Therapies

Chapter 15:

Human AdjustmentJohn W. Santrock

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Chapter Outline

Biological Therapies

Psychotherapies

Sociocultural Approaches and Issues in Treatment

Evaluating Therapy

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Learning Goals

1. Describe the biological therapies

2. Characterize four types of psychotherapy

3. Explain sociocultural approaches and issues in treatment

4. Evaluate the effectiveness of therapy

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BIOLOGICAL THERAPIES

Drug therapy

Electroconvulsive Therapy

Psychosurgery

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Therapy

Biological therapy = treatment to reduce or eliminate symptoms of psychological disorders by altering the way an individual’s body functions

Psychotherapy = process used by mental health professionals to help individuals recognize, define, an overcome psychological and interpersonal difficulties

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Drug Therapy - Antianxiety Drugs

Antianxiety drugs = commonly known as tranquilizers; drugs that reduce anxiety by making individuals calmer and less excitable

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Drug Therapy - Antianxiety Drugs

Benzodiazepines - relieve anxiety symptoms by binding to receptor sites of neurotransmitters that become overactive during anxiety–Most frequently prescribed benzodiazepines include Xanax,

Valium, Librium

–Side-effects of benzodiazepines include addiction, drowsiness, loss of coordination, fatigue

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Drug Therapy - Antidepressant Drugs

Antidepressant drugs = drugs that regulate mood

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Drug Therapy - Antidepressant Drugs

Three main classes of antidepressant drugs:– tricyclics (Elavil) - increase norepinephrine and serotonin

–MAO inhibitors (Nardil) - not as widely used because of interactions

–SSRI drugs (Prozac, Paxil, Zoloft) - inhibit reabsorption of serotonin (selective serotonin reuptake inhibitors)

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15-10Figure 15.1 How the

Antidepressant Prozac Works

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Drug Therapy - Lithium

Lithium helps reduce mood swings

Lithium = drug used to treat bipolar disorder

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Drug Therapy - Antipsychotic Drugs

Antipsychotic drugs = drugs that diminish agitated behavior, reduce tension, decrease hallucinations, improve social behavior, and produce better sleep patterns in individuals who have a severe psychological disorder, especially schizophrenia

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Drug Therapy - Antipsychotic Drugs

Neuroleptics are the most widely used antipsychotic drugs– reduce level of the neurotransmitter dopamine in the brain

Atypical antipsychotic drugs block reuptake of serotonin–Two atypical antipsychotic drugs include Clozaril and

Risperdal

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Electroconvulsive Therapy (ECT)

Patient is given anesthesia and muscle relaxants before treatment, so patient has no memory of it

ECT is effective for these who do not respond to other therapies

Electroconvulsive therapy = treatment used to treat severely depressed individuals; treatment causes seizure in the brain

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Psychosurgery

Psychosurgery = biological therapy that involves removal of brain tissue to improve individual’s adjustment

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Review - Learning Goal 1

–What types of drugs are most often used to treat anxiety disorders, mood disorders, and schizophrenia?

–What is electroconvulsive therapy and when is it used?

–What is psychosurgery?

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PSYCHOTHERAPIES

Psychodynamic Therapies

Humanistic Therapies

Behavior Therapies

Cognitive Therapies

Integrative Therapy

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Psychodynamic Therapies

Goal of psychodynamic therapies is to help individuals recognize maladaptive ways of coping and the sources of their unconscious conflicts

Psychodynamic therapies = therapies that stress importance of unconscious mind, extensive interpretation by the therapist, and the role of early childhood years

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Freud’s Psychoanalysis

Client’s current problems can be traced to early childhood experiences involving conflicts

Interpretation important - therapist searches for symbolic, hidden meaning

Psychoanalysis = Freud’s psychotherapeutic technique for analyzing an individual’s unconscious thoughts

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Freud’s Psychoanalysis

Free association - psychoanalytic technique of having individuals say aloud whatever comes to mind

Catharsis - release of emotional tension when reliving emotionally charged and conflict-filled experience

Dream analysis - psychotherapeutic technique used by psychoanalysts to interpret a dream–Psychoanalysts believe dreams contain information about

individual’s unconscious thoughts and conflicts

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15-21Figure 15.4 Freudian Interpretation of

Sexual Symbolism in Dreams

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Freud’s Psychoanalysis

Resistance - psychoanalytic term for person’s unconscious defense strategies that prevent analyst from understanding the person’s problems–Resistance occurs because it is painful to bring conflicts into

conscious awareness

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Freud’s Psychoanalysis

Transference - psychoanalytic term for person’s relation to the analyst in ways that relive important relationships in the person’s life–Transference can reveal how individuals relate to important

people in their lives

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Contemporary Psychodynamic Therapies

Today, individuals in psychodynamic therapy:– face the therapist–have weekly appointments–undergo therapy for a shorter period of time

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Contemporary Psychodynamic Therapies

Currently, psychodynamic therapists emphasize (in addition to the unconscious mind):– the conscious mind– relationships– social contexts

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15-26Adjustment Strategies

Based on Psychodynamic Therapies

1. Recognize that the reasons for your good or poor adjustment are likely beyond conscious awareness

2. Examine your childhood experiences in your family

3. Explore whether you are relying too heavily on defense mechanisms

4. Realize that different psychodynamic therapies offer different approaches to adjustment

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Humanistic Therapies

Insight therapy = therapy that encourages insight and self-awareness; includes both psychodynamic and humanistic therapies

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Humanistic Therapies

Humanistic therapies emphasize:– conscious rather than unconscious thought– the present rather than the past–growth and self-fulfillment rather than illness

Humanistic therapies = insight therapies that encourage people to understand themselves and to grow personally

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Client-Centered Therapy

Developed by Carl Rogers (1961)

Client-centered therapy = Rogers’ humanistic therapy in which the therapist provides a warm, supportive atmosphere to improve the client’s self-concept and encourage the client to gain insight about problems

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Client-Centered Therapy

Unconditional positive regard - therapist creates a warm and caring environment and never disapproves of the client

Therapist’s role is nondirective

In addition to unconditional positive regard, client-centered therapy involves:–genuineness - let client know therapist’s feelings

–active listening - give total attention to what person says

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Gestalt Therapy

Developed by Fritz Perls (1969)

Therapist pushes clients to decide whether they will continue to allow the past to control their future

Gestalt therapy = Perl’s humanistic therapy in which the therapist challenges the client to help them become aware of their feelings and to face their problems

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Gestalt Therapy

Gestalt therapists encourage clients to:–be open about their feelings

–develop self-awareness

–be themselves

–develop a sense of freedom

– look at what they are doing with their lives

To stimulate change, therapist often openly confronts client

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Behavior Therapies

Behavior therapists offer action-oriented strategies to help people change what they are doing

The maladaptive symptoms are the problem

Behavior therapies = use principles of learning to reduce or eliminate maladaptive behavior

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Applications of Classical Conditioning

Systematic desensitization steps include:–develop a hierarchy of least fearful to most fearful situation

to teach the individual how to relax

– start at the lower end of the hierarchy and work your way up

Systematic Desensitization = treats anxiety by getting the person to associate deep relaxation with increasingly intense anxiety-producing situations

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Applications of Classical Conditioning

Aversive conditioning - used to teach people to avoid behaviors such as smoking, eating, and drinking

Aversive conditioning = repeated pairings of an undesirable behavior with aversive stimuli to decrease the behavior’s rewards

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15-36Figure 15.6 Classical Conditioning: the

Backbone of Aversive Conditioning

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Applications of Operant Conditioning

Behavior modification = application of operant conditioning principles to change human behaviors, especially to replace unacceptable, maladaptive behavior with acceptable adaptive behaviors

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Applications of Operant Conditioning

Token economy - system in which desired behaviors are reinforced with tokens that later can be exchanged for desired rewards

Token economies are used in:– classrooms

– institutions for the mentally retarded

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Cognitive Therapies

Cognitive therapies:– focus more on overt symptoms

–provide structure to individual’s thoughts

–are less concerned about origin of problem

Cognitive therapies = emphasize that the individual’s cognitions are the main source of abnormal behavior and psychological problems

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Cognitive Therapies

Cognitive therapists: –aim for cognitive restructuring (changing a pattern of

thought)

–guide individuals to identify irrational and self-defeating thoughts

–use techniques to help clients:

-challenge these thoughts

-consider different, more positive ways of thinking

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Rational-Emotive Behavior Therapy

Goal of REBT is to get person to eliminate self-defeating beliefs by rationally examining them

Rational-emotive behavior therapy (REBT) = based on Albert Ellis’ assertion that individuals develop a psychological disorder because of their beliefs, especially those that are irrational and self-defeating

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Beck’s Cognitive Therapy

Aaron Beck’s (1976) cognitive therapy resembles an open-ended dialogue in which the therapist helps individuals to:– reflect on personal issues

–discover their own misconceptions

– try out unbiased experiments that reveal the inaccuracies of their beliefs

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Beck’s Cognitive Therapy

Illogical thinking can lead an individual to errors:–perceive world as harmful

–overgeneralize on the basis of limited examples

–Magnify the importance of undesirable events

–engage in absolutist thinking

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15-44Adjustment Strategies

Based on Beck’s Cognitive Therapy

1. Keep records of thoughts and emotional reactions2. Engage in thought stopping3. Examine options and alternatives4. Question the evidence5. Become positively distracted6. Decatastrophize7. Fantasize consequences8. Turn adversity into advantage

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Cognitive Behavior Therapy

Self-efficacy is an important goal of cognitive behavior therapy

Cognitive behavior therapy = consists of a combination of cognitive therapy and behavior therapy

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15-46Adjustment Strategies

Self-Instructional Methods

1. Preparing for stress or anxiety

2. Confronting and handling anxiety or stress

3. Coping with feelings at critical moments

4. Reinforcing self-statements

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Integrative Therapy

Integrative therapy = combination of techniques from different therapies based on the therapist’s judgment of which particular techniques will provide the greatest benefit for the client

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Integrative Therapy

Move toward integrative therapy includes factors such as:–proliferation of therapies

– inadequacy of a single therapy to be relevant to all clients and all problems

– lack of evidence that one therapy is better than others

– recognition that therapy commonalities play an important role in therapy outcomes

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Review - Learning Goal 2

–What is psychodynamic therapy?

–How do the humanistic therapies of Rogers and Perls differ?

–How are classical conditioning and operant conditioning applied in behavior therapies?

–What are the characteristics of RMBT, Beck’s cognitive therapy, and cognitive-behavior therapy?

–What is integrative therapy?

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15-50SOCIOCULTURAL APPROACHES

AND ISSUES IN TREATMENT

Group Therapy

Family and Couple Therapy

Self-Help Support Groups

Community Mental Health

Cultural Perspectives

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Group Therapy

Features that make group therapy attractive:– Information - from leader and others in group

–Universality - learning that others have similar problems

–Altruism - members support one another

–Corrective recapitulation of the family group

–Development of social skills - give and receive feedback

– Interpersonal learning - practice new behaviors

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Family and Couples Therapy

Family therapy - group therapy with family members Couples therapy - therapy with married or unmarried

couples whose major problem is their relationship

Although one person may have abnormal symptoms, symptoms are a function of the family or couple

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15-53Adjustment Strategies

Based on Family Therapy

1. Validation

2. Reframing

3. Structural change

4. Detriangulation

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Self-Help Support Groups

Self-help groups - voluntary organizations of individuals who get together on a regular basis to discuss topics of common interest–Groups are led by a paraprofessional or member of the

common interest group

–Self-help support groups provide members with sympathetic audience for confession and emotional release

–Alcoholics Anonymous (AA) is one of the best-known self-help groups

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15-55Adjustment Strategies for Benefiting

from Self-Help Support Groups

1. The effectiveness of self-help support groups depends on local members

2. Learn more about how self-help groups work

3. Find out about the self-help support groups available in your community

4. If a self-help support group that deals with a topic in which you are interested in is not available, start one yourself

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Community Mental Health

Through the community mental health movement, mental health professionals have tried to extend the reach of therapeutic efforts

The community mental health approach includes teachers, ministers, and family physicians who interact with community members to offer lay-counseling and workshops on topics such as stress, reducing drug use, and using assertiveness training

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Cultural Perspectives

Traditional psychotherapies (psychodynamic, humanistic, behavioral, cognitive) focus on individual–The individual approach may not be effective in collectivist

cultures

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Ethnicity

Many ethnic-minority individuals prefer discussing problems with parents, friends, and relatives rather than mental health professionals

When therapist and client are from the same ethnic background, therapy can be more effective

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Gender

Traditionally, therapy has focused on autonomy or self-determination (especially important for men)

Recently, more emphasis on relatedness and connection to others (especially important for women)

Feminist therapists believe women must become aware of bias and discrimination in their own lives

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Review - Learning Goal 3

–What is group therapy?

–What characterizes family and couples therapy?

–What are some important features of self-help support groups?

–How can the community mental health approach be described?

–How might ethnicity and gender affect the success of psychotherapy?

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EVALUATING THERAPY

Is Therapy Effective?

Common Themes in Effective Psychotherapy

Funding Therapy

Selecting a Therapist

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Is Therapy Effective?

Hans Eysenck (1952) concluded that psychotherapy was ineffective–He found two-thirds of people with neurotic symptoms

improved, whether or not they received therapy

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Is Therapy Effective?

More people receiving psychotherapy improve as compared to people who do not receive therapy

Cognitive therapies and behavior therapies - help in anxiety disorders

Cognitive therapies and behavior therapies - help in depression

Relaxation therapy - help in treating anxiety

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15-64Common Themes in

Effective Psychotherapy Effective therapies share three elements:

– inspire positive expectations

– increase the client’s sense of mastery and competence

–arouse the individual’s emotions

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Funding Therapy

Therapy can be expensive Many who need therapy do not get it Managed care tries to cut costs

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Selecting a Therapist

Psychotherapy is practiced by a variety of mental health professionals, including clinical psychologists, psychiatrists, and counselors–Different types of mental health professionals take different

approaches

–Licensing and certification require mental health professionals to engage in ethical practices

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15-67Adjustment Strategies

for Seeking Professional Help

1. Become informed about the services offered by therapists2. Consider which characteristics of a therapist are important to you3. Identify the professional’s credentials4. Give therapy some time5. If your goals are not being met, find a new therapist6. Continually evaluate your progress

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Review - Learning Goal 4

–How effective is therapy?

–What are some common themes in psychotherapy?

–What kinds of health professionals are qualified to provide mental health treatment?

–What role is managed care playing in mental health treatment?