ADVANCED PLACEMENT PSYCHOLOGYChapter 16: Treatment of Psychological Disorders
Psychotherapy – Treatment of psychological disorders through psychological methods, such as talking about problems and exploring new ways of thinking & acting
Basics of Therapy
Client: The person seeking therapy Inpatient – Treated in a hospital or institution Outpatient – Receive psychotherapy while in the community
Therapist: The person giving therapy Psychiatrist – M.D. specialized in mental disorders Psychologist – Ph.D in clinical or counseling (can’t prescribe drugs) Other Professionals
Social Workers Family Therapists Counselors
Theory: Underlying guidelines & beliefs for treatment of disorders
Procedure: Method of treatment that is unique to the theory used
Goal: Final outcome of therapy
Psychodynamic PsychotherapyAn Overview
Theory Personality & behavior reflect the efforts of
the ego to referee unconscious conflicts among various components of the personality
Procedure Psychoanalysis – Therapy aimed at
understanding the unconscious conflicts & how they affect the client (Freud)
Classical PsychoanalysisSitting on the Freudian couch
Hypnosis – Tried initially to cure somatoform disorders Free Association
Saying whatever comes to mind Doesn’t allow for as much self-censorship Freudian Slip – A slip of the tongue that reveals what you’re truly
thinking Dream Analysis
Manifest Content – What the dream is on the surface i.e. You dream that you are a Red Wings hockey player and they drafted
you when you were just 14 Latent Content – What the dream means
i.e. You have aspirations for fame & you really like to play hockey Resistance – Resisting the therapist’s efforts Transference – Transfer of feelings & thoughts onto the
therapist i.e. Being scared of the therapist because of abuse from parents
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Contemporary PsychoanalysisObject Relations Therapy
Theory Personality & conflicts among its
components are derived from the need for supportive human relationships
Mother-child relationship becomes the prototype for all future relations
Procedure Therapy focuses on developing nurturing
client-therapist relationships “Second chance” for forming a good
relationship
Phenomenological PsychotherapyAn Overview
Theory People’s perceptions of the world are subjective People are capable of consciously controlling
their own actions & taking responsibility for their own responsibilities
Behavior is motivated by an innate drive towards growth, not sexual or aggressive instincts
Procedure Therapy revolves around providing a sounding
board for people to voice opinions & thoughts
Assumptions of Phenomenological Psychotherapy
Treatment is an encounter of equals, not a cure provided by an expert Allows clients to be more comfortable & act more like
themselves Clients will improve on their own under the right
conditions Ideal conditions promote awareness, acceptance, &
expression of client feelings and perceptions Ideal treatment relies on a fully supportive &
accepting relationship between client & therapist Establishes a distinction between the client & the
problematic behavior Clients are responsible for choosing how they will
think & behave Responsibility increases the client’s confidence & comfort
Client-Centered Psychotherapy Unconditional Positive Regard
Listening without interrupting & accepting without evaluation
Therapist doesn’t need to approve of everything, but they must accept it
Empathy External Frame of Reference – looking at the client from the
outside Internal Frame of Reference – characterized by empathy
(emotional understanding) Active Listening Reflection – Paraphrasing/summarizing what the client just
said Congruence [Genuineness]
Consistency between the therapist’s feelings & actions
Gestalt Therapy
Theory People create their own versions of reality People’s natural psychological growth continues
as long as they perceive, remain aware of, & act on their true feelings
Growth stops & disorders appear when people aren’t aware of all aspects of themselves
Procedure Makes clients aware of feelings & impulses that
may have been discarded or repressed “Calling them out”
Some clarification
Behavior Therapy Classical Conditioning principles
Behavior Modification Operant Conditioning principles
Cognitive-Behavior Therapy Thinking & learned ways of thinking
Behavior Psychotherapy
Theory Therapy doesn’t revolve around treating disorders, but
learning how to change specific thoughts & behaviors.
Procedure Listing of the behaviors & thoughts to be changed
Establishes specific goals Therapist acts as a teacher by providing learning-
based treatments “Homework” to help clients make specific plans to deal
with problems Developing a good therapist-client relationship Continuous monitoring & evaluation of the treatment
Techniques for Modifying Behavior
Desensitization Hierarchy Series of increasingly
fear-provoking situations
Imagination vs. real life Once clients are able
to calmly imagine the fear, they deal with it better later in real life
Desirable behaviors can be taught through watching
Client can learn to be more appropriately self-expressive & more comfortable in social situations through assertiveness & social skills training
Systematic Desensitization Modeling
Techniques for Modifying Behavior
Using positive reinforcement through contingencies designed to alter problematic behavior & teach new skills
Token Economy System of secondary
reinforcers
Positive ReinforcementExtinction
Using operant conditioning to eliminate undesirable behaviors by removing the reinforcers that normally follow a particular response
Flooding – person is saturated with fear-provoking stimulus until the anxiety is extinguished
Exposure Techniques – systematic desensitization
Techniques for Modifying Behavior
Associating physical or psychological discomfort with unwanted behaviors
Covert Sensitization Opposite of
systematic desensitization
Presents the unpleasant stimulus after the undesirable response occurs
Overlaps a lot with aversive conditioning
Typically used as a last resort when all other treatments fail or when the client’s life is in danger
Aversive ConditioningPunishment
Cognitive-Behavior TherapyRational-Emotive Behavior Therapy
Theory Psychological problems are caused by how people
think about events Identifying self-defeating thoughts Replaces these thoughts with more realistic &
beneficial ones
Practices Cognitive Restructuring: Replacing upsetting
thoughts with alternative thinking patterns Stress Inoculation Training: Imagining being in a
stressful situation & practice new cognitive skills to stay calm
Cognitive-Behavior TherapyBeck’s Cognitive Therapy
Theory: Negative cognitive patterns are maintained by:
Errors in logic & erroneous beliefs (“I can’t do anything right”)
Thoughts that minimize the value of one’s accomplishments (“Anyone can do that”)
Practice Like a scientific investigation Critically testing the hypothesis
“I can never do anything right.” “Well, here are the cases where I have done things
right.”
Group, Family, & Couples Therapy
Group, family, & couples therapy is concerned about the subject & setting of the therapy & use many different theories.
Group Therapy Therapists can observe clients interact with other
people Clients feel less alone (raises expectations of
recovery) Increase self-confidence & self-acceptance Clients learn from each other (modeling) Positive group relationships increases willingness to
share
Family & Couples Therapy
Family Therapy A problem in one individual often reflects problems
in the entire family’s functioning Treatment cannot focus on an individual in isolation
Wife gets over depression & then husband commits suicide because he had gotten so attached to the idea of a “sick wife”
Couples Therapy Similar to family therapy, but focuses on just two
individuals Behavioral Premarital Intervention – program helps
engaged couples prevent marital problems
Addressing the “Ultimate Question”Which treatment method will work for me?
Details not yet fully mapped out
Cognitive-Behavioral Therapies better for: Phobias & other anxiety disorders Eating disorders Child clients
Client-Therapist relationships are IMPORTANT
Cultural Factors in Psychotherapy Kind of a long section, so here’s the
summary…
If the culture of the client is different from the culture of the therapist, then there will be PROBLEMS
Rules & Rights in the Therapeutic Relationship
Ethical Principles of Psychologists & Code of Conduct No sexual relationship between therapist & client Confidentiality
Situations Exempt from Confidentiality Client’s condition is used for a civil or criminal
defense Suicidal tendencies that require hospitalization Therapist defending against a malpractice suit Reveals information about the abuse of a child or
incapacitated adult The therapist believes that the client may commit a
violent act against another person
Electroconvulsive Therapy (ECT)Psychotherapy in the 1930’s
Hungarian physician noticed that schizophrenia & epilepsy rarely co-occurred, & he used drugs to induce seizures in schizophrenics, depression, & mania
Later, seizures were induced by electric shock Today, it’s used for depression in those that
don’t respond to drugs Side Effects:
Varying degrees of memory loss Speech disorders Death due to cardiac arrest (sometimes)
Electroconvulsive Therapy (ECT)The modern remix of a classic treatment
Modern techniques Focuses shock to right
side of the brain Increased oxygen Extreme muscle relaxers
Why does it work? No one knows “Reset” button Electric shock improves
neurotransmitter function
NeuroT’s that help recover from convulsions reduce activity in “depression” areas
Psychosurgery“Cut it out!” (literally)
Destruction of brain tissue to treat mental disorders
Prefrontal Lobotomy Destruction of the frontal lobe to curb
emotional reactions in the disturbed Standard treatment for schizophrenia,
depression, anxiety, aggressiveness, & OCD
Side effects include: Epilepsy, amnesia, flat affect, & death
Considered a last resort
Psychoactive Drugs
Neuroleptics (antipsychotics) Designed to reduce the symptoms of
schizophrenia Reduces hallucinations, delusions, paranoid
suspiciousness, disordered thinking, & incoherence
Produce improvement in 60-70% of patients Negative side effects
Dry mouth, blurred vision, dizziness, skin pigmentation
Muscle rigidity, restlessness, tremors, slowed movement
Tardive Dyskinesia – Extreme muscle spasms
Psychoactive Drugs
Antidepressants Designed to reduce the symptoms of depression
Monoamine Oxidase Inhibitors (MAO-I) Treats depression & some cases of panic disorder Can produce hypertension if mixed with foods with
tyramine (aged cheese, red wine, chicken livers, etc.)
Tricyclic Prescribed more frequently than MAO-I because they
work better Fewer side effects (can still cause sleepiness, dry
mouth, dizziness, blurred vision, constipation, & urinary retention)
Psychoactive Drugs
Lithium Treats mania & bipolar (effective for 80% of
patients) Dosage must be exact & carefully
controlled Too much =
Nausea, vomiting, tremors, fatigue, slurred speech, coma and death
Anticonvulsants Alternative to treating mania Fewer side effects, less danger of over
dosage, & easier to regulate
Psychoactive Drugs
Anxiolytics [Tranquilizers] Acts in a manner similar to barbiturate Creates an immediate calming effect Generalized anxiety disorder &
posttraumatic stress disorder Side Effects
Sedation, lightheadedness, & impaired psychomotor & mental functioning
Continued use can cause tolerance & physical dependence
Combined with alcohol may have fatal consequences
Human Diversity & Drug Treatment
Ethnicity Drug strengths vary depending on client ethnicity Caucasians need significantly more psychoactive
drugs than Asians to achieve the same effects African Americans show faster responses to
tricyclic antidepressants than European Americans
Gender Research so far based heavily on males Women maintain higher levels of therapeutic
psychoactive drugs in their blood Women are more vulnerable to tardive dyskinesia
Evaluating Psychoactive Drug Treatments Drugs may cover up the problem
Often times drugs simply mask the symptoms without treating the root causes
Leaves the potential for the root causes to continue to get worse
Drugs carry the potential for abuse Abuse of psychoactive drugs can create
psychological dependence Drugs have undesirable side effects
No drug is prefect & without side effects Often times, treatment will involve a lot of
weighing the pros of the drug with the side effects
Drugs or Psychotherapy?
Sometimes psychotherapy is better Cognitive-behavioral & interpersonal therapy
were as effective as antidepressants Sometimes drugs are better
Severe cases of depression, panic disorder, generalized anxiety disorder, & obsessive-compulsive disorder
In most cases, it seems that a combination of drugs & psychotherapy is the best method for treatment