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Chapter 17: Therapy Section 1: The Psychological Therapies

Eclectic Approach: An Approach to psychotherapy that, depending on the client's problems, uses techniques from various forms of therapy. Psychoanalysis: Sigmund Freud's therapeutic technique. Freud believed the patient's free associations, resistances, dreams, and transferences-and the therapist's interpretations of them-released previously repressed feelings, allowing the patient to gain self-insight. Resistance: In psychoanalysis, the blocking from consciousness of anxiety-laden material. Interpretation: In psychoanalysis, the analyst's noting supposed dream meanings, resistances, and other significant behaviors in order to promote insight. Transference: In psychoanalysis, the patient's transfer to the analyst of emotions linked with other relationships. Active Listening: Empathetic listening in which the listener echoes, restates, and clarifies. A feature of Rogers' client-centered therapy. Counterconditioning: A behavior therapy procedure that conditions new responses to stimuli that trigger unwanted behaviors; based on classical conditioning. Includes systematic desensitization and aversive conditioning. Systematic Desensitization: A type of counterconditioning that associates a pleasant relaxed state with gradually increasing anxiety-triggering stimuli. Commonly used to treat phobias. Aversive Conditioning: A type of counterconditioning that associates an unpleasant state with an unwanted behavior.

Differentiating Between The Different Therapies~

Psychotherapy: An emotionally charged, confiding interaction between a trained therapist and someone who suffers from psychological difficulties. Psychodynamic Therapy: Methods more concerned with understanding a patient's current symptoms by exploring childhood experiences. Probing for supposed repressed, emotionladen information, information, seeking to help the person gain insight into the unconscious roots of problems and work through newly resurrected feelings. Interpersonal Psychotherapy: A brief (12 to 16-session) alternative to psychodynamic therapy that has been found effective with depressed patients. Aims to help people gain insight into the roots of their difficulties. But rather than focusing on undoing past hurts and offering interpretations, interpersonal therapy focuses on current relationships and assists people in improving their relationship skills. Humanistic Therapy: Emphasizes people's inherent potential for self-fulfillment. Aim to boost self-fulfillment by helping people grow in self-awareness and self-acceptance. Unlike psychoanalytic therapists, humanistic therapists tent to focus on:

The present and future more than the past. Explore feelings as they occur, rather than achieving insights into the childhood origins of the feelings. Conscious rather than unconscious thoughts. Taking immediate responsibility for one's feelings and actions, rather than uncovering hidden determinants. Promoting growth instead of curing illness. Thus, those in therapy are clients: rather than patients.

Client-Centered Therapy: A humanistic therapy, developed by Carl Rogers, in which the therapist uses techniques such as active listening within a genuine, accepting, empathic environment to facilitate clients' growth (also called person-centered therapy). Behavior Therapy: Doubt the healing power of self-awareness. Assume that problem behaviors are the problems. Applies learning principles to the elimination of unwanted behaviors. Do not delve deep below the surface looking for inner causes, rather they view maladaptive symptoms as learned behaviors, which they try to replace with constructive behaviors. Exposure Therapies: Behavioral techniques, such as systematic desensitization, that treat anxieties by exposing people (in imagination or actuality) to the things they fear and avoid. Virtual Reality Exposure Therapy: For those unable to vividly imagine an anxiety-arousing situation and too terrified or embarrassed to experience the situation in reality, virtual reality exposure therapy offers an efficient middle ground. Wearing a head-mounted display unit that projects a three-dimensional virtual world, the client ins immersed into a lifelike series of scenes. Token Economy: An operant conditioning procedure that rewards desired behavior. A patient exchanges a token of some sort, earned for exhibiting the desired behavior, for various privileges or treats. Cognitive Therapy: Teaches people new, more adaptive ways of thinking and acting; based on the assumption that thoughts intervene between events and our emotional reactions. Cognition-Behavior Therapy: A popular integrated therapy that combines cognitive therapy (changing self-defeating thinking) with behavior therapy (changing behavior). Family Therapy: Therapy that treats the family as a system. Views an individual's unwanted behaviors as influenced by or directed at other family members; attempts to guide family members toward positive relationships and improved communication. Psychoanalysis Aims: Psychoanalysis assumes that many psychological problems are fueled by childhood's residue or repressed impulses and conflicts. Psychoanalysts try to bring these repressed feelings into conscious awareness where the patient can deal with them.

Methods: The blocks in the flow of your free association indicate resistances. They hint that anxiety lurks and that you are repressing sensitive material. In order to explore these sensitive areas, awareness of resistances is first needed, then interpretation of their underlying meaning follows after. The analyst's interpretations-suggestions of underlying wishes, feelings, and conflicts-aim to provide you with insight. Freud believed that another clue to repressed impulses is your dreams' latent content (the underlying meaning of a dream and functions as a safety valve). Psychoanalytic theory emphasizes the formative power of childhood experiences, much of what is revealed will pertain to earlier memories. Transference is the patient's transfer to the analyst of emotions linked with other relationships, and analysts and other therapists believe that this transference exposes long-repressed feelings. Critics say psychoanalysts' interpretations are hard to refute. Psychoanalysts acknowledge it's hard to prove or disprove their interpretation. But they insist that interpretation often are a great help to patients. Psychodynamic Therapy: Psychodynamic therapists try to understand a patient's current symptoms by exploring childhood experiences. Interpersonal psychotherapy aims to help people gain insight into the roots of their difficulties. But rather than focusing on undoing past hurts and offering interpretations, interpersonal therapy focuses on current relationships and assists people in improving their relationship skills. Humanistic Therapies: Humanistic therapists aim to boost self-fulfillment by helping people grow in self-awareness and self-acceptance. One humanistic technique used is Carl Rogers' client-centered therapy, which focuses on the person's conscious self-perceptions rather than on the therapist's own interpretations. The therapist listens, without judgment or interpretation, and refrains from directing the client toward certain insights, a strategy labeled nondirective therapy. Rogers encouraged therapists to exhibit genuineness, acceptance, and empathy. Usage of Rogers' technique of active listening-echoing, restating, and seeking clarification of what a person expresses (verbally or nonverbally) and acknowledging the expressed feelings. Given a nonjudgmental, grace-filled environment that provides unconditional positive regard, people internalize unconditional positive self-regard; they may accept even their worst traits and feel valued and whole. Three hints to listen more actively in relationships are 1. Paraphrase

2. Invite Clarification 3. Reflect Feelings Behavior Therapies The psychoanalyst expects problems to subside as people gain insight into their unresolved and unconscious tensions. The humanistic therapists expects to abate as people get in touch with their feelings Behavior therapists, however, doubt the healing power of self-awareness. They assume that problem behaviors are the problems. Classical Conditioning Techniques One cluster of behavior therapies derives from principles developed in Pavlov's conditioning experiments. As Pavlov and others showed, we learn various behaviors and emotions through classical conditioning. Counterconditioning pairs the trigger stimulus with a new response that is incompatible with fear. Two specific counterconditioning techniques are systematic desensitization and aversive conditioning. Systematic Desensitization Joseph Wolpe refined Jones' technique into what has become the most widely used method of behavior therapy: the exposure therapies, which exposes people to what they normally avoid. One widely used exposure therapy is systematic desensitization,which associates a pleasant relaxed state with gradually increasing anxiety-triggering stimuli. Commonly used to treat phobias. Aversive conditioning In systematic desensitization, the therapist helps the client substitute a positive (relaxed) response for a negative (fearful) response to a harmless stimulus. In aversive conditioning, the therapist tries to replace a positive response to a harmful stimulus with a negative (aversive) response. Aversive conditioning is the reverse of systematic desensitization-it seeks to condition an aversion to something the client should avoid. Operant Conditioning In institutional settings, therapists may create a token economy. When patients display appropriate behavior, they receive a token or plastic coin as a positive reinforcer. Later, they can exchange tokens for rewards. Critics of such behavior modification express two concerns. When reinforcers stop, could the person become so dependent on extrinsic rewards that the appropriate behavior quickly disappears. Proponents respond that they may wean patients from tokens by shifting them toward other rewards, such as social approval. May also train patients to behave in ways that are intrinsically rewarding. The second concern is of ethics. That the whole behavior modification process has an authoritarian taint. Advocates reply that control already exists; rewards and punishers are already

maintaining destructive behavior patterns. That treatment with positive rewards is more humane than being institutionalized or punished, and that the right to effective treatment and to an improved life justifies temporary deprivation. Cognitive Therapies The cognitive therapies assume that our thinking colors our feelings, that between the event and our response lies the mind. Cognitive therapists try in various ways to teach people new, more constructive ways of thinking. Cognitive Therapy for Depression Cognitive therapist Aaron Beck analyzed the dreams of patients with depression, he found recurring negative themes of loss, rejection, and abandonment that extended into their waking thoughts. In their form of cognitive therapy, Beck and his colleagues instead seek to reverse clients' catastrophizing beliefs about themselves, their situations, and their futures. Another variety of cognitive therapy builds on the finding that depressed people do not exhibit the self-serving bias common in nondepressed people. Instead, they often attribute their failures to themselves and attribute their successes to external circumstances. Cognitive therapists often combine the reversal of self-defeating thinking with efforts to modify behavior. This integrated therapy, called cognitive-behavior therapy, aims to alter the way people act (behavior therapy) and to alter the way they think (cognitive therapy). To change negative self-talk, Donal Meichenbaum offers stress inoculation training. Trainign people to restructure their thinking in stressful situations. Group and Family Therapies Group therapy does not provide the same degree of therapist involvement with each client; however it saves therapists' time and clients' money-and it often is no less effective than individual therapy. Group sessions offer a benefit: the social context allows people both to discoer that others have problems similar to their own and to try out new ways of behavior. One special type of group interaction, family therapy, assumes that no person is an island, that we live and grow in relations to others. Unlike most psychotherapy, which focuses on what happens inside the person's own skin, family therapists work with family groups to heal relationships and to mobilize family resources. Aim is to help family members discover the role they play within their family's social system. Also attempt to open up communication within family or to help family members discover new ways of preventing or resolving conflicts.