Chapter 18

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11 Oct 2010
Chapter 18 Notes – The Treatment Of Psychological Disorders
Early treatment of psychological disorders involved trephining
a surgical procedure in which a hole is made in the skull of a living person
This opening was made to permit evil spirits to leave the victim’s head, and was
performed with a sharp-edged stone in prehistoric times
Exorcisms were attempted too, with other rituals including beating, starving, near-
drowning, and drinking foul-tasting concoctions
As society progressed, their treatment became more humane, while other times at
asylums, patients were treated horribly, sometimes kept in chains and wallowing in
their own excrement
Philippe Pinel was a French physician who in 1793 conducted an experiment in terms of treating
patients nicer; the experiment was a success
Pinel’s success encouraged similar reforms elsewhere, such as Dorothea Dix in the US,
where she was responsible for layingthe groundwork for the first psychiatric hospital in
Nova Scotia
The modern approach to therapy can be traced to Franz Anton Mesmer, an Austrian physician
who devised a theory of “magnetic fluxes”, where he attempted to effect cures by manipulating
iron rods and bottles of chemicals
In reality, he hypnotized his patients and thereby alleviating some of their symptoms,
and as a result, hypnosis was first known as mesmerism
Jean Martin Charcot began to study hypnosis when one of his students induced her to display
the symptoms of a conversion reaction (then called hysteria)
Examining her, he then determined she was hysterical; the student woke up the woman,
and the symptoms vanished
Before Freud began private practice, he studied with Charcot
Freud then created the practice of psychoanalysis
Regardless of theoretical orientation, all therapists have in common a strong commitment to
helping people solve their problems
Eclectic approach
a form of therapy in which the therapist uses whatever method he
or she feels will work best for a particular client at a particular time
This often means combining aspects of several different treatment approaches
according to a particular client’s problem and personal circumstance
Every therapy except for 1 has the same key principle: making aware that which you are not
aware of
The only exception is behaviour therapy, where behaviourism is simply just looking at
behaviour; the outcome
All major therapies has this as their goal: exposing you to that which you are afraid of
With behaviour therapy being effective for phobias
Insight therapy assume that people are essentially normal but learn maladaptive thought
patterns and emotions, which are revealed in maladaptive behaviours
i.e. insight therapy gives you insight on things you don’t know about yourself
a form of therapy aimed at providing the client with insight into his or her
unconscious motivation and impulses, devised by Sigmund Freud
In the early stages of therapy, the nature of the client’s problems are difficult to identify
because the analyst and the client are unaware of the underlying, unconscious conflicts
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The repression of these conflicts is seldom complete though, and they frequently
intrude into consciousness in subtle ways
The purpose of therapy is to create a setting in which clues about the origins of conflicts
are most likely to be revealed by the client
One of the main goals of the psychoanalyst is to interpret the clues about the origins of
intrapsychic conflict given by the client
Although people may provide their own interpretations, Freud argued that
people are biased observers of their own problems and thus interpretations are
While the psychoanalyst’s primary role is interpretation, the client must provide the
psychoanalyst with things to interpret; this is not an easy task to accomplish because
the client unconsciously invokes one or more defence mechanisms, which prevent
anxiety-provoking memories and ideas from reaching conscious awareness
Freud felt that the “veil of amnesia” lifts the moment that insight is achieved; the client
begins to understand the true nature of his or her problems
Free association
a psychoanalytic procedure in which the client is encouraged to speak freely,
without censoring possibly embarrassing or socially unacceptable thoughts or ideas
Freud achieved his goal in two ways:
First the client was encouraged to report any thoughts or images that came to
Second Freud attempted to minimize any authoritative influence over the
client’s disclosure by eliminating eye contact
The way you talk face-to-face with other people, such as friends, is the
way you talk when you have eye contact, and as such by avoiding this,
you avoid talking like normal
When you’re lying down, you really listen to what you say, and you
reflect upon it
A desk is a barrier
In normal conversation, silence is awkward
You don’t want to make eye contact; the true meaning in
therapy happens in silence
Freud believed that dreams were a crucial component of psychoanalysis
Dream interpretation is a hallmark of psychoanalysis devised by Freud
But even dream content is subject to some censoring, so the analyst must
distinguish between the dream’s manifest and latent contents
Insight is not achieved quickly, nor do clients always find it easy to disclose private
aspects of their personal lives
In fact, there is a paradox involved in achieving insight, for the often painful or
threatening knowledge resulting from insight is precisely what led to its repression in
the first place
a development during therapy in which the client becomes defensive,
unconsciously attempting to halt further insight by censoring his or her true feelings
the process by which a client begins to project powerful attitudes and
emotions onto a therapist
This may happen as the client relives aspects of their childhood; the client may
come to love or hate the therapist with the same intensity of the powerful
emotions experienced in childhood toward parents or siblings
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the process by which the therapist projects his or her emotions
onto the client
Freud believed this to be unhealthy
You must recognize the response to a client’s transference
You must recognize where your feelings are coming from; is it their issues? Or
does it trigger your own response about your own issues? Knowing this will help
you focus on the client
To be effective, the analyst must remain emotionally detached and objective in his or
her appraisal of the client’s disclosures
For this, the analyst should undergo complete analysis with another therapist, in
order to understand his or her own unconscious conflicts, and to know when to
avoid them and if they are being influenced by them
A positive aspect about psychoanalysis in modern times is that you must go through your own
psychoanalysis for 2 years
If you’re a victim, you’re the worst kind of therapist there is because you’re biased,
unless you get counselling and understand your own issues
When people ask about deep changes, they mean “I want my therapist to change the world to
when my defence mechanisms worked”
Insight without emotional resonance is meaningless;
“Insight” should come from the patient, or the therapist must deliver it with an emotional punch
Insight in this context refers to knowledge, understanding, and awareness
“How do you know when therapy is working?
It’s when they want to stop coming because of the goal of exposing fears to
make them uncomfortable
Resistance occurs because you unconsciously don’t want to go to the scary
Psychodynamic therapy
a variation of the Freudian approach to therapy in which therapists
search for unconscious conflicts and motivations but do not adhere strictly to Freud’s
conception of psychoanalysis
Although psychodynamic therapies still focus on achieving insight, they tend to place
less emphasis on psychosexual development and more emphasis on social and
interpersonal experiences, including the complex structure and dynamics of self
Psychodynamic therapists view the ego as a more influential role, rather than merely
mediating between the id and superego
With intermittent psychodynamic therapy, clients do not continuously see a therapist;
rather they often take lengthy breaks from therapy or stop altogether and return only
when a need arises
Another form of psychodynamic therapy is brief psychodynamic therapy, which takes
about 10-25 sessions to complete, with the goal being to understand and improve the
client’s interpersonal skills through the interpretation of transference processes
This focuses on the client’s schemata for interpersonal relationships and
attempts to modify those that are maladaptive
Humanistic therapy
a form of therapy focusing on the person’s unique potential for personal
growth and self-actualization
Humanistic therapies proceed from the assumption that people are inherently good and
have innate worth
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