Therapy
Chapter 16
OVERVIEW
Psychotherapy
 Evaluating Therapeutic Outcome
 Types of Therapy

Psychoanalytic
 Humanistic
 Behavioural
 Cognitive
 Biological

Therapy Comes in Many Forms
LOBJ 16.1
 Many forms of treatment are available for
people experiencing psychological difficulties
2 Broad Types of Therapy:

Somatic therapy (biological) –
 Drugs
 ECT
 Psychosurgery

Psychotherapy  Various techniques of “talk” therapy
Video Clip
from Abn Psy
Psychotherapy: Four Areas of
Emphasis

Distorted thoughts

Disturbed emotions (Inner
Conflicts)

Maladaptive behaviours

Interpersonal and
life situation difficulties
Common Themes Among
Psychotherapies

Emotional defusing

Interpersonal learning

Self-knowledge

Therapy as a step-by-step process

Therapy as socially accepted healing
Evaluating Therapeutic Outcome:
Does Psychotherapy Work?
Placebo Effects
 A placebo effect is a therapeutic change that
occurs as a result of a person’s expectations
of change rather than as a result of any
specific treatment.
 Some patients in psychotherapy may show
relief from their symptoms simply because
they are in therapy and may expect change
DOES PSYCHOTHERAPY WORK?
 In a 1952 paper, Hans
Eysenck challenged the
effectiveness of
psychotherapy
 Eysenck claimed that
psychotherapy produced no
greater change in
maladjustment than natural
life experiences
 He was WRONG!
Meta-Analyses of Therapy
Outcome LOBJ 16.2

Meta-analysis –

Smith, Glass, & Miller
(1980) conducted the
most comprehensive
meta-analysis of
psychotherapy outcome
research
Types of Therapy
Psychoanalysis/psychodynamic
Humanistic
Behavioural
Cognitive
Group
Biological
Psychoanalysis & Psychodynamic
Therapies
Psychodynamic Therapies
 Psychoanalysis
 Developed by Freud
 Insight oriented therapy
 Uses free association, dream analysis, and
transference
 Considerable time/financial investment
 Not commonly used today
 Psychodynamically based therapies
 Insight oriented
 Use techniques derived from Freud
 Reject or modify parts of Freud’s theory
 More common than psychoanalysis
Psychodynamic Therapies
LOBJ 16.6
Assumptions of insight
therapies:
 Becoming aware of your
motivations will help you
change and adapt
 Unresolved conflict results
in maladjustment
 Childhood
 Sexual feelings
 Aggression
Psychodynamic Therapies:
Goal
 Psychoanalytic therapies
attempt to help patients
understand the unconscious
motivations that direct their
behavior
 Change your perspective =
better mental health
Psychodynamic Therapies:
Techniques LOBJ 16.7…

free association

the patient is asked to report
whatever comes to mind, no
matter how disorganized or
trivial
Free association
I feel like crying when …
If I were rich …
My mother…
I feel happy…
Psychoanalytic Therapies:
Techniques
Dream analysis

Based on idea that dreams
are unconscious drives
seeking expression

“Dreams are the royal road
to the unconscious.”
-- Sigmund Freud
Psychoanalytic Therapies:
Techniques
 Interpretation - context ,
meaning, or cause of a
specific idea, feeling, set of
behaviors
 Defense Mechanisms – signal
areas that need to be
explored
Psychoanalytic Therapies:
Processes
 Resistance is
unwillingness to
cooperate on the part of
the patient
 Belligerence
 Missing appointments
 Refusal to pay
It means you have hit on
something big
Psychoanalytic Therapies:
Processes
Transference occurs when
the therapist becomes the
object of a patient’s emotional
attitudes about an important
person in the patient’s life
* E.g. parent figure,
spouse, boss
 Countertransference refers to
personal issues the therapist
brings to professional issues
with clients

Humanistic Therapies
Humanistic Therapies

Goal is to remove constraints
upon self-fulfillment

Emphasize the ability to reflect on
conscious experience

Assume that humans have free
will and are motivated to fulfill
themselves

Focus on present and future
Client-Centered Therapy
 Developed by Carl Rogers
 The Role of the Therapist:
Video Clip of Rogers
 Description: insight therapy
that helps people evaluate the
world and themselves from their
own perspective
Client-Centered Therapy:
Techniques
 The goal of client-centered
therapy is to help people
discover the ideal self
 In client-centered therapy,
the therapist guides
clients to help them find
what they feel is right for
themselves
Client-Centered Therapy:
Techniques
The therapist must demonstrate:
 Unconditional positive regard
- be an accepting person who projects positive feelings towards
client
 Congruence
-being real or genuine; honest and aware of own feelings
 Empathic listening
- sense how the client feels and communicate these feelings to
the client
Behaviour Therapy
Operant Conditioning
Counterconditioning
Modelling
Behaviour Therapy: Goals
 Behaviour therapy
focuses on changing overt
behaviour by using
learning principles to help
people replace
maladaptive behaviours
with more effective
behaviours
Behaviour Therapy:
A Criticism
 Most insight therapists believe that if
only overt behaviour is treated,
symptom substitution will occur
 In symptom substitution, the client
substitutes a new symptom to replace
the treated one
 E.g. I did have an nervous twitch, now I
clear my throat constantly.
 Research does show that behaviour
therapy is at least as effective as insight
therapies
Not necessarily
True.
Behaviour Therapy:
Procedures
 Behaviour therapy involves three general
procedures:
1) Examining the problem behavior and its frequency
2) Developing an individually tailored treatment
strategy
3) Continually assessing whether or not the behaviour
has changed.
Behavior Therapy:
Operant Conditioning
 Uses reinforcers to establish
desired behaviours
 Reinforcer =
something that INCREASES the
likelihood of a target behavior
Operant Conditioning:
Examples

Token economy
A system based on positive
reinforcement in which people
who display appropriate
behaviours receive tokens
 Time-out
- removal from source of
reinforcement
- Use it with positive reinforcers
Counterconditioning
 Counterconditioning:
 Based on classical
conditioning
 Person is taught a new, more
adaptive response to a
stimulus
 Two types of
counterconditioning:
 Systematic desensitization
 Aversive
e.g., replace anxiety with
Relaxation in response to
The provoking stimulus/
Systematic Desensitization
 Gradually replacing an undesirable
response (e.g. anxiety) with a
desirable one (e.g. relaxation)
 Client is taught relaxation
strategies, and once relaxed is
exposed to progressively stronger
anxiety-provoking stimuli.
 Two phases:
 In imagination
 In vivo
Aversive Conditioning
 A noxious stimulus is
paired with a stimulus that
elicits an undesirable
behaviour
COGNITIVE THERAPY
Rational-Emotive Therapy
Beck’s Approach
Meichenbaum’s Approach
Cognitive Therapy
Assumption: Wrong, distorted, or
underdeveloped ideas and thoughts
may prevent a person from
developing effective coping skills.
Focus: Changing thoughts and
perceptions will change behavior.
Cognitive Therapy
Cognitive Therapy
Propositions:
1. Cognitions affect behaviour
2.
Cognitions can be monitored
3.
By changing cognitions, we can
change behaviour
Rational Emotive Therapy
 best known cognitive therapy developed by
Albert Ellis
 emphasizes the importance of logical,
rational thought processes
 assumed abnormal behaviour is caused by
faulty and irrational thinking patterns
 “What disturbs people’s minds is not
events but their judgements on
events”….Epictectus, 100 A.D.
Table 16.4, pg.598
Biological Therapies
Pharmaceutical
Psychosurgery/ECT
Drug Therapy

No drug will permanently
cure the maladjustment
of people who are not
coping well

Psychotropic drugs:
drugs given to relieve
mental problems
Drug Therapy
Antianxiety Drugs

Anxiolytics

Mood-altering –
reduce stress,
increase calm,
induce sleep

neurotransmitter
(GABA)

e.g. Librium, Xanax,
and Valium:

Long-term use
without adjunct
therapy ill-advised
Antidepressants

Thymoleptics

Elevate mood, alter levels of brain
chemicals

Common Side Effects: headache,
nausea, weight gain, decreased sex
drive

Types: Selective Serotonin Reuptake
Inhibitors – SSRI’s (e.g. Prozac, Zoloft,
Paxil) & SNRI’s (Effexor)
Antimania Drugs

Lithium carbonate has long
been used as an effective
antimania drug

Thymoleptic

Importance of dosage – too
much has negative side effects;
too little = no effect

Side Effects
Antipsychotic Drugs

neuroleptics

Treat Schizophrenia


Reduce hostility,
aggression, and
delusions
Neurotransmitter Dopamine

Phenothiazine (e.g.
Thorazine)

Issues: not helpful
for all symptoms,
side effects

Tardive dyskinesia
Psychosurgery

Psychosurgery: brain surgery

Prefrontal Lobotomy: removal of
parts of the brain’s frontal lobes
thought to alleviate symptoms of
mental disorders done in the 1940s
and 50s

Prefrontal lobotomies made some
people become unnaturally calm and
completely unemotional
Electroconvulsive Therapy
Electroconvulsive therapy (ECT)
o
An electric current is briefly applied
to the head to produce a
generalized seizure (convulsion)

was once widely employed with
depressed people

Today, ECT is not a widely used
therapy