Download Module 14.3 Biomedical Therapies Lecture Outline

CHAPTER 14
Methods of Therapy
MODULE 14.1 PATHWAYS TO THE PRESENT: A BRIEF
HISTORY OF THERAPY LECTURE OUTLINE
Refer to the Concept Web at the end of this manual for a visual synopsis of all concepts presented
in this module.
I.
II.
The Rise of Moral Therapy LB 14.1, LB 14.2 (Concept Chart 14.1)
A. Pussin and Pinel believed mentally disturbed people should be treated with
compassion, contrary to popular opinion
B. Led to reforms in the treatment of mental illness in England and U.S.
C. Pussin director of “incurably insane” ward at La Bicetre in Paris
D. Pinel became director of same ward and continued Pussin’s work
E. Dix crusaded for kinder treatment of mentally ill, helped establish 32 mental hospitals
in the U.S.
F. Moral therapy failed to help the severely ill and fell out of favor in late nineteenth
century
G. Replaced by warehousing of patients in large state hospitals
The Movement Toward Community-Based Care LB 14.3
A. Community-based facilities began to take shape in the 1960s
B. Deinstitutionalization policy—move from institutional setting to community-based
setting
C. Contemporary mental hospitals offer structured treatments and availability during
crisis periods, available to patients unable to live in the community
D. Critics of deinstitutionalization suggest many patients fall through the cracks
MODULE 14.2 TYPES OF PSYCHOTHERAPY LECTURE
OUTLINE
Refer to the Concept Web at the end of this manual for a visual synopsis of all concepts presented
in this module.
I.
II.
Mental Health Professionals—review (Table 14.1) (Concept Chart 14.2)
Psychodynamic Therapy
A. Traditional psychoanalysis: Where id is ego shall be
1. Based on Freudian proposal that unconscious conflicts lead to psychological
problems
2. Psychoanalysts—practitioners of psychoanalysis
3. Defense mechanisms, such as repression, arise from conflicts over impulses
4.
5.
Therapy to help person become aware of unconscious issues
Techniques include:
a.
Free association—saying anything that comes to mind, may reveal things
about unconscious desires
b. Dream analysis—exploring latent content of dreams
c.
Interpretation of behaviors and verbal expressions in order to help client
gain insight into unconscious
(1) Resistance on part of client is part of psychoanalysis
(2) Transference relationship
(3) Countertransference
B. Modern psychodynamic approaches: More ego, less id
1. Focus on current relationships and issues rather than past conflicts
2. Briefer form of therapy than traditional psychodynamic therapy
III. Humanistic Therapy
A. Focus on conscious choice and experiences in here-and-now
B. Client-centered therapy
1. Rogers believed that psychological problems result from roadblocks that others
place in journey toward self-actualization
2. Client-centered therapists strive to achieve warm and accepting setting
3. Nondirective approach—allows client to take the lead
4. Therapist’s role to reflect back on client’s feelings LB 14.4
5. Three qualities of effective humanistic therapist
a.
Unconditional positive regard
b. Empathy
c.
Genuineness
C. Gestalt therapy LB 14.5
1. Perls felt it important to help clients blend conflicting personality into whole
2. Direct and confrontational form of therapy
3. Empty chair technique LB 14.6
IV. Behavior Therapy LB 14.7
A. Psychological problems are largely learned and can be unlearned
B. Methods of fear reduction
1. Systematic desensitization—client taught skills to deal with anxiety and then
imagines dealing with a series of fear-inducing stimuli (fear hierarchy)
2. Gradual exposure—stepwise exposure to increasingly fearful stimuli
3. Modeling—acquiring desirable behaviors by observing and imitating others
whom they observe performing the behaviors
C. Aversive conditioning
1. Form of classical conditioning in which an undesirable response is paired with
aversive stimuli (Figure 14.1)
D. Operant conditioning methods
1. Used to strengthen desirable behaviors and weaken undesirable behaviors
2. Token economy programs
E. Cognitive-behavioral therapy
1. Combines behavioral techniques with cognitive strategies such as changing
faulty thought patterns
V. Cognitive Therapies
A. Rational-emotive behavior therapy: The importance of thinking rationally (REBT)
1. Ellis believed that irrational beliefs lead to emotional distress and cause people
to engage in self-defeating behaviors
2. Irrational beliefs in form of “should” and “must” statements (Table 14.2)
3.
ABC approach to explain causes of emotional distress (Figure 14.2) LB 14.8
a.
Activating events (life event)
b. Beliefs (difficult for people to identify)
c.
Emotional consequence (may be exaggerated)
4. Therapist helps client develop effective behaviors as well
B. Cognitive therapy: Correcting errors in thinking
1. Beck developed this therapy to help clients identify and correct problems in
thinking and replace them with rational thoughts
2. Cognitive distortions (Table 13.2) are revealed through automatic thoughts LB
14.9
3. Reality testing—testing out negative beliefs to see if they are valid
4. Similar to REBT in many ways but less confrontational
VI. Eclectic Therapy—integrating principles and techniques represented in different forms of
psychotherapy (Figure 14.3) (See Exploring Psychology, LB 14.10)
VII. Group, Family, and Couples Therapy
VIII. Is Psychotherapy Effective?
A. Measuring effectiveness: Meta-analysis technique demonstrated therapy as effective
(Figure 14.4)
B. Which therapy is best? LB 14.11
1. Little difference between different techniques, but some therapeutic techniques
may be more effective for certain problems than others
2. Empirically supported treatment (EST) (Table 14.3)
C. What accounts for the benefits of therapy?
1. Common characteristics of therapy called nonspecific factors include therapeutic
alliance, expectation of improvement (placebo effects)
2. Success in therapy based on nonspecific factors and factors specific to form of
therapy
IX. Multicultural Issues in Therapy (Table 14.4)
A. African Americans—therapist must understand long history of oppression of African
Americans, which may lead to suspiciousness of Whites
B. Asian Americans—may not be expressive concerning emotions; may value collective
goals and success over individual success; may expect therapist to provide direct
guidance in how to live their lives
C. Hispanic Americans—traditional Hispanic cultures place strong value on
interdependency of family members rather than independence
D. Native Americans—therapist should respect tribal customs and traditions
MODULE 14.3 BIOMEDICAL THERAPIES LECTURE
OUTLINE
Refer to the Concept Web at the end of this manual for a visual synopsis of all concepts presented
in this module.
I.
Drug Therapy—Psychotropic Drugs Affect Neurotransmitters (Concept Chart 14.3)
A. Antianxiety drugs (minor tranquilizers)
1. Help quell anxiety, induce calmness, and reduce muscle tension
2. Examples include diazepam (Valium), chlordiazepoxide (Librium), alprazolam
(Xanax)
3. Act on neurotransmitter GABA
Antidepressants
1. Increase availability in the brain of norepinephrine and serotonin
2. Major types include: tricyclics, MAO inhibitors, and selective serotonin-reuptake
inhibitors (SSRIs) (e.g., Prozac and Zoloft) LB 14.12
3. Use of antidepressants has increased dramatically
4. Also helpful in treating anxiety disorders, social phobia, PTSD, OCD, and
bulimia
C. Antipsychotics (major tranquilizers)
1. Phenothiazines first class developed in the 1950s
2. Affect dopamine action in the brain
D. Other psychiatric drugs
1. Mood-stabilizing drugs include lithium and anticonvulsive drugs
2. Stimulant drugs (e.g, Ritalin) used to improve attention spans and reduce
disruptive behaviors
E. Evaluating psychotropic drugs LB 14.13
1. May help reduce or control symptoms but not a cure
2. Have risk of side effects that can range from drowsiness, to tremors, to serious
movement disorders (e.g., tardive dyskinesia)
3. Dependence issues as well
4. Conventional therapy may be as or more effective in treating some conditions
(See Reality Check) LB 14.14
II. Electroconvulsive Therapy (ECT) LB 14.15
A. Used in treatment of severe depression when unresponsive to other forms of treatment
B. High rate of relapse
C. May produce permanent memory loss
III. Psychosurgery
A. Brain surgically altered to control deviant or violent behaviors
B. Prefrontal lobotomy
B.
MODULE 14.4 APPLICATION: GETTING HELP LECTURE
OUTLINE
Refer to the Concept Web at the end of this manual for a visual synopsis of all concepts presented
in this module.
I.
Steps to Getting Help LB 14.16, LB 14.17
A. Seek recommendation from respected sources, such as your family physician, course
instructor, clergyperson, or college health service
B. Seek a referral from a local medical center or local community mental health center
C. Seek a consultation with your college counseling center or health services center
D. Contact professional organizations for recommendations
E. Let your fingers do the walking—but be careful!
F. Make sure the treatment provider is a licensed member of a recognized mental health
profession, such as psychology, medicine, counseling, or social work
G. Inquire about the type of therapy being provided
H. Inquire about the treatment provider’s professional background
I.
J.
K.
L.
M.
N.
O.
P.
Inquire whether the treatment provider has had experience treating other people with
similar problems
Once the treatment provider has had the opportunity to conduct a formal evaluation of
your problem, discuss the diagnosis and treatment plan before making any
commitments to undergo treatment
Ask about costs and insurance coverage
Find out about the treatment provider’s policies regarding charges for missed or
canceled sessions
If medication is to be prescribed, find out how long a delay is expected before it starts
working
If treatment recommendations don’t sound quite right to you, discuss your concerns
openly
If you still have any doubts, request a second opinion
Be wary of online therapy services