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Date Created: 10/29/15
1 2 6 7 10 Psychology 110 Dr Gordon Module 50 The Psychological Therapies A Psychological therapies N 1 1 2 Brief history of therapies 1 Brief history of th erapy 2 Psychoanalysis 3 Humanistic therapies 4 Behavioral therapies 5 Cognitivebehavior therapies 6 Cognitive therapies 7 Group therapy Brief history of therapies hrough history it euunlcou w l B B quot39 39 the more LL L 4 L 4 L L 4 LL L L a 1 out of people Humane 39 B l B serene retreats to identifying maladaptive thoughts Brief history of therapies Treatment tended to be inhumane when money was scarce The slide below is a painting by William Hogarth depicting the conditions atthe St Mary of Bethlehan hospital The treatmmt of the mentally ill was basically a w39deshow in the 17th century Brief history of therapies The slide below illustrates the use of restraint In llIyer s review of the history of therapies he discumes restraint as a form of treatmmt Benjamin Rush the founder of Ama ican Psychiauy believed restraint would help patients regain their senu39bilities Even though Rum pushed for humane treatment his ideas of restrain were incorrec Brief history of therapies Valium of L L LL L 4 violent behavior in the howital Brief history of therapies Today we have brought psychological treatment to talk radio and televim39on To the right Frazier is a 39 39 39 39 Shows like Fraziw helped to stereotype 39 punelm mental health 39 39 B Brief history of therapies Contemporary therapy has moved to the television program Dr Phil has become a household name He brings entire families on televiu39on fights obesity and confronts people about their demons It is safe to say thatDr Phil s televim39on approach is rather unorthodox LLL 4 wLr socially sanctioned healer and a m erer Psychotherapies vary in accordance to their theoretical tive quot r39 quot 39 39 stems Iftherapy 39 Pen L L L L I W u mm blaming l Psychoanalysis F J l 3 By 11 12 13 14 15 16 17 18 19 de nition 4 motives 2 Psychoanalysis Theaimo I 39 l 39 l J quot39 Through longterm arduous therapy 3 times per week for 2 years the patient works through his conflicts bringing than to 39 39 39 39g 39 39 39 When 39 g 39 thepatient s neurosis disappears 2 Psych 0an alysis 39 F l 39 39l 39 39 mg m mume circumstances Freud took ovw the case of Anna 0 from Joseph Breuer Anna s real name was Bertha Pappenheim 2 Psych 0an alysis 39 As the story goes Breuer had developed countemanyerenceforAnna As a result ethics got the better of Breuw and he 395 Freud 39 39 39 39 quot39 the talking cure and cureAnna s converu39on disorder 2 Psychoanalysis Thmughqg J a I h quot of techniques to hypnosis and interpretation Let s turn our attention to a film clip that employs hypnosis to help a women rid her fear of bum n 2 Psych 0an alysis lit mm q First avvuit nn 39 39 wuiin the quot quot I myquot u quotmugm 4 39 g m m occur with as little cmsormip as posu39ble 2 Psychoanalysis 39 quot 39 39 l39 39 l g 39 395 quot quot Dreamshave 39l the dream 4 g Aspatients reveal their dream the 39 39 quot the l 39 ThatiVu analyst provides the patientunderlying wiMes conflicts deu39res etc 2 Psych 0an alysis Tntarnratt nn 39 L Interpretation refers to the analyst s mom to explain the inner significance of the client s thoughts feelings memories and behaviors Psychoanalyu39s has other interesting characteristics For example two phenomenon occur over the course o 39 39 39 39 39 39 hinder the 1 a J progress of therapy 2 Psych 0an alysis 39 People who reu39st have problems facing or taking ownermip of their real problems In the cartoon to the right the patient s resistance is in the form of distraction Other forms of resistance include canceling or showing up latefor an appointment When l 39 39 39 39 1 39 is close to anxiety sensitive areas in the patient s life 2 Psych 0an alysis 39 Annme 39 l 39 39 39 1 whereby 39 39 39 5 mi um ulliu in 39 39 39 39 their lives Let s turn our attention to a scene from the film Ordinary People in which a young patient quot 39 39 39 39 39 39 In other words he a l l transfers his anger toward his brother on to his therapist 2o 21 22 23 24 25 26 27 28 29 2 Psych 0an alysis whm Myws calls psychodynamic therapy 2 Psych 0an alysis l I I experiences A Inuij 39 degree of activity on part of the therapist 39 the n0 a y I Winnquot diildhood 39 tho 2 Psychoanalysis M quot interpersonal J I T T 39 39 I 39 39 1 39 mammal wimlmqm Instead of f Wing quotquot 39 39 l 39 I I 39 39 L the skills needed to mstain them 39 quotI K n 4 In WhatAbout Bob does Dr Leo Marvin practice interpersonal psychotherapy 3 Humanistic th crapics 39 The humanistic approaches to treatment focus on four major asmngptions These include I focus on the J 2 ll39uv on L 39 J 39 39 39 1 1 r I I s munemule II I J I 3 oanhniv on ownership for immediate J actualiz quot g 39 I and4 mum g on as opposed to curing one s illnem 3 Humanistic th crapics 39 Also known I I 39 39 39 395 I mu provides a supportive emotional climate for clients Gients play a major role in determining the pac and direction of tha39r ther quotquot 39 39 39 39 II quot 39 5 me climtwho I 39 39 guidance or hand holding 3 Humanistic th crapics In 39 I 39 I I 39 I 39 I 39 the client s unconscious The therapist makes no effort to modify the client s behavior Instead the goal of therapy is to clanfy the 39 I39 39 mum I 39 39 quot 39 39 I quot This is achieved through a unique therapeutic climate 3 Humanistic th crapics quotquot 1h 139 t J 39 II II 1 I I I l 39 tho 39 39 39 39 refrain judgment etc 39 39 L 3 Humanistic th crapics 39 According to Rogers 39 39 quot 39 I 39 39 39 unconditional positive regardaccqtance and empathy In other words therapists make the effort to be the thergrin dimam 39 I 39 39 39 I the client avoids u39iuuch n thanWIVES l 3 J l J client s point of view 3 Humanistic th crapics client A J J B you feet out your wrldis a my may place in be c mm a I 3 Humanistic th crapics 39 The humanistic apprth requires a keen ear Rogers calls it er listening According to IlIyers 3o 31 32 33 34 35 36 37 38 39 4o this refers to echoing Hg 4 the expressed feelings 4 Behavior Therapies F 1 1 1 1 1 r u have an acquired teaming history g clasu39cal operant or social learning The goal of behavior therapy is to team new healthy behaviors and 5 39 T quot to cluster ofunhealthy behaviors that 11 7 1415 11mmquot 1 11 J or realizing one s potential It is about leaming the new and unlean the old 4 Behavior Therapies 39 Let sstmmwith v 1 1 5 r1 J 1 rom Pavlovian principles of le 39 g 39 4 I 1 relaxation quot 39 39 3955 ueuuviw 11 1 39 39 39 5 techniques The are 39 Km 4 39 Let s take a look atSD 4 Behavior Therapies 39 The key to 111 39 39 l 39 39 l 39 l mu39m exposing the patientto afear object 1 g 39 39 39 l 39 39 l 39 l pou39ng the patient to the fear object while relaxed eventually leads to an extinction of the fear response When 11 exposure conn39sts of presenting the most intense fear stimulus it is called ood1ng 4 Behavior Therapies 39 Flooding isbased on the idea of habituation Thatis repetitive exposure to the same intense fear stimulus eventu leads to no response or boredom The slide below shows a stunt from the television Mow called Fear Factor Fear faaor is really quot 39 Thatis 39 l 39 39 f situ 39ons Contestants do notget awann up 4 Behavior Therapies Ayuzlnuu39L 39 39 39 mm l l B with m 1111111 In SD terms a u my hiwarchy A g 4 39 I J 13mm 111111 f39blrfhl 1 l WW up to the really fearful 4 Behavior Therapies 39 As one continuesto ui anrhfmrmm I I hiwarchy With each mccem 39 39 VmumLn 4 objects Let s much a clip of expomre therapy starring39 Dr Fear 4 Behavior Therapies 39 In some cases igu11esJe1u J39 a viable option 7 39 g 39 I conquer her fear of 39 Let s turn our attention to a film clip showing how virtual reality works for an arachnophobic 1 I 39 quots 1 quotj In addition therealityof theuseof 39 39 umme 14 151w 4 Behavior Therapies 39 Another form of counterconditioning is aversive therapy According to AIyers aversive therapy involves associating Im l with 39 as drinking alcohol mmquot 39 L 39 394 394 pedophilia smoking alcohol consumption selfabuse etc 4 Behavior Therapies 39 quot 39 39 39 I 39 39 l However other 1411111 111 39 mm 39 asthey 1 so Let s turn out attention to a film clip that presents the use of aversion therapy with selfabuu39ve behavior 4 Behavior Therapies l 39 39 quot 39 treatment Operant conditioning involves l quot healthyuudw 39 39 M an I Jquot 395 he y behaviors are shaping extinction g 39 39 etc have B quotJ Iquot the autistic and mentally retarded 4 Behavior Therapies In SI 1 Br l s consequences of those anions IlIyers brie y reviews the concept of token economies In its day a token economy 39 39 39 L t proved to he an 39 39l muse 439 quot 4 f 39 39 would not generalized to life outm39de the institution 41 5 Cognitive Behavior Therapies quot l 39 0M 3 J 35 5 quotquot 39 If therapists hope to change their patient s thinking they must do it through activity or behavior Donald 39 39 l 39 g quoti39 L 39 39 app aches 39 as assumw39 39 quot 5395quot 5 395 J activity 42 6 Cognitive Therapies Oneof Jammy B quot 39 B J B quot Theslide 39 39 39 1 1 1 1 l l l l u u themselves Itis no accident that cognitive approaches have dominated over the last four decades This is likely amibuted to the 1 39 39 39 L 39 B 39 depression a dime the cognitive approach 43 6 Cognitive Therapies 39 According to IlIyers cognitive therapy teaches people new more adaptive ways of thinking and acting based on the nmImp In 39 39 39 Aaron unLn s g l 39 39 39 depresu39on 11m an maladaptive thinking contributes to feelings of depremion 44 6 Cognitive Therapies 39 Aaron Beck identified a number of cognitive or thinking errors that drive depresu39on An abbreviated listis presented below 45 6 Cognitive Therapies 39 The world of the dqremed is cognitively skewed For example clinical researchers have found that l 39 not Mow n 39 g 39 39 39 39 othe my rs I 1 1 I I I I u 1 u a concerted ejj brtto change one s maladaptive 46 Z Group Therapies Group m 39 39 6to 10 quot 39 39 B I 39 39 n 39 euu39i other 39 39 I quot U each other n 1 1 393 15 1 quot139 Gmu u39muw39 that others have problems u39milar to their own an 395 E N i e S E v a 392 2 v4 The slide below illustrates the use of restraint In Myer s review of the history of therapies he discusses restraint as a form of treatment Benjamin Rush the founder of American Psychiatry believed restraint would help patients regain their sensibilities Even though Rush pushed for humane treatment his ideas of restrain were incorrect The Restraint Chair Ic39 r gg 7 39 h L 2 Psychoanalysis 0 Let s continue our discussion of psychoanalytical 39 39l irst 39 quot isa 39 39 in which the psych oanalyst allows their patients to spontaneously express their thoughts and feelings exactly as they occur with as little censorship as possible The slide to the left provides a humorous view of association th e patient provides the analyst wh atever comes to mind E a 31 E 3 3 a R i 0 Interpretation is the psych oanalyst s bread and butter Interpretation refers to the analyst s efforts to explain the inner signi cance of the client s thoughts feelings memories and beh aviors Psych oan alysis h as oth er interesting ch aracteristics For example two phenomenon occur over the course of psych oanalysis First resistance refers to largely unconscious defensive maneuvers intended to hinder the progress of th erapy quotSo Mr Fenian 1e s nagm mm vauv mower 7 Resistance E a 31 E 3 3 a R i 0 People who resist have problems facing or taking ownership of their real problems In the cartoon to the right the patient s resistance is in the form of distraction Other forms of resistance include canceling or sh owing up late for an appointment When the patient becomes resistant it simply means that the analyst is close to anxiety sensitive areas in the patient s life quotin Mr Fenian le s nagm wnn vouv molherf 7 Resistance The slide below lists the di erences between traditional psychoanalysis and modern psychoanalysis or what Myers calls psych odynamic therapy YABLE 5 SDMi DIFFERiNCES BETWiKN CLASSICAL AND MODIRN PSVCHDANALVSIS Classical Psyclmalmlys s Mndmx rxyzhunuaty s 1 1 four to ve times a week to ma times per week Pane Is named quotan the muchquot Patlem is typically seen quotface to facequot lm39 n lt support of ego functions with limited dumcter change and ndnmn usion of the analysL direc ve stance E a 31 E 3 3 a R i A wim range nlquot a mun n m v m nn m and intgkptem on and analysis m me Educative techniques rranuexence s mnsrexence and resistance rypxcauy kepl less imense some Wen mm an mus lmwmgzlxmnl mummy 8 39i E Q 4 396 39N gt a Q V The key to any counterconditioning technique is to teach an incompatible response while exposing the patient to a fear object Progressive relaxation is typically the incompatible response to fear Exposing the patient to the fear object while relaxed eventually leads to an extinction of the fear response When exposure consists of presenting the most intense fear stimulus it is called ooding 1 Helena Gallaghnv and ms conuamsw mnmqnc n1 s mullannausly cunlmnnng me dear cl hmgms sunk and me am A humorous view to exposure therapy 4 Behavior Therapies As one continues to pair relaxation with patient advances through the fear hierarchy With each success the patient gains valuable con dence and is prepared for the most fearful objects Let s watch a clip of exposure th erapy starring Dr Fear An Anxiety Niermhy In System nmnsiliullun Degvee Wear 5 m standing on he baknw the up Home an apanmem 10W m standing ana slenladderm Ihe kurhen a hangmighl m m wa king on a Iidge The edge is mum Vmsi ingamhe slaps M2 mum lnukinguul nvevthe haviznn m msinga hridgeb eel above a week The budge mists nf an Mamwide heard mm a hindm an amide Wu ridingask i Heel ahwethegwund mcmssinga shallaw wl eaeek an an 134nm wide heard 3 mm walev wel dermblng a addewulslde mehouse loreach a second snrywm w m WHIngmysE upa gudegyee wet slipperys upean a steel table m S amb ng up a M Neel high Walking In Ieemn a VESiHEM x e wnzhewme mammmmmans an BVnoIdeepgulm m wal 39ng an a wi p can 2 en 1mm the edge a a IVY m Mug an inmmedhle NIL Ybe snow 5 uatkkd waylleslle m walkingnnmesmenlan embankmenl e path slopes nrheumside m ridmgachai ikxs Yeetabwe lhegvmmd 39m walklng up a lnngsleep 5km mwalkingupnrdwna1s 1eyeesuueMamawidellaiLGnnnesmeolme Ira lhelerralndmpsdwn Shaw on lhealhersideisa steep uwavd slape I m walking an a 3fomwlde ridge The shapes on em sldesirelangand mazelhan 15 we eep mwalkingona arianwide ridgeThenallslnpesunvneswme dmpon mm o hemi s merelhan 15 deg 8 39i E g 4 396 39N 3 a Q V Researchers have obtain clinical support for the e ectiveness of aversive therapy However other researchers that patients can return to unwanted behaviors as long as they are not in the th erapist s o ice Let s turn out attention to a lm clip th at presents the use of aversion therapy with self abusive behavior The slide below illustrates how the classical conditioning paradigm is used to treat alcoh olism UCS drug UCR nausea Wquot x cs 1 ucs alcoholY drug 39 UCR CS nausea alcohol39 CR nausea ENSHE H39HE WWW 0F AUTISM 0 One of the benefactors of the 1950 s cognitive revolution was emergence of cognitive therapy The slide below indicates the therapeutic approach es that most accredited doctoral clinical programs aligned themselves It is no accident that cognitive approach es have dominated over the last four decades This is likely attributed to the significant increase in those diagnosed with depression a disorder most amenable to the cognitive approach Cognitive 49 Behavioral 9 m E m gt E Ev D d Humanistic 11 Family5ystems19 Psychoanalyticlpsychodynamic 23 Aaron Beck 0 According to Myers cognitive therapy teach es people new more adaptive ways of thinking and acting based on the assumption that thoughts intervene between events and our 39 w 39 39ns Aaron Beck s work ntemal bEl eis I39m worlhless It s hopeless Depvesswn 4 a gt E Ev D d Imemax nelrers My boss is a jerk I deserve something beuer Na depression m E m gt 1E Ev D d 0 Aaron Beck identi ed a number of cognitive or thinking errors that drive depression An abbreviated list is presented below Title 15 Cognitive Errors and the Assumptions tram Which They Are Derived According to Beck s Cognitive Theory COGNmVE ERROR ASSUMan Overgeneratiztng Setecltva abstraction assuming personai causality predicting without suttt cwent evwdence Seltreterences Cetastrophizrng Dichatornous thinking It it s true in one case it appttes to any case that s even slightiy similar The only events that matter are tartures depnvahon and so 0 I shoutd measure myseit by errors weaknesses and so on 39 rantquot and n lnnh i am the center at everyone attention especially when my padonnance is a Always think at the worst because the worst is what s most Ither to happen Everythth is eitherone extreme or the other black orwhtte good or beat 6 Cognitive Therapies The world of the depressed is cognitively skewed For example clinical research ers h ave found th at depressed patients do not sh ow selfserving biases attributing successes to self and failures to others Studies have shown that depressed subjects respond well to cognitive training Th ese programs make a concerted effort to change one s maladaptive thinking Waning Ust patients training patients Cognitive naining ess depressed 0 Pretherapy Posttherapy test test