Psychodynamic Therapy
• Used for unfocused anxiety/depression
• Psychoanalysis- pioneered by Freud  intensive technique for exploring the unconscious
- Freud believed that anxiety disorders are inabilities to resolve inner conflicts
(they become repressed) in the unconscious between the id and the superego

Psychodynamic Therapy
• GOAL of Psychoanalysis:
- make unconscious conflict
 conscious
- repressed material can then be dealt with
- ego can be strengthened & defense mechanisms do not need to be used

Job of the Therapist
• Main job: help a patient bring repressed thoughts into consciousness & gain insight into the relationship between current symptoms & the repressed conflict

Job of the Therapist
• Therapy succeeds when patients are released from the repression established in early childhood
- often through catharsis (AKA insight therapy) – expressing strong felt, but usually repressed emotions; a healing emotional release

Job of the Therapist
• It is an attempt to reconstruct longstanding repressed memories & work through painful feelings to an effective resolution
• This takes years, requires introspective patients who are highly motivated, verbally fluent & have $ to continue the therapy

Techniques Used
1. Free Association- say whatever comes to mind regardless of painful or irrelevant thoughts
- therapist will note patterns that lie beneath the words (the surface)
2. Catharsis- see notes

Free Association
• Start with a recent experience, memory, or dream and write every image or idea that enters your awareness
• Don’t self-edit OR refrain from logic

Techniques Used
3. Dream Analysis- examines content of a person’s dreams to discover motivations, life experiences, desires
- 2 kinds of content: a) manifest- people remember upon awakening b) latent- hidden, deeper content

Techniques Used
4. Analysis of Transferencetransferring of feelings about a person in the past to the therapist due to unfinished business
- positive- feeling of love/admiration
- negative- feeling of anger/hostility
- therapist provides a stage for reenacting unresolved conflicts

Techniques Used
5. Analysis of Countertransference-
- therapist begins to view client as someone in therapists life & projects feeling toward the client
- can provide useful material to look at with client, but must be careful
- become mirrors for one another

Techniques Used
6. Analysis of Resistance
- individuals put up barriers to free association
- resisting to “work” with the therapist
- therapist’s job is to break down areas the client does not want to discuss

Techniques Used
• Projective Techniques- help access unconscious, esp. in children
- Rorschach, TAT, incomplete sentences, draw a picture

Behavioral Therapy
• Abnormal behaviors are acquired through a learning process that follows basic principles of conditioning & learning
• Therapy includes applying principles of conditioning & reinforcement to increase frequency of desired behaviors or decrease frequency of problem behaviors

Behavioral Therapy
• Problems that generally use behavior modification/therapy:
- fears/phobias, compulsions, depression, addictions, aggression, & delinquent behavior

Behavioral Therapy
• When people can’t cope effectively, their maladaptive reactions can be overcome by therapy based on learning or relearning

Behavioral Therapy
• 3 Types of Behavioral Therapy:
1. Counter-Conditioning-
- a new response is conditioned to replace or “counter” a maladaptive response ex. Child afraid of the dark  have child listen to their favorite song while sitting in the dark

Behavioral Therapy
- Techniques Used: a) systematic desensitization- client is taught to prevent the arousal of anxiety by confronting the feared stimulus & using relaxation techniques; used for social phobias
(The King’s Speech);

Behavioral Therapy b) implosion- opposite; exposes a client to anxiety, provoking the stimuli (most frightening is the imagination) but in a safe setting; person cannot run away; “tough love” c) flooding- client is placed in or exposed to the phobic situation; used for agoraphobia

Behavioral Therapy
*all 3 have in common  exposure through imagery, contact, or virtual reality; all are exposed to object feared

Behavioral Therapy d) aversion therapy- used for patients attracted to harmful stimuli (drug addictions, violent behavior); an attractive stimuli is paired with shock or drugs (noxious stimuli) to get the patient to pair the noxious stimuli with the harmful behavior

Behavioral Therapy
2. Contingency Management- Skinner; changing behavior by modifying consequences (operant cond.)
- Techniques Used: a) token economy- positive reinforcement; desired behaviors are defined & token payoffs are given when behavior is performed (gold stars); can later be exchanged for rewards, etc.

Behavioral Therapy
3. Social Learning Theory- clients observe models’ desirable behaviors being reinforced b/c people learn via observation
- used to overcome phobias & to build social skills
- based on Bandura’s research

Behavioral Therapy
- Techniques Used: a) Participant Modeling- therapist demonstrates desired behavior & client is helped to imitate behavior with support & encouragement b) Behavioral Rehearsal- visual; how one should behave in a situation  helps strengthen social skills

Behavioral Therapy
Most common problem: lack of assertiveness
 often in children (have deficits in social skills that may lead to problems later)
 pre-schools, elem. schools look to build skills in withdrawn, isolated children

Cognitive Therapy
• Attempts to change the feelings & behaviors by changing the way a client thinks about or perceives significant life events

Cognitive Therapy
• Abnormal behavior patterns start with problems in what people think & how they think
(cognitive process)
• Therapy will focus on changing how people think

Cognitive Therapy

Cognitive Therapy
• 2 Types of Cognitive Therapy:
1. Cognitive Behavior Modification-
- Combines thoughts w/ focus on reinforcement contingencies in modifying performance
- Unacceptable behavior patterns are changed/modified by cognitive restructuring

Cognitive Therapy
- Change the person’s negative self statement into constructive coping statements
- Ex. I am boring, no one will invite me to another party.
Change this thought to  next time
I’ll tell a joke, be proactive, or more responsive to other’s stories

Cognitive Therapy
- Step 1: figure out together the kind of thinking that is leading to dysfunctional behavior
- Step 2: develop new selfstatements that minimize negative thoughts that elicit anxiety or lower self-esteem

Cognitive Therapy
- Step 3: set goals
- Step 4: develop strategies for meeting them  develop self-efficacy
- Step 5: evaluate feedback

Cognitive Therapy
- Changing False Beliefs- cognitive therapy for depression (Aaron Beck)
- depression arises when people are unaware of their negative automatic thoughts & faulty thinking

Cognitive Therapy
- often emotional stress is caused by cognitive misunderstanding and failure to distinguish between reality & one’s expectations
 MUST challenge patient’s basic assumptions

Cognitive Therapy
2. Rational Emotive Therapy
(RET)- based on the transformation/changing of irrational beliefs that cause severe emotional reactions
(ex. Anxiety)
- Ellis

Cognitive Therapy
- teach the client to recognize the “shoulds, oughts, haves, & musts” that control their actions & prevent them from choosing the life they want

Cognitive Therapy
- through rational confrontation, client can dispute & examine alternative reasons for their thoughts/actions
- this is followed up by replacing dogmatic thinking w/ rational, situationally appropriate ideas

Cognitive Therapy
- it aims to increase individual’s self-worth by getting rid of faulty beliefs that block personal growth

Group Therapy
• Can sometimes be more effective
1. Less Expensive- small # of mental health personnel can help more people
2. Power of Groups- less threatening, provides opportunities to practice interpersonal skills and observe others

Group Therapy
 Allows for corrective emotional experiences to take place in a
“family-like” atmosphere
 Helps people realize they are not alone
 Provides social support outside of therapy

Group Therapy
• Different Types:
1. Marital & Family- each member is treated as a member of a system of relationships
- therapist helps to understand what the problems are in the family

Group Therapy
- seeks to help communication, understand communication styles & how to express themselves
- therapist acts as interpreter, clarifier, mediator, & referee when helping to resolve dysfunctional elements

Group Therapy
2. Community Support Groups
- 10+ million Americans participate in self-help groups
- pioneered by women’s groups & AA
- 4 Main Groups:

Group Therapy a) Addictive behavior b) Physical/mental disorder c) Life transition or other crises d) Traumas experienced by friends or relatives w/ serious problems

Group Therapy
• Many groups popping up on the
Internet
 providing social support, hope
& control for problems; people dispense info about disorders & treatments

Humanistic Therapy
• Started in 1960s, goes along with theory that a human is a whole person who is constantly changing and growing
- environment and heredity place some restrictions, but people are always free to choose what they will become

Humanistic Therapy
• Therapists attempt to help clients define their own freedom, cultivate their individuality, & discover ways to reach their fullest potential (selfactualization)

Humanistic Therapy
1. Client-Centered Therapy (Carl Rogers)
- major assumption: people can selfactualize (realize their potential)
- problems arise when there is conflict between positive self-image & negative external criticisms  anxiety

Humanistic Therapy
- The counselor acts as a mirror
- Client is in the role of exploring thoughts, feelings,
& behaviors
- GOAL: help people become more confident, fully functioning, able to counsel themselves

Humanistic Therapy
• Techniques:
1. Active listening (no advice, solutions, criticisms)
- listen, reflect, rephrase
2. Respectful, unconditional positive regard, empathetic

Biomedical Therapy
• Treat mental disorders as problems in the brain
• 3 Approaches:
1. Psychosurgery- considered method of last resort; not practiced anymore; most famous is lobotomy
- severed connections between prefrontal cortex & rest of brain

Biomedical Therapy
2. Electroconvulsive Therapy (ECT)use of shock to treat psychiatric disorders such as: schizophrenia, mania, & depression
- generally used to treat depression that has not worked with drugs
- apply weak electrical current after patient has had a muscle relaxant

Biomedical Therapy
- A last resort as well- been proved effective for severe depression, acute psychotic states & mania
- Side effects: memory loss, confusions (sometimes a little, sometimes permanent)

Biomedical Therapy
3. Drug Therapy: 3 types-
A. Anti-Psychotic- dopamine blockers, mood stabilizers (Thorazine, Haldol,
Clozapine)
- try to reduce hallucinations, delusions, & paranoia
- too much dopamine = hallucinations
- too little dopamine= flat emotional response

Biomedical Therapy
B. Anti-Depressants (SSRI’s & MAO’s)
- SSRI’s- used for depression, anxiety
(panic, OCD, eating disorder), & some personality disorders
- prozac, celexa, lexapro, paxil, zoloft

Biomedical Therapy
- MAO’s- not used as much, can cause toxic reaction
- enzyme breaks down norepinephrine & serotonin

Biomedical Therapy
C. Anti-Anxiety- benzodiazepine
(Valium, Xanax, Ativan, Klonopin)
- need to be careful  can form a dependence; has a calming effect and can cause sedation affecting the CNS

Biomedical Therapy
4. Lithium- takes time to work; helps with manic highs & lows of bipolar disorder
- anticonvulsant- used for immediate treatment of manic episodes