Chapter 13 OverviewChapter 13 Overview

Insight therapiesInsight therapies Relationship therapiesRelationship therapies Behavior therapiesBehavior therapies Cognitive therapiesCognitive therapies Biomedical therapiesBiomedical therapies Evaluating the therapiesEvaluating the therapies The therapeutic relationshipThe therapeutic relationship

Insight TherapiesInsight Therapies

Approaches to psychotherapy Approaches to psychotherapy based on the notion that based on the notion that psychological well-being depends psychological well-being depends on self-understandingon self-understanding

What are the basic techniques What are the basic techniques of psychodynamic therapies?of psychodynamic therapies?

Psychotherapies that attempt to uncover repressed Psychotherapies that attempt to uncover repressed childhood experiences that are thought to cause childhood experiences that are thought to cause the patient’s current problemsthe patient’s current problems

Psychoanalysis Psychoanalysis is a technique developed by is a technique developed by FreudFreud– Free associationFree association

Explores the unconscious by having patients reveal whatever Explores the unconscious by having patients reveal whatever thoughts, feelings, or images come to mindthoughts, feelings, or images come to mind

– Dream analysisDream analysis Areas of emotional concern repressed in waking life are Areas of emotional concern repressed in waking life are

sometimes expressed in symbolic form in dreamssometimes expressed in symbolic form in dreams– TransferenceTransference

Emotional reaction that occurs during psychoanalysis, in Emotional reaction that occurs during psychoanalysis, in which the patient displays feelings and attitudes toward the which the patient displays feelings and attitudes toward the analyst that were present in another significant relationshipanalyst that were present in another significant relationship

What are the basic techniques What are the basic techniques of psychodynamic therapies?of psychodynamic therapies?

Object relations therapyObject relations therapy– Based on idea that early relationships form Based on idea that early relationships form

blueprints for future relationshipsblueprints for future relationships– Therapist helps clients restructure current Therapist helps clients restructure current

relationships, changing maladaptive patterns relationships, changing maladaptive patterns formed in early relationshipsformed in early relationships

Interpersonal therapyInterpersonal therapy– Brief psychotherapy that helps clients understand Brief psychotherapy that helps clients understand

and cope with four interpersonal problems and cope with four interpersonal problems associated with depressionassociated with depression

Severe response to death of a loved oneSevere response to death of a loved one Interpersonal role disputesInterpersonal role disputes Difficulty adjusting to role transitionsDifficulty adjusting to role transitions Deficits in interpersonal skillsDeficits in interpersonal skills

What is the goal of the What is the goal of the therapist in person-centered therapist in person-centered therapy?therapy?

Humanistic therapies Humanistic therapies assume that assume that people have the ability and freedom to lead people have the ability and freedom to lead rational lives and make rational choicesrational lives and make rational choices– Founded by Carl Rogers (1951)Founded by Carl Rogers (1951)

Therapists show empathy and create a Therapists show empathy and create a climate of climate of unconditional positive regardunconditional positive regard– Goal is to allow the client to direct the therapy Goal is to allow the client to direct the therapy

session and move toward session and move toward self-actualizationself-actualization The patient’s realization of his inner potentialThe patient’s realization of his inner potential

What is the major emphasis of What is the major emphasis of Gestalt therapy?Gestalt therapy?

Helps clients fully experience their Helps clients fully experience their feelings, thoughts, and actionsfeelings, thoughts, and actions– Emphasizes clients taking responsibility for Emphasizes clients taking responsibility for

their behavior, instead of blaming society or their behavior, instead of blaming society or parentsparents

– Goal is to help the client resolve past conflicts, Goal is to help the client resolve past conflicts, achieve a more integrated self, and become achieve a more integrated self, and become more self-acceptingmore self-accepting

Gestalt therapy is Gestalt therapy is directivedirective– Therapist actively directs the therapy sessionTherapist actively directs the therapy session– Provides answers and suggestions to the clientProvides answers and suggestions to the client

Relationship TherapiesRelationship Therapies

Therapies that attempt to Therapies that attempt to improve patients’ interpersonal improve patients’ interpersonal relationships or create new relationships or create new relationships to support patients’ relationships to support patients’ efforts to address psychological efforts to address psychological problemsproblems

What are the goals of family What are the goals of family and couple therapy?and couple therapy?

Family therapyFamily therapy– Parents and children enter therapy as a groupParents and children enter therapy as a group– Goal is to help family members heal wounds Goal is to help family members heal wounds

to the family, improve communication, and to the family, improve communication, and create more understanding within the familycreate more understanding within the family

Couple therapyCouple therapy– Goal is to help partners in an intimate Goal is to help partners in an intimate

relationship communicate and manage relationship communicate and manage conflicts more effectivelyconflicts more effectively

– May focus on behavioral change or partners’ May focus on behavioral change or partners’ emotional responses to each otheremotional responses to each other

What are some advantages of What are some advantages of group therapy?group therapy?

A group of clients (usually seven to ten) A group of clients (usually seven to ten) meets regularly with one or more meets regularly with one or more therapiststherapists

Provides client with a sense of Provides client with a sense of belonging and opportunity to belonging and opportunity to – Express feelingsExpress feelings– Get feedback from other group membersGet feedback from other group members– Give and receive emotional supportGive and receive emotional support

Self-help groupsSelf-help groups– People with similar problems who meet People with similar problems who meet

regularly, usually without a professional regularly, usually without a professional therapisttherapist

Behavior TherapiesBehavior Therapies

A treatment approach that is based A treatment approach that is based on the idea that abnormal behavior on the idea that abnormal behavior is learned and that applies the is learned and that applies the principles of operant conditioning, principles of operant conditioning, classical conditioning, and/or classical conditioning, and/or observational learning to eliminate observational learning to eliminate inappropriate or maladaptive inappropriate or maladaptive behaviors and replace them with behaviors and replace them with more adaptive responsesmore adaptive responses

How do behavior therapists How do behavior therapists modify clients’ problematic modify clients’ problematic behavior?behavior?

Uses reinforcement to shape or Uses reinforcement to shape or increase frequency of desirable increase frequency of desirable behaviorbehavior– e.g., e.g., Token economyToken economy

Extinguishes undesirable or Extinguishes undesirable or maladaptive behavior by terminating maladaptive behavior by terminating or withholding reinforcement that or withholding reinforcement that maintains the behaviormaintains the behavior– e.g., e.g., TimeoutTimeout

What behavior therapies are What behavior therapies are based on classical conditioning based on classical conditioning and social-cognitive theory?and social-cognitive theory?

Systematic desensitizationSystematic desensitization is behavior is behavior therapy based on classical conditioningtherapy based on classical conditioning– Used to treat fearsUsed to treat fears

Client is trained to relax while being confronted with a Client is trained to relax while being confronted with a graduated series of anxiety-producing situationsgraduated series of anxiety-producing situations

Eventually, client can stay relaxed while confronting Eventually, client can stay relaxed while confronting even the most feared situationeven the most feared situation

Participant modeling Participant modeling is behavior therapy is behavior therapy based on Albert Bandura’s principles of based on Albert Bandura’s principles of observational learningobservational learning– A model demonstrates appropriate responses to a feared A model demonstrates appropriate responses to a feared

stimulus in graduated stepsstimulus in graduated steps– Client then imitates the model with encouragement of a Client then imitates the model with encouragement of a

therapisttherapist– Using this technique, most specific phobias can be Using this technique, most specific phobias can be

extinguished in 3 to 4 hoursextinguished in 3 to 4 hours

What behavior therapies are What behavior therapies are based on classical conditioning based on classical conditioning and social-cognitive theory?and social-cognitive theory? Flooding Flooding is behavior therapy based on classical is behavior therapy based on classical

conditioningconditioning– Used to treat phobias by exposing clients to the feared Used to treat phobias by exposing clients to the feared

object or event for an extended period, until their anxiety object or event for an extended period, until their anxiety decreasesdecreases

Exposure and response prevention Exposure and response prevention is is behavior therapybehavior therapy – Exposes patients with obsessive-compulsive disorder to Exposes patients with obsessive-compulsive disorder to

stimuli that trigger obsessions and compulsive rituals, while stimuli that trigger obsessions and compulsive rituals, while patients resist performing the compulsive rituals for patients resist performing the compulsive rituals for progressively longer periods of timeprogressively longer periods of time

Aversion therapy Aversion therapy is behavior therapy is behavior therapy – An aversive stimulus is paired with a harmful or socially An aversive stimulus is paired with a harmful or socially

undesirable behavior until the behavior becomes associated undesirable behavior until the behavior becomes associated with pain or discomfortwith pain or discomfort

Cognitive TherapiesCognitive Therapies

Therapies that assume Therapies that assume maladaptive behavior can result maladaptive behavior can result from irrational thoughts, beliefs, from irrational thoughts, beliefs, and ideasand ideas

What is the aim of rational What is the aim of rational emotive therapy?emotive therapy?

Developed by Albert EllisDeveloped by Albert Ellis A A directivedirective form of therapy form of therapy Goal is to challenge and modify a Goal is to challenge and modify a

client’s irrational beliefs about client’s irrational beliefs about themselves and othersthemselves and others– Which are believed to be the causes of Which are believed to be the causes of

personal distresspersonal distress

How does Beck’s cognitive How does Beck’s cognitive therapy help people overcome therapy help people overcome depression and panic disorder?depression and panic disorder? Cognitive therapyCognitive therapy,, designed by Aaron designed by Aaron

Beck, helps clients stop their negative Beck, helps clients stop their negative thoughts as they occur and replace them thoughts as they occur and replace them with more objective thoughtswith more objective thoughts– DepressionDepression is treated by brief cognitive is treated by brief cognitive

therapy, usually 10-20 sessions, and is more therapy, usually 10-20 sessions, and is more effective than antidepressant drugseffective than antidepressant drugs

– Panic disorderPanic disorder is treated by teaching clients is treated by teaching clients to change the catastrophic interpretations of to change the catastrophic interpretations of their symptoms to prevent them from their symptoms to prevent them from escalating into panic, usually effective with 3 escalating into panic, usually effective with 3 months of treatmentmonths of treatment

Biomedical TherapiesBiomedical Therapies

Therapies (drug, therapy Therapies (drug, therapy electroconvulsive therapy, or electroconvulsive therapy, or psychosurgery) that are based on psychosurgery) that are based on the assumption that psychological the assumption that psychological disorders are symptoms of disorders are symptoms of underlying physical problemsunderlying physical problems

What are the advantages and What are the advantages and disadvantages of using drugs disadvantages of using drugs to treat psychological to treat psychological disorders?disorders? Antipsychotic drugsAntipsychotic drugs

– Prescribed primarily for Prescribed primarily for schizophreniaschizophrenia – Used to treat symptoms such as hallucinations, Used to treat symptoms such as hallucinations,

delusions, and disorganized behaviordelusions, and disorganized behavior– Work by inhibiting Work by inhibiting dopaminedopamine activity activity

LithiumLithium– Used to treat Used to treat bipolar disorderbipolar disorder– Reduces both manic and depressive episodesReduces both manic and depressive episodes

Antianxiety drugsAntianxiety drugs– BenzodiazepinesBenzodiazepines are effective for treating are effective for treating

generalized anxiety disordergeneralized anxiety disorder and and panic panic disorderdisorder

This family of minor tranquilizers includes This family of minor tranquilizers includes ValiumValium and and XanaxXanax

What are the advantages and What are the advantages and disadvantages of using drugs disadvantages of using drugs to treat psychological to treat psychological disorders?disorders? Antidepressant drugsAntidepressant drugs

– Act as mood elevators for people who are severely Act as mood elevators for people who are severely depresseddepressed

– Selective serotonin reuptake inhibitors Selective serotonin reuptake inhibitors (SSRIs)(SSRIs)

Block the reuptake of Block the reuptake of serotoninserotonin, increasing its , increasing its availability at the synapses of the brainavailability at the synapses of the brain

Are effective for treating Are effective for treating major depression, OCD, major depression, OCD, social phobia, panic disorder, generalized social phobia, panic disorder, generalized anxiety disorder, and binge eatinganxiety disorder, and binge eating

What are the advantages and What are the advantages and disadvantages of using drugs disadvantages of using drugs to treat psychological to treat psychological disorders?disorders? Drugs can have unpleasant or dangerous Drugs can have unpleasant or dangerous

side effectsside effects It is difficult to establish proper dosagesIt is difficult to establish proper dosages Drugs do not cure psychological disordersDrugs do not cure psychological disorders

– So relapse is likely if drug therapy is So relapse is likely if drug therapy is discontinueddiscontinued

Availability of Availability of antipsychotic drugsantipsychotic drugs led to led to a trend away from hospitalization, which a trend away from hospitalization, which may have increased homelessness among may have increased homelessness among people with people with schizophreniaschizophrenia

What is electroconvulsive What is electroconvulsive therapy (ECT) used for?therapy (ECT) used for?

Electric current is administered to the Electric current is administered to the right cerebral hemisphereright cerebral hemisphere– While patient is under anesthesiaWhile patient is under anesthesia– Usually reserved for severely depressed Usually reserved for severely depressed

patients who are suicidalpatients who are suicidal ECTECT was misused and overused in the 1940s was misused and overused in the 1940s

and 1950s, leading to a bad reputationand 1950s, leading to a bad reputation But it can be a highly effective treatment for But it can be a highly effective treatment for

major depressionmajor depression

What is psychosurgery, and for What is psychosurgery, and for what problems is it used?what problems is it used?

Brain surgery performed to alleviate serious Brain surgery performed to alleviate serious psychological disorders or unbearable psychological disorders or unbearable chronic painchronic pain

LobotomyLobotomy– Severs neural connections between frontal lobes Severs neural connections between frontal lobes

and deeper centers involved in emotionand deeper centers involved in emotion– No longer performed, because it leaves patients in No longer performed, because it leaves patients in

permanent deteriorated conditionpermanent deteriorated condition CingulotomyCingulotomy

– Destroys Destroys cingulumcingulum– Can help in extreme cases of Can help in extreme cases of OCDOCD

Psychosurgery Psychosurgery is controversial, and is is controversial, and is considered experimental and a last resortconsidered experimental and a last resort– Because results are unpredictable and permanentBecause results are unpredictable and permanent

Evaluating the Evaluating the TherapiesTherapies Therapies share many similarities. Therapies share many similarities.

Therapists use a core set of Therapists use a core set of techniques no matter which techniques no matter which perspective of therapy session perspective of therapy session they adopt, but at the same time, they adopt, but at the same time, each therapeutic approach has each therapeutic approach has elements that distinguish it from elements that distinguish it from others.others.

What therapy, if any, is most What therapy, if any, is most effective in treating effective in treating psychological disorders?psychological disorders?

Smith et al. (1980) analyzed 475 Smith et al. (1980) analyzed 475 studies with 25,000 clientsstudies with 25,000 clients– Found that psychotherapy was better than Found that psychotherapy was better than

no treatmentno treatment– But no one type of psychotherapy was But no one type of psychotherapy was

more effective than anothermore effective than another Eysenck (1994) reanalyzed the same Eysenck (1994) reanalyzed the same

studiesstudies– Reported that Reported that behavior therapybehavior therapy has a has a

slight advantage over other types of slight advantage over other types of therapiestherapies

What therapy, if any, is most What therapy, if any, is most effective in treating effective in treating psychological disorders?psychological disorders? A large survey of psychotherapy clients A large survey of psychotherapy clients

conducted by conducted by Consumer ReportsConsumer Reports found found thatthat– Overall, clients believed that they benefited Overall, clients believed that they benefited

substantially from psychotherapysubstantially from psychotherapy– Clients were equally satisfied with therapy Clients were equally satisfied with therapy

provided by psychologists, psychiatrists, and provided by psychologists, psychiatrists, and social workerssocial workers

– The longer clients stayed in therapy, the The longer clients stayed in therapy, the more they improvedmore they improved

– Clients believed that antidepressant and Clients believed that antidepressant and antianxiety drugs helped them; but overall antianxiety drugs helped them; but overall psychotherapy alone worked as well as psychotherapy alone worked as well as psychotherapy plus drugspsychotherapy plus drugs

The Therapeutic The Therapeutic RelationshipRelationship When establishing a relationship When establishing a relationship

with a therapist, it is important to with a therapist, it is important to become familiar with the various become familiar with the various professionals who offer professionals who offer therapeutic services. therapeutic services.

What distinguishes one type of What distinguishes one type of therapist from another, and what therapist from another, and what ethical standards are shared by all ethical standards are shared by all types of therapists?types of therapists?

A A PsychologistPsychologist– Has an advanced degree, usually a Has an advanced degree, usually a

doctorate, in psychologydoctorate, in psychology– Clinical psychologistsClinical psychologists generally generally

diagnose and treat psychological disordersdiagnose and treat psychological disorders– Counseling psychologistsCounseling psychologists generally generally

provide therapy for normal problems of provide therapy for normal problems of life, such as divorcelife, such as divorce

A A PsychiatristPsychiatrist– Is a medical doctorIs a medical doctor– Can prescribe drug therapyCan prescribe drug therapy

What distinguishes one type of What distinguishes one type of therapist from another, and what therapist from another, and what ethical standards are shared by all ethical standards are shared by all types of therapists?types of therapists?

Therapists are forbidden to engage in Therapists are forbidden to engage in any kind of intimate relationship with a any kind of intimate relationship with a client or anyone close to the clientclient or anyone close to the client

They are prohibited from providing They are prohibited from providing therapy to former intimate partnerstherapy to former intimate partners

They are obligated to use tests that They are obligated to use tests that are reliable and validare reliable and valid– And they must have appropriate training And they must have appropriate training

for all tests that are usedfor all tests that are used

What are the characteristics of What are the characteristics of culturally sensitive therapy?culturally sensitive therapy?

An approach to therapy in which An approach to therapy in which knowledge of clients’ cultural knowledge of clients’ cultural backgrounds guides the choice of backgrounds guides the choice of therapeutic interventionstherapeutic interventions

This approach emphasizes that This approach emphasizes that cultural variables may influence the cultural variables may influence the diagnosis and treatment of diagnosis and treatment of psychological disorderspsychological disorders

Why is gender-sensitive Why is gender-sensitive therapy important?therapy important?

An approach to therapy that takes into An approach to therapy that takes into account the effects of gender on both account the effects of gender on both the therapist’s and the client’s the therapist’s and the client’s behaviorbehavior

This approach emphasizes how a This approach emphasizes how a therapist’s gender biases may affect therapist’s gender biases may affect the techniques that they choose and the techniques that they choose and their assessments of clients’ progresstheir assessments of clients’ progress