PSYC 2009 Lecture Notes - Psychosurgery, Structural Family Therapy, Fluoxetine

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27 Jan 2013
Chapter 18 – The Treatment of Mental Disorders
4 basic approaches to treatment of mental disorders:
oInsight therapies
oBehaviour therapy
oCognitive-behaviour therapies
oTreatment of groups
Early Treatment of Mental Disorders
Disorders always there; just viewed differently-example, person with schizophrenia
may have been said to be god’s voice or spirits; possessed with devil or evil
Trephining: surgical procedure in which a hole is made in the skull of a living
an opening for the spirits of evil to leave the victims head
insults or curses were said to persuade the demon to leave; exorcism was
attempted to make the body an unpleasant place
beatings, starving, drowning, drinking of foul-tasting concoctions
18th century, Johann Wier was first to question witchcraft-said it was an illness
Eventually people with disorders were sent to asylums; kept in chains; shown to
public for fees; tied up, doused in cold water, bled, made to vomit; spun in a chair
Philippe Pinel, director of hospital in Paris, as an experiment-took off chains of
patients, out of dungeons-success, hospital was peaceful and quiet
The Development of Psychotherapy
Anton Mesmer- end of 18th century early 19th, devised theory called, “magnetic
fluxes” –attempted to effect cures by manipulating iron rods and bottles of
chemicals; hypnotized patients
Eclectic approach: form of therapy in which the therapist uses w/e method he or
she feels will work best for a particular client at a particular time; combinations of
Assume that people are essentially normal but learn maladaptive thought patterns
and emotions, which are revealed in maladaptive behaviours
Once patient understands causes of problems, the behaviour will cease
Psychoanalysis and Modern Psychodynamic Approaches
Psychoanalysis: Freud; form of therapy aimed at providing the client with insight
into his or her unconscious motivations and impulses
Early stage of therapy- problems are difficult to identity b/c unaware of
unconscious conflicts
Analyst asks questions, encourages client to talk; analyst interprets them to
uncover true meaning and get whole pic of unconscious
Purpose of theory-to create setting where clues about the origins of intrapsychic
conflicts are most likely to be revealed by client; dreams, memory, reactions etc;
by exposing client to these clues, they gain insight
Accurate interpretation is best by therapy with specially trained therapist
Client provides, description of fear and anxieties, thoughts repressed memories;
defence mechanisms are triggered
Psychoanalytic Techniques
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Free association: procedure in which client is encouraged to speak freely w/out
censoring possibly embarrassing or socially unacceptable thoughts or ideas
Dream interpretation: evaluation of underlying meaning of dream content
Manifest content: actual images and events
Latent content: hidden meaning or significance
Manifest masks the latent b/c latent is anxiety provoking and causes discomfort
Something of paradox in getting insight, for the painful and threatening knowledge
resulting from insight is what led to its repression in the first place
Resistance: development during therapy in which client becomes defensive,
unconsciously attempting to halt further insight by censoring true feelings
Transference: client begins to project powerful attitudes and emotions onto
Occurs when clients relive past experiences
Counter-transference: therapist projects emotions onto client-unhealthy and
undesirable according to Freud
Modern Psychodynamic Therapy
Less emphasis on sexual factors during development and more on social and
interpersonal experiences
Ego plays a more active role in thoughts and actions
Brief psychodynamic therapy: 10-25 sessions; focuses on schemata that a client
has about interpersonal relationships and attempts to modify those that are
incorrect or that prevent client from developing relationships with others
Behaviour or overt action is seldom important by itself, rather behaviour is only
important to the extent that it serves as a manifestation of the real, underlying
motive or conflict not all therapist agreed!
Humanistic Therapy
Humanistic therapy: form of theory focusing on the persons unique potential for
personal growth and self-actualization
2 major forms: Client-Centred Therapy & Gestalt Therapy
Client-centred therapy: developed by Carl Rogers; the client is allowed to decide
what to talk about without strong direction and judgement from the therapist
Incongruence: discrepancy b/w a client’s real and ideal selves
goal is to reduce incongruence
reflection- sensitive rephrasing or mirroring of the client’s statements to make their
thoughts more noticeable
therapist tries to establish empathy
unconditional positive regard: according to Rogers, the therapeutic expression
that a client’s worth as a human being is not dependent on anything that he or she
does, says, feels or thinks
acceptance and approval of the person does not mean approval and acceptance of
their behaviour
Gestalt Therapy: emphasizes the unity if mind and body by teaching the client to
“get in touch” with unconscious bodily sensations and emotional feelings
Emphasis on the present not the past
Empathy chair technique-client imagines that they are talking to someone sitting in
the chair beside them- express feelings and emotions to the person in chair
Encourages clients to talk to themselves and inanimate objects to gain better
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understanding of
Evaluation of Insight Therapies
The processes proposed by psychoanalytic theory have not been subjected to a
great deal of empirical scrutiny until relatively recently
For classical psychoanalysis only a small proportion of people with mental
disorders qualify for this method of treatment
Among the drawbacks of insight therapies is the relatively narrow range of people
that may benefit by undergoing such therapy.
In general, the people who seem most likely to benefit from insight psychotherapy
are those who are intelligent and able to articulate their problems
Insight therapies generally are not effective with persons with serious mental
disorders such as schizophrenia
Behaviour and Cognitive Behaviour Therapies
Insight therapies are based on the assumption that understanding leads to
behavioural change
In reality, insight is not always followed by behavioural change
Assumption made by behaviour therapists is that people learn maladaptive or self-
defeating behaviour in the same way that they learn adaptive behaviour
Therapies Based on Classical Conditioning:
In classical conditioning; the previously neutral stimulus (ultimately the CS) comes
to elicit the same response as a stimulus (UCS) that naturally elicits that response
because the CS reliably predicts the UCS
Systematic Desensitization- a method of treatment in which the client is trained
to relax in the presence of increasingly fearful stimuli
Scientific evaluations of systematic desensitization have been positive, and several
experiments have found that all elements of the procedure are necessary for its
1. For ex: a person will not get rid of a phobia merely by participating in
relaxation training or by constructing hierarchies of fear-producing situations
Implosion Therapy- A form of therapy that attempts to rid people of fears by
arousing them intensely until their responses diminish through habituation and
they learn that nothing bad happens
1. the therapist describes, as graphically as possible, the most frightening
encounters possible with the object of a client’s phobia
2. the client tries to imagine the encounter and to experiences intense fear
3. if the client actually encounters the object of his or her fear, in which case
the treatment is called flooding
4. eventually the fear response begins to subside, and the client learns that
even the worst imaginable encounter can become tolerable
5. in a sense, the client learns not to fear his or her own anxiety attack, and
avoidance responses begin to extinguish
Aversion Therapy- a form of treatment in which the client is trained to respond
negatively to a neutral stimulus that has been paired with an aversive stimulus
1. Sexual attraction to children is one example; a man who is sexually
attracted to children (Michael Jackson) might be given painful electric shocks
when a special apparatus detects an erectile response while he is being
shown pictures of children
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