Treatment and therapy (Chap 17)

First Lecture Outline:History of psychotherapy

Psychotherapy approaches

Foundations of counselling

Video 101: Psychodynnamics

Last Monday’s midterm• Results will be posted next Monday

• Many did well!! Keep it up!!

• Multiple choice (out of 40) were done well– Average around 27 to 30/40

• Score is out of 35 for both quizzes

History

• Mental illness = demonic possession– Exorcism, flogging, torture, bleeding, enemas– Braveheart: “purification of spirit”

• Middle ages: Asylum– St. Mary of Bethlehem: Bedlem, uproar, confusion– “over-crowded prison for social outcasts”

• 1800s: Mesmer, Charcot, Breuer, Freud– origins of hypnosis and cathartic methods

Other interventions from the 1900’s

• Psychosurgery 1930s to 1950s: Prefrontal lobotomy – left patients vegetative, replaced by very

specific microsurgery for lesions

Electroconvulsive therapy (ECT) in 1940s:

• 150 volts run through the head for 1-2 seconds– leads to memory loss, broken bones, still used

as “last resort” for depression– Today the patient is usually placed under

general anesthesia, paralysed with drugs, monitored and assisted with breathing.

• Antipsychotic medications in the 1950s

What is a clinical interview?

• Psychotherapy involves talking to people

• Structured and unstructured interviews

• Model of psychotherapy directs attention of interview– Psychodynamic: Focus on early experiences

– Behavioral: Focus on symptoms, ABC’s

– Cognitive: Questions about specific thought patterns

– Humanistic: Unconditional positive regard

Interviewing in an assessment

• Focus depends on what you are assessing, diagnosis

• Background includes medical, school/work, family, hobbies, description of symptoms, and “other sources of information”

• Tests then augment interview– Intelligence, neuropsychological, memory tests

– Personality and behavioral measures

– Psychophysiological and computer tasks

Who can conduct “therapy”

• Anyone can offer themselves to the public as a “therapist” or “counsellor”

• These are not protected titles or services: watch out!

• Only a psychologist can say they offer “Psychological intervention” or “Psychological assessment”

• Title and services of a “psychologist” governed by provincial statute

Psychodynamic therapy approaches

• Patients improve once they become conscious of ego-threatening material

• Free association: Client says whatever comes to mind; Dream analyysis

• Resistance is an impediment to progress

• Transference of feelings from significant others to therapist; Countertransference

• Website listing psychotherapy approaches for personality disorder

Evolution of psychoanalysis

• Originally it could take years at 3-5 sessions per week

• Unstructured and relaxed approach necessitated comfortable seating, surroundings

• Change to become more task-oriented and time limited

• “Contracting” with clients for a specific number of sessions to reach a goal