Download Examples of negative thinking

Chapter Sixteen
Treatment of
Psychological
Disorders
Main Types of Treatment
• Psychotherapy
o
Psychodynamic Psychotherapy
 Classical Psychoanalysis (Sigmund Freud)
 Contemporary Variations on Psychoanalysis
o
Humanistic
 Client Centered (Carl Rogers)
 Gestalt
o
Behavior Therapy
 Behavior Modification
 Cognitive-Behavioral Therapy (CBT)
• Biological
o
Surgical, ECT, Pharmacological
(medication)
• Eclectic
o
A combination of more than one approach
Basic Features of Treatment
• Therapist who is accepted as capable of
helping the client.
• Establishment of a special relationship
between the client and therapist.
• Theoretical explanation about the causes
of the client’s problems.
• Most therapists are eclectic - mixing
approaches
Providers of Psychological
Treatment
•
•
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•
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•
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Psychiatrists – Medical Doctors, MD
Psychologists – PhD, or PsyD, Some MA
Clinical Social Workers, MA
Marriage and Family Therapists, MA
Licensed Professional Counselors, MA
Psychiatric Nurses, RN
Substance Abuse Counselors, CADC
Pastoral Counselors - religious perspective
Psychodynamic psychotherapy
• Established by Freud.
• Assumes that personality and
behavior reflect ego’s attempt
to resolve conflicts.
• Psychoanalysis aimed at
understanding unconscious
conflicts.
• Freud’s methods have
influenced almost all forms of
psychotherapy.
Classical Psychoanalysis
• Developed out of Freud’s medical
practice.
• Success using a “talking cure.”
o
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Called process “free association.”
Focused on unconscious impulses and
the resulting conflicts.
• Goal is to recognize unconscious
thoughts and emotions.
o
Then work through the ways they
affect the client’s everyday life.
Classical Psychoanalysis (cont’d.)
• Strategies for gaining glimpses of the client’s
unconscious:
o
o
o
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Patient’s free associations
Dream analysis
“Freudian slips” ie: “breast” instead of “best”
Analysis of resistance
 Hesitations, change of subject, jokes…
o
Analysis of transference
 Feelings transferred to analyst
 Countertransference… feelings transferred back to client.
Contemporary Variations on
Psychoanalysis
Short-Term Dynamic Psychotherapy
• Object relations therapy - focused on early
attachment
• Interpersonal therapy - more focused on
present than past. Current relationships.
• Time-limited dynamic psychotherapy
o
For example 12 - 16 sessions
Humanistic Therapy
• Treatment is a human encounter between equals.
“clients” not “patients”
o
Not a “cure” given by an expert.
• Clients can and will improve on their own.
• Ideal conditions established through relationship of
acceptance and support.
• Clients responsible for choosing how they will
think and behave.
• Focus on the present and future, not past.
• Conscious rather than unconscious thoughts
• Promoting growth
Carl Rogers’ Client-Centered
Therapy
• Empathy
o
o
Seeing from the client’s perspective
Be in the client’s shoes
• Reflection
o
Active listening method where therapist
rephrases client’s statements and notes
feelings.Reflects clients thoughts back.
• Unconditional Positive Regard
o
No negative judgments of client’s thoughts
or behavior
• Congruence or Genuineness (be real)
o
Therapist really feeling the way he/she
acts and acting the way he/she feels.
Lets try some Humanistic Client
Centered Therapy
Select one of the following or choose your own
“Client” opening line.
• “I’ve been really worried about what I’m going to
do after graduation.”
• “I think everyone hates me.”
• “I don’t know what my parents want from me. I
just can’t please them no matter what.”
Remember: Empathy, Active Listening,
Reflection, Invite Clarification, Positive Regard.
Fritz & Laura Perl’s Gestalt Therapy
• The Perls’ beliefs:
People create their own versions of
reality.
o People’s natural psychological
growth continues only as long as
they perceive, remain aware of, and
act on their true feelings.
o Growth stops and symptoms of
mental disorder appear when people
are not aware of all aspects of
themselves.
o
Gestalt Therapy (cont’d.)
• Goal is to create conditions so that clients
are ready to grow again.
• Methods are experimental and
experiential - more direct and dramatic
compared to client-centered therapy.
o
o
o
Focus on body language
“Empty Chair” technique
Incongruity between thought and action
Behavior Therapy
• Most psychological problems are learned.
o
Change by learning new behaviors, not
searching for underlying problems.
• Goals based on behavioral and socialcognitive approaches.
Features of Behavioral Treatment
• Development of a productive relationship
between therapist and client.
• Careful listing of the behaviors and thoughts to
be changed.
• Therapist as a teacher/assistant to help client
learn to change behavior.
• Continuous monitoring, evaluation, and
adjustment of treatment.
Techniques for Modifying
Behavior
• Exposure Therapies
o
o
Flooding
Systematic Desensitization
 Progressive relaxation training
 Desensitization hierarchy
• Modeling
o
Assertiveness training and social skills training
• Positive Reinforcement - token economy
Continue
Fear of Flying Desensitization
Return
Positive Reinforcement Program
for an Autistic Child
Return
Techniques for Modifying
Behavior (cont’d.)
• Extinction
o
Removing positive consequences of behavior to “kill”
it.
• Flooding
o
Exposing person to feared stimulus with no negative
consequences.
• Aversion Therapy
o
Classical Cond. Pairing unwanted behavior with
unpleasant stimulus.
• Punishment
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Undesirable consequences follow unwanted behavior.
Cognitive Therapies
• Thinking affects feelings
• Often applied to depression & anxiety
• Changing thought patterns can improve
emotional well-being and behavior.
o
o
o
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Self Blaming
Overgeneralization
Internal vs. External explanations
Rumination - “chewing” on thoughts over and
over
Cognitive-Behavioral Therapies
CBT
• Rational-Emotive Behavior Therapy (REBT) Albert Ellis -1950’s & still popular
• Techniques Related to REBT
o
o
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Cognitive restructuring
Self-instruction
Stress-inoculation (“vaccination” against stress)
 Learning to remain calm in difficult situations
• Aaron Beck’s Cognitive Therapy
o
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Cognitive restructuring
Examples of negative thinking to be modified
Continue
Ellis’ Model of Maladaptive
Behavior
Continue
Beck’s Cognitive Therapy –
Relearning Negative Thinking
Return
Group Therapy
• Therapist can see clients
interacting.
• Client realizes others have same
difficulties.
• Group members can boost each
others’ self-confidence and selfacceptance.
• Clients learn from one another.
• Clients more willing to share
feelings and are more sensitive
to others.
• Clients can test new skills in a
supportive environment.
Family and Couples Therapy
• Involves the treatment of two or more
individuals from the same “family system.”
• Structural family therapy concentrates on
family communication patterns.
• Couples therapy focuses on improving
communication between partners.
“Rules” for Couples Therapy
Does Psychotherapy Work?
• 83% of patients report therapy helps.
• Value first widely questioned by Hans
Eysenck 1952 - Outcome Research.
2/3 of non-psychotic patients improved in
therapy.
o 2/3 of non-psychotic patients improved even
without therapy too.
o
• Criticism of Eysenck
o
o
He looked at only 24 studies
Since then there have been many more
studies
Meta-analysis of 475 studies of
Psychotherapy’s Effects
Rules and Rights in the Therapeutic
Relationship
• Relationship should not harm the client.
• Therapy sessions must be kept strictly
confidential.
o
Privileged communication unless special
circumstances exist.
• People cannot be casually committed to
mental hospitals.
• Client can refuse certain kinds of
treatment while hospitalized.
Biomedical Therapies
If some psych disorders are caused or made
worse by brain chemistry or structure
perhaps they can be made better my
modifying that chemistry or structure.
• Drug Therapies - psychopharmacology
• Brain Stimulation - ECT, TMS
• Psychosurgery - lobotomy
• Lifestyle changes
Biological Aspects of Psychology
and the Treatment of Disorders
• Therapeutic psychoactive drugs affect
neurotransmitters and their receptors.
Some cause neurons to fire (agonists), while
others inhibit neuron firing (antagonists).
o Some act by blocking the receptor site
normally used by a particular neurotransmitter
(antagonists)
o Some increase the amount of a neurotransmitter available to act on
receptors(agonists).
o
Psychopharmacology- Drug Therapy
• Neuroleptics aka antipsychotics
o Treat schizophrenia - dopamine antagonists
• Antidepressants
o Treat depression and anxiety disorders
o Increase serotonin (SSRI) or norepinephrine in
synapses (agonists)
• Lithium and anticonvulsants
o Mood stabilizers
o To treat bipolar disorder
• Anxiolytics
o Anti-anxiety drugs - relaxants
 Benzodiazepines
Evaluating Psychoactive
Drug Treatments
• Potential problems:
Drug may mask problem without curing it.
Abuse may lead to physical or psychological
dependence.
o Side effects.
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• Research holds promise of:
o
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Creating better drugs.
More fully understanding some disorders.
More informed prescription practices.