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Chapter 15

Chapter 15 - Psychotherapy.docx

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Psychology 2035A/B
Doug Hazlewood

CHAPTER 15: PSYCHOTHERAPY THE ELEMENTS OF THE TREATMENT PROCESS  Psychotherapies involve a helping relationship (treatment) between professional with special training (therapist) and another person in need of help (the client) TREATMENTS: HOW MANY TYPES ARE THERE?  400 distinct types of psychotherapy  3 categories 1. Insight therapies: “talk therapy”  Clients engage in complex verbal interactions with their therapies  Goals pursue increased insight regarding the nature of client’s difficulties sort through possible solutions  may be conducted with individual or group 2. behaviour therapies: based on principles of learning & conditioning  direct efforts to alter problematic responses & maladaptive habits  change clients’ overt behaviours 3. Biomedical therapies: interventions into person’s physiological functioning  Drug therapy & electroconvulsive therapy  Provided only by physicians with medical degree (psychiatrists)  BUT, here’s a twist: due to inadequate access to psychiatrists, psychologists have ability to obtain prescription authority (some states approved, others fighting) CLIENTS: WHO SEEKS THERAPY?  Of the therapeutic triad, greatest diversity seen among clients  bring full range of human problems  2 most common presenting problems 1. Excessive anxiety 2. Depression  People often hold off for many years before finally seeking treatment for psychological problems  Some people seek professional help for everyday problems or vague feelings of discontent  Study found that only half seeking help had “full-blown” disorder; other half had significant health issues  Some remission, others with severe stress  People vary in willingness to seek psychotherapy  Women more likely than men to receive treatment  Whites more likely than blacks & Hispanics to obtain therapy  More likely among those with medical insurance & higher educations  Many people who need therapy don’t receive it  Lack of finances (insurance & costs)  Biggest roadblock “stigma surrounding receipt of mental health treatment” THERAPISTS: WHO PROVIDES PROFESSIONAL TREATMENT?  Psychotherapy: professional treatment by someone with special training  Psychology & psychiatry are principal professions involved in psychotherapy  Also provided by social workers, psychiatric nurses, counsellors Psychologists  Clinical psychologist & counseling psychologists: specialize in diagnosis + treatment of psychological disorders & everyday behavioural problems  Clinical psychologist training  emphasize treatment of full-fledged disorders  Counseling psychologist training  treatment of everyday adjustment problems in normal people  Overlap between the 2 types of psychologists  Education  Ph.D, Psy.D, E.D.  5-7 years beyond bachelor’s degree  University campus  1-2 year internship in clinical setting  Style/Tasks  Most likely to use behavioural techniques; less likely to use psychoanalytic methods  Might use insight  Psychological testing + psychotherapy + research Psychiatrists  Psychiatrists: physicians who specialize in treatment of psychological disorders  Treat everyday behavioural problems  Devote more time to relatively severe disorders; devote less time to everyday marital, family, job, school problems  Education  M.D.  4 years of course work + 4 years apprenticeship in residency at approved hospital (for psychotherapy training)  Style/Tasks  Increasingly emphasize drugs  Abandoning talk therapies & behavioural interventions Other Mental Health Professionals  Psychiatric social workers, psychiatric nurses  BNSc, MSW, MA  Work with patients’ integration back into community  Practice in private clinics & hospitals  Counselors  M.A.  Work in public practices (i.e. schools, community centers, etc.)  Specialize in problem (i.e. vocational counselling, marital counselling, etc.)  Others: clinician, therapist, mental health professional INSIGHT THERAPIES  Insight therapies: involve verbal interactions intended to enhance clients’ self-knowledge and thus promote healthful changes in personality and behaviour PSYCHOANALYSIS  Freud  psychoanalysis  influence + evolve into psychoanalytical approaches we use today  Psychoanalysis: 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 (neuroses)  Believed neurotic problems caused by unconscious conflicts left over from early childhood  Battle between id, ego, superego  depend on defense mechanisms to avoid confronting conflicts  self-defeating behaviour  partially alleviate anxiety, guilt, other emotions Probing the Unconscious  Analyst attempts to probe murky paths of unconscious to discover unresolved conflicts  neurotic behaviour  Free association: clients spontaneously express their thoughts + feelings exactly as they occur, with little censorship as possible  Let everything pour out without censorship  analyst studies for clues about activity of unconscious  Dream analysis: therapist interprets symbolic meaning of client’s dreams  “royal road to unconscious”; clients  remember dreams  describe  therapist analyze symbolism to dreams Interpretation  Interpretation: involves therapist’s attempts to explain the inner significance of client’s thoughts, feelings, memories, and behaviours  Analysts move forward inch by inch  offer interpretations just outside client’s reach Resistance  Resistance: involves largely unconscious defensive manoeuvres intended to hinder the process of therapy  Clients don’t want to face painful, disturbing conflicts that have buried in unconscious  Forms: show up late, fake free association, hostility Transference  Transference: occurs when clients start relating to their therapists in ways that mimic critical relationships in their lives  Often encourage transference, so clients begin to re-enact relations with crucial people in context of therapy  Re-enactments help bring repressed (confusing & highly charged) feelings & conflicts to surface  work through them  Could take years… takes time for patient to  Work through problems  accept unnerving revelations  profound insights  Traditional psychoanalytic method  Psychodynamic approaches CLIENT-CENTERED THERAPY  1940s – 1950s: Carl Rogers  Client-centered therapy: 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  It is the client who knows what hurts, what directions to go, what problems are crucial, what experiences have been deeply buried. It began to occur to me that unless I had a need to demonstrate my own cleverness and learning, I would do better to rely upon the client for the direction of movement in the process.  Personal distress due to inconsistency between self-concept and reality  Makes people prone to feel threatened by realistic feedback about themselves from others  Anxiety from feedback  reliance on defense mechanisms, distortions of reality, stifled personal growth  Excessive incongruence  patients’ overdependence on others for approval & acceptance  Client-centred therapists help clients realize they don’t have to please others & win acceptance  Encourage clients to respect own feelings & values  Help people restructure self-concept to correspond better to reality Therapeutic Climate  Rogers: it is critical for therapist to provide warm, supportive, accepting climate in which clients can confront shortcomings without feeling threatened   reduce defensive tendencies  open up  3 conditions to be provided by client-centered therapists 1. Genuineness: be real! 2. Unconditional positive regard:  Show complete nonjudgmental acceptance of client as person  provide warmth & care with no strings attached 3. empathy: understand client’s world from client’s point of view Therapeutic Process  client & therapist work together almost as equals  therapist provides feedback to help client sort out feelings (clarification)  highlight themes  help client become more aware of true feelings  hope to build toward more far-reaching insights  try to help clients become more aware of & comfortable about genuine selves THERAPIES INSPIRED BY POSITIVE PSYCHOLOGY  positive psychology: use theory and research to better understand positive, adaptive, creative, and fulfilling aspects of human existence  increased research on contentment, well-being, human strengths, positive emotions RATHER THAN pathology, weakness, suffering  well-being therapy: seeks to enhance clients’ self-acceptance, purpose in life, autonomy, personal growth  mood disorders & anxiety disorders  positive psychotherapy: attempts to get clients to recognize strengths, appreciate blessings, savor positive experiences, forgive those who have wronged them, find meaning in lives GROUP THERAPY  group therapy: simultaneous treatment of several or more clients in a group  expected to grow  economic pressure in mental health care (just like WWII) Participants’ Roles  ideally 6-8 people; typically 4-12 people  therapist screens participants (excl. those who are disruptive)  better to have homogenous group?  what’s practical in the scenario?  Responsibilities of therapist  Selecting participants  Setting goals for group  Initiating & maintaining therapeutic process  Protecting clients from harm  Stay in background & focus mainly on promoting group cohesiveness  Participate in groups exchanges and “bare their own souls” to some extent  Group members  Describe problems  Trade viewpoints  Share experiences  Discuss coping strategies  Provide acceptance & emotional support for each other  Work at peeling away social masks that cover insecurities  correct problems  Value opinions  healthy changes to win groups approval Advantages of Group Experience  Save time & money 1. In group therapy, participants often come to realize that their misery is not unique  reassured to learn that many other people have similar or worse problems 2. Group therapy provides opportunity for participants to work on their social skills in safe environment 3. Certain kinds of problems are especially well suited to group treatment EVALUATING INSIGHT THERAPIES  Every institution has its own goals; evaluations are subjective to patients & therapists  Studies: insight therapy > placebo/no treatment; insight therapy = drug therapy  Studies: greatest improvement early in treatment (first 13-18 weeks)  diminishing gains over time  Advocates: different therapies achieve similar benefits through different processes  Common denominators that lie at core of diverse approaches to therapy 1. Development of therapeutic alliance with professional helper 2. Provision of emotional support & empathic understanding by therapist 3. Cultivation of hope and positive expectations in client 4. Provision of a rationale for client’s problems and plausible method for ameliorating them 5. Opportunity to express feelings, confront problems, gain new insights, learn new patterns of behaviour  Importance: benefits of therapy represent combined effects of common factors & specific procedures THERAPY AND THE RECOVERED MEMORIES CONTROVERSY  1990s: people recover memories of being sexually assaulted by close ones  sue  denied  acused of having “false memory”  form support group  Psychologists divided on issue  Some will accept the case at face value  Others attribute to small minority of psychologist assuming all psych problems relate to childhood sexual abuse  Psychologists who doubt authenticity of repressed memories support analysis by pointing to discredited cases of recovered memories  Psychologists who believe in recovered memories mounted rebuttals to arguments  No answer. Matters need to be addressed with great caution BEHAVIOUR THERAPIES  Don’t help clients to achieve grand insights  believe not necessary to make constructive change  Behaviour therapies: involves
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