Therapy

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The Psychological Therapies
 Psychoanalysis
 Humanistic Therapies
 Behavior Therapies
 Cognitive Therapies
 Group and Family Therapies

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 Evaluating Psychotherapies
 Is Psychotherapy Effective?
 The Relative Effectiveness of Different
Therapies
 Evaluating Alternative Therapies
 Commonalities Among Psychotherapies
 Culture and Values in Psychotherapy

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The Biomedical Therapies
 Drug Therapies
 Brain Stimulation
 Psychosurgery
 Therapeutic Life-Style Changes

Preventing Psychological
Disorders
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 History of Insane 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.
The Granger Collection

The Granger Collection

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 History of Insane Treatment
Philippe Pinel in France and Dorthea Dix in
America founded humane movements to care for
the mentally sick.

http://wwwihm.nlm.nih.gov

Culver Pictures
Philippe Pinel (1745-1826) Dorthea Dix (1802-1887) 6
 Therapies
Psychotherapy involves an emotionally
charged, confiding interaction between a trained
therapist and a mental patient.
Biomedical therapy uses drugs or other
procedures that act on the patient’s nervous
system, treating his or her psychological
disorders.
An eclectic approach uses various forms of
healing techniques depending upon the
client’s unique problems.
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 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.Behavioral theory
4.Cognitive theory

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 Psychoanalysis
The first formal psychotherapy to emerge was
psychoanalysis, developed by Sigmund Freud.

Edmund Engleman
Sigmund Freud's famous couch

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 Psychoanalysis: Aims
Since psychological problems originate from
childhood repressed impulses and conflicts, the aim
of psychoanalysis is to bring repressed feelings into
conscious awareness where the patient can deal
with them.

When energy devoted to id-ego-superego conflicts

is released, the patient’s anxiety lessens.

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 Psychoanalysis: Methods
Dissatisfied with hypnosis, Freud developed the
method of free association to unravel the
unconscious mind and its conflicts.

The patient lies on a couch and speaks about

whatever comes to his or her mind.

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http://www.english.upenn.ed
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 Psychoanalysis: Methods
During free association, the patient edits his
thoughts, resisting his or her feelings to express
emotions. Such resistance becomes important in the
analysis of conflict-driven anxiety.

Eventually the patient opens up and reveals his or

her innermost private thoughts, developing positive
or negative feelings (transference) towards the
therapist.

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 Psychoanalysis: Criticisms
1. Psychoanalysis is hard to refute because it
cannot be proven or disproven.
2. Psychoanalysis takes a long time and is very
expensive.

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 Psychodynamic Therapy
Influenced by Freud, in a face-to-face setting,
psychodynamic therapists understand symptoms and
themes across important relationships in a patient’s
life.

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 Psychodynamic Therapies
Interpersonal psychotherapy, a variation of
psychodynamic therapy, is effective in treating
depression. It focuses on symptom relief here and
now, not an overall personality change.

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 Humanistic Therapies
Humanistic therapists aim to boost self-
fulfillment by helping people grow in self-
awareness and self-acceptance.

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 Client-Centered Therapy
Developed by Carl Rogers, client-centered
therapy is a form of humanistic 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.

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 Humanistic Therapy
The therapist engages in active listening and
echoes, restates, and clarifies the patient’s
thinking, acknowledging expressed feelings.

Michael Rougier/ Life Magazine

©

Time Warner, Inc.

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 Behavior Therapy
Therapy that applies learning principles to the
elimination of unwanted behaviors.

To treat phobias or sexual disorders, behavior

therapists do not delve deeply below the surface
looking for inner causes.

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 Classical Conditioning Techniques

Counterconditioning is a procedure that conditions

new responses to stimuli that trigger unwanted
behaviors.

It is based on classical conditioning and includes

exposure therapy and aversive conditioning.

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 Exposure Therapy

Expose patients to

The Far Side

things they fear and ©

avoid. Through repeated

1986 FARWORKS. Reprinted with Permission. All Rights Reserved.

exposures, anxiety
lessens because they
habituate to the things
feared.

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 Exposure Therapy
Exposure therapy involves exposing people to
fear-driving objects in real or virtual
environments.

Both Photos: Bob Mahoney/ The Image Works

N. Rown/ The Image Works

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 Systematic Desensitization
A type of exposure therapy that associates a
pleasant, relaxed state with gradually increasing
anxiety-triggering stimuli commonly used to treat
phobias.

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 Aversive Conditioning
A type of
counterconditioning
that associates an
unpleasant state with
an unwanted behavior.
With this technique,
temporary conditioned
aversion to alcohol has
been reported.

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 Operant Conditioning
Operant conditioning procedures enable therapists
to use behavior modification, in which desired
behaviors are rewarded and undesired behaviors
are either unrewarded or punished.

A number of withdrawn, uncommunicative 3-year-

old autistic children have been
successfully trained by giving and withdrawing
reinforcements for desired and undesired
behaviors.

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 Token Economy
In institutional settings, therapists may create a
token economy in which patients exchange a token
of some sort, earned for exhibiting the desired
behavior, for various privileges or treats.

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 Cognitive Therapy
Teaches people adaptive ways of thinking and
acting based on the assumption that thoughts
intervene between events and our emotional
reactions.

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 Beck’s Therapy for Depression

Aaron Beck (1979) suggests that depressed patients

believe that they can never be happy (thinking) and
thus associate minor failings (e.g. failing a test
[event]) in life as major causes for their depression.

Beck believes that cognitions such as “Ican never

be happy” need to change in order for depressed
patients to recover. This change is brought about by
gently questioning patients.

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 Stress Inoculation Training
Meichenbaum (1977, 1985) trained people to
restructure their thinking in stressful situations.

“Relax, the exam may be hard, but it will be

hard for everyone else too. I studied harder
than most people. Besides, I don’t need a
perfect score to get a good grade.”

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 Cognitive-Behavior Therapy
Cognitive therapists often combine the reversal of
self-defeated thinking with efforts to modify
behavior.

Cognitive-behavior therapy aims to alter the way

people act (behavior therapy) and alter the way
they think (cognitive therapy).

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 Group & Family Therapies
Group therapy normally consists of 6-9 people
attending a 90-minute session that can help more
people and costs less. Clients benefit from knowing
others have similar problems.

Mary Kate Denny/ PhotoEdit, Inc.

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 Family Therapy
Family therapy treats the family as a system.
Therapy guides family members toward positive
relationships and improved communication.

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 Evaluating Therapies
Who do people turn to for help with
psychological difficulties?

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 Is Psychotherapy Effective?
It is difficult to gauge the effectiveness of
psychotherapy because there are different levels
upon which its effectiveness can be measured.

1.Does the patient sense improvement?

2.Does the therapist feel the patient has improved?
3.How do friends and family feel about the
patient’s improvement?

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 Client’s Perceptions
If you ask clients about their experiences of
getting into therapy, they often overestimate its
effectiveness. Critics however remain skeptical.

1.Clients enter therapy in crisis, but crisis may subside

over the natural course of time (regression to normalcy).
2.Clients may need to believe the therapy was worth the
effort.
3.Clients generally speak kindly of their therapists.

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 Clinician’s Perceptions
Like clients, clinicians believe in therapy’s
success. They believe the client is better off after
therapy than if the client had not taken part in
therapy.
1.Clinicians are aware of failures, but they believe
failures are the problem of other therapists.
2.If a client seeks another clinician, the former therapist is
more likely to argue that the client has developed another
psychological problem.
3.Clinicians are likely to testify to the efficacy of their
therapy regardless of the outcome of treatment.
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 Outcome Research
How can we objectively measure the
effectiveness of psychotherapy?

Meta-analysis of a number of studies

suggests that thousands of patients benefit
more from therapy than those who did not
go to therapy.

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 Outcome Research
Research shows that treated patients were 80%
better than untreated ones.

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 The Relative Effectiveness of
Different Therapies
Which psychotherapy would be most effective for
treating a particular problem?

Disorder Therapy
Depression Behavior, Cognition, Interpersonal
Anxiety Cognition, Exposure, Stress Inoculation
Bulimia Cognitive-behavior
Phobia Behavior
Bed Wetting Behavior Modification

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 Evaluating Alternative Therapies

57% of those who have had anxiety attacks and

54% who have had depression have used alternative
treatments such as herbal medicines, massage, and
spiritual healing (Kessler & others, 2001). Do
alternative therapies hold up under scientific
scrutiny?

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 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.

EMDR has not held up under scientific testing.

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 Light Exposure Therapy

Seasonal Affective
Disorder (SAD), a form
of depression, has been
effectively treated by
light exposure therapy.
This form of therapy has
been scientifically

Courtesy of Christine Brune

validated.

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 Commonalities Among
Psychotherapies
Three commonalities shared by all forms of
psychotherapies are the following:

1. A hope for
demoralized people. ©

2. A new perspective.

Mary Kate Denny/ PhotoEdit, Inc.

3. An empathic, trusting and caring relationship.

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Culture and Values in Psychotherapy

Psychotherapists may differ from each other and

from clients in their personal beliefs, values, and
cultural backgrounds.

A therapist search should include visiting two or

more therapists to judge which one makes the
client feel more comfortable.

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 Therapists & Their Training
Clinical psychologists: They have PhDs mostly.
They are experts in research, assessment, and
therapy, all of which is verified through a
supervised internship.

Clinical or Psychiatric Social Worker: They have a

Masters of Social Work. Postgraduate supervision
prepares some social workers to offer
psychotherapy, mostly to people with everyday
personal and family problems.

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 Therapists & Their Training
Counselors: Pastoral counselors or abuse
counselors work with problems arising from
family relations, spouse and child abusers and their
victims, and substance abusers.

Psychiatrists: They are physicians who specialize

in the treatment of psychological disorders. Not all
psychiatrists have extensive training in
psychotherapy, but as MDs they can prescribe
medications.

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 The Biomedical Therapies
These include physical, medicinal, and other
forms of biological therapies.

1. Drug Therapies
2. Brain Stimulation
3. Psychosurgery

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 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. 48
 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

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 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.

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 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.
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 Atypical Antipsychotic
Clozapine (Clozaril) blocks receptors for dopamine
and serotonin to remove the negative symptoms of
schizophrenia.

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 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.

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 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.

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 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.

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 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.
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 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.
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 Psychosurgery
Psychosurgery was
popular even in
Neolithic times.
Although used sparingly
today, about
200 such operations do
take place in the US

r
http://www.epub.org.b
alone.

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 Psychosurgery
Psychosurgery is used as a last resort in
alleviating psychological disturbances.
Psychosurgery is irreversible. Removal of brain
tissue changes the mind.

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 Preventing Psychological Disorders

“It is better to prevent than cure.”

Peruvian Folk Wisdom

Preventing psychological disorders means

removing the factors that affect society. Those
factors may be poverty, meaningless work,
constant criticism, unemployment, racism, and
sexism.

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Psychological Disorders are
Biopsychosocial in Nature

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