I. Therapeutic Models

 

Psychotherapy: treatment designed to help people deal with mental, emotional, or behavioral problems

 

A. Themes across models

 

(1) Core assumptions about causes of disorders

 

(2) Central goal = improved functioning

 

(3) Support Factors

(a) patient-therapist alliance: shared goal and commitment to change

 

(4) Learning Factors

        (a) Gained insight

§       Brain abnormality

§       Unconscious conflicts

§       Thought patterns

§       Learned experiences

§       Family relationships

 

(5) Action Factors

 

        (a) Tangible course of action--offers hope, control

 

B. Biological Models

(1) Core assumption:

§       Biological basis for disorder

§       Symptoms can be alleviated through biological mechanisms

 

(2) Strategies

 

(a) Drug Therapies

Facilitate/inhibit neurotransmitter production

§       Anti-psychotic drugs: Effective w/ positive symptoms of schizophrenia

§       Anti-depressant drugs: Prozac

§       Anti-anxiety drugs: Valium

All have side-effects and other concerns

 

(b) Electroconvulsive Therapy (ECT)

Shock to induce brief convulsion

Changes neurotransmitter processing, details unknown

Controversial but still used for some depressed patients

 

(c) Psychosurgery

        Physical alternation or destruction of brain tissue

§       Prefrontal lobotomy

Likely to rise in popularity

 

(d) Light for Seasonal Affect Disorder (SAD)

 

C. Psychodynamic Model

(1) Core assumption:  

§       Unconscious conflicts, fears, and motives are the source of psychopathology

§       Goals: overcome defense mechanisms that suppress unconscious, bringing them to the surface of awareness

 

(2) Strategies:

(a) Free association

 

(b) Dream analysis (manifest & latent content)

 

(c) Hypnosis

 

(d) Projective tests

 

Resistance: Patient's unconsciously motivated attempts to hinder the process of therapy

 

Transference: The patient's transfer of thoughts or feelings towards the therapist that are linked with other relationships

 

Interpretation: The analysts noting of resistance and other behaviors to promote the client's insight.

 

(3) Issues

 

(a)Therapy is lengthy and expensive

 

(b) More effective for highly educated clients

 

(4) Modern psychodynamic approach

 

D. Cognitive Therapies

(1) Core assumption:

§       Focus on maladaptive thought patterns, irrational beliefs, which are seen as source of psychological problems

§       Not events, rather interpretation of events

 

(2) Strategies:

(a) Rational-Emotive-Therapy (RET, Ellis)

        Aggressively address irrational thoughts

 

Change irrational internal statements

"This thing that I want is absolutely necessary"

"I need to be better than everyone else"

"If I fail it will be a disaster"

"He/she must approve of everything I do"

(b) Cognitive-Behavioral Therapy (Beck)

        Less aggressive, facilitate client's own insight

                Homework

 

E. Humanistic Therapy

(1) Core assumption:

§       Disorders stem from incongruence b/w actual and ideal self

§       Establishing sense of self-worth, value and potential as a human empowers one to fix own problems

 

(2) Strategies:

(a) Client-centered therapy

Supportive environment

Genuineness

Unconditional positive regard

Empathy

Active listening

 

(3) Gestalt (German: "whole") and existential Therapy

 

        "To become real, to learn to take a stand, to develop one's center, to understand the basis of existentialism… I am what I am, and at this moment I cannot possibly be different from what I am."

        -Frederick S Perls

 

F. Group Therapy

        Treat multiple people with the same/similar issues simultaneously in the same setting

 

(1) Advantages

        (a) Cost effective

        (b) Educational

        (c) Not alone

        (d) Social support

 

(2) Family Systems Therapy

(a) Core assumptions:

§       Individual problems are linked to family relationships

§       Family members treat person in ways that lead to disorders and/or are affected by disorders

 

(b) Strategies:

§         Understand how family operates as a system

§         Counsel family as a unit

 

G. Behavior Therapies

(1) Core assumptions:

§       Psychological problems learned, acquired from experience

§       Can condition new adaptive responses

 

(2) Strategies:

(a) Systematic Desensitization (phobias & OCD)

counter-conditioning: gradual shaping of non-phobic response to specific object or event

Virtual reality example

 

(b) Exposure (phobias)

Flooding (Implosion) sudden exposure to object of phobia

Goal: overcome nervous system response

 

(c) Aversion

Overloading a desirable stimulus w/ undesirable associations (e.g., smoking)

 

(d) +/- Reinforcement

Token economies

Anorexics: rewarding weight gain with privileges

                Punishment

                        Undermines client-therapist alliance

                        Teaches what not to do, not what to do

                        Ethical concerns

 

        (e) Social Skills Training

                Social skills vital to quality of life

                Learning techniques supported by reinforcement

 

H.  Evaluating and Choosing Psychotherapy

 

(1) Therapy or time?

(a) Some conclusions

§       Spontaneous remission: Some problems resolve on their own

§       Therapy works

§         Effects are long-lasting

§         Some approaches better suited for particular disorders than others

 

How many psychologists does it take to change a light bulb?