Therapy and Treatment
AP Psychology
Myers – Chapter 17
Types of Therapy

The type of therapy used depends on the problem!
Psychotherapy
interaction between a trained
EX: treating phobias that are
therapist and someone who suffers psychologically learned
from psychological difficulties
Eclectic Approach
an approach that depending on the
client’s problems, uses techniques
from various forms of
psychotherapy
Biomedical Therapy
Biopsychosocial approach
Half of therapists use a
blended approach
prescribed medications or medical EX: treating schizophrenia
procedures that act directly on the with medication because it is
patient’s nervous system.
biologically rooted in the
brain
Psychotherapies
Psychoanalysis
Humanistic
Behavioral
Cognitive
Group Therapies
Psychoanalysis
“Look into the depths of your own soul and learn first to know yourself,
then you will understand why this illness was bound to come upon you
and perhaps you will thenceforth avoid falling ill.”
- Sigmund Freud
Psychoanalysis

Based upon the ideas of Freud
Goal
Try to help patients
gain insight into the
unconscious origins
and roots of their
disorders and work
through anxietyridden feelings.
Techniques
•Free association - patient relaxes
and starts talking about anything
•Dream interpretation
•Interpretation – the analyst’s
noting of supposed meanings of
dreams, free association, projective
tests, etc in order to promote insight
into the subconscious
Criticisms
•Interpretations cannot be
proven or disproven;
psychoanalysts say that
psychoanalysis is therapy, not a
science
•Time consuming – years long
•Expensive – several sessions a
week
Psychoanalytic Phenomena

Resistance – in
psychoanalysis, the blocking
from consciousness of
anxiety-laden material


Hints that anxiety exists and
you are defending against
sensitive material
Transference – in
psychoanalysis, the
patient’s transfer to the
analysts of emotions
linked with other
relationships (such as love
or hatred for a parent).
•Example Psychoanalytic
Session
•What About Bob Trailer
Psychodynamic Therapy

Influenced by Freud, but not the
same as psychoanalysis
Goal
Try to understand a
patient’s current
symptoms by focusing on
themes across important
relationships
Techniques
•Face-to-face conversation
•Once a week for a few weeks/months
•Look for patterns in
behaviors/relationships
Humanistic Therapy
“We have two ears and one mouth that we may listen that more an
talk the less.”
- Zeno. 335-263 BC
Humanistic Therapy


Emphasis on self-acutalization and self-fullfillment
Developed largely by Carl Rogers
Goal
Aim to boost selffulfillment by
helping people grow
in self-awareness
and self-acceptance
Techniques
Criticisms
•Focusing on the future instead of the past
•Not scientific enough
•Focusing on conscious rather than unconscious
thoughts
•“Clients” rather than “patients”  clientcentered therapy in which the client feels
unconditional positive regard and the
therapist is nondirective (refrains from offering
personal interpretations).
•Active listening – therapist echoes, restates,
and clarifies
Active Listening Example
With a neighbor…

Think of the last thing recently that:
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
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For 2-3 minutes, talk about the event and feelings. The active listener
should:

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Made you angry
Made you sad
Made you anxious/nervous
Paraphrase – check your understanding by summarizing the speaker’s words in
your own words and ask if you are correct.
Invite clarification – “What might be an example of that?” may encourage the
speaker to say more.
Reflect feelings – “It sounds frustrating” might mirror what you’re sensing
from the speaker’s body language and intensity.
Remain unbiased and nonjudgmental
Did you notice any differences when you were active listening compared to
how you listen everyday?
Behavioral Therapies
Behavioral Therapy

Behavioral therapists do not emphasize the mental root of a
disorder as they assume that the problem behaviors are the
problems
Goal
Applies learning
principles to the
elimination of
unwanted
behaviors (useful
for phobias)
Techniques
•Counter-conditioning - conditions new
responses to stimuli that trigger unwanted
behaviors, based on classical conditioning.
•Exposure therapy (systematic
desensitization)
•Aversion therapy
•Behavior modification - reinforcing
desired behaviors and withholding
reinforcement or using punishment for
undesired behaviors
•Token economy
Criticisms
•Doesn’t address mental
processes behind disorders
•When reinforcement
disappears/stops, behaviors
may come back.
•Is it right for one human
to control another’s
behavior?
•Is punishment unethical?
Counter-conditioning
Aversion Therapy

associates an unpleasant state
with an unwanted behavior

Commonly used to treat addictions

Ex: quitting smoking
 1. Therapist shocks a patient
when a drag is inhaled
 2. Patient smokes rapidly, inducing
many shocks
 3. Pair together several times
 4. Patient associates pain of shock
with smoking
 5. Quit smoking

Highly successful in the short-run,
but has mixed results in the longrun.
Counter-conditioning
Exposure Therapy
(Systematic Desensitization)

associates a pleasant relaxed
state with gradually increasing
anxiety-triggering stimuli


Ex: fear of public speaking.
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commonly used to treat phobias.
1. Ranked list (high to low anxiety)
2. Relaxed state
3. Induce mild anxiety and indicate too
much
4. Return to relaxation
5. Repeat the pairing until the anxiety is
replaced by relaxed feelings
6. Move up the anxiety list implementing
desensitization each time.
7. Move from imagined situations to real
situations
Virtual reality exposure used when
situation cannot be replicated
Behavior Modification

Behaviors are influenced by their
consequences


operant conditioning –
reinforcement and punishment
Token economy –earn a token
of some sort for exhibiting a
desired behavior and can later
exchange the tokens for various
privileges or treats.


Used to help autistic children
become more social.
Can teach schizophrenic
sufferers or the mentally
retarded to care for themselves.
Behavioral Therapy

Behavioral therapists do not emphasize the mental root of a
disorder as they assume that the problem behaviors are the
problems
Goal
Applies learning
principles to the
elimination of
unwanted
behaviors (useful
for phobias)
Techniques
•Counter-conditioning - conditions new
responses to stimuli that trigger unwanted
behaviors, based on classical conditioning.
•Exposure therapy (systematic
desensitization)
•Aversion therapy
•Behavior modification - reinforcing
desired behaviors and withholding
reinforcement or using punishment for
undesired behaviors
•Token economy
Criticisms
•Doesn’t address mental
processes behind disorders
•When reinforcement
disappears/stops, behaviors
may come back.
•Is it right for one human
to control another’s
behavior?
•Is punishment unethical?
Cognitive Therapy
“Life does not consist mainly, or even largely, of facts and happenings. It
consists mainly of the storm of thoughts that are forever blowing through
one’s mind.”
- Mark Twain
Cognitive Therapy

Best for disorders in which the roots are unclear, like
generalized anxiety disorder and major depressive
disorder
Goal
Techniques
Tries to change unhealthy
or maladaptive patterns in
thinking by teaching new
healthier ways of thinking
Depressed people do not exhibit the self-serving bias
common in nondepressed people.
Instead they attribute their failure to themselves and
attribute their successes to external circumstances. 
must change that pattern of thinking
•Ex: a depressed person writes 3 positive things that
happened that day and how they contributed to them
•Ex: a person with test-anxiety repeats positive things to
themselves before an exam
Cognitive-Behavioral Therapy

Useful for disorders that involve maladaptive mental
and behavioral elements
Goal
Combines changes in thinking
(cognitive) and changes in
behaviors (behavioral)
Techniques
Rational-emotive behavior therapy –
proposes that unrealistic and irrational beliefs
cause maladaptive behaviors; focuses on changing
thinking patterns.
1.
2.
3.
Identify the underlying irrational thought
patterns/beliefs
Challenge the irrational beliefs
Gain insight and recognize irrationality
Best for OCD, eating disorders, etc (any disorder
with cognitive/behavior roots)
Other examples of CBT

EX: OCD sufferers – changing thinking patterns
concerning obsessive thoughts and changing behaviors
concerning compulsions

EX: Anorexia nervosa – changing thinking patterns
concerning depression and negative body image and
changing behaviors concerning eating.
Group Therapies
“The feeling of having shared in a common peril is one element in
the powerful cement that binds us.”
- Alcoholics Anonymous member
Group Therapy and Support Groups



Except for psychoanalytic therapies, psychotherapy
techniques can be used in therapist-led small groups.
Group therapy does not allow for the same degree of
individual attention, but it is time and cost effective and has
often been found no less effective than individual therapy.
The social context of group therapy often allows client to
feel as if they are not alone in their problems. It can be a
relief to find that others share your problems and feelings.

EX: AA and cancer, AIDS support groups, online support
groups

Rent – “Will I” – AIDS support group
Go On Trailer

Family Therapy

Treats the family as a system in which undesirable
behaviors are influenced by and affect other members


tries to foster healthier relationships within the family.
Ex: A family might attend therapy if one member is
addicted to drugs/medication during which the therapist
would evaluate relationships in the family that could
contribute to conflict and possible drug abuse.
Crash Course - Psychotherapy
Evaluating Psychotherapies
“I love therapy! There’s nothing like talking to someone who has no
emotional tie to your life.” – Eva Mendes
“I tried therapy.This had never appealed to me. For me, it was a bit
like a Chinese meal: very filing at the time, but then an hour later,
you’re hungry again.” – Rod Stewart
Is Therapy Effective?
Clients…
Clinicians…

YES
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YES
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Self-justification – rationalize
the time and money spent.

More aware of the failures of
other therapists.
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Confirmation bias and selective
recall

Enter therapy in troubled state,
when we return to a “normal”
state, we attribute this to
whatever we have done in the
interim.

Placebo effect?

The same person with the same
recurring problems could be
considered a “success story”
for several therapists.
Although treatments have
varied widely, every generation
of therapists view its own
approach as the most
enlightened and effective.

Self-serving bias
Outcome Research



Controlled experiments!
Outcome studies are randomized clinical trials in which people
on a waiting list receive therapy or no therapy.
Meta-analysis – a procedure for statistically combining the
results of many different research studies

People who remain untreated often improve (2/3)
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Regression toward the mean (tendency for events/emotions to return to
their average state)
People who receive psychotherapy are more likely to improve.
People who receive psychological treatment spend less time and money
later seeking other medical treatments, compared with those on the
waiting list.
Evaluating Pseudotherapies
As critical thinkers, exploring and evaluating pseudotherapies
requires a scientific attitude -- being skeptical but not cynical, and
open to surprise but not gullible.
Pseudotherapies

Every therapy, based on testimonials, will seem effective
for some people.

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Placebo effect? Regression toward the mean?
For many pseudotherapies, little/no scientific evidence
about the effectiveness exists (uncontrolled exp.,
unreliable results)
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Hypnotherapy
Anger-release therapists
Reflexologists
Aromatherapists
Massage therapy
Herbal medicines
Eye Movement Desensitization and
Reprocessing (EMDR)

A therapist attempts to unlock and
reprocess previously frozen
traumatic memories by waving a
finger/flashing a light in front of
the eyes of a person imagining a
traumatic scene.

EDMR has its believers and also its
critics.

Combination of exposure therapy
(repeatedly reliving traumatic
memories in a safe and reassuring
context) and the placebo effect?
EMDR
Light Exposure Therapy

Light exposure therapy – exposure
to daily timed doses of light that
mimics outdoor light.
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Seasonal affective disorder – (SAD) a
form of depression linked to periods of
decreased sunlight.
Light comes out of manufactured light
boxes that can be bought or rented
from health supply and lighting stores.
Research and controlled
experiments suggest that light
exposure therapy diminishes
symptoms associated with SAD.
Relative Effectiveness of Different
Therapies
Is there a “best” therapy?
Relative Effectiveness

Consumer Reports readers reported being equally
satisfied…
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Regardless of therapy type
Regardless of training level of therapist (psychiatrist,
psychologist, or social worker)
With both group vs. individual sessions
Relative Effectiveness

Therapy is most effective when the problem is clearcut and specific.

Phobias or panic can hope for improvement.

Less-focused problems, such as depression and anxiety,
usually benefit in the short-run but often relapse later.

Those who have chronic schizophrenia or who wish to
change their personality are unlikely to benefit from
psychotherapy alone.
Effective Therapy Depends on the Problem
Psychodynamic
Depression
Anxiety
Eating
Disorders
Phobias
OCD
Reducing
suicide risk
Exposure
Therapy
X
Behavioral Cognitive
Therapy
Therapy
X
X
X
X
X
X
X
X
X
X
X
X
When Should You Consider Therapy?

The APA suggests considering seeking a mental health
profession if you display:
Feelings of
hopelessness
Deep and lasting
depression
Self-destructive
behaviors
Disruptive fears
Sudden mood
shifts
Thoughts of
suicide
Compulsive
rituals
The Biomedical Therapies
“Medicine, the only profession that labors incessantly to destroy the
reason for its existence,”
- James Bryce
Biomedical Therapies

Physically change the brain’s functioning…


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Altering chemistry with medication
Overloading its circuits with electroconvulsive shock
Using magnetic impulses to stimulate or dampen activity
Altering its circuits through psychosurgery
Psychopharmacology

The study of the effects of drugs on mental processes and
behaviors.
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Led to more independent lives for sufferers of psychological
disorders
Reduced hospitalization of many people
To evaluate the effectiveness of new drugs, researchers
use the double-blind experimental technique to reduce
researcher bias.
Tardive Dyskenesia
Antipsychotic Drugs
Goal
Lessen responsiveness
to random stimuli by
blocking dopamine
receptors
Dopamine
hypothesis schizophrenia is
related to overactivity
of dopamine.
= Dopamine
= Antipsychotic
drug
Useful for…
Examples
Schizophrenia
(regulates
dopamine by
blocking it at the
synapse)
Thorazine
Lessens positive
symptoms
AKA Neuroleptics
Clozapine
Risperdal
Zyprexa
Negative Effects
Tardive dyskenesia –
involuntary mov’ts of facial
muscles, tongue, and limbs
Increased risk of obesity
and diabetes
Anti-anxiety Drugs
Goal
Depress central
nervous system
reactivity
Useful for…
Anxiety
Phobias
Examples
Xanax
Ativan
Can help a person learn
to cope with frightening
situations and feartriggering stimuli.
Negative Effects
Can be used as a
crutch, without
actually solving the
root of the anxiety.
Users can become
tolerant, addicted,
and dependent on
the medication.
Anti-depressant Drugs
Goal
Useful for…
Regulate levels of
Depression
neurotransmitters in Anxiety
the brain
(serotonin and
norepinephrine)
that can elevate
mood

Zoloft commercial
Examples
Negative Effects
Selective-serotoninreuptake-inhibitors
(SSRIs) – slow/block
the reabsorption or
reuptake of serotonin
Full effects take 4
weeks – high
suicide risk when
starting medication
Zoloft
Prozac
Paxil
Mood Stabilizing Drugs
Goal
Stabilize
fluctuating
moods
Useful for…
Bipolar
Disorder
Examples
Lithium
Unclear how it works –
maybe strengthens nerve
connections in brain that
regulate mood?
Negative Effects
Increased thirst
Headaches
Memory loss
Some tremors or
twitches
“Shock” Trailer
Brain Stimulation
Goal
Useful for…
Examples
Send an electric
current through
the brain while
the patient is
anesthetized
Severe
depression
that does not
respond to
meds
Electroconvulsive
therapy (ECT)
repeated pulses
of magnetic
energy to the
brain
Severe
depression
that does not
respond to
meds
Repetitive transcranial
magnetic stimulation
(rTMS) - used to stimulate
or suppress brain activity
Alternative to
ECT
Not exactly sure how it
works – maybe calms the
area of the brain that is over
active and causing
depression?
•Does not penetrate surface
of brain
•Painless, wide-awake
•No memory loss
•No seizures
Negative Effects
•Memory loss
•Stigmatized (bad
reputation)
Psychosurgery
Goal
Remove or
destroy brain
tissue to change
behavior

Useful for…
Epilepsy
Examples
Cutting the corpus callosum
Negative Effects
Irreversible – least
used therapy
Lobotomy – NOT
performed anymore
Lobotomy – a now-rare psychosurgical procedure that cut the
nerves that connect the frontal lobes to the emotion-controlling
centers of the inner brain.
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

Developed in the 1930s
Shock the patient into a coma
Hammer an ice pick-like instrument
through each eye socket into the
brain, then wiggle it to sever
connections running up to
the frontal lobes.
Lobotomies


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Crude but easy and inexpensive
(10 minutes)
Tens of thousands of severely
disturbed people were
lobotomized during the 1940s50s
The lobotomy usually produced a
permanently lethargic, immature,
impulsive personality.
In the 1950s, calming drugs were
introduced and lobotomized fell
out of favor in the US.
Other early therapies
Crash Course – Biomedical
Therapies