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Chapter 15

PSYA02 - Chapter 15.docx

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University of Toronto Scarborough
Steve Joordens

Chapter 15 – Treatment of Psychological Disorders Treatment: Getting Help to Those Who Need It - the personal costs of the disorders involve anguish to the sufferers as well as interference in their ability to carry on the activities of daily life Why People Cannot or Will Not Seek Treatment - people may fail to get treatment because of 3 major problems: 1. People may not realize that their disorder needs to be treated: => the origin of mental illness is “hidden” and usually cannot be diagnosed by a blood test => some people believe that mental illness is a sign of personal weakness or that people suffering from are not trying hard enough to help themselves 2. There may be barriers to treatment, such as beliefs and circumstances that keep people from getting help: => in some cases, families discourage their loved ones from seeking help because the public acknowledgment of a psychological disorder may be seen as an embarrassment to the family => there may be financial obstacles => barriers may even arise from treatment providers or facilities themselves, such as long waiting lists, etc 3. Even people who acknowledge they have a problem may not know where to look for services: => even when people seek and find help, they sometimes do not receive the most effective treatments => before choosing or prescribing a therapy, we need to know what kinds of treatments are available and understand which treatments are best for particular disorders Approaches to Treatment - Treatments can be divided into 2 kinds: -> psychotherapy, in which a person interacts w/ a psychotherapist -> mental or biological treatments, in which the mental disorder is treated w/ drugs or surgery Psychological Therapies: Healing the Mind through Interaction - PSYCHOTHERAPY => is an interaction b/w a therapist and someone suffering from a psychological problem, w/ the goal of providing support or relief from the problem - each approach to psychotherapy is unique in its goals, aims and methods - ECLECTIC PSYCHOTHERAPY => a form of psychotherapy that involves drawing on techniques from different forms of therapy, depending on the client and the problem - this allows the therapists to apply an appropriate theatrical perspective that is suited to the problem at hand rather than adhering to a single theatrical perspective for al clients and all types of problems Psychodynamic Therapy - PSYCHODYNAMIC PSYCHOTHERAPIES => explore childhood events and encourage individuals to use this understanding to develop insight into their psychological problems - there are a number of different psychodynamic therapies, but they all share the belief that the path to overcoming psychological problems is to develop insight into the unconscious memories, impulses, wishes, and conflicts that are assumed to underlie these problems Psychoanalysis - psychoanalysis assumes that humans are born w/ aggressive and sexual urges that are repressed during childhood development through the use of defense mechanisms - psychoanalysts encourage their clients to bring these repressed conflicts into consciousness so that the clients can understand them and reduce their unwanted influences How to Develop Insight - a psychoanalyst uses several key techniques to develop insight: Free Association: - in free association, the client reports every thought that enters the mind, w/o censorship or filtering - this strategy allows the stream of consciousness to flow unimpeded Dream Analysis: - psychoanalysts treat dreams as metaphors that symbolize unconscious conflicts or whishes that contain disguised clues that the therapist can help the client understand Interpretation: - this is the process by which the therapist deciphers the meaning underlying what the client says and does - during the process of interpretation, the analyst suggests possible meaning to the client, looking for signs that the correct meaning has been discovered - but its not that easy - the analyst could overinterpret the client’s thoughts and emotions and sometimes even contribute interpretations that are far from the truth Analysis of Resistance - in the process of “trying on” different interpretations of the client’s thoughts and actions, the analyst might suggest an interpretation that the client finds unacceptable - RESISTANCE => reluctance to cooperate w/ treatment for fear of confronting unpleasant unconscious material - if a client always shifts the topic to discussion away from a particular idea, that might signal to the therapist that this is indeed an issue the client could be directed to confront in order to develop insight The Process of Transference - TRANSFERENCE => occurs when the analyst begins to assume a major significance in the client’s life and the client reacts to the analyst based on unconscious childhood fantasies - successful psychoanalysis involves analyzing the transference so that the client understands this reaction and why it occurs - insight, may be enhanced because interpretations of the client’s interaction w/ the therapist also have implications for the client’s past and future relationships Beyond Psychoanalysis - modern psychodynamic theory reflects the contributions of many people who followed Freud - Carl Jung and Alfred Adler agreed w/ Freud that insight was a key therapeutic goal but disagreed that insight involves unconscious conflicts about sex and aggression - Jung emphasized what he called the collective unconscious, the culturally determined symbols and myths that are shared among all people - Adler believed that emotional conflicts are the results of perceptions of inferiority and that psychotherapy should help people overcome problems resulting from inferior social status, sex roles and discrimination - Melanie Klein believed that primitive fantasies of loss and persecution were important factors underlying mental illness - Karen Horney disagreed w/ Freud about inherent differences in the psychology of men and women and traced such differences to society and culture rather than biology - INTERPERSONAL PSYCHOTHERAPY (IPT) => a form of psychotherapy that focuses on helping clients improve current relationships - therapists using IPT try to focus treatment on the person’s interpersonal behaviors and feelings - they pay particular attention to the client’s grief, role disputes, role transitions, or interpersonal deficits - IPT differs from classic psychotherapy in many ways: -> the therapist and client sit face – to – face -> therapy is less intensive, w/ therapy lasting months rather than years - in contrast to classical psychoanalysis, modern psychodynamic therapists are more likely to see relief from symptoms as a reasonable goal for therapy and are more likely to offer support or advice in addition to interpretation Behavioral and Cognitive Therapies - behavioral and cognitive treatments emphasize the current factors that contribute to the problem – maladaptive behaviors and dysfunctional thoughts Behavior Therapy - BEHAVIOR THERAPY => assumes that disordered behavior is learned and that symptom relief is achieved through changing overt maladaptive behaviors into more constructive behaviors - variety of behavior therapy techniques have been developed for many disorders based on operant conditioning procedures (which focus on reinforcement and punishment) and classical conditioning procedures (which focus on extinction) - below are the 3 examples of behavior therapy techniques: 1. Eliminating Unwanted Behaviors: -> the study of operant conditioning shows that behavior can be predicted by its consequences (reinforcing or punishing events that follow) -> adjusting these might help change the behavior -> making the consequences less reinforcing and more punishing could eliminate the problem behavior 2. Promoting Desired Behaviors: -> a behavior therapy technique knows as TOKEN ECONOMY => involves giving clients “tokens” for desired behaviors, which they can later trade for rewards -> token economies have proven to be effective while the system of rewards is in place, but the learned behaviors are not usually maintained when the reinforcements are discontinued 3. Reducing Unwanted Emotional Responses: - EXPOSURE THERAPY => involves confronting an emotion – arousing stimulus directly and repeatedly, ultimately leading to a decrease in the emotional response - a behavioral method originated by psychiatrist Joseph Wolpe - this technique depends on the process of habituation and response extinction that were originally discovered in the study of classical conditioning - this form of treatment is called SYSTEMATIC DESENSITIZATION => a procedure in which a client relaxes all the muscles of his or her body while imagining being in increasingly frightening situations - it’s now known that in vivo exposure, or live exposure is more effective than imaginary exposure - in other words, if a person fears social situations, it is better for that person to practice social interaction than to merely imagine it - easier situations are practiced first, and as fear decreases, the client progresses to more difficult or frightening situations - exposure therapy can also help people overcome unwanted emotional and behavioral responses through exposure w/ response prevention Cognitive Therapy - COGNITIVE THERAPY => focuses on helping a client identify and correct any distorted thinking about self, others, or the world - cognitive theorists might emphasize the meaning of the event - it might not be the event itself that caused the fear, but rather the individual’s beliefs and assumptions about the event and the feared stimulus - cognitive therapies use a technique called COGNITIVE RESTRUCTURING => which involves teaching clients to question the automatic beliefs, assumptions, and predictions that often lead to negative emotions and to replace negative thinking w/ more realistic and positive beliefs - specifically, clients are taught o examine the evidence for and against a particular belief or to be more accepting of outcomes that may be undesirable yet still manageable - some forms of cognitive therapy include techniques for coping w/ unwanted thoughts and feelings, techniques that resemble meditation - clients are encouraged to attend to their troubling thoughts or emotions or may be given meditative techniques that allow them to gain a new focus - MINDFULNESS MEDITATION => teaches an individual to be fully present in each moment; to be aware of his or her thoughts, feelings, and sensations; and to detect symptoms before they become a problem Cognitive Behavioral Therapy - the extent to which therapists use cognitive versus behavioral techniques depends on the individual therapist as well as the type of problem being treated - most therapists working w/ anxiety and depression use a blend of cognitive and behavioral therapeutic strategies => COGNITIVE BEHAVIORAL THERAPY (CBT) - this technique acknowledges that there may be behaviors that people cannot control through rational thought but also that there are ways of helping people think more rationally when thought does play a role - in contrast to traditional behavior therapy and cognitive therapy, CBT is “problem focused” -> meaning that it is undertaken for specific problems and “action oriented” -> meaning that the therapist tries to assist the client in selecting specific strategies to help address those problems - this is in contrast to psychodynamic or other therapies where goals may not be explicitly discussed or agreed on and the client’s only necessary action is to attend the therapy sessions - CBT is transparent in that nothing is withheld from the client - by the end of the course of therapy, most clients have a very good understanding of the treatment they have received as well as the specific techniques that are used to make the desired changes - substantial effects of CBT have been found for unipolar depression, GAD, panic disorder, social phobia, anxiety disorders, childhood depressive and PTSD Humanistic and Existential Therapies - these therapies assume that human nature is generally positive, and they emphasize the natural tendency to each individual to strive for personal improvement - they share the assumption that psychological problems stem from feelings of alienation and loneliness and these feelings can be traced to failures to reach one’s potential (humanistic approach) or from failures to find meaning in life (existential approach) Person-Centered Therapy (Humanistic Approach) - PERSON-CENTERED THERAPY => also known as client-centered therapy, assumes that all individuals have a tendency toward growth and that this growth can be facilitated by acceptance and genuine reactions from the therapist - psychologist Carl Rogers developed this therapy - this type of therapy assumes that each individual is qualified to determine his or her own goals for therapy, such as making a career decision or feeling more confident - the therapist tends not to provide advice or suggestions about what the client should be doing - Rogers encouraged these therapies to demonstrate 3 basic qualities: -> Congruence – refers to openness and honesty in the therapeutic relationship and ensuring that the therapist communicates the same message to all levels -> Empathy – refers to the continuous process of trying to understand the client by getting inside his or her way of thinking, feeling, and understanding the world -> the therapist must treat the client w/ unconditional positive regard – by providing a nonjudgmental, warm, and accepting environment in which the client can feel safe expressing his or her thoughts and feelings - the therapist tries to understand the client’s experience and reflects that experience back to the client in a supportive way, encouraging the client’s natural tendency toward growth Gestalt Therapy - founded by Frederick “Fritz” Perls - GESTALT THERAPY => has the goal of helping the client become aware of his or her thoughts, behaviors, experiences, and feelings and to “own” or take responsibility for them - to help facilitate the client’s awareness, Gestalt therapists also reflect back to the client their impressions of the client - this
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