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Chapter 16
Basic features
Psychotherapy talking about problems and exploring new ways of thinking and acting
Features
Professional relationship between client and therapist Inpatients treatment in hospital or residential institution Outpatients receive tx and drugs while living in community Psychiatrists Doctors who have extra training in psychology Psychologists Holders of doctorate degree who concentrate on psychotherapy
Psychodynamic psychotherapy
Classical psychoanalysis
The talking cure using free association to cure hysteria, which is also conversion disorder Focus of treatment the unconscious becoming conscious sexual and aggressive impulses gone underground cause symptoms Dream analysis Manifest content obvious meaning Latent content hidden meaning, exploring the unconscious Transference unconscious childhood feelings and wishes towards parents transferred towards therapist. Analysis of this transference is an important psychoanalytic method
Psychodynamic psychotherapy
Humanistic psychotherapy
Basic assumptions
Treatment is an encounter between equals help clients restart growth Clients will improve on their own, given the right conditions Ideal condition of therapy client feels fully accepted and supported, no matter how horrible their behaviour is Client fully responsible for their choices
Humanistic psychotherapy
Client-centered therapy
Unconditional positive regard accept the client, so that the client can overcome conditions of worth Conditions of worth I am accepted because I am worthy (intelligent, successful, attractive, etc.) and not because I am a human being and has INHERENT WORTH. Empathy feelings WITH the client Reflection paraphrased summary of clients feelings, so that the client would feel heard Congruence therapists need to be honest with their feelings. I am confused by what youre saying. No pretensions
Humanistic psychotherapy
Gestalt therapy
Goal so that clients could become more selfaware, self accepting, and unified. Use dramatic techniques client talk to an imaginary person, therapist points out difference between what they say and how they act (eg. Smiling while talking about a sad event).
Behavior therapy
Psychological problems are LEARNED behaviors and therefore can be UNLEARNED Basic assessment:
Identify signals / triggers What are the rewards for continuing behavior
Behavior therapy
Principles
Develop rapport with client client should have confidence that change is possible Careful listing of bx and thoughts to be changed Therapist is a teacher, giving homework assignments, active planning on how to overcome the problem, etc Continuous monitoring and adjustment of plan
Behavior therapy
Behavior modification
Systematic desensitization
Progressive relaxation training Imagine thing that is scary from least scary to most scary (desensitization hierarchy) Virtual reality graded exposure replaces in vivo therapy
Behavior therapy
Exposure techniques
Flooding keeps people in feared but harmless situations, at the same time preventing them from escaping (their rewarding behavior).
Modelling
Follow what the therapist does
Behavior therapy
Positive reinforcement
Token economy system get coincs or tokens that could be exchanged for video game time, snacks, etc.
Zick Rubin, Lelitia Anne Peplau, and Peter Salovey, Psychology. Copyright 1993 by Houghton Mifflin Company. Reprinted by permission.
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Benefits:
Therapist see clients interacting with one another Clients discover they are not alone lift clients expectation for improvement Boost self confidence and self acceptance Learn from one another how they come across to others Try out new skills assertiveness
Self-help groups AA
Identified patient of the family black sheep VS. Seeing the problem as resulting from the interactions among ALL family members.
Effectiveness of therapy
Eysenck (1952) those who received therapy are worse than those who received no treatment Empirically supported therapies (ESTs)
Use experimental research to evaluate result you can choose them with confidence Criticism:
Some studies have not yet been validated Experimental studies not the same as real-life clinical settings
Client so disturbed and suicidal that hospitalization is needed client uses mental condition to defend in court therapist sued by client client talks about sexual/physical abuse of child Therapist believes client will harm others
Patients rights
Cannot be committed unless there is clear and convincing reason that they are an imminent harm to others and themselves, and gravely disabled Have the right to receive treatment, and the right not to receive treatment, EXCEPT hospital patients who are a danger to themselves and others Subjected to minimal restriction to their freedom
Biological treatments
Biological treatments
Psychoactive drugs
Neuroleptics/antipsychotics reduce hallucinations, delusions
Old generation Thorazine and Haldol New generation atypical neuroleptics Clorazil, Risperdal, Zyprexa, Seroquel, Geodon, Abilify
Biological treatments
Lithium mood stabilizer control manic & depressive episodes Anticonvulsants alternative to lithium Depakote, Lamictal Anxiolytics reduce anxiety
Benzodiazepines Highly addictive Buspirone alternative to benzodiazepines
Biological treatments
Biological treatments
Combination
Recommended for patients who are too distressed to receive psychotherapy initially Effective for long-term depression, ADHD, OCD, panic disorder, alcoholism. For those who are not exhibiting psychotic symptoms, CBT first, then medication + CBT when CBT is not effective