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Both psychoanalytic and humanistic therapies are ________ therapies—they attempt to improve functioning by increasing clients' awareness of motives and defenses.

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insight

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Behavior therapies are ____________. Their goal is to apply learning principles to modify problem behaviors

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not insight therapies

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Psychotherapy

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Involves psychological techniques derived from psychological perspectives; trained therapist uses psychological techniques to assist someone seeking to overcome difficulties or achieve personal growth

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Biomedical therapy

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Involves treatment with medical procedures; trained therapist, most often a medical doctor, offers medications and other biological treatments

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Eclectic approach

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Approach to psychotherapy that uses techniques from various forms of therapy

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Psychoanalysis

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Goals: To bring patients' repressed feelings into conscious awareness; to help patients release energy devoted to id-ego-superego conflicts so they may achieve healthier, less anxious lives. Techniques: Historical reconstruction, initially through hypnosis and later through free association; interpretation of resistance, transference

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Psychodynamic Therapy

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Goals: To help people understand current symptoms; to explore and gain perspective on defended-against thoughts and feelings Techniques: Client-centered face-to-face meetings; exploration of past relationship troubles to understand origins of current difficulties

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Psychodynamic therapy

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Influenced by traditional psychoanalysis but differs from it in many ways

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Differences

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Lack of belief in id, ego, and superego. Briefer, less expensive, and more focused on helping the client find relief from current symptoms. Helps clients understand how past relationships create themes that may be acted out in present relationships

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Interpersonal therapy

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Brief 12- to 16-session form of psychodynamic therapy that has been effective in treating depression

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Humanistic perspective

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Theme: Emphasis on people's potential for self-fulfillment; to give people new insights. Goals: To reduce inner conflicts that interfere with natural development and growth; help clients grow in self-awareness and self-acceptance promoting personal growth. Techniques: Client-centered therapy; focus on taking responsibility for feelings and actions and on present and future rather than past

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Humanistic Therapies Roger

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Person-centered therapy focuses on person's conscious self-perceptions; non-directive; active listening; unconditional positive regard. Most people possess resources for growth. Therapists foster growth by exhibiting genuineness, acceptance, and empathy

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ACTIVE LISTENING

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Carl Rogers (right) empathized with a client during this group therapy session.

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Counterconditioning

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Uses classical conditioning to evoke new responses to stimuli that are triggering unwanted behaviors

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Exposure therapies

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Treat anxieties by exposing people (in imagination or actual situations) to the things they fear and avoid

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Systematic desensitization

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Associates a pleasant, relaxed state with gradually increasing, anxiety-triggering stimuli (girl afraid of snake)

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Virtual Reality Exposure Therapy

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Treats anxiety by creative electronic simulations in which people can safely face their greatest fears, such as airplane flying, spiders, or public speaking

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Aversive conditioning

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Goal: Substituting negative response for a positive response to a harmful stimulus; conditioning an aversion to something the person should avoid Techniques: Unwanted behavior is associated with unpleasant feelings; ability to discriminate between aversive conditioning situation in therapy and all other situations can limit treatment effectiveness

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Aversion Therapy for Alcohol Abuse

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Therapists gave people with a history of alcohol abuse a mixed drink containing alcohol and a drug that produces severe nausea. After repeated treatments, some people developed at least a temporary conditioned aversion to alcohol.

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Operant conditioning therapy

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Consequences drive behavior: voluntary behaviors are strongly influenced by their consequences

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Behavior modification

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Desired behavior reinforced; undesired behavior not reinforced, sometimes punished

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Token economy

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People earn a token for exhibiting a desired behavior and can later exchange the tokens for privileges or treats

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Critics maintain

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Techniques such as those used in token economies may produce behavior changes that disappear when rewards end. Deciding which behaviors should change is authoritarian and unethical.

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Proponents argue

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Treatment with positive rewards is more humane than punishing people or institutionalizing them for undesired behaviors.

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Cognitive therapies

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Teaches people new, more adaptive ways of thinking; based on the assumption that thoughts intervene between events and our emotional reactions

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Beck's therapy for depression

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Gentle questioning seeks to reveal irrational thinking and then to persuade people to change their perceptions of their own and others' actions as dark, negative, and pessimistic. People trained to recognize and modify negative self-talk

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A COGNITIVE PERSPECTIVE ON PSYCHOLOGICAL DISORDERS

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The person's emotional reactions are produced not directly by the event but by the person's thoughts in response to the event.

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Cognitive-behavioral therapy (CBT)

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Is integrative therapy that combines cognitive therapy (changing self-defeating thinking) with behavior therapy (changing behavior). Aims to alter the way they act AND they way they think. Helps people learn to make more realistic appraisals

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Group therapy

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Conducted with groups rather than individuals, providing benefits from group interaction. Often used when client problems involve interactions with others

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Group therapy benefits

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Saves therapists' time and clients' money. Encourages exploration of social behaviors and social skill development. Enables people to see that others share their problems. Provides feedback as clients try out new ways of behaving

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Family therapy

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Attempts to open up communication within the family and help family members to discover and use conflict resolution strategies. Treats the family as a system. Views an individual's unwanted behaviors as influenced by, or directed at, other family members

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Is Psychotherapy Effective?

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Clients' and therapists' positive testimonials cannot prove that psychotherapy is actually effective. The placebo effect makes it difficult to judge whether improvement occurred because of the treatment. Research indicates that those not undergoing treatment often improve, but those undergoing psychotherapy are more likely to improve more quickly, and with less chance of relapse.

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TREATMENT VERSUS NO TREATMENT

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These two normal distribution curves based on data from 475 studies show the improvement of untreated people and psychotherapy clients. The outcome for the average therapy client surpassed the outcome for 80 percent of the untreated people.

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Which Psychotherapies Work Best?

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Some forms of psychotherapy work best for particular problems.

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Behavior therapies

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Bed-wetting, phobias, compulsions, marital problems, and sexual dysfunctions

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Psychodynamic therapy:

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Depression and anxiety

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Cognitive therapies:

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Anxiety, depression, and posttraumatic stress disorder

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Evidence-based practice

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Integration of best available research with clinicians' expertise and patients' characteristics, preferences, and circumstances

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How Do Psychotherapies Help People?

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Three basic benefits for all psychotherapies: Hope for demoralized people. New perspective for oneself and the world. Empathic, trusting, caring relationship

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Culture and Values in Psychotherapy

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Psychotherapists' personal beliefs and values influence their practice. Differences in cultural and moral diversity and religious values can create a mismatch.

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Finding a Mental Health Professional

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A person seeking therapy is encouraged to ask about Treatment approach, Values, Credentials, and Fees. An important consideration is whether the potential client feels comfortable and able to establish a bond with the therapist.

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Psychopharmacology

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Includes study of drug effects on mind and behavior, has helped make drug therapy the most widely used biomedical therapy

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Drug therapies

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Are most widely used biomedical treatments. Include prescribed antidepressants for 27 million Americans. Involve placebo and double-blind techniques to evaluate drug effectiveness

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Most common drug treatments for psychological disorders

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Antipsychotic drugs Antianxiety drugs Antidepressant drugs Mood-stabilizing medications

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Antipsychotic drugs

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Mimic certain neurotransmitters (e.g., block or increase activity of dopamine); reduce overreaction to irrelevant stimuli. May produce sluggishness, tremors, twitches and tardive dyskinesia; Thorazine. Treats schizophrenia

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Antianxiety drugs

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Depress CNS activity; Xanax or Ativan. Used in combination with psychological therapy. May reduce symptoms without resolving underlying problems; withdrawal linked to increased anxiety and insomnia

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Antidepressant drugs

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Increase availability of norepinephrine or serotonin; promote birth of new brain cells. Slow synaptic vacuuming up of serotonin. Effectiveness sometimes questioned due to spontaneous recovery and placebo effect

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Mood-stabilizing medications

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Depakote: Controlling manic episodes Lithium: Levels emotional highs and lows of bipolar disorder

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Electroconvulsive therapy (ECT)

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Manipulates brain by shocking it. Involves administration of general anesthetic and muscle relaxation to prevent convulsions. Causes less memory disruption than earlier versions. AMA concluded that ECT methods among most positive treatment effects; reduces suicidal thoughts. Involves several theories about reason for effectiveness

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Alternative neurostimulation therapies

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Vagus nerve stimulation, Deep brain stimulation, Repetitive transcranial magnetic stimulation (rTMS):

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Vagus nerve stimulation:

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Stimulates neck nerve that sends signal to limbic system; increases available serotonin by increasing firing rate of some neurons

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Deep brain stimulation:

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Manipulates depressed brain via pacemaker; stimulates inhibition activity related to negative emotions and thoughts

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Repetitive transcranial magnetic stimulation (rTMS):

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Sends magnetic energy to brain surface through coiled wire held close to brain; fewer side effects; modest effectiveness

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Psychosurgery

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Involves surgery that removes or destroys brain tissue in an effort to change behavior. Is irreversible; least used biomedical therapy

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Lobotomy

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Psychosurgical procedure once used to calm uncontrollably emotional or violent patients. Procedure cut the nerves connecting the frontal lobes to the emotion-controlling centers of the inner brain (Moniz). Today, less invasive techniques used; MRI-guided surgery in severe disorders

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Training seminars

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Human brains and bodies were designed for physical activity and social engagement Ancestors hunted, gathered, and built in groups with little evidence of disabling depression

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Therapeutic Lifestyle Change Goals

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Aerobic exercise, adequate sleep, light exposure, social connection, antirumination, nutritional supplements

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Preventive mental health programs work to build resilience.

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Based on the idea that many psychological disorders could be prevented by changing oppressive, esteem-destroying environments into more benevolent, nurturing environments that foster growth, self-confidence

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Resilience

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Involves personal strength that helps most people cope with stress and recover from adversity and trauma. Can be seen in New Yorkers after 9/11, spinal cord injury patients, Holocaust survivors, and others

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