Copyright © 2010 Pearson Education Canada17-1 Approaches to Treatment and Therapy Chapter 17.

Copyright © 2010 Pearson Education Canada 17-1

Approaches to Approaches to Treatment and TherapyTreatment and Therapy

Chapter 17Chapter 17


Chapter OutlineChapter Outline

• Biological Treatments for Mental DisordersBiological Treatments for Mental Disorders

• Kinds of PsychotherapyKinds of Psychotherapy

• Evaluating PsychotherapyEvaluating Psychotherapy

• The Value and Values of PsychotherapyThe Value and Values of Psychotherapy


Biological TreatmentsBiological Treatments

• Contemporary view alternates between mental Contemporary view alternates between mental disorders as diseases (medical treatment) & disorders as diseases (medical treatment) & emotional problems (psychological treatment)emotional problems (psychological treatment)

• Drug treatments on the rise with growing Drug treatments on the rise with growing recognition of biological and genetic recognition of biological and genetic components to disorderscomponents to disorders

– Medications that alter the production of or Medications that alter the production of or response to neurotransmitters in the brainresponse to neurotransmitters in the brain


Antipsychotic DrugsAntipsychotic Drugs

• Antipsychotic drugs (neuroleptics)Antipsychotic drugs (neuroleptics)

– Drugs used primarily in the treatment of schizophrenia & Drugs used primarily in the treatment of schizophrenia & other psychotic disordersother psychotic disorders

– Most designed to block or reduce the sensitivity of brain Most designed to block or reduce the sensitivity of brain receptors that respond to dopaminereceptors that respond to dopamine

– Reduce agitation, delusions, and hallucinationsReduce agitation, delusions, and hallucinations

– Side effects such as muscular rigidity, tremors, and Side effects such as muscular rigidity, tremors, and involuntary muscle movements (involuntary muscle movements (tardive dyskinesiatardive dyskinesia))


Antidepressant DrugsAntidepressant Drugs

• Antidepressant drugsAntidepressant drugs

– Drugs used primarily in the treatment of mood Drugs used primarily in the treatment of mood disorders, especially depression & anxietydisorders, especially depression & anxiety

– Produce unpleasant physical reactionsProduce unpleasant physical reactions

• Three classes of antidepressants:Three classes of antidepressants:

– Monoamine oxidase inhibitors (MAOIs)Monoamine oxidase inhibitors (MAOIs)– Tricyclic antidepressants Tricyclic antidepressants – Selective serotonin reuptake inhibitors (SSRIs)Selective serotonin reuptake inhibitors (SSRIs)


Tranquilizers & LithiumTranquilizers & Lithium

• TranquilizersTranquilizers

– Drugs commonly but often inappropriately Drugs commonly but often inappropriately prescribed for patients who complain of prescribed for patients who complain of unhappiness, anxiety, or worryunhappiness, anxiety, or worry

– Increase activity of GABAIncrease activity of GABA

• Lithium carbonateLithium carbonate

– Drug frequently given to people suffering from Drug frequently given to people suffering from bipolar disorder (moderates norepinephrine & stops bipolar disorder (moderates norepinephrine & stops overstimulation from glutamate)overstimulation from glutamate)


Drug TreatmentsDrug Treatments


Cautions About Drug TreatmentsCautions About Drug Treatments

• Limitations to drug treatments:Limitations to drug treatments:

1.1. The placebo effectThe placebo effect

2.2. High relapse and dropout ratesHigh relapse and dropout rates

3.3. Dosage problems (Dosage problems (therapeutic windowtherapeutic window))

4.4. Unknown long-term risksUnknown long-term risks


Direct Brain InterventionDirect Brain Intervention

• PsychosurgeryPsychosurgery

– Any surgical procedure that destroys selected areas of Any surgical procedure that destroys selected areas of the brain believed to be involved in emotional disorders the brain believed to be involved in emotional disorders or violent, impulsive behaviour (e.g., prefrontal lobotomy)or violent, impulsive behaviour (e.g., prefrontal lobotomy)

• Electroconvulsive therapy (ECT)Electroconvulsive therapy (ECT)

– A procedure used in cases of prolonged and severe A procedure used in cases of prolonged and severe major depression, in which a brief brain seizure is major depression, in which a brief brain seizure is inducedinduced

– Newer alternatives like Newer alternatives like transcranial magnetic stimulation transcranial magnetic stimulation (TMS)(TMS) used for milder stimulation used for milder stimulation


Kinds of PsychotherapyKinds of Psychotherapy

• Major schools of psychotherapy:Major schools of psychotherapy:

1.1. Psychodynamic therapyPsychodynamic therapy

2.2. Behavioural therapyBehavioural therapy

3.3. Cognitive therapyCognitive therapy

4.4. Humanist therapyHumanist therapy

5.5. Existential therapyExistential therapy

6.6. Family & couples therapyFamily & couples therapy


Psychodynamic TherapyPsychodynamic Therapy

• Relied on Freud’s method of Relied on Freud’s method of psychoanalysispsychoanalysis & traditionally involved & traditionally involved free associationfree association

• Evolved into many Evolved into many psychodynamic or psychodynamic or “depth” therapies“depth” therapies

– Major element of Major element of transference:transference: process where process where client transfers unconscious emotions or client transfers unconscious emotions or reactions (e.g., feelings about parents) onto the reactions (e.g., feelings about parents) onto the therapisttherapist


Behavioural TherapyBehavioural Therapy

• Behaviour therapyBehaviour therapy

– Therapy that applies principles of classical and Therapy that applies principles of classical and operant conditioning to help people change self-operant conditioning to help people change self-defeating or problematic behavioursdefeating or problematic behaviours

• Use a variety of methods depending on the Use a variety of methods depending on the problem or situationsproblem or situations

– Exposure, systematic desensitization, Exposure, systematic desensitization, behavioural self-monitoring, skills trainingbehavioural self-monitoring, skills training


Behavioural TechniquesBehavioural Techniques

1.1. ExposureExposure

– Graduated exposure:Graduated exposure: method where a person method where a person suffering from a phobia or panic attacks is suffering from a phobia or panic attacks is gradually taken into the feared situation or gradually taken into the feared situation or exposed to a traumatic memory until the fear exposed to a traumatic memory until the fear subsidessubsides

– Flooding:Flooding: a form of exposure treatment in a form of exposure treatment in which the client is taken directly into the feared which the client is taken directly into the feared situation until his or her anxiety subsidessituation until his or her anxiety subsides



2.2. Systematic desensitizationSystematic desensitization

– Systematic desensitization:Systematic desensitization: step-by-step step-by-step process of desensitizing a client to a feared process of desensitizing a client to a feared object or experienceobject or experience

– Based on Based on counterconditioning:counterconditioning: process of process of pairing a conditioned stimulus with a stimulus pairing a conditioned stimulus with a stimulus that elicits a response that is incompatible with that elicits a response that is incompatible with an unwanted conditioned responsean unwanted conditioned response



3.3. Behavioural self-monitoringBehavioural self-monitoring

– A method of keeping careful data on the A method of keeping careful data on the frequency and consequences of the behaviour frequency and consequences of the behaviour to be changedto be changed

4.4. Skills trainingSkills training

– An effort to teach the client skills the he or she An effort to teach the client skills the he or she may lack, as well as new constructive may lack, as well as new constructive behaviours to replace self-defeating onesbehaviours to replace self-defeating ones


Cognitive TherapyCognitive Therapy

• Cognitive therapyCognitive therapy

– Form of therapy designed to identify and change Form of therapy designed to identify and change irrational, unproductive ways of thinking and, hence, to irrational, unproductive ways of thinking and, hence, to reduce negative emotionsreduce negative emotions

– Rational emotive behaviour therapy (REBT):Rational emotive behaviour therapy (REBT): designed to designed to challenge client’s unrealistic thoughts (e.g., challenge client’s unrealistic thoughts (e.g., overgeneralizations, catastrophizing) (Ellis)overgeneralizations, catastrophizing) (Ellis)

– Other forms include cognitive therapy for depression Other forms include cognitive therapy for depression (Beck) and stress inoculation for anxiety (Meichenbaum)(Beck) and stress inoculation for anxiety (Meichenbaum)


ProcrastinationProcrastination

• Many procrastinators are Many procrastinators are perfectionists (if you can’t perfectionists (if you can’t do it perfectly, then don’t do it perfectly, then don’t do it at all)do it at all)

• Failure to accept limitations Failure to accept limitations leads to impossible leads to impossible standards & standards & catastrophizing (rather catastrophizing (rather than rational responses)than rational responses)


Bandura’s TherapiesBandura’s Therapies

• Self-control therapySelf-control therapy

– Designed to help people overcome problem habitsDesigned to help people overcome problem habits

– Required self-observation, environmental planning, Required self-observation, environmental planning, and self-contractsand self-contracts

• Modeling therapyModeling therapy

– People can overcome disorders by observing People can overcome disorders by observing another person who is dealing with the same another person who is dealing with the same problem in a productive fashionproblem in a productive fashion


Humanist TherapyHumanist Therapy

• Humanist therapyHumanist therapy

– Form of psychotherapy based on the philosophy Form of psychotherapy based on the philosophy of humanism, which emphasizes the client’s free of humanism, which emphasizes the client’s free will to change rather than past conflictswill to change rather than past conflicts

– Client-centred therapy:Client-centred therapy: emphasizes therapist’s emphasizes therapist’s empathy with the client and the use of empathy with the client and the use of unconditional positive regardunconditional positive regard (Rogers) (Rogers)

• Empathy refers to ability of therapist to understand & Empathy refers to ability of therapist to understand & accept what the client saysaccept what the client says


Existential TherapyExistential Therapy

• Existential therapyExistential therapy

– Form of therapy designed to help clients explore Form of therapy designed to help clients explore the meaning of existence and face the great the meaning of existence and face the great questions of life, such as death, freedom, questions of life, such as death, freedom, alienation, and lonelinessalienation, and loneliness

– Crucial step to take self-responsibility for Crucial step to take self-responsibility for circumstancescircumstances

– Helps clients cope with inescapable realities of Helps clients cope with inescapable realities of life and death and struggle for meaninglife and death and struggle for meaning


Family & Couples TherapyFamily & Couples Therapy

• Family therapyFamily therapy

– Perspective that holds than an individual’s Perspective that holds than an individual’s problem develops in the context of the family, problem develops in the context of the family, sustained by family dynamics, and that changes sustained by family dynamics, and that changes affect all members of the familyaffect all members of the family

• Family-systems perspectiveFamily-systems perspective

– Approach that identifies how each family Approach that identifies how each family member forms a larger part of an interacting member forms a larger part of an interacting systemsystem


Couples TherapyCouples Therapy

• Couples therapyCouples therapy

– Approach where therapist sees both partners in Approach where therapist sees both partners in a couple and helps them to manage inevitable a couple and helps them to manage inevitable conflicts that occur in all relationshipsconflicts that occur in all relationships

– May use psychodynamic, behavioural, cognitive, May use psychodynamic, behavioural, cognitive, or humanist approaches in their workor humanist approaches in their work

• In practice, many therapists take an In practice, many therapists take an integrative approach to psychologyintegrative approach to psychology


Kinds of PsychotherapyKinds of Psychotherapy


Evaluating PsychotherapyEvaluating Psychotherapy

• Success of therapy depends on quality of Success of therapy depends on quality of relationship between therapist & clientrelationship between therapist & client

– Therapeutic alliance:Therapeutic alliance: bond of confidence and mutual bond of confidence and mutual understanding established between therapist and understanding established between therapist and client, which allows them to work together to solve client, which allows them to work together to solve the client’s problemsthe client’s problems

– Client’s motivation to improve important in successClient’s motivation to improve important in success

– Cultural “match” may help with client disclosure & Cultural “match” may help with client disclosure & mutual trust relationships (cultural group therapy also mutual trust relationships (cultural group therapy also a popular approach)a popular approach)


Scientist-Practitioner GapScientist-Practitioner Gap

• Debate between practitioners & scientists as Debate between practitioners & scientists as to how psychotherapy can be evaluated?to how psychotherapy can be evaluated?

• Scientist-practitioner gapScientist-practitioner gap

– Breach between scientists & therapists over Breach between scientists & therapists over different assumptions held by researchers and different assumptions held by researchers and many clinicians regarding the value of empirical many clinicians regarding the value of empirical research for doing psychotherapy and for research for doing psychotherapy and for assessing its effectiveness assessing its effectiveness


““New” TherapiesNew” Therapies

• Gap has widened with the continued Gap has widened with the continued generation or “repackaging” of new therapiesgeneration or “repackaging” of new therapies

• Some claim to be highly successful, yet lack Some claim to be highly successful, yet lack any empirical evidence to suggest they are any empirical evidence to suggest they are any better than standardized techniquesany better than standardized techniques

– Examples: Examples: Neurolinguistic Programming (NLP), Neurolinguistic Programming (NLP), Eye Movement Desensitization and Eye Movement Desensitization and Reprocessing (EMDR)Reprocessing (EMDR)


Problems in Assessing TherapyProblems in Assessing Therapy

• Economic pressures (insurers) require empirical Economic pressures (insurers) require empirical assessment of therapiesassessment of therapies– Often use testimonials are problematic due to Often use testimonials are problematic due to

justification of effortjustification of effort effect effect

• Randomized controlled trialsRandomized controlled trials used to overcome used to overcome some of these problemssome of these problems

– People with a given problem or disorder are randomly People with a given problem or disorder are randomly assigned to one or more treatment groups or to a control assigned to one or more treatment groups or to a control group; designed to evaluate effectiveness of new group; designed to evaluate effectiveness of new medication or form of therapymedication or form of therapy


Evaluating Crisis DebreifingEvaluating Crisis Debreifing

• Critical Incident Stress Debriefing (CISD)Critical Incident Stress Debriefing (CISD) used as an used as an intervention immediately following disasters to decrease intervention immediately following disasters to decrease rates of PTSDrates of PTSD

• Found that Found that highly highly emotional emotional reactions to reactions to incidents + incidents + CISD CISD showed showed higher higher stress stress symptomssymptoms


When Therapy HelpsWhen Therapy Helps

• Many benefits to psychotherapy & certain Many benefits to psychotherapy & certain therapies may work best for certain types of therapies may work best for certain types of problems or disordersproblems or disorders

• For many problems and most emotional For many problems and most emotional disorders, cognitive and behaviour therapies disorders, cognitive and behaviour therapies are the method of choiceare the method of choice


When Therapy HelpsWhen Therapy Helps

• Depression:Depression: cognitive therapy cognitive therapy

• Prevention of suicide:Prevention of suicide: cognitive therapy cognitive therapy

• Anxiety disorders:Anxiety disorders: exposure techniques (PTSD, exposure techniques (PTSD, agoraphobia, specific phobias), cognitive-behaviour therapy agoraphobia, specific phobias), cognitive-behaviour therapy (panic, generalized anxiety, obsessive-compulsive (panic, generalized anxiety, obsessive-compulsive disorders)disorders)

• Anger and impulsive violence:Anger and impulsive violence: cognitive therapy cognitive therapy

• Health problems:Health problems: cognitive & behaviour therapies cognitive & behaviour therapies

• Childhood & adolescent problems:Childhood & adolescent problems: behaviour therapy behaviour therapy

• Relapse prevention:Relapse prevention: cognitive-behavioural approaches cognitive-behavioural approaches


Motivational InterviewingMotivational Interviewing

• Motivational interviewingMotivational interviewing

– Therapy for treating alcohol abuse that focuses Therapy for treating alcohol abuse that focuses specifically on increasing a client’s motivation to specifically on increasing a client’s motivation to change problem drinkingchange problem drinking

– Some evidence suggests this can be very Some evidence suggests this can be very effective early on in therapy processeffective early on in therapy process

– May be combined with other techniques for May be combined with other techniques for integrated approachintegrated approach


Multisystemic TherapyMultisystemic Therapy

• Special or problem populations may be addressed Special or problem populations may be addressed with with multisystemic therapy (MST)multisystemic therapy (MST)

– Community intervention that combines family systems Community intervention that combines family systems techniques with behavioural methodstechniques with behavioural methods

– Applied in context of forming “neighbourhood Applied in context of forming “neighbourhood partnerships” with local leaders, residents, parents, and partnerships” with local leaders, residents, parents, and teachers to help prevent or reduce teenagers problemsteachers to help prevent or reduce teenagers problems

– Used for teen violence, criminal activity, drug abuse and Used for teen violence, criminal activity, drug abuse and school problemsschool problems


Factors in Successful TherapyFactors in Successful Therapy


Biology & PsychotherapyBiology & Psychotherapy

• PET scans indicate that both medical and therapeutic PET scans indicate that both medical and therapeutic interventions are influencing the brain, but perhaps in interventions are influencing the brain, but perhaps in different ways & regionsdifferent ways & regions


When Therapy HarmsWhen Therapy Harms

• Risks to clients increase under these conditions:Risks to clients increase under these conditions:

1.1. The use of empirically unsupported, potentially The use of empirically unsupported, potentially dangerous techniques (e.g., rebirthing, recovered dangerous techniques (e.g., rebirthing, recovered memory therapies)memory therapies)

2.2. Inappropriate or coercive influence, which can create Inappropriate or coercive influence, which can create new problems for the clientnew problems for the client

3.3. Prejudice or cultural ignorance on the part of the Prejudice or cultural ignorance on the part of the therapisttherapist

4.4. Sexual intimacies or other unethical behaviour on Sexual intimacies or other unethical behaviour on the part of the therapistthe part of the therapist


Problematic TechniquesProblematic Techniques


Values of PsychotherapyValues of Psychotherapy

• Most people get the help they need for Most people get the help they need for ‘regular’ challenges from family & peers‘regular’ challenges from family & peers

• Consumers thinking about psychotherapy Consumers thinking about psychotherapy should carefully consider how they go about:should carefully consider how they go about:

– Choosing a therapistChoosing a therapist– Choosing a therapyChoosing a therapy– Deciding when to leaveDeciding when to leave


End of Chapter 17End of Chapter 17

Copyright © 2010 Pearson Education Canada17-1 Approaches to Treatment and Therapy Chapter 17.

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Transcript of Copyright © 2010 Pearson Education Canada17-1 Approaches to Treatment and Therapy Chapter 17.