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Chapter 17

Chapter 17 Treatment of Psychological Disease.docx

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Psychology 1000
Terry Biggs

Chapter 17 Treatment of Psychological Disease - Goal of treatment is to help - Categories of medical health professionals o Counseling and clinical psychologists o Psychiatrist o Psychiatric social worker o Marriage and family counselor o Pastoral counselor o Abuse counselor PSYCHODYNAMIC THERAPIES - Focus on internal conflict and unconscious factor PSYCHOANALYSIS - Goal – help achieve insight o Insight allows to adjust behavior and current life situations  Redirects the psychic energy devoted to keeping unconscious conflict under control to more adaptive ways of living - Free association o Trying to find clues in a constant stream of thoughts, memories, feelings, and images o Lie on couch and just talk  Psychologist sits away so client cant see him - Dream interpretation o Believed dreams express unconscious o Helps client search for unconscious material in dreams - Resistance o Defensive maneuvers that hinder process of therapy o Sign that anxiety-arousing material is being approached o Important task for analysis is to explore the reason for resistance, provide insight and prevent them from dropping out - Transference o Occurs when client responds as though analyst is an important figure from past o Most important process  Brings repressed feelings out to open o Positive transference: transfer feelings of intense affection, dependency, love to analyst o Negative transference: irrational expressions of anger, hatred, disappointment to analyst o Until transference is figured out and resolved, no full resolution of client - Interpretation o Any statement by therapist intended to provide client with insight to their behavior or dynamics o Rule = interpret what is near the surface not deep ones o If say something too deep, might cause resistance as so far from client’s current awareness  Client has to reach the insight BRIEF PSYCHODYNAMIC THERAPIES - Classical therapies required five times a week for +five years - Recent research shows unnecessary o Rate of improvement always high at beginning and decrease overtime - Utilize basic concepts from psychoanalysis but in more focused and active fashion - Seen once or twice a week - Goal- helping client deal with specific life problems instead of remaking whole personality - More likely to focus on client’s current life situation o Teach specific interpersonal and emotion-control skills - One type: interpersonal therapy o Highly structured o 15-20 sessions o Focus on current interpersonal problems o One of the more effective therapies for depression HUMANISTIC PSYCHOTHERAPIES - Goal = clients engage in self-exploration and remove barriers that block natural tendencies toward personal growth o Barriers come from childhood experiences that foster unrealistic standards for self-worth - Focus on present and future than past o Help clients become aware of feelings as they occur CLIENT-CENTRED THERAPY - Most widely used o Developed by Rogers - Most important ingredient = relationship between therapist and client - 3 important therapist attributes o Unconditional positive regard  Communicate genuine care without judgment  Sense of trust o Empathy  Willing to view world through client’s eyes  Does this by reflecting back what the client said o Genuineness  Consistency in way therapist feels and way they behave  Must be open enough to honestly express feelings GESTALT THERAPY - Perls - Most of time, focus on only part of experience (the figure) o Ignore the background - Gestalt focuses on the whole experience - Carried out in groups - Imaginative techniques - Methods: more active and dramatic than client-centered approaches o Sometimes confrontational - Empty-chair technique: client image the “enemy” in empty chair and carry on conversation playing both roles o Proven to be very effective - Rogers committed to research that would help identify factors contributing to therapeutic success - Perls against research COGNITIVE THERAPIES - Identify beliefs, ideas, and statements that trigger the abnormal emotions and behaviors o Once identified, challenged and changed ELLIS’S RATIONAL-EMOTIVE THERAPY - Convinced that irrational thoughts are most immediate cause of self- defeating emotions - ABCD model o A: activating event  Triggers emotion o B: belief system  Underlies how person interprets event o C: consequences  Emotional and behavioral consequences of appraisal o D: disputing  Challenge the belief system - Introduce clients to common irrational ideas and train them to change the ideas that underlie the maladaptive emotional response - Might also challenge the clients to place themselves in challenging situations and practice control over emotions BECK’S COGNITIVE THEORY - First step – help clients realize that its their thoughts not the situation that causes the emotion and behavior - Psychological treatment of choice for depression - Self-instructional training: Meichenbaum o Influential in treatments related to stress and coping BEHAVIOURAL THERAPIES - Denied inner working - Insisted behavior disorders are learned in some ways and maladaptive behaviors can be unlearned by applications from classical/operant conditioning CLASSICAL CONDITIONING TREATMENTS - Used in 2 major ways o 1. Reduce anxiety response o 2. Condition new anxiety responses to particular class of stimuli - Exposure: an extinction approach o Phobia arise from phobic object paired with unconditioned stimulus so phobic becomes conditioned stimulus that elicits a conditioned response o Avoidance reinforced by operant conditioning o Most direct way to reduce fear is exposure to feared stimulus without UCS while using response prevention to keep operant avoidance from happening  Exposed to stimuli by flooding or implosion therapy (imagine scene..)  Will feel anxiety at first but will extinguish if UCS is not present o Highly effective for both animals and humans o Treatment of choice for PTSD o Can administer exposure treatment on themselves with supervision of therapist o Often faster than systematic desensitization - Systematic desensitization: counterconditioning approach o Wolpe o Success rate is +80% o Use counterconditioning: new response that is incompatible with anxiety conditioned to CS o 1. Train client in voluntary muscle relaxation o 2. Help client construct stimulus hierarchy (10-15 scenes relating to fear)  Low anxiety to high anxiety o 3. Makes them relax and then visual the scenes low to high  If relaxation is strong enough, replace the CR to stimulus o In vivo desensitization: same thing but carefully controlled exposure to it - Aversion therapy o Pairs stimulus that is attractive to person to a result that does not feel good  Ex. injects alcoholic with nausea producing drug and makes them drink alcohol  Nausea and alcohol will be paired o Variable results  Some have been good like for alcoholics  Some can’t generalize the treatment to real world OPERANT CONDITIONING TREATMENTS - Behavior modification: treatment techniques that involve application of operant conditioning procedures in attempt to increase/decrease specific behavior - Effective in populations that are difficult to treat with more traditional therapies o Ex. schizophrenics… - Positive reinforcement o Danger of long-term institutionalization is loss of personal, social, occupational skills o Developed token economy (Ayllon, Azrin)  System for strengthening desired behavior through rewarding the patient with tokens whenever they do a desired behavior  Tokens can be redeemed for privileges  Highly effective - Therapeutic use of punishment o Least preferred way o Before using, always ask is there alternative and does the elimination of dangerous behavior towards themselves or society justify the severity of punishment MODELLING AND SOCIAL SKILLS TRAINING - Social skills training: clients learn new skills by observing and imitating model who perform socially skillful behavior o Used with other treatments - Effective because of increased self-efficacy - When believe they are able to do the behavior, they succeed in doing so THIRD-WAVE COGNITIVE BEHAVIOURAL THERAPIES - First wave = experiments based on animal models of classical and operant conditioning o No cognitive - Second wave= emergence of cognitive approaches o Ellis, Beck, Bandura - Third wave- add in mindfulness as center o Add in humanistic view, eastern methods MINDFULNESS-BASED TREATMENTS - Mindfulness: mental state of awareness, focus, openness, and acceptance of immediate experience - Based on nonjudgmental interpretations so that difficult thoughts and feelings have less of an impact - Important tool is meditation technique o People develop tranquil state and focus on sensations, thoughts, feelings - For stress management, shown to reduce physiological arousal and helps people to not be so emotional about it - Used to prevent lapses by increasing awareness of thoughts and emotions that trigger lapses o Help deal with lapses by helping neutralize self-blame and hopelessness - Acceptance and commitment therapy: focus on process of mindfulness as vehicle for change o Hayes o Teaches to just notice, and accept and embrace the thoughts and feelings o Examine one’s life, decide what is most important to them and set life goals  Therapist help client develop strategies to work toward the goals - Dialectical Behavioral therapy: treatment developed specifically for borderline personality disorder o Borderline clients hard to treat because of severity and diversity of symptoms, suicidal, and tendency to have bad relationship with therapist o Linehan o Combine cognitive, behavioral, humanistic, psychoanalytic  Cognitive: help learn more adaptive thinking on environment  Behavioral: help learn better skills  Psychodynamic: traces history of the problem  Humanistic: acceptance of thoughts and feelings o Mindfulne
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