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Chapter 14

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University of Toronto Scarborough
Steve Joordens

Chapter 14 : Therapies Lecture18:History,andInsightTherapies HISTORY: -Back in the day, had extreme ways of dealing with mental illness -Witch Doctors likely celebrated for their mental illness -Were prophets schizophrenic? But seen as prophets because they were “speaking to angels”, etc. -Evidence of cutting a hole in people’s heads. If someone was acting crazy, “heard voices in their heads”, they were taken literally. To treat another entity in someone’s heads, they would cut a hole and let it “leave” through a makeshift-door. -Skulls with holes found over time -Era with certainly-insane people, and no one knew what to do with them. -Ultimately decided to get them out of society (ex. Bedlam insane asylum) -If aggressive, you would be kept in a restraining chair. -The word “Bedlam” has become a reflection of that experience: crazy, dirty, chaos, etc. -Philippe Pinel was in charge of one of these asylums, take them out of the basement and chains, asked to help around of asylum, grasses cut, bushes trimmed. He noticed the patients were much better, prognosis was much better. -Treating them humanely and give them a purpose, sense of value, they were less insane. -Began the humanist movement, treating people with mental disorders as if they had physical disorders -You wouldn’t take someone with the flu and lock them up, that’s not humane -Started to view it as an illness, “mental illness”, and not “crazy” or “insane” HISTORICAL FIGURES -Franz Anton Mesmer: a medical doctor, struck by fact that people who appear biologically fine, but had odd-seeming conditions. Also a time when magnets were being discovered, and were a mystical power. Magnets were “weird”, diseases “weird”, and tried to use magnets to cure mental disease. Filling pools of water, mentally ill people in the water. And put magnetic rods in the water as well, and used magnets. He was very sure it would work, and strangely enough it did. -Charcot and Freud went to view this, and began to learn about it. They being to think it wasn’t the magnets. The important thing was that you would tell them that it worked, and the suggested belief was what had the power  a doctor telling them that by doing “this”, you would get better. -Making certain claims about people, it would come true. -Hypnosis became the focus, Mesmer  Mesmerizing  Hypnotism -Charcot tried to use suggestion, hypnotism to cure people that way without the magnets and the “set-up”, more focused on actual suggestion and closer to simply talk-therapy. -Freud thought hypnotism was “really” cool and used it to get at the unconscious issues people were having, eventually said hypnotism was “crap”, and shouldn’t be used. -realized a lot of what was told to you under hypnosis was not true. If you were to ask them to tell you about a brother who doesn’t exist, they will tell you. Even when they left the trance, people would continue to believe what was told to them. You would not be uncovering something about people, you would be making it up. -This was the beginning of insight therapies. MODERN THERAPIES -Insight therapies (Freud and his psycho-therapeutic notions was where it all began), Drug therapies, Group therapy, Cognitive-behavioral therapy (probably the go-to therapy for a lot of conditions nowadays) -Insight therapy: the person’s problem is due to some sort of psychological conflict they don’t know about. What the patient needs is to understand the true problem, which is the first step to dealing with the issue, involves talking through and working through stuff with somebody. Psychology became two psychologies, a clinical and a scientific psychology. -Drug therapies became more and more common due to the biological causes of mental disorders, this was the highlight recently, if you were to find the right drug it could be fixed. -Drug therapies are now seen as a short-term cause, it is increasingly now Cognitive-Behavioural therapy, where someone is given drugs to help them to get through therapy. INSIGHT THERAPIES [From Slides] “-Assumes the people have learned maladaptive thought patterns and emotions, which are revealed in maladaptive behaviours. -Behaviours reflective of some deeper psychological issue and when patient understands the true cause (i.e. gains insight) the maladaptive behaviours will subside. -Psychoanalysis -Free association, dreams, other projective tests -Resistance/ Transference/ Counter-Transference -‘We are what we are because we have been what we have been, and what is needed for solving the problems of human life and motives is not moral estimates but more knowledge’ -Sigmund Freud ” -These emotional irregularities are a symptom according to insight therapies. In order to get these symptoms to disappear, you need to resolve the underlying conflict. -In Freudian case, reasons it’s so problematic, people have not consciously dealt with it, and so the person partly wants to suppress the experiences and does not psychologically want to resolve it, so defenses go up. -A less direct kind of approach is needed, reason for free association, dream analysis, etc. -Freud was like “don’t talk about good/bad”, instead try to understand the patient, and therefore must know your young life. -Free association: Freud would say words, but if he thought you were abused he would try to keep the defenses low (blurt out the first word that comes into your head) At some point along there, he might sneak in “uncle” and see what you say about that, looking for hints. -Projective Tests: ink blots shown and asking what comes to mind, what sort of things a person thinks of when they don’t have any structure. There are also ones that are interpretive of images, may show a picture of ____ and asked to create a story of what’s happening. -These are seen as an art-form rather than a science by scientists. -Freud would observe the therapeutic setting, he could see resistance and not play-along with the therapy, transference is when someone has feelings for someone else and starts talking to the therapist as if they were that person. Counter-transference is that every therapist has feelings, and they also have their own “unquenched desires” and you may counter-transfer your desires back to the patient. HUMANISTIC THERAPY [From Slides] “Client-Centred Therapy: (Carl Rogers) Generally non-directive in a manner meant to help the “client” essentially help themselves… therapists provide support, encouragement, and acts to help the client achieve the smallest level of incongruence (the distance between who they are and who they would like to be) Gestalt Therapy: (Fritz Perls) Emphasizes the unity of the boys and the mind, helping the client get in touch with their feelings -E.G., the empty chair technique” -Client-Centered Therapy: Therapeutic reaction to Freud is that he is painting therapy in a negative light, not everything relates to aggression and sexual desires. Carl Rogers wanted to analogy more like someone giving you advice, not calling them a patient but a client. Problems encountered because they have an image of who they want to be, and a person they are now, and there is a distance between them. The clients must do most of the work, the ultimate therapy is one where the client decides what they should do. The therapist’s job is to help explore possibilities of how to get “from here to there”. Just to keep the person talking, how to be the “perfect friend”. -ELIZA computer program does just that, asking for feelings and keeping the person talking. Not a lot of content, but keeping the client talking and thinking. -Therapist wants to help you think through the problem space, and not tell you what’s good or bad, reflecting what you say. -There is an underlying structure the therapist must stick to, the focus sticks to that we worry what other people think of us. Make sure you want to be someone else, and not merely worrying what your “mother wants you to be”. -Push you to think about how you’re weighing everything, get to the point where your patient has their own idea of where they want to go. -Gestalt Therapy: Like a humanistic therapy, but less specified, emphasize coming together of spirit and body to understand feelings. “Mindfulness”. Attending to the things you’re feeling at a given time. -Eat a Smartie, think about the flavours in your mind, how the crunching feels, etc. -When you’re living your day-to-day life, get in touch with your feelings, can you do anything about your situations? -Often use empty-chair technique. Talk to the empty chair as if the person you have problems with is sitting in the chair. -Humanistic therapies have lost a lot of Freudian conflict, psychological conflict, more about moving forward, more symptom-based, help you be happier, less about the past, helping people explore ideas and emotions EVALUATION OF INSIGHT THERAPIES [From Slides] “-Limitations: to benefit from insight therapies a client must be intelligent, articulate, motivated (and rich) enough to spend multiple days a week for maybe years or more (especially psychoanalysis). -Not many scientific studies assessing effectives, but there are some, they show that undergoing therapy is more effective than not going. -Not as effective as cognitive-behavioural therapies” -Must be able to explore through ideas and work through feelings, must be articulate and intelligent. -Therapy will also not work if you are extremely shy, schizophrenic person, etc. -Cognitive-Behavioural therapies > Insight Therapy > No therapy at all Lecture19:BehaviouralandCognitiveBehaviouralTherapies THERAPIES: -Insight therapies are where therapies began, an underlying psychological trauma, client must gain insight to solve. Freudian therapies. -In direct contrast, behaviourist era was a reaction to Freud, and other therapies were developed. Must focus on things that can be studied scientifically. Showing how powerful the consequences of our reactions are in the sense of shaping our reactions. I. THERAPIES BASED ON CLASSICAL CONDITIONING: [From Slides] “Many anxiety disorders (e.g. phobias) are thought to have developed via classical conditioning. Thus, it should also be possible to use classical conditioning to counter these disorders. Systematic Desensitization: a technique designed to eliminate the unpleasant emotional response by the feared object or situation and replace it with an incompatible one… relaxation” -Based on anxiety and phobias people had, the irrational fear of something which leads to a negative impact on one’s life. -Systematic desensitization able to fix these, also useful technique to contend with anxiety in general. -Best way to get rid of an unwanted behaviour is to enforce an incompatible behaviour. -“Crowd-out” or “supporting an incompatible behaviour” SYSTEMATIC DESENSITIZATION: [From Slides] “1. Relaxation: -learn to relax -associate the feeling with a trigger -practice using the trigger 2. Hierarchy of Fears: -create hierarchy -go through it slowly, using trigger -one cannot progress until they can remain relaxed on the previous step” -Relaxation protocol will walk you through a process showing you how to relax your body deeply, usually involves going through all muscle groups. Much like how we believe hypnosis to start. -You cannot be anxious and relaxed at the same time, so you must learn relaxation. -You learn to associate relaxation with a trigger word, associate relaxing feelings with that word. -Once you’ve learned the skill of relaxation, you then go after your anxiety with a hierarchy of fears. HIERARCHY OF FEARS: [From Slides] “Watching someone else public speak Have others sing ‘happy birthday’ to me Be asked to give a toast at a small gathering of friends Find oneself in a position of telling a long story to a group of friends who are listening Be asked to give a toast at a formal wedding Talk about something you know a lot about Talk about something you know little about” ^Hierarchy of fears for someone afraid of public speaking -Hierarchy from least anxiety-provoking to most anxiety-provoking -If something in the hierarchy makes you feel anxious, use the trigger word to make you feel relaxed, and work your way up the hierarchy, and get you at the last point, the most anxiety-provoking situation “in vivo” (in life). OTHER (Classical Conditioning) CC-BASED THERAPIES: [From Slides] “In Vivo Exposure: Forcing clients to directly face their fears until their fears extinguish… very stressful, though not dangerous… usually. Imaginal Exposure: Same idea, except it relies on graphic imagery rather than in vivo experiences (virtual reality). Aversion Therapy: Pairing a noxious (aversive) stimulus with some undesired behaviour” -In Vivo is a very e
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