Advanced Placement Psychology

Psychotherapy – Treatment of psychological disorders through psychological methods, such as talking about problems and exploring new ways of thinking & acting Advanced Placement Psychology Chapter 16: Treatment of Psychological Disorders

Basics of Therapy • Client: The person seeking therapy • Inpatient – Treated in a hospital or institution • Outpatient – Receive psychotherapy while in the community • Therapist: The person giving therapy • Psychiatrist – M.D. specialized in mental disorders • Psychologist – Ph.D in clinical or counseling (can’t prescribe drugs) • Other Professionals • Social Workers • Family Therapists • Counselors • Theory: Underlying guidelines & beliefs for treatment of disorders • Procedure: Method of treatment that is unique to the theory used • Goal: Final outcome of therapy

Psychodynamic PsychotherapyAn Overview • Theory • Personality & behavior reflect the efforts of the ego to referee unconscious conflicts among various components of the personality • Procedure • Psychoanalysis – Therapy aimed at understanding the unconscious conflicts & how they affect the client (Freud)

Classical PsychoanalysisSitting on the Freudian couch • Hypnosis – Tried initially to cure somatoform disorders • Free Association • Saying whatever comes to mind • Doesn’t allow for as much self-censorship • Freudian Slip – A slip of the tongue that reveals what you’re truly thinking • Dream Analysis • Manifest Content – What the dream is on the surface • i.e. You dream that you are a Red Wings hockey player and they drafted you when you were just 14 • Latent Content – What the dream means • i.e. You have aspirations for fame & you really like to play hockey • Resistance – Resisting the therapist’s efforts • Transference – Transfer of feelings & thoughts onto the therapist • i.e. Being scared of the therapist because of abuse from parents

Freudian slip example(this is actually just a typo, but if it was spoken, it would be a Freudian slip)

Contemporary PsychoanalysisObject Relations Therapy • Theory • Personality & conflicts among its components are derived from the need for supportive human relationships • Mother-child relationship becomes the prototype for all future relations • Procedure • Therapy focuses on developing nurturing client-therapist relationships • “Second chance” for forming a good relationship

Phenomenological PsychotherapyAn Overview • Theory • People’s perceptions of the world are subjective • People are capable of consciously controlling their own actions & taking responsibility for their own responsibilities • Behavior is motivated by an innate drive towards growth, not sexual or aggressive instincts • Procedure • Therapy revolves around providing a sounding board for people to voice opinions & thoughts

Assumptions of Phenomenological Psychotherapy • Treatment is an encounter of equals, not a cure provided by an expert • Allows clients to be more comfortable & act more like themselves • Clients will improve on their own under the right conditions • Ideal conditions promote awareness, acceptance, & expression of client feelings and perceptions • Ideal treatment relies on a fully supportive & accepting relationship between client & therapist • Establishes a distinction between the client & the problematic behavior • Clients are responsible for choosing how they will think & behave • Responsibility increases the client’s confidence & comfort

Client-Centered Psychotherapy • Unconditional Positive Regard • Listening without interrupting & accepting without evaluation • Therapist doesn’t need to approve of everything, but they must accept it • Empathy • External Frame of Reference – looking at the client from the outside • Internal Frame of Reference – characterized by empathy (emotional understanding) • Active Listening • Reflection – Paraphrasing/summarizing what the client just said • Congruence [Genuineness] • Consistency between the therapist’s feelings & actions

Gestalt Therapy • Theory • People create their own versions of reality • People’s natural psychological growth continues as long as they perceive, remain aware of, & act on their true feelings • Growth stops & disorders appear when people aren’t aware of all aspects of themselves • Procedure • Makes clients aware of feelings & impulses that may have been discarded or repressed • “Calling them out”

Some clarification • Behavior Therapy • Classical Conditioning principles • Behavior Modification • Operant Conditioning principles • Cognitive-Behavior Therapy • Thinking & learned ways of thinking

Behavior Psychotherapy • Theory • Therapy doesn’t revolve around treating disorders, but learning how to change specific thoughts & behaviors. • Procedure • Listing of the behaviors & thoughts to be changed • Establishes specific goals • Therapist acts as a teacher by providing learning-based treatments • “Homework” to help clients make specific plans to deal with problems • Developing a good therapist-client relationship • Continuous monitoring & evaluation of the treatment

Techniques for Modifying Behavior Systematic Desensitization Modeling • Desensitization Hierarchy • Series of increasingly fear-provoking situations • Imagination vs. real life • Once clients are able to calmly imagine the fear, they deal with it better later in real life • Desirable behaviors can be taught through watching • Client can learn to be more appropriately self-expressive & more comfortable in social situations through assertiveness & social skills training

Techniques for Modifying Behavior Positive Reinforcement Extinction • Using positive reinforcement through contingencies designed to alter problematic behavior & teach new skills • Token Economy • System of secondary reinforcers • Using operant conditioning to eliminate undesirable behaviors by removing the reinforcers that normally follow a particular response • Flooding – person is saturated with fear-provoking stimulus until the anxiety is extinguished • Exposure Techniques – systematic desensitization

Techniques for Modifying Behavior Aversive Conditioning Punishment • Associating physical or psychological discomfort with unwanted behaviors • Covert Sensitization • Opposite of systematic desensitization • Presents the unpleasant stimulus after the undesirable response occurs • Overlaps a lot with aversive conditioning • Typically used as a last resort when all other treatments fail or when the client’s life is in danger

Cognitive-Behavior TherapyRational-Emotive Behavior Therapy • Theory • Psychological problems are caused by how people think about events • Identifying self-defeating thoughts • Replaces these thoughts with more realistic & beneficial ones • Practices • Cognitive Restructuring: Replacing upsetting thoughts with alternative thinking patterns • Stress Inoculation Training: Imagining being in a stressful situation & practice new cognitive skills to stay calm

Cognitive-Behavior TherapyBeck’s Cognitive Therapy • Theory: • Negative cognitive patterns are maintained by: • Errors in logic & erroneous beliefs (“I can’t do anything right”) • Thoughts that minimize the value of one’s accomplishments (“Anyone can do that”) • Practice • Like a scientific investigation • Critically testing the hypothesis • “I can never do anything right.” • “Well, here are the cases where I have done things right.”

Group, Family, & Couples Therapy • Group, family, & couples therapy is concerned about the subject & setting of the therapy & use many different theories. • Group Therapy • Therapists can observe clients interact with other people • Clients feel less alone (raises expectations of recovery) • Increase self-confidence & self-acceptance • Clients learn from each other (modeling) • Positive group relationships increases willingness to share

Family & Couples Therapy • Family Therapy • A problem in one individual often reflects problems in the entire family’s functioning • Treatment cannot focus on an individual in isolation • Wife gets over depression & then husband commits suicide because he had gotten so attached to the idea of a “sick wife” • Couples Therapy • Similar to family therapy, but focuses on just two individuals • Behavioral Premarital Intervention – program helps engaged couples prevent marital problems

Addressing the “Ultimate Question”Which treatment method will work for me? • Details not yet fully mapped out • Cognitive-Behavioral Therapies better for: • Phobias & other anxiety disorders • Eating disorders • Child clients • Client-Therapist relationships are IMPORTANT

Cultural Factors in Psychotherapy • Kind of a long section, so here’s the summary… • If the culture of the client is different from the culture of the therapist, then there will be PROBLEMS

Rules & Rights in the Therapeutic Relationship • Ethical Principles of Psychologists & Code of Conduct • No sexual relationship between therapist & client • Confidentiality • Situations Exempt from Confidentiality • Client’s condition is used for a civil or criminal defense • Suicidal tendencies that require hospitalization • Therapist defending against a malpractice suit • Reveals information about the abuse of a child or incapacitated adult • The therapist believes that the client may commit a violent act against another person

Electroconvulsive Therapy (ECT)Psychotherapy in the 1930’s • Hungarian physician noticed that schizophrenia & epilepsy rarely co-occurred, & he used drugs to induce seizures in schizophrenics, depression, & mania • Later, seizures were induced by electric shock • Today, it’s used for depression in those that don’t respond to drugs • Side Effects: • Varying degrees of memory loss • Speech disorders • Death due to cardiac arrest (sometimes)

Electroconvulsive Therapy (ECT)The modern remix of a classic treatment • Modern techniques • Focuses shock to right side of the brain • Increased oxygen • Extreme muscle relaxers • Why does it work? • No one knows • “Reset” button • Electric shock improves neurotransmitter function • NeuroT’s that help recover from convulsions reduce activity in “depression” areas

Psychosurgery“Cut it out!” (literally) • Destruction of brain tissue to treat mental disorders • Prefrontal Lobotomy • Destruction of the frontal lobe to curb emotional reactions in the disturbed • Standard treatment for schizophrenia, depression, anxiety, aggressiveness, & OCD • Side effects include: Epilepsy, amnesia, flat affect, & death • Considered a last resort

Psychoactive Drugs • Neuroleptics (antipsychotics) • Designed to reduce the symptoms of schizophrenia • Reduces hallucinations, delusions, paranoid suspiciousness, disordered thinking, & incoherence • Produce improvement in 60-70% of patients • Negative side effects • Dry mouth, blurred vision, dizziness, skin pigmentation • Muscle rigidity, restlessness, tremors, slowed movement • Tardive Dyskinesia – Extreme muscle spasms

Psychoactive Drugs • Antidepressants • Designed to reduce the symptoms of depression • Monoamine Oxidase Inhibitors (MAO-I) • Treats depression & some cases of panic disorder • Can produce hypertension if mixed with foods with tyramine (aged cheese, red wine, chicken livers, etc.) • Tricyclic • Prescribed more frequently than MAO-I because they work better • Fewer side effects (can still cause sleepiness, dry mouth, dizziness, blurred vision, constipation, & urinary retention)

Psychoactive Drugs • Lithium • Treats mania & bipolar (effective for 80% of patients) • Dosage must be exact & carefully controlled • Too much = • Nausea, vomiting, tremors, fatigue, slurred speech, coma and death • Anticonvulsants • Alternative to treating mania • Fewer side effects, less danger of over dosage, & easier to regulate

Psychoactive Drugs • Anxiolytics [Tranquilizers] • Acts in a manner similar to barbiturate • Creates an immediate calming effect • Generalized anxiety disorder & posttraumatic stress disorder • Side Effects • Sedation, lightheadedness, & impaired psychomotor & mental functioning • Continued use can cause tolerance & physical dependence • Combined with alcohol may have fatal consequences

Human Diversity&Drug Treatment • Ethnicity • Drug strengths vary depending on client ethnicity • Caucasians need significantly more psychoactive drugs than Asians to achieve the same effects • African Americans show faster responses to tricyclic antidepressants than European Americans • Gender • Research so far based heavily on males • Women maintain higher levels of therapeutic psychoactive drugs in their blood • Women are more vulnerable to tardive dyskinesia

Evaluating Psychoactive Drug Treatments • Drugs may cover up the problem • Often times drugs simply mask the symptoms without treating the root causes • Leaves the potential for the root causes to continue to get worse • Drugs carry the potential for abuse • Abuse of psychoactive drugs can create psychological dependence • Drugs have undesirable side effects • No drug is prefect & without side effects • Often times, treatment will involve a lot of weighing the pros of the drug with the side effects

Drugs or Psychotherapy? • Sometimes psychotherapy is better • Cognitive-behavioral & interpersonal therapy were as effective as antidepressants • Sometimes drugs are better • Severe cases of depression, panic disorder, generalized anxiety disorder, & obsessive-compulsive disorder • In most cases, it seems that a combination of drugs & psychotherapy is the best method for treatment

Advanced Placement Psychology