Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Therapy Lecture Mr. Tatro Revised 2013 “Shorter” Version I. Does Psychotherapy work? A. Effectiveness of Psychotherapy Copy down this graph: B. Why seek help? 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 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? 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? Psychologists Psychiatrists Psychiatric Nurses Counselors Social Workers Marriage & Family Therapists Others Physicians Pastors/Priests Friends / Family IV. Categorizing Therapy Methods 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 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. 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 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 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 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 • • • 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 • • • 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) 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 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 • • 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 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 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 Psychoactive Drugs Electroconvulsive Therapy Psychosurgery A. Psychoactive Drugs 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 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 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 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) 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? 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