Chapter Sixteen

Treatment of Psychological

Disorders

Main Types of Treatment• Psychotherapy

o Psychodynamic Psychotherapy Classical Psychoanalysis (Sigmund Freud) Contemporary Variations on Psychoanalysis

o Humanistic Client Centered (Carl Rogers) Gestalt

o Behavior Therapy Behavior Modification Cognitive-Behavioral Therapy (CBT)

• Biologicalo Surgical, ECT, Pharmacological

(medication)• Eclectic

o A combination of more than one approach

Basic Features of Treatment

• Therapist who is accepted as capable of helping the client.

• Establishment of a special relationship between the client and therapist.

• Theoretical explanation about the causes of the client’s problems.

• Most therapists are eclectic - mixing approaches

Providers of Psychological Treatment

• Psychiatrists – Medical Doctors, MD• Psychologists – PhD, or PsyD, Some MA• Clinical Social Workers, MA • Marriage and Family Therapists, MA• Licensed Professional Counselors, MA• Psychiatric Nurses, RN• Substance Abuse Counselors, CADC• Pastoral Counselors - religious perspective

Psychodynamic psychotherapy• Established by Freud.• Assumes that personality and

behavior reflect ego’s attempt to resolve conflicts.

• Psychoanalysis aimed at understanding unconscious conflicts.

• Freud’s methods have influenced almost all forms of psychotherapy.

Classical Psychoanalysis• Developed out of Freud’s medical

practice.• Success using a “talking cure.”

o Called process “free association.”o Focused on unconscious impulses and

the resulting conflicts.• Goal is to recognize unconscious

thoughts and emotions.o Then work through the ways they

affect the client’s everyday life.

Classical Psychoanalysis (cont’d.)• Strategies for gaining glimpses of the client’s

unconscious:o Patient’s free associationso Dream analysiso “Freudian slips” ie: “breast” instead of “best”o Analysis of resistance

Hesitations, change of subject, jokes…o Analysis of transference

Feelings transferred to analyst Countertransference… feelings transferred back to client.

Contemporary Variations on Psychoanalysis

Short-Term Dynamic Psychotherapy• Object relations therapy - focused on early

attachment • Interpersonal therapy - more focused on

present than past. Current relationships.• Time-limited dynamic psychotherapy

o For example 12 - 16 sessions

Humanistic Therapy• Treatment is a human encounter between equals.

“clients” not “patients”o Not a “cure” given by an expert.

• Clients can and will improve on their own.• Ideal conditions established through relationship of

acceptance and support.• Clients responsible for choosing how they will think

and behave.• Focus on the present and future, not past.• Conscious rather than unconscious thoughts• Promoting growth

Carl Rogers’ Client-Centered Therapy

• Empathyo Seeing from the client’s perspectiveo Be in the client’s shoes

• Reflectiono Active listening method where therapist

rephrases client’s statements and notes feelings.Reflects clients thoughts back.

• Unconditional Positive Regardo No negative judgments of client’s thoughts

or behavior• Congruence or Genuineness (be real)

o Therapist really feeling the way he/she acts and acting the way he/she feels.

Lets try some Humanistic Client Centered Therapy

Select one of the following or choose your own “Client” opening line. • “I’ve been really worried about what I’m going to

do after graduation.”• “I think everyone hates me.”• “I don’t know what my parents want from me. I

just can’t please them no matter what.”

Remember: Empathy, Active Listening, Reflection, Invite Clarification, Positive Regard.

Fritz & Laura Perl’s Gestalt Therapy

• The Perls’ beliefs:o People create their own versions of

reality.o People’s natural psychological

growth continues only as long as they perceive, remain aware of, and act on their true feelings.

o Growth stops and symptoms of mental disorder appear when people are not aware of all aspects of themselves.

Gestalt Therapy (cont’d.)

• Goal is to create conditions so that clients are ready to grow again.

• Methods are experimental and experiential - more direct and dramatic compared to client-centered therapy.o Focus on body languageo “Empty Chair” techniqueo Incongruity between thought and action

Behavior Therapy

• Most psychological problems are learned.o Change by learning new behaviors, not

searching for underlying problems.

• Goals based on behavioral and social-cognitive approaches.

Features of Behavioral Treatment

• Development of a productive relationship between therapist and client.

• Careful listing of the behaviors and thoughts to be changed.

• Therapist as a teacher/assistant to help client learn to change behavior.

• Continuous monitoring, evaluation, and adjustment of treatment.

Techniques for Modifying Behavior

• Exposure Therapieso Floodingo Systematic Desensitization

Progressive relaxation training Desensitization hierarchy

• Modelingo Assertiveness training and social skills training

• Positive Reinforcement - token economy

Continue

Return

Fear of Flying Desensitization

Positive Reinforcement Program for an Autistic Child

Return

Techniques for Modifying Behavior (cont’d.)

• Extinctiono Removing positive consequences of behavior to “kill”

it. • Flooding

o Exposing person to feared stimulus with no negative consequences.

• Aversion Therapyo Classical Cond. Pairing unwanted behavior with

unpleasant stimulus.• Punishment

o Undesirable consequences follow unwanted behavior.

Cognitive Therapies

• Thinking affects feelings• Often applied to depression & anxiety • Changing thought patterns can improve

emotional well-being and behavior. o Self Blamingo Overgeneralizationo Internal vs. External explanations o Rumination - “chewing” on thoughts over and

over

Cognitive-Behavioral Therapies CBT

• Rational-Emotive Behavior Therapy (REBT) - Albert Ellis -1950’s & still popular

• Techniques Related to REBTo Cognitive restructuringo Self-instructiono Stress-inoculation (“vaccination” against stress)

Learning to remain calm in difficult situations

• Aaron Beck’s Cognitive Therapyo Cognitive restructuringo Examples of negative thinking to be modified

Continue

Ellis’ Model of Maladaptive Behavior

Continue

Beck’s Cognitive Therapy – Relearning Negative Thinking

Return

Group Therapy• Therapist can see clients

interacting.• Client realizes others have same

difficulties.• Group members can boost each

others’ self-confidence and self-acceptance.

• Clients learn from one another.• Clients more willing to share

feelings and are more sensitive to others.

• Clients can test new skills in a supportive environment.

Family and Couples Therapy

• Involves the treatment of two or more individuals from the same “family system.”

• Structural family therapy concentrates on family communication patterns.

• Couples therapy focuses on improving communication between partners.

“Rules” for Couples Therapy

Does Psychotherapy Work?

• 83% of patients report therapy helps.• Value first widely questioned by Hans

Eysenck 1952 - Outcome Research.o 2/3 of non-psychotic patients improved in

therapy. o 2/3 of non-psychotic patients improved even

without therapy too. • Criticism of Eysenck

o He looked at only 24 studieso Since then there have been many more

studies

Meta-analysis of 475 studies of Psychotherapy’s Effects

Rules and Rights in the Therapeutic Relationship

• Relationship should not harm the client.• Therapy sessions must be kept strictly

confidential.o Privileged communication unless special

circumstances exist.• People cannot be casually committed to

mental hospitals.• Client can refuse certain kinds of

treatment while hospitalized.

Biomedical Therapies

If some psych disorders are caused or made worse by brain chemistry or structure perhaps they can be made better my modifying that chemistry or structure. • Drug Therapies - psychopharmacology• Brain Stimulation - ECT, TMS• Psychosurgery - lobotomy• Lifestyle changes

Biological Aspects of Psychology and the Treatment of Disorders

• Therapeutic psychoactive drugs affect neurotransmitters and their receptors. o Some cause neurons to fire (agonists), while

others inhibit neuron firing (antagonists).o Some act by blocking the receptor site

normally used by a particular neurotransmitter (antagonists)

o Some increase the amount of a neuro-transmitter available to act on receptors(agonists).

Psychopharmacology- Drug Therapy

• Neuroleptics aka antipsychoticso Treat schizophrenia - dopamine antagonists

• Antidepressantso Treat depression and anxiety disorderso Increase serotonin (SSRI) or norepinephrine in

synapses (agonists)• Lithium and anticonvulsants

o Mood stabilizerso To treat bipolar disorder

• Anxiolyticso Anti-anxiety drugs - relaxants

Benzodiazepines

Evaluating Psychoactive Drug Treatments

• Potential problems:o Drug may mask problem without curing it.o Abuse may lead to physical or psychological

dependence. o Side effects.

• Research holds promise of:o Creating better drugs.o More fully understanding some disorders.o More informed prescription practices.