Ch.18 notes.doc

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18 Mar 2012

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Ch.18 Treatment of Mental Disorders
Early Treatment of Mental Disorders
Trephining a surgical procedure in which a hole is made in the skull of a living person; earliest
known attempt to treat mental disorders – opening was made to permit evil spirits to leave victim’s
- in prehistoric times, this procedure was performed with a sharp-edged stone
- many other painful and degrading practices were directed at people’s presumed possession
by evil sprits – people thought to be unwilling hosts for evil spirits were subjected to curses
or insults designed to persuade demons to leave
- if this approach did not work, exorcism was attempted, to make person’s body an
unpleasant place for devils to reside
- other rituals included beatings, starving, near drowning, drinking of foul-tasting
- 18th century – many Europeans still believed that devils and spirits were responsible for
peculiar behaviours in some people
- Later on, medical authorities and general public regarded people with mental disorders as
ill – torture and extreme prosecution stopped
- People with mental illness eventually regarded as harmless but strange – most consigned to
asylums that were inhumane (patients tied up, doused in cold water, bled, made to vomit,
- Pinel (physician) believed that most mental patients would respond well to kind treatment
oHe tried an experiment where he took off chains from patients and took them out of
dungeons and allowed them to walk freely about the hospital grounds – it was a
success! Many patients were discharged b/c they were ok.
oLed to campaign for humane treatment of mental patients and building of first
mental hospital in Nova Scotia
The Development of Psychotherapy
- Jean Martin Charcot, a French neurologist began to study therapeutic uses of hypnosis
when one of his students hypnotized a woman and induced her to display symptoms of a
conversation reaction (hysteria) – concluded she was a hysterical patient
- The student then woke the woman and her symptoms vanished
- Charcot had previously believed that hysteria had an organic basis but this experience
changed his opinion
- Some psychotherapists adopt approaches to treatment that fit their own views of why
people behave the way they do – i.e. therapists who believe that behaviour is strongly
influenced by environmental contingencies, and people’s perceptions of them, are likely to
use cognitive-behavioural approaches to treating their client’s problems
- Therapists who believe that behaviour is strongly influenced by biological factors are likely
to use combination of drug therapy and psychotherapy in treating their client’s problems
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-Eclectic Approach – a form of therapy in which the therapist uses whatever method he/she
feels will work best for particular client at particular time
oNot strongly wedded to particular theoretical orientations
oCombining aspects of several different treatment approaches according to particular
client’s problem and personal circumstances
Psychoanalysis and Modern Psychodynamic Approaches
Psychoanalysis – a form of therapy aimed at providing the client with insight into his/her
unconscious motivations and impulses
- in the early stages of therapy, the nature of the client’s problems are difficult to identify b/c
the analyst and the client are unaware of the underlying, unconscious conflicts
- repression of these conflicts is seldom complete, though and they frequently intrude into
consciousness in subtle ways
- by encouraging the client to talk, the analyst tries to bring these conflicts into view –
obscurity of conflicts requires that analyst interpret them in order to uncover their true
meaning an gradually weave together a complete picture of unconscious
- purpose of therapy is to create a setting in which clues about origins of intrapsychic
conflicts are most likely to be revealed by client – in dreams, physical probs, memory,
manner of speech, cognitive/emotional reactions to therapy
- main goal of psychoanalyst is to interpret clues about origins of intrapsychic conflict given
by client – emphasize interpretation as basic means of uncovering root causes of clients’
- client’s main job is to provide psychoanalyst with something to interpret: fears, anxieties,
thoughts, repressed memories
- successful treatment depends not only on the psychoanalyst’s interpretations, but also on
ensuring that the patient has capacity to understand and integrate what is learned in therapy
Psychoanalytic Techniques
Free association – a psychoanalytical procedure in which the client is encouraged to speak freely,
without censoring possibly embarrassing or socially unacceptable thoughts or ideas
- client encouraged to report any thoughts or images that came to mind, without worrying
about their meaning
- minimize any authoritative influence over client’s disclosures by eliminating eye contact
-dream interpretation: evaluation of underlying meaning of dream content
-manifest content: actual images and events that occur within the dream
-latent content: hidden meaning or significance of dream
- manifest content masks latent b/c it is anxiety provoking and causes person psychological
- therapist must be skilled in recognizing symbolic nature of dreams
resistance – a development during therapy in which client becomes defensive, unconsciously
attempting to halt further insight by censoring his/her true feelings
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- when client tries to change topic, beings to miss appointments for therapy, or suddenly
forgets what he/she about to say
- therapist will redirect discussion to sensitive topics which minimizing pain of rediscovery
transference – process by which client begins to project powerful attitudes and emotions onto
- client may begin to love or hate therapist with same intensity of powerful emotions
experienced in childhood toward parents or siblings
- provides means for reliving significant early experiences
countertransference – process by which therapist projects his/her emotions onto client
- to be effective, analyst must remain emotionally detached and objective in his/her appraisal
of client’s disclosures
Modern Psychodynamic Theory
-psychoanalysis often referred to as psychodynamic theory
- modern psychodynamic therapists view ego as playing more active role in influencing
person’s thoughts and actions
- they believe that ego is proactive component in one’s overall psychological functioning
-brief psychodynamic therapy: 10-25 sessions; goal is to improve client’s interpersonal
skills through interpretation of transference process; focuses on schemata that a client has
about interpersonal relationships and attempts to modify those that are incorrect or that
otherwise prevent the client form developing fulfilling relationships with others
Humanistic Therapy
Humanistic therapy – a form of therapy focusing on person’s unique potential for persona growth
and self-actualization
- these therapies proceed from the assumption that people are good and have innate worth
Client-Centred Therapy
Client-centred therapya form of therapy in which client is allowed to decide what to talk about
without strong direction and judgment from therapist
- client takes ultimate responsibility for resolving his/her problems; focus of therapy is on
client, not a method or rigid theory
incongruence – a discrepancy between a client’s real and ideal selves
- goal is to reduce incongruence by fostering experiences that will make attainment of ideal
self possible
- believed that many psychological problems can be traced to people’s perceptions of
themselves as they actually are (their real selves) as differing from the people they would
like to be (their ideal selves)
- therapist strives to make thoughts, feelings, and perspectives more noticeable to client by
reflection (sensitive rephrasing or mirroring of client’s statements) – done to establish
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