Module 52 & 53

Therapies

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Psychotherapy Types of Therapy1) Behavioral Therapy 2) Psychotherapeutic (Talk Therapy)3) Biomedical Therapy

Eclectic Psychotherapy—drawing on techniques from different forms of therapy, depending on the client and the problem. Pragmatic – use what evidence has shown to work.

This chart shows the percentage of psychologists (from among 1,000 members

of the American Psychological Association’s Division of Psychotherapy) who have various primary psychotherapy orientations.

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Behavioral Therapies“Behavior centered”

Classical Conditioning – e.g., Bell and Pad Treatment

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Counter Conditioninge.g., Exposure Therapy

Flooding (exposing person to high levels of feared or avoided stimuli) often backfires

Systematic Desensitization- learn inhibiting response (relaxation)- progressively image feared situations

while relaxed.- very effective treatment for

phobias.

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Aversion Conditioning e.g., antabuse

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Operant Conditioning (Behavioral Modification)Rewarding desired behaviors while ignoring or punishing undesired behaviors.

- shaping (scaffolding) - token Economies

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Talk Therapies1) Psychoanalysis “insight oriented” Catharsis Transference ResistanceEvaluation - costly & time consuming- based on a questionable theory-patients need to be highly verbal,- educated and intelligent- limited application

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When would false memories be Created?Hypnosis RepetitionAuthorityExplanation of current symptoms

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"Loftus (1997) reviewed 30 cases selected at random from 670 claims submitted to the Washington Victims Compensation Program. Twenty-six had 'recovered' a memory of abuse through therapy. All 30 were still in therapy after three years, 18 for more than five years. After treatment 20 were suicidal compared with three before treatment began, 11 were hospitalized (cf. two before treatment), eight engaged in self-mutilation (cf. one before) and marriage break-up occurred in almost all. It appears that in these cases, recovery and abreaction had serious adverse effects." -- Sydney Brandon, M.D., et al, "Recovered memories of childhood sexual abuse: implications for clinical practice," British Journal of Psychiatry, April 98, p.

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Short Term Psychodynamic Therapies- focus on the present- very directive

e.g., Unresolved grief

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2) Humanist Therapies “Client-centered Insight Therapy” Non-directive - Client figures out what is wrong, Therapists Role -acts as a sounding board - genuine- unconditional positive regard (acceptance)- empathetic

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Techniques Active Listening and Reflecting back - Therapist restates what the client says.• Paraphrase• invite clarification• reflect feelings

Evaluation of Humanist Theories- shorter term and less costly- requires verbal ability

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3) Cognitive Learning TherapiesRational-Emotive Behavioral Therapy (Albert Ellis) Help Client identify and deal with irrational thoughts(Stinking Thinking)

Musturbation - e.g., I must get an A in this class. Everyone must like me.

Catastrophising - e.g., If I don’t get an A I will be a failure for life.

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ABC theory of EmotionsA - Activating event B - Belief triggered when the event occursC - Emotional Consequences

-belief is the source of the problem.Techniques-examination of beliefs- directive - writing exercises- self-talk

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Beck’s Cognitive Therapy (CT)\-distorted thinking- unrealistic beliefs

Challenge them empirically.

e.g., No one cares about me. Challenge them to call friends and family to see if that is true.

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Family Systems TherapyCommunicationBehavioral Contracts

Group Therapy - therapist led

Self-Help Groups - peer led

Module 53

Evaluating Psychotherapies

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Does Therapy Work?

Spontaneous Remission - 65% (Eysenck)

Meta-Analysis

Average person in therapy shows better improvement than 80% of persons with similar problems who are not in therapy.

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Does one Therapy work better than another?

No. -- but some work better for some problems

Non-specific Factors1) Hope2) New perspective (support and explanation) 3) Empathic, trusting, caring relationship4) Commitment to change

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Eclectism – pragmatic- draws from all therapeutic techniques- tailored to problem type- tailored to client type

Evidence Based Practice.

Alternative therapiesEye Movement Desensitization and Reprocessing (EMDR)

Does it work?

-Specific traumas (84% success)

Why ??

- perhaps just systematic desensitization.

- Placebo effect?ch15 22