1. Chapter 14 Treatment of Psychological Disorders

2. Basics  Hx – 1880s – Freud & Josef Breuer wrote about Breuer’s pt - Anna O > strange physical sx > in therapy she discussed issues > sx ended  “talking cure” > organized as psychoanalysis

3. Varieties of therapy  Hundreds  3 main types: insight, behavioral, biomedical  A. Insight Therapy – psychoanalysis, etc. – must have psychologically-minded pts – pts learn @ themselves – insight is solution

4. Varieties  B. Behavioral therapies – use learning theory – problem-directed – habits, etc  C. Biomedical therapies – handled by MDs – pharma, ECT (shock therapy) – drugs most common – some states have given psychologists prescription privileges

5. ECT

6. Clients & Patients  Who gets help ? Many types – govt estimates 15 % all Americans will use MH services in a year  Most users not “sick”  Of the pop in distress (self-identified) > 60% get help  Many not getting help – why not ?

7. Clients & Patients  Women more apt to seek help  Insured pts more apt to seek help - & get better help  Better educated more apt to seek help  Stigma of mental illness – hurts reputation, shame, image, being sick

8. Types of therapists  Many types of professionals  Psychologists: clinical, counseling & school psychologists – dx, tx – requires PhD, PsyD or Ed.D > all can work w range of pts – testing, diagnosing & treating  Psychiatrists – MD – more associated w SMI, tx w meds

9. Types of therapists  Psychiatric social workers (MSW)  Psychiatric nurses  > both provide therapy – usually part of a team  Counselors (LPCs) – Master’s-level – usually specialize – vocational, drug

10. Types of therapists  Psychoanalyst – usually a psychiatrist with many years of extra training – go though analysis themselves – programs may take others  Names: clinician – therapist – mental health professional

11. Insight Therapies  Conversations w/ analyst > learn more @ self > make Δ  Psychoanalysis  - focus on Unc – motives, conflicts  - special techniques  - Freud & others called problems neuroses (neurotic)

12. Psychoanalysis  Neuroses – caused by conflicts dating back to infancy, childhood  - neurotics use defenses > anxiety, energy spent  Analyst explores Unc  1. free association - ~ word game – pts should not censor

13. Psychoanalysis  2. dream analysis – Freud valued this – less today  3. hypnosis – Freud abandoned this  - PA a slow process – analyst interprets (feedback)  Resistance – pt uses defenses to block thpy – can hurt thpy – dropping out

14. Psychoanalysis  Transference – pt feels a relationship w therapist – difficult stage, but needed – analyst can see how pt functions in a relationship  - ~ w parents  - project problems  - reenactment  > interpret > insight

15. Insight Therapies  Modern Psychoanalysis  I. psychodynamic therapy – some Δ theory – today, try for shorter thpy – cultural adaptations – can be helpful  II. Client-centered therapy – Rogers, 1950s  - humanist/human potential mvmt  - clients lead in thpy, especially pacing  - therapists just supportive

16. Insight Therapies  - Rogers did not believe in resistance – said it was incongruence  - be less dependent on others’ approval  > defenses, anxiety, being unrealistic  - therapeutic environment/climate – warm, accepting  Psychologist needs 3 qualities : genuineness, unconditional positive regard, accurate empathy

17. Insight Therapies  Rogers’ process  - collaboration – equals  - be a mirror – clarification  - can clients become more genuine – true to self  - if works > change personality

18. Insight Therapy  III. Positive Psychology  - good aspects : creativity, growth, strength, happiness  - less stress on pathology  - positive therapy used for depression  - become more aware of what is good, “count your blessings”

19. Group Therapy  Traditionally insight  Economic  6-8 pts  Screened  Everyone a therapist for each other  Opening up  Sharing experiences

20. Group Therapy  Should be supportive, close  Being real  Experiment socially – reward what is positive  Clinician – leads, but quietly – choose members, est goals, keeps process going  Cheaper – public & private – saves time, works

21. Results of Insight Therapies  Hard to measure  Spontaneous remission – automatic recovery  Tx may/may have Δ anything  Depends on conditions  Research – some therapy better than none; no therapy better than any other  Most improvement by 15 th session

22. Behavioral Therapies  Based on relearning, not insight  Focus on beh  Use learning & conditioning theory  Used for over 50 years  1. all based on learning – good or bad things  2. relearning possible

23. Varieties of therapy