THERAPY MODELS
PSYCHOANALYSIS
GOALS AND METHODS
• Freud wanted people to be aware of their
unconscious feelings so they could deal with them
• Freud found hypnosis unreliable, so used free
association instead, with therapist out of sight
• Any pauses indicate resistance, which the therapist
would then interpret
• Freud also interpreted dreams
• Patients may transfer feelings from previous
relationships to their therapists, which may allow
them to work through those feelings
CRITICISM OF PSYCHOANALYSIS
• It’s VERY expensive (>$100/hour, 3 times a week, for
years)
• Therapists’ interpretations cannot be proven or
disproven
PSYCHODYNAMIC THERAPY
GOALS AND METHODS
• Goal: help patients experience immediate relief of
symptoms
• Patient and therapist generally talk face to face
• Therapist interprets patient’s history and finds
patterns of behavior and emotions
• Talk therapy sessions happen once a week for a few
weeks or months
• Interpersonal therapy works on building the patient’s
relational and coping skills, often useful for treating
depression
HUMANIST THERAPIES
CLIENT-CENTERED/NONDIRECTIVE
THERAPY
• Humanists focus on
• The present
• Conscious thoughts
• Taking responsibility for your own actions and
feelings
• Promoting growth
• Therapists should be genuine, accepting,
empathetic, and have unconditional positive regard
ACTIVE LISTENING
• Echo what the person is telling them by paraphrasing
• “So what you’re telling me is …”
• Ask for clarification when needed
• “When you say your work make you upset, what
do you mean by that? Can you give an
example?”
• Reflect the feelings of the speaker
• “That sounds frustrating”
• Humanistic therapy is not used to treat a particular
disorder. It has greatly influenced patient-therapist
relationships of all types and is used especially by
counseling psychologists who work with people with
mild depression, relationship issues, or career-related
problems.
BEHAVIOR THERAPIES
CLASSICAL CONDITIONING
• Classical conditioning has proven effective to stop
bed-wetting and prevent self-harm in children with
autism
• Counterconditioning teaches people a new
response to stimuli that they have averse reactions
to
• Two types: exposure therapies and aversive
therapies
EXPOSURE THERAPIES
• Developed by Mary Cover Jones
• Systematic desensitization uses the fact that you
cannot be simultaneously anxious and relaxed
• Patients are gradually taught to relax and imagine
fear-inducing stimuli and a calm response, and
eventually exposed to the actual stimuli
• A virtual reality may be used instead of real life for
embarrassing or expensive situations
AVERSIVE CONDITIONING
• Goal is to condition an aversion to something
harmful (i.e. alcohol or nail-biting)
• Works in the short run, but results are often not
permanent. May work better when paired with
other forms of therapy.
OPERANT CONDITIONING
• Token economies are used to reward appropriate
behavior (tokens can be exchanged for rewards
such as candy, outings, or TV time, etc.)
• Helpful in classrooms for “normal” children and those
with disorders/disabilities, mental institutions, homes
for elderly or mentally impaired, etc.
• Criticisms: Will behavior continue in the real world? Is
it ethical to control people in this way?
COGNITIVE THERAPIES
Teaching people more constructive ways of thinking
BECK’S THERAPY FOR DEPRESSION
• Aaron Beck, student of Freud, realized that
depressed people have negative views of the world
and themselves
• Conversations with therapists help reveal falsely
negative thought patterns and eventually to
replace them with more positive patterns
• Effective for depression and generalized anxiety
COGNITIVE-BEHAVIORAL THERAPY
• Goal: change thought patterns and behavior
• Effective for OCD, depression, and anxiety
• OCD patients learn to label their obsessive thoughts
as such and then refocus on an enjoyable activity
instead of their compulsion
GROUP AND FAMILY THERAPIES
GROUP THERAPY
• Almost all types of therapy can be done in groups
(not psychoanalysis)
• Cheaper
• Patient gets social support and feedback
FAMILY THERAPY
• Helps family members learn to communicate
• Realizes that individuals’ behavior is influenced by
those they live with
• Teaches family members how to interact more
positively
SELF-HELP/SUPPORT GROUPS
• Alcoholics Anonymous is the original; their 12 step
program has been imitated by others and they are
found to be about as effective as cognitive therapy
• Groups tend to be for disorders or illnesses that are
stigmatized or hard to talk about
DRUG THERAPIES
PSYCHOPHARMACOLOGY
• Effective drug treatments have allowed many
people to leave mental hospitals
• All drugs should be tested in double-blind
procedures
ANTIPSYCHOTIC DRUGS
• Stop hallucinations and focus attention
• Fit into dopamine receptors but don’t activate them
: antagonist (ex: Thorazine)
• May cause sluggishness and tremors, long term use
can cause tardive dyskinesia
• Involuntary movements of face and limbs
• Atypical antipsychotics may also work with serotonin
levels (ex: Clozaril, Risperdal)
ANTIANXIETY DRUGS
• Decrease central nervous system activity (should not
be used with alcohol, which does the same thing)
• Can cause physiological dependence
• Ex: Xanax, Ativan
ANTIDEPRESSANT DRUGS
• Selective-serotonin-reuptake-inhibitors keep more
serotonin available in the synapse (ex: Prozac, Zoloft,
and Paxil)
• Other drugs inhibit reuptake of serotonin and
norepinephrine, but may have more side effects
• Take up to 4 weeks to have an effect
• Aerobic exercise may have similar effects and a
similar percentage of mild-to-moderate depression
patients recover without drugs
MOOD-STABILIZING MEDICATIONS
• Lithium is generally effective for bipolar disorder and
inexpensive
BRAIN STIMULATION
ELECTROCONVULSIVE THERAPY
(ECT)
• Effective for treating patients with depression who
have not responded to medication
• Old-fashioned version: patients were strapped to a
table and shocked until they briefly blacked out,
sometimes without their permission
• Modern version: 30-60 seconds of electricity are
delivered while the patient is unconscious and only
at their request
ALTERNATIVE NEUROSTIMULATION
THERAPIES
• Repetitive transcranial magnetic stimulation (rTMS)
sends magnetic energy to the cortex (not deeper)
• May be effective for treating depression
• Has no known side effects
• Deep-brain stimulation is being tested for
effectiveness for depression and OCD
• Electrodes are implanted that stimulate specific parts
of the brain that are abnormally active in patients
PSYCHOSURGERY
PSYCHOSURGERY
• Lobotomy was designed to sever connections
between the frontal lobes and other parts of the
brain; this was thought to cure a variety of illnesses
• Often had serious side effects including death and
permanent incapacitation
• Popular from the 1930s through the 1950s – no longer
used
• Modern psychosurgery is used to stop extreme
seizures or severe OCD
THERAPEUTIC LIFESTYLE CHANGE
• Aerobic exercise, adequate sleep, light
exposure/outside time, increased social interactions,
and nutritional supplements in combination seem to
be effective in treating depression
RESILIENCE
• Preventative mental health would involve teaching
people coping skills and encouraging social
relationships