Chapter 17: Psychological Therapy The Psychological Therapies • •
Psychotherapy: an emotionally charged, confiding interaction between a trained therapist and someone who suffers from psychological difficulties. Eclectic Approach: an approach to psychotherapy that uses techniques from various forms of therapy. o Half of psychotherapists describe themselves as taking this approach.
Psychoanalysis • •
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Freud’s therapeutic technique. He believed the patient’s free associations, resistances, dreams and transferences- and the therapist’s interpretations- released previously repressed feelings. Theory presumes that healthier, less anxious living becomes possible when the patients release the energy they had previously devoted to id-ego-superego conflicts. o Resistance: The blocking from consciousness of anxiety-laden material. Repressing anxiety prone material o Interpretation: suggestions of underlying wishes feelings and conflicts. Aim to provide subject with insight. o Transference the patient’s transfer to the analyst of emotions linked with other relationships. (You begin to feel attracted to analyst…) Critics say that this theory can’t be proven, psychoanalysts agree: it’s therapy, not science. o It just helps the patient in some situations. Interpersonal psychotherapists focus more on the immediate situations of patients and how they can cope with the problems they are facing.
Humanistic Therapies •
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Humanistic therapists tend to focus on: o The present and future more than past. o Conscious rather than unconscious. o Promoting growth instead of curing illness. Client-centered therapy: developed by Carl Rogers: the therapist uses techniques such as active listening within a genuine, accepting, empathetic environment to facilitate clients’ growth. o Active Listening: echoing, restating, and seeking clarification of what the client expresses and acknowledging the expressed feelings. One cannot be totally nondirective. Accept and understand the client.
Behavior Therapies •
They doubt the healing power of self-awareness, and the ideas of Freud.
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They assume problem behaviors are the problems.
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Behavior Therapy: applies learning principles to the elimination of unwanted behaviors. Classical Conditioning Techniques • Is it possible to un-condition learned phobias? • Counterconditioning: conditions new responses to stimuli that trigger unwanted behaviors; based on classical conditioning o Systematic Desensitization Joseph Wolpe came up with what is known as the exposure therapies. Exposure Therapies: expose people to the things they fear and avoid. • One widely used exposure therapy is systematic desensitization. • Systematic Desensitization: a type of counterconditioning that associates a pleasant relaxed state with gradually increasing anxiety-triggering stimuli. o Commonly used to treat phobias. o If you repeatedly relax when facing anxiety-provoking stimuli, you can gradually eliminate your anxiety. o Aversive Conditioning Aversive Conditioning: a type of counterconditioning that associates an unpleasant state (such as nausea) with and unwanted behavior (such as drinking alcohol) • Opposite of systematic desensitization • It can work in the short run but may not in the long run because subjects know that they are being laced with a drug to make them nauseas in the lab so they might drink outside the lab. Operant Conditioning • Therapists use positive reinforcers to shape behavior. • Children with autism were shaped to function successfully in school and had normal intelligence. • Token Economy: an operant conditioning procedure that rewards desired behaviors. o A patient exchanges a token of some sort, earned for showing the desired behavior, for various privileges or treats. • Criticism: o What happens when the reinforcers stop, as when the person leaves the institute? Patients might be weaned off the tokens and trained to take social approval as reward. Also they may be trained to behave in ways that are intrinsically motivating. o Is it right for one human to control another’s behavior?
Cognitive Therapies •
Therapy that teaches people new, more adaptive ways of thinking and acting; based on the assumption that thoughts intervene between events and our emotional reactions.
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Cognitive therapists try in various ways to teach people new, more constructive ways of thinking. Cognitive Therapy for Depression • Aaron Beck o Sought to reverse clients’ catastrophizing beliefs about themselves, situations, and their future • Builds on the finding that depressed people do not express the self-serving bias common in non-depressed people. • Cognitive-Behavior Therapy: a popular integrated therapy that combines cognitive therapy (changing self-defeating thinking) with behavior therapy (changing behavior). o Experiment with depressed people writing down all the positive things that happened and how they contributed to them. This caused depression to go down substantially. o We often think in words, therefore getting people to change what they say to themselves is an effective way to change their thinking. Meichenbaum’s stress inoculation training. • Training to reconstruct thinking in stressful situations. • “Training to dispute negative thoughts.”
Group and Family Therapies • • • •
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Saves time and money- and it is often no less effective than individual therapy Therapists frequently suggest group therapy fro people experiencing family conflicts or those whose behavior is distressing to others. Group sessions offer a unique benefit: o The social context allows people both to discover that others have problems similar to their own and to try out new ways of behaving. Family Therapy: Therapy that treats the family as a system. Views an individual’s unwanted behaviors as influenced by or directed at other family members. o Attempts to guide family members toward positive relationships and improved communication. o Heal relationships and to mobilize family resources. Their aim is to help family members discover the role they play within their family’s social system.
Evaluating Psychotherapies • •
Many people believe that psychotherapy is very effective Millions of Americans seek mental help specialists and physicians every year.
Is Psychotherapy Effective? Clients’ Perceptions • 3 out of 4 clients reported themselves satisfied and 1 in 2 said they were “very satisfied” with psychotherapy. • Reasons what client testimonials don’t persuade psychotherapy’s skeptics: o People often enter therapy in crisis
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o Clients may need to believe the therapy was worth the effort o Clients generally like their therapists and speak kindly of them One experiment found that boys that seemed sure to end up in jail had a higher rate of committing a crime if they had psychotherapy than if they did not.
Clinicians’ Perceptions • Because people enter therapy when they are extremely unhappy, and usually leave when they are less extremely unhappy, most therapists (like most clients) testify to therapy’s success. Outcome Research • Meta-analysis – a procedure for statistically combining the results of many different research studies. (Combining them into one big result) • The average therapy client ends up better off than 80% of the untreated individuals on waiting lists. o “Hundreds of studies have shown that psychotherapy works better than nothing.” • Those not undergoing therapy often improve, but those undergoing therapy are more likely to improve. • Extravagant expectations that psychotherapy will transform your life and personality seem unwarranted. • Therapy is most effective when the problem is clear-cut.
The Relative Effectiveness of Different Therapies • •
Although no one type of therapy can be said to be most effective overall, some therapies are particularly well-suited to specific disorders. Behavioral conditioning, for example, is effective in treating phobias and compulsions.
Evaluating Alternative Therapies Therapeutic Touch • Practitioners move their hands a few inches from a patient’s body, purportedly “pushing energy fields into balance.” • Experiment to test this: have practitioners sit behind a screen with their hands palm up so that they couldn’t see their own hands or the experimenters’. The experimenter puts one hand over the experiment hand and leaves the control hand alone to see if the practitioner can “feel” which hand “felt the energy”. o They could only correctly identify the correct hand 47% of the time • The tentative scientific verdict is that therapeutic touch does not work. Eye Movement Desensitization and Reprocessing (EMDR) • Francine Shapiro o Rapidly moving the eyes while recalling a traumatic event. o Does it work? For 84-100% of single-trauma victims participating in four recent studies, the answer is yes. The treatment has been acknowledged as “probably efficacious” for the treatment of nonmilitary post-traumatic stress disorder.
o Critics say that it’s the combination of exposure therapy (repeatedly reliving traumatic memories in a safe and reassuring context) and a robust placebo effect. Light Exposure Therapy • Seasonal affective disorder o Give SAD people a timed daily dose of light. o Experiments proved that 90 min of bright light caused 61% people show improvement, as opposed to 32& from the control group. • For many people, morning bright light does indeed dim SAD symptoms.
Commonalities Among Psychotherapies •
Three common ingredients found in many therapies: o Hope for demoralized people o A new perspective on oneself and the world o An empathetic, trusting, caring relationship Hope for Demoralized People • One reason why therapies work is that they offer hope. • Each therapy, in its individual way, may harness the client’s own healing powers. o Placebo-treated people improve more than non-treated people, but less than receiving actual psychotherapy A New Perspective • Therapy can offer new experiences that can help people change their behaviors and their views of themselves An Empathetic, Trusting, Caring Relationship • Effective therapists are empathetic people who seek to understand another’s experience; whose care and concern the client feels. • Regardless of the psychotherapy, the empathetic therapists of both persuasions would help clients evaluate themselves, link on aspect of their lives with another, and gain insight into their interactions with others. • That all therapies offer hope through a fresh perspective offered by a caring person is supported by a meta-analysis of 39 studies.
Culture and Values in Psychotherapy • •
Psychotherapists’ personal beliefs and values influence their practice. Therapists do differ in the values that influence their aims.
The Biomedical Therapies Drug Therapies • • •
Most widely used biomedical treatments today are the drug therapies. Psychopharmacology – the study of drug effects on mind and behavior. Good news: double-blind studies have shown several types of drugs that have proven helpful in treating psychological disorders. Antipsychotic Drugs
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Antipsychotic drugs, such as chlorpromazine (Thorazine) dampen responsiveness to irrelevant stimuli. o They provide help to schizophrenia patients experiencing positive symptoms. • A newer drug, clozapine (Clozaril) doe sometimes enable “awakenings” in people experiencing negative symptoms. • Most antipsychotic drugs block dopamine receptor sites – reinforces the idea that an overactive dopamine system contributes to schizophrenia. Antianxiety Drugs • Depress central nervous system activity • Xanax or Valium • Critics say that these drugs cause people to become dependent upon these drugs because they pop a pill every time they feel any anxiety. Antidepressant Drugs • Work by increasing the availability of the NT’s norepinephrine or serotonin. o Fluoxetine (Prozac), Zoloft, and Paxil “Selective serotonin reuptake inhibitor” (SSRI’s) • Full psychological effect from these drugs usually takes place after about a month. • Placebos produced improvement that was 75 percent of the active drug’s effect. o Placebos that mimic the side effects of antidepressants are nearly as effective as the drug themselves. • Our expectations have surprisingly powerful effects on our biology and well-being. • Lithium – a chemical that provides an effective drug therapy for the mood swings of bipolar disorders.
Electroconvulsive Therapy •
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Electroconvulsive Therapy (ECT) – a biomedical therapy for severely depressed patients in which a brief electric current is sent through the brain of an anesthetized patient. o Many studies confirm that ECT is an effective treatment for severe depression in patients who have no responded to drug treatment. o No one knows for sure how this process works or why for that matter. ECT-treated patients are vulnerable to relapse- just like as other depression treated patients. Repetitive transcranial magnetic stimulation – (rTMS) when repeated pulses surge through a magnetic coil that is held to a person’s skull just above the right eyebrow.
Psychosurgery • •
Psychosurgery – surgery that removes or destroys brain tissue in an effort to change behavior. Lobotomy – once used procedure that cut the nerves that connect the frontal lobes to the emotion-controlling centers of the inner brain. o Disappeared with the emergence of psychoactive drugs. o Produced a permanently lethargic, immature, impulsive personality. o Used today as only a last resort.
