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Psychology 1000

The Helping Relationship • Basic goal of al treatment approaches is to help people change maladaptive, self-defeating thoughts, feelings, and behaviour patterns so that they can live happier and more productive lives • With a helping relationship, therapists use a variety of treatment techniques to promote positive change in the client • Amajority of people with mental health problems first seek help not from mental health professionals, but from family members, physicians, members of clergy, acquaintances, or self-help groups • Counseling and clinical psychologists typically hold a Ph.D (Doctor of Philosophy) or Psy.D (Doctor of Psychology) degree • APsy.D is not offered at Canadian universities, but a number ofAmerican schools • Psychiatrists are medical doctors who specialize in psychotherapy and biomedical treatments, such as drug therapy • These professionals typicall receive master’s degrees based on two years of highly focused and practical training • They include psychiatric social workers, who often work in community agencies; marriage and family counselors, who specialize in problems arising from family relations; pastoral and abuse counselors, who work with substance and sexual abusers and their victims Psychodynamic Therapies • The psychodynamic approach to psychotherapy focuses on internal conflict and unconscious factors that underlie maladaptive behaviour • Historical roots are found in Sigmund Freud’s development of psychoanalysis • The term psychoanalysis refers not only to Freud’s theory of personality, but also to the specific approach to treatment that he developed Psychoanalysis • Insight: the conscious awareness of unconscious dynamics that underlie psychological problems • Such awareness permits clients to adjust their behaviour to their current life situations, rather than continuing to repeat the old maladaptive routines learned in childhood • FreeAssociation: the procedure of verbalizing all thoughts that enter consciousness without censorship • Dream Interpretation • Psychoanalysts believe that dreams express impulses, fantasies, and wishes that the client’s defenses keep in the unconscious during waking hours • In dream interpretation, the analyst tries to help the client search for the unconscious material contained in the dreams • Resistance: largely unconscious maneuvers that protect clients from dealing with anxiety-arousing material in therapy • Clients may have a strong unconscious investment in maintaining th status quo • Their problems result form the fact that certain unconscious conflicts are so painful that the ego has resorted to maladaptive defensive patterns to deal with them • Aclient may experience difficulty in free-associating, may come late or “forget about” a therapy appointment, or may avoid talking about certain topics • Resistance is a sign that anxiety- arousing sensitive material is being approached • Transference: The psychoanalytic phenomenon in which a client responds irrationally to the analyst as if the latter were an important person from the client’s past who plays an important role in the client’s dynamics • Most important process in psychoanalysis, for it brings out into the open repressed feelings and maladaptive behaviour patterns that the therapist can point out to the client • Takes two basic forms: • Positive transference occurs when a client transfers feelings of intence affection, dependency, or love to the analysts • Negative transference involves irrational expressions of anger, hatred, or disappointment • Interpretation: a statement made by the analyst that is intended to promote insight in the client • An interpretative statement confronts clients with something that they have not previously admitted into consciousness: “It’s almost as if you’re angry with me without realizing it.” Brief Psychodynamic Therapies • Classical psychoanalysis as practiced by Freud is an expensive and time-consuming process, for the goal is no less than rebuilding the client’s personality • Brief psychodynamic psychotherapies emphasize understanding the maladaptive influences of the past and relating them to current patterns of self-defeating behaviour • Clients are seen once or twice a week rather than daily, and the goal is typically limited to helping the client deal with specific life problems rather than attempting a complete rebuilding of the client’s personality • Interpersonal Therapy: a form of brief therapy that focuses on the client’s interpersonal problems and seeks to develop new interpersonal skills • This therapy, which is highly structured and seldom takes longer than 15 to 20 sessions, focuses on the client’s current interpersonal problems • These include dealing with role disputes such as marital conflict, adjusting to the loss of a relationship or to changed relationship, and identifying and correcting deficits in social skills that make it difficult for the client to initiate or maintain satisfying relationships Humanistic Psychotherapies • Humanistic theorists view humans as capable of consciously controlling their actions and taking responsibility for their choices and behaviour • These theorists also believe that everyone possesses inner resources for self-healing and personal growth, and that disordered behaviour reflects a blocking of the natural growth process • This blocking is brought about by distorted perceptions, lack of awareness about feelings, or negative self-image • The therapists goal is to create an environment in which clients can engage in self- exploration and remove the barriers that block their natural tendencies toward personal growth • These barriers often result form childhood experiences that fostered unrealistic or maladaptive standards for self-worth • It focuses on the present and future instead of the past Client-Centered Therapy • Developed by Carl Rogers in the 1940s • He became convinced that the important “active ingredient” in therapy is the relationship that develops between client and therapist, and he began to focus his attention on the kind of therapeutic environment that seemed most effective in fostering self-exploration and personal growth • Rogers’s research and experiences as a therapist identified three important and interrelated therapist attributes: • Unconditional Positive Regard • Communicated when therapists show clients that they genuinely care about and accept them, without judgment or evaluation • Communicates a sense of trust in the clients’ ability to work through their problems • Empathy • The willingness and ability to view the world through the client’s eyes • Therapist comes to sense the feelings and meanings experienced by the client and communicates this understand to the client • Genuineness • Must be consistency between the way the therapist feels and the way he or she behaves • Therapist must be open enough to honestly express feelings, whether positive or negative • Ex: a therapist can express displeasure with a client’s behaviour and at the same time communicate acceptance of the client as a person • Rogers believed that when therapists can express these three critical therapeutic attributes, they create a situation in which the client feels accepted, understood, and free to explore basic attitudes and feelings without fear of being judged or rejected • Rogers believed that, as clients experience a constructive therapeutic relationship, they exhibit increased self-acceptance, greater self-awareness, enhanced slef-reliance, increased comfort with other relationships, and improved life functioning • Therapy is most likely to be successful when the therapist is perceived as genuine, warm, and empathetic Gestalt Therapy • Gestalt therapy’s goal is to bring the client into immediate awareness so that the client can be “whole” once again • Ordinarily, whatever we perceive, whether external stimuli, ideas, or emotions, we concentrate on only part of our whole experience – the figure – while largely ignoring the background against which the figure appears • For people who have psychological difficulties, that background includes important feelings, wishes, and thoughts that are blocked from ordinary awareness because they would evoke anxiety • Gestalt therapy is often carried out in groups, and use methods that are more active and dramatic than client-centered approaches, and are sometimes even confrontational in nature • Therapists often ask clients to role-play different aspects of themselves so that they may directly experience their inner dynamics • In the empty-chair technique, a client may be asked to imagine his mother sitting in the chair, and then carry on a conversation in which he alternatively role-plays his mother and himself, changing chairs for each role and honestly telling her how he feels about important issues in their relationship Cognitive Therapies • As we have seen, many behaviour disorders involve maladaptive ways of thinking about oneself and the world • Cognitive approaches to psychotherapy focus on the role of irrational and self-defeating thought patterns, and therapists who employ this approach try to help clients discover and change the cognitions that underlie their problems • In contrast to psychoanalysts, cognitive therapists do not emphasize the importance of unconscious psychodynamic processes • However, they do point out that because our habitual thought patterns are so well- practiced and ingrained, they tend to “run off” almost automatically, so that we may be only minimally aware of them • Thus, clients need help often in identifying the beliefs, ideas, and self-statements that trigger maladaptive emotions and behaviours Elli’s Rational-Emotive Therapy • Albert Ellis, originally trained a psychoanalytic therapist, became convinced that irrational thoughts, rather than unconscious dynamics, were the most immediate cause of self-defeating emotions • His theory of emotional disturbance and his rational-emotive therapy are embodied in his ABCD model: • A Stands for the activating event that seems to trigger the emotion • B Stands for the belief system that underlies the way in which a person appraises the event • C Stands for the emotional and behavioural consequences of that appraisal • D Is the key to changing maladaptive emotions and behaviours; disputing or challenging, and erroneous belief system • Ellis pointed out that people are accustomed to viewing their emotions (Cs) as being caused directly by events (As) • For example, a young man who is turned down for a date may feel rejected and depressed • However, Ellis would insist that the woman’s refusal is not the true reason for the emotional reaction • Rather, the reaction is caused by the young man’s irrational believe that “to be a worth-while person, I must be loved and accepted by virtually everyone, especially those I consider important.” • To remove this young mans depression, his belief must be countered and replaced by a more rational interpretation (e.g., “It would have been nice if she had accepted my invitation, but I don’t need to turn into a catastrophe and believe that no one will ever care about me.”) Beck’s Cognitive Therapy • Like Ellis,Aaron Beck’s goal is to point out errors of thinking and logic that underlie emotional disturbance, and to help clients identify and reprogram their overlearned and automatic though patterns • In treating depressed clients, a first step is to help clients realize that their thoughts, not the situation, cause their maladaptive emotional reactions • Beck’s contributions to the understanding and treatment of depression have made his cognitive therapy a psychological treatment of choice for that disorder • Donald Meichenbaum’s work on self- instructional training has been very influential in treatments related to stress and coping Behaviour Therapies • New practitioners of behaviour therapy deny the importance of inner dynamics and instead insist that (1) behaviour disorders are learned in the same ways normal behaviours are, and (2) these maladaptive behaviours can be unlearned by application of principles derived from research on classical conditioning and operant conditioning • In chapter 7 we described three important learning mechanisms, (1) classical conditioning, (2) operant conditioning, and (3) modelling • We now consider therapy techniques based on each of these forms of learning (1) Classical Conditioning Treatments • These procedures have been used in two major ways • First, they have been used to reduce or decondition anxiety responses • Second, they have been used in attempts to condition new anxiety responses to a particular class of stimuli, such as alcoholic beverages or inappropriate sexual objects • The most commonly used classical conditioning procedures are (A) exposure therapies, (B) systematic desensitization, and (C) aversion therapy (A) Exposure: An Extinction Approach • From a behavioural point of view, phobias and other fears result from classically conditioned emotional responses • The conditioning experience is assumed to involve a pairing of the phobic object (the neutral stimulus) with an aversive unconditioned stimulus (UCS) • As a result, the phobic stimulus becomes a conditioned stimulus (CS) that elicits the conditioned response (CR) of anxiety • The most direct way to reduce the fear is through a process of classical extinction of the anxiety response • This reduction require exposure to the feared CS in the absence of the UCS while using response prevention to keep the operant avoidance response from occurring (this is the theoretical basis for exposure) • The client may be exposed to real-life stimuli treatment known as flooding; or may be asked to imagine scenes involving stimuli, referred to as implosion therapy • Exposure has proved to be a highly effective technique for extinguishing anxiety responses in both animals and humans (B) Systematic Desensitization: A counterconditioning Approach • Joseph Wolpe introduced systematic desensitization, a new learning-based treatment for anxiety disorders • He also presented impressive outcome data for 100 phobics he had treated with the technique • Wolpe viewed anxiety as a classically conditioned emotional response • His goal was to eliminate the anxiety by using a procedure called counterconditioning, in which a new response that is incompatible with anxiety is conditioned to the anxiety-arousing CS • 1) The first step in the systematic desensitization is to train the client in the skill of voluntary muscle relaxation • 2) Next the client is helped to construct a stimulus hierarchy of 10 to 15 scenes relating to the fear • The hierarchy is carefully arranged in roughly equal steps from low-anxiety scenes to high-anxiety ones • 3) In the desensitization sessions, the therapist deeply relaxes the client and then asks the client to vividly imagine the first scene in the hierarchy for several seconds • 4) The client cant be both relaxed and anxious at the same time, so if the relaxation is strong enough, it replaces anxiety as the CR to that stimulus – the counterconditioning process (C) Aversion Therapy • For some clients, the goal is not to reduce anxiety, but to actually condition it to a particular stimulus so as tor reduce deviant (abnormal) approach behaviours • In aversion therapy, the therapist pairs a stimulus that is attractive to a person and that stimulates deviant or self-defeating behaviour (the CS) with a noxious UCS in attempt to condition an aversion for the CS • For example, aversion treatment for alcoholics may involve injecting clients with a nausea-producing drug, and then having them drink alcohol (the CS) as nausea (the UCS) develops • Similarly, pedophiles have undergone treatment in which strong electric shock is paired with slides showing children similar to those the offenders sexually abused • Aversion therapies have been applied to a range if disorders with variable results • In one study of 278 alcoholics who underwent aversion therapy, 190 (63 percent) were still abstinent a year after treatment ended (2) Operant Conditioning Treatments • The term behaviour modification refers to treatment techniques that involve the application of operant conditioning procedures in an attempt to increase or decrease a specific behaviour • These techniques may use any of the operant procedures (A) positive reinforcement, extinction, negative reinforcement, or (B) punishment • The focus on behaviour modification is on externally observable behaviours, and measurement of the behaviours targeted for change occurs throughout the treatment program • Behaviour modification techniques have been applied successfully to many different behaviour disorders • They have yielded particularly impressive results when applied to populations that are difficult to treat with more traditional therapies such as: • Chronic hospitalized schizophrenics • Profoundly disturbed children • Mentally retarded individuals • We now consider (A) positive reinforcement and (B) punishment in two of these populations (A) Positive Reinforcement • One of the dangers of long-term psychiatric hospitalization is the gradual loss of social, personal- care, and occupational skills needed to survive outside the hospital • Such deterioration is common among chronic schizophrenics who have been hospitalized for an extended period • The token economy is a system for strengthening desired behaviours – such as personal grooming, appropriate social responses, housekeeping behaviours, working on assigned jobs, and participation is vocational training programs – through the systematic application of positive reinforcement • Rather than giving tangible reinforcers, a specified number of plastic tokens is given for performance of each desired behaviour • The tokens can then be redeemed by the patients for a wide range of reinforcers • The long-term goal of token economy programs is to get the desired behaviours started with tangible reinforcers until they eventually come under the control of social reinforcers and self-reinforcement processes, which will be needed to maintain them in the world outside the hospital (B) Therapeutic Use of Punishment • Punishment is the least preferred way to control behaviour because of its aversive qualities and the potential negative side effects • Therefore, before deciding to use punishment as a therapeutic technique, therapists asks themselves two questions: • (1)Are there alternative, less painful approaches that might be effective? • (2) Is the behaviour to be eliminated sufficiently injurious to the individual or to society to justify the severity of the punishment? • Sometimes the answers to these questions lead t a decision to use punishment • Punishment is never employed without consent of the client of the client’s legal guardian in the event that the client is mentally incompetent to give consent (3) Modelling and Social Skills Training • Modelling is one of the most important and effective learning processes in humans, and modelling procedures have been used to treat a variety of behavioural problems • One of the most widely used applications is designed to teach clients social skills that they lack • In social skills training, clients learn new skills by observing and then imitating a model who performs a socially skillful behaviour • Social skills training has been used with many populations, including individuals who have minor deficits in social skills, delinquents who need to learn how to resist negative peer pressures, and even hospitalized schizophrenic patients who need to learn social
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