Therapy Chapter 14 History of Insane Treatment Maltreatment of the insane throughout the ages was the result of irrational views: such as_________? Many patients were subjected to strange, debilitating, and downright dangerous treatments. History of Insane Treatment Philippe Pinel in France and Dorthea Dix in America founded humane movements to care for the mentally sick (rather than seeing them as “possessed”). Psychological Therapies Name the focus and a major theorist for each of these four major forms of psychotherapy:
1. Psychoanalytic theory 2. Humanistic theory 3. Behavioral theory 4. Cognitive theory
Psychoanalysis The first formal psychotherapy to emerge was psychoanalysis psychoanalysis, developed by Sigmund Freud. What is the difference between psychotherapy and psychoanalysis? Psychoanalysis is the type of psychotherapy specific to Freud. Psychoanalysis: Aims Since psychological problems originate from childhood repressed impulses and conflicts, the aim of psychoanalysis is to bring repressed feelings into conscious awareness where the patient can deal with them. When energy devoted to id-ego-superego conflicts is released, the patient’s anxiety lessens. Psychoanalysis: Methods Dissatisfied with hypnosis, Freud developed the method of free association to unravel the unconscious mind and its conflicts. The patient lies on a couch and speaks about whatever comes to his or her mind to get at subconscius material. Psychoanalysis: Methods During free association, the patient edits his thoughts, resisting his or her feelings to express emotions. Such resistance becomes important in the analysis of conflict-driven anxiety. Eventually the patient opens up and reveals his or her innermost private thoughts, developing positive or negative feelings (transference) towards the therapist.
Psychoanalysis: Criticisms •Psychoanalysis is hard to refute because it cannot be proven or disproven. •Psychoanalysis takes a long time and is very expensive. Humanistic Therapies Humanistic therapists aim to boost self-fulfillment by helping people grow in self-awareness and self-acceptance. Client-Centered Therapy Developed by Carl Rogers, client-centered therapy is a form of humanistic therapy. The therapist listens to the needs of the patient in an accepting and non-judgmental way, addressing problems in a productive way and building his or her self-esteem. Humanistic Therapy—Does the client-centered therapist give advice? The therapist engages in active listening and echoes, restates, and clarifies the patient’s thinking, acknowledging expressed feelings. Behavior Therapy—Does this therapy look for deep-seated reasons for the symptoms? Therapy that applies learning principles to the elimination of unwanted behaviors. To treat phobias or sexual disorders, behavior therapists do not delve deeply below the surface looking for inner causes. Exposure Therapy Expose patients to things they fear and avoid. Through repeated exposures, anxiety lessens because they habituate to the things feared. Exposure Therapy Exposure therapy involves exposing people to fear-driving objects in real or virtual environments. Systematic Desensitization A type of exposure therapy that associates a pleasant, relaxed state with gradually increasing anxiety-triggering stimuli commonly used to treat phobias. Aversive Conditioning A type of counterconditioning that associates an unpleasant state with an unwanted behavior. With this technique, temporary conditioned aversion to alcohol has been reported. Operant Conditioning Operant conditioning procedures enable therapists to use behavior modification, in which desired behaviors are rewarded and undesired behaviors are either unrewarded or punished.
A number of withdrawn, uncommunicative 3-year-old autistic children have been successfully trained by giving and withdrawing reinforcements for desired and undesired behaviors. Token Economy In institutional settings, therapists may create a token economy in which patients exchange a token of some sort, earned for exhibiting the desired behavior, for various privileges or treats. Example: we want more participation for students in our program. They get a token for attending workshops; at the end of the school year they can use the tokens in the bookstore for certain items. Cognitive Therapy—what is the focus of this type of therapy? Teaches people adaptive ways of thinking and acting based on the assumption that thoughts intervene between events and our emotional reactions. Beck’s Therapy for Depression Aaron Beck believes that cognitions such as “I can never be happy” need to change in order for depressed patients to recover. This change is brought about by gently questioning patients. Stress Inoculation Training Meichenbaum (1977, 1985) trained people to restructure their thinking in stressful situations. “Relax, the exam may be hard, but it will be hard for everyone else too. I studied harder than most people. Besides, I don’t need a perfect score to get a good grade.” Group & Family Therapies Group therapy normally consists of 6-9 people attending a 90-minute session that can help more people and costs less. Clients benefit from knowing others have similar problems. Family Therapy Family therapy treats the family as a system. Therapy guides family members toward positive relationships and improved communication. Evaluating Therapies Who do people turn to for help with psychological difficulties? Is Psychotherapy Effective? It is difficult to gauge the effectiveness of psychotherapy because there are different levels upon which its effectiveness can be measured. Outcome Research How can we objectively measure the effectiveness of psychotherapy?
Meta-analysis of a number of studies suggests that thousands of patients benefit more from therapy than those who did not go to therapy. Outcome Research Research shows that treated patients were 80% better than untreated ones. The Relative Effectiveness of Different Therapies Which psychotherapy would be most effective for treating a particular problem? Disorder
1. A hope for demoralized people. 2. A new perspective. 3. An empathic, trusting and caring relationship.
1. Drug Therapies 2. Brain Stimulation 3. Psychosurgery
Drug Therapies With the advent of drugs, hospitalization in mental institutions has rapidly declined. Drug Therapies However, many patients are left homeless on the streets due to their ill-preparedness to cope independently outside in society. Atypical Antipsychotic Clozapine (Clozaril) blocks receptors for dopamine and serotonin to remove the negative symptoms of schizophrenia.
Antianxiety Drugs Antianxiety drugs (Xanax and Ativan) depress the central nervous system and reduce anxiety and tension by elevating the levels of the Gamma-aminobutyric acid (GABA) neurotransmitter.
Antidepressant Drugs Antidepressant drugs like Prozac, Zoloft, and Paxil are Selective Serotonin Reuptake Inhibitors (SSRIs) that improve the mood by elevating levels of serotonin by inhibiting reuptake. Mood-Stabilizing Medications Lithium Carbonate, a common salt, has been used to stabilize manic episodes in bipolar disorders. It moderates the levels of norepinephrine and glutamate neurotransmitters. Brain Stimulation Electroconvulsive Therapy (ECT) ECT is used for severely depressed patients who do not respond to drugs. The patient is anesthetized and given a muscle relaxant. Patients usually get a 100 volt shock that relieves them of depression. Alternative to ECT Repetitive Transcranial Magnetic Stimulation (rTMS) In rTMS, a pulsating magnetic coil is placed over prefrontal regions of the brain to treat depression with minimal side effects. Psychosurgery Although used sparingly today, about 200 such operations do take place in the US alone. A last resort.
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