PSY 301 Lecture 23: Psychotherapy and Self-Disclosure

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Thursday, April 13, 2017 Psychotherapy and Self-Disclosure Lecture Psychology in the News • Deliberate slow breathing decreases symptoms of anxiety and depression and helps with sleep Lecture • Sigmund Freud was interested in patients with hysteria • Symptoms were explained psychologically • “Talking cure”—talking to someone relieves the suffering • Get at the unconscious—things we’re not aware of • Iceberg model: unconscious psyche energy, superego, and ego • Neuroticism results from unconscious conflicts • Freudian slip: accidentally saying something but meaning another thing Unconsciously preoccupied by what came out • • Dreams are when the ego is relaxed and unconscious thoughts can bubble up to the surface • Psychoanalysis • Patient is on a couch, facing away from the therapist • Easier to free associate when facing the wall • Therapist’s reaction is ambiguous • Insight: looking at causes of symptoms • Dreams, childhood • Focus on treating causes of symptoms CBT focuses on treating symptoms • • Focuses on behaviors and skills • Client-centered therapy • “You” sentences • Unconditional positive regard • Client doesn’t need interpretations or practical skills; they need empathy and validation • Bipolar, schizophrenia require medication for treatment Page 1▯ Thursday, April 13, 2017 Psychotherapy is focused on managing behaviors • • Personality disorders are caused by deep-rooted problems and are best treated with psychoanalysis • Anxiety and depression can be treated with CBT or CBT + medication Debunked • Myth: low self-esteem causes psychological problems • Reality: no causal links exist between self-esteem and psychological problems Therapeutic Orientations Introduction • Nearly half of all Americans will experience mental illness at some point in their lives • Mental health problems affect more than 1/4 of the population in any given year • The most effective psychotherapy approach is CBT Psychoanalysis and Psychodynamic Therapy Earliest organized therapy for mental disorders (early 20th century)—Sigmund Freud • • Mental health problems are rooted in unconscious conflicts and desires • To resolve the illness, these unconscious struggles must be identified and addressed • Explores one’s early childhood experiences that may have continuing repercussions on one’s mental health in the present and later life • Intensive, long-term approach • Patients and therapists meet multiple times per week for many years History of Psychoanalytic Therapy • Freud suggested that psychiatric problems are the result of tension between different parts of the mind: • Id: pleasure-driven unconscious urges • Superego: semi-conscious part of the mind where morals and societal judgment are internalized • Ego: partly conscious; mediates between the id and superego • Bringing unconscious struggles—where the id demands one thing and the superego another—into conscious awareness will relieve the stress of the conflict Page 2▯ Thursday, April 13, 2017 • Largely replaced by psychodynamic therapy • Same basic tenets as psychoanalysis Briefer • • Makes more of an effort to put clients in their social and interpersonal context • Focuses more on relieving psychological distress than on changing the person Techniques in Psychoanalysis • Free association: the patient shares any and all thoughts that come to mind without attempting to organize or censor them • The analyst then uses his or her expertise to discern patterns or underlying meaning in the patient’s thoughts • Can be applied specifically to childhood recollections • A person’s childhood relationships with caregivers often determine the way that person relates to others and predicts later psychiatric difficulties • Dreams: contain manifest (literal) content and latent (symbolic) content • Therapist plays a receptive role: interprets the patient’s thoughts and behavior based on clinical experience and psychoanalytic theory • If during therapy a patient begins to express unjustified anger toward the therapist, the therapist may recognize this as an act of transference The patient may be displacing feelings for people in his or her life onto the therapist • • In a related process, called countertransference, the therapist may displace his/her own emotions onto the patient Seating patients to face away from the therapist promotes a freer self-disclosure • Advantages and Disadvantages of Psychoanalytic Therapy • Not appropriate for some types of patients, including those with severe psychopathology or mental retardation Expensive—treatment lasts many years • • Greatest disadvantage: lack of empirical support for effectiveness • These treatments do not reliably lead to better mental health outcomes Humanistic and Person-Centered Therapy • Began in mid-20th century • Mental health problems result from an inconsistency between patients’ behavior and their true personal identity Page 3▯ Thursday, April 13, 2017 • Goal is to create conditions under which patients can discover their self-worth, feel comfortable exploring their own identity, and alter their behavior to better reflect this identity History of Person-Centered Therapy • Humanistic theory and human potential were based on the idea that humans have an inherent drive to realize and express their own capabilities and creativity • PCT was developed by Carl Rogers • All people have the potential to change and improve • The role of therapists is to foster self-understanding in an environment where adaptive change is most likely to occur • The therapist must engage in a genuine, egalitarian relationship in which the therapist is nonjudgmental and empathetic • Patient should experience both a vulnerability to anxiety, which motivates the desire to change, and an appreciation for the therapist’s support Techniques in Person-Centered Therapy • Involves a largely unstructured conversation between the therapist and the patient • Therapist takes a passive role, guiding the patient toward his/her own self-discovery • Therapists do not try to change patients’ thoughts or behaviors directly • Role is to provide therapeutic relationship as a platform for personal growth • Therapist asks questions and doesn’t provide any judgment or interpretation of what the patient says Provides a safe and encouraging environment for the person to explore these issues for him/herself • • Important aspect is therapist’s unconditional positive regard for the patient’s feelings and behaviors • Patients come to appreciate their value and to behave in ways that are congruent with their own identity Advantages and Disadvantages of Person-Centered Therapy • Highly acceptable to patients—very rewarding • Some themes translate well to other therapeutic approaches—most clients respond well to being treated with nonjudgmental empathy • Effectiveness is mixed • Treatment is primarily based on unspecific treatment factors—focuses on techniques that can be applied to anyone Page 4▯ Thursday, April 13, 2017 Cognitive Behavioral Therapy (CBT) • Goal is to alleviate psychological symptoms by changing their underlying cognitions and behaviors • Thoughts, behaviors, and emotions interact and contribute to various mental disorders • Present-focused therapy—focused on the “now” rather than causes from the past, such as childhood relationships • Uses behavior goals to improve one’s mental illness, typically involving between-session homework assignments • Relatively brief intervention of 12-16 weekly sessions, closely tailored to the nature of the psychopathy and treatment of the specific mental disorder • Highly efficacious for virtually all psychiatric illnesses History of Cognitive Behavioral Therapy • Mid-20th century • Dr. Aaron T. Beck and Albert Ellis • Automatic thoughts: thoughts depressed patients report experiencing spontaneously These thoughts arise from three belief systems (schemas): • • Beliefs about the self • Beliefs about the world • Beliefs about the future • Therapy initially focuses on identifying automatic thoughts, testing their validity, and replacing maladaptive thoughts with more adaptive thoughts • In later stages, the patient’s maladaptive schemas are examined and modified • Rational-emotive-behavioral therapy (REBT) encourages patients to evaluate their own thoughts about situations Techniques in CBT • Help patients identify maladaptive appraisals, or the untrue judgments and evaluations of certain thoughts • Goal is to help people make adaptive, instead of maladaptive, appraisals • Reappraisal, or cognitive restructuring, is a fundamental aspect of CBT • It is the therapist’s job to help point out when a person has an inaccurate or maladaptive thought so that the patient can either eliminate it or modify it to be more adaptive • Every time a person engages in maladaptive behavior, he or she reinforces the validity of the maladaptive thought, thus perpetuating the psychological illness Page 5▯ Thursday, April 13, 2017 • The therapist and patient work together to develop healthy behavioral habits so that the patient can break this cycle of maladaptive thoughts and behaviors • Especially for anxiety disorders, CBT incorporates exposure therapy • Patient confronts a problematic situation and fully engages in the experience instead of avoiding it • The goal is to reduce the fear associated with the situation through extinction learning, a neurobiological and cognitive process by which the patient “unlearns” the irrational fear • After repeated exposure (starting small and building one’s way up), the patient experiences less physiological fear and maladaptive thoughts, breaking the tendency for anxiety and subsequent avoidance Advantages and Disadvantages of CBT • Brief intervention = cost-effective • Intuitive treatment that makes logical sense to patients • Can be adapted to suit the needs of many different populations • Involves significant effort on the patient’s part—patient is an active participant in treatment • Therapists often assign homework worksheets between sessions • Greatest strength: abundance of empirical support for its effectiveness • Equally or more effective than other forms of treatment, including medication and other therapies • First-line treatment for many mental disorders Acceptance and Mindfulness-Based Approaches • Born out of age-old Buddhist and yoga practices • Mindfulness: process that tries to cultivate a nonjudgmental, yet attentive, mental state • Focuses on one’s awareness of bodily sensations, thoughts, and the outside environment • Works to acknowledge and accept a maladaptive thought, understanding that the thought is spontaneous and not what the person truly believes • Two important components: • Self-regulation of attention • Orientation toward the present moment • Draws attention away from past and future stressors, encourages acceptance of troubling thoughts and feelings, and promotes physical relaxation Page 6▯ Thursday, April 13, 2017 Techniques in Mindfulness-Based Therapy (MBT) • Mindfulness-based stress reduction (MBSR) uses meditation, yoga, and attention to physical experiences to reduce stress • Reducing a person’s overall stress will allow that person to more objectively evaluate his or her thoughts • Mindfulness-based cognitive therapy (MBCT): rather than reducing one’s general stress to address a specific problem, attention is focused on one’s thoughts and their associated emotions • Helps prevent relapses in depression by encouraging patients to evaluate their own thoughts objectively and without value judgment • Used to address a wide range of illnesses, including depression, anxiety, chronic pain, coronary artery disease, and fibromyalgia • Fo