TREATMENT

OF

PSYCHOLOGICAL

DISORDERS

Psychodynamic Therapies

• Psychodynamic therapies revolve around:

• Insight– Understanding one’s own psychological

processes

• Therapist-patient relationship– Assist a patient to become “captain of my own

ship”

Insight

• Maladaptive ways of viewing self and relationships

• Unconscious conflicts and compromises among competing wishes and fears

• Maladaptive ways of dealing with unpleasant emotions

Therapeutic Techniques

• Free Association– Patient responds to verbal/visual cues with the

first thing that comes to mind

• Interpretation– Clinician interprets patient responses– Resistance involves patient’s efforts to hide the

unconscious conflict

Therapist-Patient Relationship

• Therapist as authority figure

• Transference

– Patients have similar thoughts, feelings, fears, wishes and conflicts in new relationships as existed in past relationships

• Patient tries to please therapist in the same way he/she tried to please parent

• Fears that your new partner will cheat on you just like your last partner cheated on you

Psychodynamic Therapies

• Psychoanalysis– Patient on couch and therapist on chair behind couch

– Intense discussions over a long period of time

– Goal is exploration of unconscious processes

• Psychodynamic Psychotherapy– Sessions are face to face

– Discussion is less intense, more conversational, than in psychoanalysis

– Goal is still exploration of unconscious processes

Cognitive-Behavioral Therapies

• Phobia– Irrational fear of a given stimulus

• Behavioral analysis– Determine the symptom (s) and the stimuli or thoughts

associated with it which then become the targets of treatment

• Systematic desensitization– Gradual exposure of a phobic stimulus as a means of

neutralizing the impact of the stimulus

Systematic Desensitization

• Step 1– Therapist teaches patient relaxation techniques

• Step 2– Therapist questions patient about fears & then

constructs a hierarchy of feared stimuli

• Step 3– Desensitization process begins possibly with the use of

virtual reality therapy

• Step 4– Patient encouraged to face feared stimuli in real life

Cognitive-Behavioral Therapies

• Exposure Techniques– Present patients with actual phobic stimulus in

real life rather than imagine it

• Flooding– Patient confronts the phobic stimulus all at once

Social Learning Techniques

• Participatory modeling– Therapist models the behavior and gradually

induces the patient to participate in the behavior• Role playing

• Skills training– Involves teaching the behaviors necessary to

accomplish relevant goals• Teaching someone how to dance

Cognitive Therapy

• Cognitive Therapy– Focus on changing cognitions that underlie a

psychological disorder– Learn to perceive things in a different manner

• Cognition Therapy– Focus on cognitive distortions

• View things differently

Cognitive Therapies

• Rational-emotive therapy

– Mediates between activating conditions and maladaptive emotional reactions

• “ I won’t let his mean behavior get to me anymore!”

Humanistic Therapies

• Gestalt therapy

– Focus on awareness of one’s own feelings versus our attempts to conform to social expectations

– Goal is for patient to respond to their true “inner voice” and thus become more authentic

– Focus on present state rather than historical contributors to one’s present state

Humanistic Therapies

• Client-centered therapy

– Clients versus patients• Rejects “disease” model

– Solve problems not seek cures• Problems develop when one’s concept of self is incongruent with their actual life experience

– The basic nature of humans is to grow and mature

– Unconditional positive regard• Attitude of fundamental acceptance by therapist towards client

Group Therapies

• Multiple individuals in same sessions

• Group members share same issue such as– Death of a child – Coping with cancer

• Cost effective

Family Therapies

• All members of a nuclear family participate in therapy

• Genogram– Map of family dynamics

• Couples therapy– Focus on problematic communications patterns

Biological Treatments

• Psychotropic medications act on the brain to affect mental processes

Antipsychotic Medications

• Used to treat schizophrenia and other acute psychotic states

• They have sedating impact by inhibiting dopamine which is linked to hallucinations

• Don’t work well with negative symptoms such as interpersonal difficulties

• Serious side effects such as tardive dyskinesia (slow motions)

Antidepressant & Mood Stabilizing Medications

• Tricyclic Antidepressants– 70-80% improvement rate

• MAO Inhibitors– Works better than tricyclics for patients with

depression and personality disorders– Requires food restrictions

Antidepressant & Mood Stabilizing Medications

• Selective serotonin reuptake inhibitors (SSRIs)– First-line medical treatment for depression– Fewer side effects than other antidepressants

• Lithium– Used with bipolar disease– Takes 3-4 weeks to begin having an impact

Anti-anxiety Medications

• Valium and Xanax are used for short term treatment of anxiety disorders

• Antidepressants are also used for anxiety disorders

• Patients can become psychologically and physiologically addicted

Electroconvulsive (ECT) Therapy & Psychosurgery

• Considered treatments of last resort

• ECT currently used to treat severe depression– Electric shocks administered to the brain

– Can move patient out of a state of severe depression

• Psychosurgery– Lobotomy which may be used on patients with

obsessive-compulsive disorders

Comparing forms of treatment

• Efficacy Studies– Assess treatment outcome under controlled

experimental conditions (control group)

• Effectiveness Studies– Assess treatment as practiced by clinicians in

the community