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Chapter 15: Psychological Therapies (Group Therapies (may use a variety of…
Chapter 15: Psychological Therapies
Group Therapies
may use a variety of styles, but person-centered, Gestalt, and behavioral seem to work best; may be also take several different forms
family therapy
problem-based groups
self-help groups:
may also be effective; do not have a therapists directly involved
alternatives to individual therapy; group of clients meet together to discuss similar problems with a single therapist or pair of therapists
Evaluation:
advantages include lower costs, exposure to ways other people view and handle same type of problems, social and emotional support, disadvantages include greater exposure, lees one-on-one contact with therapist, and some problems hard to treat in group setting
Does Psychotherapy Work?
where effective, greater success is often tied to the relationship between the therapist and client ( therapeutic alliance) a sense of safety and longer time in therapy
cultural, ethnic, and gender concerns should also be examined; these factors can affect not only the therapeutic alliance but also identification of actual problems and treatment options
effective is not easy to study due to different theories, techniques, time frames to success, tendency of some therapists to be eclectic variety of techniques is also a challenge
common factors approach focuses on those factors common to successful outcomes from different forms of therapy
client benefit through evidence-based practice or empirically validated treatment, identification of treatments and other aspects of treatments that work best for specific disorders
Action Therapies
Behavior Therapies
action based therapies operating on the premise that all behaviors, both normal and abnormal, are learned behavior analysis involves functional analysis and learning techniques to increase desirable behaviors and decrease undesirable behaviors
techniques based on operant conditioning-reinforcement, extinction, shaping and modeling
token economies
contingency contracting
time out
participant modeling
Evaluation:
more effective than others for specific behavioral problems ( bed wetting, overeating , drug addictions, phobic reactions
techniques based on classical conditioning- paring of stimuli
Exposure Therapies:
expose individual to anxiety-provoking stimulus in real or imaged form, in a gradual or sudden flooding manner
aversion therapy
systematic desensitization
Cognitive Therapies
action-based therapies that focus on helping people change their of thinking; emphasis on identifying distorted an unrealistic beliefs that lead to maladaptive behavior and problem emotion and then replacing them with more-positive, helpful thoughts
Cognitive-Behavioral Therapy: (CBT)
uses cognitive methods that have behavioral elements within them as well
Rational Emotive Behavior Therapy: (REBT)
was developed by Alert Ellis; teaches clients to challenge their own irrational beliefs with more rational, helpful statements
Becks Cognitive Therapy:
identifies several common disorders
overgeneralization
magnification and minimizaion
selective thinking
arbitrary inference
personalization
Evaluation
: typically shorter and less expensive than insight therapies; treating the symptom, not the cause, is both a feature and a criticism; especially effective for many disorders, including, depression, anxiety disorders and personality disorders
Biomedical Therapies
Electroconvulsive Therapy:
involves the application of an electric shock and resulting in seizures that appears to normalize the balance of neurotransmitters in the brain
traditional side effects have been minimized by lower levels of current and the use of both muscle relaxers and anesthesia
still used to treat severe depression and a few other disorders that have not responded to other forms of treatment
Electroconvulsive Therapy
prefrontal lobotomies were widely used in the mid 1900's up until the development of antipsychotic drugs
at present, bilateral anterior cingulotomy is used, primarily for obsessive-compulsive disorder, has been used with depression and bipolar disorder
used only as a last resort, involves cutting into the brain to remove or destroy brain tissue associated with symptoms of mental disorder
Psychopharmacology:
the use of drugs to control or relieve the symptoms of a psychological disorder; may be used alone or in combination with other therapies
Mood-Stabilizing Drugs:
addresses the manic episodes associated with bipolar disorder. most common is lithium; may also include anti-depressants
Anti-depressant Drugs:
are used to treat symptoms of depression and include monoamine oxidase inhibitors, tricyclic anti depressants, and selective serotonin reuptake inhibitors
Antianxiety Drugs:
address anxiety and related disorders; include the minor tranquilizers that have a sedative effect -also have potential for addiction and abuse
Antipsychotic Drugs:
treat psychotic symptoms such as hallucinations, delusions and bizarre behavior, include the typical antipsychotics, and partial dopamine agonists; work by blocking certain dopamine receptors in the brain; long term use has a variety of risks, both behavioral and cognitive
Emerging Technologies:
repetitve transcranial magnetic stimulation/ transcranial direct current stimulation
being evaluated for treatment options for PTSD and depression and other disorders
deep brain stimulation for depression and OCD
Insight Therapies
Interpersonal Therapy (IPT)
eclectic therapy with some theoretical roots in the psychodynamic approach but combines aspects from humanistic and cognitive-behavioral therapists
Humanistic Therapy:
focuses on the conscious, subjective experiences of emotion and peoples sense of self; promotes insight and emphasizes the importance of individual choice and the potential to change one behavior
Gestalt Therapy:
therapists uses a very directive approach to lead the client through a number of planned experiences with the goal fo reaching self awareness
developed by Fritz Perls; focuses on match between actual and ideal self, focuses on the gestalt or "whole picture"
although aspects of the individuals past are examined, the focus is on denied past, not hidden past; everything is conscious but possibly not in the "here and now"
Motivational Interviewing:
"client-centered with a twist"; has a specific goals to reduce ambivalence about change and increase intrinsic motivation
Person-Centered Therapy:
developed by Carl Rogers; focuses on March between real self and ideal self; maladjustment is result of not matching: unconditional positive regard is important for congruence between real and ideal self
therapists uses a nondirective approach and four basic elements to develop the person-therapists relationships
empathy
authenticity
unconditional positive regard
reflection
focuses on the conscious, subjective experience of emotion and peoples sense of self promotes insight and emphasizes the importance of individuals choices and the potential to changes ones behavior
Evaluation
: humanistic approaches benefits many therapeutic efforts; humanistic therapies are associated with large pre-post client change, maintained for a significant period of time; requires client to be fairly intelligent and verbally expressive.
Freud"s Psychoanalysis and related techniques
Free Association:
originally developed by Breuer, involved patients freely talking about whatever came to mind; believed to reveal hidden, unconscious concerns
Modern Psychodynamic Approach
: more directive than it was historically and typically focuses more on the ego or sense of self rather than the id, when looking at reasons behind behavior
Dream Interpretation:
Involved deciphering the hidden, latent content freely talking about whatever came to mind; believed to reveal hidden, unconscious concerns
Evaluation:
although techniques have been modified, still lacks scientific support for basic premises and requires client to be fairly intelligent and verbal expressive
Freud developed the techniques of Psychoanalysis, an insight therapy aimed at revealing unconscious conflicts, urges and desires
Treatment of Psychological Disorders
Early Inventions:
organized treatment began in England around the middle 1500's
Pinel started the "moral treatment" movement in France
historically, psychological or social causes identified for some disorders; for others; individuals with mental illness were believed to be possessed by demons or evil spirits
Modern Treatments:
Psychotherapy:
based on the psychological techniques, individuals talk about their problems and the therapist assists them in understanding and changing behavior
insight therapy
action therapy
Biomedical Therapy:
uses medical interventions to bring symptoms under control