Transcript Treatment of Mental Disorders

Treatment of Mental Disorders
Katie Strebin
Psychology 490
Mental Disorders and Psychotherapy
A. Early Treatment of Mental Disorders/Changing Viewpoints
1.Devil & Evil Spirits
2. Mental Illness as a Disease
a. John Weir-16th Century Physician
b. Philippe Pinel & La Bicetre (1745-1826)
c. Dorothea Dix (1802-1887)
3. Current View of Mental Illness
B. Development of Psychotherapy
1. Franz Anton Mesmer(1734-1815)
2. Jean Martin Charcot (1825-1893)
3. Freud
Insight Therapy
PROBLEM:
Maladaptive behaviors are symptoms
of deeper underlying psychological problems
CURE:
Understanding the causes of problems will
lead to a cure
INSIGHT INTO PROBLEMS CURES THEM
Types of Insight Therapies
1. Psychoanalysis and Modern Psychodynamic
2. Humanistic Therapies
a. Client Centered Therapy
b. Gestalt Therapy
*Treatments focus on talk between therapist
and client as a means to find reasons behind
client’s problems
Psychoanalysis
Developed by Sigmund Freud
 Unconscious conflicts of the competing
demands of the id, superego, and the
ego can lead to anxiety
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Psychoanalysis is aimed at
providing the client insight into his
or her unconscious motivations
and impulses that is causing the
anxiety
So how does the therapist do
this???
*Client’s underlying conflicts repressed and revealed into
the conscious thoughts through subtle clues.
*These clues are revealed in dreams, physical problems,
memory, manner of speech, and cognitive and emotional
reactions to therapy.
The primary function of the psychoanalyst is to interpret
the clues about the origins of intrapsychic conflict given by
the client
Psychoanalytic Techniques
1. Free Association
2. Dream Interpretation
A. Manifest Content
B. Latent Content
3. Resistance
4. Transference
5. Countertransference
Modern Psychodynamic
Therapy
Psychoanalysis now often referred to as
psychodynamic therapy.
 Focus on achieving insight into
unconscious, less emphasis on sexual
factors during development and more
upon social and interpersonal
experiences.
 Focus on present day issues rather than
past
 Less time consuming

Humanistic Therapy
Goal of humanistic therapy is to provide the client
with a greater understanding of his or her unique
potential for personal growth and self-actualization.
Assumption that people are good and have innate worth
Psychological Problems reflect some kind of blocking
of one’s potential for growth.
Humanistic therapy is aimed at realizing this potential
Two Types of Humanistic
Therapy
•Client-Centered Therapy
•Gestalt Therapy
Client-Centered Therapy
Problem: Psychological problems are caused by
an incongruence between a client’s real and
ideal self
Cure: Reduce incongruence by fostering
experiences that will make attainment of ideal
self possible.
Aspects of Client-Centered
Therapy
Client’s thoughts and not therapist’s
direct the course of therapy
 Therapist’s role is to make the client’s
thoughts, perceptions, and feelings
more noticeable to client--reflection

Empathy
 Unconditional Positive Regard

The therapist shouldn’t
manipulate events but should
create conditions under
which the client can makes
his or her own decisions
independently
Gestalt Therapy
Fritz Perls
 Emphasizes unity of mind and body by
teaching the client to “get in touch”
with bodily sensations and emotional
feelings long hidden from awareness.
 Emphasizes present experiences not
past

Techniques of Gestalt Therapy
Dreams
Empty Chair Technique
Talking to self and to inanimate objects
Confrontational
Behavior and Cognitive
Behavior Therapies
Assumption: People learn maladaptive behavior
in the same way they learn adaptive behaviors.
The maladaptive behavior is the problem not a
reflection of the problem.
Solution: Behavior change is caused by methods
based on extensions of classical and operant
conditioning
Therapies Based on Classical
Conditioning
Neutral stimulus(CS) comes to elicit the
same response as a stimulus(UCS) that
naturally elicits that response because
the CS reliably predicts the UCS
 Development of everyday fears,
anxieties and phobias

Types of Therapies
1. Systematic Desensitization: Treatment in which
the client is trained to relax in the presence of
increasingly fearful stimuli
2. Implosion Therapy
--in vivo
3. Aversion Therapy--treatment in which the client
is trained to respond negatively to a neutral stimulus
that has been paired with an aversive stimulus
Therapies Based on Operant
Conditioning
Reinforcement of Adaptive Behaviors
 Token Economies
 Modeling
 Assertiveness Therapy
 Extinction of Maladaptive Behaviors
 Punishment of Maladaptive Behaviors
 Covert Sensitization
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Maintaining Behavioral Change
Intermittent reinforcement
 Self-observation
 Train friends and family of the client to
become “adjunct therapists”
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Cognitive-Behavior Therapies
Goal of therapy is to change the client’s
maladaptive thoughts, beliefs, and
perceptions
 Cognitive Restructuring-process of
replacing the client’s maladaptive
thoughts with more constructive ways
of thinking
 Also use methods of behavior therapy
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Two Types of Cognitive
Behavior Therapy
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Rational-Emotive Therapy
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Cognitive Therapy for Depression
Rational Emotive Therapy
Albert Ellis--First form of cognitive
restructuring
 Problems caused not by events but how
people view them
 Highly directive and confrontational
therapy aimed at changing people’s faulty
thinking
 Therapist tells clients what they are doing
wrong and how they should change

Theory behind Rational
Emotive Therapy
Emotions are the products of cognition
(A)Significant activating event
(B)Person’s belief system
(C)Highly charged emotional consequence
*Inappropriate emotions can be abolished only if
change occurs in the person’s belief system
*Irrational beliefs that are impossible to satisfy
create anxiety, self-blame, and self doubt.
Cognitive Therapy for
Depression
Aaron Beck
 Negative beliefs are seen as conclusions
based on faulty logic
 Cognitive Triad
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– Negative view of self, the outside world,
and the future
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Focus on recognizing faulty logic and
finding ways to correct these distortions
Group Psychotherapy
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Two or more clients meet
simultaneously with a therapist to
discuss problems
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There are four advantages to group
therapy that are not found in individual
therapy
Advantages of Group Therapy
1. Allows therapist to observe and interpret
actual interactions in person--therapist doesn’t
have to rely on client’s descriptions
2. A person maybe more receptive to the same
message coming from a number of people
rather than just the therapist
3. Seeing the causes of maladaptive behavior
in others often helps people gain insight about
themselves
4. Knowing that other people have problems
similar to one’s own can bring comfort and
relief.
Family and Couples Therapy
People are products of their
environments, and the structure of a
person’s family an important part of
that environment
 Restructuring a client’s relationship with
their family members often important in
helping the client.

Structural Family Therapy
Salvador Minuchin (1974)
 Observe a family’s interactions and
draw diagrams of the relationships
inferred from the family’s behavior
 Restructure the family in a more
adaptive way
 Effectively functioning marital
subsystem leads to healthy family
interactions
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Community Psychology
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A form of treatment and education
whose goal is to address psychological
problems through an assessment of the
sociocultural context in which they
develop.
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Treat individuals and groups, establish
education programs, design programs
to promote mental health
Deinstitutionalization and
Preventive Psychology
Deinstitutionalization: Process of returning previously
hospitalized patients to their communities for treatment
Preventative Psychology: Attempts to forestall the
development of psychological problems
1. Primary Prevention
2. Secondary Prevention
Community Mental Health
Centers
Individual and group therapy for
members of the community--often in
poorer communities
 Immediate outpatient care for those
who might have difficulty getting help
 Many centers are underfunded and
understaffed
 Generally staffed by psychologists,
psychiatrists, social workers, and nurses
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Drug Therapy or
Pharmacotherapy
1. Antipsychotic Drugs--block dopamine receptors
in the brain--Thorazine, Clozapine
*Tardive Dyskinesia
2. Antidepressant and Antimanic Drugs
Antidepression--norepinephrine and
serotonin--trycyclics, MAOI, prozac
Antimanic -lithium Carbonate
3. Antianxiety-Benzodiazepines(Valium, Xanax)
Electroconvulsive Therapy
Treatment of severe depression
 small amounts of electrical current are
passed through the brain to produce a
seizure
 Believed to release higher than normal
amounts of GABA, which leads to
decreases in brain activity
 Side effects--memory loss and cognitive
deficits
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Psychosurgery
Brain surgery used to relieve the
symptoms of psychological disorders
 “Ice Pick” Prefrontal Lobotomy
 Cingulotomy-surgical destruction of the
cingulum bundle; which connects the
prefrontal cortex with the limbic
system--helps to reduce intense anxiety
and the symptoms of OCD
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Insight Therapies
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Lack of scientific
support
Difficult to evaluate
Can explain away
failures
Not appropriate for
serious
psychological
problems
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This type of therapy
can be beneficial for
intelligent, articulate
individuals
Humanistic therapies
more affordable and
less time consuming
than traditional
psychoanalysis
Behavior and CognitiveBehavior Therapies
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Criticized for focus
on symptoms rather
than causes
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Failure to generalize
treatment gains
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Ethical concerns-aversive techniques
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Can be scientifically
evaluated
Has been proven
effective in treating
a wide variety of
problems
Group and Community
Psychology
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Not a good choice
those who are
reticent about
exposing problems
to others
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A less expensive
alternative to private
therapy
Biological Treatments
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A treatment option
not a cure
People may not
adhere to drug
regimen
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Effective at
alleviating the
symptoms of certain
psychological
disorders