Download Insight Therapies

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Presentations for
Seventh Edition
Philip G. Zimbardo
Robert L. Johnson
Vivian McCann
Prepared by
Beth M. Schwartz
Randolph College
This multimedia product and its contents are protected under copyright law. The following are prohibited by law: any public performance or display,
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Copyright © 2012 Pearson Education, Inc. All rights reserved
1
Chapter 13
Therapies for
Psychological Disorders
This multimedia product and its contents are protected under copyright law. The following are prohibited by law: any public performance or display,
including transmission of any image over a network; preparation of any derivative work, including the extraction, in whole or part, of any images; any
rental, lease, or lending of the program.
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What is Therapy?
Therapy for psychological
disorders takes a variety of
forms, but all involve a
therapeutic relationship
focused on improving a
person’s mental, behavioral,
or social functioning.
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What is Therapy?
• General term for any treatment process
• In psychology and psychiatry, therapy
refers to a variety of psychological and
biomedical techniques aimed at dealing
with mental disorders or coping with
problems of living.
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Components of Therapy
Identifying the problem
Identifying the cause of the
problem or the conditions that
maintain the problem
Deciding on and carrying out
some form of treatment
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Types of Mental Health Care
Professionals
Counseling Psychologist
Clinical Psychologist
Psychiatrist
Psychoanalyst
Psychiatric Nurse Practitioner
Clinical Social Worker
Pastoral Counselor
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Professional Title
Counseling Psychologist
Specialty:
Clinical Psychologist
Problems of
normal living
Psychiatrist
Work setting:
Psychoanalyst
Schools, clinics,
other institutions
Psychiatric Nurse Practitioner
Credentials:
Clinical Social Worker
Master’s in
counseling, PhD,
EdD, or PsyD
Pastoral Counselor
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Professional Title
Counseling Psychologist
Specialty:
Clinical Psychologist
Those with severe
or less severe
disorders
Psychiatrist
Work setting:
Psychoanalyst
Private practice,
mental health
agencies,
hospitals
Psychiatric Nurse Practitioner
Clinical Social Worker
Pastoral Counselor
Credentials:
PhD or PsyD
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Professional Title
Specialty:
Counseling Psychologist
Physician trained
to treat mental
problems (often
by means of drug
therapies)
Clinical Psychologist
Psychiatrist
Psychoanalyst
Work setting:
Psychiatric Nurse Practitioner
Clinical Social Worker
Pastoral Counselor
Private practice,
clinics, hospitals
Credentials:
MD
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Professional Title
Counseling Psychologist
Clinical Psychologist
Specialty:
Psychiatrist
Freudian therapy
Psychoanalyst
Work setting:
Psychiatric Nurse Practitioner
Private practice
Clinical Social Worker
Credentials:
Pastoral Counselor
MD or PhD
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Specialty:
Professional Title
Counseling Psychologist
Clinical Psychologist
Work setting:
Psychiatrist
Private practice,
clinics, hospitals
Psychoanalyst
Credentials:
Psychiatric Nurse
Practitioner
Clinical Social Worker
Pastoral Counselor
Nursing specialty;
licensed to
prescribe drugs
RN plus special
training in treating
mental disorders
and prescribing
drugs
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Professional Title
Specialty:
Counseling Psychologist
Social worker with
a specialty in
dealing with
mental disorders
Clinical Psychologist
Psychiatrist
Psychoanalyst
Work setting:
Psychiatric Nurse Practitioner
Often employed
by government
Clinical or Psychiatric
Social Worker
Pastoral Counselor
Credentials:
MSW
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Professional Title
Counseling Psychologist
Specialty:
Combines
spiritual guidance
with practical
counseling
Clinical Psychologist
Psychiatrist
Psychoanalyst
Work setting:
Psychiatric Nurse Practitioner
Clinical Social Worker
Pastoral Counselor
Religious order or
ministry
Credentials:
Varies
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Therapy in Historical Context
Medieval Europe:
• Mental disorder the work of devils and
demons
• Exorcism needed to “beat the devil” out
More Modern Times
• Mentally ill placed in institutions called
asylums, which often resulted in neglect
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Modern Approaches to Therapy
Modern approaches abandoned demon
model and abusive treatments.
• Therapies based on psychological and
biological theories of mind and behavior
• psychological therapies, often called
psychotherapy
• Biological therapies focus on altering the
brain.
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How Do Psychologists
Treat Psychological Disorders?
Psychologists employ two
main forms of treatment:
insight therapies
and behavioral therapies.
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Types of Psychotherapy
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Insight Therapies
Insight Therapies
• Psychotherapies in which the therapists
help patients/clients understand (gain
insight into) their problems
• Aim at revealing and changing a patient’s
disturbed mental processes through
discussion and interpretation
• Numerous approaches involve this type of
therapy.
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Insight Therapies
Freudian Psychoanalysis
• Insight therapies based on the assumption
that psychological problems arise from
tension created in the unconscious mind by
forbidden impulses
• Major goal: To release conflicts and
memories from the unconscious
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Insight Therapies:
Psychodynamic Therapies
Psychoanalysis
• The form of psychodynamic therapy
developed by Sigmund Freud
• Access to unconscious material through
free association
• Helps the patient understand the
unconscious causes for his or her
symptoms
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Insight Therapies
Freudian Psychoanalysis
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Insight Therapies:
Psychodynamic Therapies
Psychoanalysis
• The ego blocks unconscious problems from
consciousness through defense mechanisms.
• e.g., displacement and repression
Analysis of Transference
• Analyzing and interpreting the patient’s
relationship with the therapist, based on the
assumption that this relationship mirrors
unresolved conflicts in the patient’s past
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Insight Therapies:
Psychodynamic Therapies
Neo-Freudian Psychodynamic Therapies
• Therapies developed by psychodynamic
theorists who embraced some but not all of
Freud’s ideas
•
•
•
•
•
•
emphasis on conscious motivation
significance of the self
experiences throughout life
the role of interpersonal relationships
abandoned the psychoanalyst’s couch
see patients once a week
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Insight Therapies:
Humanistic Therapies
Humanistic Therapies
• Mental problems arise from low self-esteem,
misguided goals, and unfulfilling
relationships.
Client-Centered Therapy: Carl Rogers
• Emphasizes healthy psychological growth
through self-actualization
• Reflection of feeling: paraphrasing client’s
words to capture the emotional tone expressed
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Insight Therapies:
Cognitive Therapies
Cognitive Therapy
• Emphasizes rational thinking as the key to
treating mental disorder
• Helps patients confront destructive thoughts
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Insight Therapies:
Group Therapies
Group Therapy
• Psychotherapy with more than one client
Self-Help Support Groups
• Groups that provide social support and an
opportunity for sharing ideas about dealing
with common problems; typically
organized/run by laypersons (not
professional therapists)
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Insight Therapies:
Group Therapies
Couples and Family Counseling
• Intended to help clients learn about
relationships
• Can be more effective than individual
therapy with one member of the relationship
at a time
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Behavior Therapies
Behavior Therapy
• Any form of psychotherapy based on the
principles of behavioral learning:
• operant conditioning and classical
conditioning
Systematic
Desensitization
Aversion
Therapy
Contingency
Management
Token
Economies
Participant
Modeling
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Classical Conditioning Therapies
Systematic Desensitization
• Technique in which anxiety is extinguished
by exposing the patient to an anxietyprovoking stimulus
Exposure Therapy
• Desensitization therapy in which patient
directly confronts the anxiety-provoking
stimulus (as opposed to imagining it)
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A Sample Anxiety Hierarchy
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Classical Conditioning Therapies
Aversion Therapy
• Involves presenting individuals with an
attractive stimulus paired with unpleasant
stimulation in order to condition a repulsive
reaction
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Operant Conditioning Therapies
Contingency Management
• Approach to changing behavior by altering
the consequences of behaviors
• Effective in numerous settings
• e.g., families, schools, work, and prisons
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Operant Conditioning Therapies
Token Economies
• Applied to groups (e.g., classrooms or
mental hospital wards)
• Involves distribution of “tokens”
contingent on desired behaviors
• Tokens can later be exchanged for
privileges, food, or other reinforcers.
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Participant Modeling: An
Observational-Learning Therapy
Participant Modeling
• The therapist demonstrates and encourages
a client to imitate a desired behavior.
• Draws on concepts from both operant and
classical conditioning
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Cognitive-Behavioral Therapy:
A Synthesis
Cognitive-Behavioral Therapy
• Combines cognitive emphasis on thoughts
with behavioral strategies that alter
reinforcement contingencies
• Assumes irrational self-statements cause
maladaptive behavior
• Seeks to help the client develop a sense of
self-efficacy
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Cognitive-Behavioral Therapy:
A Synthesis
Rational-Emotive Behavior Therapy (REBT)
• Albert Ellis
• Based on the idea that irrational thoughts
and behaviors are the cause of mental
disorders
• Attempts to eliminate the self-defeating
thoughts
Positive Psychotherapy (PPT)
• Positive emphasis on growth
• Emphasis on research
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Evaluating the
Psychological Therapies
Eysenck (1952) proposed that people with
nonpsychotic problems recover just as
well with or without therapy.
Reviews of evidence since have shown
that:
• Eysenck overestimated the improvement
rate in the group without therapy.
• Therapy is better than no therapy.
• It appears advantageous to match
specific therapies with specific conditions.
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Comparing the Different Types of Therapy
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How Is the Biomedical
Approach Used to
Treat Psychological Disorders?
Biomedical therapies seek to
treat psychological disorders
by changing the brain’s
chemistry with drugs, its
circuitry with surgery, or its
patterns of activity with pulses
of electricity or powerful
magnetic fields.
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Drug Therapy
Antipsychotic Drugs
• E.g., chlorpromazine, haloperidol, and
clozapine
• Usually affect dopamine pathways
• May have side effects
• tardive dyskinesia: incurable disorder of
motor control resulting from long-term use of
antipsychotic drugs
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Drug Therapy
Antidepressant Drugs
• Three major categories:
• tricyclic compounds (e.g., Tofranil and Elavil)
• SSRIs (e.g., Prozac)
• Monoamine oxidase (MOA) inhibitors and
lithium carbonate (effective against bipolar
disorder)
Mood Stabilizers
• E.g., Lithium and Depakote: effective for
bipolar disorders
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Drug Therapy
Antianxiety Drugs
• Include barbiturates and benzodiazepines
• May include some antidepressant drugs that
work on certain anxiety disorders
• Should not be used to relieve the ordinary
anxieties of everyday life
• Should not be taken for more than a few
days at a time
• Should not be combined with alcohol
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Drug Therapy
Stimulants (e.g., caffeine, nicotine, cocaine)
• Produce excitement or hyperactivity
• Suppress activity level in persons with
attention-deficit/hyperactivity disorder (ADHD)
• Controversy exists concerning the use of these
stimulants for children.
• side effects
• growth slowed
• concern regarding overdiagnosis of ADHD
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Psychosurgery
The general term for surgical intervention
in the brain to treat psychological
disorders
• The infamous prefrontal lobotomy is no
longer performed.
• Severing the corpus callosum, however,
can reduce life-threatening seizures.
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Brain-Stimulation Therapies
Used to treat severe depression
Electroconvulsive Therapy (ECT)
• Apply an electric current to temples briefly
• Patient is put to “sleep.”
• Memory deficits are a side effect.
Transcranial Magnetic Stimulation (TMS)
• High-powered magnetic stimulation to the brain
• Also effective for bipolar disorder
Deep Brain Stimulation
• Surgical implants of a micro electrode directly in
the brain
• Still highly experimental
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Hospitalization
and the Alternatives
Therapeutic Community
• Designed to bring meaning to patients’ lives
• Hospital setting to help patients cope with the world
outside
• Higher costs
Deinstitutionalization
• Removing patients, whenever possible, from mental
hospitals
Community Mental Health Movement
• Effort to deinstitutionalize mental patients and to
provide therapy from outpatient clinics
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How do the Psychological
Therapies and Biomedical
Therapies Compare?
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While a combination of
psychological and medical
therapies is better than either
alone for treating some (but not
all) mental disorders, most
people who suffer from
unspecified “problems in living”
are best served by
psychological treatment alone.
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Depression
Psychological vs. Medical Treatment
• Both are equally effective ways to treat
depression in the short run.
• Cognitive behavioral therapy is more
effective in the long run.
• A combination of both is most effective.
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Anxiety Disorders
Psychological vs. Medical Treatment
• Both can be effective.
• Most effective is a combination of both.
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Empirically Supported Therapy (EST)
Therapies validated by research evidence
showing that they actually work
This research raises interesting questions
about whether counselors/therapists should
be limited to these therapies.
• Can this guideline help practitioners to avoid
harmful therapies?
• Can practitioners still meet individual needs?
• How will the insurance companies be
involved?
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