General Psychology

1
General Psychology

• Chapter 13
• Treatment and Therapy for the Psychological
  Disorders

2
A Historical Perspective

• Ancient Greeks and Romans
• Hippocrates
• Middle Ages
• First insane asylum in 1547 in London

3
A Historical Perspective

• Philippe Pinel Paris Moral treatment!
• Benjamin Rush American psychiatry
• Dorethea Dix (1802-1887) American nurse who
  campaigned for reform
• Clifford Beers book in 1908 credited as impetus
  for mental health movement

4
Psychosurgery

• Surgical procedures, usually directed at the
  brain, used to affect psychological reactions
• Split-brain procedure epilepsy
• Small lesions of limbic system violent
  behaviors
• Cingulotomy extreme anxiety and symptoms of
  obsessive-compulsive disorder
• Surgical techniques Parkinsons

5
Psychosurgery

• Lobotomy severs the major neural connections
  between the prefrontal lobes and the lower brain
  centers

6
Electroconvulsive TherapyECT

• ECT (shock treatment) involves passing an
  electric current between 70-150 volts across a
  patients head for a fraction of a second

7
Electroconvulsive TherapyECT

• Depression other symptoms
• No one knows exactly why it works
• No more than 10-12 treatments
• Unilateral ECT

8
Drug Therapy

• Antipsychotic drugs alleviate or eliminate
  psychotic symptoms
• Work by blocking receptor sites for the
  neurotransmitter dopamine.

9
Drug Therapy

• Antipsychotic drugs, cont.
• Most effective in treating the positive symptoms
  of schizophrenia (such as hallucinations and
  delusions)
• Clozapine is an exception, because it reduces
  negative symptoms, as well as positive ones

10
Drug Therapy

• Antidepressant drugs elevate the mood of
  persons who are feeling depressed, and there are
  3 major classes
• MAO (monoamine oxidase) inhibiters
• Tricyclics
• SSRIs (selective serotonin reuptake inhibitors)

11
Drug Therapy MAO Inhibiters

• Inhibit the enzyme monoamine oxidase, which
  normally breaks down levels of serotonin,
  norepinephrine, and dopamine in the brain
• Major drawback is that they can be toxic and
  interact with foods containing tyramine

12
Drug Therapy Tricyclics

• These drugs generally are safer and more
  effective that the older MAO inhibitors
• They affect the operation of the neurotransmitter
  serotonin

13
Drug Therapy SSRIs

• These drugs act faster to relieve symptoms and
  have fewer side effects
• Work by inhibiting the reuptake (or breaking
  down) of serotonin, increasing serotonin levels,
  which elevates mood
• Prozac, Zoloft, Luvox, and Paxil

14
Drug Therapy Antidepressants

• Drawbacks
• Usually take 2-4 weeks to show any effect, and
  may take 6 weeks to be effective
• Unpleasant side effects
• Lithium mood stabilizer most useful in
  controlling the manic stage of bipolar disorders

15
Anti-Anxiety Drugs

• Help reduce the felt aspect of anxiety
• Majority are benzodiazepines (e.g., Librium,
  Valium, and Xanax), which act directly on CNS
• Very effective and most commonly prescribed of
  all medications
• Dependency and addiction may develop
• Muscle relaxants (e.g., Miltown, Equanil)

16
Who Provides Psychotherapy?

• Clinical psychologist
• Psychiatrist
• Counseling psychologist
• Licensed professional counselor
• Psychoanalyst
• Clinical social worker

17
How Do I Choose the Right Therapist?

• Many people and agencies can serve as good
  resources
• Check with your family physician, clergy person,
  local mental health center, college counseling
  center, psychology instructor, family and friends
• Give the therapist at least three to four
  sessions to see if working together will be
  effective
• If you do not feel that you are benefiting from
  therapy, discuss this with the therapist and be
  prepared to change if necessary

18
Spotlight Psychotherapy and Minority Groups

• Minority groups less likely to seek help
• Even true for high-income minorities
• Not all research studies address ethnicity
• African Americans are significantly more likely
  than Caucasians to terminate therapy once it has
  begun

19
Spotlight Psychotherapy and Minority Groups

• Many members of ethnic minorities
• Feel alienated
• Feel a stigma is attached to hospitalization
• Fear being labeled
• Feel that they can solve their own problems
• Tend not to be as open as Caucasian
  clients/patients

20
Psychoanalytic Techniques

• Psychoanalysis based on several assumptions
  involving conflict and the unconscious mind

21
Psychoanalytic Techniques

• The biological, sexual, and aggressive strivings
  of the id are often in conflict with the superego
  overly cautious, guilty
• The id can be in conflict with the rational ego
• Conflicts that are unresolved are repressed into
  the unconscious

22
Psychoanalytic Techniques

• Free association encouraged patients to say
  aloud whatever entered their minds
• Resistance unwillingness or inability to
  discuss freely some aspect of ones life

23
Psychoanalytic Techniques

• Dream interpretation referred to as the royal
  road to the unconscious
• Manifest content refers to dreams as they are
  recalled
• Latent content refers to dreams as a symbolic
  representation of the contents of the unconscious

24
Psychoanalytic Techniques

• Therapist-Patient Relationship
• Transference occurs when the patient
  unconsciously comes to view and feel about the
  analyst in much the same way as he or she feels
  about another important person in his or her life

25
Psychoanalytic Techniques

• Therapist-Patient Relationship
• Countertransference analyst allowing his or her
  feelings and experiences to interfere with
  objective interactions with the patient

26
Post-Freudian Psychoanalysis

• Most significant change is the concern for
  shortening the length of analysis
• Todays analyst will take a more active role in
  therapy
• Focus on present, rather than childhood
  experiences

27
Humanistic Techniques

• Client-centered therapy goal is to help the
  individual self-actualize (Carl Rogers)
• Focus is on the present
• Focuses on ones feelings or affect
• Therapist attempts to mirror the feelings of the
  person

28
Humanistic Techniques

• How Does One Mirror?
• Therapist must be an active listener.
• Therapist needs to be empathetic able to
  understand and share the essence of anothers
  feelings
• Therapist will try to express unconditional
  positive regard

29
Gestalt Therapy

• Associated with Fritz Perls (1893-1970)
• Goal is to assist person to integrate his or her
  thoughts, feelings, and actions and increase
  self-awareness, acceptance, and growth
• Sessions are often convened in small-group
  settings

30
Behavioral Techniques

• Behavior therapy collection of techniques
  focused on the principles of LEARNING!
• Systematic desensitization applying classical
  conditioning to alleviate feelings of anxiety,
  particularly those associated with phobic
  disorders
• Aversion therapy stimulus that may be harmful,
  but that produces a pleasant response, is paired
  with an aversive, painful stimulus until the
  original stimulus is avoided

31
Behavioral Techniques

• Contingency management when the therapist can
  manage the control of rewards and punishments to
  modify behavior
• Contingency contracting establishing a contract
  with a client so that exhibiting certain
  behaviors will result in certain rewards

32
Behavioral Techniques

• Modeling acquisition of an appropriate response
  through the imitation of a model
• Children with phobias
• Assertiveness training

33
Cognitive Techniques

• Rational-emotive therapy (Albert Ellis)
• Premise is that psychological problems arise when
  people try to interpret what happens in the world
  on the basis of irrational beliefs
• Therapist directive role

34
Cognitive Techniques

• Cognitive restructuring therapy (Aaron Beck)
• Less confrontational and direct than RET
• The patient is given opportunities to test his or
  her beliefs, which will lead to positive outcomes

35
Group Approaches

• Group therapy label applied to a variety of
  situations in which a number of people are
  involved in a therapeutic setting at the same time

36
Group Approaches

• Benefits of group therapy
• Participant realizes that he or she is not the
  only one with problems
• One can receive support from others
• Helping someone else can be therapeutic
• A participant can learn to present him/herself
  more effectively to others

37
Group Approaches

• Family Therapy the roles, interdependence, and
  communication skills of family members are
  addressed
• Part of a system all impact one another
• Improper family communication problems

38
Evaluating Psychotherapy

• Difficult task
• Sometimes spontaneous remission of symptoms
• Difficult to agree on what is meant by recovery
  or care
• The large, meta-analysis studies showed positive
  results for psychotherapy

39
Evaluating Psychotherapy

• No evidence that any one type of therapy is
  universally better than others
• Some types of therapy better suited for some
  problems than others
• Which therapy is best for what disorder is one of
  the most active areas of research
• Some therapists are more effective than others

40
Evaluating Psychotherapy

• Empirically Supported Therapies only therapies
  with demonstrated empirical research support
  would be offered
• Several problems with this approach
• Cognitive therapy, for example, means different
  things to different people
• Many would rather not get into the business of
  prescribing specific therapies