PSYCHOTHERAPIES

Therapy
Psychotherapy refers to the use of psychological techniques to treat personality and
behavior disorders.
Insight Therapies
Insight therapies are designed to give people a better awareness and understanding of
their feelings, motivations, and actions to help them to better adjust.
Three major insight therapies: Psychoanalysis, Client-centered therapy & Gestalt
therapy.
Psychoanalysis
Designed to bring repressed feelings and thoughts to conscious awareness.
Free association : In Freudian psychoanalysis, the client is instructed to talk about
whatever comes to mind.
Transference : Client’s feelings about authority figures, both positive and negative,
transferred to therapist
Analysis requires time and money. Few has the verbal and analytical skills to discuss
thoughts and feelings. It does not give immediate solutions to immediate problems.
Not effective with severely disturbed clients.
Client-Centered Therapy
Developed by Carl Rogers. Goal is to help clients become fully functioning to open all
of experiences an to themselves. People’s defensiveness, anxiety, and other signs of
discomfort stem from their experiences of conditional positive regard. The cardinal
rule is for the therapist to express unconditional positive regard that is, true acceptance
of clients no matter what they may say or do. -Therapist’s warmth and understanding-
Gestalt Therapy
Developed by Fritz Perls. Emphasizes the wholeness of personality, fill in the holes in
the perssonality. Attempts to reawaken people to their emotions and sensations in the
here-and-now. Encourages confrontation with issues. Empty chair technique to try to
make people aware of their feelings. Therapist is active and directive.
Virtual therapy : Therapy delivered online via the internet or telephone.
Behavior Therapies
They are active than insight therapists. Focused on changing behavior. Operate witin
an even shorter time frame. Based on the belief that all behavior both normal and
abnormal is learned.
Ex. Hypocondriacs learn to get attention when they sick, people with paranoid
personalities learn to be suspicious of others. Objective of therapy is to teach people
new ways of behaving.
Using Classical Conditioning Techniques
Systematic desensitization : Gradually associating relaxation with stimuli causing the
fear and anxiety. The key to success may not be the learning of a new conditioned
relaxation response, but rather the extinction of the old fear response through mere
exposure.
Imagining frightining situation > Relaxation
Flooding : Full-intensity exposure to feared object for a prolonged period of time.
Aversive conditioning : Eliminate undesirable behavior by associating it with pain and
discomfort.
Ex. Alcohol, smoking, obesity and psychosexual disorders.
Smoking > Pain, discomfort
Operant Conditioning
Person learns to behave a certain way because that behavior is reinforced
Behavior contracting : Client and therapist set behavioral goals and agree on
reinforcements the person will receive. Exa. Each day smoking less than 20 cigarettes
is earned 10 min bowling. Smoking more than 20 cigarettes is lost 10 min bowling.
Token economy : Clients earn tokens for desired behaviors and exchange them for
desired items or privileges. Often used in schools and hospitals
Modeling
Person learns new behaviors by watching others perform those behaviors. Albert
Bandura and colleagues helped people to overcome a snake phobia by showing films
in which models gradually moved closer and closer to snakes. Modeling techniques
have also been successfully used as part of :
Job training and independent living programs of mental retardated persons. Sometimes
used in conjunction with operant conditioning.
Cognitive Therapies
Based on the belief that person’s ideas about the world can be changed and such
change will have abeneficial effect on sebsequent behavior. Ex. Changing the way of
hinking about snakes and that their new way of thinking should lead to more adaptive
behavior in the future.
Stress-Inoculation Therapy
Used self-talk process to help people cope with stressful situations.
Ex. Student with exam anxiety.
‘I won’t be able to think and remember, I don’t get through this course, I’ll never
graduate’.
> It is dysfunctional because it will make her anxiety worse.
‘I studied hard and I know well, If it is difficult, my whole grade doesn’t depend on
just one test’
> Particularly effective for treating anxiety disorders
Rational-Emotive Therapy (RET)
Psychological distress is caused by irrational and self-defeating beliefs. Core problem
is belief in “musts” and “shoulds” that leave no room for making mistakes.
Ex., I should be competent at everything and liked by everyone, life should be fair,
quick solutions to problems should be available etc.
Reinterpret negative beliefs and experiences in a more positive light
Beck’s Cognitive Therapy
Depression results from negative patterns of thought that people develop about
themselves. Try to help clients examine each dysfunctional thought in a supportive but
objectively scientific manner. Realistic and flexible way of thinking. Ex. Are you
sure ? What is your evidence for that? Good treatment for depression.
Group Therapies
Group therapy is a type of psychotherapy in which :
Clients meet regularly to interact and help one another achieve insight into their
feelings and behavior. Advantage of social support - not the only person in the world
with problems. Group members can help one another learn useful new behaviors, like
how to disagree without antagonizing others. Group interactions can lead people
toward insights into their own behavior. Ex. Why they are defensive or annoying
another person’s constant complains. Less expensive.
Family Therapy
Sees the family as at least partly responsible for the individual’s problem. Change all
family members’ behavior to the benefit of the family and the individual by :
Improving family communication, encouraging to become more empathetic, getting to
share responsibilities, and reducing conflict. Appropriate when there are problems
between husband and wife or parents and children.
Couple Therapy
Intended to help troubled partners improve their communication and interaction.
Empathy training : Partners taught to share feelings and listen to and understand
partner’s feelings. Other couple therapists use behavioral techniques. Ex. Helping a
couple develop a schedule for exchanging specific caring actions.
Self-Help Groups
Low-cost self-help groups for support and help. Alcoholics Anonymous is an example.
Studies have demonstrated that self-help can indeed be effective.
Effectiveness of Psychotherapy
Psychotherapy works best for relatively mild psychological problems and seems to
provide the greatest benefits to people who really want to change. A very extensive
study designed to evaluate the effectiveness of psychotherapy by Martin E. P.
Seligman (1995) was reported by Consumer Reports.
Significant overall improvement after therapy. There was no difference between
therapy alone and psychotherapy with medication. No differences were found between
the various forms of psychotherapy. No differences in effectiveness between therapists
(marriage counselors were seen as less effective). Long-term therapy reported better
than short-term therapy.
Which Type of Therapy is Best for Which Disorder?
Insight therapies seems to be best suited to people self understanding, relief of inner
conflict and anxiety or better relationship with others.
Behavior therapy is most appropriate for treating spesific anxieties or behavioral
problems (Ex. Sexual dysfunctions).
Family therapy is more effective for the treatment of drug abus. Cognitive therapies
have been shown to e effective treatments for depression and anxiety disorders.
Some psychologists have focused various forms of psychotherapy have in common :
All forms of psychotherapy provide people with an explanation for their problems.
Therapeutic alliance with a therapist. Effective therapists are warm, empathetic, and
caring people. Offer hope.
Because most people who seek therapy have low selfesteem and feel demoralized and
depressed, hope and the expectation for improvement increase their feelings of
selfworth.
 Biological Treatments
Drug Therapies
Biological treatments - a group of approaches including medication, electroconvulsive
therapy, and psychosurgery.
Psychiatrists the only mental health professionals licensed to offer biological
treatments who are physicians.
Biological treatments are used for several reasons:
Some people are too agitated, disoriented, or unresponsive to be helped by
psychotherapy. Always used for disorders with a strong biological component. Often
used for people who are dangerous to themselves and to others.
Prozac, a drug used to treat depression, is today one of the best selling of all prescribed
medications. Major reasons for widespread use of drugs :
Effective at treating disorders
Often less expensive than psychotherapy.
Antipsychotic Drugs
Used for schizophrenia or psychosis. All antipsychotics block dopamine receptors in
the brain.
Phenothiazines (Thorazine) : They can have a number of undesirable side effects –
blurred vision, weight gain, and constipation, temporary neurological impairments
such as muscular rigidity or tremors. A very serious potential side effect is tardive
dyskinesia, a permanent disturbance of motor control, particularly of the face
(uncontrollable smacking of the lips, for instance), which can be only partially
alleviated with other drugs.
Antidepressant Drugs
Antidepressants, is used to combat depression. Tricyclics and MAO inhibitors. Most
common until the end of 1980s. Work by increasing amount of the neurotransmitters
serotonin and norepinephrine. Effective, but have serious side effects. Selective
Serotonin Reuptake Inhibitors (SSRIs). Work by blocking the reuptake of serotonin
thus increasing the amount of serotonin active in the brain. Prozac, Paxil, Zoloft,
Effexor.
Antidepressant drugs are not only used to treat depression, but also used :
Generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, social
phobia, and posttraumatic stress disorder.
Lithium
A naturally occurring salt that is used to treat bipolar disorder (manic depression).
Nobody knows how lithium works to alleviate symptoms. Problem with people
stopping medication when symptoms ease.
Other Medications
Antianxiety medications use to treat anxiety disorders. Produce a feeling of calm and
mild euphoria. They are potentially addictive, however, they must be used with
caution. Valium is a common antianxiety medication. Sedatives produce both calm
and drowsiness, and are used to treat agitation or to induce sleep. These drugs, too, can
become addictive.
Electroconvulsive Therapy
Commonly known as “shock therapy”. Used as a treatment for severe depression. The
technique involves briefly passing a mild electric current through the brain or, more
recently, through only one of its hemispheres. Causes brief convulsions and temporary
loss of consciousness. No one knows exactly why ECT works. Treatment normally
consists of 10 or fewer sessions. Memory loss is a side-effect.
Psychosurgery
Brain surgery performed to change a person’s behavior or emotional state. A
prefrontal lobotomy is an example. The assumption is that in extremely disturbed
people, the frontal lobes intensify emotional impulses from the lower brain centers
(chiefly, the thalamus and hypothalamus). Psychosurgery is rarely used today.
Institutionalization and Its Alternatives
Deinstitutionalization
Releasing people with severe psychological disorders into the community. Can cause
problems. Some people are ill-prepared to deal with life outside of a hospital. Up to
40% of homeless are mentally ill. Alternative forms of treatment (many):
Half-way houses, Family-crisis interventions, Day-care
Prevention
Primary prevention
Improve the social environment so that new cases of mental disorders do not develop.
Family planning. Providing genetic counseling to diagnose genetic defects in embriyo.
Designing programs to help mothers to developing problem solving skills in their
children. Campaigns to educate young people about the consequences of drugs,
alcohol abuse, violence and rape.
Secondary prevention : Detecting maladaptive behavior early and treating it
promptly. Interventions with high risk groups, for example, abused children, people
who have recently divorced, those who have lost their jobs, veterans, and victims of
terrorist incidents.
Crisis intervention, which includes such programs as suicide hotlines or short-term
crisis facilities where therapists can provide face-to-face counseling and support.

Tertiary prevention :Help people adjust after they are released from the hospital in
order to help prevent a relapse (Daytime outpatient clinics).
Gender Differences in Treatment
More women admit problems and go to therapy. Women are more likely to take
medication. Psychotherapy is seen as more acceptable for women. Recent increases in
number of males seeking psychotherapy.
Cultural Difference in Treatment
When psychotherapist and client come from different cultures, misunderstandings of
speech, body language, and customs are almost inevitable. Eye contact and body
language varies across cultures and may be misinterpreted as symptomatic of a
disorder.