Download Therapy

section 13
Therapies for Psychological
Disorders
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What is Therapy?
Therapy for psychological
disorders takes a variety of
forms, but all involve some
relationship focused on
improving a person’s mental,
behavioral, or social
functioning
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What is Therapy?
Therapy –
General term for any treatment process;
in psychology and psychiatry, therapy
refers to a variety of psychological and
biomedical techniques aimed at dealing
with mental disorders or coping with
problems of living
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The Components of Therapy
In addition to the relationship between the
therapist and the patient/client, the
therapeutic process typically involves
some or all of the following processes:
• Identifying the problem
• Identifying the cause of the problem or the
conditions that maintain the problem
• Deciding on and carrying out some form of
treatment
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Contemporary Approaches to Therapy
Psychological therapies –
Based on psychological principles (rather
than biomedical approach)
The psychological therapies
are often collectively
called psychotherapy
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Contemporary Approaches to Therapy
Biomedical therapies –
Treatments that focus on altering the
brain, especially with drugs,
psychosurgery, or electroconvulsive
therapy
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Types of Mental Health Care
Professionals
Counseling psychologist
Clinical psychologist
Psychiatrist
Psychoanalyst
Psychiatric nurse practitioner
Clinical social worker
Pastoral counselor
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Professional Title
Counseling psychologist
Specialty:
Clinical psychologist
Problems of
normal living
Psychiatrist
Work setting:
Psychoanalyst
Schools, clinics,
other institutions
Psychiatric nurse practitioner
Credentials:
Clinical social worker
Master’s in
counseling, PhD,
EdD, or PsyD
Pastoral counselor
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Professional Title
Counseling psychologist
Specialty:
Clinical psychologist
Those with severe
disorders
Psychiatrist
Work setting:
Psychoanalyst
Private practice,
mental health
agencies,
hospitals
Psychiatric nurse practitioner
Clinical social worker
Pastoral counselor
Credentials:
PhD or PsyD
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Professional Title
Counseling psychologist
Clinical psychologist
Psychiatrist
Psychoanalyst
Psychiatric nurse practitioner
Clinical social worker
Pastoral counselor
Specialty:
Severe mental
disorders (often
by means of drug
therapies)
Work setting:
Private practice,
clinics, hospitals
Credentials:
MD
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Professional Title
Counseling psychologist
Clinical psychologist
Specialty:
Psychiatrist
Psychoanalyst
Freudian therapy
Work setting:
Psychiatric nurse practitioner
Private practice
Clinical social worker
Credentials:
Pastoral counselor
MD
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Professional Title
Counseling psychologist
Clinical psychologist
Psychiatrist
Psychoanalyst
Psychiatric nurse
practitioner
Clinical social worker
Pastoral counselor
Specialty:
Nursing specialty;
licensed to
prescribe drugs
Work setting:
Private practice,
clinics, hospitals
Credentials:
RN – plus special
training in treating
mental disorders
and prescribing
drugs
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Professional Title
Counseling psychologist
Clinical psychologist
Psychiatrist
Specialty:
Social worker with
specialty in
dealing with
mental disorders
Psychoanalyst
Work setting:
Psychiatric nurse practitioner
Often employed
by government
Clinical social worker
Pastoral counselor
Credentials:
MSW
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Professional Title
Counseling psychologist
Clinical psychologist
Psychiatrist
Psychoanalyst
Psychiatric nurse practitioner
Clinical social worker
Pastoral counselor
Specialty:
Combines
spiritual guidance
with practical
counseling
Work setting:
Religious order or
ministry
Credentials:
Varies
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How Do Psychologists
Treat Mental Disorders?
Psychologists employ two
main forms of treatment:
the insight therapies
and the behavioral therapies
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Insight Therapies
Insight therapies –
Psychotherapies in which the therapist
helps patients/clients understand (gain
insight into) their problems
Freudian
psychoanalysis
Neo-Freudian
therapies
Humanistic therapies
Cognitive therapies
Group therapies
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Insight Therapies
Talk therapies –
Psychotherapies that focus on
communicating and verbalizing emotions
and motives to understand their behavior
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Insight Therapies
Psychodynamic therapies –
Insight therapies based on the
assumption that mental disorder is
caused by powerful (dynamic) mental
forces and conflicts
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Insight Therapies:
Psychodynamic Therapies
Psychoanalysis –
The form of psychodynamic therapy
developed by Sigmund Freud
Analysis of transference –
Analyzing and interpreting the patient’s
relationship with the therapist, based on the
assumption that this relationship mirrors
unresolved conflicts in the patient’s past
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Insight Therapies:
Psychodynamic Therapies
Neo-Freudian psychodynamic therapies –
Therapies developed by psychodynamic
theorists who embraced some of Freud’s
ideas, but disagreed with others
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Insight Therapies:
Humanistic therapies
Humanistic therapies –
Techniques based on the assumption that
people have a tendency for positive growth and
self actualization, which may be blocked by an
unhealthy environment
Client-centered therapy –
Emphasizes healthy psychological growth
through self-actualization
Reflection of feeling –
Paraphrasing client’s words to capture the
emotional tone expressed
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Insight Therapies:
Cognitive therapies
Cognitive therapy –
Emphasizes rational thinking as the key
to treating mental disorder
Cognitive therapy for depression involves
Evaluating evidence
Situational factors
Alternative solutions
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Insight Therapies:
Group therapies
Group therapy –
Psychotherapy with more than one client
Self-help support groups –
Groups that provide social support and
an opportunity for sharing ideas about
dealing with common problems; typically
organized/run by laypersons (not
professional therapists)
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Insight Therapies:
Group therapies
For many issues, couples counseling or
family therapy can often be more
effective than individual therapy with one
individual at a time
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Behavior Therapies
Behavior therapy –
Any form of psychotherapy based on the
principles of behavioral learning,
especially operant conditioning and
classical conditioning
Systematic
desensitization
Aversion
therapy
Contingency
management
Token
economies
Participant
modeling
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Classical Conditioning Therapies
Systematic desensitization –
Technique in which anxiety is
extinguished by exposing the patient to
an anxiety-provoking stimulus
Exposure therapy –
Desensitization therapy in which patient
directly confronts the anxiety-provoking
stimulus (as opposed to imagining it)
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Classical Conditioning Therapies
Aversion therapy –
Involves presenting individuals with an
attractive stimulus paired with unpleasant
stimulation in order to condition a
repulsive reaction
UCS
(foul odor)
UCR
(nausea)
CS
CR
(cigarette smoke)
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Operant Conditioning Therapies
Contingency management –
Approach to changing behavior by
altering the consequences, especially
rewards and punishments, of behavior
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Operant Conditioning Therapies
Token economies –
Applied to groups (e.g. classrooms,
mental hospital wards) involving
distribution of “tokens” contingent on
desired behaviors; tokens can later be
exchanged for privileges, food, or other
reinforcers
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Participant Modeling: An
Observational-Learning Therapy
Participant modeling –
Therapist demonstrates and encourages
a client to imitate a desired behavior
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Cognitive-Behavioral Therapy:
A Synthesis
Cognitive-behavioral therapy
Combines cognitive emphasis on thoughts
with behavioral strategies that alter
reinforcement contingencies
Assumes irrational self-statements cause
maladaptive behavior
Seeks to help the the client develop a sense
of self-efficacy
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Cognitive-Behavioral Therapy:
A Synthesis
Rational-emotive behavior therapy –
Based on the idea that irrational thoughts
and behaviors are the cause of mental
disorders
(REBT)
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Evaluating the Psychological
Therapies
Eysenck proposed that people with nonpsychotic problems recover just as well
with or without therapy
Reviews of evidence have shown:
That therapy is better than no therapy
It appears advantageous to match specific
therapies with specific conditions
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Mental “First Aid”
If someone asks you for help, keep in mind
that serious problems (especially those
involving suicide or threats) require
immediate professional treatment
Otherwise, your best tools may involve
Listening
Acceptance
Exploring alternatives
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How Is the Biomedical
Approach Used to
Treat Mental Disorders?
Biomedical therapies seek to
treat mental disorders by
changing the brain’s
chemistry with drugs, its
circuitry with surgery, or its
patterns of activity with pulses
of electricity or powerful
magnetic fields
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Drug Therapy
Psychopharmacology –
The prescribed use of drugs to help treat
symptoms of mental illness ostensibly to
ensure that individuals are more
receptive to talk therapies
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Drug Therapy
Antipsychotic drugs
Include chlorpromazine, haloperidol, and
clozapine
Usually affect dopamine pathways
May have side effects
Tardive dyskinesia –
Incurable disorder of motor control
resulting from long-term use of
antipsychotic drugs
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Drug Therapy
Antidepressants and mood stabilizers
• Include Prozac, monoamine oxidase (MOA)
inhibitors, and lithium carbonate (effective
against bipolar disorder)
• Treat depression and bipolar disorder
• Usually affect serotonin and/or
norepinephrine
The use of antidepressants to deal with
general feelings of unease is highly
controversial
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Drug Therapy
Antianxiety drugs
• Include barbiturates and benzodiazepines
• May include some antidepressant drugs
which work on certain anxiety disorders
• Should not be used to relieve ordinary
anxieties of everyday life
• Should not be taken for more than a few
days at a time
• Should not be combined with alcohol
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Drug Therapy
Stimulants suppress activity level in
persons with attentiondeficit/hyperactivity disorder (ADHD)
There is controversy from concern that the
causes and boundaries of ADHD are
vague and the potential exists for
overdiagnosis
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Psychosurgery
Psychosurgery –
The general term for surgical intervention
in the brain to treat psychological
disorders
The infamous prefrontal lobotomy is no longer
performed
Severing the corpus callosum, however, can
reduce life-threatening seizures
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Brain-Stimulation Therapies
Electroconvulsive therapy is used for the
treatment of severe depression
Transcranial magnetic stimulation, a
possible alternative to ECT, can also be
used for the treatment of depression,
schizophrenia, and bipolar disorder
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Hospitalization and
the Alternatives
Therapeutic community –
Program of treating mental disorder by
making the institutional environment
supportive and humane for patients
Deinstitutionalization –
Policy of removing patients, whenever
possible, from mental hospitals
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Hospitalization and
the Alternatives
Community mental health movement –
Effort to deinstitutionalize mental patients
and to provide therapy from outpatient
clinics
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End of Chapter 13
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