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The Therapeutic Enterprise Types of Psychotherapy Psychodynamic Behavioral Cognitive Cognitive-behavioral Humanistic and Existential Group Cognitive-behavioral group Family and marital therapy Psychodrama Abnormal Psychology, 11/e by Sarason & Sarason © 2005 Psychodynamic Therapy Goal is insight into one’s inner life Some therapists use hypnosis to uncover repressed material Transference – Patient displaces affect and feeling about others onto the therapist Counter transference – Therapists’ emotional responses to patient Psychoanalysis – Special type of psychodynamic therapy using free association and examination of dreams and fantasies Interpersonal psychotherapy – A form of brief therapy that focuses on social relationships Abnormal Psychology, 11/e by Sarason & Sarason © 2005 Behavior Therapy Behavioral modification Based on classical and operant conditioning theory Uses reinforcement and shaping Token economy – Reinforces desired behaviors Biofeedback – Can help develop control of internal processes Parent training Abnormal Psychology, 11/e by Sarason & Sarason © 2005 Cognitive Therapy Goal – Solve emotional problems through cognitive restructuring Aaron Beck – Focuses on changing automatic thoughts Albert Ellis – Rational-emotive therapy emphasizes needs to change self-defeating thinking and beliefs Brief psychotherapies – Often fewer than 12 sessions; specific goals and targets. Abnormal Psychology, 11/e by Sarason & Sarason © 2005 Keys Aspects of Cognitive Therapy Presentation of therapy rationale to patient Short-term intervention Focus on the “here and now” Patient-therapist collaboration Questions and homework Maintain daily records of mood, behavior, and dysfunctional thoughts Carry out informal experiments to test thoughts, beliefs, and assumptions Apply newly acquired cognitive schema to reallife situations. Abnormal Psychology, 11/e by Sarason & Sarason © 2005 Cognitive- Behavioral Therapy Integrates cognitive and behavioral therapies Relaxation training Exposure therapy Flooding Implosive therapy Systematic desensitization In vivo exposure Modeling Behavioral rehearsal Assertiveness training Abnormal Psychology, 11/e by Sarason & Sarason © 2005 Humanistic/ Existential Therapies Humanistic therapy Emphasis on people’s desire to achieve selfrespect Carl Rogers’ Client-centered Therapy Nonjudgmental, nondirective Atmosphere of unconditional positive regard Existential therapy Emphasis on people’s needs to confront questions about meaning and direction of their lives Combine humanistic and psychodynamic techniques Gestalt therapy based on view that people need to get in touch with disowned parts of themselves Abnormal Psychology, 11/e by Sarason & Sarason © 2005 Group Therapy Several people with similar problems Group membership provides Acceptance and support Normative information about behavior/feelings Learning through modeling and behavioral rehearsal Cognitive-behavioral group therapy Goal is development of social skills and comfort in social situations Family and marital therapy View marriage and family as a system Learn how behaviors affect each other Psychodrama Group acts out events of emotional significance Abnormal Psychology, 11/e by Sarason & Sarason © 2005 Does Psychotherapy work? Abnormal Psychology, 11/e by Sarason & Sarason © 2005 Does Psychotherapy work? Conventional wisdom (behind closed doors) H. Eysenck’s study (1952) Meta-analysis (Smith and Glass, 1977) Specific studies- the case of the NIMH collaborative study (1989) Randomized Clinical Trials methods The Consumer Reports Study (1998) Empirically Supported Therapies Abnormal Psychology, 11/e by Sarason & Sarason © 2005 Issues in Psychotherapy Research Specifying the problem patient characteristics and the issue of specificity Specifying the treatment: Specific and nonspecific elements of therapy Treatment manuals Therapist training and fidelity Research design issues (single case, open trials, and RCTS) Internal validity issues (e.g. measurement of outcome, sample size, blindness) External validity issues (e.g., setting, recruitment, flexibility of treatments) Abnormal Psychology, 11/e by Sarason & Sarason © 2005 Abnormal Psychology, 11/e by Sarason & Sarason © 2005 Abnormal Psychology, 11/e by Sarason & Sarason © 2005 Concerns about reliance on ESTs ESTs are limited by the methodology of psychotherapy research (e.g. RCT) Some therapies are easier to test (e.g. CBT) Some problems are more difficult to treat and therefore have fewer ESTs Just because a therapy is not listed as an EST does not mean it could not be Treatment research might not generalize to clinical settings ESTs are too restrictive in general clinical practice There is a need for dissemination research Third party payers might misuse lists of ESTs Abnormal Psychology, 11/e by Sarason & Sarason © 2005 Nonspecific factors in psychotherapy Motivation for treatment; desire to change The release of emotions; catharsis Fostering insight, awareness and self-understanding Building competency and mastery Providing new information; psychoeducation Developing new skills; assigning tasks Working with an “expert” Relationship factors/ therapeutic alliance Empathy, Genuineness Unconditional positive regard Respect and Trust Collaboration Positive expectancies of change; hope Abnormal Psychology, 11/e by Sarason & Sarason © 2005 Biological Therapies Drug therapies Antipsychotic, Antidepressant, Antianxiety, Stimulant, Antimanic Electroconvulsive therapy (ECT) Used for severe depression when drugs and other therapies have failed Psychosurgery Rarely performed for DSM-IV problems Effectiveness of biological therapies Effective for some disorders Multi-modal treatment Abnormal Psychology, 11/e by Sarason & Sarason © 2005 Hospitalization Reasons for hospitalization Behaviors poses threat to self or others Behavior intolerable to community Outpatient treatment failed Treatment requires controlled setting Withdrawal from drugs or alcohol Physical illness complicated by mental disorder requiring continuous care Legislation exists in all states to hospitalize and treat patients against their will. Abnormal Psychology, 11/e by Sarason & Sarason © 2005 Issues in Hospitalization Partial hospitalization When complete hospitalization not required Day, evening, or weekend care Day hospitalization For patients who can live at home but need structure and social interaction Deinstitutionalization Movement towards community-based treatment Initially made possible by discovery of psychoactive drugs Lack of adequate community care has led to increased homelessness and gaps in treatment for seriously mentally ill Abnormal Psychology, 11/e by Sarason & Sarason © 2005