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Therapy
Chapter 16
OVERVIEW
Psychotherapy
 Evaluating Therapeutic Outcome
 Types of Therapy

Psychoanalytic
 Humanistic
 Behavioural
 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) -

Psychotherapy -
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
Meta-Analyses of Therapy
Outcome

Meta-analysis –

Smith, Glass,& Miller
(1980) conducted the
most comprehensive
meta-analysis of
psychotherapy outcome
research
Evaluating Therapeutic Outcome:
Comparing Different Therapies
The Dodo Bird Verdict
 Dodo
bird
verdict -
Placebo Effects
 A placebo effect is a
 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)





Study by 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 –

Specific Factors – some
treatments do have a
specific effect, being
more effective for some
patients and some
conditions than for
others
Types of Therapy
Psychoanalysis/psychodynamic
Group
Biological
Behaviour
Cognitive
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
 Psychodynamically based 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
Psychodynamic Therapies:
Goal
 Psychoanalytic therapies
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…
Psychoanalytic Therapies:
Techniques
Dream analysis

Based on idea that dreams
are unconscious drives
seeking expression
Psychoanalytic Therapies:
Techniques
 Interpretation
 Defense Mechanisms
Psychoanalytic Therapies:
Processes
 Resistance is
Psychoanalytic 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
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:
 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:
 Congruence
 Empathic listening
Behaviour Therapy
Operant Conditioning
Counterconditioning
Modelling
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,
 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 =
Operant Conditioning:
Examples

Token economy
A system based on positive
reinforcement in which
people who display
appropriate behaviours
receive tokens
 Time-out
Counterconditioning
 Counterconditioning:
 Based on classical
conditioning
 Person is taught a new, more
adaptive response to a
stimulus
 Two types of
counterconditioning:
 Systematic desensitization
 Aversive
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
COGNITIVE THERAPY
Rational-Emotive Therapy
Beck’s Approach
Meichenbaum’s Approach
Cognitive Therapy
Assumption:
Focus:
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:
 Goal:
 4 stages: Awareness,
recognition, substitution, and
Feedback
Meichenbaum’s Approach
 Assumption:
 Goal:
 Anxiety: Stress Inoculation
Biological Therapies
Pharmaceutical
Psychosurgery/ECT
Drug Therapy

No drug will permanently
cure the maladjustment
of people who are not
coping well

Psychotropic drugs:
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

Common Side Effects: headache,
nausea, weight gain, decreased sex
drive

Types: Selective Serotonin Reuptake
Inhibitors – SSRI’s (e.g. Prozac, Zoloft,
Paxil) & SNRI’s (Effexor)
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:

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)
o
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