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85 terms

Therapies-Chapter 15

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