Treatment Models

Theory vs. Treatment

Theories are the way we think about how someone came to be.

Treatments arise out of the way we think about people.

Theories (and treatments) are constantly evolving based on research

Theories and treatment should be considered in historical context.

Psychoanalytic TheoryFocus on internal “drives” and how they are met or not met. We become stuck when we don’t move through stages (personality d/o).

Works to move past resistance (defense mechanisms) through things like free association.

Transference is important.

We interpret people’s free associations and dreams to find latent meaning

This takes place several times a week and can last years.

Psychodynamic

Recognized people don’t exist in bubbles.

More emphasis on early relationships (external experiences) rather than internal struggles.

Tends to be shorter term (1x per week).

Interpretation is still key, but modern practitioners practice mirroring, reflection, psycho-education, and confrontation.

Both of these are considered unscientific because we cannot empirically measure them

BehaviorismArose out of Psychodynamic theory to focus more on concrete, measurable outcomes.

By changing our behaviors, we change our feelings.

Includes exposure therapy (systematic desensitization or flooding), PMR, and aversive conditioning.

ABA focuses on those techniques and includes operant conditioning (token economies).

Works well for phobias, children, and pets

Critics see this as a band-aid and fear it denies underlying internal struggles and has limited long-term efficacy.

Cognitive

Cognitivists felt that behaviors alone couldn’t change feelings.

Our way of thinking is based on learning, so we must relearn

By changing our thoughts, we will feel better

Challenging and Socratic questioning prevents the catastrophizing and “all or nothing” thought that causes us distress

Cognitive Behavioral Therapy

The natural progression of Cognitive and Behaviorism.

Uses techniques from both treatments

Thoughts

Feelings Behaviors

Humanistic-Existentialism

Humanism uses many of the same techniques as Psychodynamic therapy, but focuses on today and the future (instead of the past)

The most important feature is unconditional positive regard.

Non-directive. The client knows what is best for him or her. Follows the premise that people naturally want to move towards their greatest potential.

Clinicians are a mirror for their client.

Humanistic-Existentialism cont:

Existentialism focuses on the “big issues”Death

Meaning in life

Nothingness

Freedom and responsibility

People react to these questions with anxiety or compassion. The therapist’s goal is to provide mirroring and empathy so compassion is the outcome.

Family Systems

Belief that people cannot be independent of their settings (especially family).

The family is the client.

Utilizes many of the same techniques as in other treatments, but encourages communication and utilizes dyads (pairing).

Supplemental Treatments

EMDR: While remembering traumatic events, clients focus an object that causes their eyes to move rapidly.

Eye movement may not be the mechanism behind the effectiveness

Special training is required for this

Light Therapy: shows some effectiveness in SAD. Morning light is also effective

Clients can buy light boxes and this is usually done on their own

PsychopharmacologyMedications tend to be prescribed by Psychiatrists, not Psychologists.

Anti-Psychotic MedicationsTarget dopamine, positive symptoms, side effects!

Anti-Anxiety MedicationsHigh dependence capacity (benzos).

Anti-Depressant MedicationsMost common SSRI’s, but many types. Serotonin, dopamine, nor-epinephrine.

Best with therapy.

Mood StabilizersTraditionally anti-convulsants

Can be used to treat bipolar disorder and psychotic disorders.

Brain Stimulation

Brain StimulationECT

Last attempt for treatment resistant depression

Much more humane than in the past

Memory loss

We don’t know what it does!

Transcranial magnetic stimulationLess invasive, magnetic energy to speed or slow certain areas of the brain.

PsychosurgeryRarely, if ever, used.