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TherapyTherapy

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TherapyTherapy

The Psychological The Psychological TherapiesTherapies PsychoanalysisPsychoanalysis

Humanistic TherapiesHumanistic Therapies

Behavior TherapiesBehavior Therapies

Cognitive TherapiesCognitive Therapies

Group and Family TherapiesGroup and Family Therapies

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History of TreatmentHistory of Treatment

Maltreatment of the mentally ill Maltreatment of the mentally ill throughout the ages was the result of throughout the ages was the result of irrational views. Many patients were irrational views. Many patients were

subjected to strange, debilitating, and subjected to strange, debilitating, and downright dangerous treatments.downright dangerous treatments.

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History of TreatmentHistory of Treatment

Philippe Pinel in France and Dorthea Dix Philippe Pinel in France and Dorthea Dix in America founded humane movements in America founded humane movements

to care for the mentally ill.to care for the mentally ill.

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Philippe Pinel (1745-1826) Dorthea Dix (1745-1826)

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PsychoanalysisPsychoanalysis

The first formal psychotherapy to emerge was The first formal psychotherapy to emerge was psychoanalysis, developed by Sigmund Freud. psychoanalysis, developed by Sigmund Freud.

Sigmund Freud's famous couch

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Psychoanalysis: AimsPsychoanalysis: Aims

Since psychological problems originate from Since psychological problems originate from childhood repressed impulses and conflicts, childhood repressed impulses and conflicts,

the aim of psychoanalysis is to the aim of psychoanalysis is to bring bring repressed feelings into conscious repressed feelings into conscious

awarenessawareness where the patient can deal with where the patient can deal with them.them.

When energy devoted to id-ego-superego When energy devoted to id-ego-superego conflicts is released, the patientconflicts is released, the patient’’s anxiety s anxiety

lessens.lessens.

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Psychoanalysis: MethodsPsychoanalysis: Methods

Dissatisfied with hypnosis, Freud developed Dissatisfied with hypnosis, Freud developed the method of the method of free associationfree association to unravel the to unravel the

unconscious mind and its conflicts.unconscious mind and its conflicts.

The patient lies on a couch and speaks about whatever comes to his or her mind.

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Psychoanalysis: MethodsPsychoanalysis: Methods

During free association, the patient edits his During free association, the patient edits his thoughts, resisting his or her feelings to express thoughts, resisting his or her feelings to express emotions. Such emotions. Such resistanceresistance becomes important becomes important

in the analysis of conflict-driven anxiety.in the analysis of conflict-driven anxiety.

Eventually the patient opens up and Eventually the patient opens up and reveals his or her innermost private reveals his or her innermost private

thoughts, developing positive or negative thoughts, developing positive or negative feelings (feelings (transferencetransference) towards the ) towards the

therapist.therapist.

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Psychodynamic TherapiesPsychodynamic Therapies

Influenced by Freud, in a face-to-face Influenced by Freud, in a face-to-face setting, psychodynamic therapists setting, psychodynamic therapists

understand symptoms and themes across understand symptoms and themes across important relationships in a patientimportant relationships in a patient’’s life.s life.

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Humanistic TherapiesHumanistic Therapies

Humanistic therapists aim to boost self-Humanistic therapists aim to boost self-fulfillment by helping people grow in fulfillment by helping people grow in

self-awareness and self-acceptance.self-awareness and self-acceptance.

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Person-Centered TherapyPerson-Centered Therapy

Developed by Carl Rogers, person-centered Developed by Carl Rogers, person-centered therapy is a form of humanistic therapy.therapy is a form of humanistic therapy.

The therapist listens to the needs of the The therapist listens to the needs of the patient in an accepting and non-patient in an accepting and non-

judgmental way, addressing problems in judgmental way, addressing problems in a productive way and building his or her a productive way and building his or her

self-esteem.self-esteem.

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Necessary ConditionsNecessary Conditions

GenuinenessGenuineness Unconditional Positive Regard Unconditional Positive Regard

(acceptance)(acceptance) EmpathyEmpathy

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Humanistic TherapyHumanistic Therapy

The therapist engages in active listening The therapist engages in active listening and echoes, restates, and clarifies the and echoes, restates, and clarifies the

patientpatient’’s thinking, acknowledging s thinking, acknowledging expressed feelings.expressed feelings.

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Behavior TherapyBehavior Therapy

Therapy that applies learning principles Therapy that applies learning principles to the elimination of unwanted behaviors.to the elimination of unwanted behaviors.

To treat phobias or sexual disorders, To treat phobias or sexual disorders, behavior therapists do not delve deeply behavior therapists do not delve deeply

below the surface looking for inner below the surface looking for inner causes.causes.

Behavior TherapyBehavior Therapy

WatsonWatson Mary Cover JonesMary Cover Jones WolpeWolpe

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Classical Conditioning Classical Conditioning TechniquesTechniques

CounterconditioningCounterconditioning is a procedure is a procedure that conditions new responses to stimuli that conditions new responses to stimuli

that trigger unwanted behaviors.that trigger unwanted behaviors.

It is based on classical conditioning and It is based on classical conditioning and includes includes exposure therapyexposure therapy, , systematic systematic

desensitization desensitization and and aversive aversive conditioning.conditioning.

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Exposure TherapyExposure Therapy

Expose patients to Expose patients to things they fear and things they fear and

avoid. Through avoid. Through repeated exposures, repeated exposures,

anxiety lessens anxiety lessens because they because they

habituate to the habituate to the things feared.things feared.

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Exposure TherapyExposure Therapy

Exposure therapy involves exposing people Exposure therapy involves exposing people to fear-driving objects in real or virtual to fear-driving objects in real or virtual

environments.environments.

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Systematic Systematic DesensitizationDesensitization

A type of exposure therapy that A type of exposure therapy that associates a pleasant, relaxed state with associates a pleasant, relaxed state with gradually increasing anxiety-triggering gradually increasing anxiety-triggering stimuli commonly used to treat phobias.stimuli commonly used to treat phobias.

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Aversive ConditioningAversive Conditioning

A type of A type of counterconditioning counterconditioning that associates an that associates an unpleasant state unpleasant state

with an unwanted with an unwanted behavior. With this behavior. With this

technique, technique, temporary temporary

conditioned conditioned aversion to alcohol aversion to alcohol has been reported.has been reported.

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Operant ConditioningOperant Conditioning

Operant conditioning procedures enable Operant conditioning procedures enable therapists to use therapists to use behavior modificationbehavior modification,, in which desired behaviors are rewarded in which desired behaviors are rewarded

and undesired behaviors are either and undesired behaviors are either ignored or punished.ignored or punished.

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Token EconomyToken Economy

In institutional settings therapists may In institutional settings therapists may create a token economy in which patients create a token economy in which patients

exchange a token of some sort, earned exchange a token of some sort, earned for exhibiting the desired behavior, for for exhibiting the desired behavior, for

various privileges or treats.various privileges or treats.

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Cognitive TherapyCognitive Therapy

““there is nothing either good or bad, there is nothing either good or bad, but thinking makes it sobut thinking makes it so””

Hamlet (II. 2)Hamlet (II. 2)

1. You feel what you think1. You feel what you think

2. Negative thinking -2. Negative thinking - negative negative feeling & behavingfeeling & behaving

3. You can change what you think3. You can change what you think

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Cognitive TherapyCognitive Therapy

Teaches people adaptive ways of thinking Teaches people adaptive ways of thinking and acting based on the assumption that and acting based on the assumption that thoughts intervene between events and thoughts intervene between events and

our emotional reactions.our emotional reactions.

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ProponentsProponents

Albert Ellis (RET)Albert Ellis (RET) Aaron Beck (CBT)Aaron Beck (CBT) Donald MeichenbaumDonald Meichenbaum

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Cognitive-Behavior Cognitive-Behavior TherapyTherapy

Cognitive therapists often combine the Cognitive therapists often combine the reversal of self-defeated thinking with reversal of self-defeated thinking with

efforts to modify behavior. efforts to modify behavior.

Cognitive-behavior therapy aims to alter Cognitive-behavior therapy aims to alter the way people act (behavior therapy) the way people act (behavior therapy) and alter the way they think (cognitive and alter the way they think (cognitive

therapy).therapy).

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Group TherapyGroup Therapy

Group therapyGroup therapy normally consists of 6-9 normally consists of 6-9 people attending a 90-minute session that people attending a 90-minute session that

can help more people and costs less. can help more people and costs less. Clients benefit from knowing others have Clients benefit from knowing others have

similar problems.similar problems.

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Family TherapyFamily Therapy

Family therapyFamily therapy treats the family as a treats the family as a system. Therapy guides family members system. Therapy guides family members

toward positive relationships and toward positive relationships and improved communication.improved communication.

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Who do people turn to for help with Who do people turn to for help with psychological difficulties?psychological difficulties?

Evaluating TherapiesEvaluating Therapies

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Evaluating Evaluating PsychotherapiesPsychotherapies

Within psychotherapies cognitive Within psychotherapies cognitive therapies are most widely used, followed therapies are most widely used, followed

by psychoanalytic and family/group by psychoanalytic and family/group therapies. therapies.

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Is Psychotherapy Is Psychotherapy Effective?Effective?

It is difficult to gauge the effectiveness of It is difficult to gauge the effectiveness of psychotherapy because there are psychotherapy because there are

different levels upon which its different levels upon which its effectiveness can be measured.effectiveness can be measured.

1.1. Does the patient sense improvement?Does the patient sense improvement?

2.2. Does the therapist feel the patient has Does the therapist feel the patient has improved?improved?

3.3. How do friends and family feel about the How do friends and family feel about the patientpatient’’s improvement?s improvement?

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Outcome ResearchOutcome Research

How can we objectively measure the How can we objectively measure the effectiveness of psychotherapy?effectiveness of psychotherapy?

Meta-analysis of a number of studies Meta-analysis of a number of studies suggests that thousands of patients suggests that thousands of patients

benefit more from therapy than those benefit more from therapy than those who did not go to therapy.who did not go to therapy.

(Smith & Glass)(Smith & Glass)

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Outcome ResearchOutcome Research

Research shows that treated patients Research shows that treated patients were 80% better than untreated ones.were 80% better than untreated ones.

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Commonalities Among Commonalities Among PsychotherapiesPsychotherapies

Three commonalities shared by all forms Three commonalities shared by all forms of psychotherapies are the following:of psychotherapies are the following:

1.1. A hope for A hope for demoralized demoralized people.people.

2.2. A new perspective.A new perspective.

3.3. An empathic, An empathic, trusting and caring trusting and caring relationship.relationship.

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Culture and Values in Culture and Values in PsychotherapyPsychotherapy

Psychotherapists may differ from each Psychotherapists may differ from each other and from clients in their personal other and from clients in their personal

beliefs, values, and cultural backgrounds. beliefs, values, and cultural backgrounds.

A therapist search should include visiting A therapist search should include visiting two or more therapists to judge which two or more therapists to judge which

one makes the client feel more one makes the client feel more comfortable.comfortable.

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The Biomedical TherapiesThe Biomedical Therapies

These include physical, medicinal, and These include physical, medicinal, and other forms of biological therapies.other forms of biological therapies.

1.1. Drug TreatmentsDrug Treatments

2.2. SurgerySurgery

3.3. Electric-shock Electric-shock therapytherapy

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Drug TherapiesDrug Therapies

Psychopharmacology is the study of drug Psychopharmacology is the study of drug effects on mind and behavior.effects on mind and behavior.

With the advent of drugs, hospitalization in With the advent of drugs, hospitalization in mental institutions has rapidly declined.mental institutions has rapidly declined.

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Double-Blind ProceduresDouble-Blind Procedures

To test the effectiveness of a drug, patients To test the effectiveness of a drug, patients are tested with the drug and a are tested with the drug and a placeboplacebo. .

Two groups of patients and medical health Two groups of patients and medical health professionals are unaware of who is taking professionals are unaware of who is taking

the drug and who is taking the placebo.the drug and who is taking the placebo.

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Antipsychotic DrugsAntipsychotic Drugs

Classical antipsychotics [Chlorpromazine Classical antipsychotics [Chlorpromazine (Thorazine)]: Remove a number of (Thorazine)]: Remove a number of positive symptoms associated with positive symptoms associated with schizophrenia such as agitation, schizophrenia such as agitation,

delusions, and hallucinations.delusions, and hallucinations.

Atypical antipsychotics [Clozapine Atypical antipsychotics [Clozapine (Clozaril)]: Remove negative symptoms (Clozaril)]: Remove negative symptoms associated with schizophrenia such as associated with schizophrenia such as

apathy, jumbled thoughts, concentration apathy, jumbled thoughts, concentration difficulties, and difficulties in interacting difficulties, and difficulties in interacting

with others.with others.

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Antianxiety DrugsAntianxiety Drugs

Antianxiety drugs (Xanax and Ativan) depress the Antianxiety drugs (Xanax and Ativan) depress the central nervous system and reduce anxiety and central nervous system and reduce anxiety and tension by elevating the levels of the Gamma-tension by elevating the levels of the Gamma-aminobutyric acid (GABA) neurotransmitter.aminobutyric acid (GABA) neurotransmitter.

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Antidepressant DrugsAntidepressant Drugs

Antidepressant drugs like Prozac, Zoloft, and Antidepressant drugs like Prozac, Zoloft, and Paxil are Selective Serotonin Reuptake Paxil are Selective Serotonin Reuptake

Inhibitors (SSRIs) that improve the mood by Inhibitors (SSRIs) that improve the mood by elevating levels of serotonin by inhibiting elevating levels of serotonin by inhibiting

reuptake.reuptake.

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Mood-Stabilizing Mood-Stabilizing MedicationsMedications

Lithium Carbonate, a common salt, has been Lithium Carbonate, a common salt, has been used to stabilize manic episodes in bipolar used to stabilize manic episodes in bipolar

disorders. It moderates the levels of disorders. It moderates the levels of norepinephrine and glutamate neurotransmitters.norepinephrine and glutamate neurotransmitters.

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Brain StimulationBrain Stimulation

Electroconvulsive Electroconvulsive Therapy (ECT) Therapy (ECT)

ECT is used for severely ECT is used for severely depressed patients who depressed patients who do not respond to drugs. do not respond to drugs.

The patient is The patient is anesthetized and given a anesthetized and given a

muscle relaxant. muscle relaxant. Patients usually get a Patients usually get a 100 volt shock that 100 volt shock that

relieves them of relieves them of depression.depression.

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Psychological Disorders are Psychological Disorders are Biopsychosocial in NatureBiopsychosocial in Nature