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York University
PSYC 1010

Chapter 15: Treatment of Psychological Disorders KEY POINTS IN THIS CHAPTER (pages 624-626) - Approaches to treatment are diverse, but they can be grouped into three categories: insight therapies, behaviour therapies, and biomedical therapies - Clients bring a wide variety of problems to therapy and do not necessarily have a disorder. People vary in their willingness to seek treatment, and many people who need therapy do not receive it. - Therapists come from a variety of professional backgrounds. Clinical and counselling psychologists, psychiatrists, clinical social workers, psychiatric nurses, and counsellors are the principal providers of therapeutic services. - Each of these professions shows different preferences for approaches to treatment. Psychologists typically practise insight or behaviour therapy. Psychiatrists rely more heavily on drug therapies The Elements of the Treatment Process - Sigmund Freud - widely credited with modern psychotherapy - was inspired by Josef Breuerʼs patient referred to as Anna O - Breuer found that her symptoms cleared up when she was encouraged to talk about emotionally charged experiences from her past - Freud applied Breuerʼs insight to other patients - led him to develop a systematic treatment procedure called psychoanalysis Treatments: How Many Types Are There? - psychotherapy treatment methods: discussion, advice, emotional support, persuasion, conditioning procedures, relaxation training, role-playing, drug therapy, biofeedback, and group therapy - As varied as therapistsʼ procedures are, approaches to treatment can be classified into three major categories: 1. Insight therapies - “talk therapy” in the tradition of Freudʼs psychanalysis - clients engage in complex verbal interactions with their therapists - goal is to pursue increased insight regarding the nature of the clientʼs difficulties and to sort through possible solutions - can be conducted individually or in a group 2. Behaviour therapies - based on the principles of learning - make direct efforts to alter problematic responses (ex: phobias) and maladaptive habits (ex: drug use) - work on changing clientsʼ overt behaviour - most of their procedures involve classical conditioning, operant conditioning or observational learning 3. Biomedical therapies - involve interventions into a personʼs biological functioning - most widely used procedures are drug therapy and electroconvulsive (shock) therapy - these treatments have traditionally been provided only by physicians with medical degree Clients: Who Seeks Therapy? - clients bring a wide variety of problems to therapy and do not necessarily have a disorder - two most common presenting problems are excessive anxiety and depression - people vary in their willingness to seek treatment, and many people who need therapy do not receive it Therapists: Who Provides Professional Treatment? - Psychotherapy refers to professional treatment by someone with special training PSYCHOLOGISTS - two types of psychologists may provide therapy: clinical psychologists and counselling psychologists - clinical psychologistsʼ training emphasizes treatment of full-fledged disorders - counselling psychologistsʼ training is slanted toward treatment of everyday adjustment problems - both require a doctoral degree (Ph.D., Psy.D., or Ed.D) - most training in schools, then serve one-year internship in a clinical setting - psychologists - more likely than psychiatrists to use psychoanalytic methods and behavioural therapies - do psychological testing as well as psychotherapy and many also conduct research - currently, psychologists in Canada are not allowed to prescribe medication Chapter 15: Treatment of Psychological Disorders PSYCHIATRISTS - psychiatrists - physicians who specialize in the diagnosis and treatment of psychological disorders - many also treat everyday behavioural problems but most focus on relatively severe disorders - have an M.D degree -4 years med. school and 4 year apprenticeship in a residency at a hospital - psychiatrists increasingly emphasize drug therapies - in comparison with psychologists, are more likely to use psychoanalysis and less likely to use group therapies or behaviour therapies OTHER MENTAL HEALTH PROFESSIONALS - clinical social workers (masterʼs degree) and psychiatric nurses (bachelorʼs or masterʼs degree)- often work as part of a treatment team with a psychologist to psychiatrist - many kinds of counsellors (in schools, colleges, and assorted human service agencies) - (masters degree) - often specialize in particular types of problems KEY POINTS IN THIS CHAPTER (pages 627-634) - Insight therapies involve verbal interactions intended to enhance self-knowledge. Freudian approaches to therapy assume that neuroses originate from unresolved conflicts lurking in the unconscious. Therefore, in psychoanalysis free association and dream analysis are used to explore unconscious - When an analystʼs probing hits sensitive areas, resistance can be expected. The transference relationship may be used to overcome this resistance so that the client can handle interpretations that lead to insight. Classical psychoanalysis is not widely practised anymore, but Freudʼs legacy lives on in a rich diversity of modern psychodynamic therapies - Rogersʼs client-centred therapy assumes that neurotic anxieties are derived from incongruence between a personʼs self-concept and reality. Accordingly, the client-centred therapist tries to provide a supportive climate in which clients can restructure their self- concept. The process of client-centred therapy emphasizes clarification of the clientʼs feelings and self-acceptance. - Beckʼs cognitive therapy concentrates on changing the way clients think about events in their lives. Cognitive therapists re- educate clients to detect and challenge automatic negative thoughts that cause depression and anxiety - Most theoretical approaches to insight therapy have been adapted for use with groups. Participants in group therapy essentially act as therapists for one another, exchanging insights and emotional support. Group therapy has unique advantages in comparison to individual therapy. - Eysenckʼs work in the 1950s raised doubts about the effectiveness of insight therapy and stimulated research on its efficacy. Evaluating the effectiveness of any approach to therapy is complex and difficult. Nonetheless, the weight of modern evidence suggests that insight therapies are superior to no treatment or to placebo treatment. Much of the improvement seen in clients in therapy may be attributable to the operation of common factors Insight Therapies - insight therapies - involve verbal interactions intended to enhance clientsʼ self-knowledge and thus promote healthful changes in personality - the leading eight or ten approaches appear to account for the lionʼs share of treatment Psychoanalysis - Freud developed his system of psychoanalysis - an insight therapy that emphasizes the recovery of unconscious conflicts, motives, and defences through techniques such as free association and transference - Freud mostly treated anxiety-dominated disturbances then called neuroses - he believed that they were caused by unconscious conflicts left over from early childhood - thought that inner conflicts involve battles among the id, ego and superego, usually over sexual and aggressive impulses - theorized people depend on defence mechanisms - which often lead to self-defeating behaviour - asserted that defences tend to have only partially successful in alleviating anxiety, guilt, and other distressing emotions PROBING THE UNCONSCIOUS - In effort to explore the unconscious, therapist relies on two techniques: free association and dream analysis - free association - clients spontaneously express their thoughts and feelings exactly as they occur, with as little censorship as possible Chapter 15: Treatment of Psychological Disorders - dream analysis - therapist interprets the symbolic meaning of the clientʼs dreams - clients are encouraged and trained to remember their dreams, which they describe in therapy INTERPRETATION - interpretation - refers to the therapistʼs attempts to explain the inner significance of the clientʼs thoughts, feelings, memories, and behaviours - analysts move forward inch by inch, offering interpretations that should be just out of the clientʼs own reach RESISTANCE - resistance - refers to largely unconscious defensive manoeuvres intended to hinder the progress of therapy - why would they not want to resist the helping process? Because they donʼt want to face up to painful, disturbing conflicts that they have buried in their unconscious - Can take many forms: - may show up late, may pretend to engage in free association, or may express hostility toward their therapist TRANSFERENCE - transference - occurs when clients unconsciously start relating to their therapist in ways that mimic critical relationships in their lives - psychoanalysts often encourage transference so that clients can re-enact relations with crucial people in the context of therapy - can help bring repressed feelings and conflicts to the surface, allowing the client to work through them - if resistance and transference can be handled effectively, the therapistʼs interpretations should lead the client to profound insights - according to Freud, once clients recognize the unconscious sources of conflicts, they can resolve these conflict and discard their neurotic defences MODERN PSYCHODYNAMIC THERAPIES - classical psychoanalysis as done by Freud is not widely practised anymore - many of his followers found it necessary to adapt psychoanalysis to different cultures, changing times, and new kinds of patients - thus many variations made original approach over the years - these descendants are collectively known as psychodynamic approaches to therapy Client-Centred Therapy - Carl Rogers, using a humanistic perspective, devised client-centred therapy - client-centred therapy - an insight therapy that emphasizes providing a supportive emotional climate for clients, who play a major roe in determining the pace and direction of their therapy - Rogerʼs theory about the principal causes of neurotic anxieties is quite different from the Freudian explanation - maintains that most personal distress is due to inconsistency, or “incongruence,” between the personʼs self concept and reality - incongruence makes people feel threatened by realistic feedback about themselves from others --> anxiety about such feedback often leads to reliance on defence mechanisms, to distortion os reality, and to stifled personal growth - excessive incongruence is thought to be rooted in clientsʼ overdependence on others for approval and acceptance - foster self-acceptance and personal growth - encourage clients to respect their own feelings and values and help people restructure their self- concept to correspond better to reality THERAPEUTIC CLIMATE Chapter 15: Treatment of Psychological Disorders - According to Rogers, the process of therapy is not as important as the emotional climate in which the therapy takes place - client-centred therapists must provide three conditions to create atmosphere of emotional support 1. Genuineness 2. Unconditional positive regard - must show complete, nonjudgemental acceptance of the client as a person, provide warmth and caring for client with no strings attached. - a therapist can disapprove of a particular behaviour while continuing to value the client as a human being 3. Empathy - must understand the clientʼs world from the clientʼs point of view - must be articulate enough to communicate this understanding to the client THERAPEUTIC PROCESS - client-centred therapy - client and therapist work together as equals - therapist provides relatively little guidance and keeps interpretation and advice to a minimum - therapist primarily provides feedback to help clients sort out their feelings - key task is clarification - reflect statements back to their clients, but with enhanced clarity - try to help clients better understand their interpersonal relationships and become more comfortable with their genuine sleeves - recent development of emotion-focused couples therapy - acknowledging and working with the underlying emotions are central to this approach Cognitive Therapy - Aaron Beck and Albert Ellis - independently devised cognitive-oriented therapies that became highly influential - Beckʼs cognitive therapy - an insight therapy that emphasizes recognizing and changing negative thoughts and maladaptive beliefs - originally devised as a treatment for depression - according to cognitive therapists, depression-prone people tend to (1) blame their setbacks on personal inadequacies without considering circumstantial explanations, (2) focus selectively on negative events while ignoring positive events, (3) make unduly pessimistic projections about the future, and (4) draw negative conclusions about their worth as a person based on insignificant events - Meichenbaum (U of Waterloo) - one of his innovations, self-instructional training - clients are taught to develop and use verbal statements that help them cope with difficult contexts GOALS AND TECHNIQUES - goal of cognitive therapy is to change the way clients think - to have more reasonable standards of evaluation - clients are taught to detect their automatic negative thoughts and then to subject these automatic thoughts to reality testing - relatively short-term treatment - cognitive therapists are actively involved in determining the pace and direction of treatment. they usually talk extensively in the therapy session and may even argue openly with clients as they try to persuade them to alter their patterns of thinking KINSHIP WITH BEHAVIOUR THERAPY - cognitive therapy borrows extensively from behavioural approaches to treatment - often use homework assignments that focus on changing clientsʼ overt behaviours - cognitive therapy is a creative blend of “talk therapy: and behaviour therapy, although it is primarily an insight therapy - has recently been adapted for use with groups Group Therapy - group therapy - the simultaneous treatment of several clients in a group Chapter 15: Treatment of Psychological Disorders - most major insight therapies have been adapted for use with groups PARTICIPANTSʼ ROLES - some theorists maintain that judicious selection of participants is crucial to effective group treatment - debate about whether it is best for the group to be homogeneous - participants in group therapy essentially act as therapists for one another, echanging insights and emotional support - the therapistʼs responsibilities include selecting participants, setting goals for the group, initiating and maintaining the therapeutic process, and protecting clients from harm - the therapist models supportive behaviours for the participants and ties to promote a healthy climate ADVANTAGES OF THE GROUP EXPERIENCE - Group therapy has unique advantages in comparison to individual therapy - save time and money, more affordable for more people, can be just as effective as individual treatment, reassurance that many other people have similar or even worse problems, provides an opportunity for participants to work on their social skills in a safe environment, certain types of problems and clients response especially well to social support that group therapy can provide Evaluating Insight Therapies - Eysenckʼs work in the 1950s raised doubts about the effectiveness of insight therapy and stimulated research on its efficacy - found recovery rate with treatment and without were the same - spontaneous remission - a recovery from a disorder that occurs without formal treatment - critics found shortcomings in his data: - used different time frames in comparing the recovery rates of treated and untreated individuals - treated and untreated groups were not matched in terms of the severity of their disorders, attitudes and expectations about therapy and recover - Evaluating the effectiveness of any approach to therapy is complex and difficult - clientsʼ ratings of their progress are likely to be slanted towards a favourable evaluation - allegiance effect - researchers comparing different therapies tend to obtain results that favour the therapeutic approach they champion - Studies have consistently indicated that insight therapy is superior to no treatment or to placebo treatment and that the effects of therapy are reasonably durable - vigourous debate about the mechanisms of action underlying these positive effects - different therapies achieve similar benefits through different processes? - diverse approaches to therapy share certain common factors which account for much of the improvement experienced by clients? (building up of evidence supporting) - The most widely cited common factors include (1) the development of therapeutic alliance with a professional helper, (2) the provision of emotional support and empathic understanding by the therapist, (3) the cultivation of hope and positive expectations in the client, (4) the provision of a rationale for the clientʼs problems and a plausible method for ameliorating them, and (5) the opportunity to express feelings, confront problems, gain new insights, and learn new patterns of behaviour KEY POINTS IN THIS CHAPTER (pages 635-638) - Behaviour therapies use the principles of learning in direct efforts to change specific aspects of behaviour. Wolpeʼs systematic desensitization, a treatment for phobias, involves the construction of an anxiety hierarchy, relaxation training, and step-by-step movement through the hierarchy, pairing relaxation with each phobic stimulus - In aversion therapy, a stimulus associated with an unwanted response is paired with an unpleasant stimulus in an effort to eliminate the maladaptive response. Social skills training can improve clientsʼ interpersonal skills through shaping, modelling, and behavioural rehearsal - There is ample evidence that behaviour therapies are effective in the treatment of a wide variety of disorders Behaviour Therapies Chapter 15: Treatment of Psychological Disorders - behaviour therapist make no attempt to help clients achieve grad insights about themselves - believe that such insights arenʼt necessary to produce constructive change - may work with clients to attain some limited insights about how situational factors evoke troublesome
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