PSYCHOTHERAPY AND BEHAVIOR MODIFICATION

1. PSYCHOTHERAPY AND BEHAVIOR MODIFICATION GROUP 8 Geronimo, Cherry P. Geronimo, Maria Angelica M. Geronimo, Ralph Ernesto R. Go, Camille Marie A. Go, Crystal Karen O. Go, Ferranti D. Go, Jill Irvette C.

2. MENTAL SICKNESS

3. Mental Sickness: How is psychological illness or mental illness different from physiological illness?

4. Europe • Middle Ages: • mixture of the divine, diabolical, magical and humoral • been victims of the witch-hunts • 18th Century: • Madness - organic physical phenomenon • Asylum care • Moral treatment movement – end of 18th century

5. 19th Century: • Industrialization and population growth • classification schemes and diagnostic terms • term psychiatry was coined • medical superintendents – alienists • 20th Century: • Development of psychoanalysis • Kraepelin's classification scheme • Asylum “inmates” – “patients” • asylums - hospitals

6. Anti-psychiatry psychiatrists • Concept of mental illness is completely invalid • Social maladjustments: • Behavior of non-conformist individual • Demands of social system • Modern Social System unable to deal with individual differences

7. Ken Kesey’s One Flew Over the Cuckoo’s Nest • The individuals are not sick, just the system • Richard M. Restak (Pre-Meditated Man) • “Most problems in bioethics are not really ethical, but political”

8. Mental Illness • Behavioral dysfunction: • Caused by organic and physiological defects • Not just CNS lesions • May be genetic • Faulty development and use of human cognitive and affective capacities

9. Medical Model • Psychiatric care that is impossible without hospitalization • Extreme caution: • Protect patient’s human rights • Right of treatment • Right to refuse some forms of treatment • Effort to help patients develop skills to cope

10. MedicalModel • Psychotherapy is different than those used in physical disease • Talking and guiding in recalling and reenacting past experiences • Education or reeducation • Mentally disturbed person has at least some capacities for normal mental life: • Not properly developed • Malfunctioning • Poorly used - fears and perceptions about the reality

11. Psychotherapeutic Methods and Goals

12. Psychotherapy • Interpersonal relationship between a Psychotherapist and a client/patient • It deals with psychic processes less conscious • Basic goals: • Increase patient’s well-being • Behavior change • Improve mental health

13. Mental Health • Psychological freedom based on realistic perception and understanding of the world • Involves self-understanding, self-consistency and self-control

14. Mental Health Is a prior condition requisite for dealing with ethical problems of moral right and wrong, since only to the degree that a person is free can there be the possibility of moral choice and moral responsibility

15. Psychotherapeutic Methods • Overlap but based on different theoretical and clinical sources • Not necessarily contradictory Insight Therapy Action Therapy

16. Psychotherapeutic Methods Insight Therapy Action Therapy • Psychoanalytical School of Thought (S. Freud) • Deterministic assumption • Aims to help patient understand and their own behavior (“have insight into”) • Make the unconscious conscious and strengthen the ego (Free Association) • Behaviorist School of Thought (B.F. Skinner) • Person is the producer and the product of his/her environment • Deals with current problems and factors influencing them • Remove undesirable behavior patterns and developing new ones (Operant Conditioning)

17. Goals of Therapy • Relief of undesirable symptoms (e.g., excessive anxiety) • Increased productivity in the person’s work • Adjustment and satisfaction in sexual relations • Better interpersonal relations • Increased ability to endure the stresses of life

18. Success of Therapy(Robert Harper) • The patient’s weak ego is supported by the therapist’s stronger ego • The patient’s lack of realism is corrected by the therapist’s more realistic attitude • The patient’s comes to see that many things he or she fears are not so terrible • The patient learns to be more patient in solving problems, and less impulsive and panicky

19. Success of Therapy(Robert Harper) • The patient acquires a greater or new faith or “life-myth” from the example of the therapist, who represents a hope for health • The patients gets a more objective perspective on his or her problems from discussing them with the therapist or with a therapy group • The patient focuses his or her floating anxieties on the outcome of the therapy process, so as to feel less isolated and helpless

20. Limitations and Criticism of the Insight Therapy • No clear record of efficiency • Time-consuming and expensive • No objective proof of therapeutic success (ex. Projective tests) • Therapeutic success mainly dependent upon the personal relation with the therapist who is sensitive, realistic and caring person (Transference) • Failure in establishing client/patient autonomy/self-reliance

21. Human Freedom

22. How free are we?

23. Freedom http://riponpolitics.files.wordpress.com/2009/03/freedom.jpg • No human being is totally free • We are limited by • Innate biological structure • Unconscious conditioning of the mind • One’s knowledge of the world and the self

24. Psychotherapy www.cartoonstock.com/directory/p/psychotherapist Deals with limitations on human freedom that arise from the level of unconscious conditioning

25. Psychotics vs Neurotics Psychotics Neurotics Area of freedom is limited in the psychotic Have some areas of freedom reached Schizophrenia, bipolar disorders, psychoactive drugs More free Have some areas of unfreedom that do not occur in normal persons Obsessive compulsive, phobias, severe anxiety

26. Normal Person Also has limited area of freedom Limits lie near the level of necessary determinisms of automatic and routine behavior compatible with normal freedom http://www.psychologytoday.com/files/u89/psychotherapy.jpg

27. Psychotherapy Freedom in Psychotherpy Susan K. Deri, Ph.D. http://www.pep-web.org/document.php?id=PSAR.048C.0097A • Deals with neuroses of emptiness or lack of meaning as a result of society’s failure to recognize the aspects of personhood • Awakens the person’s full capacity for freedom • Psychotherapists • Act as a catalyst in liberating the creative potentials for life inherent in their patients, potentials that are blocked by certain pathologies

28. Freedom and Society http://www.birchmore.org/html/shame.html&usg • Trust between persons and society • Mental illness is in part a disturbance of social relations • Group therapy • learning social communication skills • Family therapy • Issues: confidentiality and adequate professional control

29. Ethical Issues in Psychotherapy

30. Punishment • Reject psychotherapy as punishment • Some neurotic px may perceive it as such

31. Punishment • Penological reform by the court • Decide first on the facts of criminal action • Secondly: moral responsibility of the person • * Moral freedom can be destroyed by mental confusion • Based on expert testimony from psychiatrist • Should be directed to determining the defendant’s freedom limited by the psychological factors • Why the accused chronic or temporary psychological condition did or did not render him so unfree • Whether he cant be held responsible for the act • If he is partially responsible, in what degree or in what respect

32. It is unjust to punish someone for acts for which he or she was not MORALLY responsible

33. Role of the psychiatrist in the process of punishment • Limited to 2: 1. diagnose inmates who develop mental illness and thus treatment 2. As consultants to penologists in setting up routines that make good for mental health and discipline

34. Informed consent • Issue of comptency • Mentall disturbed pxs: • Unable to understand the risk or purpose of treament • May not be truly free to make a decision • Fear • Masochistic tendecies (desire to suffer or to be humiliated) • Narcississm

35. Informed consent • If impossible for the patients: patient’s guardian with observance of legal process • Treatment without consent: • Must have the objective to bring the patient as as soon as possible to the level of mental integration • Use of drugs or psychosurgery

36. transference • Primarily in therapy • Termination of therapy: patient is sufficiently autonomous and under self control • Issue of responsibility by the therapist • Must be trustworthy • Maintain secrecy • True concern for the px • Prompt in appoinments *avoid manipulating the patient for personal gratification

37. Abreaction The expression and consequent release of a previously repressed emotion, achieved by reliving the experience that caused it

38. Dangers • Former tempations and sins • Illicit sexual activity • Hostility and destruction

39. “ Is it legitimate to put oneself in the “occasion of sin” where sinful consent is possible?”

40. Purpose • To return to some error of the past where the patient failed to resolve a problem correctly and to help the patient now face it in a clearer light.

41. Value Systems

42. X Change Adjust Except: Underlying disorder Superego

43. Reinforced in therapy • More trustful • More honest • More hopeful • More courageous • More patient • More realistic

44. Therapist: Extend area of freedom X Give ethical advice

45. Psychoanalysis and Hedonism Pleasure (in the sense of desire gratification) is the highest good and proper aim of human life

46. Problems • Philip Reiff • Built in system of values and ideology that it inculcates? • Product of middle class in opulent capitalist countries?

47. Freud • Saw all of of civilization as the imposition of social controls on man’s infinite and even contradictory drives. Repressive control Explosive drive

48. Reiff Autonomous Hedonistic Goalless Conscienceless Selfish Loveless Empty Emphasis: Social life is always repression, not fulfillment of fundamental human needs.

49. Social conscience Purification of theory, training and practice Higher social and spiritual goals Trust therapists as with limited skills Also receive guidance from others Therapists: Clients:

50. BEHAVIOR CONTROL