Download Lecture Outline Therapy Mr. Tatro Revised 2009

Therapy
Lecture
Mr. Tatro
Revised 2013
“Shorter” Version
I. Does Psychotherapy work?
A. Effectiveness of
Psychotherapy
Copy down this graph:
B. Why seek help?
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People have problems that vary in type and
severity:
 suicidal, depressed, manic, hallucinating,
etc.
 dealing with life choices, marital conflict
 picking a major, test anxiety
 time management, social skill training
People regularly get help for medical issues
 major diseases like cancer, AIDS, etc.
 Even minor issues like colds & acne
 Is plastic surgery a medical or
psychological issue?
C. Why people don’t seek
therapy
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Society stigmatizes people
Mental Illness often seen as a sign of
weakness (We don’t try to ‘tough out’
leukemia!)
Compared to a typical physical illness,
mental illness can affect who we think
we are (I’m NOT crazy)
Individualistic society
II. Diathesis-Stress Model
- Why do some people get mental
disorders and some don’t?
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Some mental illnesses are triggered primarily by
genetic factors (ex: Schizophrenia) while others
are primarily learned or environmental
(ex: Anorexia)
Most mental illnesses, however, are a result of the
combination of genetics and learning (environment).
Whether an individual gets a mental illness or not
depends on which factors affect them most.
Diathesis Stress Chart
Amount of Stress

Environmental Factors
Genetic
Predisposition
* High
High
High
Low
Low
High
• Low
Low
* Most likely
to get a
mental
disorder
• Least
Likely to get
a mental
disorder
Visual Analogy.
Boat =
Low Genetic
Predisposition
Visual Analogy.
Log = High
Genetic
Predisposition
III. Who provides treatment?
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Psychologists
Psychiatrists
Psychiatric Nurses
Counselors
Social Workers
Marriage & Family Therapists
Others
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Physicians
Pastors/Priests
Friends / Family
IV. Categorizing Therapy
Methods
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Insight Therapies:
Treatment by thinking
Behavior Therapies:
Treatment by doing
(learning)
Biomedical Therapies:
Treatment by affecting
the body
V. Commonalities for ALL
successful Therapists:
1. Hope for demoralized people.
2. Client gets a new perspective
on themselves and the world.
3. Therapist forms an empathic,
trusting and caring relationship.
VI. Psychoanalysis
– Based on Freud’s Ideas
A. Assumptions:
1. Psychological problems are caused
by childhood’s supposedly repressed
impulses and conflicts.
2. Psychoanalysts try to bring these
feeling into conscious awareness – to
gain insight into the origins of the
disorder.
3. Patient works through buried
feelings which releases mental
energy used up by id-ego-superego
conflicts.
4. People are basically animalistic with
a thin shell of civilization trying to
contain our basic aggressive and
sexual urges.
B. Methods
1. Free association
Sounds easy, but you start to edit yourself.
Blocks in free association are called
Resistances.
2. Interpretations – suggestions of underlying
wishes, feelings and conflicts that lead to
insight.
3. Analyze latent content in dreams.
4. Transference
Patient experiences strong positive or
negative feelings toward therapist; this is
usually encouraged.
Allows patient to express repressed feelings
toward important people in their life letting
them work through these feelings.
Therapist as substitute parent.
C. Contemporary Variations

Neo-Freudians focus more on current problems & use
the ego to solve problems.
 More interactive
 Face-to-face
 Danger of ‘counter-transferance’:
Term used by Freud to mean emotional reactions to a patient
that are determined not by the patient's own personality
traits and disorders, but rather the psychoanalyst's own
unconscious conflict. This term was later used to assume a
broader meaning of unconscious and unwanted hostile
feelings toward a patient. These feelings are seen to get in
the way of the treatment of the patient.

Object Relations Therapy: conflicts come from a need
for more supportive relationships
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Therapists take a more active roll
The theory demonstrates the dynamic process of
developing a mind as one grows in relation to real
people in the environment. The "objects" being
referred to are both people in one's world, and
one's internalized images of these people. Object
relationships are initially formed during early
interactions with the primary care givers. These
early patterns can be altered with experience, but
often continue to exert a strong influence
throughout life.
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There are many variations on these
themes (ego analysis, interpersonal
therapy, individual analysis, etc.) and
connections can be seen to humanistic
and cognitive perspectives.
However, they share characteristics in
that they are less time-intensive and
more collaborative than traditional
Freudian Psychoanalysis.
D. Criticisms
 Based
on repressed memories,
interpretations are hard to refute – “No,
I don’t hate my mother” – “you are just
resisting” – “I am not” – “now you are in
denial!”
 Slow
and expensive, more therapist
oriented

based on Medical Model.
VII. Humanistic Therapies
(Phenomenological)
A. Abraham Maslow (Theory)
The Hierarchy of Needs:
B. Characteristics of
self-actualizing people
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Peak experiences
Open and spontaneous
Self accepting and Self Aware
Loving and Caring
Mission in Life
Problem centered, not
self centered
C. Carl Rogers (Therapy)
- Rogers took Maslow’s theories and applied them to
therapy.
 Assumptions:
- Boost self-fulfillment by helping people
grow in self-awareness and selfacceptance.
- People are basically good.
D. Humanistic therapists focus
on:
1. Present instead of past.
2. Awareness of feelings as they occur
rather than getting insight into
childhood origins of feelings.
3. Conscious vs. unconscious thoughts.
4. Taking immediate responsibility for one’s
feelings and actions rather than uncovering
hidden causes.
5. Promoting growth and fulfillment instead of
curing illness.
6. The self as the central feature of
personality.
a) Ideal self vs. Actual self
b) Hazel Marcus: Possible Selves. Self as the
organizer of our thoughts, feelings and actions.
•
Self as the pivotal center of personality.
7. High and Low Self Esteem
a) Accept yourself it is easier to accept
others.
b) Self-serving Bias: Thinking has a natural
positive bias that doesn’t necessarily
reflect reality.
•
90% of college professors rated themselves
as being “above average”.
•
Depressed people are more realistic in their
self assessments than non-depressed people.
•
“Life is the art of being well-deceived.”
E. Person-Centered Therapy –
Therapeutic Relationship
1. Non-directive:
Therapist listens, without judgment or
interpretation – does not direct toward certain
insights.
2. Unconditional positive regard:
3 Aspects: Acceptance, Genuineness, Empathy.
(A.G.E.)
3. Active listening:
Echoing, restating, seeking clarification of what
the CLIENT expresses.
4. Psychological mirror
A. Help client see themselves more clearly
B. Client realizes that the Therapist sees
them as a valuable and worthy person;
despite their faults.
C. Client comes to see themselves that way as
well.
• Grace filled environment.
F. Criticisms
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View that all humans are born basically good.
Therapy is so non-directive that some clients
get frustrated.
Difficult to make the emotional commitment
required in a therapeutic relationship to ALL
clients.
VIII. Gestalt Therapies
Fritz Perls
(Humanistic Also)
A. Goals:
Combines the psychoanalytic emphasis on
recovering unconscious feelings with the
humanistic emphasis on getting in touch
with oneself and taking responsibility for
the present.
B. Methods
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Break through Defenses.
Help sense and express moment to
moment feelings.
Role-play relationships, act out
suppressed feelings.
C. Criticisms
 Combining
what many
psychologists would consider to
be diametrically opposed
psychological theories.
IX. Behavior Therapies
A. Assumptions and Goals:
1. Behavior Therapists doubt “self-awareness”
or “insight” are the key to fixing
psychological problems.
2. They assume the problem behaviors ARE
the problem.
3. Apply well-established learning principles to
eliminate the unwanted behaviors.
4. Historically Behaviorist’s goal was to make
Psychology into a science – to counter the
non-scientific theories of the Freudian
(Psychodynamic) therapists.
B. Classical Conditioning Techniques
(Pavlov)
1. Counter-conditioning - Phobia of elevators
Pairs the trigger stimulus (elevator) with a
new response (relaxation response) that is
incompatible with Fear (old response). You can
not be simultaneously anxious and relaxed.
A. Systematic Desensitization
Create an Anxiety Hierarchy.
Use: Progressive Relaxation.
B. Aversive conditioning
Replace a positive response to a harmful stimulus
with a negative (aversive) response.
 Pair alcohol and sickness; smoking and electric
shock.
2. Flooding
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Rapid exposure to fear producing stimulus (Strap
you down and dump a box of spiders on your head!)
Response prevention
Similar to catharsis (with similar dangers)
3. Implosive Therapy
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Similar to flooding
Imaginary, but vivid and exaggerated
“Flight into health” The sooner you get better the
fewer sessions you have to endure.
4. This is the opposite of systematic
desensitization, the focal point here is overload.
5. It is controversial and can have the opposite
effect of what is intended
C. Operant Conditioning
(Skinner)
1. Behavior Therapists:
Reinforce desired behaviors and withhold
reinforcement for undesired behaviors.

(Intensive, 2 yr. 40 hr./week program for Autistic
Children. 9 of 19 normal – 1 in 40 without.)
2. Token Economy
Display appropriate behavior, receive token –
traded in later for rewards or privileges.
D. Modeling (Bandura)
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Client observes others perform desired
behavior
Participant modeling - start watching,
then participate, then take over main
role.
Part of assertiveness and social skills
training
E. Criticisms
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Doesn’t work for all types of disorders.
These all rely on the principles of learning
theory which has difficulty explaining complex
motivations
What happens when reinforcement stops?
Rewards must become intrinsic or social.
Does not take into account impact of cognitive
processes.
Ethical to control another human being?
Mechanistic, no room for Humanness.
X. Cognitive Therapies
(Developed first for treating Depression)
A. Assumptions
1. Thinking affects our feelings.
2. If depressing thought patterns are learned,
they can be replaced by new learning.
3. Cognitive Restructuring: People can be taught
new, more constructive ways of thinking
Cognitive Therapy

The
Cognitive
Revolution
B. Rational – Emotive Therapy
Albert Ellis
 Assumptions
1. Problems arise from irrational thinking.
2. Irrational thought patterns can be
exposed and annihilated by the
therapist.
C. Other Cognitive Therapies
(Mostly used for treating Depression)
1. Aaron Beck
• Kinder/Gentler Rational-Emotive.
• Reverse Clients catastrophizing beliefs
about themselves, their situations and
futures.
2. Cognitive Behavioral Therapy
(most popular of the cognitive
Therapies)
• Change negative thoughts.
• practice more positive behaviors.
• Treat problems in everyday settings outside
of therapy.
3. Stress Inoculation Training
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•
Client imagines stressful situation
Practice skills to reduce stress
4. Emphasis in all of these is that it is more
how we think about things and less the event
itself that is the problem
5. Requires person to recognize & change
perceptions and evaluations
D. Criticisms
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Doesn’t work for all
types of disorders.
Newest of the major
perspectives, not as
much data to support
theories, but lots of
new research in this
area.
XI. Eclectic Approach
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What most therapists use today.
Anyone trained in the last 15 years has
been taught to use what works - for
both the patient and the therapist.
Over time the perspectives have been
merging - taking the best of what is out
there and applying what works based on
the research.
XII. Biomedical Therapies
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Psychoactive Drugs
Electroconvulsive
Therapy
Psychosurgery
A. Psychoactive Drugs
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Idea: Disorders stem
from imbalances in body
chemistry
Methods: Reuptake
inhibitors, mood
stabilizers, blockers
Major drug types:
Antipsychotics,
antidepressants, lithium
salts, tranquilizers
Status: Meant as
adjunct to other
therapies but use is
increasing dramatically
B. Impact of Psychoactive Drugs
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The emptying of U.S. mental hospitals
State and county
mental hospital 700
residents, in 600
thousands
500
Introduction of antipsychotic drugs
Rapid decline
in the mental
hospital
population
400
300
200
100
1900 1910 1920 1930 1940 1950 1960 1970 1980 1990
Year
C. Electroconvulsive Therapy
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Idea: Electric current
causes a convulsion, EEG
patterns can change as
result.
Relieves severe
depression that hasn’t
responded to therapy or
drugs.
Methods: Mild current
applied to scalp
Status: Treatment of
last resort.
Causes short term
memory loss.
D. Psychosurgery
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Idea: brain areas are
destroyed to treat
disorders
Methods: Probes,
scalpels, electrodes
Major concepts:
prefrontal lobotomy,
cingulotomy
Status: Irreversible.
Used vary rarely,
replaced by
psychoactive drugs
E. Repetitive Transcranial
Magnetic Stimulation (rTMS)
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noninvasive method to excite
neurons in the brain.
weak electric currents are
induced in the tissue by
rapidly changing magnetic
fields (electromagnetic
induction).
This way, brain activity can
be triggered with minimal
discomfort, and the
functionality of the circuitry
and connectivity of the brain
can be studied.
Used to treat depression,
being assessed for many
other disorders.
XIII. Do they work?
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Psychotherapy produces improvement
more than no treatment (Placebo effect?)
No single type of therapy is generally
superior
Many therapies are used in conjunction
with drugs
In most cases drugs are meant to be a
short-term solution (Treating symptom,
not cause)
Therapies are often combined, and many
variations exist

Some types of therapy work best with
specific kinds of disorders or problems.
a. Cognitive and behavioral therapies
work best for fear and anxiety.
b. Humanistic therapy works best for
raising self-esteem.
c. Psychodynamic therapies work best
for achievement problems and
addictions.
d. Cognitive therapy works best for
depression