Therapies for Psychological Disorders Chapter 13 Therapies for Psychological Disorders

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

What is Therapy? Therapy: General term for any treatment process In psychology and psychiatry - a variety of psychological and biomedical techniques aimed at dealing with mental disorders or coping with problems of living

The Components of Therapy Relationship between the therapist and the patient/client and some or all of the following processes: 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

Contemporary Approaches to Therapy Psychological therapies: Based on psycho-logical principles (rather than biomedical approach) Often collectively called psychotherapy

Contemporary Approaches to Therapy Biomedical therapies: Focus on altering the brain Drugs Psychosurgery Electroconvulsive therapy

Types of Mental Health Care Professionals Counseling psychologist Clinical psychologist Psychiatrist Psychoanalyst Psychiatric nurse practitioner Clinical social worker Pastoral counselor 29

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 29

Clinical psychologist Professional Title Specialty: Those with severe disorders Work setting: Private practice, mental health agencies, hospitals Credentials: PhD or PsyD Counseling psychologist Clinical psychologist Psychiatrist Psychoanalyst Psychiatric nurse practitioner Clinical social worker Pastoral counselor 29

Professional Title Specialty: Severe mental disorders (often by means of drug therapies) Work setting: Private practice, clinics, hospitals Credentials: MD Counseling psychologist Clinical psychologist Psychiatrist Psychoanalyst Psychiatric nurse practitioner Clinical social worker Pastoral counselor 29

Professional Title Freudian therapy Private practice MD Counseling psychologist Specialty: Freudian therapy Work setting: Private practice Credentials: MD Clinical psychologist Psychiatrist Psychoanalyst Psychiatric nurse practitioner Clinical social worker Pastoral counselor 29

Psychiatric nurse practitioner 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 Professional Title Counseling psychologist Clinical psychologist Psychiatrist Psychoanalyst Psychiatric nurse practitioner Clinical social worker Pastoral counselor 29

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 29

Professional Title Specialty: Combines spiritual guidance with practical counseling Work setting: Religious order or ministry Credentials: Varies Counseling psychologist Clinical psychologist Psychiatrist Psychoanalyst Psychiatric nurse practitioner Clinical social worker Pastoral counselor 29

Insight Therapies: Psychodynamic Therapies Psychoanalysis: Form of psychodynamic therapy developed by Sigmund Freud Analysis of transference: Analyzing and interpreting the patient’s relationship with the therapist Dream interpretation, free association Neo-Freudian psychodynamic therapies: Developed by psychodynamic theorists who embraced some of Freud’s ideas, but disagreed with others (sex, childhood)

How Do Psychologists Treat Mental Disorders? Psychologists employ two main forms of treatment: the insight therapies and the behavioral therapies

Insight Therapies: Humanistic Therapies Humanistic therapies: tendency for positive growth and self actualization (may be blocked by unhealthy environment) Client-centered therapy: Emphasizes healthy psychological growth through self-actualization (Rogers) Reflection of feeling: Paraphrasing client’s words to capture the emotional tone expressed Unconditional positive regard: nonjudgmental and respect for client

Insight Therapies: Cognitive Therapies Cognitive therapy: Emphasizes rational thinking as the key to treating mental disorder Cognitive therapy for depression (Aaron Beck) Confront destructive thoughts that support it Can be at least as effective as medication

Insight Therapies Insight therapies: Psychotherapies in which the therapist helps others understand (gain insight) their problems (emotions, thoughts) AKA – talk therapies Psychodynamic – unconscious conflicts Humanistic – positive growth & self-actualization Cognitive – emphasizes rational thinking (ex. Beck – depression; confront thoughts that support it)

Systematic desensitization Contingency management Behavior Therapies Behavior therapy: based on the principles of behavioral learning, especially operant and classical conditioning Systematic desensitization Aversion therapy Contingency management Token economies

Classical Conditioning Therapies Systematic desensitization: Anxiety is extinguished by gradually exposing the patient to an anxiety-provoking stimulus Exposure therapy: patient directly confronts the anxiety-provoking stimulus (as opposed to imagining it) Aversion therapy: Present an attractive stimulus with unpleasant stimulation in order to condition a repulsive reaction

Operant Conditioning Therapies Contingency management: Changing behavior by altering the consequences (rewards and punishments) of behavior Token economies: Applied to groups involving distribution of “tokens” contingent on desired behaviors

Cognitive-Behavioral Therapy: A Synthesis Modify irrational thoughts Set attainable behavioral goals Develop realistic strategies to attain goals Evaluate results Rational-emotive behavior therapy: irrational thoughts and behaviors are the cause of mental disorders (REBT) Albert Ellis – strong approach, no acceptance of irrational thoughts, may be a heated interaction

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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Drug Therapy Psychopharmacology: The prescribed use of drugs to help treat symptoms of mental illness ostensibly to ensure that individuals are more receptive to talk therapies

Drug Therapy Antipsychotic drugs Include chlorpromazine, haloperidol, and clozapine Usually affect dopamine pathways (reduce it) May have side effects Tardive dyskinesia: Incurable disorder of motor control resulting from long-term use of antipsychotic drugs

Drug Therapy Antidepressants and mood stabilizers Usually affect serotonin/norepinephrine (increase) (MAO) inhibitors – increase norepinephrine Tryicyclics – inhibit reuptake SSRIs – inhibit reuptake of serotonin (Prozac) Lithium carbonate – treats bipolar (can be toxic) Highly controversial – suicide, using just when uneasy

Drug Therapy Antianxiety drugs Barbiturates – relax central nervous system Benzodiazepines – decrease activity in anxiety regions of brain Do not Use to relieve ordinary anxieties of everyday life Take for more than a few days at a time Combine with alcohol

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Psychosurgery Psychosurgery: The general term for surgical intervention in the brain to treat psychological disorders The infamous prefrontal lobotomy is no longer performed Severing the corpus callosum, however, can reduce life-threatening seizures

Brain-Stimulation Therapies Electroconvulsive (ECT) therapy - used for treatment of severe depression Side effect – memory disruption Transcranial magnetic stimulation (TMS): a possible alternative to ECT- treatment of depression, schizophrenia, and bipolar disorder

Hospitalization and the Alternatives Therapeutic community: Program of treating mental disorder by making the institutional environment supportive and humane for patients Deinstitutionalization: Policy of removing patients, whenever possible, from mental hospitals Community mental health movement: Effort to deinstitutionalize mental patients and to provide therapy from outpatient clinics

Drug Therapy Stimulants: suppress activity level in persons with attention-deficit/hyperactivity disorder (ADHD) Causes and boundaries of ADHD are vague and the potential exists for over-diagnosis Side effects – growth, sleep, later use

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 run by laypersons (not professional therapists) Couples and family therapy

Participant Modeling: An Observational-Learning Therapy Participant modeling: Therapist demonstrates and encourages a client to imitate a desired behavior

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: That therapy is better than no therapy It appears advantageous to match specific therapies with specific conditions

Mental “First Aid” If someone asks you for help, keep in mind that serious problems (especially those involving suicide or threats) require immediate professional treatment Otherwise, your best tools may involve Listening Acceptance Exploring alternatives