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Chapter 16

PSYC 1000 Chapter 16: 16.2, 16.3

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PSYC 1000
Dan Meegan

1. 16.2, 16.3 16.2 psychological therapies Insight Therapies  Insight therapies- general term referring to therapy that involves dialogue between client and therapist for the purposes of gaining awareness and understanding of psychological problems and conflicts  The formal beginning of insight therapy came with development of psychoanalysis by Freud and its evolution into psychodynamic therapies  Psychodynamic therapies- forms of insight therapy that emphasize the need to discover and resolve unconscious conflicts Psychoanalysis: exploring the unconscious  Freud hypothesized that much of our consciousness occurs at the unconscious level, outside of our conscious awareness  Many fundamental urges (like sexuality, appetites, and aggression, were thought to be constantly influencing how we think and behave, although we would not be explicitly aware of these processes  Because these urges are generally socially unacceptable, we would actively protect ourselves from becoming aware of them through a variety of psychological defenses  As a result, the true causes of our behaviour, and thus our psychological issues, lie in the unconscious  This led Freud to emphasize the importance of “making the unconscious conscious” believing that the process of bringing material from the unconscious into consciousness allowed clients to gain insight into their problems and the past experiences from which they stem o Believed to liberate clients from the grips of the previously unknown forces that were impacting their lives  Freud based their practice on some core ideas  Freud’s several methods they believed would help them access the mysterious unconscious realm o 1) during the practice of free association (clients are encouraged to talk or write without censoring their thoughts in any way), just allowing everything that pops into mind to come spilling out o 2) dreams were also believed to be useful sources of info about unconscious conflicts  dream analysis- method for understanding the unconscious by examining the details of what happens during a dream (the manifest content), in order to gain insight into the true meaning of the dream, the emotional, unconscious material that is communicated symbolically (the latent content)  dreams take the form of imagery and loose storylines, but within this confusing jumble, symbolic truths are hidden  psychoanalyst’s role was to help client understand the truths in order to gain insight into their unconscious conflicts o 3) resistance- occurs as the treatment brings up unconscious material that the client wishes to avoid, and the client engages in strategies for keeping the info out of conscious awareness  resistance may be subtle, such as the client using humour to avoid talking about something painful  ironically, this is a promising signal for the psychoanalyst because it means that they are beginning to access the unconscious motives of clients’ present difficulties o 4) transference- psychoanalytic process whereby clients direct the emotional experiences that they are reliving toward the therapist. Rather than the original person involved in the experiences (ex. Their parents)  ex. If patient is addressing a hidden sexual conflict, then her transference may involve developing sexual feelings for the analyst  ex. Criticized by mother, the patient might feel criticized by the analyst and respond defensively  transference is a significant milestone in the process of psychotherapy – once it is reached, the therapist and client can begin to work through specific problems and discuss ways of coping with them Modern psychodynamic therapies  diverting from Freud, these approaches are more concerned with the client’s conscious rather than unconscious experience  they also acknowledge the effect of cultural and interpersonal influences on individual behaviour, as well as the impact of important needs such as love, power, belonging, security, and status  they are more optimistic about people’s ability to reach healthy functioning  ex: object relations therapy- variation of psychodynamic therapy that focuses on how early childhood experiences and emotional attachments influence later psychological functioning  in contrast to psychoanalysis, object relations therapy doesn’t center on repressed sexual and aggressive conflicts o instead, it focuses on “objects” where are the clients mental representations of themselves and others  both object relations therapy and psychoanalysis share the goal of helping individuals gain insight into how and why their current functioning was affected by early events  sillivan’s interpersonal psychotherapy- the therapist assumes the role of participant observer, through which the therapist both interacts with and observes the client over time in order to understand any unrealistic expectations the client may have toward their relationships as well as other situations in daily life  this work influenced Interpersonal therapy  interpersonal therapy was originally developed as a treatment for depression that would work quickly, focusing on improving clients’ social skills and guiding them through their interpersonal issues and life transitions  IPT has been found to effectively treat depression, substance abuse, and eating disorders Humanistic-Existential Psychotherapy  Big in the 50s as it broke from psychoanalytic approaches, creating a new discipline based on at least 5 fundamental differences  Therapies operating within this orientation emphasize individual strengths and the potential  Shift toward the positive was believed to help individuals access their own personal power and agency for overcoming problems  Humanistic and existential therapies share many similarities: to help people express their authentic selves, to overcome alienation, to become more loving, and to take responsibility for their experiences so that they learn to dwell fully in the present  The major difference between the two is that humanistic therapists focus on removing the obstacles that prevent self-actualization from unfolding naturally, and existential therapists emphasize the importance of facing painful experiences such as feelings about isolation, death, and meaninglessness, believing that self-actualization involves transforming by facing one’s fears and negativity  Phenomenological approach- the therapist addresses the clients’ feelings and thoughts as they unfold in the present moment, rather than looking for unconscious motives or dwelling in the past  American psychologist Carl Rogers developed a version of humanistic therapy called client-centered therapy (or person-centered therapy) – cognitive therapy  client-centered therapy- which focuses on individuals’ abilities to solve their own problems and reach their full potential with the encouragement of the therapist  rogers believed that all individuals coud develop and reach their full potential  however, people experience psychological problems when other impose conditions of worth, meaning that they appear to judge or lose affection for a person who does not live up to expectations o conditions of worth are imposed. Ex: by a father who is never satisfied with his child’s report card – parents who show excessive attention and praise when their children behave in desired ways, sending the message that they child is only loveable when she is “good” o conditions of worth can produce long-term consequences to psychological health because they increase insecurities within the individual; as a result, the individual is likely to change their behaviour in an attempt to regain affection o if this happens frequently, then the individual’s behaviour starts to be primarily about gaining affection and approval living in order to please others rather than being able to express his own authentic self- which is a key aspect of most psychological dysfunction  most important aspect of client-centered therapy lies within the dialogue that unfolds between therapist and client  the therapist must show unconditional positive regard through genuine, empathetic, and non-judgmental attention  if the therapist can remove all conditions of worth, clients may begin to express themselves without fear and begin to develop inner strength Evaluating insight therapies  therapies should be used only if there is empirical support that they actually work, although it is worth remembering that a given approach may work for a given individual, even if it doesn’t work for most people  even though it is important to generally practice empirically supported approaches to treatment, it is also important to balance this with the idiosyncratic needs and beliefs of particular clients  the effectiveness if insight therapies depends on the condition being treated  studies that have used the most rigorous research designs have shown that psychodynamic therapy has not been effective in treating severe depression or schizophrenia, but it has shown promise for treating panic disorder, dependence on opiate drugs (ex. Heroin), and borderline personality disorder  insight therapies can help people gain understanding and awareness of the nature of their psychological problems  many people with psychological disorders are able to successfully learn to function effectively without digging into the possible “root causes” by instead cultivating new, adaptive behaviours  positive regard and empathy are modestly related to the outcome of therapy, although Rogers ay have overemphasized their importance somewhat  some research on the effectiveness of person-centered therapy and said is it no more effective than a placebo treatment whereas others have found it to be as effective as cognitive behavioural therapy  a complicating factor in this research may be the skill of therapists themselves; some therapists are likely much better able to connect with clients and establish the proper kind of rapport in therapy, and may be far more effective than other types of therapy  emotion-focused therapy is based on the well-supported belief that is better to face and accept difficult emotions and thoughts rather than bottle them inside o therapists employing this type of therapy aim to help clients overcome their tendency to suppress disturbing thoughts and emotions Behavioural, cognitive, and group Therapies  behavioural therapies- address problem behaviours, and the environmental factors that trigger them, as directly as possible  behavioural approaches seek to recondition clients, training them to adopt different behavioural responses to situation until they develop new, more functional, habits Systematic desensitization  how behavioural therapy works is clearly illustrated by examining how it is applied to one of the most common types of social anxiety, public speaking o can cause major anxiety, physiological arousal, and even panic attacks o as the speech approaches, cues like the prof standing at the front, can trigger anxious feelings and heighten the person’s arousal  to help ppl learn to handle such fear-inducing situation, therapists may choose the behavioural technique known as systematic desensitization  systematic desensitization- gradual exposure to a feared stimulus or situation is coupled with relaxation training o 1 , the client may be exposed to a very mild version of the fear-inducing situation, such as merely imagining walking up to the front of the room where he is going to give the speech, and as he does so, the client practices relaxing in order to counteract the mild anxiety they may feel o he then progresses to more realistic and concrete manifestations of the situation, each time practicing relaxing until he can learn to tolerate his feelings and counteract them with a relaxation response so eventually, he can handle the real thing  Behavioural therapies are their clients follow three main steps in conducting systematic desensitization: build an anxiety hierarchy (creating a list of stimuli that arouse fear responses), relaxation training, work through the hierarchy  The client may elect to undergo a process called flooding o In this procedure, the client goes straight to the most challenging part of the hierarchy, exposing himself to the scenario that causes the most anxiety and panic o The idea is that rather than avoiding the anxiety-provoking situation, the client dives right in and discovers that there are no truly negative consequences to giving a well-prepared speech  Fear and anxiety responses can be acquired through observing others  So another technique is based on observational learning or “modelling”  With this method, the client observes another person engage with the feared object or situation  Virtual reality exposure (VRE) – treatment that uses graphical displays to create an experience in which the client seems to be immersed in an actual environment Aversive Conditioning  Behavioural therapies can also be used to extinguish unwanted behaviours  behavioural principles tell us that these habits are maintained because they bring rewards in some fashion. As long as they are enjoyable or reduce stress, these habits will be difficult to break  aversive conditioning- behavioural technique that involves replacing a positive response to a stimulus with a negative response, typically by using punishment  one aversive conditioning treatment involves using the drug Antabuse (disulfiram) to reduce problem alcohol consumption  Antabuse causes nausea and vomiting when combined with alc, so the drug classically conditions an aversion to alc Cognitive-behavioural therapies  Behavioural therapies, despite their effectiveness at changing problem behaviours, do not directly address problematic throughts  This is highly important because some disorders, most notably depression, are caused in part by dysfunctional habits of thinking  Two psychodynamically trained psychologists, Ellis and Beck, found that people with depression tend to interpret and think about their lives in a negative light  It became apparent that therapies should be more directed at changing negative cognitions into more realistic and rational though patterns, as well as helping people learn to control the physiological processes (ex. Arousal) that reinforce negative thinking  Over time, this new approach became known as cognitive-behavioural therapy  Cognitive-behavioural therapy (CBT)- form of therapy that consists of procedures such as cognitive restructuring, stress inoculation training, and exposing people to experiences they may have a tendency to avoid, as in systematic desensitization  Bc avoiding thoughts and stressful situations tend t reinforce the negative feeling that would arise, helping clients to face negativity allows them the opportunity to gain insight into their feelings o To practice a courageous response to negativity, and to learn methods for coping when negativity arise o This therapy is more about present than past o Rather than excavating past traumas or conflicts, CBT therapists help clients become more aware of the thought, emotion, and behaviour patterns that arise in their current lives  At the behavioural end of CBT, clients are given exercises and guidance in gaining skills they may be lacking o EX. As with systematic desensitization, clients may learn relaxation techniques, enabling them to better tolerate negative feelings when they arise o Another ex. Person with social anxiety may learn how to make small talk  at the cognitive end of CBT, clients are given exercises and strategies to build more functional cognitive habits  cognitive restructuring involves learning to challenge their negative thought patterns, to question their self-defeating beliefs, and to view situations in a different light o ex. Ppl with anxiety or depression disorders often hold irrational beliefs like “I can’t do anything right” o as they become more aware of these negative beliefs, they can question or dispute them, helping themselves appreciate that these beliefs are far more negative than reality warrants  one set of dysfunctional thinking patterns that powerfully reinforces depression is the tendency to make internal, stable, and global attributions for negative events which is called negative explanatory style o negative explanatory style results in people making the worst out of many situations  internal attributions – thoughts that say “it’s all my fault”, blaming onself excessively for negative things that happen, rather than appreciating that, even though one may bear some responsibility, there were also other factors that contributed to the negative event, such as bad luck or the behaviour of other people  stable attributions- thoughts like “it’s never going to change”, coming to see the situation as permanent and irreversible  global events- thoughts like “my whole life is ruined”, blowing things out of proportion rather than seeing a negative event as simply that, one negative event and not something that needs to spiral into greater problems  once these self-defeating cognitive habits have been identified, a therapist and client can work on developing more functional and healthy ways of
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