Psychotherapies
Psychotherapy is the treatment of emotional or
interpersonal problems with psychological techniques
that help modify troubling feelings and improve
interpersonal relationships.
Biomedical therapy is the use of medication to treat
symptoms physiologically.
Types of professionals
1) Psychologists- training is Ph.D. in
diagnostics, testing, and therapy.
2) Psychiatrists- training is M.D. –they can
prescribe meds, treat in hospitals, and deal
with more severe disorders.
3) Others: psychiatric social workers,
psychiatric nurses, counselors usually work
in a treatment team, managing meds, home
care, and offering therapy and followup.
Psychoanalysis- an insight therapy that emphasizes
recovery of unconscious conflicts, motives and
defenses using free association, dream analysis,
transference. His thesis is that illness is a result of
suppressed unconscious conflicts that must be
uncovered and recognized.
Free association is when client’s express
thoughts and feelings without interruption or
censorship. (Stream of consciousness).
Dream analysis is when the therapist analyzes
the symbolic meaning of client’s dream content.
Interpretation is the therapist’s attempts to
explain the inner significance of the client’s thoughts,
feelings, memories, and behaviors. Conflicts may
relate to unresolved Oedipal crises and issues with
parents.
Resistance consists of unconscious defensive
maneuvers that serve to distract from the accurate
therapeutic assessment. Procrastination, being late,
expressing hostility toward the therapist.
Transference occurs when clients start relating
to their therapists in ways that mimic critical
relationships in their lives. (Turning the therapist into
mom or dad, and reacting to them as if…) It’s safer
to transfer angry or abandoned feelings from a parent,
spouse to a therapist. There can be problems if the
therapist responds to the client- Countertransference.
Short-term Dynamic Therapies have superceded
traditional psychoanalysis because of the cost & time
involved. The problem is defined in the first visit or
so and clear, specific goals are formulated. The idea
is to give the client tools and resources to access
when there is a recurrence of problems.
Humanistic Therapy (also known as ClientCentered Therapy) is an insight therapy that
emphasizes offering a supportive emotional climate
for clients, who determine the direction of their
therapy. Rogers considered the source of problems as
being an incongruence between self-concept and
reality. To protect the ego, clients use defense
mechanisms to resist any feedback that threatens the
idealized self. The process is designed to get people
to value themselves as they are, so they won’t have to
act out or defend themselves to feel safe. Rogers also
believed the therapist should be nondirective,
allowing the client to come to his/her own judgments
about one’s life and needs. Active listening is critical
for the therapist to hear the client’s needs and
feelings and be able to accurately mirror them back.
Therapeutic climate- setting the stage for
healing, developing a rapport of trust.
1) Genuineness- therapist must model
authenticity, congruence in acts and
words, emotion displayed.
2) Unconditional positive regardnonjudgmental acceptance of a person,
warmth, caring, even though s/he may
disapprove of a behavior.
3) Empathy-understanding the client’s
perspective and communicating it.
Behavior Therapies involve the application of
learning principles to direct change of client
behaviors. They don’t care about underlying motives,
just changing the current behavior.
General Principles -1) behavior is a product of
learning, past conditioning 2) Whatever has been
learned can be unlearned.
Mary Cover Jones was the first therapist to use
learning theory to desensitize a phobia. Unlike
Watson, who proved fears could be learned through
traumatic association, Jones developed a technique
called counterconditioning for therapeutic purposes.
The idea is to pair incompatible responsesrelaxation with fear. Jones also used observational
learning to help Peter overcome his fear of rabbits.
She had Peter playing with other children who petted
the rabbit until he could approach and pet it himself.
Systematic Desensitization (Wolpe)- a technique of
self-modification, setting clear goals for change and
setting up procedures to achieve that. For a phobia,
you would describe the feared object, learn relaxation
techniques, and gradually work through a hierarchy
of progressively more threatening images or
behaviors, working toward the target stimulus. Some
of it may be visualization and imagery work.
Aversion Therapy- pairing unpleasant stimuli with a
problematic behavior. Antabuse is used to stop
alcoholics by replacing a formerly pleasurable
experience with the experience of being sick when
you drink. Unfortunately alcoholics simply choose
not to take the medication when they want to drink.
Token economy is used in many institutional
settings- school, prisons, mental hospitals. Positive
behaviors earn tokens which can be exchanged for
anything from a menu of rewards.
Cognitive Therapy is an insight therapy that
emphasizes the negative thoughts and attitudes a
client holds that lead to poor adjustment. The goal is
to change the way clients think.
Beck designed cognitive therapy, especially targeted
to depressive thinking. Beck’s idea is that depression
is caused by errors in thinking: 1) blaming setbacks
on personal inadequacies, 2) focusing excessively on
negative events, ignoring positive ones,
3) pessimistic forecasts of future possibilities,
4) make negative assumptions about their worth,
emphasizing minor events that somehow confirm
their beliefs. There may be homework assignments
designed to help the client question his/her
assumptions and attitudes.
Ellis developed Rational-emotive therapy to deal
with what he called Irrational thinking. Therapy is
designed to focus and define the irrational beliefs (I
must be successful at everything I do. I must be
loved and appreciated by everyone. If I’m not
completely successful, I’m a total failure.) and
change them by disputing the truth of them. The
irrational thoughts give rise to unhealthy emotions
and responses to others. A – B – C.
Group therapy is the simultaneous treatment of
several clients in a group. The power of a group in
interpreting or confronting a behavior is greater than
that of a single therapist.
Makeup and Roles- groups range from 5-10
members, selected on the basis of openness to
therapy and functionality. Therapist’s roles are to
select group members and maintain safety. Members
function as therapists for one another, but there are
stated ground rules as far as what sort of interchanges
are acceptable.
Benefits- One of the most powerful functions is
the exchange of experiences – universalizing
problems and offering creative solutions the speaker
may never have thought of before. The other power is
confronting repeated maladaptive behaviors or
beliefs. Another benefit is it is a safe place to practice
healthier social skills. AA and other 12 step groups
function to help members stay sober. Sponsors are
long-term members who can be called when someone
is considering a slip.
Family and Couple Therapy-based on the
assumption that the family is a system and to treat
one, you must treat the whole family.
Value of Therapy –Eysenck compared recovery
rates for those in talk therapies to those who are not
treated- recovery rates are similar (2/3 recovered), as
many people experience spontaneous remission of
symptoms. Flaw in his data was that those in therapy
recovered in 2 months, those not, in 2 years. Part of
the problem in assessing effectiveness is what is the
criteria? Each client has his/her own rating of
functionality, which is why people often terminate
therapy before the therapist believes they are
finished. More therapists are eclectic in their
approach to treatment, tailoring therapy to the
specific needs and goals of each client. Unfortunately
managed care has reduced access to therapy for many
people. It has shortened hospital stays for severely
disturbed people, putting them on the streets. They
make up a large part of the homeless in this country.
Biomedical Therapies are physiological
interventions designed to control symptoms of
psychological disorders.
1) Antipsychotic Drugs reduce psychotic
symptoms, such as hyperactivity, confusion,
hallucinations, and delusions. Thorazine,
Haldol- reduce dopamine which causes the
hallucinations and delusions. Now these
patients can live outside the hospital. There
are time-release shots that work for weeks at a
time. There are side effects, though, and some
are serious- motor tremors, shuffling, flat
affect. One serious effect is tardive
dyskinesia- tics and facial grimaces. Newer
antipsychotics, clozapine and risperidone
affect serotonin as well as dopamine. They
have fewer side effects and are more effective.
2) Antianxiety Drugs relieve tension, fear,
nervousness. Valium and Xanax- increase
GABA to slow brain activity. Side effects
have to do with poor coordination, alertness
and reaction time. They have potential effects
when in interaction with alcohol,
antihistamines. They are potentially addictive
because they are so immediately effecting.
Buspar is a newer drug that doesn’t cause the
drowsiness, addictivity, and cognitive
problems of the benzodiazepines.
3) Lithium-most often used for bipolar disorder
to moderate both depressive and manic
symptoms. (Found in hot springs) It can
develop to toxic levels in the body. It affects
glutamate (neurotransmitter that is moderated
to a narrow, stable range). Depakote can also
moderate rapid cycling Bipolar symptoms.
4) Antidepressant Drugs elevate mood and
bring people out of a depressed state.
a. Tricyclics- Tofranil, Elavil- work by
increasing norepinephrine and serotonin.
b. MAO inhibitors- Nardil, Parnate also
have side effects of weight gain, dry
mouth, sedation, interaction with foods to
produce high blood pressure.
c. Second-generation- Wellbutrin,
trazodone
d. Selective serotonin reuptake inhibitorsProzac, Paxil, Zoloft, Effexor, Luvox-
target serotonin paths in brain and have
fewer side effects (sexual dysfunction,
loss of appetite, nervousness, insomnia).
When introduced, Prozac became the
most prescribed drug in the world. It
doesn’t make people mindlessly happy,
but it does return them to normal
functioning. There were fears that it was
being prescribed to change people’s
personality. Without some therapy,
however, people don’t learn to create
healthier relationships and function more
adaptively.
e. Dual action antidepressants- Serzone,
Celexa also effective
Electroconvulsive Therapy (ECT) uses electric
shock to produce a cortical seizure and convulsions.
Used originally for symptoms of schizophrenia, then
expanded to depression and even drug addiction.
Treatment is painful and disturbing to the patient, as
well as debilitating to the memory. It is being
replaced by drug therapy, but not all patients respond
to drugs. Relapse rates are high (50% after 6-12
months.)
Psychotherapies
Psychotherapy is the treatment of emotional or
interpersonal problems with psychological techniques
that help modify troubling feelings and improve
interpersonal relationships.
Biomedical therapy is the use of medication to treat
symptoms physiologically.
Types of professionals
Psychologists- training is Ph.D.
Psychiatrists- training is M.D
Others: psychiatric social workers,
psychiatric nurses
Psychoanalysis- an insight therapy that emphasizes
recovery of unconscious conflicts, motives and
defenses using free association, dream analysis,
transference.
Free association
Dream analysis
Interpretation
Resistance
Transference - Countertransference.
Short-term Dynamic Therapies- The problem is
defined in the first visit or so and clear, specific goals
are formulated. The idea is to give the client tools and
resources.
Humanistic Therapy (also known as ClientCentered Therapy) is an insight therapy that
emphasizes offering a supportive emotional climate
for clients, who determine the direction of their
therapy. Rogers considered the source of problems as
being an incongruence between self-concept and
reality. Rogers also believed the therapist should be
nondirective, allowing the client to come to his/her
own judgments about one’s life and needs. Active
listening is critical for the therapist to hear the
client’s needs and feelings and be able to accurately
mirror them back.
Therapeutic climate- setting the stage for
healing, developing a rapport of trust.
Genuineness- therapist must model
authenticity, congruence.
Unconditional positive regardnonjudgmental acceptance of a person,
warmth, caring
Empathy-understanding the client’s
perspective and communicating it.
Behavior Therapies involve the application of
learning principles to direct change of client
behaviors.
General Principles:
1) behavior is a product of learning, past conditioning
2) Whatever has been learned can be unlearned.
Mary Cover Jones was the first therapist to use
learning theory to desensitize a phobia. Unlike
Watson, who proved fears could be learned through
traumatic association, Jones developed a technique
called counterconditioning for therapeutic purposes.
The idea is to pair incompatible responsesrelaxation with fear. Jones also used observational
learning to help Peter overcome his fear of rabbits.
She had Peter playing with other children who petted
the rabbit until he could approach and pet it himself.
Systematic Desensitization (Wolpe)- a technique of
self-modification, setting clear goals for change and
setting up procedures to achieve that.
Aversion Therapy- pairing unpleasant stimuli with
a problematic behavior. Antabuse, shock.
Token economy-Positive behaviors earn tokens
which can be exchanged for anything from a menu of
rewards.
Cognitive Therapy is an insight therapy that
emphasizes the negative thoughts and attitudes a
client holds that lead to poor adjustment. The goal is
to change the way clients think.
Beck designed cognitive therapy, especially targeted
to depressive thinking. Beck’s idea is that depression
is caused by errors in thinking:
1) blaming setbacks on personal inadequacies,
2) focusing excessively on negative events, ignoring
positive ones,
3) pessimistic forecasts of future possibilities,
4) making negative assumptions about one’s worth,
emphasizing minor events that somehow confirm
their beliefs.
Ellis developed Rational-emotive therapy to deal
with what he called Irrational thinking. Therapy is
designed to focus and define the irrational beliefs (I
must be successful at everything I do. I must be
loved and appreciated by everyone. If I’m not
completely successful, I’m a total failure.) and
change them by disputing the truth of them. The
irrational thoughts give rise to unhealthy emotions
and responses to others. A – B – C.
Group therapy is the simultaneous treatment of
several clients in a group. The power of a group in
interpreting or confronting a behavior is greater than
that of a single therapist.
Makeup and Roles
Benefits
Family and Couple Therapy-based on the
assumption that the family is a system and to treat
one, you must treat the whole family.
Value of Therapy
Biomedical Therapies are physiological
interventions designed to control symptoms of
psychological disorders.
Antipsychotic Drugs reduce psychotic
symptoms, such as hyperactivity, confusion,
hallucinations, and delusions. Thorazine, Haldol
One serious effect is tardive dyskinesia- tics and
facial grimaces.
Antianxiety Drugs relieve tension, fear,
nervousness. Valium and Xanax- increase GABA to
slow brain activity. Buspar is a newer drug.
Lithium-most often used for bipolar disorder to
moderate both depressive and manic symptoms. It
affects glutamate (neurotransmitter that is moderated
to a narrow, stable range). Depakote can also
moderate rapid cycling Bipolar symptoms.
Antidepressant Drugs elevate mood and bring
people out of a depressed state.
Tricyclics- Tofranil, Elavil- work by
increasing norepinephrine and serotonin.
MAO inhibitors- Nardil, Parnate also have
side effects of weight gain, dry mouth,
sedation, interaction with foods to produce
high blood pressure.
Second-generation- Wellbutrin, trazodone
Selective serotonin reuptake inhibitorsProzac, Paxil, Zoloft, Effexor, Luvox
Dual action antidepressants- Serzone,
Celexa also effective
Electroconvulsive Therapy (ECT) uses electric
shock to produce a cortical seizure and convulsions.