Introduction to Psychology

PSY 101
Treatment/Therapies
Lecturer: Catherine Sesay
The Beginning
Psychotherapy has its origins in psychoanalysis and psychoanalysis had its beginning
with Anna O.
• she began to experience strange physical symptoms at age 21
• during some of her visits, she would sit in a trancelike state and talk uninhibitedly of
her past experiences
• each time Anna recalled a past traumatic experience, a physical symptom
associated with that trauma would vanish

Behavior therapy on the other hand had its beginning with Little Albert
• Behavior therapists believe that emotional problems may arise through
conditioning
• These emotional problems could be treated by using other principles of learning
 Early Treatment
Maltreatment of the insane throughout the ages was the result of irrational
views. Many patients were subjected to strange, debilitating, and
downright dangerous treatments.
Patients were put into straitjackets, handcuffs, and various
restraining devices, locked away in mental hospitals under wretched
conditions whilst undergoing inhumane treatment and neglect

The Granger Collection

The Granger Collection

 Reform Movement

Culver Pictures
Philippe Pinel in France and
Dorthea Dix in America
founded humane movements
to care for the mentally sick.

Her work was

part of the reform movement
that emphasized

http://wwwihm.nlm.nih.gov
moral therapy

Moral therapy was the belief

that mental patients could be
helped to function better by
providing humane treatment in
Dorthea Dix (1802-1887) a relaxed and decent
environment
Philippe Pinel (1745-1826)
Antipsychotic Drugs, Deinstitutionalization &
Community Health Centers
The moral therapy movement was abandoned and conditions in mental
hospitals went back to their previous state
In the mid-1950s, two events dramatically changed the treatment of mental
patients:
1. The discovery of antipsychotic drugs
• Chlorpromazine discovered by accident
• First drug effective in reducing severe mental symptoms, such as delusions
and hallucinations
• Led to the release of patients from mental hospitals; deinstitutionalization
• Deinstitutionalization however created a related problem: homelessness

2. The development of community mental health centers

• To help the homeless, county prisoners, those released from mental
hospitals
• offer low-cost or free mental health care to members of the surrounding
community
Questions about Psychotherapy
1. Do I need professional help?

• overwhelmed by a sense of sadness, depression, or helplessness;

worrying or expecting terrible things to happen; becoming very
dependent on drugs
• If these problems begin to interfere with daily functioning in social,
personal, business, academic, or professional interactions and
activities, then a person may need help
• however some people do not seek professional help because
• of the social stigma attached to having a mental disorders
• people don’t realize they need professional help
Questions about Psychotherapy
2. Are There Different Kinds of Therapists?

Clinical psychologists: go to graduate school in clinical psychology

and earn a doctorate degree (PhD, Psy, or EdD). This training includes
one year of work in an applied clinical setting. More focus on research
and mental disorders

Counseling Psychologist: go to graduate school in psychology or

education and earn a doctorate degree (PhD, PsyD, or EdD). This
training includes work in a counseling setting. less emphasis on
research and more emphasis on counseling in real-world settings

Psychiatrists: go to medical school, receive an MD degree, and then

take a psychiatric residency, which involves additional training in
pharmacology, neurology, psychopathology, and psychotherapeutic
techniques, but as MDs they can prescribe medications.
Questions about Psychotherapy
3. What Are the Different Approaches?

The different therapeutic approaches can be divided into three groups:

1. insight therapy: the therapist and client talk about the client’s
symptoms and problems with the goal of reaching or identifying the
cause of the problem. Once the client has an insight into the cause
of the problem, possible solutions can be discussed with the
therapist, e.g. psychoanalysis, client-centered therapy, cognitive
2. cognitive-behavioral therapy: involves the application of
principles of learning, The therapist focuses on the client’s problem,
identifies specific thoughts and behaviors that need to be changed,
and provides techniques based on learning principles to make
desired changes
3. medical therapy: involves the use of various psychoactive drugs to
treat mental disorders by changing biological factors, such as the
levels of neurotransmitters in the brain (aka biomedical therapy)
 Questions about Psychotherapy
How Effective Is Psychotherapy?

Q: Is psychotherapy more effective than just waiting for problems to go

away?
A: Meta-analysis  Meta-analysis is a powerful statistical procedure that
compares the results of dozens or hundreds of studies to determine the
effectiveness of some variable or treatment examined in these studies
• Psychotherapy was effective in relieving a wide variety of psychological
and behavioral symptoms in comparison with control groups
• The same psychological or behavioral symptoms were, in most cases,
treated effectively with different approaches
• The vast majority of patients (75%) showed measurable improvement
by the end of six months of once-a-week psychotherapy sessions (24
sessions)
The Relative Effectiveness of Different
Therapies
However, some therapeutic approaches are preferred for
certain problems

Disorder Therapy
Depression Behavior, Cognition, Interpersonal
Anxiety Cognition, Exposure, Stress Inoculation
Bulimia Cognitive-behavior
Phobia Behavior
Bed Wetting Behavior Modification
Psychological Therapies
We will look at four major forms of psychotherapies
based on different theories of human nature:
1. Psychoanalytic theory
2. Humanistic theory
3. Cognitive theory
4. Behavioral theory
 Psychoanalysis
• The first formal psychotherapy to emerge was psychoanalysis,
developed by Sigmund Freud.
• The presence of threatening thoughts and desires gives rise to
unconscious conflicts, which, in turn, can result in psychological and
physical symptoms and mental disorders
• The aim of psychoanalysis is to bring repressed feelings into conscious
awareness where the patient can deal with them.

Edmund Engleman
Sigmund Freud's famous couch
 Psychoanalysis
Psychoanalysis makes three major assumptions:

1. Freud believed that unconscious conflicts were the chief reason for
the development of psychological problems and physical symptoms

2. Dissatisfied with hypnosis, Freud developed three techniques – free

association, dream interpretation, and analysis of slips of the tongue – to
unravel the unconscious mind and its conflicts.

3. Freud found that at some point during therapy the patient would react to
the therapist and, in the process, project or transfer strong emotions onto
the therapist
Techniques to Reveal the Unconscious
In order to treat neuroses or neurotic symptoms (maladaptive thoughts &
actions) Freud wanted to discover what was in the patient’s unconscious

Free Association
• Free association is a technique that encourages clients to talk about
any thoughts or images that enter their heads; the assumption is that
this kind of free-flowing, uncensored talking will provide clues to
unconscious material

Dream Interpretation
• Dream interpretation is a psychoanalytic technique based on the
assumption that dreams contain underlying, hidden meanings and
symbols that provide clues to unconscious thoughts and desires
 Psychoanalysis: Evaluation
1. Psychoanalysis is hard to refute because it cannot be
proven or disproven.
2. Psychoanalysis takes a long time and is very expensive.
3. Lack of research on whether the psychoanalytic process
was an effective form of therapy
4. Competing therapies caused it to loose popularity; they
proved to be equally effective, quicker and less costly
5. Discovery of new drugs also resulted in psychoanalysis
experiencing a great decline
 Humanistic Therapies
Humanistic therapists aim to boost self-fulfillment by helping people
grow in self-awareness and self-acceptance

Developed by Carl Rogers, client-centered therapy is a form of

humanistic therapy.

Client-centered therapy (also called person-centered therapy) assumes

that each person has an actualizing tendency, which is a tendency to
develop one’s full potential. The therapist’s task is to be nondirective
and show compassion and positive regard in helping the client reach his
or her potential
 Client-Centered Therapy

The therapist listens to the needs of the patient in an accepting and non-
judgmental way, addressing problems in a productive way and building
his or her self-esteem.

The therapist engages in active listening and echoes, restates, and

clarifies the patient’s thinking, acknowledging expressed feelings

The therapist’s role is that of a helper or facilitator; the therapist uses a

technique called reflecting or restating the client’s concerns to show
understanding
Client-Centered Therapy
Rogers believed that personal characteristics of the
therapist—empathy, positive regard, genuineness—
would bring about the client’s change

Michael Rougier/ Life Magazine © Time Warner, Inc.

Cognitive Therapy
Cognitive therapy, as developed by Aaron Beck, assumes that we have
automatic negative thoughts that we typically say to ourselves without
much notice.
By continually repeating these automatic negative thoughts, we color and
distort how we perceive and interpret our world and influence how we
behave and feel.

Negative things we say to ourselves—for example, “Nothing ever goes

right,” “I’m a failure,” or “Everybody criticizes me”—can bias and distort
our thoughts and feelings.

The primary goals of cognitive therapy are to identify and change

maladaptive thoughts
Cognitive Therapy
Teaches people adaptive ways of thinking and
acting based on the assumption that thoughts
intervene between events and our emotional
reactions.
Cognitive Therapy
Beck identified a number of specific maladaptive thoughts that
contribute to various symptoms
Beck believes that maladaptive thought patterns cause a distorted view
of oneself and one’s world, which in turn may lead to various emotional
problems
Cognitive Therapy
Clients are shown how to monitor their thoughts and beliefs, how to
recognize maladaptive thought patterns, such as overgeneralization
and polarized thinking, and how to substitute rational thought patterns
Cognitive Therapy Daily Thought Record
Example
 Behavior Therapy
Behavior therapy, also called behavior modification, uses the principles
of classical and operant conditioning to change disruptive behaviors and
improve human functioning. It focuses on changing particular behaviors
rather than the underlying mental events or possible unconscious factors

Behavior therapy has two goals

1. to modify undesirable behaviors, using many of the principles of
operant conditioning and teach the client how to perform new
behaviors
2. to help the client meet specific behavioral goals through constant
practice and reward
Behavior Therapy
Systematic desensitization is a technique of behavior therapy in which
the client is gradually exposed to the feared object while simultaneously
practicing relaxation

Desensitization involves three steps:

1. Relaxation: learning to relax
2. Stimulus hierarchy: constructing a hierarchy with
the least feared situation on the bottom and the
most feared situation at the top
3. Exposure: being progressively exposed to the
feared situation
 Exposure Therapy
Imagined – imagining feared
stimulus

The Far Side © 1986 FARWORKS. Reprinted with Permission. All Rights Reserved.
In Vivo - clients gradually expose
themselves to the actual situation

Systematic desensitization has

proved to be a very effective
treatment for a variety of anxiety
disorders
 Cognitive-Behavior Therapy
As cognitive therapy and behavioral therapy gained popularity, therapists
began combining the two methods of therapy
Cognitive-behavioral therapy combines the cognitive therapy technique of
changing negative, unhealthy, or distorted thought patterns with the behavior
therapy technique of changing maladaptive or disruptive behaviors by
learning and practicing new skills to improve functioning

Techniques used include:

• monitoring one’s own thoughts and behaviors
• identifying thoughts and behaviors that need to be changed
• Setting specific goals that increase in difficulty
• learning to reinforce oneself for reaching a goal
• substituting positive for negative thoughts;
• doing homework, which involves practicing new behaviors in a safe setting
before performing them in the real world
 Eye Movement Desensitization and
Reprocessing (EMDR)
In EMDR therapy, the therapist attempts to unlock and reprocess previous
frozen traumatic memories by waving a finger in front of the eyes of the
client
Eye Movement Desensitization and Reprocessing, or EMDR, essentially
involves having the client talk about or imagine a troubling traumatic
memory while visually focusing on and following the back-and-forth
movement of a therapist’s hand

Controversy surrounding EMDR: It seems too unusual, too simple, and

too quick!
Medical Therapies
These include physical, medicinal, and other
forms of biological therapies.

1. Drug Therapies
2. Brain Stimulation
3. Psychosurgery
Drug Therapies
Psychopharmacology is the study of drug effects
on mind and behavior.

With the advent of drugs, hospitalization in mental

institutions has rapidly declined.
Drug Therapies
However, many patients are left homeless on the
streets due to their ill-preparedness to cope
independently outside in society.

Les Snider/ The Image Works

 Double-Blind Procedures
To test the effectiveness of a drug, patients are
tested with the drug and a placebo. Two groups of
patients and medical health professionals are
unaware of who is taking the drug and who is
taking the placebo.
Antipsychotic Drugs
Classical antipsychotics [chlorpromazine (Thorazine)]:
Remove a number of positive symptoms associated
with schizophrenia such as agitation, delusions, and
hallucinations.

Atypical antipsychotics [clozapine (Clozaril)]: Remove

negative symptoms associated with schizophrenia such
as apathy, jumbled thoughts, concentration difficulties,
and difficulties in interacting with others.
Atypical Antipsychotic
Clozapine (Clozaril) blocks receptors for
dopamine and serotonin to remove the negative
symptoms of schizophrenia.
 Antianxiety Drugs
Antianxiety drugs (Xanax and
Ativan) depress the central
nervous system and reduce
anxiety and tension by
elevating the levels of the
Gamma-aminobutyric acid
(GABA) neurotransmitter.
 Antidepressant Drugs
Antidepressant drugs like
Prozac, Zoloft, and Paxil are
Selective Serotonin Reuptake
Inhibitors (SSRIs) that improve
the mood by elevating levels of
serotonin by inhibiting
reuptake.

Also used to treat some anxiety

disorders
 Mood-Stabilizing Medications
Lithium Carbonate, a common salt, has been used to
stabilize manic episodes in bipolar disorders. It moderates
the levels of norepinephrine and glutamate
neurotransmitters.
 Brain Stimulation
Electroconvulsive Therapy
(ECT)
ECT is used for severely
depressed patients who do
not respond to drugs. The
patient is anesthetized and
given a muscle relaxant.
Patients usually get a 100
volt shock that relieves
them of depression.
 Alternatives to ECT
Repetitive Transcranial
Magnetic Stimulation
(rTMS)

In rTMS, a pulsating
magnetic coil is placed
over prefrontal regions
of the brain to treat
depression with
minimal side effects.
Psychosurgery
Psychosurgery is used as a last resort in
alleviating psychological disturbances.
Psychosurgery is irreversible. Removal of brain
tissue changes the mind.