05.06 Therapy: How can we help you?

Taboo:Against social norms.

In days of yesteryear, going to therapy was taboo —it was only for the insane or crazy. Today, therapy is considered a healthy way to solve problems and a way to live a self-fulfilled life.While many people seek therapy for mental disorders, many others seek the help of therapists for periods of adjustment in their lives such as transitioning to high school from middle school, from high school to college, and from college into the work place. Therapy can be done individually, as a family, as a couple, or in a group.

Objectives: After completing this lesson, you will be able to:

  • Contrast the therapeutic modalities.
  • Recognize appropriate therapy approaches for mental disorders.
  • Effectively collaborate with a peer to develop a mock-therapy session.

1. What is the goal of psychoanalytic therapy?

What is the role of the therapist?

What is the role of the patient?

2. What is the goal of humanistic therapy?

What is the role of the therapist?

What is the role of the client?

3. What is cognitive-behavioral therapy?

What is the role of the therapist?

What is the role of the client?

05.06 Therapy: How can we help you?

Psychologists, psychiatrists, mental health counselors, social workers and the like are all called “psychotherapists” or therapists in psychology. Each therapist has a therapeutic modality in which they feel can help their client or patient.

Types of Therapy

Humanistic Therapy

Humanistic therapy is also called client-centered therapy and was founded by Carl Rogers. The term "client" infers the idea that the therapist is working with the client for an end result. The therapist does not poke or prod or push clients, but instead allows the client to decide for themselves what is important to be talking about and which direction therapy should be going.

This technique has a firm belief that each of us is working toward a meaningful life and we are taking the steps to get there. Humanistic beliefs are that each human is innately good and this type of therapist helps the client focus on the good from within. In therapy, the humanistic therapist acts like a “mirror” for the client. One really big component of the humanistic approach is unconditional positive regard (UPG.) This term means that the therapist will provide the client with feedback and an environment that allows the client to express his or her feelings, thoughts, hopes, desires, dreams, and the like without feeling like he or she is being judged. Basically the therapist listens and then rewords what he or she hears back to the client so that client can “hear themselves” through the therapists words.

Patient: I don’t feel that well today. I almost did not come in for the session.

Analyst: You just didn’t feel like coming in today?

Patient: Well, you can say that. However, I had a bad night. I dreamed I was falling and I could not find anything to grab on to.

Analyst: It sounds like that dream really upset you. You sound like you are a bit afraid and bothered by this dream.

Behavioral Therapy

Behavioral therapy involves techniques that focus on a client’s actions to enable the client to make changes. Behavioral therapists believe that the root of the person’s problem stems from faulty learning or poor learning habits in responses to problems. This type of therapy is useful when a person would like to change a habit or their actions.

  • One of the ways behavioral therapists assist their client is through systematic desensitization. This term refers to the step-by-step process in which a therapist helps their client to become less anxious to their phobia. This is what Mary Cover Jones did with “Peter” who was afraid of rabbits when she got him to come closer and closer to the rabbit with his favorite food until he was standing next to the rabbit.
  • Another technique behavioral therapists use is called aversive conditioning. The goal with aversive conditioning is to make certain acts unpleasant so that they will be avoided. For example, smokers who are trying to break their habit would be given a medication that will make them nauseated when they begin to inhale. This process will enable the client to relearn. The client is associating the aversive (negative) feeling with the smoking and hence reduces its use.
  • One other technique, called the token economy, in one in which a client uses tokens to purchase things. This works well in mental health facilities as the patients there can earn these tokens and spend them on favorite foods, items or other rewards.

Cognitive-Behavioral Therapy

Cognitive-Behavioral Therapy was a method devised by Albert Ellis. He thought of combining the cognitive (thoughts) with the behavioral (actions) as a method of helping people. Ellis believed that humans are made up of two components:

  • the rational (mental)
  • emotional (emotive)

His therapy sessions focused on getting emotions under control. He called this technique rational-emotive therapy. From Ellis’s stand point, most emotional upset occurs because we hold irrational ideas. These irrational ideas cannot be proven nor do they hold up once challenged by logic. In other words, we are disturbed not by things, but by the view we take of them. If a women came in and reported she lost her job, Ellis would point out that she can be depressed or she can look to all of the opportunities she can create for herself now. Ellis invented a term called "awfulize" which means that we can see an event or anything in the worst possible way. He felt that this was what people needed to focus their therapy on and clients needed to challenge their irrational thoughts (cognitive) and their actions (behavioral).

Client: I don’t feel that well today. I almost did not come in for the session.

Therapist: Well, why did you?

Client: Well, I…um…well, I thought I should since I made the appointment.

Therapist: That is not much motivation. Why are you coming here in the first place? Are you coming here out of obligation to me?

Client: No, I am… um…

Therapist: Go ahead, tell me.

Client: I am here because I need some support. I need to talk to someone and for someone to listen to me. My mom does not listen and my friends are always so busy.

Therapist: So, your mom does not listen to you? Do you think that it is the end of the world? Do you believe that all moms listen to their children all of the time?

Client: But…well…

Therapist: You have some friends and they do care about you. When you are feeling sorry for yourself, you are hurting yourself. Stop saying “I am not cared for, and nobody listens to me.” That is just not true, is it?

Group Therapy

Support groups are a great example of group therapy. Many people meet in group therapy settings for various reasons. Some include: death, cancer, divorce, alcoholics, eating disorders, and so forth. One of the greatest factors in the group setting is that each person is understood and all of the members are sensitive as they have "been there" or are going through the same trials and tribulations. The therapist leads the group and also takes the role of the moderator. The clients share stories and as they explain their story, others can listen, feel, and learn.

Psychoanalytic Therapy

Psychoanalysis, for short, is the analysis of the mind or psyche. This approach is very symbolic and complicated and the client/patient is expected to be in therapy for many, many years. This approach began with Sigmund Freud. He believed that the unconscious held all of our secrets and desires. He believed that when a patient came into therapy it was beneficial to have the patient lie down on the couch with the therapist behind the patient. The therapist would request that the patient says whatever comes to mind no matter how unimportant or disconnected the material may seem. This process is called free association.

Freud believed that the therapist could gain much insight into the patient’s childhood and life this way. For example: Joe may say, “I want to kiss my boss” when he really meant to say “I want to kick to my boss." The point here is that Joe’s "slip" of his tongue (called a Freudian Slip) is what Freud pointed out to his patients and what psychoanalytic therapists point out as well. Psychoanalytic therapists may report to the patient that he has some deep feelings for his boss and he needs to explore them.

This type of therapy also lends itself to the idea of transference meaning that the patient transfers his/her feelings from the person in their life with whom they are having troubles onto the therapist. As a result, the patient’s troubles are less hidden and the patient can work out these issues in therapy with the therapist. There are not many psychoanalytic therapists around today, as much of this therapy is not effective for the way the world works. This type of therapy requires daily or weekly visits and a commitment to years of therapy. Most insurance companies today only give a set amount of visits per year. This would be really expensive and much of the technique has been discredited. Critics have noted that a slip of the tongue is simply that; not a desire to do what your slip inferred.

Patient: I don’t feel well today and I was not going to come in.

Analyst: You really did not want to come in?

Patient: No, I really did not. I had a bad night and I dreamed I was falling and I could not find anything to grab on to.

Analyst: You feel like you may be losing control of the situation?

Patient: Well, sure that is true. But I certainly don’t need a dream to tell me that. It was just a dream.

Analyst: (silence)

Patient: Funny how you have nothing to say about that. You really have no clue what it is like to have a dream and just have a dream, do you?

Analyst: Sounds like you are angry with me.

Patient: I am trying to talk and you are trying to make me look at my dream and I already know that I feel like I have no control.

Analyst: Do I remind you of someone?

Patient: Well, no. Wait, maybe. Yes, a little of my mom. Every time I try to talk to her about something she makes it into a big "ta-da" and I can’t stand that.

Discovery Education Psychotherapy—Text Version

Brian Roiter is a teenager who struggles with depression.

Brian Roiter:

I didn’t want to let my parents down by letting them know I was unhappy. Up until I first became depressed, I hid from them any kind of unhappiness; I told them I was doing great, everything was fine.

When Brian began his junior year, he was a model student athlete.

Brian Roiter:

I come back to school in the fall, played football, and it really got me back into school again; and when all of that ended, it was… It was just like everything, you know, my whole [sort of] structure was gone from my life.

After a break-up from his girlfriend, Brian began to feel and act differently. Brian maintained good grades, but his parents noticed he was losing interest in friends and sports.

Brain Roiter:

School had been so stressful, and, you know, I had been… I had so many troubles with relationships that year that I just wanted to take a break from it.

Brian needed help. A family doctor prescribed anti-depressant medication.

Brian Roiter:

I was very much against it; I didn’t think it would help at all. I didn’t want some drug altering my mind, is really what it was. I was… I wanted to get through things on my own. I didn’t want to become dependent on a drug… There were a lot of reasons.

Drugs like Prozac and Zoloft, and other SSRI’s, only work for about 65% of the people who use them. They didn’t help Brian. In fact, they have contributed to his erratic behavior at school, including a loud outburst in the school cafeteria. Brian’s family turned to the talking cure, a form of treatment called “Psychotherapy”, but Brian had some resistance.

Brian Roiter:

I felt like I should be dealing with it on my own; I didn’t want people to know, you know, that I was seeing somebody for everything.

Like many people, Brian had the wrong impression about what “therapy” really is.

Brian Roiter:

I sort of pictured it like, you know, the way a lot of people do: lying on a couch, and just telling everything about my childhood; and somebody saying ‘this is what you have, and this is what you have to do."

There are many different kinds of psychotherapy, but they fall into two broad categories: Psychodynamic therapy (the most famous kind), being Freudian analysis, looks back on past traumas and emotional loss to understand the present. Behavior therapy concentrates on changing negative patterns and behavior or thought that contribute to depression. Today, most therapists draw on a combination of techniques. Brian started an intensive behavioral program and met five days a week.

Brian Roiter:

They would listen, and through my talking I could sort out in my mind what I was saying and what was really going on.

Therapy can help change a person’s hopeless and negative thinking; it provides guidance for adjusting to changes in life. It helped Brian to return to the path of mental health.

Brian Roiter:

Talking to a therapist is not giving up and saying, “I need your help”… A therapist is a guide; somebody who can help you figure out for yourself what, you know, what’s best for you.

If you’re looking for a therapist, here are some points to consider: (1) What form of therapy do they practice? (2) What’s a typical session like? (3) Approximately how long might the course of your treatment last? (4) Do they recommend [and can they prescribe] medication (5) What type of educational background do they have to perform this therapy? (6) What is their fee and do they accept your health insurance?

Remember, the most important question is: Do you feel comfortable with this therapist?

Effectiveness of Therapy

People visit therapists for many reasons:

  • Breaking a habit.
  • Having someone to listen.
  • A fresh set of "ears" and "eyes" on their problem.
  • Having someone’s undivided attention.
  • The confidence in knowing that nobody else will know (confidentiality.)

One thing to keep in mind, a therapist is bound by law to keep confidentiality between the client and themselves. This means if a teen goes into therapy, the therapist is not allowed to tell anyone what the teen reported in therapy. However, if a client (a child, teen, or adult) reports they are going to hurt themselves or someone else, the therapist is bound by law to report this to the authorities.

Assessment 05.06 Therapy: How can we help you?

Please view the grading rubric before beginning the Assignment.

  1. Complete the reading for this lesson.
  2. Complete the mock-therapy session following the directions.
  3. Submit the mock-therapy session option you choose in Assignment "05.06 Therapy: How can we help you?"

Be sure to include information regarding the disorder, the therapy type you have selected and the dialogue between the client and therapist. You should have a total of 20 lines of dialogue; 10 from the client and 10 from the therapist. You will also need to answer the two reflection questions in complete sentences.

Collaboration Option

This lesson contains a collaboration activity. You are required to complete at least one (1) collaborative assignment in this course. There are also many 21st century tools available for effective collaboration and communication in the online environment. For more information on tools visit the Web 2.0 tools area.

One of the options below may be completed to fulfill your collaboration requirement in this course.

Mock-Therapy Directions

  • You and your partner will choose a disorder from this module and a therapy modality you both agree would help a person with the disorder you choose. You may choose any disorder from any lesson in this module as long as the demonstration of the disorder is accurate and evident in your speech.
  • One person will dialogue from the therapist’s perspective and one person will dialogue from the client’s perspective. It is not necessary to pretend you have a disorder or that you are a therapist. Your goal is speak accurately from the perspective dialoging accurately for the therapist or for the client.
  • You will provide 10 complete and accurate dialogue postings each (twenty total). Demonstrate your understanding of your role to your partner as evidenced by your dialogue.

Option 1: Voice-thread. Are you the type of person who likes to talk? Do you like to use your microphone on your computer? Do you enjoy the sound of your keyboard when you type messages? If so, this is the option for you. Voicethread - Grading Rubric

Requirements: / Points:
The dates of your mock-therapy sessionand name of partner / 5
The name of the disorder and type of therapy / 5
The discussion where you and your partner agree upon the disorder and the type of therapy (this may be a link or copied and pasted). / 5
Minimum of twenty (10 per person) total accurate dialogue postings (voice and/or text). / 30
Proper spellingand grammar. / 5
The dialogue accurately portraysthe therapy and disorder. / 10
Your answers to these reflective questions:
  • Generally, how did this collaboration assignment go? Explain.
  • Did you and your partner participate equally?Explain.
  • Did you enjoy the voicethread mock-therapy session format?Why or why not?
  • Why this type of therapy is the best for the disorder? Explain.
/ 40

Option 2: Wiki. Are you the type of person who likes to keep a wiki? Do you like to email your friends? Do you like knowing when you check your wiki; there will be messages for you? If so, this is the option for you. Wiki - Grading Rubric

Awikiis a website which allows its users to add, modify, or delete its content via a web browser usually using a simplified markup language or a rich-text editor.