Chapter 15 notes.pdf

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University of Toronto Mississauga
Sherry Fukuzawa

Chapter 15: Treatment of Psychological Disorders Introduction • Contemporary treatments of psychological disorders are varied and reflect a distinct set of theory about human functioning • Last 50 years has seen significant advances in development and scientific evaluation of treatments for psychological disorders • History of treatment for psychological disorders also has had its controversial side • As ideas regarding nature of psychological disorders have changed, so have approached to treatment The Elements of the Treatment Process • Sigmund Freud is often credited with launching modern psychotherapy • Breuer began to treat a young woman referred to as Anna O • Anna exhibited variety of physical maladies, including headaches, coughing and a loss of feeling in and movement of her right arm • Breuer discovered that Anna’s physical symptoms cleared up when he encouraged her to talk about emotionally charged experiences from her past • Freud and Breuer speculated that talking things through had enabled Anna to drain off bottled up emotions that had caused her symptoms • Freud applied Breuer’s insight to the patients and his successes led him to develop a systematic treatment procedure which he called psychoanalysis • Psychotherapy isn’t always curative, and many modern treatments place little emphasis on talking Treatments: How many types are there? • Include discussion, advice, emotional support, persuasion, conditioning procedures, relaxation training, role playing, drug therapy, biofeedback and group therapy • No one knows exactly how many distinct types of psychotherapy there are • May be over 400 approaches to treatment • Approaches to treatment can be classified into 3 major categories: • must earn a doctoral degree • In providing therapy, psychologists use either insight or behavioral approaches • Treatment by psychologists is not part of govt medical insurance funding systems- stops many people from seeking treatment Psychiatrists • defn: physicians who specialize in the diagnosis and treatment of psychological disorders • also treat everyday behavioral problems • devote more time to relatively severe disorders (schizophrenia, mood disorders) and less time to everyday marital, family, job and school problems • have an M.D. degree • in their provision of therapy, psychiatrists increasingly emphasize drug therapies • psychiatrists are more likely to use psychoanalysis and less like to use group therapies or behaviour therapies • contemporary psychiatrists primarily depend on medication as their principal mode of treatment Other mental health professionals • other mental health professions also provide psychotherapy services • in hospitals – clinical social workers and psychiatric nurses • many kinds of counselors also provide therapeutic services • usually found working in schools, colleges, and assorted human service agencies • terms clinician, therapists, and provider refer to mental health professionals of all kinds Insight Therapies • defn: involve verbal interactions intended to enhance client’s self knowledge and thus promote healthful changes in personality and behaviour Psychoanalysis • Sigmund Freud • Defn: an insight therapy that emphasizes the recovery of unconscious conflicts, motives and defenses through techniques such as free association and transference • Appreciate the logic of psychoanalysis, we have to look at Freud’s thinking about the roots of mental disorders; Freud mostly treated anxiety-dominated disturbances which were then called neuroses (ie. Phobic, panic, ocd and conversion disorders) • Freud believed that neurotic problems are caused by unconscious conflicts left over from early childhood o Inner conflicts among id, ego and superego, usually over sexual and aggressive impulses • He noted that defensive maneuvers often lead to self-defeating behaviour Probing the Unconscious • Analyst attempts to probe the murky depths of unconscious to discover unresolved conflicts causing the client’s neurotic behaviour • Therapist relies on two techniques: free association and dream analysis • Analysts must interpret their client’s dreams and free association; this is a critical process throughout psychoanalysis • therapist provides feedback to help clients sort out their feelings • therapist’s key task is clarification • client-centered therapists try to function like human mirrors, reflecting statements back to their clients but with enhanced clarity • help clients become more aware of their true feelings by highlighting themes that may be obscure in the client’s discourse • in particular, therapists try to help clients better understand their interpersonal relationships and become more comfortable with their genuine selves • Les Greenberg and Susan Johnson- emotion-focused couples therapy o Effectively used in variety of situations (ie. Child abuse victims) • Client-centered therapy resembles psychoanalysis in that both seek to achieve a major reconstruction on client’s personality Therapies Inspired by Positive Psychology • Growth of positive psychology movement has begun to inspire new approaches to insight therapies • Positive psychology uses theory and research to better understand the positive, adaptive, creative, and fulfilling aspects of human existence • Positive psychologists argue for increased research on contentment, well-being, human strengths and positive emotions rather than focusing on pathology, weakness and suffering • Well being therapy (Giovanni Fava) seeks to enhance client’s self-acceptance, purpose in life, autonomy, and personal growth o been used successfully in treatment of mood disorders and anxiety disorders • Positive Psychotherapy (Martin Seligman) used mainly in treatment of depression o Attempts to get clients to recognize their strengths, appreciate their blessing and find meaning in their lives Group Therapy • Came of age during WWII and its aftermath in that 1950s • During this period, the expanding demand for therapeutic services forced clinicians to use group techniques • Defn: simultaneous treatment of several clients in a group Participant’s Role • Therapy group typically consists of 4-15 people (8 is ideal) • Therapist usually screens the participants, excluding those who are likely to disrupt • Some debate about whether it is best for group to be homogeneous (similar in age, sex and psychological problem) • Practical necessities usually dictate that groups are at least somewhat diversified • Participants essentially function as therapists for one another • Members describe their problems, trade viewpoints and share experiences, and discuss coping strategies • Provide acceptance and emotional support for each other Therapist’s Role • include selecting participants, setting goals for the group, initiating and maintaining therapeutic process and protecting clients from harm • often play a relatively subtle role in group therapy, staying in the background and focusing mainly on promoting group cohesiveness Advantages of Group Experience • save time and money • can be just as effective as individual treatment • participants come to realize that their misery is not unique o reassured to learn that many other people have the same or similar problems • provides an opportunity for participants to work on their social skills in safe environment Evaluating Insight Therapies • evaluating the effectiveness of any approach to treatment is a complex challenge • psychological disorders sometimes run their course and clear up on their own • spontaneous remission: recovery from a disorder that occurs without formal treatment • evaluating effective of treatment is especially complicated in insight therapies • client’s ratings of their progress are likely to be slanted toward favourable evaluation because they want to justify their effort, expense and time • evaluations by professionals therapists can be highly subjective • studies indicate that insight therapies is superior to no treatment or to placebo treatmen and that the effects of therapy and reasonably durable • when insight therapies are compared directly against drug therapies, they usually show roughly equally efficacy • generally found the greatest improvement early in treatment with further gains gradually diminishing in size over time • about 50% of patients show clinically meaningful recovery within about 20 sessons How do Insight Therapies work? • Although there is considerable evidence that insight therapy tends to produce positive effects for majority of clients, debate continues about the mechanisms of action underlying these positive effects • Diverse approaches to therapy share certain common factors and these common factors account for much of the improvement experienced by clients • Most widely cited common factors include: (1) development of therapeutic alliance with professional helper, (2) provision of emotional support and emphatic understanding by the therapists, (3) cultivation of hope and positive expectations in the client, (4) provision of rationale for client’s problems and plausible method for reducing them and (5) opportunity to express feelings, confront problems, gain new insights, and learn new patterns of behaviour Behaviour Therapies • Fixing behaviour; not concerned with finding roots of problem • Behaviour therapists make no attempt to help clients achieve grand insights about themselves o They believe that such insights aren’t necessary to produce changes • Main difference between insight therapies and behaviour therapies is that insight therapies treat pathological symptoms as signs of an underlying problem, whereas, behaviour therapists think that the symptoms are the problem • Behaviour therapies: involve application of learning principles to direct efforts to change client’s maladaptive behaviours • Based on certain assumptions: 1. It is assumed that behaviour is a product of learning • Behaviourists believe that it is the result of past learning and conditioning 2. It is assumed that what has been learned can be unlearned • Same learning principles that explain how maladaptive behaviour was acquired can be used to get rid of it • Thus, behaviour therapists attempt to change client’s behaviour by applying principles of classical , operant conditioning and observational learning Systematic Desensitization • Joseph Wolpe revolutionized psychotherapy by giving therapist their first useful alternative to traditional talk therapy • Defn: behaviour therapy used to reduce phobic client’s anxiety responses through counterconditioning • Treatment assumes that most anxiety responses are acquired through classical conditioning • Goal of systematic desensitization is to weaken association between conditioned stimulus and conditioned response of anxiety • Systematic desensitization involves 3 steps: 1. The therapist helps client build an anxiety hierarchy • Hierarchy is a list of anxiety-arousing stimuli related to specific source of anxiety • Client ranks stimuli from the least anxiety-arousing to the most anxiety-arousing • Ordered list of stimuli is called the anxiety hierarchy 2. Training the client to deep muscle relaxation • May begin during early sessions while therapist and client are still constructing the anxiety hierarchy • Client must learn to engage in deep, thorough relaxation on command from the therapist 3. Client tries to work through the hierarchy, learning to remain relaxed while imagining each stimulus • Starting with the least anxiety-arousing stimulus, client imagines the situation as vividly as possible while relaxing • If the client experiences strong anxiety, he/she drops the imaginary scene and concentrates on relaxation • Client keeps repeating this process until he/she can imagine a scene with little or no anxiety • As clients conquer imagined phobic stimuli, they may be encouraged to confront real stimuli • Counterconditioning- attempt to reverse the process of classical conditioning by associating the crucial stimulus with a new conditioned response Aversion Therapy • Most controversial of all behaviour therapies • Psychologists usually suggest it only as a last resort after other interventions have failed • Client has to endure decidedly unpleasant stimuli, such as shocks or drug-induced nausea • Defn: behaviour therapy in which aversive stimulus is paired with a stimulus that elicits an undesirable response • Takes advantage of the automatic nature of responses produced through classical conditioning • Not a widely used technique • Negative consequence of certain action to encourage patient to not perform action (Example: habitual drinking-> nausea (consequence)-> patient avoids drinking to avoid nausea) Social Skills Training • Defn: behaviour therapy designed to improve interpersonal skills that emphasizes modeling, behaviour rehearsal and shaping • Many psychological problems grow out of interpersonal difficulties • People aren’t born with social skills, they acquire them through learning • Social ineptitude can contribute to anxiety, feelings of inferiority, and various kinds of disorders • Therapist are increasingly using social skills training in efforts to improve client’s social abilities • Yielded promising results in the treatment of social anxiety, autism, attention deficit disorder and schizophrenia • This behaviour therapy can be conducted individually or in group therapy • Social skills training depends on the principles of operant conditioning and observational learning Modelling: the client is encouraged to watch socially skilled friends and colleagues in order to acquire appropriate responses through observation Behaviour Rehearsal: client tries to practice social techniques in structured role-playing exercised; therapist provides corrective feedback and uses approval to reinforce progress Shaping: clients are gradually asked to handle more complicated and delicate social situations Cognitive-Behavioural Treatments • Cognitive factors play key role in development of many anxiety and mood disorders • Defn: varied combinations of verbal interventions and behaviour modification techniques to help clients change maladaptive patterns of thinking • Aaron Beck’s cognitive therapy emerged out of an insight therapy tradition • Cognitive therapy: uses specific strategies to correct habitual thinking errors that underlie various types of disorders o Originally devised as treatment for depression o According to cognitive therapists, depression is caused by “errors” in thinking
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