Different Perspectives on Psychopathology and Mental Illness PDF

Different Perspective on Psychopathology and Mental Illness Larry Lee Senior Clinical Associate Tung Wah College Cause-oriented Reasoning Outcome-oriented Reasoning Mental Illness...

Different Perspective on Psychopathology and Mental Illness Larry Lee Senior Clinical Associate Tung Wah College Cause-oriented Reasoning Outcome-oriented Reasoning Mental Illness Why? What How? What next? happened? What is the “cure” of seasonal flu? What is the root cause of seasonal flu? Viral infection Antiviral Medication, rest and plenty of water intake Cause-oriented Reasoning What is the “cure” of fracture? What is the ultimate goal after bone fracture? Bone Healing Reduction & Fixation Outcome-oriented Reasoning  What is the “cure” of mental illness? Cause-oriented Reasoning Outcome-oriented Reasoning Start with performance components Start with life role and occupations Bottom-up Approach Top-down Approach What is the “cure” of occupational dysfunction?  Psychoanalysis/ Psychodynamic FOUR major Cognitive Modern Behavioral Approach Schools in Therapy Psychology Humanistic Approach A Few Post-Modern Theories in Mental Health Practice Pragmatism Strength- based Positive Recovery Psychology Approach  1900, Sigmund 1913, Carl 1942 Carl 1890, William Freud published 1967 Aaron 3rd Century B.C. G. Jung Rogers James “interpretation Beck published Theories from departed published published of Dreams”, a model of Great Greek from “Counseling “Principles of marking the depression Philosophers Freudian’s and Psychology” beginning of view. Psychotherapy” Psychoanalysis. Ancient Ages WWI 1914-1919 Post-modern Ages WWII 1939-1945 1800s, Formal 1896, the first 1906, Ivan 1963 Alfred 1938, Psychology Labs psychological Pavlov Bandura Electroshock were found clinic was published the introduced the therapy was across the developed in first study on idea of first used on a Europe and University of classical Observational human patient. America Pennsylvania conditioning. Learning  Human nature (Personality 人性) Human mind and behaviors Causes of psychological problems How to treat the psychological problems Philosophy Conceptual Framework Skill Sets Politics in psychotherapy for Studying Specific assessment and treatment tools Skills Psychotherapy Approaches What is meant by “remission” Desirable changes Outcome Therapeutic targets/ Treatment goals PSYCHOANALYTIC/ PSYCHODYNAMIC APPROACH IMPORTANT FIGURES Sigmund Freud Carl G. Jung Inspired by early practice Worked as Freud’s in hypnotherapy “favorite student” in his 1st psychologist/ early years in the psychiatrist proclaimed professional the importance of Later on, departed from unconsciousness and early Freudian school and childhood development established his own “brand” – Analytic Psychology PHILOSOPHY Both believed the importance of studying unconsciousness/ sub-consciousness Both emphasized on the importance of having dialogue with the “patient”, resolving the intrapsychic conflicts, which can bring about the “remission” Both believed that “dream” is the doorway to unconsciousness, so they both did “dream analysis” with their patient. However, they did it in two different ways. PHILOSOPHY Unconsciousness The epicenter of repressed thought, desires, traumatic memories, and different psychic drives. Dreams – the Doorway to Unconsciousness They are manifestations resulted from the dynamics Personal Collective among three major parts: id, ego and super-ego. Unconsciousness Unconsciousness Subjective, abstract and Similarities, coincidences Id Ego Super-ego individualized and can be grouped A Set of The organized and A Set of uncoordinate realistic parts which criticism and “Dreams Dictionary” d instinctual mediates the conflict moral trends/ between id and super- standards desires ego “Ego” = Conscious Mind PHILOSOPHY Motivation – Intrapsychic Energy The primary concern is “sexuality”. Libido Human can be motivated by various internal is the primary “energy” that drive and desires, and sexual drive is only one of the direct human behaviors. possible options. Personal Growth The psychosexual development theory The personal growth move on throughout the whole lifespan – the Individuation Process People focus on Two Types of People People focus on internal world Introverts Vs Extroverts external world Four Functions Perceiving Judging iNtuition Sensing Feeling Thinking  PHILOSOPHY – DEFENSE MECHANISM Based on Anna Freud’s categorization in 1963  Projection: Attributing undesirable thought or feeling to  Repression: hiding feeling and forcing it to the unconscious level others  Introjection (Identification): Acquiring others attributes,  Regression: falling back to early stage of developmental stage which is “less demanding and safer” traits, ideas or behavior to replace his own undesirable ones  Reaction Formation: emotions and impulses are  Turning against one’s own person: indulging in self-harm mastered by exaggeration of the opposite or inflicting behaviors  Isolation: creating a “mental gap” between unpleasant  Reversal into the opposite: abrupt changes in thoughts emotion/ ideas and the reality; it can turn out into or feelings which are just opposite to the original ones dissociative state in extreme situation  Sublimation/ Displacement: transforming the idea or  Undoing (Compensation): Engaging in contrary or compensatory behaviors in order to “erase” unpleasant feeling into other behaviors (displacement) or some thought or behavior in the past acts which are regarded with great social/ moral value (Sublimation) All defense mechanisms involve certain degree of “denial”, i.e. disregarding the undesirable/ unpleasant ideas and emotions APPLICATION OF DEFENSE MECHANISM  Freudian’s approach  Modern approach  Starting with the identification of defense mechanism  Regarding as forms of “resistance” toward desirable adopted by the patient, the therapist can understand changes the intrapsychic dynamic which caused the  Can be worked on either “unconscious” or “conscious” psychological problems levels  Usually worked on the “unconscious” level of the  To manage traumatic memories, ethically or social defense mechanism, to bring about equilibrium among unacceptable thoughts, and unpleasant/ unbearable id, ego and super-ego (How?) emotions PHILOSOPHY – TRANSFERENCE AND COUNTER-TRANSFERENCE  Early definition of “Transference”  The unconscious redirection of a patient’s feeling on a significant person to the therapist (patient)  At Freudian era, it was regarded as one of the important components during psychotherapy (therapist)  Definition of “Counter-transference”  The unconscious redirection of the therapist’s feeling on a significant person back to the patient  Regarded as “danger” which may jeopardize the therapeutic process  Modern application – Therapeutic rapport, interpersonal reciprocity between the patient and the therapist  Influences on modern psychology  The Attachment Theory by John Bowlby  The Object Relations Theory by Ronald Fairbairn SKILLS AND TECHNIQUES  Interpretation of dreams  Hypnotherapy – unfolding the “sub consciousness” (the Trance state)  Detail investigation on childhood experience  Other projective techniques  Free Association (Thematic Appreciation Test)  Rorschach Inkblot Test  House-tree-person projective drawing  Symbolic meaning in sand play  Expressive art THEMATIC APPRECIATION TEST RORSCHACH INKBLOT TEST Free online test: https://www.idrla bs.com/rorschac h/test.php HOUSE-TREE-PERSON DRAWING EXPRESSIVE ARTS THERAPY SAND PLAY THERAPY INFLUENCES ON MODERN PSYCHOLOGY - NEO-FREUDIAN THEORIES  Carl Jung & Analytical Psychology  Collective Unconsciousness  Erik Erikson & 8-stage of psychosocial development  Archetypes (Antecedent concept of cognitive schema)  Trust Vs Mistrust  Psychological Types – MBTI  Autonomy Vs Shame & Doubt  Alfred Adler & Individual Psychology  Initiative Vs Guilt  Person is thriving for achievement and sense of superiority  Industry Vs Inferiority  It influences Maslow’s idea on hierarchy of needs  Identity Vs Role Confusion  Object-relation Theory  Intimacy Vs Isolation  Mental health/illness is determined by how people relate to  Generativity Vs Stagnation objects in their environment. (Antecedent concept on P-O- E relationship)  Integrity Vs Despair SUMMARY  Understanding about the “unconscious” mind  Dynamic theory about personality: Id-Ego-Superego  Theories about human motivation  Application of Defense Mechanism  The importance of “transference” – therapist-patient interaction in psychotherapy Behavioral Theories HISTORY  In 1879, the first experimental psychology laboratory was opened in Germany  In 1884, Ivan Pavlov began studying the digestive secretion of animals  In 1903, J.B. Watson completed his dissertation on rat behaviors  In 1927, Ivan Pavlov published Conditioned Reflexes, containing his theory of classical conditioning  In 1938, B.F. Skinner published his first major work The Behavior of Organism: An Experimental Analysis.  In 1941, B.F. Skinner and his associates introduced the conditioned emotional response among rats under electric shock  In 1953, B.F. Skinner outlined behavioral therapy Summary  Classical Conditioning  Operant Conditioning  Behavioral Modification  Functional analysis of human behaviors  Foundation for experimental psychology (a.k.a. experimental behavioral science) Classical Conditioning Operant Conditioning https://youtu.be/qy_mIEnnlF4 PHILOSOPHY  Human being is born as a “plain paper”.  Every“mental activity” is just an illusion we choose to explain the cause of human behaviors.  Everyhuman behaviors are either governed by physiological mechanism built within our body, or affected by the demands from the environment on our body. Ref: https://en.wikipe dia.org/wiki/Oper ant_conditioning Behavioral Modification  Main Strategies  Manipulation of reinforcement ratio and schedule  Behavioral Contract  Token Economy  Applied Behavioral Analysis (ABA)  Other techniques:  Systematic Desensitization  Flooding  Modeling Humanistic Approach - Theoretical Background  Carl Roger’s theory – Three essential therapists’ attitudes in psychotherapy  Congruence  Unconditional Positive Regards  Empathy  Ill-health Continuum  Mental health problems are results of inconsistence (incongruence) within one self, or conflicts between personal experience and the awareness of “true” self  Treatment goals  Achieving self-actualization and personal growth (Please also read the article Pioneer of Humanistic Psychology) Humanistic Approach - Skills and Techniques No legitimate tools / Methods! Summary  Three elements for change in OT process  Congruence  Unconditional positive regard  Empathy  Belief in humanity Cognitive Approach PHILOSOPHY Analytical Psychology Cognitive Approach Neuroscience PHILOSOPHY – ARCHETYPE & SCHEMA Archetype 原型 Schema 模式 Archetypes are innate, A schema consists of a pattern universal “prototypal” ideas of ideas, or a well-organized which govern your group of information which can understanding about the world. work as your basis for making There are archetypes about interpretation about everything masculinity, feminity, Schema can work in both motherhood, fatherhood, birth unconscious and conscious and death, etc. level. Archetypes are supposed to operate in unconscious, or at least sub-conscious level. PHILOSOPHY – COGNITIVE THERAPY Human’s emotion and behaviors are governed by perception and beliefs. Antecedent Belief Consequence Activating Events Automatic Emotions Thought Stimulus Behaviors Automatic Automatic Thought Thought Core Archetypes Belief Schemata Cognitive Behavioral Approach - “Hybrid” Approach Core beliefs / assumptions Human’s behaviors are affected by their beliefs Human’s behaviors are also results of behavioral learning (either through classical conditioning or operant conditioning Therapist can either change patient’s belief to have different resulted behavior; or through behavioral experiment to change patient belief Treatment goals: Desirable responses or outcome behaviors Pleasant emotional state Cognitive Behavioral Approach - Skills and Techniques Cognitive Behavioral Cognitive restructuring Manipulation of reinforcement Reframing schedules Automatic thought journal Behavioral activation techniques Systematic desensitization Flooding Supported experimentation Neurocognitive Approach - Upcoming new Trend in Psychiatric Rehab No. of Articles 4836 5000 Long history of studying Body-mind 4500 relationship in psychology since 19th 4000 century 3500 3000 The term “cognitive 2500 2010 neuroscience” was firstly coined in 1978 2000 1500 1000 382 No. of studies rapidly increase in recent 3 500 15 135 decades 0 Before 1987 to 1994 to 2001 to 2009 to 1987 1993 2000 2008 2016 No. of Articles No. of scientific articles with “Neurocognitive” & Mental illness as their subjects Common Cognitive Problems among people with Mental Illness Attention Processing Speed Selective attention Divided attention Working Memory Learning abilities Executive Function Verbal learning Visual learning Social Cognition Summary Focus on the “conscious” mind Understanding about cognition: Content (what you belief/ perceive) Process/ Form (How do you belief/ perceive/ acquire ideas) Integration with neuro-cognitive science Postmodern Approaches in Mental Health Practice Ideas for today and tomorrow PHILOSOPHY Postmodernism Skepticism – criticize everything, e.g. religion, objective reality, heritage, etc. Relativism – everything is relative to one another Constructionism – opposite of reductionism Examples: globalization, butterfly effect, etc. Pragmatism Anything work will be fine, regardless the underlying theories or beliefs 21st Century and beyond - Era of Postmodernism and Pragmatism Milton H. Erickson – well-known “Atypical” hypnotherapist Ericksonian approach in psychotherapy Strategic (Family) Therapy Solution-focus Therapy Neuro-linguistic Programming Other Post-modern approaches Narrative Therapy Motivational Interviewing Eclectic Approach 21st Century and beyond - Era of Postmodernism and Pragmatism Theoretic Background Skills and Techniques No, or very few sayings about Abundant of skills and techniques their theoretical backgrounds Much overlapping and crossover Usually, borrow beliefs or Example 1: Scaling questions assumptions from Humanistic Example 2: Explore exception approach Focus on linguistic skills/ the way of using language Example 3: Double binding option Example 4: Presupposing question Positive Psychology Martin Seligman Founder of Positive Psychology Major contribution: Theories about authentic happiness and well-being Mihaly Csikszentmihalyi Major contribution: studies about “Flow” experience Christopher Peterson Major contribution: Theories about “Value in Action” (VIA) and related topics Strength-based Recovery Approach Strength-based Approach Recovery-orientated Practice Not only focus on “deficit” or Principles in Mental Health “weakness” but also identify Recovery “assets” and “strength” SAMHSA Make use of “assets” and APA strength” to overcome challenge UK ahead Australia Summary Pragmatism Strength- based Positive Recovery Psychology Approach Psychoanalytic Approaches Postmodern Approaches Cognitive Behavioral Approach Humanistic Approach Psychoanalysts Humanistic - Unhappy childhood - Maladaptive defense - Lacking “unconditional love” - Lacking acceptance to the true self mechanism - Difficult to achieve self actualization - Unconsciously embedded - Lacking sense of superiority sadness – death instinct Postmodern - Good to be “Sad” - Learned helplessness - What do you want? - Cognitive bias or - What make you happy? distortion (irrational - What would you do to make beliefs) yourself happy again? - Mislead by automatic thought - Root from the core beliefs - Lacking reinforcement or successful experience Psychiatrist - Something wrong with the neurotransmitters in your brain Cognitive - Imbalance of electrolytes and hormones Behavioral Approach What would an OT say? Risk Prevention Medical Orientation Directive Psychiatrist Clinical OT OT Psychologist Non-directive Psychosocial Orientation Need-driven  Carl Jung Erik Erikson Sigmund Freud 1913 1950 1886 Alfred Adler Otto Rank 1911 1926 B.F. Skinner Albert Ellis Ivan Pavlov 1938 1962 1927 Aaron Beck 1967 Viktor Frankl Carl Roger 1959 1942 Abraham Maslow 1943 Virginia Satir 1964 Neuro-linguistic Programming Milton H. Erickson 1980s 1950s Strategic Therpay Solution Focused Brief Therapy 1960s 1980s Narrative Therapy 1980s Motivational interviewing 1980s OT practice dependent on physician Model of Human Occupation 1917 to 1950s 1970s - 80s The Moral Treatment Era Treating MI with SI Theory of Cognitive Disabilities 19th Century 1970s 1980s 1st OT training Course in UK Community Mental Health Act The American with Disabilities Act 1930 1963 1990 Frog or Horse Further reading:  Traditional textbook for “Psychotherapy and counseling”:  Corey, Gerald. (2017). Theory and practice of counseling and psychotherapy (Tenth edition..). Cengage Learning.  Traditional textbook in “Group work in counselling”  Corey, Marianne Schneider, & Corey, Gerald. (2002). Groups : process and practice (6th ed..). Brooks/Cole-Thomson Learning.