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Therapies: Ways of
Helping
Psychodynamic Therapies
Humanistic-Existential Therapies
Behavior Therapy
Cognitive Therapies
Group, Couples, and Family Therapy
Effectiveness of Psychotherapy
Psychotherapy and Human Diversity
Biomedical Therapies
Adjustment
What is Psychotherapy?
A systematic interaction between a
therapist and a client that brings
psychological principles to bear on
influencing the client’s thoughts,
feelings, or behavior to help that
client overcome abnormal behavior
or adjust to problems in living.
Essentials of Psychotherapy
• Systematic Interaction: Psychotherapy is a systematic
interaction between a client and a therapist. The therapist
structures the therapy process based upon a theoretical
viewpoint and an understanding of the client’s cultural and
social background.
• Psychological Principles: Psychotherapy is based on
psychological theory and research in various areas such as
personality, learning and abnormal behavior.
• Thoughts, feelings and behaviors: Psychotherapy influences
clients’ thoughts, feelings and behavior.
• Psychological Disorders, adjustment problems, and personal
growth: While psychotherapy is often used with people who
have psychological disorders, it can also be used to help people
with adjustment (loss of spouse, shyness) and personal growth.
Psychodynamic Therapies
Psychodynamic Therapy
• Psychodynamic theories are based on the
thinking of Sigmund Freud, the founder of
psychodynamic theory.
• Focus upon the conflict amongst the there
psychic structures (id, ego and superego).
• Freud’s method of therapy, psychoanalysis,
was the first psychodynamic therapy.
Psychoanalysis
• Psychoanalysis seeks to help people
develop insight into the dynamic
struggles occurring within the psyche
between the three psychic structures.
• The goal is to bring conflicts between
the psychic structures into conscious
awareness and “work through” them.
Psychoanalysis Terms and
Techniques
• Free Association: In psychoanalysis, the
uncensored uttering of all thoughts that come
to mind.
• Resistance: The tendency to block the free
expression of impulses and primitive ideas—
a reflection of the defense mechanism of
repression.
• Interpretation: An explanation of a client’s
utterance according to psychoanalytic theory.
Psychoanalysis Terms and
Techniques
• Transference: Responding to one person
(such as a spouse or the psychoanalyst) in a
way that is similar to the way one responded
to another person (such as a parent) in
childhood.
• Dream Analysis: Freud believed that
unconscious impulses tend to be expressed
in dreams as a form of wish fulfillment.
Dreams consist of both manifest (the reported
content) content and latent (the symbolized or
underlying meaning) content.
Humanistic-Existential Therapies
Client-Centered Therapy
• Client-centered therapy: Carl Rogers’s method of
psychotherapy, which emphasizes the creation of a warm,
therapeutic atmosphere that frees clients to engage in selfexploration and self-expression.
• Frame of Reference: One’s unique patterning of perceptions and
attitudes, according to which one evaluates events.
• An effective client-centered therapist has several
qualities: Unconditional positive regard (unconditional
respect for clients regardless of their behavior),
Empathic understanding (accurate recognition of the
client’s experiences and feelings) and Genuineness
(open expression of the therapist’s own feelings)
Gestalt Therapy
• Gestalt Therapy: Fritz Perls’s form of psychotherapy,
which attempts to integrate conflicting parts of the
personality through directive methods designed to
help clients perceive their whole selves.
• Gestalt exercises include The dialogue (client
undertakes verbal confrontations between opposing
wishes and ideas to heighten awareness of internal
conflict), I take responsibility (clients end statements
about themselves by adding, “and I take
responsibility for it”) and Playing the projection
(clients role-play people with whom they are in
conflict).
Behavior Therapy
Behavior Therapy
• Behavior Therapy: Systematic
application of the principles of learning
to the direct modification of a client’s
problem behaviors.
• Behavior therapists draw upon the
principles of classical and operant
conditioning as well as observational
learning.
Behavior Therapy
(Fear Reduction Methods)
• Flooding: A person is exposed for prolonged
intervals to a fear-evoking but harmless stimulus until
fear is extinguished.
• Gradual exposure: Similar to flooding, but works
upward in a hierarchy of progressively more fearful
stimuli.
• Systematic Desensitization: Wolpe’s method for
reducing fears by associating a hierarchy of images
of ear-evoking stimuli with deep muscle relaxation.
• Modeling: A technique in which a client observes and
imitates a person who approaches and copes with
feared objects or situations.
Behavior Therapy
(Aversive Conditioning)
• Aversive Conditioning: A behavior therapy
technique in which stimuli associated with
undesired responses become aversive by
pairing noxious stimuli with them. An
example would be rapid smoking.
• Rapid Smoking: An aversive conditioning
method for quitting smoking in which the
smoker inhales every 6 seconds, thus
rendering once-desirable cigarette smoke
undesireable.
Behavior Therapy
(Operant Conditioning Principles)
• The Token Economy: A controlled environment in
which people are reinforced for desired behaviors
with tokens (such as poker chips) that may be
exchanged for later privileges.
• Social Skills Training: Behavior therapists help people
alleviate social anxiety and build social skills through
having participants rehearse social behaviors in a
group setting.
• Biofeedback Training: The systematic feeding back to
an organism of information about a bodily function so
that the organism can gain control of that function.
Cognitive Therapies
Cognitive Therapies
• Cognitive therapists focus on helping people
change the beliefs, attitudes and automatic
types of thinking that are believed to underlie
psychological problems such as anxiety and
depression.
• The two most common cognitive therapies
are Aaron Beck’s cognitive therapy and Albert
Ellis’s rational-emotive behavior therapy.
Cognitive Therapies
• Beck’s Cognitive Therapy: A form of therapy
that focuses on how clients’ cognitions
(expectations, attitudes, beliefs, etc.) lead to
distress and may be modified to relieve
distress and promote adaptive behavior.
• Ellis’s Rational-emotive Behavior Therapy
(REBT): A form of therapy that encourages
clients to challenge and correct irrational
expectations and maladaptive behaviors.
Convergence of Approaches
• Today, many therapists
don’t adhere to a single
approach.
• As the graph shows,
many therapists utilize
an eclectic approach.
• These therapists tend to
be older and more
experienced.
Group, Couples and
Family Therapies
Group Therapy
•
When a therapist has several clients with similar problems, it often
makes sense to treat them together in a group rather than individually.
Group therapy has several advantages:
•
It’s economical. Therapists can work with several clients at once.
•
It can provide more information and life experience for clients to draw
upon.
•
Appropriate behavior receives support from the group.
•
Affiliating with people with similar problems is reassuring that we’re not
alone.
•
Group members who improve provide hope for other group members,.
•
Group therapy can help those who are seeking therapy because of
problems in relating to other people.
Couples Therapy
• Couples therapy focuses on helping
distressed couples resolve their conflicts
and improve their communication skills.
• Couples therapy helps correct power
imbalances in the relationship so that
partners can explore alternative ways of
relating to one another.
• The leading contemporary approach to
couples therapy is based on cognitivebehavioral principles.
Family Therapy
• A form of therapy in which the family unit is
treated as the client.
• In a systems approach to family therapy, the
therapist helps the family change the system
by which the family functions in order to
enhance growth of individual family members
and of the family as a whole.
Effectiveness of
Psychotherapy
Effectiveness of Psychotherapy
• There are several problems that researchers must address
when evaluating the effectiveness of psychotherapy. These
problems include comparing different forms of psychotherapy,
measuring outcomes of therapy and determining whether
effectiveness is due to nonspecific factors or the therapeutic
alliance. However…
• Meta-analyses by Smith and Glass (1977) and Shadish (2000)
have found that psychotherapy is effective.
• Smith and Glass: Those who receive psychodynamic therapy
showed better results, on average, than 70-75% of those who
did not receive treatment. Similarly, nearly 75% of those who
received client-centered therapy were better off than control
groups.
Psychotherapy and
Human Diversity
Psychotherapy and Human Diversity
• In general: Psychotherapists must
attend to and respect their client’s
sociocultural and individual differences.
Therapists must also recognize their
own ethical responsibilities if they are
not comfortable with, or lack the skills to
work with, a particular client.
Psychotherapy and Ethnic
Minority Groups
•
African Americans: African Americans are often reluctant to seek
psychological help because of cultural assumptions that people should
manage their own problems. African Americans may also be
suspicious of their therapists (especially if the therapist is European
American).
•
Asian Americans: Asian Americans tend to stigmatize people with
psychological disorders. As a result, they may deny problems and
refuse to seek help. Also, recent immigrants may not believe in, or
understand western approaches.
•
Latino and Latina Americans: Therapists need to be aware of the
potential conflicts between the traditional Latino and Latina American
value of interdependency in the family and the typical European
American belief in independence and self-reliance.
•
Native Americans: Many psychological disorders experienced by
Native Americans involve the disruption of their traditional culture. This
loss of identity has lead to several problems (such as alcoholism).
Therapists who wish to help, must be sensitive to Native American
culture, customs and values.
Feminist Psychotherapy and Psychotherapy
for Gay Males and Lesbians.
• Feminist Psychotherapy: An approach to
therapy rooted in feminist theory and
philosophy. Feminist therapists note that
many women experience depression and
other psychological problems as a result of
being treated as second class citizens.
• Therapy for Gay Males and Lesbians: Some
therapists may be uncomfortable with the
sexual orientation of their clients. Also, some
gays and lesbians seek therapy to change
their sexual orientation which raises the
question: “Is it ethical to try to change sexual
orientation?”
Biomedical Therapies
Biomedical Therapies
• Biomedical therapies are administered
by doctors, such as psychiatrists. The
three primary forms of biomedical
therapy are drug therapy,
electroconvulsive therapy and
psychosurgery.
Drug Therapy
• Psychotropic Drugs: Prescription
drugs that are widely used to help
relieve disturbing emotional states,
such as anxiety or depression, or to
control symptoms of severe disorders.
• There are three major classes of
psychotropic drugs: antianxiety,
antipsychotic, and antidepressants.
Drug Therapy
• Antianxiety: Most antianxiety drugs belong to the chemical
class known as benzodiazapenes. Common drugs include
Valium and Xanax. These drugs depress the activity of the
central nervous system. Many people quickly develop a
tolerance to antianxiety drugs.
• Antipsychotic: Are a group of drugs that help relieve psychotic
symptoms. These drugs are believed to act by blocking
dopamine receptors in the brain.
• Antidepressants: A group of drugs that primarily help relieve
depression, but also are used to treat obsessive-compulsive
disorder, bulimia and panic disorder amongst others. Three
major classes include Monoamine Oxidase (MAO) inhibitors
(such as Nardil), Tricyclics (such as Tofranil) and Selective
Serotonin-Reuptake Inhibitors (SSRIs) such as Prozac and
Zoloft.
Electroconvulsive Therapy (ECT)
• Treats disorders like major depression
by passing an electric current (that
causes a convulsion) through the head.
• People usually receive ECT in a series
of 6 to 12 treatments spread over
several weeks.
• Problems with ECT include potential
memory loss and high relapse rates.
Psychosurgery
• Surgery intended to promote
psychological changes or to relieve
disordered behavior.
• Prefrontal Lobotomy: The severing or
destruction of part of the frontal love of
the brain.
• Prefrontal lobotomy is no longer
practiced due to the multiple side
effects.
Evaluating Biomedical Therapies
• The introduction of antipsychotic drugs made it
possible for hundreds of thousands of mental hospital
patients to return home.
• However, psychiatric drugs are not a cure all. They
can have troubling side effects.
• Also, psychotherapy has been found to be as
effective (if not more so) than drug therapies for
certain disorders (such as depression).
• Ultimately, a combination of psychotherapy and
biomedical treatment may be the best course of
action.
Coping with Emotional
Responses to Stress
Coping with Anxiety and Fear
• 1. Define the feared object or situation.
• 2. List specific behaviors that make up a gradual
approach of the target.
• 3. Create a hierarchy of fears.
• 4. Utilize gradual exposure, starting with the least
threatening item of your hierarchy.
• 5. Pay attention to your cognitions.
Managing Anger
• Monitor your reactions in angering situations.
• Stop and think
• Practice competing responses and competing
thoughts.
• Practice self-relaxation.
• Don’t impose unrealistic expectations on others.
• Replace anger with empathy.
• Depersonalize the situation.
• Keep your voice down.
• Act assertively, not aggressively.
• Express positive feelings.
• Give yourself a pat on the back for keeping your
cool.
Lifting your Mood
• Engage in pleasant activities: Utilizing the list in
your book, engage in at least three of these
events each day. Record your activities in a diary
and toward the end of each day, rate your
response to each activity. After a week or so,
check the items in your diary that received
positive ratings and repeat successful activities
while experimenting with new ones.
• Think Rationally: Recognize and change distorted
thoughts into rational thoughts.
• Exercise: Exercise can enhance psychological
well-being and help us cope with depression.
To the Instructor:
• The preceding slides are intended to provide
you a base upon which to build your
presentation for Chapter 9 of Nevid’s
Psychology and the Challenges of Life.
• For further student and instructor resources
including images from the textbook, quizzes,
flashcard activities and e-Grade plus, please
visit our website: www.wiley.com/college/nevid
Copyright
Copyright 2004 by John Wiley & Sons, Inc., New York,
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