Download Ch 13

Psychotherapy: healing of the
soul
Early beliefs: troubled people—
possessed by demons
Later term: mental illness
Mental illness: no longer
considered an appropriate term
Implies a passive, helpless person
Problems caused by forces over
which she/he has no control
Person can avoid responsibility
The primary goal of
psychotherapy is to strengthen
the patient’s control over his/
her life
People who feel trapped in
behavior patterns
Psychological conditions
cause a lack of freedom
with limited options in
choosing directions
lives will take
For psychotherapy to work,
the client (patient) must achieve
some understanding of his/her
troubles
Another major
task of therapy
is to help the
patient find
meaningful
alternatives to
his present
unsatisfactory way of behaving
Key factor: patient’s belief or hope
that he can change
One danger in
therapy is that
sometimes
patients become
heavily
dependent on
therapists
Patients often try to avoid
problems by using the therapist
as a substitute parent or by
blaming him for their misfortunes
Patients who get the most
out of psychotherapy are people
with high intelligence, good
education and middle class
backgrounds
Identify
closely
with their
therapists
Those who
benefit most:
relatively mild
problems;
introspective;
withstand frustration
Differences from old stereotype
Wide range of problems besides the
serious DSM-IV disorders
Action, as well as talk & interpretation
Trust
Client and therapist must be able to
work together as allies, on the same
side, toward same goals
Therapeutic process
Some or all:
Identifying the problem
Identifying the cause of the problem
Deciding on and carrying out some
form of treatment
Three characteristics of
effective therapists:
Psychologically
healthy
Empathy—a capacity
for warmth and
understanding
Experienced in dealing with people
See through patients’ games
played to trick therapists
Kinds of therapists
Clinical psychologists: therapists
with Ph.D.; have completed a 3-4
year research-oriented program
in psychology plus an internship
in psychotherapy and psychological
assessment; some have a Psy.D:
a Doctor of Psychology
Kinds of therapists
Counseling psychologists: masters
or Ph.D. in counseling; usually
work in educational institutions;
work dealing with personal
problems
Clinical neuropsychologists: Ph.D.
with education similar to clinical
psychologists; extensive education
in mechanisms & operation of
the brain; work with brain injury
patients
Kinds of therapists
Psychiatrists: M.D. who specialize
in treatment of mental illness;
post-graduate training in abnormal
behavior; licensed to prescribe
medicines &
only group
who can
perform
operations
Kinds of therapists
Psychoanalysts—M.D.; training in
personality theory & techniques of
Sigmund Freud. Must be psychoanalyzed themselves before practice
Kinds of therapists
Lay analysts: psychoanalysts
who do not have degrees in
medicine but who have studied
with established psychoanalysts
Psychiatric social workers: people
with masters degrees in social
work
Paraprofessionals: clergy,
physicians, teachers, others who
dispense considerable advice with
little or no formal training in
therapy or counseling
Kinds of therapists
Psychiatrists: The American
Psychological Association is presently
discussing recommending a
regulation
change that
would
permit
psychologists
to prescribe
medication
Kinds of psychotherapy
Insight therapy:
help people
understand
their problems—
change thoughts,
motives, feelings
Behavioral: focuses primarily on
change in behavior
Insight Therapy
Attempts to change people on the
inside—the way they think and feel
AKA talk therapies—share the
assumption that distressed persons
need to develop an understanding of
the disordered thoughts, emotions,
and motives that underlie their mental
difficulties
Kinds of psychotherapy
Psychoanalysis
Based on
Freud’s theories
Basis: anxiety
about hidden
conflicts
between the
unconscious components of one’s
personality
Kinds of psychotherapy
Psychoanalysis
Provide insight: patient awareness of
unconscious impulses,
desires, and fears that
are causing the anxiety
Slow procedure—assists
patient in a thorough
examination of the
unconscious motives
behind behavior
Psychoanalysis
Psychoanalysis begins with free
association: talk about everything
that comes into her mind
Analyst suggests that the patient
express everything that comes to
mind—even what apparently is
inconsequential may have a
bearing on the problem
Patient comfortable; analyst often
says little or nothing; just asks
guiding questions
Psychoanalysis
Usually, at first, the
patient is reluctant to reveal
painful feelings and to examine
lifelong patterns that need to
be changed
Resistance: unconsciously holding
back information
Psychoanalysis
Eventually, the analyst begins to
appear in the patient’s
associations & dreams
Process of
Transference—begins
to feel toward the
analyst what she/he
feels toward other
important people
in her/his life
Psychoanalysis
Transference: may allow the
patient to experience true feelings
toward the important person
Therapist must remain impersonal
to prevent the
patient from
treating the
therapist as he/
she would the
important
person
Psychoanalysis
By eventually understanding
transference, the patient becomes
aware of real feelings and motives
One danger: can lead to symptom
substitution—one symptom disappears
only to be replaced by another
Neo-Freudian Psychodynamic Theories
Treat face-to-face
Once a week for a few months
Don’t spend as much time probing for
hidden conflicts and repressed memories
Also: ego rather than id
Influence of life experiences post-childhood
Role of social needs/interpersonal relations
The most eclectic form of therapy
Existential crises:
Problems in everyday existence
Low self-esteem
Feelings of alienation
Failure to achieve all you feel you
should
Difficult relationships
Humanist Theories
People motivated by healthy needs
for growth and psychological wellbeing
Focus on the whole person engaged
in a continual process of change
Therapies help clients
confront their problems
by recognizing their own
freedom, enhancing
self-esteem, and
realizing fullest potential
Humanist Theories
Carl Rogers
Stressed actualization
of a person’s unique
potential through
personal
responsibility,
freedom of choice,
and authentic
relationships
Rogers: person centered therapy
Humanist Theories
People are basically good and
capable of handling their own
lives
Goals of therapy: help client
realize his own strength &
confidence; be able to live
effectively by being true to
own standards and ideas
Therapist encourages the client to
speak freely about intimate
matters that may be bothering him.
Therapist:
listens and
encourages
conversation, but
avoids giving
opinions
Therapist tries to echo back as
clearly as possible the feelings
the client has expressed
Client and therapist together form
a clearer picture of how client
feels about himself, his life & people
around him.
Person-centered therapy
is conducted in an atmosphere
of emotional support—unconditional
positive regard
Therapist never says what she
thinks about the client
Therapist shows the client that
she will accept anything said
without embarrassment
Warm and accepting relationship
As the client reduces tensions,
and releases emotions, feels that
he/she is becoming a more
complete person.
Gains courage to accept parts of
personality he/she formerly
considered weak or bad, and by
recognizing his/her self worth &
can then set realistic goals &
consider steps needed to meet
them
Cognitive Therapies
Focus on changing the way
people think
Basic assumption: faulty
cognitions—irrational or
uninformed beliefs, expectations,
and ways of thinking—distort
our actions, attitudes, and
emotions
To improve lives, people need to
change thinking patterns
Cognitive-Behavior Therapy
Aaron T. Beck
Use persuasion and
logic to change the
patient’s existing
beliefs
Encourage patients to test their
own beliefs through “homework”
assignments
Group Therapy
Practical experience in getting
along with others
Can see how other people are
struggling with problems similar
to theirs
Also discover what others think
of them
People can express what they
think of others in the group—can
see mistakes in views of self and
of others & see where correct
Group Therapy
Factors that make group therapy
effective:
Hope Universality Information
Altruism Modeling
Corrective recreation of primary
family social skills
Factors that make group therapy
effective:
Interpersonal learning
Group cohesiveness
Catharsis—people can express
feelings and vulnerability
Existential factors
Group Therapy
Examples of self-help groups
Alcoholics Anonymous
Weight Watchers
Mutual encouragement, friendship,
emphasis on person responsibility
Group Therapy
Other forms of group therapy
Family therapy—untangle twisted
webs of relationships that have
led one or more members in the
family to experience emotional
suffering
Self-help groups—people who share
a common problem, often
conducted without the active involvement of professional therapists
Behavior Therapy
Much more emphasis on action
Therapist concentrates more on
finding out what is specifically
wrong with the patient’s current
life and takes steps to change it
Concept: disturbed people have
learned to behave in the wrong
way
Therapist must, therefore,
re-educate the patient
Reasons for
undesirable
behavior not
important;
What is important: change behavior
Therapist uses conditioning
techniques first discovered on
animals in laboratories
Mary Cover Jones (1924)
Desensitized “Peter’s”
intense fear of a rabbit
Classical conditioning in
humans
Hobart & Mollie Mowrer (1938)
Bed-wetting: the
bell and pad
Alarm = UCS
Waking = UR
Full bladder = CS
UCS + CS= Child wakes (CR)
One behavior therapy
technique: systematic
desensitization
Used to overcome
irrational fears and
anxieties the patient has
Joseph Wolpe
learned
Goal: encourage patients to imagine
the feared situation while relaxing,
thus extinguishing the fear response
Example: intense fear of
public speaking
Therapist might have
student make a list
of all aspects of talking
with others that are
frightening
Next, patient rank orders
those fears—most to least frightening
Next, the therapist begins teaching
the patient how to relax
Consider this hierarchy of fears constructed
by a person who is fearful of death
1. Seeing a dead person in a coffin
2. Being at a burial
3. Seeing a distant burial assemblage
4. Reading the obituary of a young person
who died of a heart attack
5. Driving past a cemetery
6. Seeing a funeral
7. Passing a funeral home
8. Reading the obituary of an old person
9. Being inside a hospital
10. Seeing an ambulance
Once patient knows how to really
relax: next step
Patient tries to imagine as vividly
as possible the least disturbing
thing on the list.
May think that speaking to a
single stranger and feel a mild
anxiety. Because therapist has
taught him how to relax, the
the patient learns to think about
the experience without fear.
Counter conditioning:
therapist attempts to replace
anxiety with its opposite—
relaxation
Follow that procedure step-by-step
through the patient’s list of
anxiety-arousing events
Patient reaches a point where he
is able to imagine the situations
that threaten him the most
without feeling anxiety
Systematic Desensitization
Next the therapist starts to expose
the patient to real-life situations
that have previously frightened
him. Continues until the client
can give a speech in front of an
audience
Virtual Reality and Systematic
Desensitization
Computer-generated images expose
phobic patients to fearful situations in
a safe virtual reality environment
Aversion therapy
Drug addiction, certain sexual
attractions, tendencies to violence
Designed to make tempting stimuli
less provocative by pairing by
pairing them with unpleasant
(aversive) stimuli
Behavior therapy
Contingency Management
Therapist & patient decide what
old, undesirable behavior needs
to disappear and what new,
desirable behavior needs to appear.
Behavior therapy
Contingency Management
Next, arrangements are made to
reinforce desired behavior and
for old behavior to go unrewarded
Reward is contingent (dependent)
on the
desired
behavior
Therapy group project
Write a script for and be prepared to
act out a therapy session
Psychoanalysis for histrionic personality disorder
Person (client)-centered therapy for
hypochondriasis
Cognitive-Behavior therapy for
depression
Family therapy for a dysfunctional
family
Couples therapy (marital problems)
Systematic desensitization for a
panic disorder
Participant Modeling therapy for a
phobia.
Behavior therapy
Contingency Management
Used in mental hospitals and
prisons—miniature system of
rewards called token economies
Participant Modeling Therapy
People learn fears by observing others
Client observes or imitates another
person who is modeling desirable
behaviors
Symbolic modeling
Desensitization therapy
Cognitive-Behavioral Therapy
Combines a cognitive emphasis on
thoughts and attitudes with
behavioral strategies (dual approach)
Therapist and client work together to:
Modify irrational self-talk
Set attainable behavioral goals
Develop realistic strategies
Evaluate results
Rational-Emotive Therapy
Albert Ellis
People behave in deliberate,
rational ways, given their
assumptions about life.
Emotional problems arise
when an individual’s
assumptions are
unrealistic
Therapist does not look for past
incidents that make the present
unbearable for the patient
Rational-Emotive Therapy
Goal: to correct a patient’s false
and self defeating beliefs.
Rejection is unpleasant, but
not unbearable
Goal: teach the individual to think
in realistic terms
Rational-Emotive Therapy
Therapy techniques:
Role-playing—see how beliefs
affect relationships
Modeling—to demonstrate other
ways of thinking and acting
Humor—to underline the
absurdity of beliefs
Simple persuasion
Rational-Emotive Therapy
Ellis: patient must take three
steps to cure or correct self
Realize that some of his
assumptions are false
Must realize that he/she is
making himself/herself disturbed
by acting on false beliefs
Must work to break old habits
of thought and behavior
Must practice, learn self-discipline,
and take risks
Cognitive-Behavioral Therapy
Changes people’s minds as well as
changing the brain itself
Re-label experiences as obsessions
or compulsions rather than
rational thinking
Wait out urges by distracting
themselves for about 15 minutes
Over time, part of brain responsible
for irrational fears becomes less
active
Consumer Reports
Therapy works
Long-term better than
short term
All forms are about
equal in effectiveness
Hans Eysenck
Roughly two-thirds of all
people with nonpsychotic
problems recover within
two years of the onset of
the problem, whether they
get therapy or not
Two conclusions:
Therapy is more effective than none
Eysenck had over-estimated the
improvement rate in no-therapy
control groups
Long-term
administration:
tardive dyskinesia
incurable
disturbance of
motor control,
especially of facial
muscles
Long-term
administration:
tardive dyskinesia
incurable
disturbance of
motor control,
especially of facial
muscles
Antidepressants relieve depression
Tricyclic (Tofranil and Elavil) reduce
the neuron’s re-absorption of
neurotransmitters after they have
been released in the synapse
in the brain cells (reuptake)
Prozac (1987)—for many years
most popular antidepressant;
Selective serotonin reuptake
inhibitors (SSRIs)
Antidepressants relieve depression
Monoamine Oxidase (MAO)
inhibitors: limit the activity of MAO—
a chemical that breaks down
norepinephrine in the synapse
MAO inhibitors are a common
somatic treatment for depression
Biological approaches to
treatment
Antidepressants (continued)
Lithium carbonate, a natural
chemical element, is now widely
used to return manic-depressive
patients to a state of equilibrium
in which extreme mood swings
disappear
Most medications have side effects
Stimulants to Treat ADHD
Ignorance of well-established calming
effect these drugs can have in
children with ADHD
Interferes with normal sleep patterns
Slow growth of children
Potential for abuse
Prefrontal Lobotomies
Sever nerve fibers connecting the
frontal lobes with deep brain
structures (thalamus & hypothalamus
Prefrontal Lobotomies
Electroconvulsive Therapy
The convulsions caused by the shock
may have a positive therapeutic effect
Electroconvulsive Therapy
Negative side effect
is memory loss
Maxwell Jones
Therapeutic community
Daily hospital routine,
structured as a therapy
to help patients learn
to cope with outside
world
Private living quarters
Decision making
Involved in planning own treatment
Maxwell Jones
Group Therapy
Occupational Therapy
Recreational Therapy
Seasonal Affective Disorder (SAD)
Light therapy is most commonly used
to treat SAD
Existential Therapy
Rollo May Viktor Frankl
Existential Therapy
Believe that for most people
autonomy and freedom are
threatening
To acknowledge that you are
unique and independent is
to acknowledge you are alone
May et al: to get in touch with
true feelings, must accept
responsibility for lives
Existential Therapy
Frankl: feelings of
emptiness and
boredom are primary
source of emotional
problems
Therapist should help
open client’s eyes to
possibilities in life and
guide him/her toward
challenges
“Why don’t you commit suicide?”
Gestalt Therapy
Emphasizes relationship between
patient and therapist in here and
now
If a patient will not respond to
the therapist’s questions, the
therapist will tell the patient that
he is angry and frustrated at the
lack of response by the patient.
Sets an example for patient to
express feelings Significant risk
Gestalt Therapy
Based on the belief that many
people are so concerned with
obtaining approval that they
become strangers to themselves
Transactional Analysis
Eric Berne
Basis: people function
from one of 3
perspectives called
ego states
Ego states: represent
ways people organize
thoughts, feelings,
and actions
Transactional Analysis
Child ego state
Act like a child
Parent ego state
Act, think, feel like parent,
close friends or teachers
Adult ego state
Thoughts, feelings, behaviors
rationally related to experiences
of the present
Transactional Analysis
Reactions in the adult ego state
allow people to deal effectively
and responsibly with their
daily problems
Goal of transactional analysis: help
people to identify maladaptive
transactions or strategies for
living (usually from parent or
child ego state) and also to help
develop more effective adult
ego state responses