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Chapter 18

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PSYC 100
Meredith Chivers

Chapter 18: The Treatment of Psychological Disorders p. 588-625 Psychological Disorders and Psychotherapy Early Treatment of Psychological Disorders - odd behaviour was viewed as the presence of the devil/evil spirits - trephining: earliest attempts of treatment by drilling into skull to allow evil spirits to leave the head - exorcisms, beating, starving, drowning, etc. were rituals to rid of evil - Johann Weir argued against the idea of evil spirits; said odd behaviour indicated suffering mental illness - mental illnesses were later accepted, but people suffering were shunned from society, usually in asylums - most asylums were extremely inhumane, patients kept in chains - Philippe Pinel said most mental patients would respond better to positivity - Dorothea Dix, based on Pinel‟s success, led the campaign for humane treatment of mental patients The Development of Psychotherapy - modenrn approach traced to Franz Anton Mesmer practiced mesmerism (hypnosis) to treat patients; Jean Charcot studied hysteria and used hypnosis in his treatment; Freud later worked with Charcot leading to his approach of psychoanalysis - most therapists adopt eclectic approach, using method(s) best suited for the particular patient, often combining aspects of several approaches Insight Therapies - believe people are essentially normal but learn maladaptive thought patterns/emotions expressed in maladaptive behaviour - behaviour viewed as a symptom of deeper underlying psyc. problems - variety of treatments; emphasizes talking between client and patient Psychoanalysis and Modern Psychodynamic Approaches - Freud created psychoanalysis, aiming to provide patient with insight into their unconscious motivations/impulses - Freud said personality reflected unconscious conflicts b/w id, ego, superego  conflicts often traced to inadequately maintained sexual/aggressive urges or incomplete progression through psychosexual stages - therapist tries to find/interpret clues about origins of intrapsychic conflicts, revealed through dreams, physical problems, memory (or lack thereof), manner of speech, and cognitive-emotional reactions to therapy Psychoanalytic Techniques - free association: client encouraged to speak freely without sensoring any thoughts/ideas; therapist limits eye contact to minimize authoritative influence over patient‟s disclosures - dream interpretation : evaluation of underlying dream content, removing possible bias by distinguishing b/w manifest content and latent content  manifest content- actual images/events occuring in dream  latent content- hidden meaning/significance of dream (masked by manifest content) - resistance: defensive maneuvers that hinder the process of therapy - transference: client relives aspects of childhood in therapy and may project powerful emotions/attitudes onto therapist (love/hate therapist) - countertransference- phenomenon where therapist projects own emotions onto client - Freud said therapy lasts between months and years, several times a week Modern Psychodynamic Therapy - less emphasis on psychosexual development, more emphasis on interpersonal experiences - ego is viewed as larger role in influencing thoughts/behaviour; people seen as less constrained by unconscious forces than Freud believed - intermittent psychodynamic therapy clients take breaks from therapist, only seeing them when necessary so client isn‟t dependent on therapy - brief psychodynamic therapy: completed in 10-25 sessions  goal of therapist to understand/improve client‟s interpersonal skills through interpretation of transference processes  focuses on client‟s vies on interpersonal relationships, attempting to modify one preveting development of fulfilling relationships Humanistic Therapy - focus on client‟s unique potential for growth and self-realization - assumes people are inherently good and have innate worth - psychological problems seen as preventing growth, therapy aims to overcome this obstruction to restore potential Client-Centred Therapy - developed by Carl Rogers - client decides what to talk about w/o direction/judgment from therapist - believed cause of many disorders can be traced to incongruence, people‟s self- perceptions differing from their ideal self - goal is to reduce incongruece by encouraging experiences that wil make the ideal self more attainable - therapist aims to make client more aware of their thoughts, feelings, perceptions through reflection (re-phrasing/mirroring client‟s statements) - unconditional positive regard: therapist shows client personal worth is not dependent on anything they say, feel, think, act Gestalt Therapy - developed by ex-students of Freud, moving away from psychoanalysis - emphasis on present experience, therapist is often confrontational and challenges client to deal honestly with emotions - like Freud, dreams viewed as a source of information and important to understand symbolism; therapist has client adopt perspective of person/object in the dream in an empathetic way - empty-chair technique: client imagines they are conversing with a person  allows client to experience present feelings/emotions and gain insight into how feelings currently affect perceptions Evaluation of Insight Therapies - short-term psychodynamic therapy better in short-term, long-term therapy reduction of symptoms lasts longer - insight, client-centred & Gestalt therapies not appropriate for serious disorders, most effective for coping with everyday stressors/anxiety Behaviour & Cognitive-Behaviour Therapies - maladaptive behaviouris learned Therapies Based on Classical Conditioning - in classical conditioning, a neutral stimulus (ultimately 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 - attempts to eliminate unpleasant emotional response caused by fear/phobia of an object/situation and replacing w/ compatible response - steps:  client & therapist constructs a stimulus hierarchy (series of anxiety-arousing stimuli that are ranked in terms of amount of anxiety they evoke)  client then trained to achieve complete relaxation  CS is then paired with stimuli that elicit relaxation response- therapist instructs client to use relaxation techniques, while describing situations on stimulus hierarchy list, gradually over series of sessions until client is able to vicariously experience most feared situations while maintaining relaxation - in vivo exposure- form of desensitization where client is exposed to intense levels of feared stimuli in an attempt to diminish fear through extinction (client learns nothing bad happens when directly exposed to fear) - imaginal exposure: therapist describes encounters with phobia in as much detail as possible, client imagines encounter and experiences intense fear until fear response eventually subsides Aversion Therapy - therapist pairs neutral stimulus (elicits unwanted response) with an aversive stimulus (UCS) to train client to respond negativey to the neutral stimulus Therapies Based on Operant Conditioning - behaviour modification: techniques using operant conditioning to increase/decrease a specific behaviour Reinforcement of Adaptive Behaviours - reinforcement to encourage positive behavioural change - ie. showing a sign of approval when desired behaviour is exhibited Token Economies - system for strengthening desired behaviours through the systematic application of positive reinforcement - tokens are rewarded when desired behaviour is observed, which can be exchanged for desireable goods or privileges Modelling - people learn new responses by imitating those of therapist, thus reinforcing their behaviour Assertiveness Therapy - client identifies variables causing distress, then learns/practices assertive behaviours which are then applied to real-life - therapy develops coping skills for interpersonal situations causing anxiety Extinction of Maladaptive Behaviours - reinforcers are removed to eliminate behaviour (ie. if child wants candy and has a tantrum, parents ignore instead of giving in) - problems: extinction burst (behaviour intensifies when reinforcer no longer present) and reinforcer not always possible to eliminate (ie. if behaviour is reinforced by peers, difficult to stop their reaction that reinforces) Punishment of Maladaptive Behaviour - punishement generally not as effective as positive reinforcement - person punished may develop resentment to punisher - tendency to overgeneralize- person avoids whole class of responses related to the punis
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