Chapter 17: Therapies

Psychotherapy: any psychological technique that can bring about positive changes in personality, behavior, adjustment -usually verbal interaction between mental health professional and clients

Individual therapy vs. group therapy

Insight therapy

Directive therapy

Nondirective: therapist assists but doesn’t advise

Support vs. personal change

Good improvement for phobias, low self-esteem, some sex problems, marital conflicts

Origins of therapy -primitive: demons, superstitions -bore holes into head

1793: regarded as “mentally ill” and given compassionate treatment

Freud: created first true psychotherapy

Psychoanalysis today: improvement in most clients -unconscious conflicts

Humanistic Therapies -restoring human potential

Client-Centered Therapy -Rogers: conscious thoughts and feelings -nondirective -therapists creates a safe “atmosphere of growth”

Rogers’ four basic conditions -unconditional positive regard: unshakable personal acceptance -acceptance without shock or disapproval -empathy: try to see and feel as clients do 2

-authentic: genuine, honest -reflects (rephrases, summarizes, repeats); see self more clearly Existential Therapy: you choose to become the person you want to be -existence creates conflicts -meaning, choice, responsibility -promotes self-knowledge and self-actualization -emphasizes free will -therapist give client courage to make rewarding and socially constructive choices -focus on death, isolation, freedom, meaninglessness -confrontation: challenged to examine values and choices and take responsibility for quality of existence

Gestalt therapy: “whole” -Fritz Perls -maladaptive people suffer from disjointed perceptions or incomplete awareness -expand personal awareness and accept responsibility for one’s thoughts, feelings, and actions and filling in gaps in experience -avoid owning upsetting feelings -more directive -emphasizes immediate experience “here and now” -therapist encourages awareness of moment to moment thoughts, perceptions, emotions -emotional health comes from knowing what you want to do not what you should do

Psych Jockeys and Cybertherapy -discuss problems in general terms -not know background of caller -hear others’ problems and solutions -telephone: lack of visual cues -established use of suicide hot lines -on-line: anonymity -may not be a professional -rural areas -problem with confidentiality of e-mail

Behavior Therapy -use of learning theory to make constructive changes in behavior -includes behavior modification, aversion therapy, desensitization, token economies -insight is unnecessary for improvement -directly alter troublesome thoughts and actions -assumes that people have learned to be the way they are -can changes themselves by relearning more appropriate behaviors 3

Behavior Modification -any use of classical or operant conditioning to directly alter behavior

Classical Conditioning -form of learning in which simple responses (esp. reflexes) are associated with new stimuli

Aversion Therapy -conditioned aversion : learned dislike or negative emotional response to some stimulus -learn to associate strong aversion to undesirable habits such as smoking, drinking, gambling -response-contingent -rapid smoking: effective for smoking cessation but dangerous

Desensitization: one of most successful behavioral treatments --hierarchy: rank-ordered series of steps -reciprocal inhibition: using 1 emotional state to block another -phobias

-construct hierarchy -taught relaxation -perform least disturbing item on list -in vivo

-vicarious desensitization -observe model perform feared behavior

-virtual reality exposure -present computerized fear stimuli in controlled fashion

Operant Therapies -positive reinforcement -non-reinforcement -extinction -punishment -shaping -stimulus control -time-out

Nonreinforcement and extinction -undesirable behavior can be extinguished by identifying and removing reinforcers that maintain it. 4

Reinforcement and Token Economies -symbolic rewards that can be exchanged for real rewards -immediate reinforcement -tokens given for wide range of behavior -pay for privileges -more effective if move from tokens to social rewards

Cognitive Therapy -helps clients changed thinking patterns that lead to troublesome emotions or behaviors -useful for depression

Aaron Beck -negative, self-defeating thoughts underlie depression -distortion in thinking -selective perception, focus on negative -overgeneralization -let upsetting events affect unrelated situations -see self as worthless if fail 1 test -all or nothing thinking; things completely good or bad

-identify and keep track of beliefs that lead to depression -look for information to challenge them -teach clients coping skills

REBT (Rational emotive behavior therapy) -change irrational beliefs that lead to depressions: Ellis -Activating experience leads to Beliefs leads to emotional Consequence

Ellis: most irrational beliefs come from 3 core ideas 1. I must perform well and be approved of or I am a rotten person 2. You must treat me fairly 3. Conditions must be the way I want them.

Group Therapy -done with more than 1 person -support from those with similar problems -lower cost -example: A.A.

Psychodrama -act out personal conflicts with other group members 5

Role-Playing: re-enactment of significant life events Role reversal

Mirror technique: observe another person enact one’s own behavior

Family Therapy: problem with a family vs. individual

Sensitivity groups: increased self-awareness; “trust walk”

Encounter groups: tearing down defenses and false fronts -honest expression of feelings

9 out of 10 people who sought treatment said it improved their lives 50% felt better in 2 months

Core features of psychotherapy -goals: - increased hope, courage, optimism -resolve conflicts -increased sense of self -find purpose -mend interpersonal relationships -change unacceptable behavior patterns

-caring relationship with therapist (therapeutic alliance) -empathy, acceptance -protected setting in which emotional catharsis (release) can occur -offer explanation or rationale for suffering -new perspective and chance to practice new behavior

Future -more short-term -more M.A. level practitioners -more internet -decreased use of psychiatrists and psychoanalysts

Behaviors that help -active listening/reflect feelings -acceptance -open-ended questions -respect -patience 6

Behaviors that hinder -probing painful topics -judging/moralizing -criticism -rejection -blaming

Clarify problem Don’t give advice Confidentiality

Medical Therapies Drugs -psychopharmacology: use of drugs to treat emotional disturbance -anxiolytics: decrease anxiety -antidepressants: mood elevators -antipsychotics: major tranquilizers -decrease hallucinations and delusions -have decreased psychiatric hospitalizations

ECT : Electro-Convulsive Therapy (shock therapy) -used for depression -temporary improvement -permanent memory loss

Psycho-surgery: irreversible

Hospitalization -for major mental disorders -away from problems -mean stay of 20 days now vs. 3 to 4 months 20 years ago

Deinstitutionalization -reduced use of full-time commitment to mental institution -in last 30 years, population in mental hospitals has decreased by two-thirds -limited success; without adequate care in community, clients may not be able to cope -homelessness -half-way houses; short-term group living facilities with supervision and support -community mental health centers -wide range of services -outpatient: crisis management 7