Psychotherapy by 7J2cb2

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									AP Psych: Therapy
modified: August 4, 2000

Psychotherapy: a general term for treatment with psychological methods. Therapy emphasizes discussion of patient
problems.

Psychoanalysis (Freud)
          1.      Cause of psychological disorders
                  a.     Fixation: The failure of personality development due to inability to integrate sexual
                         and aggressive drives into personality during childhood.
                  b.     Unconscious conflicts between the Id, Ego, and Superego also cause disorders.

          2.      Goals of treatment
                  a.      Uncover and resolve unconscious conflicts.
                  b.      Develop mature, adult personality by integrating sexual and aggressive drives.

          3.      Methods for uncovering unconscious conflicts
                  a.    Free association: The patient relaxes and speaks freely about whatever comes to
                        mind. The therapist directs thoughts toward unconscious drives and childhood
                        experiences.
                  b.    Dream analysis
                        i.      Dreams are disguised unconscious wishes.
                        ii.     Manifest content: images and other material remembered from the dream.
                        iii.    Latent content: The hidden meaning of a dream. This can only be uncovered
                                through dream interpretation.
                  c.    Projective tests: Rorshach ink blots, Thematic Apperception Test
                  d.    Hypnosis: Freud used this in his early work, but then abandoned it in favor of free
                        association.
                  e.    Freudian slips: unintentional expressions that reveal unconscious desires

          4.      Ego defense mechanisms: These are strategies used by the ego to shield itself from
                  threatening perceptions, feelings, impulses coming out of the id.
                  a.     According to Freud, the ego is weak and puny compared to the Id, so the ego needed
                         to employ special strategies to protect itself.
                  b.     These are largely unconscious reactions that protect a person from painful emotions
                         like anxiety, fear, and guilt.
                  c.     Repression (internal): Blocking unacceptable unconscious drives from awareness.
                         Freud believed that this is the most important ego defense mechanism.

          5.      Steps in Classic Psychoanalytic therapy
                  a.      Resistance: Patient reluctance to talk about unconscious conflicts (e.g., forgetting,
                          avoidance, changing topics).
                  b.      Transference: The patient-therapist relationship reflects past relationship with
                          authority figures, such as parents.
                  c.      Insight: The patient eventually understands unconscious conflicts with therapist’s
                          help. Understanding one's problems is therapeutic.
                  d.      Catharsis: Emotional release following insight. This thought to be healthy for the
                          patient, but catharisis is not always a good thing.
                  e.      Working through: The therapist helps the patient develop new behaviors and
                          attitudes to achieve a well integrated personality.

          6.      Modern psychoanalysis

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       a.      more emphasis on cultural and social factors.
       b.      more emphasis on ego as a rational, strong, problem solving entity.
       c.      more emphasis on present patient problems rather than childhood problems.
       d.      less emphasis on unconscious sexual and aggressive drives.
       e.      Short term dynamic therapy: A briefer and more flexible therapy than classic
               psychoanalysis.

Humanistic Therapy
1.    Cause: Disorders are caused by blocking or derailing personal growth, freedom, and the
      achievement of human potential.

2.     Goals of therapy
       a.      Reestablish personal growth and well being
       b.      Authenticity: Living a subjectively meaningful life. The goal is to put patients in
               touch with their real selves instead of simply following the wishes of relatives and
               friends.

3.     Client centered therapy (Carl Rogers)
       a.      Unconditional positive regard: Therapists warmly accept their patients no matter
               how the patient feels about things. This fosters patient feelings of self worth by
               treating the patient with respect and dignity. The patient’s feelings are not
               criticized. Positive feelings and acceptance of patient no matter what the patient
               does. This may replace positive nuturing lacking from many families.
       b.      Empathy: Listening and helping clients listen to themselves. Therapist attempts to
               see things from the client’s perspective.
       c.      Genuineness: The therapist must be honest and sincere.
       d.      Nondirective: Therapist does not teach the patient or make decisions for the
               patient. Therapist helps the patient find their own way.
               i.      Responsibility is with the patient, not therapist, for progression in therapy.
       e.      Client Centered Therapy (AKA Person centered therapy)
       f.      Empathy: Empathy is seeing the situation from the patient's point of view. The
               therapist must strive to view circumstances from the patient’s perspective.

4.     Humanistic therapy has been very influential on group therapy and self help books.
Behavioral Therapy
1.     Cause: Psychological disorders are maladaptive, counterproductive, or unhealthy learned
       behaviors.

2.     Goal of therapy: Unlearn maladaptive behaviors (i.e., extinction) by replacing unhealthy
       behaviors with more adaptive behaviors through learning processes.

3.     Systematic desensitization (Wolpe, 1958)
       a.    This is based on classical conditioning. Anxiety responses go through extinction, an
             “unlearning” process.
       b.    Strategy: Replace a maladaptive conditioned response (usually anxiety) with a new,

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               more healthy conditioned response (usually relaxation)
       c.      This is most often used to treat phobias.
       d.      Progressive relaxation: A relaxation technique that usually involves mental imagery
               and alternate tensing/relaxing of different muscle groups.
       e.      Anxiety hierarchy: The patient ranks situations from the least to most anxiety
               provoking.
       f.      Desensitization: The therapist exposes the patient to the least anxiety provoking
               events on the anxiety hierarchy. During exposure, the patient works on their
               relaxation exercises until they can relax completely in the presence of the fear
               provoking stimulus. The patient is gradually exposed to situations that provoke more
               fear as they work towards the top of the hierarchy.

4.     Flooding: An exposure therapy like systematic desensitization, except the patient is
       exposed to the anxiety provoking situation all at once, not gradually.

5.     Aversive conditioning: Pairing an undesirable behavior (eg, alcoholism) with illness or
       discomfort.

6.     Token economy: An operant conditioning technique where people perform operant behaviors
       to collect tokens that they can cash in for prizes or rewards.

Cognitive Therapy
1.      Cause of disorders: Negative or maladaptive ways of thinking and interpreting events.
2.      Treatment: Change thinking patterns to be more positive and more rational.
3.      Rational-emotive therapy (Albert Ellis): This therapy focuses on altering irrational thinking
        and beliefs to reduce maladaptive emotions and behavior.
        a.      ABCs of Rational Emotive Therapy
                i.      A = Activating event is any potentially stressful transaction
                ii.     B = Belief system is one's appraisal of the stress
                iii.    C = Consequence of negative thinking, typically emotional distress

       b.      The central idea is that the belief system causes the consequence (anxiety, stress,
               etc.), not the activating event.
               i.       This is similar to Lazarus and appraisal theory of stress
               ii.      This also runs contrary to common wisdom.

       c.      Common irrational and destructive beliefs generally fall into one of three general
               categories (from Kendall, Haaga, Ellis et al., 1995 as cited in Watson & Tharp, 1998
               p. 141)
               i.      “I must be a thoroughly competent, adequate, achieving, and lovable at all
                       times or else I am an incompetent, worthless person.” This belief leads to
                       feelings of anxiety, panic, depression, despair, and worthlessness
               ii.     “Others must treat me kindly and fairly at all times or else I can't stand it
                       and they are bad, rotten, and evil persons who should be severely blamed,
                       damned, and vindictively punished for their horrible treatment of me.” This

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                      leads to feelings of anger, rage, fury, and vindictiveness as well as actions
                      like verbal and physical aggression.
               iii.   “Conditions must absolutely be the way I want them to be and must never be
                      too difficult or frustrating. Otherwise, life is awful, terrible, horrible,
                      catastrophic, and unbearable.” This leads to low frustration tolerance, self
                      pity, anger, depression, and behaviors like procrastination, avoidance and
                      inaction.

4.     Cognitive Therapy (Aaron Beck)
       a.      This is similar to RET, but it emphasizes illogical, maladaptive thinking patterns
               rather than irrational beliefs.
       b.      Cognitive biases in depression
               i.      Arbitrary inference: Drawing negative conclusions with little or no evidence.
               ii.     Overgeneralization: Drawing a sweeping, global conclusion on an isolated
                       event.
               iii.    Magnification and minimization: Grossly overestimating the impact of
                       negative events and underestimating the impact of positive events.
               iv.     Personalization: Blaming failures on the self when the environment is the
                       cause.
       c.      In cognitive therapy, the therapist looks for illogical thinking patterns, then
               challenges the patient to think about it in a more logical way.

Group Therapy
1.     Cause: Social interactions have an important role in causing mental health problems.
2.     Treatment: Discuss problems with other people who have a similar problem.
3.     Examples: Alcoholics Anonymous, other drug support groups, family therapy, support groups
       for serious medical conditions.
4.     Advantages of group therapy
       a.      Powerful influence
       b.      Older group members act as role models for new group members. They also offer
               encouragement and support.
       c.      Usually inexpensive
       d.      Less stigma than other forms of therapy: Many people who refuse to see a
               psychologist are willing to get involved in group therapy.

Medical Treatments (Note: These are not psychotherapy.)
1.     Cause of disorders: Brain malfunction due to neurochemical, anatomical, and/or physiological
       problems. In other words, psychological disorders are considered to be a physical illness.

2.     Treatment: Alter brain functioning to reestablish normal behaviors, thoughts, and moods.

3.     Drug therapy: The use of chemical agents that usually block or change neurotransmitter
       release to alter brain functions.
       a.      Deinstitutionalization: Drug therapy is largely responsible for the release of
               thousands of people from mental institutions since the mid 1950s.

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       b.      Drugs are often the first line of treatment in biological therapies.
       c.      Classes of drugs
               i.      Antianxiety drugs (AKA tranquilizers): Calm anxiety. These include Valium,
                       Librium, Xanax
               ii.     Antipsychotic drugs: Control schizophrenic symptoms. These include
                       Thorazine, Prolixin, and Haldol.
               iii.    Antidepressants: These drugs treat the symptoms of depression. Examples
                       include Prozac, Zoloft, Paxil, Elavil, Tofranil.
               iv.     Antimanic: Drugs that fight bipolar disorder. An example is lithium (a light
                       metal that blunts mood swings).

4.     Electroconvulsive Therapy: Artificial seizures generated by passing electrical current
       through the brain.
       a.     These are usually applied several times a week for two to three weeks
       b.     This is used to treat severe depression.
       c.     Memory loss is a common side effect.
       d.     Experts are unclear how this works.
       e.     Not commonly used because many people consider this therapy inhumane.

5.     Psychosurgery: Destroying or removing part of the brain to change psychological
       functioning.

Effectiveness of Therapy
1.     Therapy effectiveness is difficult to determine.
       a.      It is difficult to measure good outcomes because there is so much variability.
       b.      Many people improve without treatment.
       c.      Possible placebo effects make it difficult to know whether or not a therapy is
               effective.

2.     Overall, most patients show better outcomes with therapy, although the effects are
       modest.

3.     Drug therapy is about 60% effective in treating disorders like depression, but one potential
       problem is that these therapies can treat or mask the symptoms without addressing the
       true causes of the disease.

4.     Psychotherapy and drug therapy at the same time may have the best results.




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