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PSY341H1 Lecture 4

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Hywel Morgan

PSY341H1S L4; July 15, 2013 o If children do not have chance to tell therapist what  Next class: midterm! is wrong w them  tend to not get better o Everything up to end of Treatment is testable o The end of this class: DSM categories for childhood o 3 types: disorders – not on midterm  Classical psychoanalytical play therapy – what was first proposed by Anna Freud, believe children Treatment Approaches unmotivated to participate in verbal therapy, child  Current approach: Biomedical often brought by adult a. Assess fantasies, unconscious beliefs o Pharmacotherapy & envt’al b. Children can externalize internal or A) Psychological Approaches unconscious material c. Children played out intrapsychic  Influence of psychologists  Changing the person’s envt & the way they think conflicts d. Physical games, pretend games, imitating e. More telling: Fantasy games, conflict 1. Individual Psychotherapies aka “Talk Therapy” (medium games (ex. cops and robbers), make- is talk) o Often referred to as Verbal psychotherapy aka believe, modelling bhvrs  Main Category: Non-directed Play Therapy Psychoanalysis a. Carl Rogers – Humanism (Helping to  Some validity but not very reliable  1 time we looked at ppl’s thoughts reach your potential) b. Ppl possess the drive for self-  Motivations, emotions, deep-seated problems actualization, finding self role & role of  Does not work w children since not as verbal – not as articulate, hard to have convo others in society o Invented by Freud c. Client centred therapy d. Technique: Unconditional (+)ve Regard  Free association – let them talk about whatever they want to e. No fdbk necessary  Gain insight f. Giving child complete freedom of choice, expression, to develop as human beings  Slips of tongue – At some pts your subconscious – that in of itself is therapeutic will appear – he’ll ask you to repeat what you just said (reflecting is back to you) – you might g. Therapist free to reflect the child’s feelings back to the child to clarify the child’s respond in dif ways thoughts & feelings  gain better self-  Interested in thoughts, memories, feelings, sensations understanding  Filial play therapy a. Variant of non-directed play therapy a. Play therapy o 1 proposed by Freud’s daughter Anna  famous where parents trained to give child envt psychotherapist where they can freely express themselves & trained to provide fdbk  Substitute play for talk b. Research has shown it’s more effective  Natural communication channel for children  Added benefit of rapport btwn child & therapist than non-directed therapy w psychologists c. Parents gain empathy, more  Therapeutic for child, and you get assessment info understanding of children – child purging thoughts (analytical & therapeutic & same time) o How they interact w toys, what they play w, how b. Verbal one-on-one therapy o Common way to conceptualize psychotherapy they interact w peers  May ask “why” Qs sometimes o Client meets therapist at set intervals for set periods of o Still use to treat children even though psychoanalysis time o When children at older age or in adolescence not used  Younger children won’t respond well to o Use assessment that is therapeutic – still used o The office is a play room psychoanalysis or humanistic psychotherapy o What are you thinking & why? o Does not exclude verbal interactions (ex. “You be the cop, I’ll be the robber” o When is play therapy useful, and when is it not? c. Cognitive therapy o Why?”  Unrestricted envt is not useful for children o “Why do you think what you’re thinking is right or who show a high degree of emotional arousal, low impulse control: conduct-disorder, ADHD – wrong? want to give them a restrictive envt o Learning paradigms o Why do you think that way? Why do you think those  Not useful for children w low level of affect: depression, high-anxiety thoughts?  Useful for children w limited verbal abilities, o Thinking, cognition o Need to be sophisticated enough to understand why socially-withdrawn children you’re asking “Why..?”  Useful to diagnose autism but not for assessment, particularly useful for the role-modelling aspect o “Where does that come from?” o Much more invasive than other types of therapy o Need to re-teach you, challenge what you think about situations – children often have these yourself irrational fears, which prevent them from o Very sophisticated technique of therapy fn’ing normally  I’m going to try to challenge your thoughts & i. Fear of spiders – irrational, no reprogram them poisonous spiders in Ontario; rational  Doesn’t have to be aggressive, just challenging if live in country w many poisonous o Current paradigm of psychotherapy is cognitive-bhvr’al spiders ii. Fear of heights – irrational d. Bhvr therapy aka Bhvr Modification iii. Fear of falling – rational o Treated of abnormal, unwanted bhvr, by methods j. Very effective, can sometimes take a long derived from expt’al psychologists – learning time principles (classical, operant conditioning) k. Can increase # of stimuli o Treatment strategies to increase or decrease bhvr  Flooding – conditioning/bhvr’al modification o Used quite extensively in children since for the most technique where we subject them to the extreme of part don’t require a lot of verbal interaction their anxiety-provoking envt or situation o Goes back to 1920s, 30s – pair sound of bell w wet bed a. Ex. lock door then turn on lights in room full o Not looking for reasons or origins of bhvr; just want to of spiders modify bhvr b. The phobia tends to be eliminated o Only look at observable, overt bhvr c. Not particularly ethical – not very pleasant  What we have to go by in young children d. Frequently used on children w OCD  Very easy to change overt bhvr e. Can tell them upfront that you’re going to o Chief mechanism of assessment & widely used in expose them to something uncomfortable, treatment and for them to withstand it for as long as  Children not sophisticated enough to hide bhvr possible o Punishment  Modeling – therapist models the appropriate bhvr  Problem: modeling aggressive bhvr (fearful child, & asks the client to copy the bhvr CS is pain or something you don’t like), also often a. “You try it!” punishment is delayed b. Very effective  Bhvr & punishment have to occur together to be c. Ex. petting a cooperative dog effective  Extinction – way to change bhvr by not rewarding  Not the preferred method it anymore  Immediate, unpleasant, not abusive – more a. in terms of operant conditioning, you could appropriate use (+)ve reinforcement – but not all of  There are conditions in which punishment can those bhvrs are desirable change bhvr in (+)ve ways (ex. swatting kid’s hand i. ex. kid walking down street w mom, away from electrical socket) sees candy store  excited  gives in  increases likehood of bhvr – learned o Methods: thru conditioning that a display likely  Systematic desensitization – usually used for causes reward anxiety disorders (the most common b. Stop rewarding the bhvr  bhvr is disorders, separation anxiety disorder usually extinguished w/o reward occurs in middle childhood) c. after a few days: Extinction burst – large a. Pair an incompatible experience/stimulus w emotional display gradual presence of the fear evoking stimuli i. parents often give in b. Often used w cognitive-bhvr’al therapy ii. BAD – kid learns he’ll be c. Explain to you why it’s irrational, explain intermittently reinforced – doesn’t that you’re going to turn down the lights know when he’ll be reinforced, but and relax (ex. meditation tape), and that knows he will some time you’re then going to show a stimulus that d. One of most significant rewards is will remind you of the scary thing – attention concentrate on how calm you felt  (+)ve reinforcement – increase frequency of a d. Similar to hypnosis procedure desired bhvr by rewarding it e. W children specifically, use biofeedback a. Research shows this will eventually replace – ex. sensors to monitor breathing, heart the undesired bhvrs w desired bhvrs rate, sweat – they can hear the fdbk b. Ex. token economy f. The person eventually gets expert at c. No time anymore for the undesired bhvr controlling their level of arousal to the stimulus 2. Grp & Family Therapies g.  Systemically increase the anxiety- a. Grp therapy provoking stimuli while you desensitize o Becoming more common that therapy is conducted in them to it grps h. Relaxation techniques, meditation o Cheaper (>1 person treated at same time) i. Ex. useful for Phobias – irrational (not o Recognizes that humans are social animals & their dangerous) anxiety to specific objects, development is influenced by other ppl  Electrodes applied to head  current sent thru  o 3 types often conducted w children & adolescents seizure (all neurons in brain stimulated & fire at  Activity Grp Therapy
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