chapter 18 textbook notes

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16 Apr 2011

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-1Chapter 18 The Treatment of Mental Disorders
Four basic approaches to treatment of mental disorders: insight therapies, behaviour
therapy and cognitive-behaviour therapies, treatment of groups (including treatment
of couples and the development of outreach programs that serve the community), and
biological treatments
Mental Disorders and Psychotherapy
Early Treatment of Mental Disorders:
Mental disorders have been with us since the beginning of human existence
People with the disorders were regarded with fear or awe
Often considered possessed by devils or evil sprits and made to suffer accordingly
Earliest known attempts to treat mental disorders - trephining: drilling holes into a
persons skull; the opening permitted evil spirits to leave the victims head
Signs of healing in prehistoric skulls show that some people survived trephining
People were thought to possess evil spirits; exorcisms performed, beatings, starving,
near drowning, drinking of foul-tasting concoctions
People thought they deserved to be punished because they wereevil
A few people in the 18th century decided that disorders reflected diseases and should
be treated medically and with compassion (Johann Wier, 16th century was one of first
to challenge practices combating witchcraft; his writings were banned from Church
and re-emerged in 20th century)
People with mental disorders often consigned to variousasylums to be cared for;
most institutions were very inhumane - kept in chains, wallowed in their own
Many treatments were only a little better than the tortures used before to drive out evil
spirits - ex. Tied up, doused in cold water, forced to vomit, etc.
Humanitarians changed this treatment
Philippe Pinel - believed most mental patients would respond well to kind treatment;
his patients showed improvement
The discovery of antipsychotic drugs and improvements in psychotherapy have freed
many people who would otherwise be in institutions
The Development of Psychotherapy:
Mesmer - theory of “magnetic fluxes - he attempted to effect cures by manipulating
iron rods and bottles of chemicals
He hypnotized his patients and alleviated some of their symptoms; hypnosis was first
known as mesmerism
Freud created practice of psychoanalysis (ch.14) - his methods are still influential in
today’s treatment
Therapists adopt approaches that fit their views of why people behave the way they do
- Therapists who believe that that behaviour is strongly influenced by the environment
and peoples perception of them will use cognitive-behavioural approaches
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- Those that believe behaviour is strongly influenced by biological factors are likely to
use a combination of drug therapy and psychotherapy
Most therapists use a more general, eclectic approach which involves the therapist
using whatever methods they feel will work best for a particular client at a particular
seek the form that will best suit the clientoften combining different treatment
Insight Therapies (insight will lead to a cure)
Insight therapy: assume that people are essentially normal but learn maladaptive
thought patters and emotions, which are revealed in maladaptive behaviours
Viewing behaviours as symptom of deeper underlying psychological problems
once the person understands their problems, the behaviours will cease
Some insight therapies focus on the clients past; Client-centered and Gestalt
therapies emphasize the present (attempt to get the client to see the effects of their
maladaptive thoughts and find more adaptive ways of living)
Psychoanalysis: a form of therapy aimed at providing the client with insight into their
unconscious motivations and impulses
-clues about the origins of intrapsychic conflict are revealed through dreams, physical
problems, memory (or failure to remember certain things) manner of speech and their
reactions to therapy
-main goal is to interpret the clues about the origins of the intrapsychic conflict;
clients’ own interpretations are often biased so they’re inaccurate
Clients job is to provide something to interpret
Freud felt thatveil of amnesia” lifts the moment that insight is achieved; client then
begins to understand the true nature of his/her problems
Successful treatment depends on psychoanalysts interpretations and ensuring the
patient has capacity to understand and integrate what is learned in therapy
Psychoanalytic Techniques:
Free Association: Freud used this technique to encourage the client to speak freely
without censoring possibly embarrassing or socially unacceptable thoughts. The
client was encouraged to report any thoughts or images that came to mind without
worrying about their meaning. He also attempted to minimize any authoritative
influence over the clients disclosures by eliminating eye contact
Dream interpretation - the evaluation of underlying meaning of dream content; its a
hallmark of psychoanalysis
The analyst must be able to distinguish between the dreams manifest (actual images
and events) and latent (hidden meaning or significance) contents.
-the manifest content masks the latent content because the latent content is anxiety-
provoking and causes the persons psychological discomfort
Resistance: the client often becomes defensive during therapy, unconsciously
attempting to halt further insight by censoring their true feelings (when the client
changes topic, begin missing appointments, or suddenly forgets what they are talking
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Transference: the client relives aspects of childhood and projects powerful attitudes
and emotions onto the therapist (may come to love or hate the therapist with the same
intensity of the powerful emotions experienced in childhood towards parents or
-Freud saw this as essential for the success of therapy
-it provides means for reliving significant early experiences; by becoming a substitute
for the actual people in the clients life, the therapist acts as a tool for illuminating the
unconscious conflicts
Countertransference: the therapist projects their emotions onto the client because
he/she is human too (this is unhealthy and undesirable); the therapist should remain
detached and objective
Modern Psychodynamic Therapy:
Modern psychodynamic theory (what used to be psychoanalysis) reflects differences
between modern psychoanalytic approaches and original form of Freudian
places less emphasis on the sexual factors during development and more emphasis on
social and interpersonal experiences
Also more likely to address issues and concerns of clients present life instead of early
childhood experiences only
Modern psychodynamic therapists also they view the ego as having a more active role
in influencing a persons thoughts and actions; the ego has more control over the
Brief psychodynamic therapy takes 10-25 sessions and its goal is to understand &
improve the clients interpersonal skills through interpretation of transference
processes (based on Freuds belief hat early experiences with others influence the
dynamics of our current relationships)
Behaviour is only important to the extent that it serves as a manifestation of the real,
underlying motive or conflict
Humanistic Therapy
Aim is to provide the client with a greater understanding of their potential for
personal growth and self-actualization (assumption that humans are good and have
innate worth)
Two forms of Humanistic therapy: client-centered therapy and Gestalt therapy
2. Client-centered Therapy (Carl Rogers) : client is given respect; they decide
what to talk about without direction or judgment from therapist
-the client takes responsibility for resolving their problems
-Rogers believed that the cause of many psychological problems can be traced to
peoples perceptions of themselves as they actually are (real selves) as differing
from the people they would like to be (ideal selves)
-Incongruence: the discrepancy between the real and ideal perceptions of the
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