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Chapter 17

Psych 1000 Chapter 17

12 Pages

Course Code
Psychology 1000
Laura Fazakas- De Hoog

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CHAPTER 17 – Treatment of Psychological Disorders Patients of Cameron sued CIA + Canadian gov’n claiming they were subjected to “mind-control” Were shocked and listened to audio recordings to erase thoughts and rebuilt personalities The Helping Relationship (pg. 675 chart) Counseling and clinical psychologists – Ph.D or Psy.D, 5+ years of training Psychiatrists – medical doctors who specialize in psychotherapy + biomedical treatments Psychiatric social workers – work in community agencies (Masters, 2+ years of training) Marriage and family counselors – specialize in problems from family relations (Masters) Pastoral counselors – focus on spiritual issues (Masters) Abuse counselors – work with substance/sexual abusers and their victims Improvement of Psychopathology 2 general approaches: Psychotherapies (emotional, cognitive and behaviorally based) Somatic Therapies (biologically based, early stage treatments included trephining + purge Psychoanalysis Psychoanalysis – Freud’s theory of personality + the specific approach to treatment he developed Insight – conscious awareness of psychodynamics that underlie problems (goal of psychoanalysis) Free association – ask clients to report verbally any thoughts/images in their head (sits out of view) Dream interpretation – dreams express wishes one’s defenses keep in unconscious while awake Resistance – defensive maneuvers that hinder process of therapy (ex. avoid talking about a topic) Signs that anxiety-arousing sensitive material is being approached Transference – client responds irrationally to analyst as if he/she were a figure from client’s past Positive transference – client transfers feelings of intense affection/dependency to analyst Negative transference – irrational expressions of anger/hatred/disappointment Most important process that brings repressed feelings out (no resolution until this) Interpretation – statement by therapist intended to provide client with insight to his/her behavior Best to interpret what is already near the surface (don’t go deep) -> can understand causes Brief Psychodynamic Therapies Promote insight and interpretation (focus more on current life event) Converse, not free associate (meet once/twice a week) Interpersonal therapy – addresses current interpersonal problems + enhancing interpersonal skills Humanistic Psychotherapies Focuses on present and future Therapy helps clients discover true identities + achieve personal growth (self-help approach) Therapist clarifies clients’ thoughts by restating what client is trying to say about their feelings 5 common themes 1. Emotional defusing (less fear evoked when with accepting therapist) 2. Interpersonal learning (reveals to clients how they react to others) 3. Insight (into present feelings) 4. Step-by-step process (each new skill discovered must be practiced in daily life) 5. Socially acceptable practice (seek therapy to improve life) Client-Centered Therapy (Rogers) 3 important and interrelated therapist attributes Unconditional positive regard – cares/accept clients (trusts client can solve problems) Empathy – willingness/ability to view world through client’s eyes (reflecting) Genuineness – therapist open enough to express honest feelings (positive or negative) Gestalt Therapy (Perls) Gestalt – perceptual principles through which people organize stimulus elements into a “whole” Goal is to bring blocked thoughts into immediate awareness so client can be “whole” again Ask clients to role-play different aspects of themselves so they can experience their inner dynamics Empty-chair technique – client imagines his mother and role-plays a conversation between the 2 Least effective (but still 60% improve) Therapy as a Social Education Most therapeutic techniques have the goal of eliminating unwanted behaviors Simple elimination isn’t always enough (must replace unwanted behavior with positive behavior) Three techniques commonly employed are: Graded task assignments – steps in real situations moving toward final desired behavior Modeling – therapist demonstrates a healthy response to problem situation Role-playing – exchange of roles by patient and therapist in acting out a problem situation Cognitive Therapies Focus on role of irrational + self-defeating thought patterns (change cognition that underlie issues) Ellis’s Rational-Emotive Therapy Believed irrational thoughts are most immediate cause of self-defeating emotions ABCD model Activating event that seems to trigger the emotion Belief system that underlies the way in which a person appraises the event Emotional and behavioral consequences of that appraisal Key to changing maladaptive emotions/behaviors: disputing an incorrect belief system People used to viewing their emotions (Cs) as being caused directly by events (As) Key to adaptive functioning is how disputing (D) relates back to belief system (B) Beck’s Cognitive Therapy Goal also to point out errors of thinking and logic to help identify/reprogram “automatic” thoughts Help clients realize their thoughts (no the situations) cause their maladaptive emotional reactions Self-instructional training – very influential in treatments related to stress/coping Behavioral Therapies Behavior disorders are learned in the same ways normal behaviors are learned Maladaptive behaviors can be unlearned by using principles from classical/operant conditioning Classical Conditioning Treatments Exposure Phobic object (ex. car) paired with aversive unconditioned stimulus (ex. crash) Object becomes conditioned stimulus (ex. crash) that elicits conditioned response of anxiety Classical extinction requires exposure to feared CS in the absence of UCS while using response prevention to keep the operant avoidance response from occurring Client exposed to stimulus (flooding) or imagines scene with stimuli (implosion therapy) Good for PTSD Systematic Desensitization (Wolpe) Counterconditioning – new response (not anxiety) conditioned to anxiety-arousing CS Train client in voluntary muscle relaxation Client is helped to construct a stimulus hierarchy of 10-15 scenes relating to the fear Imagine first scene in hierarchy (if relaxation strong enough, it replaces anxiety) Vivo desensitization – carefully controlled exposure to a hierarchy of real-life situations Transfer to real life situations from therapy sessions is not very successful Aversion Therapy Aversion therapy – therapist pairs an attractive stimulus that stimulates deviant/self-defeating behavior (the CS) with a harmful UCS to condition an aversion to the CS Ex. inject alcoholics with drug that makes them nauseated when they drink Treatment effects often fail to generalize from the treatment setting to the real world Treating Unipolar Depression Cognitive behavior therapy (CBT) good for unipolar depression Increased activity in the prefrontal cortex after taking antidepressant drug Paxil Reduced serotonin transport Virtual Reality as a Therapeutic Technique Virtual reality (VR) – use of computer technology to stimulate experience to evoke real reactions Used to treat PTSD (allows clients to interact with feared stimuli/situations) Operant Conditioning Treatments Behavior modification – application of operant conditioning to increase/decrease a behavior Focus on externally observable behaviors Positive Reinforcement Token economy – system for increasing desired behaviors through positive reinforcement Long-term goal is to get desired behaviors started with tangible reinforcers until patients come under control of social reinforcers/self-reinforcement processes Used with schizophrenic patients + at schools/prison/businesses/homes Therapeutic Use of Punishment If there isn’t a less painful effective approaches + if injury is enough to justify punishment Must be immediate and severe (prison is imprisonment, not punishment) Modeling and Social Skills Training Social skills training – clients learn skills by imitating model who performs socially skillful behavior Key factor underlying effectiveness is increased self-efficacy Eclecticism – therapists combine therapeutic techniques for particular clients “Third-Wave” Cognitive-Behavioral Therapies 3 /most recent phase: mindfulness as a central objective of behavior change (humanistic) Mindfulness-Based Treatments Mindfulness – mental state of awareness, focus, openness + acceptance of immediate experience Nonjudgmental appraisal (difficult thoughts/feelings have less impact) Mindfulness meditation reduces physiological arousal (also used to prevent relapses) Acceptance and Commitment Therapy Mindfulness is a vehicle for change ACT therapist teaches clients to notice, accep
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