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Early Treatment of Mental Disorders.doc

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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 person  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  18 century, Johann Wier was first to question witchcraft-said it was an illness instead  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 18 century early 19 , 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 methods INSIGHT THERAPIES  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  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 therapist  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 tha 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 understanding of  feelings 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 success  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  the therapist describes, as graphically as possible, the most frightening encounters possible with the object of a client’s phobia  the client tries to imagine the encounter and to experiences intense fear  if the client actually encounters the object of his or her fear, in which case the treatment is called flooding  eventually the fear response begins to subside, and the client learns that even the worst imaginable encounter can become tolerable  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  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  Aversion Therapy causes serious ethical questions and can involve significant pain, the client’s participation must be voluntary Therapies Based on Operant Conditioning:  Behaviour Modification-behaviour therapy based on the principles of operant conditioning o Involves altering maladaptive behaviour by rearranging the contingencies between behaviour and its consequences  Increases in desirable behaviour can be brought about through either positive or negative reinforcement and undesirable behaviour can be reduced through either extinction or punishment o Behaviour modification techniques can be found in a number of settings, such as hospitals, schools, daycare centres, businesses, and even around the home  Behavioural techniques are often used to alter the behaviour of emotionally disturbed people, and those with mental retardation for whom communication is difficult  Token Economy- a program often used in institutions in which a person’s adaptive behaviour is reinforced with tokens that are exchangeable for desirable goods or special privileges o the tokens become conditioned reinforcers for desirable and appropriate behaviours o the amount of time spent performing the desirable behaviours was high when reinforcement contingencies were imposed and low when they were not o Token economies use the promise of rewards to instigate activities in which people would otherwise not engage  There is a risk that people for whom the extrinsic rewards are superfluous may lose their intrinsic motivation  Behaviour therapists have found that clients can make much better progress when they have access to a model who provides sample of successful behaviours to imitate  Assertiveness therapy is a procedure for developing coping skills in interpersonal situations in which a client might feel anxiety or be unable to function as effectively as he or she would like  Assertiveness therapy is often used to help clients who feel frustrated at not being able to speak up to defend their rights  The first step in assertiveness therapy is to identify the variables that are causing the client to feel distressed  Assertive behaviour is believed to be incompatible with anxious behaviour o Behaving assertively appears to inhibit anxious behaviours, leading to the development of more effective interpersonal skills  Extinction is the process through which behaviour is eliminated by removing previously available reinforcers o For example; extinction might be used to eliminate a child’s tantrum behaviours. If the tantrum behaviours have been reinforced-parents or caretakers have given in to the child’s wishes- extinction might include ignoring the child’s undesirable behaviour  There are two potential problems with using extinction; one is extinction burst; when a reinforcer that has previously followed a behaviour is no longer forthcoming, that behaviour will often intensify o Problem with using extinction is that it is not always possible to eliminate the reinforcer that maintains undesirable behaviour  In general, punishment is not nearly as good a treatment method as positive reinforcement o For one thing, the person who is being punished may learn to fear or dislike the person who administers the punishment o Second, there is a tendency to overgeneralize-to avoid performing a whole class of responses related to the response that is specifically being punished  Unfortunately it is usually easier to punish a response than it is to figure out how to reinforce other responses that will replace the undesirable one  In some therapeutic situations, especially those in which the undesirable response is clearly harmful to the client, punishment is the most effective technique for eliminating an undesirable behaviour  Covert Sensitization- a method used by behaviour therapists in which a client imagines the aversive consequences of his or her inappropriate behaviour Maintaining Behavioural Change  One of the problems with behaviour therapy is that behaviours learned under one set of conditions may fail to occur in different environments; that is, the behavioural change may not generalize to other situations  Useful method that helps maintain behavioural change is self-observation, in which the client is taught to recognize when his or her behaviour is appropriate Cognitive-Behaviour Therapies  therapists suspected that maladaptive behaviour might not be due to environmental variables alone— thoughts, perceptions, expectations, self-assessment statements affect, too  cognitive-behaviour therapy: focus on changing client’s maladaptive thoughts, beliefs, perceptions o better effective in treating kids w/ psychological problems and mental disorders o therapists not interested in events occurring in childhood, but interested in the present, and in altering client’s behaviour so it becomes more functional o believe when behaviours change, its b/c of changes in cognitive processes  cognitive restructuring: attempts to change patterns of cognition  rational-emotive theory: based on belief that psychological problems caused by how people think about upsetting events and situations; highly directive+confrontational o did not grow out of tradition of behaviour therapy o emotions are elements of cognition; a significant activating event (A) is followed by highly charged emotional consequence (C) but A does not cause C; C is result of person’s belief o Ellis (founder) shows clients irrational beliefs are impossible to satisfy, make little logical sense, and adhering to them makes needless anxiety, self-blame, and self-doubt (pg 617 for full example of RET situation) o engender feeling of full self-acceptance in clients;
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