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Insight Therapies Relationship Therapies Behavior Therapies
Cognitive Behavior Therapies Biomedical Therapies Practical Issues
in Psychotherapy Copyright 2011 Pearson Education, Inc. All Rights
Reserved
Slide 3
Psychotherapy treatments that use psychological rather than
biological means to treat emotional and behavioral disorders
Insight Therapies approaches to psychotherapy based on the notion
that psychological well-being depends on self-understanding
Copyright 2011 Pearson Education, Inc. All Rights Reserved
Slide 4
Attempts to uncover repressed childhood experiences that are
thought to cause the patients current problems Psychoanalysis first
psychodynamic technique developed by Freud techniques: free
association explores the unconscious Patient reveals whatever
thoughts, feelings, or images come to mind. dream analysis Areas of
emotional concern repressed in waking life are sometimes expressed
in symbolic form in dreams. transference emotional reaction that
occurs during psychoanalysis Patient displays feelings and
attitudes toward the analyst present in another significant
relationship. Copyright 2011 Pearson Education, Inc. All Rights
Reserved
Slide 5
Object Relations Therapy The main goal of the personality is to
forge functional links between the self and others in the
environment. Early relationships form blueprints for future
relationships. Therapists help clients restructure current
relationships, changing maladaptive patterns formed in early
relationships. Interpersonal Therapy (ITP) brief psychotherapy: 12
to 16 sessions effective with depression and bipolar illness four
interpersonal problems associated with depression: Severe response
to death of a loved one Interpersonal role disputes Difficulty
adjusting to role transitions Deficits in interpersonal skills
Copyright 2011 Pearson Education, Inc. All Rights Reserved
Slide 6
Therapies assume that people have the ability and freedom to
lead rational lives and make rational choices. Person-Centered
Therapy Carl Rogers (1951) Disorder results when the natural
tendency toward self- actualization is blocked. The therapist
attempts to create an accepting climate based on unconditional
positive regard. non-directive therapy The therapist allows the
direction of the therapy sessions to be controlled by the client.
The goal is to allow the client to direct the therapy session and
move toward self-actualization. realization of inner potential
Copyright 2011 Pearson Education, Inc. All Rights Reserved
Slide 7
Developed by Fritz Perls (1969) Goal of therapy is to: Help
clients achieve a more integrated self Allow clients to become more
authentic and self- accepting Gestalt therapy is directive. The
therapist actively directs the therapy session. provides answers
and suggestions to the client Getting in touch with your feelings
is a major objective. Copyright 2011 Pearson Education, Inc. All
Rights Reserved
Slide 8
Relationship Therapies look not only at the individuals
internal struggles but also at his or her interpersonal
relationships Family Therapy Parents and children enter therapy as
a group. The goal is to help family members. Heal wounds to the
family Improve communication Create more understanding within the
family Couple Therapy The goal is to help partners in an intimate
relationship. Communicate Manage conflicts more effectively may
focus on behavioral change or partners emotional responses to each
other Copyright 2011 Pearson Education, Inc. All Rights
Reserved
Slide 9
Seven to ten clients meet regularly with one or more therapists
to resolve personal problems. Provides client with a sense of
belonging and the opportunity to: Express feelings Get feedback
from other group members Give and receive emotional support
Self-Help Groups usually not led by professional therapists groups
of people who share a common problem and meet to give and receive
support Alcoholics Anonymous one of the oldest and best-known
groups Copyright 2011 Pearson Education, Inc. All Rights
Reserved
Slide 10
A treatment approach consistent with the learning perspective
on psychological disorders Abnormal behavior is learned. the
behavior itself as the disorder use learning principles to
eliminate inappropriate or maladaptive behaviors The goal is to
change the troublesome behavior. Copyright 2011 Pearson Education,
Inc. All Rights Reserved
Slide 11
Techniques seek to control the consequences of behavior.
Extinction of undesirable behavior by terminating or withholding
reinforcement maintaining the behavior Institutional settings are
well-suited for behavior modification. Consequences of behavior can
be controlled. token economy rewards appropriate behavior with
poker chips, play money, points Therapies are effective in
modifying the behaviors of seriously disturbed people. Copyright
2011 Pearson Education, Inc. All Rights Reserved
Slide 12
Systematic Desensitization based on classical conditioning used
to treat fears Client is trained in deep muscle relaxation.
confront hierarchy of fears highly successful treatment for
eliminating fears and phobias in a relatively short time Flooding
behavior therapy based on classical conditioning used to treat
phobias by exposing clients to the feared object or event for an
extended period, until their anxiety decreases Copyright 2011
Pearson Education, Inc. All Rights Reserved
Slide 13
Exposure and Response Prevention successful with
obsessive-compulsive disorder two components: exposure exposing
clients to objects or situations that trigger obsessions and
compulsive rituals response prevention The client agrees to resist
performing compulsive rituals for longer and longer periods of
time. Treatment can bring about considerable improvement in 60 to
70 percent of patients. Copyright 2011 Pearson Education, Inc. All
Rights Reserved
Slide 14
Aversion Therapy aversive stimulus paired with a harmful or
socially undesirable behavior Behavior becomes associated with pain
or discomfort. controversial brings intentional discomfort to
client Participant Modeling based on Albert Banduras principles of
observational learning A model demonstrates appropriate responses
to a feared stimulus in graduated steps. The client imitates the
model with the encouragement of a therapist. Most specific phobias
can be extinguished in 3 to 4 hours. Copyright 2011 Pearson
Education, Inc. All Rights Reserved
Slide 15
Assume that maladaptive behavior results from irrational
thoughts, beliefs, and ideas The therapist tries to change these
(Dowd, Clen, & Arnold, 2010). The approach is effective for
treating a wide variety of problems. anxiety disorders (Kellett et
al., 2004), psychological drug dependence (Babor, 2004), and mood
disorders (Totterdell & Kellett, 2008) Two Best-Known Types of
CBT Albert Elliss rational emotive behavior therapy (REBT) Aaron
Becks cognitive therapy (CT) Copyright 2011 Pearson Education, Inc.
All Rights Reserved
Slide 16
Albert Ellis developed the technique as a way of addressing his
own problems with incapacitating anxiety (Ellis, 2004a) Based on
Ellis ABC Theory A = the activating event B = belief about the
event C = emotional consequence that follows Directive form of
therapy The goal is to challenge and modify a clients irrational
beliefs about the self and others. Individuals receiving REBT do
better than those receiving no treatment or a placebo (Browne,
Dowd, & Freeman, 2010). Copyright 2011 Pearson Education, Inc.
All Rights Reserved
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Aaron T. Beck (1976) Some misery endured by a person with
depression and anxiety can be traced to automatic thoughts.
unreasonable but unquestioned ideas that rule the persons life The
goal of therapy is to help clients overcome the impact of cognitive
errors. Helps clients stop negative thoughts as they occur and
replace them with more objective thoughts. Therapy is brief. ten to
twenty sessions effective with mild to moderate depression and
panic disorder Copyright 2011 Pearson Education, Inc. All Rights
Reserved
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Most frequently used biological treatment Breakthroughs in drug
therapies have been credited with the reduction in the amount of
time a patient is hospitalized. Copyright 2011 Pearson Education,
Inc. All Rights Reserved
Slide 22
Antipsychotic Drugs known as neuroleptics prescribed primarily
for schizophrenia control hallucinations, delusions, disorganized
speech, and behavior Fifty percent of patients have a good response
to antipsychotics. tardive dyskinesia severe side effect of
long-term drug use twitching and jerking, squirming movements Newer
antipsychotic drugs atypical neuroleptics (clozapine, risperidone,
olanzipine) treat positive and negative symptoms of schizophrenia
Copyright 2011 Pearson Education, Inc. All Rights Reserved
Slide 23
Antidepressant Drugs mood elevators for severe depression
helpful in the treatment of certain anxiety disorders Of the people
who take antidepressants, 65 to 75 percent significantly improve;
40 to 50 percent essentially completely recover. Responses to
antidepressant drugs result from a combination of: Physiological
effects of these medications on the brain Confidence in the
effectiveness of drug treatment Copyright 2011 Pearson Education,
Inc. All Rights Reserved
Slide 24
Types of Anti-Depressant Drugs First-Generation Antidepressants
tricyclics (amitriptyline, imipramine) block reuptake of
norepinephrine and serotonin into axon terminals Second-Generation
Antidepressants selective serotonin reuptake inhibitors (SSRIs)
block reuptake of serotonin, increasing its availability at
synapses in the brain Serotonin-Norepinephrine Reuptake Inhibitors
(SNRIs) appear more effective than the SSRIs; produce fewer side
effects Monoamine Oxidase (MAO) Inhibitors block action of enzyme
that breaks down norepinephrine and serotonin in the synapses
Copyright 2011 Pearson Education, Inc. All Rights Reserved
Slide 25
Lithium and Anticonvulsant Drugs The clinical effectiveness of
lithium for treating depression and bipolar disorder is unmatched.
A naturally occurring salt, lithium is effective for 40 to 50
percent of people who have bipolar disorder. anticonvulsant drugs
may be just as effective for managing bipolar symptoms as lithium
Anti-Anxiety Drugs minor tranquilizers called benzodiazepines
include: Valium, Librium and Xanax Users may experience moderate to
intense withdrawal symptoms, including intense anxiety. Copyright
2011 Pearson Education, Inc. All Rights Reserved
Slide 26
Disadvantages of Drug Therapy difficulty in establishing the
proper dosages Drugs do not cure psychological disorders. Drug
therapy often prevents people with psychological disorders from
being advised of other forms of therapy that may reduce or
eliminate the need for psychiatric drugs. Copyright 2011 Pearson
Education, Inc. All Rights Reserved
Slide 27
Electric current is administered to the right cerebral
hemisphere (unilateral ECT). Patient is under anesthesia. usually
reserved for severely depressed patients who are suicidal ECT was
misused and overused in the 1940s and 1950s, leaving it with a bad
reputation. Highly effective treatment for major depression
Possibly works by changing biochemical balance in the brain Rapid
Transcranial Magnetic Stimulation (rTMS) newer, magnetic therapy;
not invasive no known side effects Copyright 2011 Pearson
Education, Inc. All Rights Reserved
Slide 28
Brain surgery performed to alleviate serious psychological
disorders or unbearable chronic pain Lobotomy severs neural
connections between frontal lobes and deeper centers involved in
emotion no longer performed leaves patients in permanently
deteriorated condition Cingulotomy destroys cingulum can help in
extreme cases of OCD Psychosurgery is controversial. considered
experimental and a last resort Results are unpredictable and
permanent. Copyright 2011 Pearson Education, Inc. All Rights
Reserved
Slide 29
Psychologist has an advanced degreeusually a doctoratein
psychology clinical psychologists generally diagnose and treat
psychological disorders counseling psychologists generally provide
therapy for normal problems of life, such as divorce Psychiatrist
is a medical doctor can prescribe drug therapy Copyright 2011
Pearson Education, Inc. All Rights Reserved
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Ethical Considerations According to the ethics code of the
American Psychological Association (2002),therapists must take
reasonable steps to: Ensure the well-being and rights of client
Avoid causing them any kind of immediate or long-term harm informed
consent Therapists must inform clients of the cost and expected
duration of therapy prior to beginning any intervention. Therapists
are prohibited from providing therapy to former intimate partners.
Therapists are also obligated to use tests that are reliable and
valid. must have appropriate training for all tests that are used
Copyright 2011 Pearson Education, Inc. All Rights Reserved
Slide 32
Knowledge of clients cultural backgrounds guides the choice of
therapeutic interventions. Culturally sensitive therapists
recognize that language differences between therapists and clients
can pose problems. With recent immigrants, culturally sensitive
therapists will take into account the impact of the immigration
experience on clients thoughts and emotions. Cultural practices can
be used as models for therapeutic interventions. example: American
Indian healing circle Therapists attempt to address group
differences that can affect the results of therapy. Copyright 2011
Pearson Education, Inc. All Rights Reserved
Slide 33
An approach that takes into account the effects of gender on
both the therapists and the clients behavior Therapists must
examine their own gender-based prejudices. Knowledge of real
differences between the sexes is important to the practice of
gender-sensitive therapy. Therapist may place too much emphasis on
gender issues and misinterpret clients problems (Addis &
Mahalik, 2003). Copyright 2011 Pearson Education, Inc. All Rights
Reserved
Slide 34
Smith et al. (1980) analyzed 475 studies with 25,000 clients.
Psychotherapy was better than no treatment. No one type of
psychotherapy was more effective than another. Eysenck (1994)
showed a slight advantage for behavior therapies over other types.
Socioeconomic status and other variables interact with clients
problems. Interactions influence therapeutic outcomes (Falconnier,
2009). Most important determinant of effectiveness: Appropriateness
for a given clients problems Circumstances of the clients life
(Crits-Christoph et al., 2008) Copyright 2011 Pearson Education,
Inc. All Rights Reserved
Slide 35
According to a Consumer Reports survey: Clients believe they
benefit from psychotherapy. Clients are equally satisfied with
therapy provided by psychologists, psychiatrists, and social
workers. The longer clients stayed in therapy, the more they
improved. Clients believed that antidepressant and anti-anxiety
drugs helped them. Psychotherapy alone worked as well as
psychotherapy plus drugs. Copyright 2011 Pearson Education, Inc.
All Rights Reserved