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Chapter 17

chapter 17

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Western University
Psychology 1000

Chapter 17: Treating Psychological Disorders Helping Relationship Overall goal: help people change maladaptive, self-defeating thoughts, feelings and behaviour patterns so they can live happier and more productive lives Healthy relationship between person & therapist = key factor Group A o Counselling & clinical psychologists o Psychologists Hold Ph.D (Doctor of Philosophy) or Psy.D (Doctor of Psychology) Received 5 or more years of intensive training & supervision in various psychotherapeutic techniques Group B o Psychiatrists Medical doctors who specialize in psychotherapy & biomedical treatments Group C o Psychiatric social workers o Marriage & family counsellors o Pastoral counsellors o Abuse counsellors Psychodynamic Therapies Focuses on internal conflict & unconscious factors that underlie maladaptive behaviour Psychoanalysis o Refers to Freud's theory of personality & specific approach to treatment Psychoanalysis Goal: help clients achieve insight o Conscious awareness of psychodynamics that underlie their problems o Permits clients to adjust their behaviour to their current life situations Client repeatedly encounters & deals with buried emotions, motives, and conflicts psychic energy can be released and redirected to more adaptive ways of living Free Association Mental events are meaningfully associated with one another Clues to contents of unconscious are to be found in the constant stream of thoughts, memories, images, and feelings we experience Asked his clients to recline on a couch and to report verbally without censorship any thoughts, feelings, or images that entered awareness Freud sat out of sight behind client so that client's thought processes would be determined primarily by internal factors Dream Interpretation Dreams express impulses, fantasies, and wishes that defences keep in unconscious during waking hours Defensive processes usually disguise threatening material to protect dreamer from anxiety that material might evoke Tries to help client search for unconscious material contained in dreams Ask client to free associate to each element of dream and to help client arrive at an understanding of what symbols in dream really represent Resistance Avoidance patterns emerged in course of therapy Defensive manoeuvres that hinder process of therapy Client may experience difficulty in free-associating May come late or forget about a therapy appointment May avoid talking about certain topics Sign that anxiety-arousing sensitive material is being approached Explore reasons for resistance promote insight & guard against dropout Transference Occurs when client responds irrationally to te analyst as if he or she were an important figure from the client's past Most important process brings out into open repressed feelings and maladaptive behaviour patterns Two Forms o Positive Transference Client transfers feelings of intense affection, dependency, or love o Negative Transference Irrational expressions of anger, hatred, or disappointment Until transference reactions are analyzed and resolved no full resolution Interpretation Any statement by therapist intended to provide client with insight into their behaviour or dynamics Confronts clients with something that they have not previously admitted into consciousness o Ex. It's almost as if you're angry with me without realizing it Interpret what is already near surface and just beyond client's current awareness Deep interpretation - removed from awareness - cannot be informative or helpful Brief Psychodynamic Therapies Expensive & time-consuming process - goal is rebuilding client's personality Not uncommon for client to be seen 5 times a week for 5 years or more o Modern therapists consider level both impractical & unnecessary Studies show regardless of how many sessions clients attended, rate of improvement was highest at beginning & decreased over time Modern Therapies o Brief o Emphasize understanding maladaptive influences of past & relating them to current patterns of self-defeating behaviour o Therapist and client are likely to sit facing each other o Conversation typically replaces free association o Clients are seen once or twice a week rather than daily o Goal: typically limited to helping client deal with specific life problems rather than complete rebuilding of the client's personality o More likely to focus on the client's current life Interpersonal Therapy o Highly structured and no longer than 15 to 20 sessions o Focuses on the client's current interpersonal problems Dealing with role disputes such as marital conflict Adjusting to the loss of a relationship or changed relationship Identifying and correcting deficits in social skills o Very effective for depression Humanistic Psychotherapies Humans capable of consciously controlling & taking responsibility for choices & behaviour Everyone possesses inner resources for self-healing & personal growth Disordered behaviour reflects a blocking of natural growth process o Blocking due to distorted perceptions, lack of awareness about feelings, or a negative self- image Goal: Create environment in which clients can engage in self-exploration and remove barriers that block natural tendencies toward personal growth o Barriers often result from childhood experiences that fostered unrealistic or maladaptive standards for self-worth People try to live lives according to expectations of others rather than in terms of own desires and feelings o Often feel unfulfilled & empty o Unsure about who they really are as people Focus primarily on present & future instead of past Therapy directed at helping clients become aware of feelings as they occur rather than at achieving insight into the childhood origins of the feelings Client-Centered Therapy Most widely used form of humanistic therapy - Carl Rogers Relationship that develops between client and therapist key ingredient Identified 3 important & interrelated therapist attributes: o Unconditional Positive Regard Therapists show clients that they genuinely care about & accept them, without judgment or evaluation Communicates sense of trust in clients o Empathy Willingness & ability to view world through client's eyes Therapist reflects back to client what he or she is communicatingperhaps by rephrasing something the client has just said in a way that captures the meaning and emotion involved o Genuineness Consistency between way therapist feels & way they behave Therapist must be open enough to honestly express feelings, whether positive or negative Clients experience constructive therapeutic relationship exhibit increased self-acceptance, greater self-awareness, enhanced self-reliance, increased comfort with other relationships, and improved life functioning Gestalt Therapy Gestalt (organized whole) o Perceptual principles through which people actively organize stimulus elements into meaningful whole patterns Percieve external stimuli, ideas, or emotions concentrate on only part o our whole experience figurewhile largely ignoring background Psychological difficulties background includes important feelings, wishes, & thoughts blocked from ordinary awareness because they would evoke anxiety Goal: bring them into immediate awareness so that client can be whole. Often carried out in groups Developed variety of imaginative techniques to help clients get in touch with their inner selves. More active, dramatic & confrontational in nature Often ask clients to role-play different aspects of themselves so that they directly experience inner dynamics Empty-Chair technique o Client may be asked to imagine his mother sitting in chair, & then carry on conversation in which he alternatively role-plays his mother & himself
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