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Chapter 15

Psych 2035 Chapter 15.docx

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Psychology 2035A/B
Doug Hazlewood

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Chapter 15: Psychotherapy The Elements of the Treatment Process Treatments: How Many Types Are There? In efforts to help people, mental health professionals use many methods of treatments – with over 400 distinctive types of psychotherapy. Approaches to treatment can be classified into three major categories: 1. Insight therapies – “talk therapy” – conducted with an individual or a group 2. Behaviour therapies – make direct effort to alter problematic responses and maladaptive habits 3. Biomedical therapies – involve interventions into a person’s physiological functioning Clients: Who Seeks Therapy? - About 15% of the US population use mental health services in a given year. - Two most common presenting problems are excessive anxiety and depression. People often hold off for many years before finally seeking treatment. - 6y for bipolar treatment or drug dependence, 8y for depression, 9y for anxiety disorder, and 10ys for panic disorder. A client in treatment does not necessarily have an identifiable psychological disorder. - About half of the people that use these services meet the criteria for a mental disorder. - Treatment is more likely in women and men. Also when people have medical insurance or when they have more of an education (note: many ppl who need therapy, don’t have that education). Therapist: Who Provides Professional Treatment? Psychotherapy refers to professional treatment by someone with special training. Psychology and psychiatry are the principle professions involved in psychotherapy. However therapy is also provided by social workers, psychiatric nurses and counselors. Psychologist Two types: clinical psychologist and counseling psychologists specialize in the diagnosis and treatment of psychological disorders and everyday behavioural problems. Training of clinical psychologist emphasises treatment of full-fledge disorders, whereas the training of counseling psychologists is slanted toward treatment of everyday adjustment problems in normal people. Both must have a doctoral degree (5-7yrs of training beyond a bachelor’s degree). Psychiatrist Psychiatrists are physicians who specialize in the treatment of psychological disorders. Many also treat everyday behavioural problems. Compared to the ones above, psychiatrists devote more time to relatively severe disorders. They must have a M.D. degree and their graduate training requires 4ys of coursework in med school and 4y apprenticeship in a hospital. Psychiatrists increasingly emphasize drugs. Other Mental Health Professionals Include psychiatric social workers and psychiatric nurses – they often work as part of a treatment with a psychologist of psychiatrist. Nurses play a large role in hospital inpatient treatment. Social workers work with patients and their families to ease the patients integration back into the community. Both generally have a Master’s. Many kinds of counselors also provide therapeutic services and also have a Master’s Degree. Social workers and counselors are typically licensed as independent, private practitioners. 1 Insight Therapies Insight therapies involve verbal interactions intended to enhance client’s self-knowledge and thus promote healthful changes in personality and behaviour. Psychoanalysis: 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 believed that neurotic problems are caused by unconscious conflicts left over from early childhood. Therapeutic procedures used in psychoanalysis: Probing the Unconscious In the effort to explore the unconscious, he or she relies on two techniques: free association and dream analysis: in free association, clients spontaneously express their thoughts and feelings exactly as they occur, with as little censorship as possible. In dream analysis, the therapist interprets the symbolic meaning of the client’s dreams. *Analysts must interpret their clients’ dreams and free associations. This is a critical process throughout psychoanalysis. Interpretation Interpretation involves the therapist’s attempts to explain the inner significance of the client’s thoughts, feelings, memories, and behaviours. Resistance Resistance involves largely unconscious defensive manoeuvres intended to hinder the progress of therapy. They resist because they don’t want to face up to the painful, disturbing conflicts that they have buried in their unconscious. Transference Transference occurs when clients start retaliating to their therapists in ways that mimic critical relationships in their lives. *Descendents of Freuds psychoanalysis are collectively known as psychodynamic approaches to therapy Client-Centered Therapy: Client-centered therapy is 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. These therapists seek insights that are quite different from the repressed conflicts that psychoanalysts try to track down. They help clients to realize that they do not have to worry constantly about pleasing others and winning acceptance. They try to foster self-acceptance and personal growth. Therapeutic Climate The process of therapy is not as important as the emotional climate in which the therapy takes place. Client-centered therapists must provide: 1. Genuineness 2. Unconditional positive regard 3. Empathy Therapeutic Process The client and therapist work almost together as equals. The therapist provides relatively little guidance and keeps interpretation and advice to a minimum. The therapist provides feedback to help clients sort out their feelings – their key task is clarification. They function like a human mirror but with enhanced clarity. Helping clients become more aware of their true feelings. *Client-centered therapists resembles psychoanalysis – both seek to achieve major personality reconstruction 2 Therapies Inspired by Positive Psychology: Positive-psychology – uses theory and research to better understand positive, adaptive aspects of humans. Well-being therapy seeks to enhance client’s self-acceptance, purpose in life and personal growth. Positive psychotherapy, used in depression, 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. Group Therapy: Group therapy is the simultaneous treatment of several or more clients in a group. Participant’s Roles The group typically consist of 4-12ppl, with 6-8 participants regarded as an ideal number. The therapist’s usually screen the participants, excluding anyone who seems likely to be disruptive. The therapist has to set goals for the group, and focuses on maintaining group cohesion. The therapist participates in the group’s exchanges and “bare their own soles” to some extent. Participants even function as therapists for one another. They she stories, coping strategies and provide acceptance and emotional support. Advantages of the Groups Experience Group therapies save time and money. They also have other strengths: 1. In group therapy, participants often come to realize that their misery is not unique. 2. Group therapy provides an opportunity for participants to work on their social skills in a safe environment. 3. Certain kinds of problems are especially well suited to group treatment. Peer self-help groups (AA, etc.) Evaluating Insight Therapies: Evaluating the effectiveness is complex. Studies indicate that insight therapy is superior to no treatment or to placebo treatment and that the effects of therapy are reasonable durable. Studies find the greatest improvement in early treatment (first 13-18weeks), with further gains gradually diminishing over time. Therapy and the Recovered Memories Controversy: Recovered memories have led to a rash of lawsuits in which adult plaintiffs have sued their parents, teachers, neighbors, pastors, and so forth for alleged child abuse 20/30 years earlier. Many acused parents have argues that their children’s recollections are false memories. However, therapists can unknowingly create false memories in their patients and a significant portion of recovered memories of abuse are the product of suggestion – some are indeed authentic. Behaviour Therapies Behaviour therapists are different from insight therapists in that behaviour therapists make no attempt to help clients achieve grand insights about themselves. (Ex. Gambling Addict) the therapist needs to get rid of maladaptive behaviour so they design a program to eliminate compulsive gambling. Behaviour therapies involve the application of the principles of learning to direct efforts to change clients’ maladaptive behaviours. Behaviour therapies are based on two major assumptions. First, it is assumed that behaviour is a product of learning. Second, it is assumed that what has been learned can be unlearned. 3 Systematic Desensitization: Systematic desensitization is a behaviour therapy used
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