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Chapter 15

[Textbook Note] Chapter 15 - Treatment of Psychological Disorders.docx

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Steve Joordens

Chapter 15 – Reading Notes Treatment of Psychological Disorders 15.0  There are many ways to treat most psychological disorders with the goal of changing a person’s thoughts, behaviours, emotions, or coping skills. 15.2  People fail to get treatment for psychological disorders because of 3 major problems: o People may not realize that their disorder needs to be treated. Mental illnesses are not taken as seriously as physical illness. Some people have the belief that mental illness is a sign of a personal weakness or people who suffer from it are not trying hard enough to help themselves. o There may be barriers to treatment, such as beliefs and circumstances that keep people from getting help. For instance, family might discourage a loved one from seeking help in fear of the public acknowledgment of a psychological disorder in the family (bring embarrassment to the family). There are also other obstacles such as financial problems. Men are less likely than women to seek psychological services. o Even people who acknowledge they have a problem may not know where to look for services.  People who seek and find help don’t always receive the most effective treatments. 15.3  Treatments can be divided into 2 kinds: o Psychotherapy: In which a person interacts with a psychotherapist. o Medical or biological treatments: In which the mental disorder is treated with drugs or surgery. o In some cases, both psychotherapy and biological treatments are used. o The most effective treatments combine both psychotherapy and medications. 15.4  Mental illness is often misunderstood which leads them to be untreated.  Untreated mental illness can be extremely costly, affecting an individual’s ability to function and also causing social and financial burdens. 15.5  Psychotherapy: Is an interaction between a therapist and someone suffering from a psychological problem, with the goal of providing support or relief from the problem.  Currently over 400 different systems of psychotherapy exist.  Similarities are present among all the psychotherapies but each approach 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. 15.6  Psychodynamic psychotherapies: Explore childhood events and encourage individuals to use this understanding to develop insight into their psychological problems. o There are a number of different psychodynamic therapies but 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 and development through the use of defense mechanisms.  Traditional psychoanalysis takes place over an average of 3 to 6 years with 4 to 5 sessions per week. During a session, the client reclines on a couch facing away from the analyst and is asked to express whatever thoughts and feelings come to mind. The analyst may comment on some of the information presented by the client but they do not express their values or judgements.  Psychoanalyst can use several key techniques to help client develop insight such as these: o Free association: Client reports every thought that enters the mind, without censorship or filtering. o Dream analysis: Dreams are metaphors that symbolize unconscious conflicts or wishes and that contain disguised clues that the therapist can help the client understand. o Interpretation: The therapist deciphers the meaning underlying what the client says and does. It is used throughout therapy. The analyst suggests possible meanings to the client, looking for signs that the correct meaning has been discovered. However there are risks of over interpreting the client’s thoughts and emotions and sometimes even contribute interpretations that are far from the truth.  Resistance: Is a reluctance to cooperate with treatment for fear of confronting unpleasant unconscious material.  Transference: 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.  Carl Jung (1875-1961) and Alfred Adler (1870-1973) agreed with Freud that insight was a key therapeutic goal but disagreed that insight usually 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 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 (1882-1960) believed that primitive fantasies of loss and persecution were important factors underlying mental illness.  Karen Horney (1885-1952) disagreed with 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 to improve current relationships. o Try to focus treatment on the person’s interpersonal behaviours and feelings. They pay attention to client’s grief, role transitions, or interpersonal deficits.  Modern IPT differ from classical psychoanalysis in many ways: o Client typically sits face-to-face with therapist. o Therapy is less intensive, with meetings often occurring only once a week and therapy lasting months rather than years. o More likely to see relief from symptoms as a reasonable goal for therapy, they are also more likely to offer support or advice in addition to interpretation. o Less likely to interpret a client’s statements as a sign of unconscious sexual or aggressive impulses. 15.7  Behaviour therapy: Disordered behaviour is learned and that symptom relief is achieved through changing overt maladaptive behaviours into more constructive behaviours.  Token economy: “Tokens” for desired behaviours, which they can later trade for rewards. o Con: The learned behaviours are not usually maintained when the reinforcements are discontinued.  Joseph Wolpe (1958) invented the most powerful ways to reduce fear by gradual exposure to the feared object or situation.  Exposure therapy: Confronting an emotion-arousing stimulus directly and repeatedly, ultimately leading to a decrease in the emotional response.  Systematic desensitization: A procedure in which a client relaxes all the muscles of his or her body while imagining being in increasingly frightening situations.  Cognitive therapy: Helping a client identify and correct any distorted thinking about self, others, or the world.  Cognitive restructuring: Involves teaching clients to question the automatic beliefs, assumptions, and predictions that often lead to negative emotions and to replace negative thinking within more realistic and positive beliefs.  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 behavioural therapy (CBT): A blend of cognitive and behavioural therapeutic strategies. o CBT is transparent in that nothing is withheld from the client. By the end of the therapy, clients have a very good understanding of the treatment they received as well as the specific techniques that are used to make the desired changes. 15.8 th  Humanistic and existential therapies emerged in the middle of the 20 century, as a reaction to the negative views that psychodynamic psychotherapies hold about human nature.  Humanistic and existential therapies assume that human nature is generally positive, and they emphasize the nature tendency of each individual to strive for personal improvement.  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. o Carl Rogers (1902-1987) developed person-centered therapy in the 1940s and 1950s. o Clients are qualified to determine their own goals for therapy as well as the length of therapy. The therapist tends not to provide advice or suggestions about what the client should be doing. They paraphrase the client’s words, mirroring the client’s thoughts and sentiments. It is believed that with adequate support, the client will recognize the right things to do. o Rogers encouraged person-centered therapist to demonstration 3 basic qualities:  Congruence – Openness and honesty in the therapeutic relationship and ensuring that the therapist communicates the same message at all levels.  Empathy – Continuous process of trying to understand the client by getting inside their way of thinking, feeling, and understanding the world.  Unconditional positive regard – Providing a nonjudgmental, warm, and accepting environment in which the client can feel safe expressing their thoughts and feelings.  Gestalt therapy was founded by Frederick “Fritz” Perls (1893-1970) and colleagues in the 1940s and 1950s.  Gestalt therapy: Has the goal of helping the client become aware of his or her thoughts, behaviours, experiences, and feelings and to “own” or take responsibility for them. o Encouraged to be enthusiastic and warm toward clients. In order to help facilitate the client’s awareness, therapists also reflect back to the client their impressions of the client. 15.9  Couple therapy: When a married, cohabitating, or dating couple is seen together in therapy to work on problems usually arising within the relationship.  Family therapy: Psychotherapy involving members of a family.  Group therapy: A technique in which multiple participants work on their individual problems in a group atmosphere. o Helpful to clients who are otherwise socially isolated. o Clients can relate to each other and tells them that they are not alone in their suffering. o Group members model appropriate behaviours for one another and share their insights about how to deal with their problems. o As effective as individual therapy.  Self-help and support groups: Discussion or Internet chat groups that focus on a particular disorder or difficult life experience and are often run by peers who, themselves, struggle with the same issues.  Some famous self-help groups are: o Alcoholic Anonymous (AA) o Gamblers Anonymous o Al-Anon (program for family and friends of those with alcohol problems) 15.10  Psychodynamic therapy (including psychoanalysis) emphasizes helping clients gain insight into their unconscious conflicts.  Behaviour therapy applies learning principles to specific behaviour problems.  Cognitive therapy aims at challenging irrational thoughts.
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