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