1. Therapies for Psychological Disorders
Chapter 13
Therapies for Psychological Disorders
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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
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3. The Components of Therapy
In addition to the relationship between the therapist and the patient, the therapeutic process typically involves:
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
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4. Freudian psychoanalysis Neo-Freudian therapies
Insight Therapies
Insight therapies – Psychotherapies in which the therapist helps patients understand (gain insight into) their problems
Freudian psychoanalysis
Neo-Freudian therapies
Humanistic therapies
Cognitive therapies
Group therapies
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5. Insight Therapies: Psychodynamic Therapies
Psychoanalysis – The form of psychodynamic therapy developed by Sigmund Freud
Analysis of transference – Analyzing the patient’s relationship with the therapist, assuming this relationship mirrors unresolved conflicts in the patient’s past
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Resistance Interpretation Transference
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7. Insight Therapies: Humanistic therapies
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 environment
Reflection of feeling – Paraphrasing client’s words using active listening to capture the emotional tone expressed
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8. Systematic desensitization Contingency management
Behavior Therapies
Behavior therapy – Therapy based on the principles of behavioral learning, especially operant conditioning and classical conditioning
Systematic desensitization
Exposure
Therapy
Aversion therapy
Contingency management
Participant modeling
Token economies
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9. Classical Conditioning Therapies
Exposure therapy – patient directly confronts the anxiety-provoking stimulus (as opposed to imagining it) – aka flooding
Systematic desensitization – anxiety is extinguished by gradually exposing the patient to increasing levels of an anxiety-provoking stimulus (aka graduated exposure therapy)
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Counterconditioning VR exposure therapy
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11. Classical Conditioning Therapies
Aversion therapy – Pairing a pleasant and unpleasant stimulus to condition a repulsive reaction
UCS
(foul odor)
UCR
(nausea) CR CS
(cigarette smoke)
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12. 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
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13. 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
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14. Participant Modeling: An Observational-Learning Therapy
Participant modeling – Therapist demonstrates and encourages a client to observe and imitate a desired behavior
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15. Insight Therapies: Cognitive therapies
Cognitive therapy – (Aaron Beck) Emphasizes rational thinking as the key to treating mental disorder
CT for depression/anxiety involves
Challenging faulty thinking
Testing and modifying beliefs
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16. Cognitive-Behavioral Therapy: A Synthesis
Rational-emotive behavior therapy – a type of CBT developed by Albert 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
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17. Insight Therapies: Group therapies
For many issues, couples counseling or family therapy can often be more effective than individual therapy with one individual at a time
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18. Cognitive-Behavioral Therapy: A Synthesis
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
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19. 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
FAMILY THERAPY
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20. Differences between Rogers & Ellis
Carl Rogers
Albert Ellis
Client (person) centered therapy
REBT
Supportive
Confrontational
Client has answers
Therapist has answers
Mostly cognitive
Cognitive-behavioral
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21. 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
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22. Is psychotherapy effective?
Meta-analysis: The bottom line results after looking at many different research studies Evidence-based practice: Making clinical decisions by factoring in research, clinical expertise, and patient characteristics/preferences
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Therapeutic alliance: Trust and bond between therapist and client. Resilience: Personal strength that helps most people cope with and recover from adversity
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Quiz
What are some differences between psychologists and psychiatrists?
What is the difference between group therapy & self-help support groups?
What is the main difference between insight and behavioral therapies?
Give an example of a behavioral therapy
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25. How might each approach view treatment?
Cognitive Psychodynamic Humanistic Behavioral Sociocultural Biological Evolutionary
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26. How Is the Biomedical Approach Used to Treat Mental Disorders?
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
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Drug Therapy
Psychopharmacology – Using prescription drugs to treat mental disorders (often to make people more receptive to talk therapies)
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Drug Therapy
Antipsychotic drugs
Include Thorazine, Haldol, Risperdal, Clozapine
Usually affect dopamine pathways
May have side effects
Tardive dyskinesia – Incurable disorder of motor control resulting from long-term use of antipsychotic drugs
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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
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Drug Therapy
Antidepressants (in order of usage)
SSRIs like Prozac, Paxil, Celexa, Lexapro (inhibit serotonin reuptake)
Include tricyclics like Elavil (inhibit reuptake)
monoamine oxidase (MOA) inhibitors like Nardil (inhibit reuptake of norepinephrine)
Mood stabilizers (for bipolar disorder):
Lithium (carbonate)
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Drug Therapy
Stimulants (Ritalin and Adderall) suppress activity level in persons with attention-deficit/hyperactivity disorder (ADHD)
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32. Brain-Stimulation Therapies
Electroconvulsive therapy is used for the treatment of severe depression
Peter’s ECT session
Transcranial magnetic stimulation, a possible alternative to ECT, can also be used for the treatment of addiction, depression, schizophrenia, and bipolar disorder
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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
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34. 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
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35. Let’s practice identifying therapies
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36. Let’s look at the diagnosis chart
Identify the likely disorder, and speculate about what the best course of therapy would be.
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37. Types of Mental Health Care Professionals
Counseling psychologist
Clinical psychologist
Psychiatrist
Psychoanalyst
Psychiatric nurse practitioner
Clinical social worker
Pastoral counselor
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38. Counseling psychologist
Professional Title
Specialty:
Adjustment disorders
Work setting:
Schools, clinics, other institutions
Credentials:
At least a Master’s in counseling
Counseling psychologist
Clinical psychologist
Psychiatrist
Psychoanalyst
Psychiatric nurse practitioner
Clinical social worker
Pastoral counselor
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39. Clinical psychologist
Professional Title
Counseling psychologist
Specialty:
Those with severe disorders
Work setting:
Private practice, mental health agencies, hospitals
Credentials:
PsyD
Clinical psychologist
Psychiatrist
Psychoanalyst
Psychiatric nurse practitioner
Clinical social worker
Pastoral counselor
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40. Severe mental disorders (often uses drug therapies)
Professional Title
Counseling psychologist
Specialty:
Severe mental disorders (often uses drug therapies)
Work setting:
Private practice, clinics, hospitals
Credentials: MD
Clinical psychologist
Psychiatrist
Psychoanalyst
Psychiatric nurse practitioner
Clinical social worker
Pastoral counselor
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41. Professional Title Freudian therapy Private practice PhD
Counseling psychologist
Clinical psychologist
Specialty:
Freudian therapy
Work setting:
Private practice
Credentials:
PhD
Psychiatrist
Psychoanalyst
Psychiatric nurse practitioner
Clinical social worker
Pastoral counselor
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42. Psychiatric nurse practitioner
Professional Title
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
Counseling psychologist
Clinical psychologist
Psychiatrist
Psychoanalyst
Psychiatric nurse practitioner
Clinical social worker
Pastoral counselor
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43. Clinical social worker
Professional Title
Counseling psychologist
Specialty:
Social worker with specialty in dealing with mental disorders
Work setting:
Often employed by government
Credentials:
MSW
Clinical psychologist
Psychiatrist
Psychoanalyst
Psychiatric nurse practitioner
Clinical social worker
Pastoral counselor
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44. Combines spiritual guidance with practical counseling
Professional Title
Counseling psychologist
Specialty:
Combines spiritual guidance with practical counseling
Work setting:
Religious order or ministry
Credentials:
Varies
Clinical psychologist
Psychiatrist
Psychoanalyst
Psychiatric nurse practitioner
Clinical social worker
Pastoral counselor
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End of Chapter 13
The worst therapy ever
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