CHAPTER 14 – METHODS OF THERAPY
MODULE 14.1 PATHWAYS TO THE PRESENT: A BRIEF HISTORY OF THERAPY
After you have mastered the information in this unit, you will be able to:
 Describe how treatment of people with disturbed behavior has changed over time
 Discuss community-based mental health centers
 Explain whether the policy of deinstitutionalization has been successful
Terms and Concepts:
Moral Therapy
Deinstitutionalization
I.
II.
The Rise of Moral Therapy
A.
Treatment emphasizing compassion and understanding toward mentally ill
B.
Jean-Baptiste Pussin and Philippe Pinel (late eighteenth century France)
C.
Pussin, then Pinel were medical directors at mental hospital
D.
Treat patients humanely, release from chains
E.
Dorothea Dix—United States—campaigned for kinder treatment
F.
Dix’s work led to establishment of 32 U.S. mental hospitals
G.
By late nineteenth century, clear that moral therapy alone not successful
The Movement Towards Community-Based Care
A.
Call for reform by 1950s
B.
Transition to community mental health system (beginning in 1960s)
C.
Social policy was deinstitutionalization
1.
Mental hospitals vacated, closed
2.
Community-based mental health centers created
a.
Outpatient care; day treatment programs
b.
Crisis intervention; supervised residential facilities
c.
Criticism is that mental hospitals now are “revolving doors”
D.
Success of deinstitutionalization is questionable
E.
More intensive programs have better results
MODULE 14.2 TYPES OF PSYCHOTHERAPY
After you have mastered the information in this unit, you will be able to:
 Define psychotherapy
 Describe the major types of mental health professionals
 Describe the major forms of psychotherapy
 Discuss whether psychotherapy is effective
 Discuss cultural factors that therapist need to consider when working with diverse groups
Terms and Concepts:
Psychotherapy
Psychoanalysis
Psychoanalysts
Free Association
Dream Analysis
Interpretation
Insight
Resistance
Transference Relationship
Countertransference
Behavior Therapy
Systematic Desensitization
Fear Hierarchy
Gradual Exposure
Modeling
Aversive Conditioning
Cognitive-Behavioral Therapy (CBT)
Rational-Emotive Behavior Therapy (REBT)
Cognitive Therapy
Eclectic Therapy
Group Therapy
Family Therapy
Couples Therapy
Meta-Analysis
Nonspecific Factors
Placebo Effects
Virtual Reality Therapy (VRT)
I.
II.
III.
IV.
V.
VI.
Background Factors in Psychotherapy
A.
Psychologically based form of treatment to help with emotional, behavioral problems
B.
Involves exchange of communication between client and therapist (“talk therapy”)
Various Mental Health Professionals Provide Treatment (see Table 14.1 in text for review)
Psychodynamic Therapy
A.
Traditional psychoanalysis
1.
Root of problem is unconscious conflict, stemming from childhood
2.
Free association—patient speaks whatever comes to mind
3.
Dream analysis—examine latent content of dreams for real meaning
4.
Interpretation
a.
Insight—understanding regarding inner conflict, source
b.
Resistance—client blocks when topic very sensitive
c.
Transference relationship—client responds to therapist as if key individual in
past unconscious conflict—helps with insight
d.
Countertransference—therapist experiences carryover
B.
Modern psychodynamic approaches
1.
Focus is more on present, adaptive functioning
2.
More direct approach by therapist, briefer therapy format
Humanistic Therapy
A.
Basic factors in humanistic therapy
1.
Humans have free will, can make conscious, enriching choices
2.
Focus is on the present, client’s perception of issues and events
B.
Client-centered therapy
1.
Problems are a result of blocks on path to self-actualization
2.
Therapy is to restore individual’s ability to know own inner self
3.
Emphasis is on empathy, genuineness, unconditional positive regard
C.
Gestalt therapy
1.
Important to blend conflicting parts of personality into a unified whole
2.
Approach is direct, even confrontational; involves role playing
Behavior Therapy
A.
Principles of learning are applied to make changes in behavior
B.
Maladaptive behaviors have been learned, can be unlearned
C.
Methods of fear reduction
1.
Systematic desensitization—create fear hierarchy; maintain relaxed state
2.
Gradual exposure—real-life objects or experiences used
3.
Modeling—imitate others exhibiting adaptive behavior
D.
Aversive conditioning—pair undesirable stimulus with unwanted learned response
E.
Operant conditioning methods—may use token economy
F.
Cognitive-behavioral therapy—combines behavioral methods with changing thinking
Cognitive Therapies
A.
Basic cognitive therapy approach
1.
Root of problem is interpretation of events, rather than events themselves
2.
Therapy is brief; focus is on present
B.
Rational-emotive behavior therapy (REBT)
1.
“ABC” approach developed by Albert Ellis—problem is irrational beliefs
2.
Recognize irrationality of beliefs; adopt more effective strategies
Aaron Beck’s cognitive therapy approach
1.
Ineffective emotional reactions result from errors in thinking
2.
Develop rational alternatives to cognitive distortions
Eclectic Therapy—use combination of therapeutic approaches
Group, Family, and Couples Therapy
A.
Group therapy
1.
Therapy conducted among small number of participants
2.
Less expensive; particularly helpful for social, interpersonal problems
3.
May not provide sufficient confidentiality, individual attention
B.
Family therapy—whole family as a unit may be problem, is focus of therapy
C.
Couples therapy (marital therapy if applied to a married couple)
1.
Both members of couple considered unit of treatment
2.
Open communication channels, investigate power imbalances
The Effectiveness of Psychotherapy
A.
Measuring effectiveness
1.
Meta-analyses: individuals who receive treatment vs. those who do not
2.
Greatest gains shown in first few months of therapy
B.
Which therapy is best?
1.
Overall, all therapies better than receiving no treatment at all
2.
Ongoing evaluation: type of therapy relative to particular problem
a.
Behavioral and cognitive-behavioral—help anxiety, eating disorders
b.
Token economies helpful for mental institution patients
c.
Cognitive-behavioral appears helpful in treating schizophrenia
d.
Psychodynamic therapy may help with depression, bulimia, borderline
personality disorder
e.
Humanistic best for connecting with inner self, finding direction
C.
Accounting for benefits of therapy
1.
Nonspecific factors
a.
Common characteristics shared by different therapies
b.
Include interpersonal relationship; expectation for improvement
2.
Placebo effect—client does respond to positive expectancies
Multicultural Issues in Treatment
A.
Background considerations in multicultural treatment
1.
Clients, therapists from a multitude of ethnic, racial backgrounds
2.
Cultural bias destructive in therapeutic relationship
B.
African Americans
1.
Experienced a long history of oppression, discrimination
2.
Hesitation and reserve to be expected; not a result of paranoid thinking
C.
Asian Americans
1.
Asian culture discourages open display of emotion, feelings
2.
Matters relating to group valued over those relating to an individual
3.
May approach therapist as authority figure, to direct behavior
D.
Hispanic Americans
1.
Strong emphasis on family interdependence
2.
Therapist needs sensitivity regarding linguistic preferences
E.
Native Americans
1.
Remember customs, tribal culture (these may be source of comfort to client)
2.
May be expectation that therapist will do most of talking
Exploring Psychology: Virtual Reality Therapy
A.
Behavior therapy techniques—uses computer-generated simulated environments
B.
Especially helpful for phobias
C.
Advantages
1.
Can arrange for environments that can be difficult to arrange in real life
2.
Greater control over stimulus environments
3.
Same people may be more willing to experience something virtually than in actuality
C.
VII.
VIII.
IX.
X.
XI.
MODULE 14.3 BIOMEDICAL THERAPIES
After you have mastered the information in this unit, you will be able to:
 Discuss the major types of psychotropic or psychiatric drugs
 Compare and contrast the advantages and disadvantages of psychiatric drugs
 Define ECT, and explain how it is used
Terms and Concepts:
Psychotropic Drugs
Antianxiety Drugs
Antidepressants
Tricyclics
Monoamine Oxidase (MAO) Inhibitors
Selective Serotonin-Reuptake Inhibitors (SSRIs)
Antipsychotics
Tardive Dyskinesia (TD)
Electroconvulsive Therapy (ECT)
Psychosurgery
Prefrontal Lobotomy
I.
II.
Background Factors in Biomedical Therapies
A.
Many gains in biomedical treatments of individuals with psychological disorders
B.
Drugs have side effects; electroconvulsive shock, psychosurgery more controversial
Drug Therapy
A.
Basic approach in drug therapy
1.
Neurological transmission in the brain depends upon brain chemicals
(neurotransmitters) to conduct messages from one neuron to another
2.
Some psychological problems (e.g., anxiety, mood, and eating disorders;
schizophrenia) related to irregularities in brain chemical action
3.
Drugs have been developed that help alleviate abnormalities in functioning of these
neurotransmitters
B.
Antianxiety drugs (minor tranquilizers)
1.
Category includes diazepam (Valium), chlordiazepoxide (Librium), and alprazolam
(Xanax)
2.
Act on neurotransmitter gamma-aminobutyric acid (GABA)
3.
Enhance GABA’s ability to keep neural flow calm, in check
C.
Antidepressants
1.
Increase availability of norepinephrine and serotonin (neurotransmitters) in the brain
2.
Tricyclics
a.
Examples are imipramine (Tofranil), amitriptyline (Elavil), and doxepin
(Sinequan)
b.
Raise brain levels of norepinephrine and serotonin by interfering with
reuptake process (reabsorption of these brain chemicals by transmitter cells)
3.
Monoamine oxidase (MAO) inhibitors
a.
Examples are phenelzine (Nardil) and tranylcypromine (Parnate)
b.
Inhibit action of MAO, which normally breaks down norepinephrine and
serotonin in synapse
4.
Selective serotonin-reuptake inhibitors (SSRIs)
a.
Examples are fluoxetine (Prozac) and sertraline (Zoloft)
b.
Specifically raise levels of serotonin by limiting its reuptake
5.
Evaluation of use of antidepressant drugs
a.
Use of antidepressant medication has greatly increased in recent years
b.
Help relieve depression in 50 to 70 percent of cases
c.
Improvement usually modest
d.
SSRIs have less severe side effects, less dangerous regarding overdose
e.
Antidepressants may also help in treating anxiety disorders
f.
Serotonin implicated in regulation of mood, appetite
D.
Antipsychotics (major tranquilizers)
1.
Used to treat schizophrenia and other psychotic disorders
2.
E.
F.
First class of drugs (1950s): phenothiazines
a.
Includes Thorazine, Mellaril, and Prolixin
b.
Now possible to control most severe symptoms of schizophrenia
3.
Phenothiazines and newer antipsychotic drugs work by blocking action of dopamine
at dopamine receptor sites
Other psychiatric drugs
1.
Mood-stabilizing drugs (such as lithium)—help with bipolar disorder
2.
Anticonvulsant drugs help in treatment of epilepsy
3.
Stimulant drugs
a.
Methylphenidate (Ritalin) and others
b.
Improve attention spans, reduce disruptive behavior
c.
Work by increasing activity of dopamine in frontal lobes
Evaluating psychotropic drugs
1.
Do reduce or control symptoms of many psychological disorders
2.
Psychotropic drugs do not provide a cure
3.
Drugs alone do not teach more effective life skills
4.
Each has risk of adverse side effects
a.
Drowsiness from antianxiety drugs
b.
Dry mouth and problems with sexual response (from antidepressants)
c.
Muscular tremors, other motor problems from antipsychotic drugs
d.
Most serious side effect of antipsychotic drugs—tardive dyskinesia (TD;
permanent neurological damage to motor system)
e.
Possible that clozapine (Clozaril, for treatment of schizophrenia) may have
fewer neurological side effects
f.
Some drugs lead to dependency, addiction, death from overdose
g.
Concern (e.g., with widespread reliance on Ritalin) is overeagerness for “quick
fix” regarding psychological problems
h.
Antidepressants may lead to suicidal thoughts in children and adolescents
i.
Psychotherapy may be more work, but appears crucial for long term drug-free
improvement
j.
Combination of psychotherapy and drugs together more effective than
psychiatric drugs alone
MODULE 14.4 APPLICATION: GETTING HELP
After you have mastered the information in this unit, you will be able to:
 Explain the steps people can take to find qualified mental health professionals
I.
Steps
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
M.
N.
O.
P.
for Finding Qualified Mental Health Professionals
Get recommendations from knowledgeable sources
Check with a local medical center or clinic
Consult with available services at college or university
Contact professional organizations (such as the American Psychological Association)
Look in yellow pages of telephone directory—but use these sources with caution
Check credentials, licensing, and affiliations of treatment providers
Investigate the type of therapy provided (behavioral, cognitive, or other)
Inquire regarding educational and professional background
Investigate the provider’s experience in treating others with a similar problem
After initial consultation and evaluation, get a clear explanation of diagnosis and proposed
treatment plan before making any commitments
Discuss costs and insurance coverage
Know policies for missed or canceled appointments
Learn details regarding any prescribed medications
Discuss any concerns, especially if the treatment recommendations do not seem appropriate
to you
Consider a second opinion, especially if you are experiencing doubts
Be very cautious regarding online therapy services
CHAPTER 14 – METHODS OF THERAPY
MODULE 14.1 - PATHWAYS TO THE PRESENT: A BRIEF HISTORY OF THERAPY
Moral Therapy
Deinstitutionalization
MODULE 14.2 - TYPES OF PSYCHOTHERAPY
Psychotherapy
Psychoanalysis
Psychoanalysts
Free Association
Dream Analysis
Interpretation
Insight
Resistance
Transference Relatoinship
Countertransference
Behavior Therapy
Systematic Desensitization
Fear Heirarchy
Gradual Exposure
Modeling
Aversive Conditioning
Cognitive-Behavioral Therapy (CBT)
Rational Emotive Behavior Therapy (REBT)
Cognitive Therapy
Eclectic Therapy
Group Therapy
Family Therapy
Couple Therapy
Meta-Analysis
Nonspecific Factors
Placebo Effects
Virtual Reality Therapy
MODULE 14.3 - BIOMEDICAL THERAPY
Psychotropic Drugs
Antianxiety Drugs
Antidepressants
Tricyclivs
Monamine Oxidase (MAO) Inhibitors
Selective Serotonin-Reuptake Inhibitors (SSRI's)
Antipsychotics
Tardive Dyskinesia (TD)
Electronconvulsive Therapy (ECT)
Pscyhosurgery
Prefrontal Labotomy