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Chapter FifteenTherapy
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Psychotherapy
Techniques employed to improve psychological functioning and promote adjustment to life
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Myths About Therapy
• There is one best therapy• Therapists can read your mind• People who go to therapists are crazy or weak• Only the rich can afford therapy• If I am taking meds, I don’t need therapy
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Major Approaches to Therapy
ANIMATIONCognitive Behavior Therapy
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INSIGHT THERAPIES
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Insight Therapies
DefinitionVariety of therapies seeking to
improve psychological functioning by increasing awareness of underlying motives and improvement in thoughts, feelings, and/or behavior
Types• Psychoanalysis/Psychodyna-
mic therapies• Cognitive therapy• Humanistic therapy• Group, family, and marital
therapies
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Psychoanalysis
Freudian therapy designed to bring unconscious conflicts into conscious awareness
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Psychoanalysis
Major Criticisms Limited applicabilityLack of scientific
credibility
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Modern Psychodynamic Therapy
A briefer, more directive, and more modern form of psychoanalysis focusing more on conscious processes and current problems
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Cognitive Therapies
Cognitive TherapyTherapy that treats problem behaviors and
mental processes by focusing on faulty thought processes and beliefs
Self-TalkInternal dialogue; the things people say to
themselves when they interpret events
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Cognitive Therapies
Cognitive RestructuringProcess in cognitive therapy to change
destructive thoughts or inappropriate interpretations
Cognitive-Behavior TherapyCombines cognitive therapy (changing faulty
thinking) with behavior therapy (changing faulty behaviors)
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Cognitive Restructuring
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Rational-Emotive Behavior Therapy (REBT)
Cognitive therapy to eliminate emotional problems through rational examination of irrational beliefs (e.g. “musts” and “shoulds”)
Albert Ellis
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Rational-Emotive Behavior Therapy (REBT)
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Rational-Emotive Behavior Therapy (REBT)
Overcoming Irrational Misconceptions1. Identify and confront your belief system2. Evaluate consequences3. Practice effective ways of thinking and
behaving
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Beck’s Cognitive Therapy
Distorted Thinking Patterns1. Selective perception—focus on negative events2. Overgeneralization 3. Magnification—exaggerating undesirables and
shortcomings4. All-or-nothing thinking—seeing things in black or
white
Recognize and track thoughts, then test these thoughts against reality ANIMATION
Cognitive Behavior Therapy
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Evaluating Cognitive Therapies
Highly effective for:• Depression• Anxiety disorders• Bulimia nervosa• Anger management• Addiction• Procrastination• Some forms of
schizophrenia• Insomnia
Criticisms • Ignoring unconscious
processes• Overemphasis on rationality• Minimizing the importance
of the past• Uses behavior techniques
rather than changing cognitive structure
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Humanistic Therapies
Therapy that focuses on removing obstacles that block personal growth and potential
Client-Centered TherapyRogers’s therapy emphasizing theclient’s natural tendency tobecome healthy and productive.Clients (not “patients”) are in charge.
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Client-Centered Therapy
Therapeutic Qualities of Communication1. Empathy—insightful awareness and ability to
share another’s inner experience2. Unconditional Positive Regard—love and
acceptance with no contingencies3. Genuineness/Authenticity4. Active Listening—involves reflecting,
paraphrasing, and clarifying
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Evaluating Humanistic Therapies
Support• Evidence for efficacy of
client-centered therapy
Criticisms• Core concepts are difficult
to empirically test• Data on outcomes rely on
self-reports of clients• Mixed results on specific
therapeutic techniques
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Group, Family, and Marital Therapies
Group TherapyA number of people meet together to work
toward therapeutic goals; guided by a therapist
Self-Help GroupLeaderless or nonprofessionally guided groups in
which members assist one another with a specific problem
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Group Therapy
Advantages1. Less expense2. Group support3. Insight and information4. Behavior rehearsal
Can supplement individual therapy
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Family and Marital Therapies
Goal is to change maladaptive family interaction patterns
Most useful for treatment of marital infidelity, anger management, adolescent drug abuse, schizophrenia
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Informal “Counseling” Skills
• Active listening• Acceptance• Avoid advice
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BEHAVIOR THERAPIES
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Behavior Therapies
Group of techniques based on learning principles used to change maladaptive behaviors
Focus on problem behavior rather than underlying causes
• Classical conditioning• Operant conditioning• Observational learning ANIMATION
Classical Conditioning
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Classical Conditioning
Systematic DesensitizationGradual process of extinguishing a learned fear
(phobia) by working through a hierarchy of fear-evoking stimuli while staying deeply relaxed; replace anxiety with relaxation
Aversion TherapyPairing an aversive (unpleasant) stimulus with a
maladaptive behavior; learn negative associations
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Systematic Desensitization
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Aversion Therapy
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Operant Conditioning
• Increase desired behaviors through reinforcement and shaping; may use tokens
• May use some punishment and extinction to eliminate undesired behavior
• Role playing/behavior rehearsal
WILEY VIDEOExercise and Depression
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Observational Learning
Modeling therapy—watching and imitating models that demonstrate desirable behaviors
Useful for treatingphobias andtraining in socialskills andassertiveness
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Evaluating Behavior Therapies
Support for use in• Phobias• Obsessive-compulsive
disorder• Eating disorders• Autism• Intellectual disabilities• Delinquency
Criticisms• Generalizability—to the
“real world” outside of therapy
• Ethics—related to control
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BIOMEDICAL THERAPIES
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Biomedical Therapies
Using biological interventions to treat psychological disorders
• Drugs• Electroconvulsive therapy• PsychosurgeryBased on the premise that chemical imbalances
or disturbed nervous system function are involved in mental health problems
WILEY VIDEOImaging
Antidepressant Accuracy
WILEY VIDEOBuzzedBrain
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Psychopharmacology
Study of drug effects on brain and behaviorFour major categories:• Antianxiety• Antipsychotic• Mood stabilizer• Antidepressant
WILEY VIDEOPlacebo
Effect
WILEY VIDEOBrain
Viagra
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Drug Treatments
WILEY VIDEOPost-Trauma
Drugs
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Drug Treatments
WILEY VIDEOAntidepressant Suicide Genes
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Electroconvulsive Therapy (ECT)
Biomedical therapy based on passing electrical current through the brain
Used almost exclusively to treat serious depression when drug therapy fails
Likely affects moodcontrolling neurotransmitters
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Psychosurgery
Surgical alteration of the brain to bring about desirable behavioral, cognitive, or emotional changes
Generally used when patients have not responded to other forms of treatment
Lobotomy—outmoded medical procedure for mental disorders that involved cutting nerve pathways between the frontal lobes and the thalamus and hypothalamus
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Evaluating Biomedical Therapies
PsychopharmacologyMay provide relief but not a curePhysical dependenceSide and long-term effectsTardivedyskinesia—movement disorder
involving facial muscles, tongue, and limbs; possible side effect of long-term use of antipsychotic medications
Overuse
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Evaluating Biomedical Therapies
ECT and PsychosurgeryECT is controversial; seizures, memory lossRepetitive Transcranial Magnetic Stimulation
(rTMS) may replace ECTPsychosurgery is controversial, with potentially
serious or fatal side effects and complications
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THERAPY ESSENTIALS
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Common Goals of Therapy
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Eclectic Approach
Combining techniques from various theories to find the most appropriate treatment
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Mental Health Professionals
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Institutionalization
Involuntary CommitmentGenerally can occur if people are believed to be:• of danger to themselves or others• in serious need of treatmentor if there is no reasonable, less restrictive alternativeDeinstitutionalizationDischarging patients from mental hospitals as
soon as possible and discouraging admissions
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Evaluating Therapy
Controlled research and meta-analyses40 to 80% of those who receive treatment are
better off than those who do notShort-term treatments can be as effective as
long-term treatmentsCombination of therapy with medication is more
effective than drugs aloneSome therapies more effective for specific
problems
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Finding Therapy
Critical/Urgent NeedHospital emergency servicesHotlinesHave time to searchAsk for referralsUniversity/college counseling centerSeek therapist best suited to your goals
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Culture and Therapy
Similarities• Naming the problem• Qualities of the therapist• Therapist credibility• Familiar framework• Techniques that bring relief• Special time and place
Differences• Emphasis on self or
interdependence• Types of therapies• Perceptions of the therapist
Gender and Therapy
Unique concernsRates of diagnosis and treatment of mental
disordersStresses of povertyStresses of agingViolence against womenStresses of multiple roles
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WILEY VIDEOSmoking,
Stress, and Gender