Bài giảng Tâm lý học áp dụng để điều chỉnh cuộc sống hiện đại trong thế kỷ 21 Bài giảng Tâm lý học áp dụng để điều chỉnh cuộc sống hiện đại trong thế kỷ 21 Bài giảng Tâm lý học áp dụng để điều chỉnh cuộc sống hiện đại trong thế kỷ 21 Bài giảng Tâm lý học áp dụng để điều chỉnh cuộc sống hiện đại trong thế kỷ 21 Bài giảng Tâm lý học áp dụng để điều chỉnh cuộc sống hiện đại trong thế kỷ 21
Chapter 15 Psychotherapy The Treatment Process, continued • Treatments: How many types are there? – All psychotherapies involve “a helping relationship (the treatment) between a professional (the therapist) and another person in need of help (the client)” – There are three main categories of therapy: Insight therapies Behavior therapies Biomedical therapies The Treatment Process, continued • Clients: Who seeks therapy? – Approximately 15% of Americans seek mental health services each year – The most common problems are excessive anxiety and depression – People seek treatment for milder problems, such as making a career decision, as well – Women, people with medical insurance, and people with more education are all more likely to seek treatment The Treatment Process, continued Clients: Who seeks therapy?, continued – Unfortunately, many who need therapy not receive it (see Figure 15.2) – Common barriers to seeking treatment include • Lack of health insurance • The “stigma” associated with receiving mental health services Figure 15.2 Therapy utilization rates Olfson and colleagues (2002) gathered data on the use of nonhospital outpatient mental health services in the United States in relation to various demographic variables In regard to marital status, utilization rates are particularly high among those who are divorced or separated The use of therapy is greater among those who have more education and, in terms of age, utilization peaks in the 35-44 age bracket Females are more likely to pursue therapy than males are, but utilization rates are extremely low among ethnic minorities (Data from Olfson et al., 2002) The Treatment Process, continued • Therapists: Who provides treatment? – Psychologists and psychiatrists are the most common providers of treatment – However, therapy is also provided by other professionals, including • Psychiatric social workers • Psychiatric nurses • Counselors The Treatment Process, continued Therapists, continued – Clinical psychologists and counseling psychologists “specialize in the diagnosis and treatment of psychological disorders and everyday behavioral problems” – Both require a doctoral degree (Ph.D., Psy.D., or Ed.D) – Psychologists are more likely to use behavioral methods over psychoanalysis – Psychologists also psychological testing and conduct research The Treatment Process, continued Therapists, continued – Psychiatrists “are physicians who specialize in the treatment of psychological disorders” – Psychiatrists focus on more severe disorders (e.g., schizophrenia) – Psychiatrists earn an M.D and typically emphasize drug therapies (psychologists cannot prescribe medication) – Psychiatrists are also more likely to use psychoanalysis The Treatment Process, continued Therapists, continued • Other mental health professionals – Psychiatric social workers work as part of a treatment “team” with a psychologists or psychiatrist – They have a master’s degree and usually help patients integrate back into the community – Psychiatric nurses earn a bachelor’s or master’s degree and usually work with hospitalized patients Insight Therapies, continued • Insight therapies “involve verbal interactions intended to enhance clients’ self-knowledge and thus promote healthful changes in personality and behavior” – Insight therapies include • Psychoanalysis • Client-centered therapy • Positive psychology • Group therapy Current Trends and Issues, continued • Grappling with constraints of managed care – Before the 1990s, with the fee-for-service system, doctors charged patients fees for whatever services were necessary Patients were then reimbursed through insurance or the government – This system changed to a managed care system in the 1990s, in which people enroll in prepaid plans (typically run by HMOs) and make small copays for services Current Trends and Issues, continued Managed care, continued – Managed care was developed in an attempt to control inflation of medical costs – However, critics assert that, in an attempt to control costs, healthcare has been rationed and access to some medically necessary services has been limited – This is especially true in the mental health field, in which HMOs may not recognize the necessity of certain treatments Current Trends and Issues, continued Managed care, continued – In addition, critics argue that, as a result of managed care, mental health patients • Are often underdiagnosed (to avoid having to prescribe costly treatments) • Are not referred to mental health specialists by primary physicians • Are limited in the number of psychotherapy sessions, or length of treatment, they can have Current Trends and Issues, continued Managed care, continued – Critics also argue that managed care has created barriers to access, such as • Requiring referrals from primary care physicians who don’t have appointments available for weeks or months • Rerouting patients to less expensive master’s-level counselors who may not be able to handle serious disorders • Prescribing older, less expensive drugs Current Trends and Issues, continued • Blending approaches to treatment – It is becoming increasingly common for therapists to draw from various therapeutic approaches to treat a client – Studies show that there is, indeed, merit to this idea – Today, most therapists describe themselves as eclectic – “drawing ideas from two or more systems of therapy” (see Figure 15.15) Figure 15.15 The leading approaches to therapy among psychologists These data, from a survey of 531 psychologists who belong to the American Psychological Association’s Division of Psychotherapy, provide some indication of how common an eclectic approach to therapy has become The findings suggest that the most widely used approaches to therapy are eclectic, psychodynamic, and cognitive-behavioral treatments (Based on data from Norcross, Hedges, & Castle, 2002) Current Trends and Issues, continued • Increasing multicultural sensitivity in treatment – Minority groups are especially unlikely to seek and utilize therapy Cultural barriers – Some cultures emphasize assistance from family, clergy, etc., over mental health professionals – Some cultures have difficulty trusting the medical (and mental health) establishment Current Trends and Issues, continued Increasing multicultural sensitivity, continued Language barriers – Effective communication is critical to therapy, and cultural differences in language can act as a barrier to treatment Institutional barriers – Most therapists have only been trained to interact with white, middle-class clients and are unfamiliar with the cultural backgrounds of various ethnic groups Current Trends and Issues, continued Increasing multicultural sensitivity, continued • What can be done? – Recruit and train minority therapists – Train therapists how to work more effectively with a culturally diverse clientele – Research how to modify current approaches so that they are more compatible with a diverse clientele Application: Looking for a Therapist, continued • Where you find therapeutic services? – Contrary to popular belief, most therapists not operate in private practice In fact, many work in • Institutional settings (such as community mental health centers) • Human service agencies • See Figure 15.16 for more information Figure 15.16 Sources of therapeutic services Therapists work in a variety of organizational settings Foremost among them are the five described here Application: Looking for a Therapist, continued • Is the therapist’s profession or sex important? – Researchers have not found any reliable link between the therapists’ profession (e.g., psychologist versus psychiatrist) and therapeutic efficacy – However, psychiatrists are the only mental health professionals who can prescribe medication Application: Looking for a Therapist, continued • – This is a subjective matter – Thus, if the client thinks he or she will feel more comfortable with a therapist of the same gender, then that person should find one that is the same gender Is therapy always expensive? – Not necessarily Costs can be reduced by • Seeking treatment from providers who are not in private practice (e.g., human service agencies) • Using health insurance Application: Looking for a Therapist, continued • Is the therapist’s theoretical approach important? – For certain types of problems, certain theoretical approaches are a better fit – For example, • Cognitive therapy is best for panic disorders • Behavior therapy (systematic desensitization) is best for phobias • OCD is best treated with behavior therapy and medication Application: Looking for a Therapist, continued • What is therapy like? – It is important to have realistic expectations about therapy – Therapy is usually a slow process – Therapy is hard work – Your therapist is only a facilitator Ultimately, you have to make changes in your behavior or personality in order to see improvement [...]... Insight Therapies, continued Psychoanalysis, continued – Interpretation “involves the therapist’s attempts to explain the inner significance of the client’s thoughts, feelings, memories, and behaviors” – Resistance “involves largely unconscious defensive maneuvers intended to hinder the progress of therapy” • Clients may resist by “forgetting” appointments or being hostile toward the therapist Insight... therapy, continued – Therapeutic process • With this approach, the client and therapist work together almost as equals • The therapist’s key task is clarification – “reflecting the client’s statements with enhanced clarity” • The main goal of therapy is to help clients become more aware of, and comfortable with, their “genuine selves” Insight Therapies, continued • Therapies inspired by positive psychology. .. researchers often find the most support for the therapeutic approach they use – Despite this, many studies have shown insight therapy to be superior to placebo and to produce lasting effects – Also, most people find therapy beneficial Insight Therapies, continued Evaluating insight therapies, continued • Common factors that make various insight therapies effective: 1 Developing an alliance with a... empathic understanding from the therapist 3 The cultivation of hope, positive expectations Insight Therapies, continued Evaluating insight therapies, continued 4 Provision of a rationale for one’s problems and a method for alleviating them 5 The opportunity to express feelings, confront problems, gain new insights, and learn new patterns of behavior Insight Therapies, continued • Therapy and the recovered... Behavior Therapies, continued • • • Insight therapists believe that behaviors are symptoms of underlying psychological issues In contrast, behavior therapists argue that the behaviors themselves are the problem Thus, behavior therapies “involve the application of the principles of learning to direct efforts to change clients’ maladaptive behaviors” Behavior Therapies, continued • • • Behavior therapy... Certain problems are well-suited for group therapy In “peer self-help groups”, all members share the same kind of problem (e.g., Alcoholics Anonymous) and can provide support for each other Insight Therapies, continued • Evaluating insight therapies – It is difficult to compare the effectiveness of one type of insight therapy to another because of the allegiance effect, in which researchers often find... client’s neurotic behavior Insight Therapies, continued Psychoanalysis, continued – In free association, “clients spontaneously express their thoughts and feelings exactly as they occur, with as little censorship as possible” – In dream analysis, the therapist interprets the symbolic meaning of the client’s dreams” – Both techniques require the therapist to interpret the clues that these methods provide... Behavior Therapies, continued Systematic desensitization, continued – Before beginning, the therapist helps the client build a fear hierarchy, or a list of progressively more frightening versions of the conditioned stimulus (see Figure 15. 8) – Then, the client is trained in deep muscle relaxation – Finally, the client pairs the learned relaxation with each step of the hierarchy until anxiety to the fear... shown in Figure 15. 9, an alcoholic’s desire to drink could be weakened by pairing a nausea-inducing drug with alcohol – Aversion therapy is used with a wide range of undesirable behaviors including gambling, shoplifting, and smoking Figure 15. 9 Aversion therapy Aversion therapy uses classical conditioning to create an aversion to a stimulus that has elicited problematic behavior For example, in the. .. Well-being therapy, developed by Giovanni Fava, focuses on “self-acceptance, purpose in life, autonomy, and personal growth” – Positive psychotherapy – “ attempts to get clients to recognize their strengths, appreciate their blessings, savor positive experiences, forgive those who have wronged them, and to find meaning in their lives” • It has been successful in treating depression (see Figure 15. 5) ... require the therapist to interpret the clues that these methods provide about unconscious conflicts Insight Therapies, continued Psychoanalysis, continued – Interpretation “involves the therapist’s... shown insight therapy to be superior to placebo and to produce lasting effects – Also, most people find therapy beneficial Insight Therapies, continued Evaluating insight therapies, continued • Common... client’s point of view) Insight Therapies, continued Client-centered therapy, continued – Therapeutic process • With this approach, the client and therapist work together almost as equals • The therapist’s