1. Copyright © Allyn & Bacon 2007 Chapter 13 Therapies for Psychological Disorders

2. Copyright © Allyn & Bacon 2007 What is Therapy? Therapy – General term for any treatment process; a variety of psychological and biomedical techniques aimed at dealing with mental disorders or coping with problems of living

3. Copyright © Allyn & Bacon 2007 The Components of Therapy In addition to the relationship between the therapist and the patient/client, the therapeutic process typically involves the following processes: Identifying the problem Identifying the cause of the problem or the conditions that maintain the problem Deciding on and carrying out some form of treatment

4. Copyright © Allyn & Bacon 2007 Types of Mental Health Care Professionals Counseling psychologist Clinical psychologist Psychoanalyst Clinical social worker Psychiatrist Psychiatric nurse practitioner Pastoral counselor

5. Copyright © Allyn & Bacon 2007 Specialty: Adjustment disorders Work setting: Schools, clinics, other institutions Credentials: At least a Master’s in counseling Professional Title Counseling psychologist Clinical psychologist Psychoanalyst Clinical social worker Psychiatrist Psychiatric nurse practitioner Pastoral counselor

6. Copyright © Allyn & Bacon 2007 Specialty: Those with severe disorders Work setting: Private practice, mental health agencies, hospitals Credentials:PsyD Professional Title Counseling psychologist Clinical psychologist Psychoanalyst Clinical social worker Psychiatrist Psychiatric nurse practitioner Pastoral counselor

7. Copyright © Allyn & Bacon 2007 Specialty: Severe mental disorders (often uses drug therapies) Work setting: Private practice, clinics, hospitals Credentials:MD Professional Title Counseling psychologist Clinical psychologist Psychoanalyst Clinical social worker Psychiatrist Psychiatric nurse practitioner Pastoral counselor

8. Copyright © Allyn & Bacon 2007 Specialty: Freudian therapy Work setting: Private practice Credentials:PhD Professional Title Counseling psychologist Clinical psychologist Psychoanalyst Clinical social worker Psychiatrist Psychiatric nurse practitioner Pastoral counselor

9. Copyright © Allyn & Bacon 2007 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 Psychoanalyst Clinical social worker Psychiatrist Psychiatric nurse practitioner Pastoral counselor

10. Copyright © Allyn & Bacon 2007 Specialty: Social worker with specialty in dealing with mental disorders Work setting: Often employed by government Credentials:MSW Professional Title Counseling psychologist Clinical psychologist Psychoanalyst Clinical social worker Psychiatrist Psychiatric nurse practitioner Pastoral counselor

11. Copyright © Allyn & Bacon 2007 Specialty: Combines spiritual guidance with practical counseling Work setting: Religious order or ministry Credentials:Varies Professional Title Counseling psychologist Clinical psychologist Psychoanalyst Clinical social worker Psychiatrist Psychiatric nurse practitioner Pastoral counselor

12. Copyright © Allyn & Bacon 2007 insight therapies and behavioral therapies insight therapies and behavioral therapies Psychologists employ two main forms of treatment: insight therapies and behavioral therapies insight therapies and behavioral therapies How Do Psychologists Treat Mental Disorders?

13. Copyright © Allyn & Bacon 2007 Insight Therapies Insight therapies – Psychotherapies in which the therapist helps patients understand (gain insight into) their problems Freudian psychoanalysis Cognitive therapies Humanistic therapies Neo-Freudian therapies Group therapies

14. Copyright © Allyn & Bacon 2007 Insight Therapies Talk therapies – focus on verbalizing emotions and motives to understand patient behavior

15. Copyright © Allyn & Bacon 2007 Insight Therapies: Psychodynamic Therapies Psychoanalysis Psychoanalysis Psychoanalysis – The form of psychodynamic therapy developed by Sigmund Freud Analysis of transference – Analyzing the patient’s relationship with the therapist, based on the assumption that this relationship mirrors unresolved conflicts in the patient’s past

16. Copyright © Allyn & Bacon 2007 Insight Therapies: Humanistic therapies Carl Rogers Carl Rogers Humanistic therapies (Carl Rogers) – (aka client-centered therapy) based on the assumption that people can grow and self actualize; people may be blocked by an unhealthy environmentCarl Rogers Reflection of feeling – Paraphrasing client’s words to capture the emotional tone expressed

17. Copyright © Allyn & Bacon 2007 Insight Therapies: Cognitive therapies Cognitive therapyAaron Beck Cognitive therapy Cognitive therapyAaron Beck Cognitive therapy – (Aaron Beck) Emphasizes rational thinking as the key to treating mental disorderAaron Beck CT for depression/anxiety involves Challenging faulty thinking Testing and modifying beliefs

18. Copyright © Allyn & Bacon 2007 Insight Therapies: Group therapies Group therapy – Psychotherapy with more than one client Very effective for depression and PTSD Self-help support groups – Groups that provide social support and a forum to share common problems; typically NOT run by professional therapists “Anonymous” groups: AA

19. Copyright © Allyn & Bacon 2007 Insight Therapies: Group therapies couples counseling couples counseling For many issues, couples counseling or family therapy can often be more effective than individual therapy with one individual at a timecouples counseling

20. Copyright © Allyn & Bacon 2007 Systematic desensitization Token economies Contingency management Aversion therapy Participant modeling Behavior Therapies Behavior therapy – Therapy based on the principles of behavioral learning, especially operant conditioning and classical conditioning ExposureTherapy

21. Copyright © Allyn & Bacon 2007 Classical Conditioning Therapies Exposure therapy Exposure therapy Exposure therapy Exposure therapy – patient directly confronts the anxiety- provoking stimulus (as opposed to imagining it) – aka flooding Systematic desensitization Systematic desensitization Systematic desensitization Systematic desensitization – anxiety is extinguished by gradually exposing the patient to increasing levels of an anxiety-provoking stimulus (aka graduated exposure therapy)

22. Copyright © Allyn & Bacon 2007 UCS (foul odor) UCR (nausea) CR CS (cigarette smoke) Classical Conditioning Therapies Aversion therapy Aversion therapy Aversion therapy Aversion therapy – Pairing a pleasant and unpleasant stimulus to condition a repulsive reaction

23. Copyright © Allyn & Bacon 2007 Operant Conditioning Therapies Contingency management – changing behavior by altering the consequences, (rewards and punishments) of behavior -e.g. shaping, timeouts, contracts, voucher systems (WDFY), token economies

24. Copyright © Allyn & Bacon 2007 Operant Conditioning Therapies Token economies – Applied to groups (e.g. classrooms, mental hospital wards) involving distribution of “tokens” contingent on desired behaviors; tokens can later be exchanged for privileges, food, or other reinforcers

25. Copyright © Allyn & Bacon 2007 Participant Modeling: An Observational-Learning Therapy Participant modeling – Therapist demonstrates and encourages a client to observe and imitate a desired behavior

26. Copyright © Allyn & Bacon 2007 Cognitive-Behavioral Therapy: A Synthesis Cognitive-behavioral therapy Cognitive-behavioral therapy Combines cognitive emphasis on thoughts with behavioral strategies that alter reinforcement contingencies Assumes irrational self-statements cause maladaptive behavior Seeks to help the client develop a sense of self-efficacy

27. Copyright © Allyn & Bacon 2007 Cognitive-Behavioral Therapy: A Synthesis Rational-emotive behavior therapy Albert Ellis Rational-emotive behavior therapy Rational-emotive behavior therapy Albert Ellis Rational-emotive behavior therapy – a type of CBT developed by Albert EllisAlbert Ellis a person is not affected emotionally by outside things but rather by ‘perceptions and attitudes about outside things.‘ Hamlet: “Nothing is good or bad, but…” Ellis’s style was confrontational, the opposite of Carl Rogers’s

28. Differences between Rogers & Ellis Carl RogersAlbert Ellis Client (person) centered therapyREBT SupportiveConfrontational Client has answersTherapist has answers Mostly cognitiveCognitive-behavioral Copyright © Allyn & Bacon 2007

29. Evaluating the Psychological Therapies Eysenck proposed that people with non- psychotic problems recover just as well with or without therapy Reviews of evidence have shown: That therapy is better than no therapy It is best to match specific therapies with specific conditions—i.e., not all therapies work for all conditions

30. Quiz 1.What are some differences between psychologists and psychiatrists? 2.What is the difference between group therapy & self-help support groups? 3.What is the main difference between insight and behavioral therapies? 4.Give an example of a behavioral therapy Copyright © Allyn & Bacon 2007

31. Short Film Note what therapeutic techniques the therapist uses over the course of the film. http://www.youtube.com/watch?v=Osnz GqIWXDE http://www.youtube.com/watch?v=Osnz GqIWXDE Copyright © Allyn & Bacon 2007

32. How Is the Biomedical Approach Used to Treat Mental Disorders? Biomedical therapies Biomedical therapies Biomedical therapies Biomedical therapies treat mental disorders by changing the brain’s chemistry with drugs, its circuitry with surgery, or its patterns of activity with pulses of electricity or powerful magnetic fields

33. Copyright © Allyn & Bacon 2007 Drug Therapy Psychopharmacology – Using prescription drugs to treat mental disorders (often to make people more receptive to talk therapies)

34. Copyright © Allyn & Bacon 2007 Drug Therapy Antipsychotic drugs Include Thorazine and Haldol Usually affect dopamine pathways May have side effects Tardive dyskinesia disorder of motor control Tardive dyskinesia Tardive dyskinesia disorder of motor control Tardive dyskinesia – Incurable disorder of motor control resulting from long-term use of antipsychotic drugsdisorder of motor control

35. Copyright © Allyn & Bacon 2007 Drug Therapy Antidepressants (in order of usage) SSRIs like Prozac (inhibit serotonin reuptake) Include tricyclics like Elavil (inhibit reuptake) monoamine oxidase (MOA) inhibitors (inhibit reuptake of norepinephrine) Mood stabilizers (for bipolar disorder): Lithium (carbonate)

36. Copyright © Allyn & Bacon 2007 Drug Therapy Antianxiety drugs Include [rarely] barbiturates (CNS depressants) and benzodiazepines (Valium and Xanax) Should not be: taken for more than a few days at a time combined with alcohol

37. Copyright © Allyn & Bacon 2007 Drug Therapy Stimulants (Ritalin and Adderall) suppress activity level in persons with attention- deficit/hyperactivity disorder (ADHD)

38. Copyright © Allyn & Bacon 2007 Psychosurgery Psychosurgery – The general term for surgical intervention in the brain to treat psychological disorders The infamous prefrontal lobotomy is no longer performed Severing the corpus callosum, however, can reduce life-threatening seizures

39. Copyright © Allyn & Bacon 2007 Brain-Stimulation Therapies Electroconvulsive therapy Electroconvulsive therapy Electroconvulsive therapy Electroconvulsive therapy is used for the treatment of severe depression ECT session ECT session Peter’s ECT sessionECT session Transcranial magnetic stimulation Transcranial magnetic stimulationTranscranial magnetic stimulation Transcranial magnetic stimulation, a possible alternative to ECT, can also be used for the treatment of addiction, depression, schizophrenia, and bipolar disorder

40. Copyright © Allyn & Bacon 2007 Hospitalization and the Alternatives Deinstitutionalization – Policy of removing patients, whenever possible, from mental hospitals Community mental health movement – Effort to deinstitutionalize mental patients and to provide therapy from outpatient clinics

41. Let’s practice identifying therapies http://bcs.worthpublishers.com/gray/conten t/psychsim5/Mystery%20Therapist/Myste ryTherapist.htm Copyright © Allyn & Bacon 2007

42. Let’s look at the diagnosis chart Identify the likely disorder, and speculate about what the best course of therapy would be. Copyright © Allyn & Bacon 2007

43. End of Chapter 13 The worst therapy ever https://www.youtube.com/watch?v =RzERjKiyoHc