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Chapter 14

Chapter 14 Psychology.docx

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Psychology 1000

Chapter 14: Treatment of Psychological Disorders  The Helping Relationship -basic goal of treat is to help people change maladaptive, self-defeating thoughts, feelings, and behaviour patterns so that they can live a happier and more productive life -majority of people first seek help from family members, physicians, members of a clergy, acquaintances, or self-help groups -counselling and clinical psychologists have PhD and PsyD degree -psychiatrists are medical doctors specialized in psychotherapy and in biomedical treatments (drugs) -other professionals have master’s degree and these people are: 1. Psychiatric social workers – work in community agencies 2. Marriage and family counsellors – help with problems arising from family relations 3. Pastoral counsellors – spiritual issues 4. Abuse counsellors – substance and sexual abusers and victims  Psychodynamic Therapies -goal of psychoanalysis is to help clients achieve insight (conscious awareness of the psychodynamics that underlie the problem) -free association (report verbally without censorship any thoughts, feelings, or images that entered their awareness); provide clues concerning important themes and issues -dream interpretation (express impulses, fantasies, and wishes that the client’s defences keep in the unconscious during waking hours); “royal road to the unconscious” -resistance (defensive manoeuvres that hinder the process of therapy) ; sign that anxiety- arousing sensitive material is being approached -transference (client responds irrationally to the analyst as if he/she were an important figure from the client’s past); it has 2 forms: 1. Positive Transference – client transfers feelings of affection, dependency, and love to the analyst 2. Negative Transference – client transfers irrational expressions of anger, hatred, and disappointment to the analyst -interpretation (any statement by the therapist intended to provide the client with insight into his/her behaviour or dynamics); helps client detect and understand resistance, meaning of dream symbols, and transference reactions; general rule is to interpret what is already near the surface and just beyond the client’s current awareness -brief psychodynamic therapies emphasize understanding the maladaptive influences of the past and relating them to current patterns of self-defeating behaviour; conversation replaces free association and helps client deal with specific life problems rather than attempting a complete rebuilding of the client’s personality -interpersonal therapy (dealing with role disputes such as marital conflict, adjusting to loss of a relationship or to a change relationship, and identifying and correcting deficits in social skills that make it difficult for the client to initiate or maintain satisfying relationships)  Humanistic Psychotherapies -view humans as capable of consciously controlling their actions and taking responsibility for their choices and behaviour -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 -barriers often result from childhood experiences that fostered unrealistic/maladaptive standards for self-worth; focuses on the present and future instead of the past -Rogers developed client centered therapy and identified 3 important attributes: 1. Unconditional positive regard – therapist shows that he/she genuinely cares about the client, without judgment and evaluation; displays sense of trust in clients’ ability to work through problems 2. Empathy – willingness and ability to view the world through the client’s eyes; therapist comes to sense of feelings and meanings experienced by client and communicates this understand with the client; therapist does this by reflecting back to the client what he/she is communicating 3. Genuineness – consistency between the way the therapist feels and the way he/she behaves; therapist must be open to honestly express feelings -Rogers believed that as clients experience a constructive therapeutic relationship, they exhibit increased self-acceptance, greater self-awareness, enhanced self-obedience, increased comfort with relationships, and improved life functioning -Gestalt therapy’s goal is to bring client into immediate awareness so that the client can be “whole” again; empty chair technique (role play aspects of themselves so that they may directly experience the client’s inner dynamics  Cognitive Therapies -focus on role of irrational and self-defeating thought patterns -Ellis’s Rational-Emotive Theory are embodied in his ABCD model 1. A – activating event that triggers emotion 2. B – belief system that underlies way in which person appraises event 3. C – emotional and behavioural consequences of appraisal 4. D – disputing an erroneous belief system -Beck’s Cognitive Therapy helps point out errors of thinking and logic that underlie emotional disturbance and to help client identify their overlearned “automatic” thought patterns -self instructional training (giving adaptive self-instructions to oneself at crucial phases of the coping process)  Neuroscience of Treating Unipolar Depression -depression stems from underactivty of norepinephrine, dopamine, and serotonin; given drug treatments, resulting in high levels of their neurotransmitters -increased activity in prefrontal cortex, parietal cortex, and cingulate cortex -people who reacted with low levels of activity in the cingulated cortex and high levels in the amygdala when processing negative emotional words showed the most improvement after CBT  Behaviour Therapies -insisted that (1) behaviour disorders are learned in the same ways normal behaviours are and (2) maladaptive behaviours can be unlearned by application of principles derived from research on classical and operant conditioning -most direct way to reduce fear is to through process of classical extinction of anxiety response; requires exposure to feared CS in absence of UCS while using response prevention to keep the operant avoidance response from occurring -client maybe exposed to real life stimuli (flooding) or maybe asked to imagine scenes involving the stimuli (implosion therapy) -systematic desensitization (attempt to eliminate anxiety using counter-conditioning, in which a new response that is incomparable with anxiety is conditioned to the anxiety-arousing conditioned stimulus) -stimulus hierarchy (creation of a series of anxiety-arousing stimuli that are ranked in terms of the amount of anxiety they evoke) -desensitization can also be accomplished through carefully controlled exposure to a hierarchy of real life situations (in vivo desensitizations) -aversion therapy (pair a stimulus that is attractive to a person and that stimulates deviant or self-defeating behaviour (the CS) with a noxious UCS in an attempt to condition an aversion to the CS) -behaviour modification (treatment techniques that involve the application of operant conditioning procedures in an attempt to increase/decrease a specific behaviour) -positive reinforcement of token economy; strengthens desired behaviours (i.e. personal grooming, appropriate social responses, jobs, etc.) and given plastic tokens for performance of each desired behaviour -punishment is the least preferred way to control behaviour and only used if (1) if there is no alternative, less painful, and effective approach and (2) if the behaviour is injurious to the individual or society to justify the severity of the punishment? -modelling through social skills training (clients learn new skills by observing then imitating a model who performs a socially skilful behaviour)  Integrating and Combining Therapies -clinicians become eclectic (combining treatments and making use of whatever orientations and techniques seem appropriate to the client) -psychodynamic behaviour therapy (integration of psychoanalysis with behaviour therapy) -virtual reality has been used to create a highly realistic environment that stimulates actual experiences so vividly that they evoke the same reactions compared to a real environment;  Cultural Issues in Psychotherapy -some values are not shared by all cultures and ethnic groups and view psychotherapy as inappropriate for solving their problems in living -utilization of mental health services is far less for minority
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