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Chapter 18

Final Exam Notes - Chapter 18.docx

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Steve Joordens

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CHAPTER 18 – THE TREATMENT OF PSYCHOLOGICAL DISORDERS PSYCHOLOGICAL DISORDERS AND PSYCHOTHERAPY Early Treatment of Psychological Disorders Sometimes psychological disorders are thought of as products of modern times, but they have been around since human existence began In the past, people who would now be classified as paranoid schizophrenics were seen as prophets or being possessed by the devil The earliest known attempts to treat psychological disorders: trephining: a surgical procedure in which a hole is made in the skull of a living person The opening was made to let evil spirits escape Signs of healing near the holes in the skulls suggest some people survived this process Many other painful and degrading practices were directed to people “possessed by evil spirits” such as exorcism, beatings, starving, near drowning, drinking foul tasting concoctions Delusional schemes of people with psychotic disorders include beliefs of personal guilt and unworthiness, and in early times would think themselves as evil and some confessed to acts of sorcery and accepted persecution and punishment Johann Wier – first to challenge the practise intended to combat witchcraft in the 16 century saying the people th suffered from mental illness, but the Church condemned his writings and they did not remerge until the 20 century Later, belief in witchcraft and demonology waned and people with psychological illnesses were either sheltered by their families, lived a moderate life or sent to asylums that were inhumane, patients were chained and sometimes wallowed in their own excrement. Some with bizarre catatonic postures or fanciful delusions were exhibited to public for a fee Treatments designed to cure: patients tied up, doused in cold water, bled, made to vomit, strapped into tranquilizing chair (designed by Benjamin Rush) with a box placed over their head Philippe Pinel – French physician appointed director of La Bicetre, a mental hospital in France, in 1793 Believed mental patients would respond favorably to kind treatment He let some of the patients out of the chains and let them walk around the hospital grounds outside, orderliness and general calm replaced previous noise, stench and pervasive aura of despair and many were discharged Dorothea Dix – similar to Pinel in USA, spurred reform of many mental institutions and responsible for laying groundwork for the first psychiatric hospital in Nova Scotia The Development of Psychotherapy Modern approach to therapy traced to Franz Anton Mesmer – devised a theory of magnetic fluxes, according to which he attempted to effect cures by manipulating iron rods and bottles of chemicals In reality, he hypnotized his patients and thereby alleviated some of their symptoms, thus is why hypnosis at first was known as mesmerism Jean Martin Charcot – started studying hypnotism’s therapeutic uses after his student hypnotised a woman and induced her to display signs of hysteria, while hypnotised, Charcot analysed her as a hysteria patient, but when she awoke, no more symptoms Freud’s association with Charcot and Breuer started him on his life’s study of determinants of personality and origin of mental illness – he created the practice of psychoanalysis Therapists who believe behaviour strongly influenced by environmental contingencies and people’s perception of them likely to use cognitive-behavioural approaches in treating; those who believe biological factors are the strong influence would use combination of drug and psychotherapy Electic 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 Acierno, Hersen, Van Hasselt – shown combinations of behaviour and cognitive-behaviour therapies are more effective in treating panic disorder INSIGHT THERAPIES Practitioners believe people are essentially normal but learn maladaptive thought patters and emotions which are revealed in maladaptive behaviour Believe that insight into the cause of the behaviours will cure them Psychoanalysis and Modern Psychodynamic Approaches Psychoanalysis: a form of therapy aimed at providing the client with insight into his or her unconscious motivations and impulses – credited to Freud for developing According to Freud, the conflicts between id, ego and superego often lead to anxiety, and these conflicts can be traced to inadequately defended sexual and aggressive urges or incomplete progression through the psychosexual stages By encouraging client to talk, analyst tries to bring the unconscious conflicts into view; the obscurity requires the analyst to interpret them and gradually weave together a complete view Freud argued though the clients present their own interpretations, they are biased and cannot be accurate Client needs to provide therapist with something to interpret: descriptions of his or her fears ,anxieties, thoughts or repressed memories Freud felt the “veil of amnesia” is lifted at the moment insight is achieved Psychoanalytic Techniques 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 encouraged this by telling the client to report any thoughts or images without worrying about their meaning, and avoided eye contact to minimize authoritative influence Freud believed dreams were a crucial component of psychoanalysis Even dreams are subjected to some censoring and the analyst must be able to distinguish manifest and latent content Manifest content masks the latent content because the latent content is anxiety provoking and causes psychological discomfort Important step towards insight is helping the client appreciate the latent content of his or her dreams Resistance: a development during therapy in which the client becomes defensive, unconsciously attempting to halt further insight be censoring his or her true feelings Can be recognized when client tries to change the topic, starts to miss appointments, or suddenly forgets what he or she was about to say After months or years of therapy sessions, the client becomes less inhibited and discussion goes from recent events to the more distant shores of early child hood. As the client relives aspects of child hood they may begin transference: the process by which a client begins to project powerful attitudes and emotions onto the therapist, they may come to love or hate the therapist with the same intensity of the powerful emotions experienced in childhood toward parents or siblings Freud reasoned that the analyst, being human too could just as easily have Countertransference: the process by which the therapist projects his or her emotions onto the client Unlike transference, this is unhealthy and undesirable; Freud argued that the analyst in order to understand his or her own unconscious conflicts should undergo complete analysis with another therapist Modern Psychodynamic Theory Psychodynamic theory: a variation on 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 They place less emphasis on psychosexual development and more on social and interpersonal experience including the complex structure and dynamics of self Believe that ego plays a more active role in influencing a person’s thoughts and actions; rather than just mediating the superego and id, they believe it is a proactive component in the overall psychological functioning While Freud considered analysis extremely involved and demanding requiring years, Psychodynamic therapists feel that much can be gained by shortening the process and lessening the client’s dependence on the therapist Brief psychodynamic therapy: takes only 10-25 sessions to complete; goal of therapist is to understand and improve the client’s interpersonal skills through interpretation of transference processes Attempts to modify the client’s schemata for interpersonal relationships and modify those that prevent the client from fulfilling relationships with others Example – Karen in a nursing program, had headaches and dizziness, and was beginning her rotation in 3South a surgical ward. Accidently gave patients wrong medicine and had negative feelings towards the head nurse; after psychotherapy realized that that was the ward her father died of a heart attack in and there were no nurses available to help him, after realization she felt relaxed for the first time in months and her symptoms disappeared Humanistic Therapy: a form of therapy focusing on the person’s unique potential for personal growth and self- actualization Client-Centered Therapy Client centered therapy: a form of therapy in which the client is allowed to decide what to talk about without strong direction and judgement from the therapist Developed by Carl Rogers – he found formalism of psychoanalysis too confining and its emphasis on intrapsychic conflict too pessimistic Rogers believed cause of many psychological problems resulted incongruence: the discrepancy between a client’s real and ideal self Goal of client-centered therapy is to reduce incongruence by fostering experiences that will make attainment of the ideal self possible Because the client’s thoughts direct the therapy, the therapist strives to make thoughts and perceptions and feelings more noticeable to client through reflection, sensitive phrasing or mirroring the client’s statements Reflecting concerns of client makes the therapist demonstrate empathy, which is key in encouraging client to deal with incongruence For Rogers, worth and significance of the individual is basic ground rule of therapy: unconditional positive regard: according to Rogers, the therapeutic expression that a client’s worth as a human being is not dependent on anything that he or she does, says, feels or thinks Gestalt Therapy Gestalt therapy: a form of therapy emphasizing the unity of mind and body by teaching the client to get in touch with unconscious bodily sensations and emotional feelings – designed by Fritz Perls Places emphasis on the present experience not the past, and will often be confrontational, challenging the client to deal honestly with his or her emotions Perls also believed dreams are rich source of info and one must understand its symbolism, therapists often have their client adopt the perspective of some person or even some object in the dream in an empathic manor Empty chair technique – clients imagine they are talking to someone sitting in the chair beside them (from Perl’s belief our memories, fears and feelings of guilt affect our ongoing relationships with others) This allows them to express feelings they have suppressed in the past Also encourages clients to gain a better understanding of his or her feelings by talking to himself or herself and to inanimate objects Through this, the client learns that the world does not fall to pieces if he or she gets angry, sexy, joyous, mournful Evaluation of Insight Therapies Hard to evaluate psychoanalytic method because to participate in that kind of therapy, you need to be intelligent, articulate, and motivated enough to spend3+ hours a week working hard to uncover unconscious conflicts Fonagy, Leichsenring – psychoanalytic therapy is more effective than no treatment and more effective than shorter forms of psychodynamic therapy Truax – recorded sessions of client-centered therapy and sorted statements by clients into categories, only statements about improvement received positive response by Carl Rogers in the sessions Client centered and gestalt therapy are not appropriate for serious problems such as psychoses, but are most effective for people who are motivated to want to change, and intelligent enough to be able to gain some insight concerning their problems BEHAVIOUR AND COGNITIVE-BEHAVIOUR THERAPIES People learn maladaptive or self defeating behaviour in the same way they learn adaptive, undesirable behaviour is the problem not just a reflection of the problem Therapies Based On Classical Conditioning Systematic Desensitization Systematic desensitization: a method of treatment in which the client is trained to relax in presence of increasingly fearful stimuli Developed by Wolpe and has been especially successful in eliminating some kinds of fears and phobias First step to make a hierarchy of anxiety-related stimuli, with the least fearful at the top; Next client is trained tp achieve complete relaxation; essential task is to learn to respond quickly to suggestions to feel relaxed and peaceful so that these suggestions can elicit an immediate relaxation response Finally, the conditioned stimuli (fear-eliciting situations) are paired with stimuli that elicit the learned relaxation response Although this one is careful to not permit clients to become too anxious, practitioners of another form arrange for the client to confront the feared stimulus directly In vivo exposure: a form of therapy in which clients are exposed to intense levels of a feared stimuli in an attempt to diminish the fear through extinction Imaginal exposure: a form of therapy in which the therapist provides a client with graphic descriptions of a feared objet; its goal is to diminish fear by extinguishing avoidance response Aversion Therapy Aversion therapy: a form of treatment in which the client is trained to respond negatively to a neutral stimulus that has been paired with an aversive stimulus Therapies Based on Operant Conditioning Behaviour modification: behaviour therapy based on the principles of operant conditioning Reinforcement of Adaptive Behaviours Behavioural techniques often used to alter behaviour of emotionally disturbed people and those with mental retardation Token Economies: a program often used in which a person’s adaptive behaviour is reinforced with tokens that can be exchanged for desirable goods or special privileges Implementation with token economies can be difficult, everyone who interacts with the people need to cooperate and learn how the system works Can easily be sabotaged by a few people who believe that the system is foolish wrong or threatening Sometimes for purpose of efficiency, the same reward contingencies are applied to everyone in a specific area or ward which may cause superfluous rewards to those who did not need reward for a particular action causing them to lose their intrinsic motivation Modelling Behaviour therapists find clients make much better progress with access to a model who provides samples of successful behaviours to imitate Bandura example – woman afraid of snakes, he held the head and tail, and slowly the client touched the snake, or guided from his hand over to the snake and progressively was less fearful Assertiveness Therapy Procedure for developing coping skills in interpersonal situations in which a client feels anxiety or is unable to function as effectively as they would like First step is to identify the variables that cause the distress; once identified, client practises assertive behaviour in the confines of the therapy Once well practised, client is encouraged to apply them to real life situations Assertiveness is believed to be incompatible with anxiousness, incapable of feeling both of these, assertiveness is also leading to the development of more effective interpersonal skills Extinction of Maladaptive Behaviours Two problems with using extinction: extinction burst: when a reinforcer that was previously associated with a behaviour is no longer forthcoming, the behaviour may intensify (ex. Tantrums) Not always possible to eliminate the reinforcer that maintains undesirable behaviour (ex. When the client has direct control of reinforced i.e. thumbsucking) Punishment of Maladaptive Behaviours Usually positive reinforcement works better than punishment, for one thing, punishment may result in fear of punisher, or overgeneralization of the action being punished In some therapeutic situations, especially in those in which the undesirable response is harmful to the client, punishment is more effective technique for eliminating it Cowart and Whaley – example of a child who persisted in self-mutilating behaviour such as banging his head on the floor to a point they had to restrain him in his crib. They placed him in a room with a padded floor, and whenever he started to bang his head they electrically shocked his legs (causing less pain, but more shock), after a few repetitions, the boy stopped Carr and Lovaas – suggested aversive m
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