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METHODS OF THERAPY

Psychotherapy is a systematic interaction between a therapist and a client that applies psychological principles to affect the clients thoughts, feelings, or behavior in an effort to help the client overcome psychological disorders, adjust to problems in living, or develop as an individual. HISTORY Historically speaking, treatments of psychological disorders often reflected the assumption that people who behaved in strange ways were possessed by demons. Because of this belief, treatment tended to involve cruel practices such as exorcism and execution. Some people who could not meet the demands of everyday life were tossed into prisons. Others begged in the streets, stole food, or became prostitutes. A few found their way to monasteries or other retreats that offered a kind word and some support. Generally speaking, they died early. Asylums. They originated from monasteries. They were the first institutions meant primarily for people with psychological disorders. But their function was warehousing, not treatment. Their inmate populations mushroomed until the stresses created by noise, overcrowding, and disease aggravated the problems they were meant to ease. Inmates were frequently chained and beaten. Mental Hospitals. In the US mental hospitals gradually replaced asylums. The mental hospitals function is treatment, not warehousing. Still, because of high patient populations and understaffing, many patients received little attention. Even today, with somewhat improved conditions, one psychiatrist may be responsible for the welfare of several hundred residents on the weekend when other staffs are absent. The Community Mental Health Movement. Community mental health centers attempt to maintain new patients as outpatients and to serve patients who have been released from mental hospitals. Today most people with chronic psychological disorders live in the community, not in the hospital.

PSYCHOANALYTIC THERAPIES This type of therapy is based upon the theories and work of Sigmund Freud, who founded the school of thought known as psychoanalysis. Psychoanalytic therapy looks at how the unconscious mind influences thoughts and behaviors . Psychoanalysis frequently involves looking at early childhood experiences in order to discover how these events might have shaped the individual and how they contribute to current actions . People undergoing psychoanalytic therapy often meet with their therapist at least once a week and may remain in therapy for a number of weeks, months, or years. Psychoanalytic therapists generally spend time listening to patients talk about their lives, which is why this method is often referred to as "the talking cure." The therapy provider will look for patterns or significant events that may play a role in the client's current difficulties. Psychoanalysts believe that childhood events and unconscious feelings, thoughts, and motivations play a role in mental illness and maladaptive behaviors. Psychoanalytic therapy also makes use of other techniques including free association, role play, and dream interpretation.

HUMANISTIC THERAPIES Psychoanalytic therapies focus on internal conflicts and unconscious processes. Humanistic therapies focus on the quality of the clients subjective, conscious experience. Traditional psychoanalysis focuses on early childhood experiences. Humanistic therapies are more likely to focus on what clients are experiencing here and now. I. Client-Centered Therapy

Client-centered therapy, also known as person-centered therapy, is a non-directive form of talk therapy that was developed by humanist psychologist Carl Rogers during the 1940s and 1950s. He was a humanist thinker and believed that people are fundamentally good. He also believed that people have an actualizing tendency, or a desire to fulfill their potential and become the best people they can be. Rogers initially started out calling his technique non-directive therapy. While his goal was to be as non-directive as possible, he eventually realized that therapists guide clients even in subtle ways. He also found that clients often do look to their therapists for some type of guidance or direction. Eventually, the technique came to be known as client-centered therapy. Mental health professionals who utilize this approach strive to create a therapeutic environment that is conformable, non-judgmental and empathetic. Two of the key elements of client-centered therapy are that it:

Is non-directive. Therapists allow clients to lead the discussion and do not try to steer the client in a particular direction. Emphasizes unconditional positive regard. Therapists show complete acceptance and support for their clients. According to Carl Rogers, a client-centered therapist needs three key qualities: Genuineness: The therapist needs to share his or her feelings honestly. By modeling this behavior, the therapist can help teach the client to also develop this important skill. Unconditional Positive Regard: The therapist must accept the client for who they are and display support and care no matter what the client is facing or experiencing. Rogers believed that people often develop problems because they are used to only receiving conditional support; acceptance that is only offered if the person conforms to certain expectations. By creating a climate of unconditional positive regard, the client feels able to express his or her emotions without fear of rejection. Empathetic Understanding: The therapist needs to be reflective, acting as a mirror of the client's feelings, thoughts. The goal of this is to allow the client to gain a clearer understanding of their own inner thought, perceptions and emotions. By exhibiting these three characteristics, therapists can help clients grow psychologically, become more self-aware and change their behavior via self-

direction. In this type of environment, a client feels safe and free from judgment. Rogers believed that this type of atmosphere allows clients to develop a healthier view of the world and a less distorted view of themselves. II. Gestalt Therapy Gestalt therapy was originated by Fritz Perls. Like client-centered therapy, Gestalt therapy assumes that people disown parts of themselves that might meet with social disapproval or rejection. People also don social masks, pretending to be things that they are not. Therapy aims to help individuals integrate conflicting parts of their personality. The German word gestalt means unified whole. This type of therapy focuses on the here and now. Perls also belieed, along with Rogers, that people are free to make choices and to direct their personal growth. But the charismatic and forceful Perls was unlike the gentle and accepting Rogers in temperament. Thus, unlike client-centered therapy, Gestalt therapy is directive. The therapist leads the client through planned experiences. BEHAVIOR THERAPY Psychoanalytic and humanistic forms of therapy tend to focus on what people think and feel. Behavior therapists tend to focus on what people do. Behavior therapy also called behavior modification applies principles of learning to directly promote desired behavioral changes. Behavior therapists rely heavily on principles of conditioning and observational learning. They help clients discontinue self-defeating behavior patterns such as overeating, smoking, and phobic voidance of harmless stimuli. They help clients acquire adaptive behavior patterns such as the social skills required to start social relationships or say no to insistent salespeople. Behavior therapists may help clients gain insight into maladaptive behaviors such as feelings of anxiety by helping the person become aware of the circumstances in which the behaviors occur. Some frequently used behavior-therapy techniques: 1. Fear-Reduction Methods Flooding. The client is exposed to the fear-evoking stimulus until fear is extinguished. Systematic Desensitization. The client is gradually exposed to fear-evoking stimuli under circumstances in which he or she remains relaxed. Virtual Therapy. Using the technology we find in video games, programs mimic traumatic settings and events. The idea behind the treatment is to systematically expose the patient to aspects of their experience in a graded fashion so they can confront their fear of the trauma. Modeling. It relies on observational learning. In this method, clients observe and them imitate people who approach and cope with the objects or situations that the clients fear.

2. Aversive Conditioning Many people also seek behavior therapy because they want to break bad habits such as smoking, excessive drinking, nail-biting, and the like. Aversive conditioning is a method in which a painful or aversive stimuli are paired with unwanted impulses, such as desire for a cigarette, in an effort to make the impulse less appealing. For example, to help people control alcohol intake, tastes of different alcoholic beverages can be paired with drug-induced nausea and vomiting or with electric shock. 3. Operant Conditioning Procedures We tend to repeat behavior that is reinforced. Behavior that is not reinforced tends to become extinguished. The Token Economy Many psychiatric wards and hospitals use token economies in which patients need tokens such as poker chips to purchase TV viewing time, extra visits to the canteen, or a private room. The tokens are dispensed as reinforcers for productive activities such as making beds, brushing teeth, and socializing. Token economies have not eliminated all symptoms of schizophrenia but have increased patients activity and cooperation. Tokens have also been used to modify the behavior of children with conduct disorders. Successive Approximations The operant conditioning method of successive approximations is often used to help clients build good habits. For example, you want to study three hours each evening but can concentrate for only half an hour. Rather than attempting to increase your study time all at once, you could do so gradually by adding, say, five minutes each evening. After every hour or so of studying, you could reinforce yourself with five minutes of people-watching in a busy section of the library. Biofeedback Training Through biofeedback training, therapists help clients become more aware of, and gain control over various bodily functions. Therapists attach clients to devices that measure bodily functions such as heart rate. Electronic signals are used to indicate (and thereby reinforce) changes (operants) in the desired direction for example, a slower heart rate. Knowledge of results is a powerful reinforcer. Social Skills Training In social skills training, behavior therapists decrease social anxiety and build social skills through operant conditioning procedures that employ selfmonitoring, coaching, modeling, role-playing, behavior rehearsal, and feedback. Social skills training has been used to help formerly hospitalized mental patients maintain jobs and apartments in the community. Social skills training is effective in groups. Group members can role-play important

people such as parents, spouses, or potential dates in the lives of other members. COGNITIVE THERAPIES Cognitive therapy focuses on changing the beliefs, attitudes, and automatic types of thinking that create and compound peoples problems. Cognitive therapists, like psychoanalytic and humanistic therapists, aim to foster self-insight, but they mainly aim to help make people more aware of their current cognitions. Cognitive therapists also aim to directly change maladaptive thoughts in an effort to reduce negative feelings and help clients solve problems. Aaron Becks Cognitive Therapy Psychiatrist Aaron Beck encourages clients to become their own personal scientists and challenge feelings and beliefs that make no sense. Beck encourages clients to see the irrationality of their ways of thinking. For example, depressed people tend to minimize their accomplishments and expecting the worst are (usually) distortions of reality that lead to feelings of depression. Cognitive distortions can be fleeting and automatic, difficult to detect. Becks method help clients become aware of such distortions and challenge them. The following are some of cognitive errors that contribute to clients miseries: 1. Clients may selectively perceive the world as a harmful place and ignore evidence to the contrary. 2. Clients may over generalize on the basis of a few examples. 3. Clients may magnify, or blow out of proportion, the importance of negative events. 4. Clients may engage in absolutist thinking, or looking at the world in black and white rather than in shades of gray. Becoming aware of cognitive errors and modifying catastrophizing thoughts help us cope with stress. Cognitive therapists also alert clients to cognitive errors or irrational thoughts so that the clients can change their attitudes and pave the way for more effective overt behavior. Rational Emotive Behavior Therapy In rational emotive behavior therapy (REBT), Albert Ellis pointed out that our beliefs about events, not only the events themselves, shape our responses to them. Moreover, many of us harbor a number of irrational beliefs that can give rise to problems or magnify their impact. Two fo the most important ones are the belief that we must have the love and approval of people who are important to us and the belief that we must prove ourselves to be thoroughly competent, adequate, and achieving. Ellis urges clients to seek out their irrational beliefs, which can be unconscious, though not as deeply buried as Freud believed. Ellis showed clients how those beliefs lead to misery and challenged clients to change them. When he saw clients behaving according to irrational beliefs, he refuted the beliefs by asking Where is it written that you must? or What evidence do you have that?.

GROUP THERAPIES When a psychotherapist has several clients with similar problems anxiety, depression, adjustment to divorce, lack of social skills it often makes sense to treat them in a group rather than in individual sessions. Group therapy has the following advantages: It is economical. Compared with one-to-one therapy, group therapy provides more information and life experience for the clients to draw on. Appropriate behavior receives group support. When we run into troubles, it is easy to imagine that we are different from other people or inferior to them. Group members who show improvement provide hope for other members. Members of groups have the opportunity to practice social skills in a relatively non threatening atmosphere.

1. Couple Therapy Couple therapy helps couples enhance their relationship by improving their communication skills and helping them manage conflict. There are often power imbalances in relationships, and correcting power imbalances increases happiness and can decrease the incidence of domestic violence. The main approach to couple therapy is cognitive-behavioral. It teaches couples communication skills (such as how to listen and how to express feelings), ways of handling feelings like depression and anger, and ways of solving problems. 2. Family Therapy Family therapy is a form of group therapy in which one or more families constitute the group. In systems approach theoretical viewpoint of family therapy, family interaction is studied and modified to enhance the growth of individual family members and of the family unit as a whole. The family therapist attempts to teach the family to communicate more effectively and encourage growth and autonomy in each family member.