Chapter 17: Treatment of Psychological Disorders

Chapter 17: Treatment of Psychological

Disorders

Basic Features of Treatment

•A patient seeking relief from a problem•A person who is socially accepted as one who can help the patient because of training or experience•A special social relationship between the patient (client) and therapist, which helps ease the client’s problems•A theoretical explanation of those problems•A set of procedures for dealing with the problems

Psychodynamic Psychotherapy

The goal of psychoanalysis is to uncover unconscious conflicts and analyze how these conflicts affect the client. The client is then helped to “work through” these unconscious conflicts. Psychoanalysis may take as many as 3 to 5 session per week for several years.


•Techniques– Free Association: patients recline and say whatever

thoughts, memories or images that come to mind


•Techniques– Dream Interpretation:

Freud would analyze the manifest content of the dream in hopes of uncovering the latent content which reflects the clients wishes, impulses, and fantasies.


• Techniques– Transference Reflects a strong feeling a patient develops toward

the analyst, which likely occurs as a result of an increased sense of intimacy following the client’s self-disclosure, and the analyst’s listening and caring. Feelings involved in transference can be either positive (sexual attraction) or negative (contempt). Oftentimes a person will transfer his/her emotional and feeling for a significant other onto the analyst. The psychoanalytic view of transference is that it reflects unresolved conflicts from the past. The psychoanalysts will then help the client work through these feelings.


• Analyzing/Overcoming Resistance

At times, a patient may put up resistance (barriers) in therapy. He may edit his thoughts, come late for sessions, etc. The analysts will want to explore these resistances and make the client aware of them


• Criticism of Psychodynamic TherapyPsychoanalysis is slow and expensive. It is hard to prove the interpretations. If one doesn’t agree with the interpretation then that person may be accused of denial or putting up resistance.

Humanistic Psychotherapy(Phenomenological)

• Focuses on:– The present rather than the past– Awareness of feelings as they occur

rather than achieving insights into childhood origins of the feelings. Under these conditions the clients will improve on their own

– Conscious rather than unconscious materials

– Promoting growth and fulfillment instead of curing illness


• Client-Centered Therapy This is the most widely used of all humanistic

techniques. It was developed by Carl Rogers. Rogers believes that the responsibility of the therapy rests with the client. He believes that the client’s self-perceptions are more important than the therapist’s interpretations. Rogers believes that the therapist must provide unconditional positive regard and empathy. A rogerian technique is active listening


• Client-Centered Therapy– Unconditional Positive Regard A nonjudgmental attitude of total acceptance on the part of the therapist that is fundamental to client- centered therapy. It consists of nothing more nor less than treating the client as a valued person, no matter what.


•Client-Centered Therapy– Empathy the emotional understanding of what

the client might be thinking and feeling• Reflection of Feelings: a paraphrased

summary of the client’s words and especially the feelings and meanings that appear to accompany them.


•Client-Centered Therapy– Congruence (genuineness) refers to a consistency between

the way the therapist feels and the way they act toward clients


• Gestalt Therapy: This was founded by Fritz Perls in 1969.

Gestalt therapy emphasizes the total integration of physical and mental processes. Gestalt Therapy acknowledges the importance of early life experiences but the treatment focuses on the here and now. The Gestalt Model, like the client-centered model, places the responsibility for change on the individual. Techniques that are used include reenactment of dreams, role playing, etc.

Behavior Therapy• Behavior Therapies apply well-

established learning principles to eliminate the unwanted behavior. The Behavior Therapies make two basic assumptions:– Self-awareness is not the key to solving

problem behavior. They assume that the problem behaviors are the problem

– Problem thinking and maladaptive behaviors can be replaced with more constructive ways of thinking and acting

Behavior Therapy• Behavior Therapy

– Treatments that use classical conditioning principles

• Behavior Modification– Treatments that use operant

conditioning principles

• Cognitive-Behavior Therapy– Treatments that focus on changing

thinking patterns as well as overt behavior

Behavior Therapy• Techniques for Modifying

Behavior– Systematic Desensitization: This works on the principles that two

incompatible behaviors cannot exist at the same time. Therefore we cannot be anxious and at the same time

relaxed.


Behavior– Systematic Desensitization:

Step 1: Teach client relaxation techniques Step 2: Make a hierarchy of feared events

Step 3: Present the client with the hierarchy of feared events. Step 4: If these events produce anxiety, the

client engages in relaxation techniques until

he no longer experiences anxiety.

Behavior Therapy

• Techniques for Modifying Behavior– Modeling: In modeling, the client watches other people perform desired behaviors

http://www.psfk.com/2010/07/prosocial-behavior-and-the-dog-owner-effect.html

Behavior Therapy• Techniques for Modifying Behavior

– Positive Reinforcement A therapist uses positive reinforcement to

alter problematic behaviors. The receipt of rewards or tokens is dependent upon a client’s display of desirable behaviors. • Token economy: a form of behavior therapy in

which a behavior is rewarded with tokens or points that my be exchanged for tangible rewards


– Extinction This technique makes undesirable

behaviors less likely by removing the reinforcement that generally follows that behavior. Extinction changes behavior rather slowly but it is an effective way to gently eliminate undesirable behavior• Flooding: involves keeping a person in a

feared, but harmless situation. Once deprived of his normally rewarding escape pattern, the client has no reason for continued anxiety


– Aversive Conditioning This is the opposite of systematic

desensitization. Whereas systematic desensitization substitutes a + response for a - response, aversive therapy substitutes a

- response (aversive) for a positive one. Because it is unpleasant and uncomfortable,

and its effect are often temporary, many therapist avoid it or use it only long enough for the client to learn alternative behaviors


Behavior– Punishment An operant conditioning technique that

can be used to eliminate a dangerous or disruptive behavior (ex= mild electrical shock following an undesirable behavior). Punishment is used only when all other methods have failed, and ethical guidelines have been considered

Behavior Therapy

•Cognitive-Behavior Therapy Assumes that the way we think

influences our feelings. If thinking patterns are learned then they can be replaced with more

positive and constructive thinking patterns

Behavior Therapy• Cognitive-Behavior Therapy

– Rational-Emotive Therapy and Cognitive Restructuring (Albert Ellis)

Makes the assumption that many problems arise from irrational thinking. It is a confrontational therapy developed by Albert Ellis. It vigorously challenges people’s illogical, self-defeating attitudes and assumptions by revealing the absurdity of this thinking

A. (Activating situation) I tried to do something and failed

B. (irrational Belief I have about A) I must always be successful

C. (Consequences of believing B) I feel bad, depressed, etc.

D. (Dispute the Irrational Belief in B) Where is it written in stone that I must I always be successful?

E. (Effective new thinking to replace B) I would prefer always to be successful but let's be realistic- that isn't very likely, is it- I am human and humans are fallible, therefore do not succeed in everything they attempt. If success is important, then I will work harder recognizing that failure may occur again.

ABC’s of Rational Emotive Behavior Therapy (REBT)

Behavior Therapy• Cognitive-Behavior Therapy

– Beck’s Cognitive Therapy Similar to Rational Emotive Therapy

(except it is less confrontational) it tries to treat patients by reversing client’s catastrophizing beliefs, errors in logic, and false beliefs such as “I can’t do anything right,” or by thoughts that minimize the value of one’s accomplishments such as “Anyone could do that” Beck believes that this type of thinking leads to low self-esteem, depression, and anxiety

Group, Family and Couples Therapy

• You know

Evaluating Psychotherapy

• Is Psychotherapy Effective?– It doesn’t hurt– It’s better than nothing

• What Therapeutic Methods are Better– Behavior Therapy is better for treating

phobias, compulsions, or sexual dysfunctions– Cognitive Therapy is most successful for

treating depression

However…overall no one therapeutic method is better than any other

Biological Treatments

• Biological treatments for psychological disorders have been in existence since the time of Hippocrates. Methods used in the sixteenth through eighteenth centuries include laxative purges, bleeding of “excess” blood, induced vomiting, cold baths, hunger, and other physical discomforts, all of which were designed to shock the patient back to normality


• Electroconvulsive Therapy (ECT)– A controversial therapy that was

introduced in 1938. The patient receives a general anesthetic and a muscle relaxant to prevent injury from convulsions. The patient’s brain is electrically shocked for a fraction of a second. Within 30 minutes the patient awakens and remembers nothing of the treatment or the preceeding hours.

ECT is used primarily to treat severe depression in patients who don’t respond to psychoactive drugs and are at a risk for suicide. Why ECT works is unclear


•Psychosurgery– Surgery that removes or destroys brain

tissue in order to change behavior. Since it is irreversible, it is the most drastic and least-used biomedical treatment.

– Today, psychosurgery (including prefrontal lobotomies) is used only as a last resort and involves the destruction of only a tiny amount of brain tissue


• Drug Therapies– Psychopharmacology: the study of

drug effects on mind and behavior

– Neuroleptics– Antidepressants– Lithium and Anticonvulsants– Anxiolytics


• Drug Therapies– Neuroleptics (Antipsychotics)

• Chlorpromazine (Thorazine) block dopamine receptors. They are good at reducing positive symptoms. But patients exhibiting negative symptoms often do not respond well to antipsychotics. They may also cause unpleasant side effects such as muscle rigidity, restlessness, tremors, slowed movements etc. (Parkinson type symptoms) and tardive dyskinesia (involuntary movements of the facial muscles, tongue, and limbs)


• Drug Therapies– Antidepressants

• They work by increasing the availability of serotonin and norepinphrine.

• Examples: Prozac, Zoloft, Paxil (called selective-serotonin-reuptake-inhibitors SSRIs)


• Drug Therapies– Lithium and Anticonvulsants

(Mood-Stabilizing Medications)• Lithium can be effective for treating

bipolar disorder• 7 in 10 people with bipolar disorder

benefit from a long-term daily dose of lithium

• Depakote (a drug originally used to treat epilepsy) has been found effective in controlling manic episodes associated with bipolar disorder


• Drug Therapies– Antianxiety Drugs (Anxiolytics)

• Depress central nervsous system activity• Examples: Xanax, Ativan, Valium• Disadvantages: may cause physiological

dependency, can’t be used with alcohol,• May cause withdrawal symptoms when

discontinued

Drug Therapies

• Evaluating Psychoactive Drug Treatments– Drugs may cover up the problem without

permanently curing it– Drugs carry the potential for abuse,

resulting in physical or psychological dependence

– Drugs may have undesirable side effects

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Chapter 17: Treatment of Psychological Disorders