THERAPY MODELS

PSYCHOANALYSIS

GOALS AND METHODS

• Freud wanted people to be aware of their unconscious feelings so they could deal with them• Freud found hypnosis unreliable, so used free association instead, with therapist out of sight• Any pauses indicate resistance, which the therapist would then interpret

• Freud also interpreted dreams

• Patients may transfer feelings from previous relationships to their therapists, which may allow them to work through those feelings

CRITICISM OF PSYCHOANALYSIS

• It’s VERY expensive (>$100/hour, 3 times a week, for years)• Therapists’ interpretations cannot be proven or disproven

PSYCHODYNAMIC THERAPY

GOALS AND METHODS

•Goal: help patients experience immediate relief of symptoms• Patient and therapist generally talk face to face• Therapist interprets patient’s history and finds patterns of behavior and emotions• Talk therapy sessions happen once a week for a few weeks or months

• Interpersonal therapy works on building the patient’s relational and coping skills, often useful for treating depression

HUMANIST THERAPIES

CLIENT-CENTERED/NONDIRECTIVE THERAPY

•Humanists focus on• The present• Conscious thoughts• Taking responsibility for your own actions and feelings• Promoting growth

• Therapists should be genuine, accepting, empathetic, and have unconditional positive regard

ACTIVE LISTENING

• Echo what the person is telling them by paraphrasing• “So what you’re telling me is …”

• Ask for clarification when needed• “When you say your work make you upset, what do you mean by that? Can you give an example?”

• Reflect the feelings of the speaker• “That sounds frustrating”

•Humanistic therapy is not used to treat a particular disorder. It has greatly influenced patient-therapist relationships of all types and is used especially by counseling psychologists who work with people with mild depression, relationship issues, or career-related problems.

BEHAVIOR THERAPIES

CLASSICAL CONDITIONING

• Classical conditioning has proven effective to stop bed-wetting and prevent self-harm in children with autism• Counterconditioning teaches people a new response to stimuli that they have averse reactions to• Two types: exposure therapies and aversive therapies

EXPOSURE THERAPIES

•Developed by Mary Cover Jones• Systematic desensitization uses the fact that you cannot be simultaneously anxious and relaxed• Patients are gradually taught to relax and imagine fear-inducing stimuli and a calm response, and eventually exposed to the actual stimuli • A virtual reality may be used instead of real life for embarrassing or expensive situations

AVERSIVE CONDITIONING

•Goal is to condition an aversion to something harmful (i.e. alcohol or nail-biting)•Works in the short run, but results are often not permanent. May work better when paired with other forms of therapy.

OPERANT CONDITIONING

• Token economies are used to reward appropriate behavior (tokens can be exchanged for rewards such as candy, outings, or TV time, etc.)•Helpful in classrooms for “normal” children and those with disorders/disabilities, mental institutions, homes for elderly or mentally impaired, etc. • Criticisms: Will behavior continue in the real world? Is it ethical to control people in this way?

COGNITIVE THERAPIESTeaching people more constructive ways of thinking

BECK’S THERAPY FOR DEPRESSION

• Aaron Beck, student of Freud, realized that depressed people have negative views of the world and themselves• Conversations with therapists help reveal falsely negative thought patterns and eventually to replace them with more positive patterns• Effective for depression and generalized anxiety

COGNITIVE-BEHAVIORAL THERAPY

•Goal: change thought patterns and behavior• Effective for OCD, depression, and anxiety•OCD patients learn to label their obsessive thoughts as such and then refocus on an enjoyable activity instead of their compulsion

GROUP AND FAMILY THERAPIES

GROUP THERAPY

• Almost all types of therapy can be done in groups (not psychoanalysis)• Cheaper• Patient gets social support and feedback

FAMILY THERAPY

•Helps family members learn to communicate• Realizes that individuals’ behavior is influenced by those they live with• Teaches family members how to interact more positively

SELF-HELP/SUPPORT GROUPS

• Alcoholics Anonymous is the original; their 12 step program has been imitated by others and they are found to be about as effective as cognitive therapy•Groups tend to be for disorders or illnesses that are stigmatized or hard to talk about

DRUG THERAPIES

PSYCHOPHARMACOLOGY

• Effective drug treatments have allowed many people to leave mental hospitals• All drugs should be tested in double-blind procedures

ANTIPSYCHOTIC DRUGS

• Stop hallucinations and focus attention• Fit into dopamine receptors but don’t activate them : antagonist (ex: Thorazine)•May cause sluggishness and tremors, long term use can cause tardive dyskinesia• Involuntary movements of face and limbs• Atypical antipsychotics may also work with serotonin levels (ex: Clozaril, Risperdal)

ANTIANXIETY DRUGS

•Decrease central nervous system activity (should not be used with alcohol, which does the same thing)• Can cause physiological dependence • Ex: Xanax, Ativan

ANTIDEPRESSANT DRUGS

• Selective-serotonin-reuptake-inhibitors keep more serotonin available in the synapse (ex: Prozac, Zoloft, and Paxil)•Other drugs inhibit reuptake of serotonin and norepinephrine, but may have more side effects• Take up to 4 weeks to have an effect• Aerobic exercise may have similar effects and a similar percentage of mild-to-moderate depression patients recover without drugs

MOOD-STABILIZING MEDICATIONS

• Lithium is generally effective for bipolar disorder and inexpensive

BRAIN STIMULATION

ELECTROCONVULSIVE THERAPY (ECT)

• Effective for treating patients with depression who have not responded to medication•Old-fashioned version: patients were strapped to a table and shocked until they briefly blacked out, sometimes without their permission•Modern version: 30-60 seconds of electricity are delivered while the patient is unconscious and only at their request

ALTERNATIVE NEUROSTIMULATION THERAPIES

• Repetitive transcranial magnetic stimulation (rTMS) sends magnetic energy to the cortex (not deeper)•May be effective for treating depression• Has no known side effects

•Deep-brain stimulation is being tested for effectiveness for depression and OCD• Electrodes are implanted that stimulate specific parts of the brain that are abnormally active in patients

PSYCHOSURGERY

PSYCHOSURGERY

• Lobotomy was designed to sever connections between the frontal lobes and other parts of the brain; this was thought to cure a variety of illnesses• Often had serious side effects including death and permanent incapacitation• Popular from the 1930s through the 1950s – no longer used

•Modern psychosurgery is used to stop extreme seizures or severe OCD

THERAPEUTIC LIFESTYLE CHANGE

• Aerobic exercise, adequate sleep, light exposure/outside time, increased social interactions, and nutritional supplements in combination seem to be effective in treating depression

RESILIENCE

• Preventative mental health would involve teaching people coping skills and encouraging social relationships