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Chapter 13 Overview
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Insight therapies
Relationship therapies
Behavior therapies
Cognitive therapies
Biomedical therapies
Evaluating the therapies
The therapeutic relationship
Insight Therapies
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Approaches to psychotherapy based
on the notion that psychological wellbeing depends on self-understanding
What are the basic techniques of
psychodynamic therapies?
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Psychotherapies that attempt to uncover repressed
childhood experiences that are thought to cause
the patient’s current problems
Psychoanalysis is a technique developed by Freud
– Free association
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Explores the unconscious by having patients reveal whatever
thoughts, feelings, or images come to mind
– Dream analysis
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Areas of emotional concern repressed in waking life are
sometimes expressed in symbolic form in dreams
– Transference
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Emotional reaction that occurs during psychoanalysis, in
which the patient displays feelings and attitudes toward the
analyst that were present in another significant relationship
What are the basic techniques of
psychodynamic therapies?
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Object relations therapy
– Based on idea that early relationships form blueprints for
future relationships
– Therapist helps clients restructure current relationships,
changing maladaptive patterns formed in early
relationships
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Interpersonal therapy
– Brief psychotherapy that helps clients understand and
cope with four interpersonal problems associated with
depression
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Severe response to death of a loved one
Interpersonal role disputes
Difficulty adjusting to role transitions
Deficits in interpersonal skills
What is the goal of the therapist in
person-centered therapy?
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Humanistic therapies assume that people
have the ability and freedom to lead rational
lives and make rational choices
– Founded by Carl Rogers (1951)
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Therapists show empathy and create a
climate of unconditional positive regard
– Goal is to allow the client to direct the therapy
session and move toward self-actualization
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The patient’s realization of his inner potential
What is the major emphasis of
Gestalt therapy?
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Helps clients fully experience their feelings,
thoughts, and actions
– Emphasizes clients taking responsibility for their
behavior, instead of blaming society or parents
– Goal is to help the client resolve past conflicts,
achieve a more integrated self, and become
more self-accepting
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Gestalt therapy is directive
– Therapist actively directs the therapy session
– Provides answers and suggestions to the client
Relationship Therapies
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Therapies that attempt to improve
patients’ interpersonal relationships or
create new relationships to support
patients’ efforts to address
psychological problems
What are the goals of family and
couple therapy?
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Family therapy
– Parents and children enter therapy as a group
– Goal is to help family members heal wounds to
the family, improve communication, and create
more understanding within the family
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Couple therapy
– Goal is to help partners in an intimate
relationship communicate and manage conflicts
more effectively
– May focus on behavioral change or partners’
emotional responses to each other
What are some advantages of
group therapy?
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A group of clients (usually seven to ten)
meets regularly with one or more therapists
Provides client with a sense of belonging
and opportunity to
– Express feelings
– Get feedback from other group members
– Give and receive emotional support
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Self-help groups
– People with similar problems who meet
regularly, usually without a professional
therapist
Behavior Therapies
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A treatment approach that is based on
the idea that abnormal behavior is
learned and that applies the principles
of operant conditioning, classical
conditioning, and/or observational
learning to eliminate inappropriate or
maladaptive behaviors and replace
them with more adaptive responses
How do behavior therapists modify
clients’ problematic behavior?
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Uses reinforcement to shape or increase
frequency of desirable behavior
– e.g., Token economy
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Extinguishes undesirable or maladaptive
behavior by terminating or withholding
reinforcement that maintains the behavior
– e.g., Timeout
What behavior therapies are based
on classical conditioning and socialcognitive theory?
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Systematic desensitization is behavior therapy
based on classical conditioning
– Used to treat fears
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Client is trained to relax while being confronted with a
graduated series of anxiety-producing situations
Eventually, client can stay relaxed while confronting even the
most feared situation
Participant modeling is behavior therapy based
on Albert Bandura’s principles of observational
learning
– A model demonstrates appropriate responses to a feared
stimulus in graduated steps
– Client then imitates the model with encouragement of a therapist
– Using this technique, most specific phobias can be extinguished
in 3 to 4 hours
What behavior therapies are based
on classical conditioning and socialcognitive theory?
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Flooding is behavior therapy based on classical
conditioning
– Used to treat phobias by exposing clients to the feared object or
event for an extended period, until their anxiety decreases
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Exposure and response prevention is behavior
therapy
– Exposes patients with obsessive-compulsive disorder to stimuli
that trigger obsessions and compulsive rituals, while patients
resist performing the compulsive rituals for progressively longer
periods of time
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Aversion therapy is behavior therapy
– An aversive stimulus is paired with a harmful or socially
undesirable behavior until the behavior becomes associated with
pain or discomfort
Cognitive Therapies
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Therapies that assume maladaptive
behavior can result from irrational
thoughts, beliefs, and ideas
What is the aim of rational emotive
therapy?
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Developed by Albert Ellis
A directive form of therapy
Goal is to challenge and modify a client’s
irrational beliefs about themselves and
others
– Which are believed to be the causes of personal
distress
How does Beck’s cognitive therapy
help people overcome depression
and panic disorder?
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Cognitive therapy, designed by Aaron
Beck, helps clients stop their negative
thoughts as they occur and replace them
with more objective thoughts
– Depression is treated by brief cognitive
therapy, usually 10-20 sessions, and is more
effective than antidepressant drugs
– Panic disorder is treated by teaching clients to
change the catastrophic interpretations of their
symptoms to prevent them from escalating into
panic, usually effective with 3 months of
treatment
Biomedical Therapies
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Therapies (drug, therapy
electroconvulsive therapy, or
psychosurgery) that are based on the
assumption that psychological
disorders are symptoms of underlying
physical problems
What are the advantages and
disadvantages of using drugs to
treat psychological disorders?
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Antipsychotic drugs
– Prescribed primarily for schizophrenia
– Used to treat symptoms such as hallucinations, delusions,
and disorganized behavior
– Work by inhibiting dopamine activity
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Lithium
– Used to treat bipolar disorder
– Reduces both manic and depressive episodes
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Antianxiety drugs
– Benzodiazepines are effective for treating generalized
anxiety disorder and panic disorder
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This family of minor tranquilizers includes Valium and
Xanax
What are the advantages and
disadvantages of using drugs to
treat psychological disorders?
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Antidepressant drugs
– Act as mood elevators for people who are severely
depressed
– Selective serotonin reuptake inhibitors (SSRIs)
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Block the reuptake of serotonin, increasing its availability at
the synapses of the brain
Are effective for treating major depression, OCD, social
phobia, panic disorder, generalized anxiety disorder,
and binge eating
What are the advantages and
disadvantages of using drugs to
treat psychological disorders?
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Drugs can have unpleasant or dangerous
side effects
It is difficult to establish proper dosages
Drugs do not cure psychological disorders
– So relapse is likely if drug therapy is
discontinued
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Availability of antipsychotic drugs led to a
trend away from hospitalization, which may
have increased homelessness among people
with schizophrenia
What is electroconvulsive therapy
(ECT) used for?
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Electric current is administered to the right
cerebral hemisphere
– While patient is under anesthesia
– Usually reserved for severely depressed patients
who are suicidal
ECT was misused and overused in the 1940s and
1950s, leading to a bad reputation
But it can be a highly effective treatment for major
depression
What is psychosurgery, and for
what problems is it used?
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Brain surgery performed to alleviate serious
psychological disorders or unbearable chronic pain
Lobotomy
– Severs neural connections between frontal lobes and
deeper centers involved in emotion
– No longer performed, because it leaves patients in
permanent deteriorated condition
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Cingulotomy
– Destroys cingulum
– Can help in extreme cases of OCD
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Psychosurgery is controversial, and is considered
experimental and a last resort
– Because results are unpredictable and permanent
Evaluating the Therapies
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Therapies share many similarities.
Therapists use a core set of
techniques no matter which
perspective of therapy session they
adopt, but at the same time, each
therapeutic approach has elements
that distinguish it from others.
What therapy, if any, is most
effective in treating psychological
disorders?
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Smith et al. (1980) analyzed 475 studies
with 25,000 clients
– Found that psychotherapy was better than no
treatment
– But no one type of psychotherapy was more
effective than another
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Eysenck (1994) reanalyzed the same studies
– Reported that behavior therapy has a slight
advantage over other types of therapies
What therapy, if any, is most
effective in treating psychological
disorders?
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A large survey of psychotherapy clients
conducted by Consumer Reports found that
– Overall, clients believed that they benefited
substantially from psychotherapy
– Clients were equally satisfied with therapy
provided by psychologists, psychiatrists, and
social workers
– The longer clients stayed in therapy, the more
they improved
– Clients believed that antidepressant and
antianxiety drugs helped them; but overall
psychotherapy alone worked as well as
psychotherapy plus drugs
The Therapeutic
Relationship
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When establishing a relationship with
a therapist, it is important to become
familiar with the various professionals
who offer therapeutic services.
What distinguishes one type of therapist
from another, and what ethical
standards are shared by all types of
therapists?
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A Psychologist
– Has an advanced degree, usually a doctorate, in
psychology
– Clinical psychologists generally diagnose and
treat psychological disorders
– Counseling psychologists generally provide
therapy for normal problems of life, such as
divorce
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A Psychiatrist
– Is a medical doctor
– Can prescribe drug therapy
What distinguishes one type of therapist
from another, and what ethical
standards are shared by all types of
therapists?
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Therapists are forbidden to engage in any
kind of intimate relationship with a client or
anyone close to the client
They are prohibited from providing therapy
to former intimate partners
They are obligated to use tests that are
reliable and valid
– And they must have appropriate training for all
tests that are used
What are the characteristics of
culturally sensitive therapy?
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An approach to therapy in which knowledge
of clients’ cultural backgrounds guides the
choice of therapeutic interventions
This approach emphasizes that cultural
variables may influence the diagnosis and
treatment of psychological disorders
Why is gender-sensitive therapy
important?
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An approach to therapy that takes into
account the effects of gender on both the
therapist’s and the client’s behavior
This approach emphasizes how a therapist’s
gender biases may affect the techniques
that they choose and their assessments of
clients’ progress