Chapter 17 AP Psych

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Therapy

Chapter 17

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History of Insane Treatment

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Maltreatment of the insane throughout the ageswas the result of irrational views. Many patients

were subjected to strange, debilitating, and

downright dangerous treatments.

TheGrangerCollec

tion

TheGrangerCollec

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History of Insane Treatment

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Philippe Pinel in France and Dorthea Dix inAmerica founded humane movements to care

for the mentally sick.

http://wwwihm.nlm.nih.gov

Philippe Pinel (1745-1826) Dorthea Dix (1745-1826)

CulverPictures


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Therapies

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Psychotherapy involves an emotionallycharged, confiding interaction between a

trained therapist and a mental patient.

Biomedical therapy uses drugs or otherprocedures that act on the patients nervoussystem, curing him or her of psychological

disorders.An eclectic approach uses various forms of

healing techniques depending upon the clientsunique problems.


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Psychological Therapies

We will look at four major forms ofpsychotherapies based on different theories of

human nature:

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1. Psychoanalytical theory

2. Humanistic theory

3. Behavioral theory4. Cognitive theory


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Psychoanalysis

The first formal psychotherapy to emerge waspsychoanalysis, developed by Sigmund Freud.

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Sigmund Freud's famous couch

EdmundEngleman


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Psychoanalysis: Aims

Since psychological problems originate fromchildhood repressed impulses and conflicts, the

aim of psychoanalysis is to bring repressed

feelings into conscious awareness where thepatient can deal with them.

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When energy devoted to id-ego-superegoconflicts is released, the patients anxietylessens.


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Psychoanalysis: Methods

Dissatisfied with hypnosis, Freud developedthe method of free association to unravel the

unconscious mind and its conflicts.

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The patient lies on a couch and speaks aboutwhatever comes to his or her mind.

http://www.english.upenn.edu


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Psychoanalysis: Methods

During free association, the patient edits histhoughts, resisting his or her feelings to expressemotions. Such resistance becomes important in

the analysis of conflict-driven anxiety.

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Eventually the patient opens up and reveals his

or her innermost private thoughts, developingpositive or negative feelings (transference)towards the therapist.


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Psychoanalysis: Criticisms

1. Psychoanalysis is hard to refute because itcannot be proven or disproven.

2. Psychoanalysis takes a long time and is very

expensive.

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Psychodynamic Therapies

Influenced by Freud, in a face-to-face setting,psychodynamic therapists understand

symptoms and themes across important

relationships in a patients life.

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Psychodynamic Therapies

Interpersonal psychotherapy, a variation ofpsychodynamic therapy, is effective in treatingdepression. It focuses on symptom relief here

and now, not an overall personality change.

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Humanistic Therapies

Humanistic therapists aim to boost self-fulfillment by helping people grow in self-

awareness and self-acceptance.

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Person-Centered Therapy

Developed by Carl Rogers, person-centeredtherapy is a form of humanistic therapy.

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The therapist listens to the needs of the patientin an accepting and non-judgmental way,

addressing problems in a productive way andbuilding his or her self-esteem.

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Humanistic Therapy

The therapist engages in active listening andechoes, restates, and clarifies the patients

thinking, acknowledging expressed feelings.

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MichaelRougier/LifeMagazineTimeWarner,In

c.

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Behavior Therapy

Therapy that applies learning principles to theelimination of unwanted behaviors.

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To treat phobias or sexual disorders, behaviortherapists do not delve deeply below the

surface looking for inner causes.

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Classical Conditioning Techniques

Counterconditioning is a procedure thatconditions new responses to stimuli that trigger

unwanted behaviors.

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It is based on classical conditioning andincludes exposure therapy and aversive

conditioning.


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Exposure Therapy

Expose patients tothings they fear and

avoid. Throughrepeated exposures,anxiety lessens

because they habituate

to the things feared.

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TheFarSide1986FARWORKS.ReprintedwithPermission.AllRightsReserved.


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Exposure Therapy

Exposure therapy involves exposing people tofear-driving objects in real or virtual

environments.

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N.

Rown/TheImageWorks

BothPhotos:BobMahoney/TheImageWorks


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Systematic Desensitization

A type of exposure therapy that associates apleasant, relaxed state with gradually increasing

anxiety-triggering stimuli commonly used to

treat phobias.

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Aversive Conditioning

A type ofcounterconditioning

that associates anunpleasant state with

an unwanted behavior.With this technique,

temporaryconditioned aversion

to alcohol has beenreported.

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Operant Conditioning

Operant conditioning procedures enabletherapists to usebehavior modification, inwhich desired behaviors are rewarded and

undesired behaviors are either unrewarded orpunished.

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A number of withdrawn, uncommunicative3-year-old autistic children have been

successfully trained by giving and withdrawingreinforcements for desired and undesired

behaviors.

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Token Economy

In institutional settings therapists may create atoken economy in which patients exchange atoken of some sort, earned for exhibiting the

desired behavior, for various privileges ortreats.

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Cognitive Therapy

Teaches people adaptive ways of thinking andacting based on the assumption that thoughtsintervene between events and our emotional

reactions.

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Cognitive Therapy for Depression

Aaron Beck (1979) suggests that depressedpatients believe that they can never be happy

(thinking) and thus associate minor failings (e.g.

failing a test [event]) in life as major causes fortheir depression.

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Beck believes that cognitions such as I can never

be happy need to change in order for depressedpatients to recover. This change is brought about

by gently questioning patients.

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Cognitive Therapy for Depression

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Rabin et al., (1986)trained depressedpatients to record

positive events each day,and relate how theycontributed to theseevents. Compared to

other depressed patients,trained patients showedlower depression scores.


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Cognitive-Behavior Therapy

Cognitive therapists often combine the reversalof self-defeated thinking with efforts to modify

behavior.

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Cognitive-behavior therapy aims to alter theway people act (behavior therapy) and alter the

way they think (cognitive therapy).

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Group Therapy

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Group therapy normally consists of 6-9 peopleattending a 90-minute session that can help

more people and costs less. Clients benefit from

knowing others have similar problems.

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Family Therapy

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Family therapytreats the family as a system.Therapy guides family members toward

positive relationships and improved

communication.

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Evaluating Therapies

Who do people turn to for help withpsychological difficulties?

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Evaluating Psychotherapies32

Within psychotherapies cognitive therapies aremost widely used, followed by psychoanalytic

and family/group therapies.

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Is Psychotherapy Effective?

It is difficult to gauge the effectiveness ofpsychotherapy because there are different levelsupon which its effectiveness can be measured.

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1. Does the patient sense improvement?

2. Does the therapist feel the patient has improved?

3. How do friends and family feel about thepatients improvement?

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Clients Perceptions

If you ask clients about their experiences ofgetting into therapy, they often overestimate itseffectiveness. Critics however remain skeptical.

1. Clients enter therapy in crisis, but crisis maysubside over the natural course of time

(regression to normalcy).2. Clients may need to believe the therapy was

worth the effort.

3. Clients generally speak kindly of their therapists.

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Clinicians Perceptions

Like clients, clinicians believe in therapyssuccess. They believe the client is better off aftertherapy than if the client had not taken part in

therapy.

1. Clinicians are aware of failures, but they believefailures are the problem of other therapists.

2. If a client seeks another clinician, the formertherapist is more likely to argue that the client has

developed another psychological problem.

3. Clinicians are likely to testify to the efficacy oftheir therapy regardless of the outcome oftreatment.


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Outcome Research

How can we objectively measure theeffectiveness of psychotherapy?

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Meta-analysis of a number of studies suggeststhat thousands of patients benefit more from

therapy than those who did not go to therapy.


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Outcome Research

Research shows that treated patients were 80%better than untreated ones.

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The Relative Effectiveness of DifferentTherapies

Which psychotherapy would be most effectivefor treating a particular problem?

Disorder TherapyDepression Behavior, Cognition, Interpersonal

Anxiety Cognition, Exposure, Stress Inoculation

Bulimia Cognitive-behavior

Phobia Behavior

Bed Wetting Behavior Modification

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Evaluating Alternative Therapies

Lilienfeld (1998) suggests comparing scientifictherapies against popular therapies throughelectronic means. The results of such a search

are below:

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Eye Movement Desensitization andReprocessing (EMDR)

In EMDR therapy, the therapist attempts tounlock and reprocess previous frozen traumatic

memories by waving a finger in front of the

eyes of the client.

EMDR has not held up under scientific testing.


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Light Exposure Therapy

Seasonal AffectiveDisorder (SAD), a

form of depression,

has been effectivelytreated by lightexposure therapy. This

form of therapy has

been scientificallyvalidated.

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CourtesyofChristineBrune


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Commonalities AmongPsychotherapies

Three commonalities shared by all forms ofpsychotherapies are the following:

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1. A hope fordemoralized people.

2. A new perspective.

3. An empathic, trustingand caringrelationship.

MaryKateD

enny/PhotoEdit,Inc.

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Culture and Values in Psychotherapy

Psychotherapists may differ from each otherand from clients in their personal beliefs,

values, and cultural backgrounds.

A therapist search should include visiting twoor more therapists to judge which one makes

the client feel more comfortable.

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Therapists & Their Training

Clinical psychologists: They have PhDs mostly.They are experts in research, assessment, and

therapy, all of which is verified through asupervised internship.

Clinical or Psychiatric Social Worker:They havea Masters of Social Work. Postgraduate

supervision prepares some social workers to

offer psychotherapy, mostly to people witheveryday personal and family problems.

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Therapists & Their Training

Counselors:Pastoral counselors or abusecounselors work with problems arising from

family relations, spouse and child abusers and

their victims, and substance abusers.

Psychiatrists:They are physicians whospecialize in the treatment of psychological

disorders. Not all psychiatrists have extensivetraining in psychotherapy, but as MDs they canprescribe medications.

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The Biomedical Therapies

These include physical, medicinal, and otherforms of biological therapies.

1. Drug Treatments

2. Surgery

3. Electric-shock therapy


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Drug Therapies

Psychopharmacology is the study of drug effectson mind and behavior.

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With the advent of drugs, hospitalization in mental

institutions has rapidly declined.


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Drug Therapies

However, many patients are left homeless on thestreets due to their ill-preparedness to cope

independently outside in society.

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LesSnid

er/TheImageWorks

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Double-Blind Procedures

To test the effectiveness of a drug, patients aretested with the drug and a placebo. Two groups of

patients and medical health professionals are

unaware of who is taking the drug and who istaking the placebo.


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Schizophrenia Symptoms

Inappropriate symptomspresent (positive

symptoms)

Appropriate symptomsabsent (negative

symptoms)

Hallucinations,disorganized thinking,

deluded ways.

Apathy, expressionlessfaces, rigid bodies.

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Antipsychotic Drugs

Classical antipsychotics [Chlorpromazine(Thorazine)]: Remove a number of positive

symptoms associated with schizophrenia such

as agitation, delusions, and hallucinations.

Atypical antipsychotics [Clozapine (Clozaril)]:Remove negative symptoms associated with

schizophrenia such as apathy, jumbled thoughts,concentration difficulties, and difficulties in

interacting with others.


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Atypical Antipsychotic

Clozapine (Clozaril) blocks receptors fordopamine and serotonin to remove the negative

symptoms of schizophrenia.

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Antianxiety Drugs

Antianxiety drugs (Xanax and Ativan) depress thecentral nervous system and reduce anxiety and tension

by elevating the levels of the Gamma-aminobutyric acid(GABA) neurotransmitter.

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Antidepressant Drugs

Antidepressant drugs like Prozac, Zoloft, and Paxil areSelective Serotonin Reuptake Inhibitors (SSRIs) that

improve the mood by elevating levels of serotonin byinhibiting reuptake.

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Mood-Stabilizing Medications

Lithium Carbonate, a common salt, has been usedto stabilize manic episodes in bipolar disorders. It

moderates the levels of norepinephrine and

glutamate neurotransmitters.


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Brain Stimulation

Electroconvulsive Therapy(ECT)

ECT is used for severely

depressed patients who donot respond to drugs. Thepatient is anesthetized and

given a muscle relaxant.

Patients usually get a 100volt shock that relieves

them of depression.

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Alternatives to ECT

Transcranial MagneticStimulation (TMS)

In TMS, a pulsatingmagnetic coil is placedover prefrontal regions

of the brain to treat

depression withminimal side effects.

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Psychosurgery

Psychosurgery waspopular even inNeolithic times.

Although used sparinglytoday, about200 such operations do

take place in the US

alone.

http://www.epub.org.br


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Psychosurgery

Psychosurgery is used as a last resort inalleviating psychological disturbances.

Psychosurgery is irreversible. Removal of brain

tissue changes the mind.

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Psychosurgery

Modern methods usestereotactic

neurosurgery andradiosurgery (Laksell,1951) that refine older

methods ofpsychosurgery.

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p://www.epub.org.br

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Preventing Psychological Disorders

It is better to prevent than cure.Peruvian Folk Wisdom

Preventing psychological disorders meansremoving the factors that affect society. Those

factors may be poverty, meaningless work,

constant criticism, unemployment, racism, andsexism.

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Psychological Disorders areBiopsychosocial in Nature

Chapter 17 AP Psych

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