Fformal, theory-based
systematic treatment for mental problems or disorders that use psychological
means and conducted by a trained therapist.
A.
Psychodynamic therapies:
Therapy based on
the premise that psychological problems are manifestations of inner mental
conflicts and that conscious awareness of conflicts is key to recovery.
(Psychoanalysis: term coined by Freud.)
1. Wishes and memories
(especially sex and aggression) are unconscious.
2. Repression:
defense mechanism to keep wishes unconscious.
3. Neuroses: emotional
disorders arise from memories or wishes becoming conscious and causing
emotional breakdown.
a. Predisposing
experiences (infancy to 5-6 years).
b. Precipitating
experiences (later in life).
4. Free association
(defined above).
5. Dream interpretation:
purest form of free association.
a. Latent content:
unconscious meaning of dreams.
b. Manifest content:
what is remembered of dreams.
c. Freudian symbols:
universal disguises of content in dreams.
6. Mistakes (i.e.,
"slip of the tongue", "Freudian slip"): expressions
of unconscious wishes.
7. Resistance:
refusal to talk about a topic, forgetting or arguing as defenses against
unconscious memories becoming conscious.
8. Transference:
patient’s unconscious feelings about a person are experienced as
conscious feelings about the therapist.
9: Cure: Memories
and wishes become conscious and experienced directly or modified. Patient
no longer represses freeing psychic energy for other pursuits.
B.
Modern psychodynamic therapies:
1. Similar to Freud’s
psychoanalysis.
2. Differences:
a. Fewer sessions.
b. No couch.
c. Use of role
play to facilitate transference.
d. Less focus
on repressed memories; more focus on adult experiences.
3. Non-Freudian
psychodynamic therapies (Adler, Jung, Horney): emphasizes other conflicts
(not just sex and aggression).
C. Humanistic therapy: focuses on actualizing
(inner potential positive growth).
1. Roger’s
client-centered therapy: focuses client’s positive attributes and
how he/she can use them to identify problems and make improvements.
a. Therapists
role: sounding board.
i. Empathy: gain
client’s perspective.
ii. Unconditional
positive regard: client is worthy and capable.
iii. Genuineness:
empathy and positive regard cannot be fake.
b. Problem: client
disregards feelings and defers to authority resulting in distrust of
one’s ability to make decisions.
c. Therapy goals:
awareness of feelings; learn to trust decisions.
D. Cognitive therapy: focuses on thought
patterns; problem-centered.
1. Therapist’s
role: directive, teaching.
2. Problem: people
are disturbed by maladaptive thoughts that produce anxiety or depression.
3. Therapy goals:
identify maladaptive thought patterns; replace with adaptive thoughts.
4. Ellis’s
rational-emotive therapy (RET) (1955): negative emotions arise form people’s
irrational interpretations of their experiences, not objective experiences.
a. Musterbation:
happiness/worthiness is a result of specific things or acts.
b. Awfulizing:
mental exaggeration of setbacks.
c. ABC theory
of emotions: recognize and change irrational habitual beliefs.
i. A = activating
event in the environment.
ii. B = belief
triggered when the event occurs.
iii. C = emotional
consequence of that belief.
5. Beck’s
cognitive therapy: negative self-concept due to routine distortion of
experience.
a. Therapist’s
role: use of leading questions; assist client in helping self.
b. Problem: thought
patterns promote anxiety.
c. Therapy goals:
identify and correct thought distortions.
E. Behavior therapy: focuses on relationship between observable environments
and behaviors.
1. History: based
on laboratory work of Pavlov, Watson and Skinner.
2. Cognitive-behavior
therapy: focuses on mental process as mediators between stimuli and responses.
a. Therapist’s
role: monitor behaviors; modify techniques as needed.
b. Problem: learned
ways of thinking or acting.
c. Therapy goals:
unlearn problem thoughts or actions; learn new thoughts or actions.
3. Exposure treatments:
fear paired with harmless contexts until it is habituated (for unconditioned
fears) or extinguished (for conditioned fears).
a. Systematic
desensitization (Wolpe, 1958): muscle relaxation while imagining increasingly
anxious scenes.
b. Flooding:
inundated with fear inducing (imagined or real) stimuli until it declines
or disappears. (Useful with post-traumatic stress disorder.)
4. Aversion treatments:
reduction or elimination of a harmful habit by applying aversive stimuli
immediately after it occurs. (Example: antabuse.)
a. Criticism: learned
aversions do not generalize beyond the condition in which they are applied.
5. Other techniques:
a. Token economies:
exchange system where tokens are use as reinforcers which are traded
later for a desired reward.
b. Contingency
contracts: formal, written agreement between the client and therapist
regarding expected behaviors and their rewards.
c. Assertiveness/social
skills training: teaching social interaction or assertive behaviors
through practice and role play.
d. Modeling:
teaching by having the client watch someone else.
F. Other therapies:
1. Group therapies:
one therapist meeting with more than one client at once.
a. Group psychodynamic
therapy: clients’ interactions provide insights.
b. Humanistic
client-centered groups: honest expression in a safe place.
c. Group cognitive
and behavioral therapies: practice or role play ways of thinking and
acting with other clients.
d. Benefits:
support, feelings of less isolation, shared experience.
e. Self-help
groups. (Examples: Alcoholics Anonymous (AA), Gamblers Anonymous, Weight
Watchers.)
2. Couple/family
therapy: one therapist meets with a married or cohabiting couple, or a
whole family.
a. Family systems
perspective: each person’s role functions to accommodate the needs
of the family as a whole.
b. Intergenerational
approach: family members’ behavior may be affected by events in
previous generations.
c. Genogram:
diagram of family members’ perceptions or beliefs.
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