Therapy
Chapter 13
Therapy
Treating Psychological Disorders
The Psychological Therapies
 Psychoanalysis
 Humanistic Therapies
 Behavior Therapies
 Cognitive Therapies
 Group and Family Therapies
Therapy
Evaluating Psychotherapies
 Is Psychotherapy Effective?
 Which Therapies Work Best?
 How Do Psychotherapies Help
People?
 Culture and Values in Psychotherapy
Therapy
The Biomedical Therapies
 Drug Therapies
 Brain Stimulation
 Psychosurgery
 Therapeutic Lifestyle Change
Preventing Psychological
Disorders
Treating Psychological Disorders
• In earlier times, efforts to treat psychological
disorders were often cruel and often based on
irrational beliefs
• The chair on the right was once considered a more
humane form of treatment.
Treatment Reformers
• Reformers pushed for
gentler, more humane
treatments
– Constructed mental
hospitals
• Since 1950s mental
hospitals have been
emptied in favor of drug
therapies and communitybased treatments
Dorothea Dix
(1802-1887)
Today’s Therapies
• Psychotherapy: treatment involving
psychological techniques
– Consists of interactions with a trained
therapist
– Many therapists use an eclectic approach,
using a blend of therapy techniques
• Biomedical therapy: Prescribed
medications or medical procedures
The Psychological Therapies
• The most influential types of
psychotherapies:
– Psychoanalytic
– Humanistic
– Behavioral
– Cognitive
• Most can be used one-on-one or in groups
Psychoanalysis
• Originally developed by Freud
• Today, not generally practiced as Freud did
• Provides part of the foundation for treating
psychological disorders
Psychoanalysis
• Goals
– Bring patients’
repressed or
disowned feelings into
conscious awareness
– Giving them insight
into the origins of their
disorder helps them
take responsibility for
their own growth
Techniques of Psychoanalysis
• Free association
– Talking about whatever comes to mind
– Can reveal unconscious blocking of anxietyladen material (resistance)
– The psychoanalyst’s interpretation may
provide the patient with insight
• Transference: the patient may transfer to the
analyst emotions linked with other relationships
Psychoanalysis
• Few U.S. therapists offer traditional
psychoanalysis
– Underlying theory not supported by scientific research
– Interpretations cannot be proven or disproven
– Can take years of several expensive sessions per
week
• Contemporary psychodynamic therapies have
evolved from psychoanalysis
Psychodynamic Therapy
• Tries to help people
understand their
symptoms by focusing on
themes across important
relationships including
childhood experiences and
the therapist relationship
– Often face-to-face
– Shorter time frame than
traditional
psychoanalysis
Humanistic Therapies
• Therapists aim to boost patients’ self-fulfillment
by growing in self-awareness and selfacceptance
• Differences from psychoanalytic therapies
– Focuses on promoting growth, not curing illness
– Path to growth is taking immediate responsibility for
one’s feelings and actions
– Conscious thoughts are more important than
unconscious
– The present and future are more important than the past
Humanistic Therapies
• Client-centered therapy
– Developed by Carl Rogers
– Combines active listening with a genuine, accepting,
empathic, environment to promote clients’ growth
– Includes unconditional positive regard from the
therapist
Active Listening
Hints for active listening, even among
friends
1.Summarize
– Repeat the other’s statements in your own
words
2.Invite clarification
– “What might be an example of that?”
3.Reflect Feelings
– “It sounds frustrating.”
Behavior Therapies
• Doubts the healing power of self-awareness
• Applies learning principles to the elimination of
unwanted behaviors
Classical Conditioning Techniques
• Maladaptive symptoms may be examples of conditioned
responses
• Treatment for bed-wetters (O.H. Mowrer)
– Connect liquid-sensitive pads to an alarm
– Associates urinary relaxation with waking, stops the bed-wetting
• Counterconditioning: pairs the trigger stimulus (e.g.,
enclosed space) with a new response (e.g., relaxation)
– Exposure therapies
– Aversive conditioning
Exposure Therapies
• Treat anxiety by exposing people to the things
they fear and avoid
• Systematic desensitization: associates a relaxed state
with gradually increasing anxiety-triggering stimuli
• Virtual reality exposure therapy: progressively
exposes people to simulations of their greatest fears
Aversive Conditioning
• Associates an unpleasant state with an
unwanted behavior
Operant Conditioning
• Behavior modification:
– Reinforce desirable behaviors
– Don’t reinforce (or even punish) undesirable
behaviors
– Useful for solving specific behavior problems
• Token economy: a procedure in which people
earn a token for exhibiting a desired behavior,
and can later exchange the tokens for privileges
or treats
Cognitive Therapies
• Behavior therapies are good for specific
fears and problem behaviors
• What about range of behaviors
accompanying depression or anxiety?
• Cognitive therapies teach people new,
more adaptive ways of thinking and acting
– Based on the assumption that thoughts
intervene between events and our emotional
reactions
A Cognitive Perspective
Beck’s Therapy for Depression
• Aaron Beck and his colleagues developed
cognitive therapy
– Gentle questioning seeks to reveal irrational
thinking and then persuade people to remove
“dark glasses” through which they view life
Beck’s Therapy for Depression
• Many students become anxious before an exam
– “This exam’s going to be impossible”
– “I wish I were better prepared”
• To change negative self-talk, therapists teach
people to alter their thinking in stressful
situations
– “I’ve studied well, now it’s time to show what I know”
• Training people to “talk back” to negative
thoughts can be effective at curbing depression
Cognitive-Behavioral Therapy
• An integrative therapy combines cognitive
therapy (changing self-defeating thinking)
with behavior therapy (changing behavior)
– Shown to be effective at treating anxiety
disorders (like OCD) and depression
– Albert Ellis suggested that even when
cognitive therapy works, feeling better is not
enough: “You have to back it up with action,
action, action.”
Group and Family Therapies
• Most therapies may also occur in small
groups (except traditional psychoanalysis)
Group and Family Therapies
• Unique benefits
– Relief to find that others share your problems
– Receive feedback as you try out new
behaviors
• Family therapy treats the family as a
system. View an individual’s unwanted
behaviors as influenced by or directed at
other family members
Evaluating Psychotherapies
•
•
•
•
Is Psychotherapy Effective?
Which Therapies Work Best?
How Do Psychotherapies Help People?
Culture and Values in Psychotherapy
Is Psychotherapy Effective?
• Clients’ Perceptions: Almost 90% of
patients at least “fairly well satisfied”
• Criticisms of using client satisfaction as a
measure of effectiveness include:
– People often enter therapy in crisis, and might
have then improved without therapy
Is Psychotherapy Effective?
• Clinician’s Perceptions
– Therapists tend to be aware of their own
successes and the failures of others
• To objectively evaluate psychotherapies,
psychologists turn to controlled research
studies
Outcome Research
• Eysenck (1952) showed with or without
therapy, about two-thirds of patients show
improvement with time
– Research methods potentially flawed
• Today, randomized clinical trials show
that psychotherapy works
– Those not undergoing therapy often improve,
but those undergoing therapy are more likely
to improve
Outcome Research
• NIMH Study
– Experienced therapists trained in cognitive
therapy, interpersonal therapy, or drug
therapy
– 239 depressed participants randomly
assigned to one of those 3 or control group
– After 16 weeks, depression lifted for more
than half in each of treatment groups
– Only 29% improved in control group
Outcome Research
Figure is a compilation of 475 studies
Which Therapies Work Best?
• No one type of therapy is best across the
board
• Some forms work best for particular
problems
– Behavior conditioning for specific behavior
problems (bed-wetting, phobias, compulsions)
Therapies with Little Scientific Support
•
•
•
•
•
Energy therapies
Recovered-memory therapies
Rebirthing therapies
Facilitated communication
Crisis debriefing
Clinical Decision Making
What role should science play in clinical practice?
Ideal decision making is
upheld by
(1) research evidence,
(2) clinical expertise,
(3) knowledge of the
patient
How Do Psychotherapies Help
People?
• 3 basic benefits
1. Hope for demoralized people
2. A new perspective on oneself and the world
3. An empathic, trusting, caring relationship
Culture and Values in
Psychotherapy
• A mismatch can occur when therapist and client
have different cultural values
– E.g., clients from collectivist cultures may have
trouble thinking only of their own well-being
– Highly religious people prefer therapists who share
their values
• Psychotherapists’ personal beliefs and values
influence their practice
– Clients tend to adopt their therapists’ values
– Therapists should perhaps express those values
more openly
A Consumer’s Guide to Psychotherapists
When to Seek Treatment
Adapted APA list of warning symptoms, which don’t include
relationship problems:
- Feeling worthless
- Deep, lasting depression
- Self-destructive behavior
- Extreme mood shifts
- Compulsive rituals
affecting daily life
- Hearing voices or seeing
things that others don’t
perceive
- Withdrawing from others
- Fears preventing daily life
- Problems with substance abuse
- Wanting to die or hurt self
- Sexual difficulties
The Biomedical Therapies
•
•
•
•
Drug Therapies
Brain Stimulation
Psychosurgery
Therapeutic Life-Style Change
Drug Therapies
• Increase in use of drug therapies
coincides with an emptying of U.S. mental
hospitals
Drug Therapies
• To judge the effectiveness of a new treatment,
we need to compare its effectiveness to the
rates of the following:
– Normal recovery among untreated people
– Recovery due to the placebo effect
• In double-blind (neither scientist nor subject
know who is getting the real drug) studies,
several types of drugs have proven useful in
treating psychological disorders
Antipsychotic Drugs
• Drugs used to treat schizophrenia and
other forms of severe thought disorders
• Useful for treating positive symptoms
– E.g., hallucinations, paranoia
• Not as helpful in treating negative
symptoms
– E.g., apathy, withdrawal
• Work by blocking dopamine receptors,
mimicking certain neurotransmitters.
Antipsychotic Drugs
• Powerful side effects
– Sluggishness, tremors, twitches
– Newer-generation antipsychotics produce
fewer side effects
• Despite drawbacks, antipsychotics can
help people with schizophrenia when
combined with life-skills programs and
family support
Antianxiety Drugs
• Drugs used to control anxiety and agitation
• Depress central nervous system activity
• Calm anxiety as person learns to cope
with fear-triggering stimuli
• Made reduce symptoms without resolving
underlying problems
Antidepressant Drugs
• Used to treat depression and some
anxiety disorders
• Different types work by altering the
availability of various neurotransmitters
• Prozac, Zoloft, and Paxil are selectiveserotonin-reuptake-inhibitors (SSRIs)
• May take up to four weeks to reach full
therapeutic effect
How SSRIs Work
Using Antidepressant Drugs
• Best approach may be to use
antidepressants in combination with
cognitive-behavioral therapy
• In double-blind trials, placebos produced
about 75% of the improvement as active
drug
– Some conclude that there may be little reason
to use except for the most severely depressed
patients
Mood-Stabilizing Medications
• Levels the emotional highs and lows, as
with bipolar disorder
– Depakote, lithum
• Unclear how lithium works, but about 7 in
10 bipolar patients benefit
– Risk of suicide is one-sixth of those not taking
lithium
Brain Stimulation
• Electroconvulsive Therapy (ECT)
• Alternative Neurostimulation Therapies
Electroconvulsive Therapy
• A biomedical therapy for severely
depressed patients
• A brief (30-60 sec) electric current is sent
through the brain of an anesthetized
patient
• Can effectively treat severe depression in
patients who have not responded to drug
therapy
Electroconvulsive Therapy
Alternative Neurostimulation
Therapies
• Vagus nerve stimulation: Stimulates vagus
nerve in neck, sending signals to brain’s
limbic system
• Deep-brain stimulation
– Administered via implanted electrodes
• Repetitive Transcranial Magnetic
Stimulation (rTMS)
rTMS
Psychosurgery
• Surgery that removes or destroys brain
tissue in an effort to change behavior
– Most dramatic and least-used biomedical
intervention
• Lobotomy: a psychosurgical procedure
once used to calm uncontrollably
emotional or violent patients
– Cut the nerves connecting the frontal lobes to
the emotion-controlling centers of the inner
brain
Lobotomy
• Usually decreased misery
or tension
• Also produced a
permanently listless,
immature, uncreative
personality
• No longer performed
Rosemary Kennedy (middle in
photo) had a lobotomy for mood
swings; spent rest of life in
hospital, with infantile mental
capacity.
Therapeutic Life-Style Change
• Everything psychological is also biological,
so changing the body could change mood.
• Human brains and bodies were designed
for physical activity and social engagement:
– Lack of these could feed depression.
• Studies confirm that exercise reduces
depression and anxiety
– A useful adjunct to antidepressant drugs and
psychotherapy
Mind and Body are Connected
Comparing Therapies
Preventing Psychological Disorders
• Lifestyle change can reverse some
symptoms
• Such change can also prevent some
disorders by building resilience – the
personal strength that helps people cope
with stress and recover from adversity or
trauma
Resilience
• Faced with unforeseen trauma, most adults
exhibit resilience
– New Yorkers after 9/11, especially those with
supportive close relationships
– Holocaust survivors
• Struggling with challenging crises can lead to
post-traumatic growth
– Cancer survivors had a higher appreciation for life,
more meaningful relationships, increased personal
strength, changed priorities
Fostering Growth and Human
Flourishing
• Many psychological disorders are
understandable responses to a disturbing and
stressful society.
• Preventive mental health seeks to identify and
wipe out conditions that cause psychological
casualties.
– employment/income stress, discrimination, etc.
– Community Psychology/Mental Health is the effort to
create environments which support empowerment,
success, well-being.