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Types of Therapy / Treatment Insight Therapy Behavioral Therapy Cognitive Therapy Group Therapy Biological Treatments Insight Therapies Psychoanalysis Client-Centered Therapy Gestalt Therapy Short-term psychodynamic Virtual therapy Psychoanalysis Designed to bring repressed feelings and thoughts to conscious awareness Free association Transference Patient talks about whatever comes to mind Client’s feelings about authority figures, both positive and negative, transferred to therapist Insight Awareness of previously unconscious feelings and memories and how they influence present behavior Client-Centered Therapy Developed by Carl Rogers Goal is to help clients become fully functioning Therapist expresses unconditional positive regard Therapy is nondirective Therapist reflects clients’ statements Gestalt Therapy Outgrowth of the work of Fritz Perls Emphasizes the wholeness of personality Attempts to reawaken people to their emotions and sensations in the hereand-now Encourages confrontation with issues Therapist is active and directive Recent Developments Short-term psychodynamic psychotherapy Focused on trying to help people correct the immediate problems in their lives Virtual therapy Therapy delivered online Behavior Therapies Based on the belief that all behavior is learned Objective of therapy is to teach people new ways of behaving Examples: •Classical Conditioning •Operant Conditioning •Modeling Using Classical Conditioning Techniques Systematic desensitization Extinction Ending of old fears or reactions Flooding Gradually associating relaxation with what was feared Full-intensity exposure to feared object Aversive conditioning Eliminate undesirable behavior by associating it with pain and discomfort Operant Conditioning Behavior contracting Client and therapist set behavioral goals and agree on reinforcements the person will receive Token economy Clients earn tokens for desired behaviors and exchange them for desired items or privileges Often used in schools and hospitals Modeling Person learns new behaviors by watching others perform those behaviors Sometimes used in conjunction with operant conditioning Cognitive Therapies •Stress Inoculation •RET •Beck’s Cognitive Therapy Stress-Inoculation Therapy Type of cognitive therapy that trains people to cope with stressful situations by learning a more useful patterns of self-talk Taught to suppress negative and anxiety-provoking thoughts in times of stress Particularly effective for treating anxiety disorders Rational-Emotive Therapy (RET) A directive therapy based on the idea that psychological distress is caused by irrational and self-defeating beliefs Core problem is belief in “musts” and “shoulds” that leave no room for making mistakes Therapist’s job is to challenge client’s irrational beliefs Beck’s Cognitive Therapy Aimed at identifying and changing inappropriately negative and selfcritical patterns of thought Good treatment for depression Group Therapies •Family •Couple •Self-help Family Therapy Form of group therapy that sees the family as at least partly responsible for the individual’s problems Seeks to change all family members’ behavior to the benefit of the family and the individual Couple Therapy A form of group therapy intended to help troubled partners improve their communication and interaction Empathy training Partners taught to share feelings and listen to and understand partner’s feelings Self-Help Groups Small, local gatherings of people who share common problems and provide mutual assistance at very low cost Alcoholics Anonymous is an example Effectiveness of Psychotherapy Does Psychotherapy Work? Psychotherapy helps about 2/3rd of people treated Approximately 1/3 would improve without therapy Which Type of Therapy is Best for Which Disorder? No one type of therapy is better Key is to match the problem with the appropriate therapy Biological Treatments •Drug therapy Anti-psychotic, Anti-depressant, Psycho-stimulants, Anti-anxiety •Electroconvulsive •Psychosurgery Drug Therapies Major reasons for widespread use of drugs Drugs are effective at treating disorders Drug therapies are often less expensive that psychotherapy Antipsychotic Drugs Used for schizophrenia or psychosis All antipsychotics block dopamine receptors in the brain Phenothiazines (Thorazine) Antidepressant Drugs Tricyclics and MAO inhibitors Most common antidepressants prior to late 1980s Work by increasing amount of the neurotransmitters serotonin and norepinephrine Effective, but have serious side effects Selective Serotonin Reuptake Inhibitors (SSRIs) Work by blocking the reuptake of serotonin Prozac, Paxil, Zoloft, Effexor Action of SSRIs Lithium A naturally occurring salt that is used to treat bipolar disorder (manic depression) Nobody knows how lithium works to alleviate symptoms Problem with people stopping medication when symptoms ease Other Medications Psychostimulants Use to treat disorders such as AD/HD Concern that psychostimulants are being overused Antianxiety medications Use to treat anxiety disorders Produce a feeling of calm and mild euphoria Valium is a common antianxiety medication Electroconvulsive Therapy Commonly known as “shock therapy” Used as a treatment for severe depression Causes brief convulsions and temporary loss of consciousness Memory loss is a side-effect Newer techniques minimize effects on memory Psychosurgery Brain surgery performed to change a person’s behavior or emotional state A prefrontal lobotomy is an example Psychosurgery is rarely used today Institutionalization and Its Alternatives Institutions offer: •Shelter •Care •Therapy / Treatment / Counseling •Transition training and preparation for real world living •Relief for family members Deinstitutionalization Releasing people with severe psychological disorders into the community Can cause problems Some people are ill-prepared to deal with life outside of a hospital Up to 40% of homeless are mentally ill Alternative forms of treatment (many) Half-way houses Family-crisis interventions Day-care Prevention Primary prevention Improve the social environment so that new cases of mental disorders do not develop • Family planning • Genetic counseling Secondary prevention Interventions with high risk groups (e.g., suicide hot-line) Tertiary prevention Help people adjust after they are released from the hospital in order to help prevent a relapse Gender Differences in Treatment More women admit problems and go to therapy Women are more likely to take medication Psychotherapy is seen as more acceptable for women Recent increases in number of males seeking psychotherapy Cultural Difference in Treatment Eye contact and body language varies across cultures and may be misinterpreted as symptomatic of a disorder Another challenge is treating posttraumatic stress disorder in refugees There may be disorders in other cultures that do not appear in U.S. Review The main goal of insight therapies is to give clients a better understanding and awareness of their feelings, motivations, and actions in the hope that this will lead to better adjustment. Behavior therapies are based on the belief that all behavior, normal and abnormal, is learned, and that the objective of therapy is to teach people more satisfying ways of behaving. Cognitive therapies aim at changing clients' maladaptive ways of thinking about themselves and the world. Group therapy is based on the idea that psychological problems are at least partly interpersonal problems and are therefore best approached in an interpersonal setting. Group therapy provides social support and is less costly than individual therapy. Psychoanalysis is a therapy based on the belief that psychological problems stem from feelings and conflicts repressed during childhood. One way to uncover what has been repressed is through free association, a process in which the client discloses whatever thoughts or fantasies come to mind without editing or otherwise inhibiting them. In classical psychoanalysis, the patient comes to transfer feelings held toward authority figures from childhood to the analyst, a process known as transference. The goal of psychoanalysis is insight, or awareness of feelings, memories, and actions from the past that were unconscious but were exerting a strong influence on the patient's present feelings and behavior. Client-centered (or person-centered) therapy, founded by Carl Rogers, is built on the idea that therapy should be based on the client's view of the world rather than the therapist's and on the client's responsibility for change. The therapist's most important task is to provide unconditional positive regard for clients so that they will learn to accept themselves. Gestalt therapy grew out of the work of Fritz Perls and is designed to help people become more aware of their feelings and more genuine in their day-to-day interactions. The emphasis in therapy is on making the person whole and complete. Behavior therapies are based on the belief that all behavior, normal and abnormal, is learned, and that the objective of therapy is to teach people more satisfying ways of behaving. Classical conditioning therapies attempt to evoke a new conditioned response to old stimuli. For example, systematic desensitization is a method for gradually reducing irrational fears by imagining---or confronting in real life---increasingly fearful situations while maintaining a relaxed state. Eventually, relaxation replaces fear as a response, perhaps as a result of extinction. Flooding, which subjects the person to feared situations at full intensity and for a prolonged time, is a somewhat harsh but highly effective method of desensitization. Aversive conditioning has the opposite goal: it conditions a negative rather than a positive response to a stimulus such as the sight or taste of alcohol. Its purpose is to eliminate undesirable behaviors by associating them with pain and discomfort. Operant conditioning techniques work by reinforcing new behaviors and ignoring or punishing old ones. In one such technique, called behavior contracting, client and therapist agree on certain behavioral goals and on the reinforcement the client will receive upon reaching those goals. In another technique, called the token economy, tokens that can be cashed in for "rewards" are used to positively reinforce many different kinds of desired behavior. In modeling, a person learns new behaviors by watching others perform those behaviors. Stress-inoculation therapy teaches clients new and positive patterns of self-talk they can use to support themselves through stressful situations. Rational-emotive therapy (RET) is based on the idea that people's emotional problems derive from a set of irrational and self-defeating beliefs they hold about themselves and the world. The therapist vigorously challenges these beliefs until the client comes to see just how irrational and dysfunctional they are. Aaron Beck believes that depression results from negative patterns of thought that are strongly and inappropriately self-critical. His cognitive therapy tries to help clients think more positively about themselves and the world. Group therapy is based on the idea that psychological problems are at least partly interpersonal problems and are therefore best approached in an interpersonal setting. Group therapy provides social support and is less costly than individual therapy. Family therapy is based on the idea that an individual's psychological problems are to some extent family problems. Therefore, the therapist treats the family unit rather than the isolated individual, with the goal of improving communication and empathy among family members and reducing intrafamily conflict. Couple therapy concentrates on improving patterns of communication and interaction. Most researchers agree that psychotherapy helps about two-thirds of the people treated. Most kinds of therapy are more effective than no treatment at all, but researchers have found few major differences in the effectiveness of various forms of therapy. The general trend in psychotherapy is toward eclecticism, the use of a broad treatment package rather than one single form of therapy. Biological treatments, including medication, electroconvulsive therapy, and psychosurgery, are sometimes used when psychotherapy does not work or when a client has a disorder for which biological treatment is known to be safe and effective. Medication, especially, is very often used in conjunction with psychotherapy Drugs are the most common biological therapies. Antipsychotic drugs are valuable in the treatment of schizophrenia; they do not cure the disorder, but they do reduce its symptoms. Side effects can be severe, however. Antidepressant drugs alleviate depression, though some have serious side effects. Often the effectiveness of antidepressants such as Prozac seems to be due to the patient's belief that the drug will work (the placebo effect). Many other types of medication are used to treat psychological disorders, including antianxiety drugs, sedatives, and psychostimultants for children with attentiondeficit/hyperactivity disorder. Electroconvulsive therapy (ECT) is used for cases of severe depression that do not respond to other treatments. An electric current briefly passed through the brain of the patient produces convulsions and temporary coma. Psychosurgery is brain surgery performed to change a person's behavior and emotional state. It is rarely done today, and then only as a last desperate measure on patients with intractable psychoses. Large mental hospitals offer people with severe mental disorders shelter and a degree of care, but a number of problems are linked with institutionalization, including inadequate care and the tendency of patients to become lethargic and accept a permanent "sick role." With the advent of antipsychotic drugs in the 1950s, many patients were released from large public hospitals to be cared for in a community setting, in the policy of deinstitutionalization. But community mental-health centers and other support services proved inadequate to the task. As a result, many former patients stopped taking their medication, became homeless, and ended up suffering from psychosis and living on the street. Alternatives to hospitalization range from living in the family home, with training to cope with daily activities for the mentally ill individual and crisis therapy for the family, to small homelike facilities in which residents and staff share responsibilities. Most alternative treatments involve some medication of the troubled individual and skillful preparation of the family/community. The majority of studies have found more positive outcomes for alternative treatments than for hospitalization. Prevention refers to efforts to reduce the incidence of mental illness. Primary prevention refers to improving the social environment through assistance to parents, education, and family planning. Secondary prevention refers to identifying high-risk groups and directing service to them. The object of tertiary prevention is to help hospitalized patients return to the community. Reference: Psychology, an Introduction, 12th ed. ; Morris, Charles & Maisto, Albert Pearson Publishers, 2010 (chapter 14) Psychology, a Journey, 2nd ed.; Coon, Dennis Thomson/Wadsworth Publishers, 2005 (chapter 13) Let the sunshine...let the sunshine in, the sun, shine in...