Unit 13

1. Unit 13 Treatment of Psychological Disorders/ Therapy

2. Care as a Social Issue:The History of Psychological Treatment • What to do with the severely disturbed? • middle Ages to 17th century • madness = in league with devil • torture, hanging, burning, sent to sea • 18th century • mentally disordered people = degenerates • keep them away from society • http://youtu.be/1Izmyru5T_w

3. The 19th Century Attempts at Reform: The History of Psychological Treatment • Philippe Pinel (1745-1826) • reform in Paris mental hospital • some patients got better enough to leave hospital • http://youtu.be/GdxlFlAcJzw

4. The 19th Century Attempts at ReformThe History of Psychological Treatment Dorothea Dix (1802-1887) • reform of U.S. system • moral-treatment movement • kindly care • led to large, state-supported public asylums • overcrowding, loss of public attention

5. The 20th century:The History of Psychological Treatment • Deinstitutionalization (mid-1950s) • get people out of asylums and back into community • effective antipsychotic medication • general mood of optimism in country • 1961: establishment of community mental health centers

6. The Rosenhan Study • Rosenhan (1973): "On being sane in insane places”http://youtu.be/xAsqKCQDgmA • sane people got into mental hospitals as patients • found very low interaction with staff • dehumanizing nature of interactions • normal behaviors interpreted pathologically

7. Therapy • Psychotherapy • an emotionally charged, confiding interaction between a trained therapist and someone who suffers from psychological difficulties • http://youtu.be/ZdTFqpItd8I

8. THERAPY • Types of Psychotherapy • psychodynamic • humanistic • cognitive • behavior • group • family • Eclectic Approach • an approach to psychotherapy that, depending on the client’s problems, uses techniques from various forms of therapy

9. Psychotherapy • Many approaches to mental problems • 400 different forms of psychotherapy have appeared • Most common • psychodynamic • humanistic • behavioral • cognitive

10. Psychoanalysis • Freud believed the patient’s free associations, resistances, dreams, and transferences – and the therapist’s interpretations of them – released previously repressed feelings, allowing the patient to gain self-insight • use has rapidly decreased in recent years

11. Psychodynamic/Psychoanalytic Therapy Sigmund Freud • Psychological problems result from inner mental conflicts • Must make these conflicts conscious • Unconscious wishes • Repressed memories • Predisposing & precipitating experiences • http://youtu.be/VkWikN3fl7g

12. Therapy- Psychoanalysis • Interpretation • the analyst’s noting supposed dream meanings, resistances, and other significant behaviors in order to promote insight • Transference • the patient’s transfer to the analyst of emotions linked with other relationships • e.g. love or hatred for a parent • Resistance • unconscious material causes anxiety • patients resist attempts to bring unconscious into conscious • “forgetting” • refusing to discuss certain topics

13. Techniques in Psychoanalysis • Free association • patient relaxes and reports everything that comes to mind • Dream analysis • latent content • manifest content • Freudian symbols • Mistakes • slips of the tongue • http://youtu.be/EMUPr28v_ao

14. Psychoanalysis- Insight & Cure • Analyst’s job is to make inferences about patient’s unconscious conflicts • Once patient experiences them consciously, can modify or express them • Patient must accept insights of therapist • Analyst leads patient to insight so patient comes to insight themselves • http://youtu.be/oS_L8efaJ-E

15. Behavior Therapy • Behavior Therapy • therapy that applies learning principles to the elimination of unwanted behaviors • Counterconditioning • procedure that conditions new responses to stimuli that trigger unwanted behaviors • based on classical conditioning • includes systematic desensitization and aversive conditioning

16. Behavior Therapy • Concentrate on observable stimuli & responses • Consider mental events as “covert” responses • Most behaviorist therapists now practice cognitive-behavior therapy • combination of cognitive & behavioral principles used Big Bang Theory http://youtu.be/ejjZZNGfIOM

17. Other Behavioral Techniques • Token economies • an operant conditioning procedure that rewards desired behavior • patient exchanges a token of some sort, earned for exhibiting the desired behavior, for various privileges or treats • Contingency contracts • formal written agreement • Assertiveness & social skills training • Modeling • therapist models adaptive behaviors for client

18. Behavior Therapy • Exposure Therapy • treat anxieties by exposing people (in imagination or reality) to the things they fear and avoid

19. Behavioral Therapy:Exposure Treatments • Systematic Desensitization *Joseph Wolpe http://youtu.be/LcojyGx8q9U • type of counterconditioning • associates a pleasant, relaxed state with gradually increasing anxiety-triggering stimuli • commonly used to treat phobias • Aversive Conditioning • type of counterconditioning that associates an unpleasant state with an unwanted behavior • nausea ---> alcohol • Flooding • expose person to feared stimulus and allow them to experience accompanying fear • Fear gradually declines & disappears

20. Behavior Therapy • Systematic Desensitization

21. Aversion Treatment/Aversive Conditioning • Used for bad habits • drinking • smoking • gambling • Use of operant conditioning principles • painful or unpleasant stimulus follows the unwanted behavior • Example • Antabuse for alcohol usage • Controversial treatment • Limited generalizability of results

22. Behavior Therapy • Aversion therapy for alcoholics

23. Humanistic Therapy • Emphasis on inner potential for positive growth • Similarity to psychodynamic • help clients become more aware of inner feelings & desires • Differences from psychodynamic • inner feelings & desires are seen as positive & life-promoting • main goal is to help client take control of own life

24. Humanistic Therapy • Client-Centered Therapy • humanistic therapy developed by Carl Rogers • therapist uses techniques such as active listening within a genuine, accepting, empathic environment to facilitate clients’ growth

25. Client- Centered Therapy • Carl Rogers • focus on thoughts, abilities, cleverness of client • not focused on insights of therapist • therapist as a sounding board for client’s thoughts • http://youtu.be/m30jsZx_Ngs

26. Humanistic Therapy • Active Listening-empathic listening in which the listener echoes, restates, and clarifies

27. Client-Centered Therapy Concepts • Problems caused by denial of own feelings & distrust of ability to make decisions • Empathy • attempt to comprehend feelings from client’s point of view • use of reflection • Unconditional positive regard • client is worthy & capable no matter what client does or says • creates safe, nonjudgmental atmosphere • Genuineness

28. Cognitive Therapy • Cognitive Therapy • teaches people new, more adaptive ways of thinking and acting • based on the assumption that thoughts intervene between events and our emotional reactions

29. Cognitive Therapy • The Cognitive Revolution

30. Cognitive Therapy • A cognitive perspective on psychological disorders

31. Cognitive Therapy • Cognitive therapy for depression

32. Cognitive Therapy • People disturb themselves with their own thoughts • Goals of cognitive therapy • identify maladaptive ways of thinking • replace these with adaptive ways • Similarity to humanistic • focus on conscious mental experience • Differences from humanistic • problem-centered rather than client-centered • relationship is more directive

33. Beck’s Cognitive Therapy • Treatment of depression • Depressed people: • distort experiences & maintain negative views of themselves, the world, their future • minimize positive & maximize negative experiences • misattribute negative experiences to own deficiencies • http://youtu.be/GqW8p9WPweQ

34. Ellis’ Rational-Emotive Therapy • Albert Ellis • Negative emotions arise from people’s irrational interpretations of experiences • Musterbations • irrational belief that you must do or have something • Awfulizing • mental exaggeration of setbacks

35. Loss of job I’m worthless Loss of job My job sucked Ellis’ ABC theory of emotions • A = activating event in the environment • B = belief triggered in client’s mind by event • C = emotional consequence of the belief Depression Healthy Pattern No Depression http://youtu.be/2xFfdshNKYk

36. Cognitive Therapy • Cognitive-Behavioral Therapy • a popular integrated therapy that combines cognitive therapy (changing self-defeating thinking) with behavior therapy (changing behavior)

37. ECLECTIC/MODERN Martin Seligman Positive Psychology Explanatory Styles: Learned Helplessness Learned Optimism http://www.ted.com/talks/martin_seligman_on_the_state_of_psychology.html

38. Group Therapy • Psychodynamic • interactions among group members provide clues to hidden motives • gain insight into how unconscious affects relations with others • Humanistic • members gain opportunity to express selves honestly • Cognitive & Behavioral • clients can practice new skills, new ways of thinking • http://youtu.be/PwnfWMNbg48

39. Group and Family Therapies • Family Therapy • treats the family as a system • views an individual’s unwanted behaviors as influenced by or directed at other family members • attempts to guide family members toward positive relationships and improved communication

40. Couples & Family Therapy • Problem not in individual but interaction between individuals • Couples: http://youtu.be/VNSrJ1qfaQQ • Family therapy • see whole family together, observe interactions • help members gain perspective • Family systems perspective • each person accommodates to the family • fix family problems by offering insight into how each affects others http://youtu.be/6JjcIiCJaDo • Intergenerational approach • considers influence of previous generations

41. ALTERNATIVE THERAPIES http://youtu.be/zBtqWrs2-K0 Eye Movement Desensitization and Reprocessing (EMDR)1 is a comprehensive, integrative psychotherapy approach including psychodynamic, cognitive behavioral, interpersonal, experiential, and body-centered therapies During treatment various procedures and protocols are used to address the entire clinical picture. One of the procedural elements is "dual stimulation" using either bilateral eye movements, tones or taps. During the reprocessing phases the client attends momentarily to past memories, present triggers, or anticipated future experiences while simultaneously focusing on a set of external stimulus. During that time, clients generally experience the emergence of insight, changes in memories, or new associations. The clinician assists the client to focus on appropriate material before initiation of each subsequent set.

42. Places of treatment • public or private mental hospitals • general hospitals • nursing homes for older patients with mental health needs • halfway houses/group homes • community mental health centers • private offices

43. Providers of treatment • Psychiatrists • medical degree (M.D.) • special training/residency in psychiatry • mainly hospitals & private practice • can prescribe drugs • Clinical psychologists • doctoral degree (Ph.D.) in psychology • training in research & practice • universities, private practice, community mental health

44. Providers of treatment • Counseling psychologists • doctoral degree in psychology • sometimes more emphasis on practice than research • problems of living, rather than diagnosable conditions • Counselors • master's degree in psychology • schools & institutions • school-or job-related problems

45. Providers of treatment • Psychiatric social workers • master's degree in social work • public agencies, home visits • Psychiatric nurses • bachelor's or master's in nursing • hospital settings • Self-help groups • Alcoholics Anonymous • LaLeche League • Overeaters Anonymous

46. Therapists and their Training • Clinical psychologists • Most are psychologists with a Ph.D. and expertise in research, assessment, and therapy, supplemented by a supervised internship • About half work in agencies and institutions, half in private practice

47. Recipients of treatment • Most people who meet criteria for DSM diagnoses do not seek treatment • Variability due to sex, education, race & income level • women seek more treatment than men • college educated seek more treatment than high school educated • whites seek more treatment than nonwhites • higher income seek more treatment than lower income

48. Clinical Assessment • Assessment • process of gathering information to develop treatment plan for client • Assessment Interview • very common assessment technique • range from unstructured to highly structured • Objective questionnaires • self-report to get information on feelings, thoughts, behaviors of clients • examples: Beck Depression Inventory, Child Behavior Checklist

49. The Intake: MMPI • A psychometric personality test • Used in clinical assessment • 567 statements about the self • Client answers true or false to items • 10 clinical scales, 15 content scales, several validity scales

50. The Intake: Projective Tests • Most commonly used by psychodynamic therapists • Designed to provide clues about unconscious mind • Developed from free association technique • The Rorschach • Thematic Apperception Test