In this video I describe how treatments can broadly be categorized into biomedical treatments and psychotherapy. Next I explain three approaches to psychotherapy: psychoanalytic, humanistic, and behavioral. I describe the general principles of these approaches and some of the key terms associated with each, along with examples of how these might be applied in treating specific cases. Disclaimer: This channel is for educational purposes only and is not intended as medical advice for the diagnosis or treatment of psychological disorders.

Carl Rogers on Empathy: https://www.youtube.com/watch?v=iMi7uY83z-U&list=PL9w3l7GkGUr1yxU4s2PiggyCbOO3XfpRf

Video Transcript

Hi, I’m Michael Corayer and this is Psych Exam Review. In this video, we’re going to start looking at types of treatment for mental illness. And we can start by broadly dividing treatments into two main categories. We have biomedical treatments and psychotherapy. So biomedical treatments would include things like the use of medication, the use of brain stimulation, or in rare cases, the use of surgery and then everything else would be psychotherapy. And this includes a range of approaches that can differ substantially from one another But these include things like a psychoanalytic approach, a humanistic approach, a behavioral approach, and a cognitive approach to treating mental illness. And often what we see is therapists will use what’s called an eclectic approach. And what that means is they’re going to draw on different elements of different approaches. And this may also include the use of some biomedical techniques, such as the use of medication.

In this video, we’re going to look in more detail at a few types of psychotherapy. And these will be a psychoanalytic approach to psychotherapy, a humanistic approach and a behavioral approach. And in the next video, we’ll look at the cognitive approach in more detail. And then in subsequent videos, we’ll look at some biomedical treatments in more detail as well.

So we’ll start by looking at psychoanalysis, so this is the Freudian approach. And the goal of psychoanalysis was to gain insight into the unconscious. And so here we’re talking about the Freudian unconscious that refers to the person’s hidden desires and fears, which are kept out of conscious awareness. And so through different techniques, such as free association, dream analysis and interpretation the therapist is trying to figure out what’s in the person’s unconscious and help them to gain insight into that in order to resolve the conflict that the unconscious is causing. Because Freud believed that it was unconscious conflict that’s the source of mental illness And this approach is sometimes also called the talking cure, because the patient is doing a lot of talking, you know, telling about their dreams, doing free association. And then the therapist is trying to look for clues into the unconscious in all this talking. And so the goal is to resolve these conflicts and then reduce the person’s anxiety.

And what Freud thought is that patients will initially show resistance to this approach to therapy. And he thought they showed this resistance because they want to avoid confronting the unconscious because it’s going to cause some anxiety. But over time, as they become more comfortable, they’re able to overcome this resistance and begin confronting the unconscious. And as they do this, some of the conflict and the anxiety that’s produced will be redirected onto the therapist. And this is what Freud called transference.

Now we don’t often see psychoanalysis practiced much today, although some aspects of it do continue in certain types of therapy. And one example of this is in interpersonal therapy, which is focused on improving people’s relationships. And there we can see some aspects of psychoanalytic thinking that are still used today in therapy.

Now, another approach to psychotherapy is what’s called humanistic therapy. And this also originated from psychoanalysis. But the main shift from the Freudian approach was adopting a more positive view of human nature. So one of the main criticisms of Freud’s approach was that it was too focused on unconscious conflict and things like sexual drives and aggressive drives. And the humanistic therapists thought that they should have a more positive view and that people are actually striving for improvement in their lives. They’re not trying to battle against these sexual and aggressive drives of their unconscious, but that they want to improve their lives. And the therapist should help them to do this.

So one of the key figures in the humanistic movement was Carl Rogers. And he introduced what he called person-centered therapy or client-centered therapy, avoiding the use of the word patient. And he thought the main goal of client-centered therapy is to help the client to develop self awareness and then self acceptance. So the goal was personal growth for the client, not necessarily a cure for mental illness. And in doing this, in gaining self awareness, he thought conscious thoughts are more important than unconscious drives. So this is another shift from the psychoanalytic approach, which emphasized the role of unconscious processes, unconscious drives, desires, fears, whereas Rogers emphasized conscious thoughts in influencing people much more than unconscious drives.

And the goal of the therapist is to offer acceptance and empathy. So the therapist tries to recognize the person’s thinking and provide empathy. And Rogers thought that many people don’t experience enough empathy in their lives. And so the therapist may be the only source of empathy for some people. And this is an important part of their personal growth. And I’ll post a link in the video description where you can find an interview with Carl Rogers talking about this role of empathy in treatment.

And another way that this empathy shows itself is in what he called unconditional positive regard. So the therapist was not supposed to criticize or judge the person’s views. The therapist had to provide this unconditional positive regard. They need to have a positive regard for their client without any conditions attached to it, right? Regardless of what the person says, and this is to encourage the client to also have these unconditional positive feelings about themselves. So he thought many people have conditions of worth where they have certain conditions that they feel they need to meet in order to accept themselves. So if I don’t do this, then I’m not a good person or I can’t be happy or I can’t accept myself unless I’m able to do this. And he thought in order to grow, people need to put aside those conditions of worth and accept themselves. And that this will actually help them to continue improving in the future.

And so the way that the therapist would do this would be to try to understand the person’s views rather than judging or criticizing them and then reflect them back to the client in a way that will help the client to gain insight. And so this is what he called active listening, where the therapist will listen carefully to what the client says and then try to clarify those views to make sure that they’re understanding and also this reflects it back to the client who can you know, clarify some of those views or or maybe add to the views that the therapist is hearing and then acknowledge those viewpoints and through going through this process of listening, clarifying, and acknowledging these views of the world, this would help the person to gain insight into themselves, gain self awareness, and then self acceptance. And then there would be a better able to grow and improve themselves.

Now another humanistic approach is what’s called Gestalt therapy. And this is associated with Frederick “Fritz” Perls. And he was influenced by Gestalt psychologists, and you might recall that the word Gestalt is German for form or whole. And so in Gestalt therapy, the idea was that the person needs to confront their thoughts, behaviors and feelings, and then take responsibility for all of these thoughts, behaviors and feelings. And by doing so, they can integrate these into a bigger whole. So by taking responsibility for all of their thoughts, behaviors and feelings, they can become a more whole person.

And one way that this was done in Gestalt therapy was what’s called the empty chair technique. And so an empty chair would be placed in the room and the person would be asked to imagine another person in the chair. Perhaps someone who they might have some issues with. Maybe they have to imagine their mother is sitting in the chair or their father. And as they imagine the person is there, they’re encouraged to talk openly to that person. What would you say to your mother about this if she were here? And so the person talks openly, and then they may also be asked to role play certain responses. Well, what do you think your mother would say to that, and they have to sort of role play. And this will help the therapist to identify sort of the overall view, the context, the whole of the situation. And then also hopefully help the person who’s engaging in this practice to get greater insight into their views on the relationship and where maybe they’re making certain assumptions about how someone will respond or how that person would react over time. And over time, by doing this, they can hopefully get a better understanding of the whole and they could recognize the thoughts, behaviors and feelings that they’re having and how those might be influencing it.

OK, so next we’ll take a look at behavioral therapy. And so behavioral therapy uses the principles of conditioning. And this is one way we can see that I think going through these treatments is a really useful way to review a lot of the previous units that we’ve learned about. So if you can look at the main ideas from the learning theory unit or from the cognitive unit or from the biological unit, you can see that those ideas would then influence how we approach the treatment of mental illness. And that’s what we see in the behavioral approach here is we take the principles of conditioning, say, OK, how could we apply these to an illness that somebody has?

And one way that we could do this is trying to extinguish unwanted responses or unwanted behaviors. And we could also use principles of conditioning to try to encourage certain positive behaviors or constructive behaviors. So first, we’ll look at trying to extinguish certain behaviors or certain responses. And one way we can do this is through what’s called aversion therapy. And so in aversion therapy, we try to stop problem behaviors and we do this by creating something aversive by using punishment. Now, one simple way you might see this is if you were to, you know, put something on your fingernails that tastes really bad. And what this would hopefully do is stop a problem behavior like biting your fingernails. So if you put a nail polish on them that tastes really bad each time you go to bite your fingernails, you get this bad taste in your mouth. And from what we’ve learned about conditioning, you’re going to now associate biting your fingernails with this aversive taste. And hopefully that would help you to stop biting your fingernails.

Now, you can also apply this to more serious situations like alcoholism. And so we’re using the principles of classical conditioning to try to associate certain stimulus, in this case, with illness. And this is done with a drug called antabuse, and this is disulfiram, and what this does is, if you take this drug and then you drink alcohol, you’ll become very sick very quickly. So just one drink will cause nausea and vomiting. And so the idea is, if you’re taking this drug, now, you want to avoid any alcohol consumption because even just one drink will make you very ill, and then you’ll associate, hopefully, according to classical conditioning, you’ll associate that illness with the alcohol. And this will help you to avoid alcohol in the future And this can be effective in the short term. People who are taking this drug, it is a bit easier for them to avoid drinking alcohol.

But over the long term, we see it’s actually not that great of a treatment. And part of the reason for that is it doesn’t teach people any coping strategies. So it’s not really they’re not learning anything about how to control their own behavior. And they aren’t learning how to deal with the cravings that they might have for alcohol at different times. And another problem we have is they might associate the illness and the nausea with the drug that they’re taking and not with the alcohol. And so what that means is they’ll avoid the drug. They say, well, if I’m getting sick, it’s because I’m taking this drug every day. And if I stop taking the drug, then I won’t be getting sick anymore. And I can continue drinking alcohol. So we can see that over the long term, this isn’t necessarily a very effective treatment for something like alcohol abuse.

We can also look at how aversion therapy is used to extinguish emotional responses. And here we see a bit more success in this approach. And one way this can be very successful is in exposure therapy, particularly for treating things like specific phobias. So in exposure therapy, the person is going to confront some anxiety causing stimulus and learn to decrease their emotional responses. So hopefully we can extinguish the emotional responses to certain stimuli. So one way this is described is as counter conditioning and this is a similar idea where in order to overcome those negative associations, we try to replace them with more positive associations. So by pairing a stimulus with something positive rather than something negative like the negative emotional response the person is having to it, this could help them to overcome that previous association.

And this was described in 1924 by Mary Cover Jones where she helped a boy named Peter to overcome a fear of rabbits using this counter conditioning. But it wasn’t very popular as a treatment until a few decades later as systematic desensitization, which was introduced by Joseph Wolpe and systematic desensitization consists of first learning some relaxation techniques to try to reduce the negative emotional responses by learning to relax and slow your breathing and maybe reduce some of the anxiety that you’re feeling, and then exposing the person to increasingly threatening stimuli.

So for example, if somebody had a fear of snakes, a specific phobia for snakes, then first they would learn some relaxation techniques you know, maybe some breathing exercises and then they’d be exposed to a snake and at first the exposure might be, you know, somebody holding a snake on the other side of the room. And this will cause some anxiety. They’ll have this unwanted negative emotional response, and then they’ll try to relax. They’ll use those techniques. And once they’ve calmed down, the emotional response is gone. Then the person holding the snake might come a step closer, and the anxiety will go back up, and then they’ll learn to relax. And then by doing this once they feel relaxed, the person with the snake can come even closer, right? And so they’re get this increasingly threatening exposure, right? It started with the snake on the other side of the room. Eventually, over the course of perhaps several hours, the person can be touching the snake or even holding it. And so we can see actually fairly rapid extinction of some of these unwanted emotional responses.

And what I just described would be an example of in vivo exposure, right? It’s actually in real life. It’s actually a snake there. But in some cases, we can also do this through virtual reality. So especially for phobias related to certain situations, somebody has a fear of maybe being able to ride in an airplane or if they’re afraid of getting into an elevator or in the case of something like agoraphobia, they might be afraid of leaving their house or going to a subway station or a shopping mall. And these are situations that we can mimic in virtual reality until the person has learned to reduce their emotional response to those situations and then gradually help them to do this in real life. So we can start by maybe exposing them to a shopping mall in virtual reality. And then eventually leading up to the in vivo exposure in real life.

And more recent research on exposure therapy has suggested that these relaxation techniques may not even be necessary. So while people might sort of enjoy feeling that they can control their emotional responses a little better, that they’ve learned some relaxation techniques, these might not be necessary because the anxiety and the emotional response often goes away on its own. So if you expose somebody to something that causes anxiety, keep it there, then they’ll have, you know, a quick rise in their anxiety. But over time, that anxiety will fall. They won’t stay there forever. So you know, if somebody first introduces a snake, the person becomes very anxious. Their heart’s racing. They’re having trouble breathing they might feel extremely anxious. But after a few minutes, they’ll find that that anxiety starts reducing on its own, even without the use of relaxation techniques.

And another way that we can use exposure therapy rather than systematic desensitization is what’s called flooding. And so in this case, rather than gradually building up these increasingly threatening stimuli, we expose the person immediately to the worst case scenario. And this is very anxiety producing for the person. But what they quickly will learn is that, you know, their worst fears didn’t happen. So maybe their worst case scenario would be, you know, holding a snake and you immediately give them this snake hold. And of course, they’ll have extreme anxiety reactions. But then the reality is actually nothing bad is happening. And again, as I said, that anxiety will naturally start to subside over time. And so in this case, it might be able to help a person to learn how to reduce these unwanted emotional responses more quickly.

And lastly, we can use exposure therapy for preventing certain behaviors, not just unwanted emotional responses. And this is used in treatments of things like obsessive compulsive disorder. So in obsessive compulsive disorder, the person has obsessive thoughts. And these lead to compulsive behaviors to try to reduce their anxiety. And so one way we could use exposure therapy here is we expose the person to something that will cause some of those obsessive thoughts to occur. So for instance, if somebody has obsessive thoughts related to cleanliness or their hands being contaminated and they need to wash their hands, then we can have them put their hands in dirt or touch something that makes that thought occur.

And then we do what’s called response prevention. We don’t let them wash their hands. They they have to sit there and just deal, try to cope with the anxiety that the situation is causing. So they put their hands in something that contaminates them. And then they’re told, you know, you are just going to avoid washing your hands. We’re just going to try to find some other way to get those thoughts to be reduced. So that would be an example of using response prevention and in some cases, this can be effective for treating things like obsessive compulsive disorder.

Okay. And then we have the more positive parts of conditioning, which is trying to promote certain desired behaviors. And here we’re going to use the principles of operant conditioning. So we’re going to try to reward or reinforce certain behaviors in order to encourage those and make them more probable in the future. So we’re going to be using shaping in order to get desired behaviors over time. So one way we do this is through what’s called a token economy. And so in a token economy, the person can collect rewards by doing certain desired behaviors. And then as they collect these rewards or tokens, then they can redeem them for some other reward.

So for example, if a child has something like autism, they might avoid certain types of social interaction. And so if they engage in these social interactions, then they get a token or some sort of reward and then if they build up, say, you know, 10 of these rewards, then they can use that. They can redeem that in order to get maybe they get to watch their favorite movie or they get to engage in, you know, whatever their favorite activity is. And so this encourages them to keep engaging in the social interaction. And that means they’re going to be developing more social skills and getting greater competence there over time using the collection of these rewards, you know.

In some ways, we can see how businesses attempt to use token economies when they do things like give you a punch card, you know, if you buy 10 sandwiches, you know, you get the next one for free. That’s essentially a token economy design to try to encourage desired behaviors. We can also see this in the use of skills training for a self sufficiency. What that means is people who maybe have some disabilities or they have some difficulties with certain types of tasks. They’re not able to complete them on their own. Then initially they can receive some tokens for doing this. So maybe they have to learn how to complete certain types of forms. Maybe some personal information, they need to be able to fill out a form accurately in order to do things like pay bills. And so first they’ll just do some training where they each time they fill out the form correctly, they don’t make any errors, then they get a token. If they get enough tokens, they get some other reward. Maybe it’s an extra dessert at dinner or movie time or some other, you know, reward for that person And the idea is that will help them to develop these skills more quickly.

Now, we might wonder about over–justification. So if you remember in the unit on learning theory, I talked about the over-justification effect. This is the idea that if you provide extrinsic rewards for things, then this can have the side effect of reducing the intrinsic motivation for certain tasks. So in one of these studies that I described, your children were rewarded for drawing behavior. They were given stickers for drawing and this helped encourage drawing behavior. But then when the stickers were gone, when they’re no more rewards being offered, drawing behavior went back below the baseline. And so this suggested that when rewards end, the improvements in behavior also end.

So we might wonder about token economies for this and fortunately these token economies often don’t have the problem of over-justification because the behaviors and the skills that are being rewarded are also rewarding for their own sake later on. So for example, when a child learns to interact better. So a child who maybe has autism, they have this token economy for certain types of social interaction as they develop those skills and competencies. Then what we see is that behavior becomes rewarding on its own. Something they learn is that they can enjoy social interaction. They can do things that they couldn’t do before. And as a result, they have sort of a built-in reward. So we stopped giving the tokens, but they’ll continue the behavior because the behavior is now rewarding on its own.

Or similarly, people who learn to complete forms and they earn tokens later, completing forms has a built-in reward of now they can pay bills independently. Maybe they can live on their own more successfully because they’re able to do some of these tasks that they couldn’t do before or they can maybe make a phone call and order food for delivery whereas before, maybe they had some anxiety related to that or they weren’t able to get some of the information correctly. But by practicing and getting tokens, now they can do it for real. And the reward is now they can order food. There’s a real life reward that’s built into that behavior that has now replaced the use of tokens.

OK, so those are some examples of types of psychoanalytic therapies, humanistic therapies, and behavioral therapies. And in the next video, we’ll take a look at cognitive approaches to psychotherapy in more detail. So I hope you found this helpful, if so, please like the video and subscribe to the channel for more. Thanks for watching!