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Chapter 14

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Psychology 1000

CHAPTER 14: TREATMENT OF PSYCHOLOGICAL DISORDERS > THE HELPING RELATIONSHIP • Basic Goal of all treatment is to help people change maladaptive, self-defeating thought, feelings and behaviour patterns so that they can live happier and more productive lives • Counseling and clinical psychologists: typically hold a PhD  usually 5+ years of training in psychological assessment techniques • Psychiatrists: medical doctors who specialize in psychotherapy and in biomedical treatments such as drug therapy > PSYCHODYNAMIC THERAPIES: • The psychodynamic approach to psychotherapy focuses on internal conflict and unconscious factors that underlie maladaptive behaviour Psychoanalysis • Psychoanalysis: Freud’s theory of personality as well as the specific approach to treatment that he developed • Goal is to help achieve insight: the conscious awareness of the psychodynamics that underlie their problems o Permits clients to adjust their behaviour to current life situations rather than continuing maladaptive routines o As client deals with buried emotions and conflicts, the psychic energy that was previously devoted to keeping the unconscious under control can be released and redirected to more adaptive ways of living • Free association: client reclines on a couch and gives verbal reports without censorship of any thoughts, feelings, or images that entered awareness (analyst sits behind client) • Dream interpretation: Dreams express impulses, fantasies, and wishes that client’s defenses keep in the unconscious o Free associate to each element of the dream and to help the client arrive at an understanding of what the symbols in the dream really represent • Resistance: defensive maneuvers that hinder the process of therapy o May experience difficulty in free-associating, coming late to appointment or avoid certain topics o A sign that anxiety-arousing sensitive material is being approached • Transference: when the client responds irrationally to the analyst as if he or she was an important figure from the client’s past o Brings out the repressed feelings that the therapist can point out to the client o Positive transference: when the client transfers feelings of intense affection, dependency or love to the analyst o Negative transference: involves irrational expressions of anger, hatred or disappointment o Until transference reactions are analyzed/resolved there can be no full recovery • Interpretation: any statement by the therapist intended to provide the client with insight into his or her behaviour or dynamics o General rule in psychoanalytic treatment is to interpret what is already near the surface and just beyond the client’s current awareness  deep analysis will not be understood or helpful to the patient o It is the patient who must ultimately arrive at the insight Brief Psychodynamic Therapies • About half of clients approve within 8 sessions, and most of the therapeutic effects occur within 26 sessions • It becomes very expensive and time consuming Brief psychodynamic psychotherapies: • Employ insight and interpretation at a more focused and active fashion • Sit face-to-face  conversation replaces free-association • Aimed at helping to deal w/ specific life problems • only a few sessions a week • Interpersonal therapy: (15-20 sessions)  focus on client’s current interpersonal problems (marriage, etc.) > HUMANISTIC PSYCHOTHERAPIES • View humans as capable of consciously controlling their actions and taking responsibility for choices and behaviour • Believe everyone has inner resources for self-healing and personal growth, and that disorders reflect a blocking of these resources o Brought on by distorted perceptions, lack of awareness about feelings, negative self-image • Focus on present and future rather than past • Seen as a human encounter between equals • Goal is to create an environment where the client can engage in self-exploration and remove the barriers that block their natural tendencies toward personal growth o Barriers often result from standards being set too high in childhood Client-centered Therapy • Developed by Carl Rogers  stressed the relationship between client and therapist • 3 important therapist attributes: 1. unconditional positive regard: a communicated attitude of total and unconditional acceptance towards the client that convey their intrinsic worth 2. empathy: the ability of a therapist to view the world through the clients’ eyes and to understand the clients’ emotions 3. genuineness: ability of a therapist to honestly express their feelings to a client • when all 3 attributes are present they create a situation which the client feels accepted, understood and free to explore without judgment or rejection Gestalt Therapy • Frederick S. Perls  concentrate on “whole” experiences • Goal: bring ‘background’ feelings, wishes and thoughts, into immediate awareness so the client can be “whole” again. • Empty chair technique: client asked to imagine someone sitting in the chair and carry a conversation role-playing for both themselves and the absent person o makes ppl aware of unresolved issues that affect relationships and their lives • Unlike Rogers, who was committed to research that would help identify the factors that contribute to therapeutic success, such as tape recorded sessions, Perls used an antiscientific method  could not do systematic research on the effectiveness of Gestalt therapy, and it began to wane in the 70s > COGNITIVE THERAPIES - focus on the of irrational and self-defeating thought patterns - tries to help clients discover and change the cognitions that underlie their problems - do not emphasize the importance of unconscious psychodynamic processes - clients need help in identifying the beliefs, ideas, and self-statements that trigger maladaptive emotions and behaviours Albert Ellis’s Rational-Emotive Therapy: ABCD model: - A  activating event that triggers the emotion - B  belief system that underlies the way a person appraises the event - C  emotional and behavioural consequences of the appraisal - D  disputing or challenging belief system to change maladaptive emotions Example: a young man is turned down for a date. - the woman’s refusal is not the cause of the feeling of rejection and depression - instead it is his believe that he needs to be loved and accepted that caused it - Rational-emotive therapists introduce clients to common irrational ideas and train them to reject them - Clients are given homework assignments to analyze and change self-statements o eg. A shy person must go to a party and practice counteracting social anxiety techniques Beck’s Cognitive Therapy - help clients identify and reprogram their over-learned “automatic” thought patterns - his contributions to the understanding and treatment of depression has made his cognitive theory the treatment of choice for depression and anger and anxiety disorders - self-instructional training: a cognitive coping approach of giving adaptive instructions to oneself  very influential to stress and coping > BEHAVIOUR THERAPIES - denied the importance of inner dynamics - they insisted: 1. behaviour disorders are learned in the same ways normal behaviours are 2. these behaviours can be unlearned by application of principles derived from research on classical conditioning and operant conditioning Classical Conditioning Treatments - used in two major ways: o to reduce, decondition, anxiety responses o condition new anxiety responses to a particular class of Exposure Therapy: An Extinction Approach - The most direct way to reduce fear is through a process called classical extinction of anxiety responses. This requires exposure and use of response prevention to keep operant avoidance responses from occurring - flooding: exposed to real-life stimuli - implosion: imagining the stimuli Systematic Desensitization: A Counter-conditional Approach - systematic desensitization: an attempt to eliminate anxiety using counter-conditioning, in which a new response that is incompatible with anxiety is conditioned to the anxiety- arousing conditioned stimulus - counter-conditioning: a new response that is incompatible with anxiety is conditioned to the CS - first step of systematic desensitization is to train client in voluntary muscle relaxation - next they create a stimulus hierarchy of 10-15 scenes relating to fear to imagine - they then relax, and pair image with relaxation cue - after low-arousal scenes have been deconditioned, can try in vivo desensitization: exposure to real life situations Aversion Therapy - Aversion therapy: pairing a stimulus that is attractive to the person and that stimulates deviant or self-defeating behaviour with a negative UCS (eg. Pair alcohol with nauseating injections) Operant Conditioning Treatments - Behaviour modification: refers to treatment techniques that involve the application of operant conditioning procedures in attempts to increase or decrease a specific behaviour  Focused on externally observable behaviours  Very helpful w/ those that normal ther
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