The Field of Clinical Psychology

1. The Field of Clinical Psychology • Research into the causes of psychological disorders • Research into the most effective treatment approaches • Application of theories/research findings to provide psychological help to people who are having problems or wanting to make changes in their lives

2. Concepts • Different approaches have different ideas about what causes psychological disorders to develop • Most psychological disorders are caused by multiple factors. • Bio-psycho-social model

3. Concepts • Treatment is shaped by one’s understanding of the causes of the problem • Eclectic approaches combine ideas from the different approaches/schools within psychology

4. Concepts • It can be difficult sometimes to draw the line between “abnormal” & “normal” behavior. • Useful criteria: • Atypical • Maladaptive • Disturbing • Unjustifiable • Are depressed, angry, anxious feelings always bad?

5. Concepts • Psychological disorders are real problems that affect real people. • Research into the causes & treatment of psychological disorders is critically important. • Process of making a diagnosis is difficult • Stigma of mental illness creates a great deal of difficulty in our society in terms of people getting the help they need

6. Stigma & Labeling • Rosenhan study 1973 • Purpose of diagnostic labels

7. Diagnostic & Statistical Manual—IV • Concensus among professionals—psychiatrists, psychologists, psychiatric social workers, etc. • Used in obtaining insurance coverage, treatment, research

8. Schizophrenia & other related psychotic disorders Mood disorders Anxiety disorders Substance Abuse Disorders Personality Disorders Adjustment Disorders Somatoform disorders Sexual & Gender Identity Disorders Sleep Disorders Eating Disorders Dissociative Disorders Diagnostic & Statistical Manual of Mental Disorders—4th edition

9. Symptoms of Schizophrenia • Disorganized thinking • Delusions • Incoherent Speech—flight of ideas, “word salad” • Disturbed Perceptions • Hallucinations • Inappropriate Emotions & Actions • Disturbed Affect • Flat Affect

10. Schizophrenia • Different types of schizophrenia(s) • Acute vs. chronic • Disorganized, Paranoid, Undifferentiated & Catatonic • These different types have different prognoses (i.e., predictions about how the disorder will progress). For example, acute & paranoid subtypes have a better prognosis (more likely to respond well to treatment, etc.) than chronic & disorganized subtypes.

11. Causes of Schizophrenia • What does the evidence from treatment suggest? • Dopamine overactivity • What does evidence from neurological scans suggest? • Underactivity in frontal lobes • Enlarged ventricles • Underdeveloped thalamus

12. Causes of Schizophrenia • What does information about the incidence of the disorder suggest? • Prenatal viral infection? • Genetics • Role of stress • Diathesis-Stress Model • What does new genetic research suggest? • Human Genome Project—possible compensation for low levels of dopamine & malfunction in the feedback system

13. Causes of Schizophrenia • What does information about the course of the disorder suggest? • Expressed emotion

14. Treatment of Schizophrenia • Psychotropic drugs • Most success with “positive” symptoms • Recently, some drugs that also can help negative symptoms • Community Support Programs • Family Support

15. MAJOR DEPRESSION SYMPTOMS • Depressed mood most of the day nearly every day • Diminished interest or pleasure • Weight or appetite loss/gain • Sleep disturbances • Psychomotor agitation or retardation • Fatigue or Loss of Energy • Feelings of Worthlessness • Concentration problems • Suicidal thoughts or thoughts of death

16. Depression also occurs in… • Dysthymia: milder, but longer lasting (at least 2 years in adults) • Adjustment Disorder with Depressed Mood (less than 6 months)

17. MAJOR DEPRESSION • Relatively common—10% of men & 20% of women • Rate of depression increasing with each new generation • Course: for some, naturally remits, most lasts less than 3 months (even without professional help). For others, without treatment, recurrence becomes more frequent & more severe

18. BIPOLAR DISORDER • Alternating patterns of depression & mania

19. Symptoms of mania • Abnormally elevated, expansive or irritable mood • Inflated self-esteem or grandiosity • Decreased need for sleep • More talkative than usual • Flight of ideas or racing thoughts • Psychomotor agitation • Distractability • Impulsive behavior • Delusions

20. Causes of Mood Disorder • Bio-psycho-social model • Genetics & Neurotransmitter levels • Negative thinking • Low levels of social support • Difference in gender ratio in major depression

21. Anxiety Disorders • Post-traumatic Stress Disorder • Panic Disorder with or without Agoraphobia • Phobias • Generalized Anxiety Disorder • Obsessive-Compulsive Disorder

22. In groups, discuss: • What symptoms do you notice in this individual? • What diagnoses do you think best fits these symptoms? • In the interview, did you get a sense of • any of the factors that might have contributed to the person developing the disorder? or • any factors that have helped the person to cope with or recover from the disorder? • What questions do you still have about this disorder?

23. Anxiety Disorders • Panic Disorder • Panic attacks: brief, sudden, recurrent episodes of intense & uncontrollable anxiety • Sometimes (but not always) co-occurs with Agoraphobia—avoiding situations in which panic attack might occur • One cause may be over attentiveness to physical symptoms • Recommended treatment: cognitive behavioral--focuses on helping the person to better understand the symptoms & interpret them in less anxiety-provoking ways

24. Anxiety Disorders • Obsessive-Compulsive Disorder— • Obsessions • Compulsions • Post-traumatic Stress Disorder • Response to traumatic situation • Flooding • Numbing • Autonomic hyperarousal

25. Anxiety Disorders • Phobic Disorders—phobia=persistent, irrational, disruptive fear of specific object, activity or situation. • Generalized Anxiety Disorder—general, constant & high level of anxiety about multiple areas in one’s life.

26. What treatment will look like depends on… • The problem • The therapist • The client

27. Orientations to Treatment • Behavioral • Cognitive • Psychodynamic (including Freudian) • Humanistic • Family Systems • Biomedical

28. Behavioral Approach • Focus on unlearning or relearning • Counterconditioning—unlearn things that have been paired together by learning a new incompatible pairing • Systematic Desensitization • Aversive conditioning • Operant approaches • Token economies

29. Cognitive Perspective • Identifying & changing unhelpful thoughts or self-talk

30. Humanistic • Nondirective • Focus on environment provided by therapist--Unconditional Positive Regard & Genuineness • Active Listening

31. Family Systems • Assessment of role that problem/symptom may play in entire system • Work at changing system—finding a new, healthier equilibrium

32. Psychodynamic Approach • Insight-based approach—making the unconscious conscious • Techniques include dream analysis, analysis of resistance, analysis of transference to try to “get at” the unconscious • Therapist makes interpretations

33. Biomedical Approaches • Psychopharmacological treatment • Electroconvulsive Therapy (ECT)