Therapy

AP Psych
2011
Colley

The Psychological Therapies

Psychotherapy
An emotionally charged, confiding interaction
between a trained therapist and someone
who suffers from psychological difficulties
250 types of psychotherapy have been identified

Some therapists use a combination of

treatments
Eclectic Approach
An approach in psychotherapy that, depending on
the clients problems, uses techniques from
various forms of therapy

Psychoanalysis
Freuds therapeutic approach
Freud believed the patients free
associations, resistances, dreams, and
transferences and the therapists
interpretations of them released
previously repressed feelings, allowing the
patient to gain self-insight
Aims
Psychoanalysts try to bring repressed feelings
into conscious awareness where the patient can
deal with them.
Work through buried feelings

Psychoanalysis
Methods
Psychoanalysis is historical reconstruction
Resistance
The blocking from consciousness of anxietyladen material
Hint that anxiety lurks and you are repressing sensitive
material

Interpretations
The analysts noting supposed dream meanings,
resistances, and other significant behaviors in order
to promote insight

Psychoanalysis
Latent content of dreams
Underlying meaning of a dream
Functions as a safety valve
Analyst would study a dream report and suggest a
meaning

Transference
The patients transfer to the analyst of emotions linked
with other relationships (such as love or hatred for a
parent)
Exposes long repressed feelings

Much of psychoanalysis is built on the

assumption that repressed memories exist

Psychoanalysis
Critics also say that psychoanalysts
interpretations are hard to refute
Hard to prove or disprove
Its a therapy, not a science

Psychoanalysis takes a lot of time

and money
Multiple sessions a week for many years

Psychodynamic Theory
Therapists who work on
psychodynamic assumptions
Try to understand a patients current
symptoms by exploring childhood
experiences
Use face-to-face talk therapy (instead of
being out of patients sight-line)
Meet once a week (instead of a multiple times)
Meet with a patient for a few weeks/months
(not several years)

Psychodynamic
Interpersonal psychotherapy
A brief (12-16 session) alternative to
psychodynamic therapy
Has been found to be successful with
depressed patients
Focuses on current relationships and assists
people in improving their relationship skills
Goal is not personality change, but symptom
relief in the here and now

Humanistic Therapies
Humanistic therapists aim to boost selffulfillment by helping people grow in
self-awareness and self-acceptance
Humanistic therapists tend to focus on:
The present and future more than the past
Conscious rather than unconscious thoughts
Taking immediate responsibility for ones
feelings and actions, rather than uncovering hidden
issues
Promoting growth, instead of curing illness

Clients not patients

Humanistic Therapies
Client-Centered Therapy (Carl Rogers)
The therapist uses techniques such as active
listening within a genuine, accepting,
empathetic environment to facilitate clients
growth
The therapist listens, without judging or interpreting
Refrains from directing the client towards certain insights
Nondirective therapy

Active listening
Empathic listening in which the listener echoes,
restates, and clarifies

Humanistic Therapies
The therapists most important
contribution is to accept and
understand the client
Keys to active listening
Paraphrase
Invite clarification: May encourage the
speaker to say more
Reflect feelings

Behavior Therapies
Doubt the healing power of self-awareness
Assume that problem behaviors are the
problems
Ex. You can become aware of why you are highly
anxious during exams and still be anxious

Behavior therapy
Therapy that applies learning principles to the
elimination of unwanted behaviors
View maladaptive behaviors as learned behaviors,
which they try to replace with constructive behaviors

Behavior Therapies
Classical Conditioning Techniques
Are maladaptive symptoms examples of condition
responses?
If so, reconditioning might be a solution
Bed-wetting treatment

Counter-conditioning
A behavior therapy procedure that conditions
new responses to stimuli that trigger
unwanted behaviors
Phobias/Fears
Pairs the trigger stimulus with a new response that is
incompatible with fear

Behavior Therapies
Exposure Therapies
Behavioral techniques, such as
systematic desensitization, that
treat anxieties by exposing people
(in imagination or actuality) to the
things they fear and avoid
Goal being that with repeated
exposure, people become less
responsive to things that once
petrified them

Behavior Therapies
Systematic Desensitization
Type of counter-conditioning that associates a
pleasant relaxed state with gradually
increasing anxiety-triggering stimuli
Commonly used to treat phobias
If you can repeatedly relax while facing anxietyprovoking stimuli, you can gradually eliminate your
anxiety

Therapists use progressive relaxation, to

get patients to relax one muscle group at a
time until they are in a drowsy state

Behavior Therapies
Aversive Conditioning
A type of counter-conditioning that associates an
unpleasant state (such as nausea) with an
unwanted behavior (such as a drinking
alcohol)
Procedure is simple
Associates unwanted behavior with unpleasant feelings
Treat nail-biting, one can paint fingernails with a gross tasting
polish
Treat alcoholism, therapist would lace drinks with a drug that
induces nausea

May work in the short run, but cognition influences

conditioning

Behavior Therapies
Operant Conditioning
Behavior therapists can reinforce desired
behaviors and to withhold
reinforcement/punish undesired behaviors
Rewards used to modify vary
Some people only need attention or praise
Others need concrete awards

Token Economy
An operant conditioning procedure that rewards
desired behavior
Patient exchanges a token of some sort, earned for
exhibiting the desired behavior, for various privileges and
treats

Behavior Therapies
Two concerns/criticisms
What happens when the reinforcers
stop?
Is it right for one human to control
anothers behavior?

Cognitive Therapies
Cognitive Therapies
Therapy that teaches people new,
more adaptive ways of thinking and
acting
Based on the assumption that thoughts
intervene between events and our
emotional reactions
Our thinking colors our feelings

Vicious cycle of depression model

Cognitive Therapies
Cognitive Therapy for Depression
Seek to reverse clients catastrophizing beliefs
about themselves, their situations, and their
futures.
Attempt to convince depressed people to take a different
view on life
Technique is

Positive thinking gentle questioning that aims

to help people discover their irrationalities
Rabin Study
Attempt to get depressed people to think more positively
Saw a marked improvement

Cognitive Therapies
Cognitive-behavior therapy
A popular integrated theory that
combines cognitive therapy
(changing self-defeating thinking)
with behavior therapy (changing
behavior)
Seeks to make people aware of their
irrational negative thinking, to replace
it with new ways of thinking, and to
practice the more positive approach in
everyday settings

Group Therapies
Group and Family Therapies
Many of the therapies we have looked at, besides
psychoanalysis, can occur in small groups
Often just as effective as one-on-one therapy and
cheaper

Group sessions offer a unique benefit

The social context allows people to discover
that others have problems similar to their
own and to try out new ways of behaving
Can help received feedback
And is a relief to know that you are not alone

Evaluating Psychotherapies
Is psychotherapy effective???
Not an easily answered question

Clients Perceptions
If this were the only yardstick, then we would
say that psychotherapy is very effective
3 out of 4 clients have reported themselves satisfied
1 in 2 have said they are very satisfied

People enter therapy because they are

suffering and most leave feeling better
about themselves

Evaluating Psychotherapies
But there are a few reasons to skeptical
People often enter therapy in crisis
May attribute improvement to therapy

Clients may need to believe the therapy

was the effort
Self-justification is a powerful human motive

Clients generally like their therapists and

speak kindly of them
Even if their problems remain, clients may work
hard to find something positive to say

Relative Effectiveness of Different

Therapies
Relative Effectiveness of Different Therapies
No one type of therapy is superior
Whether treated by a psychologist, a psychiatrist, a social
worker, in groups, or alone did not seem to make a difference

Empirically supported therapies

Cognitive therapy, interpersonal therapy, and behavior therapy
for depression
Cognitive therapy, exposure therapy, and stress inoculation
training for anxiety
Cognitive-behavior therapy for bulimia
Behavior modification for bed wetting

Behavioral conditioning therapies have also shown

favorable results with specific behavior problems
Phobias, compulsions, or sexual disorders

Alternative Therapies
Light Exposure Therapy
Seasonal Affective Disorder (SAD)
A form of depression
Often during the winter months, people oversleep, gain weight,
and feel lethargic
Women and people who live far from the equator are those
most often affected

Light exposure was introduced as a potential treatment

Studies have shown that exposure to light in the morning and
evening produced relief in patients
The morning light would shift the secretion of melatonin to an
earlier time

For many people, morning bright light does help with

SAD symptoms

Commonalities Among
Psychotherapies
Commonalities Among Psychotherapies
All types of psychotherapy seem to offer
three benefits
A new hope
A fresh perspective
Every therapy offers people a plausible explanation of
their symptoms and an alternative way of looking at
their world

An empathic, trusting, and caring relationship

Not all therapists are equally effective
If people are supported by close friendships, they are
less likely to need or seek therapy

Biomedical Therapies
Psychotherapy is one way to treat
psychological disorders
The other is physically changing the
brains functioning
Drug therapies
Electroconvulsive therapies
Psychosurgery

Drug Therapies
The most widely used biomedical
treatment
Greatly reduces the need for psychosurgery or
hospitalization

Psychopharmacology
The study of the effects of drugs on mind and
behavior
Revolutionized the treatment of people with
severe disorders
The resident population of mental hospitals is 20% of
what it was 50 years ago

Antipsychotic Drugs
The revolution in drug therapy began with the
accidental discovery of drugs that calmed
psychotic patients
Chlorpromazine (Thorazine) dampens
responsiveness to irrelevant stimuli
Can produce sluggishness, tremors, and twitches
Twitches are similar to those of Parkinsons disease patients

Provide the most help to schizophrenia patients

experiencing positive symptoms
Not as much of a help to patients with negative symptoms
Clozapine (Clozaril) has been sometimes shown to enable
awakenings in some patients

Antipsychotic
The molecules of antipsychotic drugs
are similar to those of dopamine
Occupy their receptor sites and block its
activity
Reinforces the idea that an overactive
dopamine system contributes to
schizophrenia

Antianxiety
Antianxiety Drugs
Xanax and Valium depress the central nervous
system activity
Like alcohol

Used in combination with other therapy, these

drugs can help a person learn to cope with
frightening situations and fear-triggering stimuli
Criticism is that these drugs reduce symptoms
without resolving underlying problems
People can develop a psychological dependence on
the drugs

Antidepressants
Antidepressant Drugs
Sometimes lift people from a state of depression
Most work by increasing the availability of the
neurotransmitters norepinephrine or serotonin
Elevates arousal and mood

Fluoxetine (Prozac) partially blocks the reabsorption and

removal of serotonin from synapses
Prozac, Paxil, and Zoloft all do this
Known as selective-serotonin-reuptake-inhibitor drugs (SSRIs)
One side effect is decreased sexual appetite

Other antidepressants block the reabsorption of both

norepinephrine and serotonin or by blocking the enzyme that
breaks down serotonin
Have more potential side effects
Dry mouth, weight gain, hypertension, dizzy spells

Lithium
Lithium
A chemical that provides an effective
drug therapy for the mood swings of
bipolar disorders
With conditioned lithium, emotional
highs and lows level out
Patients using lithium have 1/6th the risk
of suicide compared to patients not
taking anything
It works, but we dont know why

Electroconvulsive Therapy (ECT)

Controversial brain manipulation treatment
A biomedical therapy for severely
depressed patients in which a brief electric
current is sent through the brain of an
anesthetized patient
First introduced in 1938
Patient was conscious and jolted with 100 volts
to the brain
Produced racking convulsions and brief
unconsciousness

ECT
Today the patient is unconscious and given a
muscle relaxant
Within 30 minutes, the patient wakes up and remembers
nothing of the treatment or the hours preceding it

Generally limited to the treatment of severe

depression
After 3 such sessions a week for a 2-4 weeks, 80% of
patients improve markedly
Show some memory loss, but no brain damage

ECT is confirmed as an effective treatment for

severe depression in patients who have not
responded to drug therapy

ECT
No one knows for sure how it works
Might increase the release of
norepinephrine or the shock-induced
seizures cause the brain to react by
calming neural centers where
overactivity produces depression

rTMS
Repetitive transcranial magnetic
stimulation
Pulses surge through a magnetic coil
held close to a persons skull above the
right eyebrow
Shown to be very effective
An idea out there is that the stimulation
energizes the depressed patients
relatively inactive frontal lobe

Psychosurgery
Surgery that removes or destroys brain tissue in an
effort to change behavior
First psychosurgical operation: the lobotomy
A now-rare psychosurgical procedure once used to calm
uncontrollably emotional or violent patients
Procedure cut the nerves that connect the frontal lobes to
the emotion-controlling centers of the inner brain
After shocking the patient into a coma, a neurosurgeon would
hammer an icepicklike instrument through each eye socket into
the brain
Would then wiggle it to sever connections
Crude, but easy and cheap

Would produced a permanently lethargic, immature,

impulsive personality

Psychosurgery
Psychosurgery was largely
abandoned in the 1950s
Used today only in extreme cases
Patients who suffer from severe seizures or
from severe OCD
MRI-guided precision surgery destroys just
those nerve centers responsible