Download Ch. 16 AP Therapy File

ABNORMAL PSYCHOLOGY, SIXTEENTH
EDITION
James N. Butcher/ Jill M. Hooley/ Susan Mineka
Chapter 16
Therapy
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An Overview of Treatment
Conviction underlying
psychotherapy
• People with
psychological problems
can change
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Why Do People Seek Therapy?
People seeking therapy may
• Be in stressful current life
circumstances
• Have long-standing problems
• Be reluctant and enter therapy at the
request of a physician, spouse, or other
• Seek personal growth
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Who Provides
Psychotherapeutic Services?
Members of many
different
professions provide
advice and counsel
Physicians
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Clergy
Who Provides
Psychotherapeutic Services?
• Clergy and physicians generally refer
seriously disturbed people to mental
health professionals.
• Who are these professionals?
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Who Provides
Psychotherapeutic Services?
Mental health
professionals
Clinical
psychologists
Psychiatrists
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Psychiatric
social
workers
The Therapeutic Relationship
Can you fill in the blanks?
The key elements of an effective working
alliance between client and therapist
include:
A sense of working ________ on the problem
________ between patient and therapist about
the goals and tasks of therapy.
A(n) ________between patient and therapist.
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The Therapeutic Relationship
Client’s motivation to change
Other qualities
enhancing
therapy
Client’s expectation of
receiving help
Protected setting
Good match between client
and therapist
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Measuring Success
in Psychotherapy
Estimated gains depend on
Therapist’s
impression
of changes
that have
occurred
Client’s
reports of
change
Reports
from the
client’s
family or
friends
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Comparison of
pretreatment
and posttreatment
scores on
personality tests
Measures of
change in
selected
overt
behaviors
Objectifying and
Quantifying Change
Measuring change with
quantitative methods
Beck
Depression
Inventory
Hamilton
Depression
Inventory
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fMRI
Would Change Occur Anyway?
Improvement often
occurs without
professional intervention
Psychotherapy can
accelerate improvement
Research findings
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Can Therapy Be Harmful?
Some clients harmed
by encounters with
psychotherapists
5-10% deteriorate
during treatment
Responsibilities of
therapists
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What Therapeutic Approaches
Should Be Used?
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Evidence-Based Treatment
Efficacy
Determined via randomized clinical trials in
which therapy is compared to placebo
Methods
Double-blind method is employed
Therapies under investigation manualized
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“Evidence-based”
Evidence-Based Treatment
“Empirically supported” treatment
Efficacy studies determine that a
therapy works
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Advances in
psychopharmacology
Medication or Psychotherapy?
Allow many to remain unhospitalized
Include problems with side effects and
matching drug and drug dosage to
needs of specific patient
May reduce symptoms but not cure
disorder
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Combined (Medication plus Psychotherapy)
Treatments
Clinical Practice
• Medication and
psychotherapy
combined used
for
schizophrenia
and bipolar
disorder.
Effectiveness
• Combined
treatment often
works better for
chronic or
recurrent
depression.
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Psychosocial Approaches to Treatment
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Behavior therapy
• Includes direct and active treatment
• Recognizes primacy of behavior
• Acknowledges role of learning
• Includes thorough assessment and
evaluation
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Behavior Therapy
Exposure therapy
Aversion therapy
Behavior therapy
approaches
Modeling
Systematic Reinforcement
approaches
Token economies
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Behavior Therapy
Relatively brief
Directed towards specific
symptoms
Characteristics
Best used with problems that are
not pervasive or vaguely defined
Often used with anxiety
disorders
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Behavior Therapy
Behavioral activation
• Relatively new development
for treatment of depression
• Encourages greater
engagement with life
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Cognitive or
cognitive-behavioral therapy
• Attempts to change behavior by
modifying self-statements
• Modifying construal of events
• Cognitive processes influence
emotions, motivation, and behavior
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Cognitive and
Cognitive-Behavioral Therapy
• Rational Emotive Behavior Therapy
• Developed by Albert Ellis
• Tries to change a client’s maladaptive
thought processes that influence
maladaptive emotional responses and
behavior.
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Cognitive and
Cognitive-Behavioral Therapy
Beck’s cognitive therapy
• Problems like depression
result from clients’ illogical
thinking about themselves
and the world around them.
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Cognitive and
Cognitive-Behavioral Therapy
Efficacy of cognitive therapy
• Well-documented with
depression, anxiety
disorders, conduct disorder,
and bulimia
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Cognitive and
Cognitive-Behavioral Therapy
What do you think?
Is cognitive change the “active ingredient”
in cognitive therapy?
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Humanistic-Experiential Therapies
Clientcentered
therapy
Humanisticexperimental
therapies
Gestalt
therapy
Motivational
interviewing
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Humanistic-Experiential Therapies
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Psychodynamic Therapies
Psychodynamic
therapy basic
forms
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Classical
psychoanalysis
Psychoanalytically
oriented
psychotherapy
Psychodynamic Therapies
Free association
Analysis of dreams
Elements of Freudian
psychoanalysis
Analysis of resistance
Analysis of transference
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Psychodynamic Therapies
Contemporary psychodynamic
approaches
• Strongly interpersonal focus
• Object relations perspective
• Attachment-based and selfpsychology perspectives
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Couple and Family Therapy
Marital Therapy
• Short-term therapy based on social
learning model.
• Teaches partners caring behaviors and
conflict resolution through
communication and problem solving.
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Couple and Family Therapy
Family Systems Therapy
Within-family behavior of any particular
family member is influenced by behaviors
and communications of other family
members.
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reserved.
Couple and Family Therapy
Integrative behavioral
couple therapy
Structural family
therapy
• Increasingly replacing
traditional behavioral
couple therapy
• Form of family
therapy that
emphasizes new
organization of family
relationships
• Requires an active,
but non-directive,
therapeutic approach
• Focuses more on
acceptance versus
change
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Eclecticism and Integration
Electicism
• Labels orientation
as eclectic, which
borrows and
combines
techniques and
concepts from
various approaches
Interpersonal therapy
• Focuses on
changing current
relationships to
reduce depression
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Sociocultural Perspectives
Critics
Psychotherapy viewed as attempt to
get people adjusted to a “sick” society
Therapists seen as guardians of
status quo
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Social Values and Psychotherapy
Therapists’ own value judgments can affect
decisions they make about treating clients.
Can you think of an example to illustrate
this statement?
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Psychotherapy and
Cultural Diversity
Members of minorities
Underrepresented in treatment
research studies
Underserved by mental health
system
Affected by different backgrounds
than their therapists
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Biological Approaches
to Treatment
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Antipsychotic Drugs
Antipsychotic
drugs
Atypical
antipsychotic
drugs
• Used to treat
psychotic
disorders such
as schizophrenia
and psychotic
mood disorders
• Have a lower risk
of side effects
• Treat positive
and negative
symptoms
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Antidepressant Drugs
Most widely
prescribed
antidepressant drugs
• Selective serotonin
re-uptake inhibitors
Older
antidepressants
• Monoamine
oxidase inhibitors
• Tricyclic
antidepressants
• Trazodone
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Anti-Anxiety Drugs
Most widely prescribed
anti-anxiety drugs
•Benzodiazepines
•Buspirone
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Lithium and Other
Mood-Stabilizing Drugs
Lithium
Other moodstabilizing drugs
• Very effective in
treating bipolar
mood disorders
• Divalproic acid
• Carbamazepine
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Electroconvulsive Therapy
Used to treat severe mood disorders
Safe, effective, and important form of
treatment
Electroconvulsive
therapy
Often used after others have failed
Kinds: Bilateral ECT, unilateral ECT
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Figure 16.4: Unilateral and Bilateral
Electrode Placement for ECT
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Neurosurgery
Neurosurgery
Decreased with use of
antipsychotic drugs
Effective with
debilitating OCD, selfmutilation, or anorexia
Includes deep brain
stimulation
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Unresolved Issues
Managed care companies get financial incentives when
patients choose medication over psychotherapy.
Has the pharmaceutical industry made questionable
claims about biological causes of mental illness for
money?
Do these medications create more long-term problems for
patients?
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