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Chapter 17

Chapter 17 – Treatment of Psychological Disorders.docx

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Psychology 1000
Mark Cole

Chapter 17 – Treatment of Psychological Disorders The Helping Relationship: - The basic goal of all treatment approaches is to help people change maladaptive, self-defeating thoughts, feelings, and behavior patterns in order for them to live a happier and more productive life - In order to do this, you must have a good relationship with the therapist and the client Counseling and Clinical Psychologists – have a Ph.D or Psy.D (mainly in the United States) and have received more than 4 years of education in a variety of psychotherapeutic techniques Psychiatrists – medical doctors who specialize in psychotherapy and biomedical treatments, like drug therapy Psychiatric Social Workers – receive a master’s degree and work in communities Marriage and Family Counselors - specialize in family relations Pastoral Counselors – focus on spiritual issues Abuse Counselors – work with substances or victims or sexual abuse Psychodynamic Therapies Psychoanalysis – help clients achieve insight to their conscious awareness of the psychodynamics that underlie their problems - The awareness permits clients to adjust their behavior to their current life situations - As the client repeatedly encounters and deals with buried emotions, the psychic energy devoted to keeping the unconscious conflict under control can be replaced Free Association – Freud asked his clients to recline on a couch and to report verbally without censorship any thoughts, feelings or images that entered awareness - Freud believed that mental images/events were meaningful and had clues to the unconscious - Freud would wait for hesitation or pauses to arise and, when they did, he would focus on those points to find the root cause Dream Interpretation – dreams express impulses, fantasies, and wishes that the client’s defenses keep in the unconscious - Freud called dreams “the royal road to the unconscious” Resistance – we have a strong unconscious with maintaining the status quo - We use defensive patterns to deal with them - A client may experience difficulty in free association, being on time or forgetting about the appointment, or avoiding certain topics Transference – occurs when the client responds irrationally to the analyst as if he or she were an important figure from the clients past - It brings out repressed feelings and maladaptive behavior patterns - Positive Transference – client transfers feelings of intense affection, dependency, or love to the analyst - Negative Transference – involves irrational expressions of anger, hatred, or disappointment - Until transference mechanisms are resolved, you cannot successfully continue on with therapy Interpretation – any statement by the therapist intended to provide the client with insight into his or her behavior or dynamics - Confronts clients with something that they have not previously admitted into consciousness - It must be relevant to the discussion at hand or else it will be too far removed from the clients current awareness and will have no effect Brief Psychodynamic Therapies: - In classical psychoanalysis, it isn’t uncommon for a client to be seen 5 times per week for 5 years (however, it is viewed as unnecessary) - Regardless of how many sessions were attended, the rate of improvement was highest at the beginning and decreased over time - Psychodynamic psychotherapies emphasize understanding the maladaptive influences of the past and relating them to current patterns (more focused) o Typically seen only once or twice a week - Interpersonal Therapy – takes longer that 20 sessions and focuses on the clients current interpersonal problems and maintaining relationships Humanistic Psychotherapies - View humans as capable of consciously controlling their actions and taking responsibility for their choices and behavior - Everyone possesses inner resources for self-healing and personal growth and that disordered behavior reflects a blocking of the natural growth process - The therapists goal is to create an environment in which clients can engage in self-exploration and remove the barriers that block their natural tendencies o The barriers are often from their childhood or unrealistic expectations for themselves based on other people - These focus on the present and the future Client-Centered Therapy – developed by Carl Rogers and he believes the active ingredient in therapy is the relationship that develops between the client and the therapist because it can result in self-acceptance, self-reliance, and self-awareness 1. Unconditional Positive Regard – therapists show clients that they are genuinely concerned and care about them without judgment 2. Empathy – the willingness to view the world through the clients eyes and coming to sense with their feelings 3. Genuineness – must be consistency between the way the therapist feels and the way the client behaves, while being able to be honest and accepting Gestalt Therapy – developed by Frederick Perls and refers to perceptual principles through which people actively organize stimulus elements into meaningful whole patterns (antiscientific approach) - We concentrate on only part of our whole experience, the main figure, and tend to ignore the background o The background includes important feelings, wishes, and thoughts that are blocked from consciousness - Often carried out in groups and involves role-playing different aspects of themselves in different situations o Empty-Chair technique – may be asked to pretend someone is sitting in a chair and have a “pretend” conversation with them while playing both roles Cognitive Therapies - Focus on the role of irrational and self-defeating thought patterns - Therapists who employ this approach try to help clients discover and change the cognitions that underlie their problems - The do not emphasize the importance of unconscious thoughts, and focus on our habitual thought patterns since they are so well-practiced and how they can sometimes go off track automatically o Clients will then need help in identifying the beliefs, ideas, and self- statements that trigger maladaptive emotions and behaviors Ellis’s Rational-Emotive Therapy – developed by Albert Ellis and says how the irrational thoughts were the most immediate cause of self-defeating emotions - ABCD Model: o A stands for activating event that seems to trigger emotion o B stands for belief system that underlies that way in which a person appraises the event o C stands for the emotional and behavioral consequences of the appraisal o D is the key to changing maladaptive emotions and behaviors: disputing or challenging an erroneous belief system - People who are accustomed to viewing their emotions, C, as being caused directly by events, A - Clients are given homework assignments to help them analyze and change self-statements Beck’s Cognitive Therapy – developed by Aaron Beck’s and points out errors of thinking and logic that underlie emotional disturbance and to help clients identify and re-program their over learned automatic thought patterns - Their thoughts, not their situation, cause their maladaptive emotional reactions - Self-Instructional Training – used for treatments related to stress and coping Behavioral Therapies - A dramatic departure from the assumptions and methods that characterized psychoanalytic and humanistic therapies - Insist that behaviors are learned in the same way as behavioral disorders and these maladaptive behaviors can be unlearned by application of principles derived from research on classical conditioning and operant conditioning o Could relate to change in the behaviors of schizophrenics Classical Conditioning Treatments – used to reduce anxiety responses and they have been used in attempts to condition new anxiety responses to a particular class of stimuli 1. Exposure: An Extinction Approach – phobias and other fears result from classically conditioned emotional responses - They involve a pairing of the phobic object (neutral stimuli) and an aversion (UCS), which will result in the phobic stimulus becoming a CS that elicits the conditioned response CR o The phobic condition is then reinforced by anxiety reduction (based on negative reinforcement) o This requires exposure to the CS in the absence of the UCS while using response prevention to keep the operant avoidance response from occurring - Flooding – when the client is exposed to real-life stimuli o The stimuli will evoke considerable anxiety, but the anxiety will extinguish in time if the person remains in the presence of the CS and the UCS does not occur 2. Systemic Desensitization: A Counterconditiong Approach- developed by Joseph Wolpe and is a new learning-based treatment for anxiety disorders and phobic disorders - He viewed anxiety as a classically conditioned emotional response and his goal was to eliminate the anxiety by using a procedure called counterconditioning o This caused a new response to the CS that caused the anxiety - You have to train the client to relax their muscles and construct a stimulus hierarchy of 15 scenes (low-high anxiety) o The client will be relaxed and then have to visualize the different scenes o Since the client cant be relaxed and anxious at the same time, eventually the relaxed feeling will replace the anxious one - In Vivo Desensitization – exposure to a hierarchy of real-life situations 3. Aversion Therapy – they want to actually condition the anxiety to a particular stimulus so as to reduce deviant approach behaviors - 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 (create an aversion to the CS) o They use this with alcoholics and pedophiles - These often fail to relate to the real world Operant Conditioning Treatments: - Behavior Mod
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