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Najwa Haddad

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 gods 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 clients real and ideal selves goal is to reduce incongruence reflection- sensitive rephrasing or mirroring of the clients statements to make their thoughts more noticeable therapist tries to establish empathy unconditional positive regard: according to Rogers, the therapeutic expression that a clients 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 betterunderstanding 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 pos
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