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PSY100Y5 (809)
Dax Urbszat (681)
Chapter 15


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Dax Urbszat

Chapter 15: Treatment of Psychological Disorders Notes The Elements of the Treatment Process 1. Treatments: How Many Types Are There? • 3 major categories: 1.Insight therapies : • based on “talk therapy” in the tradition of Freud’s psychoanalysis •clients engage in complex verbal interactions with their therapists •the goal is to pursue increased insight regarding the nature of the client’s difficulties and to sort through possible solutions •can be conducted with an individual or a group •family therapy and marital therapy fall in this category 2. Behaviour therapies: •based on principles of learning •behavioural therapists make direct efforts to alter problematic responses(ex. phobias) and maladaptive habits(ex. drug use) •work to change the client’s over behaviour •most of their procedures involve classical conditioning, operant conditioning,or observational learning 3. Biomedical therapies: •involve interventions into a person’s biological functioning •most used procedures are drug therapy and electroconvulsive (shock) therapy only provided by a physicians with a medical degree • 2. Clients: Who Seeks Therapy? • most common are anxiety and depression • people often delay for many years before finally seeking treatment for psychological problems • client in treatment does not necessary have an identifiable psychological disorder; some people seek professional help for everyday problems • many people equate seeking therapy with admitting personal weakness 3. Therapists: Who Provides Professional Treatment? a) Psychologists: • clinical psychologists’ training emphasizes the treatment of full-fledged disorders • counseling psychologists’ training is slanted toward the treatment of everyday adjustment problems both types of psychologists must earn a doctoral degree • • in providing therapy,psychologists use either insight or behavioural approaches more likely to use behavioural techniques than psychoanalytical techniques • b) Psychiatrists: psychiatrists - physicians who specialize in the diagnosis and treatment of psychological disorders • psychiatrists devote more time to relatively severe disorders,such as schizophrenia • they have an M.D. degree; they psychotherapy training occurs during their residency,since the required course work in medical school is the same for everyone • psychiatrists increasingly emphasize on drug therapies and are more likely to use psychoanalysis c) Other Mental Health Professionals: • in hospitals and other institutions,clinical social workers and psychiatric nurses often work as part of the treatment team with a psychiatrist or psychologist • psychiatric nurses,who may have a bachelor’s or master’s degree in their field,play a large role in hospital inpatient treatment • clinical social workers have a master’s degree and typically work with patients and their families to ease the patient’s integration back into the community • counsellors also provide therapeutic services and usually have a master’s degree; specialize in particular types of problems Insight Therapies insight therapies - involve verbal interactions intended to enhance clients’ self-knowledge and thus promote healthful changes in personality and behaviour. 1. Psychoanalysis: 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,such as phobic,panic,obsessive-compulsive, and conversion disorders,which were then called neuroses • Freud believed that neurotic problems are caused by unconscious conflicts left over from early childhood he also believed that these inner conflicts involve battles among the id,ego,and superego,usually over • sexual and aggressive impulses • people depend on defence mechanisms to avoid confronting these conflicts,which remain hidden in the depths of the unconscious. a) Probing the Unconscious: • the analyst attempts to probe the murky depths of the unconscious to discover the unresolved conflicts causing the client’s neurotic behaviour free association - clients spontaneously express their thoughts and feelings exactly as they occur,with as little censorship as possible. • clients expound on anything that comes to mind,regardless of how trivial,silly,or embarrassing it might be • gradually,most clients begin to let everything pour out without conscious censorship • the analyst studies these free associations for clues about what is going on in the client’s unconscious dream analysis - the therapist interprets the symbolic meaning of the client’s dreams • Freud say dreams as the most direct means of access to patients’ innermost conflicts,wishes,and impulses • clients are encouraged and trained to remember their dreams, and then the therapist analyses the symbolism in these dreams to interpret their meaning b) Interpretation: interpretation - refers to the therapist’s attempts to explain the inner significance of the client’s thoughts, feelings,memories,and behaviours. • analysts offer interpretations that should be just out of the client’s own reach c) Resistance: resistance - refers to largely unconscious defence manoeuvers intended to hinder the progress of therapy • clients try to resist the helping process because they don’t want to face up to the painful,disturbing, conflicts that they have buried in their unconscious • resistance can take many forms: • clients can show up late • they can merely pretend to engage in free association • they may also express hostility toward the therapist d) Transference: transference - occurs when clients unconsciously start relating to their therapist in ways that mimic critical relationships in their lives. • the client transfers conflicting feelings about important people onto the therapist psychoanalysts often encourage transference so that clients can re-enact relationships with crucial people in • the context of therapy these re-enactments can help bring repressed feelings and conflicts to the surface,allowing the client to • work through them e) Modern Psychodynamic Therapies: • classical analysis is not widely practice anymore many variations on Freud’s original approach to psychoanalysis have developed over the years,and collectively • known as psychodynamic approaches to therapy adaptations were made by Carl Jung,Alfred Adler,Melanie Klein,and Heinz Kohut • • interpretation,resistance,and transference still play a key role 2. Client - Centred Therapy: client - centred therapy - an 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. • Carl Rogers developed this therapy using the humanistic perspective • Rogers maintains that most personal distress is due to inconsistency,or “incongruence,” b/w a person’s self- concept and reality • incongruence makes people feel threatened by realistic feedback about themselves from others • excessive incongruence is thought to be rooted in client’s overdependence on others for approval and acceptance • client-centred therapists help clients to realize that they do not have to worry constantly about pleasing others and winning acceptance • they encourage clients to respect their own feelings and values a) Therapeutic Climate: • according to Rogers, the process of therapy is not as important as the emotional climate in which the therapy takes place • he believes that it’s critical for the therapist to provide a warm,supportive,accepting climate • client therapies must provide 3 conditions: 1. Genuineness - therapist must be genuine with the client,communicating honestly and spontaneously 2.Unconditional positive regard - the therapist must also show complete,nonjudgemental acceptance of the client as a person and provide warmth and caring for the client,with no strings attached. 3.Empathy - the therapist must provide accurate empathy,which means that the therapist must understand the client’s world from the client’s point of view. b) Therapeutic Process: the client and therapist work together as equals • • therapist provides little guidance and keeps interpretation and advice to minimum the therapist provides feedback to help clients sort out their feelings • • therapists’ key task is clarification - they help clients become more aware of their true feelings by highlighting themes that may be obscure in the clients’ rambling discourse • emotion-focus therapy - acknowledging and working with the underlying emotions 3. Therapies Inspired by Positive Psychology: • positive psychology uses theory and research to better understand the positive,adaptive,creative,and fulfilling aspects of human existence • well-being therapy seeks to enhance clients’ self-acceptance,purpose in life,autonomy,and personal growth • effective treatment for mood disorders and anxiety disorders • positive psychotherapy attempts to get clients to recognize their strengths,appreciate their blessings,savour positive experiences,forgive those who have wrong them,and find meaning in their lives • effective treatment for depression 4. Group Therapy: group therapy - the simultaneous treatment of several clients in a group a) Participant’s Roles: • group therapy typically consists of 4 to 15 people • the therapist usually screens the participants,excluding people who seem likely to be disruptive • participants essentially function as therapists for one another • group members describe problems,trade viewpoints,share experiences,discuss coping strategies, and most importantly, they provide acceptance and emotional support for one another • as members come to value one another’s opinions,they work hard to display healthy changes to win the group’s approval • therapist’s 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 tries to promote a healthy climate • the leader in group therapy expresses emotions,shares feelings,and copes with challenges from group members b) Advantages of the Group Experience: • save time and money participants often come to realize that their misery is not unique • • provides an opportunity for participants to work on their social skills in a safe environment certain types of problems and clients responds especially well to the social support that group therapy can • provide 5. Evaluating Insight Therapies: spontaneous remission - a recovery from disorder that occurs without formal treatment. • studies indicate that insight therapy is superior to no treatment or to placebo treatment and that the effects of the therapy are reasonably durable • studies generally find the greatest improvement early in treatment(the first 13-18weekly sessions),with further gains gradually diminishing in size over time 6. How Do Insight Therapies Work? • the advocates of various types of therapies tend to attribute the benefits of therapy to the particular methods and procedures used by each specific approach to therapy • theorists argue that diverse approaches to therapy share certain common factors and that these common factors account for much of the improvement experienced by clients • common factors include: • the development of a therapeutic alliance with a professional helper • the provision of emotional support and empathic understanding by the therapist • the cultivation of hope and positive expectations in the client • the provision of a rationale for the client’s problems and a plausible method for reducing them • the opportunity to express feelings,confront problems,gain new insights,and learn new patterns of behaviour Behaviour Therapies • insight therapists treat pathological symptoms as signs of an underlying problem,whereas behaviour therapists think that the symptoms are the problem behaviour therapies - involve the application of learning principles to direct efforts to change clients’ maladaptive behaviour • behavioural therapies are based on certain assumptions: 1.It is assumed that behaviour is a product of learning. 2.It is assumed that what has been learned can be unlearned. • behavioral therapists attempt to change clients’ behaviour by applying the principles of classical conditioning, operant conditioning,and observational learning 1. Systematic Desensitization: systematic desensitization - a behaviour therapy used to reduce phobic clients’ anxiety responses through counterconditioning. • this treatment assumes that most anxiety responses are acquired through classical conditioning according to this model, a harmless stimulus(ex. a bridge) may be paired with a fear-arousing event(lightning • striking in the bridge),so that it becomes a conditioned stimulus eliciting anxiety the goal of this treatment is to weaken the association b/w the conditioned stimulus and the conditioned • response of anxiety it involves 3 steps: • 1.First,the therapist helps the client build an anxiety hierarchy: • the hierarchy is a list of anxiety-arousing stimuli related to the specific source of anxiety • the client ranks the stimuli from the least anxiety-arousing to the most anxiety-arousing • the ordered list of stimuli is the anxiety
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