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Chapter 15

PSYA02 - Chapter 15

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University of Toronto Scarborough
Steve Joordens

PSYA02 – Chapter 15 – Treatment of Psychological Disorders Treatment: Getting Help to Those Who Need It - Almost one in five people suffer from some type of mental disorder - Impairment is widespread, affecting family life, the ability to work, maintenance of friendships & more o Ex. Schizophrenia/serve depression: Unable to hold down a job/get organized enough to collect a welfare check - People with many disorders top getting along with family/people who try to help Why People Can’t or Will Not Seek Treatment - 3 major problems why people fail to receive treatment o 1. People may not realize that their disorder needs to be treated.  It is often taken as seriously as physical illness (origin of mental illness is hidden). The belief that it can be cured because of “mind over matter.”Some people believe that mental illness is a sign of personal weakness or that people suffering from mental illness are not trying hard enough to help themselves. o 2. There may be barriers to treatment, such as beliefs and circumstances that keep people from getting help.  Family members discourage loved ones from getting help because it can be seen as an embarrassment to the family. Financials obstacles to getting treatment (lack of medical insurance). Barriers may arise (long waiting lists, lack of staff education about most up-to-date education. o 3. Even people who acknowledge they have a problem may not know where to look for services.  Finding the right psychologist is harder than simply flipping though the yellow pages. Approaches to Treatment - 2 types of treatment o 1. Psychotherapy : Person interacts with a psychotherapist; focuses on the mind o 2. Medical/Biological Treatments: Treated with drugs or surgery; focuses on brain and body  Both Treatments may be used; For flying: virtual reality therapy and anxiety medication may be used Psychological Therapies: Healing the Mind through Interaction - Psychological therapy/psychotherapy: an interaction between a therapist and someone suffering from a psychological problem, with the goal of providing support or relief from the problem - Eclectic Therapy: A form of psychotherapy that involves drawing on techniques from different forms of therapy, depending on the client and the problem. Psychodynamic Therapy - Psychodynamic psychotherapies: Explore childhood events and encourage individuals to use this understanding to develop insight into their psychological problems - There are numbers of different 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 - Assumes that humans are born with aggressive and sexual urges that are repressed during childhood development through defence mechanisms - Encouraged to bring repressed conflicts into consciousness so that the client can understand them and reduce unwanted influences - Focuses mostly on early childhood events as it is believed urges and conflicts were likely to be repressed during that time - Takes place over an average of 3 – 6 years, four or five sessions a week - Asked to sit on a couch, lying down and asked to express what’s on their mind How to Develop Insight - Goal of Psychoanalysis: For the client to understand the unconscious in a process Freud called “developing insight” - Several key techniques to help client develop insight o 1. Free Association  Client is asked to report everything that enters the mind, without censorship or filtering. Therapist may look for themes that recur during therapy sessions o 2. Dream Analysis  Dreams are treated as metaphors that symbolize unconscious conflict or wishes that contain disguised clues that the therapist can help the client understand o 3. Interpretation  Therapist deciphers the meaning underlying what the client says and does. Analyst suggests possible meanings to the client, looking for signs that the correct meaning has been discovered. Analyst could over interpret the client’s thoughts and emotions and sometimes even contribute interpretations that are far from the truth. o 4. Analysis of Resistance  Resistance: A reluctance to cooperate with treatment for fear of confronting unpleasant unconscious material. The Process of Transference - Client and psychoanalyst often develop a close relationship o Clients would develop an unusually strong attachment, almost as though they were viewing (him) as a parent or a lover, and (he) worried that this could interfere with achieving the goal of insight - Transference: Occurs when the analyst begins to assume a major significant in the client’s life and the client reacts to the analyst based on unconscious childhood fantasies - The ultimate goal of psychoanalysis, may be enhanced by interpretations of the client’s interaction with the therapist also possibly having implications for the client’s past and future relationships Beyond Psychoanalysis - Modern psychodynamic theory reflects contributions of many who followed, including his students - Carl Jung and Alfred Adler agreed with Freud that insight was a key therapeutic goal but disagreed that insight usually involves unconscious conflicts about sex and aggression - Jung emphasized collective unconscious, culturally determined symbols and myths that are shared among all people that, he argued, could serve as a basis for interpretation beyond sex or aggression - Adler believed that emotional conflicts are the result of perceptions of inferiority and that psychotherapy should help people overcome problems resulting from inferior social status, sex roles and discrimination - Melanie Klein; believed primitive fantasises of loss and persecution were important factors underlying mental illness - Karen Horney; disagreed with Freud about inherent differences in the psychology of men and women and traced such differences in the psychology of men and women and traced such differences to society and culture rather than biology - These social themes have been developed most explicitly in interpersonal psychotherapy (IPT) - Interpersonal Psychotherapy (IPT): a form of psychotherapy that focuses on helping clients improve current relationships - Therapists using IPT focus on the person’s interpersonal behaviours and feelings. Particular attention to grief, role disputes, role transitions, or interpersonal deficits - IPT Therapies o Client sits face to face, therapy is less intensive; meetings occur once a week and lasts months Behavioral and Cognitive Therapies - Behavioural and cognitive theories; emphasize the current factors that contribute to the problem – “maladaptive behaviours & dysfunctional thoughts” Behaviour Therapy - Was inspired by behaviourism o Behaviourists rejected theories that were based on “invisible” mental properties that were difficult to test and impossible to observe directly - Behaviour Therapy: Assumes that disordered behaviour is learned and that symptom relief is achieved through changing overt maladaptive behaviours into more constructive behaviours o Techniques  Operant conditioning procedures (Focus on reinforcement and punishment)  Shows behaviour can be predicted by its consequences  Classical conditioning procedures (Focus on extinction) Eliminating Unwanted Behaviours - Behaviour can be predicted by its consequences (the reinforcing or punishing events that follow) - Adjusting these might help change the behaviour o Making the consequences less reinforcing and more punishing could eliminate the problem behaviour Promoting Desired Behaviours - Patients may sometimes become unresponsive and apathetic, withdrawing from social interaction and failing to participate in treatment programs – solution : “Token economy” - Token Economy: Giving clients “tokens” for desired behaviours, which they can later trade in for rewards o Proven to be effective but not usually maintained when reinforcements are discontinued o Similar systems used in classrooms may work temporarily but can undermine student’s interest in these behaviours when the reinforcements are no longer available  Ex. Child who is rewarded for controlling his temper inn class may become an ogre on the playground when no teacher is present to offer rewards for good behaviour Reducing Unwanted Emotional Responses - Most powerful ways to reduce fear is by gradual exposure to the feared object or situation o Behavioural method originated by Joseph Wolpe (1958) - Exposure Therapy: Confronting an emotion-arousing stimulus directly and repeatedly, ultimately leading to a decrease in the emotional response - Technique depends on the process of habituation and response extinction - Systematic Desensitization: A procedure in which a client relaxes all the muscles of his or her body while imagining being in increasingly frightening situations o It is now known that live exposure/vivo exposure is more effective than imaginary exposure - Behaviourists use an exposure hierarchy to expose the client gradually to the feared object/situation Cognitive Therapy - Cognitive Therapy: Focuses on helping a client identify and correct any distorted thinking about self, others or the world o Ex. Phobia of dogs may be the reason because the person has been bitten by a dog before. As dogs will be associated with the experience of pain; cognitive theorists might emphasize the meaning of the event - Cognitive therapists use “cognitive restructuring” o Cognitive Restructuring: Teaching clients to question the automatic beliefs, assumptions and predictions that often lead to negative emotions and to replace negative thinking with more realistic and positive beliefs - Clients may be encouraged to attend to their troubling thoughts/emotions OR 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 o Helpful in preventing relapse in depression Cognitive Behavioural Therapy - Therapists working on anxiety and depression use a blend of cognitive and behavioural therapeutic strategies o Often referred to as “cognitive behavioural therapy” or “CBT” - CBT is problem focused – undertaken from specific problems; therefore therapists tries to assist the client in selecting specific strategies to help address problems - CBT contrasts with psychodynamic approaches in its assumptions about what the client can know o CBT is transparent, nothing is withheld/hidden to the client  At the end, clients have an understanding of the treatment they have received as well as the specific techniques that are used o Psychodynamic psychotherapy, the therapist serves as a kind of “spiritual guide” urging the client forward insight  CBT is found to be effective for a number of disorders  Unipolar depression, generalized anxiety disorder, panic disorder, social phobia, post-traumatic disorder, and childhood depressive and anxiety disorder  CBT—Moderate effects for:  Marital distress, anger, somatic disorders and chronic pain Humanistic and Existential Therapies - Assumes that human nature is generally positive, and they emphasize the natural tendency of each individual to strive for personal improvement - Humanistic and existential therapies share assumption that psychological problems stem from feelings of alienation and loneliness; can be traced to failures to reach one’s potential OR failures to find meaning in life o Approaches: Person-centered therapy (humanistic approach) OR Gestalt therapy (existential approach) Person-Centered Therapy - Person-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 - Developed by Carl Rogers in 1940s and 1950s - Assumes every individual is qualified to determine his or her own goals for therapy; “feeling more confident or making a career decision,” - Therapist tends to not provide advice or suggestions; instead therapist paraphrases the client’s words, mirroring the client’s thoughts and sentiments - Person-Centered Therapy demonstrate three basic qualities: Congruence, empathy, unconditional positive regard o Congruence: Openness and honesty in therapeutic relationship and ensuring that therapists communicates the same message at all levels o Empathy: Continuous process of trying to understand the client by getting inside his or her way of thinking, feeling, and understanding the world o Unconditional Positive Regard: Therapist must provide a nonjudgmental, warm, and accepting environment in which the client feels safe expressing his/her thoughts and feelings Gestalt Therapy - Found by Frederick “Fritz” Perls & colleagues; 1940s & 1950s - Gestalt Therapy: Goal of helping the client become aware of his or her thoughts, behaviours, experiences and feelings and to “own” of take responsibility for them - Encouraged to be enthusiastic and warm toward their clients - Emphasizes experiences and behaviours that are occurring at particular moments in t
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