Psychoanalytic Treatment

In the Freudian system, anxiety is the main problem people face.

Anxiety is produced when sexual and aggressive impulses are repressed.

Guilt occurs when the impulses are partially expressed.

These impulses occur at the unconscious level.

Today psychoanalytic techniques are called psychodynamic or insight therapy.

Humanistic Therapy

People have the power to control their fate, ideas, and movements as they move towards self-actualization.

This therapy is now known as person (client) centered therapy.

Therapist and client are considered equal partners in therapy.

In this therapy, the client decides what is to be discussed and what direction the therapy will take.

The therapist develops an atmosphere of trust and understanding.

The therapist acts as a mirror to the client, reflecting ideas and concepts.

The therapist does not judge the client. Thoughts, feelings, and ideas represent a person seeking to grow and seeking to be understood.

Humanistic Therapy (continued)

People need to accept themselves as they are, while working toward fulfilling their potential.

Behavior TherapyBehavior Therapy

Behavior TherapyBehavior Therapy therapy that applies learning principles to the therapy that applies learning principles to the

elimination of unwanted behaviorselimination of unwanted behaviors CounterconditioningCounterconditioning

procedure that conditions new responses to procedure that conditions new responses to stimuli that trigger unwanted behaviorsstimuli that trigger unwanted behaviors

based on classical conditioningbased on classical conditioning includes systematic desensitization and includes systematic desensitization and

aversive conditioningaversive conditioning

Behavioral Therapy

Behavioral therapy attempts to change behavior using the techniques of learning.

Behaviorists assume that abnormal behaviors are the result of faulty (inappropriate) learning.

Why is psychoanalysis a lot quicker for a Why is psychoanalysis a lot quicker for a man than for a woman?man than for a woman?

Because when it’s time to go back to Because when it’s time to go back to childhood, a man is already there. childhood, a man is already there.

Gestalt TherapyGestalt Therapy

Developed by Developed by Fritz PerlsFritz Perls to combine the to combine the psychoanalytic emphasis on bringing psychoanalytic emphasis on bringing unconscious feelings to awareness and the unconscious feelings to awareness and the humanistic emphasis on getting “in touch with humanistic emphasis on getting “in touch with oneself”oneself”

Aims:Aims: to help people become more aware of to help people become more aware of and able to express their feelings, and to take and able to express their feelings, and to take responsibility for their feelings and actions. responsibility for their feelings and actions.

EmphasizesEmphasizes the importance of encouraging the importance of encouraging people to sense and express their own true people to sense and express their own true moment-to-moment feelings.moment-to-moment feelings.

Cognitive TherapyCognitive Therapy

Cognitive-Behavioral TherapyCognitive-Behavioral Therapy a popular integrated therapy that a popular integrated therapy that

combines cognitive therapy combines cognitive therapy (changing self-defeating thinking) (changing self-defeating thinking) with behavior therapy (changing with behavior therapy (changing behavior)behavior)

Rational Emotive TherapyRational Emotive Therapy

Developed by Developed by Albert EllisAlbert Ellis ABC model ABC model

Activating EventActivating Event BeliefsBeliefs ConsequencesConsequences

Identification and elimination of core Identification and elimination of core irrational beliefsirrational beliefs

Aaron Beck’s Cognitive TherapyAaron Beck’s Cognitive Therapy Problems due to negative cognitive bias Problems due to negative cognitive bias

that leads to distorted perceptions and that leads to distorted perceptions and interpretations of eventsinterpretations of events

Recognize the bias then test accuracy Recognize the bias then test accuracy of these beliefsof these beliefs

Therapist acts as model and aims for a Therapist acts as model and aims for a collaborative therapeutic collaborative therapeutic

climateclimate

Effectiveness of PsychotherapyEffectiveness of Psychotherapy

Most people do not seek help with Most people do not seek help with problemsproblems

Many people report spontaneous Many people report spontaneous remissionremission

Meta-analyses show that psychotherapy is Meta-analyses show that psychotherapy is more effective than no treatmentmore effective than no treatment

Generally no differences among the types Generally no differences among the types of psychotherapyof psychotherapy

Evaluating Evaluating PsychotherapiesPsychotherapies

Regression toward the meanRegression toward the mean tendency for extremes of unusual tendency for extremes of unusual

scores to fall back (regress) toward their scores to fall back (regress) toward their averageaverage

Meta-analysisMeta-analysis procedure for statistically combining the procedure for statistically combining the

results of many different research results of many different research studiesstudies

The Relative Effectiveness of The Relative Effectiveness of Different TherapiesDifferent Therapies

The Relative Effectiveness of Different TherapiesThe Relative Effectiveness of Different Therapies

Although no one type of therapy can be said to be most Although no one type of therapy can be said to be most effective overall, some therapies are particularly well-suited effective overall, some therapies are particularly well-suited to specific disorders.to specific disorders.

1.1. Behavioral Therapy— Behavioral Therapy— works best when treating works best when treating specific behaviors such as phobias, compulsions, or sexual specific behaviors such as phobias, compulsions, or sexual dysfunctions.dysfunctions.

2.2. Cognitive Therapy—Cognitive Therapy— best treatment for depression. best treatment for depression. 3.3. Psychotherapists— Psychotherapists— increasingly offer particular increasingly offer particular

treatments for specific problems.treatments for specific problems.

Evaluating Alternative TherapiesEvaluating Alternative Therapies

Eye Movement Desensitization and Eye Movement Desensitization and Reprocessing (EMDR)Reprocessing (EMDR)

While people imagined traumatic scenes, While people imagined traumatic scenes, Francine Shapiro triggered eye Francine Shapiro triggered eye movements by waving her finger in front of movements by waving her finger in front of their eyes. 84 to 100% of the trauma their eyes. 84 to 100% of the trauma victims said it worked. ...or is it another victims said it worked. ...or is it another placebo effect???placebo effect???

Evaluating Alternative TherapiesEvaluating Alternative Therapies

Light-Exposure TherapyLight-Exposure Therapy

Treatment for Treatment for Seasonal Affective DisorderSeasonal Affective Disorder (SAD) – wintertime depression. (SAD) – wintertime depression.

Give SAD people a daily dose of intense Give SAD people a daily dose of intense light and it will relieve symptoms light and it will relieve symptoms associated with wintertime depression. associated with wintertime depression. This does work!This does work!

Biomedical TherapiesBiomedical Therapies

PsychopharmacologyPsychopharmacology study of the effects of drugs on mind study of the effects of drugs on mind

and behaviorand behavior

Antipsychotic DrugsAntipsychotic Drugs

Antipsychotic DrugsAntipsychotic Drugs

The molecules of antipsychotic drugs are The molecules of antipsychotic drugs are similar enough to molecules of the similar enough to molecules of the neurotransmitter dopamine to occupy its neurotransmitter dopamine to occupy its receptor sites and block its activity.receptor sites and block its activity.

(Thorazine, Clozapine )(Thorazine, Clozapine )

Antianxiety DrugsAntianxiety Drugs

Antianxiety DrugsAntianxiety Drugs

Valium, Xanax, LithiumValium, Xanax, Lithium – – depress nervous depress nervous system activity.system activity.

Antidepressant DrugsAntidepressant Drugs

Antidepressant DrugsAntidepressant Drugs

Most antidepressants work by increasing Most antidepressants work by increasing the availability of the neurotransmitters the availability of the neurotransmitters norepinephrine or serotonin, which elevate norepinephrine or serotonin, which elevate arousal and mood and appear scarce arousal and mood and appear scarce during depression.during depression.

Antidepressant DrugsAntidepressant Drugs

LithiumLithium—— a chemical that provides an effective drug a chemical that provides an effective drug therapy for the mood swings of bipolar (manic-therapy for the mood swings of bipolar (manic-depressive) disordersdepressive) disorders..

ProzacProzac— — (fluoxetine) blocks the reabsorption and (fluoxetine) blocks the reabsorption and removal of serotonin from synapses.removal of serotonin from synapses.

ZoloftZoloft—— cousin to Prozac; blocks reabsorption of cousin to Prozac; blocks reabsorption of serotonin.serotonin.

PaxilPaxil— — cousin to Prozac; serotonin-uptake-inhibitor.cousin to Prozac; serotonin-uptake-inhibitor.

Biomedical TherapiesBiomedical Therapies

Anti-Depressant MedicationAnti-Depressant Medication

• • First generation—tricyclics and MAO First generation—tricyclics and MAO inhibitorsinhibitors Effective for about 75% of patientsEffective for about 75% of patients Produce troubling side effectsProduce troubling side effects

• MAO inhibitorsMAO inhibitors can have serious physiological can have serious physiological side effects when taken with some common side effects when taken with some common foodsfoods

• TricyclicsTricyclics caused weight gain, dry mouth, caused weight gain, dry mouth, dizziness, sedationdizziness, sedation

Anti-Depressant MedicationAnti-Depressant Medication Second generation—chemically different but Second generation—chemically different but

no more effective than earlier drugs no more effective than earlier drugs (Wellbutrin, Desyrel)(Wellbutrin, Desyrel)

Selective serotonin reuptake inhibitorsSelective serotonin reuptake inhibitors (SSRI)(SSRI)—— have fewer undesirable side effects than have fewer undesirable side effects than earlier drugs earlier drugs

(Prozac, Paxil, Zoloft)(Prozac, Paxil, Zoloft) Double blind studies indicate placebo effect Double blind studies indicate placebo effect

also effective. (p. 714) Produced improvementalso effective. (p. 714) Produced improvement

comparable to 75% of active drug’s effect. comparable to 75% of active drug’s effect.

Mood Stabilizing drugsMood Stabilizing drugs

Lithium (a salt) has been effective in Lithium (a salt) has been effective in stabilizing mood swings in bi polar patientsstabilizing mood swings in bi polar patients

Depakote, orginally used to treat epilepsy, Depakote, orginally used to treat epilepsy,

has proven effective for bi polar disorder.has proven effective for bi polar disorder.

Dual diagnosisDual diagnosis

Patient having a mental illness and also a Patient having a mental illness and also a drug addiction. Few facilities are equipped drug addiction. Few facilities are equipped to treat both at the same time effectively.to treat both at the same time effectively.

Electroconvulsive Therapy-ECTElectroconvulsive Therapy-ECT Used for severe depressionUsed for severe depression Very effective for quick relief of symptoms Very effective for quick relief of symptoms

of severe depression (can be used until of severe depression (can be used until medication begins to work)medication begins to work)

May have cognitive side effects such as May have cognitive side effects such as short term memory lossshort term memory loss

Brief electric current sent through the brain Brief electric current sent through the brain of an anesthetized patientof an anesthetized patient

Very controversial treatmentVery controversial treatment

ECT generally lastsabout 10-20 minutes

New Alternatives to ECTNew Alternatives to ECT rTMS (repetitive transcranial magneticrTMS (repetitive transcranial magnetic

stimulation – no seizures, memory loss or side stimulation – no seizures, memory loss or side effects. Pulse surges through a magnetic coil.effects. Pulse surges through a magnetic coil.

Chest implant that intermittently stimulatesChest implant that intermittently stimulates

the vagus nerve that sends a message to the vagus nerve that sends a message to

the limbic systemthe limbic system

This stimulation appears to reduce activity This stimulation appears to reduce activity

in the brain that is hyperactive to depressionin the brain that is hyperactive to depression

Vagus Nerve Stimulation

rTMS

PsychosurgeryPsychosurgery

surgery that removes or destroys brain surgery that removes or destroys brain tissue in an effort to change behaviortissue in an effort to change behavior

Lobotomy- developed by Egas MonizLobotomy- developed by Egas Moniznow-rare psychosurgical procedure once now-rare psychosurgical procedure once

used to calm uncontrollably emotional or used to calm uncontrollably emotional or violent patients violent patients

Nerves connecting the frontal lobes to Nerves connecting the frontal lobes to the emotion controlling centers of inner the emotion controlling centers of inner brain are severed. brain are severed.

Psychiatrist WalterFreeman performinga lobotomy

DeinstitutionalizationDeinstitutionalization

The emptying of U.S. mental hospitalsThe emptying of U.S. mental hospitals

DeinstitutionalizationDeinstitutionalization 1963 Congress passed legislation establishing 1963 Congress passed legislation establishing

a network of community mental health centers a network of community mental health centers around the nation.around the nation.

Through the years, funding has dried up, Through the years, funding has dried up, facilities have closed and there is little guidance facilities have closed and there is little guidance as well as affordable housing for many who are as well as affordable housing for many who are mentally ill.mentally ill.

It is estimated that around 20-25 % of the It is estimated that around 20-25 % of the adult single homeless in U.S. are mentally illadult single homeless in U.S. are mentally ill

DeinstitutionalizationDeinstitutionalization

Recent federal statistics (2006) reveal that the Recent federal statistics (2006) reveal that the number of mentally ill inmates in U.S. prisons number of mentally ill inmates in U.S. prisons has quadrupled in the past 6 years.has quadrupled in the past 6 years.

More than More than half half of all prison and state inmates of all prison and state inmates report mental health problems including major report mental health problems including major depression, mania, psychotic disorders.(federal depression, mania, psychotic disorders.(federal Bureau of Justice Statistics)Bureau of Justice Statistics)

55% of male inmates and 75% of female 55% of male inmates and 75% of female inmates have mental health problems.inmates have mental health problems.