Are There Different Kinds of Psychotherapy?

Psychotherapies and Treatments Crosswalked with David Myers Psychology 9e

What is Therapy?

Are there different kinds of psychotherapy?

Yes; we will look at four major forms of psychotherapies based on different theories of human nature

Psychoanalysis

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

Psychoanalysis: Aims

Assumptions: Psychological problems originate from childhood repressed impulses and conflicts

Goal of therapy: Bring repressed feelings into conscious awareness where the patient can understand and resolve them.

Psychoanalysis: Methods

Role of the therapist: Active

Leading patient to insight

Providing Interpretation

Methods

Free association – The patient lies on a couch and speaks about whatever comes to his or her mind.

The goal is to unravel the unconscious mind and its conflicts by encouraging thoughts to flow freely without interruptions or inhibition.

Resistance – Look for evidence that the patient is avoiding an issue

Dream Interpretation – Look for the “latent” content – symbols that are disguised unconscious issues or motives

Transferences – Look for how the patient/therapist relationship mirrors unresolved conflicts in the patients past

Projective Tests

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.

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. What is Interpersonal Psychotherapy?

Interpersonal psychotherapy is a variation of psychodynamic therapy, a therapy influenced by Freud. Unlike psychoanalysis, it focuses on symptom relief here and now, not an overall personality change.

Psychodynamic Therapy: Interpersonal Psychotherapy

Assumptions

Interpersonal factors contribute heavily to psychological problems

Goals of therapy

Find common themes in relationships, indentify and explore defensive thoughts and feelings, improve relationships

Emphasis

Interpersonal Relationships

Past & Present

Sense of self

Psychodynamic Therapy: Interpersonal Psychotherapy

Role of Therapist

Interactive

Face to face

Methods

Identification of problem areas: unresolved grief, role disputes, role transitions, or interpersonal deficits

Humanistic Therapies

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

Client-Centered Therapy

Humanistic Therapy: Methods

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

Humanistic Therapy: Methods

Active listening

Genuineness – Therapist is completely honest and spontaneous with client

Acceptance - Unconditional positive regard, patient, nonjudgmental Empathy – An understanding of the client’s point of view www.manifestation.com/neurotoys/eliza.php3

Treats people as “clients” rather than patients

Creates atmosphere that emphasizes the clients tendency toward health

What is Behavior Therapy?

An ‘action’ therapy that applies learning principles to the elimination of unwanted behaviors.

Assumptions

Behavior is learned

Unlearn maladaptive behavior and learn adaptive ones

Emphasis

Conscious

Present and the future

What is Behavior Therapy?

Role of the Therapist

Teach new, more satisfying ways of behaving

Methods

Classical Conditioning techniques

Operant Conditioning techniques

Classical Conditioning Techniques

Counterconditioning is a procedure that conditions new responses to stimuli that trigger unwanted behaviors.

Exposure Therapy

Expose patients to things they fear and avoid. Through repeated exposures, anxiety lessens because they habituate to the things feared.

Exposure Therapy

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

Systematic Desensitization

A type of exposure therapy that reduces fear and anxiety by associating a new, pleasant, relaxed state with stimuli that have been causing the fear and anxiety.. Systematic Desensitization

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.

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.

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.

What is Cognitive Therapy?

Assumptions

Thoughts intervene between events and our emotional reactions.

Problem emotions result from faulty thought processes

People disturb themselves with their own thoughts

Identify maladaptive ways of thinking

Replace maladaptive ways of thinking with adaptive ways

Emphasis

Problem centered

Thinking/perceptions/beliefs

Conscious mental experiences

Cognitive Therapy

Role of therapist

Directive role

Examine thoughts

Help restructure thought processes

Methods Teach people adaptive ways of thinking and acting

Example

Beck’s Cognitive Therapy

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’s Therapy for Depression

Depression reflects maladaptive thought processes.

Depressives distort experiences & maintain negative views of themselves, the world, their future

Examples of Cognitive Distortions:

Selective perception: Depressed person focuses on negative events, while ignoring positive life events

Overgeneralization: Depressed persons draw negative conclusions about their self-worth, based on minimal data

Magnification: Person magnifies the significance of a negative event

All-or-none thinking: Everything is good or bad

Stress Inoculation Training

What is Cognitive-Behavior Therapy?

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

Ellis’ Rational-Emotive Therapy

Rational-emotive behavior therapy (REBT)

Based on the idea that irrational interpretations of life experiences are the cause of negative emotions and mental disorders.

Irrational/self-defeating beliefs involve absolutes (“musts” and “shoulds”) that allow no room for mistakes.

Musterbations irrational belief that you must do or have something

Awfulizing mental exaggeration of setbacks

Ellis’ ABC theory of emotions

A = activating event in the environment Following are 4 brief descriptions of how different therapists might approach a problem for which you have sought their help. Your task is to state or describe what kind of therapy each therapist is using to help you solve your problem.

Therapist 1:

Your therapist counsels you that it is impossible for you to be loved or cared for by all people who are significant at your job and in your community. She further urges you to abandon the irrational approach you take to interpreting the events that occur in your life.

Therapist 2:

Upon entering her office, your therapist asks you to sit down and be comfortable. She then tells you that you should speak freely, and not to worry about censoring any thoughts you may have during the therapy session. She sits behind you to minimize any eye contact--she does not wish to serve as an authority figure during your session. At one point she cautions you about becoming defensive and suggests that you might be unconsciously attempting to block her access into gaining insight into the inner workings of your thought processes.

Therapist 3:

After spending some time with your therapist, it becomes obvious to you that she believes you are making unrealistic comparisons between the person you are and the person that you would like to be. You find that she mirrors many of your statements, as if asking you to reflect upon what you have just said. At the same time, you are convinced that she holds you in high esteem, no strings attached.

Therapist 4:

After confessing to your therapist that you are horribly afraid of bees, he works with you to construct a hierarchy of stimuli that are increasingly fearful to you. Lowest in the hierarchy is reading the word buzz and the highest on the list is seeing a bee flying close to your face. Once the hierarchy is completed, he teaches how to feel relaxed to these stimuli, starting first with the stimuli to which you are least afraid.

An observation of one session with OCD patient using

Cognitive Therapy

Behavioral Therapy ( Exposure)

Drug Therapy

Group & Family Therapies

Group Therapy

Advantages of group therapy:

Economy: group therapy is less expensive

Group support: there is comfort in knowing that others have similar problems

Feedback: group members learn from each other

Behavioral rehearsal: group members can role-play the activities of the key persons in a member’s life Group therapies

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

Couples Therapy - The focus is on the relationship rather than the individual

Self-help support groups – Groups that provide social support and an opportunity for sharing ideas about common problems; may be organized by/run by laypersons (not professional therapists)

Evaluating Therapies

Who do people turn to for help with psychological difficulties?

Outcome Research

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

The Relative Effectiveness of Different Therapies

Which psychotherapy would be most effective for treating a particular problem?

Commonalities Among Psychotherapies

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

The Biomedical Therapies

Drug Therapies

Antipsychotic Drugs

Atypical Antipsychotic

Antianxiety Drugs

Antidepressant Drugs

Mood-Stabilizing Medications

Brain Stimulation

Alternatives to ECT rTMS

Can be used for the treatment of depression, schizophrenia, and bipolar disorder

Psychosurgery – The general term for surgical intervention in the brain to treat psychological disorders

A frontal lobotomy involves surgically cutting the nerves connecting the frontal lobes to the emotion-controlling centers of the inner brain