Chapter 15Chapter 15If You Go for HelpIf You Go for Help

Chapter OverviewChapter OverviewHow Well Does Therapy Work?

Cognitive-Behavioral Therapies

•Behavioral Therapies•Cognitive Therapies•Status of Psychotherapy Today

Insight Therapies-The Talking Cure

•Psychoanalysis•The Person-Centered Approach

•A Variety of Approaches

If You Go for If You Go for HelpHelp

Other Approaches to Treatment

•Family, Couples, and Relationship Therapy

•Biomedical Therapies•Community-Based Services

Chapter SummaryChapter Summary

Insight Therapies – The Talking Insight Therapies – The Talking CureCure

• PsychoanalysisPsychoanalysis

• The Person-Centered ApproachThe Person-Centered Approach

• A Variety of ApproachesA Variety of Approaches

Cognitive-Behavioral Cognitive-Behavioral TherapiesTherapies

• Behavioral TherapiesBehavioral Therapies

• Cognitive TherapiesCognitive Therapies

• Status of Psychotherapy TodayStatus of Psychotherapy Today

Chapter SummaryChapter Summary cont’dcont’d

Other Approaches to Other Approaches to TreatmentTreatment

• Family, Couples, and Relationship Family, Couples, and Relationship TherapyTherapy

• Biomedical TherapiesBiomedical Therapies

• Community-Based ServicesCommunity-Based Services

Chapter SummaryChapter Summary cont’dcont’d

HFDocsRank[d],D11

Chapter SummaryChapter Summary cont’dcont’d

How Well Does Therapy Work?How Well Does Therapy Work?

IntroductionIntroduction• PsychotherapyPsychotherapy is is the helping process the helping process

in which a trained, socially sanctioned in which a trained, socially sanctioned therapist performs certain activities therapist performs certain activities that facilitate a change in the client’s that facilitate a change in the client’s attitudes and behaviorsattitudes and behaviors..

• A A therapisttherapist is is a person trained to help a person trained to help people with psychological problemspeople with psychological problems..

• One type of psychotherapy is One type of psychotherapy is insight insight therapytherapy, , therapy designed to bring therapy designed to bring change by increasing self change by increasing self understandingunderstanding..

Insight Therapies--Insight Therapies--The Talking CureThe Talking Cure

PsychoanalysisPsychoanalysisA form of psychotherapy aimed at A form of psychotherapy aimed at helping the person gain insight and helping the person gain insight and mastery over unconscious conflictsmastery over unconscious conflicts..

• Founded by Dr. Sigmund Freud.Founded by Dr. Sigmund Freud.• Uses the processes of free association, Uses the processes of free association,

resistance, transference, dream analysis, resistance, transference, dream analysis, etc.etc.

• Greatly criticized in the past, but shorter Greatly criticized in the past, but shorter versions today are gaining some recognition versions today are gaining some recognition from the psychological community.from the psychological community.

The Person-Centered ApproachThe Person-Centered ApproachPsychotherapy designed to change a client Psychotherapy designed to change a client

via the therapist’s genuineness, via the therapist’s genuineness, acceptance, and empathic understanding.acceptance, and empathic understanding.

• Developed by Dr. Carl Rogers.Developed by Dr. Carl Rogers.• Uses the processes of acceptance, and Uses the processes of acceptance, and

empathy.empathy.• As clients are understood and accepted by As clients are understood and accepted by

the therapist, they come to accept the therapist, they come to accept themselves more fully and listen more themselves more fully and listen more accurately to their inner experiences.accurately to their inner experiences.

Insight Therapies--Insight Therapies--The Talking Cure The Talking Cure cont’dcont’d

A Variety of ApproachesA Variety of ApproachesOther forms of insight therapy exist. They Other forms of insight therapy exist. They

include:include:

• Existential therapyExistential therapy: : An approach that An approach that emphasizes the client’s capacity for growth emphasizes the client’s capacity for growth through affirmation of his or her free choice and through affirmation of his or her free choice and personal values.personal values.

• LogotherapyLogotherapy: : Therapy that stresses the Therapy that stresses the importance of clarifying values that give personal importance of clarifying values that give personal meaning and purpose to life.meaning and purpose to life.

Insight Therapies--Insight Therapies--The Talking Cure The Talking Cure cont’dcont’d

A Variety of ApproachesA Variety of ApproachesOther forms of insight therapy exist. They Other forms of insight therapy exist. They

include:include:

• Gestalt therapyGestalt therapy: : Therapy that makes use of the Therapy that makes use of the here-and-now, the client’s responsibility, and here-and-now, the client’s responsibility, and nonverbal behavior as a way of helping clients nonverbal behavior as a way of helping clients unify their feelings and actions.unify their feelings and actions.

• Actualization therapyActualization therapy: : Therapy that combines Therapy that combines elements of other therapies as a way of elements of other therapies as a way of maximizing the individual’s growth.maximizing the individual’s growth.

Insight Therapies--Insight Therapies--The Talking Cure The Talking Cure cont’dcont’d

Cognitive-Behavioral Cognitive-Behavioral TherapiesTherapies

Behavioral TherapyBehavioral TherapyThis therapy involves discovering the factors This therapy involves discovering the factors

that trigger and reinforce problem behavior; that trigger and reinforce problem behavior; specifying a target behavior to replace it; specifying a target behavior to replace it; and then, by manipulating these factors, and then, by manipulating these factors,

bringing about the desired change.bringing about the desired change.

Cognitive-Behavioral Cognitive-Behavioral TherapiesTherapies

cont’dcont’dBehavioral TherapyBehavioral Therapy

• These therapies are based on operant These therapies are based on operant and classical conditioning.and classical conditioning.

• One example is One example is desensitizationdesensitization, , a a method for controlling anxiety by method for controlling anxiety by learning to associate an incompatible learning to associate an incompatible response, like relaxation, with a fear-response, like relaxation, with a fear-provoking stimulus (i.e. phobia).provoking stimulus (i.e. phobia).

Cognitive TherapiesCognitive TherapiesTherapies that focus on faulty cognitive processes Therapies that focus on faulty cognitive processes

as the crucial element in maladaptive as the crucial element in maladaptive behaviorsbehaviors..

• The central assumptionThe central assumption:: emotional and emotional and behavioral problems result from an individual’s behavioral problems result from an individual’s distorted thoughts and reactions to external distorted thoughts and reactions to external events rather than from the events themselves.events rather than from the events themselves.

• These therapies are meant to help clients think These therapies are meant to help clients think more rationally about themselves and their more rationally about themselves and their problems.problems.

• Therapists do not probe for deep-seated causes.Therapists do not probe for deep-seated causes.

Cognitive-Behavioral Cognitive-Behavioral TherapiesTherapies

cont’dcont’d

Status of Psychotherapy TodayStatus of Psychotherapy Today

• Most practitioners today are Most practitioners today are eclecticeclectic—they use a variety of approaches.—they use a variety of approaches.

• They hope to find and match the best They hope to find and match the best technique to each client, given the technique to each client, given the client’s uniqueness.client’s uniqueness.

• Therapy today is done in fewer Therapy today is done in fewer sessions than in the past; this is most sessions than in the past; this is most likely because of managed health likely because of managed health care.care.

Cognitive-Behavioral Cognitive-Behavioral TherapiesTherapies

cont’dcont’d

Other Approaches to Other Approaches to TreatmentTreatment

Mutual-Help Groups (Self-Help Groups)Mutual-Help Groups (Self-Help Groups) Group members share a common issue and meet Group members share a common issue and meet

regularly to discuss their concerns without the regularly to discuss their concerns without the guidance of a professionalguidance of a professional..

•An example is An example is Alcoholics Alcoholics Anonymous.Anonymous.

•A major assumption is that no A major assumption is that no one can understand you as one can understand you as well as someone else who has well as someone else who has the same problem.the same problem.

•Research supports that these Research supports that these nonprofessional groups are nonprofessional groups are effective. effective.

From MentalHealth.orgFrom MentalHealth.org

Family, Couples, and Relationship TherapyFamily, Couples, and Relationship TherapyRelationship therapistsRelationship therapists try to try to help small units of help small units of people be more aware of how they treat each other, people be more aware of how they treat each other, how they may unwittingly hurt one another, and how how they may unwittingly hurt one another, and how

they can nurture each other betterthey can nurture each other better..

An example is An example is family therapyfamily therapy..

Other Approaches to Other Approaches to

TreatmentTreatment cont’dcont’d

Family therapyFamily therapy involves involves the the larger family unit, including larger family unit, including children and adolescents, on children and adolescents, on the assumption that the assumption that disturbance of one family disturbance of one family member reflects problems in member reflects problems in the overall familythe overall family..

Biomedical TherapiesBiomedical TherapiesStrategies that rely on direct Strategies that rely on direct

physiological intervention to treat the physiological intervention to treat the symptoms of psychological disorderssymptoms of psychological disorders..

• These treatments include drugs, These treatments include drugs, electroconvulsive treatment, and electroconvulsive treatment, and psychosurgery. psychosurgery.

Other Approaches to Other Approaches to

TreatmentTreatment cont’dcont’d

Other Approaches to Other Approaches to

TreatmentTreatment cont’dcont’d

Biomedical TherapiesBiomedical Therapies• Many disorders are related to imbalances in Many disorders are related to imbalances in

neurotransmittersneurotransmitters––chemical substances involved in chemical substances involved in the transmission of neural impulses between neurons.the transmission of neural impulses between neurons.

• Antianxiety drugsAntianxiety drugs are drugs used primarily for are drugs used primarily for alleviating anxietyalleviating anxiety; these drugs include minor ; these drugs include minor tranquilizers.tranquilizers.

• AntidepressantsAntidepressants are are used to treat depression or to used to treat depression or to elevate mood, usually by increasing the level of elevate mood, usually by increasing the level of certain neurotransmittercertain neurotransmitter such as norepinephrine and such as norepinephrine and serotonin.serotonin.

Other Approaches to Other Approaches to

TreatmentTreatment cont’dcont’d

Biomedical TherapiesBiomedical Therapies• LithiumLithium, which is which is a natural mineral salt used to a natural mineral salt used to

treat bipolar disordertreat bipolar disorder..

• Antipsychotic drugsAntipsychotic drugs are are medications to medications to relieve the symptoms of psychoses such as relieve the symptoms of psychoses such as extreme agitation, hallucinations, and extreme agitation, hallucinations, and delusionsdelusions..

• Each drug has its own advantages and Each drug has its own advantages and disadvantages such as tardive dyskinesia disadvantages such as tardive dyskinesia caused by antipsychotic medication.caused by antipsychotic medication.

Other Approaches to Other Approaches to

TreatmentTreatment cont’dcont’d

Biomedical TherapiesBiomedical TherapiesElectroconvulsive Therapy (ECT)Electroconvulsive Therapy (ECT) involves involves

the administration of an electric current to the administration of an electric current to the patient’s brain to produce a convulsion.the patient’s brain to produce a convulsion.

• Commonly used to treat depression.Commonly used to treat depression.

• Generally requires multiple treatments.Generally requires multiple treatments.

• Can cause memory loss.Can cause memory loss.

Other Approaches to Other Approaches to

TreatmentTreatment cont’dcont’d

Biomedical TherapiesBiomedical TherapiesPsychosurgery Psychosurgery is is surgery designed to destroy or surgery designed to destroy or

disconnect brain tissue in an attempt to regulate disconnect brain tissue in an attempt to regulate abnormal behaviorabnormal behavior..

• An example is a An example is a frontal lobotomyfrontal lobotomy which is which is surgery surgery of the frontal lobes of the brain intended to alter the of the frontal lobes of the brain intended to alter the emotion-controlling center of the brainemotion-controlling center of the brain..

• ……a very controversial treatment, but still utilized a very controversial treatment, but still utilized today.today.

• Some patients emerge from surgery in a vegetative Some patients emerge from surgery in a vegetative state!state!

Community-Based ServicesCommunity-Based ServicesServices located in the individual’s own Services located in the individual’s own community, such as a community mental community, such as a community mental

health center.health center.

• Such services were promoted by the Such services were promoted by the Community Mental Health Centers Act Community Mental Health Centers Act (1963).(1963).

• Outpatient community services are heavily Outpatient community services are heavily used today with the closing of so many used today with the closing of so many psychiatric hospitals.psychiatric hospitals.

Other Approaches to Other Approaches to

TreatmentTreatment cont’dcont’d

Community-Based ServicesCommunity-Based Services• The system does not seem to work well; The system does not seem to work well;

many people with mental disorders end up in many people with mental disorders end up in jail, then the hospital, later the streets, only jail, then the hospital, later the streets, only to be put in jail again.to be put in jail again.

• This This revolving door syndrome of moving from revolving door syndrome of moving from institution to institutioninstitution to institution is known as is known as transinstitutionalizationtransinstitutionalization..

• Other places in the community where Other places in the community where mentally disordered individuals are found mentally disordered individuals are found include halfway houses and crisis intervention include halfway houses and crisis intervention centers.centers.

Other Approaches to Other Approaches to

TreatmentTreatment cont’dcont’d

How Well Does Therapy Work?How Well Does Therapy Work?

Is therapy better than no therapy?Is therapy better than no therapy?

• Research shows that after treatment, the Research shows that after treatment, the average treated patient is better off than average treated patient is better off than 80 percent of untreated patients.80 percent of untreated patients.

• This result is encouraging, especially as This result is encouraging, especially as more and more people in need of therapy more and more people in need of therapy are finding ways to participate.are finding ways to participate.

What elements make therapy What elements make therapy effective?effective?

• A good match between client and therapist A good match between client and therapist is important. For example, directive is important. For example, directive therapy (where the therapist plays an therapy (where the therapist plays an active or authoritative role) works best for active or authoritative role) works best for low-resistance clients.low-resistance clients.

• Longer treatments provide better results.Longer treatments provide better results.• Assigning projects (“homework”) between Assigning projects (“homework”) between

sessions also improves effectiveness.sessions also improves effectiveness.• Monitoring the effectiveness of therapy with Monitoring the effectiveness of therapy with

assessments also improves results.assessments also improves results.

How Well Does Therapy Work? How Well Does Therapy Work? cont’dcont’d

Is one type of therapy more Is one type of therapy more effective than another?effective than another?

There is little difference among types of There is little difference among types of psychotherapies.psychotherapies.

Therapist characteristics that enhance Therapist characteristics that enhance the effectiveness of therapy includethe effectiveness of therapy include::

• flexibilityflexibility• respectfulnessrespectfulness• honestyhonesty• warmthwarmth• trustworthinesstrustworthiness• emotional expressivenessemotional expressiveness

How Well Does Therapy Work? How Well Does Therapy Work? cont’dcont’d

Is one type of therapy more Is one type of therapy more effective than another?effective than another?

Clients who:Clients who:• are articulateare articulate• are motivatedare motivated• believe in psychological processesbelieve in psychological processes• match the therapist in terms of ethnicity, match the therapist in terms of ethnicity,

race, or genderrace, or gender……are more likely to do well in therapy!are more likely to do well in therapy!

How Well Does Therapy Work? How Well Does Therapy Work? cont’dcont’d

Is one type of therapy better or Is one type of therapy better or worse for a particular disorder?worse for a particular disorder?

Research indicates thatResearch indicates that::• Behavior therapy is most effective for Behavior therapy is most effective for

phobias and other anxiety disorders.phobias and other anxiety disorders.• Psychoactive medication is best for Psychoactive medication is best for

treating schizophrenia.treating schizophrenia.• Cognitive-behavioral techniques are Cognitive-behavioral techniques are

best for depression.best for depression.

How Well Does Therapy Work? How Well Does Therapy Work? cont’dcont’d

Getting HelpGetting Help

When should you seek When should you seek professional help?professional help?

A general guideA general guide: when a problem : when a problem interferes with your daily life, it is interferes with your daily life, it is time to seek help.time to seek help.

BUTBUT

you don’t need to wait until a problem you don’t need to wait until a problem arises; therapy is a good way to arises; therapy is a good way to

experience personal growth.experience personal growth.

Where do you find help?Where do you find help?• Many private therapists (counselors, Many private therapists (counselors,

psychologists, social workers) may psychologists, social workers) may be available in your community. Be be available in your community. Be sure you know the qualifications of sure you know the qualifications of any therapist!any therapist!

• The local or state psychological The local or state psychological association can provide the names of association can provide the names of practitioners.practitioners.

• Many hospitals, schools, and work Many hospitals, schools, and work sites employ therapists.sites employ therapists.

Getting Help Getting Help cont’dcont’d

What should you look for in a What should you look for in a therapist?therapist?

• Professional training and certificationProfessional training and certification

• Someone you are comfortable withSomeone you are comfortable with

DiscussDiscuss::

• his/her theoretical orientationhis/her theoretical orientation

• fees/payment policiesfees/payment policies

Getting Help Getting Help cont’dcont’d

What can you expect from What can you expect from therapy?therapy?

Common benefits of therapy Common benefits of therapy include:include:

• hope for the futurehope for the future• caring for otherscaring for others• better understanding of personal better understanding of personal

problemsproblems• better relationships with othersbetter relationships with others• positive personality changespositive personality changes

Getting Help Getting Help cont’dcont’d

How long must therapy How long must therapy continue?continue?

• There are no hard and fast guidelines….There are no hard and fast guidelines….• Managed care has shortened the Managed care has shortened the

amount of time.amount of time.Two key conditions must be met to Two key conditions must be met to

terminate therapyterminate therapy::• Is the crisis or problem under control?Is the crisis or problem under control?• Can the client maintain the gains Can the client maintain the gains

acquired in therapy on his or her own?acquired in therapy on his or her own?

Getting Help Getting Help cont’dcont’d