1. PSYCHOTHERAPY AND BEHAVIOR MODIFICATION GROUP 8 Geronimo, Cherry P. Geronimo, Maria Angelica M. Geronimo, Ralph Ernesto R. Go, Camille Marie A. Go, Crystal Karen O. Go, Ferranti D. Go, Jill Irvette C.

2. MENTAL SICKNESS

3. Mental Sickness: How is psychological illness or mental illness different from physiological illness?

4. Europe –Middle Ages: mixture of the divine, diabolical, magical and humoral been victims of the witch-hunts –18 th Century: Madness - organic physical phenomenon Asylum care Moral treatment movement – end of 18 th century

5. –19 th Century: Industrialization and population growth classification schemes and diagnostic terms term psychiatry was coined medical superintendents – alienists –20 th Century: Development of psychoanalysis Kraepelin's classification scheme Asylum “inmates” – “patients” asylums - hospitals

6. Anti-psychiatry psychiatrists –Concept of mental illness is completely invalid –Social maladjustments: Behavior of non-conformist individual Demands of social system –Modern Social System unable to deal with individual differences

7. Ken Kesey’s One Flew Over the Cuckoo’s Nest –The individuals are not sick, just the system Richard M. Restak (Pre-Meditated Man) –“Most problems in bioethics are not really ethical, but political”

8. Mental Illness –Behavioral dysfunction: Caused by organic and physiological defects Not just CNS lesions May be genetic –Faulty development and use of human cognitive and affective capacities

9. Medical Model Psychiatric care that is impossible without hospitalization Extreme caution: –Protect patient’s human rights –Right of treatment –Right to refuse some forms of treatment Effort to help patients develop skills to cope

10. Medical Model Psychotherapy is different than those used in physical disease –Talking and guiding in recalling and reenacting past experiences –Education or reeducation –Mentally disturbed person has at least some capacities for normal mental life: Not properly developed Malfunctioning Poorly used - fears and perceptions about the reality

11. PSYCHOTHERAPEUTIC METHODS AND GOALS

12. Psychotherapy Interpersonal relationship between a Psychotherapist and a client/patient It deals with psychic processes less conscious Basic goals: –Increase patient’s well-being –Behavior change –Improve mental health

13. Mental Health Psychological freedom based on realistic perception and understanding of the world Involves self-understanding, self-consistency and self-control

14. Mental Health Is a prior condition requisite for dealing with ethical problems of moral right and wrong, since only to the degree that a person is free can there be the possibility of moral choice and moral responsibility

15. Psychotherapeutic Methods Overlap but based on different theoretical and clinical sources Not necessarily contradictory Insight TherapyAction Therapy

16. Psychotherapeutic Methods Insight TherapyAction Therapy Psychoanalytical School of Thought (S. Freud) Deterministic assumption Aims to help patient understand and their own behavior (“have insight into”) Make the unconscious conscious and strengthen the ego (Free Association) Behaviorist School of Thought (B.F. Skinner) Person is the producer and the product of his/her environment Deals with current problems and factors influencing them Remove undesirable behavior patterns and developing new ones (Operant Conditioning)

17. Goals of Therapy Relief of undesirable symptoms (e.g., excessive anxiety) Increased productivity in the person’s work Adjustment and satisfaction in sexual relations Better interpersonal relations Increased ability to endure the stresses of life

18. Success of Therapy (Robert Harper) The patient’s weak ego is supported by the therapist’s stronger ego The patient’s lack of realism is corrected by the therapist’s more realistic attitude The patient’s comes to see that many things he or she fears are not so terrible The patient learns to be more patient in solving problems, and less impulsive and panicky

19. Success of Therapy (Robert Harper) The patient acquires a greater or new faith or “life-myth” from the example of the therapist, who represents a hope for health The patients gets a more objective perspective on his or her problems from discussing them with the therapist or with a therapy group The patient focuses his or her floating anxieties on the outcome of the therapy process, so as to feel less isolated and helpless

20. Limitations and Criticism of the Insight Therapy No clear record of efficiency Time-consuming and expensive No objective proof of therapeutic success (ex. Projective tests) Therapeutic success mainly dependent upon the personal relation with the therapist who is sensitive, realistic and caring person (Transference) Failure in establishing client/patient autonomy/self-reliance

21. HUMAN FREEDOM

22. How free are we?

23. Freedom No human being is totally free We are limited by –Innate biological structure –Unconscious conditioning of the mind –One’s knowledge of the world and the self http://riponpolitics.files.wordpress.com/2009/03/freedom.jpg

24. Psychotherapy Deals with limitations on human freedom that arise from the level of unconscious conditioning www.cartoonstock.com/directory/p/psychotherapist

25. Psychotics vs Neurotics Psychotics Area of freedom is limited in the psychotic Have some areas of freedom reached Schizophrenia, bipolar disorders, psychoactive drugs Neurotics More free Have some areas of unfreedom that do not occur in normal persons Obsessive compulsive, phobias, severe anxiety

26. Normal Person Also has limited area of freedom Limits lie near the level of necessary determinisms of automatic and routine behavior compatible with normal freedom http://www.psychologytoday.com/files/u89/psychotherapy.jpg

27. Psychotherapy Deals with neuroses of emptiness or lack of meaning as a result of society’s failure to recognize the aspects of personhood Awakens the person’s full capacity for freedom Psychotherapists –Act as a catalyst in liberating the creative potentials for life inherent in their patients, potentials that are blocked by certain pathologies Freedom in Psychotherpy Susan K. Deri, Ph.D. http://www.pep- web.org/document.php?id=PSAR.048C.0097A

28. Freedom and Society Trust between persons and society Mental illness is in part a disturbance of social relations Group therapy –learning social communication skills Family therapy Issues: confidentiality and adequate professional control http://www.birchmore.org/html/shame.html&usg

29. ETHICAL ISSUES IN PSYCHOTHERAPY

30. Punishment Reject psychotherapy as punishment Some neurotic px may perceive it as such

31. Punishment Penological reform by the court –Decide first on the facts of criminal action –Secondly: moral responsibility of the person –* Moral freedom can be destroyed by mental confusion Based on expert testimony from psychiatrist –Should be directed to determining the defendant’s freedom limited by the psychological factors –Why the accused chronic or temporary psychological condition did or did not render him so unfree –Whether he cant be held responsible for the act –If he is partially responsible, in what degree or in what respect

32. It is unjust to punish someone for acts for which he or she was not MORALLY responsible

33. Role of the psychiatrist in the process of punishment –Limited to 2: 1. diagnose inmates who develop mental illness and thus treatment 2. As consultants to penologists in setting up routines that make good for mental health and discipline

34. Informed consent Issue of comptency Mentall disturbed pxs: –Unable to understand the risk or purpose of treament –May not be truly free to make a decision Fear Masochistic tendecies (desire to suffer or to be humiliated) Narcississm

35. Informed consent If impossible for the patients: patient’s guardian with observance of legal process Treatment without consent: –Must have the objective to bring the patient as as soon as possible to the level of mental integration Use of drugs or psychosurgery

36. Transference Primarily in therapy Termination of therapy: patient is sufficiently autonomous and under self control Issue of responsibility by the therapist –Must be trustworthy –Maintain secrecy –True concern for the px –Prompt in appoinments *avoid manipulating the patient for personal gratification

37. Abreaction The expression and consequent release of a previously repressed emotion, achieved by reliving the experience that caused it

38. Dangers –Former tempations and sins –Illicit sexual activity –Hostility and destruction

39. “ Is it legitimate to put oneself in the “occasion of sin” where sinful consent is possible?”

40. Purpose –To return to some error of the past where the patient failed to resolve a problem correctly and to help the patient now face it in a clearer light.

41. VALUE SYSTEMS

42. ChangeAdjust X Except: Underlying disorder Superego

43. Reinforced in therapy More trustful More honest More hopeful More courageous More patient More realistic

44. Therapist: Extend area of freedom Give ethical advice X

45. Psychoanalysis and Hedonism Pleasure (in the sense of desire gratification) is the highest good and proper aim of human life

46. Problems Philip Reiff –Built in system of values and ideology that it inculcates? –Product of middle class in opulent capitalist countries?

47. Freud Saw all of of civilization as the imposition of social controls on man’s infinite and even contradictory drives. Repressive control Explosive drive

48. Reiff Autonomous Hedonistic Goalless Conscienceless Selfish Loveless Empty Emphasis: Social life is always repression, not fulfillment of fundamental human needs.

49. Social conscience Purification of theory, training and practice Higher social and spiritual goals Trust therapists as with limited skills Also receive guidance from others Therapists:Clients:

50. BEHAVIOR CONTROL

51. Any medically intended therapy, with or without a person’s consent, to cause a person to discontinue a personally and socially undesirable activity

52. BEHAVIOR CONTROL Therapeutic purpose

53. ETHICAL ISSUES GOVERNING BEHAVIOR CONTROL No form of treatment may be used that will destroy human freedom The benefit to the patient must be the purpose of the action

54. ETHICAL ISSUES GOVERNING BEHAVIOR CONTROL Long term effect of the treatment must be considered as well as the short-term alleviation of some particular difficulty Rules of free and informed consent apply, including the right to refuse treatment

55. ETHICAL ISSUES GOVERNING BEHAVIOR CONTROL Professional confidentiality applies Experimental research should conform to the norms of human experimantation

56. ETHICAL ISSUES GOVERNING BEHAVIOR CONTROL Human betterment or human improvement is ethically acceptable and beneficial Care is required in the use of any behavior-modifying substance

57. ADDICTION

58. Definition Habituation to some harmful practice Usually refers to habituation to drugs, but can also be addicted to other substances or activities.

59. Effects of Addiction Many people use all these things in ways that do not destroy human equilibrium But some persons become addicted to them so that their whole life is more and more absorbed by a single activity that distorts the personality and consumes physical and psychic energy Results in being self-centered, personality deterioration, and inability to communicate with others

60. Hedonsim Philosophy which argues that pleasure has an ultimate importance and is the most important pursuit of humanity A component of chemical addiction Being used as an excuse by chemically addicted persons because they lack healthy pleasures in their lives

61. In the face of difficulty of life, the chemically dependent person runs away from the loss of normal satisfaction and achievement by indulging in the physical pleasure, relaxation, and euphoria of the addicting experience.

62. The search for pleasure alone does not constitute addiction, but rather the increasing sense of guilt and helplessness that begin to accompany each overindulgence.

63. A common feature of addicted persons is excessive dependency needs Chemical dependency can affect people of all backgrounds often the gifted, talented, wealthy, and successful.

64. Classification of Addiction Physiological Addiction –Causes modification or need in the addict’s physiological system, usually requires increasing doses of the addicting substance to obtain the same physiologic effect –Example: Drugs (Heroin, Marijuana) Medications (Pain killers)

65. Classification of Addiction Psychological Dependency –Results from a learned conditioned behavior pattern that leads the victim to anticipate the pleasure and release of tension –Example: Gambling Internet Addiction

66. Solutions Voluntary acts must be distinguished from free acts Addictive behavior is voluntary in the sense that it proceeds from an inner compulsion but it always involves a restriction of freedom since the addict becomes less and less able to perceive alternatives of action or to choose among them.

67. Solutions An important part of therapy is to get addicts to accept moral responsibility for the harm they have done to themselves and others.

68. Solutions The real moral responsibility of the addicted person lies in the obligation to ask and receive help from others when this is offered since therapy cannot be effective until the addict accepts help. Students of addiction emphasize that the earlier the addiction therapy takes place, the better

69. Solutions Family, friends, and co-workers can be both a positive and negative agent to the addict But these people can contribute to the problem by covering up, excusing, or attempting to endure addictive behavior, hoping that the addict will finally come to his/her senses

70. Solutions Intervention is best done by those who can be supportive rather than judgmental but who can also face the addict with detailed evidence of the seriousness of his/her condition.

71. Solutions Alcoholics Anonymous –Led the way in the most successful method of therapy for chemical dependency –Has always emphasized that the addict cannot recover without a reaching out for a Higher Power and willingness to repair damage done to others and to be of service to them, especially to fellow victims of addiction

72. CONCLUSION

73. Simply because one has ethical goals does not mean that one will always use ethical means to reach those goals. Psychotherapy and behavior modification have the ethical goals of helping people overcome mental illness or harmful behavior.

74. Both forms of therapy must be analyzed carefully lest individuals rights be violated or the freedom of the person be weakened or destroyed. Care must be exercised when helping the mentally ill regain their health so that the person’s higher needs and functions are considered.

75. THANK YOU

76. References Corey, G(2005). Theory and Practice of Counseling and Psychotherapy. 7 th ed. Brooks/Cole – Thomson Learning. USA. p. 56, 69, 231, 236