Different Styles

Therapy Mental health therapies can be

classified into two main categoriesPsychotherapy: trained therapist uses

psychological techniques to assist someone seeking to overcome difficulties or achieve personal growth

Biomedical: prescribed medication or medical procedure that acts directly on the patient’s nervous system○ Many patients receive drug therapy in addition

to psychotherapy

Therapy

PsychoanalysisSigmund Freud’s therapeutic technique.

Freud believed the patient’s free associations, resistance, dreams, and transference- and the therapist’s interpretations of them- released previously repressed feelings, allowing the patient to gain self-insight

TherapyAims of Psychoanalysis:

sought to bring repressed feelings into patients’ conscious awareness○ Presumes that

healthier, less anxious living becomes possible when people release the energy they had previously devoted to id-ego-superego conflicts

TherapyMethods: psychoanalysis

emphasizes the power of childhood experiences, and aims to unearth the past○ Freud first tried hypnosis but

discarded it because it is unreliableFreud turned to free association:

the client/patient says aloud whatever comes to his/her head- While this sounds easy it is

actually very difficult not to omit information, change the subject quickly when uncomfortable, or when feeling shame

Therapy○ Resistance: the blocking from consciousness

of anxiety-laden materialThe analyst will note your resistances and then

interpret their meaning, providing insight

○ Another way to reach into the unconscious is dream analysis and interpreting the latent content of dreams

○ Transference: the patient’s transfer to the analyst of emotions linked with other relationships (such as love or hatred for

a parent)○ This takes time and several years and can get quite expensive

Therapy

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

TherapyDifferences between psychodynamics and

psychoanalysis○ Face to face○ Lasts only a few weeks or months

Malan: I get the feeling that you’re the sort of person who needs to keep active. If you don’t keep active, then something goes wrong. Is that true?

Patient: Yes. Malan: I get a second feeling about you and that is that you must,

underneath all this, have an awful lot of very strong and upsetting feelings. Somehow they’re there but you aren’t really quite in touch with them. Isn’t this right? I feel you’ve been like that as long as you can remember.

Patient: For quite a few years, whenever I really sat down and thought about it I got depressed, so I tried not to think about it.

Malan: You see, you’ve established a pattern, haven’t you? You’re even like that here with me, because in spite of the fact that you’re in some trouble and you feel that the bottom is falling out of your world, the way you’re telling me this is just as if there wasn’t anything wrong.

TherapyInterpersonal psychotherapy: variation of

psychodynamic therapy○ Has been effective in treating depression○ Goal is symptom relief in the here and now,

not an overall personality change

Therapy Humanistic Therapy

Humanistic perspective emphasizes people’s inherent potential for self-fulfillment○ Therapy aims to boost self-fulfillment by helping

people grow in self-awareness and self-acceptanceTherapy attempted to reduce the inner conflicts that are

impeding natural developmentInsight therapies: a variety of therapies which

aim to improve psychological functioning by increasing the client’s awareness of underlying motives and defenses○ Both humanistic and psychoanalysis are

considered insight therapies

TherapyHumanistic therapy differs from

psychoanalysis:○ Focus on present and future more than the

past○ Focus on conscious rather than unconscious○ Focus on taking immediate responsibility for

one’s feelings and actions○ Promoting growth instead of curing illness

Call those in therapy clients and not patients

TherapyCarl Rogers develop the technique called client-

centered therapy○ This is a humanistic therapy, developed by Carl

Rogers, in which the therapist uses techniques such as active listening within a genuine, accepting, empathic environment to facilitate clients’ growth (also call person centered therapy)

○ Client-centered therapy hinges on the therapist providing the client with unconditional positive regardUnconditional positive regard is blanket support and

acceptance of a person regardless of what is said or behavior- Rogers believed this was essential

○ Client-centered therapy is non-directive

Therapy○ Active listening is essential to the humanistic

view pointEmpathic listening in which the listener echoes,

restates, and clarifies. A feature of Rogers’ client-centered therapy

Steps:- Paraphrase- Invite clarification- Reflect feelings

○ Rogers encouraged genuineness, acceptance, and empathy

Therapy

Group TherapyGroup therapy can be just as effective for

the individual and save time and moneyAlso offers the unique benefit of social

context○ This allows people both to discover that others

have problems similar to their own and to receive feedback as they try out new ways of behaving

TherapyFamily therapy

○ Therapy that treats the family as a system. Views an individual’s unwanted behavior as influenced by, or direct at, other family members

Other types of groups○ Closed group: only members of the group can

attend or those with the same problem○ Open group: anyone can come to the meeting

TherapySupport groups and self-help groupsOther examples of groups:

○ AA: Alcoholics Anonymous○ GA: Gamblers Anonymous○ Eating disorder groups

Therapy

Behavior TherapyTherapy that applies learning principles to

the elimination of unwanted behaviors○ Doubt the healing power of self-awareness○ Behaviorist assume that problem behaviors

are the problems and the application of learning principles can eliminate them

TherapyClassical Conditioning Techniques

○ Since we learn many behaviors and emotions through classical conditioning, then we should be able to treat disorders with this technique as wellGoal is to unlearn associations and relearn

constructive behaviors and associationsCounter 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

TherapyExposure therapy: behavioral techniques,

such as systematic desensitization, that treat anxieties by exposing people 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

Therapy○ Virtual reality exposure therapy: an anxiety

treatment that progressively exposes people to simulations of their greatest fears, such as airplane flying, spiders, or public speaking

○ In systematic desensitization, the goal is substituting a positive response for a negative response to a stimulus

TherapyAversive conditioning, however, is a type of

counter conditioning that associates an unpleasant state (such as nausea) with an unwanted behavior (such as drinking alcohol)○ Usually use with a combination of other

treatments

TherapyOperant Conditioning

○ Therapist apply the concepts of operant conditioning to the treatment of various behavioral issues in order to help the patient overcome their issuesOne concept that is used is called Token Economy

- An operant conditioning procedure in which people earn a token of some sort for exhibiting a desired behavior and can later exchange the tokens for various privileges or treats

Therapy

Cognitive TherapyTherapy 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 and overgeneralization

explanations for bad events are often integral part of the vicious cycle of depressionGoal is to change the way of thinking

Therapy

Lost your job

Internal Beliefs: I’m worthless. It’s hopeless

Depression

Lost Job

Internal beliefs: My boss is a jerk. I deserve something better.

No depression

TherapyCognitive Behavioral Therapy

○ A popular integrated therapy that combines cognitive therapy with behavior therapyChange thoughts & actions

- For a person with OCD, instead of washing hands again, tell yourself that your it’s your brain’s abnormal activity and move on to an enjoyable activity to avoid the urge.

Therapy

Is Psychotherapy effective?Client’s perceptions: people often enter

therapy in crisisClients may need to believe the therapy was

worth the effortClients generally speak kindly of their

therapist

Therapy

Commonalities Among PsychotherapiesHope for demoralized peopleA new perspectiveAn empathic, trusting, caring relationship

TherapyDifferent therapies

○ Energy therapies○ Recovered-memory therapy○ Rebirthing therapies○ Facilitated communication○ Crisis debriefing○ Eye Movement Desensitization and

Reprocessing○ Light Exposure therapy

Therapy Homework: Over the weekend you are to

research any three therapy methods on the list on the previous slide. One of the three methods must be EMDR, but the other two are you choice. Here is what you need to includeThe process of therapy (what the client must

due during therapy)Discuss the effectiveness of the therapyCriticisms of the therapy methodYou own thoughts on each of the three.

○ Should total three pages (one page per method)

Therapy

Biomedical TherapiesPrescribed medications or medical

procedures that act directly on the patient’s nervous system○ Often used with serious disorders

TherapyDrug therapies

○ Psychopharmacology: the study of the effects of drugs on mind and behavior

○ Most widely used biomedical treatment○ Allowed people to leave hospital confinements

and live a life for their ownHowever, in many cases this means homelessness,

not liberation

Therapy○ Antipsychotic Drugs

Example: Chlorpromzine (sold as Thorazine)Drugs used to treat schizophrenia and other forms of

severe thought disorder- Reduce positive symptoms of schizophrenia

Similar to the molecules of the neurotransmitter of dopamine to block activity at those sites

Long term-use of medication can also produce tardive dyskinesia: involuntary movements of the facials muscles, tongue, and limbs; a possible neurotoxic side effect of long-term use of antipsychotic drugs that target certain dopamine receptors

Therapy○ Schizophrenia pateitns exhibiting negative

symptoms do not respond well to antipsychoticsHowever, newer atypical antipsychotics, such as

clozapine (known as Clozaril), target both dopamine and serotonin receptors

○ Newer antipsychotic medications have fewer side effects

○ Antipsychotic need to be combined with life-skills and family support

TherapyAntianxiety Drugs

○ Drugs used to control anxiety and aggressionXanax and AtivanDepress central nervous systemNew antianxiety drug D-cycloserine (an antibiotic)

can help facilitate the extinction of fears- Experiments show that the drug enhances the

benefit of exposure therapy and helps relieve the symptoms of PTSD and OCD

TherapyAntidepressant Drugs

○ Drugs used to treat depression; also increasingly prescribed for anxiety. Different types work by altering the availability of various neurotransmittersFluoxetine, known as Prozac, partially blocks the

absorption and removal of serotonin- Prozac and Paxil are known as SSRI (selective-

serotonin-reuptake-inhibitors)- Side effects such as: dry mouth, weight gain,

hypertension, or dizzy spells

Therapy○ For all medication therapy it is important that it

is linked to other treatment methods such as counseling or psychotherapy

○ For depressed patients other things help such as: exercise, eating better, and family therapy

TherapyMood-Stabilizing Medications

○ The salt lithium can be effective for those with bipolar disorder

○ Depakote found effective to control manic episodes

TherapyElectroconvulsive Therapy (ECT)

○ Although controversial, ECT is often an effective treatment for depression that does not respond to drug therapy

○ Therapist delivers 30 to 60 seconds of electrical current to the patient’s brainSome memory loss is associated with it, but no

discernible brain damage

○ No one is really sure how ECT works

Therapy

TherapyPsychosurgery

○ Surgery that removes or destroys brain tissue in an effort to change behavior

○ Lobotomy: a now-rare psychosurgical procedure once used to calm uncontrollably emotional or violent patients. The procedure cut the nerves connecting the frontal lobes to the emotion-controlling centers of the inner brain

TherapyTherapeutic Life Changes

○ Aerobic exercise○ Adequate sleep○ Light exposure○ Social connection○ Anti-rumination○ Nutritional supplements