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Chapter 15

2035- Chapter 15.docx

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English 2017
Joel Faflak

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Chapter 15- Psychotherapy
The Elements of the Treatment Process
-All psychotherapies involve a helping relationship (the treatment) between a
professional with special training and another person in need of help
Treatments: How Many Types are there?
-Some people say there are as many as over 400 types of therapy
-Insight therapies
o“talk therapy”
oClients engage in complex verbal interactions with their therapists
oThe goal is to pursue increased insight regarding the nature of the clients
difficulties and to sort through possible solutions
oIndividual or group
-Behavior therapies
oBased on the principles of learning and conditioning
oMake direct effort to alter problematic responses and maladaptive habits
-Biomedical therapies
oInvolve interventions into a persons physiological functioning
oDrug therapy and electroconvulsive therapy
oPsychologists want privileges to diagnose these drugs
Clients: Who Seeks Therapy?
-About 15% of the population use mental health services
-Two most common presenting problems are excessive anxiety and depression
-People hold off on seeking help from 6 – 10 years on average
-A client in treatment does not necessarily have an identifiable disorder
-Only about half of people who use mental health services meet the criteria for a
full- fledged mental disorder
-Only 8% of people seeking treatment appeared to be relatively free of psychiatric
-When people perceive they need help, only about 59% actually seek it
-Women are more likely to receive treatment, and whites
-More likely when people have medical insurance and more education
-Many people who need treatment don’t receive it
-Highest age group: 35 – 44 also: divorced or separated
Therapists: Who Provides Professional Treatment?
-Professional treatment by someone with special training
oClinical psychologists and counseling psychologists specialize in the
diagnosis and treatment of psychological disorders and everyday
behavioral problems
oTraining of clinical emphasizes treatment of full-fledged disorders
oTraining of counseling is slanted toward treatment of ever day adjustment
problems in normal people
oIn providing therapy, often use insight or behavioral approaches
oMore likely to use behavioral techniques and less likely psychoanalytical
oAre physicians who specialize in the treatment of psychological disorders
oAlso treat every day behavioral problems
oDevote more time to relatively severe disorders and less time to ever day
oIncreasingly emphasize drugs
oPsychiatrists are abandoning talk therapies and behavioral interventions in
favor of drug treatments
-Other Mental Health Professionals
oPsychiatric social workers and psychiatric nurses
oCounselors also provide therapeutic services
Insight Therapies
-Insight therapies involve verbal interactions intended to enhance clients’ self-
knowledge and thus promote healthful changes in personality and behavior
-8 or 10 types are most popular
-Sigmund Freud
-Psychoanalysis is an insight therapy that emphasizes the recovery of unconscious
conflicts, motives, and defenses through techniques such as free association,
dream analysis, and transference
-Freud treated mostly anxiety-dominated disturbances which were then called
-He believed that neurotic problems are caused by unconscious conflicts left over
from early childhood
oThought these inner conflicts involve battles among the id, ego, and
-Probing the unconscious
oAttempts to probe the murky depths of the unconscious to discover the
unresolved conflicts causing the clients neurotic behaviour
oFree association: clients spontaneously express their thoughts and feelings
exactly as they occur, with as little censorship as possible
Say anything that comes to mind without censorship
oDream analysis: the therapist interprets the symbolic meaning of the
client’s dreams

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Chapter 15­ Psychotherapy  The Elements of the Treatment Process - All psychotherapies involve a helping relationship (the treatment) between a  professional with special training and another person in need of help Treatments: How Many Types are there? - Some people say there are as many as over 400 types of therapy - Insight therapies  o “talk therapy” o Clients engage in complex verbal interactions with their therapists o The goal is to pursue increased insight regarding the nature of the client’s  difficulties and to sort through possible solutions  o Individual or group - Behavior therapies o Based on the principles of learning and conditioning o Make direct effort to alter problematic responses and maladaptive habits  - Biomedical therapies o Involve interventions into a person’s physiological functioning  o Drug therapy and electroconvulsive therapy o Psychologists want privileges to diagnose these drugs Clients: Who Seeks Therapy? - About 15% of the population use mental health services - Two most common presenting problems are excessive anxiety and depression  - People hold off on seeking help from 6 – 10 years on average  - A client in treatment does not necessarily have an identifiable disorder  - Only about half of people who use mental health services meet the criteria for a  full­ fledged mental disorder  - Only 8% of people seeking treatment appeared to be relatively free of psychiatric  problems  - When people perceive they need help, only about 59% actually seek it  - Women are more likely to receive treatment, and whites  - More likely when people have medical insurance and more education  - Many people who need treatment don’t receive it  - Highest age group: 35 – 44 also: divorced or separated Therapists: Who Provides Professional Treatment? - Professional treatment by someone with special training - Psychologists o Clinical psychologists and counseling psychologists specialize in the  diagnosis and treatment of psychological disorders and everyday  behavioral problems o Training of clinical emphasizes treatment of full­fledged disorders o Training of counseling is slanted toward treatment of ever day adjustment  problems in normal people o In providing therapy, often use insight or behavioral approaches o More likely to use behavioral techniques and less likely psychoanalytical - Psychiatrists o Are physicians who specialize in the treatment of psychological disorders o Also treat every day behavioral problems o Devote more time to relatively severe disorders and less time to ever day o Increasingly emphasize drugs o Psychiatrists are abandoning talk therapies and behavioral interventions in  favor of drug treatments - Other Mental Health Professionals  o Psychiatric social workers and psychiatric nurses o Counselors also provide therapeutic services Insight Therapies - Insight therapies involve verbal interactions intended to enhance clients’ self­ knowledge and thus promote healthful changes in personality and behavior  - 8 or 10 types are most popular Psychoanalysis  - Sigmund Freud  - Psychoanalysis is an insight therapy that emphasizes the recovery of unconscious  conflicts, motives, and defenses through techniques such as free association,  dream analysis, and transference  - Freud treated mostly anxiety­dominated disturbances which were then called  neuroses  - He believed that neurotic problems are caused by unconscious conflicts left over  from early childhood o Thought these inner conflicts involve battles among the id, ego, and  superego  - Probing the unconscious o Attempts to probe the murky depths of the unconscious to discover the  unresolved conflicts causing the client’s neurotic behaviour o Free association: clients spontaneously express their thoughts and feelings  exactly as they occur, with as little censorship as possible  Say anything that comes to mind without censorship o Dream analysis: the therapist interprets the symbolic meaning of the  client’s dreams - Interpretation o Involves the therapist’s attempt to explain the inner significance of the  client’s thoughts, feelings, memories, and behaviours o Mr N. example: oedipal complex problem – unresolved sexual feelings  toward his mother and hostile feelings about his father  - Resistance o Involves largely unconscious defensive maneuvers intended to hinder the  progress of therapy o This happens because the patients don’t want to face the painful,  disturbing conflicts that they have buried in their unconscious o Can take the form of showing up late, hostility toward therapist - Transference o Occurs when clients start relating to their therapists in ways that mimic  critical relationships in their lives o Psychoanalysts often encourage transference so that clients can re­enact  relations in the context of therapy o Can help bring repressed feelings and conflicts to the surface, allowing  them to be worked out o Psychoanalysis typically takes 3­5 years - Classical psychoanalysis is not as widely practiced - Client­Centered Therapy - An insight therapy that emphasizes providing a supportive emotional climate for  clients, who play a major role in determining the pace and direction of their  therapy  - Rogers believes that personal distress is due to inconsistency, or “incongruence”  between a person’s self­concept and reality  - Help clients realize that they do not have to worry constantly about pleasing  others and winning acceptance  - Encourage clients to respect their own feelings and values - Therapeutic climate o The process of therapy is not as important as the emotional climate in  which the therapy takes place o Genuineness: therapist must be genuine and honest o Unconditional positive regard: complete, nonjudgmental acceptance of the  client  o Empathy: must provide accurate empathy for the client - Therapeutic process o Client and therapist must work together almost as equals o Therapist provides relatively little guidance and keeps interpretation and  advice to a minimum o Key task is clarification Therapies Inspired by Positive Psychology - Well­being therapy seeks to enhance clients; self­acceptance, purpose in life,  autonomy, and personal growth o Been used successfully in the treatment of mood and anxiety disorders  - Positive psychotherapy: attempts to get clients to recognize their strengths,  appreciate their blessings, savor positive experiences, forgive those who have  wronged them, and find meaning in their lives o Mainly in the treatment of depression  Group Therapy  - The simultaneous treatment of several or more clients in a group - Use of group therapy appears likely to grow in the future (due to economic  pressures)  - Participants’ roles  o Typically 4 – 12 people (6 – 8 is ideal) o Practical necessities usually dictate that groups be at least somewhat  diversified  o Essentially act as therapists for one another o Provide acceptance and emotional support for one another  - Therapist often plays a subtle role, staying in the background - Advantages of the group experience o Save time and money o Participants often come to realize that their misery is not unique o Group therapy provides an opportunity for participants to work on their  social skills in a safe environment o Certain kinds of problems are especially well suited to group treatment Evaluating Insight Therapies - Greatest improvement in early therapy  - Studies consistently indicate that insight therapy is superior to no treatment or to  placebo treatment and that the effects of therapy are reasonably durable  - Insight and drug therapies usually show equal  - Common factors:  o The development of a therapeutic alliance with a professional helper o The provision of emotional support and empathic understanding by the  therapist  o The cultivation of hope and positive expectations in the client o The provision of a rationale for the client’s problems and a plausible  method for ameliorating them o The opportunity to express feelings, confront problems, gain new insights,  and learn new patterns of behavior Therapy and the Recovered Memories Controversy - Reports of people recovering repressed memories of sexual abuse and other  childhood trauma through therapy  - “false memory syndrome”  - A lot of people think that the “repressed memories” are false and made up  - Some people believe that some therapists prod and probe patients until they  inadvertently create the memories of abuse that they are searching for o This is because they believe that virtually all psychological problems are  attributable to childhood sexual abuse)  - Hypnosis tends to increase memory distortions while paradoxically making  people feel more confident about their recollections Behavior Therapies  - Different from insight therapy in that behavior therapists make no attempt to help  clients achieve grand insights about themselves - Behavior therapies: involve the application of the principles of learning to direct  efforts to change clients’ maladaptive behaviors  - Based on two main assumptions: o It is assumed that behavior is a product of learning o It is assumed that what has been learned can be unlearned  - Behavior therapists attempt to change clients; behavior by applying the principles  of classical condition, operant conditioning, and observational learning Systematic Desensitization  - Is a behavior therapy used to reduce clients’ anxiety responses through  counterconditioning  - Assumes that most anxiety responses are acquired through classical conditioning  - A harmless stimulus may be paired with a frightening event, so it becomes a  conditioned stimulus eliciting anxiety  - Goal is to weaken the association between the conditioned stimulus and the  conditioned response of anxiety  - Three steps: o The therapist helps the client build an anxiety hierarchy o Training the client in deep muscle relaxation o The client tries to work through the hierarchy, learning to remain relaxed  while imagining each stimulus - As clients conquer imagined phobic stimuli, they may be encouraged to confront  the real stimuli  - Counterconditioning – an attempt to reverse the process of classical conditioning  by associating the crucial stimulus with a new conditioned response  Aversion Therapy  - Behavior therapy in which an aversive stimulus is paired with a stimulus that  el
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