Therapies for Therapies for Psychological Psychological

DisordersDisorders

Chapter 13Chapter 13

AP PsychologyAP Psychology

Forest Grove High SchoolForest Grove High School

Mr. TusowMr. Tusow

What are TherapistsWhat are Therapists

Therapists are Therapists are trained trained professionals who professionals who know the art of know the art of establishing a establishing a helping relationship helping relationship and know how to and know how to apply the apply the knowledge of knowledge of psychology to an psychology to an individual struggling individual struggling with problems and with problems and choices.choices.

TherapyTherapyWe often hear that We often hear that someone was in someone was in therapy, but what therapy, but what is therapy?is therapy?

There are many There are many stereotypes about stereotypes about therapy, like the therapy, like the picture of a picture of a bearded therapist bearded therapist taking notes while taking notes while a patient lies on a a patient lies on a couch and spills couch and spills his or her guts. his or her guts. This is a very This is a very Freudian image. Freudian image.

TherapyTherapy

Therapy is a term used for any treatment Therapy is a term used for any treatment process; in psychology and psychiatry, process; in psychology and psychiatry, therapy refers to a variety of techniques therapy refers to a variety of techniques used to deal with mental disorders or cope used to deal with mental disorders or cope with problems of living.with problems of living.

There are endless reasons why people go to There are endless reasons why people go to see a therapist or counselor including see a therapist or counselor including making difficult decisions, dealing with making difficult decisions, dealing with academic problems, coping with the loss of a academic problems, coping with the loss of a loved one, or dealing with an unhappy loved one, or dealing with an unhappy relationship.relationship.

TherapyTherapyThere are a variety of techniques and There are a variety of techniques and methods therapists and counselors methods therapists and counselors use, but all center on developing a use, but all center on developing a strong, supportive relationship with strong, supportive relationship with the patient. the patient.

Another similarity amongst all therapy Another similarity amongst all therapy techniques is their end goal of techniques is their end goal of changing a person’s functioning in changing a person’s functioning in some way.some way.

Components of TherapyComponents of Therapy

In addition to developing a strong In addition to developing a strong relationship between client/patient and relationship between client/patient and counselor, the therapeutic process counselor, the therapeutic process generally involves some or all of the generally involves some or all of the following processes:following processes:

1.1. Identifying the problemIdentifying the problem

2.2. Identifying the cause of the problem or Identifying the cause of the problem or the current conditions that maintain the the current conditions that maintain the problemproblem

3.3. Deciding on and carrying out some form Deciding on and carrying out some form of treatmentof treatment

7 Main Types of Professional 7 Main Types of Professional HelpHelp

Professional Professional TitleTitle

Specialty and common work Specialty and common work settingsetting

Credential and Credential and qualificationsqualifications

Counseling Counseling PsychologistPsychologist

Provides help in dealing with the common Provides help in dealing with the common problems of normal living-relationships, problems of normal living-relationships, child rearing, school problems. Typically child rearing, school problems. Typically counselors in schools clinics or other counselors in schools clinics or other institutionsinstitutions

Depends on the state; Depends on the state; minimum master’s in minimum master’s in counseling, but most counseling, but most commonly a PhDcommonly a PhD

Clinical Clinical PsychologistPsychologist

Trained primarily to work with those who Trained primarily to work with those who have more severe disorders, but may also have more severe disorders, but may also work with clients having less severe work with clients having less severe problems. Usually private practiceproblems. Usually private practice

Usually required to hold Usually required to hold a PhD and state a PhD and state certificatecertificate

PsychiatristPsychiatrist A specialty of medicine; deals with sever A specialty of medicine; deals with sever mental problems-most often prescribes mental problems-most often prescribes drugs. May be private practice or employed drugs. May be private practice or employed by clinics and mental hospitalsby clinics and mental hospitals

MD; licensed by medical MD; licensed by medical boardboard

PsychoanalystPsychoanalyst Practitioners of Freudian therapy. Usually in Practitioners of Freudian therapy. Usually in private practiceprivate practice

MDMD

Psychiatric Psychiatric Nurse Nurse PractitionerPractitioner

A nursing specialty; licensed to prescribe A nursing specialty; licensed to prescribe drugs for mental disorders. May work in drugs for mental disorders. May work in private practice or in clinics and hospitalsprivate practice or in clinics and hospitals

Requires RN credential Requires RN credential plus specialty trainingplus specialty training

Clinical or Clinical or Psychiatric Psychiatric Social WorkerSocial Worker

Social workers with a specialty in dealing Social workers with a specialty in dealing with mental disorders, especially from the with mental disorders, especially from the viewpoint of social and environmental viewpoint of social and environmental contexts contexts

MSW-Masters of Social MSW-Masters of Social WorkWork

Pastoral Pastoral CounselorCounselor

A member of a religious order or ministry A member of a religious order or ministry who specializes in treatment of who specializes in treatment of psychological disorderspsychological disorders

VariesVaries

Current MovementsCurrent Movements

The world of psychology is constantly changing. The world of psychology is constantly changing. One of the current movements is clinical One of the current movements is clinical psychologists who are seeking to obtain the psychologists who are seeking to obtain the privilege to give prescriptions to clients.privilege to give prescriptions to clients.

New Mexico became the first state to allow this, New Mexico became the first state to allow this, putting psychologists through a rigorous putting psychologists through a rigorous program, including 850 hours of course work program, including 850 hours of course work and a supervised internship.and a supervised internship.

Not surprisingly this is hotly contested in the Not surprisingly this is hotly contested in the medical profession.medical profession.

History of TherapyHistory of Therapy

Much like the history of psychology Much like the history of psychology itself and psychological disorders, itself and psychological disorders, therapy has had its fair share of therapy has had its fair share of misguided theories.misguided theories.

In medieval Europe, people often In medieval Europe, people often thought mental disorders were the thought mental disorders were the work of the devil and other demons. work of the devil and other demons. The job the therapists was to perform The job the therapists was to perform exorcisms. exorcisms.

Bedlam and its OriginsBedlam and its Origins

One of the most well known asylums One of the most well known asylums was that of Bethlehem Hospital in was that of Bethlehem Hospital in London. On the weekend, a person London. On the weekend, a person could pay a few pence to go could pay a few pence to go sightseeing and watch the inmates who sightseeing and watch the inmates who often put on a noisy and wild show. As often put on a noisy and wild show. As a result, “Bedlam,” the shortened term a result, “Bedlam,” the shortened term Londoners used for Bethlehem, became Londoners used for Bethlehem, became a word used to describe any noisy, a word used to describe any noisy, chaotic place (Zimbardo et al.) chaotic place (Zimbardo et al.)

Medieval AsylumsMedieval Asylums

In the medieval asylums, patients, at In the medieval asylums, patients, at most only custodial care; at worst, most only custodial care; at worst, they were neglected and put in cruel they were neglected and put in cruel restraints such as cages and restraints such as cages and straightjackets. straightjackets.

Some received other forms of torture Some received other forms of torture like beatings and cold showers.like beatings and cold showers.

Modern Approaches to Modern Approaches to TherapyTherapy

There are two main modern approaches:There are two main modern approaches:

Psychological therapies Psychological therapies (psychotherapy) (psychotherapy) focus on changing focus on changing disordered thoughts, feelings and disordered thoughts, feelings and behaviors using psychological techniques. behaviors using psychological techniques. They come in two main forms:They come in two main forms:

Insight therapy:Insight therapy: focuses on helping people understand focuses on helping people understand their problems and change their thoughts, motives or their problems and change their thoughts, motives or feelings.feelings.

Behavior therapy:Behavior therapy: focuses primarily on changing focuses primarily on changing behavior.behavior.

Modern Approaches to Modern Approaches to TherapyTherapy

Biomedical therapiesBiomedical therapies focus on focus on treating mental problems by treating mental problems by changing the underlying biology of changing the underlying biology of the brain. To do so, a physician or the brain. To do so, a physician or nurse practitioner can use a variety nurse practitioner can use a variety of drugs, including antidepressants, of drugs, including antidepressants, tranquilizers and stimulants.tranquilizers and stimulants.

Disorders and Therapies in Disorders and Therapies in CulturalCultural

The way a disorder is treated relies on the way it is The way a disorder is treated relies on the way it is viewed. The way it is viewed is heavily dependent viewed. The way it is viewed is heavily dependent on the culture it is being treated in.on the culture it is being treated in.

IndividualisticIndividualistic Western views generally regard Western views generally regard psychological disorders to be a result of disease psychological disorders to be a result of disease process, abnormal genetics, disordered thinking, process, abnormal genetics, disordered thinking, unhealthy environments or stressors.unhealthy environments or stressors.

CollectivistCollectivist cultures often think of mental cultures often think of mental disorders as a disconnect between the person and disorders as a disconnect between the person and the group. In such cultures, treating mentally the group. In such cultures, treating mentally disturbed people by removing them from society is disturbed people by removing them from society is unthinkable.unthinkable.

How do Psychologists Treat How do Psychologists Treat Disorders?Disorders?

Treatment of disorders falls into one Treatment of disorders falls into one of the two categories we just of the two categories we just discussed. Insight therapies were the discussed. Insight therapies were the first truly psychological treatments first truly psychological treatments used. In recent years, behavioral used. In recent years, behavioral therapies have also become common therapies have also become common and effective.and effective.

Insight TherapiesInsight Therapies

Insight therapies attempt to change Insight therapies attempt to change people on the inside-changing the way people on the inside-changing the way they think and feel. These are they think and feel. These are sometimes called think therapies. These sometimes called think therapies. These therapies share the assumption that therapies share the assumption that distressed persons need to develop an distressed persons need to develop an understanding of the disordered understanding of the disordered thoughts, emotions and motives that thoughts, emotions and motives that underline their mental difficulties.underline their mental difficulties.

Freudian PsychoanalysisFreudian Psychoanalysis

In the classical Freudian view, psychological In the classical Freudian view, psychological problems arise from tension in the problems arise from tension in the unconscious mind by forbidden impulses and unconscious mind by forbidden impulses and threatening memories.threatening memories.

Psychoanalysis, therefore, probes the Psychoanalysis, therefore, probes the unconscious in an attempt to bring these unconscious in an attempt to bring these issues into the “light of day” or into issues into the “light of day” or into consciousness. The major goal of consciousness. The major goal of psychoanalysis, then, is to reveal and interpret psychoanalysis, then, is to reveal and interpret the contents of the unconscious mind.the contents of the unconscious mind.

PsychoanalysisPsychoanalysisIn the final stages of psychoanalysis, In the final stages of psychoanalysis, patients learn how their relationship patients learn how their relationship with the therapist mirrors the with the therapist mirrors the unresolved issues they have with their unresolved issues they have with their parents. This is referred to as parents. This is referred to as analysis analysis of transferenceof transference. .

According to this theory, people will According to this theory, people will recover when they are finally released recover when they are finally released from the repressive mental restraints from the repressive mental restraints established in the relationship with established in the relationship with their parents during early childhood.their parents during early childhood.

Neo-Freudian Psychodynamic Neo-Freudian Psychodynamic TherapiesTherapies

These therapies were developed by These therapies were developed by psychologists why embraced some of psychologists why embraced some of Freud’s ideas, but disagreed with others. Freud’s ideas, but disagreed with others.

While they follow many of the same While they follow many of the same techniques, their emphasis is on the techniques, their emphasis is on the conscious, rather than the unconscious, conscious, rather than the unconscious, mind. Basically they spend less time mind. Basically they spend less time probing for hidden conflicts and probing for hidden conflicts and repressed memories.repressed memories.

Psychotherapy

Insight Therapies

Behavior Therapies

Psychodynamic Therapies

Humanistic Therapies

Cognitive Therapies

Therapies based on Operant Conditioning

Therapies Based On Observational

Learning

Therapies Based on Classical Conditioning

Freudian Psychoanalysis

Neo-FreudianTherapies

Humanistic TherapiesHumanistic Therapies

Many people struggle with the problems of Many people struggle with the problems of everyday existence. These are commonly everyday existence. These are commonly called existential crises.called existential crises.

This term underscores the idea that many This term underscores the idea that many problems deal with questions about the problems deal with questions about the meaning and purpose of one’s existence.meaning and purpose of one’s existence.

Humanistic psychology developed theories Humanistic psychology developed theories to specifically address these problemsto specifically address these problems

Humanistic TherapiesHumanistic Therapies

Humanistic psychology believes that Humanistic psychology believes that people are generally motivated by healthy people are generally motivated by healthy needs for growth and psychological well needs for growth and psychological well being. Problems only occur when being. Problems only occur when conditions interfere with normal conditions interfere with normal development and produce low self esteem.development and produce low self esteem.

These therapies, then, try to help clients These therapies, then, try to help clients confront their problems by recognizing confront their problems by recognizing their own freedom, enhancing their self-their own freedom, enhancing their self-esteem and realizing their fullest potential.esteem and realizing their fullest potential.

Client-Centered TherapyClient-Centered Therapy

This therapy assumes that people all have This therapy assumes that people all have a need to realize their fullest potential a need to realize their fullest potential (self actualization). But, development can (self actualization). But, development can be hindered by a conflict between one’s be hindered by a conflict between one’s desire for a positive self image and desire for a positive self image and criticism by self and others.criticism by self and others.

One therapy technique called “reflection One therapy technique called “reflection of feeling,” or reflective listening, is where of feeling,” or reflective listening, is where the therapist paraphrases the clients the therapist paraphrases the clients words, making sure to capture the words, making sure to capture the emotional tone, so the client can see and emotional tone, so the client can see and hear themselves.hear themselves.

Humanistic vs. Humanistic vs. PsychoanalysisPsychoanalysis

In stark contrast to psychoanalysis, In stark contrast to psychoanalysis, humanistic therapists assume that humanistic therapists assume that people are generally good and people are generally good and healthy, but can be negatively healthy, but can be negatively effected by pressure from oneself effected by pressure from oneself and society.and society.

Humanistic therapists accomplish Humanistic therapists accomplish treatment through genuineness, treatment through genuineness, empathy, and unconditional regard empathy, and unconditional regard and acceptance for their clients.and acceptance for their clients.

Cognitive TherapiesCognitive Therapies

Cognitive Therapies see rational Cognitive Therapies see rational thinking as the key to therapeutic thinking as the key to therapeutic change. The assumption is that change. The assumption is that psychological problems arise from psychological problems arise from erroneous thinking.erroneous thinking.

Cognitive therapists help the Cognitive therapists help the individuals confront the destructive individuals confront the destructive thoughts that support depression.thoughts that support depression.

Behavior TherapiesBehavior Therapies

Behavior therapy, or behavior Behavior therapy, or behavior modification, is based on the assumption modification, is based on the assumption that undesirable behaviors have been that undesirable behaviors have been learned, and therefore, can be unlearned. learned, and therefore, can be unlearned.

Behavior therapist focus on the problem Behavior therapist focus on the problem behaviors rather than inner thoughts, behaviors rather than inner thoughts, motives or emotions. Their goal is to motives or emotions. Their goal is to determine how these behaviors were determine how these behaviors were learned and see if they can eliminate learned and see if they can eliminate them.them.

Systematic DesensitizationSystematic Desensitization

One behavioral technique to One behavioral technique to extinguish anxiety is systematic extinguish anxiety is systematic desensitization. In this, a patient is desensitization. In this, a patient is exposed to an anxiety producing exposed to an anxiety producing stimulus gradually. Over time, the stimulus gradually. Over time, the anxiety will become extinguished.anxiety will become extinguished.

Steps of Systematic Steps of Systematic DesensitizationDesensitization

For a fear of public speaking:For a fear of public speaking:

1.1. Seeing a picture of a person giving a speechSeeing a picture of a person giving a speech2.2. Watching another person give a speechWatching another person give a speech3.3. Preparing a speech to givePreparing a speech to give4.4. Having to introduce oneself to a large groupHaving to introduce oneself to a large group5.5. Waiting to be called upon to speak at a Waiting to be called upon to speak at a

meeting.meeting.6.6. Being introduced as a speaker to a groupBeing introduced as a speaker to a group7.7. Walking to the podium to make a speechWalking to the podium to make a speech8.8. Making a speech to a large groupMaking a speech to a large group

Aversion TherapyAversion Therapy

Aversion therapy takes on the Aversion therapy takes on the psychological problems with a conditioning psychological problems with a conditioning procedure designed to make tempting procedure designed to make tempting stimulus less provocative by pairing them stimulus less provocative by pairing them with an unpleasant (aversive) stimuli.with an unpleasant (aversive) stimuli.

In time, the negative reaction (UCR) In time, the negative reaction (UCR) associated with the averse stimuli come to associated with the averse stimuli come to be associated with the conditioned stimuli.be associated with the conditioned stimuli.

This is usually a last resort type of This is usually a last resort type of therapy, though it has been shown to be therapy, though it has been shown to be successful.successful.

Operant Conditioning Operant Conditioning TherapiesTherapies

These therapies rely on the tools of operant These therapies rely on the tools of operant conditioning: reward and punishment.conditioning: reward and punishment.

Contingency Management:Contingency Management: An approach An approach to changing behavior by changing the to changing behavior by changing the consequences associated with a behavior.consequences associated with a behavior.

Token Economy:Token Economy: A technique involving A technique involving the distribution of “tokens” or indicators of the distribution of “tokens” or indicators of reinforcement contingent on desired reinforcement contingent on desired behaviorsbehaviors

Cognitive-Behavioral Cognitive-Behavioral TherapyTherapy

This therapy combines a cognitive This therapy combines a cognitive emphasis on thoughts and attitudes emphasis on thoughts and attitudes with the behavioral strategies.with the behavioral strategies.

This approach assumes that an This approach assumes that an irrational self-statement often irrational self-statement often underlies maladaptive behavior.underlies maladaptive behavior.

Cognitive-Behavioral Cognitive-Behavioral TherapyTherapy

In this form of treatment, therapist and In this form of treatment, therapist and client work together to modify client work together to modify irrational self-talk, set attainable irrational self-talk, set attainable behavioral goals and develop realistic behavioral goals and develop realistic strategies for attaining them.strategies for attaining them.

In this way, people change the way In this way, people change the way they approach problems and gradually they approach problems and gradually develop new skills and a sense of self-develop new skills and a sense of self-efficacy.efficacy.

Does Therapy Actually Does Therapy Actually Work?Work?

In 1952, Hans Eysenck shook the In 1952, Hans Eysenck shook the psychology world by releasing a study that psychology world by releasing a study that suggested 2/3 of all people with suggested 2/3 of all people with nonspychotic problems recovered within nonspychotic problems recovered within two years if the onset of the problem, two years if the onset of the problem, whether they got therapy or not. whether they got therapy or not.

Essentially he was arguing that therapy Essentially he was arguing that therapy was worthless, and no better than having was worthless, and no better than having no treatment at all.no treatment at all.

Response to EysenckResponse to Eysenck

As you can imagine, this set off a fire As you can imagine, this set off a fire storm of studies on this subject. storm of studies on this subject.

Overall (375 studies) research Overall (375 studies) research supports two major conclusions:supports two major conclusions:

1.1. Therapy is more effective than Therapy is more effective than nontherapy.nontherapy.

2.2. Eysenck overestimated the improvement Eysenck overestimated the improvement rate in no-therapy control groups.rate in no-therapy control groups.

Biomedical ApproachBiomedical Approach

Biomedical therapies seek to treat Biomedical therapies seek to treat psychological disorders by changing psychological disorders by changing the brain’s chemistry with drugs, its the brain’s chemistry with drugs, its circuitry with surgery or its patterns circuitry with surgery or its patterns of activity with pulses of electricity or of activity with pulses of electricity or magnetic fields. magnetic fields.

Drug Drug Therapy/PsychopharmacologyTherapy/PsychopharmacologyThe first psychological drugs were The first psychological drugs were administered in 1953 with the antipsychotic administered in 1953 with the antipsychotic drugs.drugs.

In 1955, over ½ a million Americans were In 1955, over ½ a million Americans were living in mental institutions, each staying an living in mental institutions, each staying an average of a few years. Then, with the average of a few years. Then, with the introduction of tranquilizers, the number introduction of tranquilizers, the number declined. By 1965, the number of patients was declined. By 1965, the number of patients was down to ¼ million, with most patients staying down to ¼ million, with most patients staying for only a few months.for only a few months.

Antipsychotic DrugsAntipsychotic Drugs

Antipsychotic drugs are used to treat the Antipsychotic drugs are used to treat the symptoms of psychosis: delusions, symptoms of psychosis: delusions, hallucinations, social withdrawal and hallucinations, social withdrawal and agitation.agitation.

Most work by reducing the activity of the Most work by reducing the activity of the neurotransmitter dopamine. Although the neurotransmitter dopamine. Although the exact reason why this has an antipsychotic exact reason why this has an antipsychotic effect, these drugs have proven to be effect, these drugs have proven to be quite effective.quite effective.

+/- of Antipsychotic Drugs+/- of Antipsychotic Drugs

While these drugs reduce the overall brain While these drugs reduce the overall brain activity, they do not simply put the patient activity, they do not simply put the patient in a trance. Instead they simply reduce the in a trance. Instead they simply reduce the “positive” symptoms of psychosis.“positive” symptoms of psychosis.

Unfortunately, long-term use can cause Unfortunately, long-term use can cause problems like tardive dyskinesia, which problems like tardive dyskinesia, which produces an uncontrollable disturbance of produces an uncontrollable disturbance of motor control, especially in the facial motor control, especially in the facial muscles.muscles.

Positive and Negative Positive and Negative CategoriesCategories

Often times, researchers now simply Often times, researchers now simply characterize symptoms of characterize symptoms of schizophrenia into schizophrenia into positivepositive and and negativenegative categories. categories.

Positive symptomsPositive symptoms refer to active refer to active process such as delusions, and process such as delusions, and hallucinations while hallucinations while negative negative symptomssymptoms refer to passive processes refer to passive processes like social withdrawal.like social withdrawal.

Antidepressant DrugsAntidepressant Drugs

There are three major classes of There are three major classes of antidepressant drugs, and all three work antidepressant drugs, and all three work by “turning up the volume” on messages by “turning up the volume” on messages transmitted over certain brain pathways, transmitted over certain brain pathways, especially those using norepinephrine and especially those using norepinephrine and serotonin.serotonin.

The major downside of these drugs is that The major downside of these drugs is that it often takes a few weeks for them to it often takes a few weeks for them to have an effect. In some cases, time is not have an effect. In some cases, time is not a luxury a mentally ill patient has. a luxury a mentally ill patient has.

Antianxiety DrugsAntianxiety Drugs

Antianxiety drugs most commonly Antianxiety drugs most commonly fall into two categories: fall into two categories: barbituratesbarbiturates and and benzodiazepinesbenzodiazepines..

Barbiturates act as a central nervous Barbiturates act as a central nervous system depressant, so they have a system depressant, so they have a relaxing effect. Benzodiazepines relaxing effect. Benzodiazepines work by increasing the activity of work by increasing the activity of certain neurotransmitters.certain neurotransmitters.

StimulantsStimulants

Stimulants is a broad category that Stimulants is a broad category that includes everything from caffeine to includes everything from caffeine to nicotine to amphetamines to cocaine-nicotine to amphetamines to cocaine-they are any drugs that produce they are any drugs that produce excitement or hyperactivity.excitement or hyperactivity.

These drugs are prescribed for a These drugs are prescribed for a variety of disorders including variety of disorders including narcolepsy and ADHD.narcolepsy and ADHD.

Truths About DrugsTruths About Drugs

Cannot cure any mental illnessCannot cure any mental illness Can alter the brain to suppress some Can alter the brain to suppress some

symptomssymptoms Can have negative long term effectsCan have negative long term effects Can be habit formingCan be habit forming Often over prescribedOften over prescribed

PsychosurgeryPsychosurgery

Psychosurgery is the general term Psychosurgery is the general term given for any surgical intervention in given for any surgical intervention in the brain to treat a psychological the brain to treat a psychological disorder.disorder.

These surgeries were far more These surgeries were far more common in the past, and today have common in the past, and today have become a method of last resort.become a method of last resort.

Brain-Stimulation TherapiesBrain-Stimulation Therapies

Electroconvulsive Therapy (ECT)-Electroconvulsive Therapy (ECT)-

A treatment used primarily for depression that A treatment used primarily for depression that involves the application of an electric current involves the application of an electric current to head, producing a generalized seizure.to head, producing a generalized seizure.

Transcranial Magnetic Stimulation (TMS)-Transcranial Magnetic Stimulation (TMS)-

A treatment that involves magnetic stimulation A treatment that involves magnetic stimulation of specific regions of the brain, but unlike ECT, of specific regions of the brain, but unlike ECT, it does not produce a seizure.it does not produce a seizure.