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PS101 Approaches to Treatment and Therapy

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Mindi Foster

Approaches to Treatment and Therapy 11/27/2012 1:52:00 PM Evaluating psychotherapy Is difficult because:  Each client if different  Each therapist is different  The needs of the client can come before the needs of the science Would you participate in a study where you have a 1/3 change of being in waiting list control? Some complements  Hospitals and medical staff do a difficult job  Research and therapy are different  Not everything is a clear sign of a disease, some may be mixed. It could be A, it could be B or it could be AB.  As you saw last chapter diagnosis is not easy  Help is needed—cant wait for better treatment  Easy to criticize what is being don and this is necessary but… we need to evaluate. Types of Therapy:  Range from Pills to Psychodynamic  Some are less popular today  Not mutually exclusive, some can be combined to be very effective (some cannot)  Talk o The relationship between patient and therapist is verbal and you are reconfiguring your thinking  Behaviouralist o Based on learning new skills and behaviours  Biology o Brain functions. “Talk” and Behaviour Therapies: Therapies for Psychological disorders Psychodynamic  Psychoanalysis o Based on Freudian principles  He believed that if the patient recognized the root problems, that the insight would help them achieve insight into the real problem.  Three part structure theory.  Id= root, the child in you. Personal needs. No constraints  Ego= contact with reality. Plays the game with working in real like  Superego= what constrains you socially. Response to societal pressure.  He believed that the superego and the id were always in conflict with each other which resulted in conflicts. o Goal: to help patients achieve insight o Insight= conscious awareness of psychodynamics underlying problems  Adjust behavior underlying problems learned in childhood.  Brief psychodynamic therapies o Free association  Not regular conversation  Uncensored  Will hopefully speak to an underlying issue.  Table… chair. You say a word, and you say the first word that comes to your head.  You can find unsettled issues this way that you are not consciously aware of.  Verbal reports of thoughts, feelings, or images that enter awareness without censorship. o Dream Interpretation  “Royal road to the unconscious”  therapist helps client understand the symbolic meaning of their dreams. o Therapist expects client to try and maintain status quo (i.e. not respond to help) o Resistance  Defensive maneuvers that hinder process of therapy.  Sign that anxiety-arousing material is being approached.  A sign that therapy is working  One of the reasons of why it is working. o Intrapsychic conflict (between id. Ego, and superego)  anxiety  reliance on defense mechanisms o Freud’s view of the roots of disorders. According to Freud, unconscious conflicts between the three sometimes lead to anxiety. This discomfort may lead to pathological reliance on defensive behavior. o How does psychoanalysis help clients?  Interpretation  Statements by therapist  Provide client with insight into behavior  Time consuming as client must arrive at “insight”  Need clients who can verbalize well. Humanistic  Focus o Conscious control of behavior o Personal responsibility o Disordered behavior  Function of distorted perceptions, lack of awareness, negative self- image o Present and future, not past.  Client-centered therapy o Key figure: Carl Rogers  Focused on therapeutic environment  Identified 3 important therapist attributes  Unconditional positive reward  Therapists accept clients without judgment or evaluation  Empathy  Willingness and ability to view the world through clients eyes  Genuineness  Consistency between therapists feelings and behaviours.  Belief affection from others is conditional  need to distort shortcomings to feel worthy or affection  relatively incongruent self=concept  recurrent anxiety  defensive behaviour protects inaccurate self-concept and then loops back to relatively incongruent self=concept  Gestalt therapy Cognitive  Focus: o Role of irrational and self-defeating thought patterns  Ellis’ rational emotive therapy o Activating event o Belief system o Consequences (emotional and behavioural) o Disrupting or challenging maladaptive emotions and behaviours.  Becks view of the roots of disorders o According to beck, depression is caused by the types of negative thinking shown here:  Blame set backs on personal inadequacies  Focus selevively on negatice events  Make unduly pessimistic projections about the future  Draw negative conclusions about personal worth. o They all increase vulnerability to depression.  Rational-emotive therapy  Cognitive therapy Behavioural  Maladaptive behaviours are the problem, not a symptom  Problem behaviours are learned  Maladaptive behaviours can be unlearned through classical and operant conditioning, modeling.  Based on Skinners and Pavlov’s work.  Classical conditioning o Exposure o PAVLOV o Systematic desensitization o Aversion therapy o Unconditioned stimulus (US)  Elicits a response in the absence of learning o Unconditioned response (UR)  The reflexive response to a stimulus in the absence of learning. o A neutral stimulus is them regularly paired with an unconditioned stimulus. o Conditioned stimulus (CS)  An initially neutral stimulus that comes to elicit a conditioned response after being paired with an unconditioned stimulus. o Conditioned response (CR)  A response that is elicited by the conditioned stimulus.  Occurs after the CS is associated with the US.  Is usually similar to US.  Behaviour Therapies o Exposure  Treat phobias through exposure to feared CS in the absence of UCS.  Response prevention used to keep the operant avoidance response from occurring  Highly effective for extinguishing anxiety responses.  Virtual reality being used.  Criticism  Intense anxiety created by treatment. o Flooding  Exposed to real-life stimuli o Implosion  Imagine scenes involving stimuli o Systematic desensitization  Learning-based treatment for anxiety disorders  Eliminate anxiety through counterconditioning  Steps  Train muscle relaxation skills  Anxiety and relaxation cannot co-exist  Stimulus hierarchy  Low-anxiety to high-anxiety scenes (10-15)  Relaxation and progressive association with stimulus hierarchy. o In-Vivo desensitization  Controlled exposure to “real life” situations  Creates more anxiety during treatment than systematic
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