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Copyright © Allyn & Bacon 2005 Copyright © Allyn & Bacon 2005 11
Chapter 15Chapter 15
Therapies for Psychological Disorders
Therapies for Psychological Disorders
Copyright © Allyn and Bacon 2005. Developed and prepared by Joseph A. Davis, Ph.D. This Allyn and Bacon multimedia product and its contents are protected under copyright law. The following are prohibited by law: any public performance or display, including transmission over any network; preparation of any derivative work, including the extraction, in whole or part, of any images; any rental, lease, or lending of the program.
Copyright © Allyn and Bacon 2005. Developed and prepared by Joseph A. Davis, Ph.D. This Allyn and Bacon multimedia product and its contents are protected under copyright law. The following are prohibited by law: any public performance or display, including transmission over any network; preparation of any derivative work, including the extraction, in whole or part, of any images; any rental, lease, or lending of the program.
Copyright © Allyn & Bacon 2005 Copyright © Allyn & Bacon 2005 22
Q: Have you ever been to therapy? Or counseling?
Q: Have you ever been to therapy? Or counseling?
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What do you think psychotherapy should be like?
What do you think psychotherapy should be like?
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Copyright © Allyn & Bacon 2005 Copyright © Allyn & Bacon 2005 55
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Goals of Major TherapiesGoals of Major Therapies
Diagnosis (DSM) 診斷 Probable Etiology 病因 Prognosis 預後 Treatment Planning 療程規劃
Diagnosis (DSM) 診斷 Probable Etiology 病因 Prognosis 預後 Treatment Planning 療程規劃
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Types of Major TherapiesTypes of Major Therapies
Biomedical Therapies 生物醫學治療 : 手術 , 電擊 , 藥物等
Psychotherapy 心理治療 : 藉由心理學的方法對案主進行治療 ; 涵蓋不同取向
Biomedical Therapies 生物醫學治療 : 手術 , 電擊 , 藥物等
Psychotherapy 心理治療 : 藉由心理學的方法對案主進行治療 ; 涵蓋不同取向
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Several types of therapistsSeveral types of therapists Social worker 社工 Pastoral counselor 教牧諮商 Clinical psychologist 臨床心理學家 Counseling psychologist 諮商心理學家 Psychiatrist 精神科醫師 Psychoanalyst 心理 / 精神分析師
Social worker 社工 Pastoral counselor 教牧諮商 Clinical psychologist 臨床心理學家 Counseling psychologist 諮商心理學家 Psychiatrist 精神科醫師 Psychoanalyst 心理 / 精神分析師
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Therapists and Therapeutic SettingsTherapists and Therapeutic Settings
Patient 病人– Used in the biomedical approach
to treatment
Client 個案 / 案主– Used by clinicians who think
of psychological disorders as problems in living
Patient 病人– Used in the biomedical approach
to treatment
Client 個案 / 案主– Used by clinicians who think
of psychological disorders as problems in living
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Historical and Cultural ContextsHistorical and Cultural Contexts Early Psychotherapy: locked up
patients as prisoners.
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Historical and Cultural ContextsHistorical and Cultural Contexts
1900 年代初期 : begin to improve 1950 年代 : anti-depressants &
anti-anxiolytics - no need to live in the hospital
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Psychoanalysis 精神分析 /Psychodynamic 心理動力 : Freud Internal conflicts; repressed E.g., You envy your younger sister who took
parents away; cannot show your impulse to hurt the baby; envy classmate; competition
Goal: make the unconscious conscious; gain insight
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Psychoanalysis 精神分析 /Psychodynamic 心理動力 :
Free association 自由聯想
Lying on the couch – talk freely
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Resistance 抗拒 :
- e.g., doesn’t talk much about “father”; changes topic; says his father is irrelevant
(e.g., silence, not answering therapist’s questions, lateness, no-show)
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Transference 移情作用 : the thoughts and feelings that client has toward the therapist
positive or negative
may remind the clt of another person
therapist is like a blank slate on which the clt projects his/her feelings
different therapists – different pulls
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• Countertransference 反移情作用 :
The thoughts & feelings that the therapist has toward the clt
In psychoanalysis, the therapist needs to monitor own countertransferences. (Therapists themselves receive psychoanalysis).
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Structure of Psychotherapy:
- Psychoanalysis: 3 – 5 times/wk
- Psychodynamic: once/week
- 50 minutes – 60 minutes
- now: modified
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Behavior TherapiesBehavior Therapies
- Based on the learning theories - Focus on the problem behaviors (e.g.
hyperactive behavior; cleaning behavior)
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Behavior TherapiesBehavior Therapies
- E.g., fear of talking on the stage, due to your critical father,your overachieving brother
- Insight change?
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Behavior TherapiesBehavior Therapies
Flooding 洪水猛獸法– Clients are exposed to stimuli most
frightening to them
e.g., fear of height
Flooding 洪水猛獸法– Clients are exposed to stimuli most
frightening to them
e.g., fear of height
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Behavior TherapiesBehavior Therapies Systematic Desensitization 系統減敏法 : present less anxiety-
provoking objects first- Theory of reciprocal Inhibition 交互抑制 relaxation training (VCD) hierarchy of feared situations
e.g., fear of dog
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Group DiscussionGroup Discussion Systematic Desensitization 系統減敏法 :
- You have a male client w/ fear of females. He likes Mary, but cannot ask her out.
- How would you use systematic desensitization to treat him?
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Behavior TherapiesBehavior Therapies
Aversion Therapy 厭惡療法 用電擊和催吐劑 , 讓個案先服催吐劑再喝
酒 , 配對數次後 , 個案就會對酒發出嫌惡反應 .
e.g., worry – rubber band
Aversion Therapy 厭惡療法 用電擊和催吐劑 , 讓個案先服催吐劑再喝
酒 , 配對數次後 , 個案就會對酒發出嫌惡反應 .
e.g., worry – rubber band
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Behavior TherapiesBehavior Therapies
Contingency Management 增強管理
– Changing behavior by modifying its consequences
Contingency Management 增強管理
– Changing behavior by modifying its consequences
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Behavior TherapiesBehavior Therapies
Contingency Management 增強管理
e.g., good behavior: give yourself a present (positive reinforcement 正增強 )
e.g., bad behavior: clean the bathroom (punishment 懲罰 )
Contingency Management 增強管理
e.g., good behavior: give yourself a present (positive reinforcement 正增強 )
e.g., bad behavior: clean the bathroom (punishment 懲罰 )
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Behavior TherapiesBehavior Therapies
Contingency Management 增強管理
- Token economy 代幣法
Contingency Management 增強管理
- Token economy 代幣法
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Behavior TherapiesBehavior Therapies Social-learning Therapy 社會學習治療
– Clients observe models’ desirable behaviors being reinforced
有樣學樣
Social-learning Therapy 社會學習治療– Clients observe models’ desirable
behaviors being reinforced
有樣學樣
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Cognitive TherapiesCognitive Therapies
Cognitive Therapy– Attempts to change feelings and behaviors by
changing the way a client thinks about life experiences
– VCD
Cognitive Therapy– Attempts to change feelings and behaviors by
changing the way a client thinks about life experiences
– VCD
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Cognitive TherapiesCognitive Therapies
Aaron Beck:Aaron Beck: 認知治療認知治療
Replace the self-defeating thoughts with Replace the self-defeating thoughts with more adaptive thoughts more adaptive thoughts
Effective with depressed cltsEffective with depressed clts
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Humanistic TherapiesHumanistic Therapies
Client-centered 案主中心 Therapy– Carl Rogers– Emphasizes the healthy psychological growth
of the individual– Optimistic view: Humans are basically good.
Client-centered 案主中心 Therapy– Carl Rogers– Emphasizes the healthy psychological growth
of the individual– Optimistic view: Humans are basically good.
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Humanistic TherapiesHumanistic Therapies
If given the following 3 elements, clients can improve:
1) Congruence 真誠 ( 表裡一致 )
2) Unconditional positive regard 無條件的正向關懷
3) Accurate empathy 準確地同理
** Now, these are regarded as necessary but not sufficient.
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Group TherapiesGroup Therapies
Marital and Family Therapy– Couples counseling– Family therapy
Community Support Groups– Self-help groups
Marital and Family Therapy– Couples counseling– Family therapy
Community Support Groups– Self-help groups
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• Meta-analysis 統合分析法 :
• Length of therapy – positively associated with successful outcome
Is Psychotherapy Effective?
Research findings: Overall, yes.
Treatment groups do better than the Control groups.