Download Psychodynamic therapies

Therapy
Chapter 16
OVERVIEW

Psychotherapy

Evaluating Therapeutic Outcome

Types of Therapy
Psychoanalytic
 Humanistic
 Behavioral
 Cognitive
 Biological

Therapy Comes in Many Forms
 Many forms of treatment are available for
people experiencing psychological difficulties
2 Broad Types of Therapy:
 Somatic therapy (biological)
- treating
psychological disorders by treating the body
 Psychotherapy - the treatment of psychological
problems through psychological techniques
Psychotherapy: Four Areas of
Emphasis

Distorted thoughts

Disturbed emotions (Inner
Conflicts)

Maladaptive behaviours

Interpersonal and
life situation difficulties
Common Themes Among
Psychotherapies

Emotional defusing

Interpersonal learning

Self-knowledge

Therapy as a step-by-step process

Therapy as socially accepted healing
Evaluating Therapeutic Outcome:
Does Psychotherapy Work?
DOES PSYCHOTHERAPY WORK?
 In a 1952 paper, Hans Eysenck
challenged the effectiveness of
psychotherapy
 Eysenck claimed that
psychotherapy produced no
greater change in maladjustment
than natural life experiences
 More recent research found that
Eysenck overestimated the rate of
spontaneous improvement
Meta-Analyses of Therapy
Outcome

Meta-analysis – a statistical
technique by means of which
the results of many different
studies can be combined

Smith, Glass,& Miller (1980)
conducted the most
comprehensive meta-analysis
of psychotherapy outcome
research

Concluded that psychotherapy
works!
Evaluating Therapeutic
Outcome: Comparing Different
Therapies
The Dodo Bird Verdict
 Dodo
bird verdict all the major forms of
psychotherapy are
equally effective.
Placebo Effects
 A placebo effect is a
nonspecific improvement as a
result of a person’s
expectations of change
 Some patients in
psychotherapy may show relief
from their symptoms simply
because they are in therapy
and may expect change
Placebo Effects:
Study by Paul (1966)





Paul (1966) demonstrated placebo effect
in psychotherapy
Students who suffered from severe
anxiety during public speaking were
given 5 sessions of a bogus treatment
The subjects believed the treatment
would help them
When later tested for speech anxiety
these subjects improved considerably
more than an untreated control group
However, research has shown that over
the long term, psychotherapy is more
effective than placebo
Explaining the Dodo Bird Effect

Common Factors – the
various approaches to
psychotherapy share themes
and therefore exert similar
benefits

Specific Factors – some
treatments do have a specific
effect, being more effective
for some patients and some
conditions than for others
Types of Therapy
Psychodynamic
Behaviour
Cognitive
Biological
Psychoanalysis & Psychodynamic
Therapies
Psychodynamic Therapies
 Psychoanalysis
 Developed by Freud
 Insight oriented therapy
 Uses free association, dream analysis, and
transference
 Considerable time/financial investment
 Not commonly used today
 Psychodynamic therapies
 Insight oriented
 Use techniques derived from Freud
 Reject or modify parts of Freud’s theory
 More common than psychoanalysis
Psychodynamic Therapies
Assumptions of insight
therapies:
 Unresolved conflict results
in maladjustment
 Becoming aware of one’s
motivations will result in
more adaptable behavior
Psychodynamic Therapies:
Goal
 Focus:
Attempt to help patients
understand the unconscious
motivations that direct their
behavior
Psychodynamic Therapies:
Techniques

Free Association
 the patient is asked to
report whatever comes to
mind, no matter how
disorganized or trivial
Free association
I feel like crying when …
If I were rich …
My mother…
I feel happy…
Psychodynamic Therapies:
Techniques
Dream analysis

Based on idea that dreams are
unconscious drives seeking
expression

The patient is asked to
describe their dreams in detail

The therapist interprets the
dream
Psychodynamic Therapies:
Techniques
 Interpretation
 providing a context,
meaning, or cause, for an
idea, feeling, or set of
behaviours
 Defense Mechanisms
often used in the
interpretation process
Psychodynamic Therapies:
Processes
 Resistance is an
unwillingness to
cooperate, provide
information, or help in
interpretation
Psychodynamic Therapies:
Processes
 Transference occurs when
the therapist becomes the object of
a patient’s emotional attitudes about
an important person in the patient’s
life
 Countertransference refers to a
therapist’s feelings for a patient that
can awaken elements from the
therapists emotional history
Humanistic Therapies
Humanistic Therapies

Goal is to remove constraints
upon self-fulfillment

Emphasize the ability to reflect on
conscious experience

Assume that humans have free
will and are motivated to fulfill
themselves

Focus on present and future
Client-Centered Therapy
 Developed by Carl Rogers
 Therapists role: to provide a
climate where clients draw upon
their own resources to reach
fulfillment
 Description: insight therapy that
helps people evaluate the world
and themselves from their own
perspective
Client-Centered Therapy:
Techniques
 The goal of client-centered
therapy is to help people
discover their ideal selves
 In client-centered therapy,
the therapist guides clients
to help them find what
they feel is right for
themselves
Client-Centered Therapy:
Techniques
The therapist must demonstrate:
 Unconditional positive regard:
The ability to accept and project positive feelings toward clients
 Congruence
The ability to be honest and aware of their own feelings
 Empathic listening
The ability to sense how their client feels and communicate these
feelings to the clients
Behaviour Therapy
Operant Conditioning
Counterconditioning
Behaviour Therapy: Goals
 Behaviour therapy
focuses on changing overt
behaviour by using
learning principles to help
people replace
maladaptive behaviours
with more effective
behaviours
Behaviour Therapy:
A Criticism
 Most insight therapists believe that if
only overt behaviour is treated,
symptom substitution will occur
 In symptom substitution, a new overt
symptom appears to replace one
eliminated by treatment
 Research does show that behaviour
therapy is at least as effective as
insight therapies
Behaviour Therapy:
Procedures
 Behaviour therapy involves three general
procedures:
1) Examining the problem behavior and its frequency
2) Developing an individually tailored treatment
strategy
3) Continually assessing whether or not the behaviour
has changed.
Behavior Therapy:
Operant Conditioning
 Uses reinforcers to establish
desired behaviours
 Reinforcer = an event or
circumstance that increases the
probability a response will occur
Operant Conditioning:
Examples

Token economy
A system based on positive
reinforcement in which people
who display appropriate
behaviours receive tokens
 Time-out
The removal of a person from
sources of reinforcement to
decrease behaviour
Counterconditioning
 Counterconditioning:
 Based on classical conditioning
 Person is taught a new, more
adaptive response to a stimulus
 Two types of
counterconditioning:
 Systematic desensitization
 Aversive counterconditioning
Systematic Desensitization
 Gradually replacing an undesirable
response (e.g. anxiety) with a
desirable one (e.g. relaxation)
 Client is taught relaxation
strategies, and once relaxed is
exposed to progressively stronger
anxiety-provoking stimuli.
 Two phases:
 In imagination
 In vivo
Aversive Conditioning
 A noxious stimulus is
paired with a stimulus that
elicits an undesirable
behaviour
Group Activity & Assignment

Select an undesirable behavior and develop a simple
behavior modification plan using a number of the
techniques that we just discussed.

Select someone in your group to write it up:

Make sure you include:
What behavior you are trying to change
What techniques you will use
How you will know when it has been changed
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COGNITIVE THERAPY
Rational-Emotive Therapy
Beck’s Approach
Meichenbaum’s Approach
Cognitive Therapy
Assumption: distorted ideas
prevent people from establishing
effective coping behaviours
Focus: changing client behaviour
by changing the person’s
thoughts or perceptions
Cognitive Therapy
Propositions:
1. Cognitions affect behaviour
2.
Cognitions can be monitored
3.
By changing cognitions, we can
change behaviour
Rational Emotive Therapy
 best known cognitive therapy developed by
Albert Ellis
 emphasizes the importance of logical,
rational thought processes
 assumed abnormal behaviour is caused by
faulty and irrational thinking patterns
 “What disturbs people’s minds is not
events but their judgements on
events”….Epictectus, 100 A.D.
Beck’s Approach
 Assumption: depression caused by
distorted thoughts about reality that
lead to pervasive negative views
 Goal: help people develop realistic
appraisals of situations
 4 stages: Awareness, recognition,
substitution, and Feedback
Meichenbaum’s Approach
 Assumption: what people say to
themselves determines what they
do
 Goal: to change what people say to
themselves
 Sequence: 1. Cognitive Prep., 1.
Skill Acquisition, 3. Application &
practice
Biological Therapies
Pharmaceutical
Psychosurgery/ECT
Drug Therapy

No drug will permanently
cure the maladjustment
of people who are not
coping well

Psychotropic drugs:
Drugs for the relief of
mental problems
Antianxiety Drugs

Anxiolytics

Mood-altering

neurotransmitter (GABA)

e.g. Librium, Xanax, and Valium:

Long-term use without adjunct
therapy ill-advised
Antidepressants

Thymoleptics

Elevate mood, alter levels of brain
chemicals

Types: Selective Serotonin Reuptake
Inhibitors – SSRI’s (e.g. Prozac, Zoloft,
Paxil) & SNRI’s (Effexor)

Common Side Effects: headache,
nausea, weight gain, decreased sex
drive
Antimania Drugs

Lithium carbonate has long
been used as an effective
antimania drug

Thymoleptic

Importance of dosage

Side Effects
Antipsychotic Drugs

Neuroleptics

Treat Schizophrenia

Reduce hostility, aggression, and delusions

Neurotransmitter - Dopamine

Phenothiazine (e.g. Thorazine)

Issues: not helpful for all symptoms, side effects
Psychosurgery

Psychosurgery: brain surgery

Prefrontal Lobotomy: removal of
parts of the brain’s frontal lobes
thought to alleviate symptoms of
mental disorders done in the 1940s
and 50s

Prefrontal lobotomies made some
people become unnaturally calm and
completely unemotional
Electroconvulsive Therapy
Electroconvulsive therapy (ECT)

An electric current is briefly applied
to the head to produce a
generalized seizure (convulsion)

was once widely employed with
depressed people

Today, ECT is not a widely used
therapy
HAVE A GOOD WEEK!!!!