Treatment

1. TREATMENT
Meghan Fraley, PhD
Skyline College, Summer 2015

2. Psychotherapy
Outcome
Research
¨ Eysenk,
1950,
no
impact
¨ Meta-­‐analysis:
review
literature
and
find
effect
size
(Smith)
¨ Effect
size:
¤ Measure
of
standard
deviaHon
units
of
difference
between
treated
and
untreated
Average effect size of .85
50% improved by 8th session
75% imporved after 6 months
People do well, women more likely to seek treatment

3. Research Overview
META-ANALYSIS
• Smith, Glass and Miller
Effect Size Meta-Analysis
• Eysneck said untreated
people did better than
treated people
• What’s the criticism of meta-
analysis?
• You end up crunching
numbers, and can’t control
for the quality of the
research
RESULTS:
• 50% of clients showed
marked improvement
after 8 sessions.
• Dose dependent effect
• Howard et al. (1986):
• The bigger the does, the
better the outcome
• 75% at 26 sessions, and
85% at 52 sessions, 2
years, a little more!

4. How Much Does Therapy Help?
Average effect
size of .85
50% improved
by 8th session
75% improved
after 6 months

5. Effects of Treatment Length
Remoralization
Remediation
Rehabilitation
Phase Model
Dose dependent effect
• Howard et al. (1986):
• The bigger the does, the better the outcome
• 75% at 26 sessions, and 85% at 52 sessions, 2 years, a little more!

6. Therapy
Variables
¨ Client:
¤ Largest
contribuHon
to
outcome
¤ Lower
SES
and
educaHon,
drop
out
earlier
and
more
frequently
(but
doesn’t
effect
outcome
if
you
stay)
¤ Individual
and
Group
similar
¤ Individuals
over
65
less
problems
(except
demenHa)
¤ Highest
rates
25-­‐44

7. Therapy Variables: Therapist and
Relationship
Therapy relationship
alliance,
cohesion,
empathy,
collecting feedback
Therapist:
Non-technical aspects most important, little
difference in outcome
If matched ethnicity, therapist factors
account for 30% of outcome variance

8. Behavioral
Therapies:
1) Classical
Conditioning
2) Operant
conditioning
3) Social Learning
Theory

9. IntervenHons
Based
on
Behaviorism
¨ Behaviorists
believe
behavior
is
generated
and
maintained
by
factors
external
to
the
person

10. Systematic Desensitization
Systematic
desensitization is a
specific technique that
breaks the link
between the anxiety-
provoking stimulus and
the anxiety response.
This treatment
requires the patient to
gradually confront the
object of fear.

11. OPERANT
CONDITIONING:
Aversive
Control
of
Behavior

12. Punishment
¨ Influences on punishment:
¤ Immediacy
¤ Consistency
¤ Intensity
¤ Verbal clarification
¤ Removal of All Positive
Reinforcement
¤ Reinforcement for
Alternative of Behaviors

13. Beck’s Cognitive Therapy
¨ AutomaHc
thoughts:
maladapHve
lead
to
symptoms
¨ Cognitive targets of
CT:
¤ Cognitive Schemas
¤ Automatic Thoughts
¤ Cognitive Distortion
¤ Cognitive Profile

14. Beck’s
Cogni4ve
Profiles
Negative View
of Self
Negative View
of World
Negative View
of Future
Beck’s
CogniHve
Profile
of
Depression Beck’s
CogniHve
Profile
of
Anxiety
Excessive Form of
Normal Survival
Mechanisms
• Unrealistic Fears about
Physical Threats
• Unrealistic Fears about
Psychological Threats

15. Basic Cognitive Therapy Techniques.
• Usually takes about 12 - 20 weeks.
• The essential goal of cognitive therapy is to understand the realities of an anxiety-provoking situation and to respond to reality
with new actions based on reasonable expectations.Treatment
• First, the patient must learn how to recognize anxious reactions and thoughts as they occur.
• One way of accomplishing this is by keeping a daily diary that reports the occurrences of anxiety attacks and any thoughts and
events associated with them. A patient with OCD, for instance, may record repetitive thoughts.Recognize Reactions
• These entrenched and automatic reactions and thoughts must be challenged and understood.
• Again, using the OCD example, one approach is to record and play back the words of the repetitive thoughts, over exposing the
patient to the thoughts and reducing their effect. One effective approach for patients with generalized anxiety disorder targets
their intolerance of uncertainty and helps them develop methods to cope with it.
Understand and
Challenge
• Patients are usually given behavioral homework assignments to help them change their behavior.
• For example, a person with generalized social phobia may be asked to buy an item and then return it the next day. As the patient
performs this action, they observe any unrealistic fears and thoughts triggered by such an event.Homework
• As the patient continues with self-observation, they begin to perceive the false assumptions that underlie the anxiety.
• For example, patients with OCD may learn to recognize that their heightened sense of responsibility for preventing harm in non-
threatening situations is not necessary or even useful.
Perceive false
assumptions
• At that point, the patient can begin substituting new ways of coping with the feared objects and situations.
New Ways of Coping

16. Linehan’s
DialecHcal
Behavioral
Therapy
¨ OutpaHent
for
borderline
¨ DialecHc:
Acceptance
and
Change
¨ Focus
on
present
¨ Four
requirements:
¤ commit
to
period
of
Tx
&
a^end
all
sessions,
¤ reduce
suicidal
behavior,
¤ work
on
behaviors
that
interfere
with
therapy,
¤ a^end
skills
training

17. Psychodynamic Therapies
¨ Insight oriented
¨ Past determines the
present:
¤ Transference (Past will
determine present
relationships through
projection).
¨ General principles apply
to everyone
¤ Defense mechanisms,
Dr. Freud said every one
of us must use them to
allay fears
¨ Conflicts affect
personality development

18. Classical
Psychoanalysis
• Primitive
• Ruled by Instinct
• Libido
• Aggression
• Immediate Pleasure
Id
• Operates on reality principe
• Defer immediate gratification
• Executive functioning
• Manage Id impulses
• Social Acceptable
Ego
• Conscious
• Moral code
• Standards internalized from
parents and society
• Right and Wrong: GUILT
Superego
Deterministic: irrational
forces, unconscious
motivations, bio drives, and
psychosexual events up to
age 6 determine behavior

19. Anxiety
and
the
Defense
Mechanisms
Repression
Regression
Projection
Displacement
• Behaviors exactly opposite of what we
are feeling
Reaction Formation
• Cut off from affect
Intellectualization
Rationalization
• Normal and desirable
• Channel into something else
Sublimation
We get anxious when
Id impulses get too
strong and start
moving into
consciousness. Prevent
us from becoming
aware of forbidden id
impulses

20. Freudian Psychoanalysis
Psychopathology results from unconscious, unresolved conscious from childhood
Defense Mechanisms: Include repression, reaction formation, and displacement
Therapy goal: Reduce maladaptive behavior by bringing unconscious material into conscious awareness
Therapy process:
• Clarification, confrontation, interpretation, and working through

21. PsychoanalyHc
Treatment
and
Techniques
¨ Make
conscious
the
unconscious
¨ Bring
to
the
light
id
conflicts
¨ Free
associaHon
¨ Treatment
includes:
¤ ClarificaHon
¤ ConfrontaHon
¤ InterpretaHon
¤ Working
Through
¨ Transference
and
Countertransference

22. Freudian Therapy process:
Clarification
Confrontation:
• Bring up something below the surface
Interpretation
Working through

23. Jung’s Analytic Psychology
Stood alone for decades
Personality is not shaped by age 5 or 6, it is a life long continuum
Focus is on adulthood. Personality changes are made mid-life, they don’t necessarily, but
they can
Components of the Unconscious: the personal unconscious consists of personal experiences
and the collective unconscious consists of collective epeirneces of the human race
(archetypes).
Personality Theory: Development continues throughout the lifespan. Individuation is a key
task of the second half of life and involves developing a unique, integrated identity

24. Jungian Concepts:
Collective Unconscious
• We humans share a collective
unconscious. Two unconscious layers
personal and collective. There from
beginning of time.
Archetypes
• Primordial images that exist in the
collective unconscious.

25. Archetypes
¨ Universal
and
Pa^erns
of
experience
passé
dhtrough
generaHons
(art,
literature,
dreams)
¨ Neurosis
is
a^empt
to
free
ourselves
from
our
archetypes,
they
are
prevenHng
us
from
fulfiling
our
potenHal.
Part
of
process
on
way
to
individuaHon.

26. Therapies
and
IntervenHons
Based
on
Humanism/ExistenHalism
Emphasize
subjective
experience
Phenomenlogica
l approach:
• Enter client’s
subjective
world
Trust clients’
capacity
Focus on
freedom, choice,
autonomy,
purpose,
meaning, focuse
on present
Humanists:
Move toward
actualization if
nurture
Existentialists:
NO internal
nature, world
lacks intrinsic
meaning, we
must make
sense of
meaninglessnes
s

27. Rogers:
Client/Person
Centered
Therapy
Inborn capacity for
purposive, goal-
directed behavior
Faulty learning leads
to hateful, self-
centered, ineffective,
antagonistic
approaches
Therapy: expand
awarnes and liking of
self
Key characteristics of
treatment:
• Empathy
• Warmth
• Genuiness
Unconditional
Positive
Regard!

28. Gestalt
Boundary
Disturbances
• Taking information in whole
without crtical examination
• Become overly compliant
Introjection
• Put out our feelings on to
others
• Leads to Paranoia
Projection
• Turn onto you what you
would like to do to someone
else
Retroflection
• Distancing from your feelings
and others. Excessive humor.
• Asking a lot of questions
Deflection
• Lack of awareness of how
you and someone else are
actually two different people
Confluence
Boundary Disturbances:
When you engage, you don’t have true
contact

29. Existential Therapy Overview
• Personal choice and responsibility for developing meaningful life
• We are evolving and becoming
• Inability to cope authentically with concerns of existence
• Existential versus neurotic anxiety
• Live more committed, self-aware and authentic life
• Here and now
• Therapeutic relationship

30. Hypnotherapy
Hypnosis
• State or condition in which person can respond to suggestions by
experiencing alternations in perceptions, memory, or mood
Can lead to altered or dissociated state
Used for:
• Pain, asthma, conversion, substance use, Acute stress and other
anxiety, Obesity, insomnia
Aid memory, but can create false memories (and
exagerrate comnfidence in them)
True memory or not, reflects relevant treatment issues
Ekricksonian involves techinques that rely on
psycholinguistic nuance

31. Consequences of Oppression
¨ Internalized Oppression
¨ Conceptual Incarceration
¤ Adopt White worldview/
lifestyle
¨ Split-self syndrome
¤ Polarizing self into good
and bad (bad represent
one’s African American
identity)
¨ Survival Mechanisms
¤ Playing it cool
¤ Happy-go-lucky

32. Cultural versus Functional Paranoia
Cultural Paranoia
• Lack of disclosure due to experiences
of prejudice in past
• Healthy response
• When meaning of paranoia is
discussed, client encouraged when it
is desirable or not to disclose
Functional Paranoia
• Pathology, won’t disclose to anyone,
general distrust
Intercultural Nonparanoiac
Discloser
• Low functional, low cultural
• Willing to disclose
Functional Paranoiac
• High Fucntional, low cultural
• Generally nondisclosive
• Primarily pathology
• Therapist competence rather than race
or culture
• Alleviate pathology
Healthy Cultural Paranoiac
• Low functional, high cultural
• Reluctant with Anglo therapists
• Explore meaning, make conscious,
therapist disclosure
• Disclosure flexibility
Confluent Paranoiac
• High fucntional, high cultural
• Combination of pathology and effects
of racism
• Combine approaches
• Likely therapist from same racial/ethnic
group
Ridley’s Paranoia
and Disclosure
Model