Therapies-Chapter 15

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The World of Psychology Seventh Edition Samuel E. Wood, Ellen Green Wood, Denise Boyd

Therapies

Any type of treatment for emotional and behavioral disorders that uses psychological rather than biological means

Insight therapies

Approaches to psychotherapy based on the notion that psychological well-being depends on self-understanding
-Understanding of one's own thoughts, emotions, motives, behavior, and coping mechanisms

Psychodynamic therapies

Attempt to uncover childhood experiences that are thought to explain a patient's current difficulties
-Psychoanalysis
---Freud's first psychodynamic therapy
---Uses free association, dream analysis, and transference

Psychodynamic Therapies

Free association
Dream analysis
Transference
Brief psychodynamic therapy

Psychodynamic Therapies-Free association

Technique used to explore the unconscious by having patients reveal whatever thoughts, feelings, or images come to mind
-Analyst pieces together the free-flowing associations, explaining their meanings
-Helps the patient gain insight into troubling thoughts and behaviors
-Resistance
---When a patient avoids revealing certain painful or embarrassing thoughts
----Halting speech, "forgetting" appointments, or arriving late

Psychodynamic Therapies-Dream analysis

Areas of repressed emotional concerns expressed symbolically in dreams

Psychodynamic Therapies-Transference

An emotional reaction that occurs during psychoanalysis
Patient displays feelings and attitudes toward the analyst that were present in another significant relationship
Freud believed it to be an essential part of therapy
-Patient can relive troubling experiences from the past with the analyst as a parent substitute
-Aids in resolving any hidden conflicts

Psychodynamic Therapies-Brief psychodynamic therapy

Patient and therapist agree beforehand about what issues to work on rather than waiting for them to emerge
Therapist assumes active role
-emphasizes the present rather than the past
As effective as other therapies
-For patients without multiple psychological disorders

Interpersonal Therapy

Brief psychotherapy designed to help depressed people understand and cope with problems relating to their interpersonal relationships

Four types of interpersonal problems commonly associated with major depression

1.Unusual or severe responses to death of a loved one
2.Interpersonal role disputes
-Helps understand others' points of view
-Explore options for bringing about change
3.Difficulty adjusting to role transitions
-Divorce
-Career change
-Retirement
4.Deficits in interpersonal skills
-Use role playing and analysis of communication styles
-Develop interpersonal skills to initiate and sustain relationships
12 to 16 weekly sessions
Effective, with low drop-out rate

Humanistic Therapies

Assume people have the ability and freedom to lead rational lives and make rational choices

Person-Centered Therapy

A nondirective, humanistic therapy
-Developed by Carl Rogers
Therapist creates an accepting climate and shows empathy
-Unconditional positive regard
Frees clients to be themselves, releasing their natural tendency toward self-actualization
Psychological disorders result when a person's natural tendency towards self-actualization is blocked by oneself or others
Therapist empathizes with client's concerns and emotions
-Reflecting listening used in responses, allowing the client to control the direction of the sessions
-Also called nondirective therapy
Rogers rejects all forms of therapy that cast the therapist as an "expert" who prescribes something to "cure" the problem

Humanistic Therapies

Assume people have the ability and freedom to lead rational lives and make rational choices

Person centered therapy (aka client-centered therapy)

Developed by Carl Rogers
People grow towards self-actualization if allowed to develop naturally
Disorders result when a person's natural tendency is blocked by self or others
Therapist as "expert" rejected by Rogers

Unconditional positive regard

An accepting environment created by the therapist
Utilizes reflecting listening, allowing client to direct session

Gestalt Therapy

Originated by Fritz Perls
Emphasizes importance of clients' fully experiencing, in the present moment, their feelings, thoughts, and actions
Client must then take responsibility for them

Goal of gestalt therapy

Help clients achieve a more integrated self and become more authentic and self-accepting
Learn to assume personal responsibility for their behavior rather than blaming society, past experiences, parents, or others

Directive Therapy

Any type of therapy in which the therapist takes an active role in determining the course of therapy sessions and provides answers and suggestions to the patient
"Getting in touch with your feelings" a major objective
Those in need of therapy carry around unfinished business
Empty Chair technique role plays past relationships

Relationship Therapy

Attempt to improve patients' interpersonal relationships or create new relationships to support patients' efforts to address psychological problems

Couple Therapy

Traditional behavioral couple therapy
Integrated behavioral couple therapy
Family Therapy

Couple Therapy-Traditional behavioral couple therapy

Focuses on behavior change
Observe interactions to assess accuracy of complaints and to identify each spouse's strengths
Attempt to modify problem behaviors and enhance items helpful to communication process

Couple Therapy-Integrated behavioral couple therapy

Emphasizes both behavior change and mutual acceptance
Problems arise from changeable behaviors, the individuals, and the personality traits of both partners
Helps couples learn to accept and adjust to each other's personalities rather than trying to change them

Couple Therapy-Family Therapy

Involves entire family
Goal is to help family members reach agreement on changes that will help heal the family unit
Improve communication
Create understanding
Enhance harmony within the group
Dynamics of the family unit
How family members communicate
How they act towards and view each other
Positive effect on treating disorders and clinical problems
Sexual dysfunctions
Schizophrenia (when therapy accompanies medication)
Reduces relapse by reducing criticism, hostility, or emotional over-involvement
Adolescent drug abuse

Group Therapy

Several clients (7-10 usually) meet regularly with one or more therapists to resolve personal problems
Self-help group

Group Therapy-Several clients

Less expensive than regular therapy
Provides individuals with:
-Sense of belonging
-Opportunity to express feelings
-Opportunity to get feedback from other members
-Chance to give and receive help and emotional support

Group Therapy-Self-help group

Usually not led by a professional therapist
Provides people who share a common problem the chance to meet and get support
Most focus on a single problem (drug abuse or depression)
Alcoholics Anonymous
-The oldest and best known with 1.5 million members world wide
-Derivatives include Gamblers Anonymous, Overeaters Anonymous, Narcotics Anonymous, Sex Addicts Anonymous

Group Therapy

Can give individuals a sense of belonging. Provides the emotional opportunity to give and receive support.

Behavior Therapies

Based on the idea that abnormal idea is learned
Not a sign of an underlying disorder
If afraid to fly, then fear of flying is the problem
Applies the principles of operant and classical conditioning, or observational learning
Eliminate inappropriate or maladaptive behaviors and replace them with more adaptive responses
Doesn't change the individual's personality structure or search for the origin of the problem
Behavior modification
Uses learning principles to eliminate inappropriate or maladaptive behaviors and replace them with more adaptive responses

Behavior Modification Therapy Based on Operant Conditioning

Seek to control the consequences of behavior
Extinction of undesirable behaviors accomplished by:
-Terminating or withholding the reinforcement
-Seek to reinforce desirable behavior to increase its frequency
-Best done in hospitals, prisons, and schools classrooms

Token economies

Rewards appropriate behavior with tokens
-Poker chips, coupons, play money, stars, stickers, etc.
Tokens later exchanged for desired goods and/or privileges
-Weekend passes, candy, gum, TV time, etc.
Undesirable behaviors can be "fined" a certain number of tokens

Behavior Modification Therapy Based on Operant Conditioning-Time Out

Used to eliminate undesirable behavior by withdrawing all reinforcers for a period of time
Works well with children and adolescents
Children are told of rules in advance
If they do undesirable behaviors they will be removed from the situation for a period of time
No more than 15 minutes
In a place containing no reinforcers
No toys, friends, television, books, etc.
The undesirable behavior will stop if it is no longer reinforced
Also works for breaking bad habits or developing good habits
Devise a reward system for desirable behaviors
Reward gradual changes in the direction of the ultimate goal

Behavior Therapies Based on other Learning Theories

Systematic desensitization
Flooding
Exposure and response prevention
Aversion therapy
Participant modeling
Exposure and response prevention
Aversion therapy
Participant modeling

Behavior Therapies Based on other Learning Theories-Systematic desensitization

Used to treat fears by training clients in deep muscle relaxation
Then they confront a hierarchy of anxiety producing situations
Real or Imagined)
Repeated until they remain relaxed even in the most feared situation
Highly successfully treatment for eliminating fears and phobias in a short period of time

Behavior Therapies Based on other Learning Theories-Flooding

Used to treat phobias by exposing clients to feared object or event for an extended period of time until anxiety decrease
-Client with a fear of heights may stand on roof of high building until anxiety subsides
Sessions do not end until patients are markedly less afraid
In vivo flooding (real life) works faster - up to 6 sessions

Behavior Therapies Based on other Learning Theories-Exposure and response prevention

A behavior therapy that exposes clients with obsessive-compulsive disorder to stimuli that trigger obsessions and compulsive rituals
While clients resist performing the compulsive rituals for progressively longer periods of time

Behavior Therapies Based on other Learning Theories-Aversion therapy

An aversive stimulus is paired with a harmful or socially undesirable behavior until the behavior becomes associated with pain or discomfort

Behavior Therapies Based on other Learning Theories-Participant modeling

An appropriate response to a feared stimulus is modeled in graduated steps
The client attempts to imitate the model step by step
Encouraged and supported by the therapist

Behavior Therapies Based on other Learning Theories-Exposure and response prevention

Exposes patients with obsessive-compulsive disorder to stimuli that trigger obsessions and compulsive rituals
Touching a doorknob, piece of unwashed fruit, or garbage bin
Patients resist performing the compulsive rituals for progressively longer periods of time
Washing hands, bathing, etc.
Therapist identifies trigger thoughts, objects, or situations
Typically 10 treatment sessions over 3-7 weeks bring improvement in 60-70% of patients
Less relapse than those treated with drugs alone
Also useful in treatment of posttraumatic stress disorder

Cognitive Therapies

Assume maladaptive behavior can result from irrational thoughts, beliefs, and ideas
Often called cognitive-behavioral approach

Cognitive Therapies

Combine cognitive insight with methodological behavioral approach
Therapists seek to change the way clients think
-Determine effectiveness by assessing changes in the client's behavior
Effective in treatment of:
-Anxiety disorders
-Hypochondriasis
-Psychological drug dependence
-Pathological gambling

Rational emotive therapy

Directive form of psychotherapy designed to challenge client's irrational beliefs about themselves and others

Cognitive Therapies-Based on Ellis' ABC Theory

= activating event
= person's belief about the event
= emotional consequence that follow

Cognitive Therapies-Rational emotive therapy

Ellis believes clients do not benefit from warm, supportive therapeutic approaches that do not address the irrational thoughts that underlie the problem
As irrational beliefs are replaced, emotional reactions become appropriate and less distressing, eventually leading to constructive behaviors
Client's are taught they can not control demands of others but can control their emotional reactions
Relaxation techniques often taught to control emotional reactions
RET equally effective with systematic desensitization

Cognitive Therapies-Beck's cognitive therapy

Help patients stop negative thoughts as they occur and replace them with more objective or positive thoughts
Automatic thoughts cause misery of depression and anxiety:
-"To be happy I must be liked by everyone."
-"If people disagree with me, it means they don't like me."
Depressed people hold a negative view of present, past, and future experiences
-"It has never worked and I can't make it happen."
Notice only negative unpleasant things
-Fail to recognize positive events and feelings
Jump to the wrong conclusions
-"No one likes me."

Cognitive Therapies-Beck's cognitive therapy

Therapist identifies and challenges irrational thoughts
Sets up a plan and guides the client so life experiences become evidence to refute false beliefs
Homework assignments given to track automatic thoughts and feelings evoked by them; clients write substitute rational thoughts
Brief, lasting 10-20 sessions
Extensive research demonstrates high success rate with:
-Mild to moderate depression
-Panic disorder
-Generalized anxiety disorder
-Cocaine addiction, insomnia, and bulimia
-Negative and positive symptoms of schizophrenia
-Less likely to relapse than those treated with antidepressant drugs

Biomedical Therapies

Therapy based on the assumption that psychological disorders are symptoms of underlying physical problems
Includes drug therapy, electroconvulsive therapy, and psychosurgery
Millions of people take medications for psychological problems

Biomedical Therapies-Drug therapy

Antipsychotic drugs
-Drugs used to control severe psychotic symptoms
---Delusions, hallucinations, disorganized speech and behavior
-Inhibiting dopamine activity
---Also known as neuroleptics
---Thorazine, Stelazine, Compazine, Mellaril
---50% of patients have a good response
---Long-term use may lead to tardive dyskinesia
------Almost continual twitching and jerking of face and tongue and squirming movements of the hands and trunk

Antipsychotic drugs

Atypical neuroleptics (newer drugs)
Clozapine, Risperidone, Olanzipine
Target both dopamine and serotonin
Marked improvement in quality of life - tardive dyskinesia is rare
Treat both positive and negative effects of schizophrenia

Antidepressant Drugs

Act as mood elevators for severely depressed people and are also prescribed to treat some anxiety disorders
65-75% of patients report significant improvement
40-50% report complete recovery

Antidepressant Drugs

Tricyclics - first generation of antidepressants

Antidepressant Drugs-Tricyclics

Block reuptake of norepinephrine and serotonin into axon terminals
-Enhances the action of these neurotransmitters in the synapses
Side effects include:
-Sedation, fatigue, dizziness, nervousness, dry mouth, forgetfulness, and weight gain
-Weight gain #1 reason (20 or more pounds) people stop taking them despite benefit

Antidepressant Drugs-Second generation antidepressants

Selective serotonin reuptake inhibitors
-Block the reuptake of serotonin increasing availability at the brain synapses
Fewer side effects and safer in case of overdose
Effective in treating:
-Obsessive-compulsive disorder
-Social phobia
-Panic disorder
-Generalized anxiety disorder
-Binge eating
Side effects
-Sexual dysfunction
---Returns to normal when drug is discontinued
-Increase in suicide risk not substantiated

Antidepressant Drugs-Monoamine oxidase inhibitors (MAOI)

Block the action of an enzyme that breaks down norepinephrine and serotonin in the synapses
Increase the availability of norepinephrine and serotonin
Usually prescribed to patients who do not respond to other antidepressants
Similar side effects to tricyclic antidepressants plus patients must avoid certain foods to reduce the risk of stroke

Antidepressant Drugs-Lithium and anticonvulsant drugs

Naturally occurring salt used to treat bipolar disorder
Effectiveness in treating depression and bipolar is unmatched
40-60% of patients experience a recurrence
Monitoring blood level necessary to prevent nervous system damage
Anticonvulsant drugs effective treating bipolar symptoms with fewer side effects

Anti-Anxiety Drugs-Benzodiazepines

Valium, Librium, and Xanax
Prescribed more often than any other class
Effective in treating panic disorder and anxiety
Xanax
-Works fast and has few side effects
-Relapse is likely if discontinued
-Withdrawal symptoms include intense anxiety

Anti-Anxiety Drugs-Disadvantages of Drug Therapy

Difficulty establishing proper dosages
Help with symptoms but do not cure psychological disorders
Maintenance doses are required to prevent relapse
Increase in homeless population

Psychiatric Drugs for Children and Adolescents

Number of children in U.S. taking psychiatric drugs between 5-6%
Typical and atypical neuroleptics to treat psychotic symptoms
May be used to treat autism

Psychiatric Drugs for Children and Adolescents

Response to antidepressants similar to that in adults
Higher incidence of suicidal thinking
Diagnosis and drug treatment of children with bipolar disorder is controversial
Tranquilizers
Used only in unusual circumstances
May have opposite effect - agitating not calming

Electroconvulsive Therapy

An electric current is passed through the right hemisphere of the brain
Usually reserved for severely depressed patients who are suicidal and don't respond to other treatments
Highly effective for major depression

Electroconvulsive Therapy

Unilateral ECT used today instead of bilateral ECT
Equally effective with milder cognitive side-effects
Patients are given anesthesia, controlled oxygenation, and a muscle relaxant
When effective, ECT:
Changes the biochemical balance in the brain
Reduces cerebral blood flow in the prefrontal cortex
Triggers delta waves
No structural brain damage demonstrated in MRI or CT scans

Psychosurgery

Brain surgery performed to alleviate serious psychological disorders or unbearable chronic pain
Severe depression, anxiety, or obsessions

Psychosurgery-Lobotomy

The first surgery severing neural connections between the frontal lobes and the deeper brain centers involved in emotions
Initially a tremendous contribution, however treatment left patients in a severely deteriorated condition

Psychosurgery-Modern psychosurgery

Results in less intellectual impairment
Surgeons deliver electrical currents through electrodes to destroy smaller, localized areas of brain tissue
Helpful with obsessive-compulsive disorder
Results still not predictable and consequences are irreversible
Treatment is considered experimental and an absolute last resort

Psychiatrist-Training

Medical degree (M.D or O.D);residency in pschiatry

Psychiatrist-Services Provided

Psychotherapy; drug therapy; hospitalization for serious psychological disorders

Psychoanalyst-Training

M.D., Ph.D., or Psy.D.;additional training in psychoanayysis

Psychoanalyst-Services Provided

Psychodynamic therapy

Clinical psychologist-Training

Ph.D. or Psy.D.;Internship in clinical psychology

Clinical psychologist-Services Provided

Diagnosis and treatment of psychological disorders; can prescribe drugs in some settings after additional training; psychological testing

Counseling psychologist-Training

Ph.D. or Ed.D.'Internship in counseling psychology

Counseling psychologist-Services provided

Assessment and therapy for normal problems of life (e.g. divorce); psychological testing

School psychologist-Training

Ph.D. or Ed.D.,Ed.S. or master's degree; internship in school psychology; school psychologists with Ed.S. or master's degrees are limited to practicing in schools or under the supervision of a doctoral-level psychlogist

School psychologist-Services provided

Assessment and treatment of school problems in children and adolescents; psychological testing

Clinical or psychiatric social worker (M.S.W.)-Training

Master's degree; internship in psychiatric social work

Clinical or psychiatric social worker (M.S.W.)-Services provided

Diagnosis and treatment of psychological disorders;identification of supportive community services

Licensed professional counselor (L.P.C.)-Training

Master's degree; internship in counseling

Licensed professional counselor (L.P.C.)-Services provided

Assessment and therapy for normal problems of life; some psychological testing

Licensed marriage and family therapist (L.M.F.T.)-Training

Master's degree; internship in couples therapy and family therapy

Licensed marriage and family therapist (L.M.F.T.)-Services provided

Assessment and therapy for relationships problems

Licensed chemical dependency counselor (L.C.D.C.)-Training

Educational requirements vary from one state to another; often former addicts themselves

Licensed chemical dependency counselor (L.C.D.C.)-Services provided

Treatment and education for substance abuse problems

Culturally Sensitive Therapy

Knowledge of clients' cultural backgrounds guides the choice of therapeutic interventions
The meaning of symptoms, outcomes, and responses to therapy are viewed within a cultural context
Cultural difference may affect the therapeutic alliance
Language differences can pose problems
Bilingual patients more fluent in Spanish but speaking English may exhibit "symptoms" causing therapist to misdiagnose:
Hesitations
Backtracking
Delayed responses to questions
Affect results on standardized tests
Need to consider immigration experiences on thoughts and emotions

Culturally Sensitive Therapy

Cultural models should be included with interventions
Native American healing circles
Promote physical, mental, emotional, and spiritual well-being
May also include discussion, meditation, and prayer

Culturally Sensitive Therapy

Address group differences that can affect therapy results
African Americans are less likely to follow medication instructions
Compliance increased by understanding the importance of kinship and community relationships within the culture
Have the patient participate in a support group of members with the same disorder, medication, and culture
Discuss racial perspectives prior to beginning therapy

Gender-Sensitive Therapy

Takes into account the effects of gender on both the therapist's and the client's behaviors

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