Approaches to Treatment and Therapy

Approaches to Treatment and Therapy

• Biological Treatments• Kinds of Psychotherapy• Evaluating Psychotherapy

Biological Treatments

• The Question of Drugs• Surgery and Electroshock

The Question of Drugs

Cautions About Drug Treatment

• Placebo Effect• High Relapse and Dropout Rates• Dosage Problems• Long-Term Risks

Surgery and Electroshock

• Psychosurgery: – Any surgical procedure that destroys

selected areas of the brain believed to be involved in emotional disorders or violent, impulsive behavior.

• Electroconvulsive Therapy (ECT): – A procedure used in cases of prolonged and

severe major depression, in which a brief brain seizure is induced.

Kinds of Psychotherapy

• Psychodynamic Therapy• Behavioral and Cognitive Therapy• Humanist and Existential Therapy• Family Therapy• Psychotherapy in Practice

Psychodynamic Therapy

• Free Association: – In psychoanalysis, a method of uncovering

unconscious conflicts by saying freely whatever comes to mind.

• Transference: – In psychodynamic therapies, a critical step in

which the client transfers unconscious emotions or reactions, such as conflicts about his or her parents, onto the therapist.

Behavioral and Cognitive Therapy

• Systematic Desensitization• Aversive Conditioning• Exposure Treatments• Behavioral Records and Contracts• Skills Training

Cognitive Techniques

• Examine the evidence for beliefs.• Consider other explanations for the

behavior of others.• Identify assumptions and biases.

Humanist and Existential Therapy

• Client-Centered Therapy : – Developed by Carl Rogers; therapist tries to

create climate of Unconditional Positive Regard to allow clients to seek self-actualization and self-fulfillment.

– a.k.a., “Nondirective Therapy”

• Existential Therapy: – Helps clients explore the meaning of

existence and face with courage the great issues of life.

One Family’s Genogram

Systemic Therapy

• Salvador Minuchin (structural family therapy)– All individuals belong to a system.– Systems have structure.– Structure is defined by rules and boundaries.– Rules and boundaries define interaction patterns.– A family system consists of three smaller

subsystems• Spousal• Parental• Sibling

– Treatment focus is on fixing the systems structural problem and not on the individual or identified patient.

Primary Goals of Therapies

• Psychodynamic: – Insight into unconscious motives and

feelings.

• Cognitive-Behavioral: – Modification of behavior and irrational

beliefs.

Primary Goals of Therapies

• Humanist: – Insight; self-acceptance and self-fulfillment.

• Family: – Modification of individual habits and family

patterns.

Primary Methods of Therapies

• Psychodynamic: – Probing the unconscious through dream

analysis, free association, transference.

• Cognitive-Behavioral: – Behavioral techniques such as systematic

desensitization, flooding; cognitive exercises to identify and change faulty beliefs.

Primary Methods of Therapies

• Humanist: – Providing a safe, non-judgmental setting in

which to discuss life issues.

• Family: – Working with couples, families, and

sometimes individuals to identify and change patterns that perpetuate problems.

Evaluating Psychotherapy

• The Scientist-Practitioner Gap• When Therapy Helps• Which Therapy for Which Problem?• When Therapy Harms

The Scientist-Practitioner Gap

• Some psychotherapists believe that evaluating therapy using research methods is futile.

• Scientists find that therapists who do not keep up with empirical findings are less effective and can do harm to clients.

• Economic pressures require empirical assessment of therapies.

Is More Psychotherapy Better?

• With additional therapy sessions, the percentage of people improved increased up to 26 sessions.

• Rate of improvement then levels off.– Based on a summary

of 15 studies, 2400 clients (Howard, et al., 1996)

• Patients’ sense of improvement slower but more steady.

Psychotherapy Research: Three Questions

• What are the common ingredients in successful therapies?

• What kinds of therapy are best suited for which problems?

• Under what conditions can therapy be harmful?

When Therapy Helps

• Therapeutic Alliance: – The bond of confidence and mutual

understanding established between therapist and client, which allows them to work together to solve the client’s problems.

Which Therapy for Which Problem?

• Depression: – Cognitive therapy’s greatest success has

come in treatment of mood disorders.• Anxiety Disorders:

– Exposure techniques are more effective than others.

• Anger and Impulsive Violence: – Cognitive therapy is extremely successful.

Which Therapy for Which Problem?

• Health Problems: – Cognitive and behavior therapies are

effective for a wide range of health problems.• Childhood and Adolescent Behavior Problems:

– Behavior therapy is the most effective treatment.

Cognitive Inoculation Against Depression

• Children at risk for depression split into two groups

• Cognitive intervention with one group lowered depression risk

• Effects of intervention seem to grow over time

Successful Therapy

• Psychotherapy outcome depends not only on method of therapy.

• Qualities of client and therapist, and their alliance, also determine success.

When Therapy Harms

• Animosity or biased treatment on the part of the therapist.

• Coercion to adopt the therapist’s advice, sexual intimacies, or other unethical behavior.

When Therapy Harms

• Therapist-induced disorders resulting from inadvertent suggestions or influence.

Although suggestive techniques may result in false memories, one third of licensedpsychotherapists usethese methods.