Therapies and Treatments SMU F24 PDF

Therapies and Treatments Ch. 14 Today What is psychotherapy Early therapies Contemporary therapies Types of therapy: ▫ Insight therapies (classic psychoanalysis, psychodynamic, humanistic ▫ Behavioural therapies ▫ Cognitive & CBT ▫ Biological / Biomedical The...

Therapies and Treatments Ch. 14 Today What is psychotherapy Early therapies Contemporary therapies Types of therapy: ▫ Insight therapies (classic psychoanalysis, psychodynamic, humanistic ▫ Behavioural therapies ▫ Cognitive & CBT ▫ Biological / Biomedical Therapies Contemporary trends What do you think of when you hear the term “therapy”? What is Psychotherapy? The term psychotherapy refers to the diverse range of approaches used in the treatment of mental disorder and psychological problems. ▫ Experts estimate that there may be over 400 different approaches to psychotherapy Today we’ll concentrate on four: ▫ Insight therapies (classic psychoanalysis, psychodynamic, humanistic ▫ Behavioural therapies ▫ Cognitive & CBT ▫ Biological / Biomedical Therapies Early “Therapies” for Psychological Disorders The treatment of psychological disorders has changed over time as the understanding of the disorders has become more complete. Early therapies were based on the idea that psychological disorders were caused by evil spirits. Trephination: An early therapy for mental disorders that involved cutting a hole in the skull (to allow demons to release through an exit). Early “Therapies”… Beginning in the sixteenth century, “hospitals for the insane” were established throughout Europe. Conditions were barbaric, chaotic, and patients were sometimes displayed to the public for a fee. This painting shows London's Bethlehem ("Bedlam") Hospital, where patients were exhibited as though they were zoo animals to anyone curious enough to pay the required penny per visit. In 1814, there were 96,000 such visits. Early “Therapies”… A centrifugal-force bed Early “Therapies”… A crib for violent patients Early “Therapies”… A swinging bed Early “Therapies” for Psychological Disorders (3) In 1897, general paresis was discovered to be a consequence of syphilis. This paved the way for antibiotics and a medical perspective regarding psychological disorders. Sigmund Freud’s “talking cure” in the late nineteenth century became the first psychological therapy that drew attention to environmental and social dimensions. Types of Therapy: Insight Therapies Insight therapies involve pursuing increased insight regarding the nature of the client’s difficulty and sorting through possible solutions. Classical Psychoanalysis Sigmund Freud was a pioneer in psychological therapy. Hysteria: An older term for a group of presumably psychogenic disorders that included a wide variety of physical and psychological symptoms; the term used today is conversion disorder. Psychogenic: Resulting from a psychological cause rather than from organic damage to the nervous system. Classical Psychoanalysis Freud hypothesized that emotionally charged memories were repressed (pushed out of consciousness) and were veiled in the form of physical symptoms. Free association: A therapeutic method in which the patient says anything that comes to mind, no matter how apparently trivial, embarrassing, or disagreeable. Resistance: In psychoanalysis, a patient’s self-censorship or avoidance of certain topics. Classical Psychoanalysis Freud concluded that patients could or would not reveal their painful memories directly, so he attempted to develop an indirect method of analysis. Psychoanalysis: A method of therapy, developed by Sigmund Freud, asserting that clinical symptoms arise from unconscious conflicts rooted in childhood. Classical Psychoanalysis Elements of psychoanalysis: Interpretations: In psychoanalysis, explanations of how various thoughts, feelings, and behaviors are linked to prior experiences. Transference: The tendency of patients to respond to an analyst or therapist in ways that recreate patient’s responses to major figures in their own lives. o By maintaining neutrality during transference, Freud tried to improve life outcomes by providing emotional reeducation. Psychodynamic Approaches Contemporary psychodynamic therapists use techniques that bear Freud’s imprint, but have modified the treatment in various ways to include the adaptive capacities of the ego and the importance of real relationships. Usually less frequent and intensive than Freud’s sessions Meet face-to-face, rather than Freud’s method of treating out of sight while the patient reclined on a couch Relief from symptoms, as well as insights, are the primary focus of treatment. Humanistic Approaches Humanistic approach: An approach to therapy centered around the idea that people must take responsibility for their lives and actions. Regarded psychoanalysis as too concerned to basic urges, tension reduction, and the past Instead, focused on the search for meaning, self-actualization, and the present and future Humanistic Approaches Client-centered therapy (person-centered therapy): A form of humanistic therapy in which the therapist’s genuineness, unconditional positive regard, and empathic understanding are crucial to therapeutic success; also known as person-centered therapy. Pioneered by Carl Rogers Seeks to help clients accept themselves as they are without pretense or self-imposed limits Humanistic Approaches Gestalt therapy: A form of humanistic therapy that aims to help patients integrate inconsistent aspects of themselves into a coherent whole by increasing self-awareness and self-acceptance. Pioneered by Fritz Pearls Humanistic Approaches Experiential therapy: The collective term for modern humanistic therapies. Assumes all human are oriented toward growth Challenges clients to live more actively and deeply Rejects the notion of transference Types of Therapy: Behavioural Therapies Behaviour therapies are based on the principles of learning, with behaviour therapists working more directly to alter maladaptive habits and change overt behaviours. Behavioral Approaches Behavioral approaches: A family of therapeutic approaches based on the idea that problematic behaviors are the result of learning. Treatments are drawn from the principles of behavior change: o Classical conditioning o Operant conditioning o Modeling. Behavioral Approaches Exposure techniques: Behavioral techniques designed to remove the anxiety connected to a feared stimulus through repeated approach toward the feared stimulus. E.g., Systematic desensitization: involves periods of relaxation between gradually advancing encounters with the feared stimulus Behavioral Approaches Behavior modification techniques based on the principles of instrumental/operant conditioning (reinforcing the relationships between acts and consequences): Token economy: A behavioral therapy technique based on operant conditioning in which patients’ positive behaviors are reinforced with tokens that they can exchange for desirable items. Behavioral Approaches Modeling: A behavioral therapy technique based on observational learning in which patients learn new skills of change their behavior by watching and imitating another person. Vicarious reinforcement: A form of modeling in which the learner acquires a conditioned response merely by observing another participant being conditioned. Types of Therapy: Cognitive Therapy and CBD Cognitive therapies involve challenging maladaptive thought patterns. Cognitive Approaches Cognitive approaches: A family of therapeutic approaches based on the idea that maladaptive behaviors arise due to errors in thinking. Treatment focuses on thought patterns and changing a client’s thinking to produce more adaptive behavioral and emotional responses. Cognitive Approaches Rational emotive behavioral therapy: A form of cognitive therapy in which the therapist actively challenges the patient’s irrational beliefs. Pioneered by Albert Ellis Assumes that beliefs (B) link activating events (A) and consequences (C) If a client’s beliefs are irrational, they will lead to negative consequences. o The therapist disputes the irrational beliefs and offers more effective substitutes. Practicing Cognitive Restructuring Cognitive Restructuring involves replacing irrational, maladaptive beliefs with more rational, adaptive beliefs. Thought Record: worksheets that help a client identify, evaluate, and restructure negative automatic thoughts.  Evidence Evidence Automatic Situation Emotions FOR this AGAINST Thought Restructuring (2) Thought this Thought He didn’t People don’t always respond respond to my to texts I must have text yet. immediately. said something that put him Perhaps he was I just texted a just busy and off, there’s no guy I met at a Sad (90) didn’t get a way he will party, and he Hopeless (80) chance to text me ever want to didn’t respond Anxious (65) yet. see me again. to my text yet. Even if he I will never find a doesn’t want to date me, that boyfriend. doesn’t mean I will never find a boyfriend. Cognitive-Behavioral Approaches Cognitive-behavioral therapy (CBT): A hybrid form of psychotherapy focused on changing the patient’s habitual interpretations of the world and ways of behaving by combining cognitive and behavioral approaches to therapy. Cognitive-Behavioral Approaches General principles of CBT: Present-focused Concerned with identifying and solving problems that clients wish to address Sessions are highly structured, with assigned homework. Goals are transparent, set collaboratively, and progress is openly discussed. Types of Therapy: Biological Therapies Biological therapies look at psychological disorders from a physiological perspective  34 Biomedical Therapies © 2022 Cengage Learning Canada Inc. Biomedical therapies are physiological interventions aimed at ameliorating symptoms associated with psychological disorders. These therapies are based on the assumption that psychological disorders are caused, at least in part, by biological malfunctions. Psychopharmacotherapy (drug therapy) is the treatment of mental disorders with medication falls into three major categories: antianxiety, antipsychotic, and antidepressant  35 Biomedical Therapies © 2022 Cengage Learning Canada Inc. ▪ Psychopharmacotherapy Antianxiety—Valium, Xanax, Buspar relieve tension, apprehension, and nervousness. Antipsychotic—Thorazine, Mellaril, Haldol to gradually reduce psychotic symptoms, including hyperactivity, mental confusion, hallucinations, and delusions. Antidepressant E.g., Selective serotonin reuptake inhibitors (SSRIs)— Prozac gradually elevate mood and help bring people out of a depression Mood stabilizers: treatment of bipolar disorder Lithium and Valproic acid  36 © 2022 Cengage Learning Canada Inc.  37 © 2022 Cengage Learning Canada Inc.  38 © 2022 Cengage Learning Canada Inc. Evaluating Drug Therapies Several criticisms: Not as effective as advertised; effects are superficial and short term. Relapse rates are high when discontinued. Drugs are overprescribed; potential drug conflicts. Overreliance on drug therapy has undermined other therapeutic interventions. Side effects can be severe; data skewed by pharmaceutical industry influence.  39 © 2022 Cengage Learning Canada Inc. Electroconvulsive Therapy (ECT) Biomedical treatment involving introduction of brief electric shocks to produce cortical seizure. Originally quite barbaric, modern ECT is safer and more humane. Rates of use continue to decline. Appears effective in treating major depression. Particularly efficacious for intractable depression. Relapse rates remain high.  40 © 2022 Cengage Learning Canada Inc. Biomedical Therapies Transcranial magnetic stimulation (TMS) Temporarily enhance or depress activity in specific part of the brain (e.g., PFC) Appears effective in reducing symptoms of depression Deep brain stimulation (DBS) Surgically implant thin electrode into brain, connecting to pulse generator Pulse generator stimulates nearby tissue Appears effective in treating motor disturbances  41 © 2022 Cengage Learning Canada Inc. Contemporary Therapy Providers and clients Contemporary Therapy Providers () Contemporary therapy providers vary in their level of licensing and provide psychological therapy and/or biological therapies. Providers primarily offering psychological therapies include: Clinical psychologist Marriage, family, and child counselor Mental health counselor Clinical social worker Contemporary Therapy Providers TABLE 14.1 Therapy Providers Providers providing primarily OCCUPATION DUTIES SETTING biological therapy include: Primarily Psychological Clinical psychologist Assessment and Private practice, medical psychological treatment centers, agencies, clinics, Psychiatrist, general medical schools Marriage, family, and Psychological treatment, with Private practice, clinics child counselor a focus on couples, families, practitioner, neurologist, psychiatric School psychologist and and children Assessment and counseling, Schools nurse vocational counselor with a focus on vocation and adjustment Mental health counselor Assessment and counseling Private practice, medical centers, agencies, clinics Clinical social worker Psychological treatment and Private practice, medical assistance with housing, centers, agencies, clinics Administration of biological therapies Primarily Biological health care, and treatment always requires a license. Psychiatrist Assessment and psychological and biological Private practice, medical centers, clinics treatment There is active debate on who should be General medical practitioner Assessment and biological treatment Private practice, medical centers, clinics allowed to prescribe medication to treat Neurologist Assessment and treatment, with a focus on the brain and nervous system Private practice, medical centers, clinics psychological disorders. Psychiatric nurse Assessment and psychological and biological Medical centers, clinics treatment Contemporary Therapy Providers Providers of psychological therapy can claim the title of “counselor” or “therapist” without any special license. Neither professional credentials nor years of experience strongly predict a person’s success in providing psychological therapies. However, there are clear advantages to receiving therapy from a trained professional. Cultural Considerations A key determinant of the success of any intervention for a psychological disorder is the rapport a client feels with the health-care provider. Rapport: A patient’s sense of trust in, respect for, and comfort with the treatment provider. Cultural Considerations Rapport largely depends on Cultural competence: An understanding of how patients’ cultural backgrounds shape their beliefs, values, and expectations for therapy. To allow for Culturally appropriate therapy: Therapy that is conducted in a manner that is sensitive to the patient’s cultural background and expectations. Cultural Considerations Example: For example, in Canada, attention is finally being given to understanding the role of cultural and historical factors in the cause and treatment of mental health issues in Indigenous Peoples.