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PSY240 Txt Notes 15,17,18.docx

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Psychology
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PSY240H5
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Hywel Morgan

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Chapter 15 – Behaviour and Emotional Disorders of Childhood and Adolescence ** Main disorders discussed in this chapter areADHD, oppositional defiant disorder, and anxiety disorder Historical Perspective ­ How we study and perceive children changes throughout time as means of doing so advances (ex. genetic testing) ­ Most child psychologists today study disorders with the idea that the issue is biological ­ In the beginning abnormal child behaviour was attributed to inadequate parenting and that the child needed a more strict upbringing, mostly because children were thought to be incapable of reason and that their behavioural problems were a reflection of their environment (bad parenting = bad environment = bad child) ­ Mandatory schooling created the opportunity to identify those who had intellectual delays and were the FIRST PROBLEMS to be studied ­ At the end of the 1800s, attention shifted to abnormal brain functioning to be the source, based on observations that many disordered children had parents who were low in intellectual functioning ­ Leo Kanner made the first textbook for child psychiatry and provided a framework for assessment, including sections on personality problems arising from physical illness, psychosomatic problems, behavioural problems, and a practical guide on collecting patient history ­ Child guidance clinics were first introduced in the States and England ­ The first forms of research in children’s mental disorders were descriptions of children with autism and behavioural issues with deficient maternal care or overprotection ­ The first population survey in Ontario in the 1980s addressed questions that dealt with child psychology ­ The main diagnostic text for psychiatric disorders used in North America (the DSM) has evolved to include child psychiatric disorders ­ It is still a topic for debate in the DSM, though, as to what the onset times are for some of these childhood disorders ­ Treatments in child psychiatry include family therapy and psychoanalytic therapy, influenced by Anna Freud and Melanie Klein, prior to the discovery of medications to treat hyperactivity Current Issues in Assessing and Treating Children andAdolescents ­ The main issues are studying age-specific variations in symptoms and to establish what is normal behaviour/emotion for a child based on age ­ This is because children may present different symptoms based on their cognitive stage and because change and development of new skills or brain maturation may be adaptive to children and reduce their symptoms ­ Youth are influenced by their environments, which can influence the presentation of symptoms which is why parents or teachers report a child’s problems, not so much the child ­ When trying to identify a mental disorder in a child, the psychologist will look at the patient first, and then at additional information (which will also help direct the development of treatment plans) ­ The proves of providing a diagnosis for a given clinical presentation and figuring out whether or not the diagnosis is reliable is an ongoing issue Prevalence of Childhood Disorders ­ Mental disorders in childhood are divided into: 1. Externalizing Problems: attention deficit/hyperactivity disorder (ADHD), oppositional deviant disorder (ODD), and conduct disorder (CD) 2. Internalizing Problems: separation anxiety (SAD), selective mutism, reactive attachment disorder (RAD), anxiety disorders, and mood disorders ­ In the DSM4, externalizing problems and some internalizing problems are in the section “Disorders Usually First Diagnosed in Childhood”, however, anxiety and mood disorders are not included in this section because it’s assumed that these disorders are essentially the same disorder in children and in adults ­ Although there’s a distinction between externalizing and internalizing problems, it’s possible for one person to have both ­ Comorbidity is when two types of disorders can coexist in the same person ­ Children will often receive more than one diagnosis at a given time, but their current diagnosis is often predictive of their receiving the same diagnosis in the future (homotypic continuity) or receiving a different diagnosis in the future (heterotypic continuity) ­ In order of prevalence (aka. Commonness) of child mental disorders: 1. Any Disorder 2. Anxiety Disorders 3. Conduct Disorder 4. ADHD ­ The prevalence of mental disorders varies by the sex and age of the child ­ Females are more likely to be diagnosed with mood or anxiety disorders ­ Males are more likely to be diagnosed with behaviour or substance use disorders Attention Deficit/ Hyperactivity Disorder (ADHD) ­ Are motorically and verbally hyperactive ­ Have problems maintaining their focus in conversations and activities ­ Show impulsive and erratic behaviours ­ Almost always emerge in early childhood, although some aspects improve with brain maturation Clinical Description Classification of Subtypes - In DSM4, symptoms are grouped into: 1. Hyperactivity 2. Inattention 3. Impulsivity - Based on the main symptom shown, the child will receive one of the following diagnoses: 1. ADHD-I  inattentive type 2. ADHD-H  hyperactive-impulsive type 3. ADHD-HI  combined type - Girls will more likely haveADHD-I, symptoms reflecting in listening, learning, remembering, organization and motor control; they’ll have messy handwriting and problems eating neatly - Boys will more likely have eitherADHD-H orADHD-HI, symptoms including interrupting others, fidgeting, and motor hyperactivity Validity of Subtypes - It’s recommended that in the DSM5 that there are no subtypes, but instead classifying all youth with ADHD as having the combined type and specifying clearly what the predominant subtype is over the past 6 months Comorbidity - Most people with ADHD have other mental disorders - Children with the hyperactive and combined subtypes will have problems with their academic, employment, and relationships Prevalence - Order of prevalence: 1. Children and adolescents 2. Pre-school aged children 3.Adults - More boys than girls haveADHD Developmental Trajectory -Most children with ADHD continue to have symptoms that require a chronic approach to management as they age -Adults withADHD have greater academic problems and lower occupational attainment Etiology ­ Most research goes into comparing brains of children withADHD versus those without ­ There’s a strong biological basis forADHD in that many of the symptoms are related to delays or abnormalities in the development of the connections between emotional and motor areas of the brain ­ Medications focus on these parts ­ It was calledADD in the 1970s in the DSM2 and the diagnosis was made on the basis of three symptoms: inattention, impulsivity, and hyperactivity ­ It was renamed ADHD in the 1980s in the DSM3 and two new diagnostic features were required: functional impairment and symptoms being present before the age of seven ­ The cause ofADHD is not known for sure because it’s often found to be paired with other disorders ­ Because the cause is still unknown, these are the risk factors that may lead toADHD: Brain Structure and Function -Reduced brain size -Abnormalities in the metabolism of dopamine and neurotransmitters -Abnormalities in the functioning of genes that regulate these neurotransmitter systems -MRIs show abnormalities in the prefrontal cortex (executive functioning) and the basal ganglia (higher motor control, learning, and memory) -There’s a marked delay when peak thickness throughout the cerebellum is attained, which is responsible for motor control and attention which causes clumsiness and poor emotional self-regulation Genetics -Family and twin studies show that more than half of the kids that get ADHD are due to genetics Prenatal Risk Factors -Toxins such as poor diet, exposure to antidepressants, drugs, lead, and alcohol have been proven to causeADHD along with many other mental health disorders Psychosocial Risk Factors -Includes low socio-economic status, large family size, paternal criminality, and child maltreatment Gene-Environmental Interactions -Psychiatric disorders are not the result of nature or nurture, but the result of nature via nurture -It’s any interaction between genes and the environment -It’s similar to the diathesis-stress perspective of disease, which says that environmental stressors should exact their greatest toll on individuals who have an underlying genetic vulnerability Assessment and Treatment ­ Assessments of the child’s development and academic, social, and family functioning are required to make a diagnosis ­ The severity of the impairment and potential worsening factors (anxiety, learning disabilities, etc.) need to be identified ­ Self-reports are used as children approach adolescence ­ An understanding of the developmental history, the onset of problems and the degree of impairment, medical diagnoses (ex. toxin exposure), possible psychological issues, and family mental health history are also required Pharmacological Treatment -The main form of treatment forADHD is the use of stimulant medication which works by increasing the release of dopamine and norepinephrine from storage sites in nerve terminals -Anew medication, atomoxetine, alters levels of brain norepinephrine -These medications increase reaction time, short-term memory, and learning of new material -Stimulant medications include short-acting or long acting methylphenidate (Ritalin) -Side effects of stimulant medications include weight loss, trouble falling asleep, headaches, and increased irritability -Despite the use of stimulants, most children withADHD will continue to have social, academic, and emotional difficulties Psychoeducational -Adults responsible for the child (parents and teachers) are educated about Interventions the symptoms, course of the disorder, and deficits associated with ADHD and how they can facilitate the use of the child’s strengths to his/her advantage -This info helps parents and teachers feel that they have a role to play in facilitating the child’s development with ADHD Academic Skill Facilitation -School-focused interventions forADHD symptoms are required to ensure that the child is achieving the academic and social skills appropriate for his/her age developmental level -Ex. Scheduled breaks, the use of the reward system, auditory versus written instructions, and the use of agendas can help improve a child’s academic performance Parent Training -Parent education helps them develop skills to manage their child’s ADHD related problem behaviours -Parents learn techniques to help the child modify his/her won behaviours by providing rewards and attention when the child completes a task or ceases a negative behaviour Other Treatments -There is less convincing evidence for family therapy, cognitive-behavioural therapy, and social skills training in helping a child’s ADHD symptoms -The most effective treatments are those that help children to enhance their deficient self-motivation and working memory to show what they know as opposed to teaching them something new -The current gold standard in the treatment ofADHD is multimodal- a combo of stimulants and some targeted combos of non-drug interventions Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) ­ Will frequently argue with adults, have temper tantrums, deliberately annoy others, and are spiteful and vindictive ­ They don’t take responsibility for their actions and blame others for their outbursts ­ Is generally diagnosed by the time children are eight years old ­ Their negativistic behaviours and poor attitude are obvious to parents and teachers ­ It’s argued that ODD is an earlier expression of CD, which also has hostile behaviour ­ Most children won’t develop CD after being diagnosed with ODD ­ What differentiated CD from ODD is that the behaviours in CD violate the basic rights of others or major societal norm or rules ­ The DSM4 organizes CD behaviour into these groups: 1. Aggressions directed towards people or animals 2. Destruction of property 3. Deceitfulness or theft 4. Serious violations of rules ­ The DSM5 wants to divide the ODD symptoms and distinguish irritable mood from defiant behaviours ­ Most children with CD or ODD also haveADHD or learning difficulties ­ Some children with CD display psychopathic tendencies, showing a general disregard for others and are not distressed by their negative behaviour and showing no remorse ­ The specifier asks clinicians to consider if the child shows at least two of the following characteristics, which are persistent for over 12 months: 1. Lack of remorse 2. Callous lack of empathy 3. Absence of concern about performance at school or work 4. Shallow or deficient affect Clinical Description Classification of -The DSM4 includes three subtypes of CD: Subtypes 1.Childhood-onset type (before the age of 10) 2.Adolescent-onset type 3.Unspecified onset type Sex Differences -Boys are more likely to meet the diagnostic criteria for CD, but girls are more likely to be diagnosed with CD at a later age than boys -More boys than girls have ODD -Conduct problems in girls are associated with outcomes such as teen pregnancy and suicidal behaviour, issues that become more pronounced if girls with CD become involved with antisocial partners -Females with CD tend to date men with CD, called assortative mating Comorbidity -Conditions associated with ODD and CD tend to be externalizing -Most people with ODD also meet the criteria for another lifetime disorder, mainly ADHD Prevalence -Prevalence of ODD in preschool is 12%, and the lifetime prevalence being 10% -Prevalence of CD in preschool is 7% -Boys have it more than girls Developmental -Most people diagnosed with antisocial personality disorder had CD as a child Trajectory -Most people diagnosed with CD had ODD earlier on in childhood Etiology ­ The real cause of ODD and CD is unknown and are not likely to be the result of any one factor Genetics -Runs in families -However, as antisocial parents are not only contributing their genes to their offspring, but also raising them in environments that tend to be less than nurturing Neurobiology -Aggression is associated with decreased glucose metabolism in the frontal lobe and damage to the prefrontal cortex (regulates the neural systems that mediate the basic reaction to threat) -Damage to the amygdala (emotion centre) is linked to aggressive behaviours -Aggression is also associated with serotonergic abnormalities such as reduction in the turnover of serotonin -Low norepinephrine is linked to conduct disorders -High testosterone isn’t fully associated with aggressive behaviour -The underarousal of the autonomic nervous system (low heart rate) is found with aggression and in psychopaths Neurological -Early difficult temperament, low IQ, reading disorders, lack of empathy, and poor social cognition Prenatal Risk Factors -Maternal smoking is predictive of CD as is substance abuse Psychosocial Risk Factors -Poor parenting, harsh discipline, and child abuse is linked to externalizing difficulties in children -Other psychosocial correlates include peer rejection, association with deviant peers, large family size, lone-parent families, teenage parenthood, and poverty Gene-Environment -In a study, almost all of the individuals who were severely maltreated in Interactions childhood and had low monoamine oxidase activity had CD Treatment ­ Methods for treating ODD and CD include: 1. Problem-solving skills 2. Pharmacological interventions 3. Parent management training 4. School and community based treatments Problem Solving Skills -Deficits in problem-solving skills and social perception are found in children Training with aggressive conduct problems and are more likely to interpret ambiguous situations as being hostile -This training combines different procedures, which include modeling and practice, role-playing, and reinforcement contingencies Pharmacological -Mood stabilizers, neuroleptics (antipsychotic meds), and stimulants help Treatment children with CD -Mood stabilizers are effective in short-term therapy for inpatient aggressive children -Neuroleptics improve symptoms -The stimulant methylphenidate is most commonly prescribed and improves some symptoms of CD even when ADHD isn’t present Parent Training -Parent training (PT) programs use the coercive process where interactions between the parent and the child assessed, promoting prosocial behaviour while also applying effective discipline techniques to minimize the negative behaviour School and -Group or peer programs in schools help reduce the stigmatization of children Community Based with mental health issues Treatments Anxiety Disorders ­ Separation anxiety disorder (SAD) is listed separately in the childhood disorders section in the DSM4 because it’s unique to childhood ­ Children can have any type of anxiety disorder, including generalized anxiety disorder (GAD) Clinical Description ­ The main symptom of SAD is distress when separated from the attachment figure, often accumulating to a full-blown panic ­ They’re fearful of new situations, new people, change, something happening to their parents, and for changes in activities ­ They withdraw or appear timid as a means of reducing their exposure to distressing situations ­ Hallmark features for SAD include: distress upon separation from a parent, excessive worry about losing a parent, excessive worry that an event will harm the parent, reluctance to go places without the parent or to sleep away from the parent, and physical symptoms when separation occurs ­ Children with SAD tend to recover within the first year of its onset, but 1/3 of children develop other anxiety disorders later on ­ The main symptoms of GAD are having different types of worries, finding it difficult to control their worries, and that worries are accompanied by physical symptoms ­ The main difference between SAD and GAD is that, with GAD, the distress and uncertainty the child feels becomes directed outward to the world around them, where they become concerned about whether others like them, worry about doing badly at school, etc. Comorbidity -Children with anxiety disorders also have mood disorders -Homotypic comorbidity (one anxiety disorder with another anxiety disorder) was low, whereas heterotypic comorbidity (an anxiety disorder with another disorder) was high Prevalence -Order of prevalence: 1.SAD 2.GAD 3.Social anxiety disorder 4.Simple phobias -Fewer children experience other common anxiety disorders of adulthood, such as OCD, panic disorder, and PTSD -Anxiety disorders are equally found in boys and girls Developmenta -In a longitudinal study, children who had SAD continued to have SAD years later while l Trajectory children who had GAD went on to have panic attacks, depression, and CD later on in life Etiology ­ Compared to externalizing disorders, far less is known about the etiology of anxiety Temperament -Will have had a history of anxious temperament (called behavioural inhibition, where children display a withdrawal or fear behaviours in novel situations) in infancy -This temperament style will persist throughout life in most affected children with their risk of developing more anxiety disorders increasing (more than children who are not behaviourally inhibited) Brain Structure and -Abnormal functioning in the temporal lob, altering a person to threat Function -Higher resting heart rates and blood pressure Genetics -Heritable -But, environment plays a role in the development of anxiety Prenatal Risk -Stress during pregnancy will increase the chances of the child having an anxiety Factors disorder because it increases the amount of cortisol (stress hormone) on the developing brain Psychosocial Risk -It’s not typical for the same anxiety disorder to be passed form parent to child, Factors suggesting that the genetic risk may be channeled by the type of environment in which the child grows up in -The child learns what and how to fear from the parent and through experiences (classical conditioning) Gene-Environment -Most anxiety is thought o be a result from fear conditioning, where the brain is Interactions engaged by threats that the person would naturally want to avoid and the neutral stimulus becomes paired with the threat to induce a similar fear and avoidance response Treatment ­ The main aim of treatment of anxiety is reduction of children’s physical symptoms and their pattern of avoidance of situations that would provoke their fear symptoms ­ This reduction in physical symptoms of anxiety will help the children think more clearly about their anxieties and how to function more normally ­ Treatment first includes providing psychoeducation about the causes of anxiety and which of the child’s behaviours are most likely related to anxiety (which is provided to the child, parents, and teachers) Cognitive-Behavioural -Most used method is the Coping Cat program Treatment -Components of CBT include extensive education about anxiety ad the treatment approach, helping the parents and child learn new ways to cope with anxiety (skills building) and systematic exposure to anxiety-provoking situations in which they can practice their skills -Many anxious children have a parent who is also anxious Pharmacological -Selective serotonin reuptake inhibitors (SSRIs) are often used Treatment Chapter 17 – Therapies Biological Treatments ­ First treatments of psychological disorders were biological, such as bleeding, leeches, etc. ­ In the late 1800s, they used physical strategies designed to calm disturbed behaviour such as physical restraints, warm baths, or cold baths Electroconvulsive Therapy ­ In the 1930s, they began creating seizures in patients through ECT because they noted that patients with schizophrenia who spontaneously experienced epileptic seizures showed a reduction in their symptoms ­ ECT is still used to treat severe depression that hasn’t responded to other treatments ­ ECT used to have severe side effects, but they’ve been minimized through less intense currents ­ Anesthesia and muscle relaxants reduce distress and the risk of injury ­ The most common side effect today with ECT is retrograde amnesia ­ Problems with ECT are that more than half of the patients that are treated with ECT relapse and that there’s a risk for cognitive impairment Psychopharmacology ­ Psychoactive agents affect the individual’s psychological functioning ­ When developing new meds, you first have to understand the pathological process by which a disorder develops, then identify an agent that will change that process ­ Drugs are grouped according to their application in the disorder they treat: Antipsychotics -Prior to the development of this class of drugs in the 1950s, patients diagnosed with schizophrenia typically spent their lives confined in psychiatric institutions -The development of tranquilizers offered the possibility of reducing psychotic symptoms such as hallucinations and offered relief to patients -Once the drug was stabilized, patients were able to return to the community -It was economically beneficial because less money was being spent on institutionalizing patients -These drugs don’t cure schizophrenia, instead they control its symptoms -Many patients want to discontinue their medication when they are feeling symptom- free, increasing their risk of relapsing -To address this concerns, medication can be delivered through intramuscular injection rather than orally -After a few weeks of taking major tranquilizers, some patients experience extrapyramidal effects similar to the symptoms of Parkinson’s disease, including muscular rigidity, stooped posture, and drooling -Anew negation of antipsychotic meds such as clozapine and olanzapine have fewer extrapyramidal effects, but have the side effect of weight gain -There’s no evidence proving that the newer generation of drugs is more effacious than the older antipsychotics -The second generation antipsychotics have mood-stabilizing properties, which make them effective in the treatment of bipolar disorder Anxiolytics -Are used to alleviate symptoms of anxiety and muscle tension -This is done by reducing activity in parts of the CNS, which lowers activity in the sympathetic nervous system, leading to lower respiration and heart rate and decreased muscle tension -Aproperty in barbiturates (the first class of anxiolytic drugs) is that patients develop a tolerance for them which means that they need to take more for it to maintain its effectiveness, but large doses of barbiturates are highly toxic, which make them a common choice for suicide attempts -Benzodiazepines (the second class) offer effective control of anxiety without toxicity at high doses, but they’re addictive and sudden withdrawal can provoke convulsion that may be life-threatening – so they’re only used for brief periods Antidepressants -Main types of antidepressants are: 1.MAOIs  includes severe dietary restrictions because certain foods can cause high blood pressure 2.TCAs  side effects include dry mouth, blurry vision, constipation, etc., is toxic in overdose (ironic because it’s meant for depression but can be used for suicide) 3.SSRIs  most recently developed (ex. Prozac), side effects include nausea, sleepiness, headaches, etc., help with eating disorders and anxiety disorders, lower toxicity in overdose, higher risk of suicidal behaviours when taking SSRIs than when taking a placebo 4.SNRIs  flu-like symptoms will occur if SNRIs are stopped abruptly -They take time to reach beneficial levels in the blood, so improvement is typically evident only after a few weeks of treatment -Benefits of antidepressants are more pronounced in those with severe depression -Depression is a major risk factor for suicidal behaviour Mood Stabilizers -Lithium and related mood stabilizers reduce rapid cycling between depressive and manic or hypomanic states in bipolar disorder -Side effects of lithium at therapeutic dosages include nausea, weight gain, etc. -There’s a narrow window of effectiveness, with low doses being ineffective and high doses being toxic Stimulants -Used in the treatment ofADHD -Ritalin reduces hyperactive and impulsive behaviour, allowing the child to sustain attention -Side effects are appetite suppression and sleep disturbance Psychotherapy:ADefinition ­ Aprocess in which a professionally trained therapist systematically uses techniques derived from psychological principles to relieve another person’s psychological distress or to facilitate growth ­ Psychology, psychiatry, social work, medicine, and nursing Theoretical Orientations ­ The main types of psychotherapy practiced by therapists today include psychodynamic, cognitive- behavioural, humanistic-experimental, and integrative or eclectic PsychodynamicApproaches ­ Freud said that psychological problems have their roots in early childhood and in unconscious conflicts ­ The main goal is to help patients understand the unconscious factors that drive/control their behaviour ­ Psychoanalysts rely on these basic techniques: 1. FreeAssociation  says everything that comes to mind without censoring thoughts. The analyst helps the patient recognize unconscious motives and conflicts expressed in the spontaneous speech 2. Dream Interpretation  distinguishes between the manifest content of the dream (consciously remembered by the client) and the more important latent content (the unconscious ideas) 3. Interpretation  interprets what the client says or does. Slips of the tongue, forgetfulness, and the clients behaviour are presumed to reveal unconscious impulses, defence mechanisms, or conflicts 4. Analysis of Resistance  clients may become resistant, like not wanting to discuss certain topics, joking during sessions, or remaining silent. Resistance prevents painful or difficult thoughts, and the therapist must determine the source of resistance 5. Analysis of Transference  transference occurs when the client responds to the therapist as he or she responded to significant figures from is or her childhood. Freud thought that individuals unconsciously re-experience repressed thoughts during transference Brief Psychodynamic -Alexander and French Psychotherapy -Used Freudian techniques in an active , flexible manner -Is short term, with sessions occurring twice a week instead of daily -Goals are concrete, there are conversations (not free association), and therapists are empathetic (not emotionally detached) -Interpretations focus on current life events (not childhood fears/conflicts) Ego Analysis -Horney and Erikson -Argued that Freudian analysis was too focused on the unconscious sexual and aggressive motivation -Believed that individuals are capable of controlling their own behaviour -Ego analysts use Freudian techniques to explore the ego rather than the id -Therapists help clients understand how they have relied on defence mechanisms to cope with conflicts Adler’s Individual Psychology -Proposed that sexual and aggressive instincts are less important than the individual’s striving to overcome personal weakness -Based on the assumption that mental disorders are the consequence of deeply entrenched mistaken beliefs, which lead individuals to develop a maladaptive style of life that protects them from discovering their own imperfections -Therapists interpret dreams in terms of current behaviour, offer direct advice, and encourage new behaviours Interpersonal Psychodynamic -Believed that mental disorders resulted from maladaptive early Psychotherapy interactions between child and parent -Is a variation of brief psychodynamic therapy -Emphasizes the interactions between the client and his/her social environment -Therapists provide feedback to help the client understand how his/her interpersonal styles are provoking conflicts and helps the client learn to interact with others in more flexible and positive ways Time-Limited Dynamic -Tends to be briefer and involves the client to be face to face with the Psychotherapy therapist -Retains Freud’s emphasis on analysis of transference as a central mechanism of therapeutic change -Therapists help identify patterns of interaction with others that strengthen unhelpful thoughts about self and others -Atherapeutic alliance is important, because the quality of the relationship between therapist and client is recognized to be a predictor of therapy outcome Humanistic-Experimental Approaches ­ Focuses on the person’s subjective experience, giving attention to emotional aspects of experience ­ Places emphasis on the person’s current experience rather than on the past ­ Encourages the client to take responsibility for personal choices ­ Emphasizes the human qualities of the therapist ­ Therapists are more effective when their clients feel that they are genuine Client-Centered Therapy -Rogers -Emphasizes the warmth and permissiveness of the therapist and the tolerant climate in which the feelings of the client can be expressed -Believed that psychological problems arise when personal growth is stunted by judgments imposed by others -This creates conditions of worth in which the client believes that he/she must meet the standards of others in order to be a worth while person -Genuineness and empathy by the therapist help provide an atmosphere of acceptance Existential Therapy -Inspired by the work of existential philosophers -Focuses on the importance of the human situation as perceived by the individual, with the main goal of making the client more aware of his/her own potential for growth and capacity for making choices -Therapists don’t follow any particular procedures, but emphasize the uniqueness of each individual -Therapists challenge and confront the client on past and present choices -Therapists share themselves, their feelings, and their values with the client -They examine the lack of meaning in a person’s life and this type of therapy works best with those who are having conflicts regarding their existence or those with anxiety or personality disorders Gestalt Therapy -Perls -Emphasizes the idea that individuals have a distorted awareness of genuine feelings hat leads to impairments in personal growth and behavioural problems -Therapists help clients become more aware of feelings and needs that have been ignored or distorted -The main goal is client awareness -Clients must integrate both their inner feelings and their external environments -Clients are instructed to communicate directly by talking to people rather than about them -The most popular technique is the empty chair technique, used to make the client more aware of his/her genuine feelings Emotion-Focused Therapy -The client enters into an empathic relationship with a therapist who is directive and responsive to his/her experience -Used on depression, trauma, and marital distress by enhancing and then focusing on clients’emotional reactions Cognitive-Behavioural Approaches ­ The term behaviour therapy was first used in the 1950s to describe an operant conditioning treatment for psychotic patients ­ Behavioural approaches emphasize that problem behaviours are learned and that faulty learning can be reversed ­ Behaviour therapy includes research findings from areas such as perception, cognition, and the biological basis of behaviour ­ Behavioural therapists focus on present thoughts and beha
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