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Therapy
Chapter 17
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History of Insane Treatment
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Maltreatment of the insane throughout the ageswas the result of irrational views. Many patients
were subjected to strange, debilitating, and
downright dangerous treatments.
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History of Insane Treatment
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Philippe Pinel in France and Dorthea Dix inAmerica founded humane movements to care
for the mentally sick.
http://wwwihm.nlm.nih.gov
Philippe Pinel (1745-1826) Dorthea Dix (1745-1826)
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Therapies
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Psychotherapy involves an emotionallycharged, confiding interaction between a
trained therapist and a mental patient.
Biomedical therapy uses drugs or otherprocedures that act on the patients nervoussystem, curing him or her of psychological
disorders.An eclectic approach uses various forms of
healing techniques depending upon the clientsunique problems.
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Psychological Therapies
We will look at four major forms ofpsychotherapies based on different theories of
human nature:
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1. Psychoanalytical theory
2. Humanistic theory
3. Behavioral theory4. Cognitive theory
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Psychoanalysis
The first formal psychotherapy to emerge waspsychoanalysis, developed by Sigmund Freud.
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Sigmund Freud's famous couch
EdmundEngleman
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Psychoanalysis: Aims
Since psychological problems originate fromchildhood repressed impulses and conflicts, the
aim of psychoanalysis is to bring repressed
feelings into conscious awareness where thepatient can deal with them.
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When energy devoted to id-ego-superegoconflicts is released, the patients anxietylessens.
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Psychoanalysis: Methods
Dissatisfied with hypnosis, Freud developedthe method of free association to unravel the
unconscious mind and its conflicts.
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The patient lies on a couch and speaks aboutwhatever comes to his or her mind.
http://www.english.upenn.edu
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Psychoanalysis: Methods
During free association, the patient edits histhoughts, resisting his or her feelings to expressemotions. Such resistance becomes important in
the analysis of conflict-driven anxiety.
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Eventually the patient opens up and reveals his
or her innermost private thoughts, developingpositive or negative feelings (transference)towards the therapist.
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Psychoanalysis: Criticisms
1. Psychoanalysis is hard to refute because itcannot be proven or disproven.
2. Psychoanalysis takes a long time and is very
expensive.
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Psychodynamic Therapies
Influenced by Freud, in a face-to-face setting,psychodynamic therapists understand
symptoms and themes across important
relationships in a patients life.
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Psychodynamic Therapies
Interpersonal psychotherapy, a variation ofpsychodynamic therapy, is effective in treatingdepression. It focuses on symptom relief here
and now, not an overall personality change.
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Humanistic Therapies
Humanistic therapists aim to boost self-fulfillment by helping people grow in self-
awareness and self-acceptance.
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Person-Centered Therapy
Developed by Carl Rogers, person-centeredtherapy is a form of humanistic therapy.
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The therapist listens to the needs of the patientin an accepting and non-judgmental way,
addressing problems in a productive way andbuilding his or her self-esteem.
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Humanistic Therapy
The therapist engages in active listening andechoes, restates, and clarifies the patients
thinking, acknowledging expressed feelings.
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Behavior Therapy
Therapy that applies learning principles to theelimination of unwanted behaviors.
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To treat phobias or sexual disorders, behaviortherapists do not delve deeply below the
surface looking for inner causes.
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Classical Conditioning Techniques
Counterconditioning is a procedure thatconditions new responses to stimuli that trigger
unwanted behaviors.
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It is based on classical conditioning andincludes exposure therapy and aversive
conditioning.
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Exposure Therapy
Expose patients tothings they fear and
avoid. Throughrepeated exposures,anxiety lessens
because they habituate
to the things feared.
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Exposure Therapy
Exposure therapy involves exposing people tofear-driving objects in real or virtual
environments.
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Systematic Desensitization
A type of exposure therapy that associates apleasant, relaxed state with gradually increasing
anxiety-triggering stimuli commonly used to
treat phobias.
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Aversive Conditioning
A type ofcounterconditioning
that associates anunpleasant state with
an unwanted behavior.With this technique,
temporaryconditioned aversion
to alcohol has beenreported.
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Operant Conditioning
Operant conditioning procedures enabletherapists to usebehavior modification, inwhich desired behaviors are rewarded and
undesired behaviors are either unrewarded orpunished.
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A number of withdrawn, uncommunicative3-year-old autistic children have been
successfully trained by giving and withdrawingreinforcements for desired and undesired
behaviors.
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Token Economy
In institutional settings therapists may create atoken economy in which patients exchange atoken of some sort, earned for exhibiting the
desired behavior, for various privileges ortreats.
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Cognitive Therapy
Teaches people adaptive ways of thinking andacting based on the assumption that thoughtsintervene between events and our emotional
reactions.
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Cognitive Therapy for Depression
Aaron Beck (1979) suggests that depressedpatients believe that they can never be happy
(thinking) and thus associate minor failings (e.g.
failing a test [event]) in life as major causes fortheir depression.
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Beck believes that cognitions such as I can never
be happy need to change in order for depressedpatients to recover. This change is brought about
by gently questioning patients.
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Cognitive Therapy for Depression
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Rabin et al., (1986)trained depressedpatients to record
positive events each day,and relate how theycontributed to theseevents. Compared to
other depressed patients,trained patients showedlower depression scores.
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Cognitive-Behavior Therapy
Cognitive therapists often combine the reversalof self-defeated thinking with efforts to modify
behavior.
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Cognitive-behavior therapy aims to alter theway people act (behavior therapy) and alter the
way they think (cognitive therapy).
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Group Therapy
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Group therapy normally consists of 6-9 peopleattending a 90-minute session that can help
more people and costs less. Clients benefit from
knowing others have similar problems.
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Family Therapy
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Family therapytreats the family as a system.Therapy guides family members toward
positive relationships and improved
communication.
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Evaluating Therapies
Who do people turn to for help withpsychological difficulties?
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Evaluating Psychotherapies32
Within psychotherapies cognitive therapies aremost widely used, followed by psychoanalytic
and family/group therapies.
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Is Psychotherapy Effective?
It is difficult to gauge the effectiveness ofpsychotherapy because there are different levelsupon which its effectiveness can be measured.
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1. Does the patient sense improvement?
2. Does the therapist feel the patient has improved?
3. How do friends and family feel about thepatients improvement?
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Clients Perceptions
If you ask clients about their experiences ofgetting into therapy, they often overestimate itseffectiveness. Critics however remain skeptical.
1. Clients enter therapy in crisis, but crisis maysubside over the natural course of time
(regression to normalcy).2. Clients may need to believe the therapy was
worth the effort.
3. Clients generally speak kindly of their therapists.
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Clinicians Perceptions
Like clients, clinicians believe in therapyssuccess. They believe the client is better off aftertherapy than if the client had not taken part in
therapy.
1. Clinicians are aware of failures, but they believefailures are the problem of other therapists.
2. If a client seeks another clinician, the formertherapist is more likely to argue that the client has
developed another psychological problem.
3. Clinicians are likely to testify to the efficacy oftheir therapy regardless of the outcome oftreatment.
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Outcome Research
How can we objectively measure theeffectiveness of psychotherapy?
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Meta-analysis of a number of studies suggeststhat thousands of patients benefit more from
therapy than those who did not go to therapy.
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Outcome Research
Research shows that treated patients were 80%better than untreated ones.
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The Relative Effectiveness of DifferentTherapies
Which psychotherapy would be most effectivefor treating a particular problem?
Disorder TherapyDepression Behavior, Cognition, Interpersonal
Anxiety Cognition, Exposure, Stress Inoculation
Bulimia Cognitive-behavior
Phobia Behavior
Bed Wetting Behavior Modification
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Evaluating Alternative Therapies
Lilienfeld (1998) suggests comparing scientifictherapies against popular therapies throughelectronic means. The results of such a search
are below:
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Eye Movement Desensitization andReprocessing (EMDR)
In EMDR therapy, the therapist attempts tounlock and reprocess previous frozen traumatic
memories by waving a finger in front of the
eyes of the client.
EMDR has not held up under scientific testing.
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Light Exposure Therapy
Seasonal AffectiveDisorder (SAD), a
form of depression,
has been effectivelytreated by lightexposure therapy. This
form of therapy has
been scientificallyvalidated.
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Commonalities AmongPsychotherapies
Three commonalities shared by all forms ofpsychotherapies are the following:
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1. A hope fordemoralized people.
2. A new perspective.
3. An empathic, trustingand caringrelationship.
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Culture and Values in Psychotherapy
Psychotherapists may differ from each otherand from clients in their personal beliefs,
values, and cultural backgrounds.
A therapist search should include visiting twoor more therapists to judge which one makes
the client feel more comfortable.
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Therapists & Their Training
Clinical psychologists: They have PhDs mostly.They are experts in research, assessment, and
therapy, all of which is verified through asupervised internship.
Clinical or Psychiatric Social Worker:They havea Masters of Social Work. Postgraduate
supervision prepares some social workers to
offer psychotherapy, mostly to people witheveryday personal and family problems.
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Therapists & Their Training
Counselors:Pastoral counselors or abusecounselors work with problems arising from
family relations, spouse and child abusers and
their victims, and substance abusers.
Psychiatrists:They are physicians whospecialize in the treatment of psychological
disorders. Not all psychiatrists have extensivetraining in psychotherapy, but as MDs they canprescribe medications.
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The Biomedical Therapies
These include physical, medicinal, and otherforms of biological therapies.
1. Drug Treatments
2. Surgery
3. Electric-shock therapy
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Drug Therapies
Psychopharmacology is the study of drug effectson mind and behavior.
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With the advent of drugs, hospitalization in mental
institutions has rapidly declined.
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Drug Therapies
However, many patients are left homeless on thestreets due to their ill-preparedness to cope
independently outside in society.
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Double-Blind Procedures
To test the effectiveness of a drug, patients aretested with the drug and a placebo. Two groups of
patients and medical health professionals are
unaware of who is taking the drug and who istaking the placebo.
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Schizophrenia Symptoms
Inappropriate symptomspresent (positive
symptoms)
Appropriate symptomsabsent (negative
symptoms)
Hallucinations,disorganized thinking,
deluded ways.
Apathy, expressionlessfaces, rigid bodies.
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Antipsychotic Drugs
Classical antipsychotics [Chlorpromazine(Thorazine)]: Remove a number of positive
symptoms associated with schizophrenia such
as agitation, delusions, and hallucinations.
Atypical antipsychotics [Clozapine (Clozaril)]:Remove negative symptoms associated with
schizophrenia such as apathy, jumbled thoughts,concentration difficulties, and difficulties in
interacting with others.
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Atypical Antipsychotic
Clozapine (Clozaril) blocks receptors fordopamine and serotonin to remove the negative
symptoms of schizophrenia.
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Antianxiety Drugs
Antianxiety drugs (Xanax and Ativan) depress thecentral nervous system and reduce anxiety and tension
by elevating the levels of the Gamma-aminobutyric acid(GABA) neurotransmitter.
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Antidepressant Drugs
Antidepressant drugs like Prozac, Zoloft, and Paxil areSelective Serotonin Reuptake Inhibitors (SSRIs) that
improve the mood by elevating levels of serotonin byinhibiting reuptake.
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Mood-Stabilizing Medications
Lithium Carbonate, a common salt, has been usedto stabilize manic episodes in bipolar disorders. It
moderates the levels of norepinephrine and
glutamate neurotransmitters.
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Brain Stimulation
Electroconvulsive Therapy(ECT)
ECT is used for severely
depressed patients who donot respond to drugs. Thepatient is anesthetized and
given a muscle relaxant.
Patients usually get a 100volt shock that relieves
them of depression.
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Alternatives to ECT
Transcranial MagneticStimulation (TMS)
In TMS, a pulsatingmagnetic coil is placedover prefrontal regions
of the brain to treat
depression withminimal side effects.
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Psychosurgery
Psychosurgery waspopular even inNeolithic times.
Although used sparinglytoday, about200 such operations do
take place in the US
alone.
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Psychosurgery
Psychosurgery is used as a last resort inalleviating psychological disturbances.
Psychosurgery is irreversible. Removal of brain
tissue changes the mind.
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Psychosurgery
Modern methods usestereotactic
neurosurgery andradiosurgery (Laksell,1951) that refine older
methods ofpsychosurgery.
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Preventing Psychological Disorders
It is better to prevent than cure.Peruvian Folk Wisdom
Preventing psychological disorders meansremoving the factors that affect society. Those
factors may be poverty, meaningless work,
constant criticism, unemployment, racism, andsexism.
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Psychological Disorders areBiopsychosocial in Nature