Therapy

Chapter 16
 OVERVIEW

Psychotherapy
Evaluating Therapeutic Outcome
Types of Therapy
Psychoanalytic
Humanistic
Behavioural
Cognitive
Biological
 Therapy Comes in Many Forms
LOBJ 16.1

Many forms of treatment are available for

people experiencing psychological
difficulties

2 Broad Types of Therapy:

Somatic therapy (biological)
Drugs
ECT
Psychosurgery Video Clip
Psychotherapy - from Abn Psy
Various techniques of talk therapy
 Psychotherapy: Four Areas of
Emphasis
Distorted thoughts

Disturbedemotions
(Inner Conflicts)

Maladaptive behaviours

Interpersonal and
life situation difficulties
 Common Themes Among
Psychotherapies
Emotional defusing

Interpersonal learning

Self-knowledge

Therapy as a step-by-step process

Therapy as socially accepted healing

Evaluating Therapeutic
Outcome: Does
 Placebo Effects
A placebo effect is a therapeutic change
that occurs as a result of a persons
expectations of change rather than as a
result of any specific treatment.

Some patients in psychotherapy may

show relief from their symptoms simply
because they are in therapy and may
expect change
 DOES PSYCHOTHERAPY WORK?

In a 1952 paper, Hans

Eysenck challenged the
effectiveness of
psychotherapy

Eysenck claimed that

psychotherapy produced
no greater change in
maladjustment than
natural life experiences

He was WRONG!
 Meta-Analyses of Therapy
Outcome LOBJ 16.2
Meta-analysis

Smith,Glass, & Miller

(1980) conducted the
most comprehensive
meta-analysis of
psychotherapy
outcome research
Types of Therapy
Psychoanalysis/psychodynamic Humanistic
Behavioural Cognitive
Group Biological
 Psychoanalysis &
Psychodynamic Therapies
 Psychodynamic Therapies
Psychoanalysis
Developed by Freud
Insight oriented therapy
Uses free association, dream analysis,
and transference
Considerable time/financial investment
Not commonly used today

Psychodynamically based
therapies
Insight oriented
Use techniques derived from Freud
Reject or modify parts of Freuds theory
More common than psychoanalysis
 Psychodynamic Therapies
LOBJ 16.6

Assumptions of insight
therapies:

Becoming aware of your

motivations will help you
change and adapt
Unresolved conflict
results in maladjustment

Childhood
Sexual feelings
Aggression
 Psychodynamic Therapies:
Goal

Psychoanalytic
therapies
attempt to help patients
understand the
unconscious motivations
that direct their behavior
Change your perspective
= better mental health
 Psychodynamic Therapies:
Techniques LOBJ 16.7
free association
the patient is asked to
report whatever comes to
mind, no matter how
disorganized or trivial
 Free association

I feel like crying when

If I were rich

My mother

I feel happy
 Psychoanalytic Therapies:
Techniques
Dream analysis

Based on idea that

dreams are unconscious
drives seeking expression

Dreams are the royal

road to the unconscious.
-- Sigmund Freud
 Psychoanalytic Therapies:
Techniques
Interpretation -
context , meaning, or
cause of a specific idea,
feeling, set of behaviors

Defense Mechanisms
signal areas that need to
be explored
 Psychoanalytic Therapies:
Processes
Resistance is
unwillingness to
cooperate on the part
of the patient
Belligerence

Missing appointments
Refusal to pay

It means you have hit on

something big
 Psychoanalytic Therapies:
Processes
Transference occurs when
the therapist becomes the
object of a patients
emotional attitudes about an
important person in the
patients life
* E.g. parent figure,
spouse, boss
Countertransference refers to
personal issues the therapist
brings to professional issues
with clients
Humanistic Therapies
 Humanistic Therapies
Goal is to remove constraints
upon self-fulfillment

Emphasize the ability to reflect

on conscious experience

Assume that humans have free

will and are motivated to fulfill
themselves

Focus on present and future

 Client-Centered Therapy

Developed by Carl Rogers

The Role of the Therapist:

Video Clip of Rogers

Description: insight therapy

that helps people evaluate
the world and themselves
from their own perspective
 Client-Centered Therapy:
Techniques
The goal of client-
centered therapy is to
help people discover
the ideal self

In client-centered
therapy, the therapist
guides clients to help
them find what they
feel is right for
themselves
 Client-Centered Therapy:
Techniques
The therapist must demonstrate:

Unconditional positive regard

- be an accepting person who projects positive feelings
towards client

Congruence
-being real or genuine; honest and aware of own feelings

Empathic listening
- sense how the client feels and communicate these
feelings to the client
 Behaviour Therapy
Operant Conditioning Counterconditioning
Modelling
 Behaviour Therapy: Goals

Behaviour therapy
focuses on changing
overt behaviour by
using learning
principles to help
people replace
maladaptive
behaviours with more
effective behaviours
 Behaviour Therapy:
A Criticism
Most insight therapists believe that if
only overt behaviour is treated,
symptom substitution will occur

In symptom substitution, the client

substitutes a new symptom to replace Not necessarily
the treated one True.
E.g. I did have an nervous twitch, now I
clear my throat constantly.

Research does show that behaviour

therapy is at least as effective as
insight therapies
 Behaviour Therapy:
Procedures
Behaviour therapy involves three general
procedures:

1) Examining the problem behavior and its frequency

2) Developing an individually tailored treatment

strategy

3) Continually assessing whether or not the

behaviour has changed.
 Behavior Therapy:
Operant Conditioning

Uses reinforcers to establish

desired behaviours

Reinforcer =
something that INCREASES
the likelihood of a target
behavior
 Operant Conditioning:
Examples
Token economy
A system based on positive
reinforcement in which
people who display
appropriate behaviours
receive tokens

Time-out
- removal from source of
reinforcement
- Use it with positive reinforcers
 Counterconditioning
Counterconditioning:
Based
e.g., replace anxiety with
on classical
Relaxation in response to
conditioning
The provoking stimulus/
Personis taught a new,
more adaptive response to
a stimulus

Twotypes of
counterconditioning:
Systematic desensitization
Aversive
 Systematic Desensitization
Gradually replacing an
undesirable response (e.g.
anxiety) with a desirable one
(e.g. relaxation)

Client is taught relaxation

strategies, and once relaxed is
exposed to progressively
stronger anxiety-provoking
stimuli.

Two phases:
In imagination
In vivo
 Aversive Conditioning
A noxious stimulus is
paired with a stimulus
that elicits an
undesirable behaviour
COGNITIVE THERAPY
Rational-Emotive Therapy Becks
Approach
 Cognitive Therapy

Assumption: Wrong, distorted, or

underdeveloped ideas and
thoughts may prevent a person
from developing effective coping
skills.

Focus: Changing thoughts and

perceptions will change
behavior.
Cognitive Therapy
 Cognitive Therapy

Propositions:
1. Cognitions affect behaviour

2. Cognitions can be monitored

3. By changing cognitions, we
can change behaviour
 Rational Emotive Therapy
best known cognitive therapy
developed by Albert Ellis

emphasizes the importance of logical,

rational thought processes

assumed abnormal behaviour is caused

by faulty and irrational thinking
patterns
Table 16.4, pg.598
What disturbs peoples minds is not
events but their judgements on
events.Epictectus, 100 A.D.
Biological Therapies
Pharmaceutical
 Drug Therapy
Nodrug will
permanently cure the
maladjustment of
people who are not
coping well

Psychotropicdrugs:
drugs given to relieve
mental problems
Drug Therapy
 Antianxiety Drugs
Anxiolytics e.g. Librium,
Xanax, and
Mood-altering Valium:
reduce stress,
increase calm, Long-term use
induce sleep without adjunct
therapy ill-
neurotransmitter advised
(GABA)
 Antidepressants
Thymoleptics

Elevate mood, alter levels of brain

chemicals

Common Side Effects: headache,

nausea, weight gain, decreased sex
drive

Types: Selective Serotonin Reuptake

Inhibitors SSRIs (e.g. Prozac,
Zoloft, Paxil) & SNRIs (Effexor)
 Antimania Drugs
Lithium carbonate has long
been used as an effective
antimania drug

Thymoleptic

Importance of dosage too

much has negative side
effects; too little = no effect

Side Effects
 Antipsychotic Drugs
neuroleptics Phenothiazine
(e.g. Thorazine)
Treat
Schizophrenia Issues: not helpful
for all symptoms,
Reduce hostility, side effects
aggression, and Tardive dyskinesia
delusions
Neurotransmitter -
Dopamine
 Psychosurgery
Psychosurgery: brain surgery

Prefrontal Lobotomy: removal

of parts of the brains frontal
lobes thought to alleviate
symptoms of mental disorders
done in the 1940s and 50s

Prefrontal
lobotomies made some
people become unnaturally calm
and completely unemotional
 Electroconvulsive Therapy

Electroconvulsive therapy (ECT)

o An electric current is briefly
applied to the head to produce a
generalized seizure (convulsion)

was once widely employed with

depressed people

Today, ECT is not a widely used

therapy