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Treatment of Psychological Disorders

Chapter 16

Basic features

Psychotherapy talking about problems and exploring new ways of thinking and acting

Features

Professional relationship between client and therapist Inpatients treatment in hospital or residential institution Outpatients receive tx and drugs while living in community Psychiatrists Doctors who have extra training in psychology Psychologists Holders of doctorate degree who concentrate on psychotherapy

Psychodynamic psychotherapy

Classical psychoanalysis
The talking cure using free association to cure hysteria, which is also conversion disorder Focus of treatment the unconscious becoming conscious sexual and aggressive impulses gone underground cause symptoms Dream analysis Manifest content obvious meaning Latent content hidden meaning, exploring the unconscious Transference unconscious childhood feelings and wishes towards parents transferred towards therapist. Analysis of this transference is an important psychoanalytic method

Psychodynamic psychotherapy

Contemporary psychodynamic therapy


Short-term psychodynamic therapy Object relations most of the problems come from relationship with others, especially parents

Humanistic psychotherapy

Basic assumptions
Treatment is an encounter between equals help clients restart growth Clients will improve on their own, given the right conditions Ideal condition of therapy client feels fully accepted and supported, no matter how horrible their behaviour is Client fully responsible for their choices

Humanistic psychotherapy

Client-centered therapy
Unconditional positive regard accept the client, so that the client can overcome conditions of worth Conditions of worth I am accepted because I am worthy (intelligent, successful, attractive, etc.) and not because I am a human being and has INHERENT WORTH. Empathy feelings WITH the client Reflection paraphrased summary of clients feelings, so that the client would feel heard Congruence therapists need to be honest with their feelings. I am confused by what youre saying. No pretensions

Humanistic psychotherapy

Gestalt therapy
Goal so that clients could become more selfaware, self accepting, and unified. Use dramatic techniques client talk to an imaginary person, therapist points out difference between what they say and how they act (eg. Smiling while talking about a sad event).

Behavior therapy

Psychological problems are LEARNED behaviors and therefore can be UNLEARNED Basic assessment:
Identify signals / triggers What are the rewards for continuing behavior

Behavior therapy

Principles
Develop rapport with client client should have confidence that change is possible Careful listing of bx and thoughts to be changed Therapist is a teacher, giving homework assignments, active planning on how to overcome the problem, etc Continuous monitoring and adjustment of plan

Behavior therapy

Behavior modification
Systematic desensitization
Progressive relaxation training Imagine thing that is scary from least scary to most scary (desensitization hierarchy) Virtual reality graded exposure replaces in vivo therapy

Behavior therapy

Exposure techniques
Flooding keeps people in feared but harmless situations, at the same time preventing them from escaping (their rewarding behavior).

Modelling
Follow what the therapist does

Social skills training Assertiveness training

Behavior therapy

Positive reinforcement
Token economy system get coincs or tokens that could be exchanged for video game time, snacks, etc.

Extinction, punishment, aversion conditioning


Aversion therapy when you think of what you should not think of, you get electric shocks, nauseated, etc.

Cognitive behavioral therapy (CBT)

Rational Emotive Behavioral Therapy Ellis


All problems are caused by how people think about events, not the events themselves shoulds and musts. Replace upsetting thoughts with new thoughts which are more adaptive cognitive restructuring Meichenbaums stress inoculation training imagine being in a stressful situation, then use newly learned cognitive skills to remain calm

Ellis Model of Maladaptive Behavior

Zick Rubin, Lelitia Anne Peplau, and Peter Salovey, Psychology. Copyright 1993 by Houghton Mifflin Company. Reprinted by permission.

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Cognitive behavioral therapy (CBT)

Cognitive therapy Beck


Cognitive distortions like
catastrophizing all-or-none thinking personalization

recognizing and correcting distortions

Group therapy therapy with unrelated clients

Benefits:

Therapist see clients interacting with one another Clients discover they are not alone lift clients expectation for improvement Boost self confidence and self acceptance Learn from one another how they come across to others Try out new skills assertiveness

Self-help groups AA

Family therapy therapy with related family members


Identified patient of the family black sheep VS. Seeing the problem as resulting from the interactions among ALL family members.

Couples therapy husband and wife

Effectiveness of therapy

Eysenck (1952) those who received therapy are worse than those who received no treatment Empirically supported therapies (ESTs)
Use experimental research to evaluate result you can choose them with confidence Criticism:

Some studies have not yet been validated Experimental studies not the same as real-life clinical settings

Rules and rights of therapeutic relationship

Confidentiality (dont tell anyone) maintained EXCEPT

Client so disturbed and suicidal that hospitalization is needed client uses mental condition to defend in court therapist sued by client client talks about sexual/physical abuse of child Therapist believes client will harm others

Rules and rights of therapeutic relationship

Patients rights
Cannot be committed unless there is clear and convincing reason that they are an imminent harm to others and themselves, and gravely disabled Have the right to receive treatment, and the right not to receive treatment, EXCEPT hospital patients who are a danger to themselves and others Subjected to minimal restriction to their freedom

Biological treatments

Psychosurgery lobotomy 1940s, 1950s Electroconvulsive therapy


Patients anesthesized, administered to half the brain Used for patients who are deeply depressed but do not respond to medication. Cure temporarily, but relapse soon afterwards

Biological treatments

Psychoactive drugs
Neuroleptics/antipsychotics reduce hallucinations, delusions

Old generation Thorazine and Haldol New generation atypical neuroleptics Clorazil, Risperdal, Zyprexa, Seroquel, Geodon, Abilify

Biological treatments

Antidepressants reduce depression, obsessive thoughts, panic


Effective only after 2 weeks Monoamine oxidase inhibitors MAOIs Tricyclic antidepressants (TCAs) SSRIs Prozac, Zoloft, Anafranil

Lithium mood stabilizer control manic & depressive episodes Anticonvulsants alternative to lithium Depakote, Lamictal Anxiolytics reduce anxiety
Benzodiazepines Highly addictive Buspirone alternative to benzodiazepines

Biological treatments

Choosing between psychotherapy vs. drugs


Psychotherapy and drugs both useful Psychotherapy superior when
Dropout rate lower long-term benefits

Biological treatments

Combination
Recommended for patients who are too distressed to receive psychotherapy initially Effective for long-term depression, ADHD, OCD, panic disorder, alcoholism. For those who are not exhibiting psychotic symptoms, CBT first, then medication + CBT when CBT is not effective