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17 - Treatment of Psychological Disorders.docx

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Psychology 1000

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Chapter 17 T reatment of Psychologica l Disorders The Helping Relationship  Counselling and clinical psychologists have Ph.D. in Philosophy or Psy.D in psychology  Medical doctors who specialize in psychotherapy and biomedical treatments (drug therapy)  Master degrees with practical training  Psychiatric social workers work in community agencies  Abuse, marriage, family, pastoral (spiritual) counsellors  Therapy o Goal is to change maladaptive self-defeating thoughts, feelings, behaviours to live happier, better  Socially acceptable step by step process – gradual affair o Psychoanalytic (understand), behavioural (do), cognitive-behavioural (think), humanistic (feel) o Emotional defusing – reduce/eliminate fear Psychodynamic Therapies Psychoanalysis  Help clients achieve insight (conscious awareness of problems) for anxiety (not schizo) and younger people o Therapeutic relationship + therapy technique  therapeutic outcome  Awareness permits to adjust behaviour to current life situations rather than to repeat old maladaptive routines  Psychic energy that controls unconscious conflict is released and redirected to more adaptive ways of living Free Association  Repeat verbally without censorship any thoughts, feelings, images that entered awareness  Provide clues concerning important issues or themes Dream Interpretation  Dreams express impulses, fantasies, wishes defences keep in unconscious during waking hours (ego out of way)  Usually disguise threatening material to protect dreamer from anxiety Resistance  Defenses that slow down therapy e.g. difficulty in free-associating (avoid topics), come late or forget appointment  Sign of anxiety-arousing sensitive material being approached Transference  Client responds with open repressed feelings, maladaptive behaviour to analyst like important figure from past  Positive transference – intense affection, dependency or love to analyst  Negative transference – irrational expressions of anger, hatred, disappointment  Until transference are resolved, no full resolution of current problem Interpretation  Confronts clients with insight or meaning of behaviour that they have not admitted into consciousness Brief Psychodynamic Therapies  Classical psychoanalysis is expensive and time consuming and degree of improvement varies  Neo Freudian and ego analysis – brief interpretation of insight on influences of past and behaviour o Goal is to help client deal with problem rather than rebuild client’s personality  Focus on current situation than past  Teach interpersonal and emotion-control skills  Interpersonal Therapy: less than 20 sessions that focus on client’s current interpersonal problems o Marital conflict, loss/change of relationship, enhance social skills to initiate or maintain relationships o More effective for depression 2 Humanistic psychotherapies  Human capable of consciously controlling their actions and taking responsibility for their choices and behaviour  Everyone has inner resources for self-healing and personal growth but disorder blocks it  Goal: self-exploration with no barriers (unrealistic or maladaptive standards for self-worth) environment  Aware of present feelings and future instead of past insight of childhood origins Client-Centred Therapy  Carl Roger thought relationship that develops between client and therapist and environment is important o Clients feel accepted, understood, free to explore basic attitudes, feelings without fear of being judged o Increase self-acceptance, self-awareness, self-reliance, comfort with other relationships, improved life o People are good and move toward ideal self but blocked from realizing full potential  Unconditioned Positive Regard: therapists show clients that they genuinely care about and accept them o Sense of trust is communicated in therapist’s refusal to offer advice or guidance  Empathy: willingness and ability to view the world through the client’s eyes o Reflecting back to client by rephrasing something client had said to capture meaning and emotion  Genuineness: consistent feelings and behaviour o Express displeasure with behaviour but also show acceptance with choice of action Gestalt Therapy  We concentrate on whole experience and ignore important background (blocked feelings, wishes, thoughts)  Goal is to bring background back to awareness  Carried out in groups  Developed imaginative techniques to help get in touch with their inner selves such as role play o Empty-chair technique –imagine mother sitting in the chair and carry a conversation  Powerful feelings and make clients aware of unresolved issues  Roger’s – research to identify factors that contribute to therapeutic success  Perl’s – antiscientific attitude that prevented research  Greenberg and Malcolm o Empty-chair technique where clients relisten to the conversation o Resolved clients experienced more emotion Cognitive Therapies  Irrational and self-defeating thought patterns now and not past and change cognitions that underlie problems  Habitual thought patterns become automatic and become less aware of them and accept them as reality  Goal: identify beliefs, ideas, self-statements that trigger maladaptive emotions, behaviours in order to change it Ellis’s Rational-Emotive Therapy  A – activating event that seems to trigger emotion  B – belief system that underlies how a person appraises event activated by A  C – emotional and behavioural consequences of that appraisal produced by B  D – key to changing maladaptive emotions and behaviours is disputing/challenging belief system of B  Introduce common irrational ideas and train them to replace with rational thoughts and demands  Continue asking questions to get at belief and be aware of them Beck’s Cognitive Therapy  Point out errors of thinking and logic of emotional disturbance and reprogram automatic thought patterns  Depression – realize their thoughts and not the situation cause their maladaptive emotional reaction  Realization sets stage for identifying and changing  Self-Instructional Training: influential in treatments related to stress and coping 3 Behaviour Therapies  Behaviour disorders are learned and unlearned in the same ways normal behaviour are Classical Conditioning Treatments Exposure: An Extinction Approach  Exposure to feared CS in absence of UCS of anxiety  Flooding – exposed to real life stimuli  Impolsion theory – imagine scenes involving stimuli Systematic Desensitization: A Counterconditioning Approach  Wolpe view anxiety as a classically conditioned emotional response  Eliminate by counterconditioning (new response (relax muscles) conditioned to anxiety-arousing CS) o Stimulus hierarchy – construct of 10 – 15 fear relating sense arranged in steps from low to high anxiety o Low arousal scenes deconditioned, total anxiety reduced  Can image more anxiety-arousing images without feeing anxious  Vivo desensitization – controlled exposure to hierarchy of real life situation  Systematic desensitization preferred since less anxiety experienced Aversion Therapy  Not reducing anxiety but give up an undesirable UCS by associate it with an unpleasant effect  Often fail to generalize from treatment setting to real world The Neuroscience of Treating Unipolar Depression  Cognitive behaviour theory’s treatment by changing brain function of limbic system, frontal cortex, hippocampus o Low levels of cingulate cortex activity linked to regulation of limbic system  Identify maladaptive thoughts and behaviours and think more rationally  Reduced serotonin transport for those who expressed higher levels of dysfunctional belief  Maladaptive thoughts related to lower levels of serotonin  Talking therapy can alter brain function in much the same way that drug treatments do Virtual Reality as a Therapeutic Technique  Virtual reality that can control environment and condition to create realistic environments, simulate experience  Treat phobias, occupational rehabilitation to PTSD Operant Conditioning Treatments  Behaviour modification using operant conditioning to increase or decrease behaviour o Positive reinforcement, extinction, negative reinforcement or punishment o Observable behaviours  Chronic hospitalized schizophrenics, disturbed children, mentally retarded Positive Reinforcement  Token Economy: help strengthen decreased social, personal care, skills if in long term psychiatric hospitalization  Get tangible reinforcers e.g. food based on tokens to phase out so desired behaviours develops to occur naturally Therapeutic Use of Punishment  Are there alternative, less painful approaches that might be effective? Modelling and Social Skills Training  Social skills training – learn skills by observing and imitating a model who performs a socially skilful behaviour  Effectiveness due to self-efficacy to believe they are capable of performing the desired behaviour 4 “Third-Wave” Cognitive Behavioural Therapies  Cognitive behavioural therapies: rational emotive behaviour, cognitive and modelling and role playing Mindfulness-Based Treatments  Mental state of awareness, focus, openness, acceptance of immediate experience  Nonjudgmental appraisal so in state of mindfulness, difficult thoughts and feelings have much less impact  Cognitive focus nonjudgmentally on sensations than distract oneself that increase ability to tolerate painful stimuli  Meditation technique to develop tranquil state and focus closely on sensations, thoughts, feelings o Reduce physiological arousal, detach cognitive outlook to be emotion-escalating emotional process-free o Prevent relapse by increasing awareness of thoughts and emotions that trigger lapses  Interrupting previous cycle of automatic substance abuse behaviour  Neutral self-blame and thoughts of hopelessness Acceptance and Commitment Therapy  Focus on process of mindfulness as vehicle for change  Just notice, accept and embrace them  Decide what is most important and setting life goals with those values and commit and work towards them Dialectical Behaviour Therapy  Intense treatment developed specifically for the treatment of borderline personality disorder  Chaotic interpersonal relationships, poor emotional control, self-destructive behaviours, low self-esteem  Behavioural techniques help clients learn interpersonal, problem-solving and emotion-control skills  Cognitive approaches help learn more adaptive thinking about the world, relationships and themselves  Psychodynamic element traces history of early deprivation and rejection that crated many problems  Humanistic emphasis acceptance of thoughts, feelings to tolerate unhappiness and negative emotions  Foundation of mindfulness procedures for skills taught in DBT to help accept and tolerate powerful emotions  Goal: be capable of calmly recognizing situations, thoughts, impact and not be overwhelmed or avoiding them Cultural and Gender Issues in Psychotherapy  Europe and North America assume people can express feelings, take personal responsibility to improve themselves  Asian cultures disapprove therapeutic expression since you need to stand up for one’s rights Cultural Factors in Treatment Utilization  Minori
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