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Treatment and therapy (Chap 17) First Lecture Outline: History of psychotherapy Psychotherapy approaches Foundations of counselling Video 101: Psychodynnamics Last Monday’s midterm • Results will be posted Monday • Many did well!! Keep it up!! • Multiple choice (out of 40) were done well – Average around 27 to 29/40 • Score is out of 30 for both quizzes History • Mental illness = demonic possession – Exorcism, flogging, torture, bleeding, enemas – Braveheart: “purification of spirit” • Middle ages: Asylum – St. Mary of Bethlehem: Bedlem, uproar, confusion – “over-crowded prison for social outcasts” • 1800s: Mesmer, Charcot, Breuer, Freud – origins of hypnosis and cathartic methods Other interventions from the 1900’s • Psychosurgery 1930s to 1950s: Prefrontal lobotomy – left patients vegetative, replaced by very specific microsurgery for lesions Electroconvulsive therapy (ECT) in 1940s: • 150 volts run through the head for 1-2 seconds – leads to memory loss, broken bones, still used as “last resort” for depression – Today the patient is usually placed under general anesthesia, paralysed with drugs, monitored and assisted with breathing. • Antipsychotic medications in the 1950s What is a clinical interview? • Psychotherapy involves talking to people • Structured and unstructured interviews • Model of psychotherapy directs attention of interview – Psychodynamic: Focus on early experiences – Behavioral: Focus on symptoms, ABC’s – Cognitive: Questions about specific thought patterns – Humanistic: Unconditional positive regard Interviewing in an assessment • Focus depends on what you are assessing, diagnosis • Background includes medical, school/work, family, hobbies, description of symptoms, and “other sources of information” • Tests then augment interview – Intelligence, neuropsychological, memory tests – Personality and behavioral measures – Psychophysiological and computer tasks Who can conduct “therapy” • Anyone can offer themselves to the public as a “therapist” or “counsellor” • These are not protected titles or services: watch out! • Only a psychologist can say they offer “Psychological intervention” or “Psychological assessment” • Title and services of a “psychologist” governed by provincial statute Psychodynamic therapy approaches • Patients improve once they become conscious of ego-threatening material • Free association: Client says whatever comes to mind; Dream analyysis • Resistance is an impediment to progress • Transference of feelings from significant others to therapist; Countertransference • Website listing psychotherapy approaches for personality disorder Evolution of psychoanalysis • Originally it could take years at 3-5 sessions per week • Unstructured and relaxed approach necessitated comfortable seating, surroundings • Change to become more task-oriented and time limited • “Contracting” with clients for a specific number of sessions to reach a goal