Psychotherapy Ch. 15

Music: “Therapy”India Arie

“Mr. Therapy Man” Justin Nozuka

Today’s Agenda• 1. Seeking Professional Help

– When, where and how?– Which therapy works best?

• 2. Different Therapeutic Approaches:– i) Psychodynamic Therapy

• Clip illustration

– ii) Behavioural Therapies• Example of behavioural technique• Movie: Virtual Reality Therapy (5 min.)

– iii) Cognitive Therapy • Clip illustration • Distinction with CBT

– iv) Client-Centred Therapy – v) Biomedical Treatments

• Movie: Deep Brain Stimulation (10 min.)

• 3. Basic Counseling Skills

1. Seeking Professional Help: When, Where and How?

When: 1. You’re feeling significant levels of discomfort 2. Your functioning is impaired 3. Someone else tells you that you need help 4. Have have persistent suicidal thoughts

Where do you find help? Ontario Psychological Association: (416) 961-0069 Your physician can refer you Local Hospitals:

• North York General 416-756-6316• Humber River Regional 416-747-3833

Distress Centers: (416) 598-1211 or (416) 486-1456 Counseling and Development Center: 736-5297 York University Psychology Clinic: 650-8488 Free online mental health advice and information for young people:

www.yoomagazine.net How to pay?

Distinction between psychologists, psychiatrists, social workers and other “therapists”

1. Most people don’t get the help they need!

1. Which therapy works best?

• Depends on the problem• Depends on the technique• Depends on the therapist

• But overall, studies show that different therapies have comparable results

• Common therapeutic ingredients:• Alliance with the therapist * • Emotional support and empathic understanding

allowing emotional expression• Rationale for one’s problems and provision of hope • Gaining new insights and learning more adaptive

ways to relate to others and the self

2. Different Therapeutic Approaches

• All approaches differ on:– Assumptions regarding the origins of the

problem– Therapist’s stance– Method of treatment– Goals of treatment

• 2. i) Psychodynamic Therapy:– Problem: resides in unconscious conflicts,

repressed memories– Therapist: “blank-screen” – Method: free-association, dream analysis,

transference analysis– Goal: make the unconscious conscious– Case illustration:

http://www.youtube.com/watch?v=_KjmLNuyuuA&feature=related

2. Different Therapeutic Approaches

• 2. ii) Behaviour Therapy– Problem: resides in faulty learning– Therapist: examines current conditions that elicit the

problem– Method: apply learning principles to get rid of symptoms

• training/ exposure/ counter-conditioning

– Goal: alleviate symptoms/ modify behavior

2. ii) Example of behavioural techniques

• a) Systematic Desensitization:– Effective with phobias – Use “counterconditioning” – Steps:

• Set-up a hierarchy of anxiety-triggering situations

• Learn relaxation response

• Imagine least anxiety-provoking situation while maintaining a relaxed state

• Imagine more difficult situations until most difficult is imagined while maintaining a relaxed state

• Practice with real-life situations

• b) “Virtual Reality Therapy” (movie 5 min.) • Virtual reality moves into the clinician’s office

• Makes use of behavioural principle of “exposure” to treat phobias

2. iii) Cognitive Therapy– Problem: is a function of the way you think– Therapist: more directive and challenging– Method: Challenge your automatic thoughts and underlying beliefs

• Use of homework exercises

– Goal: Realistic thinking/ Better perspective– p. 672

2. iii) Cognitive Therapy (cont’d)

– Examples of cognitive techniques• Clip: The case of Tim• http://www.youtube.com/watch?v=LIzm4jiyvXI&feature=related

– Cognitive-Behaviour Therapy (CBT):• Combines elements of both cognitive and behavioural therapies• Recommended for depression and anxiety• http://www.youtube.com/watch?v=B5Z-dvL-qo8

– Mindfulness-based cognitive therapy:• Learn to watch the contents of your consciousness and to label

thoughts and feelings• Prevents people from spiraling down and ruminating (getting

“caught” in their dysfunctional thinking)

2. iv) Client-Centered Therapy – Problem: incongruence with one’s true

self– Therapist: Non-directive, genuine,

empathic and unconditional – Method: therapeutic relationship allows

fuller experiencing and greater acceptance of the self

– Goal: self-actualization / greater congruence

– Clip with Carl Rogers• http://www.youtube.com/watch?v

=HarEcd4bt-s&feature=related

2. v) Biomedical Approach

– Problem: • Chemical imbalance/ Structural abnormalities in the brain

– Therapist: • Medical doctor (family or psychiatrist) will monitor

symptoms and adjust medication/ monitor treatment

– Method: psychopharmacological drugs• Depression: Antidepressants, ECT• Bipolar Disorders: Mood stabilizers • Anxiety: Tranquilizers• Schizophrenia: Anti-psychotics

– Goal: reduce symptoms– Movie: “Deep Brain Stimulation” (10 min.)

• A new invasive brain surgery to alter patterns of thinking and emotions

• Impressive results with treatment resistant cases

3. Basic Counseling Skills

• Or how to better help your family and friends:– Active listening: really listen

• Try to avoid giving advice or telling the person what to do

– Avoid judgment• Better not expressed

– Clarify the problem– Empathize with the feelings– Maintain confidentiality!

4. See you next week!