ADVANCED PLACEMENT PSYCHOLOGYChapter 16: Treatment of Psychological Disorders

Psychotherapy – Treatment of psychological disorders through psychological methods, such as talking about problems and exploring new ways of thinking & acting

Basics of Therapy

Client: The person seeking therapy Inpatient – Treated in a hospital or institution Outpatient – Receive psychotherapy while in the community

Therapist: The person giving therapy Psychiatrist – M.D. specialized in mental disorders Psychologist – Ph.D in clinical or counseling (can’t prescribe drugs) Other Professionals

Social Workers Family Therapists Counselors

Theory: Underlying guidelines & beliefs for treatment of disorders

Procedure: Method of treatment that is unique to the theory used

Goal: Final outcome of therapy

Psychodynamic PsychotherapyAn Overview

Theory Personality & behavior reflect the efforts of

the ego to referee unconscious conflicts among various components of the personality

Procedure Psychoanalysis – Therapy aimed at

understanding the unconscious conflicts & how they affect the client (Freud)

Classical PsychoanalysisSitting on the Freudian couch

Hypnosis – Tried initially to cure somatoform disorders Free Association

Saying whatever comes to mind Doesn’t allow for as much self-censorship Freudian Slip – A slip of the tongue that reveals what you’re truly

thinking Dream Analysis

Manifest Content – What the dream is on the surface i.e. You dream that you are a Red Wings hockey player and they drafted

you when you were just 14 Latent Content – What the dream means

i.e. You have aspirations for fame & you really like to play hockey Resistance – Resisting the therapist’s efforts Transference – Transfer of feelings & thoughts onto the

therapist i.e. Being scared of the therapist because of abuse from parents

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Contemporary PsychoanalysisObject Relations Therapy

Theory Personality & conflicts among its

components are derived from the need for supportive human relationships

Mother-child relationship becomes the prototype for all future relations

Procedure Therapy focuses on developing nurturing

client-therapist relationships “Second chance” for forming a good

relationship

Phenomenological PsychotherapyAn Overview

Theory People’s perceptions of the world are subjective People are capable of consciously controlling

their own actions & taking responsibility for their own responsibilities

Behavior is motivated by an innate drive towards growth, not sexual or aggressive instincts

Procedure Therapy revolves around providing a sounding

board for people to voice opinions & thoughts

Assumptions of Phenomenological Psychotherapy

Treatment is an encounter of equals, not a cure provided by an expert Allows clients to be more comfortable & act more like

themselves Clients will improve on their own under the right

conditions Ideal conditions promote awareness, acceptance, &

expression of client feelings and perceptions Ideal treatment relies on a fully supportive &

accepting relationship between client & therapist Establishes a distinction between the client & the

problematic behavior Clients are responsible for choosing how they will

think & behave Responsibility increases the client’s confidence & comfort

Client-Centered Psychotherapy Unconditional Positive Regard

Listening without interrupting & accepting without evaluation

Therapist doesn’t need to approve of everything, but they must accept it

Empathy External Frame of Reference – looking at the client from the

outside Internal Frame of Reference – characterized by empathy

(emotional understanding) Active Listening Reflection – Paraphrasing/summarizing what the client just

said Congruence [Genuineness]

Consistency between the therapist’s feelings & actions

Gestalt Therapy

Theory People create their own versions of reality People’s natural psychological growth continues

as long as they perceive, remain aware of, & act on their true feelings

Growth stops & disorders appear when people aren’t aware of all aspects of themselves

Procedure Makes clients aware of feelings & impulses that

may have been discarded or repressed “Calling them out”

Some clarification

Behavior Therapy Classical Conditioning principles

Behavior Modification Operant Conditioning principles

Cognitive-Behavior Therapy Thinking & learned ways of thinking

Behavior Psychotherapy

Theory Therapy doesn’t revolve around treating disorders, but

learning how to change specific thoughts & behaviors.

Procedure Listing of the behaviors & thoughts to be changed

Establishes specific goals Therapist acts as a teacher by providing learning-

based treatments “Homework” to help clients make specific plans to deal

with problems Developing a good therapist-client relationship Continuous monitoring & evaluation of the treatment

Techniques for Modifying Behavior

Desensitization Hierarchy Series of increasingly

fear-provoking situations

Imagination vs. real life Once clients are able

to calmly imagine the fear, they deal with it better later in real life

Desirable behaviors can be taught through watching

Client can learn to be more appropriately self-expressive & more comfortable in social situations through assertiveness & social skills training

Systematic Desensitization Modeling

Techniques for Modifying Behavior

Using positive reinforcement through contingencies designed to alter problematic behavior & teach new skills

Token Economy System of secondary

reinforcers

Positive ReinforcementExtinction

Using operant conditioning to eliminate undesirable behaviors by removing the reinforcers that normally follow a particular response

Flooding – person is saturated with fear-provoking stimulus until the anxiety is extinguished

Exposure Techniques – systematic desensitization

Techniques for Modifying Behavior

Associating physical or psychological discomfort with unwanted behaviors

Covert Sensitization Opposite of

systematic desensitization

Presents the unpleasant stimulus after the undesirable response occurs

Overlaps a lot with aversive conditioning

Typically used as a last resort when all other treatments fail or when the client’s life is in danger

Aversive ConditioningPunishment

Cognitive-Behavior TherapyRational-Emotive Behavior Therapy

Theory Psychological problems are caused by how people

think about events Identifying self-defeating thoughts Replaces these thoughts with more realistic &

beneficial ones

Practices Cognitive Restructuring: Replacing upsetting

thoughts with alternative thinking patterns Stress Inoculation Training: Imagining being in a

stressful situation & practice new cognitive skills to stay calm

Cognitive-Behavior TherapyBeck’s Cognitive Therapy

Theory: Negative cognitive patterns are maintained by:

Errors in logic & erroneous beliefs (“I can’t do anything right”)

Thoughts that minimize the value of one’s accomplishments (“Anyone can do that”)

Practice Like a scientific investigation Critically testing the hypothesis

“I can never do anything right.” “Well, here are the cases where I have done things

right.”

Group, Family, & Couples Therapy

Group, family, & couples therapy is concerned about the subject & setting of the therapy & use many different theories.

Group Therapy Therapists can observe clients interact with other

people Clients feel less alone (raises expectations of

recovery) Increase self-confidence & self-acceptance Clients learn from each other (modeling) Positive group relationships increases willingness to

share

Family & Couples Therapy

Family Therapy A problem in one individual often reflects problems

in the entire family’s functioning Treatment cannot focus on an individual in isolation

Wife gets over depression & then husband commits suicide because he had gotten so attached to the idea of a “sick wife”

Couples Therapy Similar to family therapy, but focuses on just two

individuals Behavioral Premarital Intervention – program helps

engaged couples prevent marital problems

Addressing the “Ultimate Question”Which treatment method will work for me?

Details not yet fully mapped out

Cognitive-Behavioral Therapies better for: Phobias & other anxiety disorders Eating disorders Child clients

Client-Therapist relationships are IMPORTANT

Cultural Factors in Psychotherapy Kind of a long section, so here’s the

summary…

If the culture of the client is different from the culture of the therapist, then there will be PROBLEMS

Rules & Rights in the Therapeutic Relationship

Ethical Principles of Psychologists & Code of Conduct No sexual relationship between therapist & client Confidentiality

Situations Exempt from Confidentiality Client’s condition is used for a civil or criminal

defense Suicidal tendencies that require hospitalization Therapist defending against a malpractice suit Reveals information about the abuse of a child or

incapacitated adult The therapist believes that the client may commit a

violent act against another person

Electroconvulsive Therapy (ECT)Psychotherapy in the 1930’s

Hungarian physician noticed that schizophrenia & epilepsy rarely co-occurred, & he used drugs to induce seizures in schizophrenics, depression, & mania

Later, seizures were induced by electric shock Today, it’s used for depression in those that

don’t respond to drugs Side Effects:

Varying degrees of memory loss Speech disorders Death due to cardiac arrest (sometimes)

Electroconvulsive Therapy (ECT)The modern remix of a classic treatment

Modern techniques Focuses shock to right

side of the brain Increased oxygen Extreme muscle relaxers

Why does it work? No one knows “Reset” button Electric shock improves

neurotransmitter function

NeuroT’s that help recover from convulsions reduce activity in “depression” areas

Psychosurgery“Cut it out!” (literally)

Destruction of brain tissue to treat mental disorders

Prefrontal Lobotomy Destruction of the frontal lobe to curb

emotional reactions in the disturbed Standard treatment for schizophrenia,

depression, anxiety, aggressiveness, & OCD

Side effects include: Epilepsy, amnesia, flat affect, & death

Considered a last resort

Psychoactive Drugs

Neuroleptics (antipsychotics) Designed to reduce the symptoms of

schizophrenia Reduces hallucinations, delusions, paranoid

suspiciousness, disordered thinking, & incoherence

Produce improvement in 60-70% of patients Negative side effects

Dry mouth, blurred vision, dizziness, skin pigmentation

Muscle rigidity, restlessness, tremors, slowed movement

Tardive Dyskinesia – Extreme muscle spasms

Psychoactive Drugs

Antidepressants Designed to reduce the symptoms of depression

Monoamine Oxidase Inhibitors (MAO-I) Treats depression & some cases of panic disorder Can produce hypertension if mixed with foods with

tyramine (aged cheese, red wine, chicken livers, etc.)

Tricyclic Prescribed more frequently than MAO-I because they

work better Fewer side effects (can still cause sleepiness, dry

mouth, dizziness, blurred vision, constipation, & urinary retention)

Psychoactive Drugs

Lithium Treats mania & bipolar (effective for 80% of

patients) Dosage must be exact & carefully

controlled Too much =

Nausea, vomiting, tremors, fatigue, slurred speech, coma and death

Anticonvulsants Alternative to treating mania Fewer side effects, less danger of over

dosage, & easier to regulate

Psychoactive Drugs

Anxiolytics [Tranquilizers] Acts in a manner similar to barbiturate Creates an immediate calming effect Generalized anxiety disorder &

posttraumatic stress disorder Side Effects

Sedation, lightheadedness, & impaired psychomotor & mental functioning

Continued use can cause tolerance & physical dependence

Combined with alcohol may have fatal consequences

Human Diversity & Drug Treatment

Ethnicity Drug strengths vary depending on client ethnicity Caucasians need significantly more psychoactive

drugs than Asians to achieve the same effects African Americans show faster responses to

tricyclic antidepressants than European Americans

Gender Research so far based heavily on males Women maintain higher levels of therapeutic

psychoactive drugs in their blood Women are more vulnerable to tardive dyskinesia

Evaluating Psychoactive Drug Treatments Drugs may cover up the problem

Often times drugs simply mask the symptoms without treating the root causes

Leaves the potential for the root causes to continue to get worse

Drugs carry the potential for abuse Abuse of psychoactive drugs can create

psychological dependence Drugs have undesirable side effects

No drug is prefect & without side effects Often times, treatment will involve a lot of

weighing the pros of the drug with the side effects

Drugs or Psychotherapy?

Sometimes psychotherapy is better Cognitive-behavioral & interpersonal therapy

were as effective as antidepressants Sometimes drugs are better

Severe cases of depression, panic disorder, generalized anxiety disorder, & obsessive-compulsive disorder

In most cases, it seems that a combination of drugs & psychotherapy is the best method for treatment