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PSYCHOLOGY AN EXPLORATION Second Edition CHAPTER 13 psychological therapies Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White why study therapies for psychological disorders? There are almost as many therapy methods as there are disorders. Correctly matching the type of therapy to the disorder can mean the differ- ence between a cure or a crisis. It is important to know the choices available for treatment and how they relate to the different kinds of disorders so that an informed decision can be made and the best possible outcome can be achieved for mental health and wellness. Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Learning Objective Menu • • • • • • • • • • LO 13.1 Two ways modern ways to treat psychological disorders LO 13.2 Elements of Freud’s psychoanalysis and psychoanalysis today LO 13.3 Basic elements Humanistic therapies LO 13.4 Behavior therapists’ use of classical and operant conditioning LO 13.5 Goals of cognitive therapies LO 13.6 Types of group therapy LO 13.7 Effectiveness of psychotherapy LO 13.8 Types of drugs used to treat psychological disorders LO 13.9 Modern electroconvulsive therapy and psychosurgery LO 13.10 How might computers be used in psychotherapy Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Two Kinds of Therapy LO 13.1 Two modern ways to treat psychological disorders • Therapy – Treatment with goal of improved mood and functioning • Psychotherapy – Treats mental disorders Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Two Kinds of Therapy LO 13.1 Two modern ways to treat psychological disorders • Psychotherapy – Talk with a psychological professional Insight therapy – Gain insight about behavior, thoughts, and feelings Action therapy – Change behavior directly Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Two Kinds of Therapy LO 13.1 Two modern ways to treat psychological disorders • Biomedical therapy – Treatment with biological or medical methods to relieve symptoms Includes drugs, surgical methods, electroconvulsive treatment – Medication alone not sufficient Treats symptoms of disorder Psychotherapy builds coping strategies, aids in adjustment Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Treatment in the Past LO 13.1 Two modern ways to treat psychological disorders • Early efforts to treat mentally ill – 1500’s Bethlehem Hospital converted to asylum – Treatments included beatings bloodletting, ice baths Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Treatment in the Past LO 13.1 Two modern ways to treat psychological disorders • Philippe Pinel’s Reforms – Unchained inmates La Bicêtre Asylum, Paris 1793 – Treated mentally ill with kindness – Advocated “moral” therapy Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White In this famous painting by French artist Robert Fleury, French psychiatrist Dr. Philippe Pinel orders the chains removed from patients at a Paris asylum for insane women. Pinel was one of the first psychiatrists to recommend humane treatment of the mentally ill. Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Freud’s Psychoanalysis LO 13.2 Elements of Freud’s psychoanalysis and psychoanalysis today • Insight therapy – Emphasizes revealing unconscious conflicts Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Freud’s Psychoanalysis LO 13.2 Elements of Freud’s psychoanalysis and psychoanalysis today • Two techniques for accessing unconscious: – Dream interpretation Manifest content – Actual dream and it’s events Latent content – Symbolic or hidden meaning of dreams Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Freud’s Psychoanalysis LO 13.2 Elements of Freud’s psychoanalysis and psychoanalysis today • Two techniques for accessing unconscious: – Free association Patient free to say anything that came to mind No fear of negative evaluation Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Freud’s Psychoanalysis LO 13.2 Elements of Freud’s psychoanalysis and psychoanalysis today • Resistance – Patient reluctant to talk about certain topics Changes subject or becomes silent Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Freud’s Psychoanalysis LO 13.2 Elements of Freud’s psychoanalysis and psychoanalysis today • Transference – Therapist becomes a symbol of parental authority figure from the past Countertransference – Therapist has transference reaction to the patient Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Evaluation of Psychoanalysis and Psychodynamic Approaches LO 13.2 Elements of Freud’s psychoanalysis and psychoanalysis today • Criticisms – Lack of scientific methodology – Over-emphasis on sexual problems Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Evaluation of Psychoanalysis and Psychodynamic Approaches LO 13.2 Elements of Freud’s psychoanalysis and psychoanalysis today • Modern Psychodynamic therapy – Client sits face-to-face with therapist – Therapist is more directive Asks questions, suggests helpful behavior, and gives opinions Therapy not useful for clients with psychoses Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Interpersonal Psychotherapy LO 13.2 Elements of Freud’s psychoanalysis and psychoanalysis today • • • • Developed to treat depression Insight-oriented therapy Focus on relationships Psychodynamic origins – More eclectic – Combines elements of humanistic and cognitive behavioral therapies • Effectiveness supported by research Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Psychotherapy often takes place one-on-one, with a client and therapist exploring various issues together to achieve deeper insights or to change undesirable behavior. Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Roger’s Person-Centered Therapy LO 13.3 Basic elements of Humanistic therapies • Non-directive insight therapy • Based on the work of Carl Rogers • Client talks and the therapist listens Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Roger’s Person-Centered Therapy LO 13.3 Basic elements of Humanistic therapies • Four Elements: – Reflection Therapist restates client’s talk No interpretation of statements – Unconditional positive regard Accepting atmosphere created by therapist – Empathy Therapist understands client feelings Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Roger’s Person-Centered Therapy LO 13.3 Basic elements of Humanistic therapies • Four Elements: – Authenticity Genuine, open, and honest response of therapist Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White A Rogerian person-centered therapist listens with calm acceptance to anything the client says. A sense of empathy with the client’s feelings is also important. Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Gestalt Therapy LO 13.3 Basic elements of Humanistic therapies • Founded by Fritz Perls • People hide parts of self behind false “mask” – Mask is socially acceptable behavior – Inner self not matching mask causes conflict Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Gestalt Therapy LO 13.3 Basic elements of Humanistic therapies • Therapist is confrontational and directive – Lead clients through exercises • Attention to body language • Focus on “denied parts” not hidden past of psychoanalysis Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White In Gestalt therapy, it is not unusual to find a client talking to an empty chair. The chair represents some person from the past with whom the client has unresolved issues, and this is the opportunity to deal with those issues. Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Evaluation of Humanistic Therapy LO 13.3 Basic elements of Humanistic therapies • Little experimental research to support ideas – Theories built around case studies • Clients need to be intelligent, highly verbal – Not a good choice for seriously mentally ill Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Behavioral Therapy and Classical Conditioning LO 13.4 Behavior therapists’ use of classical and operant conditioning • Action-based rather than insight-based therapy • Change behavior through learning new responses – Learning created problem – New learning corrects problem Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Therapies Based on Classical Conditioning LO 13.4 Behavior therapists’ use of classical and operant conditioning • Through classical conditioning: – Old and undesirable automatic responses can be replaced by desirable ones • Techniques originally called Behavior Modification Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Therapies Based on Classical Conditioning LO 13.4 Behavior therapists’ use of classical and operant conditioning • Applied behavior analysis – Newer term – Highlights need for a functional analysis of behavior – Analysis followed by conditioning Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Therapies Based on Classical Conditioning LO 13.4 Behavior therapists’ use of classical and operant conditioning • Systematic desensitization – Used to treat phobias – Client is first taught deep muscle relaxation – Next creates a list of ordered fears Hierarchy of fears – Pairs relaxation with fears – Computer generated simulations used Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Therapies Based on Classical Conditioning LO 13.4 Behavior therapists’ use of classical and operant conditioning • Aversion therapy – Undesirable behavior is paired with aversive stimulus – Reduces frequency of behavior Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White This device allows the delivery of high levels of nicotine to the smoker in a process known as rapid smoking. Rapid smoking is an aversive technique for helping people to quit smoking and is based on the classical conditioning principle of counterconditioning. Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Therapies Based on Classical Conditioning LO 13.4 Behavior therapists’ use of classical and operant conditioning • Flooding – Technique for treating phobias, stress disorders – Person is intensely exposed to fearprovoking situation – Prevented from making avoidance or escape response Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Therapies Based on Classical Conditioning LO 13.4 Behavior therapists’ use of classical and operant conditioning • Techniques include reinforcement, extinction, shaping, and modeling – Change the frequency of voluntary behavior – Results quick and practical Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Therapies Based on Classical Conditioning LO 13.4 Behavior therapists’ use of classical and operant conditioning • Modeling – Learning through observation, imitation of a model – Participant modeling Model demonstrates the desired behavior in a step-by-step process Client is encouraged to imitate Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Therapies Based on Classical Conditioning LO 13.4 Behavior therapists’ use of classical and operant conditioning • Reinforcement – Strengthening of response by following it with: A pleasurable consequence (positive reinforcement) Removal of an unpleasant stimulus (negative reinforcement) Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Therapies Based on Classical Conditioning LO 13.4 Behavior therapists’ use of classical and operant conditioning • Reinforcement – Token economy Tokens to reinforce behavior Can be accumulated and exchanged for desired items or privileges Used effectively to modify behavior of disturbed institutionalized individuals Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Therapies Based on Classical Conditioning LO 13.4 Behavior therapists’ use of classical and operant conditioning • Contingency contract – Formal, written agreement between the therapist and client – Goals for behavioral change, reinforcements, and penalties are clearly stated – Useful in treating problems such as drug addiction Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Therapies Based on Classical Conditioning LO 13.4 Behavior therapists’ use of classical and operant conditioning • Extinction – Removal of a reinforcer – Reduces frequency of behavior – Time-out Extinction process Person is removed from situation reinforcing an undesirable behavior Placed away from attention and reinforcement opportunities Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White This boy is sitting in the “time-out” corner at his school. By removing the attention that he found rewarding, the teacher is attempting to extinguish the behavior that earned the boy a time-out. Do you see anything in this time-out corner that might make it less effective? Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Evaluation of Behavioral Therapies LO 13.4 Behavior therapists’ use of classical and operant conditioning • Effective in treating specific problems – Bedwetting, drug addictions, phobias • More serious psychological disorders do not respond as well to behavioral treatments • Overall behavior therapies are: – Relatively quick and efficient – Eliminate or greatly reduce symptoms Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Cognitive Therapy LO 13.5 Goals of cognitive therapy • Focus on: – Helping clients recognize distortions in thinking – Replace distorted, unrealistic beliefs with realistic thoughts • Is critical thinking applied to one’s own beliefs Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Cognitive Therapy LO 13.5 Goals of cognitive therapy • Beck – Identified five common distortions – Arbitrary inference Jumping to conclusions Drawing conclusions not based on evidence Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Beck's Cognitive Therapy LO 13.5 Goals of cognitive therapy • Selective thinking – Focusing on one aspect of a situation – Ignoring all other relevant aspects • Overgeneralization – Drawing sweeping conclusions based on only one incident – Applying conclusions to events unrelated to original Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Beck's Cognitive Therapy LO 13.5 Goals of cognitive therapy • Magnification and minimization – Negative event blown out of proportion to its importance (magnification) – Ignore relevant positive events (minimization) • Personalization – Taking responsibility for events unconnected to the person Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Cognitive-Behavioral Therapy LO 13.5 Goals of cognitive therapy • Assumes disorders come from illogical, irrational cognitions • Is an action therapy – Learning to think more rationally and logically Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Cognitive-Behavioral Therapy LO 13.5 Goals of cognitive therapy • Three goals: – Relieve the symptoms and solve the problems – Develop strategies for solving future problems – Help change irrational, distorted thinking Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Rational-Emotive Behavior Therapy LO 13.5 Goals of cognitive therapy • A cognitive-behavioral therapy • Clients are directly challenged on irrational beliefs • Restructures thinking into rational belief statements • Therapists are directive – Provide homework assignments – Challenge “my way or nothing” statements Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Success of CBT LO 13.5 Goals of cognitive therapy • CBT has seemed successful in treating – Depression, stress disorders, and anxiety • Criticized for focusing on symptoms, not causes of disordered behavior Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Table 13.1 Characteristics of Psychotherapies Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Group Therapies LO 13.6 Types of group therapy • Therapist may use one of many approaches or a combination – Insight, cognitive-behavioral, person-centered, behavioral – Share problems, provide support Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Group Therapies LO 13.6 Types of group therapy • Family counseling – Family members meet together with a counselor – Discover and resolve unhealthy patterns of relating – Open lines of communication – Resolve problems that affect the entire family Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Group Therapies LO 13.6 Types of group therapy • Self-help groups – People with similar problems meet together without a therapist or counselor – Purpose is discussion, problem solving, emotional support Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White In family therapy, all family members participate in therapy sessions, with the therapist guiding them through open communication. Although it appears that the young boy in the corner is the focus of this session, all family members are encouraged to see how their own behavior may contribute to the problem behavior. Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Advantages of Group Therapy LO 13.6 Types of group therapy • Lower cost • Exposure to way other persons view and handle the same kinds of problems • Opportunity for therapist and client to see interaction with others • Social and emotional support from people with similar problems Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White In group therapy, several people who share similar problems gather with a therapist to discuss their feelings and concerns. The presence of others who are going through the same kind of emotional difficulties can be comforting as well as provide the opportunity for insights into one’s own problems by hearing about the problems of others. Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Disadvantages of Group Therapy LO 13.6 Types of group therapy • Need to share therapist’s time with others in the group • Lack of a private setting in which to reveal concerns • Possibility that shy people will not be able to speak up within a group setting • Inability of people with severe disorders to tolerate being in a group Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Does Psychotherapy Really Work? LO 13.7 Effectiveness of psychotherapy • Psychotherapy is more effective than no treatment at all. • 75 to 90 percent of people who receive therapy improve – Longer a person stays in therapy the better the improvement – Psychotherapy works as well alone as with drugs Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Does Psychotherapy Really Work? LO 13.7 Effectiveness of psychotherapy • Some types of psychotherapy are more effective for certain types of problems – No one psychotherapy method is effective for all problems Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Characteristics of Effectiveness Psychotherapy LO 13.7 Effectiveness of psychotherapy • Common factors approach – Modern approach to eclecticism – Focuses on factors common to successful outcomes in therapy Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Characteristics of Effectiveness Psychotherapy LO 13.7 Effectiveness of psychotherapy • Therapeutic Alliance – Relationship between client and therapist • Protected setting – Privacy, safety for client • Opportunity for catharsis • Learning and practice of new behavior Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Culture, Ethnic and Gender Concerns LO 13.7 Effectiveness of psychotherapy • Differences between therapist and client – Difficult for the therapist to understand concerns – Misunderstandings and misinterpretations can occur Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Culture, Ethnic and Gender Concerns LO 13.7 Effectiveness of psychotherapy • Four barriers to effective psychotherapy – Language – Culture-bound values – Class-bound values – Nonverbal communication Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Cybertherapy LO 13.7 Effectiveness of psychotherapy • Psychotherapy offered on the Internet • Offers advantages of low or no cost, accessible, anonymous • No guarantee cybertherapist has credentials or training in psychotherapy • Difficult for cybertherapist to assess client’s body language or emotional state Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Biomedical Therapies LO 13.8 Types of drugs used to treat psychological disorders • Therapies directly affecting the biological functioning of body and brain • Psychopharmacology – The use of drugs to control or relieve the symptoms of psychological disorders Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Biomedical Therapies LO 13.8 Types of drugs used to treat psychological disorders • Psychopharmacology – Anti-psychotic drugs Used to treat psychotic symptoms – Delusions, hallucinations, and other bizarre behavior – Anti-anxiety drugs Include anti-anxiety and antidepressant drugs Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Biomedical Therapies LO 13.8 Types of drugs used to treat psychological disorders • Psychopharmacology – Anti-manic drugs Used to treat bipolar disorder Include lithium and anticonvulsant drugs – Antidepressant drugs Used to treat depression and anxiety Include MAOIs, tricyclics, SSRIs Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Table 13.2 Types of Drugs Used in Psychopharmacology Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Electroconvulsive Therapy LO 13.9 Modern electroconvulsive therapy and psychosurgery • Treats severe depression – Electrodes are placed on one or both sides of the head – Bilateral ECT Electrodes are placed on both sides of the head – Unilateral ECT Electrodes are placed on only one side of the head and forehead Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Electroconvulsive therapy consists of applying an electric shock to one or both sides of the head. The result is rapid improvement in mood. It has been shown to be most effective in treating severe depression that has not responded to medication or where medication side effects cannot be tolerated. Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Electroconvulsive Therapy LO 13.9 Modern electroconvulsive therapy and psychosurgery • Treats severe depression – An electric current is passed through the electrodes – Strong enough to cause a seizure or convulsion Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Psychosurgery LO 13.9 Modern electroconvulsive therapy and psychosurgery • Surgery performed on brain tissue to relieve or control severe psychological disorders – Prefrontal lobotomy Connections between prefrontal cortex to other brain areas are severed Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Psychosurgery LO 13.9 Modern electroconvulsive therapy and psychosurgery • Surgery performed on brain tissue to relieve or control severe psychological disorders – Bilateral cingulotomy MRI used to guide electrode to area in brain Electrode is inserted into the cingulate gyrus Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Psychosurgery LO 13.9 Modern electroconvulsive therapy and psychosurgery • Surgery performed on brain tissue to relieve or control severe psychological disorders – Bilateral cingulotomy Small current run to electrode to destroy small area of cells – Referred to as deep lesioning – Effective in ⅓ to ½ cases of major depression, bipolar and OCD Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Emerging Techniques LO 13.9 Modern electroconvulsive therapy and psychosurgery • Repetitivetranscranial magnetic stimulation (rTMS) – Magnetic pulses are applied to the cortex • Transcranial direct current stimulation (tDCS) – Scalp electrodes used to pass low amplitude currents to the brain Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Repetitive transcranial magnetic stimulation (rTMS) uses a pulsating magnetic field to activate specific parts of the brain’s surface. As seen above, by placing an electromagnet on the scalp, TMS can be used to stimulate small areas of the cortex and is being evaluated as a way to control some psychological symptoms, such as those related to depression and PTSD. Photo courtesy of Martijn Arns, http://www.brainclinics.com Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Virtual Realities LO 13.10 How might computers be used in psychotherapy • Software-generated, three-dimensional simulated environment • Useful with exposure therapy • Vivid and realistic imagery possible – Particularly helpful for clients that do not visualize well • Post-traumatic stress disorder (PTSD) – Benefits from the use of VR psychotherapy Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White Some behavioral therapists now use virtual reality to expose patients to phobic objects and situations—like the cabin of an airplane. As part of systematic desensitization, this patient receives exposure to anxiety-provoking visual displays through a virtual reality headset. Credit: Charles Undermost, Delft University of Technology. Psychology: An Exploration, Second Edition Saundra K. Ciccarelli • J. Noland White