1. The Treatment of Psychological Disorders

2. modern psychotherapy originated in systematic treatment (psychoanalysis) developed by Sigmund Freud now, three main categories of treatment: – insight therapies – behavior therapies – biomedical therapies

3. therapeutic triad: therapist, treatment, client 15% of U.S. population annually uses mental health services why? anxiety, depression, interpersonal relations, bad habits, poor self control, low self esteem, marital conflict, self doubt, emptiness, stagnation most common: anxiety and depression

4. PROVIDERS: friends, relatives, clergy: may help, but their advice does not qualify as therapy – requires professional treatment by someone with special training psychologists: clinical and counseling psychiatrists: physicians who specialize in the diagnosis and treatment of psychological disorders other mental health professionals: clinical social workers, psychiatric nurses, counselors

5. INSIGHT THERAPIES: involve verbal interactions intended to enhance client’s self- knowledge and thus promote healthful changes in personality and behavior psychoanalysis: an insight therapy developed by Freud that emphasized the recovery of unconscious conflicts, motives and defenses through techniques such as free association, dream analysis and transference

6. Freud: neurotic problems are caused by unconscious conflicts left over from early childhood – battles among id, ego and superego, usually over sexual and/or aggressive impulses – people depend on defense mechanisms to avoid confronting these conflicts, but this leads to self- defeating behavior and only partially successful in alleviating anxiety, guilt, and other distressing emotions

7. Freud’s therapeutic procedures: probe the unconsciousness, analyst as detective, using several techniques (1) free association: client spontaneously expresses thoughts and feelings exactly as they occur, with minimal censorship (2) dream analysis: therapist interprets symbolic meaning of client’s dreams (3) interpretation: therapist attempts to explain the inner significance of clients’ thoughts, memories and behaviors (4)resistance: largely unconscious defensive maneuvers intended to hinder the progress of therapy (5) transference: client unconsciously starts relating to therapist in ways that mimic critical relationships in the client’s life

8. MODERN PSYCODYNAMIC THERAPIES adaptations of classical psychoanalysis interpretation, resistance and transference continue to play key roles CLIENT-CENTERED THERAPY: insight therapy that emphasizes providing a supportive emotional climate for client, who plays a major role in determining the pace and direction of their own therapy

9. therapeutic climate: the process of therapy is les important than the climate – warm, supportive, accepting, safe – lack of threat reduces defensive tendencies 3 conditions: – genuineness (by therapist) – unconditional positive regard – empathy

10. therapeutic process: client and therapist work together as equals – therapist provides little guidance, minimal interpretation and guidance – therapist’s key task: provide feedback and clarification – highlight themes in rambling client discourse – like psychotherapy, seeks a major restructuring of client’s personality

11. positive psychology-inspired therapies positive psychology: uses theory and research to better understand the positive, adaptive, creative, and fulfilling aspects of human existence – critical of psychology’s traditional focus on pathology, weakness, suffering – emphasize health and resilience, contentment, well-being, human strength, positive emotions

12. well-being therapy: enhance client’s self- acceptance, purpose, autonomy, personal growth – success in treatment of mood and anxiety disorders positive psychotherapy: in treatment of depression, recognize strengths, appreciate blessings, emphasize positive experiences, forgiveness, finding meaning in life

13. group therapy: simultaneous treatment of several clients in a group – 4 to 12 participants – screened by therapist – participants function essentially as therapists for each other – describe problems, discus coping strategies – provide acceptance and emotional support – therapist promotes group cohesiveness, sets goals, models support, protects clients from harm – advantages: more affordable, clients learn their problems are not unique, practice social skills in safe environment

14. Efficacy of Insight Therapies spontaneous remission: recovery from a disorder without formal treatment efficacy depends on goals outcomes studies demonstrate that insight therapy is superior to no therapy, and that effects are reasonably durable roughly equal in efficacy to drug therapies

15. mechanism of action of insight therapies: – develop a therapeutic alliance with the professional helper – emotional support, empathetic understanding – cultivation of hope and positive expectations – provide a rationale for problems and a method for reducing them – opportunity to express feelings, confront problems, gain insight, learn new patterns of behavior

16. BEHAVIOR THERAPIES no attempt to achieve grand insight – considered unnecessary to produce constructive change – single goal: eliminate maladaptive behavior insight therapists treat pathological symptoms as signs of underlying problems, while behavioral therapists assume that the symptoms are the problem

17. behavior therapies: involve the application of learning principles to direct efforts to change clients’ maladaptive behaviors assumptions: – behavior is a product of learning – what has been learned can be unlearned through classical conditioning operant conditioning observational learning

18. Systematic Desensitization: reduce phobic clients’ anxiety responses through counterconditioning – assume that most anxiety responses are acquired through classical conditioning – goal: weaken the association between the conditioned stimulus and the conditioned response

19. counterconditioning: reverse the process of classical conditioning by pairing the stimulus with a new conditioned response 3 steps: – build an anxiety hierarchy list and then rank anxiety-arousing stimuli train in deep muscle relaxation work through hierarchy (least to most) while remaining relaxed – underlying principle: anxiety and relaxation are incompatible responses

20. aversion therapy: a behavior therapy in which an aversive stimulus is paired with a stimulus that elicits an undesirable response – most controversial – not widely used, only as a last resort, and usually combined with a larger treatment program – substance abuse, sexual deviance, gambling, shoplifting, stuttering, smoking, overeating

21. social skills training: a behavior therapy designed to improve interpersonal skills that emphasizes modeling, behavioral rehearsal, and shaping – used in treatment of autism, ADD, schizophrenia – based on principles of operant conditioning and observational learning – modeling: watch socially skilled people, acquire their skills – behavioral rehearsal: practice techniques in structured role play – shaping: gradually handle more complicated, delicate situations

22. cognitive therapy: use specific strategies to correct habitual thinking errors that underlie various types of disorders goal: change client’s negative thoughts and maladaptive beliefs

23. Cognitive Behavioral Treatments: use varied combinations of verbal interactions and behavior modification techniques to help clients change maladaptive patterns of thinking

24. Biomedical Therapies physiological interventions intended to reduce symptoms associated with psychological disorders treatment with drugs – antianxiety – antipsychotic – antidepressant – mood stabilizers – ECT – brain stimulation

25. antianxiety drugs: relieve tension, apprehension and nervousness

26. antipsychotic drugs: used to gradually reduce psychotic symptoms, including hyperactivity, mental confusion, hallucinations, delusions

27. antidepressant drugs: gradually elevate mood and help bring people out of a depression

28. mood stabilizing drugs: used to control mood swings in patients with bipolar mood disorders

29. electroconvulsive therapy (ECT): a biomedical treatment in which electric shock is used to produce a cortical seizure accompanied by convulsions

30. brain stimulation: – transcranial magnetic stimulation (TMS): a technique that permits scientists to temporarily enhance or depress activity in a specific area of the brain – deep brain stimulation (DBS): a thin electrode is surgically implanted in the brain, connected to an implanted pulse generator, so that various electrical currents can be delivered to brain tissue adjacent to the electrode

31. Current trends and issues in treatment transition from fee-for-service to managed care blended therapy: integrate various approaches

32. current trends, cont. cultural diversity institutionalization variety of therapeutic services