ICL 10.7: Psychotherapy

Question 1

which therapies are biological therapies?

Answer 1

1. medication therapy
2. electroconvulsive therapy
3. psychosurgery/psychostimulation

Question 2

which therapies are psychotherapies?

Answer 2

1. self-help/online mobile app
2. psychodynamic/behavior/cognitive/humanistic
3. hospital/residential assistance

Question 3

how is psychotherapy different than talking to the bartender or the barber?

Answer 3

they don’t help resolve problems

venting makes you feel good for a few hours but it’s not lasting

Question 4

what are psychotherapies?

Answer 4

all psychotherapies involve:

1. a helping relationship –> there has to be relationship between the patient and physician
2. systematic interaction based on a theoretical viewpoint ( which could be exploring unconscious, facilitating insight, action oriented, applying learning principles and more . . .)
3. use of behavioral science/psychological principles from personality, learning, developmental, and abnormal psychology to treat emotional, behavioral, social and cognitive problems

Question 5

what brain changes happen after psychotherapy for depression, anxiety, borderline personality disorder?

Answer 5

therapies change the brain just as much as medications!!

Question 6

what are the 2 psychodynamic approaches?

Answer 6

psychodynamic approaches stem from hidden inner conflicts –> conflict between what we want and the constraints placed on us by others and the self; conflicts originate in childhood and if not resolved, lead to adult dysfunctional behavior

psychodynamic theory talks about how the unconscious has a very powerful effect on our behaviors and emotions

there’s no behavior without a cause –> psychodynamic approaches say the cause is always internal: id, ego, superego or childhood traumas

psychodynamic approaches try to uncover those unconscious feelings, thoughts, events, etc. –> what are defending against? what is the conflict going on inside you?

1. psychoanalysis
2. psychodynamic

Question 7

what is psychodynamic therapy?

Answer 7

understanding conflict area and particular defense mechanisms used, making unconscious, conscious

provide insight into hidden conflicts by bringing them to the surface

every 1-2 weeks for 4-12 months

Question 8

what is psychoanalysis?

Answer 8

resolution of symptoms and major reworking of personality structures related to childhood conflicts

psychoanalysis tears things down and takes a slow time to build things back up; it’s very intense

2-3 x week, 3-10 years

Question 9

what do you do during psychodynamic therapy?

Answer 9

1. identify defense mechanisms
2. identify patient resistance
3. free association/projection

“when i say mom, you say…”

4. dream analysis
5. interpretation of the patient’s problems by the therapist –> if the patient says their boss is demanding you could say it reminds you of his demanding relationship from his dad
6. transference/counter transfers

Question 10

what is is the rorschach test?

Answer 10

the inkblots!!

you ask the patient what they see and interpret what they see so you can try to understand their unconscious so you can understand their problems

the problem is there aren’t a lot of empirical findings but people still use it

a type of psychodynamic therapy

Question 11

what is the thematic apperception test?

Answer 11

TAT is again what do you see in a picture/scene?

again, there isn’t a ton of empirical evidence but it can reveal unconscious thoughts/problems of the patient

a type of psychodynamic therapy

Question 12

what is the behavioral approach?

Answer 12

it stems from faulty learning: inappropriate/dysfunctional emotional and physiological conditioned responses

the goal of the behavioral approach is dysfunctional behavior is learned through conditioning/ reinforcement so treatment is based on unlearning inappropriate behaviors/emotional responses and learning appropriate behaviors/emotional responses

something in the environment is triggering a behavior; if someone is struggling with alcohol withdrawal, driving past his favorite bar will trigger a relapse – so this is an environmental trigger that’s a conditioned response and if you can figure out the links then you can work towards breaking them!

Question 13

what are the strategies used during behavioral therapy?

Answer 13

you are trying to accomplish extinction of classically and operantly conditioned responses; you can do this through:

1. aversion therapy: reduce unwanted behavior by pairing it with an unpleasant stimulus
2. exposure, flooding: alleviating fears and phobias (conditioned responses) by using extinction
3. systematic desensitization: reducing fear and anxiety through planned, systematic exposure to fear but also include some level of relaxation/calming strategy –> associate fear with relaxation!
4. observational learning: use of modeling
5. relaxation/biofeedback

Question 14

what is exposure?

Answer 14

it’s a type of behavior therapy

extinguish behavior/ emotional response (e.g., fear) by “exposing” one to the stimulus, long enough to learn nothing bad happens

usually “gradual” exposure (systematic desensitization)

Question 15

what is flooding?

Answer 15

it’s a type of behavior therapy

exposure is all at once and person “flooded” with emotion (e.g., fear)

Question 16

what is habituation?

Answer 16

it’s a type of behavior therapy

the result of exposure

it’s a decreased response to a stimulus; this means one is habituated (has adapted) to feared stimulus and begins to associate arousal with calmness or relaxation

Question 17

what is exposure therapy used to treat?

Answer 17

1. phobias (flying, elevators, needles, MRI’s, dentist drill, thunder, public spaces etc.)
2. PTSD
3. OCD
4. social anxiety

Question 18

what is systematic desensitization used to treat?

Answer 18

1. sensitive to physical sensations, i.e. panic

2. use of relaxation with exposure to feared sensations

Question 19

what are the goals fo behavior therapy?

Answer 19

1. remove reward for unwanted response
   ex. tantrums (children/adults) or pain behavior (grimacing, groans, posture)
2. sometimes a “new” response must be taught/rewarded to replace inappropriate response
3. selectively reinforce appropriate behavior
4. biofeedback: systematic positive feedback (operant conditioning)
5. token economy

Question 20

how is behavioral therapy different from psychodynamic therapy?

Answer 20

behavioral therapy:

1. does not emphasize insight and self awareness; it’s not looking at your childhood, it’s looking at now and what needs to change now to alter the current behavior you’re struggling with
2. emphasis on external/environmental factors; what’s going on in the environment that’s reinforcing my behaviors and how can i break this association
3. emphasizes the influence of external stimuli as rewards/punishments or conditioned responses (classical conditioning)

Question 21

what is cognitive therapy?

Answer 21

it’s about your thoughts; it stems from distorted patterns of thought, irrational, incorrect beliefs about self, future and the world (Cognitive Triad) which all result in dysfunctional behaviors and emotions

the goal of cognitive therapy is to change feelings and behaviors by changing self-defeating thoughts, beliefs

if i go around saying the material is too hard and you can’t do it, you won’t have a good day and emotionally you won’t do well – the question is, is that thought an honest, realistic thought?

so cognitive therapy looks at your thinking and try to decide how realistic or helpful is that thinking?

Question 22

what is the general strategy used by physicians during cognitive therapy?

Answer 22

the general strategy is to encourage expression of “thoughts” along with feelings when negative life events occur

distinguishes between feeling appropriately and helpfully concerned, sorry, sad, frustrated and feeling inappropriately and destructively panicked, depressed, enraged and self-pitying

Question 23

what are the strategies used during cognitive behavior?

Answer 23

1. question the evidence for patient’s thoughts, beliefs (never question the feelings/emotions)
2. label distortions; cognitive errors/bias, catastrophize, black or white all-or-nothing thinking, defense mechanisms
3. socratic questioning, collaboration
4. explain how thoughts can precipitate feelings; the thoughts that elicit certain feelings are called into question (are you reallyyyy going to die?)
5. distinguish thoughts from facts
6. rate the degree of emotion and the strength of the related belief; how much do they really believe what they’re thinking?
7. categorize the distortion in thinking; emotional reasoning, catastrophizing, perfectionism

Question 24

what is the cognitive triad?

Answer 24

people think unrealistically about themselves, their world and their future = cognitive triad

they need help to see their distortions

so cognitive therapy does not focus on origins but on the here-and-now

Question 25

what is rational emotive therapy?

Answer 25

people can be irrational being and they need to be TOLD they are irrational

this is a different form of cognitive therapy

Question 26

what is humanistic psychotherapy?

Answer 26

it’s about achieving one’s potential, personal growth, having meaning and purpose; this is an existential therapy!

it stems from not living up to ones felt potential or personal growth being blocked

the goal is to eliminate unrealistic conditions of worth; the change is chosen and directed by patient – goal of achieving enhanced levels of personal fulfillment

Question 27

what are the strategies used during humanistic therapy?

Answer 27

self awareness and personal growth flourish in an atmosphere of:

1. genuineness
2. unconditional positive regard
3. empathetic understanding

contrary to psychodynamic therapy, the therapist does not:

1. direct the patient
2. make decisions for the patient
3. offer solutions

the therapist is a guide!

Question 28

what are the types of group therapy?

Answer 28

1. psychotherapy group
2. psycho-education grou
3. support/self help group

Question 29

what is a psychotherapy group?

Answer 29

usually time-limited, led by a professional therapist

it’s collaborative

Question 30

what is a psycho-education group?

Answer 30

provide forum to inform individuals about their illness and strategies for better managing illness

Question 31

what is a support/self help group?

Answer 31

members come together to offer social and emotional support around a shared illness/problem

so it’s a group run by patients themselves

Question 32

what is couples/marital therapy?

Answer 32

the “relationship” is the patient!

you’re not putting one patient under the microscope while not criticizing the other; the relationship is the focus!

Question 33

what are characteristics of a good relationship?

Answer 33

1. foundation of affection and friendship
2. validation

respecting partners opinion/feelings, compromising often, resolving disagreement

2. positive expression
   a 5:1(or better) compliment-criticism ratio is optimal – as the ratio decreases, marriage satisfaction decreases
3. presence of conflict relatively unimportant

Question 34

what are the goals of couples/marital therapy?

Answer 34

1. help partners negotiate behavior change
2. teach more effective communication skills
3. encourage honest positive expression
4. acceptance (interrupting partners’ attempts to change each other)
5. identify exceptions to the problem and reinforce strengths in the couple’s relationship

Question 35

what are the techniques used during couples/marital therapy?

Answer 35

1. maintain balanced approach (don’t show favoritism)

2. the couple talk to each other, not the therapist

Question 36

what is family therapy?

Answer 36

family “interactions” are focus of therapy

Question 37

what are the contributors to family problems?

Answer 37

1. marital conflict between parents
2. dysfunction in one spouse
3. impairment of one or more children
4. emotional distance

Question 38

what is the family systems theory?

Answer 38

one member impacts all others

systems tend to seek homeostasis

if you have family with a sibling in college not participating in therapy, when they come home on the weekends they’re going to pull towards things going back to the way they used to be so that’s why it’s so important that all family members are involved in therapy

Question 39

what is the focus of family therapy?

Answer 39

1. family members have roles

Mom, dad, child, responsible one, clown etc. –> make them aware and break down roles

2. families have unspoken rules

How is love/compassion/empathy expressed? How is disagreement/anger expressed? How are decisions made? How one expresses self/interacts with those outside family How is homeostasis maintained?

Question 40

Jake is a freshman at UT. He is struggling in classes. He has a hard time studying. There is little motivation and he has a hard time focusing. He is enjoying himself as he is involved in sports and active with many friends.

what is the humanistic, psychodynamic, behavioral, vs. cognitive approach to this?

Answer 40

humanistic = Do you want to be here? What do you want for yourself? What do you value?

psychodynamic = urges and desires driving behavior; ego not fully developed; conscious desire to succeed at UT, unconscious desire to just have fun, feels competing against father, trying to please mother

behavioral = sports being reinforced, studying currently not

cognitive = distorted thoughts/beliefs: I’ll never get this stuff, I might as well drop out; Everyone is doing better than I am. I’m such a screw-up. Dad’s right, I will never amount to much.