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Chapter 15
Treatment of Psychological
Disorders
Psychoanalysis is a therapy that emphasizes
a correcting habitual thinking errors
.
b the recovery of unconscious conflicts,
. motives, and defenses
c providing a supportive climate for
. clients
d improving interpersonal skills
.
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Freud considered ____ to be the most direct way to access
the patient's unconscious or the "royal road to the unconscious."
a truth-serum
.
b hypnosis
.
c free association
.
d dreams
.
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At times, individuals decide to terminate therapy at a time
the therapist feels is premature and at a point when therapy
is about to make significant progress. This is an example of
a interpretation
.
b repression
.
c transference
.
d resistance
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ANSWERS



B
D
D
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Trephinated Skull
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Types of Treatment

Psychotherapy
– Insight therapies
• “talk therapy”
– Behavior therapies
• Changing overt behavior
– Biomedical therapies
• Biological functioning interventions
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Who Seeks Treatment?


15% of U.S population in a given year
Most common presenting problems
– Anxiety and Depression
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
Women more than men
Medical insurance
Education level
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Who Provides Treatment?
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Clinical psychologists
Counseling psychologists
Psychiatrists
Clinical social workers
Psychiatric nurses
Counselors
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Psychoanalysis
Developed by Sigmund Freud
based on his theory of personality
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Insight Therapies: Psychoanalysis

Sigmund Freud and followers
– Goal: discover unresolved unconscious conflicts
•
•
•
•
Free association
Dream analysis
Interpretation
transference - the patient’s transfer to the analyst of emotions
linked with other relationships
– e.g. love you should have had for a parent focused on therapist
instead. Sybil and Dr. Wilbur
• resistance - blocking from consciousness of anxiety-laden
material
– e.g. Sybil told Dr. Wilbur it was all an act, just when they were
about to get to the repressed memories
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Insight Therapies: Client Centered
Therapy

Carl Rogers
– Goal: restructure self-concept to better correspond to reality
– Therapeutic Climate
• Genuineness
• Unconditional positive regard
• Empathy
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Therapists who think the primary role of therapy is to assist a client
in changing his or her maladaptive behavior employ
a
.
b
.
c
.
d
.
behavior therapy
group therapy
cognitive therapy
insight therapy
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Behavior therapy assumes that psychological
disorders are caused by
a
.
b
.
c
.
d
.
current stressful situations in one's life
inconsistency between one's self-concept
and reality
unconscious conflicts left over from
childhood
past conditioning
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Systematic desensitization is a therapy designed to
a
.
b
.
c
.
d
.
create a negative response to a stimulus that
has elicited problematic behavior
correct habitual thinking errors and
maladaptive beliefs
reduce phobic responses
improve interpersonal skills
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ANSWERS:



A
D
C
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Behavior Therapies

B.F. Skinner and colleagues
– Goal: unlearning maladaptive behavior and learning adaptive ones
– Systematic Desensitization – Joseph Wolpe
• Classical conditioning
• Anxiety hierarchy
– Aversion therapy
• Alcoholism, smoking, etc.
– Social skills training
• Modeling
• Behavioral rehearsal
– Biofeedback
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Behavior Therapy

Systematic Desensitization
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Systematic Desensitization
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Behavior Therapy

Aversion
therapy for
alcoholics
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Behavior Therapy

Token Economy
 an operant conditioning procedure that
rewards desired behavior
 patient exchanges a token of some sort,
earned for exhibiting the desired
behavior, for various privileges or treats
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Behavior Therapy

Exposure Therapy
 treat anxieties by exposing people (in imagination or reality) to the
things they fear and avoid
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Insight Therapies: Cognitive Therapy

Aaron Beck
– Cognitive therapy

Albert Ellis
– Rational-emotive therapy

Goal: to change the way clients think
– Detect and recognize negative thoughts
– Reality testing
– Kinship with behavior therapy
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Rational Emotive Therapy
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Developed by Albert Ellis
ABC model
– Activating Event
– Beliefs
– Consequences
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Identification and elimination of core irrational beliefs
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Aaron Beck’s Cognitive Therapy
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Problems due to negative cognitive bias
that leads to distorted perceptions and interpretations
of events
Recognize the bias then test accuracy of these
beliefs
Therapist acts as model and aims for a collaborative
therapeutic climate
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Cognitive Therapy

Cognitive-Behavioral Therapy
 a popular integrated therapy that
combines cognitive therapy (changing
self-defeating thinking) with behavior
therapy (changing behavior)
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Biomedical Therapies

Psychopharmacotherapy
– Antianxiety - Valium, Xanax, Buspar
– Antipsychotic –
• Neuroleptics – all have side effects, worst is tardive
dyskinesia - an incurable neurological disorder marked by
involuntary writhing and tick-like movements of the mouth,
tongue, face, hands, or feet
• 1st generation - Chlorpromazine (Thorazine), et.al. - 1950’s
- Atypical antipsychotic – reduce motor effects and other
neurotransmitters
• 2nd generation - Clozapine (Clozaril) – 1960’s-80’s
• 3rd generation – Aripiprazole (Abilify) – 2002
• all cause tardive dyskinesia but 2nd and 3rd gen. take longer
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Biomedical Therapies
– Antidepressant:
• Tricyclics – Elavil, Tofranil
• Mao inhibitors (MAOIs) - Nardil
• Selective serotonin reuptake inhibitors (SSRIs) – Prozac, Paxil,
Zoloft
– Mood stabilizers
• Lithium
• Valproic acid
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Electroconvulsive therapy (ECT)
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Therapies Inspired
by Positive Psychology
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
Martin Seligman
Uses theory and research to better understand the
positive, adaptive, creative, and fulfilling aspects of
human existence
– well-being therapy
– positive psychotherapy
• can be an effective treatment for depression – F 15.6
• Positive psychotherapy (PPT) contrasts with standard
interventions for depression by increasing positive emotion,
engagement, and meaning rather than directly targeting
depressive symptoms
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Figure 15.6 Positive psychotherapy for depression
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Group and Family Therapies

Family Therapy
 treats the family as a system
 views an individual’s unwanted behaviors as
influenced by or directed at other family members
 attempts to guide family members toward positive
relationships and improved communication

Group Therapy
 support from people who know what you’re going
through
 guidance on what you should be doing to cope
 good forum for opening up about problems
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Insight into
childhood conflicts,
motives, and feelings
Self-acceptance
and self-fulfillment
Changing behaviors
through learning
Changing
irrational beliefs
Using free
association and
transference
A safe nonjudgmental
environment to discuss
problems and
unconditional positive
regard
Systematic
Desensitization,
Aversive Conditioning,
and Token Economies
Identification of faulty
belief systems
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Current Trends and Issues in
Treatment
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Managed care
Empirically validated treatments
Blending Approaches to treatment – eclectic
Multicultural sensitivity
Deinstitutionalization
– Revolving door problem
– Homelessness - Approximately 20 - 25% of the single adult
homeless population suffers from some form of severe and
persistent mental illness (National Resource and Training Center
on Homelessness and Mental Illness, 2003)
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