Approaches to Treatment and Therapy
11/27/2012 1:52:00 PM
Evaluating psychotherapy Is difficult because:
Each client if different
Each therapist is different
The needs of the client can come before the needs of the science
Would you participate in a study where you have a 1/3 change of being in waiting list
Hospitals and medical staff do a difficult job
Research and therapy are different
Not everything is a clear sign of a disease, some may be mixed. It could be A, it
could be B or it could be AB.
As you saw last chapter diagnosis is not easy
Help is needed—cant wait for better treatment
Easy to criticize what is being don and this is necessary but… we need to
Types of Therapy:
Range from Pills to Psychodynamic
Some are less popular today
Not mutually exclusive, some can be combined to be very effective (some
o The relationship between patient and therapist is verbal and you are
reconfiguring your thinking
o Based on learning new skills and behaviours
o Brain functions.
“Talk” and Behaviour Therapies:
Therapies for Psychological disorders
o Based on Freudian principles He believed that if the patient recognized the root problems, that
the insight would help them achieve insight into the real problem.
Three part structure theory.
Id= root, the child in you. Personal needs. No constraints
Ego= contact with reality. Plays the game with working in
Superego= what constrains you socially. Response to
He believed that the superego and the id were always in
conflict with each other which resulted in conflicts.
o Goal: to help patients achieve insight
o Insight= conscious awareness of psychodynamics underlying problems
Adjust behavior underlying problems learned in childhood.
Brief psychodynamic therapies
o Free association
Not regular conversation
Will hopefully speak to an underlying issue.
Table… chair. You say a word, and you say the first word
that comes to your head.
You can find unsettled issues this way that you are not
consciously aware of.
Verbal reports of thoughts, feelings, or images that enter
awareness without censorship.
o Dream Interpretation
“Royal road to the unconscious”
therapist helps client understand the symbolic meaning of their
o Therapist expects client to try and maintain status quo (i.e. not respond to
Defensive maneuvers that hinder process of therapy.
Sign that anxiety-arousing material is being approached.
A sign that therapy is working
One of the reasons of why it is working. o Intrapsychic conflict (between id. Ego, and superego) anxiety
reliance on defense mechanisms
o Freud’s view of the roots of disorders. According to Freud, unconscious
conflicts between the three sometimes lead to anxiety. This discomfort
may lead to pathological reliance on defensive behavior.
o How does psychoanalysis help clients?
Statements by therapist
Provide client with insight into behavior
Time consuming as client must arrive at “insight”
Need clients who can verbalize well.
o Conscious control of behavior
o Personal responsibility
o Disordered behavior
Function of distorted perceptions, lack of awareness, negative self-
o Present and future, not past.
o Key figure: Carl Rogers
Focused on therapeutic environment
Identified 3 important therapist attributes
Unconditional positive reward
Therapists accept clients without judgment or
Willingness and ability to view the world through
Consistency between therapists feelings and
Belief affection from others is conditional need to
distort shortcomings to feel worthy or affection
relatively incongruent self=concept recurrent
anxiety defensive behaviour protects inaccurate self-concept and then loops back to relatively
o Role of irrational and self-defeating thought patterns
Ellis’ rational emotive therapy
o Activating event
o Belief system
o Consequences (emotional and behavioural)
o Disrupting or challenging maladaptive emotions and behaviours.
Becks view of the roots of disorders
o According to beck, depression is caused by the types of negative thinking
Blame set backs on personal inadequacies
Focus selevively on negatice events
Make unduly pessimistic projections about the future
Draw negative conclusions about personal worth.
o They all increase vulnerability to depression.
Maladaptive behaviours are the problem, not a symptom
Problem behaviours are learned
Maladaptive behaviours can be unlearned through classical and operant
Based on Skinners and Pavlov’s work.
o Systematic desensitization
o Aversion therapy
o Unconditioned stimulus (US)
Elicits a response in the absence of learning
o Unconditioned response (UR)
The reflexive response to a stimulus in the absence of learning. o A neutral stimulus is them regularly paired with an unconditioned
o Conditioned stimulus (CS)
An initially neutral stimulus that comes to elicit a conditioned
response after being paired with an unconditioned stimulus.
o Conditioned response (CR)
A response that is elicited by the conditioned stimulus.
Occurs after the CS is associated with the US.
Is usually similar to US.
Treat phobias through exposure to feared CS in the absence of
Response prevention used to keep the operant avoidance response
Highly effective for extinguishing anxiety responses.
Virtual reality being used.
Intense anxiety created by treatment.
Exposed to real-life stimuli
Imagine scenes involving stimuli
o Systematic desensitization
Learning-based treatment for anxiety disorders
Eliminate anxiety through counterconditioning
Train muscle relaxation skills
Anxiety and relaxation cannot co-exist
Low-anxiety to high-anxiety scenes (10-15)
Relaxation and progressive association with stimulus
o In-Vivo desensitization
Controlled exposure to “real life” situations Creates more anxiety during treatment than systematic