UNIT XIII OUTLINE

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