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Abnormal
Psychology PSY404
VU
LESSON
22
PSYCHOTHERAPY
The
Decline of Freudian Psychoanalysis
Although
Freudian psychoanalysis has declined
greatly, the approach spawned numerous
therapeutic
variations
broadly referred to as psychodynamic
psychotherapy.
Ego
Analysis
Ego
analysis originated in the work of a number of
therapists trained in psychoanalysis but
who developed
somewhat
different theories and
techniques.
Whereas
Freud emphasized the role of the id,
these new theorists focused
much more on the ego.
The
patient's past and present interpersonal
relationships are of greatest importance
according to Harry
Stack
Sullivan, an influential ego
analyst.
Other
influential ego analysts include
Erik
Erikson and
Karen
Horney.
Horney's
lasting contribution was her
view that people have
conflicting ego needs: to move toward,
against,
and
away from others.
Erikson
introduced the argument that an
individual's personality is not fixed by
early experience but
continues
to develop as a result of predictable psychosocial
conflicts throughout the life
span.
John
Bowlby's attachment
theory perhaps
has had the greatest effect on
contemporary thought about
interpersonal
influences on psychopathology.
Unlike
Freud, Bowlby elevated the need
for close relationships to a primary
human characteristic.
Psychodynamic
Psychotherapy
The
approaches of the ego analysts
seek to uncover hidden motivations
and emphasize the importance of
insight.
However, psychodynamic psychotherapists
are much more actively
involved with their
patients.
They
are more ready to direct the patient's
recollections, to focus on current life
circumstances, and to
offer
interpretations
quickly and directly.
Short-term
psychodynamic psychotherapy is a
form of treatment that uses
many psychoanalytic
techniques.
Therapeutic
neutrality is typically maintained,
and transference remains a
central issue, but the
short-term
psychodynamic
therapist actively focuses on a particular emotional
issue rather than relying on
free
association.
Cognitive
Behavior Therapy
Cognitive
behavior therapy involves teaching new
ways of thinking, acting,
and feeling using
different,
research-based
techniques. In contrast to the
psychodynamic approach, cognitive
behavior therapists
focus
on
the present and on behavior,
adhering to the concept that, "Actions
speak louder than
words."
The
beginnings of behavior therapy can be
traced to John B.Watson's
Watson
viewed
the behavior therapist's job as being a
teacher. The therapeutic goal is to
provide new, more
appropriate
learning experiences. More recently,
behavior therapy has been
extensively influenced by the
findings
of cognitive psychology.
Cognitive
behavior therapy is a practical approach
oriented to changing behavior rather
than trying to alter
the
dynamics of personality. One of the most
important aspects of cognitive
behavior therapy is its
embrace
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of
empirical evaluation. This anxiety hierarchy places
situations in increasing order of
fearfulness. The
patient
does not have to confront
the hierarch items physically
but, after relaxation, the patient
imagines the
each
situation in turn until no anxiety is
felt.
The
behavioral therapists claim high
transfer from imagined to
real.
Systematic
Desensitization
Systematic
desensitization is a technique
for eliminating fears that
has three key
elements.
The
first is relaxation training using
progressive
muscle relaxation, a
method of inducing a calm
state through the
tightening
and subsequent relaxation of all of the
major muscle groups.
The
second is the construction of a hierarchy
of fears ranging
from very mild to very frightening, a
ranking that
allows
clients to confront their
fears gradually.
The
third part of systematic
desensitization is the learning
process, namely,
the gradual pairing of
ever-
increasing
fears in the hierarchy with the
relaxation response.
Systematic
desensitization involves imagining
increasingly fearful events
while simultaneously maintaining a
state
of relaxation.
Evidence
shows that systematic
desensitization can be an effective treatment
for fears and phobias,
but it is
not
clear whether classical conditioning
accounts for the
change.
Other
Exposure Therapies
Although
many factors contribute to effective
cognitive behavior therapy, most
investigators agree
that
exposure
is the key to fear reduction.
Vivo
desensitization
involves
gradually confronting fears in
real life simultaneously maintaining a
state of
relaxation
while Flooding
involves
helping clients to confront
their fears at full
intensity.
Case:
person suffers from snake
phobia
Technique:
Systematic Desensitization
Steps
involved
1-
Relaxation exercise
2-
Phobia hierarchy
3-
Gradual confrontation of Phobia hierarchy in
imagination
Example
The
patient is relaxed
1-
Show picture of snake
2-
Movies of snake
3-
Zoo where sees
snakes
4-
Visit a snake charmer
5-
Handle a snake with
gloves
6-
Handle snake without
gloves
At
every step the patient should be
relaxed otherwise the session
can not proceed.
Aversion
Therapy
The
goal in aversion
therapy is to
use classical conditioning to
create, not eliminate, an
unpleasant
response.
The technique is used primarily in the
treatment of substance use disorders
such as alcoholism
and
cigarette smoking. Aversion
treatments often achieve short-term
success, but relapse rates
are high.
Aversion
therapy is used to treat inappropriate or
excessive attraction to people or objects
such as excessive
alcohol
consumption or Smoking or overeating
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Presentation
of the stimulus in reality is accompanied by an
aversive stimulus with an
electric shock or drug
induced
nausea. Individual is forced to give up
alcohol.
Contingency
Management
Contingency
management is an operant
conditioning technique that directly
changes rewards and
punishments
for identified
behaviors.
A
contingency
is the relationship
between a behavior and its
consequences; thus, contingency
management
involves
changing this relationship.
The
goal of contingency management is to
reward desirable behavior
systematically and to extinguish
or
punish
undesirable behavior.
Token
economy
The
token
economy is an
example of contingency management that
has been adopted in many
institutional
settings.
In a token economy, desired
and undesired behaviors are
clearly identified, contingencies
are
defined,
behavior is carefully monitored, and
rewards or punishments are given
according to the rules of the
token
economy.
Tokens
are specialized currency
that can be exchanged for
food or other goods or
privileges.
Example
The
token economy program can be applied in a
class room where children
were behaving disruptively or
doing
poorly in their
studies.
The
children earned tokens when they
did well on daily reading
tests or successfully performed
other
targeted
behaviors they could then
exchanged these rewards
(token) such as extra recess
time or seeing a
movie
Research
shows that contingency management
successfully changes behavior
for diverse problems such
as
institutionalized
clients with schizophrenia
and juvenile offenders in group
homes.
However,
improvements often do not generalize to
real life situations where
the therapist cannot control
rewards
and punishments.
Time
out
The
time
out is another
technique of contingency management
When
a child is involved in an inappropriate
behavior such as using
abusive language or stealing or
lying he
is
asked to go to his room and
stay there alone and
not permitted to go out to friends or
party.
Modeling
The
modeling
is
technique pioneered by Albert Bandura.
The basic design is for
therapist to demonstrate
appropriate
behaviors for clients, who
through a process of imitation
and rehearsal, then acquire
the ability
to
perform the behaviors in their
own lives.
Therapists
model new emotional responses
for clients.
Example
therapists calmly handle
snakes to show snake phobic
clients that it is possible to be
relaxed in the
presence
of these animals. After
several modeling sessions, clients
themselves are encouraged to
interact
with
snakes.
Social
Skills Training
The
goal of social
skills training is to
teach clients new ways of
behaving that are both
desirable and likely
to
be rewarded in everyday
life.
Two
commonly taught skills are assertiveness
and social problem
solving.
The
goal of assertiveness
training is to
teach clients to be direct about
their feelings and
wishes.
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Social
problem solving is a multi-step
process that has been
used to teach children and
adults ways to go
about
solving a variety of life's problems.
The
first step involves
assessing and defining the
problem in detail, breaking a complex difficulty
into
smaller,
more manageable
pieces.
"Brainstorming"
is the second step in social
problem solving.
The
third step involves carefully evaluating the
options generated during
brainstorming.
Finally,
the best solution is chosen
and implemented, and its
success is evaluated
objectively.
If
the option does not work,
the entire process can be repeated
until an effective solution is
found.
Cognitive
Techniques
All
of the cognitive behavior therapies we
have discussed so far have
foundations in either classical or
operant
conditioning. More recent
techniques are rooted in
cognitive psychology.
One
example is attribution
retraining,
which is based on the idea
that people are "intuitive
scientists" who
are
constantly drawing conclusions about the causes of
events in their lives. These
perceived causes,
which
may
or may not be objectively
accurate, are called
attributions. Attribution retraining
involves trying to
change
attributions, often by asking
clients to abandon intuitive
strategies. Instead, clients are
instructed in
more
scientific methods, such as objectively
testing hypotheses about
themselves and
others.
Self-instruction
training is another
cognitive technique that is often
used with children. In
Meichenbaum's
self-instruction
training, the adult first
models an appropriate behavior while
saying the self-instruction
aloud.
This procedure is designed as a
structured way of developing internalization,
helping
children to learn
internal
controls over their
behavior.
Beck's
Cognitive Therapy
Aaron
Beck's cognitive
therapy was
developed specifically as a treatment for
depression.
Beck
suggested that depression is
caused by errors in
thinking.
These
hypothesized distortions lead
depressed people to draw incorrect,
negative conclusions
about
themselves,
thus creating and maintaining the
depression.
Beck's
cognitive therapy involves challenging
these negative distortions by gently
confronting clients'
cognitive
errors in therapy, and asking
clients to see how their
thinking is distorted based on their
own
analysis
of their life.
Rational-Emotive
Therapy
Albert
Ellis's rationalemotive
therapy (RET) is
also designed to challenge
cognitive distortions.
According
to Ellis, emotional disorders
are caused by irrational
beliefs, absolute,
unrealistic views of the
world.
The
rationalemotive therapist searches
for a client's irrational
beliefs, points out the
impossibility of
fulfilling
them, and uses any
and every technique to
persuade the client to adopt more
realistic beliefs.
Integration
and Research
What
unites cognitive behavior
therapists is a commitment to research,
not to a particular form of
treatment.
Cognitive
behavior therapists have
been vigorous in conducting psychotherapy
outcome research, and
they
generally
embrace any treatment with
demonstrated effectiveness.
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For
this reason, we envision what is now
called cognitive behavior therapy as
becoming the integrated,
systems
approach to treatment, as more and
more therapists offer
eclectic but effective treatments
for
different
disorders.
Effectiveness
of behavioral approaches
·
They
seem more effective because they
focus on symptom removal which is
easier to observe
and
measure as in case of phobias
than in self
actualization.
·
The
duration of the therapy is short.
·
The
cost in terms of money and
manpower is low.
Limitations
of behavioral therapies
·
The
improvements learned in clinic or hospital settings do
not extend to real life
situations.
·
These
therapies do not appear to be
particularly effective with complex, broad and
vaguely defined
disorders.
·
Token
economy being used without
their permission raises
ethical questions.
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