Download The ego is not master in its own house

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The ego is not master in its own house. From A Difficulty in the Path of Psycho-Analysis, 1917.
A Freudian slip is when you say one thing but mean your mother. ~Author Unknown
TERMS
1. Psychotherapy
17. Exposure therapies
32. eye movement desensitization and
2. biomedical therapies
18. Systematic desensitization
reprocessing - EMDR
3. eclectic approach
19. Virtual reality exposure therapy
33. light exposure therapies
4. Psychoanalysis
20. aversive conditioning
34. Psychopharmacology
5. Resistances
21. Operant conditioning therapies
35. Antipsychotic drugs, classical and
6. Transference
22. cognitive therapy
atypical
7. Interpersonal psychotherapy
23. cognitive-behavior therapy
36. tardive dyskinesia,
8. Humanistic Therapies
24. Rational Emotive Therapy / Albert
37. Antianxiety drugs
9. Carl Rogers
Ellis
38. Antidepressants
10. active listening
25. Aaron Beck 's Cognitive Therapy
39. Mood stabilizers
11. empathy
26. stress inoculation training
40. simple salt lithium
12. client-centered counselor
27. group therapy
41. psychosurgery
13. Imposter Phenomenon
28. self-help and support groups
42. Electroconvulsive therapy
14. catastrophic fantasy
29. Family therapy
43. transcranial magnetic stimulation
15. Behavior Therapies
30. regression toward the mean
16. Counterconditioning
31. meta-analysis
Complete the chart – research those your text does not ‘cover’
Developer / if applicable
Type of Therapy
Brief Description
Psychoanalysis
Client-centered therapy
Interpersonal Therapy
Systematic desensitization
Behavioral Therapy
Aversive conditioning
Cognitive Behavioral Therapy
Rational Emotive Therapy
Cognitive therapy for depression
Family therapy
Drug therapy
Electroconvulsive therapy
Psychosurgery
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1. Create a chart like this for each therapy mentioned below: this should be a major-ly detailed chart!
Type/modality Brief Description
Key Points in the view point
What are some of the key
of therapy
points one undergoes in
therapy?
2. Here’s the scenario - You are in need of counseling, you are very depressed, have been for 8 months, your family has just
moved to this area, your best friends are in your old state, you have not met anyone here, your grades have slipped and you
are thinking of not going to college. All you do is argue with your parents and sleep. Now- choose two modalities of therapy
and describe how each would approach your therapy, how would the therapist view your issues, how would they plan your
course of treatment, etc?
1. PSYCHOANALYTIC THERAPY TECHNIQUES AND GOALS
MAKE THE UNCONSCIOUS CONSCIOUS: Psychoanalysts assume problems are caused by tension between unconscious
forbidden impulses, repressed memories, frustrated needs and constraints of present life. UNDERLYING CAUSAL FACTORS must
be understood and treated. Goals are to uncover UNCONSCIOUS material, defenses, unconscious conflicts and motives and make
them CONSCIOUS.
CATHARSIS: By surfacing unconscious conflicts, achieving insight, and working through and resolving conflicts and repressed
emotions, CATHARSIS, psychic energy is freed for productive use.
ANALYSIS OF THE MIND AND INTERPRETATION of material expressed by the patient is important to uncover the hidden
meaning (latent content) and necessary insights. Highly trained analysts must interpret unconscious messages of dreams,
"Freudian slips" of the tongue, projective tests and repressed material. INTERPRETATION of deeper significance of thoughts,
memories and behaviors is critical.
INSIGHT AND SELF-UNDERSTANDING: ANALYSIS AND INTERPRETATION enable the patient to understand the meaning
of behavior in relation to past experiences and intrapsychic conflicts. Insight and self-understanding are essential to enable the
person to make more conscious and productive decisions.
UNCOVER REPRESSED MEMORIES: Effective therapy MUST allow the patient to relive his or her past to discover causes
of psychological conflicts that have been repressed. Only then can the underlying factors be known and treated successfully.
PSYCHOANALYTIC THERAPEUTIC RELATIONSHIP
INTENSIVE, LONG-TERM THERAPY: Uncovering the unconscious is a lengthy process and understanding and treating the
underlying causal factors necessitates an INTENSIVE, LONG-TERM THERAPEUTIC RELATIONSHIP that is expensive, making it
unaffordable for most people.
TRANSFERENCE: Transference of deep feelings from unresolved significant relationships onto the therapist is an important part
of the unconscious that must be analyzed. The patient must work through the TRANSFERENCE PROCESS and resolve emotional
conflicts with others for therapy to be effective.
TECHNIQUES used in analysis: ANALYSIS OF DREAMS provides valuable insight into the human psyche.. Dreams are the
"royal road to the unconscious". Therapists find the latent "hidden" meaning of the dream from the given "manifest" content.
FREE ASSOCIATION, wherein the patient says whatever comes to mind, and PROJECTIVE TESTS are other techniques to
uncover unconscious conflicts and repressed memories.
RESISTANCES that occur in the therapeutic process need to be pursued and analyzed for the powerful underlying fears or desires
expressed. RESISTANCE is the patient’s unconscious attempt to block the uncomfortable process of revealing repressed memories
and conflicts that are psychologically threatening.
DIRECTIVE: Therapist should be DIRECTIVE but engage in little self-disclosure, remaining relatively anonymous. The therapist
INTERPRETS information and ANALYSES conflicts to help the patient achieve INSIGHTS necessary for CATHARIS and to gain
EGO STRENGTH to resolve inner conflicts.
CRITICISMS OF THE PSYCHOANALYTIC APPROACH
1. COST, TIME - Cost and length of time make psychoanalysis inaccessible to most people.
2. NOT EFFECTIVE ON SEVERE PROBLEMS – Psychoanalysis works best on intelligent functional adults and poorly on
patients with problems such as schizophrenia.
3. INSIGHT MAY NOT BE CURATIVE – Behaviorists argue that insight may not be curative and may add to problems by giving
a "reason" or "justification" for the ineffective and self-defeating behavior.
4. PSYCHOLOGICAL CONSTRUCTS – Key ideas such as the id, repression and the unconscious do not exist in reality and are
"psychological constructs" impossible to observe or measure
2. HUMANISTIC PERSON-CENTERED THERAPY
BASIC UNDERSTANDINGS AND SOURCE OF PROBLEMS
VIEW OF MAN: Man is essentially GOOD,RATIONAL and FREE. Given a nurturing environment, a person GROWS in positive,
fulfilling ways toward SELF-ACTUALIZATION of one’s potential. The WHOLE PERSON is in a process of changing and
becoming, actively, freely choosing one’s path.
SELF-CONCEPT, a person’s conscious subjective perception of self, is the key to understanding problem behavior. One "acts
according to his or her self-concept", be it positive or negative. When children are given CONDITIONAL REGARD with strong
CONDITIONS OF WORTH, judgments from parents, they can develop defensiveness, guilt, and feelings of worthlessness and
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despair, a NEGATIVE SELF-CONCEPT. They feel bad, lack self-esteem and act accordingly. Children and clients in therapy need
UNCONDITIONAL POSITIVE REGARD, a NON-JUDGEMENTAL caring person to develop a POSITIVE SELF-CONCEPT.
Therapy is CLIENT-CENTERED, PERSON-CENTERED AND NON-DIRECTIVE. Humanistic therapists believe one must
direct one's own life and one can resolve problems without interpretation or advice from an "expert." The therapist is an empathic
FACILITATOR, listening deeply and helping the client in the process of self-exploration to achieve self-awareness, selfacceptance, personal growth and self-fulfillment.
SELF-ACTUALIZATION MOTIVE: We are motivated by an innate drive for SELF-ACTUALIZATION. The positive growth
force leads us to develop our full potential. To Maslow, "What a man CAN be, he MUST be." Therapy should foster selfexploration and personal growth, not "problem-fixing."
PSYCHOLOGICAL GROWTH AND WELLNESS Humanistic therapists emphasize human potential, self-awareness, choice,
creativity, personal growth, self-fulfillment and PSYCHOLOGICAL HEALTH.
KEY CONCEPTS OF HUMANISTIC THERAPY
CORE THERAPEUTIC CONDITIONS are NECESSARY AND SUFFICIENT for client change. The core conditions are
GENUINENESS, EMPATHY AND POSITIVE REGARD. This climate of trust is therapeutic in itself, allowing the person to freely
explore his/her life without fear of judgment.
UNCONDITIONAL POSITIVE REGARD, total acceptance and respect for the person without judgement or evaluation, is
critical. This nurtures the client’s search for self-awareness and self-acceptance and frees the client to openly and honestly engage
in the process of self-exploration.
FOCUS ON GROWTH, SELF-FULFILLMENT: The aim of therapy is not merely to solve problems, but to assist persons in
their GROWTH PROCESS towards actualizing their potential. Most "problems" are EXISTENTIAL in origin and are related to
problems of living meaningful lives such as lack of fulfilling relationships, absence of meaningful goals, feelings of alienation and
failure to achieve personal goals.
GOAL: AUTHENTIC, CONGRUENT SELF -In a therapeutic climate of trust, clients will gradually drop their masks, defenses
and facades, becoming increasingly honest and in touch with their real, authentic, congruent self, a major therapeutic goal.
Congruence exists when the inside is "congruent", the same as the outside, when one can be honest and reveal the real inside
without fear of evaluation or rejection.
HUMANISTIC THERAPEUTIC RELATIONSHIP
CLIENT-CENTERED -A therapist should encounter a client on a PERSON-TO-PERSON real, human level as an equal. The
therapist's role is to be without roles, a real GENUINE, AUTHENTIC, CONGRUENT PERSON focused on helping the client
achieve self-awareness, self-insight and self-fulfillment.
UNCONDITIONAL POSITIVE REGARD -A client must feel unconditional POSITIVE regard, RESPECT AND
ACCEPTANCE to open up and fully disclose himself without fear of evaluation or rejection. Therapists are genuine, congruent,
accepting, empathic, trusting, warm and NONJUDGEMENTAL
NON-DIRECTIVE FACILITATOR- A therapist should not give advice, evaluations, judgments, diagnoses or directives. It is
important to be NON-DIRECTIVE and to FACILITATE self-awareness and self-disclosure so clients may freely choose their own
path to personal self-fulfillment.
EMPATHIC UNDERSTANDING - It is important for the therapist to communicate EMPATHY, an understanding of the client's
subjective world, a "seeing the world through THEIR eyes."
CRITICISMS OF THE HUMANISTIC APPROACH
FEELINGS ARE DIFFICULT TO DEFINE AND MEASURE – It is difficult to define important feelings such as love,
freedom, self-fulfillment, trust and wellness. Behaviorists argue for more scientific standards that are concrete and behavior based
that can be researched and measured.
NON-SCIENTIFIC CONCEPTS and ideas like freedom, empathy and self-actualization are non-scientific unvalidatable
"illusions", perceptual distortions of reality. Behaviorists argue constructs such as freedom are unreal false "psychological
constructs" that do not exist in the real world and cannot be observed, measured or validated.
INSIGHT IS NOT CURATIVE - Behaviorists argue that insight does not necessarily lead to a cure and
in fact the "insight" might become a convenient label to justify the "reason" for unhealthy behavior.
3. BEHAVIORAL APPROACHES TO THERAPY
BASIC UNDERSTANDINGS
ALL BEHAVIOR IS LEARNED, whether adaptive or maladaptive. Abnormal behavior is the result of faulty learning
experiences, a product of social learning and conditioning.
BEHAVIOR MODIFICATION is the goal of therapy. This includes eliminating maladaptive behaviors and learning new
effective behaviors.
NATURE OF ABNORMAL BEHAVIOR: Man is a PRODUCT OF HIS/HER ENVIRONMENT. There is no such thing as an
abnormal person, only a normal person in an ABNORMAL ENVIRONMENT.
ENVIRONMENTAL ENGINEERING -To change behavior we must be ENVIRONMENTAL ENGINEERS, constructing an
environment conducive and reinforcing of constructive behavior change.
 FOCUS ON SCIENTIFIC STUDY OF BEHAVIOR - It is important to be SCIENTIFIC, to study only OBSERVABLE,
MEASURABLE BEHAVIORS and to have objective evaluation of therapeutic outcomes.
KEY METHODS OF LEARNING: Behavior is learned through CLASSICAL CONDITIONING, (Pavlov), OPERANT
CONDITIONING ( B.F.Skinner) AND OBSERVATIONAL LEARNING, (Bandura). (see Learning Chapter for specifics)
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
WHAT CAN BE LEARNED CAN BE UNLEARNED – People can use the same learning principles that conditioned the
maladaptive behavior to get rid of it .(Classical, Operant and Observational Learning.)
KEY CONCEPTS
 BEHAVIOR IS DETERMINED by learning. We are "programmed puppets" determined by environment and history of
conditioning patterns specified by our environment..
 THERAPY AS NEW LEARNING PROGRAMS: As behavior is learned, therapy and behavior modification involves
creating a new BEHAVIORAL LEARNING PROGRAM to replace ineffective behaviors and learning patterns with effective
behaviors. This involves RELEARNING and environmental engineering.
 FOCUS ON OVERT AND SPECIFIC BEHAVIOR rather than on the person's feelings. BEHAVIORS, NOT FEELINGS,
are important. Behaviors are observable and measurable, feelings are not.
 FOCUS ON PRESENT BEHAVIOR – Current behavior and thoughts should be the FOCUS. It is NOT essential to
understand the origin of problems to produce behavior change.
 BEHAVIOR IS SHAPED BY ITS CONSEQUENCES – Behaviorists believe that behavior does not occur at random but is
shaped by its consequences. Behavior that is rewarded will likely be repeated (POSITIVE REINFORCEMENT). Behavior that
is punished is likely to be avoided (AVOIDANCE CONDITIONING)
 PROCESS OF REINFORCEMENT - To shape a new behavior, use POSITIVE REINFORCEMENT to reward a person for
the desired behavior.
 PROCESS OF EXTINCTION - TO EXTINGUISH an unwanted behavior, FAIL TO REINFORCE IT (PROCESS OF
EXTINCTION).
THERAPEUTIC PROCESS AND BEHAVIORAL TECHNIQUES
 BEHAVIOR SHAPING AND SUCCESSIVE APPROXIMATION – As behavior is SHAPED BY ITS CONSEQUENCES, to
shape a new behavior, one designs a reinforcement schedule to reward desired new behaviors. Rewarding behaviors closer and
closer to desired behavior is SUCCESSIVE APPROXIMATION.
 BEHAVIOR-MODIFICATION PLANS Therapists focus on identifying problematic BEHAVIOR, creating treatment goals
and plans, replacing problem behaviors with effective behaviors and evaluating outcome.
 SYSTEMATIC DESENSITIZATION is an effective procedure to COUNTER-CONDITION a classically conditioned behavior
such as pairing a fear or anxiety-producing stimulus with a relaxation response.
 AVERSION THERAPY is a counter-conditioning technique to teach people to avoid destructive behaviors such as smoking or
drinking by pairing it with a noxious stimuli. Although controversial, these techniques are used with behaviors that have been
learned through classical conditioning.
 OPERANT CONDITIONING TECHNIQUES strengthen desired behaviors through rewards. Some therapies that use
reinforcement are BEHAVIOR MODIFICATION PLANS, TIME-OUT TECHNIQUES AND TOKEN ECONOMIES.
Therapeutic environments are designed to reinforce desired behaviors.
 OBSERVATIONAL LEARNING - Learning through observational learning involving MODELING AND IMITATION, is an
important tool for therapeutic change. Therapies include Assertion Training, Social Skills Training, Role-Playing, Behavioral
Rehearsal and specific Homework Assignments.
 THERAPEUTIC RELATIONSHIP
WORKING RELATIONSHIP -A good "WORKING RELATIONSHIP" is necessary between the therapist and client but it is
NOT A SUFFICIENT condition for behavior change, the main focus. Therapist and client are working partners involved in
identifying problems, creating and implementing treatment plans.
DIRECTIVE ACTIVE THERAPIST - The therapist should be ACTIVE AND DIRECTIVE. He/she identifies the problem,
creates goals and a treatment program for behavioral change.
THERAPIST AS TEACHER/TRAINER - The therapist should function as a TEACHER, teaching more effective behaviors
through coaching, modeling, facilitating and problem-solving.
POSITIVE REINFORCEMENT PROVIDER -The therapist should provide POSITIVE REINFORCEMENT to enhance
learning. The therapist's attention and approval are powerful reinforcers.
TOKEN ECONOMIES - In "therapeutic environments" such as juvenile delinquent, mental retardation facilities and mental
hospital, Token Economies reinforce positive behaviors. Tokens given for desired behaviors are exchanged for food, activities or
privileges that are reinforcing to the client.
CRITICISMS OF BEHAVIORAL APPROACHES
1. SYMPTOM SUBSTITUTION - If OVERT behavior is treated instead of the underlying cause, a patient might substitute another
symptom such as drug addiction instead of alcoholism.
2. SOME TECHNIQUES MAY BE HARMFUL such as AVERSION THERAPY and PUNISHMENT.
For instance, children who are physically punished may model the behavior and hit others.
3. PERSONAL FREEDOM ISSUE – As behavior is shaped, those in charge of the treatment program or institutional environment
may "shape" behavior of others, taking away personal freedom.
4. NOT APPROPRIATE FOR GENERAL PSYCHOLOGICAL DISORDERS – Behavioral approaches are effective for specific
behaviors but not general conditions such as depression, anxiety etc.
4. COGNITIVE THERAPIES – EXAMPLE, RATIONAL-EMOTIVE THERAPY
BASIC UNDERSTANDINGS AND SOURCE OF PROBLEMS
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FAULTY ILLOGICAL IRRATIONAL THOUGHTS create maladaptive behaviors. People are born with the potential for
rational logical thought as well as for irrational illogical thinking. Abnormal behavior is caused by faulty and irrational thinking.
The goal of cognitive therapy is to change thinking.
 DISTURBANCES ROOTED IN CHILDHOOD -Emotional disturbance is rooted in CHILDHOOD when we UNCRITICALLY
introject many IRRATIONAL BELIEFS AND VALUES such as we MUST be successful in all respects and we MUST be loved
and approved of by most everyone.
 MENTAL DISTURBANCE – The cause of mental distress is disturbing thoughts. Humans are a unique species. They can invent
disturbing beliefs and keep themselves disturbed about their own disturbing beliefs!
 SELF-REFLECTION - People are also unique in that they have the power of self-reflection and insight. They can understand
their limitations and problematic irrational beliefs and confront their self-defeating tendencies. They can adopt more positive
logical beliefs and change their perceptions, feelings and behaviors.
 COGNITIVE RESTRUCTURING - People can change their cognitive, behavioral and emotive processes. People can retrain
themselves and change misconceptions, strengthen their coping skills and increase their self-control. They can choose to think
differently which will lead to more constructive behavior patterns.
KEY CONCEPTS
 R-E-T (Rational-Emotive Therapy) is a COGNITIVE THERAPY, an approach designed by Albert Ellis that actively attempts to
modify faulty thinking and believing, the "cause" of a person's problem. The goal of cognitive therapy is to change the way
clients think.
 GOAL: COGNITIVE RESTRUCTURING - To change negative emotions and consequences one must DISPUTE and restructure
one’s negative and self-defeating thoughts. The goal of COGNITIVE RESTRUCTURING is to replace one's negative irrational
beliefs with rational constructive thoughts.
 GOAL: RATIONAL THINKING: An important goal of therapy is RATIONAL THINKING, eliminating a self-defeating
irrational outlook on life and acquiring a productive RATIONAL philosophy.
THERAPEUTIC PROCESS AND GOALS
 THERAPY IS A COGNITIVE PROCESS. Thinking, questioning, analyzing, evaluating thought processes is critical to behavior
change. When one understands the maladaptive behavior is a consequence of illogical, irrational thinking, one can change his
thinking to rational self-enhancing beliefs.
 REEDUCATION – Therapy is a process of REEDUCATION. A central focus is challenging and disputing the client's illogical
ideas and teaching the person how to think rationally.
 HOMEWORK ASSIGNMENTS -BEHAVIOR CHANGE is a LEARNING PROCESS. It is important to have the client
ACTIVELY rehearse new behaviors and to do active HOMEWORK ASSIGNMENTS.
 CATASTROPHIC THINKING - Therapy should attack CATASTROPHIC THINKING, irrational beliefs about events, negative
self-talk and unwarranted emotional reactions.
 FOCUS ON PRESENT - Therapy should focus on the PRESENT. If we correct our present faulty thinking, we will eliminate the
consequent emotional turmoil.
THERAPEUTIC RELATIONSHIP
 THERAPIST AS TEACHER: Therapy is a reeducation process. The THERAPIST should function as a TEACHER, THE
CLIENT as a STUDENT. A personal relationship is not necessary.
 DIRECTIVE THERAPIST DISPUTES FAULTY THINKING. A cognitive therapist directs the sessions and actively
challenges, attacks, confronts, disputes faulty thinking and persuades as a COUNTER PROPAGANDIST. Therapists are actively
involved in determining pace and direction of therapy.
 COGNITIVE RESTRUCTURING - Therapists should attack CATASTROPHIC THINKING AND MUSTURBATION, behavior
that is rigid because we tell ourselves we MUST, SHOULD OR OUGHT TO do or be something. After attacking irrational
beliefs, the therapist actively leads the client to discover healthy rational beliefs that will restructure his or her thinking into
positive, rational, constructive thoughts.
 COGNITIVE BEHAVIOR TECHNIQUES are self-instructional methods aimed at teaching individuals to modify their behavior
by changing what they say to themselves. They practice statements that promote positive coping behaviors in the face of anxiety
or stress. BEHAVIOR CHANGE is crucial and many behavioral approaches may be used such as role-playing, behavior
rehearsal, contracts, counterconditioning, assertion training, modeling, operant conditioning and homework assignments.
 SELF-EFFICACY – Clients develop Self-Efficacy, the belief that one can master a situation and produce positive outcomes. As
people learn and practice new ways of thinking and responding, they gain self-confidence and feel they have control over their
destiny by learning new ways of thinking and behaving.
BECK’S COGNITIVE THERAPY FOR DEPRESSION
 AARON BECK developed a form of cognitive therapy to treat psychological dysfunctions, particularly depression.
 COGNITIVE ERRORS – Beck believes cognitive errors promote depression. Common "cognitive errors" are catastrophizing,
overgeneralizing, excessive responsibility (assuming personal causality), selective abstraction (focusing only on the negative)
and dichotomous thinking (everything is one extreme, good or bad, black or white.)
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Fact or Falsehood?
“Psychoanalysis” is another word for “psychotherapy.”
Regardless of their theoretical orientation, therapists agree
that self-awareness is the key to overcoming
psychological problems.
Group therapy is used primarily because it saves time and
money.
Most people who suffer psychological problems become
worse without therapy.
Electroconvulsive therapy is no longer used in the
treatment of psychological disorders.
Give students Attitudes toward Seeking Professional Psychological
Help Survey
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Attitudes toward Seeking Professional Psychological Help
Respond to the statements below using the following scale:
3 = Agree
2 = Partly Agree 1 = Partly Disagree
0 = Disagree
1. If I believed I was having a mental breakdown, my first inclination would
be to get professional attention.
2. The idea of talking about problems with a psychologist strikes me as a
poor way to get rid of emotional conflicts.
3. If I were experiencing a serious emotional crisis at this point in my life, I
would be confident that I could find relief in psychotherapy.
4. There is something admirable in the attitude of a person who is willing to
cope with his or her conflicts and fears without resorting to professional
help.
5. I would want to get psychological help if I were worried or upset for a long
period of time.
6. I might want to have psychological counseling in the future.
7. A person with an emotional problem is not likely to solve it alone; he or
she is likely to solve it with professional help.
8. Considering the time and expense involved in psychotherapy, it would
have doubtful value for a person like me.
9. A person should work out his or her own problems; getting psychological
counseling would be a last resort.
10. Personal and emotional troubles, like many things, tend to work out by
themselves.
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Overhead ATTITUDES

To score, students first need to reverse the numbers they placed before items 2, 4, 8, 9,
and 10, and then add the numbers in front of all 10 items.

Total scores can range from 0 to 30, with higher scores reflecting a more favorable
attitude toward seeking professional psychological help.

Fischer and Farina report mean scores of 19.08 and 15.46 for female and male
undergraduates, respectively.
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Broughton Hospital was established by
the Enabling Act passed in 1874. The
first patient, a medical doctor, was
admitted in 1883. In 1890, the name of
the hospital was changed from Western
Carolina Insane Asylum to State Hospital at Morganton and retained this name until 1959,
when it was named Broughton Hospital after
Governor J. Melville Broughton.
The hospital is organized into seven treatment
divisions: adult admissions, adolescent,
geropsychiarty, rehabilitation, extended care,
mental retardation, and medical-surgical.
Today it serves approximately 3,700 per
year……
You can use the scale to initiate a class
discussion of possible obstacles to seeking help.
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1. Is it more difficult for people to seek help for psychological problems than for
medical problems?
2. What accounts for gender differences in attitudes toward seeking professional
psychological help?
3. In addition to gender differences, the authors report that within certain ethnic
groups, those who hold strong cultural affiliations are less inclined to favor
seeking professional help than are those who identify with the broader
American culture.
4. There is also a tendency for psychology and social science majors to be more
favorably inclined toward seeking professional help.
5. Among the major academic concentrations, those with business
concentrations were least in favor of it.
6. What might account for these individual differences?
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How many people who need therapy
actually receive it?
N= 9282 Americans
41 % of those with a disorder
actually sought treatment in the
past year
 This rate is significantly higher
than the 25 % who obtained
treatment a decade ago or the
19% who were treated two
decades ago.
 About 30% went to “alternative” practitioners, IE, herbalists,
whose interventions show little evidence of effectiveness.
 Two of every five visits are to a mental health specialist who
were not a psychiatrist—psychologist, marriage counselor,
 Those least likely to receive care are the elderly, racial
minorities, and rural residents.
Nearly a third of visits for mental health care are made by people
who don’t have a disorder.
 Men don’t seek care as quickly as white women.
How long do people wait to go for treatment if they have symptoms of mental
disorder?

The average delay is almost a decade.

The sooner in life an illness begins, the longer the delay and the more
persistent the disorder.
Delay also depends on the specific disorder.

Average time of delay for bipolar disorder is 6 years

For generalized anxiety disorder it is 9 years

For attention-deficit/hyperactivity, 13 years For specific phobia, 20 years.
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Introducing Therapy
History of Insane Treatment
Maltreatment of the insane throughout the ages
was the result of irrational views. Many patients
were subjected to strange, debilitating, and
downright dangerous treatments.
The Granger Collection
The Granger Collection
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History of Insane Treatment
Philippe Pinel in France and Dorthea Dix in
America founded humane movements to care
for the mentally sick.
Culver Pictures
http://wwwihm.nlm.nih.gov
Philippe Pinel (1745-1826)
Dorthea Dix (1745-1826)
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OLDEST SURGURY KNOWN TO MAN
Trepanning, also known as trephination, trephining or making a
burr hole, is a medical intervention in which a hole is drilled or
scraped into the human skull, exposing the
dura mater in order to treat health problems
related to intracranial diseases. It may also
refer to any "burr" hole created through other
body surfaces, including nail beds.
Aztec trephination
tool 1300 AD
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Budapest
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17
year old girl is confined
to a makeshift straitjacket for 20 hours a day in Hidalgo, Mexico. When it’s removed, she throws her
arms in the air and laughs, then shoves her hand down her throat and begins to chew obsessively
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BRIEF INTRODUCTION…………INSIGHT THERAPIES
The main goal of insight therapies – talk
therapy is to give clients a better
understanding and awareness of their
feelings, motivations, and actions in the
hope that this will lead to better
adjustment.
Psychoanalysis - Freudian
Client-centered Therapy – Carl Rogers
Gestalt therapy grew out of the work of Fritz Perls and is designed to help people become more
aware of their feelings and more genuine in their day-to-day interactions.
The emphasis in therapy is on making the person whole and complete.
Recent Developments
Contemporary insight therapists are more active than traditional psychoanalysts, giving clients direct
guidance and feedback.
They are also more focused on clients' immediate problems than on their childhood
traumas.
An especially significant development is the trend to short-term psychodynamic
psychotherapy
PSYCHOTHERAPY uses psychological principles to influence a
person's thoughts, feelings and behavior for the purpose of
helping the client to adjust to problems of living or to overcome
abnormal behavior.
There are various approaches to psychotherapy.
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Psychological Therapies
We will look at four major forms of
psychotherapies based on different theories of
human nature:
1.
2.
3.
4.
Psychoanalytical theory
Humanistic theory
Behavioral theory
Cognitive theory
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Define psychoanalysis, and discuss the aims of this form of therapy.
Psychoanalysis: Aims
Since psychological problems originate from
childhood repressed impulses and conflicts, the
aim of psychoanalysis is to bring repressed
feelings into conscious awareness where the
patient can deal with them.
When energy devoted to id-ego-superego
conflicts is released, the patient’s anxiety
lessens.
11
$$$$$$$$
Psychoanalysis is
long and costly
$$$$$$$$$$$
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Psychoanalysts seem to agree that the following four
personal qualities are crucial to determining whether the
analysis will be successful:
1.
Motivation. The person needs strong internal
motivation to persist in treatment that will require
several sessions per week for several years.
2. Capacity to form interpersonal relationships. The
potential patient must have the capacity to form,
maintain, and ultimately detach from an intimate,
trusting relationship.
3. Capacity for introspection and insight. The
therapy requires natural curiosity about oneself and the
capacity for self-scrutiny.
4. Ego strength. The person must be able to accept
the “rules” of psychoanalysis and be open to painful facts
and interpretations about himself or herself.
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HELLO, MY NAME IS ____________ .
Free associate? But my mind is a blank.
Blank.
Blank.
Blank.
Bank.
Change.
Superman.
PacBell.
Trapeze.
Sneeze.
Brachiosaurus.
Iguana.
Wood chips.
Potato chips.
Chip away the parts that
don't look like an elephant.
Pygmalion.
Shade.
Sam Spade.
Maltese.
Millennium.
Solo cups.
Zube Tube.
Tubular.
Moon Unit.
Unit circle.
Flat Earth
Society.
Singing
monks.
Mendel.
Triffids.
Trafalgar.
Crows with
clipped wings.
Jacob's
Ladder.
Ice water.
Needles.
Stitches.
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I Have No Mouth
but I Must Scream.
The Zone.
Submitted for your approval.
Oh but this form isn't stamped you see.
Fresnel lenses.
Worms on fire.
Yggdrasil.
Loki.
Locutus.
Mr. Rogers.
Drug dealers.
Cell phones.
Testicular cancer.
Chastity belts.
The Cantebury Tales.
Harlequin romances.
Weird Science.
Oingo Boingo.
Rollercoasters.
Time Cop.
The Punisher.
Dolph Lundgren's butt.
Arnold Schwarzenegger's
butt.
Ronald Reagan's cancer of
the butt, and nose.
Danny Thomas.
Hollywood Squares.
The Gong Show.
JP Morgan.
PJ Harvey.
Invisible rabbits.
Skinning chickens.
Slaughterhouses.
Slaughterhouse 5.
A Clockwork Orange.
Blobby modern art.
Remote controls.
Rodents.
Marsupials.
Aurstralian fer beer, mite.
I could have had a v8.
Muscle cars.
The Fonz.
The Andy Griffith Show.
The Munsters.
Aabot and Costello
meet The Wolfman.
Ed Wood.
That's Fronkensteen.
Photographic enlargers.
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Circular saws.
Lathes.
Of Heaven.
Eraserhead.
Vomit.
Peter Bagge.
Performance art.
What goes clink-clinkclink-clink ow-wooo?
Barbecue sauce.
Chicken McNuggets.
Chinese food boxes full of
worms and maggots.
Kieffer Sutherland.
Crane shot.
Falling.
Dizziness.
You'll find yourself slipping into
and out of a hallucinatory state.
Sensory deprivation tank.
Cloth cubicle walls.
Veal fattening pens.
Feedbags.
Straitjackets.
Yellow teeth caked with filth.
H. P. Lovecraft.
Cracked plaster.
``Plaster? I don't even know her!''
Improv.
Oprah.
The camera scene in The Wall.
Detention.
A swimming pool with a
layer of grease like bad soup.
The Beverly Hillbillies.
I Dream of Genie.
The Space Program.
The Magic Bullet.
For a Few Dollars More.
Akira Kurisowa.
Akira.
Legend of the Overfiend.
Weird animated japanese sex.
Ken and Barbie.
Dave Barry.
Klaus Barbie.
Klaus Von Bulow.
Dead Ringers.
Car jacks.
Jackalope.
Heliotrope.
Microscope.
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Plucking a hair.
Shaving.
Pimples.
Oreo cookies.
Stephen Wright.
Hairless pony.
Unicorn.
Tom Cruise.
bus error:
core dumped.
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Psychoanalysis is Sigmund Freud’s
therapeutic approach of using the
patient’s:
1. Free associations - (saying aloud
anything that comes to mind)
2. Resistances - the defensive
blocking from awareness of
anxiety-laden material
3. Dreams and their interpretation - Freud also believed that
the latent content of dreams was another clue to unconscious
conflicts.
4. and transference - transferring to the therapist of
long-repressed feelings
5. And the therapist’s
interpretations of them to
help the person release
repressed feelings and gain
self-insight.
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The goal of psychoanalysis is to:
1. help people gain insight into the unconscious origins of their
disorders
2. to work through the accompanying feelings
3. And to take responsibility for their own growth.
Contrast psychodynamic therapy and interpersonal therapy with
traditional psychoanalysis.
Today, there are relatively few traditional psychoanalysts.
Most have been replaced by therapists who make psychodynamic
assumptions, that is, those who try to understand patients’ current
symptoms by:
1. exploring their childhood experiences
2. by exploring the therapist-patient relationship.
3. They may also help the person explore defended-against thoughts
and feelings.
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However, they talk with the
patient face-to-face, once a week, and
for
only a few weeks or months.
ECLECTIC
Interpersonal psychotherapy, variation of
psychodynamic therapy - a brief alternative to
psychodynamic therapy, emphasizes symptom relief
in the present, not overall personality change.
 The therapist also focuses on current relationships
and the mastery of relationships skills.
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 It has been found effective with depressed
patients.
HUMANISTIC PERSON-CENTERED THERAPY
VIEW OF MAN:
Man is essentially GOOD, RATIONAL and FREE.
Given a nurturing environment, a person GROWS in positive,
fulfilling ways toward SELF-ACTUALIZATION of one’s
potential.
Humanistic Therapies catch
words:
1. SELF-CONCEPT
2. FREE WILL
3. CLIENT-CENTERED,
PERSON-CENTERED
AND NON-DIRECTIVE.
4. SELFACTUALIZATION
MOTIVE
5. PSYCHOLOGICAL
GROWTH AND WELLNESS
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Humanistic Therapy
The therapist engages in active listening and
echoes, restates, and clarifies the patient’s
thinking, acknowledging expressed feelings.
Michael Rougier/ Life Magazine © Time Warner, Inc.
19
The text suggests that establishing an empathic, trusting, caring
relationship is one of the key components of all effective
psychotherapy.
In his client-centered therapy, Carl Rogers used active listening to express
genuineness, acceptance, and empathy.
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CRITICISMS OF THE HUMANISTIC APPROACH
 FEELINGS ARE DIFFICULT TO DEFINE AND
MEASURE – It is difficult to define important feelings such
as love, freedom, self-fulfillment, trust and wellness.
Behaviorists argue for more scientific standards that are
concrete and behavior based that can be researched and
measured.
 NON-SCIENTIFIC CONCEPTS and ideas like freedom,
empathy and self-actualization are non-scientific
unvalidatable "illusions", perceptual distortions of reality.
Behaviorists argue constructs such as freedom are unreal
false "psychological constructs" that do not exist in the real
world and cannot be observed, measured or validated.
 INSIGHT IS NOT CURATIVE - Behaviorists
argue that insight does not necessarily lead
to a cure and in fact the "insight" might
become a convenient label to justify the
"reason" for unhealthy behavior.
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BEHAVIORAL THERAPIES focus on the problem
behaviors and apply principles of learning to modify
problem behaviors.
Behavior therapists attempt to teach the person more
appropriate responses to replace maladaptive ones.
Behaviorists set up environments for people that
reinforce desired behaviors and extinguish
undesirable behavior.
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Traditional psychoanalysts attempt to help people gain insight into
their unresolved and unconscious conflicts.
Humanistic therapists help clients to get in touch with their
feelings.
Versus
In contrast, behavior therapists question the therapeutic power of
increased self-awareness.
They assume problem behaviors are the problems and thus do
not look for inner causes.
They apply learning principles to eliminate a troubling
behavior.
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1. Counterconditioning is a behavior therapy procedure, based on
classical conditioning, that conditions new responses to stimuli that
trigger unwanted behaviors.
2. Exposure therapies treat anxieties by exposing people to the things
they fear and avoid.
In systematic desensitization, a prime example of
exposure therapy, a pleasant, relaxed state is associated
with gradually increasing anxiety-triggering stimuli.
This procedure is commonly used to treat phobias/anxiety
disorders.
3. Virtual reality exposure therapy equips patients with a headmounted display unit that provides vivid simulations of feared
stimuli, such as a plane’s takeoff.
4. In aversive conditioning, an unpleasant state (such as nausea) is
associated with an unwanted behavior (such as drinking alcohol).
This method works in the short run, but for long-term effectiveness it
is combined with other methods.
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Aversive Conditioning
A type of
counterconditioning
that associates an
unpleasant state with
an unwanted
behavior. With this
technique, temporary
conditioned aversion
to alcohol has been
reported.
25
In aversive conditioning, an unpleasant state (such as nausea) is associated with an unwanted
behavior (such as drinking alcohol).
This method works in the short run, but for long-term effectiveness it is combined with
other methods.
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Three major elements of systematic
desensitization, including:
(1)
the creation of an anxiety
hierarchy that orders fear-producing
stimuli from the lowest to highest
(2)
the learning of the relaxation
response
(3)
The progressive association of
each hierarchy item with relaxation.
The therapist may accomplish this association by having the
client imagine hierarchy items or by actually presenting the
feared items.
Often both strategies are used.
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Operant conditioning therapies are based on the premise that voluntary
behaviors are strongly influenced by their consequences.
The rewards used to modify behavior vary from attention or praise to
more concrete rewards such as food.
In institutional settings, therapists may create a token economy in
which a patient exchanges a token of some sort, earned for
exhibiting the desired behavior, for various privileges or treats.
Critics express two concerns:
1. First, what happens when the reinforcers stop?
Might the person have become so dependent upon the extrinsic
rewards that the appropriate behaviors quickly disappear?
2. Second, is it ethical for one person to control another’s behavior?
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CRITICISMS OF BEHAVIORAL APPROACHES
1. SYMPTOM SUBSTITUTION - If OVERT behavior is treated
instead of the underlying cause, a patient might substitute another
symptom such as drug addiction instead of alcoholism.
2. SOME TECHNIQUES MAY BE HARMFUL such as
AVERSION THERAPY and PUNISHMENT.
For instance, children who are physically punished may model
the behavior and hit others.
3. PERSONAL FREEDOM ISSUE – As behavior is shaped,
those in charge of the treatment
program or institutional environment
may "shape" behavior of others, taking
away personal freedom.
4. NOT APPROPRIATE FOR
GENERAL PSYCHOLOGICAL
DISORDERS – Behavioral approaches
are effective for specific behaviors but
not general conditions such as depression, anxiety etc.
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Cognitive Therapy
Teaches people adaptive ways of thinking and
acting based on the assumption that thoughts
intervene between events and our emotional
reactions.
28
Contrast cognitive therapy and cognitive-behavior therapy, and
give some examples of cognitive therapy for depression.
 Cognitive therapists assume that our thinking colors our feelings,
and so they try to teach people who suffer psychological disorders new,
more constructive ways of thinking.
Therapy IS aimed at changing a person's
irrational thoughts
and perceptions in
order to achieve a
change in behavior
Rational
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Emotive Therapy (Albert Ellis): Confrontational therapy where the
therapist actively challenges the client's self-defeating beliefs and cognitions.
Albert Ellis's Rational-Emotive Therapy
 Ellis is a very different person from Rogers.
 While Rogers is a quiet, laid-back sort of therapist, Ellis is more dynamic
and is as likely to argue with his clients as sympathize with them.
Basically, Ellis believes that a person's problems come from their mistaken
beliefs about the world, others, and themselves.
Your beliefs lead you to see things, feel things, and do things in a certain way,
and if those beliefs are wrong, so will be your perceptions, your emotions, and
your behaviors.
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Here are the twelve most
common mistaken beliefs:
1. I must be loved.
2. Some acts are unredeemably
wicked, and some people are
damned.
3. It is absolutely horrible
when things don't go right.
4. All my suffering comes from
outside, from others.
5. I should get upset at problems and obsess about them.
6. I should avoid problems.
7. I need someone or something stronger to lean on.
8. I should be really competent at all things, because it is bad to be
imperfect.
9. Once something bad happens, it will affect me forever.
10.
I must have control over everything.
11.
I can only be happy by avoiding all action.
12.
I have no control over my emotions.
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He simplifies the list a bit with three beliefs, about the world, others,
and ourselves:
1. The world must give me happiness, or I will die.
2. People must treat me right, or they are rotten.
3. I must be completely competent, or I'm worthless.
His way of dealing with these
mistaken beliefs is pretty straight
forward: He argues with his clients!
He asks them why they have this belief,
what kind of evidence they have that
they are true -- and what kind of
evidence they might also have that they
are not true!
He asks them, what's the worst that can
happen if you give up your particular beliefs -- and what is the best that can happen!
Although
RET sounds very different from Rogers' therapy, it has a lot of
commonalities as well.
 Ellis, like Rogers, strongly believes that all people should develop unconditional
self-regard and should stop passing judgments on themselves.
 Many therapists that combine aspects of Rogers' and Ellis' begin with Rogers' quiet
listening approach, and later, when therapist and client have developed trust and a
real rapport, will start using Ellis' more aggressive approach.
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BECK’S COGNITIVE THERAPY FOR DEPRESSION
AARON BECK developed a form of cognitive therapy to treat
psychological dysfunctions, particularly depression.
COGNITIVE ERRORS – Beck believes cognitive errors promote
depression. Common "cognitive errors" are catastrophizing,
overgeneralizing, excessive responsibility (assuming personal
causality), selective abstraction (focusing only on the negative)
and dichotomous thinking (everything is one extreme, good or
bad, black or white.)
SELF-LABELS – Clients are trained to identify negative SelfLabels, ways they view themselves that cause negative emotions
and self-defeating beliefs and actions.
COGNITIVE TRAINING - Clients are trained to notice when
they are thinking irrational or distorted thoughts and how to
substitute appropriate thoughts for inappropriate thoughts.
THERAPIST AS MOTIVATOR – Therapists give clear feedback to the clients and give motivating support to
the process of cognitive change.
Cognitive Depression Therapy - In stress inoculation training, people suffering
depression learn to dispute their negative thoughts and to restructure their
thinking in stressful situations.
Still other therapists teach depressed adults to interpret life events as nondepressed people do, for example, to take credit for their successes.
Increasing self-efficacy
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Group and Family Therapies
Group Therapy
Group therapy normally consists of 6-9 people
attending a 90-minute session that can help
more people and costs less. Clients benefit from
knowing others have similar problems.
© Mary Kate Denny/ PhotoEdit, Inc.
33
The social context provided by group therapy allows people to discover
that others have problems similar to their own and to try out new ways
of behaving.
 Receiving honest feedback can be very helpful, and it can be
reassuring to find that you are not alone.
 Many participate in self-help and support groups—for divorced
people, the addicted, the bereaved, and those simply seeking
personal growth.
Family therapy assumes that we live and grow in relation to others,
especially our families. In an effort to heal relationships, therapists help
family members discover the role they play within the family’s social
system.
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Evaluating Psychotherapies
A. Is Psychotherapy Effective?
Explain why clients tend to overestimate the effectiveness of
psychotherapy.
Clients tend to overestimate the effectiveness of psychotherapy
because they enter therapy in crisis.
Placebo Effect of Therapy??? - With the normal ebb and flow of
events, the crisis passes and people attribute their improvement to
the therapy.
Finally, clients generally speak positively of therapists who have been
very understanding and who have helped them gain a new
perspective.
Research has generally not supported clients’ estimates of therapy’s
effectiveness.
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Evaluating Psychotherapies
Within psychotherapies cognitive therapies are
most widely used, followed by psychoanalytic
and family/group therapies.
36
Give some reasons why clinicians tend to overestimate the effectiveness of psychotherapy,
and describe two phenomena that contribute to clients’ and clinicians’ misperceptions in
this area.
Clients enter therapy when they are extremely unhappy, usually leave when they are less
extremely unhappy, and stay in touch only if satisfied.
Thus, therapists, like most clients, testify to therapy’s success.
Clinicians are mostly aware of other therapists’ failures as clients seek new therapists for
their recurring problems.
Two phenomena that contribute to perceived value in ineffective therapies are the
placebo effect (the belief a treatment will work) and regression toward the mean (the
tendency for extremes of unusual scores to fall back toward the average).
Feeling low tends to be followed by our return to a more normal state and anything we
tried in the interim may seem effective.
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Describe the importance of outcome studies in
judging the effectiveness of psychotherapies, and
discuss some of these findings.
Randomized clinical trials assign people on a waiting list to therapy or no therapy.
Research that includes use of meta-analysis reveals that:
(1) people who remain untreated often improve
(2) those who receive psychotherapy are more likely to improve
(3) when people seek psychological treatment, their search for other medical treatment
declines, compared with their counterparts on waiting lists.
Summarize the findings on which psychotherapies are most effective for
specific disorders.
No one therapy has been shown to be best in all cases, nor is there any relationship between
clinicians’ experience, training, supervision, and licensing and their clients’ outcomes.
Some therapies are, however, well suited to particular disorders such as:
 Cognitive, interpersonal, and behavior therapies for depression
 Cognitive, exposure, and stress inoculation therapies for anxiety
 Cognitive-behavior therapy for bulimia
 Behavior modification for bedwetting.
In addition, behavioral conditioning therapies achieve especially favorable results in treating:
 phobias, compulsions
 marital problems
 and sexual disorders.
Therapy is most effective when the problem is clear-cut.
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Evaluate the
effectiveness of eye
movement desensitization
and reprocessing (EMDR)
and light exposure
therapies.
In eye movement desensitization and reprocessing (EMDR) therapy,
the therapist waves a finger in front of the eyes of the client to
unlock and reprocess previously frozen trauma memories.
Scientific testing has not supported the effectiveness of EMDR
 belief in its effectiveness may be explained in terms of the
placebo effect.
In contrast, the light exposure
therapies (exposure to daily doses of
light that mimics outdoor light) have
proven effective in treating people
with seasonal affective disorder, a
form of depression linked to periods of
decreased sunlight.
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Evaluating Alternative Therapies
Lilienfeld (1998) suggests comparing scientific
therapies against popular therapies through
electronic means. The results of such a search
are below:
43
The Biomedical Therapies
A.
Drug Therapies
Define psychopharmacology, and explain how double-blind studies help
researchers evaluate a drug’s effectiveness.
Psychopharmacology, the study of the effects of drugs on mind and behavior, has
revolutionized the treatment of severely disordered people.
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To evaluate the effects of any new drug, researchers used the double-blind technique, in which
half the patients receive the drug while the other half receive a placebo.
Because neither staff nor patients know who gets which, this research strategy eliminates bias
that results from therapists’ and patients’ expectations of improvement.
Using this approach, several types of drugs have proven effective in treating psychological
disorders.
Describe the characteristics of antipsychotic drugs, and discuss their use in
treating schizophrenia.
Antipsychotic drugs, also called NEUROLEPTICS, such as chlorpromazine (sold as
Thorazine), provide help to people experiencing the positive symptoms of auditory
hallucinations and paranoia by dampening their responsiveness to irrelevant stimuli.
 Clozapine (sold as Clozaril) helps reanimate schizophrenia patients with the negative
symptoms of apathy and withdrawal.
 Long-term use of the the first generation drugs (e.g., Thorazine) block D2 dopamine
receptors and can produce tardive dyskinesia, which is marked by involuntary
movements of facial muscles, tongue, and limbs.
 New-generation antipsychotics (e.g., clozapine) target D1 dopamine receptors and seem
to increase the risk of obesity and diabetes.
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Schizophrenia Symptoms
Inappropriate symptoms
present (positive
symptoms)
Hallucinations,
disorganized thinking,
deluded ways.
Appropriate symptoms
absent (negative
symptoms)
Apathy, expressionless
faces, rigid bodies.
54
NEUROLEPTICS
Antipsychotic Drugs
Classical antipsychotics [Chlorpromazine
(Thorazine)]: Remove a number of positive
symptoms associated with schizophrenia such
as agitation, delusions, and hallucinations.
Atypical antipsychotics [Clozapine (Clozaril)]:
Remove negative symptoms associated with
schizophrenia such as apathy, jumbled thoughts,
concentration difficulties, and difficulties in
interacting with others.
55
NEUROLEPTICS
+
0
0_
0
0
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Describe the characteristics of antianxiety drugs.
Antianxiety drugs such as Xanax and Ativan depress central nervous system activity.
 Used in combination with other therapy, they can help people learn to cope with
frightening stimuli.
 Antianxiety drugs can be both psychologically and physically addictive.
Describe the characteristics of antidepressant drugs, and discuss their use in
treating specific disorders.
Antidepressants aim to lift people up, typically by increasing the availability of the
neurotransmitters norepinephrine and serotonin.
 For example, fluoxetine (Prozac) blocks the reabsorption and removal of serotonin from
the synapses.
Other dual action antidepressants work by blocking the reabsorption or breakdown of both
norepinephrine and serotonin.
Although no less effective, these dual-action drugs have more potential side effects, such as
dry mouth, weight gain, hypertension, or dizzy spells.
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Antidepressants influence neurotransmitter systems almost immediately; their full
psychological effects may take weeks.
The risk of suicide for those taking these drugs has probably been overestimated.
Describe the use and effects of mood-stabilizing medications.
The
simple salt lithium is often an effective mood stabilizer for those suffering
the BIPOLAR swings of bipolar disorder.
Although lithium significantly lowers the risk of suicide, we do not fully understand how it
works.
Describe the use of electroconvulsive
therapy in treating severe depression, and
describe some possible alternatives to ECT.
Electroconvulsive therapy (ECT), or shock
treatment, is used for severely depressed patients.
 A brief electric current is sent through the
brain of an anesthetized patient.
 Although ECT is credited with saving many from suicide, no one knows for sure how it
works.
 The aim of ECT is to produce a seizure in the brain, similar to what occurs
spontaneously in some types of epilepsy.
 Researchers in Iowa found that more than 10 percent of untreated
patients diagnosed as suffering from major depressive disorder died
within three years.
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 Although some were suicide victims, 75 percent of those who died did so
as a result of illnesses such as heart attack and cancer. Only 2 percent of
patients who received ECT died within three years.
READ THIS!!!!!!!!!!!!
Sackeim provides a case history to illustrate ECT’s potential effectiveness.
Anna, a 36-year-old teacher and mother of two, had a history of
recurrent depression and had been in psychotherapy for several years.
She also had been treated with antidepressant drugs, which were
ineffective. Finally hospitalized, Anna described life as a “living hell.” She
slept poorly, had little appetite, and experienced significant weight loss.
Her concentration was so poor she could barely read a newspaper
headline. Obsessed with the notion that she had ruined her children’s
lives, she threatened to kill herself. With her consent, psychiatrists began
ECT. After five treatments, she had completely recovered and returned
to her family and job.
Some patients with chronic depression have found relief through a chest implant that
intermittently stimulates the vagus nerve, which sends signals to the limbic system.
Repetitive transcranial magnetic stimulation (rTMS) is performed on wide-awake
patients.
 Magnetic energy penetrates only to the brain’s surface (although tests are underway with
a higher energy field that penetrates more deeply).
 Unlike ECT, the rTMS procedure produces no seizures, memory loss, or other side
effects. Recent studies have confirmed its therapeutic effect.
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By 1949, when Egas
Moniz won a Nobel
prize for developing
the lobotomy, tens of
thousands had been
lobotomized—alcohol
abusers, criminals,
and retarded people,
including Rosemary
Kennedy, sister of the
future president.
During the 1950s,
calming drugs
became available
and psychosurgery
was largely abandoned.
The text notes that lobotomies are no longer performed and that other psychosurgery is
used only in extreme cases.
For the most part, psychosurgery has become taboo, even though refinements targeting
very limited areas in the brain are now much safer. Neurosurgeons perform operations at
the risk of being picketed.
Students may be interested in learning that Moniz himself was shot and left partially
paralyzed by one of his lobotomized patients.
One notable exception is a procedure known as cingulotomy, which has been performed
at Massachusetts General Hospital.
Bearing little relation to the lobotomy, the procedure involves passing an electrode
needle through two small holes in the skull and searing a tiny lesion in the cingulum, a
bundle of nerve fibers linking the emotional centers of the brain with the thought
centers in the cortex.
Since 1962, about 700 patients have received cingulotomies, averaging about 20
operations annually.
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Used primarily in the treatment of obsessive-compulsive disorder, certain phobias, and
depression, the surgery is offered only to those who have been ill for years and, in
many cases, are at risk for suicide.
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Summarize the history of the psychosurgical procedure known as a lobotomy,
and discuss the use of psychosurgery today.
Psychosurgery removes or destroys
brain tissue in an effort to change
behavior.
 For example, the lobotomy was
once used to calm
uncontrollably emotional or
violent patients.
 The nerves that connect the
frontal lobes to the emotioncontrolling centers of the inner
brain are cut.
 The lobotomy usually produced a permanently lethargic, immature, impulsive
personality.
 Because of these effects and the introduction of drug treatments in the 1950s, the
procedure has been abandoned.
Other psychosurgery is used only in extreme cases.
 For example, for patients who suffer uncontrollable seizures, surgeons may deactivate
the specific nerve clusters that cause or transmit the convulsions.
 MRI-guided precision surgery may also be used to cut the circuits involved in severe
obsessive-compulsive disorder.
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Name:
Explain the rationale of preventive mental health programs.
Preventive mental health experts view many psychological disorders as an
understandable response to a disturbing and stressful society.
It is not only the person who needs treatment but also the person’s social context.
Thus, the aim of preventive mental health programs is to change oppressive, esteemdestroying environments into more benevolent, nurturing environments that foster
individual growth and self-confidence.
Clearly, a human being is an integrated biopsychosocial system.
 For example, stress affects body chemistry and health. Effective treatment requires
treating biological, psychological, and social-cultural factors.
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Psychological Disorders are
Biopsychosocial in Nature
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ALPHABETICAL LIST OF MEDICATIONS BY GENERIC NAME8
GENERIC NAME
Antipsychotic Medications-ALSO CALLED NEUROLEPTIC
Treat schizophrenia and other psychotic disorders
Antimanic Medications - Bipolar
lithium carbonate
lithium citrate
Antidepressant Medications - depression
SSRIs – Lexapro, prozac, Celexa, Luvox
NDRI - Wellbutrin
Antianxiety Medications
(All of these antianxiety medications except buspirone are benzodiazepines and VERY addictive)They
do NOT work via reuptake or to reduce neurotransmission of say Dopamine…..they ‘ZZZZZZZ” you
out.
alprazolam
Xanax
clonazepam
Klonopin
clorazepate
Azene, Tranxene
diazepam
Valium
halazepam
Paxipam
lorazepam
Ativan
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