Psychotherapy

1. Psychotherapy • In psychotherapy, a trained therapist uses psychological techniques to assist someone seeking to overcome difficulties or achieve personal growth. They are also called the 'talk therapies'. • Biomedical therapy primary offers medication, or body-centered work that acts directly on a person's physiology. • The combination is called the eclectic approach. • Psychoanalysis is Sigmund Freud's therapeutic technique. Freud believed the patient's free associations, resistances, dreams, and transferences--and the therapist's interpretation of them--released previously repressed feelings, allowing the patient to gain self-insight. • Resistance: in psychoanalysis, the blocking from consciousness of anxiety-laden material.

2. Psychotherapy Cont'd • Interpretation: in psychoanalysis, the analyst's noting supposed dream meanings, resistances, and other significant behaviours and events in order to promote insight. • Transference: in psychoanalysis, the patient's transfer to the analyst of emotions linked with other relationships (such as love or hatred for a parent). • Counter-transference: in psychoanalysis, the therapist's transfer of their disowned emotions onto the patient. The most famous case can be seen in the film 'A Dangerous Method'. • Relatively few North American therapists now offer traditional psychoanalysis, because its underlying theory is not supported by scientific research.

3. Psychodynamic Theory • Face-to-face therapy: In this type of therapy session, the couch has disappeared. But the influence of psychoanalytic theory may not have, especially if the therapist seeks information from the patient's childhood and helps the patient reclaim unconscious feelings. • For example, the patient when questioned about personal troubles, may treat the therapist as an adversary; the therapist's task it to help the patient recognize the relationship pattern, and its roots in bitter childhood experiences (such as an alcohol-dependent, hypercritical father). (Shedler, 2010). • Interpersonal therapy a brief (12 to 16 session) variation, has effectively treated depression. (Cuijpers, 2011). Its goal is symptom relief in the here and now. (Markowitz et al., 1998)

4. Humanistic Therapies • Insight therapies: a variety of therapies that aim to improve psychological functioning by increasing a person's awareness of underlying motives and defenses. • Client-centred therapy: a humanistic therapy, developed by Carl Rogers, in which the therapist uses techniques such as active listening within a genuine, accepting, empathic environment to facilitate clients' growth. • Active listening: empathic listening in which the listener echoes, restates, and clarifies. A feature of Roger's client-centred therapy. • The key skill is unconditional positive regard, a non-judgmental environment created by paraphrasing, inviting clarification, and reflecting upon feelings.

5. Behavior Therapies • Therapies that apply learning principles based on the work of B.F. Skinner to the elimination of unwanted behaviours. Cognition--thinking without measurable physical actions or words--is not part of this approach at all. • Take the case of Mowrer's bed-wetting cure. The child sleeps on a liquid sensitive pad connected to an alarm. Moisture on the pad triggers the alarm, waking the child. With sufficient repetition, this association of bladder relaxation with waking stops the bed-wetting. Successful in 3 of 4 cases, and improves the child's self-image. (Houts et al., 1994). • Counterconditioning alleviated fears by pairing the trigger stimulus with a new response that is incompatible with fear. Based on classical Pavlovian conditioning.

6. Face Your Fears • Exposure therapies help a patient face their fears, and thus overcome their fear of the fear response itself. (Rose-Alcazar et al., 2008) • Systematic desensitization assumes that a patient cannot be simultaneously anxious and relaxed. The therapist begins with progressive relaxation, making the patient aware of their muscle tension, and letting it go. • The therapist then progresses up the constructed anxiety hierarchy, using the relaxed state to desensitize the patient to the imagined (fearful) situation. • Later there is real-world practice. Conquering anxiety in an actual situation raises self-confidence. (Williams, 1987). • The modern version of this can be seen at http://www.neurovr.org

7. Aversive Conditioning • Fig. 52.1 (m683 c 16.1 659) will be on the next exam. • In aversive conditioning, the goal is substituting a negative aversive response for a positive response to a harmful stimulus such as alcohol; the reverse of systematic desensitization. • It works in the short run, but not in the long run (Menustik 1983), because cognition influences conditioning. At the height of 'behaviourist' academic culture, cognition was ignored; such results forced scientists to reconsider. • This leads us to operant conditioning. Lovaas (1987) worked with 19 withdrawn uncommunicative autistic 3-year-olds. Their behaviour was shaped; desired behaviours were positively reinforced, aggressive or self-abusive behaviours were ignored or punished (later studies left the latter out).

8. Token Economies • For some people the reinforcing power of attention and praise is sufficient, others require concrete rewards. • Used mostly in institutional settings when a patient or inmate cooperates, they receive a plastic token as a positive reinforcer, which can be used like money. • The first critique: how durable are the behaviours? Extrinsic rewards will not work that well in real-life; but as a withdrawn person becomes more socially competent, the intrinsic satisfactions of social interaction may help the person maintain the behaviour. • It is too authoritarian? In these settings, rewards and punishers presently maintain destructive behaviours; why not reinforce adaptive behaviour instead? • An improve life justifies temporary deprivation (?)

9. Cognitive Therapies • Therapies that teach people new, more adaptive ways of thinking; based on the assumption that thoughts intervene between events and our emotional reactions. • Fig. 52.2 (m685 c 16.2 661) will be on the next exam. • Albert Ellis (1993) created rational-emotive behaviour therapy, on the assumption that many problems including the vicious cycle of depression, stem from irrational thinking. • A confrontational cognitive therapy that vigorously challenges a person's illogical, self-defeating attitudes and assumptions. • Read the Beck et al., 1979 dialogue in the Myers' text. • Table 52.1 (m 687 c t661 p663) will be on the next exam.

10. Cognitive-Behavioural Therapy • Behaviour change is typically addressed first; followed by session on cognitive change, the goal is to prevent relapses. • Anxiety and mood disorders are a common problem: emotion regulation (Aldao & Nolen-Hoeksema, 2010). An effective treatment for these emotional disorders trains people to replace their catastrophic thinking with more realistic appraisals and to practice behaviours incompatible with their problem. (If you are jogging on a treadmill, you are not in front of television obsessing about your failures). • In one study, OCD patients learned to relabel their compulsive thoughts. (Schwartz et al., 1996). They would engage in an enjoyable 'alternate' behaviour (as opposed to brushing their teeth until their gums bleed). This helped 'unstick' the brain by shifting attention and engaging other brain areas. PET scans normalized by 2 or 3 months.

11. Group & Family Therapies • It saves therapists' time and clients' money, often with no less effectiveness than individual therapy. (Fuhriman & Burlingame, 1994). • It offers a laboratory for exploring social behaviours and developing social skills. The therapist can guide the interactions. • It enables people to see that others share their problems. • It provides feedback as clients try out new ways of behaving. • Family therapy treats the family as a system, viewing an individual's unwanted behaviours as influenced by, or directed at, other family members. The therapist helps family members understand how their ways of relating to one another create problems. The goals is to change relationships, not individuals. (Shadish et al. 1993). • Table 52.2 (m690 ct 16.2 666) will be on the next exam.