Treatment of Psychological Disorders
-Philippe Pinel-France
-Dorothea Dix-United States, Canada, Scotland
-Two main forms of treatment
-Psychotherapy
-Biomedical Therapy
-Eclectic Approach
-Draws from techniques of various forms of therapy
I. The Psychological Therapies
-Dozens of types of psychotherapy
-Focus on the most influential
-Psychoanalytic
-Humanistic
-Behavioral
-Cognitive
-Effective in one-on-one and in group therapy
A. Psychoanalysis
-Developed by Sigmund Freud
-Freud has permeated our culture
-BUT very few psychologists practice psychoanalysis
i. Aims
-Freud aimed to bring repressed memories into a patient’s conscious mind
-Healthy living becomes possible after freeing up energy from Id-Ego-Super Ego conflicts
ii. Methods
-Historical reconstruction
-Hypnosis labeled unreliable
-Free association
-Resistance-the blocking from consciousness of anxiety-laden material
-Based on interpretation
-Dream content
-Transference
-Psychoanalysis is therapy and not science
iii. Psychodynamic Therapies
-Therapy deriving from the psychoanalytic tradition that views individuals as responding to unconscious forces and childhood experience
-Face to face
B. Humanistic Therapies
-Humanistic therapists look to boost self fulfillment
-Self-awareness
-Self-acceptance
-Insight therapy
-Client-centered therapy (Rogers)
-Genuineness, acceptance, and empathy
-Active listening-echoing, restating, and clarifying
-Unconditional positive regard
-Paraphrase-Summarize the speakers words in your own way
-Invite Clarification-Ask for examples to encourage the speaker to say more
-Reflect Feelings-It sounds……..
C. Behavior Therapies
-Assumptions of insight therapies-problems diminish as awareness grows
-Assumptions of psychoanalysts-problems diminish as people gain insight into unresolved and unconscious tensions
-Assumptions of humanists-Problems diminish as people get in touch with their feelings
-Behaviorists assume that problem behaviors ARE the problem and that you can learn to eliminate them
i. Classical Conditioning Techniques
-Principles taken from Pavlov’s research
-Conditioning vs counterconditioning
-Two main types of therapy
-Exposure therapy
-Aversive conditioning
a. Exposure Therapies
-To expose people to things they would normally avoid
-Systematic desensitization-used to treat phobias
-Virtual reality exposure therapy
b. Aversive Conditioning
ii. Operant Conditioning
-Behaviors are influenced by their consequences
-Behavior modification
-Token economy (AA)
-How durable are new behaviors?
-Is it right for one human to control another human’s behavior?
D. Cognitive Therapies
-How do behavioral therapists approach depression or generalized anxiety?
-Vicious cycle
-Suggestion as Criticism
-Disagreement as Dislike
-Praise as flattery
-Friendliness as Pity
i. Beck’s Therapy for Depression
-Aaron Beck-Trained in the Freudian technique
-Dream analysis
-Negativity feeds negativity
-Restructuring of thought
-Changing the way you “talk” to yourself, changes the way you feel
ii. Cognitive-Behavioral Therapy
-Integrative therapy that combines cognitive therapy with behavior therapy
-Eliminate self-defeating thinking
-Change behavior
-OCD treatment-acknowledge the urge, replace the behavior with another
E. Group and Family Therapies
-Except for psychoanalysis, most therapy can occur in groups
-Saves time, saves money, yields positive results
-Family therapy “No man is an island”
-Therapists focus on the group, not the individual
-Support group
II. Evaluating Psychotherapies
-Does psychotherapy work? Who decides?
-Are some therapies more effective than others?
-How do alternative therapies fare under scientific scrutiny?
-What three elements are shared by all forms of psychotherapy?
-How do culture and values influence the therapist-client relationship?
A. Is Psychotherapy Effective?
-Not like checking a fever…
-Who decides when real progress has been made?
-Ourselves?
-Our therapist?
-Our family and friends?
i. Clients’ Perceptions
-Clients’ testimonials affirm the effectiveness of therapy
-Critiques
-People enter therapy in crisis (nowhere to go but up)
-Self justification (people need to believe therapy was worth the time and money)
-Even if the problem persists… they gave it the old college try
ii. Clinicians’ Perceptions
-The therapist hop…
-IF one is not successful, perhaps another will be
-Again, people enter therapy in crisis
-VERY positive results
iii. Outcome Research
-Controlled research studies can avoid bias
-Time has been found to be a good healer
-Meta-analysis-combining the results of many different research studies statistically
-Those not undergoing therapy improve: Those undergoing therapy improve more
-Therapy has been proven to be cost effective
B. The Relative Effectiveness of Different Therapies
-Are some therapies more effective than others?
-Short answer: NO
-Therapy is most effective when there is a clear cut problem
-Evidence-based practice
C. Evaluating Alternative Therapies
-Pseudo therapy
-Placebo effect + time
-Testimonials praise effectiveness
D. Commonalities Among Psychotherapies
-Scientific Attitude allows us to separate sense from nonsense
-All offer 3 commonalities
-Hope
-A new Perspective
-An empathetic, trusting, caring relationship
i. Hope for Demoralized People
-Again, people don’t usually seek out therapy if they are doing fine!
-Offers an expectation that things can and will get better
-Placebo effect?
ii. A New Perspective
-An alternative way of looking at yourself
-Fresh perspective may allow for a new attitude
-A new outlook allows for changes to be made
iii. An Empathetic, Trusting, Caring Relationship
-Therapy outcome is not related to training and experience
-This DOES NOT mean that all therapists are equally effective!!!
-Emotional bond is key
-More empathy= More effective
-More caring= More effective
E. Culture and Values in Psychotherapy
-Inter-cultural clashes
-Religion
-Other areas?
III. The Biomedical Therapies
-Psychotherapy is one way to treat psychological disorders
-Another is the biomedical approach
-Physically changing the brain’s functioning by altering its chemistry with drugs, electroconvulsive shock therapy, magnetic impulses, or psychosurgery
A. Drug Therapies
-Psychopharmacology
-Normal recovery rate if untreated
-Placebo effect?
-Double Blind Procedure
i. Antipsychotic Drugs
-Helpful with symptoms of schizophrenia
-Auditory hallucinations
-Paranoia
-Dampened responsiveness to irrelevant stimuli
-Bind to dopamine receptor sites
-Newer drugs target serotonin sites as well
ii. Antianxiety Drugs
-Depress central nervous system activity (shouldn’t be mixed with alcohol)
-Often used with therapy
-Psychological dependence
iii. Antidepressant Drugs
-Mainly used to life people from a state of depression
-Now being used to treat OCD
-Selective-Serotonin Reuptake Inhibitor
-WARNINGS!!!!!
-Up to 4 weeks until medicine is effective
-Aerobic exercise and therapy are other options
iv. Mood-Stabilizing Medication
-Lithium and Depakote
-Used to control epilepsy and manic episodes associated with Bipolar Disorder
B. Brain Stimulation
-Electroconvulsive therapy
-Magnetic therapy
i. Electroconvulsive Therapy
-Procedure
-Severe depression
-Problems/ side effects
