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Therapy. What Is Psychotherapy?. A psychologically based form of treatment used to help people better understand their emotional or behavioral problems and resolve them Often called “talk therapy” because consists of a series of verbal interactions between therapist and client.

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  1. Therapy

  2. What Is Psychotherapy? • A psychologically based form of treatment used to help people better understand their emotional or behavioral problems and resolve them • Often called “talk therapy” because consists of a series of verbal interactions between therapist and client

  3. Who does therapy?Major Types of Mental Health Professionals • Clinical psychologist: PhD, PsyD and MS/MA • Counseling psychologist: PhD, PsyD, MS/MA • Psychiatrists: MD • Clinical or psychiatric social workers:MSW • Psychoanalysts: any advanced degree • Counselors • Psychiatric nurses

  4. Psychodynamic and Humanistic therapies

  5. Psychodynamic Therapy • Psychological problems are rooted in unconscious psychological conflicts dating from childhood. • Gaining insight into conflicts and working through them are the key steps to restoring psychological health. • Traditional psychoanalysis developed by Freud.

  6. Psychoanalytic Techniques • Free association • Dream analysis • Latent versus manifest content • Use of interpretations to help the client gain insight • Interpretation of client’s resistance • Analysis of the transference relationship • Problem of countertransference

  7. Modern Psychodynamic Approaches • Less focus on sexual issues • Focus more on the: • Adaptive functioning of ego • Client’s current relationships • Briefer, more direct approach

  8. Humanistic Therapy • Humans possess free will and can make conscious choices that enrich their lives. • Emphasis on the client’s subjective, conscious experience • Focus is on the here-and-now, not the past

  9. Rogers’s Client-Centered Therapy • Psychological problems stem from blocked self-actualization. • Focus of therapy is on the person: • Therapist strives to create warm, accepting atmosphere for client. • Nondirective approach

  10. Client-Centered Therapy • Effective therapists display: • Unconditional positive regard • Empathy • Genuineness • Nondirective: • Client finds solution themselves • Therapist’s role is to guide the client to the solution

  11. Perls’s Gestalt Therapy • Important to help clients blend conflicting parts of personality into an integrated whole or “Gestalt” • Characteristics: • Direct, even confrontational approach • Challenging of clients to express feelings • Use of role playing, such as empty chair technique

  12. Cognitive and Behavioral Therapies

  13. Behavior Therapy • Application of learning principles to help person make adaptive changes in behavior • Assumption that psychological problems are learned • Focus is on changing problem behaviors, not exploring client’s feelings

  14. Behavior Therapy: • Fear Reduction • Systematic desensitization • Construction of a fear hierarchy • Gradual exposure • Modeling • Virtual therapy • Aversive Conditioning • Form of classical conditioning • Objects paired with aversive stimuli • e.g., electric shock, nausea-inducing drug • Effects often temporary

  15. Other Behavior Therapy Methods • Operant Conditioning Methods • Reinforcement and punishment • Token economy • Cognitive-Behavioral Therapy (CBT) • Combines behavioral techniques with cognitive techniques. • ABA therapy • Intensive behavioral therapy • Must be done by certified ABA therapist • Used most often to treat autism-spectrum disorders

  16. Cognitive Therapy • Focus on helping people to change how they think • Assumption that distorted thinking underlies: • Emotional problems • Self-defeating behaviors • Maladaptive behaviors • Focus on present, not distant past

  17. Eclectic Therapy • Draws upon principles and techniques representing different schools of therapy • Most widely endorsed theoretical orientation • Some argue that therapeutic integration is neither desirable nor achievable.

  18. Figure 12.2: Clinical and Counseling Psychologists Identifying with Each Theoretical Orientation

  19. Biomedical Therapies

  20. Drug Therapy: Anti-anxiety Drugs • Also called minor tranquilizers or anxiolytics • Effects: • Reduces anxiety • Produces calmness • Reduces muscle tension • Effect on GABA receptors • Examples: • Valium, Librium, Xanax

  21. Drug Therapy: Antidepressants • Increases availability of neurotransmitters • Serotonin, norepinephrine • Major types: • Tricyclics • MAO inhibitors • Selective serotonin-reuptake inhibitors • Therapeutic benefits for both depression and anxiety disorders • Questionable efficacy- is it a placebo effect?

  22. Drug Therapy: Antipsychotics and Mood Stabilizers • Sometimes called major tranquilizers • Used to treat schizophrenia and other psychotic disorders • Many actions • Act on Serotonin, Norepinephrine and dopamine receptors • Newer drugs block the action of dopamine at receptor sites in brain. • Mood stabilizers to reduce mood swings • e.g., Lithium • Stimulants used to improve attention spans and reduce disruptive behavior in hyperactive children • e.g., Ritalin, Cylert

  23. Evaluating Psychotropic Drugs • Limitations: • May reduce or control symptoms, but not a cure • Does not teach how to resolve problems or develop necessary life skills • Risks of adverse side effects • Some drugs can lead to psychological or physical dependence. • Relapses common when taking drugs stopped • May be seen as a “quick fix” • Useful for temporary relief • Usually used in tandem with psychotherapy

  24. Electroconvulsive Therapy (ECT) • Can produce dramatic relief from severe depression • High rates of relapse in weeks and months following treatment • May produce permanent memory loss • Many view as treatment of last resort

  25. Psychosurgery • Involves surgically altering the brain to control deviant or violent behavior • Prefrontal lobotomy a widely practiced form in the past • More sophisticated techniques have been introduced in recent years. • But still, procedures rarely used and only as a treatment of last resort

  26. Other or combination therapies

  27. Community-Based Care • Social policy of deinstitutionalization • Resulted in the back wards of many mental hospitals being vacated • Community-based mental health centers offer a variety of services. • Has deinstitutionalization been successful? • A work in progress

  28. Group Therapy • People brought together to explore and resolve problems • Advantages: • Less costly • Helps with interpersonal problems, social skills • Share coping strategies • Drawbacks: • No individual attention • Reluctance to disclose personal problems to group • Feelings of inhibition

  29. Family Therapy • Helps troubled families learn to communicate better and resolve their differences • Family, not the individual, is the unit of treatment. • Individual problems symptomatic of family system breakdown

  30. Couples Therapy • The couple is the unit of the treatment. • Goal is to build healthier relationships: • Acquire more effective communication and problem-solving skills • Resolve power struggles • Aim is to help open channels of communication between partners.

  31. Choosing a therapist

  32. Choosing a Therapist • Seek recommendations from respected sources. • Seek a referral from a local medical center or local community mental health center. • Seek consultation from college counseling center or health services • Contact professional organizations for recommendations. • Can use local Yellow Pages, but be wary. • Check for proper licensing • Ask about type of therapy being provided. • Ask about provider’s background and experience.

  33. Working with the Therapist • Discuss diagnosis and treatment plan before committing. • Ask about costs and insurance. • Find out about policies for missed or canceled sessions. • If medication is to be prescribed, inquire about delay, side effects. • Openly discuss concerns about treatment. • Request a second opinion if in doubt. • Be wary of online therapy services.

  34. But, is therapy effective? • Yes and no… • General statistic is that people in therapy show 80% more improvement than those in control group • Pharmacologicals are more questionable • Current studies suggest many antidepressant effects may be placebo • Even if placebo- works! • Still, at what cost to system?

  35. Effectiveness of Psychotherapy

  36. Examples of Empirically Supported Treatments

  37. Nonspecific Factors Accounting for the Benefits of Psychotherapy • Interpersonal relationship with therapist • Therapeutic alliance • Expectation of improvement • Self-fulfilling prophecy • Placebo or expectancy effects

  38. Multicultural Issues • Psychotherapy designed around Americans of Western European descent. • How does it work for: • African Americans • Asian Americans • Hispanic Americans • Native Americans

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