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Final Exam Questions #6-10

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6. Periodically, someone contends that psychotherapy is no more effective than no treatment at all. Discuss the conclusion (i.e., discuss the evidence) that the techniques of psychotherapy are ineffective as it applies to: a) Rogerian therapy, b) Gestalt therapy, c) behavior therapy, d) family therapy, e) eclectic therapies, and f) cognitive therapy. What ethical problems does this conclusion raise (if it’s correct)? What evidence is there to refute this conclusion (from the literature)? What criticism of this drastic conclusion might a transtheoretical theorist use to refute the contention? Rogerian: - Reviews have concluded that a patient’s positive perception of a therapist’s facilitative attitude has only a modest effect on treatment gains. - When applied to a group of schizophrenics, Rogerian psychotherapy showed no effect – certain disorders (notably brain diseases) are not effected by Rogerian psychotherapy. Gestalt: - Studies have consistently shown that Gestalt therapy is superior to no treatment, but have also shown that it is barely higher in success to placebo treatment. It has also been shown that it is no more successful than other methods of therapy. - Effectiveness has been shown to vary significantly between therapies depending on the characteristics of the patient, however. For example, Gestalt therapy was shown to be most effective for patients who are internalizing, have low-resistance, and are overly socialized. Patients who cope by acting out and projecting, however, fared significantly better with cognitive therapy. Behavior: - A huge amount of studies have been performed to show the consistent positive effect that behavior psychotherapy has over no treatment and placebo effects on multiple different problems - However, a primary criticism of behavior therapy is that it is too focused on short term recovery and removal of symptoms without addressing the underlying roots of the pathology. Similar to no treatment, there is a significant risk for relapse when neglecting to address underlying issues to psychopathology that other approaches might address Family: - Despite being successful in 66% of cases, some specific disorders (such as alcohol dependence) have been found to be equally effective in treatment with individual therapy than with family therapy. - Also, no research has been performed proving the assumption that the symptoms of the identified patient are really a reflection of problematic family dynamics. Eclectic: - The principle concern with eclectic theory is the constant need of the therapist to continually keep up to date on the most effective methods of treatment. While many studies have shown eclectic therapy to be superior to no treatment, there have been problems in contrasting these results to other single-theory methods because of researchers mistakenly identifying eclectic therapies as a result of lacking information. - Another potential criticism to eclectic therapy is the significance of matching patient and therapist. This criticism is a kind of double-edged blade – correctly matching therapist approach and patient characteristics can have a significant effect on the patient’s performance, but incorrectly approaching the patient can result in an opposite effect. Cognitive: - Despite being found to be effective in many diverse aspects of problems, cognitive therapy was found to be ineffective in one specific category, namely in treating domestic violence. Cognitive therapy was found to have no effect on batterers that was not already established by the action of being arrested. - However, this result was also found when this category of patients was treated using different psychotherapy approaches. All types of psychotherapy currently produce little to no effect in these patients General Ineffectiveness: - A 1952 study by Eysenck reported that 66% of patients will recover without the need of psychotherapy treatment. The paper claimed that this percentage of patients will experience spontaneous recovery as a possible result of mood fluctuations or normal situation changes. - This finding was later refuted by research such as the Smith, Glass and Miller (1980) meta-analysis that found psychotherapy to be more effective than no treatment in 500 cases. 7. A patient comes to a clinic complaining of intense anxiety attacks that are interfering with his ability to go out of his home. What would a RET, a Gestalt, a Freudian, a Rogerian, a behavior therapist, a cognitive therapist, and a family therapist do if each one were confronted with such a patient? How would therapy begin in each case and where would it go? How would a transtheoretical therapist deal with this and what information would such a therapist need in order to decide how to begin? RET: - A rational emotion therapist would attempts to establish a connection between the anxiety attacks the patient is experiencing and the beliefs the patient holds about being outside. For example, the patient may have the belief that “If I go outside the sun will set me on fire”, resulting in the consequence of the patient not going outside of his home and suffering extreme anxiety if he does - In this case, therapy would begin with the therapist attempting to discover the A of the ABC model – the therapist would first have to identify the event that lead to the faulty cognition causing the behavioural consequence. Once the problematic cognition is identified, therapy would focus on disputing the beliefs about the event from A in an attempt to change the patient’s belief. Gestalt: - In gestalt therapy, the notion that taking responsibility for our own existence is of primary importance. The therapist would attempt to raise the awareness of the patient by making them aware of everything within their perceptual field – ranging from their thoughts to their physical actions. - This notion of making the patient aware of their perceptual field and therefore responsible for their actions would be utilized to show the patient that they are the one responsible for their anxiety and are therefore able to control it. Freudian: - Because Freudian therapy recognizes the root of anxiety as a result of unconscious problems that developed during childhood, this therapy would likely begin with the therapist attempting to discover the root of this anxiety. Psychopathologies in Freudian therapy are the result of conflicts between the id and the ego, and the therapist would likely attempt to establish a connection between the anxiety that arises when the patient goes outside and the unconscious desires of the id that are in conflict. The therapist would attempt to raise the consciousness of the patient to make them aware of these desires. Rogerian: - Rogerian therapy places positive regard and a warm therapeutic relationship above all else, and that would be no exception in this case. The therapist would likely begin by establishing a strong empathetic and genuine relationship with the patient. The therapist would allow the patient to fully explore their feelings and thoughts in an attempt to establish congruence between their self-perception and their experiences, hopefully relieving this anxiety. Behaviour: - Because behavioural therapists view the source of psychopathology as problems in learning, a behavioural therapist would likely begin by re- conditioning the event of going outside with a more positive response, such as muscle relaxation. This problem would likely be resolved through the use of in vivo desensitization, in which the patient is exposed to stimuli that illicit their abnormal response in increasing severity so it can be re-conditioned. For example, the patient may begin by looking out a window, then proceed to stand in front of a glass door, then finally take more and more steps outside until the event no longer elicits their anxiety response. Cognitive: - Rather than dispute the patient’s cognitive beliefs (like RET therapy), Beck’s method of cognitive therapy questions the patient’s maladaptive cognitions in an attempt to have the patient change them. The therapy would likely begin with the patient explaining their problem to the therapist, and then would be given “homework” to complete whenever they experience this problematic situation. By keeping a daily record of automatic thoughts and writing out alternative ways to perceive the situation of being outside, the patient questions their cognitions and changes them. Family: - A family therapist would begin by determining the dynamic and communication between members of the identified patient’s family. Because family therapists believe that psychopathology is the result of unresolved conflict within the family, the therapist would use the determined relationships between family members to root out any unresolved issues that may be resulting in the identified patient’s anxiety. These issues could be resolved within the therapy setting. Transtheoretical: - The first thing that a transtheoretical therapist should attempt to do with a new patient is determine which stage of change the patient is in. The stage of change the patient is in will be reflected by the patient’s attitudes, intentions and behaviors related to the readiness to change the patient expresses. The stages of change are: Precontemplation, in which the patient has no intention to change the behavior in the foreseeable future; Contemplation, in which the patient is aware of the problem and is considering overcoming it, but has not yet taken action; Preparation, in which the patient is intending to take action and may report small behavioral changes; Action, in which the patient is actively modifying their behavior or experiences in order to overcome the problem through the use of much time and energy; Maintenance, in which the patient is working to prevent relapse and consolidate the gains made during the action stage, and finally; Termination, in which the patient no longer experiences any temptation to return to the problem behavior and does not have to work to prevent relapsing. Recycling is a stage that can occur in any of the previously discussed stages of change, and is the relapse of the patient that occurs subsequent to unsuccessful attempts to change. - From the information provided regarding the current patient, it would seem that this patient is in the Preparation stage. The individual has made the action of seeking professional help and has accepted that anxiety experienced upon leaving the house is a problematic behavior. For this psychopathology and in regards to the stage of change the patient is in, a transtheoretical therapist would likely work with the patient to develop an action plan for how they will work to change this behavior. Small steps would be taken towards change through methods of counterconditioning and stimulus control in order to substitute healthier behaviors in response to the stimulus of going outside. Emphasis would also have to be placed on the patient’s feeling of self- liberation so that the patient believes they have the autonomy to make the change happen. 8. If psychotherapy is only marginally more effective than a control group (i.e., no therapy), why might it still be worth doing? What ethical and practical considerations would suggest that one should/should not do therapy rather than let spontaneous remission effect the cure? Even if psychotherapy is only marginally more effective than a control, it might still be worth doing for multiple reasons: - Prevention of remission: in the case of behaviors and attitudes that would be addressed by behavioral and cognitive therapies, allowing for spontaneous remission m
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