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77 terms

Chapter 15 - Therapy

STUDY
PLAY
Eclectic Approach
An approach to psychotherapy that, depending on the clients problems, uses techniques from various forms of therapy
Psychotherapy
Treatment involving psychological techniques; consists of interactions between a trained therapist and someone seeking to overcome psychological difficulties or achieve personal growth

Psychotherapy integration attempts to combine a selection of assorted techniques into a single coherent system.
Psychoanalysis
- Freud's theory of personality and therapeutic technique that attributes thoughts and actions to unconscious motives and conflicts.

- Freud believed the patient's free associations, resistances, dreams, and transferences—and the therapist's interpretations of them—released previously repressed feelings, allowing the patient to gain self-insight.

- Presumes that healthier, less anxious living becomes possible when people release the energy they had previously devoted to id-ego-superego conflicts.
- Uses free association
Historical Reconstruction
Emphasizes the power of childhood experiences
Resistance
In psychoanalysis, the blocking from consciousness of anxiety-laden material.

Characterized by abrupt shift the focus of her attention and lose her train of thought
Interpretation
In psychoanalysis the analyst's noting supposed dream meanings, resistances, and other significant behaviours and events in order to promote insight
Transference
In psychoanalysis, the patient's transfer to the analyst of emotions linked with other relationships (such as love or hatred for a parent)

Feeling positive or negative toward the analyst
Latent Content
Underlying, but censored meaning
Psychodynamic Therapy
Therapy deriving from the psychoanalytic tradition that views individuals as responding to unconscious forces and childhood experiences, and that seeks to enhance self-insight.

Talk to the patient face to face, rather than out of the line of vision, once a week, rather than several times weekly, and only for a few weeks or months, rather than several years
Interpersonal Psychotherapy
A brief 12-16 session variation of psychodynamic therapy has been effective in treating depression.

Aims to help people gain insight into the roots of their difficulties. Goal is symptom relief not overall personality change.

Focuses on current relationships and interpersonal skills
Humanistic Perspective
Emphasized peoples inherent potential for self-fulfillment.

Helping people grow in self-awareness and self-perspective
Insight Therapies
A variety of therapies which aim to improve psychological functioning by increasing the client's awareness of underlying motives and defenses - psychoanalytic and humanistic
Humanistic Therapies Differ From Psychoanalytic
- Focus on present and future more than the past.

- Conscious rather than unconscious, taking immediate responsibility, rather than uncovering hidden determinants.

- Promoting growth instead of curing illness.
- Expect problems to diminish as people come in touch with their emotions
Client-Centred Therapy
- A humanistic therapy, in which the therapist uses techniques such as active listening within a genuine accepting ,empathic environment to facilitate client's growth. (person-centred therapy).

- Barriers to self understanding and self-acceptance.
- Personal growth thru self insight.
- Active listening and unconditional positive regard

(Rogers)
Non-Directive Therapy
The therapist listens, without judging or interpreting, and seeks to refrain from directing the client toward certain insights.
Active Listening
- Empathic listening in which the listener echoes, restates, and clarifies.

- Paraphrase
- Invite clarification
- Reflect feelings.

- A feature of Rogers' client-centered therapy
Unconditional Positive Regard
A caring, accepting, non-judgemental attitude, which Rogers believed to be conducive to developing self-awareness and self-acceptance
Behaviour Therapy
Therapy that applies learning principles to the elimination of unwanted behaviours.

View maladaptive symptoms such as phobias, as learned behaviours that can be replaced by constructive behaviours
Counter Conditioning
A behavior therapy procedure that uses classical conditioning to evoke new responses to stimuli that are triggering unwanted behaviors; includes exposure therapies and aversive conditioning
Exposure Therapies
Behavioural techniques, such as systematic desensitization, that treat anxieties by exposing people (in imagination or reality) to the things they fear and avoid.
Systematic Desensitization
A type of exposure therapy that associates a pleasant relaxed state with gradually increasing anxiety-triggering stimuli.

Commonly used to treat phobias.
Progressive Relaxation
Relaxing one muscle group after another
Virtual Reality Exposure Therapy
An anxiety treatment that progressively exposes people to simulations of their greatest fears, such as an airplane flying, spiders or public speaking.
Aversive Conditioning
A type of counterconditioning that associates an unpleasant state (such as nausea) with an unwanted behavior (such as drinking alcohol).

Lacing alcohol with a nausea-triggering drug
Operant Conditioning
Behaviour modification - reinforcing desired behaviours and withholding reinforcement for undesired behaviours or punishing them.

Treatment must be intensive.
Token Economy
An operant conditioning procedure in which people can earn a token of some sort for exhibiting a desired behaviour and can later exchange the tokens for various privileges or treats
Cognitive Therapies
Therapy that teaches people new, more adaptive ways of thinking and acting; based on the assumption that thoughts intervene between events and our emotional reactions.

Self-blaming with bad events are often an integral part of the vicious cycle of depression. (Beck)
Stress Inoculation Training
Encouraging people to say positive things to themselves during anxiety-producing situations (cognitive therapy)
Catastrophizing Beliefs
Dreams of depressed people, negative themes of loss, Beck's therapy for depression - gentle questioning seeks to reveal irrational thinking, and then to persuade the person to remove the dark glasses through which they view life
Meichenbaum
Stress inoculation training: teaching people to restructure their thinking in stressful situations
Cognitive Behaviour Therapy
A popular integrated therapy that combines cognitive therapy (changing self-defeating thinking) with behavior therapy (changing behavior)
Family Therapy
Therapy that treats the family as a system.

Views an individual's unwanted behaviors as influenced by, or directed at, other family members
Psychodynamic
- Unconscious forces and childhood experiences.
- Reduced anxiety through self insight.
- Analysis and interpretation
Regression Towards The Mean
The tendency for extremes of unusual scores to fall back toward their average.

When people's symptoms of psychological distress are at their worst, anything done to alleviate the condition is likely to be followed by improvement rather than further deterioration
Randomized Clinical Trials
Researchers randomly assign people on a waiting list to therapy or to no therapy, and later evaluate everyone, using tests and the reports of people who don't know whether therapy was given
Meta-analysis
A procedure for statistically combining the results of many different research studies.
Energy Therapies
Maniplulaters people's invisible energy fields
Recovered Memory Therapies
Aim to unearth repressed memories of early childhood abuse.
Rebirthing Therapies
Engage people in re-enacting the supposed trauma of their birth.
Facilitated Communication
Has an assistant touch the typing hand of a child with autism.
Crisis Debriefing
Forces people to rehearse and process their traumatic experience
Evidence-Based Practice
Clinical decision making that integrates the best available research with clinical expertise and patient characteristics and preferences
Eye Movement Desensitization and Reprocessing - (EMDR)
She had people imagine traumatic scenes while Shapiro triggered eye movements by waving her finger in front of their eyes, supposedly enabling them to unlock and process previously frozen memories.

Works better than nothing.
Light Exposure Therapy
For seasonal affective disorder (SAD) patients.

This therapy sparks activity in the brain region that influences the body's arousal and hormones
All Therapies Have In Common
Hope for demoralized people. A new perspective on oneself and the world.

Empathic, trusting, caring relationship
Therapeutic Alliance
Bond between therapist and client
Counsellors
- Marriage and family counsellors specialize in problems arising from family relations.

- Pastoral counsellors provide counselling to countless people.

- Abuse counsellors work with substance abusers and with spouse and child abusers and their victims.
Clinical or Psychiatric Social Workers
A 2 year master of social work graduate program plus post-graduate supervision prepares some social workers to offer psychotherapy, mostly to people with everyday personal and family problems.

About half have earned the National Ass. Of Social Workers designation of clinical social worker.
Clinical Psychologists
Most are psychologists with a PHD or PSY.D and expertise in research, assessment and therapy, supplemented by supervised internship and often post-doctoral training.

About half work in agencies and institutions, half in private practise.
Clinical Psychiatrists
Are physicians who specialize in the treatment of psychological disorders.

Not all psychiatrists have had extensive training in psychotherapy but as MD's they can prescribe medications.

Thus they tend to see those with the most serious problems. Many have their own private practice.
Biomedical Therapy
Prescribed medications or medical procedures that act directly on the patient's nervous system

(Biologically influenced disorders - schizophrenia)
Psychopharmacology
The study of effects of drugs on mind and behaviour
Double Blind
Neither the staff nor the patient knows who gets what
Antipsychotic Drugs
- Drugs used to treat schizophrenia and other forms of severe thought disorder.
- Similar to neurotransmitter dopamine.
- Some produce side effects similar to parkinsons disease - twitch, tremors, sluggishness.

- Long term use can produce Tardive Dyskinesia

(Such as chlorpromazine (Thorazine))
Tardive Dyskinesia
Involuntary movements of the facial muscles, tongue and limbs, a possible neurotoxic side effect of long term use of antipsychotic drugs that target certain dopamine receptors
Antianxiety Drugs
- Drugs used to control anxiety and agitation.

- Antibiotic D-cycloserine - acts upon a receptor that facilitates the extinction of learned fears.

- Relieves PTSD and OCD
Antidepressants
Drugs used to treat depression - also increasingly prescribed for anxiety

Different types work by altering the availability of various neurotransmitters

Can Take up to four weeks to take effect

(Prozac, Xanax, Ativan)
Mood-Stabilizing Drugs
Lithium (simple salt) - treats bipolar
Electroconvulsive Therapy
A biomedical therapy for severely depressed patients in which a brief electric current is sent through the brain of an anesthetised (muscle relaxant) patient. 30-60 seconds long.

4/10 relapse into depression.

The results of ECT in treating severe depression are among the most positive treatment effects in all of medicine"
Repetitive Transcranial Magnetic Stimulation - RTMS
The application of repeated pulses of magnetic energy to the brain used to stimulate or suppress brain activity.

Pulses surge through ha magnetic coil held close to a persons skull.

Energizes relatively inactive left frontal lobe.
Psychosurgery
Surgery that removes or destroys brain tissue in an effort to change behaviour
Lobotomy
A rare procedure once used to calm uncontrollably emotional or violent patients.

Cut the nerves connecting the frontal lobes to the emotion-controlling centres of the inner brain
Anti-Renumination
- Identifying and redirecting negative thoughts.
- Enhances positive thinking.
Therapeutic Drugs and Treatment During 1950's
Therapeutic drugs and community-based treatment programs - 1950's cleared out a lot of mental hospitals
Behaviour Therapy and Cognitive Behaviour Therapy
Two empirically supported therapies for treating depression
Most Effective Psychotherapists Are:
Most effective psychotherapists are those who: establish an empathic, caring relationship with their clients
Clozaril
- Antipsychotic drug

- Blocks serotonin activity as well as dopamine.

- Antipsychotic which requires regular blood tests to determine any abnormal changes on white blood cells
Chlorpromazine
- Antipsychotic drug
- Thorazine

- Dampen responsiveness to irrelevant stimuli.

- Drugs used to treat schizophrenia and other forms of severe thought disorder.
- Similar to neurotransmitter dopamine.
- Some produce side effects similar to parkinsons disease - twitch, tremors, sluggishness
Depakote
Originally used to treat epilepsy and is also found effective in controlling manic episodes associated with bi-polar disorder
Ativan
Anti-anxiety medication to relax the patient and help with sleep
Xanax
Anti-anxiety agent
Prozac
Selective-serotonin-reuptake-inhibitors (SSRI) they slow the synaptic reuptake of serotonin.

Potential side effects - dry mouth, weight gain, hypertention and dizzy spells. Administering by a patch helps bypass the liver, reducing side effects.

Can take up to 4 weeks to take effect
Therapy Success
Therapy is likely to be most effective when a client's problem is clear-cut
Bed Wetting Treatment
Behaviour modification = empirically supported to treat bed wetting
Psychotherapy Cost-Effectiveness
Psychotherapy is cost-effective compared with the greater costs of medical care for psychologically related complaints
Aerobic Exercise and Depression/Anxiety
Aerobic exercise, which helps calm people who feel anxious and energize those who feel depressed, does about as much good for some people with mild to moderate depression, and has additional positive side effects
Mental Health Reform
Mental health reform came about from Pinel in France and Dix in the United States