Unit 9 Study Questions

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Identify the three major categories of therapy. Discuss the factors

affecting why people do or do not seek therapy. (pp. 696-697) The three major types of psychotherapy treatments are the following: Insight therapies - “talk therapy” or therapy that utilizes complex verbal interactions in order to provide insight to the patient regarding their difficulties, and to offer solutions. Behavioural therapies - make direct efforts to alter problematic responses (ex. phobias) or maladaptive habits (ex. drug use). Behaviour therapists look to change the clients overt behaviour, usually through classical and/or operant conditioning, or observational learning. Biomedical therapies - involves interventions into a person’s biological functioning. Procedures include drug therapy and electroconvulsive (shock) therapy, with drug therapy being the most common mode for treating psychological disorders.

Describe the various types of mental health professionals involved in providing psychotherapy. (pp. 697-699) Psychologists, both clinical and counselling, specialize in the diagnosis and treatment of psychological disorders and behavioural issues. Clinical psychologists emphasize the treatment of full-fledged disorders, while counselling psychologists are focused on treating everyday adjustment problems. They use either insight or behavioural therapies (usually behavioural). Psychiatrists are physicians who specialize in the diagnosis and treatment of psychological disorders. They focus on severe disorders (schizophrenia, mood swings, etc) rather than everyday problems, and usually implement a drug therapy, but may implement an insight therapy. Psychiatric nurses and clinical social workers work as a team in a hospital setting to provide inpatient treatment. Counsellors at schools or other human services agencies (youth centres, geriatric centres, etc.) provide specialized treatment of particular issues, such as vocational, marital, rehabilitation, or drug counselling.

Define insight therapies. Explain the logic of Freudian psychoanalysis. Describe the techniques by which analysts probe the unconscious. (pp. 699-701) Insight therapies involve verbal interactions intended to enhance clients’ self-knowledge and thus promote healthful changes in personality and behaviour. Psychoanalysis is an insight therapy that emphasizes the recovery of unconscious conflicts, motives, and defences through techniques such as free association and transference. These two techniques are used by analysts to probe the unconscious: Free association - clients spontaneously express their thoughts and feelings exactly as they occur, with as little censorship as possible. Dream analysis - the therapist interprets the symbolic meaning of the client’s dreams. Interpretation refers to the therapist’s attempts to explain the inner significants of the client’s thoughts, feelings, memories, and behaviours.

Discuss resistance and transference in psychoanalysis. (pp. 701-702) Resistance refers to largely unconscious defensive manoeuvres intended to hinder the progress of therapy. People often don’t want to face up to the painful, disturbing conflicts that they have buried in their unconscious. Resistance can be clients showing up late, merely pretending to engage in free association, or being hostile toward the therapist. Transference occurs when clients unconsciously start relating to their therapist in ways that mimic critical relationships in their lives. The client transfers conflicting feelings about important people onto their therapists. Transference is encouraged in order to get the clients to re-enact relationships with important people, which then can help bring repressed feelings and conflicts to the surface.

Identify the elements of a therapeutic climate. Discuss the therapeutic process in Rogers’ client-centred therapy. (pp. 702-704) The therapeutic alliance consists of the emotional bond between therapist and client, along with agreement on goals and agreement on therapeutic tasks. For therapists to create a positive therapy climate, they must do the following: Genuineness - the therapist must be genuine with the client, communicating honesty and spontaneously. The therapist should not be phoney or defensive. Unconditional positive regard - the therapist must show complete, nonjudgemental acceptance of the client as a person. The therapist should provide warmth and caring for the client, with no strings attached. This does not mean that the therapist must approve of everything the client says or does. A therapist can disapprove of a particular behaviour while continuing to value the client as a human being. Empathy - the therapist must provide accurate empathy for the client. This means that the therapist must understand the clients world from the clients point of view. Furthermore, the therapist must be articulate enough to communicate this understanding to the client.

How has positive psychology contributed to new approaches in insight therapy? (pp. 704-706) Positive psychology uses theory and research to better understand the positive, adaptive, creative, and fulfilling aspects of human existence. Positive psychotherapy takes this idea and applies it into an insight therapy, which attempts to get clients to recognize their strengths, appreciate their blessings, savour positive experiences, forgive those who have wronged them, and find meaning in their lives. Positive psychotherapy can be an effective treatment for depression, as it proves to be more effective than “treatment as usual”, and “treatment as usual with medication”.

Describe how group therapy is generally conducted. (pp. 706-708) Group therapy is the simultaneous treatment of several clients in a group. They consist of 4-15 clients, who are screened prior to the session for anyone who is disruptive, and tends to have the group be diverse. Clients essentially function as therapists for one another, through the sharing of their problems, viewpoints, experiences and coping strategies. Clients provide each other with acceptance and emotional support, which helps them realize that they aren’t the only one’s experiencing problems. The therapist fosters a positive environment, and keeps everyone on track. Group therapy is similar to Couples therapy (involves the treatment both partners in a committed, intimate relationship, in which the main focus is on relationship issues) and Family therapy (involves the treatment of a family unit as a whole, in which the main focus is on family dynamics and communication).

Discuss recent evidence on the efficacy of insight therapies. (pp. 708-709) Evaluating the effectiveness of insight therapies has proven to be difficult, as both clients and therapists ratings of effectiveness are slanted to a favourable one. As well, one could haver a spontaneous remission, in which they are recovered from a disorder without formal treatment. Studies have shown that insight therapies work better than no therapy, or a placebo, and its effectiveness is about equal to that of drug therapy.

Summarize the general principles underlying behavioural approaches to therapy. (pp. 709-710) Behavioural therapies involve the application of learning principles to direct efforts to change clients’ maladaptive behaviours. This is done through the means of classical and/or operant conditioning, and observational learning. Behaviour therapies are based on these assumptions: (1) Behaviour is a product of learning, and (2) what we have learned can be unlearned.

Describe the goals and procedures of systematic desensitization and aversion therapy. (pp. 710-712) Systematic desensitization is a behaviour therapy used to reduce phobic clients’ anxiety responses through counterconditioning (an attempt to reverse the process of classical conditioning by association the crucial stimulus with a new conditioned response). These are the steps: (1) The therapist helps the client build an anxiety hierarchy (ranks anxiety arousing stimuli from least to most anxiety-arousing). (2) Training the client in deep muscle relaxation (client must learn to engage in deep relaxation on command from the therapist). (3) Client tries to work through the hierarchy, learning to remain relaxed while imagining each stimulus (the client goes between the imagined stimuli and relaxation until the client feels relaxed with previously feared stimulus. Then they continue to the next feared stimulus in the hierarchy). In exposure therapies, clients are confronted with situations that they fear so that they learn that these situations are really harmless. Aversion therapy is a behaviour therapy in which an aversive stimulus is paired with a stimulus that elicits an undesirable response. Electric shocks or nausea-inducing drugs may be paired with alcohol, sexual deviance, etc in order to make the previously desirable activity undesirable. Aversion therapy is used very little and is considered a last resort treatment option.

Describe the goals and techniques of social skills training. (p. 712) Social skills training is a behaviour therapy designed to improve interpersonal skills that emphasizes modelling (client watches socially skilled friends and colleagues to acquire appropriate responses [eye contact, active listening, etc]), behavioural rehearsal (client practises social techniques in structured role-playing exercises), and shaping (clients are gradually asked to handle more complicated and delicate social situations). Social skills training depends on operant conditioning and observational learning. Social skills training is used to remove anxiety associated with social situations.

Discuss the logic, goals, and techniques of cognitive therapy. (pp. 713-715) Cognitive-behavioural treatments use varied combinations of verbal interventions and behavioural modification techniques to help clients change maladaptive patterns of thinking. Cognitive therapy uses specific strategies to correct habitual thinking errors that underlie various types of disorders. The goal is to change clients’ negative thoughts, appraisals and maladaptive beliefs. Clients are taught to detect their automatic negative thoughts (“no one likes me,” “I am not smart enough, etc) and then taught to subject these thoughts to reality testing, with the therapist helping the client realize how unrealistic their negative thoughts are.

Discuss the evidence regarding the effectiveness of behaviour therapies. (p. 715) While it is difficult to make general statements about the effectiveness of behavioural therapies (due to each therapy being used for, and is effective for each specific purpose), there is favourable evidence on the efficacy of most of the widely used behavioural interventions.

Describe the goals and techniques of biomedical therapies. (p. 716) Biomedical therapies are physiological interventions intended to reduce symptoms associated with psychological disorders. These therapies assume that psychological disorders are in part caused by biological functions. Psychosurgery and lobotomies were the first biomedical procedures before being replaced by drug therapy as the new norm.

Describe the principal categories of drugs used in the treatment of psychological disorders. (pp. 716-720) Psychopharmacotherapy, or drug therapy, is the treatment of mental disorders with medication. The four main categories are (1) antianxiety drugs, (2) antipsychotic drugs, (3) antidepressant drugs, and (4) mood stabilizing drugs. Antianxiety drugs are used to relieve tension, apprehension, and nervousness (vallium and xanex) Antipsychotic drugs are used to gradually reduce psychotic symptoms, including hyperactivity, mental confusion, hallucinations, and delusions. Used primarily in the treatment of schizophrenia. Antidepressant drugs gradually elevate mood and help bring people out of depression (SSRI). Mood stabilizers are drugs used to control mood swings in patients with bipolar mood disorders (lithium).

Discuss the evidence regarding the effects and problems of drug treatments for psychological disorders. (pp. 720-721) Drug therapies are clearly effective in controlling symptoms associated with mental illness. Problems of drug treatment include the over prescription of drugs (drugs only mask symptoms, and relapse occurs with discontinued drug use). Drugs are prescribed often without considering other time-consuming therapy options, and the drugs’ side-effects may be more harmful then the mental illness. Dangerous side effects of some of the medication include: tardic dyskinesia (a neurological disorder marked by involuntary tic like movements of the mouth, tongue, face, hands or feet [antipsychotic]), lithium toxicity (mood stabilizers), and addiction to antianxiety drugs (vallium and xanex [tranquilizers in the benzodiazephine family]). Negative effects of psychiatric drugs are not fully appreciated because of possible selective publication practises, and suggest that the pharmaceutical industry has gained influence over the drug testing process. This financial ties jepordise the objectivity needed in scientific research, as company-funded studies are less likely to report newly discovered negative side-effects.

Describe electroconvulsive therapy (ECT). Discuss its therapeutic

effects and risks. What other newer techniques are available? (pp.

721-723) Electroconvulsive therapy is a biomedical treatment in which electric shock is used to produce a cortical seizure accompanied by convulsions. While it can help those suffering from depression who don’t benefit from antidepressant drugs, the rate or relapse are high, with 64% of patients relapsing within 6 months. ECT causes short-term losses of memory, impaired attention, and other cognitive deficits. Newer techniques include transcranial magnetic stimulation (TMS), a new technique that permits scientists to temporarily enhance or depress activity in a specific area of the brain, and deep brain stimulation, a thin electrode is surgically implanted in the brain and connected to an implanted pulse generator so that various electrical currents can be delivered to brain tissue adjacent to the electrode.

Discuss the merits of blending or combining different approaches to therapy. (pp. 723, 726-727) Eclecticism in the practise of therapy involves drawing ideas from two or more systems of therapy instead of committing to just one system. There are two common approaches: Theoretical integration - two or more systems of therapy are combined or blended to take advantage of the strengths of each. Technical eclecticism involves borrowing ideas, insights, and techniques from a variety of sources while tailoring ones’ intervention strategy to the need of each client. The benefit is that you can maximize effectiveness of treatment when multiple therapies are used simultaneously.

Discuss the barriers that lead to underuse of mental health services

by ethnic minorities. Describe possible solutions to this problem.

(pp.727 -729) Modern psychotherapy is effective for treating people who are familiar of western values and cultural expectations. But for people who were born in other cultures, it is much more difficult for them to utilize therapies that do not represent their culture. Here are the barriers: (1) Cultural barriers - some cultural groups prefer to rely on assistance from family, elders, and others who share their same heritage. (2) Language barriers - communication is essential for psychotherapy, yet there aren’t very many therapists who speak languages used by minority groups in western nations. (3) Institutional barriers - therapists have been trained to treat white middle-class clients almost exclusively, and therapists need to build a therapeutic alliance to overcome institutional barriers.

Explain why people grew disenchanted with mental hospitals. (pp. 729-730) This was because mental hospitals were overcrowded and understaffed, and the personnel were undertrained and overworked, thus the hospitals were not able to provide the care needed. As well, the conditions were demoralizing, and patients were often uprooted from their communities and support networks.

Describe the deinstitutionalization trend, and evaluate its effects. (pp. 730-731) Deinstitutionalization refers to transferring the treatment of mental illness from inpatient institutions to community-based facilities that emphasize outpatient care. This was made possible by the emergence of drug therapy, and the coordinated creation of community mental health centres for local care. Positive effects include the drop of beds per 100 000 population fell from four to one over the last forty years, and many of those people avoided potentially unnecessary institutionalization. Negative effects include leaving a ‘revolving door’ population of people who flow in and out of psychiatric facilities (many have no where to go and/or have no life skills to make it on their own) and a population of homeless mentally ill people. Over two-thirds of all psychiatric inpatient admissions involve rehospitalizing a former patient.

Explain how Chapter 15 highlights two of the textbook’s unifying themes. (p. 731) The themes that were prominent in this chapter are the following: (1) The importance of culture. Many aspects of psychotherapy and various forms of treatment are products of modern, white, middle-class, Western culture, most are irrelevant or counterproductive when used with different culture groups, including minorities. (2) Value of theoretical diversity. Many people have benefited from alternatives that have arisen from conflicts between psychoanalytic theory and other theoretical perspectives, and the combinations of each can create a more efficient and higher quality form of care for the patient.

The task of selecting an appropriate therapist can be difficult. List several options for therapeutic services offered in your community. (p. 732) Principal sources of therapeutic services include the following: Private practitioners - self-employed therapists, such as psychologists and psychiatrists, usually are expensive, but highly experienced therapists. Community health centres - they have salaried psychologists, psychiatrists, mental health and social workers on staff, and they provide a variety of services and often have staff on weekends and for emergencies. Hospitals - Public and private mental hospitals, and psych wards, offer specialized care for people with mental illness. Hospitals focus on inpatient care, but may provide outpatient care. Human service agencies - various agencies employ therapists to provide short-term counselling, such as family, juvenile, drug, etc. Schools and workplaces - most high schools, colleges, and universities have counselling centres where students can get help with personal problems. Large businesses may provide counselling through their extended medical plan.

Discuss the potential importance of a therapist’s sex and theoretical

approach. Describe the qualities one should look for in a prospective

therapist. (pp. 732-735) The sex of the therapist is a problem for potential patients who have issues surrounding the opposite sex, such as a woman who suffers from extensive sexism, and needs a therapist with a feminist perspective. The degree that a therapist holds has no barring on the efficacy of the treatment from the therapist, as there are both high and low quality therapists in all levels of prior education. As well, the theoretical perspective that a therapist employs has no bearing on effectiveness, but while this is the case, the consensus is that different approaches for specific issues are more effective than others (cognitive therapy for panic disorders, systematic desensitization for specific phobias, and behaviour therapy and/or drug therapy for obsessive-compulsive disorder). A therapist should have personal warmth and sincere concern for your problems, and speak in a candid, non-defensive way. As well, they should be empathetic and understanding (able to appreciate your point of view), and be self-confident. Ultimately, like your therapist.

Discuss two major reasons why people entering therapy are likely to get better. (pp. 736-737) There are two reasons who people entering therapy are likely to get better, even if the therapy is ineffective. (1) Placebo effects (they occur when people’s expectations lead them to experience some change though they receive a fake treatment. (2) Regression toward the mean (occurs when people who score extremely high or low on some trait are measured a second time and their new scores fall closer to the mean [average]). With regression effects, if someone came in for therapy at a low point in their lives (which is most often the case), then did an assessment about how they were feeling, then even if the therapy had no effect, or even if they didn’t bother to go, they would feel better after a few months based on a subsequent evaluation showing their improvement.