Unformatted text preview: Chapter 16
Therapy I 0. Overview of Treatment
1. Pharmacological Approaches 0. (different sequence than in text) 2. Psychological Approaches
3. Psychotherapy and Society An Overview of Treatment (I) 4. The belief that people with psychological problems can change is the conviction underlying psychotherapy
1. Change could be view of world, selfconcept, unsatisfying job, unhappy marriage
2. Change is hard; therapy takes time
3. No magical transformation
4. Therapy is less expensive than alternatives An Overview of Treatment (II) 5. Several hundred therapeutic approaches exist, but the efficacy of all of these have not been experimentally demonstrated
6. Here will be considered more widely accepted approaches
7. (Note references to ‘client’ or ‘patient’) Why Do People Seek Therapy? (I)
Why Do People Seek Therapy? (I)
8. People may seek therapy because: 5. They feel overwhelmed by a highly stressful situation (e.g. divorce, unemployment, crisis, feelings of vulnerability)
6. They were referred by their physician – most common source of referral; often reluctant (males more than females) Why Do People Seek Therapy? (II)
9. People may seek therapy because: 7. They have experienced longterm distress – interpersonal problems, chronic unhappiness
8. They feel they have not lived up to their own potential – seeking personal growth 10.There is no ‘typical’ client 9. Wide range of motives, reasons, goals, degree of problems, personalities, issues Who Provides Psychotherapeutic Services? (I)
11.Members of many different professions provide advice and counsel including:
10. Physicians – family doctors
11. Clergy – minister, priest, rabbi 12.Clergy and physicians generally refer seriously distressed people to mental health professionals Who Provides Psychotherapeutic Services? Who Provides Psychotherapeutic Services?
13.Mental health professionals include:
12. Clinical & counseling psychologists
13. Psychiatrists – medically oriented
0. Most likely to use medication 14. Psychiatric social workers 14.Settings include: 15. Doctor’s office, clinic, hospital
16. Individual, group, family, couples The Therapeutic Relationship (I) 15.The key elements of an effective working alliance between client and therapist include: 17. A sense of working collaboratively on the problem
18. Agreement between patient and therapist about the goals and tasks of therapy
19. An affective bond between patient and therapist The Therapeutic Relationship (II) 16.Other qualities enhancing therapy include: 20. The client’s motivation to change – if not motivated, can’t help
21. A client’s expectation of receiving help – recognizing that it takes time and work
22. A protected setting – safe in disclosing fears and concerns; not being judged
23. A good match between client and therapist – personalities match Success in Therapy (Factors)
Success in Therapy (Factors) 17.Success in therapy depends on:
27. Therapeutic alliance
Skill of therapist in fostering relationship
Client’s motivation and personality Success in Psychotherapy (Measurement I )
18.Estimated gains depend on: 28. A therapist’s impression of changes that have occurred – possible bias, limited contact w. client
29. A client’s reports of change – bias, expectations
30. Reports from the client’s family or friends
31. Reports may be more objective, but also subject to bias Success in Psychotherapy (Measurement II )
19.Estimated gains depend on: 32. Comparison of pretreatment and posttreatment scores on personality tests May be objective, but problem of regression toward mean
33. Measures of change in selected overt behaviors
34. Measures reflect bias and theoretical orientation Success in Psychotherapy (Measurement III) 35. Today the emphasis is on using more quantitative methods of measuring change (Preselect behaviors) 36. Improvement often occurs without professional 36.
intervention (Short episode, crisis ends, situation changes)
37. Some clients are actually harmed by their encounters with psychotherapists (Can get worse, Axis II, unprofessional)
38. Therapy does help & is better than nothing (Eysenck's research in 1950's) What Therapeutic Approaches Should Be Used? (I) 20.Investigators have attempted to empirically validate treatments
21.Evidence based treatment follows model of drug efficacy using randomized clinical trials 39. Comparing (using doubleblind approach) placebo with treatment
40. Using manualized treatments (for standardization)
41. Single DSM IV diagnosis What Therapeutic Approaches Should Be Used? (II) 42. Psychopharmacology has brought about a reduction in the severity and chronicity of many types of disorders (Problems of side effects, symptomatic relief) 43. For some disorders, psychotherapy may produce 43.
more longlasting benefits than medications alone (Training new behavior)
44. It is now common practice to combine medication and psychological treatment (Not either/or; biopsychosocial approach complementary benefits (relief & skills) What Therapeutic Approaches Should Be Used: Therapy or Drugs
Pharmacological Approaches to Treatment: Take a Pill
Pharmacological Approaches to Treatment: Antipsychotic Drugs (I)
22.Antipsychotic drugs are used to treat psychotic disorders such as
45. Schizophrenia; psychotic mood disorders
46. Give relief within 6 weeks
47. Thorazine, haldol, stelazine 23.One side effect of traditional antipsychotics is tardive dyskinesia – abnormal movement Pharmacological Approaches to Treatment: Antipsychotic Drugs (II)
24.Atypical antipsychotic drugs clozaril, risperdal, zyprexa, seroquel, abilify
48. Have a lower risk of side effects 49. Treat positive and negative symptoms
50. Problems with weight gain, diabetes, cost Pharmacological Approaches to Treatment: SSRI’s
25.The most widely prescribed antidepressant drugs are selective serotonin reuptake inhibitors (SSRI’s)
51. Prozac, zoloft, paxil, luvox, celexa, lexapro
52. Inhibit reuptake of serotonin
53. Easy to use; fewer sideeffects
54. Problems – nausea, insomnia, sexual problems (e.g. cymbalta commercial) 55. (Some drugs effect reuptake of both serotonin and norepinepherine – e.g. effexor) Pharmacological Approaches to Treatment: MAO & Tricyclic Drugs
26.Older antidepressants include:
27.Monoamine oxidase inhibitors 56. Used infrequently; developed in the 1950’s
57. Originally used for TB; blocks enzyme (MO) 28.Tricyclic antidepressants – inhibit reuptake of norepinephrine (originally for schizophrenia) 58. Trazodone – first antidepressant in US (Tends to be sedating) Tricyclic Antidepressants as ReUptake Tricyclic Antidepressants as ReUptake
Pharmacological Approaches to Treatment: Antidepressants
29.Antidepressants are also widely used in the treatment of various other disorders 59. Panic attacks, anxiety, OCD, bulemia, cluster B personality disorders Pharmacological Approaches to Treatment: Antianxiety Drugs
30.The most widely prescribed antianxiety drugs are benzodiazepines
63. Came out in 1960's; widely prescribed
Xanax, valium, klonopin, ativan
Work quickly; problems of dependency
Enhance activity of GABA 31.Buspirone has also shown to be effective 64. Buspar; effects serotonin, not sedating, no withdrawal; takes two to four weeks to work Pharmacological Approaches to Treatment: Moodstabilizing Drugs (I)
32.Lithium is very effective in treating bipolar mood disorders
65. Discovered in 1940’s 66. Drug of choice for bipolar (7080% improve)
67. High relapse if discontinued
68. Problems: toxic (kidneys), weight gain, fatigue Pharmacological Approaches to Treatment: Moodstabilizing Drugs (II)
33.Other moodstabilizing drugs include
71. Divalproic acid depakote
Also topamax, neurontin, lamictal Other Biological Approaches: Electroconvulsive Therapy (I) 0. Electroconvulsive therapy is used to treat severe mood disorders
1. Treatment of choice for severely depressed when medications don't work
2. It is a safe, effective, and important form of treatment
3. Anesthetics allow patients to sleep through the procedure Other Biological Approaches: Electroconvulsive Therapy (II) 4. Bilateral ECT appears to be more effective than unilateral ECT
5. ECT produces some shortterm side effects including amnesia
6. Seems to effect norepinephrine 7. Involves a dozen or less sessions
8. Can be better and quicker than medication Other Biological Approaches: Neurosurgery 34.Antipsychotic drugs have decreased the use of psychosurgery
35.Psychosurgery appears to be effective at reducing the symptoms of severe obsessivecompulsive disorder Other Biological Approaches: Neurosurgery
Therapy II Introduced in 1930's
Severing frontal lobes (Prefrontal lobotomy)
Typically used as last resort
Currently more specific and selective
Now deep brain stimulation 37.Psychological Approaches
81. Behavior Therapy
Cognitive & Cognitive –behavior therapy
Family and Marital Therapy 38.Psychotherapy and Society Behavior Therapy: Approach 39.Behavior therapy is a direct and active treatment 39.
82. Recognizes the primacy of behavior 83. Acknowledges the role of learning
84. Includes thorough assessment and evaluation Behavior Therapy: Assumption 40.Behavior therapy focuses on the presenting problem that is causing distress 85. Assumption: abnormal behavior is acquired like normal behavior – by learning
86. Unlearn maladaptive behavior and learn adaptive behavior Behavior Therapy: Exposure 41.Behavior therapy approaches include: 87. Exposure therapy – guided exposure
88. Systematic desensitization, in vivo exposure, flooding
89. For classically conditioned fear
90. While relaxed, client is presented hierarchy of anxiety producing stimuli (may be images or in vivo) Behavior Therapy: Aversion 42.Behavior therapy approaches include:
94. Aversion therapy punishment
Antabuse for alcohol; electric shock
Goal is to condition anxiety to produce avoidance
(reverse of treatment for phobias) Behavior Therapy: Modeling
Behavior Therapy: Modeling
43.Modeling imitation 95. Learning new skills by imitating another
96. With children overcoming phobias
97. With adults assertiveness training; social skills Behavior Therapy: Reinforcement
44.Reinforcement approaches 98. Differential reinforcement contingency management
99. Shaping behavior in children, hospitalized patients 45.Token economies – Institutionalized patients
Payment with tokens 101.
Effective with severely mentally ill, developmentally disabled Behavior Therapy: Pros and Cons
46.Behavior therapy 102.
Advantages: change in short period of time – directed toward specific symptoms
Disadvantages: not good with pervasive, vague problems Cognitive and CognitiveBehavioral Therapy: Approach 47.A reaction to behavior therapy which ignored inner thoughts
48.This approach recognizes the importance of thoughts, perceptions, evaluations, selfstatements as processes that mediate stimuli and behavior Cognitive and CognitiveBehavioral Cognitive and CognitiveBehavioral
Therapy: Assumptions 49.Cognitive or cognitivebehavioral therapy changing a person’s behavior by
105. Modifying selfstatements Modifying construal of events 50.Assumptions: 106.
Cognitive processes influence emotions, motivations and behavior
These techniques may be used in a pragmatic or hypothesistesting manner Cognitive and CognitiveBehavioral Therapy: RET (I) 51.Albert Ellis argues that we have learned unrealistic beliefs (e.g. perfectionism) which lead us to behave irrationally
52.The goal of RET (Rational Emotive Therapy) is to restructure an individual’s belief system and self
108. Get rid of shoulds, oughts and musts 53.RET attempts to change a client’s thought processes Cognitive and CognitiveBehavioral Therapy: RET (II) 54.Example of application of RET: 54. 109.
Stressinoculation therapy is a type of self
instructional training focused on altering the self
statements an individual routinely makes in stressful situations
Used with patients prior to undergoing surgery
Used by military to prepare soldiers for battle front Cognitive and CognitiveBehavioral Therapy: Beck (I) 55.Aaron Beck developed a cognitive approach to treat depression
56.Approach was extended to anxiety disorders, eating disorders, etc.
57.Model is informationprocessing model of psychopathology Cognitive and CognitiveBehavioral Therapy: Beck (II) 58.Beck’s cognitive therapy is based on the assumption that problems like depression result from
Biased processing of external and internal stimuli 1. Clients’ illogical thinking about themselves
2. Clients’ illogical thinking about the world around them 113.
Biases distort how a person experiences the world and lead to cognitive errors Cognitive and CognitiveBehavioral Cognitive and CognitiveBehavioral
Therapy: Beck (III)
59.Errors from biases in processing:
118. Selective perception (attending to negative)
Catastrophizing (blowing out of proportion)
Absolutistic thinking (allornothing)
Attributional biases Cognitive and CognitiveBehavioral Therapy: Beck (IV) 60.Underlying these biases that are relative stable cognitive structures or schemas and contain dysfunctional beliefs
61.Triggered by situations causing errors in how information is processed HumanisticExistential Therapies: Origins
62.Emerged out of WW II 119.
Concerns about alienation, depersonalization, loneliness, loss of meaning 63.Based on assumption that we have the freedom and responsibility to control our behavior
120. Therapist is guide; patient is responsible HumanisticExistential Therapies: Approaches (I) 64.Humanisticexistential therapies include: 65.Clientcentered therapy – Carl Rogers
Resolve incongruity between who we are vs who we want to be
Therapy is process of removing unrealistic demands that people put on themselves HumanisticExistential Therapies: Approaches (II) 66.Humanisticexistential therapies include:
67.Existential therapy – Victor Frankl 123.
Dealing with essential questions about life and death 68.Gestalt therapy – Fritz Perls 124.
We need to interpret our thoughts, feelings and emotions to increase our selfawareness and selfacceptance In Treatment 69.Portrait of Sophie Psychodynamic Therapies: Forms 70.Psychodynamic therapy is mainly practiced in two basic forms:
71.Classical psychoanalysis – Freud
126. Intensive, long term Recovering repressions 127.
128. Less intensive, less lengthy
Facetoface, more direct 72.Psychoanalytically oriented psychotherapy Psychodynamic Therapies: Freudian 73.Elements of Freudian psychoanalysis include (4 73.
74.1. Free association
Saying what comes to mind regardless of what it is
Allows for exploration of preconscious 75.2. Analysis of dreams royal road to unconscious
131. When asleep, defenses are down Psychodynamic Therapies: Freudian 76.Elements of Freudian psychoanalysis include (4 basic techniques):
77.3. Analysis of resistance e.g. unwillingness to talk
132. Forgetting, missing appointments, arriving late 78.4. Analysis of transference relationship with therapist (client transfers feelings from other relationships on to therapist) Psychodynamic Therapies: Contemporary 79.Contemporary psychodynamic approaches tend to have 133.
A strongly interpersonal focus
Revisions to the object (people) relations perspective 135.
Revisions to the attachment 135.
and self psychology perspectives Marital and Family Therapy (I) 136.
The focus of marital therapy and family systems therapy is to change the way in which members of the family unit interact
Assumption: behavior of individual is influenced by behavior and communication of rest of family
Focus on relationships Marital and Family Therapy (II)
80.In couple’s therapy
141. See together
Communication skills and problem solving Both have to change 81.In family therapy 142.
Focus on organization of family, communication, boundries, power Eclecticism and Integration 82.How do they all fit together?
144. Old view: schools of thought in conflict
New view: eclectic, using what works Psychotherapy and Society (I) 83.The role of values in therapy is complex and controversial
146. Therapist as gate keeper of social values?
Therapy takes place in context of society 147.
147. Potential dilemma in client needs and society Psychotherapy and Society (II)
84.Members of minorities 148.
Are underrepresented in treatment research studies
Are underserved by the mental health system
Often have very different backgrounds than their therapists
Issues of client may be unique to ethnic minority End of Chapter 16 ...
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