Ch.

14 Therapy
December 2, 2021
 Treating psychological disorders

The psychological therapies

Chapter Evaluating psychotherapies

Overview

The biomedical therapies

Preventing psychological disorders

and building resilience
 The History of
Treatment

 Early harsh treatment

of psychological
disorders: cut,
restrain, bleed, beat
 Transition to gentler
methods
 Philippe Pinel
 Dorothea Dix
 Psychotherapy

• Treatment involves using

psychological techniques
• Consists of interactions between a
Modern trained therapist and someone
seeking to overcome psychological
Western difficulties or achieve personal
Therapies: growth
Categories
Biomedical therapy

• Treatment involves prescribing

medications or procedures that act
directly on the person’s physiology
 Psychoanalysis and
psychodynamic therapy
Humanistic therapies

The
Behavior therapies
Psychological
Therapies
Cognitive therapies

Group and family therapies

Goals of
Psychoanalysis
 Freud’s therapeutic
technique
 Aims to bring
patients’ repressed
feelings into
conscious awareness
 Helps patients gain
insight into the
origins of their
disorders
 Historical reconstruction:

• Unearths the past in hopes of

loosening its bonds on the present
• Uses free association, in which clients
are asked to share their thoughts
Techniques of
Therapists:
Psychoanalysis
• Look for thoughts that indicate
resistance
• Offer interpretations and
explanations
• Initiate transference and help clients
gain insight
 Therapeutic approach derived from
the psychoanalytic tradition

• Views individuals as responding to unconscious

forces and childhood experiences
Psychodynamic • Seeks to enhance self-insight
Therapy
Helps clients explore and gain
perspective on defended-against
thoughts and feelings
• Exploring past relationship troubles may help
clients understand the origin of their current
difficulties.
Psychodynamic
Therapy  [Link]
Session
 Emphasize people’s innate
potential for self-fulfillment

• Help them grow in self-awareness and self-

acceptance
Humanistic
Therapies Attempt to reduce the inner
conflicts that interfere with natural
development and growth
• The path to growth involves taking
immediate responsibility for one’s feelings
and actions.
  Humanistic and psychodynamic
therapies are referred to as insight
therapies.
Insight  Conscious thoughts outweigh the
Therapies unconscious.
 Present and future are more
important than the past.
  Rogers believed that unconditional
positive regard would help clients
Person- develop self-awareness and self-
acceptance.
Centered  Focuses on the person’s conscious self-
(Client- perceptions
 Nondirective in nature
Centered)
Therapy  Therapists foster growth by exhibiting
genuineness, acceptance, and empathy.
 Engage in active listening
 Summarize
Carl Rogers:
Ways to
Improve Invite clarification
Communication

Reflect feelings
 Applies learning principles to eliminate
unwanted behaviors

Assumes that problem behaviors are

the problems
Behavior
Therapy Counterconditioning

• Uses classical conditioning to evoke new

responses to stimuli that trigger unwanted
behaviors
• Therapists use exposure therapies and aversive
conditioning.
 Treat anxieties by exposing people (in
their imagination or in actual situations)
to the things they fear and avoid

Exposure
Therapies Systematic desensitization

• Associates a pleasant, relaxed state with

gradually increasing, anxiety-triggering stimuli
• Employs progressive relaxation
• Used to treat phobias
Aversion
Therapy for
Alcohol Use
Disorder
  Associates an unpleasant state with an
unwanted behavior
Aversive  Creates a negative (aversive) response to a
Conditioning harmful stimulus
 Built-in problem: Individual’s thoughts can
override conditioning processes
Virtual Reality
Exposure Therapy
 Within the confines of a
room, virtual reality
technology exposes
people to vivid simulations
of feared stimuli, such as
walking across a rickety
bridge high off the
ground.
 Behavior modification

• The desired behavior is reinforced.

• The undesired behavior is not
Operant reinforced and is sometimes ignored
Conditioning or punished.
Techniques • Some people respond well to
attention or praise, while others seek
concrete rewards.

Therapists may create a token

economy to modify behavior.
 Teaches people new, more
adaptive ways of thinking
Cognitive
Therapy
Based on the assumption
that thoughts intervene
between events and people’s
emotional reactions
A Cognitive Perspective on Psychological
Disorders
  Aims to:
 Show depressed clients the
irrational nature of their
thinking
Beck’s
 Reverse negative views of
Therapy for themselves, their situations,
Depression and their futures
(part 1)  Uses gentle questioning to reveal
irrational thinking.
 Persuades people to change
their views on life
  Therapists teach people to alter their
Beck’s thinking in stressful situations.
 Dealing with catastrophizing: Relentless,
Therapy for overgeneralized, self-blaming behavior
Depression  Research shows that learning to talk back to
(part 2) negative thoughts can greatly reduce the
rate of future depression.
 Aim of Technique Therapists’ Directives
Technique
Reveal beliefs Question your Explore your beliefs, revealing faulty
interpretations assumptions such as “I need to be liked by
everyone.”
Rank thoughts and Gain perspective by ranking your thoughts
emotions and
emotions from mildly to extremely

Selected Test beliefs Examine

consequences
upsetting.
Explore difficult situations, assessing
possible consequences and challenging

Cognitive Decatastrophize
faulty
reasoning.
Work through the actual worst-case

Therapy thinking consequences of the situation you face (it is

often not as bad as imagined). Then
determine

Techniques how to cope with the real situation you face.

Change beliefs Take appropriate Challenge total self-blame and negative

responsibility thinking, noting aspects for which you may
be
truly responsible, as well as aspects that
aren’t
your responsibility.
Resist extremes Develop new ways of thinking and feeling to
replace maladaptive habits. For example,
change from thinking “I am a total failure”
to “I got a failing grade on that paper, and I
can
IMPROVE YOUR EVERYDAY LIFE make
these changes to succeed next time.”
  Integrative therapy that combines
cognitive therapy with behavior
therapy
Cognitive-  Seeks to make people aware of
Behavioral their irrational negative thinking
Therapy and to replace it with new ways of
thinking
(CBT)  Trains people to practice a more
positive approach in everyday
settings
  Newer CBT variant
 Helps change harmful and
suicidal behavior patterns
Dialectical
 Combines cognitive tactics (for
Behavior tolerating distress and regulating
Therapy emotions) with social skills
training and mindfulness
(DBT) meditation
 Common treatment for
Borderline Personality Disorder
CBT Example  [Link]
Session
 Conducted with groups, rather
than with individuals

Benefits:
Group • Saves therapists’ time and clients’ money
Therapy • Offers a social laboratory for exploring
social behaviors and developing social
skills
• Enables clients to see that others share
their problems
• Provides feedback as clients try out new
ways of behaving
 Often acts as a preventive mental health
strategy

May include marriage therapy, as shown

Family here at a retreat for U.S. military families
Therapy
• The therapist helps family members understand how
their ways of relating to one another create problems.

The treatment’s emphasis is not on changing

the individuals, but rather on changing their
relationships and interactions.
 Is psychotherapy effective?

Which psychotherapies work best?

Evaluating
How do psychotherapies help
Psychothera people?
pies
How do culture and values influence
psychotherapy?
Finding a mental health
professional
Effectiveness of Psychotherapy: Clients’
Perceptions

 Client self-reports indicate that psychotherapy is

effective.
 Skepticism often occurs in client self-reports
because people often enter therapy in crisis.
 Clients:
 Believe treatment will be effective
 Generally speak kindly of their therapists
 Want to believe that the therapy was worth the
effort
Effectiveness of Psychotherapy:
Clinicians’ Perceptions

 Clients, having experienced only temporary relief,

could seek a new therapist for their recurring problems.
 The same person may be a success story in several
therapists’ files.
 Obstacles to critical thinking among therapists:
 Confirmation bias
 Tendency to see illusory correlations
  Eysenck found that people improved
noticeably over time with or without
Effectiveness psychotherapy.
of  Studies have summarized that:
Psychotherapy  Those not undergoing therapy
: Outcome improve.
Research  Those undergoing therapy are more
likely to improve more quickly and with
less risk of relapse.
Treatment
Versus No
Treatment
 Energy therapies

• Seek to manipulate people’s invisible energy

fields

Recovered-memory therapies

• Aim to unearth repressed memories of early

Psychotherapies childhood abuse
That Lack
Scientific Support Rebirthing therapies

• Engage people in reenacting their supposed

birth trauma

Conversion therapies

• Aim to enable homosexuals to change their

sexual orientation
Evidence-
Based Clinical
Decision
Making
 Hope for demoralized
people

Benefits of
New perspective on
Psychotherapies oneself and the world

Empathic, trusting,
and caring relationship
 Effective counselors, such as this chaplain A Caring
working aboard a ship, form a bond of trust
with the people they are serving. Relationship
How Do  Client–psychotherapist mismatches can stem from
Culture and differences in culture and religious values.

Values  Collectivist versus individualist

perspective
Influence
 Religious versus other worldviews
Psychothera
 Cultural differences
py?
  Common trouble signals according to
the American Psychological
Association (APA):
 Feelings of hopelessness
 Deep and lasting depression
Finding a  Self-destructive behavior, such as
substance abuse
Mental  Disruptive fears
Health  Sudden mood shifts
Professional  Thoughts of suicide
 Compulsive rituals, such as hand
washing
 Sexual difficulties
 Hearing voices or seeing things that
others do not experience
 Type Description
Clinical Most are psychologists with a Ph.D. (includes research training) or
psychologists Psy.D. (focuses on therapy) supplemented by a supervised internship and,
often, post-doctoral training. About half work in agencies and
institutions, half in private practice.

Therapists Psychiatrists Psychiatrists are physicians who specialize in the treatment of

psychological disorders. Not all psychiatrists have had extensive training
in psychotherapy, but as M.D.s or D.O.s they can prescribe medications.

and Their Clinical or

Thus, they tend to see those with the most serious problems. Many have
their own private practice.

A two-year master of social work graduate program plus post-graduate

Training psychiatric social

workers
supervision prepares some social workers to offer psychotherapy, mostly
to people with everyday personal and family problems. About half
have earned the National Association of Social Workers’ designation of
clinical social worker.

Counselors Marriage and family counselors specialize in problems arising from

family relations. Clergy provide counseling to countless people. Abuse
counselors work with substance abusers, spouse and child abusers, and
victims of abuse. Mental health and other counselors may be required to have
a two-year master’s degree.
  Thinking critically about therapeutic
The lifestyle change
Biomedical  Drug therapies
Therapies  Brain stimulation
 Psychosurgery
 Changes the brain’s chemistry
with drugs

Affects the brain’s circuitry with

Biomedical
electrical stimulation, magnetic
Therapy
impulses, or psychosurgery

Influences the brain’s responses

with lifestyle changes
  Therapeutic lifestyle change
 Exercise, nutrition, relationships,
recreation, relaxation, and
religious or spiritual engagement
 Influence the brain and body
and affect mental health
Thinking  Human beings were designed for
Critically (part physical activity and social
engagement.
1)
 Modern researchers have
found that outdoor activity in a
natural environment reduces
stress and promotes health.
 Biomedical therapies assume that
mind and body are a unit.
  Training seminars promote
therapeutic lifestyle change.
 Goals:
Thinking  Aerobic exercise
Critically (part  Light exposure
2)  Reducing rumination
 Adequate sleep
 Social connection
 Nutritional supplements
Drug Therapy

 Most widely used biomedical treatment

 When testing a new drug, the double-blind technique is
employed.
 Researchers give half the patients the drug, and
the other half a similar-appearing placebo.
 Neither the staff nor the patients know who gets
which one.
 Antipsychotic drugs
Drug Antianxiety drugs
Treatments for
Psychological
Disorders Antidepressant drugs

Mood-stabilizing medications
 Used to treat schizophrenia and other
forms of severe thought disorders

Reduce patients’ overreactions to

Antipsychotic irrelevant stimuli
Drugs
Mimic certain neurotransmitters

• Some drugs block the activity of dopamine by

occupying its receptor sites.
 Possible side effects:

• Sluggishness
Antipsychotic
• Tremors
Drugs: Effects
• Twitches
and Uses
• With long-term use, tardive dyskinesia.

Used with life-skills programs and

family support to treat
schizophrenia
  Depress central nervous system activity
 Calm anxiety as the person learns
to cope with frightening situations
and fear-triggering stimuli
Antianxiety  Successfully used in combination with
Drugs psychological therapy to treat:
 Anxiety disorders
 Obsessive-compulsive disorder
 Posttraumatic stress disorder
  May reduce symptoms without
resolving underlying problems
Antianxiety  Can be addictive
Drugs: Effects  Withdrawal symptoms:
 Increased anxiety
 Insomnia
Antidepressant Drugs (part 1)

 Used to treat depression, anxiety disorders, obsessive-

compulsive disorder, and posttraumatic stress disorder
 Increase the availability of norepinephrine or serotonin
 Selective serotonin reuptake inhibitors (SSRIs)
 Slow (inhibit) synaptic vacuuming up (reuptake) of
serotonin and promote birth of new brain cells
Antidepressant Drugs (part 2)

 Drugs
 Commonly prescribed drugs: Prozac, Zoloft, and
Paxil
 Exploration of newer, quicker-acting drugs:
Ketamine
 Other ways to improve moods
 Aerobic exercise; cognitive therapy; combination
 • Lithium
• Effective in leveling the
Mood- emotional highs and lows of
Stabilizing bipolar disorder
Medications • Depakote
• Effective in controlling the
manic episodes associated with
bipolar disorder
Electroconvulsive Therapy (ECT)

 Biomedical therapy for severely depressed patients

 A brief electric current is sent through the
brain of an anesthetized patient.
 The patient receives a general anesthetic and
a muscle relaxant to prevent convulsions.
 Causes less memory disruption than earlier versions
 Reduces suicidal thoughts
Transcranial electrical
stimulation

Alternative
Deep brain stimulation Neurostimulation
Therapies

Magnetic stimulation
Repetitive Transcranial Magnetic
Stimulation (rTMS)

 Application of repeated pulses of magnetic energy to the brain

 Used to stimulate or suppress brain activity
 Produces no memory loss or other serious side effects
 Not all researchers agree that rTMS reduces depressive
symptoms.
Deep Brain Stimulation

 Manipulates the depressed brain by means of a

pacemaker
 The pacemaker activates implanted electrodes in
brain areas that feed negative emotions and
thoughts.
 Stimulation inhibits activity in those brain
areas.
 Effective in treating depression
 Patients become more responsive to drugs or
psychotherapy.
A Stimulating Experience
  Removes or destroys brain tissue in
an effort to change behavior
 Least-used biomedical therapy
 Lobotomy: Psychosurgical
procedure once used to calm
uncontrollably emotional or violent
Psychosurgery patients
 Nerves connecting the frontal
lobes to the emotion-
controlling centers of the
inner brain are cut.
 People became permanently
listless, immature, and
uncreative.
  Today, more precise
micropsychosurgery is used in extreme
cases.
Psychosurgery
 MRI-guided precision surgery is
Today occasionally done to cut the circuits
involved in severe obsessive-compulsive
disorder.
 Prevent psychological casualties
by identifying and eliminating
the conditions that cause them
Preventive
Mental Strategies to prevent mental or
Health Care emotional disturbance:

• Improving the human condition

• Making life more fulfilling and
meaningful
 Focus on creating environments
that support psychological
health
Preventive
Mental Health
Care: Aim to empower people and to
Community enhance their:
Psychologists
• Competence
• Health
• Well-being
Resilience
 Personal strength that
helps people cope with
stress and recover from
adversity and trauma
 Struggling with
challenging crises can
lead to posttraumatic
growth.
 Posttraumatic
growth: Positive
psychological
changes as a
result of
struggling with
extremely
challenging
circumstances
and life crises