Psychotherapy: techniques employed to improve psychological functioning and promote adjustment to life.
Active listening: listening with total attention to what another is saying; involves reflecting, paraphrasing, and clarifying what the person says and means.
Client-centered therapy: Roger’s therapy technique emphasizing the client’s natural tendency to become healthy and productive; techniques include empathy, unconditioned positive , regard, genuiness, and active listening.
Cognitive-behavior therapy: Beck’s system for confronting and changing behaviors associated with destructive cognitions.
Cognitive restructuring: process in cognitive therapy to change destructive thoughts or inappropriate interpretations.
Cognitive therapy: therapy that focuses on faulty thought processes and beliefs to treat problem behaviors.
Dream analysis: In psychoanalysis, interpreting the underlying true meaning to dreams to reveal unconscious processes.
Psychoanalysis: Freudian therapy designed to bring unconscious conflicts, which usually date back to early childhood experiences, into consciousness; also Freud’s theoretical school of thought emphasizing unconscious processes.
Psycho-dynamic therapy: a briefer, more directive, and more modern form of psychoanalysis that focuses on conscious processes and current problems.
Rational-emotive behavior therapy: Ellis’s cognitive therapy to eliminate self-defeating beliefs through rational examination.
Resistance: In psychoanalysis, the person’s inability or unwillingnesss to discuss or reveal certain memories, thought, or experiences.
Self-help group: leaderless or non-professionally guided groups in which members assist each other with a specific problem, as in Alcoholics Anonymous.
Self-talk: Internal dialogue; the things people say to themselves when they interpret events.
Transference: Occurs during pyschoanlysis, the patient may displace (or transfer) unconscious feelings about a significant person in his or her life onto the therapist.
Unconditioned positive regard: Rogers’s term for live and acceptance with no contingencies attached.
Aversion therapy: Pairing and aversive or unpleasant stimulus with a maladaptive behavior. It uses the principles of classical conditioning to create anxiety so that the negative associations can compete with positive ones. Limited success, controversial.
Behavior therapy: group of techniques based on learning principles used to change maladaptive behaviors, focuses on the problem behavior instead of on the underlying causes.
Modeling therapy: watching and imitating models that demonstrate desirable behaviors. It can be very effective.
Systematic Desensitization: a gradual process to extinguish a learned fear. Or phobia, by working through a hierarchy of fear-evoking stimuli while staying deeply relaxed, 3 step process; maintain relaxation, hierarchy of anxiety-arousing images and relaxed client visualizes items at the bottom of the hierarchy and works their way up.
Antianxiety Drugs: Medications used to treat anxiety disorders or minor tranquilizers, produce relaxation or reduce anxiety while also relieving muscle tension.
Antidepression Drugs: medications used to treat depression, some anxiety disorders and certain eating disorders (such as bulimia). There are four types: 1. Tricyclics 2. Monoamine oxidase inhibitors 3. Selective serotonin reuptake inhibitors 4. Atypical antidepressants.
Antipsychotic Drugs: medications used to diminish or eliminate hallucinations, delusions, withdrawal, and other symptoms of psychosis also known as neuroeptics or major tranquilizers. They are used to treat Schizophrenia and other acute psychotic states. They do not sedate the patient.
Empathy: in Rogerian terms, an insightful awareness and ability to share another’s inner feelings.
Family Therapy: Treatment to change maladaptive interaction patterns with a family.
Free Association: In psychoanalysis, reporting whatever comes to mind without monitoring content.
Genuineness: In Rogerian terms, authenticity or congruence the awareness of one’s true inner thoughts and feelings and begin able to share honestly with others.
Group Therapy: a number of people meet together to work toward therapeutic goals.
Humanistic Therapy: Therapy to maximize personal growth through affective restructuring.
Interpretation: A psychoanalysis’s explanation of a patients free associations, dreams, resistance and transference; more generally, any statement by a therapist that presents a patient’s problem in a new way.
Biomedical therapy: Using physiological interventions (drugs, electroconvulsive therapy, and psychosurgery) to reduce or alleviate symptoms of psychological disorders.
Electroconvulsive Therapy: (ECT) biomedical therapy based on passing electrical cureent through the brain; used almost exclusively to treat serious depression when drug therapy does not work.
Lobotomy: Outmoded medical procedure for mental disorders, which involved cutting nerve pathways between the frontal loves and the thalamus and hypothalamus.
Psychopharmacology: the study of drug effects on mind and behavior
Psychosurgery: operative procedures on the brain designed to relieve severs mental symptoms that have no responded to other forms for treatment.
Eclectic Approach: combining techniques from various theories to find the most appropriate treatment.
Exposure Therapy: Systematic desensitization; flooding.

Therapy Chapter 15 Outline

1) Mentally ill people and their treatment has been the subject of the media.Memory Hint: the movie Anger Management
a) Causing stereotypes and impeding progress of future progress in this field.
b) Two-thirds of people who have a mental illness avoid getting treatment as a result of these negative stereotypes.

2) People seek therapy for reasons more than mental illnesses.
a) Self knowledge and personal fulfillment.
3) Psychotherapy: ways to increase the functioning and helps people adjust to life differently.
a) Psychoanalysis, behavior modification, client centered therapy.
4) Three approaches to therapy
a) Insight:
i) Personal understanding and self-knowledge
b) Behavior
i) Changing maladaptive behaviors
c) Biomedical
i) Medical treatments for mental illnesses
Insight Therapies
1. Strive to gain self knowledge and insight into the client’s problems and difficulties.
2. Belief- for people’s thought, feelings, and behavior to improve they must first discover what motivates them.

Psychoanalysis/Psychodynamic Therapies: Unlocking the Secrets of the Unconscious
1. Psychoanalysis: Call to mind unconscious conflicts
a. Usually bringing back childhood memories.
2. Five methods:

a. Free association
i. Saying whatever comes to mind, no matter its relevance or content.
Memory Hint: Free, free to say whatever you want

b. Dream analysis
i. Interpreting the real meaning of dreams to determine what is happening in the unconscious.
ii. Dream symbols- images that have a deeper meaning
iii. Manifest content- surface description
iv. Latent content- underlying, true meaning

c. Analyzing resistance
i. Resistance: When a person refuses to remember and discuss memories or other painful experiences.
ii. The closer the therapist and the patient get to the source of their problem, the better chance that the patient will run from their feelings of anxiety.

d. Analyzing transference
i. Transference: Since a patient and therapist get very personal and discuss the patients problems frequently and in depth, the patient may associate these feelings with their therapist.
ii. Therapist uses technique to help patient “relive” the painful past in a way that is safe and comfortable for the patient.
iii. The person is “transferring” their old feelings unto the therapist

e. Interpretation
i. Reasons therapist gives for patient’s free associations, resistance, dreams, and transference.
ii. Therapist explains the underlying meanings for their problems.

3. Evaluation
a. Limited applicability
i. Developed for upper-class Viennese people, primarily women, during the 1900’s
ii. Success shows up with less severe disorders.
iii. Time consuming
iv. Expensive

b. Lack of scientific credibility
i. Patients can accept therapist’s interpretations just to cooperate with their belief system.
ii. If patients disagree with therapist, the therapist can say the patient is exhibiting resistance.
iii. Impossible to scientifically document certain aspects.

4. Modern Psychodynamic Therapy
a. Psychodynamic therapy: A shorter form of psychoanalysis that focuses on current problems
b. Meet less often and patient is seen face to face.
c. Focus more attention on current problems rather than past ones.
d. Interpersonal therapy (IPT)- focuses on the current relationships and problems of the client.

Cognitive Therapies
1. focuses on faulty thought processes and beliefs to treat problem behavior
    1. holding beliefs that are irrational, overly demanding or fail to match reality, such as “I’m worthless if I don’t do everything perfectly” can lead people to become disturbed

2. Cognitive therapistsMemory Hint: cognitive= brain= thoughts
    1. analyze people’s thought processes to alter destructive thought
    2. assume that beliefs that create problems come from an unexamined but not necessarily unconscious level

i. exploring unexamined belief system produces reasons for disturbed behavior
ii. insight into negative
self-talk (internal, unrealistic dialogue people have with themselves to interpret events)helps an individual to:
a. challenge their thoughts
b. change how they interpret events
c. change maladaptive behavior

    1. An irrational statement about perfection can be changed to “ I can accept my limits” is called cognitive restructuring (changing of destructive thoughts or inappropriate interpretations)

  1. Albert Ellis and Rational Emotive Therapy

a. developed rational-emotive behavior therapy (REBT)- (therapy that eliminates self-defeating beliefs through rational examination)
Memory Hint: rational therapy means rational thoughts

b. Four-step process to create and deal with maladaptive thinking
i. activating event (a type of stimulus) such as a failing grade
ii. belief system, the person’s interpretation of activating experiernce
iii. emotional and behavioral consequences experienced
iv. disputing of erroneous belief

c. unless we think about interpretation of events we go from A to C skipping B because we fail to see that step B creates the following emotion and behavior
i.getting a bad grade (A) does not cause depression believing “I’ll never get into college” (B) is responsible
d. concept of “demandingness” meaning that people’s “musts” and “shoulds”create emotional distress and behavioral dysfunction that require therapeutic intervention
ii. for example, a wife left her husband for another man. the left husband engages in the following self-talk “ She should not and must not reject me. I demand that she come back to me.”
e. unrealistic self-talk can only be examined in therapy by direct confrontation, once clients recognize their self-defeating thoughts they begin to work on how to behave differently
i. by controlling how we think in the present we can be liberated from the past

  1. Aaron Beck and Cognitive Behavior Therapy

a. psychological problems result illogical thinking and destructive self-talk
b. Beck provides clients with experiences inside and outside the session that will change their negative talk in a positive way to confront and change behaviors associated with negative cognition
c. thinking patterns associated with depression
1. Selective perception- focusing on negatives while ignoring the positive
Overgeneralization- based on limited information, people overgeneralize and make negative conclusions about their self worth Memory Hint: Like when someone over-thinks what their friend said to them and ends up thinking there was an underlying meaning
3. Magnification- importance of undesirable events or personal shortcomings exaggerated
4. All-or-nothing thinking- everything is seen in terms of black and white
d. Process of Beck’s therapy
1.clients taught to keep track of thoughts
2. client is trained to develop ways to test automatic thoughts against reality
3.awareness that thoughts are products of faulty or unrealistic thought processes
4. client is persuaded to pursue pleasurable activities

  1. Evaluating Cognitive Therapies

a.cognitive therapies effective in treating depression, anxiety disorders, bulimia nervosa, anger management, addiction and some symptoms of schizophrenia and insomnia
b. criticized for ignoring/denying client’s unconscious dynamics, overemphasizing rationality and minimizing importance of client’s past
c. Ellis criticized for imposing his own set of standards

Humanistic Therapies:Blocked Personal Growth
  • humanists believe that humans are free to become what they want to be
  • Humanistic Therapy- maximizes personal growth through affective restructuring (emotional readjustment)
  • assumes people with problems are suffering from a blockage in their normal growth potential that creates a negative self-concept, when its removed people are free to become person everyone is capable of being
  1. Carl Rogers and Client-Centered Therapy

a. people actualize their potential and relate to others in genuine ways called client-centered therapy ( emphasizes client’s natural tendency to become healthy and productive) Memory Hint: everything evolves around the client.
b. client not patient; being a patient implies being sick and emphasizes equality of therapist-client relationship
1. client is responsible for discovering maladaptive behaviors
2. therapists provide a space where clients can explore thoughts and feelings
c. how to therapists create these spaces
1. Empathy- understanding and sharing of another persons inner experience; therapists use body language and cues to understand emotion experiences and open-ending statements to encourage further reflection
2. Unconditional Postive Regard- genuine caring for people based on their value as individuals, clients can be respected without having to prove their worthMemory Hint: positive thinking usually involves good thoughts
3. Genuineness- being aware of inner thoughts and feelings and sharing them honestly; a therapist will share feelings of pleasure or displeasure at clients progress
Active Listening (listening with total attention to what another is saying involving reflection, paraphrasing and clarifying)

  1. Evaluating Humanistic Therapies

a. supporters claim there is empirical evidence for efficacy of client-centered therapy critics argue tenets of humanism are difficult to scientifically test
b. most research relies on client self-reports

Group, Family, and Marital Therapies:Healing Interpersonal Relationships
  • multiple people are treated simultaneously
  1. Group Therapy
    • multiple people (8-10) meet together and work towards a therapeutic goal

a. response to need for more therapists and more economical
b. therapists works from any psychotherapeutic orientation, members talk of personal problems
Self-Help Group- leaderless or unprofessionally guided group in which members assist each other with a specific problem like AA external image 19tuwyka5LPe1DYDLEqDQpQO8mNAJzbL1c_0DPl4V4A8QcUWg5vBgu8k0OrV4_6gAR1bYZSUvbnWN9Ag59TsVg_B3SgxjCxBAcBo5M3X0V1qmDnRnl8
Self help group: Alcoholics Anonymous
"Alcoholics Anonymous ." Hanley Center. N.p., 2011. Web. 17 Feb. 2011.

d. advantages of group and self-help therapies
1. less expensive- fees can be divided in group therapy no fees in self-help group
2. Group support- seeing others improve, knowing others have similar problems
3. insight and information- learn from each other’s mistakes,group more convincing than a single therapist
4. behavior reversal- practice with new social skills, feedback, insight
e. group or self-help therapies are used as supplements to individual therapy

  1. Family and Marital Therapies

a. problem of one individual can affect a family or marriage because they are a system of interdependent parts
b. family therapy- treatment to change maladaptive behaviors in a family
c. all members of family attend occasional individual or smaller sessions (therapist may take any orientation)
d. “identified patient” is usually a scapegoat
-for example- a married couple who is having problems with intimacy focus all their attention and frustration on their delinquent child
e. also useful in treating some disorders and clinical problems in helping to modify behavior towards patient or to be able to express emotions, attitudes, behaviors etc that involve hostility, criticism and emotional over involvement
- most favorable setting for adolescent drug abuse

Biomedical Therapies:
a. uses physiological interventions (drugs, electroconvulsive therapy, and psychosurgery) to reduce symptoms of psychological disorders
b. based that mental health problems are caused by chemical imbalances
c.psychiatrist over psychologist prescribes biomedical therapies usually

A. Psychopharmacology:
-studies drug effects on mind and behaviorMemory Hint: Pharmacies deal with drugs.
a. help fix chemical imbalances
anti-anxiety drugs: minor tranquilizers- medications used to treat anxiety disorders
a. most abused drugs (Valium & Xanax)
b. increase effectiveness of neurotransmitter GABA (gamma-aminobutyric acid), that has a calming effect on neuronsMemory Hint: anti means against; against anxiety
2. anti-psychotic
drugs: medications that eliminate hallucinations, delusions, withdrawal, and other symptoms of psychosis
a. Haldol: reduce hallucinations
b. Clozarlil: energize patients
c. do not “cure” psychotic disorders or outbreaks-only improvement of symptoms
mood stabilizer: help episodes of depression
a. body reacts slowly (3-4 weeks)
b. primary use is preventing future outbreaks
antidepressant drugs: medications that treat depression, anxiety disorders, and eating disorders
tricyclics: increase levels of serotonin & catecholamines
i.contains 3 rings in chemical structure Memory Hint: tri= three
ii.-ie. Tofranil
monoamine oxidase inhibitors (MAOIs): block enzyme monoamine oxidase
i.increases readiness of serotonin & catecholamines
ii.ie. Nardil
selective serotonin reputake inhibitors (SSRIs): only affect serotonin
i.most commonly prescribed antidepressants
ii.ie. Prozac

external image jEWlPx6XJ8IQnDWucQvnZRPEj_Cwm-ff2ZZ0XewyjUw10IlYtiJPLlzrIbVw3w0ym7rMOCHhDjSS6dCDIahuD1mC1DyDhBw6XqXiQwDW3RwAhA5mrls

How Prozac & Antidepressants Work
"Depressants ." Human Diseases & Conditions. N.p., 2011. Web. 16 Feb. 2011.

d.atypical antidepressants: used for patients who don’t respond to other drugs & experience side effects to other drugs
i.ie. Buspar and Effexor

  1. Electroconvulsive Therapy & Psychosurgery:

1.electroconvulsive therapy: biomedical therapy thats based on passing electrical currents through the brain; used only to treat serious depression when drug therapy isn’t successful
a. or “electroshock therapy” (EST)
b. triggers convulsions in central & peripheral nervous systems
c. increased secretion of hormones & neurotransmitters
d. changes in blood-brain transmissions
e. patients receive 12 or less treatments
f. used in cases of severe depression that don’t respond to antidepressant drugs or psychotherapy
g. used in suicidal patients (works faster than antidepressants)
h. controversial: makes for functional & structural changes in the brain & we don’t know exactly why it works
psychosurgery: operative procedures on the brain that relieves severe mental symptoms that were not cured by other forms of treatment
a. NOT same as brain surgery
b. long history of attempts to change the disturbed
i.Romans believed sword wound to head relieved insanity
ii.1936-Egaz Moniz cut nerve fibers between frontal lobes & lower brain centers (lobotomy)- Portuguese neurologist
lobotomy: outdated medical procedure for mental disorders-involved cutting nerve paths between frontal lobes & thalamus & hypothalamusexternal image cjIiKLuxXhaqohJK3t-ONzRHJi2jOMg7wLbTQ7i7aGoF88LM_vyN8tGV3hntKY6qlPjxqxyZ486pCAghDjjLQQoFyc5_1ANIAq9SYEfBQtvO6rEBIx4
Diagram of Lobotomy
"The Visual Culture of Lobotomy." Miriam Posner. N.p., 2010. Web. 17 Feb. 2011.

  1. Are Biomedical Therapies Effective?:

1.psychopharmacology: do not provide long term cures
a. long term effects are unknown from the drugs
b. tolerance is built up to the drugs/drug dependence
c. withdrawal symptoms
i. side effects: controlling reactions
tardive dyskinesia- movement disorder-develops 15-20% of patients
1. symptoms appear when drugs are taken for long time
2. involuntary movements of tongue, face, other muscles
b. dry mouth, fatigue, sexual dysfunction, weight gain, memory difficulties
c. some are positive-improving wellness
ECT and psychosurgery: no full understanding of methods
a. barbaric treatments
b. society knows no visible reactions: muscle contractions & memory blockage of procedure from anesthesia
c. repetitive transcranial magnetic stimulation: (rTMS) delivers brief & strong electric current through coil of wire placed on the head”

1. magnetic field geared to specific parts of the brain
2. for depression its placed on left prefrontal cortex
3. positive effect on major depression
4. fewer side effects from ECT
d. considered experimental
e. controversial

Group Therapy
a. Based on need for more therapists and more economical
b. Group therapy is multiple people meeting together to work toward therapeuticgoals
i. 8-10 people
ii. Once a week for two hours typically

c. Variations: Self – Help Groups: groups in which people share a common problem, giving and receiving support
i. Example: AA
ii. Advantages of Self –Help Groups:

a. Less expensive
b. Group Support
c. Insights and information
d. Behavior rehearsal
e. Family and Marital Therapies

d. Problems of one part of the family effects all family members
Family Therapy- the primary aim is to change maladaptive family interaction patterns.

i. all members attend
f. Some family members may blame one member for problem but it is a scapegoat for family’s true issues.
i. Behavior Therapies
g. Change behavior to solve a problem using learning principles
h. No need to gain insight or restructure feelings
i. Find and diagnose problem by organizing negative behaviors and gaining positive behaviors that are lacking through:

i. Classical conditioning
ii. Operant conditioning
iii. Observational learning

2. Classical Conditioning Techniques: The Power of Association
a. From Pavlov’s model- create new stimulus associations and responses to replace negative ones.
i. Systematic desensitization
ii. Aversion Therapy

b. Systematic Desensitization
i. Developed by Joseph Wolpe
ii. Relaxation training, facing fear while relaxed
iii. Replace anxiety reaction with relaxation reaction
iv.Three steps to desensitization

1. Maintain deep relaxation
2. Make hierarchy of stimulus’ creating anxiety
3. Create constant relaxation throughout exposure to anxiety inducing stimulus’

Memory Hint- example: Sally has a fear of height. While in a relaxed state, through virtual reality, she can experience being at a top of a ladder all the way to being at a lot of a mountain or tall building.
c. Aversion Therapy
i. Classical conditioning to create anxiety rather than extinguish it
ii. Using negative associations to rid self of harmful action
iii. Ethical issues: is it okay to harm someone in order to change behavior?
iv.Not a long lasting treatment

Memory Hint- Bob is an alcoholic trying to quit drinking. He takes a drug called Anatbuse which causes nausea. He then puts the Antabuse in an alcoholic drink, causing him to feel nauseous. Now he tries an alcoholic drink without the drug and feels sick. This is because he associated the feeling of nausea with alcohol.

d. Operant Conditioning Techniques: Increasing the “Good” and Decreasing the “Bad”
i.Reward and punishment technique
ii.Target Behavior= desired behavior
Shaping- reward for positive step toward target behavior
iv.Reinforcement and shaping applied with great success with:

a.Autistic children
i.Develop language skills
b.People with social anxiety
iii.Behavior rehearsal- the foundation of assertiveness training or teaching others to stand up for themselves

e. Adaptive behaviors can be taught through tokens or tangible objects which can be exchanged for rewarded privileges.
3. Observational Learning Techniques: The Power of Modeling
a. Model Therapy- asks clients to observe and imitate appropriate models as they perform desired behaviors
Participant Modeling- the slow practice of imitating other’s behaviors
Memory Hint- Observing how Tyra Banks “smizes” and mimicking her behaviors to be the same.

4. Evaluating Behavior Therapies: How well do they work?
a. Generalizability: how will the “real world” treat the fragile new behaviors the person has adopted?
b. Ethics: is it ethical to control another’s behavior?

i. Believe therapists teach others how to control their own behaviors

Therapy and Clinical Thinking:
1.cultural similarities-5 common goals
Distrubed thoughts: therapists work to changed one’s troubled thoughts or patterns of life by understanding their problems
Distrubed emotions: patients with extreme emotional discomfort-clients understand their own problems
c. Disturbed
behaviors: realize their problems and guide them towards better lives
Interpersonal and life situation difficulties: improve relationships with friends, family, coworkers-avoid conflicts
biomedical disturbances: chemical imbalances solved with drugs
Memory Hint: Debbie (disturbed) thinks (thoughts) Eddie (emotions) buried (behaviors) Lilly's (life) button (body).
Applying Psychology to Work: Careers in Mental Health
1. Clinical Psychologist- Ph.D, Psy.D (doctor of psychology, doctor of Philosophy)

  • 5-7 years
  • have doctoral degree with training in research and clinical practice
  • supervised one year internship in a psychiatric hospital or mental health facility
  • work with patients suffering from mental disorders, in colleges/universities as teachers while maintaining private practices

2. Counseling Psychologist- M.A (master of arts), Ph.D (Doctor of Philosophy), Psy.D (Doctor of Psychology), Ed.D (Doctor of Education)
  • (3-7) years
  • masters degree with more emphasis on patient care and less on research
  • work in school, other institutions
  • focus on problems of living rather than mental disorders

3. Psychiatrist- M.D (Doctor of Medicine)
  • (7-10) years
  • four years of medical school, an internship, residency in psychiatry are required
  • supervised practice in psychotherapy techniques and biomedical therapies
  • only health specialists can regularly prescribe drugs

4. Psychiatric Social Worker- M.S.W (Master in Social Work), D.S.W ( Doctorate in Social Work), Ph.D (Doctor of Philosophy)
  • (2-5) years
  • masters degree in social work, advanced training and experience in hospitals or outpatient settings working with people who have psychological problems

5. Psychiatric Nurse- R.N (Registered Nurse), M.A ( Master of Arts), Ph.D (Doctor in Philosophy)
  • (0-5) years
  • bachelors or masters degree in nursing, advanced training in the care of mental patients in hospital settings; mental health facility

6. School Psychologist- M.A (Master of Arts), Ph.D ( Doctor of Philosophy), Psy.D ( Doctor of Psychology), Ed.D ( Doctor of Education)
  • (3-7) years
  • begin with bachelors degree in psychology, graduate training in psychological assessment, counseling in school-related issues and problems

Gender & Cultural Diversity- cultural similarities
1. Naming the problem
  • labeling the problem
  • people feel better when they know that others experience the same problem and that the therapist has previous experience with their specific problem

2. Qualities of the Therapist
  • Clients want therapists who are: caring, competent, approachable, and concerned with finding a solution to their problem

3. Establishing credibility
  • verbal testimonials, status symbols establish therapists identity
  • serve as apprentice to revered healer

4. Placing the problem in a familiar framework
  • Memory Hint: if the client believes evil spirits cause psychological disorder, the therapist will direct treatment toward these spirits

5. Applying techniques to bring relief
  • therapist or climate must do something
  • the therapist must do something that fit the clients expectations
  • “talk therapy”

6. A special time and place
  • therapy occurs outside the clients everyday experiences seems to be an important feature of all therapies
  • people need to set aside a special time
  • go to special place to concentrate on their problems

Cultural Differences
-clinicians who work with clients from different cultural backgrounds should learn about their clients’ cultures
- should be aware of cultural disparities in access to care and of their own cultural and ethnic-based values and beliefs
1. traditional Western European and American model

  • self-awareness, self-fulfillment, self-actualization, modifying self-behavior
  • emphasis on self and on independence and control over ones life

2. Collectivist culture model
  • Focus on interdependence and accepting realities of one’s life
  • Memory Hint: Japanese Naikan

- Naikan therapy - the patient sits quietly from 5:30a.m- 9p.m for seven days and is visited by an interviewer every 90 minutes
care and received- recollect and examine the care and kindness you have received from others)
troubles caused ( think about the troubles and worries you have caused others)
Alternative therapies- in all cultures, therapy involves specific actions or treatments

Women and Therapy
- gender differences
- women are more comfortable and familiar with their emotions, have fewer negative attitudes toward therapy, more likely to seek psychological help
- 5 unique concerns related to women and psychotherapy
1. Rates of diagnosis and treatment of mental disorders

  • women are diagnosed and treated for mental illness at a much higher rate than men
  • Memory Hint: Think of a mother always worrying about her children being ill.

2. Stresses of Poverty
  • poverty is an important contributor to many psychologist disorders
  • women bring special challenges to the therapy situation because of over representation in lowest economic groups

3. Stresses of multiple roles
  • women are mothers, wives, homemakers, wage earners, students
  • conflicting demands of multiple roles often create special stresses

4. Stresses of Aging
  • women live longer than men do
  • women tend to be poorer, less educated, more serious health problems
  • elderly women (age related dementia) account for 70% of the chronically mentally ill who live in nursing homes in the US

5. Violence against women
  • Rape, violent assault, incest, sexual harassment take a harsh toll on women’s mental health
  • all incidents are more likely to happen to women than men
  • lead to depression, insomnia, post-traumatic stress disorder, eating disorder, and others

Institutionalization: Treating Chronic and Serious Mental Disorders
- we all believe in freedom
-the hospitalization of the mentally ill is reserved for only the most serious and life-threatening situations
1. Involuntarily Commitment

  • people can be sent to psychiatric hospitals if:

- they are believed to be dangerous to themselves (suicidal) or dangerous to others (potentially violent)
- they are believed to be in serious need of treatment (indicated by bizarre behavior and loss of contact with reality)
- there is no reasonable, less restrictive alternative
- in emergencies psychologists and other professionals an authorize temporary commitment for 24 to 72 hours
- during observation lab tests can be performed to rule out medical illnesses
-patients can receive: psychological testing, medication, short-term therapy
2. Deinstitutionalization- discharging patients from mental hospitals as soon as possible and discouraging admissions

  • many people who are discharged end up livng in rundown hotels or understaffed nursing homes, jails, or on streets

3. Community Mental Health (CMI) Centers
  • provide individual and group therapy and prevention programs
  • coordinate short-term impatient care and programs for discharged mental patients (halfway houses)
  • expensive

Evaluating and Finding Therapy: Does it work? How to Choose?
1. Judging Effectiveness
  • meta-analysis combines and analyzes data from many studies
  • 40-80% of people who receive treatment are better off than people who do not

2. Finding a Therapist
  • consult psychology instructor or college counseling system for referrals
  • telephone hot-lines
  • immediate, short-term therapy in most colleges and universities that are free of charge for students
  • help locate a therapist for someone
  • attend therapy yourself in order to help someone else deal with the situation

Applying Psychology to Everyday Life
1. Movie Portrayals of Therapy
  • create dangerous stereotypes and lasting misconceptions
  • therapists must follow all ethical standards
  • sex between patient and therapists is a criminal defense
  • create a bad image that may cause people to not seek help

Interesting People:

1. Albert Ellis: Ellis formed the rational-emotive therapy. This is a four step process which deals with manipulating the way one thinks. The steps include first, activating the event-figuring out what kind of stimulus, next irrational beliefs-or persons understanding of the activating experiences, third consequences that are both behavioral and emotional experiences, and last disputing irrational beliefs. This rational-emotive theory is known as the “ ABCD” model. Also associated with Ellis is the term coined “demandingness”. Demanding certain “musts” and “shoulds” create emotional distress and behavior dysfunction, explains Ellis. Criticisms: He ignored the clinic unconscious and overemphasized rationality and underscored the client’s past. Ellis also imposed his own set of standards by labeling behavior as rational or irrational behaviors. 2. Aaron Beck: Beck formed the cognitive-behavior therapy. This type of therapy confronts and changed behaviors associated with destructive cognitions. Most successfully, his treatment has helped patients with depression. The thinking patters that he believes are associated with depression are selective perception, overgeneralizing, magnification, and all or nothing thinking. His “second phase” of therapy is persuading the client to actively pursue pleasurable activities. Criticisms: Beck ignored the clinic unconscious and overemphasized rationality, also underscoring the client’s past. 3. Carl Rogers: Rogers formed the client-centered therapy. This therapy involves “emphasizing the client’s natural tendency to become healthy and productive”. Through empathy, unconditional positive regard, genuineness, and active listening Rogers believes creating a therapeutic relationship by focusing on the qualities of communication will lead to success. He explores thoughts and feelings, trying to obtain insight into the behaviors of his clients. Criticisms: Rogers has no empirical evidence for his success, even though some argue that the basic tendencies of humanistic therapy are hard to test scientifically. Also, most of the “Rogerian” research has accumulated mixed results because of client self-reports.

4. Sigmund Freud: Freud developed psychoanalytic therapy or psychoanalysis as a way to treat patients. A psychoanalyst works to move unresolved, hidden issues from the unconscious into the conscious. The techniques that a psychoanalyst would utilize to treat a patient are: free association, dream analysis, resistance, transference and interpretation. According to Freud, these unresolved issues usually were introduced into the psyche during childhood. Once the patient realizes their issues stem from experiences that no longer exist they will cease to be burdened by them. Once this insight takes place, the conflict is resolved and the patient can develop healthier or more adaptive behavior patterns.

Criticisms: Freud's methods were developed with a specific group of people in mind, primarily upper-class Viennese women. Psychoanalysis is both time consuming and expensive and it rarely works for people with severe mental disorders.

5. Richard S. Lazarus: Developed behavior therapy which uses learning principles to change behaviors. Behavior therapy focuses on the problem behavior itself and not the underlying cause. Therapists who practice this branch of therapy do not believe special insight or restructures feelings are necessary before a change or changes in behavior can be made. A therapists diagnoses the problem by listing the maladaptive behaviors that are present and the adaptive behaviors that are not. Then, the therapist, attempts to lessen the frequency of the maladaptive behaviors and increase the frequency of adaptive behaviors by using principles from classical conditioning, operant conditioning and observational learning. It is important to not that a client's feelings and interpretations are entirely disregarded, they are simply not emphasized. Systematic desensitization, aversion therapy and modeling therapy are all other forms of Behavioral therapy.

Criticisms: Behavior therapies have been effective in treating phobias, OCD, eating disorders, autism, mental retardation, and delinquency. Critics argue that patient's newly acquired behaviors may disappear in the "real world" since they will not be constantly reinforced. Others question whether it is ethical for one person to control another's behavior.

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