Transcript clineabnormalextendedch1617

Abnormal Psychology
Therapy: History and
Principles
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Today’s Lecture
Treatment Basics
the history of treatment of the
mentally ill
places of treatment
providers of treatment
recipients of treatment
Assessment
Biological treatments
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Care as a social issue -- the
history of treatment
What to do with the severely
disturbed?
middle Ages to 17th century
madness = in league with devil
torture, hanging, burning, sent to sea
18th century
mentally disordered people =
degenerates
keep them away from society
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The 19th century & attempts at
reform
Philippe Pinel
(1745-1826)
reform in Paris
mental hospital
some patients got
better enough to
leave hospital
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The 19th century & attempts at
reform
Dorothea Dix (1802-1887)
reform of U.S. system
moral-treatment
movement
kindly care
led to large, statesupported public asylums
overcrowding, loss of
public attention
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The 20th century
Deinstitutionalization (mid-1950s)
get people out of asylums and back
into community
effective antipsychotic medication
general mood of optimism in
country
1961: establishment of community
mental health centers
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Hospitals from a patient's
perspective
Rosenhan (1973): "On being sane in
insane places”
sane people got into mental
hospitals as patients
found very low interaction with staff
dehumanizing nature of interactions
normal behaviors interpreted
pathologically
There are successful inpatient &
outpatient treatment programs
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Places of treatment
 public or private mental hospitals
 general hospitals
 nursing homes for older patients with mental
health needs
 halfway houses/group homes
 community mental health centers
 private offices
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Providers of treatment
Psychiatrists
medical degree (M.D.)
special training/residency in psychiatry
mainly hospitals & private practice
can prescribe drugs
Clinical psychologists
doctoral degree (Ph.D.) in psychology
training in research & practice
universities, private practice, community
mental health
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Providers of treatment
Counseling psychologists
doctoral degree in psychology
sometimes more emphasis on practice
than research
problems of living, rather than diagnosable
conditions
Counselors
master's degree in psychology
schools & institutions
school-or job-related problems
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Providers of treatment
Psychiatric social workers
master's degree in social work
public agencies, home visits
Psychiatric nurses
bachelor's or master's in nursing
hospital settings
Self-help groups
Alcoholics Anonymous
LaLeche League
Overeaters Anonymous
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Recipients of treatment
 Most people who meet criteria for DSM
diagnoses do not seek treatment
 Variability due to sex, education, race &
income level
women seek more treatment than men
college educated seek more treatment
than high school educated
whites seek more treatment than
nonwhites
higher income seek more treatment than
lower income
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Income level and seeking
treatment
At least 1 disorder
Visit to specialist, has
disorder
Visit to specialist,
no disorder
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Clinical Assessment
 Assessment
process of gathering information to
develop treatment plan for client
 Assessment Interview
very common assessment technique
range from unstructured to highly
structured
 Objective questionnaires
self-report to get information on feelings,
thoughts, behaviors of clients
examples: Beck Depression Inventory,
Child Behavior Checklist
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The MMPI
 A psychometric personality test
 Used in clinical assessment
 567 statements about the self
 Client answers true or false to items
 10 clinical scales, 15 content scales, several
validity scales
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Projective Tests
 Most commonly used by psychodynamic
therapists
 Designed to provide clues about unconscious
mind
 Developed from free association technique
client asked to just say what comes into
mind, without censoring
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Projective Tests
 The Rorschach
client looks at ink blots and discusses
what each looks like to them
therapist interprets these explanations
 Thematic Apperception Test (Roberts
Apperception Test for Children)
client tells story based on picture they see
therapist interprets the stories
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Behavioral Monitoring
 Used to help with treatment & assessment
Counting actual instances of target
behaviors
Hospital staff, therapist, patient
Self-monitoring done by patient
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Assessment of the physical brain
 Electroencephalogram (EEG)
pattern of electrical activity in brain
used to scan for brain damage
 Computerized axial tomography (CAT scan)
multiple x-rays of brain
can look for anatomical abnormalities
 Magnetic resonance imaging (MRI)
pictures of brain sections
 Positron emission tomography (PET scan)
images that reflect the pattern of blood
flow and rate of oxygen use
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Biological Treatments
 Attempts to solve the
disorder by altering
bodily processes
 History
drilling holes in head
blood letting
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Antipsychotic Drugs
 Used for schizophrenia & other psychotic
disorders
 Most work on neurotransmitter dopamine
 Problems
relieve positive but not negative symptoms
make person seem more normal, but don’t
increase life satisfaction
unpleasant & harmful side effects
tardive dyskinesia
may reduce chances of full recovery
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Antipsychotics & relapse
Hogarty & Goldberg (1973)
Counseling & drug combination had
lowest relapse rate
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Antidepressants
 Many work to increase availability of
monoamine transmitters
 Tricyclics
imipramine
amitriptyline
block reuptake of serotonin &
norepinephrine
 Selective serotonin reuptake inhibitors
(SSRIs)
fluoxetine (Prozac)
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Effectiveness of
antidepressants
Tricyclics
good rate of recovery from major
depression with use
side effects include fatigue, dry
mouth, blurred vision
SSRIs
as effective as tricyclics
fewer side effects
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Lithium
Used for bipolar disorder
Especially effective for manic phases
Unclear how it works
Most dangerous side effect is
dehydration
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Antianxiety Drugs
 Historically, barbituates were prescribed
 Benzodiazepines are safer
chlordiazepoxide (Librium) & diazepam
(Valium)
most effective for generalized anxiety
not effective for phobias, OCD, or panic
disorder
work by augmenting action of GABA
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Electroconvulsive Shock
Therapy (ECT)
 Used primarily in cases of severe,
unrelenting depression
 Modern ECT is very different from early ECT
safer
patient given drugs to sedate beforehand
painless
 70% people who don’t respond to other
treatments get relief with ECT
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Concerns with ECT
 Permanent brain damage?
no evidence to support
do find temporary disruptions in cognition
(memory)
 Bilateral ECT can result in loss of memory for
events a day or two previous to treatment
usually returns in a month
 Unilateral ECT produces little apparent
memory loss
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Psychosurgery
 Treatment of last resort
 1930s to 1950s
prefrontal lobotomy
incapacitated patients
not utilized anymore
 Cingulotomy
partial destruction of structure in limbic
system
results show some success with fewer
side effects
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Summary
History of treatment
alliance with the Devil = torture, death
degenerates = imprisonment
Pinel reforms Paris hospital
Dix reforms US mental hospitals
Places of treatment
Providers of treatment
Recipients of treatment
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Summary
Assessment
clinical interviews
tests
projective tests
MMPI
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Summary
Biological treatments
drugs
antipsychotics
antidepressants
lithium
antianxiety
ECT
psychosurgery
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Abnormal Psych
Therapy: Methods and
Evaluation
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Today’s Lecture
 Types of Psychotherapy
psychodynamic
humanistic
cognitive
behavior
group
 Evaluating Psychotherapies
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Varieties of psychotherapy
 Many different
theories of approach
to mental problems
 400 different forms of
psychotherapy have
appeared
 Most common
psychodynamic
humanistic
behavioral
cognitive
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Psychodynamic Therapy
 Freud
 Psychological
problems result from
inner mental conflicts
 Must make these
conflicts conscious
 Unconscious wishes
 Repressed memories
 Predisposing &
precipitating
experiences
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Techniques in psychoanalysis
 Free association
patient relaxes and
reports everything
that comes to mind
 Dream analysis
latent content
manifest content
Freudian symbols
 Mistakes
slips of the tongue
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Resistance & Transference
 Resistance
unconscious material causes anxiety
patients resist attempts to bring
unconscious into conscious
“forgetting”
refusing to discuss certain topics
 Transference
patient’s unconscious feelings about
person in their life experienced as feelings
toward therapist
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Insight & Cure
 Analyst’s job is to make inferences about
patient’s unconscious conflicts
 Once patient experiences them consciously,
can modify or express them
 Patient must accept insights of therapist
 Analyst leads patient to insight so patient
comes to insight themselves
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Humanistic Therapy
 Emphasis on inner potential for positive
growth
 Similarity to psychodynamic
help clients become more aware of inner
feelings & desires
 Differences from psychodynamic
inner feelings & desires are seen as
positive & life-promoting
main goal is to help client take control of
own life
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Carl Rogers
 Client-centered therapy
focus on thoughts, abilities,
cleverness of client
not focused on insights of
therapist
therapist as a sounding
board for client’s thoughts
Abraham Maslow is also a
contributor (hier of needs/
desire to reach selfactualization
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Concepts of client-centered
therapy
 Problems caused by denial of own feelings &
distrust of ability to make decisions
 Empathy
attempt to comprehend feelings from
client’s point of view
use of reflection
 Unconditional positive regard
client is worthy & capable no matter what
client does or says
creates safe, nonjudgmental atmosphere
 Genuineness
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Cognitive therapy
 People disturb themselves with their own thoughts
 Goals of cognitive therapy
identify maladaptive ways of thinking
replace these with adaptive ways
 Similarity to humanistic
focus on conscious mental experience
 Differences from humanistic
problem-centered rather than client-centered
relationship is more directive
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Albert Ellis’ Rational-Emotive
Therapy
 Albert Ellis
 Negative emotions arise from
people’s irrational
interpretations of experiences
 Musterbations
irrational belief that you
must do or have something
 Awfulizing
mental exaggeration of
setbacks
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Ellis’ ABC theory of emotions
 A = activating event in the environment
B = belief triggered in client’s mind by event
C = emotional consequence of the belief
Loss of job
I’m
worthless
Depression
My boss
is a jerk
No
Depression
Healthy Pattern
Loss of job
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Aaron Beck’s Cognitive Therapy
 Treatment of depression
 Depressed people
distort experiences &
maintain negative
views of themselves,
the world, their future
minimize positive &
maximize negative
experiences
misattribute negative
experiences to own
deficiencies
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Behavior Therapy
 Concentrate on observable stimuli &
responses
 Consider mental events as “covert”
responses
 Most behaviorist therapists now practice
cognitive-behavior therapy
combination of cognitive & behavioral
principles used
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Exposure Treatments
 Used for phobia treatment
 Systematic desensitization
train client in muscle relaxation
then combine imagery of feared object with
relaxation
use increasingly frightening scenes
highly effective for treating phobias
 Flooding
expose person to feared stimulus and allow
them to experience accompanying fear
Fear gradually declines & disappears
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Aversion Treatment (aversive
conditioning; a behavior
approach)
 Used for bad habits
drinking
smoking
gambling
 Use of operant conditioning principles
painful or unpleasant stimulus follows the
unwanted behavior
 Example
Antabuse for alcohol usage
 Controversial treatment
 Limited generalizability of results
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Other Behavioral Techniques
 Token economies
exchange system
often used in inpatient treatment
 Contingency contracts
formal written agreement
 Assertiveness & social skills training
 Modeling
therapist models adaptive behaviors for
client
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Group Therapy
 Psychodynamic
interactions among group members
provide clues to hidden motives
gain insight into how unconscious affects
relations with others
 Humanistic
members gain opportunity to express
selves honestly
 Cognitive & Behavioral
clients can practice new skills, new ways
of thinking
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Couple & Family Therapy
 Problem not in individual but interaction between
individuals
 Family therapy
see whole family together, observe
interactions
help members gain perspective
 Family systems perspective
each person accommodates to the family
fix family problems by offering insight into how
each affects others
 Intergenerational approach
considers influence of previous generations
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Does therapy work?
 People report feeling better after therapy
 Maybe they would have gotten better anyway
Need studies comparing no treatment to treatment to evaluate
efficacy
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Does therapy work?
 Studies show that
people in therapy
Do better than no-treatment
controls
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General conclusions about
therapy effectiveness
 People in treatment do better than those not
 Each type of therapy as effective as the others
 Some types of therapy work better for specific
problems
cognitive-behavioral best for fear & anxiety
humanistic best for self-esteem
psychodynamic best for work/school
achievement
 Some therapists are better than others
warm, understanding, motivated
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Nonspecific factors in therapy
effectiveness
 Nonspecific = unrelated to specific principles
but critical to outcome
 Support
acceptance, empathy, encouragement,
guidance
 Hope
sense of faith in therapy process
placebo effect = improvement from belief,
rather than actual effect
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Summary
 Psychodynamic therapy
unconscious motives
free association, dream analysis, mistakes
resistance, transference, insight
best therapy for achievement problems
 Humanistic therapy
focus on inner potential of client
Carl Rogers’ client-centered therapy
empathy, unconditional positive regard,
genuineness
best therapy for self-esteem issues
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Summary
 Cognitive therapy
maladaptive thinking causes mental problems
Albert Ellis’ rational-emotive therapy (ABC’s)
Aaron Beck’s cognitive therapy for depression
 Behavior therapy
observable stimulus-response patterns
thoughts are private behaviors
phobias
systematic desensitization, flooding, aversion
therapist is very directive
 Cognitive-behavioral therapy best for anxiety
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Summary
 Group therapy
each theory has own type of group therapy
family & couple therapy
family systems perspective
interaction of family members creates problems
 Evaluating Psychotherapies
being in therapy better than not
each type of therapy is effective
therapist attributes very important
nonspecific factors also important
support
hope
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