
– Resistance in psychoanalysis, the blocking from
consciousness of anxiety-laden material
• Interpretation in psychoanalysis, analyst’s
noting supposed dream meanings,
resistances, & other significant behaviors &
events in order to promote insight of
the meaning
Psychoanalysis:
Methods at work
During free association, the patient edits his
thoughts, resisting his or her feelings to express
emotions. Such resistance becomes important
in the analysis of conflict-driven anxiety.
Eventually the patient opens up & reveals his or
her innermost private thoughts, developing
positive or negative feelings (transference)
towards the therapist.
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Humanistic Therapies
focus more on:
–the present rather than the past
–conscious rather than the unconscious
–taking immediate responsibility
–promoting growth instead of curing
Humanistic Therapies
• Client-centered therapy (AKA person-centered therapy.)
Humanistic therapy, developed by Carl Rogers, the therapist
uses techniques such as active listening within a genuine,
accepting, empathic environment to facilitate client’s growth.
– Nondirective therapy: no interpretation. No insight.
– Genuineness, acceptance, & empathy
– Active listening empathic listening in which the listener
echoes, restates, & clarifies.
• Paraphrase
• Invite clarification
• Reflect feelings
Ex: School Councilors
– Unconditional positive regard: is basic acceptance and support of a
person regardless of what the person says or does
Behavior Therapies
• Behavior Therapy- therapy that applies learning principles to the
elimination of unwanted behaviors.
Focus: the ACTION, not the thought patterns associated with the
behavior, doesn’t look for the “inner cause”
– Classical conditioning techniques
• We learn various behaviors & emotions via classical
conditioning
– Operant conditioning techniques
• Behavior modification – reinforces desired behaviors &
withholding reinforcement for undesired behaviors or
punishments
Behavior Therapies
I. Classical Conditioning Therapies
Counterconditioning The patient comes in with a
stimuli that triggers unwanted behaviors. This
procedure tries to condition new responses to the
stimuli
– Very effective with phobias
1. Exposure Therapies: behavior therapy procedure that
uses classical conditioning to evoke new responses to
stimuli that are triggering unwanted behaviors; Includes
• Systematic desensitization
• Virtual reality exposure therapy
2. Intensive Exposure therapy
3. Aversive conditioning
1. Exposure Therapy
Expose patients to things they fear and avoid.
Through repeated exposures, anxiety lessens because
they habituate to the things feared.
Can be in real or virtual environments.
• Virtual reality Exposure Therapy
N. Rown/ The Image Works
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Systematic Desensitization
A method in exposure therapy that associates a
pleasant, relaxed state with gradually increasing
anxiety-triggering stimuli commonly used to treat
phobias.
• Fear Hierarchy
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2. Intensive Exposure Therapy
(Flooding)
The Far Side © 1986 FARWORKS. Reprinted with Permission. All Rights Reserved.
Expose patients to
things they fear and
avoid. Through
repeated exposures,
anxiety lessens
because they habituate
to the things feared.
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3. Aversive Conditioning
A type of
counterconditioning
that associates an
unpleasant state with
an unwanted behavior.
With this technique,
temporary
conditioned aversion
to alcohol has been
reported.
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Behavior Therapies
II. Operant Conditioning
Behavior modification- reinforce desired behaviors
withholding reinforcement for undesired behavior or punishment.
Can work b/c a behavior strongly influenced by consequences.
(effective with autism, retardation, schizophrenia).
• Rewards used to modify behavior vary from praise, to attention
to more concrete rewards, food.
– Raises ethical Questions
1. Token economy operant conditioning procedure.
People earn a token of some sort for exhibiting a desired
behavior & can later exchange tokens for various
privileges/treats. Successful in various settings, cultures, &
many mental disorders.
Token Economy
2. Behavior Contracting
Therapist and the client agree on behavior goals
and on the reinforcement usually in the form of
a contract with punishments and rewards.
(Example behavior plans in school)
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Cognitive Therapies
Cognitive therapy that teaches people new,
more adaptive ways of thinking & acting; based
on the assumption that thoughts intervene
between events & our emotional reactions
Cognitive Therapy
Aaron Beck’s Therapy for Depression
Aaron Beck (1979) suggests that depressed
patients believe that they can never be happy
(thinking) and thus associate minor failings (e.g.
failing a test [event]) in life as major causes for
their depression.
Beck believes that cognitions such as “I can never be
happy” need to change in order for depressed patients
to recover. This change is brought about by gently
questioning patients.
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Cognitive Therapy
Aaron Beck’s therapy for depression
• Catastrophizing beliefs- recurring negative themes
of loss, rejection, abandonment, self-blaming & over
generalizing that perpetuate existing feelings of
depression
• Cognitive-behavioral therapy popular integrative
therapy that combines:
– cognitive therapy (changing self-defeating
thinking)
– behavior therapy (changing behavior).
– Seeks to restructure thinking (retrain) people to
restructure negative thinking
Cognitive Therapy
Albert Ellis
• Rational Emotive Behavior Therapy (REBT)
– Directly confronting patients about their irrational thinking
and irrational beliefs.
ABCDE Model
– Activating events (what activates the negative thought)
– Beliefs (Negative beliefs about ourselves or others)
– Consequences (Emotional and behavioral reactions)
– Disputing irrational beliefs (Confront irrational beliefs)
– Effective new beliefs (Positive beliefs)
– https://www.youtube.com/watch?v=Vzp-7-LKQIs
Cognitive Therapy
Teaches people adaptive ways of thinking & acting
based on the assumption that thoughts intervene
between events & our emotional reactions.
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The Relative Effectiveness of Different
Therapies
Which psychotherapy would be most effective
for treating a particular problem?
Disorder
Therapy
Depression
Behavior, Cognition, Interpersonal
Anxiety
Cognition, Exposure, Stress Inoculation
Bulimia
Cognitive-behavior
Phobia
Behavior
Bed Wetting
Behavior Modification
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Group Therapy
Group therapy normally consists of 6-9 people
attending a 90-minute session
If the problems are interpersonal then why not
broaden the therapy?
Positives:




behaviors towards others show up quickly in a group setting
client social support, not only one with this problem,
learn new behaviors
seeing others will help insight,
 Clients benefit from knowing others have similar problems.
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Family Therapy
• Goal: To change all family members’ behavior to the benefit
of the family unit as well as the troubled individual.
• Method:
– If one person is having problems, then it is likely the whole family is.
– Must improve communication, empathy, responsibility, and reduce
conflict.
– Requires that all family members see the benefits.
– Focus on changing self not others.
• Concerns: Key person won’t come or monopolizes the
sessions.
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Couple Therapy
• Goal: To improve a couple’s problems in communication,
interaction, and mutual expectations.
• Method:
– Empathy Training – each is taught to share the inner feelings and to
listen to and understand the partner’s feelings before responding.
– Behavioral Techniques – schedule for caring actions
– Cognitive Techniques – tries to dispel the cognitive distortions that
disrupt communication
• Concerns: Much more affective when it is two instead of one
(56% vs. 29%)
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Self-Help Groups
• Goal: Low cost support and social network for a
disorder
• Method:
– Since 40 million Americans suffer from some form of
psychological disorder there are not enough psychologists
to go around and they are expensive.
– These small local gatherings of people share a common
problem and provide mutual assistance at a very low cost.
• AA is the best known.
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Evaluating Psychotherapies
Within psychotherapies cognitive therapies are most widely used, followed by
psychoanalytic and family/group therapies.
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The Biomedical Therapies
These include physical, medicinal, and other
forms of biological therapies.
1. Drug Treatments
2. Surgery
3. Electric-shock
therapy
Used if:
1. The client is too agitated, disoriented, or unresponsive for
psychotherapy.
2. The disorder has a strong biological component.
3. Dangerous to themselves or others.
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I. Antipsychotic Drugs
Classical antipsychotics [Thorazine (Chlorpromazine)]:
Remove a number of positive symptoms associated
with schizophrenia such as agitation, delusions, and
hallucinations.
Atypical antipsychotics [Clozapine (Clozaril)]:
Remove negative symptoms associated with
schizophrenia such as apathy, jumbled thoughts,
concentration difficulties, and difficulties in
interacting with others.
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Atypical Antipsychotic
Clozapine (Clozaril) blocks receptors for
dopamine and serotonin to remove the negative
symptoms of schizophrenia.
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• tardive dyskinesia
– side effect for long-term use of antipsychotic
drugs that target D2 dopamine receptors.
– involuntary movements of the facial muscles,
tongue, and limbs
II. Antianxiety Drugs
Antianxiety drugs (Xanax and Valium)
depress the central nervous system and reduce
anxiety and tension by elevating the levels of the
Gamma-aminobutyric acid (GABA)
neurotransmitter. GABA is the chief inhibitory
neurotransmitter in the CNS
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III. Antidepressant Drugs
Antidepressant drugs like Prozac, Zoloft, and
Paxil are Selective Serotonin Reuptake
Inhibitors (SSRIs) that improve the mood by
elevating levels of serotonin by inhibiting
reuptake. MAO Inhibitors increase the
concentration of serotonin
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IV. Mood-Stabilizing Medications
Lithium Carbonate, a common salt, has
been used to stabilize manic episodes in
bipolar disorders. It moderates the levels of
norepinephrine and glutamate
neurotransmitters.
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Brain Stimulation
Electroconvulsive Therapy
(ECT)
ECT is used for severely
depressed patients who do
not respond to drugs. The
patient is anesthetized and
given a muscle relaxant.
Patients usually get a 100
volt shock that relieves
them of depression.
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Brain Stimulation
Alternative Neurostimulation Therapies
• Magnetic Stimulation
–Repetitive transcranial magnetic
stimulations (rTMS) - the application of
repeated pulses of magnetic energy to the
prefrontal regions brain;
used to stimulate
or suppress brain activity
• Deep-Brain
Stimulation
Brain Stimulation
Alternative Neurostimulation Therapies
Psychosurgery
http://www.epub.org.br
Psychosurgery was
popular even in
Neolithic times.
Although used sparingly
today, about
200 such operations do
take place in the US
alone.
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Psychosurgery
Psychosurgery is used as a last resort in alleviating
psychological disturbances.
Psychosurgery is irreversible. Removal of brain tissue
changes the mind.
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Psychosurgery
• Psychosurgery surgery that removes or
destroys brain tissue in an effort to change
behavior
–Lobotomy a now-rare psychosurgical procedure
once used to calm uncontrollably emotional or
violent patients. The procedure cut the nerves
connecting the frontal lobes to the emotioncontrolling centers of the inner brain
• History
• Procedure
• Side effects
• Use today
Psychosurgery
http://www.epub.org.br
Modern methods use
stereotactic
neurosurgery and
radiosurgery (Laksell,
1951) that refine older
methods of
psychosurgery.
http://www.epub.org.br
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Psychological Disorders are
Biopsychosocial in Nature
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