Chapter 13. What is Therapy? PowerPoint Presentations for. Therapies for Psychological Disorders

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1 PowerPoint Presentations for Philip G. Zimbardo Robert L. Johnson Vivian McCann Prepared by Beth M. Schwartz Randolph College

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Seventh Edition

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This multimedia product and its contents are protected under copyright law. The following are prohibited by law: any public performance or display, including transmission of any image over a network; preparation of any derivative work, including the extraction, in whole or part, of any images; any rental, lease, or lending of the program.

Chapter 13

Therapies for Psychological Disorders

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Therapy for psychological disorders takes a variety of

forms, but all involve a therapeutic relationship focused on improving a person’s mental, behavioral,

or social functioning.

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What is Therapy?

• General term for any treatment process • In psychology and psychiatry, therapy

refers to a variety of psychological and biomedical techniques aimed at dealing with mental disorders or coping with problems of living.

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Components of Therapy

Identifying the problem

Identifying the cause of the problem or the conditions that

maintain the problem

Deciding on and carrying out some form of treatment

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Types of Mental Health Care

Professionals

Counseling Psychologist Clinical Psychologist

Psychoanalyst

Clinical Social Worker Psychiatrist

Psychiatric Nurse Practitioner

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7 Specialty: Problems of normal living Work setting: Schools, clinics, other institutions Credentials: Master’s in counseling, PhD, EdD, or PsyD Professional Title Counseling Psychologist Clinical Psychologist Psychoanalyst

Clinical Social Worker Psychiatrist

Psychiatric Nurse Practitioner

Pastoral Counselor

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Specialty: Those with severe

or less severe disorders Work setting: Private practice, mental health agencies, hospitals Credentials: PhD or PsyD Professional Title Counseling Psychologist Clinical Psychologist Psychoanalyst

Clinical Social Worker Psychiatrist

Psychiatric Nurse Practitioner

Pastoral Counselor

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9 Specialty: Physician trained to treat mental problems (often by means of drug therapies) Work setting: Private practice, clinics, hospitals Credentials: MD Professional Title Counseling Psychologist Clinical Psychologist Psychoanalyst

Clinical Social Worker

Psychiatrist

Psychiatric Nurse Practitioner

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10 Specialty: Freudian therapy Work setting: Private practice Credentials: MD or PhD Professional Title Counseling Psychologist Clinical Psychologist Psychoanalyst

Clinical Social Worker Psychiatrist

Psychiatric Nurse Practitioner

Pastoral Counselor

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11 Specialty: Nursing specialty; licensed to prescribe drugs Work setting: Private practice, clinics, hospitals Credentials: RN plus special training in treating mental disorders and prescribing drugs Professional Title Counseling Psychologist Clinical Psychologist Psychoanalyst

Clinical Social Worker Psychiatrist

Psychiatric Nurse Practitioner

Pastoral Counselor

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Specialty: Social worker with

a specialty in dealing with mental disorders Work setting: Often employed by government Credentials: MSW Professional Title Counseling Psychologist Clinical Psychologist Psychoanalyst Clinical or Psychiatric Social Worker Psychiatrist

Psychiatric Nurse Practitioner

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13 Specialty: Combines spiritual guidance with practical counseling Work setting: Religious order or ministry Credentials: Varies Professional Title Counseling Psychologist Clinical Psychologist Psychoanalyst

Clinical Social Worker Psychiatrist

Psychiatric Nurse Practitioner

Pastoral Counselor

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Therapy in Historical Context

Medieval Europe:

• Mental disorder the work of devils and demons

• Exorcism needed to “beat the devil” out

More Modern Times

• Mentally ill placed in institutions called asylums, which often resulted in neglect

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Modern Approaches to Therapy

Modern approaches abandoned demon

model and abusive treatments. • Therapies based on psychological and

biological theories of mind and behavior

• psychological therapies, often called psychotherapy

• Biological therapies focus on altering the brain.

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Psychologists employ two main forms of treatment:

insight therapies and behavioral therapies.

How Do Psychologists

Treat Psychological Disorders?

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Insight Therapies

Insight Therapies

• Psychotherapies in which the therapists help patients/clients understand (gain insight into) their problems

• Aim at revealing and changing a patient’s disturbed mental processes through discussion and interpretation

• Numerous approaches involve this type of therapy.

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Insight Therapies

Freudian Psychoanalysis

• Insight therapies based on the assumption that psychological problems arise from tension created in the unconscious mind by forbidden impulses

• Major goal: To release conflicts and memories from the unconscious

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Insight Therapies:

Psychodynamic Therapies

Psychoanalysis

• The form of psychodynamic therapy developed by Sigmund Freud

• Access to unconscious material through free association

• Helps the patient understand the unconscious causes for his or her symptoms

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Insight Therapies:

Psychodynamic Therapies

Psychoanalysis

• The ego blocks unconscious problems from consciousness through defense mechanisms.

• e.g., displacement and repression

Analysis of Transference

• Analyzing and interpreting the patient’s relationship with the therapist, based on the assumption that this relationship mirrors unresolved conflicts in the patient’s past

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Insight Therapies:

Psychodynamic Therapies

Neo-Freudian Psychodynamic Therapies

• Therapies developed by psychodynamic theorists who embraced some but not all of Freud’s ideas

• emphasis on conscious motivation

• significance of the self

• experiences throughout life

• the role of interpersonal relationships

• abandoned the psychoanalyst’s couch

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Insight Therapies:

Humanistic Therapies

Humanistic Therapies

• Mental problems arise from low self-esteem, misguided goals, and unfulfilling

relationships.

Client-Centered Therapy: Carl Rogers

• Emphasizes healthy psychological growth through self-actualization

Reflection of feeling: paraphrasing client’s words to capture the emotional tone expressed

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Insight Therapies:

Cognitive Therapies

Cognitive Therapy

• Emphasizes rational thinking as the key to treating mental disorder

• Helps patients confront destructive thoughts

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Insight Therapies:

Group Therapies

Group Therapy

• Psychotherapy with more than one client Self-Help Support Groups

• Groups that provide social support and an opportunity for sharing ideas about dealing with common problems; typically

organized/run by laypersons (not professional therapists)

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Insight Therapies:

Group Therapies

Couples and Family Counseling • Intended to help clients learn about

relationships

• Can be more effective than individual therapy with one member of the relationship at a time

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26 Systematic Desensitization Token Economies Contingency Management Aversion Therapy Participant Modeling

Behavior Therapies

Behavior Therapy

• Any form of psychotherapy based on the principles of behavioral learning:

• operant conditioning and classical conditioning

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Classical Conditioning Therapies

Systematic Desensitization

• Technique in which anxiety is extinguished by exposing the patient to an anxiety-provoking stimulus

Exposure Therapy

• Desensitization therapy in which patient directly confronts the anxiety-provoking stimulus (as opposed to imagining it)

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A Sample Anxiety Hierarchy

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Classical Conditioning Therapies

Aversion Therapy

• Involves presenting individuals with an attractive stimulus paired with unpleasant stimulation in order to condition a repulsive reaction

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Operant Conditioning Therapies

Contingency Management

• Approach to changing behavior by altering the consequences of behaviors

• Effective in numerous settings

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Operant Conditioning Therapies

Token Economies

• Applied to groups (e.g., classrooms or mental hospital wards)

• Involves distribution of “tokens” contingent on desired behaviors • Tokens can later be exchanged for

privileges, food, or other reinforcers.

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Participant Modeling: An

Observational-Learning Therapy

Participant Modeling

• The therapist demonstrates and encourages a client to imitate a desired behavior. • Draws on concepts from both operant and

classical conditioning

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Cognitive-Behavioral Therapy:

A Synthesis

Cognitive-Behavioral Therapy

• Combines cognitive emphasis on thoughts with behavioral strategies that alter reinforcement contingencies

• Assumes irrational self-statements cause maladaptive behavior

• Seeks to help the client develop a sense of self-efficacy

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Cognitive-Behavioral Therapy:

A Synthesis

Rational-Emotive Behavior Therapy (REBT)

• Albert Ellis

• Based on the idea that irrational thoughts and behaviors are the cause of mental disorders

• Attempts to eliminate the self-defeating thoughts

Positive Psychotherapy (PPT)

• Positive emphasis on growth

• Emphasis on research

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Evaluating the

Psychological Therapies

Eysenck (1952) proposed that people with

nonpsychotic problems recover just as well with or without therapy.

Reviews of evidence since have shown that:

• Eysenck overestimated the improvement rate in the group without therapy. • Therapy is better than no therapy. • It appears advantageous to match

specific therapies with specific conditions. Copyright © 2012 Pearson Education, Inc. All rights reserved

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How Is the Biomedical

Approach Used to

Treat Psychological Disorders?

Biomedical therapies seek to treat psychological disorders

by changing the brain’s chemistry with drugs, its circuitry with surgery, or its patterns of activity with pulses

of electricity or powerful magnetic fields.

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Drug Therapy

Antipsychotic Drugs

• E.g., chlorpromazine, haloperidol, and clozapine

• Usually affect dopamine pathways • May have side effects

tardive dyskinesia: incurable disorder of

motor control resulting from long-term use of antipsychotic drugs

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Drug Therapy

Antidepressant Drugs

• Three major categories:

• tricyclic compounds (e.g., Tofranil and Elavil)

• SSRIs (e.g., Prozac)

• Monoamine oxidase (MOA) inhibitors and lithium carbonate (effective against bipolar disorder)

Mood Stabilizers

•E.g., Lithium and Depakote: effective for bipolar disorders

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Drug Therapy

Antianxiety Drugs

• Include barbiturates and benzodiazepines

• May include some antidepressant drugs that work on certain anxiety disorders

• Should not be used to relieve the ordinary anxieties of everyday life

• Should not be taken for more than a few days at a time

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Drug Therapy

Stimulants (e.g., caffeine, nicotine, cocaine)

• Produce excitement or hyperactivity

• Suppress activity level in persons with attention-deficit/hyperactivity disorder (ADHD)

• Controversy exists concerning the use of these stimulants for children.

• side effects

• growth slowed

• concern regarding overdiagnosis of ADHD

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Psychosurgery

The general term for surgical intervention in the brain to treat psychological disorders

•The infamous prefrontal lobotomy is no longer performed.

•Severing the corpus callosum, however, can reduce life-threatening seizures.

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Brain-Stimulation Therapies

Used to treat severe depression

Electroconvulsive Therapy (ECT) • Apply an electric current to temples briefly

• Patient is put to “sleep.”

• Memory deficits are a side effect.

Transcranial Magnetic Stimulation (TMS) • High-powered magnetic stimulation to the brain

• Also effective for bipolar disorder

Deep Brain Stimulation

• Surgical implants of a micro electrode directly in the brain

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Hospitalization

and the Alternatives

Therapeutic Community

• Designed to bring meaning to patients’ lives

• Hospital setting to help patients cope with the world outside

• Higher costs Deinstitutionalization

• Removing patients, whenever possible, from mental hospitals

Community Mental Health Movement

• Effort to deinstitutionalize mental patients and to provide therapy from outpatient clinics

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