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Psyc102c - Ch17 - Treatment to Psychological Disorders.docx

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PSYC 102
Russell Day

Psychology 102 Chapter 17: Treatment of Psychological Disorders Helping Relationship  Goal is to help change maladaptive feelings/behavior  The process of therapy involves a relationship between a client and a therapist who applies the techniques dictated by his/her approach to treatment. The quality of the therapeutic relationship, the therapy techniques used, and the client’s commitment to change all influence the outcome.  Many seek help within family, physicians, church, acquaintances, self-help groups etc.  If not enough, they search professional help:  Counselling and clinical psychologists: PHD degree, 5+years training and research  Psychiatrists: medical doctor who specialize in psychotherapy and biomedical treatments  Other (master degree 2 years): o Psychiatric social workers – work in community agencies o Marriage/family counsellors – specialize in problems in family relationships o Pastoral counsellors – spiritual issues o Abuse counsellors – substance, sexual abusers and victims PSYCHODYNAMIC THERAPIES (Focuses on internal conflict and unconscious factors (Sigmund Freud) Psychoanalysis: Freud’s approach to treatment  Insight: conscious awareness of the psychodynamic that underlie their problems  Free association: sit on couch and report verbally without censorship any thoughts, feelings or images that enter awareness  Dream analysis: understand symbols in dreams that may express impulses/ fantasies/ wishes that are hidden when awake o Even in dreams, things are in disguise to avoid anxiety  Resistance: unconscious defense that hinder the process of therapy o Eg may have difficulty in free-associating, may come late or ‘forgot’ about it, avoid talking about certain topics o Resistance is a sign that anxiety-arousing topics is being approached o If explore reasons for resistance, can gain insight or avoid ultimate resistance: drop out of therapy  Transference: when client reacts irrationally to therapist as if he was important figure from client’s past o Positive transference: intense affection, love, dependency o Negative transference: anger, hatred, disappointment  Interpretation: any statement by the therapists intended to provide client with insight into his/her behavior o Say something they won’t admit, but closed to surface, near consciousness o Deep interpretations will not help, thus even if therapist know what it is, it takes years for treatment, in order to client himself to gain insight Brief Psychodynamic Therapies  Old style too expensive and time consuming, because trying to completely rebuild personality  Now just understand influences of past, and deal with current life events.  Deal with specific life problems, and learn specific interpersonal and emotional-control skills  Interpersonal therapy – focus on interpersonal problems (divorce, breakup, loss, etc.) and enhance social skills  Proven effective for depression HUMANISTIC PSYCHOTERPAIES  Believe maladaptive behaviour reflect a blocking of natural growth brought about by distorted perceptions, lack of awareness about feelings, negative self-image  Focus on present and future, help achieve maximum self-growth Client-Centered Therapy  By Carol Rogers (focusing on relationship between client and therapist) 1. Unconditional positive regard: when therapists show that they care, accept and don’t judge, communicate sense of trust in client’s ability to work through problems 2. Empathy: see world in client’s eye, let client know they can feel the same, use reflection: rephrase with same meaning 3. Genuineness: consistency between the way therapist feels and behaves. Therapist must be open about feelings and be honest, express both positive and negative feelings. Therapist can express displeasure with client’s behavior and at the same time communicate acceptance.  When client experience good relationship with therapist, they increase self-acceptance, greater self-awareness, enhance self-reliance, more comfortable with others, etc. Gestalt Therapy  By Frederick Perls (Fritz)  Gestalt: “organized whole” – perceptual principles through which people organize stimulus into meaningful ‘whole’ patterns o Some people can only see one part of experience, ignoring background (ignore important feelings, wishes, because would evoke anxiety)  Goal is to bring awareness, and help client be ‘whole’ again  Empty chair technique: ask client to image person sitting in opposite chair and carry a conversation, talk about important issues, resolve unfinished business COGNITIVE THERAPIES  Focus on irrational/self-defeating thought patterns  Sometimes our thought pattern is so ingrained that we use it automatically, and is not aware of it  Goal is to help identify beliefs and ideas that trigger maladaptive emotions/behaviors Rational-emotive therapy – (ellis)  His theory of emotional disturbance and rational-emotive therapy follow ABCD model:  A – activating event that seems to trigger the emotion  B – belief system  C – emotional/behavioural consequences of appraisal  D – disputing/changing/challenging erroneous belief system  Let to know about irrational ideas and train them to think differently about self, learn emotional control, eventually modifying belief system Cognitive Therapy (beck)  Point out errors of thinking and change ‘automatic’ thought patterns  Help them realize it’s their thoughts, not situation that causes emotional reaction  Self-instructional training: treatment related to stress and coping (Donald Meichenbaum’s work) BEHAVIOUR THERAPIES Classical Conditioning Treatments A. Exposure: experience CS without presence of UCS (extinction), using response prevention to keep operant avoidance response from occurring  Expose to real-life stimuli (flooding)  Imagine scenes involving the stimuli (implosion therapy)  Good for treating phobias or PTSD B. Systematic Desensitization: counterconditioning – new response is conditioned with anxiety-arousing CS  Stimulus hierarchy: learn voluntary muscle relaxation; construct 10-15 scenes relating to fear, from low to high arousal level. Vividly imagine the scene. If relaxation is strong enough, it replaces anxiety as new CR.  Vivo desensitization: controlled exposure to a real-life situation (eg high phobia, stepstool, bridge, etc.)  Exposure often reduces anxiety more quickly  VR (virtual reality): through a 3D screen that displays pictures C. Aversion Therapy: pair bad behavior (CS) with an undesirable UCS to create aversion to CS (eg. Nausea drug to alcohol, shock to pedophiles while watching children pictures) Operant Conditioning Treatments A. Positive Reinforcement: Token Economy – rewarded with tokens, strengthen desired behavior, increase social reinforcer and self-reinforcement processes (eg pride) B. Punishment: only use when no other alternative, inflict pain to decrease behavior C. Social skills training: observe and imitating a model who performs a socially skilful behavior – if believe they can do, they will succeed. Increases self-efficacy. “Third Wave” Cognitive Behaviour Therapies A. Mindfulness: be more aware and accepting of experience, nonjudgmental appraisal, rather than be overwhelmed by it – able to tolerate painful stimuli  Association cognitive techniques: focusing nonjudgmentally on the sensations rather than trying to distract oneself B. Acceptance and commitment therapy –  Acceptance - “just notice”, accept and embrace experiences. Even if anxiety were aroused, try to examine and accept it as a temporary experience.  Commitment – deciding what is important to self and set life goals in accordance with those values. Learn strategies to work toward and remain committed to it C. Dialectical Behaviour Therapy - treatment of borderline personality disorder (chaotic interpersonal relationships, poor emotional control, self-destructive behaviours, low self-esteem, suicidal)  Package deal – cognitive (learn adaptive thinking about world and self) psychodynamic (find history of early deprivation/rejection) humanistic (acceptance of thoughts and feelings, tolerate unhappiness)
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