Download III. Psychodynamic Approaches

Chapter Summary/Lecture Organizer
Chapter 16 — Psychological Disorders and Their Treatments
I.
II.
What is Abnormal Psychology?
A.
Abnormal psychology is the specialized area within psychology that studies
psychological disorders. Clinical scientists conduct research, and clinical practitioners
diagnose and treat people.
B.
Treatment, or therapy, is a procedure designed to change abnormal behavior into
more normal behavior. Although there are many forms of therapy, all have three key
features in common:
1.
a sufferer who seeks relief from the healer
2.
a trained healer whose expertise is accepted by the sufferer and his or her social
group
3.
a series of contacts between the healer and the sufferer through which the healer
tries to produce certain changes in the sufferer’s emotional state, attitudes, and
behavior
Defining, Classifying, and Diagnosing Psychological Abnormality
A.
There is no universally accepted definition of abnormality.
B.
Commonly accepted definitions of psychological disorders often include the “four
Ds”:
1.
deviance—when behavior, thoughts, or emotions differ from a society’s ideas
about proper functioning
2.
distress— when behavior, thoughts, or emotions cause significant unhappiness
3.
dysfunction— when behavior, thoughts, or emotions interfere with daily
functioning
4.
danger—when behavior is dangerous to self or others
C.
The Diagnostic and Statistical Manual of Mental Disorders, or DSM (current revision
DSM-IV-TR) is the leading classification of disorders in the United States. There are
nearly 400 mental disorder diagnoses in the DSM-IV-TR.
D.
Clinicians use a variety of methods to assess an individual’s psychological
functioning, including:
1.
structured and unstructured clinical interviews
2.
3.
E.
II.
clinical and psychological tests
analog, naturalistic, and self-report observations
Diagnosis refers to a decision made by a clinician about whether a person’s
symptoms fit the criteria for a particular disorder.
1.
Comorbidity refers to the situation when an individual qualifies for more than
one diagnosis.
2.
Clinicians use a variety of clinical tests to diagnose people’s disorders. Each of
these tools has strengths and weaknesses, so effective clinicians combine
information from several sources.
Biological Approaches What Happens in the Brain
A.
Biological approaches view abnormal behavior as a result of malfunctions in brain
structure or physiological processes.
1.
Malfunctions can be caused by anatomical problems, abnormal neurotransmitter
activity, or abnormal hormonal activity.
2.
Abnormal brain functioning also may be caused by injuries or other factors,
including genetics or viruses.
3.
There is evidence that genetic inheritance plays a part in mood disorders,
schizophrenia, and mental retardation. Yet, in most cases no single gene is
responsible for a particular behvior or mental disorder.
B.
Biological treatments include drug therapy, electroconvulsive therapy (ECT) and
psychosurgery.
1.
Biological treatments can bring relief when other treatments have failed, but all
carry a risk of sometimes-severe side effects.
2.
One limitation of the biological view of abnormal behavior is that it fails to
consider nonbiological factors in the origins and treatments of disorders.
III. Psychodynamic Approaches
A.
Psychodanimic theorists view abnormal functioning as the result of unconscious
conflicts that may have originated in our early development.
1.
Freud focused on fixations during the oral, anal, and genital stages of
personality development.
a.
Fixation at the oral stage may lead to extreme dependence, mistrust, or
overindulgence.
b.
Fixation at the anal stage may lead to stubborn, contrary, stingy,
overcontrolling, or obsessive-compulsive tendencies.
2.
Other theorists emphasized difficulties in ego development, our relationships
with others, or maintaining a complete and integrated self.
B.
Classic psychodynamic therapy techniques include:
1.
free association—patients describe any thought, feeling, or image that comes to
mind, even it if seems unimportant or irrelevant
2.
3.
4.
5.
6.
therapist interpretation of resistance—blocks in free association that avoids
potentially painful material
therapist interpretation of transference—patients act toward therapists as they
did toward important figures in their childhood
therapist interpretation of dreams—reveals patient’s unconscious instincts,
needs, and wishes
catharsis—patients relive the past and reexperience repressed feelings
repeatedly working through issues—examining the same issues repeatedly to
gain new insights and greater clarity
C.
Recent developments in psychodynamic therapy include short-term therapy and
relational therapy.
D.
The psychodynamic approach has had a lasting influence on treatment, and offers an
alternative to biological explanations of abnormal functioning, but the effectiveness
of psychodynamic therapy is not well supported by research.
IV. Behavioral Approaches
V.
A.
Behavioral theorists argue that abnormal behaviors are caused by the same processes
as more adaptive behaviors: classical conditioning, operant conditioning, and
modeling.
B.
Behavioral treatments, aimed at replacing abnormal behaviors with more normal
ones, are also based on learning processes.
1.
Systematic desensitization and aversion therapy rely on classical conditioning.
a.
Systematic desensitization involves leaerning a relaxation response,
constructing a fear hierarchy, and then either imaginally or physically
confronting each item on the fear hierarchy and pairing the fear response
with relaxation, progressively moving to fearful situations that provoke
anxiety.
b.
Aversion therapy involves pairing an aversive stimulus (electric shock,
nausea-producing drug) with a behavior the individual wishes to control or
eliminate (drinking).
2.
Token economies are one example operant conditioning therapy.
3.
Social skills training uses modeling.
C.
Research suggests that behavioral therapies are often effective, although they may not
bring lasting change outside therapy, and do not focus in unobservable behaviors,
such as thoughts.
Cognitive Approaches
A.
Cognitive theorists believe that abnormal functioning can result from disordered
thoughts, including irrational assumptions, specific upsetting thoughts, and illogical
thinking processes.
B.
There are several versions of cognitive therapy.
1.
Ellis’s Rational-emotive therapy focuses on helping clients identify their
irrational assumptions, test them, and change them, if needed.
2.
Cognitive therapy guides clients to challenge their own automatic and upsetting
thoughts.
3.
Beck has linked depression to a negative cognitive triad that includes negative
thoughts about onself, the world, and the future. In addition, individuals engage
in selective perception, magnification, and overgeneralization, each contributing
to depression.
4.
Meichenbaum thinks individuals with anxiety disorders generate
counterproductive self-statements during stressful situations.
5.
Cognitive-behavioral therapies treat thoughts as behaviors that can be replaced
with new ones.
C.
The cognitive view has broad appeal. Research suggests that cognitive treatment is
often effective, although little research has included non-White populations. It is also
not clear whether psychological disorders create or result from maladaptive thoughts.
VI. Humanistic-Existential Approaches
A.
Humanists suggest that people are vulnerable to psychological disorders when they
are denied unconditional positive regard and experience conditions of worth.
Humanists think children required to meet certain standards in order to gain love of
their parents develop inaccurate views of their worth or goals in life.
B.
Therapists practicing Carl Rogers’ client-centered therapy create a therapeutic
environment that provides unconditional positive regard, accurate empathy, and
genuiness, so that clients come to value their own emotions thoughts and behaviors.
C.
Gestalt therapists use skillful frustration, role playing, rules, and games to help clients
recognize and accept their needs and goals.
D.
Existentialist therapies focus on helping clients discover their personal freedom of
choice and take responsibility for making choices.
E.
Only recently has much research has been conducted on humanist and existential
therapies. Early research suggests they can be beneficial.
VII. Formats of Therapy
A.
There are several formats in which therapy may be employed: individual therapy,
group therapy, family and couple therapy, and community treatment.
B.
The oldest of the modern therapy formats is individual therapy, in which practitioners
meet with one client at a time.
C.
In group therapy several clients with similar problems meet with a single therapist at
the same time. Self-help groups are similar, but conducted without the leadership of a
therapist. Both types of groups can be helpful.
D.
Family therapy treats all members of a family, together or individually, and therapists
usually consider the family as a system.
E.
Two people in a long-term relationship can seek couples therapy to help address
issues in their relationship.
F.
Community mental health treatment focuses on preventing abnormal functioning
through:
1.
primary prevention—policies that reduce psychological risk in a community
2.
secondary prevention—treating minor problems before they become serious
3.
tertiary prevention—providing prompt treatment for moderate and severe
disorders so they do not become long-term problems.
VIII. Evaluating Psychotherapy
A.
Therapy outcome studies measure the effects of various treatments. Research shows
that getting therapy of any kind is more likely to help people than going without
treatment.
B.
Research has found that each of the major forms of therapy is of some help to clients,
although some therapy formats are best suited to particular disorders.
C.
Successful therapists of any orientation share similar effective habits, including:
1.
giving feedback to clients
2.
helping clients focus on their own thoughts and behaviors
3.
paying attention to therapist-client interactions
4.
promoting self-mastery in their clients
IX. Abnormal Psychology How We Differ
A.
Rapid urbanization can lead to increases in abnormal functioning in a society, yet it is
unclear what aspects of urbanization contribute most to mental disorders.
B.
Economic depression is associated with clinical depression and suicide.
C.
Abnormal functioning is more common among people in lower socioeconomic
groups than in higher ones. The stresses of poverty may increase risk of disorders or
perhaps there is a “downward drift” where disorders contribute to an inability to
function at higher socioeconomic levels.
D.
Multicultural models emphasize the influences and pressures cultures exert on people.
Women, members of ethnic minority groups, people in low socioeconomic classes,
and homosexual individuals face pressures that result in higher rates of diagnosis of
certain disorders in each group. Culture-sensitive and gender-sensitive therapy
approaches help clients become aware of and react adaptively to the cultural pressures
they face.
E.
Religious beliefs can be helpful in preventing psychological disorders or to support
treatment.