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 Ú Beliefs Ú 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