Download Psychological therapies

6th Edition
Psychology
Stephen F. Davis
Morningside College
Joseph J. Palladino
University of Southern Indiana
PowerPoint Presentation by
Fred W. Whitford
Montana State University
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13-1
Chapter 13
6th Edition
Therapy
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13-2
Therapy Through the Ages
• Throughout history, prevailing views of the
causes of psychological disorders have
influenced treatments.
• Some people believed in “possession” by
evil spirits, so they used treatments such as
exorcism or trephining.
• The Greek philosopher and physician
Hippocrates proposed that physical and
psychological disorders have natural
causes.
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13-3
Therapy Through the Ages
• The Greek emphasis on naturalistic
explanations continued in ancient Rome,
where people received treatments such as
baths, exercise, and massage.
• During the 16th and 17th centuries, some
people whose only “crimes” may have been
that they suffered from psychological
disorders were accused of being witches.
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13-4
Therapy Through the Ages
• In the 18th century, mentally ill people in
Paris were often chained to walls.
• The attendants, or “keepers” as they were
called, rarely showed compassion and
even administered punishment when they
deemed it necessary.
• A physician, Philippe Pinel, argued that
these patients needed humane care and
treatment.
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13-5
Therapy Through the Ages
• Pinel’s efforts led to a treatment
philosophy called moral management or
moral therapy.
• The term did not suggest any moralistic
content of the treatment; rather, it reflected
the belief that providing a humane and
relaxed environment could produce
positive changes in a person’s behavior.
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13-6
Therapy Through the Ages
• Benjamin Rush introduced moral therapy
at Philadelphia’s Pennsylvania Hospital,
the first general hospital in the United
States with a separate unit for the mentally
ill.
• Yet he restrained manic patients in his
tranquilizer chair, which he thought was
more humane than other restraints used at
the time.
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13-7
Therapy Through the Ages
• In the mid-19th century, Dorothea Dix, a former
teacher, became concerned about the plight of
homeless and disturbed people.
• Her survey of Massachusetts institutions that
housed the mentally ill yielded numerous
examples of misery and horror.
• Dix insisted that the states had an obligation to
provide care for the mentally ill and she
convinced legislatures in 20 states to establish
or enlarge mental hospitals.
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13-8
Therapy Through the Ages
• As the states assumed more responsibility
for custodial care of the mentally ill,
economics dictated that they build larger
institutions to handle more patients.
• As the institutions expanded, conditions
deteriorated and the use of restraining
devices increased.
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13-9
Therapy Through the Ages
• Franz Anton Mesmer and his notion of
animal magnetism offered a very different
view of psychological disorders and their
treatment.
• Mesmer believed he could harness this
magnetism as a form of therapy to treat
patients.
• With modifications, his techniques evolved
into hypnotism.
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13-10
Therapy Through the Ages
• Sigmund Freud, an early advocate of
hypnotism as a therapeutic technique,
developed the notion that psychological
disorders result from unconscious feelings
and conflicts, which required a different
approach to therapy.
• Freud later turned to other techniques
when hypnosis proved less effective than
he had hoped.
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13-11
Therapy Through the Ages
• Early in the 20th century, the disorder known as
general paresis, which included symptoms such
as paralysis and memory difficulties, was found
to result from syphilis.
• This finding stimulated the search for biological
causes of other psychological disorders, as well
as the development of biomedical treatments
such as psychosurgery and electroconvulsive
(shock) therapy.
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13-12
Therapy Through the Ages
• Beginning in the mid 1950s, the populations of
mental hospitals began to decline.
• One reason for this decline was the use of drugs,
which made it possible to control many serious
symptoms.
• At the same time, there was a growing belief that
community care was more effective than
hospitalization.
• Numerous factors led to deinstitutionalization, a
policy of discharging large numbers of patients
from mental hospitals and then closing part or all
of those hospitals.
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13-13
Therapy Through the Ages
• In 1963, Congress passed the Community
Mental Health Centers Act.
• This law provided funds for the
establishment of community mental health
centers in which patients would be treated
on an outpatient basis.
• In addition, the 1963 law helped finance
community-based programs to prevent
mental illness.
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13-14
Therapy Through the Ages
• Psychologists recognize three forms of
prevention: primary, secondary, and tertiary.
• Primary prevention is designed to prevent
disorders from occurring.
• Secondary prevention is designed to detect
existing disorders and provide treatment at early
stages.
• The goal of tertiary prevention is to reduce the
damage caused by disorders for both the
patients and society.
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13-15
Therapy Through the Ages
• Not everyone who seeks therapy suffers
from a psychological disorder.
• Some people need help to cope with such
lifestyle events as the loss of a job, schoolrelated difficulties, or family
disagreements.
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13-16
Therapy Through the Ages
• About 30% of
individuals with a
psychological disorder
seek treatment.
• Those with
schizophrenia, bipolar
disorder, or panic
disorder are more
likely to seek treatment
than individuals with
substance-use
disorders.
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13-17
Therapy Through the Ages
• There are two treatment categories for
psychological disorders: biomedical and
psychological therapies.
• Biomedical therapies use psychotropic
drugs (drugs that affect the brain),
electroconvulsive therapy, and
psychosurgery to alter brain functioning
and thus reduce symptoms.
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13-18
Therapy Through the Ages
• Psychological therapies range from “talk
therapies” to treatments based on the
principles of learning.
• Psychotherapy is a general term that
describes psychological treatments
designed to help people resolve
behavioral, emotional, and interpersonal
problems and improve the quality of their
lives.
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13-19
Therapy Through the Ages
• Members of several professions as well as
paraprofessionals provide psychotherapeutic
services.
• The term therapist encompasses a diverse group
of people with different backgrounds.
• Included here are people with a master’s or
doctoral degree in psychology and people with a
medical degree and special training in psychiatry,
as well as self-designated psychotherapists.
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13-20
Therapy Through the Ages
• Among the most common types of licensed
psychotherapists are clinical and counseling
psychologists, marriage and family therapies
psychiatric nurses, psychiatrists, psychoanalysts
and social workers.
• Although states regulate many mental health
professions, they do not regulate practitioners like
psychotherapists or counselors.
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13-21
Psychologically-Based Therapies
• Although it is convenient to distinguish
among various forms of psychotherapy,
clinical psychologists are increasingly
using elements of different therapeutic
approaches in treating their clients.
• The use of components from several
therapies is called an eclectic or
integrative approach.
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13-22
Psychologically-Based Therapies
• There are five stages of the therapy
process; introduction, goal-setting,
intervention, evaluation and
termination/follow-up.
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13-23
The Primary Theoretical Orientations of
Clinical Psychologists
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13-24
Psychologically-Based Therapies
• Psychotherapy involves a special
relationship between a distressed person
and a therapist, in which the therapist
helps the client make changes in his or her
thinking, feeling, and behavior.
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13-25
Psychologically-Based Therapies
• Psychoanalytic therapy is a treatment of
maladaptive behavior developed by Sigmund
Freud; its goal is to uncover unconscious
conflicts and feelings and bring them to the
conscious level.
• Freud used free association, dream
interpretation, resistance, and transference to
probe beneath the surface of a patient’s
conscious feelings and thoughts.
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13-26
Psychologically-Based Therapies
• In free association, patients are asked to relate
thoughts, feelings, or images without modifying
them in any way.
• Freud called dreams “the royal road to the
unconscious” and distinguished between two
forms of dream content: manifest and latent.
• Manifest content is the dream you recall when
you awaken; latent content is the underlying
meaning of that dream.
• The psychoanalyst’s task is to interpret dreams
by discovering the latent content.
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Psychologically-Based Therapies
• Resistance occurs during free association
when the patient’s flow of words and
thoughts stops.
• The cessation of associations might
indicate that the defense mechanism of
repression is operating to protect the ego
from the anxiety generated by the
thoughts and feelings revealed through the
associations.
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Psychologically-Based Therapies
• Transference refers to the patient’s positive
or negative reaction to the therapist, which is
believed to reflect the patient’s relationship to
a significant person outside of therapy.
• One problem that researchers of
psychoanalytic therapy face is the difficulty of
defining the essential elements of the
treatment and knowing when they are
present.
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13-29
Psychologically-Based Therapies
• Humanistic therapies emphasize the
present and the ability of clients to solve
their own problems once they are able to
accept themselves.
• Client-centered therapy is designed to
create an environment in which the client
is able to find solutions to his or her
problems.
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13-30
Psychologically-Based Therapies
• Cognitive therapies are designed to
change cognitions in order to eliminate
maladaptive behaviors.
• Rational-emotive behavior therapy is a
cognitive therapy in which the therapist
challenges and questions the client’s
irrational ideas.
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13-31
Psychologically-Based Therapies
• Rational-emotive behavior therapy is
understood best in terms of what Ellis calls the
ABC framework.
• A represents an activating event related to an
important desire, goal, or preference (getting the
job, in our example); B is the belief, usually
related to failure to attain the goal, that follows
the activating event (“I’m no good because I
didn’t get the job”).
• That belief determines C, consequences, such
as feelings of anger, anxiety, and depression.
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13-32
Psychologically-Based Therapies
• Therefore, the role of the therapist is to
challenge the client’s irrational beliefs.
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13-33
Psychologically-Based Therapies
• Aaron Beck notes that depressed people have
negative views of their world, themselves, and
their future—called the cognitive triad.
• They often interpret events in ways that lead to
self-blame, and they also rely on cognitive
distortions that can maintain their negative
views.
• These distorted interpretations and errors are
fueled by automatic thoughts (negative
sentences repeated to oneself) that occur
despite their being contrary to objective reality.
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13-34
Psychologically-Based Therapies
• Behavior therapists view maladaptive
behaviors as learned and rely on classical
and operant conditioning and modeling to
teach the client new behaviors.
• Behavior modification and behavior
therapy are often used interchangeably.
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13-35
Psychologically-Based Therapies
• Systematic
desensitization is an
effective treatment for
phobias in which
clients are taught
relaxation techniques
and then asked to
imagine or approach
feared situations
gradually.
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13-36
Psychologically-Based Therapies
• Aversion therapy
uses unpleasant or
painful stimuli such as
electrical shock,
nausea-inducing
drugs, or repugnant
tastes or smells to
decrease unwanted
behavior.
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13-37
Psychologically-Based Therapies
• Aversion therapy is based on classical
conditioning principles; it involves the
repeated pairing of a problem behavior
with an aversive stimulus.
• One of the most effective techniques for
treating phobias is modeling, or
observational learning.
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13-38
Psychologically-Based Therapies
• In this procedure a person—live or on
videotape—demonstrates gradual contact
with the feared object under controlled or
protected circumstances.
• The client observes these behaviors and is
given the opportunity to engage in similar
behaviors.
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Psychologically-Based Therapies
• Extinction occurs when reinforcers that
maintained an undesired behavior no
longer follow that behavior.
• Extinction is used to reduce the
occurrence of maladaptive behaviors.
• To extinguish a behavior, you must know
what reinforcer is maintaining it.
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13-40
Psychologically-Based Therapies
• Another procedure used by behavior
therapists is punishment, which can be
either the withdrawal of a positive stimulus
(such as candy) or event or the
presentation of a negative stimulus or
event (such as an electric shock).
• Ethical and legal considerations mandate
that less distressing forms of treatment be
tried before punishment is considered.
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13-41
Psychologically-Based Therapies
• Token economy is a technique that
reinforces desirable behaviors with tokens
(secondary reinforcers), which can be
redeemed for other reinforcers, especially
primary reinforcers.
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13-42
Psychologically-Based Therapies
• Cognitive behavior therapy (CBT) is a
therapeutic approach that consciously
combines behavioral and cognitive
theories and practices.
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13-43
Psychologically-Based Therapies
• Group therapy is a therapy in which
clients discuss problems in groups that
may include individuals with similar
problems.
• Some of the advantages of group therapy
are social support and opportunities to
practice coping skills and to receive
feedback.
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13-44
Psychologically-Based Therapies
• Marital therapy (also called couples therapy)
typically attempts to stabilize and improve the
relationship of two individuals who regard
themselves as marital partners.
• Family therapy focuses on the larger family
unit: a parent and a child at a minimum, or
both parents, stepparents, or grandparents,
depending on the environment in which the
child lives.
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13-45
Psychologically-Based Therapies
• Most self-help groups are developed and
run by laypersons, although some invite
professional therapists to help with
unusual cases.
• People in these groups pool their
knowledge, share their experiences with
common problems, and help one another.
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13-46
The Effectiveness of Psychotherapy
• Eysenck concluded that psychotherapy
clients are just as likely to improve without
treatment.
• The results of several meta-analyses have
been reported and support the conclusion
that psychotherapy is generally effective,
although we are uncertain as to why.
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13-47
The Effectiveness of Psychotherapy
• Meta-analysis supports the idea that there is
little difference among various psychotherapy
treatments.
• Certain characteristics of therapy may contribute
to improvement, regardless of the form of
therapy we are considering.
• For example, the therapist’s ability to
communicate empathy to clients is important.
• The evidence also suggests that particular
therapies are effective in alleviating certain
problem behaviors.
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13-48
The Effectiveness of Psychotherapy
• Therapists are becoming increasingly
aware of the influence of ethnic and
cultural factors on psychotherapy.
• Members of many ethnic groups drop out
early from psychotherapy, in part because
there is a dearth of therapists who share
their native language, as well as a failure
to provide appropriate forms of therapy.
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13-49
The Effectiveness of Psychotherapy
• The decision to enter psychotherapy
should involve asking questions about:
– the degree of distress one is
experiencing;
– one’s ability to cope with that distress;
– the effect of the symptoms on oneself,
one’s family, and one’s work.
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13-50
The Effectiveness of Psychotherapy
• Current forms of psychotherapy are
offered in fewer sessions than in the past.
• Many symptoms, especially distress
symptoms, respond quickly to treatment.
• There is also a growing recognition that
there are limits to what aspects of our
behavior can be changed.
• A final concern about beginning and
continuing therapy deals with stigma.
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13-51
Biomedical Therapies
• The major category of antianxiety drugs,
the benzodiazepines, affect the ability of
the inhibitory neurotransmitter GABA to
bind to receptor sites in the brain.
• The resulting increase in the firing of
inhibitory neurons lowers the level of the
neurological activity that produces anxiety.
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13-52
Biomedical Therapies
• Three categories of drugs are used to treat
depression:
– tricyclic antidepressants prevent reuptake of
norepinephrine and serotonin;
– MAO inhibitors prevent an enzyme from
breaking down norepinephrine and serotonin;
– selective serotonin reuptake inhibitors
(SSRIs), including drugs such as Prozac,
reduce the reuptake of serotonin.
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13-53
Biomedical Therapies
• Drugs used to treat bipolar disorder (which
reduce mania and raise the depressive
mood) are called mood stabilizers.
• Lithium and anticonvulsant drugs are
treatments for mania.
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Biomedical Therapies
• Antipsychotic drugs reduce the
symptoms of schizophrenia by blocking
dopamine receptors in the brain.
• The typical antipsychotic drugs work by
blocking dopamine, whereas the atypical
drugs (such as Clozapine) also block
serotonin.
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Biomedical Therapies
• These drugs are more effective at
reducing the positive symptoms of
schizophrenia than the negative ones.
• The use of antipsychotic drugs can lead to
tardive dyskinesia, a serious adverse
reaction involving involuntary motor
movements such as lip smacking.
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13-56
Biomedical Therapies
• There are some significant ethnic
differences in responses to some drugs
used to treat psychological disorders.
• The Food and Drug Administration has
issued new guidelines for the study of
possible sex differences in responses to
drugs.
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Biomedical Therapies
• Proponents of drug therapy believe that
the increased use and effectiveness of
drugs heralded a new era in treating
psychological disorders.
• Drugs can make some patients more
manageable for therapists and hospital
staff, reduce patients’ anxiety levels, lift a
depressed mood, and eliminate some
delusions.
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Biomedical Therapies
• But they cannot replace lost social skills or
teach patients how to interact with family
members and other people.
• Many psychotropic drugs are often
associated with side effects.
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13-59
Biomedical Therapies
• Electroconvulsive therapy (ECT) is a
biomedical treatment in which an electric
current is passed through the brain to
induce a seizure.
• When ECT was first used, the seizures it
induced were so violent that some patients
suffered broken bones and a few even
died.
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13-60
Biomedical Therapies
• Today, repeated evaluations of ECT indicate that it
is a successful treatment for severe depression,
especially in cases that have not responded to
antidepressant drugs.
• Modified procedures for administering ECT, such
as use of muscle relaxants, have reduced the
severity of side effects.
• The most prominent side effect is memory
disturbance immediately following ECT
administration.
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13-61
Biomedical Therapies
• Psychosurgery is the alteration of brain
tissue in an attempt to alleviate
psychological disorders.
• In 1935, Egas Moniz devised the first
psychosurgery, the prefrontal lobotomy.
• Present-day psychosurgical procedures
are more refined than the earlier, crude
operations; nevertheless, they are rarely
performed, and then only as a last resort.
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13-62