Chapter 16: Therapy
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Date Created: 04/20/16
Key: Definitions Important People/Psychologists Important Terms/Concepts Chapter 16: Therapy Psychotherapy versus Biomedical Therapies Philippe Pinel and Dorthea Dix pushed for more humane treatments and mental hospitals Psychotherapy – treatment involving psychological techniques; consists of interactions between a trained therapist and someone seeking to overcome psychological difficulties or achieve personal growth Biomedical Therapy – prescribed medications or procedures that act directly on the person’s physiology to reduce symptoms Eclectic Approach – an approach to psychotherapy that uses techniques from various forms of therapy Psychoanalysis Psychoanalysis – Freud’s therapeutic technique o Believed patients’ free associations, resistances, dreams, and transferences (and therapists’ interpretations of it) released previously repressed feelings, allowing the patient to gain selfinsight and resolve inner unconscious conflicts Interpretation – analyst’s noting supposed dream meanings, resistances, and other significant behaviors and events in order to promote insight Transference – patient’s transfer to the analyst of emotions linked with other relationships (such as love or hatred for a parent) o Reclaim unconscious thoughts and feelings into conscious awareness o Resistance – blocking from consciousness anxietyladen material Psychodynamic Therapists – therapy deriving from the psychoanalytic tradition; views individuals as responding to unconscious forces and childhood experiences and seeks to enhance selfinsight o Discover themes on relationships and focus on improved selfawareness and self insight Interpersonal psychotherapy focuses on currency rather than the undoing of the past to improve relationship views Humanistic Therapy Insight Therapies – variety of therapies that aim to improve psychological functioning by increasing a person’s awareness of underlying motives and defenses Humanistic therapies differences from psychoanalytic theories o Humanistic therapies aim to boost selffulfillment by helping to grow in self awareness and selfacceptance o Promoting this growth, not curing illness, is the focus o The path to growth is taking immediate responsibility for one’s feelings and actions rather than uncovering hidden determinants Key: Definitions Important People/Psychologists Important Terms/Concepts o Conscious thoughts are more important than the unconscious o Present and future are more important than the past ClientCentered Therapy – Carl Rogers’ humanistic therapy in which the therapist uses techniques such as active listening with a genuine, accepting, empathic environment to facilitate the client’s growth (personcentered therapy) o Unconditional positive regard Active Listening – empathic listening in which the listener echoes, restates, and clarifies (part of clientcentered therapy) Unconditional Positive Regard – caring, accepting, nonjudgmental attitude, which Rogers believed would help clients develop selfawareness and selfacceptance Tips to listen more actively in your own relationship 1. Paraphrase 2. Invite clarification 3. Reflect feelings Behavior Therapy and Exposure Therapies Behavior Therapies – applies learning principles to the elimination of unwanted behaviors o Derived from Pavlov’s principles o Includes classical and operant conditioning Counterconditioning – behavior therapy procedures that use classical conditioning to evoke new responses to stimuli that are triggering unwanted behaviors (exposure therapies and aversive conditioning) o Exposure Therapies – behavioral techniques, such as systematic desensitization and virtual reality exposure therapy, that treat anxieties by exposing people (in imagination or actual situations) to the things they fear and avoid Avoidance worsens a conditioned fear, need guided exposure Systematic Desensitization – a hierarchy of anxiety triggering situations in which a pleasant relaxed state is associated with gradually increasing anxietytriggering stimuli commonly used to treat phobias Virtual Reality Exposure Therapy – anxiety treatment that progressively exposes people to electronic simulations of their greatest fears o Aversive Conditioning – counterconditioning that associates an unpleasant state with an unwanted behavior Therapy Based on Operant Conditioning Voluntary behaviors are strongly influenced by their consequences o Operant conditioning reinforces for desired behavior and withholds reinforcement for undesired behaviors Token Economy – people earn token for exhibiting a desired behavior and can later exchange their tokens for various privileges or treats Key: Definitions Important People/Psychologists Important Terms/Concepts Criticisms o The durability of the behaviors o Is it right for one human to control another’s behavior? Cognitive Therapy Cognitive Therapy – teaches people new, more adaptive ways of thinking based on the assumption that thoughts intervene between events and our emotional reactions o Gentle questioning reveals irrational thinking which can then be removed (Beck) Change negative selftalk The causes of disorders are thoughts o If thinking patterns can be learned, they can also be replaced Aim of Technique Technique Therapist’s Directives Reveal beliefs Question interpretations and Explore beliefs and faulty rank emotions and thoughts assumptions and rank from mildly to extremely upsetting Test beliefs Examine consequences and Explore situations, decatastrophize thinking consequences, and faulty reasoning and determine how to cope with consequences Change beliefs Take responsibility and resist Change total selfblame and extremes; stress inoculation develop new ways of training – restructure thinking thinking, replacing in stressful situations maladaptive habits CognitiveBehavioral Therapy – popular integrative therapy that combines cognitive therapy (changing selfdefeating thinking) with behavior therapy (changing behavior) Group and Family Therapies Group Therapy – therapy conducted with groups rather than individuals, permitting therapeutic benefits from group interactions o Saves therapists time and clients’ money o Offers social laboratory for developing social skills o Enables people to see that others share their problems o Provides feedback as clients try new ways of behaving Family Therapy – treats family as a system and views individual’s unwanted behavior as influenced by or directed at other family members o Focus on communication, conflicts, and parenting styles Support groups focus on stigmatized or hardtodiscuss illness o Long for community and connectedness o Run by clients themselves Therapy Problem Aim Technique Psychodynamic Unconscious Reduce anxiety Interpret memories Key: Definitions Important People/Psychologists Important Terms/Concepts conflicts from through selfinsight and feelings childhood ClientCentered Barriers to self Enable growth via Listen actively and understanding and unconditional reflect feelings selfacceptance positive regard, genuineness, acceptance, and empathy Behavior Dysfunctional Adaptive behaviors Classical and operant behaviors extinguish problems conditioning Cognitive Negative and self Promote healthier Train people to defeating thinking thinking and selftalk dispute negative thoughts and attributions CognitiveBehavioral Selfharmful thoughts Promote healthy Train to counter self and behaviors thinking and adaptive harmful thoughts and behaviors act out new ways of thinking Group/Family Stressful Heal relationships Understand family, relationships social systems, roles, and communication Psychotherapy’s Effectiveness Client testimonials o People use therapy in crisis o Clients believe treatment will be effective o Clients want to believe therapy was worth it o Clients speak kindly of their therapists Therapists testify to therapies success o Clients leave when they are less unhappy but may seek another therapist’s help with future recurring problems MetaAnalysis – procedure for statistically combining the results of many different research studies Those not undergoing therapy improve but those with therapy are more likely to improve quicker with less chance of relapse EvidenceBased Practice – clinical decision making that integrates the best available research with clinical expertise and patient characteristics and preferences o Available therapies are evaluated and applied to what is best in the unique situation Use experimental design with control group that does not receive treatment Key: Definitions Important People/Psychologists Important Terms/Concepts o Includes patient’s values, evidence and research, and clinical expertise Alternative Therapies EMDR (Eye Movement Desensitization and Reprocessing) – clients imagine traumatic experience while therapist waves finger in front of their eyes to unlock and reprocess frozen memories o Criticized as a combination of exposure therapy and the placebo effect Light exposure during dark seasons dims depression symptoms the same as taking drugs or doing cognitivebehavioral therapy Elements of All Psychotherapy Hope for demoralized people New perspectives lead to new behaviors Create empathetic, trusting, and caring relationship Therapeutic Alliance – bond of trust and mutual understanding between a therapist and client who work together constructively to over the client’s problem Cultures and Values in Therapy Cultures and clients differ in values and communication styles and language o Asian minorities in the US do not form strong bonds with American individualist therapists Religious people may prefer religiously similar therapists Selecting a Therapist When to seek help o Feel hopeless o Depression o Selfdestructive behavior o Disruptive fears o Mood shifts o Thoughts of suicide o Compulsive rituals o Sexual difficulties o Hearing voices/seeing things Type Description Clinical psychologists Ph.D. or Psy.D, with supervised internship and postdoctoral training; works in agencies, Key: Definitions Important People/Psychologists Important Terms/Concepts institutions and private practices Psychiatrists Specialize in treatment, can prescribe medication, and see those with most serious problems in a private practice Clinical or psychiatric social workers 2 year master of social work and post graduate supervision, works with everyday personal and familial problems Counselors Marriage and family, clergy, abuse, mental health; may need master’s degree Biomedical Therapy – physically changing the brain’s functioning by altering its chemistry with drugs, affecting circuitry with electroconvulsive shock, magnetic impulses, or psychosurgery; or influencing responses with changes in lifestyle Drug Therapies Psychopharmacology – study effects of drugs on the mind’s behavior DoubleBlind Procedure – neither staff nor patients know who is taking medication or a placebo Antipsychotic Drugs – drugs used to treat schizophrenia and other forms of severe thought disorder o Block dopamine receptors o Side effects like movement problems and obesity Antianxiety Drugs – drugs used to control anxiety and physical agitation o Depress the central nervous system o Do not solve underlying problems, addictive, slow thinking, withdrawal symptoms Antidepressant Drugs – treat depression and anxiety disorders by improving mood and eliminating depressive thoughts o Increase neurotransmitters and inhibit reuptake (serotonin and norepinephrine) o SSRI (selective serotonin reuptake inhibitor) o Aerobic exercise, cognitive therapy, or using drugs with cognitivebehavioral therapy helps o Placebo can work just as effectively MoodStabilizing Drugs – eliminate highs and lows of mania and depression o Lithium Stimulants – control impulses, focus attention, and reduce need for stimulation o Block dopamine reuptake Psychosurgery Electroconvulsive Therapy (ECT) – biomedical therapy for severely depressed patients in which a brief electric current is sent through the brain or an anesthetized patient o Treat severe depression (weakens connections in hyper connected hub in the left frontal lobe) Key: Definitions Important People/Psychologists Important Terms/Concepts o Neural rewiring and boosts neurogenesis o Seen as barbaric Repetitive Transcranial Magnetic Stimulation (rTMS) – repeated pulses of magnetic energy to the brain to stimulate or suppress brain activity Deepbrain stimulation to neural “sadness center” aids in depression Psychosurgery – surgery that removes or destroys brain tissue in an effort to change behavior Lobotomy – psychosurgical procedure once used to calm uncontrollably emotional or violent patients by cutting the nerves connecting the frontal lobes to the emotion controlling centers of the inner brain o Produced permanently lethargic, immature, and uncreative people Healthy Lifestyle Humans were designed for physical activity and social engagement Outdoor activity reduces stress and promotes health Aerobic exercise, adequate sleep, light exposure, social connection, antirumination, empowerment, love, and nutritional supplements all help in depression Therapy Presumed Problem Aim Technique Drug therapies Neurotransmitter Control symptoms of Alter brain chemistry malfunction disorder through drugs Brain stimulation Severe, treatment Alleviate what is not Electro compulsive resistant depression responsive to drugs shock, magnetic impulses, deepbrain stimulation to stimulate the brain Psychosurgery Brain malfunction Relieve sever Remove and destroy disorders brain tissue Therapeutic lifestyle Stress and unhealthy Restore healthy Alter lifestyle change lifestyle biological state through exercise, sleep, etc. Preventative Mental Health Programs Understand psychological disorders as understandable responses to a stressful society Prevent psychological casualties by identifying and alleviating the conditions that cause them Empowering those that are helpless and change environments that breed loneliness Resilience – personal strength that helps most people cope with stress and recover from adversity and even trauma Posttraumatic Growth – positive psychological changes as a result of struggling with extremely challenging circumstances and life crisis
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