Chapter 16/L23-25

unconditional positive regard

- not judging clients and simply accepting them for who they are; therapists should demonstrate genuineness, empathy, and acceptance toward their clients because this helps people become more accepting of themselves, which results in personal growth

Insight therapies

-Freud developed psychoanalysis in trying to treat disorders that seemed not to be physical disorders, and were illogical. -psychoanalysis is an example of this type of therapy

aversion therapy

-a treatment of last resort -used when the problem behavior has powerful reinforcers built in: e.g., substance addiction; sexual deviance. If the behavior is dangerous to self or others and needs to be suppressed: e.g., sexual predators. When there is no effective alternative.

anti-anxiety agents

-anxiety and agitation that occur in OCD, PTSD, panic disorder, and social phobia; depress central nervous system activity -most widely used are Valium and Xanax -Benzodiasepine family -act quickly for a short interval

Gestalt theory

-prominently associated with the figure-ground illusion -By analogy, in our general psychological experience, some things are attended to as figure, and some ignored as ground. -Gestalt therapists use exercises to help client become aware of things they may be unaware of. -One prominent example is the empty chair technique

anti-depressants

-treat depression and anxiety; alter levels of neurotransmitters such as serotonin and norepinephrine -three types: tricyclics, monoamine oxidase inhibitors, selective serotonin reuptake inhibitors -side effects: MAOI's pretty dangerous in combination with other things including diet. SSRI's and tricyclics can affect sexual functioning. Both Serotonin and Norepinephrine mediate effects.

exposure treatment

-treatment for phobia -Fantasy Exposure, Media Modeling, In-vivo Modeling, In-vivo Exposu

antipsychotics

-used to treat schizophrenia and other types of severe thought disorders; treat positive psychotic symptoms and paranoia -slow acting; take weeks to work -Examples: Chlorpromazine (Thorazine), Haloperidol (Haldol). -side effects: Tardive Dyskinesia: Involuntary writhing or tic like movements of the mouth, tongue, face, hands, or feet.

Behavioral Marital Therapy

1. Behavioral exchange. 2. Communications training.

sources of non-assertion

1. Faulty conditioning 2. Faulty thinking 3. Skill deficit

Assertion training

1. Modeling 2. Rehearsal 3. Coaching Principles 1. Minimal effective response 2. Escalation.

examples of negative thoughts

1. People blame themselves rather than circumstances. 2. Focus on negative events and ignore positive. 3. Pessimistic about the future. 4. Draw negative conclusions about their worth as a person, based on minor events.

Rogers' 6 Conditions for Psychotherapy

1. Two persons are in psychological contact. 2. The first (client) is in a state of incongruence, being vulnerable or anxious. 3. The second (therapist) is congruent or integrated in the relationship. 4. The therapist experiences unconditional positive regard for the client. 5. The therapist experiences an empathic understanding of the client's internal frame of reference and endeavors to communicate this experience to the client. 6. The communication to the client of the therapist's empathic understanding and unconditional positive regard is to a minimal degree achieved.

Biomedical Therapy: Reynolds, et al. (1999)

107 elderly depressed patients, previously successfully treated. Treatment in the experiment was to try to maintain gains achieved. Treatments: 1) Interpersonal Therapy + Medication; 2)Nortriptyline (Tricyclic antidepressant); 3) Interpersonal Therapy + placebo; 4) Placebo alone. Evaluated "double blind" to minimize bias. Treatment continued for 3 years, or until a recurrence.

Cash (1984)

Administered Irrational Beliefs Test. Identified 2 groups: 1. Rational, and 2. Irrational. Then gave each of these 2 groups one of Velten's Mood Induction Procedures: Elation Neutral Depression Result: Irrational Group became more depressed than Neutrals. Rational became more elated than Neutrals.

Eysenck

Asked is psychotherapy effective? His conclusions: In 1959 there was little formal research on this. The research available was badly flawed, methodologically. Example: Ellis (1957) 1. Orthodox Psychoanalysis (16) 50% improved. 2. Psychoanalytic Psychotherapy (78) 65% improved. 3. Rational Emotive Therapy (78) 90% improved. Eysenck's Overall Conclusion? The case for effectiveness of therapy still unproven.

shock therapy

Can control the onset and termination precisely. Can control the duration. It is a discrete event. No after effects. Popular alternative is covert sensitization with descriptions of nausea. Why nausea? Aversive in every sensory modality. Everyone has experienced it, so you are not creating the experience entirely in imagination. It is a natural evolutionary warning event.

Greenberg & Foerster Empty Chair Technique

For dealing with "unfinished business", meaning problematic unresolved feelings related to another, experienced but not fully expressed. Client asked to role play that the Other is in the chair and address them. Then role play the Other. Desirable kinds of expressions: Intense feeling. Positive other. Self affirmation and self assertion. Changed understanding of the other.

prominent ingredients of psychoanalysis

Free association Dream analysis ("royal road to the unconscious") Transference Resistance Interpretation

Rush, Beck, Kovacs, & Hollon

Group 1: Cognitive Therapy for Depression (n = 19) Mn. 10.9 wks. Tx: 78.9% marked improvement. 1 drop out. Group 2: Imipramine (tricyclic antidepressant) (n = 22) Mn. 10.8 wks. Tx: 22.7% marked improvement. 8 drop outs. Cognitive Therapy showed significantly better results. Historically, one of the first studies pitting medication against a therapy specifically designed for the disorder. Subsequently, more common to see treatments designed for specific disorders.

assertion

Honest and relatively straightforward expression of thoughts and feelings. Takes others' feelings and welfare into account.

Behavior Therapy with Children

Interview parents. Visit in the home and observe. Offer prescriptions for changing parents behavior. Monitor if it makes a difference.

common factors in psychotherapy

Provoked by 2 recurring research findings: 1. Psychotherapy is more effective than untreated control condition. 2. Different approaches to psychotherapy show comparable results. Can implicit common factors account for this? (Frank) 1. An emotionally intense, confiding relationship. 2. A therapeutic setting. 3. A therapeutic rationale or "myth". 4. A prescription for action, or "ritual".

Howard, et al. (1986)

Reviewed data from over 2000 clients. Gathered ratings from clients and therapists, as to when improvement occurred. Then could plot two curves, one for clients, one for therapists, showing when they respectively thought change occurred. Results? 1. Surprising amount of change reported early on. 2. Change continued with continuing therapy.

Effectiveness of behavioral marital therapy

Snider, et al. (1991) 38% divorce rate for BMT at 4 yrs. Jacobson, et al. (1984) 50% of treated couples happily married at end of treatment.

reciprocal inhibition

Sympathetic and parasympathetic branches of a.n.s. reciprocally inhibit each other.

Systems approach

The family is viewed as an organized system, and each individual within the family is a contributing member who creates and maintains processes within the system that shape behavior (Minuchin, 1985). Each member of the family influences and is influenced by the others. The goal of this approach is to enhance the growth of each family member as well as that of the family as a whole.

three factors for successful treatment

The first is the use of evidence-based treatment that is deemed appropriate for your particular issue. The second important factor is the clinical expertise of the psychologist or therapist. The third factor is your own characteristics, values, preferences, and culture.

Rogers Client Centered Therapy

The focus of Rogers' therapy has been stated as "You really feel..." Due to conditions of worth, clients have often ignored, suppressed, or belittled their feelings. Rogers' supportive accepting therapy relationship both identifies feelings, or has client label them and also accords them importance. Why should feelings be considered so important in the context of helping people overcome problems? As an evaluative response of our organism, they have priority and potentially convey genuine information.

Velten

Wanted to assess whether Ellis' assumptions correct. Pre-tested on mood and speed in repetitive task. Participants read 60 statements aloud with feeling. Group 1: Elation Group 2: Neutral Group 3: Depression Post-tested on mood and speed. Depression group performed as more depressed than Neutral control group. Elation group not significantly different from Neutral. Velten inferred that we respond more readily to negative experience.

constructivism

We construct our reality by how we think about our experience.

Systematic desensitization

a calm and pleasant state is gradually associated with increasing levels of anxiety-inducing stimuli

Counterconditioning

a client learns a new response to a stimulus that has previously elicited an undesirable behavior

group therapy

a clinician meets together with several clients with similar problems

trephining

a small hole was made in the afflicted individual's skull to release spirits from the body; archaic method of treating mental illness

Family therapy

a special form of group therapy, consisting of one or more families

nondirective therapy

a therapeutic approach in which the therapist does not give advice or provide interpretations but helps the person to identify conflicts and understand feelings

Dream analysis

a therapist interprets the underlying meaning of dreams

Exposure therapy

a therapist seeks to treat clients' fears or anxiety by presenting them with the object or situation that causes their problem, with the idea that they will eventually get used to it

Aversive condition

an unpleasant stimulus to stop an undesirable behavior

cognitive therapy

awareness of cognitive process helps patients eliminate thought patterns that lead to distress -type of insight therapy focused on identifying and changing negative thoughts and maladaptive beliefs

Dorothea Dix

in the 19th led reform efforts for mental health care in the US. She investigated how those who are mentally ill and poor were cared for, and she discovered an underfunded and unregulated system that perpetuated abuse of this population. Dix began lobbying various state legislatures and the U.S. Congress for change (Tiffany, 1891). Her efforts led to the creation of the first mental asylums in the United States

Pinel

in the late 1700s he argued for more human treatment of the mentally ill. He suggested that they be unchained and talked to. He began doing this at La Salpêtrière in Paris in 1795.

behavioral exchange

increase positive affect and motivation for the couple

humanistic therapy

increase self-awareness and acceptance through focus on conscious thoughts; to help people become more self-aware and accepting of themselves. In contrast to psychoanalysis, these therapists focus on conscious rather than unconscious thoughts. They also emphasize the patient's present and future, as opposed to exploring the patient's past.

Token economy

involves a controlled setting where individuals are reinforced for desirable behaviors with tokens, such as a poker chip, that can be exchanged for items or privileges

Couples therapy

involves two people in an intimate relationship who are having difficulties and are trying to resolve them

Electroconvulsive therapy

involves using an electrical current to induce seizures to help alleviate the effects of severe depression. The exact mechanism is unknown, although it does help alleviate symptoms for people with severe depression who have not responded to traditional drug therapy

Biomedical therapy

medication and/or medical procedures to treat psychological disorders.

researching effectiveness of therapy

method: meta-analysis effect size = (treatment mean - control mean)/SD enables one to summarize results across many different variables with the same statistic

critical constructivism

our constructions need to be checked against phenomena and experience

behavior therapy

principles of learning applied to change undesirable behaviors

play therapy

psychoanalytical therapy wherein interaction with toys is used instead of talk; used in child therapy

Psychotherapy

psychological treatment that employs various methods to help someone overcome personal problems, or to attain personal growth

Smith and Glass

reviewed the psychotherapy literature to try to answer effectiveness question. 475 separate studies, each with multiple variables. Conclusion? Overall Effect Size = 0.85.

psychodynamic psychotherapy

talk therapy based on the belief that the unconscious and childhood conflicts impact behavior

individual therapy

the client and clinician meet one-on-one (usually from 45 minutes to 1 hour). These meetings typically occur weekly or every other week, and sessions are conducted in a confidential and caring environment

Deinstitutionalization

the closing of large asylums, by providing for people to stay in their communities and be treated locally;

Asylums

the first institutions created for the specific purpose of housing people with psychological disorders, but the focus was ostracizing them from society rather than treating their disorders. (18th century)

strategic family therapy

the goal is to address specific problems within the family that can be dealt with in a relatively short amount of time. Typically, the therapist would guide what happens in the therapy session and design a detailed approach to resolving each member's problem

free association

the patient relaxes and then says whatever comes to mind at the moment

Transference

the patient transfers all the positive or negative emotions associated with the patient's other relationships to the psychoanalyst

Voluntary treatment

the person chooses to attend therapy to obtain relief from symptoms

structural family therapy

the therapist examines and discusses the boundaries and structure of the family: who makes the rules, who sleeps in the bed with whom, how decisions are made, and what are the boundaries within the family. In some families, the parents do not work together to make rules, or one parent may undermine the other, leading the children to act out. The therapist helps them resolve these issues and learn to communicate more effectively.

intake

the therapist's first meeting with the client. The therapist gathers specific information to address the client's immediate needs, such as the presenting problem, the client's support system, and insurance status. Confidentiality means the therapist cannot disclose confidential communications to any third party unless mandated or permitted by law to do so.

Involuntary treatment

therapy that is not the individual's choice

radical constructivism

there are only constructions.

atypical antipsychotics

they treat schizophrenia and other sever thought disorders; treat the negative symptoms of schizophrenia

homelessness

those released from institutions were supposed to go to newly created centers, but the system was not set up effectively. Centers were underfunded, staff was not trained to handle severe illnesses such as schizophrenia, there was high staff burnout, and no provision was made for the other services people needed, such as housing, food, and job training. Without these supports, those people released under deinstitutionalization often ended up homeless. Even today, a large portion of the homeless population is considered to be mentally ill (Figure). Statistics show that 26% of homeless adults living in shelters experience mental illness.

communications training

to enable the couple to negotiate successfully through conflicts

mood stabilizers

treat bipolar disorders; treat both episodes of mania and depression

stimulants

used to treat ADHD; improve ability to focus on a task and maintain attention

Virtual reality exposure therapy

using a simulation to help conquer fears; now being used in veterans with PTSD

cognitive-behavioral therapy

work to change cognitive distortions and self-defeating behaviors