11

Therapies for Psychological Disorders

22

Mind Jog:Mind Jog:

What do you know about therapy?

Try to define therapy.

33

Therapy for psychological disorders takes a variety of forms, but all involve some

relationship focused on improving a person’s mental,

behavioral, or social functioning

What is Therapy?What is Therapy?

44

What is Therapy?What is Therapy?

Therapy – General term for any treatment process; in psychology and psychiatry, therapy refers to a variety of psychological and biomedical techniques aimed at dealing with mental disorders or coping with problems of living

55

Entering TherapyEntering Therapy

Why is it ok to tell people you are in therapy?

What are the real goals of the therapist?

66

The Components of TherapyThe Components of Therapy

In addition to the relationship between the therapist and the patient/client, the therapeutic process typically involves some or all of the following processes:• Identifying the problem• Identifying the cause of the problem or the

conditions that maintain the problem• Deciding on and carrying out some form of

treatment

77

Who is a therapist?Who is a therapist?

There are various types of Mental Health Care Professionals.

- No longer the demon model – Asylums

88

Types of Mental Health Care Types of Mental Health Care ProfessionalsProfessionals

Counseling psychologistCounseling psychologist

Clinical psychologistClinical psychologist

PsychoanalystPsychoanalyst

Clinical social workerClinical social worker

PsychiatristPsychiatrist

Psychiatric nurse practitionerPsychiatric nurse practitioner

Pastoral counselorPastoral counselor

99

Specialty:Specialty:

Problems of Problems of normal livingnormal living

Work setting:Work setting:

Schools, clinics, Schools, clinics, other institutionsother institutions

Credentials:Credentials:

Master’s in Master’s in counseling, PhD, counseling, PhD,

EdD, or PsyDEdD, or PsyD

Professional TitleProfessional Title

Counseling psychologistCounseling psychologist

Clinical psychologist

Psychoanalyst

Clinical social worker

Psychiatrist

Psychiatric nurse practitioner

Pastoral counselor

1010

Specialty:Specialty:

Those with severe Those with severe disordersdisorders

Work setting:Work setting:

Private practice, Private practice, mental health mental health

agencies, agencies, hospitalshospitals

Credentials:Credentials:

PhD or PsyDPhD or PsyD

Professional TitleProfessional Title

Counseling psychologist

Clinical psychologistClinical psychologist

Psychoanalyst

Clinical social worker

Psychiatrist

Psychiatric nurse practitioner

Pastoral counselor

1111

Specialty:Specialty:

Severe mental Severe mental disorders (often disorders (often

by means of drug by means of drug therapies)therapies)

Work setting:Work setting:

Private practice, Private practice, clinics, hospitalsclinics, hospitals

Credentials:Credentials:

MDMD

Professional TitleProfessional Title

Counseling psychologist

Clinical psychologist

Psychoanalyst

Clinical social worker

PsychiatristPsychiatrist

Psychiatric nurse practitioner

Pastoral counselor

1212

Specialty:Specialty:

Freudian therapyFreudian therapy

Work setting:Work setting:

Private practicePrivate practice

Credentials:Credentials:

MDMD

Professional TitleProfessional Title

Counseling psychologist

Clinical psychologist

PsychoanalystPsychoanalyst

Clinical social worker

Psychiatrist

Psychiatric nurse practitioner

Pastoral counselor

1313

Specialty:Specialty:

Nursing specialty; Nursing specialty; licensed to licensed to

prescribe drugsprescribe drugs

Work setting:Work setting:

Private practice, Private practice, clinics, hospitalsclinics, hospitals

Credentials:Credentials:

RN – plus special RN – plus special training in treating training in treating mental disorders mental disorders and prescribing and prescribing

drugsdrugs

Professional TitleProfessional Title

Counseling psychologist

Clinical psychologist

Psychoanalyst

Clinical social worker

Psychiatrist

Psychiatric nurse Psychiatric nurse practitionerpractitioner

Pastoral counselor

1414

Specialty:Specialty:

Social worker with Social worker with specialty in specialty in dealing with dealing with

mental disordersmental disorders

Work setting:Work setting:

Often employed Often employed by governmentby government

Credentials:Credentials:

MSWMSW

Professional TitleProfessional Title

Counseling psychologist

Clinical psychologist

Psychoanalyst

Clinical social workerClinical social worker

Psychiatrist

Psychiatric nurse practitioner

Pastoral counselor

1515

Specialty:Specialty:

Combines Combines spiritual guidance spiritual guidance

with practical with practical counselingcounseling

Work setting:Work setting:

Religious order or Religious order or ministryministry

Credentials:Credentials:

VariesVaries

Professional TitleProfessional Title

Counseling psychologist

Clinical psychologist

Psychoanalyst

Clinical social worker

Psychiatrist

Psychiatric nurse practitioner

Pastoral counselorPastoral counselor

1616

St. Mary of BethlehemSt. Mary of Bethlehem

1717

Contemporary Approaches to TherapyContemporary Approaches to Therapy

Psychological therapies –Based on psychological principles (rather than biomedical approach)

The psychological therapiesare often collectivelycalled psychotherapy

1818

Psychologists employ two main forms of treatment:

the insight therapies and the behavioral therapies

How Do PsychologistsHow Do PsychologistsTreat Mental Disorders?Treat Mental Disorders?

1919

Contemporary Approaches to TherapyContemporary Approaches to Therapy

Biomedical therapies –Treatments that focus on altering the brain, especially with drugs, psychosurgery, or electroconvulsive therapy

2020

Insight TherapiesInsight Therapies

Insight therapies –Psychotherapies in which the therapist helps patients/clients understand (gain insight into) their problems

Freudian Freudian psychoanalysispsychoanalysis

Cognitive therapiesCognitive therapiesHumanistic therapiesHumanistic therapies

Neo-Freudian Neo-Freudian therapiestherapies

Group therapiesGroup therapies

2121

Insight TherapiesInsight Therapies

Talk therapies –Psychotherapies that focus on communicating and verbalizing emotions and motives to understand their behavior

2222

Insight TherapiesInsight Therapies

Psychodynamic therapies –Insight therapies based on the assumption that mental disorder is caused by powerful (dynamic) mental forces and conflicts

2323

Insight Therapies:Insight Therapies: Psychodynamic Therapies Psychodynamic Therapies

Psychoanalysis –The form of psychodynamic therapy developed by Sigmund FreudAnalysis of transference –

Analyzing and interpreting the patient’s relationship with the therapist, based on the assumption that this relationship mirrors unresolved conflicts in the patient’s past

2424

Insight Therapies:Insight Therapies: Psychodynamic Therapies Psychodynamic Therapies

Neo-Freudian psychodynamic therapies –Therapies developed by psychodynamic theorists who embraced some of Freud’s ideas, but disagreed with others

2525

Insight Therapies:Insight Therapies: Humanistic therapies Humanistic therapies

Humanistic therapies –Techniques based on the assumption that people have a tendency for positive growth and self actualization, which may be blocked by an unhealthy environment

Client-centered therapy –Emphasizes healthy psychological growth through self-actualizationReflection of feeling –

Paraphrasing client’s words to capture the emotional tone expressed

2626

Insight Therapies:Insight Therapies: Cognitive therapies Cognitive therapies

Cognitive therapy –Emphasizes rational thinking as the key to treating mental disorder

Cognitive therapy for depression involvesEvaluating evidence

Situational factors

Alternative solutions

2727

Insight Therapies:Insight Therapies: Group therapies Group therapies

Group therapy – Psychotherapy with more than one client

Self-help support groups – Groups that provide social support and an opportunity for sharing ideas about dealing with common problems; typically organized/run by laypersons (not professional therapists)

2828

Insight Therapies:Insight Therapies: Group therapies Group therapies

For many issues, couples counseling or family therapy can often be more effective than individual therapy with one individual at a time

2929

Systematic Systematic desensitizationdesensitization

TokenTokeneconomieseconomies

Contingency Contingency managementmanagement

AversionAversiontherapytherapy

ParticipantParticipantmodelingmodeling

Behavior TherapiesBehavior Therapies

Behavior therapy – Any form of psychotherapy based on the principles of behavioral learning, especially operant conditioning and classical conditioning

3030

Classical Conditioning TherapiesClassical Conditioning Therapies

Systematic desensitization – Technique in which anxiety is extinguished by exposing the patient to an anxiety-provoking stimulus

Exposure therapy – Desensitization therapy in which patient directly confronts the anxiety-provoking stimulus (as opposed to imagining it)

3131

UCS(foul odor) UCR

(nausea)

CRCS(cigarette smoke)

Classical Conditioning TherapiesClassical Conditioning Therapies

Aversion therapy – Involves presenting individuals with an attractive stimulus paired with unpleasant stimulation in order to condition a repulsive reaction

3232

Operant Conditioning TherapiesOperant Conditioning Therapies

Contingency management – Approach to changing behavior by altering the consequences, especially rewards and punishments, of behavior

3333

Operant Conditioning TherapiesOperant Conditioning Therapies

Token economies – Applied to groups (e.g. classrooms, mental hospital wards) involving distribution of “tokens” contingent on desired behaviors; tokens can later be exchanged for privileges, food, or other reinforcers

3434

Participant Modeling: An Participant Modeling: An Observational-Learning TherapyObservational-Learning Therapy

Participant modeling – Therapist demonstrates and encourages a client to imitate a desired behavior

3535

Cognitive-Behavioral Therapy: Cognitive-Behavioral Therapy: A SynthesisA Synthesis

Cognitive-behavioral therapyCombines cognitive emphasis on thoughts

with behavioral strategies that alter reinforcement contingencies

Assumes irrational self-statements cause maladaptive behavior

Seeks to help the the client develop a sense of self-efficacy

3636

Cognitive-Behavioral Therapy: Cognitive-Behavioral Therapy: A SynthesisA Synthesis

Rational-emotive behavior therapy – Based on the idea that irrational thoughts and behaviors are the cause of mental disorders (REBT)

3737

Evaluating the Psychological Evaluating the Psychological TherapiesTherapies

Eysenck proposed that people with non-psychotic problems recover just as well with or without therapy

Reviews of evidence have shown:That therapy is better than no therapy

It appears advantageous to match specific therapies with specific conditions

3838

Mental “First Aid”Mental “First Aid”

If someone asks you for help, keep in mind that serious problems (especially those involving suicide or threats) require immediate professional treatment

Otherwise, your best tools may involveListeningAcceptanceExploring alternatives

3939

How Is the BiomedicalHow Is the BiomedicalApproach Used toApproach Used to

Treat Mental Disorders?Treat Mental Disorders?

Biomedical therapies seek to treat mental disorders by

changing the brain’s chemistry with drugs, its

circuitry with surgery, or its patterns of activity with pulses

of electricity or powerful magnetic fields

4040

Drug TherapyDrug Therapy

Psychopharmacology – The prescribed use of drugs to help treat symptoms of mental illness ostensibly to ensure that individuals are more receptive to talk therapies

4141

Drug TherapyDrug Therapy

Antipsychotic drugsInclude chlorpromazine, haloperidol, and

clozapine

Usually affect dopamine pathways

May have side effects

Tardive dyskinesia – Incurable disorder of motor control resulting from long-term use of antipsychotic drugs

4242

Drug TherapyDrug Therapy

Antidepressants and mood stabilizers• Include Prozac, monoamine oxidase (MOA)

inhibitors, and lithium carbonate (effective against bipolar disorder)

• Treat depression and bipolar disorder• Usually affect serotonin and/or

norepinephrine

The use of antidepressants to deal with general feelings of unease is highly controversial

4343

Drug TherapyDrug Therapy

Antianxiety drugs• Include barbiturates and benzodiazepines• May include some antidepressant drugs

which work on certain anxiety disorders• Should not be used to relieve ordinary

anxieties of everyday life• Should not be taken for more than a few

days at a time• Should not be combined with alcohol

4444

Drug TherapyDrug Therapy

Stimulants suppress activity level in persons with attention-deficit/hyperactivity disorder (ADHD)

There is controversy from concern that the causes and boundaries of ADHD are vague and the potential exists for overdiagnosis

4545

PsychosurgeryPsychosurgery

Psychosurgery –The general term for surgical intervention in the brain to treat psychological disordersThe infamous prefrontal lobotomy is no longer

performed

Severing the corpus callosum, however, can reduce life-threatening seizures

4646

Brain-Stimulation TherapiesBrain-Stimulation Therapies

Electroconvulsive therapy is used for the treatment of severe depression

Transcranial magnetic stimulation, a possible alternative to ECT, can also be used for the treatment of depression,schizophrenia, and bipolar disorder

4747

Hospitalization andHospitalization andthe Alternativesthe Alternatives

Therapeutic community –Program of treating mental disorder by making the institutional environment supportive and humane for patients

Deinstitutionalization – Policy of removing patients, whenever possible, from mental hospitals

4848

Hospitalization andHospitalization andthe Alternativesthe Alternatives

Community mental health movement –Effort to deinstitutionalize mental patients and to provide therapy from outpatient clinics