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Copyright © Allyn & Bacon 2007
Therapy for psychological disorders takes a variety of forms, but all involve some
relationship focused on improving a person’s mental,
behavioral, or social functioning.
What is What is TherapyTherapy??
Copyright © Allyn & Bacon 2007
What is Therapy?What is Therapy?
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.
Copyright © Allyn & Bacon 2007
The Components of TherapyThe Components of Therapy
• In addition to the relationship between the therapist and the patient/client, the therapeutic process typically involves:• 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.
Copyright © Allyn & Bacon 2007
Contemporary Approaches to TherapyContemporary Approaches to Therapy
Psychological therapies –Based on psychological principles (rather than biomedical approach).
• The psychological therapiesare often collectivelycalled psychotherapy.
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Contemporary Approaches to TherapyContemporary Approaches to Therapy
Biomedical therapies –Treatments that focus on altering the brain, especially with drugs, psychosurgery, or electroconvulsive therapy.
Copyright © Allyn & Bacon 2007
Types of Mental Health Care Types of Mental Health Care ProfessionalsProfessionals
Counseling psychologistCounseling psychologist
Clinical psychologistClinical psychologist
PsychoanalystPsychoanalyst
Clinical social workerClinical social worker
PsychiatristPsychiatrist
Psychiatric nurse practitionerPsychiatric nurse practitioner
Pastoral counselorPastoral counselor
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Specialty:Specialty:
Problems of Problems of normal livingnormal living
Work setting:Work setting:
Schools, clinics, Schools, clinics, other institutionsother institutions
Credentials:Credentials:
Master’s in Master’s in counseling, PhD, counseling, PhD,
EdD, or PsyDEdD, or PsyD
Professional TitleProfessional Title
Counseling psychologistCounseling psychologist
Clinical psychologist
Psychoanalyst
Clinical social worker
Psychiatrist
Psychiatric nurse practitioner
Pastoral counselor
Copyright © Allyn & Bacon 2007
Specialty:Specialty:
Those with severe Those with severe disordersdisorders
Work setting:Work setting:
Private practice, Private practice, mental health mental health
agencies, agencies, hospitalshospitals
Credentials:Credentials:
PhD or PsyDPhD or PsyD
Professional TitleProfessional Title
Counseling psychologist
Clinical psychologistClinical psychologist
Psychoanalyst
Clinical social worker
Psychiatrist
Psychiatric nurse practitioner
Pastoral counselor
Copyright © Allyn & Bacon 2007
Specialty:Specialty:
Severe mental Severe mental disorders (often disorders (often
by means of drug by means of drug therapies)therapies)
Work setting:Work setting:
Private practice, Private practice, clinics, hospitalsclinics, hospitals
Credentials:Credentials:
MDMD
Professional TitleProfessional Title
Counseling psychologist
Clinical psychologist
Psychoanalyst
Clinical social worker
PsychiatristPsychiatrist
Psychiatric nurse practitioner
Pastoral counselor
Copyright © Allyn & Bacon 2007
Specialty:Specialty:
Freudian therapyFreudian therapy
Work setting:Work setting:
Private practicePrivate practice
Credentials:Credentials:
MDMD
Professional TitleProfessional Title
Counseling psychologist
Clinical psychologist
PsychoanalystPsychoanalyst
Clinical social worker
Psychiatrist
Psychiatric nurse practitioner
Pastoral counselor
Copyright © Allyn & Bacon 2007
Specialty:Specialty:
Nursing specialty; Nursing specialty; licensed to licensed to
prescribe drugsprescribe drugs
Work setting:Work setting:
Private practice, Private practice, clinics, hospitalsclinics, hospitals
Credentials:Credentials:
RN – plus special RN – plus special training in treating training in treating mental disorders mental disorders and prescribing and prescribing
drugsdrugs
Professional TitleProfessional Title
Counseling psychologist
Clinical psychologist
Psychoanalyst
Clinical social worker
Psychiatrist
Psychiatric nurse Psychiatric nurse practitionerpractitioner
Pastoral counselor
Copyright © Allyn & Bacon 2007
Specialty:Specialty:
Social worker with Social worker with specialty in specialty in dealing with dealing with
mental disordersmental disorders
Work setting:Work setting:
Often employed Often employed by governmentby government
Credentials:Credentials:
MSWMSW
Professional TitleProfessional Title
Counseling psychologist
Clinical psychologist
Psychoanalyst
Clinical social workerClinical social worker
Psychiatrist
Psychiatric nurse practitioner
Pastoral counselor
Copyright © Allyn & Bacon 2007
Specialty:Specialty:
Combines Combines spiritual guidance spiritual guidance
with practical with practical counselingcounseling
Work setting:Work setting:
Religious order or Religious order or ministryministry
Credentials:Credentials:
VariesVaries
Professional TitleProfessional Title
Counseling psychologist
Clinical psychologist
Psychoanalyst
Clinical social worker
Psychiatrist
Psychiatric nurse practitioner
Pastoral counselorPastoral counselor
Copyright © Allyn & Bacon 2007
Psychologists employ two main forms of treatment: the insight therapies
and the behavioral therapies.
How Do PsychologistsHow Do PsychologistsTreat Mental Disorders?Treat Mental Disorders?
Copyright © Allyn & Bacon 2007
Insight TherapiesInsight Therapies
Insight therapies –Psychotherapies in which the therapist helps patients understand (gain insight into) their problems.
Freudian Freudian psychoanalysispsychoanalysis
Cognitive therapiesCognitive therapiesHumanistic therapiesHumanistic therapies
Neo-Freudian Neo-Freudian therapiestherapies
Group therapiesGroup therapies
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Insight TherapiesInsight Therapies
Talk therapies –Psychotherapies that focus on communicating and verbalizing emotions and motives to understand their behavior.
Psychodynamic therapies –Insight therapies based on the assumption that mental disorder is caused by powerful (dynamic) mental forces and conflicts.
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Insight Therapies:Insight Therapies: PsychodynamicPsychodynamic Therapies Therapies
Psychoanalysis –The form of psychodynamic therapy developed by Sigmund Freud.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:Insight Therapies: HumanisticHumanistic Therapies Therapies
Humanistic therapies –Techniques based on the assumption that people have a tendency for positive growth and self actualization, which may be blocked by an unhealthy environment.
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Insight Therapies:Insight Therapies: HumanisticHumanistic Therapies Therapies
Client-centered therapy –Emphasizes healthy psychological growth through self-actualization.
- developed by Carl Rogers
Reflection of feeling – Paraphrasing client’s words to capture the emotional tone expressed.
(page 534)
Copyright © Allyn & Bacon 2007
Insight Therapies:Insight Therapies: CognitiveCognitive Therapies Therapies
Cognitive therapy –Emphasizes rational thinking as the key to treating mental disorder.
Aaron Beck’s cognitive therapy for depression (page 536)
• Proven to be as effective as medication
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Insight Therapies:Insight Therapies: GroupGroup Therapies 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:Insight Therapies: GroupGroup Therapies Therapies
• For many issues, couples counseling or family therapy can often be more effective than individual therapy with one individual at a time.
• Therapist helps them to perceive the issues or patterns that are creating problems.
Copyright © Allyn & Bacon 2007
Psychotherapy
Insight TherapiesPsychodynamic
HumanisticCognitive
Behavior TherapiesOperant Conditioning
Observational LearningClassical Conditioning
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Systematic Systematic desensitizationdesensitization
TokenTokeneconomieseconomies
Contingency Contingency managementmanagement
AversionAversiontherapytherapy
ParticipantParticipantmodelingmodeling
BehaviorBehavior Therapies Therapies
Behavior therapy – Any form of psychotherapy based on the principles of behavioral learning, especially operant conditioning and classical conditioning.
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Classical ConditioningClassical Conditioning Therapies Therapies
Systematic desensitization – Technique in which anxiety is extinguished by exposing the patient to an anxiety-provoking stimulus.
Exposure therapy – Desensitization therapy in which patient directly confronts the anxiety-provoking stimulus (as opposed to imagining it).
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UCS(foul odor) UCR
(nausea)
CRCS(cigarette smoke)
Classical ConditioningClassical Conditioning Therapies 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 ConditioningOperant Conditioning Therapies Therapies
Contingency management –
Approach to changing behavior by altering the consequences, especially rewards and punishments, of behavior.
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Operant ConditioningOperant Conditioning Therapies Therapies
Token economies – Applied to groups (e.g. classrooms, mental hospital wards) involving distribution of “tokens” contingent on desired behaviors; tokens can later be exchanged for privileges, food, or other reinforcers.
Copyright © Allyn & Bacon 2007
Observational-Learning Observational-Learning TherapiesTherapies
Participant modeling – Therapist demonstrates and encourages a client to imitate a desired behavior.
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Cognitive-BehavioralCognitive-Behavioral Therapy Therapy
Cognitive-behavioral therapy (CBT) • 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 Cognitive-Behavioral TherapyTherapy
Rational-emotive behavior therapy (REBT) – Based on the idea that irrational thoughts and behaviors are the cause of mental disorders.
• “Don’t ‘should’ on yourself.” - Albert Ellis
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Evaluating the Psychological Evaluating the Psychological TherapiesTherapies
• Eysenck proposed that people with non-psychotic problems recover just as well with or without therapy.
• Reviews of evidence have shown:• Therapy is better than no therapy!• It appears advantageous to match specific
therapies with specific conditions.• Quality of relationship between therapist and
client is important.
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Most Effective Therapies?Most Effective Therapies?
Behavior Therapy
Specific Phobias
OCD
Alcoholism
Cognitive-Behavioral Therapy (CBT)
Depression
Eating Disorders
Insight Therapy
Couples Counseling
Relationship Problems
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How Is the BiomedicalHow Is the BiomedicalApproach Used toApproach Used to
Treat Mental Disorders?Treat Mental Disorders?
Biomedical therapies seek to treat mental 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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DrugDrug Therapy Therapy
Psychopharmacology – The prescribed use of drugs to help treat symptoms of mental illness to ensure that individuals are more receptive to talk therapies.
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DrugDrug Therapy Therapy
Antipsychotic drugs – medicine that diminishes psychotic symptoms, usually by their effect on the dopamine pathways in the brain.• Reduce positive symptoms of psychosis • May have side effects
Tardive dyskinesia – Incurable disorder of motor control,
especially involving muscles of the face, resulting from long-term use of antipsychotic drugs.
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DrugDrug Therapy Therapy
Antidepressants – medicines that affect depression, usually by their effect on serotonin and/or norepinephrine.
Mood stabilizers:• Lithium carbonate – highly effective in dampening
extreme mood swings (effective against bipolar disorder)
• In high concentrations lithium can be toxic!
*The use of antidepressants to deal with general feelings of unease is highly controversial.
Copyright © Allyn & Bacon 2007
DrugDrug Therapy Therapy
Antianxiety drugs - drugs that diminish feelings of anxiety.• Include barbiturates and benzodiazepines.
• Valium and Xanax
• Should not be used to relieve ordinary anxieties of everyday life.
• Should not be combined with alcohol!
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DrugDrug Therapy Therapy
Stimulants – drugs that increase activity level by encouraging communication among neurons in the brain.
• Stimulants actually suppress activity level in persons with ADHD.
• There is controversy from concern that the causes and boundaries of ADHD are vague and the potential exists for overdiagnosis.
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PsychosurgeryPsychosurgery
Psychosurgery – the general term for surgical intervention in the brain to treat psychological disorders.• Prefrontal lobotomy – involves severing
the nerve fibers connecting the frontal lobe with deep brain structures, especially the thalamus and hypothalamus.
• Split-brain operation - Severing the corpus callosum can reduce life-threatening seizures.
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Brain-StimulationBrain-Stimulation Therapies Therapies
Electroconvulsive therapy (ECT)
- A treatment used primarily for depression and involving the application of an electric current to the head, producing a generalized seizure (called shock treatment).
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Brain-StimulationBrain-Stimulation Therapies Therapies
Transcranial magnetic stimulation (TMS) A treatment that involves magnetic stimulation of specific regions of the brain (an alternative to ECT).
- Can be used for the treatment of depression, schizophrenia, and bipolar disorder.
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Mental HospitalsMental Hospitals
Prior to the 1950s:•Understaffed•Poorly funded•Prisonlike
FEW PATIENTS EVER LEFT!
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DeinstitutionalizationDeinstitutionalization
• The removal of patients from mental hospitals.• Advances in psychotic
drugs and psychotherapy.
• Provide the least restrictive care.
• Receive outpatient care.
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Hospitalization andHospitalization andthe Alternativesthe Alternatives
Community mental health movement –Effort to deinstitutionalize mental patients and to provide therapy from outpatient clinics.