TREATMENT OF PSYCHOLOGICAL DISORDERS
Mental illnesses are brought on by a variety of causes therefore therapists must use a variety of methods to treat them.
Research shows that about two-thirds of adults who undergo psychotherapy show marked improvement or recover however, about the same number improve without treatment also.
- also known as insight therapies, based on Freud’s ideas
- goal is to uncover the material in the unconscious mind
- free association
- dream analysis
- symptom substitution
- emphasize peoples’ positive capacities, ability to self-actualize
- Carl Rogers, client-centered therapy, Unconditional positive regard
- Gestalt therapy
- Existential therapies
- attempts to directly manipulate the client’s thinking and reasoning processes
- Rational-emotive therapy
- Attributional style
- Beck cognitive triad
- family therapy
- encounter groups
- self-help groups
- The most common somatic therapy is drug therapy or psychopharmacology
- electroconvulsive therapy, shock treatment
How do psychotherapies differ? How did psychotherapy originate?
• Psychotherapies may be classified as insight, action, directive, nondirective, or supportive therapies, and combinations of these.
• Therapies may be conducted either individually or in groups, and they may be time limited.
• Primitive approaches to mental illness were often based on belief in supernatural forces.
• Trepanning involved boring a how in the skull.
• Demonology attributed mental disturbance to demonic possession and prescribed exorcism as the cure.
• In some instances, the actual cause of bizarre behavior may have been ergot poisoning.
• More humane treatment began in 1793 with the work of Philippe Pinel in Paris.
Is Freudian psychoanalysis still used?
• Freud’s psychoanalysis was the first formal psychotherapy. Psychoanalysis seeks to release repressed thoughts and emotions from the unconscious.
• The psychoanalyst uses free association, dream analysis, and analysis of resistance and transference to reveal health-producing insights.
• Some critics argue that traditional psychoanalysis receives credit for spontaneous remissions of symptoms. However, psychoanalysis has been shown to be successful for many patients.
• Brief psychodynamic therapy (which relies on psychoanalytic theory but is brief and focused) is as effective as other major therapies.
What are the major humanistic therapies?
• Client-centered (or person-centered) therapy is nondirective and is dedicated to creating an atmosphere of growth.
• Unconditional positive regard, empathy, authenticity, and reflection are combined to give the client a chance to solve his or her own problems.
• Existential therapies, such as Frankl’s logotherapy, focus on the end result of the choices one makes in life. Clients are encouraged through confrontation and encounter to exercise free will and to take responsibility for their choices.
• Gestalt therapy emphasizes immediate awareness of thought and feelings. Its goal is to rebuild thinking, feeling, and acting into connected wholes and to help clients break through emotional blockages.
• Media psychologists, telephone counselors, and cybertherapists may, on occasion, do some good. However each has serious drawbacks, and the effectiveness of telephone counseling and cybertherapy has not been established.
• Therapy by videoconferencing shows more promise as a way to provide mental health services at a distance.
What is behavior therapy?
• Behavior therapists use various behavior modification techniques that apply learning principles to change human behavior.
• In aversion therapy, classical conditioning is used to associate maladaptive behavior (such as smoking or drinking) with pain or other aversive events in order to inhibit undesirable responses.
How is behavior therapy used to treat phobias, fears, and anxieties?
• Classical conditioning also underlies systematic desensitization, a technique used to overcome fears and anxieties. In desensitization, gradual adaptation and reciprocal inhibition break the link between fear and particular situations.
• Typical steps in desensitization are: Construct a fear hierarchy, learn to produce total relaxation, and perform items on the hierarchy (from least to most disturbing).
• Desensitization may be carried out with real settings, or it may be done by vividly imagining the fear hierarchy.
• Desensitization is also effective when it is administered vicariously – that is, when clients watch models perform the feared responses.
• In some cases, virtual reality exposure can be used to present fear stimuli in a controlled manner.
• A new technique called eye movement desensitization and reprocessing (EMDR) shows promise as a treatment for traumatic memories and stress disorders. At present, however, EMDR is highly controversial.
What role does reinforcement play in behavior therapy?
• Behavior modification also makes use of operant principles, such as positive reinforcement, nonreinforcement, extinction, punishment, shaping, stimulus control, and time out. These principles are used to extinguish undesirable responses and to promote constructive behavior.
• Nonreward can extinguish troublesome behaviors. Often this is done by simply identifying and eliminating rein forcers, particularly attention and approval.
• To apply positive reinforcement and operant shaping, symbolic rewards known as tokens are often used. Tokens allow immediate reinforcement of selected target behaviors.
• Full-scale use of tokens in an institutional setting produces a token economy. Toward the end of a token economy program, patients are shifted to social rewards such as recognition and approval.
Can therapy change thoughts and emotions?
• Cognitive therapy emphasizes changing thought patterns that underlie emotional or behavioral problems. Its goals are to correct distorted thinking and/or teach improved coping skills.
• In a variation of cognitive therapy called rational-emotive behavior therapy (REBT), clients learn to recognize and challenge their own irrational beliefs.
Can psychotherapy be done with groups of people?
• Group therapy may be a simple extension of individual methods, or it may be based on techniques developed specifically for groups
• In psychodrama, individuals enact roles and incidents resembling their real-life problems. In family therapy, the family group is treated as a unit.
• Although they are not literally psychotherapies, sensitivity and encounter groups attempt to encourage positive personality change. In recent years, commercially offered large-group awareness trainings have become popular. However, the therapeutic benefits of such programs are questionable.
What do various therapies have in common?
• To alleviate personal problems, all psychotherapies offer a caring relationship, emotional rapport, a protected setting, catharsis, explanations for the client’s problems, a new perspective, and a chance to practice new behaviors.
• Many basic counseling skills underlie a variety of therapies. These include listening actively, helping to clarify the problem, focusing on feelings, avoiding the giving of unwanted advice, accepting the person’s perspective, reflecting thoughts and feelings, being patient during silences, using open questions when possible, and maintaining confidentiality.
How do psychiatrists treat psychological disorders?
• Three medical, or somatic, approaches to treatment are pharmacotherapy, electroconvulsive therapy (ECT), and psychosurgery. All three techniques are controversial to a degree because of questions about effectiveness, and side effects.
• Community mental health centers seek to avoid or minimize mental hospitalization. They also seek to prevent mental health problems through education, consultation, and crisis intervention.
How are behavioral principles applied to everyday problems?
• Cognitive techniques can be an aid to managing personal behavior.
• In covert sensitization, aversive images are used to discourage unwanted behavior.
• Thought stopping uses mild punishment to prevent upsetting thoughts.
• Covert reinforcement is a way to encourage desired responses by mental rehearsal.
• Desensitization pairs relaxation with a hierarchy of upsetting images in order to lessen fears.
How could a person find professional help?
• In most communities, a competent and reputable therapist can be located with public sources of information or through a referral.
• Practical considerations such as cost and qualifications enter into choosing a therapist. However, the therapist’s personal characteristics are of equal importance.
Do cultural differences affect counseling and psychotherapy?
• Many cultural barriers to effective counseling and therapy have been identified.
• Aware therapists are beginning to seek out the knowledge and skills needed to intervene successfully in the lives of clients from diverse cultural backgrounds.
• The culturally skilled counselor must be able to establish rapport with a person from a different cultural background and adapt traditional theories and techniques to meet the needs of clients from non-European ethnic or racial groups.
PSYCHOLOGY ON THE NET
• Basics of Cognitive Therapy – An overview of cognitive therapy with suggesting readings. http://mindstreet.com/cbt.html
Types of Therapies – Describes four different approaches to therapy. Also has information about choosing a therapist. http://www.grohol.com/therapy.htm