Therapies for Human Adjustment

1. Therapies Chapter 15: Human Adjustment John W. Santrock McGraw-Hill 2006 by The McGraw-Hill Companies, Inc. All rights reserved.

2. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-2 Chapter Outline Biological Therapies Psychotherapies Sociocultural Approaches and Issues in Treatment Evaluating Therapy

3. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-3 Learning Goals 1. Describe the biological therapies 2. Characterize four types of psychotherapy 3. Explain sociocultural approaches and issues in treatment 4. Evaluate the effectiveness of therapy

4. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-4 BIOLOGICAL THERAPIES Drug therapy Electroconvulsive Therapy Psychosurgery

5. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-5 Therapy Biological therapy = treatment to reduce or eliminate symptoms of psychological disorders by altering the way an individuals body functions Psychotherapy = process used by mental health professionals to help individuals recognize, define, an overcome psychological and interpersonal difficulties

6. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-6 Drug Therapy - Antianxiety Drugs Antianxiety drugs = commonly known as tranquilizers; drugs that reduce anxiety by making individuals calmer and less excitable

7. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-7 Drug Therapy - Antianxiety Drugs Benzodiazepines - relieve anxiety symptoms by binding to receptor sites of neurotransmitters that become overactive during anxiety Most frequently prescribed benzodiazepines include Xanax, Valium, Librium Side-effects of benzodiazepines include addiction, drowsiness, loss of coordination, fatigue

8. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-8 Drug Therapy - Antidepressant Drugs Antidepressant drugs = drugs that regulate mood

9. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-9 Drug Therapy - Antidepressant Drugs Three main classes of antidepressant drugs : tricyclics (Elavil) - increase norepinephrine and serotonin MAO inhibitors (Nardil) - not as widely used because of interactions SSRI drugs (Prozac, Paxil, Zoloft) - inhibit reabsorption of serotonin (selective serotonin reuptake inhibitors)

10. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-10 Figure 15.1 How the Antidepressant Prozac Works

11. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-11 Drug Therapy - Lithium Lithium helps reduce mood swings Lithium = drug used to treat bipolar disorder

12. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-12 Drug Therapy - Antipsychotic Drugs Antipsychotic drugs = drugs that diminish agitated behavior, reduce tension, decrease hallucinations, improve social behavior, and produce better sleep patterns in individuals who have a severe psychological disorder, especially schizophrenia

13. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-13 Drug Therapy - Antipsychotic Drugs Neuroleptics are the most widely used antipsychotic drugs reduce level of the neurotransmitter dopamine in the brain Atypical antipsychotic drugs block reuptake of serotonin Two atypical antipsychotic drugs include Clozaril and Risperdal

14. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-14 Electroconvulsive Therapy (ECT) Patient is given anesthesia and muscle relaxants before treatment, so patient has no memory of it ECT is effective for these who do not respond to other therapies Electroconvulsive therapy = treatment used to treat severely depressed individuals; treatment causes seizure in the brain

15. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-15 Psychosurgery Psychosurgery = biological therapy that involves removal of brain tissue to improve individuals adjustment

16. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-16 Review - Learning Goal 1 What types of drugs are most often used to treat anxiety disorders, mood disorders, and schizophrenia? What is electroconvulsive therapy and when is it used? What is psychosurgery?

17. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-17 PSYCHOTHERAPIES Psychodynamic Therapies Humanistic Therapies Behavior Therapies Cognitive Therapies Integrative Therapy

18. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-18 Psychodynamic Therapies Goal of psychodynamic therapies is to help individuals recognize maladaptive ways of coping and the sources of their unconscious conflicts Psychodynamic therapies = therapies that stress importance of unconscious mind, extensive interpretation by the therapist, and the role of early childhood years

19. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-19 Freuds Psychoanalysis Clients current problems can be traced to early childhood experiences involving conflicts Interpretation important - therapist searches for symbolic, hidden meaning Psychoanalysis = Freuds psychotherapeutic technique for analyzing an individuals unconscious thoughts

20. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-20 Freuds Psychoanalysis Free association - psychoanalytic technique of having individuals say aloud whatever comes to mind Catharsis - release of emotional tension when reliving emotionally charged and conflict-filled experience Dream analysis - psychotherapeutic technique used by psychoanalysts to interpret a dream Psychoanalysts believe dreams contain information about individuals unconscious thoughts and conflicts

21. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-21 Figure 15.4 Freudian Interpretation of Sexual Symbolism in Dreams

22. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-22 Freuds Psychoanalysis Resistance - psychoanalytic term for persons unconscious defense strategies that prevent analyst from understanding the persons problems Resistance occurs because it is painful to bring conflicts into conscious awareness

23. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-23 Freuds Psychoanalysis Transference - psychoanalytic term for persons relation to the analyst in ways that relive important relationships in the persons life Transference can reveal how individuals relate to important people in their lives

24. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-24 Contemporary Psychodynamic Therapies Today, individuals in psychodynamic therapy : face the therapist have weekly appointments undergo therapy for a shorter period of time

25. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-25 Contemporary Psychodynamic Therapies Currently, psychodynamic therapists emphasize (in addition to the unconscious mind): the conscious mind relationships social contexts

26. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-26 Adjustment Strategies Based on Psychodynamic Therapies 1. Recognize that the reasons for your good or poor adjustment are likely beyond conscious awareness 2. Examine your childhood experiences in your family 3. Explore whether you are relying too heavily on defense mechanisms 4. Realize that different psychodynamic therapies offer different approaches to adjustment

27. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-27 Humanistic Therapies Insight therapy = therapy that encourages insight and self-awareness; includes both psychodynamic and humanistic therapies

28. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-28 Humanistic Therapies Humanistic therapies emphasize: conscious rather than unconscious thought the present rather than the past growth and self-fulfillment rather than illness Humanistic therapies = insight therapies that encourage people to understand themselves and to grow personally

29. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-29 Client-Centered Therapy Developed by Carl Rogers (1961) Client-centered therapy = Rogers humanistic therapy in which the therapist provides a warm, supportive atmosphere to improve the clients self-concept and encourage the client to gain insight about problems

30. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-30 Client-Centered Therapy Unconditional positive regard - therapist creates a warm and caring environment and never disapproves of the client Therapists role is nondirective In addition to unconditional positive regard, client- centered therapy involves: genuineness - let client know therapists feelings active listening - give total attention to what person says

31. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-31 Gestalt Therapy Developed by Fritz Perls (1969) Therapist pushes clients to decide whether they will continue to allow the past to control their future Gestalt therapy = Perls humanistic therapy in which the therapist challenges the client to help them become aware of their feelings and to face their problems

32. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-32 Gestalt Therapy Gestalt therapists encourage clients to: be open about their feelings develop self-awareness be themselves develop a sense of freedom look at what they are doing with their lives To stimulate change, therapist often openly confronts client

33. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-33 Behavior Therapies Behavior therapists offer action-oriented strategies to help people change what they are doing The maladaptive symptoms are the problem Behavior therapies = use principles of learning to reduce or eliminate maladaptive behavior

34. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-34 Applications of Classical Conditioning Systematic desensitization steps include: develop a hierarchy of least fearful to most fearful situation to teach the individual how to relax start at the lower end of the hierarchy and work your way up Systematic Desensitization = treats anxiety by getting the person to associate deep relaxation with increasingly intense anxiety-producing situations

35. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-35 Applications of Classical Conditioning Aversive conditioning - used to teach people to avoid behaviors such as smoking, eating, and drinking Aversive conditioning = repeated pairings of an undesirable behavior with aversive stimuli to decrease the behaviors rewards

36. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-36 Figure 15.6 Classical Conditioning: the Backbone of Aversive Conditioning

37. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-37 Applications of Operant Conditioning Behavior modification = application of operant conditioning principles to change human behaviors, especially to replace unacceptable, maladaptive behavior with acceptable adaptive behaviors

38. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-38 Applications of Operant Conditioning Token economy - system in which desired behaviors are reinforced with tokens that later can be exchanged for desired rewards Token economies are used in: classrooms institutions for the mentally retarded

39. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-39 Cognitive Therapies Cognitive therapies : focus more on overt symptoms provide structure to individuals thoughts are less concerned about origin of problem Cognitive therapies = emphasize that the individuals cognitions are the main source of abnormal behavior and psychological problems

40. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-40 Cognitive Therapies Cognitive therapists : aim for cognitive restructuring (changing a pattern of thought) guide individuals to identify irrational and self-defeating thoughts use techniques to help clients: -challenge these thoughts -consider different, more positive ways of thinking

41. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-41 Rational-Emotive Behavior Therapy Goal of REBT is to get person to eliminate self- defeating beliefs by rationally examining them Rational-emotive behavior therapy (REBT) = based on Albert Ellis assertion that individuals develop a psychological disorder because of their beliefs, especially those that are irrational and self-defeating

42. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-42 Becks Cognitive Therapy Aaron Becks (1976) cognitive therapy resembles an open-ended dialogue in which the therapist helps individuals to: reflect on personal issues discover their own misconceptions try out unbiased experiments that reveal the inaccuracies of their beliefs

43. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-43 Becks Cognitive Therapy Illogical thinking can lead an individual to errors: perceive world as harmful overgeneralize on the basis of limited examples Magnify the importance of undesirable events engage in absolutist thinking

44. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-44 Adjustment Strategies Based on Becks Cognitive Therapy 1. Keep records of thoughts and emotional reactions 2. Engage in thought stopping 3. Examine options and alternatives 4. Question the evidence 5. Become positively distracted 6. Decatastrophize 7. Fantasize consequences 8. Turn adversity into advantage

45. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-45 Cognitive Behavior Therapy Self-efficacy is an important goal of cognitive behavior therapy Cognitive behavior therapy = consists of a combination of cognitive therapy and behavior therapy

46. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-46 Adjustment Strategies Self-Instructional Methods 1. Preparing for stress or anxiety 2. Confronting and handling anxiety or stress 3. Coping with feelings at critical moments 4. Reinforcing self-statements

47. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-47 Integrative Therapy Integrative therapy = combination of techniques from different therapies based on the therapists judgment of which particular techniques will provide the greatest benefit for the client

48. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-48 Integrative Therapy Move toward integrative therapy includes factors such as: proliferation of therapies inadequacy of a single therapy to be relevant to all clients and all problems lack of evidence that one therapy is better than others recognition that therapy commonalities play an important role in therapy outcomes

49. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-49 Review - Learning Goal 2 What is psychodynamic therapy? How do the humanistic therapies of Rogers and Perls differ? How are classical conditioning and operant conditioning applied in behavior therapies? What are the characteristics of RMBT, Becks cognitive therapy, and cognitive-behavior therapy? What is integrative therapy?

50. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-50 SOCIOCULTURAL APPROACHES AND ISSUES IN TREATMENT Group Therapy Family and Couple Therapy Self-Help Support Groups Community Mental Health Cultural Perspectives

51. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-51 Group Therapy Features that make group therapy attractive: Information - from leader and others in group Universality - learning that others have similar problems Altruism - members support one another Corrective recapitulation of the family group Development of social skills - give and receive feedback Interpersonal learning - practice new behaviors

52. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-52 Family and Couples Therapy Family therapy - group therapy with family members Couples therapy - therapy with married or unmarried couples whose major problem is their relationship Although one person may have abnormal symptoms, symptoms are a function of the family or couple

53. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-53 Adjustment Strategies Based on Family Therapy 1. Validation 2. Reframing 3. Structural change 4. Detriangulation

54. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-54 Self-Help Support Groups Self-help groups - voluntary organizations of individuals who get together on a regular basis to discuss topics of common interest Groups are led by a paraprofessional or member of the common interest group Self-help support groups provide members with sympathetic audience for confession and emotional release Alcoholics Anonymous (AA) is one of the best-known self- help groups

55. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-55 Adjustment Strategies for Benefiting from Self-Help Support Groups 1. The effectiveness of self-help support groups depends on local members 2. Learn more about how self-help groups work 3. Find out about the self-help support groups available in your community 4. If a self-help support group that deals with a topic in which you are interested in is not available, start one yourself

56. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-56 Community Mental Health Through the community mental health movement , mental health professionals have tried to extend the reach of therapeutic efforts The community mental health approach includes teachers, ministers, and family physicians who interact with community members to offer lay-counseling and workshops on topics such as stress, reducing drug use, and using assertiveness training

57. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-57 Cultural Perspectives Traditional psychotherapies (psychodynamic, humanistic, behavioral, cognitive) focus on individual The individual approach may not be effective in collectivist cultures

58. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-58 Ethnicity Many ethnic-minority individuals prefer discussing problems with parents, friends, and relatives rather than mental health professionals When therapist and client are from the same ethnic background, therapy can be more effective

59. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-59 Gender Traditionally, therapy has focused on autonomy or self- determination (especially important for men) Recently, more emphasis on relatedness and connection to others (especially important for women) Feminist therapists believe women must become aware of bias and discrimination in their own lives

60. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-60 Review - Learning Goal 3 What is group therapy? What characterizes family and couples therapy? What are some important features of self-help support groups? How can the community mental health approach be described? How might ethnicity and gender affect the success of psychotherapy?

61. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-61 EVALUATING THERAPY Is Therapy Effective? Common Themes in Effective Psychotherapy Funding Therapy Selecting a Therapist

62. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-62 Is Therapy Effective? Hans Eysenck (1952) concluded that psychotherapy was ineffective He found two-thirds of people with neurotic symptoms improved, whether or not they received therapy

63. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-63 Is Therapy Effective? More people receiving psychotherapy improve as compared to people who do not receive therapy Cognitive therapies and behavior therapies - help in anxiety disorders Cognitive therapies and behavior therapies - help in depression Relaxation therapy - help in treating anxiety

64. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-64 Common Themes in Effective Psychotherapy Effective therapies share three elements: inspire positive expectations increase the clients sense of mastery and competence arouse the individuals emotions

65. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-65 Funding Therapy Therapy can be expensive Many who need therapy do not get it Managed care tries to cut costs

66. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-66 Selecting a Therapist Psychotherapy is practiced by a variety of mental health professionals, including clinical psychologists , psychiatrists , and counselors Different types of mental health professionals take different approaches Licensing and certification require mental health professionals to engage in ethical practices

67. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-67 Adjustment Strategies for Seeking Professional Help 1. Become informed about the services offered by therapists 2. Consider which characteristics of a therapist are important to you 3. Identify the professionals credentials 4. Give therapy some time 5. If your goals are not being met, find a new therapist 6. Continually evaluate your progress

68. McGraw-Hill 2006 by the McGraw-Hill Companies, Inc. All rights reserved. 15-68 Review - Learning Goal 4 How effective is therapy? What are some common themes in psychotherapy? What kinds of health professionals are qualified to provide mental health treatment? What role is managed care playing in mental health treatment?