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PSYCHOTHERAPY:Ego Analysis, Psychodynamic Psychotherapy, Aversion Therapy

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Abnormal Psychology ­ PSY404
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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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Table of Contents:
  1. ABNORMAL PSYCHOLOGY:PSYCHOSIS, Team approach in psychology
  2. WHAT IS ABNORMAL BEHAVIOR:Dysfunction, Distress, Danger
  3. PSYCHOPATHOLOGY IN HISTORICAL CONTEXT:Supernatural Model, Biological Model
  4. PSYCHOPATHOLOGY IN HISTORICAL CONTEXT:Free association, Dream analysis
  5. PSYCHOPATHOLOGY IN HISTORICAL CONTEXT:Humanistic Model, Classical Conditioning
  6. RESEARCH METHODS:To Read Research, To Evaluate Research, To increase marketability
  7. RESEARCH DESIGNS:Types of Variables, Confounding variables or extraneous
  8. EXPERIMENTAL REASEARCH DESIGNS:Control Groups, Placebo Control Groups
  9. GENETICS:Adoption Studies, Twin Studies, Sequential Design, Follow back studies
  10. RESEARCH ETHICS:Approval for the research project, Risk, Consent
  11. CAUSES OF ABNORMAL BEHAVIOR:Biological Dimensions
  12. THE STRUCTURE OF BRAIN:Peripheral Nervous System, Psychoanalytic Model
  13. CAUSES OF PSYCHOPATHOLOGY:Biomedical Model, Humanistic model
  14. CAUSES OF ABNORMAL BEHAVIOR ETIOLOGICAL FACTORS OF ABNORMALITY
  15. CLASSIFICATION AND ASSESSMENT:Reliability, Test retest, Split Half
  16. DIAGNOSING PSYCHOLOGICAL DISORDERS:The categorical approach, Prototypical approach
  17. EVALUATING SYSTEMS:Basic Issues in Assessment, Interviews
  18. ASSESSMENT of PERSONALITY:Advantages of MMPI-2, Intelligence Tests
  19. ASSESSMENT of PERSONALITY (2):Neuropsychological Tests, Biofeedback
  20. PSYCHOTHERAPY:Global Therapies, Individual therapy, Brief Historical Perspective
  21. PSYCHOTHERAPY:Problem based therapies, Gestalt therapy, Behavioral therapies
  22. PSYCHOTHERAPY:Ego Analysis, Psychodynamic Psychotherapy, Aversion Therapy
  23. PSYCHOTHERAPY:Humanistic Psychotherapy, Client-Centered Therapy, Gestalt therapy
  24. ANXIETY DISORDERS:THEORIES ABOUT ANXIETY DISORDERS
  25. ANXIETY DISORDERS:Social Phobias, Agoraphobia, Treating Phobias
  26. MOOD DISORDERS:Emotional Symptoms, Cognitive Symptoms, Bipolar Disorders
  27. MOOD DISORDERS:DIAGNOSIS, Further Descriptions and Subtypes, Social Factors
  28. SUICIDE:PRECIPITATING FACTORS IN SUICIDE, VIEWS ON SUICIDE
  29. STRESS:Stress as a Life Event, Coping, Optimism, Health Behavior
  30. STRESS:Psychophysiological Responses to Stress, Health Behavior
  31. ACUTE AND POSTTRAUMATIC STRESS DISORDERS
  32. DISSOCIATIVE AND SOMATOFORM DISORDERS:DISSOCIATIVE DISORDERS
  33. DISSOCIATIVE and SOMATOFORM DISORDERS:SOMATOFORM DISORDERS
  34. PERSONALITY DISORDERS:Causes of Personality Disorders, Motive
  35. PERSONALITY DISORDERS:Paranoid Personality, Schizoid Personality, The Diagnosis
  36. ALCOHOLISM AND SUBSTANCE RELATED DISORDERS:Poly Drug Use
  37. ALCOHOLISM AND SUBSTANCE RELATED DISORDERS:Integrated Systems
  38. SCHIZOPHRENIA:Prodromal Phase, Residual Phase, Negative symptoms
  39. SCHIZOPHRENIA:Related Psychotic Disorders, Causes of Schizophrenia
  40. DEMENTIA DELIRIUM AND AMNESTIC DISORDERS:DELIRIUM, Causes of Delirium
  41. DEMENTIA DELIRIUM AND AMNESTIC DISORDERS:Amnesia
  42. MENTAL RETARDATION AND DEVELOPMENTAL DISORDERS
  43. MENTAL RETARDATION AND DEVELOPMENTAL DISORDERS
  44. PSYCHOLOGICAL PROBLEMS OF CHILDHOOD:Kinds of Internalizing Disorders
  45. LIFE CYCLE TRANSITIONS AND ADULT DEVELOPMENT:Aging