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PSYC31H3 (106)
Chapter 13

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Zachariah Campbell

Chapter 13: Individual Therapy Individual Therapy Ethics Confidentiality: assures the client of privacy of information verbally and written form; reasons to break confidentiality: • Threats of suicide, homicide, physical or sexual abuse (with the client as perpetrator or victim), abuse of a vulnerable adult (with the client as perpetrator or victim) Some individuals with CNS difficulties may be considered vulnerable adults (unable to take of themselves or their affairs because of physical/mental difficulties) or may have a legal guardian (person appointed to guard the person or property of another person who is incapable of doing it themselves). • If a person has a legal guardian or is a minor, then the client must be informed that the other person is allowed to know the topics discussed within the therapy session In therapy, focus is on client. There is no reciprocation. There needs to be boundaries (ability of neuropsychologist to keep a professional therapeutic relationship intact; implies that the client does not become invested in the therapist’s life). • The neuropsychologist needs to be able to remain objective • In some cases, patients and their friends/families may become dependent on the clinical neuropsychologist – need to look out for this • NO SEXUAL RELATIONSHIPS WITH CLIENTS Setting The usual – calm, relaxing, nonthreatening Theories of therapy There are more than 400 named therapies – most have similarities to the three big schools of thought Psychodynamic Actually started with: • Dubois and Janet o Freud based off of them Freud based all of his ideas on 6 case studies  not a really great scientific method Psychotherapy does work with 2/3 to ¾ of people reporting that they feel better • Research suggests that it’s not really the type of therapy responsible for this but the qualities of the therapeutic relationship Freud’s patients were diagnosed as suffering from hysteria (physical manifestations of psychological disorders – no longer in use at all), now known as somatoform disorders. He said that his patients were suffering from the effects of being sexually assaulted as children – scientific community would not accept this. So Freud recanted, saying the assault was childhood fantasies  led to idea of Oedipus and Electra Complexes • This has made the future of modern defense of sexual assault victims very difficult • In courts of law, victims of sexual assault are blamed and must prove that the assault actually happened • The idea of ‘willingness’ of the victim in an assault can be traced back to Freud Freud’s 3-part of personality functioning • Id: develops first; contains primitive urges towards sex/aggression that demand immediate gratification o Pleasure principle: id functions through this; pushes for immediate gratification • Superego: similar to the idea of a conscience; develops through interactions with parents, school, and other situations in life • Ego: deals with the constraints of reality; must satisfy the impulses of the id and constrains of the superego o Reality principle: ego functions and develops through this; allows ego to interact with real world There were five stages of personality development: 1. Oral stage (0-2 years): focus with putting everyone in one’s mouth a. Those whose oral desires were frustrated were more pessimistic as adults 2. Anal stage (2-3 years): focus is on independence and the major issue is toilet training a. Child may react to frustrations by becoming stubborn or disagreeable b. Overcompensation may be shown by individual becoming very clean, very punctual, or stingy with their possessions 3. Phallic stage (3.5-6 years): focus is on the functions of the genitals. Development of the Electra (female child has sexual feelings for the parent of the opposite sex and jealousy of the same sex parent) and Oedipus complex (male child has sexual feelings for the parent of the opposite sex and jealousy of the same sex parent) 4. Latency (6 – onset of puberty): focus is on school and development of competence a. No sexuality involved in this 5. Genital stage (late adolescent to adulthood): successfully mastered when child identifies with same-sex parent and was heterosexual a. Homosexuality = failure Freud felt that certain experiences (usually sexual or aggressive) were too difficult for a person to deal with consciously and were automatically shoved into the unconscious. Defense mechanisms (various mechanisms of the ego function automatically to keep unpleasant information from the individual’s conscious awareness). • When defense mechanisms failed, the repressed information was shown as anxiety • Anxiety = repressed material needed to be uncovered Psychoanalysis was LONG process. Patient usually met with analyst 5 days/week for 1 hour. Thought to be treatment of leisure class = very expensive. Had four distinct phases: 1. Opening phase (lasts 3-6 months): during this time, evaluated to see if they were eligible for treatment. a. Patient and analyst sit face-to-face 2. Development of transference  main goal of psychoanalyst; patient transfers feelings from a significant relationship onto the analyst who then assists the patient to understand the feelings a. This is the stage where the patient lay on the couch away from the analyst so they couldn’t see the analyst’s face b. During this, the patient free associated (psychoanalyst remained quiet while the patients talks; the contents are thought to come from patient’s unconscious) 3. Working through transference: where the analyst pointed out themes in the transference material. This implied that whatever issue surfaced can be dealt without worrying about symptom substitution (replacement of one symptom for another; signals the underlying issues have been resolved) 4. Termination (about the same amount of time as the opening phase): analyst predicts when this occurred. Return of symptoms was predicted and normalized. This will happen as important relationships ended Others did not agree with Freud totally but kept some of his ideas – they became the pseudoanalytic and psychodynamic area. • Adler didn’t like Freud’s intrapsychic focus and developed his own interpersonal theory. Also felt that all children felt inferior at a young age due to their dependence on others. Individuals develop at their own personal lifestyle as a way to deal with this. Also felt that birth order was important for people. o Considered the father of modern family therapy • Jung thought Freud’s idea of the unconscious was too negative. He believed that the unconscious was a mix of good and bad, striving for balance Modern analysts usually meet their patients one a week for 1 or 2 years at most. The four phases of psychoanalysis is condensed. Major component is the development of transference and working through that. Major differences between the various types of psychodynamic forms of therapy are the belief in an unconscious or its contents, that its contents often reflect inner behaviour. Psychodynamics flourished in 1930s to 1950s. Behaviourism Behan as a form of learning theory in laboratories and then was translated into methods of therapy. • Early behaviourists were very clear that they did not believe in any form of unconscious processes and the only behaviours which could be dealt with were those that were observable. Basic theory/therapy came from classical conditioning by Pavlov: • Unconditioned stimulus (US) caused an unconditioned response (UR), naturally with no learning. • Conditioned stimulus (CS) was then paired with the US which over time caused a conditioned stimulus. o Ability of the CS to elicit the CR diminishes in the absence of pairings (extinction) o CRs are not necessarily a permanent aspect of the person o Spontaneous recovery is when the CR is recovered after a period of extinction • Once a CR has been conditioned to the CS, similar stimuli may elicit responses (stimulus generalization)  one dog bites you and you’re scared or all dogs • Stimulus discrimination: person learned to respond differently to stimuli that were distinct for the CS Classical conditioning explained the development of anxiety (especially phobia) and was useful for treatment using counterconditioning methods – systematic desensitization. Other theory/therapy came from Watson’s operant conditioning: • Watson dismissed all thought, emotion, and free will. There were a lot of critics for this. • Little Albert example Thorndike worked on animal learning • Cat in box example o Cats learned through trial-and-error learning: occurs after an organism has made random attempts at solving a problem • Law of effect: behaviour that is followed by favourable conditions will recur, those that are unfavourable will not Skinner expanded on Watson’s Operant Conditioning • Operant: behaviour that has an effect on the environment • Reinforcement contingency: consistent relationship between a response and the changes in the environment it produced • Reinforcer: any stimuli which when made contingent on a behaviour occurring increased the probability of that behaviour recurring. • Positive reinforcement: when a behaviour is followed by an appetitive stimulus and therefore increases • Negative reinforcement: when a behaviour is followed by the removal of an aversive stimulus • Extinction can also occur with OC • Punisher: any stimulus that when made contingent on a response, decreases the occurrence of that response o Positive punishment: occurred when a behaviour was followed by the delivery of an aversive stimulus o Negative punishment: occurred when a behaviour was followed by the removal of an appetitive stimulus • Schedules of reinforcement: o Partial reinforcement: a situation in which not every behaviour is reinforced; it can be based on time or number of behaviours  Fixed ration (FR): deliver reinforcement after a certain number of responses. Has a high rate of responding.  Variable ration: deliver reinforcement after an average number of
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