Chapter 13: Treating Psychological Disorders Amber Gilewski Tompkins Cortland Community College

Psychological Treatment Who seeks it? 15% of U.S. population in a given year Most common presenting problems Anxiety and Depression Women more than men Medical insurance Education level Typical sequence of steps AssessmentDiagnosisTreatment

Figure 15.2 Therapy utilization rates

Who Provides Treatment? Clinical psychologists: doctorate degree Counseling psychologists: doctorate degree Psychiatrists: medical doctors Clinical social workers: master’s degree Psychiatric nurses: bachelor’s/master’s degree Counselors: master’s degree

Psychological Approach: Psychoanalysis Sigmund Freud and followers Goal: discover unresolved unconscious conflicts Goal: discover unresolved unconscious conflicts Free association: Free association: spontaneously expressing thoughts Dream analysis: interpreting our unconscious thoughts Interpretation: understanding the inner meaning Resistance – unconscious ways of hindering therapy Resistance – unconscious ways of hindering therapy Transference – unconsciously relating to therapist in a similar way to key relationships in one’s life Transference – unconsciously relating to therapist in a similar way to key relationships in one’s life

Psychological Approach: Person-Centered Therapy Carl Rogers Carl Rogers – humanistic perspective Goal: restructure self-concept to better correspond to reality Goal: restructure self-concept to better correspond to reality Therapeutic Climate Therapeutic ClimateGenuineness Unconditional positive regard Empathy

Psychological Approach: Behavior Therapies B.F. Skinner and colleagues Goal: unlearning maladaptive behavior and learning adaptive ones Goal: unlearning maladaptive behavior and learning adaptive ones Systematic Desensitization – Joseph Wolpe – Systematic Desensitization – Joseph Wolpe – reducing phobic anxiety behavior Classical conditioning Anxiety hierarchy Aversion therapy Aversion therapy Alcoholism, sexual deviance, smoking, etc. Social skills training Social skills trainingModeling Behavioral rehearsal

Psychological Approach: Cognitive Therapy or Cognitive-Behavioral Therapy Aaron Beck Cognitive therapy Cognitive therapy Albert Ellis Rational emotive behavior therapy Rational emotive behavior therapy Goal: to change the way clients think Identify incorrect or distorted beliefs Identify incorrect or distorted beliefs Detect and recognize negative thoughts Detect and recognize negative thoughts Reality testing Reality testing Kinship with behavior therapy Kinship with behavior therapy

Social Approach: Group Therapies Advantages Economical Economical More experiences for client to draw upon More experiences for client to draw upon Social support of the group Social support of the groupDisadvantages Unable to express feelings to group Unable to express feelings to group Couple therapy Family therapy

Biomedical Therapies Psychopharmacotherapy Antianxiety - Valium, Xanax, Buspar Antianxiety - Valium, Xanax, Buspar Antipsychotic - Thorazine, Mellaril, Haldol Antipsychotic - Thorazine, Mellaril, Haldol Tardive dyskinesia Clozapine – Clozapine – newer medication Antidepressants: Antidepressants: Tricyclics – Elavil, Tofranil Mao inhibitors (MAOIs) - Nardil Selective serotonin reuptake inhibitors (SSRIs) – Prozac, Paxil, Zoloft Mood stabilizers Mood stabilizersLithium Valproic acid

Biomedical Therapies Electroconvulsive therapy (ECT): electric shock used to induce seizures/convulsions - unsure why it works - last resort treatment - controversial Psychosurgery (i.e. lobotomies) - rarely used - refined versions used today Transcranial magnetic stimulation (TMS) - newer treatment; stimulates brain electrically