psychotherapy. therapy comes in many forms many sources and types of treatment are available many...
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PsychotherapyPsychotherapy
Therapy Comes in Many FormsTherapy Comes in Many Forms
Many sources and types of treatment are Many sources and types of treatment are availableavailable
There are two broad categories of therapyThere are two broad categories of therapy
• Somatic therapySomatic therapy
Treating psychological disorders by treating the Treating psychological disorders by treating the bodybody
Somatic therapy often involves methods that Somatic therapy often involves methods that affect hormone levels and brain chemistryaffect hormone levels and brain chemistry
• PsychotherapyPsychotherapy
Treatment of psychological problems Treatment of psychological problems through psychological techniquesthrough psychological techniques
It is a change-oriented processIt is a change-oriented process
Its goal is to teach people to cope better Its goal is to teach people to cope better and lead more fulfilling livesand lead more fulfilling lives
It does so by teaching people to relieve It does so by teaching people to relieve stress, improve interpersonal stress, improve interpersonal communication, understand previous life communication, understand previous life events, and/or modify their thinkingevents, and/or modify their thinking
Therapy Comes in Many Forms
Is Psychotherapy Necessary and Is Psychotherapy Necessary and Effective?Effective?
Does psychotherapy simply create Does psychotherapy simply create placebo effect?placebo effect?
• A A placebo effectplacebo effect is a nonspecific is a nonspecific improvement as a result of a person’s improvement as a result of a person’s expectations of changeexpectations of change
It is not a result of a therapeutic treatmentIt is not a result of a therapeutic treatment
Some patients in psychotherapy may show Some patients in psychotherapy may show relief from their symptoms simply because relief from their symptoms simply because they are in therapy and may expect changethey are in therapy and may expect change
Is Psychotherapy Effective?Is Psychotherapy Effective?
• Researchers must determine if Researchers must determine if improvements are due to expectations or improvements are due to expectations or real benefits of therapyreal benefits of therapy
• The double-blind technique helps The double-blind technique helps distinguish between improvements due to distinguish between improvements due to expectations or therapyexpectations or therapy
Some patients in psychotherapy may show Some patients in psychotherapy may show relief from their symptoms simply because relief from their symptoms simply because they are in therapy and may expect changethey are in therapy and may expect change
The placebo effect complicates research on The placebo effect complicates research on therapy effectivenesstherapy effectiveness
Is Psychotherapy Effective?Is Psychotherapy Effective?
• TheThe double-blind eliminates any potential double-blind eliminates any potential bias by reducing demand characteristicsbias by reducing demand characteristics
The double-blind technique helps distinguish between improvements due to expectations or therapy
In the double-blind technique neither the experimenter nor participants know who is in the experimental or control groups
The double-blind eliminates any potential The double-blind eliminates any potential bias by reducing demand characteristicsbias by reducing demand characteristics
• Demand characteristicsDemand characteristics are elements of an are elements of an experiment that might bias the participant experiment that might bias the participant to act in a certain wayto act in a certain way
By perceiving the situation in a certain way, or By perceiving the situation in a certain way, or becoming aware of the purpose of the studybecoming aware of the purpose of the study
Demand characteristics distort the results of a Demand characteristics distort the results of a studystudy
Is Psychotherapy Effective?
Is Psychotherapy Effective?
Demand characteristics distort the Demand characteristics distort the results of a studyresults of a study
Research studies that compare Research studies that compare psychotherapy and placebo psychotherapy and placebo treatment show the therapies are treatment show the therapies are consistently more effectiveconsistently more effective
Research on PsychotherapyResearch on Psychotherapy
In a 1952 paper, Hans Eysenck challenged In a 1952 paper, Hans Eysenck challenged the effectiveness of psychotherapythe effectiveness of psychotherapy
• He claimed that it produced no greater change He claimed that it produced no greater change in maladjustment than natural life experiencesin maladjustment than natural life experiences
• Thousands of studies investigating the Thousands of studies investigating the effectiveness of therapy followedeffectiveness of therapy followed
• These studies, and analyses using sophisticated These studies, and analyses using sophisticated statistical techniques, found psychotherapy to statistical techniques, found psychotherapy to be effectivebe effective
Research on PsychotherapyResearch on Psychotherapy
These studies, and These studies, and analyses using analyses using sophisticated sophisticated statistical statistical techniques, found techniques, found psychotherapy to be psychotherapy to be effectiveeffective
Effectiveness and Effectiveness and the client’s speed of the client’s speed of response vary with response vary with the type of problemthe type of problem
Is one type of therapy Is one type of therapy more effective?more effective?
• Many researchers Many researchers contend that most contend that most psychotherapies are psychotherapies are equally effectiveequally effective
• If most therapies are If most therapies are effective, there must effective, there must be a common be a common underlying underlying component making component making them successfulthem successful
Research on PsychotherapyResearch on Psychotherapy
If most therapies are effective, there must If most therapies are effective, there must be a common underlying component be a common underlying component making them successfulmaking them successful
• Researchers are seeking to systematize Researchers are seeking to systematize research strategies to investigate the research strategies to investigate the effectiveness of therapieseffectiveness of therapies
• This research will lead to a clearer picture of This research will lead to a clearer picture of which approaches are best for certain disorders which approaches are best for certain disorders and clients of various ages and ethnic groupsand clients of various ages and ethnic groups
Which Therapy, Which Therapist?Which Therapy, Which Therapist?
There are hundreds of types of There are hundreds of types of therapytherapy
• Some focus on individuals, some on Some focus on individuals, some on groups (group therapy) and others on groups (group therapy) and others on families (family therapy)families (family therapy)
• Community psychologistsCommunity psychologists focus on focus on whole communitieswhole communities
Which Therapy?Which Therapy?
Community Community psychologistspsychologists focus on whole focus on whole communitiescommunities
They try to They try to develop action-develop action-oriented oriented approaches to approaches to individual and individual and social problemssocial problems
A therapist’s A therapist’s training usually training usually determines the determines the approach takenapproach taken
Many therapists Many therapists take an take an eclectic eclectic approachapproach, , combining different combining different techniquestechniques
Which Therapy?Which Therapy?
A number of specific psychotherapeutic A number of specific psychotherapeutic approaches are in use todayapproaches are in use today
• Psychodynamically based approaches Psychodynamically based approaches are based on are based on Freud’s ideasFreud’s ideas
Psychodynamic approaches aim to help patients Psychodynamic approaches aim to help patients understand the motivations underlying their behaviorunderstand the motivations underlying their behavior
They assume abnormal behavior occurs when people They assume abnormal behavior occurs when people do not understand themselves do not understand themselves
• Humanistic approachesHumanistic approaches assume assume people are essentially goodpeople are essentially good
Humanistic approaches try to help Humanistic approaches try to help people realize their full potential and people realize their full potential and find meaning in lifefind meaning in life
• Behavior therapyBehavior therapy is based on the is based on the assumption most behaviors are assumption most behaviors are learnedlearned
Behavior therapists encourage clients Behavior therapists encourage clients to learn new adaptive behaviorsto learn new adaptive behaviors
Which Therapy?
• Cognitive therapyCognitive therapy focuses on changing a focuses on changing a client’s behavior by changing thoughts client’s behavior by changing thoughts and perceptionsand perceptions
A new approach, A new approach, psychotherapy psychotherapy integrationintegration, is now emerging, is now emerging
• It is more than an eclectic approach, because It is more than an eclectic approach, because the goal is to integrate theories into a new the goal is to integrate theories into a new approachapproach
• Research on psychotherapy integration is Research on psychotherapy integration is relatively scarcerelatively scarce
Which Therapy?
The effectiveness of The effectiveness of different kinds of different kinds of therapy depends on therapy depends on two things, the two things, the disorder treated and disorder treated and the goals of the the goals of the clientclient
Research to discover Research to discover the best treatment the best treatment usually focuses on usually focuses on specific disordersspecific disorders
Research on Research on psychotherapy psychotherapy integration is integration is relatively scarcerelatively scarce
This is because it is This is because it is difficult to generate difficult to generate hypotheses based on hypotheses based on the new points of the new points of view it createsview it creates
Which Therapy?
Which Therapy?Which Therapy?
• These include ethnicity, personality, level of These include ethnicity, personality, level of experience, and degree of empathyexperience, and degree of empathy
• While there are differences among therapists, While there are differences among therapists, there are also commonalitiesthere are also commonalities
Research to discover the best treatment Research to discover the best treatment usually focuses on specific disordersusually focuses on specific disorders
Besides therapeutic approaches, some Besides therapeutic approaches, some characteristics of the therapist affect characteristics of the therapist affect treatmenttreatment
Which Therapy?Which Therapy?
• Good therapists communicate interest, Good therapists communicate interest, understanding, respect, tact, and maturityunderstanding, respect, tact, and maturity
• Good therapists use suggestions, Good therapists use suggestions, interpretation, encouragement, and interpretation, encouragement, and perhaps rewards to help clients changeperhaps rewards to help clients change
While there are differences among While there are differences among therapists, there are also commonalitiestherapists, there are also commonalities
• Clients receive attention, which helps them Clients receive attention, which helps them maintain a positive attitudemaintain a positive attitude
Which Therapy?Which Therapy?
Good therapists use suggestions, Good therapists use suggestions, interpretation, encouragement, and interpretation, encouragement, and perhaps rewards to help clients changeperhaps rewards to help clients change
But clients must be willing to make some But clients must be willing to make some changes in their lifestyles and ideaschanges in their lifestyles and ideas
The therapist and client must form an The therapist and client must form an alliance to work together purposefullyalliance to work together purposefully
Culture and TherapyCulture and Therapy
The therapy process and its outcome are The therapy process and its outcome are effected by the client’s ethnicityeffected by the client’s ethnicity
• Care must be taken to be culturally Care must be taken to be culturally congruentcongruent
Have a match between therapist and clientHave a match between therapist and client
At a minimum, the therapist must respect At a minimum, the therapist must respect multiculturalismmulticulturalism
Culture and TherapyCulture and Therapy At a minimum, the therapist must respect At a minimum, the therapist must respect
multiculturalismmulticulturalism
• The acceptance of and celebration of distinct The acceptance of and celebration of distinct cultural heritagescultural heritages
• Therapists must also see beyond the Therapists must also see beyond the distinct margins of a specific culturedistinct margins of a specific culture
• Therapists must see individuals as made up Therapists must see individuals as made up of a confluence of different influencesof a confluence of different influences
Culture and TherapyCulture and Therapy
Therapists must see individuals as made Therapists must see individuals as made up of a confluence of different influencesup of a confluence of different influences
• This view is called This view is called transculturalismtransculturalism
This view reflects changes that have This view reflects changes that have occurred in the world through occurred in the world through globalization, mobility, improved globalization, mobility, improved communication, and intermarriagecommunication, and intermarriage
Therapists need to be well informed Therapists need to be well informed about clients’ backgroundsabout clients’ backgrounds
Culture and TherapyCulture and Therapy
Therapists need to be well about clients’ Therapists need to be well about clients’ backgroundsbackgrounds
• They should provide interventions based They should provide interventions based upon and using cultural symbols and upon and using cultural symbols and rituals meaningful to the clientrituals meaningful to the client
Asian culture reflects family and roles in Asian culture reflects family and roles in the family, so they must be taken into the family, so they must be taken into accountaccount
Some cultures have prohibitions against Some cultures have prohibitions against self-disclosure, or toward controlself-disclosure, or toward control
Culture and TherapyCulture and Therapy
Some cultures have prohibitions Some cultures have prohibitions against self-disclosure, or toward against self-disclosure, or toward controlcontrol
Some Arab cultures resist emotional Some Arab cultures resist emotional explorationexploration
Such cultures are more likely to value Such cultures are more likely to value and adapt to cognitive therapiesand adapt to cognitive therapies
Cultural mistrust of therapy situations Cultural mistrust of therapy situations is common among African-Americansis common among African-Americans
Culture and TherapyCulture and Therapy
Cultural mistrust of therapy situations is Cultural mistrust of therapy situations is common among African-Americanscommon among African-Americans
By contrast, many Hispanic cultures have By contrast, many Hispanic cultures have a high regard for experts like therapistsa high regard for experts like therapists
The therapists ethnicity is also importantThe therapists ethnicity is also important
Latino, African-American, and Asian-Latino, African-American, and Asian-American therapists are viewed differently American therapists are viewed differently than European-American therapiststhan European-American therapists
Culture and TherapyCulture and Therapy
Latino, African-American, and Asian-Latino, African-American, and Asian-American therapists are viewed differently American therapists are viewed differently than European-American therapiststhan European-American therapists
It must be remembered that culture is It must be remembered that culture is dynamic, contextual, and even politicaldynamic, contextual, and even political
Stereotypes and oversimplifications also Stereotypes and oversimplifications also aboundabound
Therapists must recognize that members of Therapists must recognize that members of other groups may not share their own cultural other groups may not share their own cultural valuesvalues
Culture and TherapyCulture and Therapy
Therapists must recognize that members of Therapists must recognize that members of other groups may not share their own other groups may not share their own cultural valuescultural values
They must also realize that their They must also realize that their preconceived ideas can affect the outcome preconceived ideas can affect the outcome of therapyof therapy
• They may be oppressive to their clientsThey may be oppressive to their clients
• This may constrain their effectiveness as This may constrain their effectiveness as therapiststherapists
Gender and TherapyGender and Therapy
Not only is ethnicity important, gender is Not only is ethnicity important, gender is also a significant factor in therapyalso a significant factor in therapy
• Women seek out therapy more often than menWomen seek out therapy more often than men
• They also respond differently to therapy, and They also respond differently to therapy, and to drug therapyto drug therapy
• Communication differences may also affect Communication differences may also affect therapy (Tannen, 2001)therapy (Tannen, 2001)
Gender and TherapyGender and Therapy
• Clients may also experience gender bias in their Clients may also experience gender bias in their families that affects their gender assumptionsfamilies that affects their gender assumptions
• Gender differences can be compounded by Gender differences can be compounded by ethnicityethnicity
Communication differences may also Communication differences may also affect therapyaffect therapy
• Men tend to give Men tend to give reportsreports while women try to while women try to establish establish rapportrapport
Gender and TherapyGender and Therapy
• Gay men and lesbians bring still another Gay men and lesbians bring still another view to gender roles in the therapeutic view to gender roles in the therapeutic situationsituation
• Therapists must also understand how their Therapists must also understand how their own gender socialization affects therapyown gender socialization affects therapy
Gender differences can be compounded by Gender differences can be compounded by ethnicityethnicity
• People from different cultural backgrounds People from different cultural backgrounds may view masculinity differentlymay view masculinity differently
Gender and TherapyGender and Therapy
Therapists must also understand Therapists must also understand how their own gender socialization how their own gender socialization affects therapyaffects therapy
They must avoid gender They must avoid gender stereotypes, and recognize the stereotypes, and recognize the diversity of men’s and women’s diversity of men’s and women’s experiencesexperiences
Managed Care and PsychologyManaged Care and Psychology
““Managed care” emphasizes active Managed care” emphasizes active coordination and arrangement of health care coordination and arrangement of health care servicesservices
• It usually involves three components:It usually involves three components:
Oversight of the care givenOversight of the care given
Contractual relationships with, and Contractual relationships with, and organization of, the providers giving careorganization of, the providers giving care
Determines the covered benefitsDetermines the covered benefits
Managed Care and PsychologyManaged Care and Psychology
The aim of managed care is to control costsThe aim of managed care is to control costs
There are two major difficulties with managed careThere are two major difficulties with managed care
• First, insurance companies seek to limit the time or First, insurance companies seek to limit the time or type of psychotherapy a person may accesstype of psychotherapy a person may access
• The second problem is that insurance companies limit The second problem is that insurance companies limit who a client can seewho a client can see
Both deal with access to timely and effective Both deal with access to timely and effective treatmenttreatment
Managed CareManaged Care
Insurance Insurance companies limit who companies limit who a client can seea client can see
Many HMOs require Many HMOs require re-approval of re-approval of therapy every six therapy every six sessionssessions
This tends to make This tends to make therapy shortertherapy shorter
It also means the It also means the therapist must therapist must continually justify a continually justify a person’s treatmentperson’s treatment
Edwards (1999) Edwards (1999) believes that these believes that these factors compromise factors compromise the the practitioner/client practitioner/client alliancealliance
Managed CareManaged Care
Edwards (1999) believes that these factors Edwards (1999) believes that these factors compromise the practitioner/client alliancecompromise the practitioner/client alliance
Managed care has led to Managed care has led to brief therapybrief therapy
• Six weeks is common, and 16 is considered Six weeks is common, and 16 is considered lengthylengthy
• One objective of brief therapy is saving clients One objective of brief therapy is saving clients time and moneytime and money
Managed CareManaged Care
One objective of One objective of brief therapy is brief therapy is saving clients time saving clients time and moneyand money
Clients may remain Clients may remain in therapy longer if in therapy longer if they feel it is they feel it is needed and can needed and can continue to paycontinue to pay
Clients can also Clients can also return to therapy if return to therapy if they feel they need they feel they need it in the futureit in the future
Brief TherapyBrief Therapy
Practitioners of brief therapy think in Practitioners of brief therapy think in terms of terms of plannedplanned short-term treatments short-term treatments
• They make sure treatment begins in the They make sure treatment begins in the first sessionfirst session
An An operational diagnosisoperational diagnosis is made is made
The operational diagnosis answers the The operational diagnosis answers the question “Why is the client here today?”question “Why is the client here today?”
Brief TherapyBrief Therapy
The operational The operational diagnosis answers diagnosis answers the question “Why the question “Why is the client here is the client here today?”today?”
The answer helps The answer helps pinpoint the pinpoint the specific problem specific problem for which the client for which the client is seeking helpis seeking help
During the first During the first session, the client session, the client also makes a also makes a “therapeutic “therapeutic contract” with the contract” with the therapiststherapists
The therapeutic The therapeutic contract establishes contract establishes precise goals for the precise goals for the therapytherapy
Brief TherapyBrief Therapy
• Especially when tailored to the clients needs and Especially when tailored to the clients needs and timetime
• Brief therapy is highly effective with couples and Brief therapy is highly effective with couples and when combined with cognitive restructuringwhen combined with cognitive restructuring
The therapeutic contract establishes The therapeutic contract establishes precise goals for the therapyprecise goals for the therapy
Research on brief therapy suggests that it Research on brief therapy suggests that it is effective and has long-lasting effectsis effective and has long-lasting effects
Brief TherapyBrief Therapy
Brief therapy is highly Brief therapy is highly effective with couples effective with couples and when combined and when combined with cognitive with cognitive restructuringrestructuring
However, research However, research has been limited to has been limited to relatively few clients relatively few clients and a narrow range and a narrow range of problemsof problems
Further research Further research on brief therapy is on brief therapy is being conductedbeing conducted
But, it is inaccurate But, it is inaccurate and misleading to and misleading to say no one gets say no one gets appropriate care appropriate care from managed from managed carecare
Managed CareManaged Care
• They also fear it is managed by people with little or They also fear it is managed by people with little or no training who never meet patientsno training who never meet patients
• It poses a social policy question whether our society It poses a social policy question whether our society wants to provide psychotherapy for those in needwants to provide psychotherapy for those in need
It is inaccurate and misleading to say no one It is inaccurate and misleading to say no one gets appropriate care from managed caregets appropriate care from managed care
Still, many practitioners worry that care is Still, many practitioners worry that care is terminated too quicklyterminated too quickly
Choosing a TherapistChoosing a Therapist The best way to choose a therapist is to The best way to choose a therapist is to
ask aroundask around
• Ask family and friendsAsk family and friends
• Talk to one’s doctorTalk to one’s doctor
Many doctors work with a team of health Many doctors work with a team of health care providers, including psychotherapistscare providers, including psychotherapists
Doctors can suggest someone they know to Doctors can suggest someone they know to be effectivebe effective
Choosing a TherapistChoosing a Therapist
Doctors can suggest someone they Doctors can suggest someone they know to be effectiveknow to be effective
Consult the psychology department of Consult the psychology department of local colleges or the staff of community local colleges or the staff of community health care centershealth care centers
Once one has a list of several Once one has a list of several practitioners, find out if they are licensedpractitioners, find out if they are licensed
Choosing a TherapistChoosing a Therapist
Once one has a list Once one has a list of several of several practitioners, find practitioners, find out if they are out if they are licensedlicensed
Ask what kind of Ask what kind of treatment treatment procedures they procedures they useuse
Find out if they have a Find out if they have a specialty specialty
• Such as working with Such as working with children or teenschildren or teens
• Working with eating Working with eating disordersdisorders
In the end, one must In the end, one must choose a therapist with choose a therapist with whom one is whom one is comfortablecomfortable
PsychoanalysisPsychoanalysis
And Psychodynamic TherapiesAnd Psychodynamic Therapies
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PsychoanalysisPsychoanalysis
PsychoanalysisPsychoanalysis is a lengthy insight is a lengthy insight therapy developed by Freudtherapy developed by Freud
• It aims at uncovering unconscious conflictsIt aims at uncovering unconscious conflicts
• It uses techniques such as free association It uses techniques such as free association and dream analysisand dream analysis
Psychodynamically based therapiesPsychodynamically based therapies use use techniques derived from Freud, but techniques derived from Freud, but reject or modify parts of his theoryreject or modify parts of his theory
Psychodynamically based therapiesPsychodynamically based therapies use use techniques derived from Freud, but techniques derived from Freud, but reject or modify parts of his theoryreject or modify parts of his theory
Freud’s therapy is an Freud’s therapy is an insight therapyinsight therapy
• It attempts to discover relationships between It attempts to discover relationships between unconscious motivation and abnormal behaviorunconscious motivation and abnormal behavior
• Any insight therapy has two basic assumptionsAny insight therapy has two basic assumptions
Psychoanalysis
• Second, the causes of maladjustment are Second, the causes of maladjustment are unresolved conflictsunresolved conflicts
The person is unaware of these conflicts, The person is unaware of these conflicts, and therefore cannot deal with themand therefore cannot deal with them
Any insight therapy has two basic Any insight therapy has two basic assumptions:assumptions:
• First, becoming aware of one’s motivations First, becoming aware of one’s motivations helps one change and become more helps one change and become more adaptiveadaptive
Psychoanalysis
Goal of PsychoanalysisGoal of Psychoanalysis The goal is to help patients understand the The goal is to help patients understand the
unconscious motivations that direct their unconscious motivations that direct their behaviorsbehaviors
• Only by becoming aware of these motivations Only by becoming aware of these motivations can they choose behaviors that lead to more can they choose behaviors that lead to more fulfilling livesfulfilling lives
• During analysis, patients are encouraged to During analysis, patients are encouraged to express healthy impulses, strengthen day-to-express healthy impulses, strengthen day-to-day functioning based on reality, and perceive day functioning based on reality, and perceive the world as a positive placethe world as a positive place
Copyright © Allyn & Bacon 2003
Techniques of PsychoanalysisTechniques of Psychoanalysis Psychoanalysis is geared toward the Psychoanalysis is geared toward the
exploration of early experiencesexploration of early experiences
Two major techniques are free association Two major techniques are free association and dream analysisand dream analysis
In In free associationfree association, the patient is asked to , the patient is asked to report whatever comes to mind, no matter report whatever comes to mind, no matter how disorganized or trivialhow disorganized or trivial
Techniques of PsychoanalysisTechniques of Psychoanalysis In In free associationfree association, the patient is asked to report , the patient is asked to report
whatever comes to mind, no matter how whatever comes to mind, no matter how disorganized or trivialdisorganized or trivial
• One purpose is to help patients recognize connections One purpose is to help patients recognize connections and patterns among their thoughtsand patterns among their thoughts
• It also allows free expression of the unconsciousIt also allows free expression of the unconscious
In In dream analysisdream analysis, patients are asked to , patients are asked to describe their dreams in detaildescribe their dreams in detail
Techniques of PsychoanalysisTechniques of Psychoanalysis
In In dream analysisdream analysis, patients are asked to , patients are asked to describe their dreams in detaildescribe their dreams in detail
• The dreams are interpreted to provide insight The dreams are interpreted to provide insight into unconscious motivationinto unconscious motivation
• Freud believed dreams represent some element Freud believed dreams represent some element of the unconscious seeking expressionof the unconscious seeking expression
Both free association and dream analysis Both free association and dream analysis involve the therapist’s interpretationsinvolve the therapist’s interpretations
Both free association and dream analysis Both free association and dream analysis involve the therapist’s interpretationsinvolve the therapist’s interpretations
InterpretationInterpretation involves providing a context, involves providing a context, meaning, or cause, for an idea, feeling, or meaning, or cause, for an idea, feeling, or set of behaviorsset of behaviors
• The therapist attempts to find a common thread in a The therapist attempts to find a common thread in a patient’s behaviors and thoughtspatient’s behaviors and thoughts
• Patients’ use of defense mechanisms may point to areas Patients’ use of defense mechanisms may point to areas that need to be exploredthat need to be explored
Techniques of Psychoanalysis
Techniques of PsychoanalysisTechniques of Psychoanalysis
Defense mechanisms may point to areas Defense mechanisms may point to areas that need to be exploredthat need to be explored
Two processes in psychoanalysis are Two processes in psychoanalysis are resistance and transferenceresistance and transference
• ResistanceResistance is an unwillingness to cooperate is an unwillingness to cooperate
• In resistance, the patient may be unwilling In resistance, the patient may be unwilling to provide information, or help in to provide information, or help in interpretationinterpretation
Resistance shows one of Resistance shows one of two thingstwo things
• The patient wishes to The patient wishes to avoid talking about a avoid talking about a topictopic
• Or, a difficult stage of Or, a difficult stage of therapy has been therapy has been reachedreached
To minimize resistance, To minimize resistance, analysts try to accept a analysts try to accept a patient’s behaviorpatient’s behavior
In resistance, the In resistance, the patient may be patient may be unwilling to provide unwilling to provide information, or help information, or help in interpretationin interpretation
Resistance may Resistance may sometimes reach sometimes reach the point of the point of belligerencebelligerence
Techniques of Psychoanalysis
To minimize resistance, analysts try to accept To minimize resistance, analysts try to accept a patient’s behaviora patient’s behavior
During During transferencetransference, the therapist becomes , the therapist becomes the object of a patient’s emotional attitudes the object of a patient’s emotional attitudes about an important person in the patient’s lifeabout an important person in the patient’s life
• The importance of transference is that the therapist will The importance of transference is that the therapist will respond differently than the important personrespond differently than the important person
• This allows the patient to experience conflict differentlyThis allows the patient to experience conflict differently
Techniques of Psychoanalysis
The therapist can The therapist can also guide the person also guide the person to explore repressed to explore repressed ideasideas
Examining previously Examining previously unacceptable unacceptable thoughts and thoughts and feelings helps feelings helps patients identify patients identify underlying conflictsunderlying conflicts
This allows the This allows the patient to patient to experience conflict experience conflict differentlydifferently
This gives patients This gives patients a new opportunity a new opportunity to explore their to explore their feelingsfeelings
Techniques of Psychoanalysis
Examining previously Examining previously unacceptable unacceptable thoughts and feelings thoughts and feelings helps patients identify helps patients identify underlying conflictsunderlying conflicts
Psychoanalysis Psychoanalysis involves slowly involves slowly gaining insights into gaining insights into the unconsciousthe unconscious
These insights allow These insights allow the patient to learn the patient to learn new ways of coping new ways of coping with instinctual with instinctual urgesurges
The patient also The patient also develops mature develops mature ways of dealing ways of dealing with anxiety and with anxiety and guiltguilt
Techniques of Psychoanalysis
Techniques of PsychoanalysisTechniques of Psychoanalysis The patient also develops mature ways of dealing The patient also develops mature ways of dealing
with anxiety and guiltwith anxiety and guilt
The cycle of interpretation, resistance, and The cycle of interpretation, resistance, and transference occurs repeatedly during transference occurs repeatedly during psychoanalysispsychoanalysis
It is sometimes referred to as It is sometimes referred to as working working throughthrough
Ego AnalysisEgo Analysis Ego analystsEgo analysts are psychoanalysts who are psychoanalysts who
assume the ego has greater control over assume the ego has greater control over behavior than Freud suggestedbehavior than Freud suggested
• They focus more on a person’s reality testing They focus more on a person’s reality testing and control over the environmentand control over the environment
• They place less emphasis on unconscious They place less emphasis on unconscious motivation and processesmotivation and processes
A major disagreement between A major disagreement between “traditional” and “ego” analysts has to “traditional” and “ego” analysts has to do with the role of the id and the egodo with the role of the id and the ego
Ego AnalysisEgo Analysis A major disagreement A major disagreement
between “traditional” between “traditional” and “ego” analysts and “ego” analysts has to do with the role has to do with the role of the id and the egoof the id and the ego
Traditional analysts Traditional analysts feels the ego grows feels the ego grows out of the id and is out of the id and is controlled by itcontrolled by it
An ego analyst An ego analyst asserts the ego is asserts the ego is independent of the independent of the idid
The ego is assumed The ego is assumed to control memory to control memory and perception, and and perception, and is not in constant is not in constant conflict with the idconflict with the id
Ego AnalysisEgo Analysis The ego is assumed to control memory and The ego is assumed to control memory and
perception, and is not in constant conflict with the perception, and is not in constant conflict with the idid
Traditional analysis focuses on unconscious Traditional analysis focuses on unconscious material in the id before trying to increase a material in the id before trying to increase a person’s ego controlperson’s ego control
Ego analysts begin by trying to strengthen Ego analysts begin by trying to strengthen the egothe ego
Ego analysts begin Ego analysts begin by trying to by trying to strengthen the egostrengthen the ego
They may ask a They may ask a client to be client to be assertive and take assertive and take control of a control of a situationsituation
A weak ego is seen A weak ego is seen to cause to cause maladjustment as maladjustment as it fails to perceive, it fails to perceive, understand, and understand, and control the idcontrol the id
By learning to By learning to master and master and develop their ego, develop their ego, people gain greater people gain greater control of their control of their liveslives
Ego Analysis
Criticisms of PsychoanalysisCriticisms of Psychoanalysis
Critics of psychoanalysis contend it is Critics of psychoanalysis contend it is unscientific, imprecise, and subjectiveunscientific, imprecise, and subjective
• They assert concepts such as id, ego, and They assert concepts such as id, ego, and superego are not linked to realitysuperego are not linked to reality
• Other critics object to Freud’s biologically Other critics object to Freud’s biologically oriented approach oriented approach
• These critics object to the notion that we are These critics object to the notion that we are bundles of energy caught in conflictbundles of energy caught in conflict
Criticisms of PsychoanalysisCriticisms of Psychoanalysis
These critics These critics object to the object to the notion that we are notion that we are bundles of energy bundles of energy caught in conflictcaught in conflict
They also object to They also object to the idea we are the idea we are driven toward driven toward hedonistic goalshedonistic goals
Freud’s ideas Freud’s ideas have been have been criticized as sexistcriticized as sexist
The effectiveness The effectiveness of psychoanalysis of psychoanalysis is open to is open to questionquestion
Criticisms of PsychoanalysisCriticisms of Psychoanalysis
• In general, it can be In general, it can be asas effective as other effective as other therapies, but not therapies, but not moremore effective effective
Psychoanalysis has certain inherent Psychoanalysis has certain inherent disadvantagesdisadvantages
The effectiveness of psychoanalysis is The effectiveness of psychoanalysis is open to questionopen to question
• It is more effective for some people than It is more effective for some people than othersothers
Criticisms of PsychoanalysisCriticisms of Psychoanalysis
Psychoanalysis has certain inherent Psychoanalysis has certain inherent disadvantagesdisadvantages
• The patient must be highly motivated The patient must be highly motivated and articulateand articulate
• It is also typically extremely expensiveIt is also typically extremely expensive
• Many people cannot afford the time or Many people cannot afford the time or money for this type of treatmentmoney for this type of treatment
Humanistic TherapiesHumanistic Therapies
Focusing on the PresentFocusing on the Present
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Humanistic TherapiesHumanistic Therapies
Humanistic therapies emphasize the Humanistic therapies emphasize the ability to reflect on conscious experienceability to reflect on conscious experience
They also emphasize that humans have They also emphasize that humans have free willfree will
Unlike psychoanalysis, humanistic Unlike psychoanalysis, humanistic therapies tend to focus on the present and therapies tend to focus on the present and futurefuture
Humanistic TherapiesHumanistic Therapies To some extent, To some extent,
humanistic humanistic therapies are therapies are insight therapiesinsight therapies
• They focus on They focus on helping people see helping people see the causes of their the causes of their behaviorbehavior
• Client-centered Client-centered therapy is a major therapy is a major humanistic therapyhumanistic therapy
Unlike psychoanalysis, Unlike psychoanalysis, humanistic therapies humanistic therapies tend to focus on the tend to focus on the present and futurepresent and future
They also assert that They also assert that people are creative people are creative and born with a desire and born with a desire to fulfill themselvesto fulfill themselves
Client-Centered TherapyClient-Centered Therapy Client-centered therapyClient-centered therapy is also known as is also known as
person-centered therapyperson-centered therapy
• It is an insight therapyIt is an insight therapy
It helps people evaluate the world and It helps people evaluate the world and themselves from their own perspectivethemselves from their own perspective
Client-centered therapy was developed by Carl Client-centered therapy was developed by Carl Rogers (1902 – 1987)Rogers (1902 – 1987)
Rogerian therapists hold that problems occur Rogerian therapists hold that problems occur when a person is kept from developing his or when a person is kept from developing his or her unique potentialher unique potential
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Techniques of Client-Centered Techniques of Client-Centered TherapyTherapy
The goal of client-centered therapy is to The goal of client-centered therapy is to help people discover their ideal selveshelp people discover their ideal selves
• This is then reconciled with their real selvesThis is then reconciled with their real selves
• The word The word clientclient rather than rather than patientpatient is is important in Roger’s form of therapyimportant in Roger’s form of therapy
In psychoanalysis, the analyst In psychoanalysis, the analyst directsdirects a a patient toward a “cure”patient toward a “cure”
In client-centered therapy, the therapist In client-centered therapy, the therapist guidesguides clients to help them find what they feel clients to help them find what they feel is right for themselvesis right for themselves
First, the therapist First, the therapist must show must show unconditional positive unconditional positive regardregard
• Be an accepting Be an accepting person who projects person who projects positive feelingspositive feelings
• Unconditional positive Unconditional positive regard counteracts a regard counteracts a client’s negative client’s negative encounters with encounters with unaccepting peopleunaccepting people
In client-centered In client-centered therapy, the therapist therapy, the therapist guidesguides clients to help clients to help them find what they them find what they feel is right for feel is right for themselvesthemselves
Rogers felt a therapist Rogers felt a therapist must have certain must have certain characteristics in characteristics in order for therapy to order for therapy to be successfulbe successful
Techniques
• Therapists are honest and aware of their own feelingsTherapists are honest and aware of their own feelings
• Counselors’ congruence allows them to communicate Counselors’ congruence allows them to communicate more effectively and help clients be more aware and more effectively and help clients be more aware and openopen
CongruenceCongruence is another component is another component
Techniques
TechniquesTechniques
The final ingredient is The final ingredient is empathic empathic listeninglistening
• Therapists must sense how their client feels and Therapists must sense how their client feels and communicate these feelings to the clientcommunicate these feelings to the client
• Therapists help their clients organize their thoughts and Therapists help their clients organize their thoughts and ideasideas
TechniquesTechniques Therapists help their clients organize Therapists help their clients organize
their thoughts and ideastheir thoughts and ideas
• Three techniques can be used to do this:Three techniques can be used to do this:
The therapist can The therapist can paraphraseparaphrase a client’s ideas a client’s ideas
The client can be asked to The client can be asked to rephraserephrase an idea or an idea or feelingfeeling
The client can The client can reflectreflect back what they had said back what they had said
TechniquesTechniques
• They are defensive, and show disorganized behaviorThey are defensive, and show disorganized behavior
• Over time, the client begins to use her or his own Over time, the client begins to use her or his own ideas as standards for self-evaluationideas as standards for self-evaluation
The client can The client can reflectreflect back what they had said back what they had said
At the beginning of therapy, clients tend to At the beginning of therapy, clients tend to express attitudes adopted from other peopleexpress attitudes adopted from other people
TechniquesTechniques
Over time, the client begins to use her or his Over time, the client begins to use her or his own ideas as standards for self-evaluationown ideas as standards for self-evaluation
• Two things may occur as a resultTwo things may occur as a result
The client may adjust the ideal self so it is in line The client may adjust the ideal self so it is in line with his or her own goals, rather than those of with his or her own goals, rather than those of othersothers
Behavior may change so it is more adaptive and Behavior may change so it is more adaptive and positivepositive
Criticisms of Client-Centered TherapyCriticisms of Client-Centered Therapy
No other therapy makes clients feel so No other therapy makes clients feel so warm, accepted, and safewarm, accepted, and safe
• Critics argue this may not be enough to bring Critics argue this may not be enough to bring about long-lasting changeabout long-lasting change
• Critics also argue that lengthy discussions Critics also argue that lengthy discussions about problems do not necessarily help about problems do not necessarily help people with present difficultiespeople with present difficulties
• It is also said that client-centered therapy It is also said that client-centered therapy focuses on concepts that are hard to define, focuses on concepts that are hard to define, such as self-actualizationsuch as self-actualization
Behavior TherapyBehavior Therapy
From the Behavioral From the Behavioral PerspectivePerspective
Behavior TherapyBehavior Therapy Behavior therapy has become especially Behavior therapy has become especially
popular in the last 30 yearspopular in the last 30 years
• This has occurred for three reasons:This has occurred for three reasons:
People sometimes have problems that may not People sometimes have problems that may not require insights or in-depth discussions of feelingsrequire insights or in-depth discussions of feelings
Managed care organizations see it as quicker and Managed care organizations see it as quicker and less expensive than other approachesless expensive than other approaches
Finally, behavior therapy can be highly effectiveFinally, behavior therapy can be highly effective
Goals of Behavior TherapyGoals of Behavior Therapy
Behavior therapyBehavior therapy focuses on focuses on changing overt behaviorchanging overt behavior
• It is also called It is also called behavior modificationbehavior modification
It uses learning principles to help people It uses learning principles to help people replace maladaptive behaviors with more replace maladaptive behaviors with more effective oneseffective ones
Behavior therapists assume changes in the Behavior therapists assume changes in the environment affect people’s responsesenvironment affect people’s responses
Goals of Behavior TherapyGoals of Behavior Therapy
Behavior therapists assume changes in the Behavior therapists assume changes in the environment affect people’s responsesenvironment affect people’s responses
Unlike psychoanalysis, behavior therapy Unlike psychoanalysis, behavior therapy does not try to discover the origins of does not try to discover the origins of behaviorbehavior
• It only tries to alter behaviorIt only tries to alter behavior
• Behavior therapists try to help people unlearn Behavior therapists try to help people unlearn faulty behaviors and learn more effective onesfaulty behaviors and learn more effective ones
Goals of Behavior TherapyGoals of Behavior Therapy
Behavior therapists try to help people unlearn Behavior therapists try to help people unlearn faulty behaviors and learn more effective onesfaulty behaviors and learn more effective ones
They do not always focus on the problem leading They do not always focus on the problem leading the client to seek therapythe client to seek therapy
If behavior therapists see the problem is If behavior therapists see the problem is associated with another situation, they associated with another situation, they may try to change that situationmay try to change that situation
Goals of Behavior TherapyGoals of Behavior Therapy If behavior therapists see the problem is If behavior therapists see the problem is
associated with another situation, they may associated with another situation, they may try to change that situationtry to change that situation
Unlike psychodynamic and humanistic Unlike psychodynamic and humanistic therapies, behavior therapy does not therapies, behavior therapy does not encourage clients to interpret past eventsencourage clients to interpret past events
Behavior therapists are dissatisfied with Behavior therapists are dissatisfied with psychodynamic and humanistic therapies psychodynamic and humanistic therapies for three basic reasonsfor three basic reasons
Goals of Behavior TherapyGoals of Behavior Therapy Second, some studies Second, some studies
show that people show that people who do not receive who do not receive those therapies those therapies improve anywayimprove anyway
Finally, once a person Finally, once a person is labeled “abnormal” is labeled “abnormal” the label itself may the label itself may lead to maladaptive lead to maladaptive behaviorbehavior
Behavior therapists Behavior therapists are dissatisfied with are dissatisfied with psychodynamic and psychodynamic and humanistic humanistic therapies for three therapies for three basic reasonsbasic reasons
First, those First, those therapies use therapies use concepts difficult to concepts difficult to define and measuredefine and measure
Goals of Behavior TherapyGoals of Behavior Therapy Once a person is labeled “abnormal”, the Once a person is labeled “abnormal”, the
label itself may lead to maladaptive behaviorlabel itself may lead to maladaptive behavior
Behavior therapists assume people do not Behavior therapists assume people do not display maladaptive behavior because they display maladaptive behavior because they are “abnormal”are “abnormal”
• They display maladaptive behavior because they They display maladaptive behavior because they are having trouble adjusting to the environmentare having trouble adjusting to the environment
• If they are taught how to cope, maladjustment If they are taught how to cope, maladjustment will disappearwill disappear
Behavior Therapy: A CriticismBehavior Therapy: A Criticism
Most insight therapists believe that if only Most insight therapists believe that if only overt behavior is treated, symptom overt behavior is treated, symptom substitution will occursubstitution will occur
• In In symptom substitutionsymptom substitution, a new overt symptom , a new overt symptom appears to replace one eliminated by appears to replace one eliminated by treatmenttreatment
• Research does show, however, that behavior Research does show, however, that behavior therapy is at least as effective as insight therapy is at least as effective as insight therapiestherapies
Techniques of Behavior TherapyTechniques of Behavior Therapy
The techniques of behavior therapy The techniques of behavior therapy include operant conditioning, modeling, include operant conditioning, modeling, and counterconditioningand counterconditioning
• A therapist will use whatever combination of A therapist will use whatever combination of techniques is needed to help a clienttechniques is needed to help a client
• Behavior therapy usually involves three Behavior therapy usually involves three general proceduresgeneral procedures
Techniques of Behavior TherapyTechniques of Behavior Therapy
Behavior therapy usually involves Behavior therapy usually involves three general procedures:three general procedures:
• First, the problem behavior and its First, the problem behavior and its frequency is examinedfrequency is examined
• Next, a treatment strategy is used, Next, a treatment strategy is used, individually tailored to the clientindividually tailored to the client
• Finally, there is continual assessment Finally, there is continual assessment as to whether behavior has changedas to whether behavior has changed
Operant ConditioningOperant Conditioning
Operant conditioning to establish a new Operant conditioning to establish a new behavior often depends on a behavior often depends on a reinforcerreinforcer
• An event or circumstance that increases the An event or circumstance that increases the probability a response will occurprobability a response will occur
• One method of rewarding adaptive behavior One method of rewarding adaptive behavior is through a is through a token economytoken economy
Token EconomiesToken Economies
In a token economy people who In a token economy people who display appropriate behaviors display appropriate behaviors receive tokensreceive tokens
• These can be exchanged for desirable These can be exchanged for desirable items and activitiesitems and activities
• Token economies are used to modify Token economies are used to modify behavior in social settingsbehavior in social settings
Token EconomiesToken Economies
Token economies Token economies are used to modify are used to modify behavior in social behavior in social settingssettings
The aim is to The aim is to strengthen strengthen behaviors behaviors compatible with compatible with normsnorms
They have been They have been used successfully in used successfully in schools and hospital schools and hospital settingssettings
Other operant Other operant techniques include techniques include extinction, extinction, punishment, and punishment, and time outtime out
ExtinctionExtinction
Extinction occurs when reinforcers are Extinction occurs when reinforcers are withheldwithheld
• This eventually leads a previously reinforced This eventually leads a previously reinforced behavior to stopbehavior to stop
• It can be used in conjunction with a token It can be used in conjunction with a token economy, or separately, to stop an economy, or separately, to stop an undesirable behaviorundesirable behavior
PunishmentPunishment
Another way to stop an undesirable Another way to stop an undesirable behavior is to use punishmentbehavior is to use punishment
• This often involves the presentation of an This often involves the presentation of an aversive stimulusaversive stimulus
It only suppresses a behaviorIt only suppresses a behavior
Punishment does not establish new, desired Punishment does not establish new, desired behaviorsbehaviors
PunishmentPunishment
Punishment does not establish new, Punishment does not establish new, desired behaviorsdesired behaviors
Thus, it is often combined with positive Thus, it is often combined with positive reinforcement for desirable behaviorsreinforcement for desirable behaviors
Punishment has other drawbacksPunishment has other drawbacks
People (especially young people) People (especially young people) sometimes imitate aggressionsometimes imitate aggression
PunishmentPunishment
Punishment can be harmfulPunishment can be harmful
People (especially young people) sometimes People (especially young people) sometimes imitate aggressionimitate aggression
Punishment can lead to generalized aggressionPunishment can lead to generalized aggression
Time-OutTime-Out
Time-outTime-out is the removal of a person from is the removal of a person from sources of reinforcementsources of reinforcement
• It is used to decrease behaviorIt is used to decrease behavior
• Time-out is principally used with childrenTime-out is principally used with children
• It is especially effective when combined with It is especially effective when combined with positive reinforcers for appropriate behaviorpositive reinforcers for appropriate behavior
CounterconditioningCounterconditioning
In In CounterconditioningCounterconditioning, a person is taught , a person is taught a new, more adaptive response to a a new, more adaptive response to a stimulusstimulus
• It is a process of reconditioningIt is a process of reconditioning
• Joseph Wolpe (1915 – 1997) was one of the Joseph Wolpe (1915 – 1997) was one of the original proponents of counterconditioningoriginal proponents of counterconditioning
• Wolpe used counterconditioning to inhibit Wolpe used counterconditioning to inhibit anxiety as a responseanxiety as a response
CounterconditioningCounterconditioning Wolpe used Wolpe used
counterconditionincounterconditioning to inhibit anxiety g to inhibit anxiety as a responseas a response
Therapy using the Therapy using the technique begins technique begins with a specific with a specific stimulus (S1) that stimulus (S1) that elicits a specific elicits a specific response (R1)response (R1)
After therapy, S1 After therapy, S1 should elicit a new should elicit a new response (R2)response (R2)
Two approaches use Two approaches use counterconditioning:counterconditioning:
• Systematic Systematic desensitizationdesensitization
• Aversive conditioningAversive conditioning
Systematic DesensitizationSystematic Desensitization
Systematic desensitizationSystematic desensitization is a three-stage is a three-stage counterconditioning procedurecounterconditioning procedure
• The client is first taught to relaxThe client is first taught to relax
The client then describes the specific The client then describes the specific situations that arouse anxietysituations that arouse anxiety
While deeply relaxed, the client imagines While deeply relaxed, the client imagines increasingly vivid scenes of the situations increasingly vivid scenes of the situations causing anxietycausing anxiety
Systematic DesensitizationSystematic Desensitization
• With each successive experience, the client With each successive experience, the client learns relaxation rather than fear as a learns relaxation rather than fear as a responseresponse
While deeply relaxed, the client imagines While deeply relaxed, the client imagines increasingly vivid scenes of the situations increasingly vivid scenes of the situations causing anxietycausing anxiety
• This gradually exposes the client to the This gradually exposes the client to the source of the anxietysource of the anxiety
Systematic DesensitizationSystematic Desensitization With each successive experience, the client With each successive experience, the client
learns relaxation rather than fear as a responselearns relaxation rather than fear as a response
Systematic desensitization is most successful for Systematic desensitization is most successful for people with two types of problemspeople with two types of problems
• Problems with impulse controlProblems with impulse control
• Particular forms of anxiety such as phobiasParticular forms of anxiety such as phobias
It is not effective for people with psychotic It is not effective for people with psychotic symptoms, or situations of interpersonal conflictsymptoms, or situations of interpersonal conflict
Aversive ConditioningAversive Conditioning
Another method using counterconditioning Another method using counterconditioning is is aversive conditioningaversive conditioning
• A noxious stimulus is paired with a stimulus A noxious stimulus is paired with a stimulus that elicits an undesirable behaviorthat elicits an undesirable behavior
This will cause the undesirable behavior to This will cause the undesirable behavior to stopstop
The goal is to teach a new response to the The goal is to teach a new response to the aversive stimulusaversive stimulus
ModelingModeling
Bandura (1997) believes modeling can be Bandura (1997) believes modeling can be used effectively for:used effectively for:
• Teaching a new behaviorTeaching a new behavior
• Helping eliminate fearsHelping eliminate fears
• Enhancing already existing behaviorEnhancing already existing behavior
One problem is that people may imitate One problem is that people may imitate the behavior of inappropriate modelsthe behavior of inappropriate models
Cognitive TherapyCognitive Therapy
An Outgrowth of Behavior An Outgrowth of Behavior TherapyTherapy
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Cognitive TherapyCognitive Therapy
Cognitive therapists assume that Cognitive therapists assume that distorted, undeveloped ideas prevent distorted, undeveloped ideas prevent people from establishing effective coping people from establishing effective coping behaviorsbehaviors
Cognitive therapy focuses on changing Cognitive therapy focuses on changing client behavior by changing the person’s client behavior by changing the person’s thoughts or perceptionsthoughts or perceptions
Cognitive therapy is derived from three Cognitive therapy is derived from three propositionspropositions
Cognitive TherapyCognitive Therapy
Cognitive therapy is derived from Cognitive therapy is derived from three propositions:three propositions:
• Cognitive activity affects behaviorCognitive activity affects behavior
• Cognitive activity can be monitoredCognitive activity can be monitored
• Behavior can be changed by altering Behavior can be changed by altering cognitive patternscognitive patterns
Cognitive TherapyCognitive Therapy
• Cognitive therapy is also known as Cognitive therapy is also known as cognitive cognitive restructuringrestructuring
• Cognitive therapy is effective for people who Cognitive therapy is effective for people who have attached narrow or inappropriate labels have attached narrow or inappropriate labels to certain behaviors or situationsto certain behaviors or situations
Many behavior therapists currently Many behavior therapists currently incorporate thought processes into incorporate thought processes into treatmenttreatment
• This is called This is called cognitive behavior therapycognitive behavior therapy
Cognitive TherapyCognitive Therapy
Cognitive therapy focuses on Cognitive therapy focuses on current behaviors and thoughtscurrent behaviors and thoughts
• It is not especially concerned with uncovering childhood It is not especially concerned with uncovering childhood experiencesexperiences
• It is especially effective if combined with techniques such It is especially effective if combined with techniques such as use of reinforcementas use of reinforcement
Rational Emotive TherapyRational Emotive Therapy The best known cognitive therapy is The best known cognitive therapy is
rational emotive therapyrational emotive therapy
• It emphasizes the importance of logical, It emphasizes the importance of logical, rational, thought processesrational, thought processes
It was developed by Albert Ellis over 30 It was developed by Albert Ellis over 30 years agoyears ago
Ellis assumed abnormal behavior is caused Ellis assumed abnormal behavior is caused by faulty and irrational thinking patternsby faulty and irrational thinking patterns
Rational Emotive TherapyRational Emotive Therapy
Ellis assumed abnormal behavior is caused Ellis assumed abnormal behavior is caused by faulty and irrational thinking patternsby faulty and irrational thinking patterns
A major goal is to help people examine A major goal is to help people examine past events that produce irrational beliefspast events that produce irrational beliefs
• Clients adopt different behavior patterns based on more Clients adopt different behavior patterns based on more rational thought processesrational thought processes
• Research supports the effectiveness of the approachResearch supports the effectiveness of the approach
Beck’s ApproachBeck’s Approach
Aaron Beck developed another cognitive Aaron Beck developed another cognitive therapytherapy
• Beck assumes depression is caused by Beck assumes depression is caused by people’s distorted thoughts about realitypeople’s distorted thoughts about reality
These lead to negative views of the world, These lead to negative views of the world, the self, and the futurethe self, and the future
A goal of Beck’s therapy is to help people A goal of Beck’s therapy is to help people develop realistic appraisals of situationsdevelop realistic appraisals of situations
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Beck’s ApproachBeck’s Approach
A goal of Beck’s therapy is to help people A goal of Beck’s therapy is to help people develop realistic appraisals of situationsdevelop realistic appraisals of situations
The therapist acts as a trainer and The therapist acts as a trainer and coinvestigatorcoinvestigator
• Providing data to be examinedProviding data to be examined
• The therapist also guides the client in The therapist also guides the client in understanding how cognitions influence behaviorunderstanding how cognitions influence behavior
Beck’s ApproachBeck’s Approach
Beck says a successful client passes through Beck says a successful client passes through four stages in moving toward mental healthfour stages in moving toward mental health
• First the client becomes aware of her/his thoughtsFirst the client becomes aware of her/his thoughts
• The client recognizes what thoughts are awryThe client recognizes what thoughts are awry
• Accurate judgments then need to be substituted for inaccurate Accurate judgments then need to be substituted for inaccurate onesones
• Finally, the client needs feedback as to whether the changes are Finally, the client needs feedback as to whether the changes are correctcorrect
Meichenbaum’s ApproachMeichenbaum’s Approach
Meichenbaum developed a third Meichenbaum developed a third cognitive therapycognitive therapy
• He believes that what people say to He believes that what people say to themselves determines what they dothemselves determines what they do
A goal of his therapy is to change what A goal of his therapy is to change what people say to themselvespeople say to themselves
The therapist must change the client’s The therapist must change the client’s appraisal of situations and the client’s use of appraisal of situations and the client’s use of self-instructionsself-instructions
Meichenbaum’s ApproachMeichenbaum’s Approach
The therapist must The therapist must change the client’s change the client’s appraisal of situations appraisal of situations and the client’s use and the client’s use of self-instructionsof self-instructions
A strength of the A strength of the approach is that it approach is that it can be used in many can be used in many settings for many settings for many problemsproblems
No attempt is No attempt is made to change made to change irrational beliefsirrational beliefs
Clients learn a Clients learn a repertoire of repertoire of activities they can activities they can use to make their use to make their behavior more behavior more adaptiveadaptive
Meichenbaum’s ApproachMeichenbaum’s Approach
• They may learn to organize their responses They may learn to organize their responses to specific situations in orderly stepsto specific situations in orderly steps
Clients learn a repertoire of activities they can Clients learn a repertoire of activities they can use to make their behavior more adaptiveuse to make their behavior more adaptive
• They may learn to conduct a private monologue in They may learn to conduct a private monologue in which they work out adaptive ways of copingwhich they work out adaptive ways of coping
Cognitive TherapyCognitive Therapy
Cognitive therapy is influencing an Cognitive therapy is influencing an increasing number of therapists who increasing number of therapists who conduct long-term, as well as brief, therapyconduct long-term, as well as brief, therapy
It can be applied to a variety of problems It can be applied to a variety of problems including anxiety, depression, marital including anxiety, depression, marital difficulties, and chronic paindifficulties, and chronic pain
Cognitive therapy in its many forms has Cognitive therapy in its many forms has been used with adults and childrenbeen used with adults and children
Cognitive TherapyCognitive Therapy
Cognitive therapy in its many Cognitive therapy in its many forms has been used with adults forms has been used with adults and childrenand children
It can be used with groups having It can be used with groups having particular characteristicsparticular characteristics
Group TherapyGroup Therapy
Group TherapyGroup Therapy
In In group therapygroup therapy, several people meet , several people meet together with a therapist to receive together with a therapist to receive treatmenttreatment
• This allows a therapist to see more clientsThis allows a therapist to see more clients
• Since fees are shared, it is also less expensiveSince fees are shared, it is also less expensive
• Group therapy can also be more effective than Group therapy can also be more effective than individual therapyindividual therapy
Group TherapyGroup Therapy
Group therapy can also be more effective Group therapy can also be more effective than individual therapythan individual therapy
• The social pressure in the group can help The social pressure in the group can help shape members’ behaviorshape members’ behavior
• Group members can also act as useful modelsGroup members can also act as useful models
• Mutual reinforcement and support can also be Mutual reinforcement and support can also be providedprovided
Techniques and Formats of Techniques and Formats of Group TherapyGroup Therapy
The techniques used are determined by The techniques used are determined by the nature of the groupthe nature of the group
It is also determined by the theoretical It is also determined by the theoretical orientation of the therapistorientation of the therapist
In traditional group therapy, 6 to 12 In traditional group therapy, 6 to 12 clients meet once a weekclients meet once a week
Techniques and FormatsTechniques and Formats
In traditional group therapy, 6 to 12 In traditional group therapy, 6 to 12 clients meet once a weekclients meet once a week
• Members are chosen on the basis of what they Members are chosen on the basis of what they can gain from and offer to the groupcan gain from and offer to the group
• The aim is to construct a group whose The aim is to construct a group whose members are compatible in terms of age, members are compatible in terms of age, needs, and problemsneeds, and problems
Techniques and FormatsTechniques and Formats
The format of traditional group therapy The format of traditional group therapy variesvaries
• Generally, each member describes his or her Generally, each member describes his or her problems to the other membersproblems to the other members
The other members relate their experiences The other members relate their experiences with similar problems, and how they copedwith similar problems, and how they coped
Thus, each member expresses their fears and Thus, each member expresses their fears and anxieties to people who are acceptinganxieties to people who are accepting
Techniques and FormatsTechniques and Formats
Thus, each member expresses their fears Thus, each member expresses their fears and anxieties to people who are acceptingand anxieties to people who are accepting
Group members have an opportunity to role Group members have an opportunity to role play new behaviors in a safe environmentplay new behaviors in a safe environment
Sometimes the therapist is directive in helping to Sometimes the therapist is directive in helping to address problemsaddress problems
At other times, the therapist has the group At other times, the therapist has the group resolve a problem independentlyresolve a problem independently
Family TherapyFamily Therapy
A A familyfamily is a group of people who are is a group of people who are committed to one another’s well-committed to one another’s well-being, preferably for lifebeing, preferably for life
• In In family therapyfamily therapy, two or more people , two or more people who are committed to each other’s well-who are committed to each other’s well-being are treated togetherbeing are treated together
• Family therapists often attempt to Family therapists often attempt to change change family systemsfamily systems
Family TherapyFamily Therapy
• Therapists assume there are multiple sources of Therapists assume there are multiple sources of psychological influencepsychological influence
Individuals in a family affect family interactionsIndividuals in a family affect family interactions
Family interactions affect individualsFamily interactions affect individuals
Family therapists often attempt to change Family therapists often attempt to change family systemsfamily systems
• Treatment takes place within the dynamic Treatment takes place within the dynamic social system of the marriage or familysocial system of the marriage or family
Family TherapyFamily Therapy
Family interactions Family interactions affect individualsaffect individuals
Sometimes family Sometimes family therapy is called therapy is called relationship relationship therapytherapy, because , because relationships are a relationships are a focus of focus of interventionintervention
A useful technique A useful technique is to is to restructurerestructure the family’s the family’s interactionsinteractions
For example, a son For example, a son may be responding may be responding passively to a passively to a domineering domineering mothermother
Family TherapyFamily Therapy
An issue in family therapy is how all An issue in family therapy is how all members of a family may become members of a family may become enmeshed in one member’s problemsenmeshed in one member’s problems
A son may be responding passively to a A son may be responding passively to a domineering motherdomineering mother
The therapist may suggest he only be The therapist may suggest he only be assigned chores by his fatherassigned chores by his father
Family TherapyFamily Therapy
• A family member may be alcoholic, but A family member may be alcoholic, but codependence may be an additional codependence may be an additional adjustment problemadjustment problem
• Codependents are often plagued by feelings Codependents are often plagued by feelings of shame, fear, anger, and painof shame, fear, anger, and pain
An issue in family therapy is how all An issue in family therapy is how all members of a family may become members of a family may become enmeshed in one member’s problemsenmeshed in one member’s problems
• This problem is called This problem is called codependencecodependence
Family TherapyFamily Therapy
Codependents are Codependents are often plagued by often plagued by feelings of shame, feelings of shame, fear, anger, and fear, anger, and painpain
However, they feel However, they feel obligated to care obligated to care for the person with for the person with the disorder or the disorder or addictionaddiction
This prevents them This prevents them from expressing from expressing their feelingstheir feelings
In some cases, In some cases, people people need need the the person to stay person to stay disordereddisordered
Family TherapyFamily Therapy
In some cases, people In some cases, people need need the the person to stay disorderedperson to stay disordered
This allows them to maintain a This allows them to maintain a controlling positioncontrolling position
Family Therapy: AssessmentFamily Therapy: Assessment
Some researchers believe family therapy to Some researchers believe family therapy to be as effective as individual therapybe as effective as individual therapy
• In some situations they say it is more effectiveIn some situations they say it is more effective
• However, not all families profit equallyHowever, not all families profit equally
It is difficult with families that are disorganizedIt is difficult with families that are disorganized
Outcomes are not as good when depression is Outcomes are not as good when depression is involvedinvolved
Family Therapy: AssessmentFamily Therapy: Assessment
Outcomes are not Outcomes are not as good when as good when depression is depression is involvedinvolved
If family members If family members drop out or refuse drop out or refuse to participate, the to participate, the outcome is almost outcome is almost always negativealways negative
Younger couples Younger couples seem to have seem to have better outcomesbetter outcomes
There is no There is no one one solution to family solution to family problemsproblems
Biologically Based Biologically Based TherapiesTherapies
Medical TherapiesMedical Therapies
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Biologically Based TherapyBiologically Based Therapy
The usual approach to a The usual approach to a psychological problem is “talking psychological problem is “talking therapy”therapy”
• For some patients, this is not enoughFor some patients, this is not enough
They may be exhibiting symptoms of bipolar They may be exhibiting symptoms of bipolar disorder or schizophreniadisorder or schizophrenia
Some people may be suicidalSome people may be suicidal
Biologically Based TherapyBiologically Based Therapy
These therapies often involve medication, or These therapies often involve medication, or hospitalizationhospitalization
Biological therapies are often used in Biological therapies are often used in combination with traditional psychotherapycombination with traditional psychotherapy
Some people may be suicidalSome people may be suicidal
• These are cases where biologically These are cases where biologically based therapies come into playbased therapies come into play
Biologically Based TherapyBiologically Based Therapy
Biological therapies are often used in Biological therapies are often used in combination with traditional combination with traditional psychotherapypsychotherapy
Most practitioners and theoreticians Most practitioners and theoreticians believe the most effective treatment believe the most effective treatment is drugs in combination with is drugs in combination with psychotherapypsychotherapy
Drug TherapyDrug Therapy
Clinicians who use drug therapy must be Clinicians who use drug therapy must be aware of several key issuesaware of several key issues
• Dosages are important and must be monitoredDosages are important and must be monitored
• Long-term use of many drugs is ill advisedLong-term use of many drugs is ill advised
• No drug will permanently cure the No drug will permanently cure the maladjustment of people who are not coping maladjustment of people who are not coping wellwell
Drug TherapyDrug Therapy
Psychotropic drugs are grouped into four Psychotropic drugs are grouped into four categoriescategories
No drug will permanently cure the No drug will permanently cure the maladjustment of people who are not maladjustment of people who are not coping wellcoping well
Drugs for the relief of mental problems Drugs for the relief of mental problems are sometimes called are sometimes called psychotropic drugspsychotropic drugs
Drug TherapyDrug Therapy
• Antianxiety drugsAntianxiety drugs
• Antimania drugsAntimania drugs
• Antipsychotic drugsAntipsychotic drugs
Psychotropic drugs are grouped Psychotropic drugs are grouped into four categoriesinto four categories
• Antidepressant drugsAntidepressant drugs
Antianxiety DrugsAntianxiety Drugs Librium, Xanax, and Valium are trade Librium, Xanax, and Valium are trade
names of widely prescribed antianxiety names of widely prescribed antianxiety drugsdrugs
• They are also known as tranquilizersThey are also known as tranquilizers
• They reduce feelings of stress, and have a They reduce feelings of stress, and have a calming effectcalming effect
• Abuse and overreliance can be a problem Abuse and overreliance can be a problem with antianxiety drugswith antianxiety drugs
Antidepressant DrugsAntidepressant Drugs
Antidepressants (Antidepressants (thymolepticsthymoleptics) ) work by altering levels of brain work by altering levels of brain chemicalschemicals
• Selective serotonin reuptake inhibitors Selective serotonin reuptake inhibitors (SSRIs) relieve depression by affecting (SSRIs) relieve depression by affecting the neurotransmitter serotoninthe neurotransmitter serotonin
• Depression is believed to occur when Depression is believed to occur when serotonin does not bind to receptors on serotonin does not bind to receptors on the next neuronthe next neuron
Antidepressant DrugsAntidepressant Drugs Depression is Depression is
believed to occur believed to occur when serotonin when serotonin does not bind to does not bind to receptors on the receptors on the next neuronnext neuron
After release, After release, neurotransmitters neurotransmitters are neutralized, or are neutralized, or re-uptake occursre-uptake occurs
SSRIs prevent the SSRIs prevent the neutralization or neutralization or reuptake of reuptake of serotoninserotonin
SSRIs thus allow SSRIs thus allow serotonin to serotonin to remain in the remain in the synapse so it can synapse so it can be effectivebe effective
Antidepressant DrugsAntidepressant Drugs
SSRIs allow SSRIs allow serotonin to remain serotonin to remain in the synapse so it in the synapse so it can be effectivecan be effective
Prozac, Zoloft, and Prozac, Zoloft, and Paxil are SSRIsPaxil are SSRIs
Two other Two other categories of categories of antidepressants antidepressants are:are:
• TricyclicsTricyclics
• Monoamine oxidase Monoamine oxidase (MAO) inhibitors(MAO) inhibitors
Tricyclics and MAO InhibitorsTricyclics and MAO Inhibitors
Tricyclics block neurotransmitter Tricyclics block neurotransmitter reuptakereuptake
MAO inhibitors break down monoamine MAO inhibitors break down monoamine oxidase (MAO)oxidase (MAO)
• MAO is an enzyme that destroys MAO is an enzyme that destroys neurotransmittersneurotransmitters
• Tricyclics pose less of a danger of Tricyclics pose less of a danger of complications than MAO inhibitorscomplications than MAO inhibitors
Tricyclics and MAO InhibitorsTricyclics and MAO Inhibitors
Tricyclics pose less of a danger of Tricyclics pose less of a danger of complications than MAO inhibitorscomplications than MAO inhibitors
Therefore, they are used more Therefore, they are used more frequentlyfrequently
ProzacProzac
About 31 million people have taken the About 31 million people have taken the SSRI Prozac since its introduction in 1987SSRI Prozac since its introduction in 1987
• Yearly sales of Prozac and other SSRIs such Yearly sales of Prozac and other SSRIs such as Zoloft and Paxil amount to more than $4 as Zoloft and Paxil amount to more than $4 billionbillion
• Earlier antidepressants could cause increased Earlier antidepressants could cause increased heart rate and blood pressure, nausea, and heart rate and blood pressure, nausea, and sleeplessnesssleeplessness
ProzacProzac
• However, Prozac does not help everyoneHowever, Prozac does not help everyone
• Psychologists worry that Prozac is so Psychologists worry that Prozac is so effective that the original problems leading effective that the original problems leading to depression may be overlookedto depression may be overlooked
Earlier antidepressants could cause Earlier antidepressants could cause increased heart rate and blood pressure, increased heart rate and blood pressure, nausea, and sleeplessnessnausea, and sleeplessness
Prozac has fewer side effectsProzac has fewer side effects
ProzacProzac
Psychologists worry that Prozac is so Psychologists worry that Prozac is so effective that the original problems effective that the original problems leading to depression may be leading to depression may be overlookedoverlooked
Most psychologists feel SSRIs should Most psychologists feel SSRIs should be part of a full treatment program be part of a full treatment program that also includes psychotherapythat also includes psychotherapy
Antidepressants: ResearchAntidepressants: Research
Research on the effectiveness of Research on the effectiveness of antidepressants is contradictoryantidepressants is contradictory
Some studies show strong effects, Some studies show strong effects, others report only modest help others report only modest help from the drugsfrom the drugs
Antimania DrugsAntimania Drugs
Lithium carbonate has long been Lithium carbonate has long been used as an effective antimania drugused as an effective antimania drug
The dosage is vitalThe dosage is vital
• Too much produces noxious side effectsToo much produces noxious side effects
• Too little has no effectToo little has no effect
Antipsychotic DrugsAntipsychotic Drugs
Schizophrenia is treated using Schizophrenia is treated using antipsychoticsantipsychotics
• Technically called Technically called neurolepticsneuroleptics
The most common are the The most common are the phenothiazinesphenothiazines
Chlorpromazine (Thorazine) is the most Chlorpromazine (Thorazine) is the most common phenothiazinecommon phenothiazine
Antipsychotic DrugsAntipsychotic Drugs Clozapine (Clozaril) Clozapine (Clozaril)
is one of these new is one of these new drugsdrugs
• It is effective, but It is effective, but has severe side has severe side effectseffects
• Newer drugs such Newer drugs such as Risperidone as Risperidone (Risperdal) may be (Risperdal) may be as effective with as effective with fewer side effectsfewer side effects
Chlorpromazine Chlorpromazine (Thorazine) is the (Thorazine) is the most common most common phenothiazinephenothiazine
Other drugs, Other drugs, called “atypical called “atypical antipsychotics,” antipsychotics,” have been have been introduced in the introduced in the last decadelast decade
Antipsychotic DrugsAntipsychotic Drugs
Antipsychotics are less effective at Antipsychotics are less effective at reducing other symptoms, such as reducing other symptoms, such as problems of emotionsproblems of emotions
Newer drugs such as Risperidone (Risperdal) Newer drugs such as Risperidone (Risperdal) may be as effective with fewer side effects may be as effective with fewer side effects
Antipsychotics are often very effective at Antipsychotics are often very effective at treating hallucinations and delusionstreating hallucinations and delusions
Antipsychotic DrugsAntipsychotic Drugs
Antipsychotics are Antipsychotics are less effective at less effective at reducing other reducing other symptoms, such as symptoms, such as problems of problems of emotionsemotions
As with other drugs, As with other drugs, dosages are crucialdosages are crucial
If patients are If patients are maintained on maintained on antipsychotics for antipsychotics for too long, problems too long, problems may emergemay emerge
One problem with One problem with antipsychotics is antipsychotics is tardive dyskinesiatardive dyskinesia
Antipsychotic DrugsAntipsychotic Drugs
One problem with antipsychotics is One problem with antipsychotics is tardive dyskinesiatardive dyskinesia
• A nervous system disorderA nervous system disorder
• It involves involuntary, spasmodic It involves involuntary, spasmodic movements of the upper body, movements of the upper body, especially the face and fingersespecially the face and fingers
PsychosurgeryPsychosurgery
PsychosurgeryPsychosurgery is brain surgery is brain surgery
• In the 1940s and 50s, a common type In the 1940s and 50s, a common type was the was the prefrontal lobotomyprefrontal lobotomy
Removal of parts of the brain’s frontal lobes Removal of parts of the brain’s frontal lobes would alleviate symptoms of mental would alleviate symptoms of mental disordersdisorders
However, prefrontal lobotomies made some However, prefrontal lobotomies made some people become unnaturally calm and people become unnaturally calm and completely unemotionalcompletely unemotional
PsychosurgeryPsychosurgery
Prefrontal lobotomies Prefrontal lobotomies made some people made some people become unnaturally become unnaturally calm and completely calm and completely unemotionalunemotional
Others became Others became unable to control unable to control their impulsestheir impulses
Today, despite Today, despite advances, advances, psychosurgery is psychosurgery is rarerare
Drug therapy has Drug therapy has proven more proven more effective than effective than surgical proceduressurgical procedures
PsychosurgeryPsychosurgery
Most important, Most important, psychosurgery is psychosurgery is irreversibleirreversible
Therefore, it is Therefore, it is morally morally objectionable to objectionable to many patients and many patients and their familiestheir families
Drug therapy has Drug therapy has proven more proven more effective than effective than surgical surgical proceduresprocedures
The long-term The long-term effects of effects of psychosurgery psychosurgery are also are also questionablequestionable
Electroconvulsive TherapyElectroconvulsive Therapy
Electroconvulsive therapyElectroconvulsive therapy (ECT) was once (ECT) was once widely employed with depressed peoplewidely employed with depressed people
• It is a treatment for severe mental illnessIt is a treatment for severe mental illness
• An electric current is briefly applied to the head An electric current is briefly applied to the head to produce a generalized seizure (convulsion)to produce a generalized seizure (convulsion)
• The duration of the shock is less than a secondThe duration of the shock is less than a second
Electroconvulsive TherapyElectroconvulsive Therapy
In the 1940s and 50s, ECT was routinely In the 1940s and 50s, ECT was routinely given to severely disturbed patients in given to severely disturbed patients in mental hospitalsmental hospitals
The duration of the shock is less than a secondThe duration of the shock is less than a second
Patients are treated in 3 to 12 sessions over Patients are treated in 3 to 12 sessions over several weeksseveral weeks
Electroconvulsive TherapyElectroconvulsive Therapy
Today, ECT is not a widely used Today, ECT is not a widely used treatmenttreatment
In the 1940s and 50s, ECT was routinely In the 1940s and 50s, ECT was routinely given to severely disturbed patients in given to severely disturbed patients in mental hospitalsmental hospitals
Unfortunately, it was often used with Unfortunately, it was often used with patients who did not need it, or as a means patients who did not need it, or as a means of controlof control
Electroconvulsive TherapyElectroconvulsive Therapy
Today, ECT is not a Today, ECT is not a widely used widely used treatmenttreatment
ECT is effective in ECT is effective in short-term short-term management of management of severe depressionsevere depression
It is sometimes It is sometimes used when there used when there is a risk of suicideis a risk of suicide
However, the However, the effects of ECT are effects of ECT are temporarytemporary
Electroconvulsive TherapyElectroconvulsive Therapy
The effects of ECT are temporaryThe effects of ECT are temporary
Use of ECT should be followed by Use of ECT should be followed by psychotherapy and drug therapypsychotherapy and drug therapy
ECT should also be used only as a ECT should also be used only as a last optionlast option
Electroconvulsive TherapyElectroconvulsive Therapy Risk of death due to Risk of death due to
ECT is lowECT is low
However, it may However, it may cause memory losscause memory loss
Law requires that the Law requires that the patient be given the patient be given the option to refuse ECT option to refuse ECT treatment, as is true treatment, as is true for any treatmentfor any treatment
ECT is not ECT is not appropriate for appropriate for treating treating schizophreniaschizophrenia
It is also It is also inappropriate for inappropriate for managing unruly managing unruly behaviorbehavior