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Transcript
Therapy – General term for any treatment process. People who seek treatment are referred to as patients or clients. 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: 1. Identify the problem 2. Identify the cause of the problem 3. Make a prognosis (prediction) 4. Decide upon treatment Modern Approaches to Therapy 1. Psychological Therapies Based on psychological principles (rather than biomedical approach) The psychological therapies are often collectively called psychotherapy 2. Biomedical Therapies Treatments that focus on altering the brain, especially with drugs, psychosurgery, or electroconvulsive therapy. Copyright © Allyn & Bacon 2007 Types of Mental Health Care Professionals Counseling psychologist Clinical psychologist Psychiatrist Psychoanalyst Psychiatric nurse practitioner Clinical social worker Pastoral counselor 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 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 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 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 Copyright © Allyn & Bacon 2007 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 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 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 Forensic Psychology The application of psychology to the criminal justice system. Forensic Psychology Forensic psychologists often deal with legal issues, such as public policies, new laws, competency, and also whether a defendant was insane at the time a crime occurred. They may also pursue a related task, in which they “profile” offenders. Copyright © Allyn & Bacon 2007 Insight Therapies Psychotherapies in which the therapist helps patients/clients understand (gain insight into) their problems. Also known as ‘talk therapies” Freudian Psychoanalysis Neo-Freudian Therapies Humanistic Therapies Cognitive Therapies Group Therapies Copyright © Allyn & Bacon 2007 Insight Therapies: Freudian Psychoanalysis As you learn this, think “what psychopathologies would this work best with” Copyright © Allyn & Bacon 2007 Psychodynamic Therapies Insight therapies based on the assumption that mental disorder is caused by powerful (dynamic) mental forces and conflicts Psychoanalysis The form of psychodynamic therapy developed by Sigmund Freud. Its goal is to release conflicts and memories form the unconscious Accomplished through 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 Styles of Psychoanalysis Traditional Approach Modern Approach Free Association Briefer…less intense Hypnosis Focus on revealing unconscious material Interpretation of revealed ideas that reflect deep seated feelings and conflicts Dream Analysis Client-therapist sit face to face…no client on the couch Usually more focus on ego…less on id Therapist is directive Copyright © Allyn & Bacon 2007 Neo-Freudian Psychodynamic Therapies Therapies developed by psychodynamic theorists who embraced some of Freud’s ideas, but disagreed with others. Humanistic Therapies: based on the motto that you can be your best YOU. Client-Centered Therapy Emphasizes healthy psychological growth through self-actualization. • Its main technique is reflection of feeling. • Paraphrasing a client’s words to capture the emotional tone expressed. “You seem as if you’re upset.” “You look as if you’re a bit down.” “You act as if you are irritated” “So what I hear you saying is…” The tone of voice accompanying the words must be compassionate, gentle and accepting. Developed by Other techniques used are empathy, genuineness, and unconditional positive regard . Carl Rogers. Cognitive Therapy Emphasizes rational thinking as the key to treating mental disorder For example…cognitive therapy for depression involves Evaluating evidence Situational factors Alternative solutions Group Therapy Advantages: Psychotherapy with more than one client Economical, support of the group, non-threatening atmosphere, provides more information and life experiences for clients to draw upon. Couples Counseling or Family Therapy These can often be more effective than individual therapy with one individual at a time. 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 Copyright © Allyn & Bacon 2007 Behavior Therapies • Any form of psychotherapy based on the principles of behavioral learning, (especially operant conditioning and classical conditioning) Behavior Modification is another term for Behavior Therapy Therapies using Classical Conditioning Therapies using Operant Conditioning Systematic Desensitization Participant Modeling Exposure Therapy Token Economies Aversion Therapy Contingency Copyright © Allyn & Bacon 2007Management Classical Conditioning Therapies: Systematic Desensitization Technique in which anxiety is extinguished by exposing the patient to an anxiety-provoking stimulus. Copyright © Allyn & Bacon 2007 Classical Conditioning Therapies: Exposure Therapy • Desensitization therapy in which patient It’s based on habituation directly confronts the anxiety-provoking It also counteracts Anxiety Disorders’ avoidance stimulus (as opposed to imagining it) Copyright © Allyn & Bacon 2007 Classical Conditioning Therapies Aversion Therapy • Involves presenting individuals with an attractive stimulus (smoking) paired with unpleasant stimulation (A foul odor) in order to condition a repulsive reaction…so one stops smoking. UCS (foul odor) UCR (nausea) CS (cigarette smoke) Copyright © Allyn & Bacon 2007 CR Operant Conditioning Therapies Contingency Management • Approach to changing behavior by altering the consequences of behavior, especially rewards and punishments. Copyright © Allyn & Bacon 2007 Operant Conditioning Therapies Token Economies • Applied to groups (e.g. classrooms, mental hospital wards) involving distribution of “tokens” dependent on desired behaviors Tokens can later be exchanged for privileges, food, or other reinforcers Participant Modeling: An Observational-Learning Therapy • Therapist demonstrates and encourages a client to imitate a desired behavior Cognitive-Behavioral Therapy: A Synthesis A form of psychotherapy that combines the techniques of cognitive therapy and behavioral therapy . Seeks to help the client develop a sense of self-efficacy (The belief that one is capable of performing in a certain manner to attain certain goals. ) The MOST popular type of CBT is known as REBT: Rational Emotive Behavior Therapy REBT Rational-Emotive Behavior Therapy Based on the idea that irrational thoughts and behaviors are the cause of mental disorders. Proposed by Albert Ellis Copyright © Allyn & Bacon 2007 The ABC’s of REBT A = Activating Event/Adversity What do you think happened? What would a camera see? B = Beliefs about Activating Event What did you tell yourself? C = Consequences How did you act? How did you feel? While it may seem odd at the beginning, you want to start somewhat backwards. Start with the (C). Ellis’ REBT provides 12 irrational thoughts and their rational counterparts Irrational Thoughts •We should be thoroughly competent, intelligent, and achieving in all possible respects •It is a dire necessity for adults to be loved by significant others for almost everything they do, everyday. •We must have certain and perfect control over things •If something is or may be dangerous or fearsome we should be terribly upset and endlessly obsess about it Rational Thoughts •No one can be perfect. •It is not possible for everyone to love and approve of us •No matter how evil an act, there are reasons for it. •You can't change the past but you can learn from it Copyright © Allyn & Bacon 2007 Active Listener Someone who gives the speaker feedback (nodding, affirmation, paraphrasing, asking question, showing interest…) This is REQUIRED of a CBT Not listening at all! Copyright © Allyn & Bacon 2007 Different Therapeutic techniques are effective for different disorders Behavior Therapies: specific phobias, bedwetting, autism, alcoholism Cognitive –Behavioral Therapies: chronic pain, anorexia, bulimia, agoraphobia Insight Therapies: relationship/marriage problems Depression is best treated with a variety of therapies Copyright © Allyn & Bacon 2007 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 be… Listening Acceptance Exploring alternatives Copyright © Allyn & Bacon 2007 How Is the Biomedical Approach Used to Treat Mental Disorders? Biomedical therapies seek to treat mental disorders by 1. changing the brain’s chemistry with drugs, its 2. circuitry with surgery, or its 3. patterns of activity with pulses of electricity or powerful magnetic fields Copyright © Allyn & Bacon 2007 Psychopharmacology The prescribed use of drugs to help treat symptoms of mental illness… The psychological approach would use these to ensure that individuals are more receptive to talk therapies. Antipsychotic Drugs Medicines that diminish psychotic symptoms such as agitation, delusions, or hallucinations. These include chlorpromazine, haloperidol, and clozapine They may have side effects like.. Diminish symptoms usually by their effect on dopamine pathways in the brain. Tardive dyskinesia blurred vision dizziness drowsiness dry mouth light sensitivity Tardive Dyskinesia An incurable disorder of motor control resulting from long-term use of antipsychotic drugs Copyright © Allyn & Bacon 2007 Antidepressants and mood stabilizers • Include Prozac, monoamine oxidase (MAO) inhibitors, and lithium carbonate (effective against bipolar disorder) • Treat depression and bipolar disorder • Usually affects serotonin and/or norepinephrine by increasing their reuptake or production • May take weeks to get to therapeutic levels Paxil Zoloft Luvox Effexor Wellbutrin Drugs used to treat depression usually fall in TWO types: 1. MAOs: monoamine oxidase inhibitors Monoamine oxidase…inhibitors that block the activity of an enzyme that breaks down serotonin 2. SSRIs: selective serotonin reuptake initiators Dangerous side effects can include an increase in suicidal thoughts or actions, changes in appetite or sleep patterns, withdrawals if stopped unexpectedly etc… Copyright © Allyn & Bacon 2007 Anti-Anxiety Drugs • Include barbiturates and benzodiazepines • May include some antidepressant drugs which work on certain anxiety disorders • Are intended to decrease extreme anxiety and PAs by increasing the inhibitory effects of the neurotransmitter GABA • These are heavy depressants which can cause fatigue and a disconnection from reality. CANNOT be taken with regularity or while trying to perform most tasks • 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 Copyright © Allyn & Bacon 2007 Stimulants Suppress activity level in persons with attention-deficit/hyperactivity disorder (ADHD). Work by increasing the activity of the thalamus, thereby increasing the “filter” with which we focus. Side effects include fatigue/”crash”, decrease in appetite, weight loss, etc… Since 1991 prescriptions for all drugs to treat ADHD have quintupled. This year about six million children, will take Ritalin or other forms of methylphenidate. Copyright © Allyn & Bacon 2007 Psychosurgery The general term for surgical intervention in the brain to treat psychological disorders Prefrontal Lobotomy aka the "Ice pick lobotomy" The infamous prefrontal lobotomy, introduced in 1935, is no longer performed for mental disorders treatment. By 1951, almost 20,000 lobotomies had been performed in the United States Copyright © Allyn & Bacon 2007 Prefrontal Lobotomy Copyright © Allyn & Bacon 2007 Split Brain Severing the corpus callosum, however, can reduce life-threatening seizures… usually used as a last resort to treat difficult epilepsy. Split-brain is a lay term to describe the result when the corpus callosum connecting the two hemispheres of the brain is severed Copyright © Allyn & Bacon 2007 Electroconvulsive Therapy Also known as electroshock Introduced in the 1930’s,it is a treatment in which seizures are electrically induced in anesthetized patients for therapeutic effect. Copyright © Allyn & Bacon 2007 Electroconvulsive Therapy ECT is most often used as a treatment for severe major depression , mania (often in bipolar disorder), and catatonia. Today, an estimated 1 million people worldwide receive ECT every year,usually in a course of 6–12 treatments administered 2 or 3 times a week. Copyright © Allyn & Bacon 2007 Transcranial Magnetic Stimulation Weak electric currents are induced in the tissue by rapidly changing magnetic fields It can be used for the treatment of depression, schizophrenia, and bipolar disorder A form of psychiatric treatment in which patients were repeatedly injected with large doses of insulin in order to produce daily comas over several weeks. Insulin Shock Therapy It was introduced in 1933 and used extensively in the 1940s and 1950s, mainly to induce remission in schizophrenia. There were no standard guidelines for treatment; different hospitals and psychiatrists developed their own protocols. Copyright © Allyn & Bacon 2007 3 Newer Types of Psychosurgery Capsulotomy The surgeon inserts probes through the top of the skull and down into the capsule, which is deep in the brain near the thalamus. By leading the tips of the probes, the doctor can burn away small portions of tissue, each about the size of a raisin. Used in OCD Cingulotomy Probes are inserted through the skull into the cingulum, a bundle of connections located near the capsule. The probes' tips are heeded and tissue is burned, as the capsulotomy. Used with Chronic Pain, OCD or depression Deep brain stimulation The surgeon inserts a “brain pacemaker” through the skull and into the capsule no tissue is destroyed. Helps control tremors ie: Parkinson’s. Has also been helpful in treating chronic pain Copyright © Allyn & Bacon 2007 Hospitals Provide an immediate solution to an immediate danger: suicidal/homicidal thoughts, psychosis, etc BUT this is not a good long term solution. Instead… Copyright © Allyn & Bacon 2007 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. 1950’s state hospital ward Copyright © Allyn & Bacon 2007 Community Mental Health Movement Effort to deinstitutionalize mental patients and to provide therapy from outpatient clinics Copyright © Allyn & Bacon 2007 Homeless in America 23% of Homeless in America are diagnosed with Mental Illness 45% of homeless veterans have mental disorders Copyright © Allyn & Bacon 2007