1. Treatment of Psychological Disorders
Chapter 15
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2. Types of Treatment Psychotherapy Classifications of Psychotherapy
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Types of Treatment
Psychotherapy
all the diverse approaches used in the treatment of mental disorder and psychological problems
Classifications of Psychotherapy
A. Insight therapies
“talk therapy”
B. Behavior therapies
Use of conditioning/behavior modification techniques to change overt behavior
C. Biomedical therapies
Biological functioning interventions
Psychotherapy is used in the text in its broadest sense, to refer to all the diverse approaches used in the treatment of mental disorder and psychological problems.
Many different treatment methods are used, and experts estimate that there may be over 400 different approaches to psychotherapy, although approaches to treatment can be classified into three major categories.
Insight therapy involves pursuing increased insight regarding the nature of the client’s difficulty and sorting through possible solutions.
Behavior therapy is based on the principles of learning, with behavior therapists working to alter maladaptive habits and change overt behaviors.
Biomedical therapies involve interventions to alter a person’s biological functioning.

3. Who Provides Treatment?
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Who Provides Treatment?
Psychiatrists (M.D.)
Physicians who specialize in treating psychological disorders
* They can prescribe medications,
Tend to see those with the most serious problems
Clinical psychologists (Ph.D., Psy.D., or Ed.D.)
expertise in research, assessment, and therapy, supplemented by a supervised internship
About half work in agencies and institutions, half in private practice
Counseling psychologists (Ph.D., Psy.D., or Ed.D.)
Clinical social workers (Master’s degree)
two-year Master of Social Work graduate program plus postgraduate supervision
offer psychotherapy, mostly to people with everyday personal and family problems
Psychiatric nurses (Bachelor’s or Master’s)
Counselors (Master’s)
Marriage & family counselors
Pastoral counselors
Abuse counselors
There are a variety of “helping professions” available: Psychologists who provide psychotherapy may have degrees in clinical or counseling psychology, specializing in the diagnosis and treatment of psychological disorders and everyday behavioral problems. Both types must earn a doctoral degree (Ph.D., Psy.D., or Ed.D.), which requires 5-7 years beyond a bachelor’s degree. Admission to Ph.D. programs in clinical psychology is very competitive, about like getting into medical school.
Psychiatrists are medical doctors who specialize in the diagnosis and treatment of psychological disorders. They are, at present, the only psychotherapy administering profession to be able to prescribe drugs, although psychologists are lobbying for prescription rights (given appropriate training).
Clinical 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 are usually found working in schools, colleges, and assorted human service agencies. They typically have a master’s degree and often specialize in specific areas, such as vocational or marital counseling.

4. Who’s Providing Therapy?
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Who’s Providing Therapy?

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A. Insight Therapies: verbal interactions intended to enhance clients’ self-knowledge, thus promote healthful changes in personality and behavior.
1. Psychoanalysis
Sigmund Freud and followers
Goal: discover unresolved unconscious conflicts
Therapeutic Process
Free association
Dream analysis
Interpretation
Resistance
Transference
Insight therapies involve verbal interactions intended to enhance clients’ self-knowledge and thus promote healthful changes in personality and behavior.
Psychoanalysis is an insight therapy that emphasizes the recovery of unconscious conflicts, motives, and defenses through a variety of techniques.
Freud believed that inner conflicts among the id, ego, and superego (usually over sexual and aggressive impulses) cause problems and that defense maneuvers on the part of the ego often lead to self-defeating behavior and are only partially successful.
In free association, clients spontaneously express their thoughts and feelings exactly as they occur, with as little censorship as possible. The analyst looks for clues about what is going on in the unconscious.
Dream analysis involves the therapist interpreting the symbolic meaning of the client’s dreams. Freud called dreams the “royal road to the unconscious."
Interpretation refers to the therapist’s attempts to explain the inner significance of the client’s thoughts, feelings, memories, and behaviors.
Resistance refers to the largely unconscious defensive maneuvers intended to hinder the progress of therapy.
Transference occurs when the clients unconsciously start relating to their therapist in ways that mimic critical relationships in their lives.

6. A Freudian View: The Roots of a Disorder
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A Freudian View: The Roots of a Disorder

7. Insight Therapies (con’t)
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Insight Therapies (con’t)
2. Humanist Therapies
a. Client Centered Therapy
insight therapy that emphasizes providing a supportive emotional climate for clients, who play a major role in the pace and direction of their therapy
Carl Rogers (1950’s)
Goal: restructure self-concept to better correspond to reality (become more congruent)
Therapeutic Climate
Genuineness
Unconditional positive regard (warmth)
Empathy
Encounter groups
Using a humanistic perspective, Carl Rogers developed Client-centered therapy in the 40s and 50s.
Client-centered therapy is 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.
Rogers maintained that most personal distress is due to incongruence between a person’s self-concept and reality. The goal of therapy involves helping people restructure their self-concept to correspond better to reality.
Rogers held that there are 3 main elements to creating this atmosphere: genuineness, or the therapist being completely honest and spontaneous with the client; unconditional positive regard, or a complete nonjudgmental acceptance of the client as a person; and empathy, an understanding of the client’s point of view.

8. A Rogerian View: The Roots of a Disorder
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A Rogerian View: The Roots of a Disorder

9. Insight Therapies (con’t)
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Insight Therapies (con’t)
b. Gestalt Therapy
Insight therapy in which client confronts past and present experiences in an attempt to restore a sense of completeness ~ “whole self”
More intensive and directed than client-centered therapy

10. Insight Therapies (con’t )
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Insight Therapies (con’t )
3. Cognitive Therapy
Insight therapy that emphasizes recognizing and changing negative thoughts and maladaptive beliefs
(Note: sometimes called cognitive –behavioral therapy ~ use of behavioral techniques along w/ individual’s perception to change behavior/cognitions)
Goal: restructure inappropriate/ “defeatist” thinking
Detect and recognize negative thoughts
Reality testing
Use of behavioral techniques to change behavior
Cognitive therapy is an insight therapy that emphasizes recognizing and changing negative thoughts and maladaptive beliefs.
Beck and Ellis independently devised cognitive oriented therapies. The goal of these therapies is to change the way clients think, detecting and recognizing negative thoughts, reality testing, and devising behavioral “homework assignments” that focus on changing overt behaviors.

11. Insight Therapies (con’t )
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Insight Therapies (con’t )
“The Cognitive Revolution”

12. Insight Therapy (con’t)
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Insight Therapy (con’t)
a. Cognitive therapy
Aaron Beck
Belief: disorders result from distorted thinking about the “cognitive triad”
self
world/experiences
future
Goal: Restructure thinking
Early view dealt w/ depression, later expanded to additional disorders

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Did you know…
people with higher education levels & medical insurance also seek treatment more often?
Another correlation!

14. Beck’s View: The Roots of a Disorder
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Beck’s View: The Roots of a Disorder

15. Insight Therapy (con’t)
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Insight Therapy (con’t)
b. Rational-Emotive therapy (RET)
Direct (confrontational) therapy in which therapist confront client’s illogical beliefs w/ rational arguments
Developed by Albert Ellis
Goal: restructure thinking and view environment more realistically
Updated to Rational-Emotive Behavioral Therapy (1993)

16. Insight Therapy (con’t)
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Insight Therapy (con’t)
c. Stress-Inoculation Therapy
Use of negative cues to initiate positive self statements
d. Social skills training
Modeling (based on Bandura’s work)

17. Insight Therapy (con’t)
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Insight Therapy (con’t)
4. Family & Group therapy
Family
Therapy designed to investigate and treat the social network of the family unit along with the individual
Group
Therapy within a “safe setting” for a group
Basic format: self-revelation
Note: a self-help group, though therapeutic, is NOT psychotherapy

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B. Behavior Therapies: the application of learning principles to change/eliminate maladaptive behaviors.
B.F. Skinner & colleagues
Goal: unlearning maladaptive behavior and learning adaptive ones
1. Counterconditioning
A. Systematic Desensitization – client associates a pleasant, relaxed state with gradually increasing anxiety-triggering stimuli
Developed by Joseph Wolpe
Based on Classical conditioning
Uses Mary Cover-Jones’ earlier “reconditioning” experiments, but replaces food w/ relaxation
Behavior therapies involve the application of learning principles to direct efforts to change clients’ maladaptive behaviors.
Behavior therapies are based on the work of B.F. Skinner, assuming that behavior is a product of learning, and that what is learned can be unlearned.
Joseph Wolpe (1958) developed a therapy called systematic desensitization to reduce phobic clients’ anxiety responses through counterconditioning. Systematic desensitization involves 3 steps: the therapist first helps the client build an anxiety hierarchy (a ranked list of anxiety-arousing stimuli); next, the client is trained in deep muscle relaxation; finally, the client tries to work through the hierarchy, learning to remain relaxed while imagining each stimulus. The basic idea is that you cannot be anxious and relaxed at the same time. Research shows that this technique is very effective in treating phobias.

19. Behavior Therapy con’t
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Behavior Therapy con’t
3 steps:
build an anxiety hierarchy (a ranked list of anxiety-arousing stimuli)
client is trained in deep muscle relaxation
work through the hierarchy, while remaining relaxed
“in vivo” desensitization – use of real rather than imagined fear- eliciting stimulus
Effective phobia treatment

20. Conditioned Phobias & Systematic Desensitization
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Conditioned Phobias & Systematic Desensitization

21. Behavior Therapy con’t
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Behavior Therapy con’t
B. Aversive Conditioning (aka Aversion Therapy)
Type of type of counterconditioning that tries to associate an unpleasant state with an already acquired negative/unwanted behavior
Ex: antabuse (alcohol nausea)
Used for Alcoholism, sexual deviance, smoking, etc.
Aversion therapy is the most controversial of the behavior therapies, where an aversive stimulus is paired with a stimulus that elicits an undesirable response. Alcoholics, for example, have had emetic drugs paired with their favorite drinks, with the subsequent vomiting creating a conditioned aversion to alcohol. This technique has been used with alcohol and drug abuse, sexual deviance, smoking, shoplifting, gambling, stuttering, and overeating.
Social skills training is a behavior therapy, designed to improve interpersonal skills, that emphasizes modeling, behavioral rehearsal, and shaping.
In biofeedback, a bodily function is monitored, and information about the function is fed back to the person so that they can develop more control over the physiological process.

22. Behavior Therapy con’t
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Behavior Therapy con’t
2. Extinction Methods (aka. Exposure Therapy)
Use of massive amounts of anxiety in a non-threatening environment to extinguish a behavior, typically a phobia
a. Flooding
extinction method, used to treat phobias, that exposes the individual to real-life anxiety eliciting stimuli and escape is prevented
Based on classical conditioning
Explanation: the CS loses it’s ability to elicit the CR (fear) when no longer paired with the US

23. Behavior Therapy con’t
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Behavior Therapy con’t
b. Implosive Therapy
Extinction method used to treat phobias in which the fear-eliciting events are presented in imagined form
Uses an unrealistic verbal description presented by the therapist
Based on classical conditioning (CC)
* Extinction methods (Flooding & implosive therapy) differ from desensitization in that the individual works through the anxiety as opposed to avoiding it!

24. Behavior Therapy con’t
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Behavior Therapy con’t
3. Token Economy (B.F. Skinner)
an operant conditioning procedure that rewards desired behavior
patient exchanges a secondary reinforcer, earned for exhibiting the desired behavior, for various privileges or treats

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C. Biomedical Therapies: physiological interventions intended to reduce symptoms associated with psychological disorders
1. Psychopharmacotherapy (drug therapy)
A. 3 Major Categories
1. Antianxiety Compounds
Relieve tension, apprehension, nervousness
Early compounds were barbiturates
1960’s - benzodiazepines introduced (ex: Valium, Xanax)
New compound : Buspar
Biomedical therapies are physiological interventions intended to reduce symptoms associated with psychological disorders. They assume that these disorders are caused, at least in part, by biological malfunctions.
Psychopharmacotherapy is the treatment of mental disorders with medication…drug therapy.
Drugs used to treat psychological disorders fall into 3 major categories, antianxiety, antipsychotic, and antidepressant. Mood stabilizers do not fit well into any of these categories, but they are very important drugs in the treatment of bipolar disorder.
Antianxiety drugs relieve tension, apprehension, and nervousness.

26. Biomedical Therapies con’t
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Biomedical Therapies con’t
2. Antipsychotics (a.k.a neuroleptics)
Reduce psychotic symptoms, including hyperactivity, mental confusion, hallucinations, and delusions
Decreases the dopamine synapse
Examples: Thorazine, Mellaril, Haldol
Side effects
Tardive dyskinesia (an incurable neurological disorder marked by tics and spasms)
Parkinson’s disease
Newer compound: Clozapine (less motor side effects)
Antipsychotic drugs are used to gradually reduce psychotic symptoms, including hyperactivity, mental confusion, hallucinations, and delusions. Antipsychotic drugs appear to decrease activity at dopamine synapses, sometimes producing unfortunate side-effects such as symptoms of Parkinson’s disease and tardive dyskinesia, an incurable neurological disorder marked by involuntary writhing and ticklike movements of the mouth, tongue, face, hands, or feet.
Newer drugs, which have a different mechanism of action, such as clozapine, have fewer motor side effects but are not risk free.

27. Biomedical Therapies con’t
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Biomedical Therapies con’t
3. Antidepressants:
Tricyclics
Purpose: block neurotransmitter reuptake
Examples: Elavil, Tofranil
Mao inhibitors (MAOIs)
MAO: enzymes that breaks down monoamine neurotransmitters (i.e.norepinephrine, dopamine, serotonin) in the synaptic cleft
MAOIs reduce MAO, therefore, transmitters stay in cleft longer
Example: Nardil
Selective serotonin reuptake inhibitors (SSRIs)
Operate on the serotonin synapse
Examples: Prozac, Paxil, Zoloft
Most frequently prescribed
Antidepressants gradually elevate mood and help bring people out of a depression. The 3 major classes of antidepressant drugs are listed on the slide. Today, the SSRIs are the most frequently prescribed.

28. Biomedical Therapies con’t
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Biomedical Therapies con’t
B. Mood stabilizers
Not in the 3 major categories, but important for “bipolar” treatment
Examples
Lithium (can be toxic, requires monitoring)
Valproic acid
Lithium is 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.
Electroconvulsive therapy (ECT) is a biomedical treatment in which electric shock is used to produce a cortical seizure accompanied by convulsions. While the use of ECT peaked in the 40s and 50s, there has been a recent resurgence in this therapy.

29. Biomedical Therapies con’t
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Biomedical Therapies con’t
2. Electroconvulsive therapy (ECT)
administration of a bilateral or unilateral electric shock to produce a cortical seizure
Used w/ unipolar and bipolar disorders
may increase responsiveness, therefore, allowing use of other treatments
Noted side effects:
memory loss
hippocampus and amygdala damage in animals
peaked in 40s and 50s; a recent resurgence

30. Biomedical Therapies con’t
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Biomedical Therapies con’t
3. Psychosurgery
surgery designed to alter the behavior of profoundly disturbed patients by lesioning a portion of the brain
Example: prefrontal lobotomy
Historic case: Phineous Gage
1848
Psychosurgery roots
Trephining

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Science “off track”
Transorbital or "ice pick" lobotomy – a crude and destructive brain-scrambling operation performed on thousands of psychiatric patients between the 1930s and 1960s
Touted as a cure for mental illness.
Walter J. Freeman performs a lobotomy in (Bettmann/corbis)
By Sandra G. Boodman
Washington Post Staff Writer January 15, 2008

32. II. Current Trends & Issues in Treatment
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II. Current Trends & Issues in Treatment
Managed care
Empirically validated treatments
Blending Approaches to treatment
Multicultural sensitivity
Deinstitutionalization (1963)
Revolving door problem
Homelessness
Many clinicians and their clients believe that 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. Managed care involves a tradeoff: consumers pay lower prices but give up freedom to choose providers and obtain whatever treatments they believe necessary. Further, in the mental health domain, the question of what is “medically necessary” is more ambiguous.
One response to the demands of managed care has been to increase research efforts to validate the efficacy of specific treatments for specific problems. While this seems to be a step in the right direction, there are concerns in some quarters primarily regarding the inability of empirical studies to capture the complexity of the real world or the flexibility with which therapists must practice their craft. Some argue that the movement toward empirically supported treatment runs counter to the eclectic blending of therapeutic approaches, which current studies suggest has merit.
Combinations of insight, behavioral, and biomedical therapies are often used today in the treatment of psychological disorders, as many modern therapists are eclectic.
The highly-culture bound origins of Western therapies have raised doubts about their applicability to other cultures and even ethnic groups in Western society.
Deinstitutionalization refers to the movement away from inpatient treatment in mental hospitals to more community based treatment. The negative effects of mental hospitals have fueled this movement, as has the ability to treat serious mental problems with effective drug therapy, and long-term hospitalization for mental disorders is largely a thing of the past.
Unfortunately, many people with serious mental problems receive short-term inpatient treatment, are sent back to communities that aren’t prepared to provide adequate outpatient care, and end up back in inpatient treatment; the revolving door problem. Some researchers argue that this has significantly increased homelessness, while others see the homelessness problem as primarily an economic one.

33. Finish your cards & study for the test! 100 multiple choice questions
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THE END!
Finish your cards & study for the test!
100 multiple choice questions
& a free response