Chapter 13 -

5th Edition

Therapy

Chapter 13

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Therapy Through The Ages

• Throughout history, prevailing views of the causes of psychological disorders have influenced treatments.

• Some people believed in "possession" by evil spirits, so they used treatments such as exorcism or trephining.

• Some cultures still believe in evil spirits causing mental health issues

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• In the 18th century, mentally ill people in Paris were often chained to walls.

• The attendants, or “keepers” as they were called, rarely showed compassion and even administered punishment when they deemed it necessary.

• A physician, Philippe Pinel, argued that these patients needed humane care and treatment.– How are you suppose to recover unless you get

humane treatment?Copyright © Prentice Hall 2007

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• In the mid-19th century, Dorothea Dix, a former teacher, became concerned about the plight of homeless and disturbed people.

• Her survey of Massachusetts institutions that housed the mentally ill yielded numerous examples of misery and horror.

• Dix insisted that the states had an obligation to provide care for the mentally ill and she convinced legislatures in 20 states to establish or enlarge mental hospitals.

• http://www.forgottenoh.com/Ridges/ridges.htmlCopyright © Prentice Hall 2007

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http://www.forgottenoh.com/Ridges/ridges.html


• As the states assumed more responsibility for custodial care of the mentally ill, economics dictated that they build larger institutions to handle more patients.

• As the institutions expanded, conditions deteriorated and the use of restraining devices increased.

• Thus the level of care went down

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• Sigmund Freud, an early advocate of hypnotism as a therapeutic technique, developed the notion that psychological disorders result from unconscious feelings and conflicts, which required a different approach to therapy.

• Freud later turned to other techniques when hypnosis proved less effective than he had hoped.



• Early in the 20th century, the disorder known as general paresis, which included symptoms such as paralysis and memory difficulties, was found to result from syphilis. – Why is this important?

• This finding stimulated the search for biological causes of other psychological disorders, as well as the development of biomedical treatments such as psychosurgery and electroconvulsive (shock) therapy.

• http://www.ect.org/video/index.shtml– 3rd video down


http://www.ect.org/video/index.shtml

Therapy Through The Ages• Beginning in the 1950s, the populations of mental

hospitals began to decline.• One reason for this decline was the use of drugs,

which made it possible to control many serious symptoms.

• At the same time, there was a growing belief that community care was more effective than hospitalization.

• Numerous factors led to deinstitutionalization, a policy of discharging large numbers of patients from mental hospitals and then closing part or all of those hospitals.



• In 1963, Congress passed the Community Mental Health Centers Act.

• This law provided funds for the establishment of community mental health centers in which patients would be treated on an outpatient basis.

• In addition, the 1963 law helped finance community-based programs to prevent mental illness.



• Psychologists recognize three forms of prevention: primary, secondary, and tertiary.

• Primary prevention is designed to prevent disorders from occurring.

• Secondary prevention is designed to detect existing disorders and provide treatment at early stages.

• The goal of tertiary prevention is to reduce the damage caused by disorders for both the patients and society.



• Not everyone who seeks therapy suffers from a psychological disorder.

• Some people need help to cope with such lifestyle events as the loss of a job, school-related difficulties, or family disagreements.

• Many people go to therapy, high level athletes, business people, me, any one who wants to help improve their life Copyright © Prentice Hall 2007

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Therapy Through The Ages• About 30% of individuals

with a psychological disorder seek treatment.

• Those with schizophrenia, bipolar disorder, or panic disorder are more likely to seek treatment than individuals with substance-use disorders.



• There are two treatment categories for psychological disorders: biomedical and psychological therapies.

• The biomedical therapies use psychotropic drugs (drugs that affect the brain), electroconvulsive therapy, and psychosurgery to alter brain functioning and thus reduce symptoms.



• Psychological therapies range from “talk therapies” to treatments based on the principles of learning.

• Psychotherapy is a general term that describes psychological treatments designed to help people resolve behavioral, emotional, and interpersonal problems and improve the quality of their lives.


Therapy Through The Ages• Members of several professions as well as paraprofessionals

provide psychotherapeutic services. • The term therapist encompasses a diverse group of people with

different backgrounds. • Included here are people with a master’s or doctoral degree in

psychology and people with a medical degree and special training in psychiatry, as well as self-designated psychotherapists.

• Among the most common types of licensed psychotherapists are clinical and counseling psychologists, psychiatric nurses, psychiatrists, and social workers.

• Although states regulate many mental health professions, they do not regulate practitioners like psychotherapists or counselors.


Psychologically Based Therapies

• Although it is convenient to distinguish among various forms of psychotherapy, clinical psychologists are increasingly using elements of different therapeutic approaches in treating their clients.

• The use of components from several therapies is called an eclectic or integrative approach.


The Primary Theoretical Orientations of Clinical Psychologists



• Psychotherapy involves a special relationship between a distressed person and a therapist in which the therapist helps the client make changes in his or her thinking, feeling, and behavior.

• Trust is a big part of counseling!



• Psychoanalytic therapy is a treatment of maladaptive behavior developed by Sigmund Freud; its goal is to uncover unconscious conflicts and feelings and bring them to the conscious level.

• Freud used free association, dream interpretation, resistance, and transference to probe beneath the surface of a patient’s conscious feelings and thoughts.



• In free association, patients are asked to relate thoughts, feelings, or images without modifying them in any way. – Volunteer?

• Freud called dreams “the royal road to the unconscious” and distinguished between two forms of dream content: manifest and latent.

• Manifest content is the dream you recall when you awaken; latent content is the underlying meaning of that dream.

• The psychoanalyst’s task is to interpret dreams by discovering the latent content.

• With Freud it was all sexual!!!Copyright © Prentice Hall 2007

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• Resistance occurs during free association when the patient’s flow of words and thoughts stops.

• The cessation of associations might indicate that the defense mechanism of repression is operating to protect the ego from the anxiety generated by the thoughts and feelings revealed through the associations.

• Transference refers to the patient’s positive or negative reaction to the therapist, which is believed to reflect the patient’s relationship to a significant person outside of therapy.



• Humanistic therapies emphasize the present and the ability of clients to solve their own problems once they are able to accept themselves.

• Client-centered therapy is designed to create an environment in which the client is able to find solutions to his or her problems.

• Gestalt therapy is a humanistic form of therapy developed by Fritz Perls in which therapists may frustrate and challenge clients to lead them toward self-acceptance.

• Cognitive therapies are designed to change cognitions in order to eliminate maladaptive behaviors.



• Rational-emotive behavior therapy is a cognitive therapy in which the therapist challenges and questions the client’s irrational ideas.

• Rational-emotive behavior therapy is understood best in terms of what Ellis calls the ABC framework.

• A represents an activating event related to an important desire, goal, or preference (getting the job, in our example); B is the belief, usually related to failure to attain the goal, that follows the activating event (“I’m no good because I didn’t get the job”).

• That belief determines C, consequences, such as feelings of anger, anxiety, and depression.




• Therefore, the role of the therapist is to challenge the client's irrational beliefs.


• Systematic desensitization is an effective treatment for phobias in which clients are taught relaxation techniques and then asked to imagine or approach feared situations gradually.



• Aversion therapy uses unpleasant or painful stimuli such as electrical shock, nausea-inducing drugs, or repugnant tastes or smells to decrease unwanted behavior.



• Aversion therapy is based on classical conditioning principles; it involves the repeated pairing of a problem behavior with an aversive stimulus.

• One of the most effective techniques for treating phobias is modeling, or observational learning.



• In this procedure a person —live or on videotape—demonstrates gradual contact with the feared object under controlled or protected circumstances.

• The client observes these behaviors and is given the opportunity to engage in similar behaviors.



• Token economy is a technique that reinforces desirable behaviors with tokens (secondary reinforcers), which can be redeemed for other reinforcers, especially primary reinforcers.



• Group therapy is a therapy in which clients discuss problems in groups that may include individuals with similar problems.

• Some of the advantages of group therapy are social support and opportunities to practice coping skills and to receive feedback.



• Marital therapy (also called couples therapy) typically attempts to stabilize and improve the relationship of two individuals who regard themselves as marital partners.

• Family therapy focuses on the larger family unit: a parent and a child at a minimum, or both parents, stepparents, or grandparents, depending on the environment in which the child lives.



• Most self-help groups are developed and run by laypersons, although some invite professional therapists to help with unusual cases.

• People in these groups pool their knowledge, share their experiences with common problems, and help one another.


The Effectiveness of Psychotherapy

• Therapists are becoming increasingly aware of the influence of ethnic and cultural factors on psychotherapy.

• Members of many ethnic groups drop out early from psychotherapy, in part because there is a dearth of therapists who share their native language as well as a failure to provide appropriate forms of therapy.



• The decision to enter psychotherapy should involve asking questions about;– the degree of distress one is experiencing;– one's ability to cope with that distress; – the effect of the symptoms on oneself,

one's family, and one's work.



• Current forms of psychotherapy are offered in fewer sessions than in the past.

• Many symptoms, especially distress symptoms, respond quickly to treatment.

• There is also a growing recognition that there are limits to what aspects of our behavior can be changed.

• A final concern about beginning and continuing therapy deals with stigma.


Biomedical Therapies

• Antipsychotic drugs reduce the symptoms of schizophrenia by blocking dopamine receptors in the brain.

• The typical antipsychotic drugs work by blocking dopamine, whereas the atypical drugs (such as Clozapine) also block serotonin.



• Proponents of drug therapy believe that the increased use and effectiveness of drugs heralded a new era in treating psychological disorders.

• Drugs can make some patients more manageable for therapists and hospital staff, reduce patients’ anxiety levels, lift a depressed mood, and eliminate some delusions.



• But they cannot replace lost social skills or teach patients how to interact with family members and other people.

• Many psychotropic drugs are often associated with side effects.



• Psychosurgery is the alteration of brain tissue in an attempt to alleviate psychological disorders.

• In 1935, Egas Moniz devised the first psychosurgery, the prefrontal lobotomy.

• Present-day psychosurgical procedures are more refined than the earlier, crude operations; nevertheless, they are rarely performed, and then only as a last resort.
