Download Psychology 120 – Module #33 Psychological Therapies Semester 2

Psychology 120 – Module #33 Psychological Therapies
Semester 2- 2017
Blake
Essential Question: How can disorders be treated psychologically?
Student outcomes: At the end of this module, students will be able to:
1. Describe how mental disorders develop, according to Sigmund Freud.
2. Identify the techniques used in psychoanalysis to reveal and resolve conflicts.
3. Compare and contrast psychodynamic and interpersonal therapies with
psychoanalysis.
4. Differentiate between psychoanalytic and humanistic therapies.
5. Define unconditional positive regard, determining why it is important to
humanistic therapy.
6. Differentiate behaviour therapies from humanistic therapies.
7. Determine the basic assumptions underlying behaviour therapy based on
classical and operant conditioning.
8. Analyze how cognitive therapies help patients with depression.
9. Explain the advantages of group therapy and when group therapy is most often
used.
10. Evaluate the benefits of all therapies for people.
11. Evaluate the effectiveness of online psychotherapy.
Vocabulary: Are you familiar with these terms?
Psychotherapy Transference Systematic desensitization Cognitive-behaviour
therapy Eclectic approach Client centered therapy Aversive conditioning
Family therapy Psychoanalysis Active listening Token economy Sigmund Freud
Resistance Behaviour therapy Cognitive therapy Carl Rogers Interpretation
**Introductory Group Discussion: Assume the role of therapists. Imagine that a friend
has exhibited behaviours that would lead them to diagnose clinical depression. As their
friend’s therapist, develop some possible interventions.
Therapy sometimes involves prescription medications and even medical
procedures in severe cases but more often, it involves non-medical options which
are the focus of this module.
Psychological therapy or psychotherapy is an emotionally charged, confiding
interaction between a trained therapist and someone who suffers from psychological
difficulties. There are approximately 250 types of psychotherapy, but each centers on
one or more of four major approaches: psychoanalytic, humanistic, behavioural and
cognitive. Depending on the person’s problems, a therapist may use techniques from
various forms of therapy in an eclectic approach.
** Assignment – Seeking Help – Are You Covered?
Psychoanalysis
Psychoanalysis is a theory of personality and a therapeutic technique that attributes
thoughts and actions to unconscious motives and conflicts. Even though few therapists
practice psychotherapy the way Freud did at the turn of the century, his influence is easy
to spot in the treatment methods of several current therapies.
Review and summarize psychoanalytic assumptions pg. 588 text (include diagram
of Freud’s view of the mind)
Psychoanalytic Methods
Psychoanalysis aims to dig up the past to clarify the present. Analysts dig with several
different therapeutic tools:
Free association – method of exploring the unconscious in which the person relaxes
and says whatever comes to mind, no matter how trivial or embarrassing.
Resistance – is the blocking from consciousness of anxiety laden material. The patient
may hesitate, leave something out of the story, change their story or joke their way out
of the situation.
Interpretation – the analyst’s of noting ideas on the meaning behind dreams,
resistances and other significant behaviours to promote insight.
Transference – the patient’s transfer of strong emotions (such as love or hatred) linked
with other relationships to the analyst. Freud felt that patients could gain insight into
current and past relationships by exploring these transferred feelings for their analyst
and dealing with the long repressed issues they represent.
Freud’s ideas have influenced therapy but contemporary critics of psychoanalysis noted
several problems with Freud’s work:
1.
2.
3.
The Psychodynamic Perspective
Few therapists practice strict psychoanalysis today, Freud’s theories and techniques have
broadly influenced many therapists’ work. These therapists make psychodynamic
assumptions (related to psychoanalysis). They try to understand a person’s problems by
looking at childhood experiences, unconscious drives and unresolved conflicts. They
would have weekly meetings over the period of a few months compared to a few years,
as Freud would have requested.
Freud’s techniques also influenced Interpersonal psychotherapy – therapists using this
12-16 session method try to foster insights into the origins of a problem, but they focus
on what’s going on in the patient’s life now, rather than trying to untie the knots of a
childhood conflict. This type of therapy asks how current relationships can be mended
and social skills improved.
** Read examples on Serena pg. 591-592 text
Humanistic Therapies
To a humanistic therapist, the potential for self-fulfillment already exists in each of us.
Humanistic therapy aims to promote self-fulfillment by increasing self-acceptance and
self-awareness. Humanists differ from psychoanalysts in their approach to therapy by:
1.
2.
3.
Humanistic therapists typically use nondirective methods. Therapists listen without
interpreting and do not direct clients to any particular insight.
Carl Rogers developed the most famous form of humanistic therapy – Client-centered
therapy. This type of therapy uses active listening within as genuine, accepting and
empathic environment to facilitate the client’s growth. Rogers believed that for client
centered therapy to be successful, therapists must provide a supportive environment
that includes active listening, where the therapist echoes, restates, and then clarifies
the client’s thoughts and feelings:
Echoing feelings – The therapist mirrors the feelings of the client with statements like
“That must be really frustrating.”
Restating – The therapist uses the words of the client to summarize the conversation.
Clarifying – The therapist encourages the client to say more by asking questions like
“Could you give me an example of what you’re saying?”
The therapist is accepting and understanding while becoming the client’s psychological
mirror. The goal of the type of therapy is for the client to be able to see himself more
clearly at the conclusion of therapy. Example from text – pg. 593
Rogers believed a key element of therapy was that the client should feel unconditional
positive regard, a feeling of being accepted that does not depend on any specific
behaviours. Rogers believed that this feeling would follow from the therapist’s nonjudgemental, accepting environment. Unconditional positive regard allows clients to
feel valued and to accept themselves.
**Activity – Handout – The Self-Concealment Scale
Behaviour Therapies
Behaviour therapy applies learning principles to the elimination of unwanted
behaviours. Both classical conditioning and operant conditioning principles have
contributed to the behaviour therapy methods.
Classical Conditioning Techniques
Classical conditioning is a type of learning in which we associate two things that occur
together. For example, we can learn to associate most emotions with behaviours, such
as fear with public speaking. If we can learn such fears, can we “unlearn” them? In some
cases, yes, through the process of counterconditioning, a behaviour therapy technique
that teaches us to associate new responses to places or things that have in the past
triggered unwanted behaviours. Two popular counterconditioning techniques are
systematic desensitization and aversive conditioning.
1. Systematic Desensitization – is a type of counterconditioning that associates a
pleasant, relaxed state with gradually increasing, anxiety-triggering stimuli. For
example, fear of flying. Patients work through a hierarchy of anxiety producing
events associated with flying and learn to relax at each level of the hierarchy. The
idea being that you can’t be anxious and relaxed at the same time. Read example
pg. 595-596- text.
** Relaxation Handout – 32-10
A newer option is a virtual reality exposure therapy. Clients would wear a
head-mounted display unit that projects a three-dimensional virtual world and
would view a lifelike series of scenes. For example, someone being treated for
fear of flying would peer out a virtual window of a stimulated plane, feel the
vibrations and hear the engine roar as the plane taxis down the runway and takes
off.
**Group activity on systematic desensitization
2. Aversive Conditioning – is a type of counterconditioning that associates an
unpleasant state (nausea) with an unwanted behaviour (drinking alcohol). This
process is the opposite of systematic desensitization - which replaces a negative
(fearful) response with a positive (relaxed) response. Aversive conditioning
replaces a positive response to a harmful experience (drinking alcohol) with a
negative (aversive) response. For example, alcoholics agree to have a substance
put in their drink that makes them vomit. In theory, these people associate the
vomiting with drinking and become less inclined to drink substances containing
alcohol.
Operant Conditioning Techniques
Our voluntary behaviours are greatly influenced by their consequences. Therapists have
applied this basic principle of operant conditioning to help people solve problems at
home, school and in other settings. This simple principle – reward desired behaviours
and withholds rewards or punish for unwanted behaviours – has even helped those with
disorders learn to function in normal settings. Example in text pg.598 – token economy
** Activity – Handout - Assessing Assertiveness
Cognitive Therapies
Cognitive therapists believe our thinking affects how we feel. Cognitive explanations of
illnesses like depression include the idea that self blame (“I lost my job because I’m
worthless”) and overgeneralization (I’m worthless at everything”) set the stage for being
depressed. Cognitive therapists assume that our thoughts filter the events in our lives
and influence our emotional reactions to them. Cognitive therapies teach people new
and more adaptive ways of thinking and acting.
Example of constructive Interpretations (text pg.600)
The best psychological therapies for depression, especially major depression appear to
be cognitively based. Why? Give an example.
Cognitive therapists teach clients to think constructively instead of destructively. They
try to help depressed people take more responsibility for things that go well and to
encourage them to give less permanent and devastating explanations for failure.
Pessimistic thinking has 3 important distinctions from optimistic thinking:
1. It is permanent. Pessimists believe that bad events will become a permanent
fixture in their lives, whereas optimists believe that bad events are temporary.
2. It is personal. Pessimists believe that bad events are a result of some personal
flaw that cannot be changed, while optimists believe that bad events are the
result of circumstances that they can control.
3. It is pervasive. Pessimists believe that a bad experience in one area of their lives
will influence other areas. On the other hand, optimists believe that bad events
will remain isolated in time and will not affect later decisions or opportunities.
Activity – Handout – Frequency of Self-Reinforcement
Cognitive-behaviour therapy combines cognitive therapy (changing self-defeating
thoughts) with behaviour therapy (changing inappropriate behaviours). With this
therapy, people become aware of their irrationally negative thoughts and are taught to
practice a better everyday approach. Read example pg. 602 on treating OCD.
Family and Group Therapies
Most therapies we have studied can occur either individually, one on one with a
therapist, or in small groups of 6-10 people. Group therapy participants discuss and
react to one another’s issues. Families in conflict are often recommended for group
therapy. Compared with one-on-one therapy, group therapy has some advantages:
1.
2.
3.
4.
Family therapy, which treats the family as a system, is a special kind of group therapy
that views the individual’s unwanted behaviours as influenced by or directed at other
members of the family. For example, a child who rebels inappropriately adds to and is
affected by family tension. Family therapists help the members of the family discover
the roles they play inside their family’s social unit. They try to guide the family toward
positive relationships and improved communication. Opening the communication
pathways within a family helps its members learn new ways of resolving and preventing
conflicts.
Which Therapies Work the Best?
Research has consistently shown that clients have not found that any one type of
therapy is generally better than others. There is little if any connection between
clinicians’ experience, training, supervision and licensing and their clients’ outcomes.
Clients seemed equally satisfied. Some therapies do however; get better results for
particular problems. For example, behavioural conditioning therapies have had
especially good results with specific behaviour problems such as bed-wetting or
phobias, and research confirms cognitive therapy’s effectiveness in coping with
depression and reducing suicide risk.
All Therapies Offer 3 Basic Benefits
1. Hope for demoralized people – People seeking therapy typically feel anxious,
self-disapproving and not capable of turning things around. What any therapy
offers is the expectation that, with commitment from the client, things can and
will get better. This belief, apart from any therapy technique, may help improve
morale, create feelings of inner strength and reduce symptoms. Each therapy, in
its own way may therefore harness the person’s own healing powers.
2. A New perspective – Every therapy offers people an explanation of their
symptoms. Therapy can also offer new experiences. These new windows on the
world can help people change their behaviours and their views of themselves.
3. An empathic, trusting, caring relationship – No matter what technique they
use, effective therapists are empathetic people. They seek to understand peoples’
experience, to communicate care and concern, and to earn trust through
respectful listening, reassurance and advice. At key moments, empathetic
therapists of any type will help clients evaluate themselves, link one aspect of
their life with another and gain insight into their interactions with others.
** Online Psychotherapy - handout and discussion
Seeking Help (page 601-text)
The American Psychological Association cites the following as common signs of trouble
that may require professional help:
1.
2.
3.
4.
5.
6.
Review of Therapists and Their Training:
Clinical psychologist –
Clinical or psychiatric social worker –
Counsellor –
Psychiatrist –
(pg. 601 text)
**Activity – Handout – Attitudes toward Seeking Professional Psychological Help
** Closing Activity Questions
1.
Has your view of therapy changed? Explain
2. If you were experiencing a mental, relational or social problem, would you seek
help from a professional licensed therapist? Why or why not?
3. If you were to see a therapist, which perspective would you prefer he/she
followed? Why?
4. Summary of what you learned about your attitudes toward seeking professional
help. (from handout)