Chapter 14: Treatment of Psychological Disorders

Treatment: How Many Types Are There? Psychotherapy- all the diverse approaches used in the treatment of mental disorder and psychological problems. –Insight therapies- pursuing increased insight regarding the nature of the client’s difficulty and sorting through possible solutions. “talk therapy” –Behavior therapies- based on the principles of learning, with behavior therapists working to alter maladaptive habits and change overt behaviors. Changing overt behavior –Biomedical therapies- involve interventions to alter a person’s biological functioning. Biological functioning interventions

Clients: Who Seeks Therapy? 15% of U.S. population in a given year Full range of human problems Women more than men Medical insurance Education level

Figure 14.1 Therapy utilization rates

Figure 14.2 Psychological disorders and professional treatment

Therapists: Who Provides Treatment? Clinical psychologists-specializing in the diagnosis and treatment of psychological disorders and everyday behavioral problems Counseling psychologists-specializing in the diagnosis and treatment of psychological disorders and everyday behavioral problems Psychiatrists-medical doctors who specialize in the diagnosis and treatment of psychological disorders. Psychiatric social workers-generally have a master’s degree and are increasingly providing a wide range of therapeutic services as independent practitioners. Psychiatric nurses-may hold a bachelor’s or master’s degree and often play a large role in hospital inpatient treatment. Counselors-usually found working in schools, colleges, and assorted human service agencies. Often specialize in specific areas, such as vocational or marital counseling.

Insight Therapies: Psychoanalysis Involves verbal interactions intended to enhance clients’ self-knowledge and thus promote healthful changes in personality and behavior. Sigmund Freud and followers –Goal: discover unresolved unconscious conflicts Free association Dream analysis Interpretation –Resistance and transference

Figure 14.3 Freud’s view of the roots of disorders

Insight Therapies: Client-Centered Therapy An insight therapy that emphasizes providing a supportive emotional climate for clients, who play a major role in determining the pace and direction of their therapy. Carl Rogers –Goal: restructure self-concept to better correspond to reality –Therapeutic climate Genuineness Unconditional positive regard Empathy –Therapeutic process Clarification

Figure 14.4 Rogers’s view of the roots of disorders

Insight Therapies: Group Therapy Simultaneous treatment of several clients in a group Role of therapist –Screen participants –Facilitate therapeutic process –Monitor interactions Not just less costly alternative to individual therapy

Evaluating Insight Therapies Spontaneous remission Early improvement Most important factors: –Development of therapeutic alliance –Emotional support and empathy –Hope –Provision of a rationale for problem and treatment –Opportunity to express feelings and “try out” new ideas, solutions

Behavior Therapies Involve the application of learning principles to direct efforts to change clients’ maladaptive behaviors. B.F. Skinner and colleagues –Goal: unlearning maladaptive behavior and learning adaptive ones –Systematic Desensitization- desensitization to reduce phobic clients’ anxiety responses through counterconditioning Classical conditioning Anxiety hierarchy –Aversion therapy- an aversive stimulus is paired with a stimulus that elicits an undesirable response. Alcoholism, sexual deviance, smoking, etc.

Figure 14.6 The logic underlying systematic desensitization

Figure 14.8 Aversion therapy

Behavior Therapy B.F. Skinner and colleagues –Social skills training- a behavior therapy, designed to improve interpersonal skills, that emphasizes modeling, behavioral rehearsal, and shaping. Modeling Behavioral rehearsal

Cognitive-Behavioral Therapy An insight therapy that emphasizes recognizing and changing negative thoughts and maladaptive beliefs. Aaron Beck –Cognitive therapy Goal: to change the way clients think –Detect and recognize negative thoughts –Reality testing –Kinship with behavior therapy

Figure 14.9 Beck’s view of the roots of disorders

Evaluating Behavior Therapies Slightly better than insight therapies for some types of problems –There can be no general “X is better than Y” statement about the preferability of one type of therapy over others for all kinds of problems. Can also be used in conjunction with other forms of therapy –Along with other forms of therapy for the treatment of phobias, OCD, sexual dysfunction, schizophrenia, drug-related disorders, eating disorders, and other problems.

Biomedical Therapies Physiological interventions intended to reduce symptoms associated with psychological disorders. They assume that these disorders are caused, at least in part, by biological malfunctions. Treatment with drugs –Antianxiety - Valium, Xanax, Buspar –Antipsychotic - Thorazine, Mellaril, Haldol Tardive dyskinesia Clozapine –Antidepressant: Tricyclics – Elavil, Tofranil Mao inhibitors (MAOIs) - Nardil Selective serotonin reuptake inhibitors (SSRIs) – Prozac, Paxil, Zoloft

Biomedical Therapies Treatment with drugs –Mood stabilizers Lithium- a chemical used to control mood swings in patients with bipolar mood disorders; it is very successful at preventing future episodes of mania and depression, but it can be toxic and requires careful monitoring. Valproic acid Electroconvulsive therapy (ECT)- is a biomedical treatment in which electric shock is used to produce a cortical seizure accompanied by convulsions. Although the use of ECT peaked in the 1940s and 1950s, there has been a recent resurgence in this therapy.

Evaluating Biomedical Therapies Drugs –Often help otherwise resistant problems –Controversial Provides relief only from symptoms Overprescription Influence of pharmaceutical industry Electroconvulsive therapy –Helpful for major depression

Figure Antidepressant drugs’ mechanisms of action

Current Trends and Issues in Treatment Managed care- or health-care systems that involve pre- paid plans with small copayments that are run by health maintenance organizations (HMOs), is negatively impacting psychological care. –consumers pay lower prices but give up freedom to choose providers and obtain whatever treatments they believe necessary. Multicultural sensitivity Deinstitutionalization- the movement away from inpatient treatment in mental hospitals to more community based treatment. –Revolving door problem –Homelessness

Figure Declining inpatient population at state and county mental hospitals