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• History of Treatment Ancient Treatments exorcism, caged like animals, beaten, burned, castrated, mutilated, blood replaced with animal’s blood Trephinated Skulls History of Treatment Therapy Psychotherapy an emotionally charged, confiding interaction between a trained therapist and someone who suffers from psychological difficulties Eclectic Approach an approach to psychotherapy that, depending on the client’s problems, uses techniques from various forms of therapy Psychoanalysis Developed by Sigmund Freud based on his theory of personality Therapy - Psychoanalysis • Aims To try to bring repressed feelings into conscious awareness where the patient can deal with them. The theory presumes that healthier, less anxious living becomes possible when patients release the energy previously devoted to id-egosuperego conflicts. Why is psychoanalysis a lot quicker for a man then for a women? Because when it's time to go back to childhood, a man is already there. Psychoanalytic Treatment In the Freudian system, anxiety is the main problem people face. Anxiety is produced when sexual and aggressive impulses are repressed. Guilt occurs when the impulses are partially expressed. These impulses occur at the unconscious level. Today psychoanalytic techniques are called psychodynamic or insight therapy. Causes of Psychological Problems • Undesirable urges and conflicts are “repressed” or pushed to the unconscious • Unconscious conflicts exert influence on behaviors, emotions, and interpersonal dynamics • Understanding and insight into repressed conflicts leads to recognition and resolution Therapy - Psychoanalysis Psychoanalysis - Freud believed the patient’s free associations, resistances, dreams, and transferences – and the therapist’s interpretations of them – released previously repressed feelings, allowing the patient to gain self-insight use has rapidly decreased in recent years Resistance - blocking from consciousness of anxiety-laden material Psychoanalytic techniques include: Free Association In a safe environment, people say whatever comes to mind without limiting or censoring thoughts. A trained therapist can interpret what is said and provide insights for the client. food Reward Therapy- Psychoanalysis § Interpretation § § the analyst’s noting supposed dream meanings, resistances, and other significant behaviors in order to promote insight Transference § the patient’s transfer to the analyst of emotions linked with other relationships § e.g. love or hatred for a parent Transference Emotional conflicts of earlier years are transferred onto the therapist. By doing this, unconscious conflicts become conscious. Other Dynamic Therapies Most therapies today are shorter-term Based on goals that are specific and attainable Therapists are more directive than traditional psychoanalysis Traditional psychoanalysis is seldom practiced today Humanistic Therapy People have the power to control their fate, ideas, and movements as they move towards self-actualization. This therapy is now known as person (client) centered therapy. Therapist and client are considered equal partners in therapy. In this therapy, the client decides what is to be discussed and what direction the therapy will take. Humanistic Therapy Client-Centered Therapy humanistic therapy developed by Carl Rogers therapist uses techniques such as active listening within a genuine, accepting, empathic environment to facilitate clients’ growth unconditional positive regard for clients Humanistic Approach in Therapy Active Listening-empathic listening in which the listener echoes, restates, and clarifies Active Listening-empathic listening in which the listener echoes, restates, and clarifies Humanistic Therapy (continued) People need to accept themselves as they are, while working toward fulfilling their potential. The therapist develops an atmosphere of trust and understanding. The therapist acts as a mirror to the client, reflecting ideas and concepts. The therapist does not judge the client. Thoughts, feelings, and ideas represent a person seeking to grow and seeking to be understood. Humanistic Therapies • • Humanistic perspective emphasizes human potential, self-awareness, and free-will Humanistic therapies focus on self-perception and individual’s conscious thoughts and perceptions Gestalt Therapy • Gestalt Therapy Developed by Fritz Perls to combine the psychoanalytic emphasis on bringing unconscious feelings to awareness and the humanistic emphasis on getting “in touch with oneself” Aims: to help people become more aware of and able to express their feelings, and to take responsibility for their feelings and actions. Emphasizes the importance of encouraging people to sense and express their own true moment-to-moment feelings. Behavior Therapy • • Joe has been seeing a psychoanalyst for four years for treatment of the fear that he had monsters under his bed. It had been years since he had gotten a good night's sleep. Furthermore, his progress was very poor, and he knew it. So, one day he stops seeing the psychoanalyst and decides to try something different. A few weeks later, Joe's former psychoanalyst meets his old client in the supermarket, and is surprised to find him looking well-rested, energetic, and cheerful. "Doc!" Joe says, "It's amazing! I'm cured!" "That's great news!" the psychoanalyst says. "you seem to be doing much better. How?" "I went to see another doctor," Joe says enthusiastically, "and he cured me in just ONE session!" "One?!" the psychoanalyst asks incredulously. "Yeah," continues Joe, "my new doctor is a behaviorist." "A behaviorist?" the psychoanalyst asks. "How did he cure you in one session?" "Oh, easy," says Joe. "He told me to cut the legs off of my bed." Behavior Therapy § Behavior Therapy § § therapy that applies learning principles to the elimination of unwanted behaviors Counterconditioning § § § procedure that conditions new responses to stimuli that trigger unwanted behaviors based on classical conditioning includes systematic desensitization and aversive conditioning Behavioral Therapy Behavioral therapy attempts to change behavior using the techniques of learning. Behaviorists assume that abnormal behaviors are the result of faulty (inappropriate) learning. Behavior Therapy Behavioristic perspective emphasizes that behavior (normal and abnormal) is learned Uses principles of classical and operant conditioning to change maladaptive behaviors Behavior change does not require insight into causes Often called behavior modification Behavior Therapy § Exposure Therapy § treat anxieties by exposing people (in imagination or reality) to the things they fear and avoid Behavior Therapy § Systematic Desensitization § § § § type of counterconditioning associates a pleasant, relaxed state with gradually increasing anxiety-triggering stimuli commonly used to treat phobias Aversive Conditioning § § type of counterconditioning that associates an unpleasant state with an unwanted behavior nausea ---> alcohol Systematic Desensitization Based on classical conditioning Uses three steps: Progressive relaxation Development of anxiety hierarchy and control scene Combination of progressive relaxation with anxiety hierarchy Behavior Therapy Systematic Desensitization Systematic Desensitization Systematic Desensitization Behavior Therapy Aversion therapy for alcoholics Behavior Therapy § Token Economy an operant conditioning procedure that rewards desired behavior § patient exchanges a token of some sort, earned for exhibiting the desired behavior, for various privileges or treats § Cognitive Therapy § Cognitive Therapy teaches people new, more adaptive ways of thinking and acting § based on the assumption that thoughts intervene between events and our emotional reactions § Cognitive Behavioral Therapy Cognitive behavioral therapy combines learned behaviors with conscious thoughts. Albert Ellis developed rational-emotive therapy. He believed that emotional upsets occur when people hold irrational ideas (contrary to logic). Thus people are disturbed not by things but by the view we take of them. The therapist attempts to give the client a rational or logical view of reality. Rational Emotive Therapy Developed by Albert Ellis ABC model Activating Event Beliefs Consequences Identification and elimination of core irrational beliefs Aaron Beck’s Cognitive Therapy • • • Problems due to negative cognitive bias that leads to distorted perceptions and interpretations of events Recognize the bias then test accuracy of these beliefs Therapist acts as model and aims for a collaborative therapeutic climate Cognitive Therapy The Cognitive Revolution A cognitive perspective on psychological disorders Cognitive Therapy Cognitive therapy for depression Cognitive Therapy Cognitive-Behavioral Therapy a popular integrated therapy that combines cognitive therapy (changing self-defeating thinking) with behavior therapy (changing behavior) Comparing Cognitive Therapies Summary Chart Treatment Primary Goal Psychoanalytic Insight into childhood conflicts, motives, and feelings Methods Using free association and transference Humanistic Self-acceptance and self-fulfillment A safe nonjudgmental environment to discuss problems and unconditional positive regard Behavioral Changing behaviors through learning Systematic Desensitization, Aversive Conditioning, and Token Economies CognitiveBehavioral Changing irrational beliefs Identification of faulty belief systems Group and Family Therapies Family Therapy treats the family as a system views an individual’s unwanted behaviors as influenced by or directed at other family members attempts to guide family members toward positive relationships and improved communication Group and Family Therapy • • Group therapy— one or more therapists working with several people at the same time. Couple therapy— relationship therapy that helps with difficulty in marriage or other committed relationships Evaluating Psychotherapies To whom do people turn for help for psychological difficulties? Factors in Successful Therapy • • • Therapeutic relationship—caring and mutually respectful Therapist characteristics—caring attitude, ability to listen, sensitive Client characteristics—motivated, actively involved, emotionally and socially mature Effectiveness of Psychotherapy • • • • Most people do not seek help with problems Many people report spontaneous remission Meta-analyses show that psychotherapy is more effective than no treatment Generally no differences among the types of psychotherapy Evaluating Psychotherapies Regression toward the mean tendency for extremes of unusual scores to fall back (regress) toward their average Meta-analysis procedure for statistically combining the results of many different research studies Evaluating Psychotherapies Number of persons Average untreated person Average psychotherapy client Text Poor outcome 80% of untreated people have poorer outcomes than average treated person Good outcome The Relative Effectiveness of Different Therapies • The Relative Effectiveness of Different Therapies Although no one type of therapy can be said to be most effective overall, some therapies are particularly well-suited to specific disorders. • • • 1.Behavioral Therapy— works best when treating specific behaviors such as phobias, compulsions, or sexual dysfunctions. 2.Cognitive Therapy— best treatment for depression. 3.Psychotherapists— increasingly offer particular treatments for specific problems. Evaluating Alternative Therapies Therapeutic touch A practitioner moves their hands a few inches from a patient’s body to push the energy fields into balance. Advocates say these manipulations help heal everything from headaches to burns to cancer. Skeptics say the evidence shows no healing power beyond the placebo effect. Evaluating Alternative Therapies Eye Movement Desensitization and Reprocessing (EMDR) While people imagined traumatic scenes, Francine Shapiro triggered eye movements by waving her finger in front of their eyes. 84 to 100% of the trauma victims said it worked. ...or is it another placebo effect??? Evaluating Alternative Therapies Light-Exposure Therapy Treatment for Seasonal Affective Disorder (SAD) – wintertime depression. Give SAD people a daily dose of intense light and it will relieve symptoms associated with wintertime depression. This does work! Commonalities Among Psychotherapies Hope for Demoralized People Any therapy offers an expectation that, with commitment from the patient, things can and will get better. Commonalities Among Psychotherapies A New Perspective Therapy offers new experiences that help people change their views of themselves and their behaviors. They may approach life with a new attitude. Commonalities Among Psychotherapies An Empathic, Trusting, Caring Relationship Effective therapists are empathic people who seek to understand another’s experience; whose care and concern the client feels; and whose respectful listening, reassurance, and advice earn the client’s trust and respect. Culture and Values in Psychotherapy Culture and Values in Psychotherapy Albert Ellis and Allen Bergin disagree about the value of self-sacrifice and marital fidelity, they both appear to agree that psychotherapists’ personal values influence the process of therapy. Therapists and their Training § Clinical psychologists § § Most are psychologists with a Ph.D. and expertise in research, assessment, and therapy, supplemented by a supervised internship About half work in agencies and institutions, half in private practice Therapists and their Training § Clinical or Psychiatric Social Worker § § A two-year Master of Social Work graduate program plus postgraduate supervision prepares some social workers to offer psychotherapy, mostly to people with everyday personal and family problems About half have earned the National Association of Social Workers’ designation of clinical social worker Therapists and their Training § Counselors § § § Marriage and family counselors specialize in problems arising from family relations Pastoral counselors provide counseling to countless people Abuse counselors work with substance abusers and with spouse and child abusers and their victims Therapists and their Training § Psychiatrists § § § Physicians who specialize in the treatment of psychological disorders Not all psychiatrists have had extensive training in psychotherapy, but as M.D.s they can prescribe medications. Thus, they tend to see those with the most serious problems Many have a private practice Biomedical Therapies § Psychopharmacology § study of the effects of drugs on mind and behavior Antipsychotic Drugs Antipsychotic Drugs The molecules of antipsychotic drugs are similar enough to molecules of the neurotransmitter dopamine to occupy its receptor sites and block its activity. (Thorazine, Clozapine ) Antianxiety Drugs Antianxiety Drugs Valium, Xanax, Lithium – depress nervous system activity. Antidepressant Drugs Antidepressant Drugs Most antidepressants work by increasing the availability of the neurotransmitters norepinephrine or serotonin, which elevate arousal and mood and appear scarce during depression. Antidepressant Drugs Lithium— a chemical that provides an effective drug therapy for the mood swings of bipolar (manic-depressive) disorders. Prozac— (fluoxetine) blocks the reabsorption and removal of serotonin from synapses. Zoloft— cousin to Prozac; blocks reabsorption of serotonin. Paxil— cousin to Prozac; serotonin-uptakeinhibitor. Anti-Depressant Medication • First generation—tricyclics and MAO inhibitors Effective for about 75% of patients Produce troubling side effects MAO inhibitors can have serious physiological side effects when taken with some common foods Tricyclics caused weight gain, dry mouth, dizziness, sedation Anti-Depressant Medication Second generation—chemically different but no more effective than earlier drugs (Wellbutrin, Desyrel) Selective serotonin reuptake inhibitors (SSRI)— have fewer undesirable side effects than earlier drugs (Prozac, Paxil, Zoloft) Biomedical Therapies The emptying of U.S. mental hospitals Biomedical Therapies Biomedical Therapies Electroconvulsive Therapy Used for severe depression Very effective for quick relief of symptoms of severe depression (can be used until medication begins to work) May have cognitive side effects such as memory loss Very controversial treatment Biomedical Therapies § Electroconvulsive Therapy (ECT) § § therapy for severely depressed patients in which a brief electric current is sent through the brain of an anesthetized patient Psychosurgery § § surgery that removes or destroys brain tissue in an effort to change behavior lobotomy § now-rare psychosurgical procedure once used to calm uncontrollably emotional or violent patients Preventing Psychological Disorders Preventing Psychological Disorders Advocates of preventive mental health argue that many psychological disorders could be prevented. Their aim is to change oppressive, esteem-destroying environments into more benevolent, nurturing environments that foster individual growth and self-confidence