The Treatment of Psychological Disorders

• modern psychotherapy originated in systematic treatment (psychoanalysis) developed by Sigmund Freud

• now, three main categories of treatment:– insight therapies– behavior therapies– biomedical therapies

• therapeutic triad: therapist, treatment, client• 15% of U.S. population annually uses mental

health services• why? anxiety, depression, interpersonal

relations, bad habits, poor self control, low self esteem, marital conflict, self doubt, emptiness, stagnation

• most common: anxiety and depression

• PROVIDERS:• friends, relatives, clergy: may help, but their

advice does not qualify as therapy– requires professional treatment by someone with

special training• psychologists: clinical and counseling• psychiatrists: physicians who specialize in the

diagnosis and treatment of psychological disorders

• other mental health professionals: clinical social workers, psychiatric nurses, counselors

• INSIGHT THERAPIES: involve verbal interactions intended to enhance client’s self-knowledge and thus promote healthful changes in personality and behavior

• psychoanalysis: an insight therapy developed by Freud that emphasized the recovery of unconscious conflicts, motives and defenses through techniques such as free association, dream analysis and transference

• Freud: neurotic problems are caused by unconscious conflicts left over from early childhood– battles among id, ego and superego, usually over

sexual and/or aggressive impulses– people depend on defense mechanisms to avoid

confronting these conflicts, but this leads to self-defeating behavior and only partially successful in alleviating anxiety, guilt, and other distressing emotions

• Freud’s therapeutic procedures: probe the unconsciousness, analyst as detective, using several techniques

• (1) free association: client spontaneously expresses thoughts and feelings exactly as they occur, with minimal censorship

• (2) dream analysis: therapist interprets symbolic meaning of client’s dreams

• (3) interpretation: therapist attempts to explain the inner significance of clients’ thoughts, memories and behaviors

• (4)resistance: largely unconscious defensive maneuvers intended to hinder the progress of therapy

• (5) transference: client unconsciously starts relating to therapist in ways that mimic critical relationships in the client’s life

• MODERN PSYCODYNAMIC THERAPIES• adaptations of classical psychoanalysis• interpretation, resistance and transference

continue to play key roles

• CLIENT-CENTERED THERAPY: insight therapy that emphasizes providing a supportive emotional climate for client, who plays a major role in determining the pace and direction of their own therapy

• therapeutic climate: the process of therapy is les important than the climate– warm, supportive, accepting, safe– lack of threat reduces defensive tendencies

• 3 conditions:– genuineness (by therapist)– unconditional positive regard– empathy

• therapeutic process: client and therapist work together as equals– therapist provides little guidance, minimal

interpretation and guidance– therapist’s key task: provide feedback and

clarification– highlight themes in rambling client discourse– like psychotherapy, seeks a major restructuring of

client’s personality

• positive psychology-inspired therapies• positive psychology: uses theory and research

to better understand the positive, adaptive, creative, and fulfilling aspects of human existence– critical of psychology’s traditional focus on

pathology, weakness, suffering– emphasize health and resilience, contentment,

well-being, human strength, positive emotions

• well-being therapy: enhance client’s self-acceptance, purpose, autonomy, personal growth– success in treatment of mood and anxiety

disorders

• positive psychotherapy: in treatment of depression, recognize strengths, appreciate blessings, emphasize positive experiences, forgiveness, finding meaning in life

• group therapy: simultaneous treatment of several clients in a group– 4 to 12 participants– screened by therapist– participants function essentially as therapists for each

other– describe problems, discus coping strategies– provide acceptance and emotional support– therapist promotes group cohesiveness, sets goals,

models support, protects clients from harm– advantages: more affordable, clients learn their problems

are not unique, practice social skills in safe environment

• Efficacy of Insight Therapies• spontaneous remission: recovery from a

disorder without formal treatment• efficacy depends on goals• outcomes studies demonstrate that insight

therapy is superior to no therapy, and that effects are reasonably durable

• roughly equal in efficacy to drug therapies

• mechanism of action of insight therapies:– develop a therapeutic alliance with the

professional helper– emotional support, empathetic understanding– cultivation of hope and positive expectations– provide a rationale for problems and a method for

reducing them– opportunity to express feelings, confront

problems, gain insight, learn new patterns of behavior

• BEHAVIOR THERAPIES• no attempt to achieve grand insight– considered unnecessary to produce constructive

change– single goal: eliminate maladaptive behavior

• insight therapists treat pathological symptoms as signs of underlying problems, while behavioral therapists assume that the symptoms are the problem

• behavior therapies: involve the application of learning principles to direct efforts to change clients’ maladaptive behaviors

• assumptions:– behavior is a product of learning– what has been learned can be unlearned through• classical conditioning• operant conditioning• observational learning

• Systematic Desensitization: reduce phobic clients’ anxiety responses through counterconditioning– assume that most anxiety responses are acquired

through classical conditioning– goal: weaken the association between the

conditioned stimulus and the conditioned response

• counterconditioning: reverse the process of classical conditioning by pairing the stimulus with a new conditioned response

• 3 steps:– build an anxiety hierarchy• list and then rank anxiety-arousing stimuli• train in deep muscle relaxation• work through hierarchy (least to most) while remaining

relaxed

– underlying principle: anxiety and relaxation are incompatible responses

• aversion therapy: a behavior therapy in which an aversive stimulus is paired with a stimulus that elicits an undesirable response– most controversial– not widely used, only as a last resort, and usually

combined with a larger treatment program– substance abuse, sexual deviance, gambling,

shoplifting, stuttering, smoking, overeating

• social skills training: a behavior therapy designed to improve interpersonal skills that emphasizes modeling, behavioral rehearsal, and shaping– used in treatment of autism, ADD, schizophrenia– based on principles of operant conditioning and

observational learning– modeling: watch socially skilled people, acquire their

skills– behavioral rehearsal: practice techniques in

structured role play– shaping: gradually handle more complicated, delicate

situations

• cognitive therapy: use specific strategies to correct habitual thinking errors that underlie various types of disorders

• goal: change client’s negative thoughts and maladaptive beliefs

• Cognitive Behavioral Treatments:• use varied combinations of verbal interactions

and behavior modification techniques to help clients change maladaptive patterns of thinking

Biomedical Therapies

• physiological interventions intended to reduce symptoms associated with psychological disorders

• treatment with drugs– antianxiety – antipsychotic– antidepressant– mood stabilizers– ECT– brain stimulation

• antianxiety drugs: relieve tension, apprehension and nervousness

• antipsychotic drugs: used to gradually reduce psychotic symptoms, including hyperactivity, mental confusion, hallucinations, delusions

• antidepressant drugs: gradually elevate mood and help bring people out of a depression

• mood stabilizing drugs: used to control mood swings in patients with bipolar mood disorders

• electroconvulsive therapy (ECT): a biomedical treatment in which electric shock is used to produce a cortical seizure accompanied by convulsions

• brain stimulation: – transcranial magnetic stimulation (TMS): a technique

that permits scientists to temporarily enhance or depress activity in a specific area of the brain

– deep brain stimulation (DBS): a thin electrode is surgically implanted in the brain, connected to an implanted pulse generator, so that various electrical currents can be delivered to brain tissue adjacent to the electrode

Current trends and issues in treatment

• transition from fee-for-service to managed care

• blended therapy: integrate various approaches

current trends, cont.

• cultural diversity

• institutionalization

• variety of therapeutic services