Chapter 16: Therapy
Interpretation
in psychoanalysis, the analyst's noting supposed dream meanings, resistances, and other significant behaviors and events in order to promote insight
Resistance
in psychoanalysis, the blocking from consciousness of anxiety-laden material
Transference
in psychoanalysis, the patient's transfer to the analyst of emotions linked with other relationships (such as love or hatred for a parent)
Post traumatic Growth
positive psychological changes as a result of struggling with extremely challenging circumstances and life crises
Biomedical Therapy
prescribed medications or procedures that act directly on the person's physiology - Involves treatment with medical procedures; trained therapist, most often a medical doctor, offers medications and other biological treatments
Psychosurgery
surgery that removes or destroys brain tissue in an effort to change behavior
Repetitive Transcranial Magnetic Stimulation (rTMS)
the application of repeated pulses of magnetic energy to the brain; used to stimulate or suppress brain activity
Resilience
the personal strength that helps most people cope with stress and recover from adversity and even trauma - Involves personal strength that helps most people cope with stress and recover from adversity and trauma - Can be seen in New Yorkers after 9/11, spinal cord injury patients, Holocaust survivors, and others
Psychopharmacology
the study of the effects of drugs on mind and behavior
What should a person look for when selecting a therapist?
A person seeking therapy may want to ask about the therapist's treatment approach, values, credentials, and fees. An important consideration is whether the therapy seeker feels comfortable and able to establish a bond with the therapist.
Psychoanalysis
Freud's therapeutic technique - 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
Electroconvulsive Therapy (ECT)
a biomedical therapy for severely depressed patients in which a brief electrical current is sent thorough the brain of an anesthetized patient
Therapeutic Alliance
a bond of trust and mutual understanding between a therapist and client, who work together constructively to overcome the client's problem
Unconditional Positive Regard
a caring, accepting, nonjudgemental attitude, which Carl Rogers believed would help clients develop self-awareness and self-acceptance
Client-Centered Therapy
a humanistic therapy, developed by Carl Rogers, in which the therapist uses techniques such as active listening within a genuine, accepting, empathetic environment to facilitate clients' growth (also called person-centered therapy)
Cognitive-Behavioral Therapy (CBT)
a popular integrative therapy that combines cognitive therapy (changing self-defeating thinking) with behavior therapy (changing behavior) - more likely to remember negative events more so than positive ones, so need to enforce positive ones - see slide 24
Meta-Analysis
a procedure for statistically combining the results of many different research studies
Lobotomy
a 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
Aversive Conditioning
a type of counterconditioning that associates an unpleasant state (such as nausea) with an unwanted behavior (such as drinking alcohol)
Systematic Desensitization
a type of exposure therapy that associates a pleasant relaxed state with gradually increasing anxiety-triggering stimuli (commonly used to treat phobias)
Insight Therapies
a variety of therapies that aim to improve psychological functioning by increasing a person's awareness of underlying motives and defenses
Virtual Reality Exposure Therapy
an anxiety treatment that progressively exposes people to electronic stimulations of their greatest fears, such as airplane flying, spiders or public speaking
Eclectic Approach
an approach to psychotherapy that uses techniques from various forms of therapy
Token Economy
an operant conditioning procedure in which people earn a token of some sort for exhibiting a desired behavior and can later exchange their tokens for various privileges or treats
Exposure Therapies
behavioral techniques, such as systematic desensitization and virtual reality exposure therapy, that treat anxieties by exposing people (in imagination or actual situations) to the things they fear and avoid
Evidence-Based Practice
clinical decision making that integrates the best available research with clinical expertise and patient characteristics and preferences
Anti anxiety Drugs
drugs used to control anxiety and agitation
Antidepressant Drugs
drugs used to treat depression, anxiety disorders, obsessive-compulsive disorder, and post-traumatic stress disorder (several widely used antidepressant drugs are selective serotonin reuptake inhibitors - SSRIs)
Antipsychotic Drugs
drugs used to treat schizophrenia and other forms of severe thought disorder
Active Listening
empathetic listening in which the listener echoes, restates, and clarifies (as seen in client-centered therapy)
Mindfulness
• Be in the moment • Focus your attention on yourself (or your breath) • Be aware of your thoughts, but don't be involved in them • Do not pass judgments, do not dwell on negativity
What are the differences between psychoanalysis and psychodynamic therapies?
• Differences - No id, ego, and superego - Briefer, less expensive, and more focused on helping the client find relief from current symptoms • Interpersonal therapy: Brief 12-16 session form of psychodynamic therapy that has been effective in treating depression
Behavior Therapies
• Operant conditioning therapy: Consequences drive behavior: voluntary behaviors are strongly influenced by their consequences • Behavior modification: Desired behavior reinforced; undesired behavior not reinforced, sometimes punished • Token economy: People earn a token for exhibiting a desired behavior and can later exchange the tokens for privileges or treats
What are some cognitive behavioral strategies?
• Recognize negative self talk and correct it - Example: "I always fail at everything" --> "I didn't do as well as I would have liked, but that doesn't mean I'm a failure as a person. Here are some things I'm good at." • Schedule a "worry time" - Worry only during a particular time of day; the rest of the time if something comes up, remind yourself that it's not "worry time" yet • Make a concrete plan of action - "This is my study schedule; it will help me do well on the exam." • Write down a list of positive qualities about yourself that you can refer to in the futures • Make a list of strategies to cope with stress when it comes up • Come up with a list of activities that put you in a good mood
Behavioral Therapy
• Reward desired behaviors and eliminate undesired behaviors during the sessions (reward good behaviors, don't reward bad behavior) - No concern for the psychoanalytic state of the patient • Systematic desensitization - Relaxation skills extinguish anxiety - Move up hierarchy of fears
Which psychotherapies work best?
• Some forms of psychotherapy work best for particular problems. - Behavior therapies: Bed-wetting, phobias, compulsions, marital problems, and sexual dysfunctions - Psychodynamic therapy: Depression and anxiety - Cognitive therapies: Anxiety, depression, and posttraumatic stress disorder - Evidence-based practice: Integration of best available research with clinicians' expertise and patients' characteristics, preferences, and circumstances
Dialectical Behavior Theory
- Combines cognitive behavioral therapy with mindfulness exercises. - Particularly helpful in treating BPD and bulimia. - Change behaviors to help the person
What three elements are shared by all forms of psychotherapy?
- Hope for demoralized people - A new perspective leading to new behaviors - An empathetic, trusting, caring relationship
How do alternative therapies fare under scientific scrutiny?
Abnormal states tend to return to normal on their own, and the placebo effect can create the impression that a treatment has been effective. These two tendencies complicate assessments of alternative therapies (nontraditional therapies that claim to cure certain ailments). Eye movement desensitization and reprocessing (EMDR) has shown some effectiveness - not from the eye movement but rather from the exposure therapy nature of the treatments. Light exposure therapy does not seem to relieve depression symptoms for those with a seasonal pattern of major depressive disorder by activating a brain region that influences arousal and hormones.
How does the basic assumption of behavior therapy differ from the assumptions of psychodynamic and humanistic therapies? What techniques are used in exposure therapies and aversive conditioning?
Behavior therapies are not insight therapies. Their goal is to apply learning principles to modify problem behaviors. Classical conditioning techniques, including exposure therapies (such as systematic desensitization or virtual reality exposure therapy) and aversive conditioning, attempt to change behaviors through counterconditioning - evoking new responses to old stimuli that trigger unwanted behaviors.
What are the basic themes of humanistic therapy? What are the specific goals and techniques of Rogers' client-centered approach?
Both psychoanalytic and humanistic therapies are insight therapies - they attempt to improve functioning by increasing clients' awareness of motives and defenses. Humanistic therapy's goals have included helping clients grow in self-awareness and self-acceptance; promoting personal growth rather than curing illness; helping clients take responsibility for their own growth; focusing on conscious thoughts rather than unconscious motivations; and seeing the present and future as more important than the past. Carl Rogers' client-centered therapy proposed that therapists' most important contributions are to function as a psychological mirror though active listening and to provide a growth-fostering environment of unconditional positive regard, characterized by genuineness, acceptance, and empathy.
Does psychotherapy work? How can we know?
Clients' and therapists' positive testimonials cannot prove that psychotherapy is actually effective, and the placebo effect makes it difficult to judge whether improvement occurred because of the treatment. Using meta-analysis to statistically combine the results of hands of randomized psychotherapy outcome studies, researchers have found that those not undergoing treatment often improve, but those undergoing psychotherapy are more likely to improve more quickly , and with less chance of relapse. - People often enter therapy in crisis - Clients believe that treatment will be effective - Clients want to believe the therapy was worth the effort - Clients generally speak kindly of their therapists
What are the 4 D's of abnormality?
DEVIANCE: Statistical Rarity & Societal Disapproval - Is this behavior or thought uncommon in the general population? DISTRESS: Subjective Distress - Is the behavior or thought causing the individual distress? DYSFUNCTION: Impairment - Is the behavior interfering with the individual's ability to function? DANGER: Self harm, suicide, or harming others - Is the behavior or thought dangerous to the individual or those around him/her?
How, by taking care of themselves with a healthy lifestyle, might people find some relief from depression? How does this reflect our being biopsychosocial systems?
Depressed people who undergo a program of aerobic exercise, adequate sleep, light exposure, social engagement, negative-thought reduction, and better nutrition often gain some relief. In our integrated biopsychosocial system, stress affects our body chemistry and health; chemical imbalances can produce depression; and social support and other lifestyle changes can lead to relief of symptoms.
How are brain stimulation and psychosurgery used in treating specific disorders?
Electroconvulsive therapy (ECT), in which a brief electric current is sent though the brain of an anesthetized patient, is an effective, last-resort treatment for severely depressed people who have not responded to other therapy. Newer alternative treatments for depression include repetitive transcranial magnetic stimulation (rTMS) and, in preliminary clinical experiments, deep-brain stimulation that calms an overactive brain region linked with negative emotions. Psychosurgery removes or destroys brain tissue in hopes of modifying behavior. Radical psychosurgical procedures such as lobotomy were once popular, but neurosurgeons now rarely perform brain surgery to change behavior or moods. Brain surgery is a last-resort treatment because its effects are irreversible.
What are the aims and benefits of group and family therapies?
Group therapy sessions can help more people and costs less per person than individual therapy would. Clients may benefit from exploring feelings and developing social skills in a group situation, from learning that others have similar problems, and from getting feedback on new ways of behaving. Family therapy views a family as an interactive system and attempts to help members discover the roles they play and to learn to communicate more openly and directly.
Are some psychotherapists more effective than others for specific disorders?
No one type of psychotherapy is generally superior to all others. Therapy is more effective for those with clear-cut, specific problems. Some therapists - such as behavior conditioning for treating phobias and compulsions - are more effective for specific disorders. Psychodynamic therapy has been effective for depression and anxiety, and cognitive and cognitive-behavioral therapies have been effective in coping with anxiety, PTSD and depression. Evidence-based practice integrates the best available research with clinicians' expertise and patients' characteristics, preferences and circumstances.
What is the main premise of therapy based on operant conditioning principles, and what are the views of it proponents and critics?
Operant conditioning operates under the premise that voluntary behaviors are strongly influenced by their consequences. Therapy based on operant conditioning principles uses behavior modification techniques to change unwanted behaviors through positively reinforcing desired behaviors and ignoring or punishing undesirable behaviors. Critics maintain that (1) techniques such as those used in token economies may produce behavior changes that disappear when rewards end, and (2) deciding which behaviors should change is authoritarian and unethical. Proponents argue that treatment with positive rewards is more humane than punishing people or institutionalizing them for undesired behaviors.
What is the rationale for preventive mental health programs, and why is it important to develop resilience?
Preventative mental health programs are based on the idea that many psychological disorders could be prevented by changing oppressive, esteem-destroying environments into more benevolent, nurturing environments that foster growth, self-confidence, and resilience. Struggling with challenges can lead to post traumatic growth. Community psychologists re often active in preventive mental health programs.
What are the drug therapies? How do double-blind studies help researchers evaluate a drug's effectiveness?
Psychopharmacology, the study of drug effects on mind and behavior, has helped make drug therapy the most widely used biomedical therapy. Antipsychotic drugs, used in treating schizophrenia, block dopamine activity. Side effects may include tardive dyskinesia (with involuntary movements of facial muscles, tongue and limbs) or increased risk of obesity and diabetes. Anti anxiety drugs, which depress CNS activity, are used to treat anxiety disorders, OCD and PTSD. These drugs can be physically and psychologically addictive. Antidepressant drugs, which increase the availability of serotonin and norepinephrine, are used for depression, with modest effectiveness beyond that of placebo drugs. The antidepressants known as selective serotonin reuptake inhibitors (SSRIs) are now used to treat other disorders, including strokes and anxiety disorders. Lithium and Depakote are are mood stabilizers prescribed for those with bipolar disorder. Studies may use a double blind procedure to avoid the placebo effect and researcher's bias.
How do psychotherapy and the biomedical therapies differ?
Psychotherapy is treatment involving psychological techniques; it consists of interactions between a trained therapist and someone seeking to overcome psychological difficulties or achieve personal growth. The major psychotherapies derive from psychology's psychodynamic, humanistic, behavioral, and cognitive perspectives. Biomedical therapy treats psychological disorders with medications or procedures that act directly on a patient's physiology. An eclectic approach combines techniques from various forms of therapy.
What are the goals and techniques of cognitive therapy and of cognitive behavioral therapy?
The cognitive therapies, such as Aaron Beck's cognitive therapy for depression, assume that our thinking influences our feelings, and that the therapist's role is to change clients' self-defeating thinking by training them to view themselves in more positive ways. The widely researched and practiced cognitive-behavioral therapy (CBT) combines cognitive therapy and behavior therapy by helping clients regularly act out their new ways of thinking and talking in their everyday life.
How do culture and values influence the therapist-client relationship?
Therapists differ in the values that influence their goals in therapy and their views of progress. These differences may create problems if therapists and clients differ in their cultural or religious perspectives.
What are the goals and techniques of psychoanalysis, and how have they been adapted in psychodynamic therapy?
Through psychoanalysis, Freud tried to give people self-insight and relief from their disorders by bringing anxiety-laden feelings and thoughts into conscious awareness. Psychoanalytic techniques included using free association and interpretation of instances of resistance and transference. Psychodynamic therapy has been influenced by traditional psychoanalysis but differs from it in many ways, including the lack of belief in id, ego and superego. This contemporary therapy is briefer, less expensive, and more focused on helping the client find relief from current symptoms. Psychodynamic therapists help clients understand how past relationships create themes that may be acted out in present relationships. Interpersonal therapy is a brief 12-16 session form of psychodynamic therapy that has been effective in treating depression.
Counterconditioning
behavior therapy procedures that use classical conditioning to evoke new responses to stimuli that are triggering unwanted behaviors; include exposure therapies and aversive conditioning
Group Therapy
therapy conducted with groups rather than individuals, permitting therapeutic benefits from group interaction • Conducted with groups rather than individuals, providing benefits from group interaction • Often used when client problems involve interactions with others • Benefits - Saves therapists' time and clients' money - Encourages exploration of social behaviors and social skill development - Enables people to see that others share their problems - Provides feedback as clients try out new ways of behaving
Psychodynamic Therapy
therapy driving from the psychoanalytic tradition; views individuals as responding to unconscious forces and childhood experiences, and seeks to enhance self-insight
Behavior Therapy
therapy that applies learning principles to the elimination of unwanted behaviors
Cognitive Therapy
therapy that teaches people new, more adaptive ways of thinking; based on the assumption that thought intervene between events and our emotional reactions - Teaches people new, more adaptive ways of thinking; based on the assumption that thoughts intervene between events and our emotional reactions Beck's therapy for depression: - Gentle questioning seeks to reveal irrational thinking and then to persuade people to change their perceptions of their own and others' actions as dark, negative, and pessimistic - People trained to recognize and modify negative self-talk goal: identify negative cognitions, and replace them with something more helpful
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 • Attempts to open up communication within the family and help family members to discover and use conflict resolution strategies • Treats the family as a system • Views an individual's unwanted behaviors as influenced by, or directed at, other family members
Psychotherapy
treatment involving psychological techniques; consists of interactions between a trained therapist and someone seeking to overcome psychological difficulties or achieve personal growth - Involves psychological techniques derived from psychological perspectives; trained therapist uses psychological techniques to assist someone seeking to overcome difficulties or achieve personal growth
Humanistic Therapies
• Theme: Emphasis on people's potential for self-fulfillment; to give people new insights • Goals: To reduce inner conflicts that interfere with natural development and growth; help clients grow in self-awareness and self-acceptance promoting personal growth • Techniques: Client-centered therapy; focus on taking responsibility for feelings and actions and on present and future rather than past
Phobias
• Two-process theory of phobia development - Phase 1: conditioning to associate the object with fear/negative events - Phase 2: operant conditioning where the individual avoids the phobic object and no bad outcomes occur • Reinforces the avoidance of the phobic object/mental notion that it should be feared • Systematic desensitization: progressive exposure to the phobic object