1. Treatment of Disorders

2. History of Treatment

3. Ethical Issues in Treatment
Deinstitutionalization occurred during the mental health movement of the 1960s
Don’t exclude mentally ill from society, but help them function within society
Shorten in-patient treatment (only keep in hospital if necessary)
More out-patient care
APA guidelines 

4. Who Provides Treatment?
Psychiatrists – Medical doctors, MD
Psychologists – PhD, PsyD, some MA
Clinical Social Workers, MA
Marriage/Family Therapists, MA
Licensed Professional Counselors, MA
Psychiatric Nurses, RN
Substance Abuse Counselors, CADC
Pastoral Counselors

5. Psychotherapy – trained therapist uses psychological techniques to help someone to overcome problems or difficulties
Biomedical therapy – prescribed medication that acts on nervous system
Eclectic approach – use a blend of therapies and approaches

6. Psychoanalysis Free association Transference
Say whatever comes to mind, no censoring of thoughts
Overcome resistance (blocking of anxiety-laden material)
Transference
Patient transfers unconscious feelings towards someone else onto the therapist
i.e. patient w/Electra complex has attraction to Freud (transfers attraction to father onto therapist)

7. Type of Therapy Cause/Problem Aim of Treatment
Psychodynamic
Unconscious forces & childhood experiences
Reduce anxiety through self-insight; analysis & interpretation
Client-centered (Humanistic)
Barriers to self-understanding & self-acceptance
Personal growth through self-insight
Behavior
Maladaptive behaviors (learned or observed)
Extinguish maladaptive behaviors
Cognitive
Negative, self-defeating thoughts
Healthier thinking, positive self-talk
Group (Family)
Stressful relationships
Relationship healing, better communication
Biomedical
Chemical imbalances or nervous system dysfunction
Prescribed medications of medical surgery

8. Psychodynamic Childhood experiences Enhance self-insight
Interpersonal therapy – brief (12-16 session) treatment, effective for depression

9. Psychoanalysis v. Humanistic
Humanistic therapies differ from psychoanalysts in focusing on…
1) Present & future (not past)
2) Conscious rather than unconscious
3) Immediate responsibility
4) Promoting growth instead of curing illness

10. Client-Centered Therapy (Carl Rogers)
Nondirective  Active listening
Clarification or “reflect” what has been said back to patient
Genuineness, acceptance, empathy
Unconditional positive regard  no judgment

11. Behavior Therapies – Classical Conditioning
Counterconditioning
Pair feared stimulus w/good outcome
Exposure therapy
Learn relaxation techniques
Systematic desensitization hierarchy
Aversive conditioning
Pair the undesirable behavior with bad outcome

12. Behavior Therapy
Systematic Desensitization

13. Behavior Therapy
Aversion therapy for alcoholics

14. Behavior Therapies – Operant
Behavior Modification – use reinforcement to increase desired behaviors
Token Economy – provide “tokens” each time desired behavior is performed that can be redeemed later for a bigger reward

15. Cognitive Therapies Cause = irrational thinking patterns
Aim = correct habitual thinking errors
Aaron Beck’s Cognitive(-Behavioral) Therapy
 Cognitive Triad
1) Negative feelings about self
“I am a failure”
2) Negative feelings about world
“The world is unfair”
3) Negative feelings about future
“The future is hopeless, it will never get better”

16. Beck’s Cognitive Therapy for Depression
Over-generalization  drawing general conclusions from a single (usually negative) event. E.g. thinking that failing to be promoted at work means a promotion will never come.
Minimalization and Maximization  Getting things out of perspective: e.g. either grossly underestimating own performance or overestimating the importance of a negative event.
Dichotomous thinking  Thinking that everything is either very good or very bad so that there are no gray areas. In reality, of course, life is one big gray area.

17. Cognitive-Behavioral Therapies
Albert Ellis’s Rational Emotive Behavior Therapy (REBT)
The A-B-C model
A= Adversity (anticipating event)
B = Belief about “A”
C = Consequences (behavioral, emotional)

18. Evaluating Psychotherapies
To whom do people turn for help for psychological difficulties?

19. Is Psychotherapy Effective?
Overestimation
Clients enter in crisis (temporary)
Want to believe it was worth the effort
Placebo effect (expect to get better)
Regression toward the mean (the usual state is better than rock bottom, which is where most patients start)

20. Is Psychotherapy Effective?
Those not treated often improve, but those undergoing therapy are more likely to improve
No one therapy is best in all cases
Evidence-based practice – clinical decision making that integrates best available research w/clinical expertise and patient characteristics

21. Three Benefits of Psychotherapies
Offer expectation that things can and will get better
Offers plausible explanation for symptoms and alternative way of thinking
Effective therapists are empathetic and seek to understand  builds trust

22. Evaluating Psychotherapies
Poor outcome
Good outcome
Average
untreated
person
psychotherapy
client
Number of
persons
80% of untreated people have poorer
outcomes than average treated person

23. Biomedical Therapies
Psychopharmacology

24. Antipsychotic Drugs Treats schizophrenia
Decrease receptiveness to irrelevant stimuli
Block dopamine
Thorazine, Haldol, neuroleptics
Atypical antipsychotics (Clozapine)
Tardive dyskinesia – involuntary movements of face, tongue, limbs

25. Antianxiety Drugs
Depress CNS activity (tranquilizers – benzodiazepines)
Boost GABA
Xanax, Ativan, D-cycloserine
Can lead to psychological and physiological dependence
Treats anxiety disorders (PTSD, OCD)

26. Antidepressant Drugs Increase serotonin & norepinephrine
Selective Serotonin Reuptake Inhibitors (SSRIs)
Prozac, Zoloft, Paxil
Block reabsorption of serotonin from synapse
Treat depression, some anxiety disorders (OCD)
Tricyclics are more effective (serotonin & norepinephrine)

27. Lithium
Mood stabilizer
Treats bipolar disorder
Lowers risk of suicide

28. Brain Stimulation Techniques
Electroconvulsive Therapy (ECT)
Repetitive transcranial magnetic stimulation (rTMS)

29. Psychosurgery Removes or destroys brain tissue to change behavior
Lobotomy
ONLY USED IN EXTREME CASES