Copyright © Allyn & Bacon 2007 Chapter 13 Therapies for Psychological Disorders

Copyright © Allyn & Bacon 2007

Chapter 13Chapter 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 What is TherapyTherapy??


What is Therapy?What is Therapy?

Therapy – General term for any treatment process; in psychology and psychiatry, therapy refers to a variety of psychological and biomedical techniques aimed at dealing with mental disorders or coping with problems of living.


The Components of TherapyThe Components of Therapy

• In addition to the relationship between the therapist and the patient/client, the therapeutic process typically involves:• 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 TherapyContemporary Approaches to Therapy

Psychological therapies –Based on psychological principles (rather than biomedical approach).

• The psychological therapiesare often collectivelycalled psychotherapy.


Contemporary Approaches to TherapyContemporary Approaches to Therapy

Biomedical therapies –Treatments that focus on altering the brain, especially with drugs, psychosurgery, or 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



Those with severe Those with severe disordersdisorders


Private practice, Private practice, mental health mental health

agencies, agencies, hospitalshospitals


PhD or PsyDPhD or PsyD


Counseling psychologist

Clinical psychologistClinical psychologist

Psychoanalyst


Psychiatrist


Pastoral counselor



Severe mental Severe mental disorders (often disorders (often

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


Private practice, Private practice, clinics, hospitalsclinics, hospitals


MDMD




Psychoanalyst


PsychiatristPsychiatrist


Pastoral counselor



Freudian therapyFreudian therapy


Private practicePrivate practice


MDMD




PsychoanalystPsychoanalyst


Psychiatrist


Pastoral counselor



Nursing specialty; Nursing specialty; licensed to licensed to

prescribe drugsprescribe drugs


Private practice, Private practice, clinics, hospitalsclinics, hospitals


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

drugsdrugs




Psychoanalyst


Psychiatrist

Psychiatric nurse Psychiatric nurse practitionerpractitioner

Pastoral counselor



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

mental disordersmental disorders


Often employed Often employed by governmentby government


MSWMSW




Psychoanalyst

Clinical social workerClinical social worker

Psychiatrist


Pastoral counselor



Combines Combines spiritual guidance spiritual guidance

with practical with practical counselingcounseling


Religious order or Religious order or ministryministry


VariesVaries




Psychoanalyst


Psychiatrist


Pastoral counselorPastoral counselor


Psychologists employ two main forms of treatment: the insight therapies

and the behavioral therapies.

How Do PsychologistsHow Do PsychologistsTreat Mental Disorders?Treat Mental Disorders?


Insight TherapiesInsight Therapies

Insight therapies –Psychotherapies in which the therapist helps patients understand (gain insight into) their problems.

Freudian Freudian psychoanalysispsychoanalysis

Cognitive therapiesCognitive therapiesHumanistic therapiesHumanistic therapies

Neo-Freudian Neo-Freudian therapiestherapies

Group therapiesGroup therapies


Insight TherapiesInsight Therapies

Talk therapies –Psychotherapies that focus on communicating and verbalizing emotions and motives to understand their behavior.

Psychodynamic therapies –Insight therapies based on the assumption that mental disorder is caused by powerful (dynamic) mental forces and conflicts.


Insight Therapies:Insight Therapies: PsychodynamicPsychodynamic Therapies Therapies

Psychoanalysis –The form of psychodynamic therapy developed by Sigmund Freud.Analysis of transference –

Analyzing and interpreting the patient’s relationship with the therapist, based on the assumption that this relationship mirrors unresolved conflicts in the patient’s past.


Insight Therapies:Insight Therapies: HumanisticHumanistic Therapies Therapies

Humanistic therapies –Techniques based on the assumption that people have a tendency for positive growth and self actualization, which may be blocked by an unhealthy environment.


Insight Therapies:Insight Therapies: HumanisticHumanistic Therapies Therapies

Client-centered therapy –Emphasizes healthy psychological growth through self-actualization.

- developed by Carl Rogers

Reflection of feeling – Paraphrasing client’s words to capture the emotional tone expressed.

(page 534)


Insight Therapies:Insight Therapies: CognitiveCognitive Therapies Therapies

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

Aaron Beck’s cognitive therapy for depression (page 536)

• Proven to be as effective as medication


Insight Therapies:Insight Therapies: GroupGroup Therapies 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 organized/run by laypersons (not professional therapists).


Insight Therapies:Insight Therapies: GroupGroup Therapies Therapies

• For many issues, couples counseling or family therapy can often be more effective than individual therapy with one individual at a time.

• Therapist helps them to perceive the issues or patterns that are creating problems.


Psychotherapy

Insight TherapiesPsychodynamic

HumanisticCognitive

Behavior TherapiesOperant Conditioning

Observational LearningClassical Conditioning


Systematic Systematic desensitizationdesensitization

TokenTokeneconomieseconomies

Contingency Contingency managementmanagement

AversionAversiontherapytherapy

ParticipantParticipantmodelingmodeling

BehaviorBehavior Therapies Therapies

Behavior therapy – Any form of psychotherapy based on the principles of behavioral learning, especially operant conditioning and classical conditioning.


Classical ConditioningClassical Conditioning Therapies Therapies

Systematic desensitization – Technique in which anxiety is extinguished by exposing the patient to an anxiety-provoking stimulus.

Exposure therapy – Desensitization therapy in which patient directly confronts the anxiety-provoking stimulus (as opposed to imagining it).


UCS(foul odor) UCR

(nausea)

CRCS(cigarette smoke)

Classical ConditioningClassical Conditioning Therapies Therapies

Aversion therapy – Involves presenting individuals with an attractive stimulus paired with unpleasant stimulation in order to condition a repulsive reaction.


Operant ConditioningOperant Conditioning Therapies Therapies

Contingency management –

Approach to changing behavior by altering the consequences, especially rewards and punishments, of behavior.


Operant ConditioningOperant Conditioning Therapies Therapies

Token economies – Applied to groups (e.g. classrooms, mental hospital wards) involving distribution of “tokens” contingent on desired behaviors; tokens can later be exchanged for privileges, food, or other reinforcers.


Observational-Learning Observational-Learning TherapiesTherapies

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


Cognitive-BehavioralCognitive-Behavioral Therapy Therapy

Cognitive-behavioral therapy (CBT) • Combines cognitive emphasis on thoughts

with behavioral strategies that alter reinforcement contingencies.

• Assumes irrational self-statements cause maladaptive behavior.

• Seeks to help the client develop a sense of self-efficacy.


Cognitive-Behavioral Cognitive-Behavioral TherapyTherapy

Rational-emotive behavior therapy (REBT) – Based on the idea that irrational thoughts and behaviors are the cause of mental disorders.

• “Don’t ‘should’ on yourself.” - Albert Ellis


Evaluating the Psychological Evaluating the Psychological TherapiesTherapies

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

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

therapies with specific conditions.• Quality of relationship between therapist and

client is important.


Most Effective Therapies?Most Effective Therapies?

Behavior Therapy

Specific Phobias

OCD

Alcoholism

Cognitive-Behavioral Therapy (CBT)

Depression

Eating Disorders

Insight Therapy

Couples Counseling

Relationship Problems


BiomedicalPsychotherapy

THERAPYTHERAPY


How Is the BiomedicalHow Is the BiomedicalApproach Used toApproach Used to

Treat Mental Disorders?Treat 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.


DrugDrug Therapy Therapy

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



Antipsychotic drugs – medicine that diminishes psychotic symptoms, usually by their effect on the dopamine pathways in the brain.• Reduce positive symptoms of psychosis • May have side effects

Tardive dyskinesia – Incurable disorder of motor control,

especially involving muscles of the face, resulting from long-term use of antipsychotic drugs.



Antidepressants – medicines that affect depression, usually by their effect on serotonin and/or norepinephrine.

Mood stabilizers:• Lithium carbonate – highly effective in dampening

extreme mood swings (effective against bipolar disorder)

• In high concentrations lithium can be toxic!

*The use of antidepressants to deal with general feelings of unease is highly controversial.



Antianxiety drugs - drugs that diminish feelings of anxiety.• Include barbiturates and benzodiazepines.

• Valium and Xanax

• Should not be used to relieve ordinary anxieties of everyday life.

• Should not be combined with alcohol!



Stimulants – drugs that increase activity level by encouraging communication among neurons in the brain.

• Stimulants actually suppress activity level in persons with ADHD.

• There is controversy from concern that the causes and boundaries of ADHD are vague and the potential exists for overdiagnosis.


PsychosurgeryPsychosurgery

Psychosurgery – the general term for surgical intervention in the brain to treat psychological disorders.• Prefrontal lobotomy – involves severing

the nerve fibers connecting the frontal lobe with deep brain structures, especially the thalamus and hypothalamus.

• Split-brain operation - Severing the corpus callosum can reduce life-threatening seizures.


Brain-StimulationBrain-Stimulation Therapies Therapies

Electroconvulsive therapy (ECT)

- A treatment used primarily for depression and involving the application of an electric current to the head, producing a generalized seizure (called shock treatment).


Brain-StimulationBrain-Stimulation Therapies Therapies

Transcranial magnetic stimulation (TMS) A treatment that involves magnetic stimulation of specific regions of the brain (an alternative to ECT).

- Can be used for the treatment of depression, schizophrenia, and bipolar disorder.


Mental HospitalsMental Hospitals

Prior to the 1950s:•Understaffed•Poorly funded•Prisonlike

FEW PATIENTS EVER LEFT!


DeinstitutionalizationDeinstitutionalization

• The removal of patients from mental hospitals.• Advances in psychotic

drugs and psychotherapy.

• Provide the least restrictive care.

• Receive outpatient care.


Hospitalization andHospitalization andthe Alternativesthe Alternatives

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


End of Chapter 13End of Chapter 13

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Copyright © Allyn & Bacon 2007 Chapter 13 Therapies for Psychological Disorders