I. Insight-Oriented Therapy: Healing through personal insight

A. Psychoanalysis

Freud & Anna O: 21-year old woman who suffered from hysteria: paralysis of arms/legs, loss of sight/speech, memory loss, nausea, etc; through hypnosis, Anna brought the origins of her symptoms, usually traumatic events (such as the death of her father), to consciousness -- at which point, the symptoms disappeared

• Catharsis: emotional release of anxiety
• Without catharsis (direct expression), anxiety manifests itself in physical symptoms

• Free association: having patients lie on a couch and encouraging them to speak freely about whatever comes to mind; Usually results in bringing traumatic event to consciousness
• Resistance: Reluctance/refusal to bring trauma to consciousness – goal of psychoanalysis is to overcome resistance and rationally ponder traumatic event
• Dream analysis: second way to tap the unconscious
• Freud viewed dreams as symbolic manifestations of repressed traumatic thoughts, similar to hysterical symptoms Anna O. experienced
• A dream’s manifest content, or what it appears to be about, is often different from its latent content, or what it is really about, stemming from unconscious conflict
• Freud thought that nearly all dreams are wish-fulfillments, usually in a sexual way
• Snakes, sticks, knives: phallus; box, garden, oven: vagina; king, queen, governor: parent; ascending ladders, falling: sex; going bald or losing teeth: castration; death of parent: Oedipus/Electra complex; travel: death
• Transference: strong sexual or aggressive feelings, positive or negative, developed toward the therapist during treatment
• Patients feel toward therapist the same way they previously felt toward important person (usually parent)
• Positive transference is essential to success of treatment
• Permits patients to relive childhood traumatic experiences within a non-threatening climate of supportive therapist

Rogers: self-actualization is achieved through a healthy self-concept

• Incongruence: Real self (actual self) does not match ideal self (who you would like to be)
• Leads to blocking of personal growth, self-esteem
• Client-centered therapy
• Unconditional Positive Regard: acceptance of client by therapist without pre-requisites for behavior; acceptance without possessiveness, evaluation, reservation
• Most of us receive conditions of worth: we feel that we are loved/accepted only if we meet others’ expectations and approval
• Even favorable evaluation can be restrictive and may lead to defensiveness
• Throwing out evaluation leads to self-discovery and motivation for self-growth
• Also, the therapist needs to be congruent (sincere or “real” in expression of all feelings) and empathetic (accurate sense of client’s feelings) for client-centered therapy to be successful

A. Classical Conditioning

• Systematic Desensitization: Progressive muscle relaxation in the presence of a feared object or situation
• Followed by anxiety hierarchy of events: performing or imagining feared situation in a steady progression of anxiety levels until all stages are mastered
• Counterconditioning: If you have a fear of rabbits, then continuously pairing a rabbit with something good, such as eating, can unlearn your fear and replace it with affection
• Flooding: forced exposure with object of fear until person learns that nothing bad will happen from exposure to object
• Exposure with response prevention: flooding a person while restricting maladaptive response to object

• Behavior modification: Rewarding new behavior and not rewarding old behavior (i.e., response contingencies for reward); Token economies in prisons
• Punishment: adding something negative to the situation.
• Believed not to be ultimately effective…transfers fear from original object to something else present in situation; justification of fear used in inflicting punishment, etc.

• Cognitive therapy: rational thinking in attempt to control distressing feelings & behaviors

• Developed to treat depression
• Similar to RET: irrational thoughts are the root cause of psychological problems
• Aim to eliminate exaggerated negative beliefs & cognitive distortions through “experimentation” -- testing the validity of these negative beliefs
• Cognitive restructuring of dysfunctional thoughts by noticing that emotional state is not as bad as depressed person would predict before experimentation

A. Group Therapy: Many clients with compatible needs can meet with one or two therapists; group setting provides information, support, empathy from persons with same illness

B. Family Therapy: Premise is that a client’s symptoms occur in the larger context of his/her family (systems therapy); whole family is considered the “patient” to be treated

C. Self-Help Therapies: Support groups similar to group therapy, although not usually led by clinically trained therapist (e.g., AA); can come in form of books & tapes

V. Biomedical therapies

Psychopharmacology: use of medication in treating disorders; alteration/interaction of neurotransmitters in the brain

A. Anti-anxiety

• Benzodiazepines: Valium & Xanax are only prescribed on a short-term basis b/c of addiction and drowsiness

• Thorazine & Haldol: reduce symptoms but are not a cure
• Long term use can cause tardive dyskinesia: involuntary, irreversible movements (e.g., grimacing)

• Tricyclics (TCAs): affect serotonin levels
• MAO inhibitors: effective against increased appetite & increased need for sleep
• SSRIs: Prozac, Paxil & Zoloft affect specific serotonin receptors
• Lithium as mood stabilizer for bipolar disorder