Chapter 16 Flashcards
What is psychotherapy?
A psychological intervention designed to help people resolve emotional, behavioral, and interpersonal problems and improve the quality of their lives
Who practices psychotherapy?
Clinical psychologists, psychiatrists, counselors, and social workers are the bulk of the mental health field;
Paraprofessionals vs professinals
Little to no difference in effectiveness between experienced and novice therapists
Still advantages to seeking a professional therapist:
*Some measure of quality control
*Use empirically backed treatments
*More training in ethics
*Breadth and depth of treatment expertise
Qualities of effective therapists
Warm and direct
Establish a positive working relationship
Tend not to contradict clients
Select important topics to focus on in session
Match treatments to needs of clients
What are insight therapies?
Psychotherapies where the goal is to expand awareness or insight (example: psychodynamic and humanistic therapies)
What is psychodynamic therapy?
- Believe that abnormal behaviors stem from adverse childhood experiences
- Analyze avoided thoughts and feelings; wishes and fantasies; significant past events; and the therapeutic relationship
- Believe that symptoms will vanish when clients gain insight into unconscious material
What is psychoanalysis?
Made by freud
- Goal is to decrease guilt and frustration and make the unconscious conscious
- Tries to bring to awareness previously repressed impulses, conflicts, and memories
Techniques of psychoanalysis?
Free association: Interpretation: Dream analysis: Resistance: Transference: Working through:
What is neo-freudian school of thought?
- analyzed the conscious aspects of functioning
- Emphasize the impact of cultural and interpersonal influences on behavior
- More optimistic; emphasize needs for power, love, and status (not just sex and aggression)
Evaluation of psychodynamic therapies
- Research shows that insight is not necessary to relieve distress.
- Many claims difficult to falsify.
- Research shows no evidence for repressing hurtful memories.
- not effective for all disorders
- better than no therapy, less effective than cognitive-behavioral therapy
Humanistic Therapies
- insight therapy
- Development of human potential
- Belief that human nature is basically positive
- Importance of taking responsibility for our lives and living in the present
Person-Centered
Non-directive form of therapy by Carl Rogers that encourages clients to direct the course of their therapy to increase awareness and heightened self-acceptance
*To ensure positive outcome, therapist must:
Be authentic and genuine
Express unconditional positive regard
Show emphatic understanding
What are the desired outcomes of person-centered therapy
Think more realistically
Become more tolerant of others
Engage in more adaptive behaviors
Gestalt Therapy
Aims to integrate differing and sometimes opposing aspects of clients’ personalities into a unified sense of self
Recognizes the importance of awareness, acceptance, and expression of feelings
*2 chair technique - talk to an imaginary person in another chair
Humanistic therapy evaluated
- Core concepts are generally difficult to falsify.
- BUT Rogers was pretty on-the-mark about the importance of the therapeutic relationship (sometimes even more important than the actual therapy)
- more effective and no treatment, mixed compared to other
Group Therapies
Range from 3-20 people; can be efficient, time-saving, and less costly than individual
Effective for a wide range of problems and about as helpful as individual treatments
Alcoholics Anonymous
- Range from 3-20 people; can be efficient, time-saving, and less costly than individual
- Effective for a wide range of problems and about as helpful as individual treatments
Alternatives to AA
*Controlled drinking programs encourage people to set limits and drink moderately.
*Can be effective for many people
*Relapse prevention treatment assumes people will “slip up” and plans accordingly.
Lapse does not equal relapse.
Family Therapies
- See most psychological problems as rooted in a dysfunctional family system
- The “patient” is the whole family system, not one individual.
- Focus on interactions among family members
Family Therapies
- Structural family therapy has the therapist immerse herself in the family to remove barrier to communication
- Group and Family are more effective than no treatment and at least as effective as individual therapy
Cognitive-Behavioral Approaches
*Behavioral therapists focus on specific problem behaviors and the variables that maintain them.
*Assume that behavior change results from the application of basic principles of learning
*Use a wide variety of behavioral assessment techniques
Observation, pencil/paper, etc.
Exposure Therapies
- Confronts clients with what they fear with the goal of reducing the fear
- Earliest was systematic desensitization
- > gradually exposes clients to anxiety producing situations through the use of imagined scenes.
Systematic Desensitization
- Based on principle of reciprocal inhibition - we can’t be anxious and relaxed at the same time
- Uses counterconditioning by repeatedly pairing an incompatible relaxation response with anxiety
- Can use imagined and actual exposure to the fear situations listed on a hierarchy created at the start of therapy
Systematic Desensitization Evaluated
- Dismantling research showed that no single component was essential.
- Led to development of exposure with response prevention and flooding
- Very effective for many anxiety disorders, like phobias, OCD, and PTSD
Modeling In Therapy
- observational learning as participant modeled by the therapist:
- Model a calm encounter with the client’s feared object or situation
- Guide the client through the steps of the encounter until she can cope unassisted
- Used in assertion and social skills training, along with behavioral rehearsal
Operant Procedures
- Token economies reward clients for desirable behaviors with tokens to exchange for items.
- Mixed support for the use of aversion therapies (e.g., Antabuse and alcohol)
Cognitive Behavior Therapy 3 assumptions
- Cognitions are identifiable and measurable.
- Cognitions are key in both healthy and unhealthy psychological functioning.
- Irrational beliefs or thinking can be replaced by more rational and adaptive cognitions.
Rational Emotive Behavior Therapy
- Developed by Albert Ellis starting in 1950s
- Emphasizes changing how we think, as well as how we act
- How we feel about the consequences of an event is determined by our beliefs or opinions.
- May use behavioral tasks to dispute the beliefs and reveal the belief as irrational
Rational Emotive Behavior Therapy Steps
Activating Event -> Beliefs -> Consequences - > dispute the beliefs -> adapt more effective ones
Beck’s Cognitive Therapy
Focuses on identifying and then modifying distorted thoughts and long-held core beliefs
Works very well for depression; some evidence of success with bipolar disorder and schizophrenia
Therapies that focus on acceptance
- Often teach meditation and “mindfulness”
- Highly eclectic; remains to be seen if these are superior to established CogBehaT methods
- Some have raised concerns they are overhyped and that existing evidence is not convincing
Cognitive Behavioral Evaluated
- More effective than no or placebo treatment
- At least as or more effective than psychodynamic and humanistic therapies
- At least as effective as drug therapies for depression
- In general, CBT and BT are equally effective for most problems.
Psychtherapy
Prior to 1970s, considerable controversy
Meta-analysis studies now show that therapy does work.
Most Effective Therapy
*Most do equally well with the common trend of changing mindset, emotional bond, etc
*Behavioral Therapy and CBT consistently outperform in many areas like behavior problems, anxiety disorders
*Some treatments can be harmful:
“Scared Straight” programs
DARE
Recovered-memory techniques
Empirically Support Treatment
- EST lists contain effective treatments for specific disorders:
- *EX: Behavior Therapy and CBT for anxiety, depression
- Some pushback because not everything has been sufficiently researched yet; many therapists don’t rely heavily on strict EST
Biomedical Treatment
*Attempt to directly alter the brain’s chemistry or physiology
*Psychopharmacotherapy is the use of medications
*Generally, psychiatrists prescribe them.
*Medications available for many disorders today
Antidepressants for depression (Prozac)
Mood stabilizers for bipolar disorder
Etc
Psychopharmacotherapy
*Often don’t know EXACTLY how they work
Ex: Prozac helps treat depression by increasing serotonin – but we don’t know how much serotonin is “optimal”
*Often don’t know exactly the correct dosage
*Some “trial-and-error” involved to maximize effectiveness and minimize side effects.
*Should be weary of polypharmacy
*Always report all medications to your doctor
Some concern about overprescription
Psychopharmacotherapy Evaluated
In many cases, therapy alone can produce as good or better.
- Clear advantages to combining meds and therapy when: Symptoms interfere greatly with functioning
- Therapy alone hasn’t worked for a 2 month period
Electroconvulsive Therapy (ECT)
- Electrical pulses administered to induce seizure.
- Used for severe disorders that have resisted other treatments (severe depression, schizophrenia)
- *Basically a last-resort
- However, modern ECT is NOT how it is portrayed in movies:
- *Patients are given muscle relaxants and anesthetics before hand, so it is not violent or painful (A Beautiful Mind)
- *Lasting effects are typically positive, and side-effects are typically not severe
Electrical Stimulation Therapy
Some new methods are being developed involving direct stimulation of the brain:
- *Vagus nerve and transcranial magnetic stimulation are both FDA-approved for treatment-resistant depression.
- Little evidence thus far on effectiveness
Psychosurgery
- Brain surgery to treat psychological disorders, like prefrontal lobotomies
- Used today as an absolute last-last resort with a handful of conditions:
- Severe OCD, depression, bipolar disorders
