Who Seeks Treatment? Psychotherapy Psychoanalysis
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12/6/11 Who Seeks Treatment? Psychotherapy 15% of U.S population in a given year We will limit ourselves to 4 types: Most common presenting problems • Psychodynamic-Unconscious conflicts and motivations • Anxiety and Depression • Humanistic-Importance of self-esteem, self understanding, support in moving toward positive Women more than men mental health People with Medical insurance • Behavioral-actions learned through basic learning People with higher levels of education principles can lead to serious maladaptive behavior However, many people still do not seek help • Cognitive-habitual ways of thinking affect our moods because of the stigma attached to treatment and our interactions with others Psychoanalysis Freud’s psychodynamic approach has had a strong influence in our understanding of psychotherapy. Freud began career treating patients with Hysteria • Demonstrated that physical symptoms had Psychogenic causes. The Case of Anna O. • Patient fixated psychic energy as a result of unconscious conflicts • Anna’s understanding of her problems led to cure. Psychoanalysis- Sigmund Freud Psychoanalysis Source of Problem: • Unresolved conflicts from early childhood (first five years) • Primary talk therapy • The conflicts are unconscious and unknown to the patient • Takes a long time and is expensive. • Patient develops symptoms which indicate the conflict exists • The therapist is in control and decides whether Basis for recovery: patient improving. • Insight into the unconscious source of current feelings and • “Good” patients tend to be intelligent, drives that give rise to maladaptive behavior . articulate, and motivated, also rich. • Therapist’s job is to uncover source of the hidden conflicts and liberate the affect that supports them (catharsis). Techniques to gain access to unconscious conflicts : • Free association and resistances • Dream interpretation • Transference, acting toward therapist as though source of conflict 1 12/6/11 Humanistic Approach to Psychotherapy Client (person) Centered Therapy Carl Rogers called his therapy Client Centered, in Humanistic Psychotherapy grew out of: contrast to the hierarchical doctor/patient • A reaction to non-democratic and authoritarian relationship emphasized by Freud. psychodynamic approach of Freud. Source of problem • Existential Philosophy which stresses that each person • Rogers saw low self esteem as a major problem as a result of must decide for themselves what is a full and a Self Concept that was Incongruent with what was their meaningful life Ideal self Concept. Humanistic Approach assumes: • Parents who treated their Conditional positive regard by • Every person inherently good and naturally strives and withholding their love if child didn’t meet their expectations is capable of developing their own inherent human created incongruence. This could be real or imagined. potential. • Incongruence prevents self-actualization because an • Need for positive self-regard to be able to make individual has a a need to distort reality to hide shortcomings positive choices (actualizing your potential) in order to feel worthy of affection. Defensive maladaptive adaptive behavior leads to problems with others, and prevents optimal development. Client Centered Therapy Basis for recovery • Healing of the client comes with Unconditional Positive Regard: The granting of love and approval regardless of an individual's behavior allows realize their human potential. • Being able to accept oneself as you actually are (achieving congruence) leads to an openness to change and becoming a fully functioning person. Rogers Client Centered Therapy Mirroring: Clarifying Feelings Main Therapeutic Techniques: "I thought I'd have something to talk about--then • Providing an environment for the client to discover the reality it all goes around in circles. I was trying to of their condition by helping client to clarify their feelings, and supporting change. think of what I was going to say. Then coming • Requires special Characteristics of therapist for acceptance: in here it doesn't work out....I tell you, it – Unconditional positive regard seemed that it would be much easier before I – Empathy came." – Genuineness • Mirroring. Therapist actively listens and repeats or rephrases thoughts and feelings expressed by client to help them “ become aware of what they are actually feeling. To reflect Rogers: You thought you would have more to the reality they are saying is there. say before you came here” 2 12/6/11 Rogerian Reflections Rogerian Reflections "I tell you, I just can't make a decision: I don't "I find myself and my thoughts getting back to know what I want. I've tried to reason this the days when I was a kid, and I cry very easily. thing out logically--tried to figure out which The dam would break through." things are important to me." Rogers: “When you think about the time when Rogers: “It seems confusing to you and you you were a child you feel yourself becoming don’t know what to do.” emotional.” Mirroring causes both the therapist and the patient to gain greater insight into underlying conflicts in the self-concept. Client: Let's put it this way. My stepfather and I are not on the happiest terms in the world. Therapist: But part of what really makes for difficulty is the fact that you and your stepfather, as you say, are not... the relationship Behavior Therapy isn't completely rosy. Client: Let's just put it this way, I hate him and he hates me. It's that way. Behavior Therapy a reaction to the vague and Therapist: But you really hate him and you feel he really hates you. non-scientific approach of other therapies. Client: Well, I don't know if he hates me or not, but I know one thing, I don't like him whatsoever. Therapist: You can't speak for sure about his feelings because only he knows exactly what those are,but as far as you are • Reaction against medical model. Patient not “sick” but concerned... has learned to respond in maladaptive ways Client: ... he knows how I feel about it. Therapist: You don't have any use for him. • Application of principles of operant and classical Client: None whatsoever. And that's been for about eight years now. conditioning for therapeutic effect. Therapist: So for about eight years you've lived with a person whom you have no respect for and really hate. • Unlike any of the other therapies, behavior therapy is Client: Oh, I respect him. “ ” Therapist: Ah. Excuse me. I got that wrong. not talk therapy. Client: I have to respect him. I don't have to, but I do. But I don't love him, I hate him. I can't stand him. Source of problem: Therapist: There are certain things you respect him for, but that doesn't alter the fact that you definitely hate him and don't love him. Client: That's the truth. I respect anybody who has bravery and courage, and he does. • The environmental contingencies of reinforcement and Therapist: ... You do give him credit for the fact that he is brave, he has guts or something. punishment that support the maladaptive behavior. Client: Yeah. He shows that he can do a lot of things that, well, a lot of men can't. • Symptom oriented. Symptoms are learned responses Therapist: M-hm, m-hm. Client: And also he has asthma, and the doctor hasn't given him very long to live. And he, even though he knows he is going to die, not indicators of a “disease.” Get rid of symptom and he keeps working and he works at a killing pace, so I respect him for that, too. disease is gone. Symptom substitution, no problem Therapist: M-hm. So I guess you're saying he really has... Client: .. .what it takes. • Insight into past childhood conflicts not important. Behavior Therapy Behavioral Cure for Bedwetting Therapeutic Techniques: Developed by Hobart Mowrer in 1940s • Change contingencies that support maladaptive behavior and reinforce new responses to replace them. • Because it is a science based therapy it is very concerned with immediate, measureable results. 3 12/6/11 Systematic Desensitization Systematic Desensitization Systematic Desensitization is used to extinguish Systematic desensitization for phobic reactions fear behavior to phobic stimuli. • Uses anxiety hierarchy and counteract emotion through reciprocal inhibition. • Problem in phobias is that fear of stimulus reinforced by avoidance behavior. • Very successful in treatment of phobias. Anxiety hierarchy and reciprocal inhibition 0 Beginning a new course 10 A professor announces a quiz in two weeks 30 A professor announces a major exam in three weeks 45 Reading the material to be given on the exam 55 A fellow student asks you if you know the material 70 Studying with other students several days before the exam 80 Hearing students talk about things that you don’t know 90 Walking down the hallway to the exam room 100 Looking at the exam and finding a question you don’t know the answer to. Techniques in Behavioral Therapy Implosion Therapy Implosion or flooding therapy. • A sudden and large-scale exposure to the object under controlled conditions • Assumption is that the sympathetic nervous system cannot maintain a panic state for very long and that the level of arousal will decline, extinguishing the fear. Technology has changed methods • Digital Reality helmets can expose patients to objects that create fear (snakes, spiders), and situations that create fear (heights), in a very safe effective manner. Other Techniques in Behavior Therapy Aversion Therapy • Conditioning negative reactions to serious maladaptive behavior or to inappropriate stimuli. • Punishment Unlike other therapies, behavior therapy does not require insight into one’s problems or client’s cooperation. This means people can be given “therapy” against their will. 4 12/6/11 Extinction of Self Destructive Behavior Aversion Therapy Aversion therapy associates a punisher with the behavior that is to be avoided or suppressed. Techniques in Behavioral Therapy Enforcing Treatment Example: 47 year old chronic Schizophrenic.