Psychoanalysis

1. Psychoanalysis Psychosurgery Humanistic Therapies Electroconvulsive Therapy Token Economies Chapter 15: Therapy Family Therapy Aversive Conditioning Cognitive Therapy Client-centered Therapy Behavior Therapy Biomedical Therapies Systematic Desensitizaiton

2. Upstate Therapy • Two main categories:  The Psychological Therapies  The Biomedical Therapies • The Psychological Therapies – called psychotherapy • Cause of symptoms is not biological, • but due to early childhood experience and/or faulty learning • Many different types.

3. Upstate • Psychotherapy - an interaction between a trained helper and a person in need of treatment • Most therapists are eclectic, meaning that they use techniques from many approaches.

4. Upstate Psychoanalysis • Based on Freud’s theory • Goal - to uncover unconscious impulses relating to early childhood and to bring repressed feelings & impulses into conscious awareness • But how?

5. Upstate Uncovering the Unconscious • Freud first used hypnosis, but later discarded • Free association • Transference • Dream analysis • Interpretation • Interpretation supposedly produces insight.

6. Upstate • Criticism of psychoanalysis • Does not produce behavior change • No focus changing behavior • Freud assumed insight would bring change • Another approach - the Behavioral Approach focuses on behavior change, ignores the unconscious, insight/ understanding.

7. Upstate Behavior Therapies • Are based on learning theories of Pavlov (Classical Conditioning) and Skinner (Operant Conditioning) • Techniques based on classical conditioning 1) Systematic Desensitization – an exposure therapy used to alleviate fears and anxiety Involves 3 things: - Creation of anxiety hierarchy - Relaxation training - The desensitization process. Example.

8. Upstate 2) Aversive conditioning/therapy • Conditioning that associates an unpleasant state with an unwanted behavior • Used to treat bad habits (unwanted behavior) • Examples: associate nausea with alcohol, associate bad taste with nail biting.

9. Upstate • Techniques based on operant conditioning • Utilizes reinforcement, extinction, and possibly punishment • Can involve a token economy • A procedure that rewards desirable behavior • with a token which can be exchanged for privileges or treats (backup reinforcers) • Example.

10. Upstate Cognitive Therapy: Rational Emotive Therapy • Ellis devised an A-B-C Theory.   C Emotional and Behavioral Consequences A Activating Event B Belief about A (Thoughts) Break up in relationship. “This is awful, I can’t stand it.” (self statements) Feels depressed, cries, unable to work. “This is unfortunate. I am sad, but it’s not the end of the world.” Normal emotions. Continues to work.

11. Upstate Situation (Activating Event) Negative Self Statement Positive Self Statement “I’ll reapply next year. There are other programs I can apply to. It’s unbelievably competitive.” “I’m really dumb. I will never amount to anything.” Not getting into graduate school “Everyone else knows more than I do, so what’s the use of saying anything. I’m so stupid.” “I have as much to say as anyone else and my ideas are valid. It’s OK to be nervous.” Having to participate in class discussion

12. Upstate Rational Emotive Therapy • Ellis confronts people with their irrational beliefs • Encourages them to make positive self statements • Gives homework assignments to practice positive self statements and rational responding • Practice, practice, practice • Reinforce success.

13. Upstate Humanistic Therapy • Client-centered therapy - developed by Carl Rogers • Rogers believed that clients need three things in order for positive change to occur: 1. Unconditional positive regard 2. Empathic understanding/active listening 3. A therapist who is genuine/real.

14. Upstate Commonalities Among Psychotherapies • Hope for demoralized people • An empathic caring, trusting relationship • A new perspective - an alternative way of looking at yourself, your problem & behavior Is Psychotherapy Effective? • Need outcome research • McCord’s study of adolescent boys • After years of research, general conclusion: • “the evidence overwhelmingly supports the effectiveness of psychotherapy”.

15. Upstate Biomedical Therapies • The second major type of therapies are the biomedical therapies • Those using psychotherapies believe that disorders are due to early childhood experiences and/or faulty learning. • Those using biomedical theories, relate disorders to a malfunctioning nervous system • These therapies intervene to change the nervous system. There are three types:

16. Upstate 1. Drug Therapies • Most widely used • Has allowed many patients to live outside hospital environments • Three types of drugs used: A. Antipsychotic drugs - Do not cure, but sometimes help - Can have debilitating side effects - Many patients refuse to take - Examples: Thorazine, Clozaril.

17. Upstate B. Antianxiety drugs - Widely used and possibly abused - Examples: Valium, Librium, Xanax - Used with high anxiety patients - Criticism: doesn’t treat underlying problems C. Antidepressant drugs - Elevate mood - Examples: Prozac, Zoloft, Paxil - Widely prescribed drugs.

18. Upstate 2. Electroconvulsive Therapy (ECT) • Sends a brief electric shock through the brain of an anesthetized patient • Used with severely depressed patients • 80% improve markedly • Controversial • Why is it still used? • How does it work?

19. Upstate 3. Psychosurgery • Surgery that removes or destroys brain tissue in an effort to change behavior • Least used biomedical treatment • Old lobotomy operations – tragic mistakes, poor outcomes • New psychosurgery procedures, such as, split brain operation.