copyright © allyn & bacon 2005 1 chapter 15 therapies for psychological disorders therapies for...

Copyright © Allyn & Bacon 2005 Copyright © Allyn & Bacon 2005 11

Chapter 15Chapter 15

Therapies for Psychological Disorders

Therapies for Psychological Disorders

Copyright © Allyn and Bacon 2005. Developed and prepared by Joseph A. Davis, Ph.D. This Allyn and Bacon multimedia product and its contents are protected under copyright law. The following are prohibited by law: any public performance or display, including transmission over any network; preparation of any derivative work, including the extraction, in whole or part, of any images; any rental, lease, or lending of the program.

Copyright © Allyn and Bacon 2005. Developed and prepared by Joseph A. Davis, Ph.D. This Allyn and Bacon multimedia product and its contents are protected under copyright law. The following are prohibited by law: any public performance or display, including transmission over any network; preparation of any derivative work, including the extraction, in whole or part, of any images; any rental, lease, or lending of the program.


Q: Have you ever been to therapy? Or counseling?

Q: Have you ever been to therapy? Or counseling?


What do you think psychotherapy should be like?

What do you think psychotherapy should be like?


Goals of Major TherapiesGoals of Major Therapies

Diagnosis (DSM) 診斷 Probable Etiology 病因 Prognosis 預後 Treatment Planning 療程規劃

Diagnosis (DSM) 診斷 Probable Etiology 病因 Prognosis 預後 Treatment Planning 療程規劃


Types of Major TherapiesTypes of Major Therapies

Biomedical Therapies 生物醫學治療 : 手術 , 電擊 , 藥物等

Psychotherapy 心理治療 : 藉由心理學的方法對案主進行治療 ; 涵蓋不同取向

Biomedical Therapies 生物醫學治療 : 手術 , 電擊 , 藥物等

Psychotherapy 心理治療 : 藉由心理學的方法對案主進行治療 ; 涵蓋不同取向


Several types of therapistsSeveral types of therapists Social worker 社工 Pastoral counselor 教牧諮商 Clinical psychologist 臨床心理學家 Counseling psychologist 諮商心理學家 Psychiatrist 精神科醫師 Psychoanalyst 心理 / 精神分析師

Social worker 社工 Pastoral counselor 教牧諮商 Clinical psychologist 臨床心理學家 Counseling psychologist 諮商心理學家 Psychiatrist 精神科醫師 Psychoanalyst 心理 / 精神分析師


Therapists and Therapeutic SettingsTherapists and Therapeutic Settings

Patient 病人– Used in the biomedical approach

to treatment

Client 個案 / 案主– Used by clinicians who think

of psychological disorders as problems in living

Patient 病人– Used in the biomedical approach

to treatment

Client 個案 / 案主– Used by clinicians who think

of psychological disorders as problems in living


Historical and Cultural ContextsHistorical and Cultural Contexts Early Psychotherapy: locked up

patients as prisoners.


Historical and Cultural ContextsHistorical and Cultural Contexts

1900 年代初期 : begin to improve 1950 年代 : anti-depressants &

anti-anxiolytics - no need to live in the hospital


Psychoanalysis 精神分析 /Psychodynamic 心理動力 : Freud Internal conflicts; repressed E.g., You envy your younger sister who took

parents away; cannot show your impulse to hurt the baby; envy classmate; competition

Goal: make the unconscious conscious; gain insight


Psychoanalysis 精神分析 /Psychodynamic 心理動力 :

Free association 自由聯想

Lying on the couch – talk freely


Resistance 抗拒 :

- e.g., doesn’t talk much about “father”; changes topic; says his father is irrelevant

(e.g., silence, not answering therapist’s questions, lateness, no-show)


Transference 移情作用 : the thoughts and feelings that client has toward the therapist

positive or negative

may remind the clt of another person

therapist is like a blank slate on which the clt projects his/her feelings

different therapists – different pulls


• Countertransference 反移情作用 :

The thoughts & feelings that the therapist has toward the clt

In psychoanalysis, the therapist needs to monitor own countertransferences. (Therapists themselves receive psychoanalysis).


Structure of Psychotherapy:

- Psychoanalysis: 3 – 5 times/wk

- Psychodynamic: once/week

- 50 minutes – 60 minutes

- now: modified


Behavior TherapiesBehavior Therapies

- Based on the learning theories - Focus on the problem behaviors (e.g.

hyperactive behavior; cleaning behavior)



- E.g., fear of talking on the stage, due to your critical father,your overachieving brother

- Insight change?



Flooding 洪水猛獸法– Clients are exposed to stimuli most

frightening to them

e.g., fear of height

Flooding 洪水猛獸法– Clients are exposed to stimuli most

frightening to them

e.g., fear of height


Behavior TherapiesBehavior Therapies Systematic Desensitization 系統減敏法 : present less anxiety-

provoking objects first- Theory of reciprocal Inhibition 交互抑制 relaxation training (VCD) hierarchy of feared situations

e.g., fear of dog


Group DiscussionGroup Discussion Systematic Desensitization 系統減敏法 :

- You have a male client w/ fear of females. He likes Mary, but cannot ask her out.

- How would you use systematic desensitization to treat him?



Aversion Therapy 厭惡療法用電擊和催吐劑 , 讓個案先服催吐劑再喝

酒 , 配對數次後 , 個案就會對酒發出嫌惡反應 .

e.g., worry – rubber band

Aversion Therapy 厭惡療法用電擊和催吐劑 , 讓個案先服催吐劑再喝

酒 , 配對數次後 , 個案就會對酒發出嫌惡反應 .

e.g., worry – rubber band



Contingency Management 增強管理

– Changing behavior by modifying its consequences


– Changing behavior by modifying its consequences




e.g., good behavior: give yourself a present (positive reinforcement 正增強 )

e.g., bad behavior: clean the bathroom (punishment 懲罰 )


e.g., good behavior: give yourself a present (positive reinforcement 正增強 )

e.g., bad behavior: clean the bathroom (punishment 懲罰 )




- Token economy 代幣法


- Token economy 代幣法


Behavior TherapiesBehavior Therapies Social-learning Therapy 社會學習治療

– Clients observe models’ desirable behaviors being reinforced

有樣學樣

Social-learning Therapy 社會學習治療– Clients observe models’ desirable

behaviors being reinforced

有樣學樣


Cognitive TherapiesCognitive Therapies

Cognitive Therapy– Attempts to change feelings and behaviors by

changing the way a client thinks about life experiences

– VCD

Cognitive Therapy– Attempts to change feelings and behaviors by

changing the way a client thinks about life experiences

– VCD


Cognitive TherapiesCognitive Therapies

Aaron Beck:Aaron Beck: 認知治療認知治療

Replace the self-defeating thoughts with Replace the self-defeating thoughts with more adaptive thoughts more adaptive thoughts

Effective with depressed cltsEffective with depressed clts


Humanistic TherapiesHumanistic Therapies

Client-centered 案主中心 Therapy– Carl Rogers– Emphasizes the healthy psychological growth

of the individual– Optimistic view: Humans are basically good.

Client-centered 案主中心 Therapy– Carl Rogers– Emphasizes the healthy psychological growth

of the individual– Optimistic view: Humans are basically good.


Humanistic TherapiesHumanistic Therapies

If given the following 3 elements, clients can improve:

1) Congruence 真誠 ( 表裡一致 )

2) Unconditional positive regard 無條件的正向關懷

3) Accurate empathy 準確地同理

** Now, these are regarded as necessary but not sufficient.


Group TherapiesGroup Therapies

Marital and Family Therapy– Couples counseling– Family therapy

Community Support Groups– Self-help groups

Marital and Family Therapy– Couples counseling– Family therapy

Community Support Groups– Self-help groups


• Meta-analysis 統合分析法 :

• Length of therapy – positively associated with successful outcome

Is Psychotherapy Effective?

Research findings: Overall, yes.

Treatment groups do better than the Control groups.

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