Chapter Fourteen

Module 14.1

Pathways to the Present: A Brief History of Therapy

The Rise of Moral Therapy

•      Moral therapy

–   Philosophy of treatment for mentally disturbed

–   Treatment should be compassionate and humane

•      Individuals involved

–   Jean-Baptiste Pussin

–   Philippe Pinel

–   Dorothea Dix

Community-Based Care

•      Community mental health system

–   Began in 1960s

–   Response to poor conditions in mental hospitals

•      Includes

–   Outpatient care

–   Day treatment

–   Crisis intervention

•      Deinstitutionalization

–   Mixed results

Module 14.2

Types of Psychotherapy

Mental Health Professionals

•      Clinical psychologists

–   Doctoral degree in psychology, licensing exam

–   Psychological testing, diagnosing mental disorders, psychotherapy

•      Counseling psychologists

–   Doctoral degree in psychology, licensing exam

–   Counseling for milder range of problems

•      Psychiatrists

–   Medical degree, residency

–   Physicians specializing in diagnosis and treatment of mental illness

–   May prescribe psychiatric drugs or practice psychotherapy

•      Clinical or psychiatric social workers

–   Master’s degree in social work

–   Help individuals with severe mental illness to receive services from community agencies and organizations

•      Psychoanalysts

–   Psychologist or psychiatrist with additional training in psychoanalysis

•      Counselors

–   Master’s degree in counseling field

–   Varied settings and types of counseling

•   Examples: vocational, marital, college, substance abuse

•      Psychiatric nurses

–   R.N. with master’s degree in psychiatric nursing

–   Working with people who have severe psychological disorders

Psychodynamic Therapy

•      Traditional psychoanalysis

–   Sigmund Freud

–   Psychoanalysts, analysts

–   Defense mechanisms, especially repression

–   Goal of therapy: to realize unconscious conflicts

Psychoanalytic Techniques

•      Used to probe unconscious mind

–   Free association

–   Dream analysis

•   Latent versus manifest content

–   Interpretation of

•   Resistance

•   Transference relationship

•   Countertransference

Modern Psychodynamic Approaches

•      Less focus on sexual issues

•      More focus on

–   Adaptive functioning of ego

–   Client’s current relationships

•      Briefer, more direct approach

Humanistic Therapy

•      General qualities

–   Belief in free will

–   Emphasis on subjective, conscious experience

–   Focus on here-and-now

Humanistic Therapy:
Client-Centered Therapy

•      Developed by Carl Rogers

•      General characteristics

–   Focus on self-actualization, self-concept

–   Warm, accepting atmosphere

–   Nondirective approach

•      Qualities of supportive therapist

–   Unconditional positive regard

–   Empathy

–   Genuineness

Humanistic Therapy: Gestalt Therapy

•      Developed by Fritz Perls

•      “Gestalt”: integrated whole

•      Qualities

–   Direct, confrontational approach

–   Identifying feelings

–   Use of role playing, such as empty chair technique

Behavior Therapy

•      Behavior therapy or behavior modification

•      Apply principles of learning

•      Focus on present situation

Behavior Therapy: Fear Reduction

•      Systematic desensitization

–   Fear hierarchy

•      Gradual exposure (in-vivo exposure)

•      Modeling

•      Virtual therapy

Behavior Therapy:
Aversive Conditioning

•      Form of classical conditioning

•      Objects paired with aversive stimuli

–   Electric shock, nausea-inducing drug

•      Discouraging an undesirable behavior

Behavior Therapy: Operant Conditioning Methods

•      Reinforcement and punishment

•      Token economy

Behavior Therapy: Cognitive-Behavioral Therapy (CBT)

•      Combines

–   Behavioral techniques

–   Challenging and correcting faulty patterns of thinking

Cognitive Therapy

•      Focus on helping people change how they think

•      Distorted thinking underlies

–   Emotional problems

–   Self-defeating behaviors

–   Maladaptive behaviors

Cognitive Therapy: Rational-Emotive Behavior Therapy (REBT)

•      Developed by Albert Ellis

•      Irrational beliefs lead to problems

–   Shoulds, musts

•      ABC approach:

–   Activating events Ϊ Beliefs Ϊ Consequences

•      Learning rational beliefs

 Cognitive Therapy

•      Developed by Aaron Beck

•      Cognitive Therapy

–   Identify and correct errors in thinking

•   Cognitive distortions

•   Automatic thoughts

–   Reality testing

–   Replace negatives with rational alternatives

Eclectic Therapy

•      Combined approaches

•      Integrate principles and techniques

Group Therapy

•      People brought together to explore and resolve problems

•      Advantages over individual therapy

–    Less costly

–    Helps with interpersonal problems, social skills

–    Share coping strategies

•      Drawbacks

–    No one-on-one attention

–    Reluctance to disclose

–    Feelings of inhibition

Family Therapy

•      Helps troubled families

–   Better communication

–   Resolution of differences

•      Individual problems symptomatic of family system breakdown

Couples Therapy

•      Also called marital therapy

•      Builds healthier relationships

–   Effective communication

–   Problem-solving skills

–   Resolve power struggles

•      Focus on disturbed role relationships

Effectiveness of Psychotherapy

•      Measuring effectiveness of therapy in general

–   Controlled studies

•   Psychotherapy versus wait list

–   Meta-analysis

•   400 controlled studies

•   Supports overall effectiveness of psychotherapy

•      Comparing different kinds of therapy

–   Little difference between kinds of therapy overall

–   Effectiveness may rely on matching problem to therapy

•      Accounting for the benefits

–   Nonspecific factors

•   Interpersonal relationship with therapist

–  Therapeutic alliance

•   Expectation of improvement

–  Self-fulfilling prophecy
–  Placebo or expectancy effects

 

Multicultural Issues

•      African Americans

•      Asian Americans

•      Hispanic Americans

•      Native Americans

Module 14.3

Biomedical Therapies

Drug Therapy

•      Antianxiety drugs

•      Antidepressants

•      Antipsychotics

•      Other psychiatric drugs

Antianxiety Drugs

•      Also called minor tranquilizers

•      Effects

–   Reduce anxiety

–   Produce calmness

–   Reduce muscle tension

•      Effect on GABA receptors

•      Examples

–   Valium, Librium, Xanax

Antidepressants

•      Increase availability of neurotransmitters

–   Serotonin, norepinephrine

•      Treatment for depression, anxiety disorders

•      Major types

–   Tricyclics

–   MAO inhibitors

–   Selective serotonin-reuptake inhibitors (SSRIs)

Antipsychotics

•      Also called major tranquilizers

•      Treatment for schizophrenia, other psychotic disorders

•      Phenothiazines, others

•      Change dopamine levels in brain

Other Psychiatric Drugs

•      Mood stabilizers

–   Lithium

•      Stimulants

–   Ritalin, Cylert

 

Evaluating Psychotropic drugs

•      Limitations

•      Side effects

–   Many possible sides effects

–   Example: tardive dyskinesia with antipsychotics

•      Psychological, physical dependence

•      Relapses

•      Useful for temporary relief

–   Used in tandem with psychotherapy

Other Biomedical Therapies

•      Electroconvulsive therapy (ECT)

–   Severe depression

•      Psychosurgery

–   Prefrontal lobotomy

–   Newer more specified techniques

•   Still rarely used

Module 14.4

Application: Getting Help

Getting Help

•      Choosing a therapist

–   Seek recommendations from respected sources

–   Seek a referral

–   College counseling center or health services

–   Professional organizations

–   Yellow pages

–   Check for proper licensing

–   Ask about type of therapy

–   Ask about provider’s background and experience

Getting Help

•      Working with therapist

–   Discuss diagnosis and treatment plan before committing

–   Ask about costs and insurance

–   Find out about late/missed session policy

–   With medication inquire about delay, side effects

–   Discuss concerns about treatment

–   Request a second opinion if in doubt

–   Be wary of online services