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Chapter 14

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Western University
Psychology 1000

Chapter 14: Treatment of Psychological Disorders - The basic goal of all treatment approaches is to help people change maladaptive, self-defeating thoughts, feelings, and behavior patterns so that they can live happier and more productive lives o The relationship between the client and the person providing help is a prime ingredient of therapeutic success o A majority of people with mental health problems first seek help not from mental health professionals, but from family members, physicians, members of the clergy, acquaintances, or self-help groups – obviously this isn’t enough - There are several categories of treatments o Counseling and clinical psychologists typically hold Ph.D. or Psy.D.  They receive five or more years of intensive training and supervision in a variety of psychotherapeutic techniques as well as training in research and psychological assessment techniques  Psy.D. is not offered in Canada o Psychiatrists are medical doctors who specialize in psychotherapy and in biomedical treatments, such as drug therapy o Psychiatric social workers often work in community agencies o Marriage and family counselors focus on spiritual issues o Abuse counselors work with substance and sexual abusers and their victims  The last three need master’s degree Psychodynamic Therapies - Psychodynamic approach to psychotherapy focuses on internal conflict and unconscious factors that underlie maladaptive behavior - Psychoanalysis refers not only to Freud’s theory of personality, but also the specific approach to treatment he developed o Psychoanalysis: to help clients achieve insight, the conscious awareness of the psychodynamics that underlie their problems  Analysts believe that as the client repeatedly encounters and deals with buried emotions, motives, and conflicts, the psychic energy that was previously devoted to keeping the unconscious conflict under control can be released and redirected to more adaptive ways of living o Free association: report verbally without censorship any thoughts, feelings, or images that entered awareness o Psychoanalysts believe that dreams express impulses, fantasies, and wishes that the client’s defenses keep in the unconscious during waking hours o Resistance: defensive maneuvers that hinder the process of therapy  Resistance is a sign that anxiety-arousing sensitive material is being approached o Transference: occurs when the client responds irrationally to the analyst as if he or she were an important figure from the client’s past  Most important process in psychoanalysis  Positive transference: client transfers feelings of intense affection, dependency, or love to the analyst  Negative transference: irrational expressions of anger, hatred, or disappointment o Interpretation: any statement by the therapist intended to provide the client with insight into his or her behavior or dynamics  An interpretive statement confronts clients with something that they have not previously admitted into consciousness  A general rule in psychoanalytic treatment is to interpret what is already near the surface and just beyond the client’s current awareness  Offering deep interpretation is not a good idea  It is the client who must eventually arrive at the insight - Classical psychoanalysis is an expensive and time-consuming process o Brief psychodynamic psychotherapies emphasize understanding the maladaptive influences of the past and relating them to current patterns of self-defeating behavior; conversation usually replaces free association  Interpersonal therapy: highly structured and seldom takes longer than 15 to 20 sessions, focuses on the client’s current interpersonal problems such as role disputes  The therapist collaborates very actively with the client in finding solution to these problems  Interpersonal therapy has proven to be one of the more effective current therapies for depression Humanistic Psychotherapies - Humanistic theorists view humans as capable of consciously controlling their actions and taking responsibility for their choices and behavior o Everyone possesses inner resources for self-healing and personal growth and disordered behavior reflects a blocking of the natural growth pattern - The therapist’s goal is to create an environment in which clients can engage in self-exploration and remove the barriers that block their natural tendencies toward personal growth o The barriers often result from childhood experiences that fostered unrealistic or maladaptive standards for self-worth o Unlike psychoanalysis, humanistic approaches focus on the present and future instead of the past - Client-centered therapy: most widely used; developed by Carl Rogers; he believed that the relationship between client and therapist is the important ingredient in psychotherapy o There are three important therapist attributes  Unconditional positive regard: therapists show clients that they genuinely care about and accept them, without judgment or evaluation; this is often conveyed through refusal to offer advice or guidance  Empathy: willingness and ability to view the world through the client’s eyes  Genuineness: consistency between the way the therapist feels and the way he or she behaves o Rogers believed that as clients experience a constructive therapeutic relationship, they exhibit increased self-acceptance, greater self-awareness, enhanced self-reliance, increased comfort with other relationships, and improved life-functioning - Gestalt Therapy: the term gestalt refers to perceptual principles through which people actively organize stimulus elements into meaningful whole patterns o For people who have psychological difficulties, that background includes important feelings, wishes, and thoughts that are blocked from ordinary awareness because they would evoke anxiety o Gestalt therapy is often carried out in groups and therapists have developed a variety of imaginative techniques to help clients get in touch with inner selves  Empty-chair technique or role play may be used  These techniques can evoke powerful feelings and make clients aware of unresolved issues that affect other relationships in their lives as well o Rogers was committed to research that would help identify the factors that contribute to therapeutic success o In contrast, Perls had a strong antiscientific attitude that kept him and his followers from doing systematic research on the effectiveness of gestalt therapy  Compared to those who did not reach complete resolution, resolved clients expressed more intense emotions during the empty-chair exercise and had significantly better treatment outcomes on measures of psychological distress, self-esteem, and improvement in interpersonal problems Cognitive Therapies - Cognitive approaches to psychotherapy focus on the role of irrational and self-defeating thought patterns, and therapists who employ this approach try to help clients discover and change the cognitions that underlie their problems - Ellis’s Rational-Emotive Therapy: ABCD model o A: activating event that seems to trigger the emotion o B: belief system that underlies the way in which a person appraises the event o C: emotional and behavioral consequences of that appraisal o D: key to changing maladaptive emotions and behaviors – disputing or challenging an erroneous belief system - Rational-emotive therapists introduce clients to common irrational ideas and then train them to ferret out the particular ideas the underlie their maladaptive emotional responses - Beck’s Cognitive Therapy: goal is to point out errors of thinking and logic that underlie emotional disturbance and to help clients identify and reprogram their over learned automatic thought patterns o More recently, cognitive therapy has been extended to the treatment of anger and anxiety disorders, with encouraging results o Self instructional training: has been very influential in treatments related to stress and coping Focus on Neuroscience - Cognitive behavior therapy (CBT) is the treatment of choice for unipolar depression - The goal of this approach is to identify maladaptive thoughts and behaviors and through therapy, help the patient to think more rationally o Depression may stem from the underactivity of monoamines (norepinephrine, dopamine, and serotonin) - Reduced serotonin transport was observed for those expressed higher levels of depression o Cingulated cortex is involved in the regulation of activity in the limbic system; thus, depressed individuals showing this lack of regulation are precisely those who will benefit from CBT since CBT will help them to regain emotional control Behavioral Therapies - Behavior therapists insisted that behavior disorders are learned in the same ways normal behaviors are, and these maladaptive behaviors can be unlearned by application of principles derived from research on classical conditioning and operant conditioning - Classical conditioning treatments: used to reduce, or de-condition anxiety responses o They have also been used in attempts to condition new anxiety responses to a particular class of stimuli, such as alcoholic beverages or inappropriate sexual objects - Most direct way to reduce the fear is through a process of classical extinction of the anxiety response o Exposure to the feared CS in the absence of the UCS while using response prevention to keep the operant avoidance response from occurring o Flooding: client may be exposed to real-life stimuli o Implosion: clients may be asked to imagine scenes involving stimuli  Anxiety will extinguish in time if the person remains in the presence of the CS and the UCS does not occur  As well, clients can administer exposure treatment to themselves under a therapist’s direction, with high success rates o Exposure has proved to be a highly effective technique for extinguishing anxiety responses in both animals and humans - Systematic desensitization is a new learning based treatment for anxiety disorders o Counter-conditioning: a new response that is incompatible with anxiety is conditioned to the anxiety arousing CS o Clients are helped to construct stimulus hierarchy of 10 to 15 scenes relating to the fear o Desensitization also can be accomplished through carefully controlled exposure to a hierarchy of real-life situations (in vivo desensitization) o Both desensitization approaches are highly effective in reducing anxiety o On the other hand, exposure often reduces anxiety more quickly than does systematic desensitization - Aversion therapy: the therapist pairs a stimulus that is attractive to a person and that stimulates deviant or self-defeating behavior (the CS) with a noxious UCS in an attempt to condition an aversion to the CS o Unfortunately, treatment effects from aversion therapies often fail to generalize from the treatment setting to the real world o Some experts believe that aversion therapy is most likely to succeed if it is part of a more comprehensive treatment program in which the client also learns specific coping skills for avoiding relapses - Behavior modification: refers to treatment techniques that involve the application of operant conditioning procedures in an attempt to increase or decrease a specific behavior; these techniques may use positive reinforcement, extinction, negative reinforcement, or punishment o Token economy: system for strengthening desired behaviors, such as personal grooming, appropriate social responses, housekeeping behaviors, working on assigned jobs, and participation in vocational training programs, through the systematic application of positive reinforcement  The long-term goal of token economy programs is to get the desired behaviors started with tangible reinforcers until they eventually come under the control of social reinforcers and self-reinforcement processes, which will be needed to maintain them in the world outside the hospital o Token economy programs have proven highly effective with some of the most challenging populations o They have also been applied successfully within business, school, prison, and home environments to increase desired behaviors - Before deciding to use punishment as a therapeutic technique, therapists ask themselves these questions: o Are there alternative, less painful approaches that might be effective? o Is the behavior to be eliminated sufficiently injurious to the individual or to society to justify the severity of the punishment? - Punishment is never employed without consent of the client or the client’s legal guardian in the event that the client is mentally incompetent to give consent - Modeling is one of the most important and effective learning processes in humans o Social skills training: clients learn new skills by observing and then imitating a model who performs a socially skilful behavior o Observing others also increases self-efficacy by encouraging the view, “if she can do it, so can I” “Third-Wave” Cognitive-Behavioural Therapies - Mindfulness: mental state of awareness, focus, openness, and acceptance of immediate experience - Acceptance and Commitment Therapy (ACT): focuses on the process of mindfulness as a vehicle for change - Dialectical behavior therapy (DBT): treatment developed specifically for the treatment of borderline personality disorder Integrating and Combining Therapies - Eclectic: combining treatments and making use of whatever orientations and therapeutic techniques seem appropriate to the particular client they are treating o Many therapists now label themselves cognitive-behavioral therapists because their techniques include elements of both perspectives o Psychodynamic behavior therapy involves an integration of psychoanalysis and behavior
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