Treatment of Psychological Disorders

CHAPTER 16

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PSYCHOLOGICAL TREATMENTS

 Goal of all psychotherapy is to help people

change maladaptive thoughts, feelings, and
behavior patterns
 Allowspeople to live happier and more
productive lives
 Relationship between client and therapist is very
important

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PSYCHOLOGICAL TREATMENT
 Clinical and counseling psychologists
 Hold a Ph.D. or Psy.D.

 Five or more years of intensive training and

supervision
 In Turkey, to become a clinical psychologist you need
to have 4 year psychology degree & 2 years master
degree. The training is very labor-intensive involving
lecture, applications, internships at hospitals, seeing
clients, preparing case studies, receiving supervision,
for some psychotherapy schools personal therapy and
a scientific research project (Master thesis). Therefore,
good programs only receive small number of students
between 10-20. It is critical to check the therapist
credentials and background before receiving help!
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PSYCHOLOGICAL TREATMENT
 Psychiatrists: medical doctors who specialize
in psychotherapy and biomedical treatment

 Psychiatric Social Workers

 Counselors

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MAJOR APPROACHES TO TREATMENT

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PSYCHODYNAMIC THERAPIES

 Focus on internal conflicts and unconscious

factors that underlie maladaptive behavior

 Goal is to help clients achieve insight

 Conscious awareness of the psychodynamics
that underlie their problems

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PSYCHODYNAMIC TECHNIQUES
 Free association: clients verbally report any thoughts, feelings, or
images that enter their awareness
 Provides clues about important themes and issues
 Dream interpretation: dreams express unconscious fantasies, and
wishes
 Analyst helps client interpret the symbolism in the dream
 Resistance: defensive maneuvers that hinder the process of therapy
 Can appear in many different forms
 Signals that anxiety-arousing material is being approached
 Transference: the client responds to the analyst as if she or he
were an important figure from the client’s life
 Most important process in psychoanalysis 7
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PSYCHODYNAMIC TECHNIQUES
 Interpretation: any statement by the therapist that is intended to
provide the client with insight into his or her behavior or dynamics

 Confronts clients with something that they have not previously

admitted into consciousness
 Interpret only what is already near the surface
 Interpretations that are too deep will be rejected and
misunderstood
 Current psychodynamic therapies are adopting briefer and
more economical approaches
 More likely to focus on client’s current situation than on
past childhood experiences
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HUMANISTIC PSYCHOTHERAPIES
 Humanists view people as capable of consciously controlling their actions
 People should take responsibility for their own choices and behavior
 Everyone possesses inner resources for self-healing and personal
growth
 Resources can become blocked
 Distorted perceptions
 Lack of awareness about feelings
 Negative self-image
 Goal is to allow clients to engage in self-exploration
 Remove the barriers that block natural tendencies toward personal
growth
 Focus is primarily on the present and future instead of the past
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HUMANISTIC PSYCHOTHERAPIES

 Person-centered approach (Carl Rogers):

 Unconditional positive regard: therapist shows
that he or she genuinely cares about and
accepts the client, without judgment or
evaluation
 Empathy: willingness and ability to view the world
through the client’s eyes
 Genuineness: consistency between the way the
therapist feels and the way he or she behaves

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HUMANISTIC PSYCHOTHERAPIES

 Gestalt therapy (Frederick Perls): goal is to

bring the client’s feelings, wishes, and
thoughts into immediate awareness
 Makes the client “whole” again
 Often carried out in groups
 Active role-play of different self-aspects
Empty-chair technique

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COGNITIVE THERAPIES
 Focus on the role of irrational and self-defeating thought patterns
 Therapists help clients discover and change problematic
cognitions
 Thought patterns are not unconscious, but they can be
automatic and ingrained
 Cognitive therapy (Aaron Beck): goal is to point out errors of
thinking and logic
 Help clients identify and reprogram automatic thoughts
 Help clients realize that their thoughts cause their maladaptive
emotional reactions

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BEHAVIOR THERAPIES

 Behavioral approaches believe that:

 Maladaptive behaviors are not merely symptoms
of underlying problems
 Problem behaviors are learned in the same ways
normal behaviors are
 Behavioral approaches believe that:
 Maladaptive behaviors can be unlearned by
applying classical conditioning, operant
conditioning, and modeling principles
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 BEHAVIOR THERAPIES
 Exposure approach:
 Treat phobias through exposure to the feared CS in the absence of the UCS
 Response prevention is used
 Highly effective for reducing anxiety responses
 Controversial because intense temporary anxiety is created by treatment
 Virtual reality (VR): the use of computer technology to create highly realistic virtual
environments
 They evoke the same reactions as a comparable real-world environment
 Used to treat anxiety disorders
 Systematic desensitization: a learning-based treatment for anxiety disorders
 Counterconditioning: a new response that is incompatible with anxiety is
conditioned to the anxiety-arousing CS

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BEHAVIOR THERAPIES
 Aversion therapy: the
therapist pairs an attractive
CS with a noxious UCS in
an attempt to condition an
aversion to the CS
 Examples: alcohol,
pedophiles
 More effective if paired with
a comprehensive treatment
program
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 BEHAVIOR THERAPIES
 Behavior modification: techniques that apply operant conditioning procedures in an attempt to
increase or decrease a specific behavior
 Uses positive/negative reinforcement, extinction, or punishment
 Focuses on externally observable behaviors
 Positive reinforcement techniques:
 Token economy: strengthening desired behaviors through the systematic application of
positive reinforcement
 Tokens can then be exchanged for tangible reinforcers
 Very effective in a wide variety of situations
 Behavioral activation therapy: a depression treatment that increases positively reinforcing
behaviors
 Teaches skills for problem-solving, emotional control, and social interaction
 Goal is to counter depression and increase overall life satisfaction
 Social skills training: clients learn new skills by observing and imitating a model
 Often used along with other treatments 16
 Increases self-efficacy Copyright McGraw-Hill, Inc. 2011
THIRD WAVE
 Incorporate concept of mindfulness
 Add humanistic concepts and eastern methods
 Mindfulness: mental state of awareness, focus, openness, and acceptance of
immediate experience
 Similar to association cognitive techniques
 Acceptance and commitment therapy (ACT):
 Teaches clients to “just notice”
 Reduces emotional impact of thoughts
 Develop strategies to work toward life commitments
 Dialectical behavior therapy (DBT): treatment for borderline personality disorder
 Includes elements from many types of therapies
 Goal is to reduce self-destructive behaviors 17
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GROUP THERAPY

 Clients can:
 Experience acceptance, support, and a sense of
belonging
 Observe others’ approaches to problems
 Gain insight into how they are perceived by
others

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FAMILY THERAPY
 Patient’s disorder may reflect dysfunctional relationships within the family
 Entire family system becomes the focus of therapy
 Therapists help the family understand how their interactions contribute to
conflicts
 Therapist typically works with both partners together
 Focuses on improvement in key areas:
 Communication patterns
 Sensitivity to each other’s feelings/needs
 Problem-solving
 Acceptance of others’ permanent behaviors

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BIOLOGICAL APPROACHES

 Drug therapies:
 Most commonly used biological interventions
 Psychopharmacology: the study of how drugs
affect cognitions, emotions, and behavior
 Three major categories:
 Antipsychotic drugs
 Antianxiety drugs
 Antidepressant drugs
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BIOLOGICAL APPROACHES

 Electroconvulsive therapy:
 Patient is given a sedative and a muscle relaxant
 Patient is placed on padded mattress;
electrodes are attached to scalp

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BIOLOGICAL APPROACHES
 Electroconvulsive therapy:
 Brief shock (less than one second) is applied, causing CNS seizure
 Short-term effects: headache, sore muscles, confusion
 Useful in treating severe depression, particularly if there is a high risk of suicide
 Effects can be immediate
 No one knows why it works
 Used primarily in patients with major depression who cannot take or do not
respond to medication
 Criticisms of ECT:
 Possibility of relapse is high
 Possibility of permanent memory loss
 Possibility of permanent brain damage
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BIOLOGICAL APPROACHES

 Psychosurgery: surgical procedures that

remove or destroy brain tissue in an attempt
to change disordered behavior
 Used rarely, as a last resort
 Lobotomy

 Cingulotomy

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LEVELS OF ANALYSIS

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EVALUATING TREATMENTS

 The specificity question: which types of

therapy administered by which kinds of
therapists to which kinds of clients having
which kinds of problems produce which kinds
of effects?
 Still not answered

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 PSYCHOTHERAPY RESEARCH METHODS
 Difficult to conduct psychotherapy research

 Many variables cannot be controlled

 Difficult to measure the effects of psychotherapy

 Various sources of data

 Various outcome variables

 Research techniques:

 Case studies

 Surveys

 Experiments

 Research techniques:

 Randomized clinical trial: clients are randomly assigned

to treatment or control conditions; groups are then
compared on outcome measures
 Types of control groups: No treatment, Placebo control
condition,Other effective treatment
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THERAPEUTIC OUTCOME

 Factors that influence treatment outcome:

 Client variables
 Therapist variables
 Technique variables

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THERAPEUTIC OUTCOME

 Client variables:
 Openness: clients’ general willingness to invest
themselves in therapy and take the risks
required to change themselves
 Self-relatedness:

Experience and understand internal states

Be attuned to the processes that go on in their
relationship with the therapist
Apply what they learn in therapy to their
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outside lives
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THERAPEUTIC OUTCOME
 Client variables:
 Nature of the problem and its degree of fit with the therapy being used
 Therapist variables:
 Quality of the relationship with the client
 Empathy
 Unconditional acceptance of the client as a person
 Genuineness
 Trusting and caring relationship
 Technique variables:
 Therapist must select and implement the appropriate technique for each
client and situation

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THERAPEUTIC OUTCOME

 Common factors:
 Clients’ faith in the therapist and a belief that they are receiving help
 A plausible explanation for clients’ problems
 An alternative way of helping them look at themselves and their problems
 A protective setting where clients can experience and express their deepest
feelings
 An opportunity for clients to practice new behaviors
 Clients’ achieving increased optimism and self-efficacy

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