1. Copyright © Allyn & Bacon 2007 Chapter 13 Therapies for Psychological Disorders This multimedia product and its contents are protected under copyright law. The following are prohibited by law: Any public performance or display, including transmission of any image over a network; Preparation of any derivative work, including the extraction, in whole or in part, of any images Any rental, lease or lending of the program. ISBN: 0-131-73180-7

2. Copyright © Allyn & Bacon 2007 Therapy for psychological disorders takes a variety of forms, but all involve some relationship focused on improving a persons mental, behavioral, or social functioning What is Therapy?

3. Copyright © Allyn & Bacon 2007 What is Therapy? Therapy – General term for any treatment process; in psychology and psychiatry, therapy refers to a variety of psychological and biomedical techniques aimed at dealing with mental disorders or coping with problems of living

4. Copyright © Allyn & Bacon 2007 The Components of Therapy In addition to the relationship between the therapist and the patient/client, the therapeutic process typically involves 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

5. Copyright © Allyn & Bacon 2007 Contemporary Approaches to Therapy Psychological therapies – Based on psychological principles (rather than biomedical approach) The psychological therapies are often collectively called psychotherapy

6. Copyright © Allyn & Bacon 2007 Contemporary Approaches to Therapy Biomedical therapies – Treatments that focus on altering the brain, especially with drugs, psychosurgery, or electroconvulsive therapy

7. Copyright © Allyn & Bacon 2007 Types of Mental Health Care Professionals Counseling psychologist Clinical psychologist Psychoanalyst Clinical social worker Psychiatrist Psychiatric nurse practitioner Pastoral counselor

8. Copyright © Allyn & Bacon 2007 Specialty: Problems of normal living Work setting: Schools, clinics, other institutions Credentials: Masters in counseling, PhD, EdD, or PsyD Professional Title Counseling psychologist Clinical psychologist Psychoanalyst Clinical social worker Psychiatrist Psychiatric nurse practitioner Pastoral counselor

9. Copyright © Allyn & Bacon 2007 Specialty: Those with severe disorders Work setting: Private practice, mental health agencies, hospitals Credentials: PhD or PsyD Professional Title Counseling psychologist Clinical psychologist Psychoanalyst Clinical social worker Psychiatrist Psychiatric nurse practitioner Pastoral counselor

10. Copyright © Allyn & Bacon 2007 Specialty: Severe mental disorders (often by means of drug therapies) Work setting: Private practice, clinics, hospitals Credentials:MD Professional Title Counseling psychologist Clinical psychologist Psychoanalyst Clinical social worker Psychiatrist Psychiatric nurse practitioner Pastoral counselor

11. Copyright © Allyn & Bacon 2007 Specialty: Freudian therapy Work setting: Private practice Credentials:MD Professional Title Counseling psychologist Clinical psychologist Psychoanalyst Clinical social worker Psychiatrist Psychiatric nurse practitioner Pastoral counselor

12. Copyright © Allyn & Bacon 2007 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 Psychoanalyst Clinical social worker Psychiatrist Psychiatric nurse practitioner Pastoral counselor

13. Copyright © Allyn & Bacon 2007 Specialty: Social worker with specialty in dealing with mental disorders Work setting: Often employed by government Credentials:MSW Professional Title Counseling psychologist Clinical psychologist Psychoanalyst Clinical social worker Psychiatrist Psychiatric nurse practitioner Pastoral counselor

14. Copyright © Allyn & Bacon 2007 Specialty: Combines spiritual guidance with practical counseling Work setting: Religious order or ministry Credentials:Varies Professional Title Counseling psychologist Clinical psychologist Psychoanalyst Clinical social worker Psychiatrist Psychiatric nurse practitioner Pastoral counselor

15. Copyright © Allyn & Bacon 2007 Psychologists employ two main forms of treatment: the insight therapies and the behavioral therapies How Do Psychologists Treat Mental Disorders?

16. Copyright © Allyn & Bacon 2007 Insight Therapies Insight therapies – Psychotherapies in which the therapist helps patients/clients understand (gain insight into) their problems Freudian psychoanalysis Cognitive therapies Humanistic therapies Neo-Freudian therapies Group therapies

17. Copyright © Allyn & Bacon 2007 Insight Therapies Talk therapies – Psychotherapies that focus on communicating and verbalizing emotions and motives to understand their behavior

18. Copyright © Allyn & Bacon 2007 Insight Therapies Psychodynamic therapies – Insight therapies based on the assumption that mental disorder is caused by powerful (dynamic) mental forces and conflicts

19. Copyright © Allyn & Bacon 2007 Insight Therapies: Psychodynamic Therapies Psychoanalysis – The form of psychodynamic therapy developed by Sigmund Freud Analysis of transference – Analyzing and interpreting the patients relationship with the therapist, based on the assumption that this relationship mirrors unresolved conflicts in the patients past

20. Copyright © Allyn & Bacon 2007 Insight Therapies: Psychodynamic Therapies Neo-Freudian psychodynamic therapies – Therapies developed by psychodynamic theorists who embraced some of Freuds ideas, but disagreed with others

21. Copyright © Allyn & Bacon 2007 Insight Therapies: Humanistic therapies Humanistic therapies – Techniques based on the assumption that people have a tendency for positive growth and self actualization, which may be blocked by an unhealthy environment Client-centered therapy – Emphasizes healthy psychological growth through self-actualization Reflection of feeling – Paraphrasing clients words to capture the emotional tone expressed

22. Copyright © Allyn & Bacon 2007 Insight Therapies: Cognitive therapies Cognitive therapy – Emphasizes rational thinking as the key to treating mental disorder Cognitive therapy for depression involves Evaluating evidence Situational factors Alternative solutions

23. Copyright © Allyn & Bacon 2007 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 organized/run by laypersons (not professional therapists)

24. Copyright © Allyn & Bacon 2007 Insight Therapies: Group therapies For many issues, couples counseling or family therapy can often be more effective than individual therapy with one individual at a time

25. Copyright © Allyn & Bacon 2007 Systematic desensitization Token economies Contingency management Aversion therapy Participant modeling Behavior Therapies Behavior therapy – Any form of psychotherapy based on the principles of behavioral learning, especially operant conditioning and classical conditioning

26. Copyright © Allyn & Bacon 2007 Classical Conditioning Therapies Systematic desensitization – Technique in which anxiety is extinguished by exposing the patient to an anxiety-provoking stimulus Exposure therapy – Desensitization therapy in which patient directly confronts the anxiety-provoking stimulus (as opposed to imagining it)

27. Copyright © Allyn & Bacon 2007 UCS (foul odor) UCR (nausea) CR CS (cigarette smoke) Classical Conditioning Therapies Aversion therapy – Involves presenting individuals with an attractive stimulus paired with unpleasant stimulation in order to condition a repulsive reaction

28. Copyright © Allyn & Bacon 2007 Operant Conditioning Therapies Contingency management – Approach to changing behavior by altering the consequences, especially rewards and punishments, of behavior

29. Copyright © Allyn & Bacon 2007 Operant Conditioning Therapies Token economies – Applied to groups (e.g. classrooms, mental hospital wards) involving distribution of tokens contingent on desired behaviors; tokens can later be exchanged for privileges, food, or other reinforcers

30. Copyright © Allyn & Bacon 2007 Participant Modeling: An Observational-Learning Therapy Participant modeling – Therapist demonstrates and encourages a client to imitate a desired behavior

31. Copyright © Allyn & Bacon 2007 Cognitive-Behavioral Therapy: A Synthesis Cognitive-behavioral therapy Combines cognitive emphasis on thoughts with behavioral strategies that alter reinforcement contingencies Assumes irrational self-statements cause maladaptive behavior Seeks to help the the client develop a sense of self-efficacy

32. Copyright © Allyn & Bacon 2007 Cognitive-Behavioral Therapy: A Synthesis Rational-emotive behavior therapy – Based on the idea that irrational thoughts and behaviors are the cause of mental disorders (REBT)

33. Copyright © Allyn & Bacon 2007 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

34. Copyright © Allyn & Bacon 2007 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

35. Copyright © Allyn & Bacon 2007 How Is the Biomedical Approach Used to Treat Mental Disorders? Biomedical therapies seek to treat mental disorders by changing the brains chemistry with drugs, its circuitry with surgery, or its patterns of activity with pulses of electricity or powerful magnetic fields

36. Copyright © Allyn & Bacon 2007 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

37. Copyright © Allyn & Bacon 2007 Drug Therapy Antipsychotic drugs Include chlorpromazine, haloperidol, and clozapine Usually affect dopamine pathways May have side effects Tardive dyskinesia – Incurable disorder of motor control resulting from long-term use of antipsychotic drugs

38. Copyright © Allyn & Bacon 2007 Drug Therapy Antidepressants and mood stabilizers Include Prozac, monoamine oxidase (MOA) inhibitors, and lithium carbonate (effective against bipolar disorder) Treat depression and bipolar disorder Usually affect serotonin and/or norepinephrine The use of antidepressants to deal with general feelings of unease is highly controversial

39. Copyright © Allyn & Bacon 2007 Drug Therapy Antianxiety drugs Include barbiturates and benzodiazepines May include some antidepressant drugs which work on certain anxiety disorders Should not be used to relieve ordinary anxieties of everyday life Should not be taken for more than a few days at a time Should not be combined with alcohol

40. Copyright © Allyn & Bacon 2007 Drug Therapy Stimulants suppress activity level in persons with attention- deficit/hyperactivity disorder (ADHD) There is controversy from concern that the causes and boundaries of ADHD are vague and the potential exists for overdiagnosis

41. Copyright © Allyn & Bacon 2007 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

42. Copyright © Allyn & Bacon 2007 Brain-Stimulation Therapies Electroconvulsive therapy is used for the treatment of severe depression Transcranial magnetic stimulation, a possible alternative to ECT, can also be used for the treatment of depression, schizophrenia, and bipolar disorder

43. Copyright © Allyn & Bacon 2007 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

44. Copyright © Allyn & Bacon 2007 Hospitalization and the Alternatives Community mental health movement – Effort to deinstitutionalize mental patients and to provide therapy from outpatient clinics

45. Copyright © Allyn & Bacon 2007 End of Chapter 13