Therapy
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Copyright © Allyn & Bacon 2006
by Pearson Education.
Reproduced by permission of the publisher. Further reproduction
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What is Psychotherapy, and
What Types Are Available?
A. Is Psychotherapy Necessary and Effective?
1. Placebo Effects
• Controlled with double-blind studies
– Reduce demand characteristics
• Such studies show psychotherapy is
effective
2. Effectiveness of Psychotherapy
• Psychotherapy patients are better off than
80% of untreated patients
• Most therapies are equally effective
Copyright © Allyn & Bacon 2006
What is Psychotherapy, and
What Types Are Available?
B. Which Therapy, Which Therapist?
– Eclectic approaches
– Systematic psychotherapeutic approaches
• Psychodynamically based therapies
• Humanistic therapy
• Behavior therapy
• Cognitive therapy
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What is Psychotherapy, and
What Types Are Available?
C. Are There Common Factors Among
Therapists?
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Expectations of change
Attention from the therapist
Therapist characteristics
Rapport between therapist and client
Initiative from client
Adherence to ethical guidelines
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Psychotherapy Effectiveness
Therapist and client should form an alliance to
work on problems
The client should be motivated to make changes
There should be rapport (connection and mutual
understanding) between therapist and client
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Mental Health Practitioners
Clinical Psychologist Ph.D. or Psy.D.
trained to diagnose, treat, and conduct
research on psychological and behavioral
disorders
Psychiatrist M.D.
Social Worker M.S.W.
Psychiatric Nurse M.S.N.
Counselor M.A.
Copyright © Allyn & Bacon 2006
What Roles Do Culture and Gender Play
in Therapy?
-- All therapy occurs in a cultural context
– Multiculturalism
• Acceptance and celebration of all cultures
– Transculturalism
• Recognition of the interaction of multiple
cultural influences on an individual
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What Roles Do Culture and Gender Play
in Therapy?
• Therapists’ ethnicity affects how they are
viewed by clients
• Clients’ ethnicity affects how they respond to
treatment
• Therapists must respect culture without
stereotyping clients
• Gender
– Women seek therapy more than men
– Women and men often communicate
differently (rapport talk Vs. report talk)
– Effects of gender biases and gender roles
Copyright © Allyn & Bacon 2006
How Do Psychodynamic
Therapies Work?
A. Goals of Psychoanalysis
– Understanding and awareness of unconscious
conflicts
B. Techniques of Psychoanalysis
– Exploration of early experiences
– Free association
– Dream analysis
– Interpretation
– Use of resistance
– Transference
– Working through
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How Do Psychodynamic
Therapies Work?
C. Criticisms of Psychoanalysis
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Unscientific
Ignores free will
Based on an untestable theory
Sexist
No more effective than other therapies
Time-consuming and expensive
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What Do Humanistic
Therapies Emphasize?
Carl Rogers: Techniques of ClientCentered Therapy
– Essential techniques
• Unconditional positive regard
• Congruence
• Empathy
• Paraphrasing
• Reflecting
Copyright © Allyn & Bacon 2006
What Do Humanistic
Therapies Emphasize?
Criticisms of Client-Centered Therapy
– Emphasis on therapeutic relationship may
not be enough to bring long-lasting change
– Focuses on hard-to-define concepts, like
self-actualization
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What Are the Methods of
Behavior Therapy?
Assumptions and Goals of Behavior Therapy
– Behavior modification
– Uses learning principles to change overt
behavior
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Assumptions and Goals of
Behavior Therapy
• Does not interpret past events
• Behaviorists criticize insight-oriented therapies
because
– They use concepts that can’t be defined or
measured
– Patients improve without these treatments
– Being labeled “abnormal” may lead to more
abnormal behavior
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Assumptions and Goals of
Behavior Therapy
• Insight-oriented therapists criticize
behaviorists because
– Treat symptoms, not the underlying
problems
– May lead to symptom substitution
• Research shows behavior therapy is as, if not
more, effective than insight-oriented therapies
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What Are the Methods of
Behavior Therapy?
Operant Conditioning in Behavior Therapy
1. Token Economies
• Receive tokens for desirable behaviors
• Exchange tokens for desired items or
privileges
• Used effectively in schools and hospitals to
modify behavior in social settings
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Operant Conditioning in
Behavior Therapy
2. Extinction
3. Punishment
– Usually combined with reinforcement of a
desirable replacement behavior
– May lead to aggression
4. Time-Out
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What Are the Methods of
Behavior Therapy?
C. Counterconditioning in Behavior Therapy
– Based on principles of classical conditioning
– Systematic desensitization
• Learn to relax
• Once relaxed, imagines increasingly vivid
scenes of anxiety-arousing stimulus
• Based on the principle that a person cannot
be afraid and relaxed at the same time
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Counterconditioning in
Behavior Therapy
• Aversive Counterconditioning
– Pairs an unpleasant stimulus with a stimulus
that prompts inappropriate behavior
• E.g., Give an alcoholic drink laced with a
drug that induces nausea
• Eventually, even the thought of alcohol will
make the person feel sick
– Not widely used
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What Are the Methods of
Behavior Therapy?
D. Modeling in Behavior Therapy
– According to Bandura, modeling is most
effective for
• Teaching new behaviors
• Eliminating fears
• Enhancing already existing behaviors
– Unfortunately, people may learn from
inappropriate models, too
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Why is Cognitive Therapy
So Popular?
A. Assumptions of Cognitive Therapy
– Three basic assumptions:
• Thinking affects behavior
• Cognitive activity can be monitored
• Behavior changes can be affected through
cognitive changes
– Cognitive behavior therapists
– Cognitive restructuring modifies faulty
thought patterns
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Why is Cognitive Therapy So
Popular?
B. Types of Cognitive Therapy
1. Rational–Emotive Therapy
• Albert Ellis
• Faulty and irrational thinking causes
irrational behavior
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Types of Cognitive Therapy
2. Beck’s Approach
– Focuses on negative views about self, the
world, and the future
– Four stages:
• Awareness of thoughts
• Recognize when faulty
• Substitute accurate thoughts
• Feedback about whether correct
Copyright © Allyn & Bacon 2006
How Does Therapy Work In
A Group?
A. Techniques of Group Therapy
– Varies for each therapist and each group
– In general, groups consist of 6–12
unrelated people
– Allows members to share problems and
learn from each other
– Members can role-play new behaviors
Copyright © Allyn & Bacon 2006
How Does Therapy Work In
A Group?
B. Family Therapy
– Special form of group therapy in which two or more
people have a special relationship and are committed
to each other
– Focus on the family’s structure and organization
• Relationship therapy
• Family systems approach
– Codependence (being enmeshed)
– As, if not more, effective than individual therapy
Copyright © Allyn & Bacon 2006
How Do Biologically Based
Therapies Create Change?
A. Drugs and the Therapeutic Process
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Increasingly used
Correct dosages are crucial
Long-term use may not be advisable
Can not permanently cure most
problems
– Some psychologists lobbying for
prescription privileges
– Various types of psychotropic drugs
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Drugs and the Therapeutic
Process
1. Antianxiety Drugs
– Tranquilizers or anxiolytics
• Xanax, Librium, Valium
2. Antidepressant Drugs
– Selective serotonin reuptake inhibitors
(SSRIs)
• Block reuptake of serotonin
• E.g., Prozac, Zoloft, Paxil, Celexa
• Effects usually seen within about 4 weeks
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Antidepressant Drugs
• Tricyclics
• Also block reuptake of neurotransmitters
• E.g., imipramine (Tofranil), amitriptyline
(Elavil)
c. Monoamine Oxidase (MAO) inhibitors
• Inhibts MAO, an enzyme that breaks down
neurotransmitters
• Can have serious side effects
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Antidepressant Drugs
• All antidepressant drugs have some side
effects in some people
• Research evidence for effectiveness is mixed
• Most appropriate for serious and / or chronic
depression
• Also appropriate when talk therapy isn’t working
or is refused
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Drugs and the Therapeutic
Process
3. Antimania Drugs
– E.g., Lithium carbonate
– Used to treat bipolar disorder
4. Antipsychotic Drugs
– Neuroleptics
– Used to treat schizophrenia
• Phenothiazines (e.g., Thorazine)
• Atypical antipsychotics (e.g., Clozaril)
• Newer drugs (e.g., Risperdal)
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Antipsychotic Drugs
• Newer drugs have fewer side effects
• Especially effective for treating hallucinations
and delusions
• Long-term use associated with significant
problems
– Tardive dyskinesia
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How Do Biologically Based
Therapies Create Change?
B. Psychosurgery and Electroconvulsive Therapy
– Psychosurgery (brain surgery)
• Prefrontal lobotomy
– Very rare today
» Drugs more effective
» Questionable long-term effects
» Irreversible
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Psychosurgery and
Electroconvulsive Therapy
• Electroconvulsive therapy (ECT)
– Electrical current applied to the head to
produce a seizure
– Overused in the 1940s and 1950s
– Effective in short-term treatment of severe
depression
– Drug treatment and talk therapy needed to
maintain long-term change
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How Do Biologically Based
Therapies Create Change?
C. Alternative Therapies
– Very little controlled, scientific evidence for their
effectiveness
D. The Debate Over Hospitalization
– Hospitalization occurs when patients are at a
risk of harming themselves or others
– Deinstitutionalization: Transition from inpatient
hospitalization to outpatient treatment
• Cheaper than hospitalization
• Large numbers of the homeless are
deinstitutionalized
Copyright © Allyn & Bacon 2006