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Types of Therapy / Treatment
Insight TherapyBehavioral TherapyCognitive TherapyGroup TherapyBiological Treatments
Insight Therapies
Psychoanalysis
Client-Centered Therapy
Gestalt Therapy
Short-term psychodynamic
Virtual therapy
Psychoanalysis Designed to bring repressed feelings and
thoughts to conscious awareness Free association
Patient talks about whatever comes to mind Transference
Client’s feelings about authority figures, both positive and negative, transferred to therapist
Insight Awareness of previously unconscious
feelings and memories and how they influence present behavior
Client-Centered Therapy
Developed by Carl Rogers Goal is to help clients become fully
functioning Therapist expresses unconditional
positive regard Therapy is nondirective Therapist reflects clients’ statements
Gestalt Therapy
Outgrowth of the work of Fritz Perls Emphasizes the wholeness of
personality Attempts to reawaken people to their
emotions and sensations in the here-and-now
Encourages confrontation with issues Therapist is active and directive
Recent Developments
Short-term psychodynamic psychotherapyFocused on trying to help people
correct the immediate problems in their lives
Virtual therapyTherapy delivered online
Behavior Therapies
Based on the belief that all behavior is learned
Objective of therapy is to teach people new ways of behaving
Examples:
•Classical Conditioning
•Operant Conditioning
•Modeling
Using Classical Conditioning Techniques Systematic desensitization
Gradually associating relaxation with what was feared
Extinction Ending of old fears or reactions
Flooding Full-intensity exposure to feared object
Aversive conditioning Eliminate undesirable behavior by associating it
with pain and discomfort
Operant Conditioning
Behavior contractingClient and therapist set behavioral goals
and agree on reinforcements the person will receive
Token economyClients earn tokens for desired behaviors
and exchange them for desired items or privileges
Often used in schools and hospitals
Modeling
Person learns new behaviors by watching others perform those behaviors
Sometimes used in conjunction with operant conditioning
Cognitive Therapies
•Stress Inoculation
•RET
•Beck’s Cognitive Therapy
Stress-Inoculation Therapy
Type of cognitive therapy that trains people to cope with stressful situations by learning a more useful patterns of self-talk
Taught to suppress negative and anxiety-provoking thoughts in times of stress
Particularly effective for treating anxiety disorders
Rational-Emotive Therapy (RET)
A directive therapy based on the idea that psychological distress is caused by irrational and self-defeating beliefs
Core problem is belief in “musts” and “shoulds” that leave no room for making mistakes
Therapist’s job is to challenge client’s irrational beliefs
Beck’s Cognitive Therapy
Aimed at identifying and changing inappropriately negative and self-critical patterns of thought
Good treatment for depression
Group Therapies•Family
•Couple
•Self-help
Family Therapy
Form of group therapy that sees the family as at least partly responsible for the individual’s problems
Seeks to change all family members’ behavior to the benefit of the family and the individual
Couple Therapy
A form of group therapy intended to help troubled partners improve their communication and interaction
Empathy trainingPartners taught to share feelings and
listen to and understand partner’s feelings
Self-Help Groups
Small, local gatherings of people who share common problems and provide mutual assistance at very low cost
Alcoholics Anonymous is an example
Effectiveness of Psychotherapy Does Psychotherapy Work?
Psychotherapy helps about 2/3rd of people treated
Approximately 1/3 would improve without therapy
Which Type of Therapy is Best for Which Disorder? No one type of therapy is better Key is to match the problem with the
appropriate therapy
Biological Treatments
•Drug therapy
Anti-psychotic, Anti-depressant, Psycho-stimulants, Anti-anxiety
•Electroconvulsive
•Psychosurgery
Drug Therapies
Major reasons for widespread use of drugsDrugs are effective at treating
disordersDrug therapies are often less
expensive that psychotherapy
Antipsychotic Drugs
Used for schizophrenia or psychosis All antipsychotics block dopamine
receptors in the brain Phenothiazines (Thorazine)
Antidepressant Drugs
Tricyclics and MAO inhibitors Most common antidepressants prior to late
1980s Work by increasing amount of the
neurotransmitters serotonin and norepinephrine Effective, but have serious side effects
Selective Serotonin Reuptake Inhibitors (SSRIs) Work by blocking the reuptake of serotonin Prozac, Paxil, Zoloft, Effexor
Action of SSRIs
Lithium
A naturally occurring salt that is used to treat bipolar disorder (manic depression)
Nobody knows how lithium works to alleviate symptoms
Problem with people stopping medication when symptoms ease
Other Medications
PsychostimulantsUse to treat disorders such as AD/HDConcern that psychostimulants are being
overused Antianxiety medications
Use to treat anxiety disordersProduce a feeling of calm and mild
euphoriaValium is a common antianxiety medication
Electroconvulsive Therapy
Commonly known as “shock therapy” Used as a treatment for severe
depression Causes brief convulsions and
temporary loss of consciousness Memory loss is a side-effect Newer techniques minimize effects on
memory
Psychosurgery
Brain surgery performed to change a person’s behavior or emotional state
A prefrontal lobotomy is an example Psychosurgery is rarely used today
Institutionalization and Its Alternatives
Institutions offer:
•Shelter
•Care
•Therapy / Treatment / Counseling
•Transition training and preparation for real world
living
•Relief for family members
Deinstitutionalization
Releasing people with severe psychological disorders into the community
Can cause problems Some people are ill-prepared to deal with life
outside of a hospital Up to 40% of homeless are mentally ill Alternative forms of treatment (many)
Half-way houses Family-crisis interventions Day-care
Prevention
Primary prevention Improve the social environment so that new
cases of mental disorders do not develop• Family planning• Genetic counseling
Secondary prevention Interventions with high risk groups (e.g.,
suicide hot-line) Tertiary prevention
Help people adjust after they are released from the hospital in order to help prevent a relapse
Gender Differences in Treatment
More women admit problems and go to therapy
Women are more likely to take medication
Psychotherapy is seen as more acceptable for women
Recent increases in number of males seeking psychotherapy
Cultural Difference in Treatment Eye contact and body language varies
across cultures and may be misinterpreted as symptomatic of a disorder
Another challenge is treating post-traumatic stress disorder in refugees
There may be disorders in other cultures that do not appear in U.S.
The main goal of insight therapies is to give clients a better understanding and awareness of their feelings, motivations,
and actions in the hope that this will lead to better adjustment. Behavior therapies are based on the belief that all behavior, normal and abnormal, is learned, and that the objective of
therapy is to teach people more satisfying ways of behaving. Cognitive therapies aim at changing clients' maladaptive ways of thinking about themselves and the world. Group therapy is
based on the idea that psychological problems are at least partly interpersonal problems and are therefore best
approached in an interpersonal setting. Group therapy provides social support and is less costly than individual
therapy.
Review
Psychoanalysis is a therapy based on the belief that psychological problems stem from feelings and conflicts repressed during childhood. One way to uncover what has been repressed is through free association, a process in which the client discloses whatever thoughts or fantasies come to mind without editing or otherwise inhibiting them. In classical psychoanalysis, the patient comes to transfer feelings held toward authority figures from childhood to the analyst, a process known as transference. The goal of psychoanalysis is insight, or awareness of feelings, memories, and actions from the past that were unconscious but were exerting a strong influence on the patient's present feelings and behavior.
Client-centered (or person-centered) therapy, founded by Carl Rogers, is built on the idea that therapy should be based on the client's view of the world rather than the therapist's and on the client's responsibility for change. The therapist's most important task is to provide unconditional positive regard for clients so that they will learn to accept themselves. Gestalt therapy grew out of the work of Fritz Perls and is designed to help people become more aware of their feelings and more genuine in their day-to-day interactions. The emphasis in therapy is on making the person whole and complete.
Behavior therapies are based on the belief that all behavior, normal and abnormal, is learned, and that the objective of therapy is to teach people more satisfying ways of behaving. Classical conditioning therapies attempt to evoke
a new conditioned response to old stimuli. For example, systematic desensitization is a method for gradually reducing irrational fears by imagining---or confronting in real life---increasingly fearful situations while maintaining a relaxed state. Eventually, relaxation replaces fear as a response, perhaps as a result of extinction. Flooding, which subjects the person to feared situations at full intensity and for a prolonged time, is a somewhat harsh but highly effective method of desensitization. Aversive conditioning has the opposite goal: it conditions a negative rather than a positive response to a stimulus such as the sight or taste of alcohol. Its purpose is to eliminate undesirable behaviors by associating them with pain and discomfort. Operant conditioning techniques work by reinforcing new behaviors and ignoring or punishing old ones. In one such technique, called behavior contracting, client and therapist agree on certain behavioral goals and on the reinforcement the client will receive upon reaching those goals. In another technique, called the token economy, tokens that can be cashed in for "rewards" are used to positively reinforce many different kinds of desired behavior. In modeling, a person learns new behaviors by watching others perform those behaviors.
Stress-inoculation therapy teaches clients new and positive patterns of self-talk they can use to support themselves through stressful situations. Rational-emotive therapy (RET) is based on the idea that people's emotional problems derive from a set of irrational and self-defeating beliefs they hold about themselves and the world. The therapist vigorously challenges these beliefs until the client comes to see just how irrational and dysfunctional they are. Aaron Beck believes that depression results from negative patterns of thought that are strongly and inappropriately self-critical. His cognitive therapy tries to help clients think more positively about themselves and the world.
Group therapy is based on the idea that psychological problems are at least partly interpersonal problems and are therefore best approached in an interpersonal setting. Group therapy provides social support and is less costly than individual therapy. Family therapy is based on the idea that an individual's psychological problems are to some extent family problems. Therefore, the therapist treats the family unit rather than the isolated individual, with the goal of improving communication and empathy among family members and reducing intrafamily conflict. Couple therapy concentrates on improving patterns of communication and interaction.
Most researchers agree that psychotherapy helps about two-thirds of the people treated. Most kinds of therapy are more effective than no treatment at all, but researchers have found few major differences in the effectiveness of various forms of therapy. The general trend in psychotherapy is toward eclecticism, the use of a broad treatment package rather than one single form of therapy.
Biological treatments, including medication, electroconvulsive therapy, and psychosurgery, are sometimes used when psychotherapy does not work or when a client has a disorder for which biological treatment is known to be safe and effective. Medication, especially, is very often used in conjunction with psychotherapy
Drugs are the most common biological therapies. Antipsychotic drugs are valuable in the treatment of schizophrenia; they do not cure the disorder, but they do reduce its symptoms. Side effects can be severe, however. Antidepressant drugs alleviate depression, though some have serious side effects. Often the effectiveness of antidepressants such as Prozac seems to be due to the patient's belief that the drug will work (the placebo effect). Many other types of medication are used to treat psychological disorders, including antianxiety drugs, sedatives, and psychostimultants for children with attention-deficit/hyperactivity disorder.
Electroconvulsive therapy (ECT) is used for cases of severe depression that do not respond to other treatments. An electric current briefly passed through the brain of the patient produces convulsions and temporary coma.
Psychosurgery is brain surgery performed to change a person's behavior and emotional state. It is rarely done today, and then only as a last desperate measure on patients with intractable psychoses.
Large mental hospitals offer people with severe mental disorders shelter and a degree of care, but a number of problems are linked with institutionalization, including inadequate care and the tendency of patients to become lethargic and accept a permanent "sick role." With the advent of antipsychotic drugs in the 1950s, many patients were released from large public hospitals to be cared for in a community setting, in the policy of deinstitutionalization. But community mental-health centers and other support services proved inadequate to the task. As a result, many former patients stopped taking their medication, became homeless, and ended up suffering from psychosis and living on the street.
Alternatives to hospitalization range from living in the family home, with training to cope with daily activities for the mentally ill individual and crisis therapy for the family, to small homelike facilities in which residents and staff share responsibilities. Most alternative treatments involve some medication of the troubled individual and skillful preparation of the family/community. The majority of studies have found more positive outcomes for alternative treatments than for hospitalization.
Prevention refers to efforts to reduce the incidence of mental illness. Primary prevention refers to improving the social environment through assistance to parents, education, and family planning. Secondary prevention refers to identifying high-risk groups and directing service to them. The object of tertiary prevention is to help hospitalized patients return to the community.
Reference:
Psychology, an Introduction, 12th ed. ; Morris, Charles & Maisto, Albert
Pearson Publishers, 2010 (chapter 14)
Psychology, a Journey, 2nd ed.; Coon, Dennis
Thomson/Wadsworth Publishers, 2005 (chapter 13)
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