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Chapter 16

Chapter 16

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Western University
Psychology 2035A/B
Doug Hazlewood

Chapter 16: Psychotherapy The Elements of the Treatment Process - all psychotherapies involve a helping relationship (the treatment) b/n the professional with special training (therapist) and the person in need of help (client) called the Therapeutic triad Treatments: How Many Are There? - Kazdin estimates there are over 400 distinct types of psychotherapy - Approaches to treatment can be classified into 3 major categories: 1. Insight Therapies: talk therapy- closest to the approach most people invision; clients engage in complex verbal interaction with their therapist with the goal of these discussions being to pursue increased insight regarding the nature of the clinets difficulties and sort through possible solutions 2. Behaviour Therapies: based on the principles of learning and conditioning where focus is shifted from personal insifghts to direct efforts to alter problematic responses like phobic behaviours. It works by changing the clinets overt behaviours with different procedures depending on the situation 3. Biomedical therapies: there involve interventions into a persons physiological functioning that are most widely manipulated in the forms of drug therapy and electroconvulsive therapy. Traditionally only physicians have been able to prescribe medications but psychologists have been fighintg for privelages and they have obtained privelages in 2 states to date (New Mexico and Louisiana) The 3 major classes are not incompatible; someone seen in insight therapy can also be given medication Clients: Who Seeks Therapy? - report in 1999 says, ~15% of the US population use mental health services every year - there are SO many human problems people are treated for but anxiety and depression are the most excessive - STUDY by Wang Et Al (LOL AT HIS NAME!) found that people delay seeking treatment for years and the % of people who do seek treatment within the first year is really low- 6yrs on avg for bipolar and drug dependence (~40% w/in the 1 yr for bipolar and 20-26% for dependence), 8 years for depression (~37%), 9 years for generalized anxiety (~33%), and 10 years for panic disorder (~33%) - only about of people who use mental health services in a given year meet the criteria for a full fledged mental disorder; others seek help for every day problems (e.g. career decisions) - people vary in their willingness to seek therapy- STUDY found that only 59% of people who perceive a need for help actually seek it, and women are more likely to seek help then men, and whites are more likely then blacks of Hispanics to obtain help. The utilization peaks in the 35-44yrs old bracket - Treatment is also more likely for people with medical insurance and more education; the 2 biggest barriers to therapy are lack of health insurance and cost concerns - Biggest roadblock is the stigma surrounding the receipt of mental health services many people adequate seeking help with weakness - FIG 16.3: Psychological disorders and professional treatment o 15% receive treatment, and 28% have a disorder o 7% have treatment but no psychiatric diagnosis and 20% have a diagnosis and no treatment, and the overlapping 8% have diagnosis and treatment Therapists: Who Provides Professional Treatment? Psychologists - The 2 types are Clinical and Counseling but the distinction is more theoretical than real- they specialize in the diagnosis and treatment of psychological disorders and everyday behavioural problems. In theory the clinical psy. are more trained towards treatment of full-fledged disorders whereas counselling is slnted more towards everyday adjustment problems; in practice the overlap is huge - They require a PH.d (5-7 years past bachelors) and mostly use insight and behavioural approaches Psychiatrists - they are physicians who specialize in treatment of psychological disorders - many also treat everyday behavioural problems but devote more time to severe disorders - they require an MD and a 4 year apprencticeship/residency - they emphasize drug therapies and are more likely to use psychoanalysis vs. behavioural methods or group therapies Other Mental Health Professionals - psychiatric social workers and psychiatric nurses work at hospitals alongside psychiatrists - the nurses play a huge role in the hospital inpatient treatment (masters, or bachelor) - social workers work with patients and their families to ease the patient\s integration back into the community (need a masters). Traditionally work in hospitals and agenicies but are many are now licensed independently - many counsellors also provide therapeutic services schools, colleges, human service agencies, and are often specialized in particular problems *drug counselling, marital, vocational..) Insight Therapies - all approaches involve verbal interactions intended to enhance clients self-knowledge and thus promote healthful changes in personality and behaviour - there are hundreds but the leading 8-10 make up most of present treatments Psychoanalysis - first developed and practiced by Sigmund Freud and emphasized the recovery of unconscious conflicts, motives, and defenses through techniques such as free association, dream analysis, and transference - Freud treated many anxiety-dominated disturbances such as phobic, panic, OCD, and conversion disorders which are all termed neuroses that he believed all stemed from unresolved unconscious conficts from childhood (conflicts b/n id, super/ego) usually involving sexual/aggression impulses - Probing the unconscious o Free association: clients spontaneously express their feelings/thoughts exactly as they occur- they lie on a coach and pour out everything that comes to mind without conscious cencorship; analyst then studies there free associations for clues about the unconscious o Dream analysis: therapist interprets the symbloci meaning of the clients dreams. Freud though they were the royal road to the unconscious clinets are trained to remember their dreams, which they then describe in therapy - CASE: Mr.N had marital problems claimed to love his wife, but prefereed sex with prostitutes; his parents also had problems in their marriage. In his session, he described a dream about being bumped from behind and about cars and his father; therapist saw sexual overtones in the dream, and also a competitive orientation towards his father - Interpretation o Involved the therapists attemps to explain the clients feelings, memories, and behaviours o E.g the therapist interpreted Mr.Ns thoughts about a box of condoms and his assumtions as wanting to fulfill his wish-fulfilling fantasy: mother doesnt want sex with father and father is not very potent the therapist then concluses that Mr.Ns difficulties are rooted in an OedipalComplex; he has unresolved sexual feelings towards his mother and hostile feelings towards his father- these unconscious conflicts are now distroing his intimate adult relations - Resistance o Involves largely unconscious defensive maneuvers intended to hinder the progess of therapy o Assumed to be an inevitable part of the psychoanalytica process o Although people have sought help, they are reluctant to confront their real problems o Patients can then show up late for sessions, or be hostile towards the therapist - Transference o Occurs when clients start relating to their therapists in ways that mimic critical relationships in their lives trander conflicting feelings about important feelings onto the therapist o Psychoanalysts encourage transference so clients reeanct relations which helps bring repressed feelings to the surface and help people work through them Classical psychoanalysis as done by Freud is not practiced anymore but have evolved into psychodynamic approaches to therapy Client-Centered Therapy - emphasizes providing a supportive emotional climate for clinets, who play a major role in determining the pace and direction of their own therapy - focuses on people finding themselves and getting in touch with their own feelings - Largely started from the work of Carl Rogers and his belief that most personal distress comes from incongruence b/n a persons self concept and reality; incongruence makes people prone to feel threatned bu relisric feedback about themselves
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