Chapter 13

Therapies for Psychological Disorders

Therapy for psychological disorders takes a variety of forms, but all involve some

relationship focused on improving a person’s mental,

behavioral, or social functioning

What is Therapy?

What is Therapy?

Therapy: General term for any treatment process In psychology and psychiatry - a variety of

psychological and biomedical techniques aimed at dealing with mental disorders or coping with problems of living

The Components of Therapy

Relationship between the therapist and the patient/client and some or all of the following processes: Identifying the problem Identifying the cause of the problem or the

conditions that maintain the problem Deciding on and carrying out some form of

treatment

Contemporary Approaches to Therapy

Psychological therapies: Based on psycho-logical principles (rather than biomedical approach)

Often collectively called psychotherapy

Contemporary Approaches to Therapy

Biomedical therapies: Focus on altering the brain Drugs Psychosurgery Electroconvulsive therapy

Types of Mental Health Care Types of Mental Health Care ProfessionalsProfessionals

Counseling psychologistCounseling psychologist

Clinical psychologistClinical psychologist

PsychoanalystPsychoanalyst

Clinical social workerClinical social worker

PsychiatristPsychiatrist

Psychiatric nurse practitionerPsychiatric nurse practitioner

Pastoral counselorPastoral counselor

Specialty:Specialty:

Problems of Problems of normal livingnormal living

Work setting:Work setting:

Schools, clinics, Schools, clinics, other institutionsother institutions

Credentials:Credentials:

Master’s in Master’s in counseling, PhD, counseling, PhD,

EdD, or PsyDEdD, or PsyD

Professional TitleProfessional Title

Counseling psychologistCounseling psychologist

Clinical psychologist

Psychoanalyst

Clinical social worker

Psychiatrist

Psychiatric nurse practitioner

Pastoral counselor

Specialty:Specialty:

Those with severe Those with severe disordersdisorders

Work setting:Work setting:

Private practice, Private practice, mental health mental health

agencies, agencies, hospitalshospitals

Credentials:Credentials:

PhD or PsyDPhD or PsyD

Professional TitleProfessional Title

Counseling psychologist

Clinical psychologistClinical psychologist

Psychoanalyst

Clinical social worker

Psychiatrist

Psychiatric nurse practitioner

Pastoral counselor

Specialty:Specialty:

Severe mental Severe mental disorders (often disorders (often

by means of drug by means of drug therapies)therapies)

Work setting:Work setting:

Private practice, Private practice, clinics, hospitalsclinics, hospitals

Credentials:Credentials:

MDMD

Professional TitleProfessional Title

Counseling psychologist

Clinical psychologist

Psychoanalyst

Clinical social worker

PsychiatristPsychiatrist

Psychiatric nurse practitioner

Pastoral counselor

Specialty:Specialty:

Freudian therapyFreudian therapy

Work setting:Work setting:

Private practicePrivate practice

Credentials:Credentials:

MDMD

Professional TitleProfessional Title

Counseling psychologist

Clinical psychologist

PsychoanalystPsychoanalyst

Clinical social worker

Psychiatrist

Psychiatric nurse practitioner

Pastoral counselor

Specialty:Specialty:

Nursing specialty; Nursing specialty; licensed to licensed to

prescribe drugsprescribe drugs

Work setting:Work setting:

Private practice, Private practice, clinics, hospitalsclinics, hospitals

Credentials:Credentials:

RN – plus special RN – plus special training in treating training in treating mental disorders mental disorders and prescribing and prescribing

drugsdrugs

Professional TitleProfessional Title

Counseling psychologist

Clinical psychologist

Psychoanalyst

Clinical social worker

Psychiatrist

Psychiatric nurse Psychiatric nurse practitionerpractitioner

Pastoral counselor

Specialty:Specialty:

Social worker with Social worker with specialty in specialty in dealing with dealing with

mental disordersmental disorders

Work setting:Work setting:

Often employed Often employed by governmentby government

Credentials:Credentials:

MSWMSW

Professional TitleProfessional Title

Counseling psychologist

Clinical psychologist

Psychoanalyst

Clinical social workerClinical social worker

Psychiatrist

Psychiatric nurse practitioner

Pastoral counselor

Specialty:Specialty:

Combines Combines spiritual guidance spiritual guidance

with practical with practical counselingcounseling

Work setting:Work setting:

Religious order or Religious order or ministryministry

Credentials:Credentials:

VariesVaries

Professional TitleProfessional Title

Counseling psychologist

Clinical psychologist

Psychoanalyst

Clinical social worker

Psychiatrist

Psychiatric nurse practitioner

Pastoral counselorPastoral counselor

Insight Therapies: Psychodynamic Therapies

Psychoanalysis: Form of psychodynamic therapy developed by Sigmund Freud Analysis of transference: Analyzing and

interpreting the patient’s relationship with the therapist

Dream interpretation, free association Neo-Freudian psychodynamic therapies:

Developed by psychodynamic theorists who embraced some of Freud’s ideas, but disagreed with others (sex, childhood)

Psychologists employ two main forms of treatment:

the insight therapies and the behavioral therapies

How Do PsychologistsTreat Mental Disorders?

Insight Therapies: Humanistic Therapies

Humanistic therapies: tendency for positive growth and self actualization (may be blocked by unhealthy environment)

Client-centered therapy: Emphasizes healthy psychological growth through self-actualization (Rogers) Reflection of feeling: Paraphrasing client’s

words to capture the emotional tone expressed Unconditional positive regard: nonjudgmental

and respect for client

Insight Therapies: Cognitive Therapies

Cognitive therapy: Emphasizes rational thinking as the key to treating mental disorder

Cognitive therapy for depression (Aaron Beck) Confront destructive thoughts that support it Can be at least as effective as medication

Insight Therapies Insight therapies: Psychotherapies in which

the therapist helps others understand (gain insight) their problems (emotions, thoughts) AKA – talk therapies

Psychodynamic – unconscious conflicts Humanistic – positive growth & self-actualization Cognitive – emphasizes rational thinking (ex. Beck –

depression; confront thoughts that support it)

Systematic Systematic desensitizationdesensitization

TokenTokeneconomieseconomies

Contingency Contingency managementmanagement

AversionAversiontherapytherapy

Behavior Therapies Behavior therapy: based on the principles of

behavioral learning, especially operant and classical conditioning

Classical Conditioning Therapies

Systematic desensitization: Anxiety is extinguished by gradually exposing the patient to an anxiety-provoking stimulus Exposure therapy: patient directly confronts the

anxiety-provoking stimulus (as opposed to imagining it)

Aversion therapy: Present an attractive stimulus with unpleasant stimulation in order to condition a repulsive reaction

Operant Conditioning Therapies

Contingency management: Changing behavior by altering the consequences (rewards and punishments) of behavior

Token economies: Applied to groups involving distribution of “tokens” contingent on desired behaviors

Cognitive-Behavioral Therapy: A Synthesis

Cognitive-behavioral therapy Modify irrational thoughts Set attainable behavioral goals Develop realistic strategies to attain goals Evaluate results

Rational-emotive behavior therapy: irrational thoughts and behaviors are the cause of mental disorders (REBT) Albert Ellis – strong approach, no acceptance of

irrational thoughts, may be a heated interaction

How Is the Biomedical Approach Used toTreat Mental Disorders?

Biomedical therapies seek to treat mental disorders by

changing the brain’s chemistry with drugs, its

circuitry with surgery, or its patterns of activity with pulses

of electricity or powerful magnetic fields

It’s your last day of notes!

Drug Therapy

Psychopharmacology: The prescribed use of drugs to help treat symptoms of mental illness ostensibly to ensure that individuals are more receptive to talk therapies

Drug Therapy Antipsychotic drugs

Include chlorpromazine, haloperidol, and clozapine

Usually affect dopamine pathways (reduce it) May have side effects

Tardive dyskinesia: Incurable disorder of motor control resulting from long-term use of antipsychotic drugs

Drug Therapy

Antidepressants and mood stabilizers Usually affect serotonin/norepinephrine (increase)

(MAO) inhibitors – increase norepinephrine Tryicyclics – inhibit reuptake SSRIs – inhibit reuptake of serotonin (Prozac) Lithium carbonate – treats bipolar (can be toxic)

Highly controversial – suicide, using just when uneasy

Drug Therapy Antianxiety drugs

Barbiturates – relax central nervous system Benzodiazepines – decrease activity in anxiety

regions of brain Do not

Use to relieve ordinary anxieties of everyday life Take for more than a few days at a time Combine with alcohol

ONLY TWO MORE SLIDES OF NOTES FOR THE YEAR!!!

Psychosurgery

Psychosurgery: The general term for surgical intervention in the brain to treat psychological disorders The infamous prefrontal lobotomy is no longer

performed Severing the corpus callosum, however, can

reduce life-threatening seizures

Brain-Stimulation Therapies

Electroconvulsive (ECT) therapy - used for treatment of severe depression Side effect – memory disruption

Transcranial magnetic stimulation (TMS): a possible alternative to ECT- treatment of depression, schizophrenia, and bipolar disorder

Hospitalization andthe Alternatives

Therapeutic community: Program of treating mental disorder by making the institutional environment supportive and humane for patients

Deinstitutionalization: Policy of removing patients, whenever possible, from mental hospitals

Community mental health movement: Effort to deinstitutionalize mental patients and to provide therapy from outpatient clinics

Drug Therapy

Stimulants: suppress activity level in persons with attention-deficit/hyperactivity disorder (ADHD)

Causes and boundaries of ADHD are vague and the potential exists for over-diagnosis

Side effects – growth, sleep, later use

Insight Therapies: Group therapies

Group therapy: Psychotherapy with more than one client

Self-help support groups: Groups that provide social support and an opportunity for sharing ideas about dealing with common problems typically run by laypersons (not professional

therapists) Couples and family therapy

Participant Modeling: An Observational-Learning Therapy

Participant modeling: Therapist demonstrates and encourages a client to imitate a desired behavior

Evaluating the Psychological Therapies

Eysenck proposed that people with non-psychotic problems recover just as well with or without therapy

Reviews of evidence have shown: That therapy is better than no therapy It appears advantageous to match specific

therapies with specific conditions

Mental “First Aid”

If someone asks you for help, keep in mind that serious problems (especially those involving suicide or threats) require immediate professional treatment

Otherwise, your best tools may involve Listening Acceptance Exploring alternatives