Psychological Therapies

1. Psychological Therapies

2. History of Treatment Video • Trephing – YouTube (2:00)?? • Early Treatment of Mental Disorders • For The Incurable Insane • Dorothea Dix- reform treatment of mentally ill. • Pinel – The medical Model which changed the paradigm (view) of mental illness as a curable disease just some physical diseases.

3. Deinstitutionalization • 1950’s because of development of drugs (especially anti-psychotic), local clinics did not take care of led to boom in homeless population. (686) • Sick: A Documentary • YOUTUBE: Bellevue inside and out

4. Preventative efforts (suffering and costs will be less if we can be proactive with treatment.) • Primary- decrease joblessness, homelessness, prejudice, economic inequality, HS drop out rates. • Secondary- treat at-risk such as PTSD for war veterans, traumatic event survivors, community health. • Tertiary- those with disorders that could get worse without treatment.

5. Psychotherapy • Psychotherapy – an emotionally charged, confiding interaction between a trained therapist and someone who suffers from psychological difficulties. • At least 250 types of psychotherapies exist • Most influential – Psychoanalytic, Humanistic, Behavioral, Somatic and Cognitive • Many therapists today use an eclectic approach – using techniques from various therapies

6. Types of Therapists • Psychiatrists – medical doctors, can prescribe medication, oftentimes favor the biomedical model • Clinical psychologists – doctoral degrees in psychology • Counseling psychologists – graduate degrees in psychology • Psychoanalysts – people trained in Freudian methods (may or may not hold medical degrees)

7. Psychoanalysis • Sigmund Freud’s therapeutic technique. • Cause of psychological disorders - Repressed conflicts (in the unconscious) • Focus – Identify the underlying cause of the problem • Must find the underlying cause, otherwise you are simply treating symptoms of the disorder and not the disorder itself. • To release repressed feelings and thus allowing the patient to gain self-insight.

8. Sybil and Psychoanalytic Treatment using Hypnosis • Sybil and Hypnosis: Psychologist trying to figure out what causes Sybils’ Dissociation. Sybil is unaware of other personalities. She is unaware of the abuse that her mother did to her. Therapist is beginning to make breakthrough. • Video: beginning Part 2 (11:00)

9. Psychoanalysis • Techniques – (Insight Therapies) • Free Association – saying whatever comes to mind (thought, feeling or image) • Resistance – blocks in the flow of a free association (evidence of anxiety and repression), could also refer to a patient’s tendency to disagree with the therapist’s interpretation • Psychoanalysts will oftentimes use interpretation to analyze a resistance. • Transference may occur – patient redirects emotion from their troubled relationships to their therapist (love or aggression) • Analysis of a dream’s latent content • Psychodynamic Therapy – Search for repressed childhood experiences that explain current symptoms. (Practiced by Neo-Freudians)

10. Ordinary People and Psychoananlysis • Ordinary People. Best Picture 1981 Upper class family Conrad 17 years old who just returned from spending 3 months in a mental institution after he tried to kill himself. Suffering from depression (quit the swim team) lost interest in friends, activities, weight loss, sleeping 12 hours per day.

11. Ordinary People and Psychonanlysis • During that time the mother never came to visit him in the hospital. He also suffers from PTSD the event was a boating accident which killed his older brother. He begins to see a psychotherapist that comes from the psychoanalytic perspective. Also uses a little Cognitive Therapy in which he challenges the assumptions, way of thinking of Conrad.

12. Insight Therapies • Freudian Slips • Hypnosis • Assignment: During these clips find the following: • Sybling Rivalry (Neo-Freudian) • Resistance- • Transference • Freudian Slips • Cognitive Therapy

13. Psychoanalysis and Ordinary People. • ( • Ordinary People part 8 – YouTube • ordinary people part 10 – YouTube (begin 4:00) • Ordinary People Conrad's Breakthrough

14. Humanistic Therapy • Cause of psychological disorders – failure to strive towards one’s potential. (Patient has the opportunity to change due to free-will) • Focus – Goal is to encourage self-fulfillment by the therapist helping the patient grow in self-awareness and self-acceptance

15. Humanistic Therapy • Techniques – • Client-centered therapy (Carl Rogers) • Focus on client’s conscious self-perceptions rather than therapist’s interpretations • Therapist is empathetic, genuine and offers unconditional positive regard • Use active listening – repeating what you’ve heard (Re: p. 664) • Carl Rogers Client Centered Therapy Beginning 1:30

16. Gestalt Therapy • Gestalt therapy • Developed by Fritz Perls • Get in touch with your whole self - Encourage their client to integrate all of their actions, feelings and thoughts into a harmonious whole. • - Gestalt Therapy (1:50)

17. Humanistic Therapy • Existential therapy – helping clients achieve a subjectively meaningful perception of their lives. • Believes client’s problems are due to loss of purpose • Therapist helps client form a worthwhile vision • Group Therapy – people meet regularly (with those with similar issues) to interact and help one another achieve insight into feelings and behaviors. • Ex. Family Therapy • Ex. Couple Therapy • Ex. Self-help groups – AA

18. Behavior Therapy • Cause of psychological disorder – due to the environment and can be changed with a change in one’s surroundings . People have been conditioned into a behavior • Focus – apply learning principles (Operant and Classical Conditioning) to eliminate unwanted behavior, replace maladaptive symptoms with constructive behavior

19. Behavior Therapy • Techniques • Counter conditioning - reversing the present conditioned response. (Classical Conditioning) • Systematic Desensitization – conditioning a patient to replace anxious feelings with relaxed feelings. (used to treat phobias) • Anxiety (fear) hierarchy – ranking fear of a particular object/experience from least to most fear provoking P.667 • Exposure Therapy – treating anxiety through exposure to that which you normally avoid (in imagination or actuality) Ex. – virtual reality therapy . Treating Arachnophobia • Implosive Therapy – exposure to the most frightening scenario first. Client should eventually realize that their behavior is irrational. Intensive Exposure Therapy • Aversive Conditioning - An unpleasant state is associated with an unwanted behavior. (Ex. Shocking bed wetters, pill causing nausea in an alcoholic's drink, terrible tasting nail polish for nail biting)

20. Behavior Therapy • Techniques • Modeling – observe appropriate behavior and then reenact that behavior. • Ex. Watch people who act calm and you will act calm. • Token Economy - Rewarding desired behavior (operant conditioning) Ex. Reward a child with ADHD when they takes notes and participate in class. Reward could be candy, points, etc.)

21. Cognitive Therapy • Causes of psychological disorders – irrational or dysfunctional ways of thinking. A Patients interpretation of events including a realistic appraisal of the consequences. Ex. Biff thinks “I will never get another girlfriend again” • Focus – teaching clients new and rational ways of thinking

22. Cognitive Therapy • Techniques – • Aaron Beck’s Cognitive Therapy – seek to reverse client’s beliefs about themselves, their situations and their futures. • Read dialogue on page 670 • Changing negative thoughts to more positive thinking. • Ex Halle Berry • Albert Ellis’ Rational Emotive Therapy (RET) – therapist points out dysfunctional thinking. Many patients in therapy have an irrational set of beliefs that include “musts? and “shoulds” (Ex. I should be competent at everything. I must be liked by everyone.) Therapists challenge this thinking. • Ellis’s RET is more confrontational than Beck’s CT • Re: P. 669 bottom • Ellis and Gloria

23. Stress Inoculation Therapy • Changing the conversations that one has in his/her head. • Ex. Ben Stein, Alex Rodriquez

24. Biomedical (Biological / Somatic Therapy) • Causes of psychological disorders – genetic predisposition to the disorder, biochemical (neurotransmitter) imbalance • Focus – advocate somatic therapies that produce bodily change.

25. How Psychoactive Drugs work LIVE!Psych

26. Biomedical (Biological / Somatic Therapy) • Techniques – • Prefrontal lobotomy - cutting the nerves connecting the frontal lobes with the inner brain’s thalamus. • Rarely used today – but in the 1940s and 1950s – thousands of lobotomies were administered • Used on patients with extreme schizophrenia, high anxiety or uncontrollably violent patients. • Lobotomy - PBS documentary • Electroconvulsive Therapy (ECT) – brief electric current is sent through the brain of an anesthetized person. • maj depressive disorder and ECT • Used for severe depression ECT

27. Biomedical (Biological / Somatic Therapy) • Psychopharmacology (Drug Therapy) – the study of the effects of drugs on the mind and behavior (p. 686 – review double-blind technique) • Antianxiety drugs – Xanax, Valium (barbiturates) – depress the central nervous system (Re:p.687) • Antidepressant drugs – Prozac, Zoloft, Paxil (all three are SSRIs – increase the amount of serotonin) MAO inhibitors (inhibits the breakdown of serotonin)- Do antidepressants help teens or hurt them Re: 686) • Antipsychotic drugs – Thorazine (Chlorpromazine), Haldol (Haloperidol)– block receptor sites for dopamine – Antagonist drugs • Mood Stabilizers – Lithium (used to treat bipolar disorder)

28. review • YOUTUBE- Bellevue- inside and out