A. P. Psychology

I. Overview

A. We can classify therapies into two main categories.

1. The psychological therapies employ structured interactions (usually verbal) between a trained professional and a client with a problem. This is called psychotherapy.

i. While each therapy technique is distinctive, there are common threads.

ii. Many psychotherapists describe themselves as taking an eclectic approach (use techniques from various forms of therapy).

iii. Closely related to eclecticism is psychotherapy integration (aims to combine therapies into a single, coherent system).

2. The biomedical therapies act directly on the patient’s nervous system.

II. The Psychological Therapies

A. Psychoanalysis (Sigmund Freud) – Freud believed that patient’s free associations, resistances, dreams, and transferences – and the therapist’s interpretations of them – released previously repressed feelings, allowing the patient to gain self-insight.

1. Less anxious living becomes possible when patients release the energy they had previously devoted to id-ego-superego conflicts.

2. Methods:

i. Free Association – say aloud whatever comes to your mind from moment to moment.

ii. Resistance – blocks the flow of free association due to anxiety-laden material.

iii. Interpretation – the analyst’s noting supposed dream meanings, resistances, and other significant behaviors in order to promote insight.

iv. Transference – the patient’s transfer to an analyst of emotions linked with other relationships (such as love or hatred for a parent).

a. By examining your feelings toward the analyst, you may also gain insight into your current relationships.

3. Psychoanalysis is built on the assumption that repressed memories exist (this assumption is now questioned).

4. Psychoanalysts acknowledge it’s hard to prove or disprove their interpretations. But they insist that interpretations often are a great help to the patient.

5. Psychodynamic Therapy (neo-Freudian approach)– try to understand a patient’s current symptoms by exploring childhood experiences.

i. Although influenced by Freud’s psychoanalysis, these therapist may talk to the patient face to face (rather than out of the line of view), once a week (rather than several times weekly), and for only a few weeks or months (rather than several years).

6. Interpersonal Psychotherapy – rather than focusing on undoing past hurts and offering interpretations, this approach focuses on current relationships, and assists people in improving their relationship skills.

i. This is a brief alternative to psychodynamic therapy.

ii. Like psychodynamic therapies, interpersonal psychotherapy aims to help people gain insight into the roots of their difficulties.

iii. Its goal is not personality change but symptom relief in the here and now.

B. Humanistic Therapies – emphasizes people’s inherent potential for sulf-fulfillment.

1. Client-Centered Therapy (Carl Rogers) – the therapist uses techniques such as active listening within a genuine, accepting, empathetic environment to facilitate clients’ growth (also called person-centered therapy)

i. Active Listening – empathetic listening in which the listener echoes, restates, and clarifies.

ii. The client-centered counselor seeks to provide a psychological mirror that helps clients see themselves more clearly.

iii. Roger conceded that one cannot be totally nondirective.

iv. If you want to listen more in your own relationships, three hints may help:

a. Paraphrase – check your understanding by summarizing the speaker’s words in your own words.

b. Invite clarification – "What might be an example of that?" may encourage the speaker to say more.

c. Reflect feelings – mirror what you are sensing from the speaker’s body language and intensity.

C. Behavior Therapies – therapy that applies learning principles to the elimination of unwanted behaviors. Insight and self-awareness are not necessary - problem behaviors are the problem.

1. Classical Conditioning Techniques – therapy that aims to reverse maladaptive behavior through counterconditioning. Two specific counterconditioning techniques are:

i. Systematic Desensitization – a type of counterconditioning that associates a pleasant relaxed state with gradually increasing anxiety-triggering stimuli. Commonly used to treat phobias.

a. The trick is to proceed gradually using progressive relaxation.

b. The therapist progresses up the client’s anxiety hierarchy from imagined situations to real situations.

c. Desensitization is a prime example of exposure therapy.

d. A therapy that is more aggressive than systematic desensitization is called flooding, an extinction procedure that forces a person to confront feared stimuli.

e. Therapist sometimes combine systematic desensitization with other techniques, such as modeling.

f. Notice that this therapy makes no attempt to help you achieve insight into your fear’s underlying cause.

ii. Aversion Conditioning – a type of counterconditioning that associates an unpleasant state (such as nausea) with an unwanted behavior (such as drinking alcohol).

a. A weakness is people know that outside the therapist’s office they can drink without fear of nausea or engage in sexually deviant behavior without fear of shock, etc.

b. This treatment is often used in combination with another treatment.

2. Operant Conditioning – a therapist uses positive reinforcers to shape behavior in a step-by-step manner.

i. For some, the reinforcing power of attention or praise is sufficient. Others require concrete rewards.

a. Token economy – tokens given for positive behavior. Accumulated tokens may be exchanged for various rewards (often used in institutional settings).

3. Critics of behavior modification express two concerns

i. What happens when reinforcers stop?

ii. Is it right for one human to control another’s behavior?

D. Cognitive Therapies – assume that our thinking colors our feelings, that between the event and our response is the mind.

1. Cognitive therapists try in various ways to teach people new, more constructive ways of thinking.

2. Cognitive Therapy for Depression

i. Seeks to reverse clients’ catastrophizing beliefs about themselves, their situations, and their futures.

ii. The technique is a gentle questioning that aims to help people discover their irrationalities.

iii. Depressed people often attribute their failures to themselves and attribute their successes to external circumstances.

iv. The more people change their negative thinking styles, the more their depression lifts.

3. Cognitive-Behavior Therapy – a popular integration therapy that combines cognitive therapy (changing self-defeating thinking) with behavior therapy (changing behavior).

i. Uses techniques such as relabeling, refocusing, thought and action interruption.

E. Group and Family Therapies

1. It saves therapists’ time and clients’ money – and is often no less effective than individual therapy.

2. For up to 90 minutes a week, the therapist guides the interactions of 6 to 10 people as they engage issues and react to one another.

3. Social context allows people both to discover that others have problems similar to their own and to try out new ways of behaving.

4. In an individualistic age, the popularity of support groups reflects a longing for community and connectedness.

5. Family Therapy – treats the family as a system.

i. Views an individual’s unwanted behavior as influenced by or directed at other family members.

ii. Attempts to guide family members toward positive relationships and improved communication.

 

III. Evaluating Psychotherapies

A. Is Psychotherapy Effective?

1. Clients’ Perceptions

i. If clients’ testimonials were the only yardstick, we could strongly affirm the effectiveness of psychotherapy.

ii. Client testimonials do not persuade psychotherapy’s skeptics. Here’s why:

a. People often enter therapy in crisis.

b. Clients may need to believe the therapy was worth the effort.

c. Clients generally like their therapists and speak kindly of them.

iii. Testimonials can be misleading.

2. Clinicians’ Perceptions

i. If clinicians’ perceptions accurately reflected therapeutic effectiveness, we would have even more reason to celebrate.

ii. Therapists are aware of failures, but they are mostly the failures of other therapists.

a. The client may be now seeking a new therapist for their recurring problem.

3. Outcome Research

i. Clients and therapists’ perceptions of therapy’s effectiveness are vulnerable to inflation from two phenomena:

a. The power of belief in treatment (placebo effect).

b. Regression toward the mean – the tendency for unusual events (or emotions) to "regress" (return) toward their average state.

ii. New findings through meta-analysis – a procedure for statistically combining the results of many different research studies.

a. Mary Lee Smith and her colleagues found "the evidence overwhelmingly supports the efficacy of psychotherapy."

- The average client ends up better off than 80 percent of the untreated individuals

b. Hundreds of studies have shown that psychotherapy works better than nothing.

c. Those not undergoing therapy often improve, but those undergoing therapy are more likely to improve.

iii. On average, psychotherapy is somewhat effective – and is also cost-effective when compared with the greater cost of medical care for psychologically related ailments.

iv. Psychotherapy is most effective when the problem is clear-cut. The more specific the problem, the more hope there is.

B. The Relative Effectiveness of Different Therapies

1. Smith’s comparison of therapies revealed no one type of therapy that was actually superior.

2. Moreover – and more astonishing – the group or individual context of the therapy made no discernible difference, nor did the level of training and experience of the therapist.

3. However, some therapies are well suited to particular disorders.

i. Behavioral conditioning therapies achieve especially favorable results with specific behavior problems such as phobias, compulsions, or sexual disorders.

ii. Psychotherapists are aiming toward particular treatment for specific psychological problems.

C. Evaluating Alternative Therapies.

1. About alternative therapies have no empirical data because their proponents and devotees feel no need for controlled research. Personal experience is enough.

2. Examples of alternative therapies: therapeutic touch, eye movement desensitization and reprocessing (EMDR), light exposure therapy.

D. Commonalities Among Psychotherapies.

1. All therapies offer at least three benefits:

i. Hope for demoralized people.

ii. A new perspective on oneself and the world.

iii. An empathic, trusting, caring relationship.

E. Culture and Values in Psychotherapy

1. Psychotherapists’ personal beliefs and values influence their practice

2. Recognizing that therapists and clients may differ in values, communication styles, and language, many therapy training programs now provide training in cultural sensitivity and recruit members of underrepresented culture groups.

IV. The Biomedical Therapies

A. Drug Therapies

1. Psychopharmacology (the study of the effects of drugs on mind and behavior) has revolutionized the treatment of people with severe disorders, liberating hundreds of thousands from confinement in mental hospitals.

2. The resident population of state and county mental hospitals in the United States is but 20 percent of what it was half a century ago.

3. To evaluate the effectiveness of any new drug, researchers use the double-blind technique.

i. Half the patients receive the drug, the other half a similar-appearing placebo. Neither the staff nor the patients know who gets which.

4. Antipsychotic Drugs

i. The molecules of antipsychotic drugs are similar enough to molecules of the neurotransmitter dopamine to occupy its receptor sites and block its activity.

ii. Used with schizophrenic patients, who are believed to have an overactive dopamine system.

iii. These drugs can produce sluggishness, tremors, and twitches.

iv. Levels are carefully monitored. What is an effective dose for some people may be an overdose for others.

5. Antianxiety Drugs

i. These drugs depress central nervous system activity.

ii. These medications can help a person learn to cope with frightening situations and fear-triggering stimuli.

iii. A criticism is that these drugs reduce symptoms without resolving underlying problems, thus producing psychological dependence on the drug.

6. Antidepressant Drugs

i. These drugs sometimes lift people up from a state of depression.

ii. Most antidepressants work by increasing the availability of the neurotransmitter norepinephrine or serotonin, which elevate arousal and mood and appear scarce during depression.

iii. These drugs full psychological effect often requires four weeks, sometimes aided by cognitive therapy.

iv. Aerobic exercise does about as much good as these drugs, and with positive side effects.

 

B. Electroconvulsive Therapy (ECT) – a biomedical therapy for severely depressed patients in which a brief electric current is sent through the brain of an anesthetized patient.

1. Psychiatrists usually limit ECT to treatment of severe depression.

2. 80 percent or more of people receiving ECT improve markedly, showing some memory loss for the treatment period but no discernible brain damage.

3. ECT has regained respectability as a "major treatment" for depression.

C. Psychosurgery – surgery that removes or destroys brain tissue in an effort to change behavior.

1. This is the most drastic and the least-used biomedical intervention for changing behavior.

2. Lobotomy – a now-rare psychosurgical procedure once used to calm uncontrollably emotional or violent patients. The procedure cut the nerves that connect the frontal lobes to the emotion-controlling centers of the inner brain.

3. Psychosurgery is used only in extreme cases.

i. For example, if a patient suffers uncontrollable seizures, surgeons can deactivate the specific nerve cluster that cause or transmit the convulsions.

V. Preventing Psychological Disorders

A. Advocates of preventive mental health argue that many psychological disorders could be prevented.

Their aim is to change oppressive, esteem-destroying environments into more benevolent, nurturing environments that foster individual growth and self-confidence.