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Psychological Therapies

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Clare Gruszka

on 28 November 2012

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Transcript of Psychological Therapies

Psychological Therapies Two Kinds of Therapy The Early Days of Therapy Psychotherapy Begins Behavior Therapies Cognitive Therapies Humanistic Therapy Does Psychotherapy Really Work? Psychotherapy: Mentally ill people began to be confined to institutions called asylums in the mid-1500s
Treatments were harsh and often damaging Sigmund Freud developed a treatment called psychoanalysis, an insight therapy that emphasizes revealing the unconscious conflicts, urges, and desires that are assumed to cause disordered emotions and behaviors Humanistic therapies focus on the conscious mind and subjective experiences to help clients gain insights Behavior therapies are action therapies that do not look at thought processes but instead focus on changing the abnormal or disordered behavior itself through classical or operant conditioning Cognitive therapy was developed by Aaron T. Beck and is focused on helping people change their ways of thinking
Rather than focusing on behavior itself, cognitive therapists focus on distorted thinking and unrealistic beliefs that lead to maladaptive behavior
The goal is to help clients test the truth of their beliefs and assumptions, as well as their attributes concerning both their own behavior and the behavior of others in their lives
Some of the cognitive distortions in thinking include arbitrary inference, selective thinking, overgeneralization, magnification and minimization, and personalization Surveys of people who have received therapy suggest that psychotherapy is more effective than no treatment at all
Surveys reveal that from 75 to 90 percent of people who receive therapy feel that psychotherapy has helped them
The longer a person stays in therapy, the better the improvement
Some types of psychotherapy are more effective for certain types of problems, and no one psychotherapy method is effective for all problems Biomedical Therapy: Involves a person talking to a psychological professional about the person's problems Psychotherapy for the purpose of gaining understanding into one's motives and actions is called insight therapy, whereas psychotherapy aimed at changing disordered behavior directly is called action therapy Uses a medical procedure to bring about changes in behavior When used together, these two types of therapy facilitate each other
For example, when medications are needed, individuals taking the proper medications benefit more from psychotherapy as their symptoms will be better controlled
Furthermore, psychotherapy, not medication, is going to help better understand what symptoms of disorder are and facilitate adjustment, other coping strategies, and proactive ways of addressing the disorder or its related outcomes Philippe Pinel became famous for demanding that the mentally ill be treated with kindness, personally unlocking the chains of inmates at Bicetre Asylum in Paris, France Psychoanalysis uses interpretation of dreams, free association, transference, and resistance to help patients reveal their unconscious concerns Evaluation of Psychoanalysis and Psychodynamic Approaches Freud's original therapy technique is criticized for its lack of scientific research and his own personal biases that caused him to misinterpret much of what his patients revealed
Modern psychodynamic therapists have modified the technique so that it takes less time and is much more directive (asking questions, suggesting helpful behavior, and giving opinions and interpretations), and they do not focus on the id and sexuality as Freud did
Psychodynamic techniques require the client to be fairly intelligent and verbally able to express ideas, feelings, and thoughts effectively
People who are extremely withdrawn or who suffer from more severe psychotic disorders are not good candidates for this form of psychotherapy Roger's Person-Centered Therapy Rogers believed that the goal of the therapist should be to provide the unconditional positive regard that has been absent from the troubled person's life and to help the person recognize the discrepancies between the real and ideal selves Person-centered therapy is very nondirective, allowing the client to talk through problems and concerns while the therapist provides a supportive background Free Association: patients were encouraged to talk about anything that came to mind without fear of negative evaluations Transference: the tendency for a patient or client to project positive or negative feelings for important people from the past onto the therapist Resistance: occurring when a patient becomes reluctant to talk about a certain topic, by either changing the subject or becoming silent Gestalt Therapy Evaluation of the Humanistic Therapies Founded by Fritz Perls, who believed that people's problems often stemmed from hiding important parts of their feelings from themselves
The person experiences unhappiness and maladjustment when the inner self does not match the mask of socially acceptable behavior Humanistic therapies are not based on experimental research and work best with intelligent, highly verbal persons Gestalt therapy is more directive, helping clients to become aware of their feelings and to take responsibility for their choices in life
Gestalt therapists try to help clients deal with things in their past that they have denied and will use body language and other nonverbal cues to understand what clients are really saying The warmth, respect, and accepting atmosphere created by the therapist for the client Ability of the therapist to understand the feelings of the client The genuine, open, and honest response of the therapist to the client Reflection: therapy technique in which the therapist restates what the client says rather than interpreting those statements Therapies Based on Classical Conditioning Therapies Based on Operant Conditioning Evaluation of Behavior Therapies Through classical conditioning, old and undesirable reflex responses can be replaced by desirable ones
There are several techniques that have been developed using this type of learning to treat disorders such as phobias, obsessive-compulsive disorder, and similar anxiety disorders Classical conditioning techniques for changing behavior include systematic desensitization, aversion therapy, and exposure therapy When bringing a behavior under control (rather than finding out why it occurs in the first place) is the goal, operant and other behavioral techniques are very practical Therapies based on operant conditioning include modeling, reinforcement and the use of token economies, and extinction Behavior therapies can be effective in treating specific problems, such as bed-wetting, drug addictions, and phobias, and can help improve some of the more troubling behavioral symptoms associated with more severe disorders
More serious psychological disorders, such as severe depression or schizophrenia, do not respond as well overall to behavioral treatments, although improvement of specific symptoms can be achieved Systematic Desensitization: behavior technique used to treat phobias, in which the client is asked to make a list of ordered fears and taught to relax while concentrating on those fears Aversion Therapy: form of behavioral therapy in which an undesirable behavior is paired with an aversive stimulus to reduce the frequency of the behavior Exposure therapies: behavioral techniques that exposure individuals to anxiety- or fear-related stimuli, under carefully controlled conditions, to promote new learning Can be in vivo ("in life"), where the client is exposed to the actual anxiety-related stimulus Or imaginal, where the client visualizes or imagines the stimulus Or virtual, where virtual reality (VR) technology is used Exposure methods can introduce the feared stimulus gradually, or quite suddenly Flooding: when exposure is rapid and intense and begins with most feared event Modeling: learning through the observation and imitation of others A person with specific fears or someone who needs to develop social skills can learn to do so by watching someone else (the model) confront those fears or demonstrate the needed social skills Participant Modeling: technique in which a model demonstrates the desired behavior in a step-by-step, gradual process while the client is encouraged to imitate the model Reinforcement: the strengthening of a response by following it with a pleasurable consequence or the removal of an unpleasant stimulus Token economy: use of objects called tokens to reinforce behavior in which the tokens can be accumulated and exchanged for desired items or privileges Extinction: removal of a reinforcer to reduce the frequency of a behavior Time-out: an extinction process in which a person is removed from the situation that provides reinforcement for undesirable behavior, usually by being placed in a quiet corner or room away from possible attention and reinforcement opportunities Beck's Cognitive Therapy Ellis and Rational-Emotive Behavior Therapy (REBT) Evaluation of Cognitive and Cognitive-Behavioral Therapies Rational-Emotive Behavior Therapy is a directive therapy in which the therapist challenges clients' irrational beliefs, often arguing with clients and even assigning them homework Although CBT has seemed successful in treating depression, stress disorders, and anxiety, it is criticized for focusing on the symptoms and not the cause of disordered behavior Arbitrary Inference: distortion of thinking in which a person draws a conclusion that is not based on any evidence Selective Thinking: distortion of thinking in which a person focuses on only one aspect of a situation while ignoring all other relevant aspects Overgeneralization: distortion of thinking in which a person draws sweeping conclusions based on only one incident or event and applies those conclusions to events that are unrelated to the original Magnification and minimization: distortions of thinking in which a person blows a negative event out of proportion to its importance (magnification), while ignoring relevant positive events (minimization) Personalization: distortion of thinking in which a person takes responsibility or blame for events that are unconnected to the person Studies of Effectiveness Characteristics of Effective Therapy Cultural, Ethnic, and Gender Concerns in Psychotherapy The most important common factor of successful psychotherapy seems to be the relationship between the client and the therapist, known as the therapeutic alliance This relationship should be caring, warm, and accepting, and be characterized by empathy, mutual respect, and understanding Therapy should also offer clients a protected setting in which to release emotions, reveal private thoughts and concerns and should help clients understand why they feel the way they do and provide them with ways to feel better
Other common factors in therapy effectiveness are opportunity for catharsis (relieving pent-up emotions), learning and practice of new behaviors, and positive experiences for the client When the culture, ethnic group, or gender of the therapist and the client differs, misunderstanding and misinterpretations can occur due to differences in cultural/ethnic values, socioeconomic differences, gender roles, and beliefs
One of the problems that can occur when the culture or ethnic backgrounds of the client and therapist are mismatched is that the therapist may project his or her values onto the client, failing to achieve true empathy with the client's feelings or even to realize what the client's true feelings are, thus causing the client to drop out of therapy
Studies of such situations have found that members of minority racial or ethnic groups drop out of therapy at a significantly higher rate than the majority group clients The four barriers to effective psychotherapy that exist when the backgrounds of client and therapist differ are language, cultural values, social class, and nonverbal communication Biomedical Therapies Therapies that directly affect the biological functioning of the body and brain Include the use of drugs, induced convulsions, and surgery to relieve or control the symptoms of mental disorders Psychopharmacology The use of drugs to control or relieve the symptoms of psychological disorders Although these drugs are sometimes used alone, they are more often combined with some form of psychotherapy and are more effective as a result Antipsychotic drugs are used to control delusions, hallucinations, and bizarre behavior These drugs work by blocking certain dopamine receptors in the brain, thereby reducing the effect of dopamine in synaptic transmission Antianxiety drugs are used to treat anxiety disorders and include the benzodiazepines (Xanax, Ativan, Valium) and certain antidepressant drugs Antimanic drugs are used to treat bipolar disorder and include lithium and certain anti convulsant drugs Antidepressant drugs are used in the treatment of depression and include monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants, and selective serotonin reuptake inhibitors (SSRIs) Benzodizepines have a sedative effect and in the right dose can relieve symptoms of anxiety within half an hour of taking the drug Although many side effects are possible, the main concern in using these drugs is in their potential for addiction as well as abuse in the form of taking larger doses to "escape" Although antidepressants take from 3 to 5 weeks to show any effect, they are not as subject to abuse as the minor tranquilizers and have fewer of the same side effects Monoamine oxidase is the brain's "cleanup worker" because its primary function is to break down the neurotransmitters norepinephrine, serotonin, and dopamine—the three neurotransmitters most involved in control of mood In depression, these neurotransmitters need more time to do their job, and the MAOIs allow them that time by inhibiting the enzyme's action Tricyclic antidepressants increase the activity of serotonin and norepinephrine in the nervous system by inhibiting their reuptake into the synaptic vesicles of the neurons SSRIs inhibit the reuptake process of only serotonin SSRIs cause fewer side effects while still providing effective antidepressant action, making these drugs relatively safe when compared to the older antidepressants
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