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Lecture

Chpater_18_-_The_Treatment_of_Mental_Disorders.doc

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Department
Psychology
Course
PSYCH 485
Professor
Jiahua Chen
Semester
Fall

Description
Chapter 18 – The Treatment of Mental Disorders MENTAL DISORDERS AND PSYCHOTHERAPY • 4 basic approaches to treatment of mental disorders: o Insight therapies o Behaviour therapy o Cognitive-behaviour therapies o Treatment 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 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 th • 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 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 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 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 • 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 conse
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