1. Therapies for Psychological Disorders
Chapter 13
Therapies for Psychological Disorders
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What is Therapy?
Therapy for psychological disorders takes a variety of forms, but all involve some relationship focused on improving a person’s mental, behavioral, or social functioning.
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What is Therapy?
Therapy – General term for any treatment process; in psychology and psychiatry, therapy refers to a variety of psychological and biomedical techniques aimed at dealing with mental disorders or coping with problems of living.
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4. The Components of Therapy
In addition to the relationship between the therapist and the patient/client, 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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5. Contemporary Approaches to Therapy
Psychological therapies – Based on psychological principles (rather than biomedical approach).
The psychological therapies are often collectively called psychotherapy.
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6. Contemporary Approaches to Therapy
Biomedical therapies – Treatments that focus on altering the brain, especially with drugs, psychosurgery, or electroconvulsive therapy.
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7. Types of Mental Health Care Professionals
Counseling psychologist
Clinical psychologist
Psychiatrist
Psychoanalyst
Psychiatric nurse practitioner
Clinical social worker
Pastoral counselor
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8. Counseling psychologist
Professional Title
Specialty:
Problems of normal living
Work setting:
Schools, clinics, other institutions
Credentials:
Master’s in counseling, PhD, EdD, or PsyD
Counseling psychologist
Clinical psychologist
Psychiatrist
Psychoanalyst
Psychiatric nurse practitioner
Clinical social worker
Pastoral counselor
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9. Clinical psychologist
Professional Title
Counseling psychologist
Specialty:
Those with severe disorders
Work setting:
Private practice, mental health agencies, hospitals
Credentials:
PhD or PsyD
Clinical psychologist
Psychiatrist
Psychoanalyst
Psychiatric nurse practitioner
Clinical social worker
Pastoral counselor
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10. Severe mental disorders (often by means of drug therapies)
Professional Title
Counseling psychologist
Specialty:
Severe mental disorders (often by means of 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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11. Professional Title Freudian therapy Private practice MD
Counseling psychologist
Clinical psychologist
Specialty:
Freudian therapy
Work setting:
Private practice
Credentials: MD
Psychiatrist
Psychoanalyst
Psychiatric nurse practitioner
Clinical social worker
Pastoral counselor
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12. 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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13. 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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14. 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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15. How Do Psychologists Treat Mental Disorders?
Psychologists employ two main forms of treatment: the insight therapies and the behavioral therapies.
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16. 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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Insight Therapies
Talk therapies – Psychotherapies that focus on communicating and verbalizing emotions and motives to understand their behavior.
Psychodynamic therapies – Insight therapies based on the assumption that mental disorder is caused by powerful (dynamic) mental forces and conflicts.
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18. Insight Therapies: Psychodynamic Therapies
Psychoanalysis – The form of psychodynamic therapy developed by Sigmund Freud.
Analysis of transference – Analyzing and interpreting the patient’s relationship with the therapist, based on the assumption that this relationship mirrors unresolved conflicts in the patient’s past.
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19. Insight Therapies: Humanistic Therapies
Humanistic therapies – Techniques based on the assumption that people have a tendency for positive growth and self actualization, which may be blocked by an unhealthy environment.
Insight Therapies: Humanistic Therapies
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20. Insight Therapies: Humanistic Therapies
Client-centered therapy – Emphasizes healthy psychological growth through self-actualization.
- developed by Carl Rogers
Reflection of feeling – Paraphrasing client’s words to capture the emotional tone expressed.
(page 534)
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Reflection of Feeling
Example:
The patient says, "I get sick of working so much overtime!"
The therapist might respond, "I hear you feeling angry and resentful at being asked to work so much overtime."
Feeling reflections are perhaps the most difficult active listening responses to make. Not only do you actively listen to what is being said but you also actively listen for what is being felt.
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22. Insight Therapies: Cognitive Therapies
Cognitive therapy – Emphasizes rational thinking as the key to treating mental disorder.
Aaron Beck’s cognitive therapy for depression (page 536)
Proven to be as effective as medication
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Cognitive Therapy
Example:
When walking down the hallway at work, John says hello to the company CEO. The CEO does not respond and keeps walking.
John interprets this as the CEO’s lack of respect for him. He gets demoralized and feels rejected.
However, the CEO’s behavior may have nothing to do with John. He may have been preoccupied about an upcoming meeting, or had a fight with his wife that morning.
If John considered that the CEO’s behavior may not be related to him personally, he is likely to avoid this negative mood.
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24. Insight Therapies: Group Therapies
Group therapy – Psychotherapy with more than one client.
Self-help support groups – Groups that provide social support and an opportunity for sharing ideas about dealing with common problems; typically organized/run by laypersons (not professional therapists).
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25. 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.
Therapist helps them to perceive the issues or patterns that are creating problems.
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27. Systematic desensitization Contingency management
Behavior Therapies
Behavior therapy – Any form of psychotherapy based on the principles of behavioral learning, especially operant conditioning and classical conditioning.
Systematic desensitization
Aversion therapy
Contingency management
Token economies
Participant modeling
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28. Classical Conditioning Therapies
Systematic desensitization – Technique in which anxiety is extinguished by exposing the patient to an anxiety-provoking stimulus.
Exposure therapy – Desensitization therapy in which patient directly confronts the anxiety-provoking stimulus (as opposed to imagining it).
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Big Bang Theory
Sheldon’s Compulsive Closure Therapy
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30. Classical Conditioning Therapies
Aversion therapy – Involves presenting individuals with an attractive stimulus paired with unpleasant stimulation in order to condition a repulsive reaction.
UCS
(foul odor)
UCR
(nausea) CR CS
(cigarette smoke)
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31. Operant Conditioning Therapies
Contingency management – Approach to changing behavior by altering the consequences, especially rewards and punishments, of behavior.
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32. 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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33. Observational-Learning Therapies
Participant modeling – Therapist demonstrates and encourages a client to imitate a desired behavior.
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34. Cognitive-Behavioral Therapy
Cognitive-behavioral therapy (CBT)
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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35. Cognitive-Behavioral Therapy
Rational-emotive behavior therapy (REBT) – Based on the idea that irrational thoughts and behaviors are the cause of mental disorders.
“Don’t ‘should’ on yourself.”
- Albert Ellis
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36. 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:
Therapy is better than no therapy!
It appears advantageous to match specific therapies with specific conditions.
Quality of relationship between therapist and client is important.
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37. Most Effective Therapies?
Behavior Therapy
Specific Phobias
OCD
Alcoholism
Cognitive-Behavioral Therapy (CBT)
Depression
Eating Disorders
Insight Therapy
Couples Counseling
Relationship Problems
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THERAPY
Biomedical
Psychotherapy
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39. How Is the Biomedical Approach Used to Treat Mental Disorders?
Biomedical therapies seek to 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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Psychopharmacology – The prescribed use of drugs to help treat symptoms of mental illness to ensure that individuals are more receptive to talk therapies.
Drug Therapy
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Drug Therapy
Antipsychotic drugs – medicine that diminishes psychotic symptoms, usually by their effect on the dopamine pathways in the brain.
Reduce positive symptoms of psychosis
May have side effects
Tardive dyskinesia – Incurable disorder of motor control, especially involving muscles of the face, resulting from long-term use of antipsychotic drugs.
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Drug Therapy
Antidepressants – medicines that affect depression, usually by their effect on serotonin and/or norepinephrine.
Mood stabilizers:
Lithium carbonate – highly effective in dampening extreme mood swings (effective against bipolar disorder)
In high concentrations lithium can be toxic!
*The use of antidepressants to deal with general feelings of unease is highly controversial.
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Drug Therapy
Antianxiety drugs - drugs that diminish feelings of anxiety.
Include barbiturates and benzodiazepines.
Valium and Xanax
Should not be used to relieve ordinary anxieties of everyday life.
Should not be combined with alcohol!
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Drug Therapy
Stimulants – drugs that increase activity level by encouraging communication among neurons in the brain.
Stimulants actually suppress activity level in persons with ADHD.
There is controversy from concern that the causes and boundaries of ADHD are vague and the potential exists for overdiagnosis.
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Psychosurgery
Psychosurgery – the general term for surgical intervention in the brain to treat psychological disorders.
Prefrontal lobotomy – involves severing the nerve fibers connecting the frontal lobe with deep brain structures, especially the thalamus and hypothalamus.
Split-brain operation Severing the corpus callosum can reduce life-threatening seizures.
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46. Brain-Stimulation Therapies
Electroconvulsive therapy (ECT)
- A treatment used primarily for depression and involving the application of an electric current to the head, producing a generalized seizure (called shock treatment).
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47. Brain-Stimulation Therapies
Transcranial magnetic stimulation (TMS) A treatment that involves magnetic stimulation of specific regions of the brain (an alternative to ECT).
- Can be used for the treatment of depression, schizophrenia, and bipolar disorder.
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Mental Hospitals
Prior to the 1950s:
Understaffed
Poorly funded
Prisonlike
FEW PATIENTS EVER LEFT!
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49. Deinstitutionalization
The removal of patients from mental hospitals.
Advances in psychotic drugs and psychotherapy.
Provide the least restrictive care.
Receive outpatient care.
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50. Hospitalization and the Alternatives
Community mental health movement – Effort to deinstitutionalize mental patients and to provide therapy from outpatient clinics.
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