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TREATMENT OF PSYCHOLOGICAL DISORDERS Psychodynamic Therapies • Psychodynamic therapies revolve around: • Insight – Understanding one’s own psychological processes • Therapist-patient relationship – Assist a patient to become “captain of my own ship” Insight • Maladaptive ways of viewing self and relationships • Unconscious conflicts and compromises among competing wishes and fears • Maladaptive ways of dealing with unpleasant emotions Therapeutic Techniques • Free Association – Patient responds to verbal/visual cues with the first thing that comes to mind • Interpretation – Clinician interprets patient responses – Resistance involves patient’s efforts to hide the unconscious conflict Therapist-Patient Relationship • Therapist as authority figure • Transference – Patients have similar thoughts, feelings, fears, wishes and conflicts in new relationships as existed in past relationships • Patient tries to please therapist in the same way he/she tried to please parent • Fears that your new partner will cheat on you just like your last partner cheated on you Psychodynamic Therapies • Psychoanalysis – Patient on couch and therapist on chair behind couch – Intense discussions over a long period of time – Goal is exploration of unconscious processes • Psychodynamic Psychotherapy – Sessions are face to face – Discussion is less intense, more conversational, than in psychoanalysis – Goal is still exploration of unconscious processes Cognitive-Behavioral Therapies • Phobia – Irrational fear of a given stimulus • Behavioral analysis – Determine the symptom (s) and the stimuli or thoughts associated with it which then become the targets of treatment • Systematic desensitization – Gradual exposure of a phobic stimulus as a means of neutralizing the impact of the stimulus Systematic Desensitization • Step 1 – Therapist teaches patient relaxation techniques • Step 2 – Therapist questions patient about fears & then constructs a hierarchy of feared stimuli • Step 3 – Desensitization process begins possibly with the use of virtual reality therapy • Step 4 – Patient encouraged to face feared stimuli in real life Cognitive-Behavioral Therapies • Exposure Techniques – Present patients with actual phobic stimulus in real life rather than imagine it • Flooding – Patient confronts the phobic stimulus all at once Social Learning Techniques • Participatory modeling – Therapist models the behavior and gradually induces the patient to participate in the behavior • Role playing • Skills training – Involves teaching the behaviors necessary to accomplish relevant goals • Teaching someone how to dance Cognitive Therapy • Cognitive Therapy – Focus on changing cognitions that underlie a psychological disorder – Learn to perceive things in a different manner • Cognition Therapy – Focus on cognitive distortions • View things differently Cognitive Therapies • Rational-emotive therapy – Mediates between activating conditions and maladaptive emotional reactions • “ I won’t let his mean behavior get to me anymore!” Humanistic Therapies • Gestalt therapy – Focus on awareness of one’s own feelings versus our attempts to conform to social expectations – Goal is for patient to respond to their true “inner voice” and thus become more authentic – Focus on present state rather than historical contributors to one’s present state Humanistic Therapies • Client-centered therapy – Clients versus patients • Rejects “disease” model – Solve problems not seek cures • Problems develop when one’s concept of self is incongruent with their actual life experience – The basic nature of humans is to grow and mature – Unconditional positive regard • Attitude of fundamental acceptance by therapist towards client Group Therapies • Multiple individuals in same sessions • Group members share same issue such as – Death of a child – Coping with cancer • Cost effective Family Therapies • All members of a nuclear family participate in therapy • Genogram – Map of family dynamics • Couples therapy – Focus on problematic communications patterns Biological Treatments • Psychotropic medications act on the brain to affect mental processes Antipsychotic Medications • Used to treat schizophrenia and other acute psychotic states • They have sedating impact by inhibiting dopamine which is linked to hallucinations • Don’t work well with negative symptoms such as interpersonal difficulties • Serious side effects such as tardive dyskinesia (slow motions) Antidepressant & Mood Stabilizing Medications • Tricyclic Antidepressants – 70-80% improvement rate • MAO Inhibitors – Works better than tricyclics for patients with depression and personality disorders – Requires food restrictions Antidepressant & Mood Stabilizing Medications • Selective serotonin reuptake inhibitors (SSRIs) – First-line medical treatment for depression – Fewer side effects than other antidepressants • Lithium – Used with bipolar disease – Takes 3-4 weeks to begin having an impact Anti-anxiety Medications • Valium and Xanax are used for short term treatment of anxiety disorders • Antidepressants are also used for anxiety disorders • Patients can become psychologically and physiologically addicted Electroconvulsive (ECT) Therapy & Psychosurgery • Considered treatments of last resort • ECT currently used to treat severe depression – Electric shocks administered to the brain – Can move patient out of a state of severe depression • Psychosurgery – Lobotomy which may be used on patients with obsessive-compulsive disorders Comparing forms of treatment • Efficacy Studies – Assess treatment outcome under controlled experimental conditions (control group) • Effectiveness Studies – Assess treatment as practiced by clinicians in the community