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Chapter 15

PSYC 100 Ch. 15 Textbook Notes.docx

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PSYC 100
Samuel Reed

CHAPTER 15: TREATMENT OF PSYCHOLOGICAL DISORDERS A) The Elements of the Treatment Process A.1) Treatments: How Many Types Are There? (3) - Insight therapies (talk therapy) > clients engage in verbal interaction > focus: to gain insights of the nature of the difficulties and sort possible solutions > can be conducted in a group or individually - Behavior therapies > based on principles of learning > make direct effort to alter problematic response > work on changing clients’ overt (perceivable) behaviors > mostly involve: classical conditioning, operant conditioning and observational learning - Biomedical therapies > intervention into a person’s biological functioning > mostly used: electroconvulsive (shock) therapy and drug therapy A.2) Clients: Who Seek Therapy? - therapeutic triad: therapists, treatments, clients A.3) Therapists: Who Provides Professional Treatment? (3) - Psychotherapy: professional treatment by someone with special training A.3.1) Psychologists - traditionally, had to earn PhD which requires 5-7 years - but, recently this has changed > e.g: Psy.D includes a greater emphasis on the scientist practitioner model in PhD programs > Clinical psychologists: treatment of full-fledged (fully-developed) problem > Counselling psychologists: treatment of everyday problem - Approaches: Insight or behavioral approaches > more likely to use behavioral approaches rather than psychoanalytic A.3.2) Psychiatrists. - def: physician who specializes in the diagnosis and treatment of psychological disorders > have M.D. degree, train for 4 years in medical school - heavily involved in treating severe disorders - emphasize the use of drug therapies which other nonmedical profession can’t provide - initially, they depend more heavily on psychoanalysis than group therapy or behavior therapy - but contemporary psychiatrists rely more on giving medication as the treatment A.3.3) Other Mental Health Professionals - others: clinical social workers and psychiatric nurses B) Insight Therapies (5) - involves verbal interactions intended to enhance client’s self-knowledge and promote healthful changes in personality and behavior B.1) Psychoanalysis – IDENTIFYING THE SOURCE OF THEIR PROBLEM - a type of insight therapy which focuses on the recovery of the unconscious conflicts, motives and defences through techniques such as 1) free association and 2) transference B.1.1) Probing the Unconscious (2) - free association: expressing thoughts and feelings exactly as they occur with as little censorship as possible - dream analysis: therapist interpret the symbolic meaning of clients’ dreams B.1.2) Interpretation - therapist’s attempts to explain the inner significance of the client’s 1) thoughts, 2) feelings, 3) memories and 4) behaviors > simply offers explanation that seem to be out of client’s reach B.1.3) Resistance - unconscious defensive manoeuvres intended to hinder the progress of therapy B.1.4) Transference - occurs when clients unconsciously start relating to their therapist in ways that mimic critical relationships in their lives > clients may relate to therapists as though they are: overprotective mother, rejecting brother or a passive spouse - this is encouraged as it helps to bring repressed feeling and tend to be lengthy - THE WHOLE PURPOSE: from here, clients will be able to recognize the source of their problem B.1.5) Modern Psychodynamic Therapies - Central features of modern psychodynamic therapies: 1) focus on emotional experience 2) exploration of efforts to avoid distressing thoughts and feelings 3) identification of recurring patterns in patients’ life experiences 4) discussion of past experience, especially event in early childhood 5) analysis of interpersonal relationships 6) focus on the therapeutic relationship itself 7) exploration of dreams and other aspects of fantasy life Example: Carl Jung, Alfred Adler, Melanie Klein, Heinz Kohut B.2) Client-Centred Therapy (Person-Centred Therapy) – LOOKS LIKE CONFIDENCE- BUILDING - a type of insight therapy that emphasizes providing a supportive emotional climate for clients, who play a major role in determining the pace and direction of their therapy - focus: clients don’t have to always worry about pleasing others and winning acceptance > encourage clients to respect their own feelings and values > ultimately: foster self-acceptance and foster growth B.2.1) Therapeutic Alliance: The Importance of Therapy Climate - stress on the relationship between client and the therapist - consists of: > emotional bond between therapist and client > consensus on goals for the therapy and agreement on the therapeutic tasks [heading towards the same way] - Factors needed to create this condition 3(THERAPISTS HAVE TO BE PROACTIVE): 1) genuineness: therapists cant act like fraud. Be as honest as possible so that clients will reciprocate 2) Unconditional +ve regard: show nonjudgmental acceptance to clients and can disapprove of a particular behavior while continuing to value the client as a human being 3) Empathy: being able to position oneself in client’s perspective - supportive climate is important to reduce client’s defence tendencies and help to open up B.2.2) Therapeutic Process (the progress of the therapy) - provides feedback to client to help sort out their feelings - 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 Treatment developed: - Emotion-focused couples therapy (Les Greenberg) > focus on emotions to the treatment of dysfunctional relationships > Steps: the nature of the relationship issues and underlying emotions are first identified > partners are encouraged to express these needs - evident in Carl Rogers and Fritz Perls - client-centred therapy like psychoanalysis therapy also strive to reconstruct clients’ personality B.3) Therapies Inspired by Positive Psychology 1) Well being-therapy: Giovanni Fava > seek to enhance client’s self-acceptance, purpose in life, autonomy and personal growth 2) Positive psychotherapy: Martin Seligman > mainly used in treatment of depression > attempts to get client to recognize their strengths, appreciate their blessings, savor +ve experiences, forgive those who wronged them and find meaning in their lives > proven to be effective: compared with treatment as usual and treatment as usual w medication B.4) Group Therapy - the simultaneous treatment of several clients in a group B.4.1) Participants’ Roles - selection of participants is crucial - participants function as therapists to one another - activities: describe problems, trade viewpoints, share experiences and discuss coping strategies - the group provide acceptance and support. As they value each other’s opinions, they tend to work hard to win approval - therapist’s role: selecting participants, setting goals for the group, initiating and maintaining the therapeutic process and protecting clients from harm B.4.2) Advantages of the Group Experience - participants realize that their misery is not unique - work on their social skills in a safe environment - save time and money B.5) Couples and Family Therapy - Couples or marital therapy: treatment of partners in intimate relationships and the main focus is on relationship issues - family therapy: treatment of a family unit as a whole in which the main focus is family dynamics and communication - both therapies strive to improve communication and move towards healthier patterns of interaction - marital: clarify needs, enhance communication pattern, increase role flexibility, work out balance of power and deal with conflict more constructively B.6) How Effective Are Insight Therapies? - Spontaneous remission: a recovery from a disorder that occurs without formal treatment > when disorder clears up on its own 5 insight therapies: psychoanalysis, client-centred, positive, group, couple and marital and family C) Behavior Therapies (4) - make no attempt to help client achieve grand insights about themselves - crux of insight versus behavioral therapy: insight treat symptoms as clues for the underlying problem whilst behavioral treats symptoms as the problem - hence, behavioral includes the effort to change one’s maladaptive behavior < CHANGE BEHAVIOR - assumption for behavioral therapy: > behavior is a product of learning - what has been learned can be unlearned C.1) Systematic Desensitization (for phobic disorder) - reduce phobic client’s anxiety responses by counterconditioning > target: weakens the link between conditioned stimulus and conditioned response Three Steps: 1) therapists help clients to build anxiety-hierarchy > rank stimuli from the least anxiety-arousing to most-anxiety arousing 2) Training the client in deep muscle relaxation > must engage in deep, thorough relaxation on command from the therapist 3) client tries to work out through the hierarchy, learning to remain relaxed while imagining each stimulus < IMAGINE ONLY/PASSIVE ACTION > clients imagine the anxiety-arousing stimulus as vividly as possible > this process is repeated until clients are able to imagine the situation without getting anxious > after the stimulus is conquered, move on the next level > as client managed to conquer imagined phobic stimuli, they are encouraged to confront the real stimuli***** - Trick: counterconditioning- recondition people so that the conditioned stimulus elicits relaxation instead of anxiety - exposure therapies: clients are confronted with feared situations so that they learn that these situations are really harmless > very versatile treatment. Can treat: OCD, PTSD, panic disorder C.2) Aversion Therapy (Most Controversial Treatment) - aversive stimulus is paired with a stimulus that elicits undesirable response (recall sauce bernace case) > treat drug and alcohol abuse, sexual deviance, gambling, shoplifting, stuttering, smoking, binge eating C.3) Social Skills Training (Improve Interpersonal skills) - treatment designed to improve interpersonal skills by emphasizing on modeling, shaping and behavioral rehearsal - can be conducted individually or in a group - modeling: client is encouraged to watch socially skilled friends and colleagues in order to acquire appropriate responses - behavioral rehearsal: clients try to practice social techniques in structured role-playing exercises - shaping: clients are gradually asked to handle more complicated and delicate social situations C.4) Cognitive-Behavioral Treatment- (correct client’s maladaptive pattern of thinking) - treatment that uses varied combination of verbal interactions and behavior modifications to help clients change maladaptive patterns of thinking - cognitive therapy: correct habitual thinking errors that underlie various types of disorders > goal: change client’s negative thoughts and appraisals and maladaptive beliefs - depression-prone people tend to have these –ve thoughts: 1) blame their setbacks on personal inadequacies without considering circumstantial explanations 2) foc
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