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Ancient Treatments

exorcism, caged like animals, beaten, burned, castrated, mutilated, blood replaced with animal’s blood

History of Treatment

Trephinated Skulls

History of Treatment

Psychotherapy

an emotionally charged, confiding interaction between a trained therapist and someone who suffers from psychological difficulties

Eclectic Approach

an approach to psychotherapy that, depending on the client’s problems, uses techniques from various forms of therapy

Therapy

Developed by Sigmund Freud

based on his theory of personality

Psychoanalysis

• Aims

To try to bring repressed feelings into conscious awareness where the patient can deal with them. The theory presumes that healthier, less anxious living becomes possible when patients release the energy previously devoted to id-ego-superego conflicts.

Why is psychoanalysis a lot quicker for a man then for a women?Because when it's time to go back to childhood, a man is already there.

Therapy - Psychoanalysis

Psychoanalytic Treatment

In the Freudian system, anxiety is the main problem people face.

Anxiety is produced when sexual and aggressive impulses are repressed.

Guilt occurs when the impulses are partially expressed.

These impulses occur at the unconscious level.

Today psychoanalytic techniques are called psychodynamic or insight therapy.

•Undesirable urges and conflicts are “repressed” or pushed to the unconscious

•Unconscious conflicts exert influence on behaviors, emotions, and interpersonal dynamics

•Understanding and insight into repressed conflicts leads to recognition and resolution

Causes of Psychological Problems

Psychoanalysis - Freud believed the patient’s free associations, resistances, dreams, and transferences – and the therapist’s interpretations of them – released previously repressed feelings, allowing the patient to gain self-insight

use has rapidly decreased in recent years

Resistance - blocking from consciousness of anxiety-laden material

Therapy - Psychoanalysis

In a safe environment, people say whatever comes to mind without limiting or censoring thoughts. A trained therapist can interpret what is said and provide insights for the client.

Psychoanalytic techniques include:

Free AssociationFree Association

food

Reward

Therapy- Psychoanalysis

§ Interpretation § the analyst’s noting supposed dream

meanings, resistances, and other significant behaviors in order to promote insight

§ Transference§ the patient’s transfer to the analyst of

emotions linked with other relationships§ e.g. love or hatred for a parent

Emotional conflicts of earlier years are transferredonto the therapist. By doing this, unconscious conflicts become conscious.

TransferenceTransference

Other Dynamic Therapies

Most therapies today are shorter-term Based on goals that are specific and

attainable Therapists are more directive than

traditional psychoanalysis Traditional psychoanalysis is seldom

practiced today

Humanistic Therapy

People have the power to control their fate, ideas, and movements as they move towards self-actualization.

This therapy is now known as person (client) centered therapy.

Therapist and client are considered equal partners in therapy.

In this therapy, the client decides what is to be discussed and what direction the therapy will take.

Client-Centered Therapy

humanistic therapy developed by Carl Rogers

therapist uses techniques such as active listening within a genuine, accepting, empathic environment to facilitate clients’ growth

unconditional positive regard for clients

Humanistic Therapy

Active Listening-empathic listening in which the listener echoes, restates, and clarifies

Humanistic Approach in TherapyActive Listening-empathic listening in which the listener

echoes, restates, and clarifies

The therapist develops an atmosphere of trust and understanding.

The therapist acts as a mirror to the client, reflecting ideas and concepts.

The therapist does not judge the client. Thoughts, feelings, and ideas represent a person seeking to grow and seeking to be understood.

Humanistic Therapy (continued)

People need to accept themselves as they are, while working toward fulfilling their potential.

• Humanistic perspective emphasizes human potential, self-awareness, and free-will

• Humanistic therapies focus on self-perception and individual’s conscious thoughts and perceptions

Humanistic Therapies

• Gestalt Therapy

Developed by Fritz Perls to combine the psychoanalytic emphasis on bringing unconscious feelings to awareness and the humanistic emphasis on getting “in touch with oneself”

Aims: to help people become more aware of and able to express their feelings, and to take responsibility for their feelings and actions.

Emphasizes the importance of encouraging people to sense and express their own true moment-to-moment feelings.

Gestalt Therapy

Behavior Therapy

• Joe has been seeing a psychoanalyst for four years for treatment of the fear that he had monsters under his bed. It had been years since he had gotten a good night's sleep. Furthermore, his progress was very poor, and he knew it. So, one day he stops seeing the psychoanalyst and decides to try something different.

• A few weeks later, Joe's former psychoanalyst meets his old client in the supermarket, and is surprised to find him looking well-rested, energetic, and cheerful. "Doc!" Joe says, "It's amazing! I'm cured!""That's great news!" the psychoanalyst says. "you seem to be doing much better. How?""I went to see another doctor," Joe says enthusiastically, "and he cured me in just ONE session!""One?!" the psychoanalyst asks incredulously."Yeah," continues Joe, "my new doctor is a behaviorist.""A behaviorist?" the psychoanalyst asks. "How did he cure you in one session?""Oh, easy," says Joe. "He told me to cut the legs off of my bed."

Behavior Therapy§ Behavior Therapy

§ therapy that applies learning principles to the elimination of unwanted behaviors

§ Counterconditioning§ procedure that conditions new responses to

stimuli that trigger unwanted behaviors§ based on classical conditioning§ includes systematic desensitization and

aversive conditioning

Behavioral Therapy

Behavioral therapy attempts to change behavior using the techniques of learning.

Behaviorists assume that abnormal behaviors are the result of faulty (inappropriate) learning.

Behavior Therapy Behavioristic perspective emphasizes

that behavior (normal and abnormal) is learned

Uses principles of classical and operant conditioning to change maladaptive behaviors

Behavior change does not require insight into causes

Often called behavior modification

Behavior Therapy§ Exposure Therapy

§ treat anxieties by exposing people (in imagination or reality) to the things they fear and avoid

Behavior Therapy§ Systematic Desensitization

§ type of counterconditioning § associates a pleasant, relaxed state with

gradually increasing anxiety-triggering stimuli§ commonly used to treat phobias

§ Aversive Conditioning§ type of counterconditioning that associates an

unpleasant state with an unwanted behavior§ nausea ---> alcohol

Systematic Desensitization Based on classical conditioning Uses three steps:

Progressive relaxation Development of anxiety hierarchy and control

scene Combination of progressive relaxation with

anxiety hierarchy

Systematic Desensitization

Behavior TherapySystematic Desensitization

Systematic Desensitization

Aversion therapy for alcoholics

Behavior

Therapy

Behavior Therapy

§ Token Economy§ an operant conditioning procedure

that rewards desired behavior§ patient exchanges a token of some

sort, earned for exhibiting the desired behavior, for various privileges or treats

Cognitive Therapy

§ Cognitive Therapy § teaches people new, more

adaptive ways of thinking and acting

§ based on the assumption that thoughts intervene between events and our emotional reactions

Albert Ellis developed rational-emotive therapy. He believed that emotional upsets occur when people hold irrational ideas (contrary to logic).

Thus people are disturbed not by things but by the view we take of them.

Cognitive Behavioral Therapy

Cognitive behavioral therapy combines learned behaviors with conscious thoughts.

The therapist attempts to give the client a rational or logical view of reality.

Rational Emotive Therapy Developed by Albert Ellis ABC model

Activating Event Beliefs Consequences

Identification and elimination of core irrational beliefs

•Problems due to negative cognitive bias that leads to distorted perceptions and interpretations of events

•Recognize the bias then test accuracy of these beliefs

•Therapist acts as model and aims for a collaborative therapeutic climate

Aaron Beck’s Cognitive Therapy

The Cognitive Revolution

Cognitive Therapy

A cognitive perspective on psychological disorders

Cognitive therapy for depression

Cognitive Therapy

Cognitive-Behavioral Therapy

a popular integrated therapy that combines cognitive therapy (changing self-defeating thinking) with behavior therapy (changing behavior)

Cognitive Therapy

Comparing Cognitive Therapies

Identification of faulty belief systems

Insight into childhood conflicts,

motives, and feelings

Using free association and transference

Changing behaviors through learning

Systematic Desensitization, Aversive Conditioning, and

Token Economies

Changing irrational beliefs

Self-acceptance and self-fulfillment

A safe nonjudgmental environment to discuss

problems and unconditional positive regard

Treatment Primary Goal Methods

Psychoanalytic

Humanistic

Behavioral

Cognitive-Behavioral

Sum

mary

Chart

Family Therapy

treats the family as a system

views an individual’s unwanted behaviors as influenced by or directed at other family members

attempts to guide family members toward positive relationships and improved communication

Group and Family Therapies

•Group therapy— one or more therapists working with several people at the same time.

•Couple therapy— relationship therapy that helps with difficulty in marriage or other committed relationships

Group and Family Therapy

To whom do people turn for help for psychological difficulties?

Evaluating Psychotherapies

•Therapeutic relationship—caring and mutually respectful

•Therapist characteristics—caring attitude, ability to listen, sensitive

•Client characteristics—motivated, actively involved, emotionally and socially mature

Factors in Successful Therapy

•Most people do not seek help with problems

•Many people report spontaneous remission

•Meta-analyses show that psychotherapy is more effective than no treatment

•Generally no differences among the types of psychotherapy

Effectiveness of Psychotherapy

Regression toward the mean

tendency for extremes of unusual scores to fall back (regress) toward their average

Meta-analysis

procedure for statistically combining the results of many different research studies

Evaluating Psychotherapies

Poor outcome Good outcome

Averageuntreated

person

Averagepsychotherapy

client

Number ofpersons

80% of untreated people have pooreroutcomes than average treated person

Text

Evaluating Psychotherapies

• The Relative Effectiveness of Different Therapies

Although no one type of therapy can be said to be most effective overall, some therapies are particularly well-suited to specific disorders.

• 1. Behavioral Therapy— works best when treating specific behaviors such as phobias, compulsions, or sexual dysfunctions.

• 2. Cognitive Therapy— best treatment for depression.

• 3. Psychotherapists— increasingly offer particular treatments for specific problems.

The Relative Effectiveness of Different Therapies

Therapeutic touch

A practitioner moves their hands a few inches from a patient’s body to push the energy fields into balance. Advocates say these manipulations help heal everything from headaches to burns to cancer. Skeptics say the evidence shows no healing power beyond the placebo effect.

Evaluating Alternative Therapies

Eye Movement Desensitization and Reprocessing (EMDR)

While people imagined traumatic scenes, Francine Shapiro triggered eye movements by waving her finger in front of their eyes. 84 to 100% of the trauma victims said it worked. ...or is it another placebo effect???

Evaluating Alternative Therapies

Light-Exposure Therapy

Treatment for Seasonal Affective Disorder (SAD) – wintertime depression.

Give SAD people a daily dose of intense light and it will relieve symptoms associated with wintertime depression. This does work!

Evaluating Alternative Therapies

Hope for Demoralized People

Any therapy offers an expectation that, with commitment from the patient, things can and will get better.

Commonalities Among Psychotherapies

A New Perspective

Therapy offers new experiences that help people change their views of themselves and their behaviors. They may approach life with a new attitude.

Commonalities Among Psychotherapies

An Empathic, Trusting, Caring Relationship

Effective therapists are empathic people who seek to understand another’s experience; whose care and concern the client feels; and whose respectful listening, reassurance, and advice earn the client’s trust and respect.

Commonalities Among Psychotherapies

Culture and Values in Psychotherapy

Albert Ellis and Allen Bergin disagree about the value of self-sacrifice and marital fidelity, they both appear to agree that psychotherapists’ personal values influence the process of therapy.

Culture and Values in Psychotherapy

Therapists and their Training

§ Clinical psychologists§ Most are psychologists with a Ph.D. and

expertise in research, assessment, and therapy, supplemented by a supervised internship

§ About half work in agencies and institutions, half in private practice

Therapists and their Training

§ Clinical or Psychiatric Social Worker§ A two-year Master of Social Work graduate

program plus postgraduate supervision prepares some social workers to offer psychotherapy, mostly to people with everyday personal and family problems

§ About half have earned the National Association of Social Workers’ designation of clinical social worker

Therapists and their Training

§ Counselors§ Marriage and family counselors specialize in

problems arising from family relations§ Pastoral counselors provide counseling to

countless people§ Abuse counselors work with substance

abusers and with spouse and child abusers and their victims

Therapists and their Training

§ Psychiatrists§ Physicians who specialize in the treatment of

psychological disorders § Not all psychiatrists have had extensive

training in psychotherapy, but as M.D.s they can prescribe medications. Thus, they tend to see those with the most serious problems

§ Many have a private practice

Biomedical Therapies

§ Psychopharmacology§ study of the effects of drugs on mind and

behavior

Antipsychotic Drugs Antipsychotic Drugs The molecules of antipsychotic drugs are

similar enough to molecules of the neurotransmitter dopamine to occupy its receptor sites and block its activity.

(Thorazine, Clozapine )

Antianxiety Drugs Antianxiety Drugs Valium, Xanax, Lithium – depress nervous

system activity.

Most antidepressants work by increasing the availability of the neurotransmitters norepinephrine or serotonin, which elevate arousal and mood and appear scarce during depression.

Antidepressant Drugs

Antidepressant Drugs

Antidepressant Drugs Lithium— a chemical that provides an effective

drug therapy for the mood swings of bipolar (manic-depressive) disorders.

Prozac— (fluoxetine) blocks the reabsorption and removal of serotonin from synapses.

Zoloft— cousin to Prozac; blocks reabsorption of serotonin.

Paxil— cousin to Prozac; serotonin-uptake-inhibitor.

Anti-Depressant Medication

• First generation—tricyclics and MAO inhibitors Effective for about 75% of patients Produce troubling side effects

MAO inhibitors can have serious physiological side effects when taken with some common foods

Tricyclics caused weight gain, dry mouth, dizziness, sedation

Anti-Depressant Medication Second generation—chemically different

but no more effective than earlier drugs (Wellbutrin, Desyrel)

Selective serotonin reuptake inhibitors (SSRI)— have fewer undesirable side effects than earlier drugs

(Prozac, Paxil, Zoloft)

The emptying of U.S. mental hospitals

Biomedical Therapies

Biomedical Therapies

Biomedical Therapies

Electroconvulsive Therapy Used for severe depression Very effective for quick relief of symptoms

of severe depression (can be used until medication begins to work)

May have cognitive side effects such as memory loss

Very controversial treatment

Biomedical Therapies§ Electroconvulsive Therapy (ECT)

§ therapy for severely depressed patients in which a brief electric current is sent through the brain of an anesthetized patient

§ Psychosurgery§ surgery that removes or destroys brain tissue

in an effort to change behavior§ lobotomy

§ now-rare psychosurgical procedure once used to calm uncontrollably emotional or violent patients

Preventing Psychological Disorders Preventing Psychological Disorders

Advocates of preventive mental health argue that many psychological disorders could be prevented. Their aim is to change oppressive, esteem-destroying environments into more benevolent, nurturing environments that foster individual growth and self-confidence