Chapter 16: Therapy

Introduction to Therapy and the Psychological Therapies

Treating Psychological Disorders

LOQ: How do psychotherapy and the biomedical therapies differ?

Modern therapies can be classified into two categories

• In psychotherapy, a trained therapist uses psychological techniques to assist someone seeking either to overcome difficulties or to achieve personal growth. The therapist may explore a client’s early relationships, encourage the client to adopt new ways of thinking, or coach the client in replacing old behaviors with new ones.
• Biomedical therapy offers medications and other biological treatments. For example, a person with severe depression may receive antidepressants, electroconvulsive shock therapy (ECT), or deep-brain stimulation

Some therapists combine techniques called eclectic which uses a combination of both of the therapies

Psychotherapy Treatment: involving psychological techniques; consists of interactions between a trained therapist and someone seeking to overcome psychological difficulties or achieve personal growth.

Biomedical Therapy: prescribed medications or procedures that act directly on the person’s physiology.

Eclectic Approach: an approach to psychotherapy that uses techniques from various forms of therapy.

Psychoanalysis and Psychodynamic Therapies

LOQ: What are the goals and techniques of psychoanalysis, and how have they been adapted in psychodynamic therapy?

The first major psychological therapy was Sigmund Freud’s psychoanalysis

• Few people practice this now but it developed a base for treating psychological disorders, and it continues to influence modern therapists working from the psychodynamic perspective.

Psychoanalysis: Sigmund Freud’s therapeutic technique. Freud believed the patient’s free associations, resistances, dreams, and transferences—and the therapist’s interpretations of them—released previously repressed feelings, allowing the patient to gain self-insight.

The Goals of Psychoanalysis

Psychoanalysis was Freud’s method of helping people to bring these repressed feelings into conscious awareness

• This helped them reclaim their unconscious thoughts and feelings, and by giving them insight into the origins of their disorders
  • the therapist could help them reduce growth-impeding inner conflicts

The Techniques of Psychoanalysis

Psychoanalytic theory emphasizes the power of childhood experiences to mold the adult

• It aims to unearth the past in the hope of loosening its bonds on the present

To the analyst, these mental blocks indicate resistance

• This hints that anxiety lurks and you are defending against sensitive material and the analyst will note your resistance and then provide insight into its meaning
• If offered at the right moment, this interpretation may show the underlying wishes, feelings, and conflicts you are avoiding
  • The analyst might offer an explanation of how this resistance fits with other pieces of your psychological puzzle

Over many such sessions, your relationship patterns surface in your interaction with your therapist and you might experience strong positive or negative feelings towards your analyst

• They may suggest that you are transferring feelings from other relationships

Resistance: in psychoanalysis, the blocking from consciousness of anxiety laden material.

Interpretation: in psychoanalysis, the analyst’s noting supposed dream meanings, resistances, and other significant behaviors and events in order to promote insight.

Transference: in psychoanalysis, the patient’s transfer to the analyst of emotions linked with other relationships (such as love or hatred for a parent).

Psychodynamic Therapy

Psychodynamic therapists don’t talk much about id-ego-superego conflicts but they do try to help people understand their current symptoms

• They focus on important relationships

Psychodynamic therapists aim to help people gain insight into unconscious dynamics that arise from their life experience.

Psychodynamic Therapy: therapy deriving from the psychoanalytic tradition; views individuals as responding to unconscious forces and childhood experiences, and seeks to enhance self-insight.

Humanistic Therapies

LOQ: What are the basic themes of humanistic therapy? What are the specific goals and techniques of Rogers’ client-centered approach?

The humanistic perspective emphasizes people’s innate potential for self-fulfillment

• This kind of therapy attempts to o reduce the inner conflicts that interfere with natural development and growth
  • This is often called as insight therapies

Humanistic therapies differ from psychodynamic therapies in many other ways:

• Humanistic therapists aim to boost people’s self-fulfillment by helping them grow in self-awareness and self-acceptance.
• Promoting this growth, not curing illness, is the therapy focus. Thus, those in therapy have become “clients” or just “persons” rather than “patients” (a change many other therapists adopted).
• The path to growth is taking immediate responsibility for one’s feelings and actions, rather than uncovering hidden determinants.
• Conscious thoughts are more important than the unconscious.
• The present and future are more important than the past. Therapy thus focuses on exploring feelings as they occur, rather than on achieving insights into the childhood origins of those feelings

Carl Rogers developed client-centered therapy

• This is a nondirective therapy where the client leads the discussion
• Rogers encouraged therapists to foster acceptance, genuineness, and empathy

To Rogers, “hearing” was active listening

• The therapist echoes, restates, and seeks clarification of what the person expresses (verbally or nonverbally) and acknowledges those expressed feelings
• Active listening is now an accepted part of counseling practices
• Also said that one cannot be totally nondirective
  • Said that the therapist’s most important contribution is to accept and understand the client

Rogers hinted at three ways to improve communication

• Paraphrase. Check your understanding by summarizing the person’s words out loud, in your own words.
• Invite clarification. “What might be an example of that?” may encourage the person to say more.
• Reflect feelings. “It sounds frustrating” might mirror what you’re sensing from the person’s body language and intensity.

Insight Therapies: therapies that aim to improve psychological functioning by increasing a person’s awareness of underlying motives and defenses.

Client-Centered Therapy: a humanistic therapy, developed by Carl Rogers, in which the therapist uses techniques such as active listening within an accepting, genuine, empathic environment to facilitate clients’ growth. (Also called person-centered therapy.)

Active Listening: empathic listening in which the listener echoes, restates, and clarifies. A feature of Rogers’ client-centered therapy.

Unconditional Positive Regard: a caring, accepting, nonjudgmental attitude, which Carl Rogers believed would help clients develop self-awareness and self acceptance.

Behavior Therapies

LOQ: How does the basic assumption of behavior therapy differ from the assumptions of psychodynamic and humanistic therapies? What techniques are used in exposure therapies and aversive conditioning?

Behavior therapies doubt the healing power of self-awareness and assume that problem behaviors are the problems.

Behavior Therapy: therapy that applies learning principles to the elimination of unwanted behaviors.

Classical Conditioning Techniques

Counterconditioning, such as with exposure therapy, pairs the trigger stimulus with a new response that is incompatible with fear

Counterconditioning: behavior therapy procedures that use classical conditioning to evoke new responses to stimuli that are triggering unwanted behaviors; include exposure therapies and aversive conditioning.

Exposure Therapies

Joseph Wolpe refined Mary Cover Jones counterconditioning technique into the exposure therapies used today to try and change people’s reactions by repeatedly exposing them to stimuli that trigger unwanted reactions

One exposure therapy that is used to treat phobias is systematic desensitization

• You cannot simultaneously be anxious and relaxed. Therefore, if you can repeatedly relax when facing anxiety-provoking stimuli, you can gradually eliminate your anxiety.
  • This happens over a gradual period of time
• You would then train in progressive relaxation to tense and relax one muscle group after another

Another type is virtual reality exposure therapy

• This happens through experiencing your fears through virtual simulations

Exposure Therapies: behavioral techniques, such as systematic desensitization and virtual reality exposure therapy, that treat anxieties by exposing people (in imaginary or actual situations) to the things they fear and avoid.

Systematic Desensitization: a type of exposure therapy that associates a pleasant relaxed state with gradually increasing anxiety-triggering stimuli. Commonly used to treat phobias.

Virtual Reality Exposure Therapy: a counterconditioning technique that treats anxiety through creative electronic simulations in which people can safely face their greatest fears, such as airplane flying, spiders, or public speaking

Aversive Conditioning

Aversive conditioning creates a negative (aversive) response to a harmful stimulus (such as alcohol).

• Helps you learn what to not do
• It associates the unwanted behavior with unpleasant feelings

Aversive Conditioning: associates an unpleasant state (such as nausea) with an unwanted behavior (such as drinking alcohol).

Operant Conditioning

LOQ: What is the main premise of therapy based on operant conditioning principles, and what are the views of its proponents and critics?

Rewards used to modify behavior vary

• reinforcing power of attention or praise is sufficient, others require concrete rewards, such as food
• Some therapists may create a token economy
  • When clients display desired behavior, they receive a token that they can exchange for rewards

Behavior modification critics have two concerns:

• How durable are the behaviors?
• Is it right for one human to control another’s behavior?

Token Economy: an operant conditioning procedure in which people earn a token for exhibiting a desired behavior and can later exchange the tokens for privileges or treats.

Cognitive Therapies

LOQ: What are the goals and techniques of the cognitive therapies and of cognitive-behavioral therapy?

The cognitive therapies assume that our thinking colors our feelings

• Cognitive therapies aim to help people change their mind with new, more constructive ways of perceiving and interpreting events

Cognitive Therapy: therapy that teaches people new, more adaptive ways of thinking; based on the assumption that thoughts intervene between events and our emotional reactions.

Beck’s Therapy for Depression

Beck found that depressed people often reported dreams with negative themes of loss, rejection, and abandonment

• With cognitive therapy, Beck and his colleagues sought to reverse clients’ negativity about themselves, their situations, and their futures

Therefore, getting people to change what they say to themselves is an effective way to change their thinking

• “This exam’s probably going to be impossible. Everyone seems so relaxed and confident. I wish I were better prepared. I’m so nervous I’ll forget everything.”
  • Psychologists call this sort of relentless, overgeneralized, self-blaming behavior catastrophizing

To change such negative self-talk, therapists have offered stress inoculation training:

• teaching people to restructure their thinking in stressful situations

Cognitive-Behavioral Therapy

Cognitive-behavioral therapy (CBT) takes a combined approach to depression and other disorders.

• This integrative therapy wants to o alter not only the way people think but also the way they act
• It seeks to make people aware of their irrational negative thinking and to replace it with new ways of thinking and trains people to practice the more positive approach in everyday settings.

Dialectical-behavioral therapy (DBT) helps change helps change harmful and even suicidal behavior patterns

• This is a newer version of CBT
• This attempts to make peace between two opposing forces- acceptance and change

Cognitive-Behavioral Therapy (CBT): a popular integrative therapy that combines cognitive therapy (changing self-defeating thinking) with behavior therapy (changing behavior).

Group and Family Therapies

LOQ: What are the aims and benefits of group and family therapies?

Group Therapy

Group therapy doesn’t provide the same degree of therapist involvement with each client, but does offers other benefits:

• It saves therapists’ time and clients’ money, and often is no less effective than individual therapy
• It offers a social laboratory for exploring social behaviors and developing social skills. Therapists frequently suggest group therapy for people experiencing frequent conflicts or whose behavior distresses others. The therapist guides people’s interactions as they discuss issues and try out new behaviors.
• It enables people to see that others share their problems. It can be a relief to discover that others, despite their composure, experience some of the same troublesome feelings and behaviors
• It provides feedback as clients try out new ways of behaving. Hearing that you look poised, even though you feel anxious and self-conscious, can be very reassuring

Group Therapy: therapy conducted with groups rather than individuals, providing benefits from group interaction.

Family Therapy

Family therapists tend to view families as systems, in which each person’s actions trigger reactions from others

• Ex. A child’s rebellion, for example, affects and is affected by other family tensions

Family Therapy: therapy that treats people in the context of their family system. Views an individual’s unwanted behaviors as influenced by, or directed at, other family members

Self-Help Groups

The popularity of support groups—for the addicted, the bereaved, the divorced, or simply those seeking fellowship and growth—may reflect a longing for community and connectedness.

• One great example of this is Alcoholics Anonymous (AA)

Evaluating Psychotherapies

Is Psychotherapy Effective?

LOQ: Does psychotherapy work? How can we know?

Clients’ Perceptions

If clients’ testimonials were the only measuring stick, we could strongly affirm psychotherapy’s effectiveness, but we should not dismiss these testimonials. Some critics note several things such as

• People often enter therapy in crisis. When, with the normal ebb and flow of events, the crisis passes, people may attribute their improvement to the therapy. Depressed people often get better no matter what they do.
• Clients believe that treatment will be effective. The placebo effect is the healing power of positive expectations.
• Clients generally speak kindly of their therapists. Even if the problems remain, clients “work hard to find something positive to say.
• Clients want to believe the therapy was worth the effort. To admit investing time and money in something ineffective is like admitting to having one’s car serviced repeatedly by a mechanic who never fixes it.

Clinicians’ Perceptions

If clinicians’ perceptions were proof of therapy’s effectiveness, we would have even more reason to celebrate

• therapists are most aware of the failures of other therapists— those whose clients, having experienced only temporary relief, are now seeking a new therapist for their recurring problem
• therapists are most aware of the failures of other therapists— those whose clients, having experienced only temporary relief, are now seeking a new therapist for their recurring problem

Outcome Research

In the twentieth century, psychology, faced a challenge with all of the different types of therapies

• Hans Eysenck summarized 24 studies of psychotherapy outcomes and found ⅔ those receiving psychotherapy for disorders not involving hallucinations or delusions improved markedly

A glimpse of psychotherapy’s overall effectiveness can then be provided by means of a meta-analysis