Psychology applied to modern life adjustment in the 21st century, 11e chapter 15

Bài giảng Tâm lý học áp dụng để điều chỉnh cuộc sống hiện đại trong thế kỷ 21 Bài giảng Tâm lý học áp dụng để điều chỉnh cuộc sống hiện đại trong thế kỷ 21 Bài giảng Tâm lý học áp dụng để điều chỉnh cuộc sống hiện đại trong thế kỷ 21 Bài giảng Tâm lý học áp dụng để điều chỉnh cuộc sống hiện đại trong thế kỷ 21 Bài giảng Tâm lý học áp dụng để điều chỉnh cuộc sống hiện đại trong thế kỷ 21

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Chapter 15 Psychotherapy

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The Treatment Process, continued

• Treatments: How many types are there?

– All psychotherapies involve “a helping relationship (the treatment) between a professional (the therapist) and another person in need of help (the client)”

– There are three main categories of

therapy:

1 Insight therapies

2 Behavior therapies

3 Biomedical therapies

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• Clients: Who seeks therapy?

– Approximately 15% of Americans seek mental health services each year

– The most common problems are

excessive anxiety and depression

– People seek treatment for milder

problems, such as making a career decision, as well

– Women, people with medical insurance, and people with more education are all more likely to seek treatment

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Clients: Who seeks therapy?, continued

– Unfortunately, many who need therapy do not receive it (see Figure 15.2)

– Common barriers to seeking treatment

include

• Lack of health insurance

• The “stigma” associated with receiving mental health services

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Figure 15.2 Therapy utilization rates Olfson and

colleagues (2002) gathered data on the use of

nonhospital outpatient mental health services in the United States in relation to various demographic variables In regard to marital status, utilization rates are particularly high among those who are divorced or separated The use of therapy is greater among those who have more education and, in terms of age,

utilization peaks in the 35-44 age bracket Females are more likely to pursue therapy than males are, but utilization rates are extremely low among ethnic

minorities (Data from Olfson et al., 2002)

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• Therapists: Who provides treatment?

– Psychologists and psychiatrists are the

most common providers of treatment

– However, therapy is also provided by other professionals, including

• Psychiatric social workers

• Psychiatric nurses

• Counselors

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– Psychologists are more likely to use

behavioral methods over psychoanalysis.– Psychologists also do psychological

testing and conduct research

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Therapists, continued

– Psychiatrists “are physicians who

specialize in the treatment of psychological disorders”

– Psychiatrists focus on more severe

disorders (e.g., schizophrenia)

– Psychiatrists earn an M.D and typically emphasize drug therapies (psychologists cannot prescribe medication)

– Psychiatrists are also more likely to use psychoanalysis

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Therapists, continued

• Other mental health professionals

– Psychiatric social workers work as part of

a treatment “team” with a psychologists or psychiatrist

– They have a master’s degree and usually help patients integrate back into the

community

– Psychiatric nurses earn a bachelor’s or

master’s degree and usually work with hospitalized patients

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Insight Therapies, continued

• Insight therapies “involve verbal interactions

intended to enhance clients’ self-knowledge and thus promote healthful changes in

personality and behavior”

– Insight therapies include

• Psychoanalysis

• Client-centered therapy

• Positive psychology

• Group therapy

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• Psychoanalysis was developed by

Sigmund Freud, and “emphasizes the

recovery of unconscious conflicts, motives, and defenses through techniques such as

free association, dream analysis and

transference”

– Probing the unconscious

• Therapists use two techniques to probe the unconscious in an attempt to

identify unresolved conflicts causing the client’s neurotic behavior

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Psychoanalysis, continued

– In free association, “clients spontaneously

express their thoughts and feelings exactly

as they occur, with as little censorship as

possible”.

– In dream analysis, “the therapist interprets

the symbolic meaning of the client’s dreams” – Both techniques require the therapist to

interpret the clues that these methods

provide about unconscious conflicts.

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– Interpretation “involves the therapist’s

attempts to explain the inner significance

of the client’s thoughts, feelings, memories, and behaviors”

– Resistance “involves largely unconscious

defensive maneuvers intended to hinder the progress of therapy”

• Clients may resist by “forgetting”

appointments or being hostile toward the therapist

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– Transference “occurs when clients start

relating to their therapists in ways that mimic critical relationships in their lives”.– Although classical psychoanalysis (as

performed by Freud) is rare today, newer versions of the therapy are used and are

referred to as psychodynamic approaches.

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• Client-centered therapy “is an insight

therapy that emphasizes providing a

supportive emotional climate for clients, who play a major role in determining the pace and direction of their therapy”

– This approach is rooted in the humanistic

perspective and the work of Carl Rogers.

– Therapists try to foster self-acceptance

and personal growth in their clients

– Therapists also help clients restructure

their self-concept to better correspond with reality

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Client-centered therapy, continued

– Therapeutic climate

• Rogers believed three elements were necessary to promote positive changes in therapy:

1 Genuineness (honest

communication)

2 Unconditional positive regard

(therapist remains supportive, judgmental)

non-3 Empathy (therapist understands

issues from client’s point of view)

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Client-centered therapy, continued

– Therapeutic process

• With this approach, the client and therapist work together almost as equals

• The therapist’s key task is clarification

– “reflecting the client’s statements with enhanced clarity”

• The main goal of therapy is to help clients become more aware of, and comfortable with, their “genuine selves”

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• Therapies inspired by positive psychology

– Well-being therapy, developed by Giovanni

Fava, focuses on “self-acceptance, purpose in life, autonomy, and personal growth”

– Positive psychotherapy – “ attempts to get

clients to recognize their strengths, appreciate their blessings, savor positive experiences,

forgive those who have wronged them, and to find meaning in their lives”

• It has been successful in treating depression (see Figure 15.5)

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Figure 15.5 Positive psychotherapy for depression In a study of the efficacy

of positive psychotherapy, it was

compared to treatment as usual

(clinicians delivered whatever treatment they deemed appropriate) and to

treatment as usual combined with

antidepressant medication At the end of

12 weeks of treatment, symptoms of depression were measured with the widely used Hamilton Rating Scale for Depression The mean depression

scores for each group are graphed here

As you can see, the positive

psychotherapy group showed less

depression than the other two treatment groups, suggesting that positive

psychotherapy can be an effective

intervention for depression.

SOURCE: Adapted from Seligman, M.E.P., Rashid,T.,& Parks, A.C (2006) Positive psychotherapy

American Psychologist, 61,

774-778 (Figure 2, p 784).

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• Group therapy “is the simultaneous

treatment of several or more clients (typically five to ten people) in a group”

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Group therapy, continued

– Advantages of the group experience

1 Clients realize their problems are not unique

2 It provides an opportunity to practice and enhance social skills

3 Certain problems are well-suited for group therapy In “peer self-help groups”, all

members share the same kind of problem (e.g., Alcoholics Anonymous) and can

provide support for each other

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• Evaluating insight therapies

– It is difficult to compare the effectiveness

of one type of insight therapy to another

because of the allegiance effect, in which

researchers often find the most support for the therapeutic approach they use

– Despite this, many studies have shown

insight therapy to be superior to placebo and to produce lasting effects

– Also, most people find therapy beneficial

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Evaluating insight therapies, continued

• Common factors that make various insight

therapies effective:

1 Developing an alliance with a professional helper

2 Emotional support and empathic

understanding from the therapist

3 The cultivation of hope, positive

expectations

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Evaluating insight therapies, continued

4 Provision of a rationale for one’s problems and a method for alleviating them

5 The opportunity to express feelings,

confront problems, gain new insights, and learn new patterns of behavior

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• Therapy and the recovered memories

controversy

– Much debate has centered around clients’

“recovery” of forgotten memories of traumatic events, including abuse by parents

– This is controversial because it is not

possible to be absolutely certain whether

or not the memory is real

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Therapy and recovered memories, continued

– Furthermore, some recovered “memories”

of abuse have been proven to be false,

and people (e.g., parents) have been falsely accused of crimes they did not commit

– Psychologists are sharply divided on the issue

– Proponents argue that recovered

memories are genuine and valuable

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Therapy and recovered memories, continued

– Critics cite research showing that false

memories can be “implanted” in

experimental conditions

– Critics also argue that clients, confused about the source of their troubles, are persuaded by therapists who are overly eager to attribute problems to childhood abuse

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Behavior Therapies, continued

• Insight therapists believe that behaviors are symptoms of underlying psychological

issues

• In contrast, behavior therapists argue that

the behaviors themselves are the problem.

• Thus, behavior therapies “involve the

application of the principles of learning to

direct efforts to change clients’ maladaptive behaviors”

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• Behavior therapy is based on two

assumptions:

1 Behavior is a product of learning

2 What has been learned can be unlearned

• Clients’ vague complaints are redefined in terms of concrete, specific goals

• Specific procedures are then used for

specific kinds of problems to reach the goal

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• Systematic desensitization “is a behavior

therapy used to reduce clients’ anxiety

responses through counterconditioning”

– The goal with this technique is to break down the association between the

conditioned stimulus (or the stimulus that triggers fear) and the conditioning

response of anxiety (see Figure 15.7)

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Figure 15.7 The logic underlying systematic desensitization Behaviorists argue that many phobic

responses are acquired through classical conditioning, as in the example diagrammed here Systematic desensitization targets the conditioned associations between phobic stimuli and fear responses

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Systematic desensitization, continued

– Before beginning, the therapist helps the

client build a fear hierarchy, or a list of

progressively more frightening versions of the conditioned stimulus (see Figure 15.8).– Then, the client is trained in deep muscle relaxation

– Finally, the client pairs the learned

relaxation with each step of the hierarchy until anxiety to the fear stimulus is

reduced

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Figure 15.8 Example of an anxiety hierarchy Systematic

desensitization requires the construction of an anxiety hierarchy like the one shown here, which was developed for a woman with a fear of heights who had a penchant for hiking in the mountains

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• Aversion therapy “is a behavior therapy in

which an aversive stimulus is paired with a

stimulus that elicits an undesirable

response”

– For example, as shown in Figure 15.9, an alcoholic’s desire to drink could be

weakened by pairing a nausea-inducing

drug with alcohol

– Aversion therapy is used with a wide range

of undesirable behaviors including

gambling, shoplifting, and smoking

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Figure 15.9 Aversion therapy Aversion therapy uses classical conditioning to create an aversion to a

stimulus that has elicited problematic behavior For example, in the treatment of drinking problems, alcohol may be paired with a nausea-inducing drug to create a conditioned aversion to alcohol

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• Social skills training “is a behavior therapy

designed to improve interpersonal skills that

emphasizes shaping, modeling, and behavioral rehearsal”

– First, the client watches socially skilled people

model (or demonstrate) successful

interactions with others

– In behavioral rehearsal, the client practices

modeled techniques through role-playing

exercises – and eventually – in real life

– Shaping is used to get clients to handle

gradually more demanding social situations

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• Cognitive-behavioral treatments blend

verbal and behavioral interventions

• Cognitive therapy “is a treatment that

emphasizes recognizing and changing

negative thoughts and maladaptive beliefs”.– It emerged from the work of two former

psychoanalysts: Albert Ellis and Aaron

Beck (this chapter will focus on the work of

Aaron Beck)

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Cognitive therapy, continued

– According to Beck, depression is caused by errors in thinking, and people who

experience depression are more likely to

1 Blame their setbacks on personal inadequacies

2 Focus selectively on negative events

3 Make overly pessimistic projections about the future

4 Draw negative conclusions about their self-worth

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Cognitive therapy, continued

– The main goal of cognitive therapy is to change the way clients think

– The therapist’s goal is to help clients

detect automatic negative thoughts and to use more reasonable standards of

evaluation

– The therapist primarily sets the pace and direction of treatment

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• Evaluating behavior therapies

– Generally, behavior therapies are very effective This is especially true with regard to treatment of

• Anxiety problems, phobias, OCD, and schizophrenia

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Biomedical Therapies, continued

• Biomedical therapies “are physiological

interventions intended to reduce symptoms associated with psychological disorders”

• Two prominent biomedical therapies are

– Drug therapy

– Electroconvulsive (ECT)

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Biomedical Therapies, continued:

• Treatment with drugs

– Psychopharmacotherapy (or drug

therapy) “is the treatment of mental disorders with medication”

– Therapeutic drugs fall into four main categories:

1 Antianxiety drugs

2 Antipsychotic drugs

3 Antidepressant drugs

4 Mood stabilizers

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