Chapter 13: Methods of Therapy Page 1

Chapter 13: Methods of Therapy Page 1

Chapter 13

Methods of Therapy

LEARNING OUTCOMES:

After exploring Chapter 13, students should:

1. Define psychotherapy and describe the history of treatment.
2. Describe traditional psychoanalysis and short-term psychodynamic therapies.
3. Define humanistic therapy and contrast its two main approaches.
4. Define behavior therapy and identify various behavioral approaches to therapy.
5. Define cognitive therapy and describe Beck’s approach and REBT.
6. Identify various types of group therapy and discuss their advantages and disadvantages.
7. Explain whether psychotherapy works and who benefits from it.
8. Describe methods of biological therapy – both benefits and side effects.

LECTURE OUTLINE

1. What Is Psychotherapy?
2. Definition
3. Psychotherapy: a systematic interaction between a therapist and a client.
4. Applies psychological principles to affect the client’s thoughts, feelings, or behavior in order to
5. Help the client overcome psychological disorders.
6. Adjust to problems in living.
7. Develop as an individual.
8. Essentials include the following:
9. Systematic interaction between therapist and client.
10. Psychological principles: based on theory and research.
11. Thoughts, feelings, and behavior are the focus.
12. Psychological disorders, adjustment problems, and personal growth are the focus in an effort to help clients reach their full potential.
13. The History of Therapies
14. Treatments often reflected demonological thinking.
15. Asylums (first institutions) built for warehousing not treatment.
16. Bedlam derives from St. Mary’s of Bethlehem, the London asylum.
17. Humanitarian reform began in the 18th century.
18. Paris: Philippe Pinel at the La Bicetre hospital.
19. England: William Tuke.
20. America: Dorothea Dix.
21. Mental hospitals gradually began replacing asylums.
22. In the mid 1950s, more than a million people resided in facilities.
23. The community mental health movement: attempt to maintain new patients as outpatients and to serve patients who have been released from mental hospitals.

1. Psychodynamic Therapies
2. Based on Freud
3. Assume that psychological disorders reflect early childhood experiences and internal conflicts.
4. The focus is also on a shift of psychic energy among three psychic structures, the id, ego, and superego.
5. Traditional Psychoanalysis
6. Psychoanalysis can extend for months, even years.
7. The aim is to provide insight into the conflicts that are the cause of the person’s problems.
8. Catharsis is a spilling forth of repressed conflicts and guilt.
9. Clients can express feelings and urges that have been repressed.
10. Replace impulsive behavior with coping behavior.
11. Free association:the client is made comfortable and asked to talk about anything that comes to mind.
12. Hypnosis allowed clients to focus on repressed conflicts.
13. Resistance: clients may not talk about threatening ideas. These ideas are repressed.
14. Transference: clients respond to the therapist with the attitudes and feelings they have toward other people in their lives.
15. Often, clients reenact their childhood conflicts.
16. Dream analysis
17. Freud believed that dreams were the royal road to the unconscious.
18. Dreams are determined by unconscious processes as well as the events of the day.
19. Unconscious impulses are expressed in dreams as a form of wish fulfillment.
20. Short-Term Dynamic Therapies
21. The modern approach is briefer and less intense.
22. Focus is on revealing unconscious material and breaking through defenses.
23. Client and therapist usually sit face to face rather than having the client lie on a couch.
24. The therapist is usually directive.
25. Usually more focus on the ego and less emphasis on the id.
26. Modern psychoanalysts are sometimes referred to as ego analysts.
27. Interpersonal psychotherapy (ITP) focuses on clients’ relationships rather than their childhoods.
28. Usually lasts no longer than 9-12 months.
29. Anxiety and depression occur within social relationships.
30. Attempts are made to alleviate anxiety and depression directly.

1. Humanistic Therapies
2. Definition
3. Humanistic therapies focuson quality of the client’s subjective, conscious experience.
4. Focus on the here and now.
5. Client-Centered Therapy
6. Client-centered therapy is intended to help people get in touch with their genuine feelings and pursue their own interests, regardless of other people’s wishes.
7. People have an inborn tendency toward growth.
8. Clients are free to make choices and control their destinies.
9. Psychological problems arise from roadblocks placed in the path of self-actualization.
10. Client-centered therapy is nondirective and focuses on helping the person feel whole.
11. The therapist creates a warm atmosphere that encourages self-exploration and self-expression.
12. The therapist does not tell clients what to do but helps them arrive at their own decisions.
13. To achieve this, the therapist has the following qualities:
14. Unconditional positive regard.
15. Empathetic understanding.
16. Genuineness.
17. Gestalt Therapy
18. Gestalt therapy was originated by Fritz Perls.
19. The approach assumes that people disown parts of themselves and don social masks.
20. The goal is to integrate conflicting parts of their personality.
21. Focuses on the here and now.
22. Gestalt therapy is highly directive.
23. People are free to make choices and to direct their own personal growth. Yet Gestalt therapy will lead a client through planned experiences.

1. Behavior Therapy
2. Definition
3. Behavior therapy (behavior modification) focuses on what people do.
4. Applies the principles of learning to directly promote desired behavioral change.
5. The principles of conditioning and observational learning.
6. Help clients acquire adaptive behaviors.
7. Fear-Reduction Methods
8. Systematic desensitization is a method for reducing phobic responses.
9. The client learns to handle increasingly disturbing stimuli while anxiety is counterconditioned.
10. Counterconditioning:a response that is incompatible with anxiety is made to appear under conditions that usually elicit anxiety.
11. Feared objects are “arranged” in a hierarchy according to their ability to trigger anxiety.
12. Virtual therapy uses elaborate equipment to desensitize clients.
13. Modeling relies on observational learning. Clients model individuals dealing with the feared object.
14. Can also increase self-efficacy.
15. Aversive Conditioning
16. Controversial procedure in which painful or aversive stimuli are paired with unwanted impulses.
17. Rapid smoking is an aversive conditioning method designed to help smokers quit by having smokers inhale every six seconds or by having smoke blown into the smoker’s face while he or she is smoking.
18. Eye movement desensitization and reprocessing (EMDR) is a therapeutic technique used to treat stress disorders.
19. EMDR patients are asked to imagine a traumatic scene while the therapist moves a finger rapidly back and forth before their eyes for about 20-30 seconds.
20. The client follows the finger while keeping the troubling scenes in mind.
21. Research suggests that this is helpful for clients.
22. Why it works is still questioned.
23. May be due to the therapeutic alliance created.
24. Other exposure therapies also work.
25. Conclusion: exposure therapy helps people cope with trauma. Eye movements may not be needed.
26. Operant Conditioning Procedures
27. We tend to repeat behavior that is reinforced.
28. Behavior that is not reinforced tends to become extinguished.
29. In a token economy, patients must use tokens to purchase things they like.
30. Tokens are reinforcements for productive activities.
31. Successive approximationsis often used to help clients build good habits; gradually work toward a goal, rewarding for each step accomplished.
32. Biofeedback training (BFT)helps clients become more aware of, and gain control over, various bodily functions once thought to be beyond conscious control:
33. Heart rate.
34. Blood pressure.
35. Brain waves associated with relaxation.
36. Social skills traininguses self-monitoring, coaching, modeling, role-playing, behavioral rehearsal, and feedback.
37. Often used to help formerly hospitalized patients maintain jobs and apartments in the community.

1. Cognitive Therapies
2. Definition
3. Cognitive therapy focuses on changing the beliefs, attitudes and automatic types of thinking that create and compound their client’s problems.
4. Heighten insight into current cognitions.
5. Appraisals of unfortunate events can heighten our discomfort and impair our coping ability.
6. Directly change maladaptive thoughts in an effort to reduce negative feelings and solve problems.
7. Cognitive Therapy: Correcting Cognitive Errors.
8. Therapists need to challenge beliefs that are not supported by evidence.
9. Clients need to become personal scientists and also challenge beliefs that are not supported by evidence.
10. Beck noted a number of client errors.
11. Clients selectively perceive the world.
12. Clients overgeneralize on the basis of a few examples.
13. Clients magnify or blow out of proportion the importance of negative events.
14. Clients engage in absolutist thinking or looking at the world in black and white.
15. Rational Emotive Behavior Therapy
16. Rational emotive behavior therapy (REBT) focuses on beliefs about events as well as the events; developed by Albert Ellis.
17. Many harbor irrational beliefs.
18. The irrational belief that we must have the love and approval of people who are important to us.
19. The irrational belief that we must prove ourselves to be thoroughly competent, adequate, and achieving.
20. The methods are directive and active.
21. Ellis suggested that we need less misery, less blaming, and more action.
22. Toward a Cognitive-Behavioral Therapy
23. Many theorists consider cognitive therapy to be a collection of techniques that are a part of behavior therapy.
24. Beck refers to this approach as cognitivebehavioral.
25. Now referred to as cognitive-behavioral therapy (CBT).
26. An integration of the two approaches.

1. Group Therapies
2. Advantages
3. It is economical.
4. Provides more information and life experience for clients to draw on.
5. Appropriate behavior receives group support.
6. Affiliating with people with similar problems is reassuring.
7. Group members provide hope for other members.
8. Many clients practice social skills in a relatively nonthreatening atmosphere.
9. Disadvantages
10. They may not want to disclose their problems to a group.
11. Group therapy needs to be confidential.
12. Couple Therapy
13. Intended to enhance relationships by improving communication skills and helping couples manage conflict.
14. Corrects power imbalances.
15. Ways of dealing with depression and anger.
16. Ways to solve problems.
17. Typical approach is cognitivebehavioral.
18. Family Therapy
19. Form of group therapy with the family.
20. Family interaction is studied and modified to enhance the growth of individual family members and the family unit as a whole.
21. Focus on individuals with low self-esteem to increase tolerance.
22. Increase communication and encourage growth and autonomy.
23. Self-Help and Support Groups
24. Self-help and support groups meet in person, online, or even by telephone.
25. The groups tend to be specific and members share problems and possible solutions.
26. The best known self-help and support group is Alcoholics Anonymous (AA), which seems to be as effective as all forms of psychotherapy that have been tested.

1. Does Psychotherapy Work?
2. In 1952, Hans Eysenck published a review of psychotherapy research and determined that the rate of improvement among people in psychotherapy was no greater than the rate of spontaneous remission.
3. Recent research shows that psychotherapy tends to be effective.
4. Psychodynamic and client-centered are most effective with well-educated, verbal, strongly motivated clients who report problems with depression, anxiety, and interpersonal relationships.
5. Cognitive therapy can alleviate anxiety and depression.
6. Behavioral and cognitive therapies provide strategies for treating anxiety disorders, social skills deficits, problems in self-control, health problems, smoking, chronic pain, bulimia, and sexual dysfunctions.
7. Evidence-based practices are those that are effective in random controlled experiments (RCEs) and in which treatment manuals are uses that concretely outline the treatment methods.
8. Favor cognitive-behavioral therapies because they are more standardized.
9. Ethnicity and psychotherapy
10. Americans from ethnic minorities are less likely than European Americans to seek therapy.
11. Unawareness that therapy would help.
12. Lack of information about the availability of services.
13. Distrust of professionals.
14. Language barriers.
15. Reluctance to open up about personal matters.
16. Cultural inclinations toward other approaches.
17. Negative experiences with professional authority figures.
18. Clinicians need to be sensitive to culture.
19. They need to develop multicultural competence.

African Americans often assume that people should manage their own problems and are suspicious of therapists.

Asian Americans tend to stigmatize people with psychological disorders. The Asian tradition is to practice restraint in public; prefer to receive concrete advice.

Latino Americans value interdependency in the family. Therapists need to use methods that are consistent with the client’s values.

• There may be conflicts between the traditional Latino American value of interdependency.
• Interact with clients in the language requested by them.
• Use methods that are consistent with the client’s values and levels of acculturation.
• Develop therapy methods that incorporate cultural values.

Native Americans feel a loss of cultural identity and social disorganization. Therapy should focus on strengthening cultural identity, pride, and cohesion.

1. Biological Therapies
2. Definition
3. Biological therapies apply what is known of people’s biological structures and processes to the amelioration of psychological disorders.
4. Drug Therapy: In Search of the Magic Pill?
5. Antianxiety drugs (many fall in the category of benzodiazepines).
6. Valium is usually prescribed for patients who complain of generalized anxiety or panic attacks.
7. Depresses activity of the central nervous system.
8. This, in turn, decreases sympathetic activity and the feeling of nervousness and tension.
9. Side effects:
10. Sedation is the most common side effect.
11. When use is stopped, clients may experience anxiety rebound.
12. Can induce physical dependence.
13. Antipsychotic drugs
14. Antipsychotic drugs reduce agitation, delusions, and hallucinations.
15. Phenothiazines (Clozaril and Thorazine) act by blocking dopamine receptors in the brain.
16. Antidepressants
17. Antidepressants are used to help clients with eating disorders, panic attacks, obsessive-compulsive disorders, and social phobia.
18. May stem from problems in the regulation of noradrenaline and serotonin.
19. Antidepressants work by increasing levels of neurotransmitters.
20. Serotonin-reuptake inhibitors (Prozac) block the reuptake of serotonin.
21. Usually takes weeks to build up to therapeutic levels.
22. Side effects (many are temporary) include nausea, agitation, and weight gain.
23. Mood Stabilizers
24. Lithium is used to flatten out cycles of manic behavior and depression.
25. Affects the functioning of neurotransmitters.
26. Many other drugs are also used to help stabilize the moods of patients with bipolar disorder.
27. Electroconvulsive Therapy
28. Used mainly for people with major depression who do not respond to antidepressants.
29. Electrodes are attached to the temples and an electrical current strong enough to produce a convulsion is induced.
30. Patients are given a sedative so that they are asleep during the treatment.
31. Patients typically obtain one ECT treatment three times a week for up to 10 sessions.
32. Electroconvulsive therapy is controversial.
33. Many professionals are distressed by the thoughts of passing an electric current through a patient’s head to produce convulsions.
34. Side effects of ECT:
35. Memory problems; effects may be temporary.
36. Psychosurgery
37. Prefrontal lobotomy: a pick-like instrument severs the nerve pathways that link the prefrontal lobes of the brain to the thalamus.
38. Intended to sever thought from emotion.
39. Egas Moniz brought the procedure to the U.S. in the 1930s.
40. Thousands of people had the procedure performed on them.
41. Side effects:
42. Hyperactivity.
43. Distractibility.
44. Impaired learning ability.
45. Overeating.
46. Apathy.
47. Withdrawal.
48. Epileptic-type seizures.
49. Reduced creativity.
50. Death.
51. This method has been largely discontinued in the U.S.
52. Does Biological Therapy Work?
53. Drug therapy has helped many people with severe psychological disorders.
54. Antipsychotic drugs largely account for the reduced need for the use of restraints and supervision of people diagnosed with schizophrenia.
55. A treatment package that includes psychotherapy and pharmacotherapy is more effective than psychological treatment alone.
56. Cognitive-behavior therapy can help relieve the positive symptoms of schizophrenia but is more effective when combined with medication.
57. Antianxiety drugs are only appropriate for managing short-term periods of unusual anxiety or tension.
58. ECT helps many people who do not respond to antidepressant drugs.
59. In sum, drug therapy and ECT seem to be effective for some disorders that do not respond to psychotherapy alone.
60. No chemical can show a person how to change an idea or solve an interpersonal problem.

© 2014 Wadsworth, a division of Cengage LearningHANDOUT 13-1

Psychotherapy

© 2014 Wadsworth, a division of Cengage LearningHANDOUT 13-2

Biological-Based Therapies