Psychotherapy

clients

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Type of Disorder

Psychotherapy therapistssts  psychologist  PhD with clinical training  clinical vs counselling  psychiatrist  MD with clinical internship  others

Insight Therapies Psychoanalysis free association dream analysis interpretation resistance transference Modern Psychodynamic Therapy

Client-Centred Therapy Carl Rogers non-directive incongruence therapeutic climate genuineness unconditional positive regard empathy therapeutic process

Gestalt Therapy Fritz Perls developed 1950s figure-ground relationships skillful frustration role playing

Cognitive Therapies

Albert Ellis Rational-Emotive Therapy catastrophic thinking ABC model activating event belief system consequence

Rational-Emotive Therapy

“D” component of the model detecting instances of catastrophic thinking disputing irrationality of this thinking

Beck’s Cognitive Theory depressives: blame setbacks on themselves focus on negative events unduly pessimistic make overly negative evaluations

Behavioural Therapies General Principles behaviour is the product of learning what has been learned can be unlearned Systematic Desensitization Wolpe, 1950’s based on classical conditioning phobias relaxation training anxiety hierarchy

Anxiety Hierarchy

Behavioural Therapies Exposure Therapies Flooding Implosion Aversion Therapy UCS (Drug in Alcohol) UCR (Nausea) CS (Alcohol) CR (Nausea)

Behavioural Therapies Social Skills Training  Token Economies

Theoretical Orientations eclecticism

Biomedical Therapies Psychosurgery Golz Burkhardt Jacobsen lobotomy (lobe-cutting) Dr. Antônio Egas Moniz leukotomy (white matter cutting)

Psychosurgery Walter Freeman 1936 initial procedure Freeman-Watts Standard Procedure prefrontal lobotomy cingulotomy “ice-pick” lobotomy (1945) 18,000+ between 1939 & Nobel Prize

Psychopharmacotherapy Antianxiety drugs e.g., Valium, Xanax, BuSpar

Psychopharmacotherapy Antipsychotics e.g., Thorazine, Haldol side effects tardive dyskinesia Antidepressants tricyclics MAO inhibitors selective serotonin reuptake inhibitors (SSRIs) Prozac, Paxil, Zoloft

Psychopharmacotherapy Lithium tx for bipolar mood disorder

Electroconvulsive Therapy (ECT) volt AC 1-3 times/week 2-4 weeks side-effects total amnesia retrograde amnesia anterograde amnesia

Evaluating Therapeutic Outcomes Eysenck’s (1952) criticism 2/3 rds spontaneous remission same as success rate later spontaneous remission revised to 30% meta analysis (Smith, 1980) people who were treated were better off than 80% of non-treated

Evaluating Therapeutic Outcomes

Changes in Treatment of Disorders Community Health Movement local, community-based care reduced reliance on hospitalization focus on prevention deinstitutionalization

Changes in Treatment of Disorders deinstitutionalization Advantages: more cost effective improved tx in hospitals Disadvantages: increased re-admissions lack of appropriate alternatives results in increased # of homeless