<p> Chapter 17: Therapies</p><p>Psychotherapy: any psychological technique that can bring about positive changes in personality, behavior, adjustment -usually verbal interaction between mental health professional and clients</p><p>Individual therapy vs. group therapy</p><p>Insight therapy</p><p>Directive therapy</p><p>Nondirective: therapist assists but doesn’t advise</p><p>Support vs. personal change</p><p>Good improvement for phobias, low self-esteem, some sex problems, marital conflicts</p><p>Origins of therapy -primitive: demons, superstitions -bore holes into head</p><p>1793: regarded as “mentally ill” and given compassionate treatment</p><p>Freud: created first true psychotherapy</p><p>Psychoanalysis today: improvement in most clients -unconscious conflicts</p><p>Humanistic Therapies -restoring human potential</p><p>Client-Centered Therapy -Rogers: conscious thoughts and feelings -nondirective -therapists creates a safe “atmosphere of growth”</p><p>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</p><p>-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</p><p>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</p><p>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</p><p>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</p><p>Behavior Modification -any use of classical or operant conditioning to directly alter behavior</p><p>Classical Conditioning -form of learning in which simple responses (esp. reflexes) are associated with new stimuli</p><p>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</p><p>Desensitization: one of most successful behavioral treatments --hierarchy: rank-ordered series of steps -reciprocal inhibition: using 1 emotional state to block another -phobias</p><p>-construct hierarchy -taught relaxation -perform least disturbing item on list -in vivo</p><p>-vicarious desensitization -observe model perform feared behavior</p><p>-virtual reality exposure -present computerized fear stimuli in controlled fashion</p><p>Operant Therapies -positive reinforcement -non-reinforcement -extinction -punishment -shaping -stimulus control -time-out</p><p>Nonreinforcement and extinction -undesirable behavior can be extinguished by identifying and removing reinforcers that maintain it. 4</p><p>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</p><p>Cognitive Therapy -helps clients changed thinking patterns that lead to troublesome emotions or behaviors -useful for depression</p><p>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</p><p>-identify and keep track of beliefs that lead to depression -look for information to challenge them -teach clients coping skills</p><p>REBT (Rational emotive behavior therapy) -change irrational beliefs that lead to depressions: Ellis -Activating experience leads to Beliefs leads to emotional Consequence</p><p>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.</p><p>Group Therapy -done with more than 1 person -support from those with similar problems -lower cost -example: A.A.</p><p>Psychodrama -act out personal conflicts with other group members 5</p><p>Role-Playing: re-enactment of significant life events Role reversal</p><p>Mirror technique: observe another person enact one’s own behavior</p><p>Family Therapy: problem with a family vs. individual</p><p>Sensitivity groups: increased self-awareness; “trust walk”</p><p>Encounter groups: tearing down defenses and false fronts -honest expression of feelings</p><p>9 out of 10 people who sought treatment said it improved their lives 50% felt better in 2 months</p><p>Core features of psychotherapy -goals: - increased hope, courage, optimism -resolve conflicts -increased sense of self -find purpose -mend interpersonal relationships -change unacceptable behavior patterns</p><p>-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</p><p>Future -more short-term -more M.A. level practitioners -more internet -decreased use of psychiatrists and psychoanalysts</p><p>Behaviors that help -active listening/reflect feelings -acceptance -open-ended questions -respect -patience 6</p><p>Behaviors that hinder -probing painful topics -judging/moralizing -criticism -rejection -blaming</p><p>Clarify problem Don’t give advice Confidentiality</p><p>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</p><p>ECT : Electro-Convulsive Therapy (shock therapy) -used for depression -temporary improvement -permanent memory loss</p><p>Psycho-surgery: irreversible</p><p>Hospitalization -for major mental disorders -away from problems -mean stay of 20 days now vs. 3 to 4 months 20 years ago</p><p>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</p>