THERAPIES BASED ON PSYCHOLOGICAL APPROACHES

PSYCHODYNAMIC APPROACH

WHAT IS THE AIM OF PSYCHOANALYTIC THERAPY?

WHAT ARE THE 3 TECHINIQUES?

WHAT HAPPENS IN THE FREE ASSOCIATION TECHIQUE?

WHAT IS THE DREAM ANAYLSIS TECHNIQUE?

WHAT IS INVOLVED IN THE PROCESS OF DISPLACEMENT?

WHAT IS INVOLVED IN THE PROCESS OF SYMBOLISATION?

Uncover repressend material and help the client come to an understanding of the origins of their problem

Free association / dream anaylsis / projective tests

Client encouraged to express everything that comes to mind and follown any associations that occur - get aroung defeces of the ego - 'talking cure'

Therapist interprets manifest content of dream to uncover latent content using processes such as symbolisation and displacement

e.g. dream where girl was strangling a dog - free asscoation revealed tensions between her sister in law - dream of strangling her sister would have been to threatening and so the dog displaced the sister

Objects and images act as symbols e.g. snakes, swords, trains symbollically represent the penis

WHAT HAPPENS IN PROJECTIVE TESTS?

WHAT IS GOOD ABOUT THIS THERAPY?

WHAT IS THE PROBLEM WITH THIS THERAPY BEING VERY LONG LASTING?

HOW HAS THIS BEEN DEALT WITH?

WHY IS THIS THERAPY NOT SUITABLE FOR EVERYONE?

WHAT DISORDERS MIGHT THIS THERAPY NOT BE SUITABLE FOR?

WHAT ARE THE EITHICAL ISSUES OF THIS THERAPY?

Client projects own thoughs/associations on stimulus material - ink block test

Accepts many adult disorders have roots in childhood and repressed material

Can become very expensive - can go one for moths/years

therapist and client agree with a fixed number of sessions

depends on client developing insights into condition - people may be unwilling to analyse their lives in this way

Schizophrenia - individual diesn't have insight into condition

cofronting clients with distressing material - e.g childhood sexual abuse cases

BEHAVIOURL THERAPY - CLASSICAL CONDITIONING

WHAT IS THE AIM OF BEHAVIOURAL THERAPY?

WHAT THE 3 TECHIQUES FOR ACHIEVING THIS?

WHAT IS SYSTEMATIC DESENSITISATION?

WHAT ARE THE FIVE STEPS OF THIS THERAPY?

WHAT IS THE FLOODING TECHNIQUE?

to remove the conditional association between fear and the situation/object

Systematic desensitisation, flooding, aversion therapy

counter-conditioning - people with phobias are gradually desensitised to the phobic object/situation - using gradual exposure from least to most feared situation

• therapist asks client to list situatios from the least to the most fearful
• therapist trains clients in relaxation techiques - replace fear response with relaxation
• therapist asks clients to visualise least feared situation
• When client feels comfertable at level asked to imagine next situation
• Eventually they can cope with most feared situation

People with phobias are exposed to feared object/situation without possibility of escape until the fear response is extinguished

WHAT IS THE ACERSION THERAPY TECHNIQUE?

WHY IS BEHAVIOUR THERAPY REDUCTIONIST?

HOW HAS SYSTEMATIC DESENSITISATION SHOWN TO BE EFFECTIVE?

WHY DOES BEHAVIOURAL THERAPY HAVE SIGNIFICANT ETHICAL ISSUES?

Undesirable behaviour is paired with unpleasant stimulus

No attempt to adress deeper psychological or emotional issues related to disorder

can be effective in treatment of phobias, 60-90% for spider phobias

flooding and aversion clients subjected to intense fear and anxiety. Systematic desensitisation client visualise feared situations

BEHAVIOURAL MODIFICATION  - OPERANT CONDITIONING

WHAT IS INVOLVED IN THE TECHIQUE TOKEN ECONONMY?

WHAT IS INVOLVED IN THE SOCIAL LEARNING THEORY TECHNIQUE?

WHY ARE THESE THERAPIES EFFECTIVE?

WHY IS IT A PROBLEM THAT TOKEN ECONOMY IS SET IN HIGHLY STRUCTURED INSITUTIONS?

Increases desirable behaviours by positive reinforcement, e.g in psychiatric hospitals tokens are given as rewards for good behaviour

when model is rewarded for behaviour, observer is more likely to imitate, e.g. phobic people can benifit form observing a model coping effectively with the phobic situation

Rewards are effective way of changing behaviour

Problem is whether behavioural improvement generalises to outside world when pateint returns to community and rewards are less consistent

COGNITIVE THERAPY

WHAT IS THE MAIN AIM OF COGNITIVE THERAPIES?

WHAT WAS THE AIM OF BECKS COGNITIVE THERAPY?

WHAT TECHNIQUES ARE USED IN BECKS COGNITIVE THERAPY?

WHAT IS INVOLVED IN RET?

HOW IS THIS THERAPY EFFECTIVE?

WHAT ARE THE WEAKESSES OF THIS THERAPY?

Challenge the irrational and dysfunctional thought proccesses, through Becks cognitive therapy, and Ellis's rational-emotive therapy (RET)

Challenge irrational cognitons and replace them with realistic appraisals

Therapist and client identify negative thoughts - therapist challenges cogntions using reality testing (client encouraged to compare irrational cognitions against real world - Becks used behavioural techniques (e.g clients given list of goals)

Therapist and client identify situations and negative reactions - helps client rationalise situation - challenges the clients self-defeating beliefs through debates

effective for depression and social anxiety - less time consuming and expensive - avoids in depth probing - effects last longer

Behavoural therapies more effective in treating phobias - schizophrenia not suited - ignores gentic and biological factors

WHAT WAS THE STUDY DONE BY ELKIN ET AL?

WHAT DID HE FIND?

WHAT WAS THE STUDY DONE BY DAVIDSON ET AL?

WHAT DID HE FIND?

WHAT DID HE CONCLUDE?

240 Patients with depression were treated with either CBT, psycotherapy / antidepressnat drugs - placebo control group

large placebo effect (35-40%) - therapies more effective then placebo - drugs most effective for sever depression - overall 30-40% didn't respond to therapy

295 patients with social anxiety - treated either with CBT, SSRI antidepressant fluoxetine, CBT + fluoxetine

placebo effect 19% - no differnce between therapy groups - 30-40% didn't respond to therapy

Drugs and CBT equally effective, combing them doesnt improve effectivness

WHAT ARE THE METHODOLOGICAL ISSUES THAT NEED TO BE CONSIDERED IN THESE STUDIES?

WHAT ARE THE ETHICAL ISSUES THAT NEED TO BE CONSIDERED?

WHAT HAS RESEARCH INTO EFFECTIVNESS OF DRUGS SHOWN US?

• Seperate patient groups should be matched in terms of severity
• length od study should be sufficent for treatment
• Should be non treated group to control
• Measure of improvment should be cosistent

• People with disorders may not be able to give informed consent
• Control group is being denied help

No one therapy is consistenly the best - drug therapies act faster, most common form of therapy - benifits of CBT last longer