chapter 16 psychtx basic

7/28/2019 Chapter 16 Psychtx Basic

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Treatment of

PsychologicalDisorders

Chapter 16


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Basic features

Psychotherapy talking about problems

and exploring new ways of thinking and

acting


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Features

Professional relationship between client and therapist

Inpatients treatment in hospital or residential institution

Outpatients receive tx and drugs while living incommunity

Psychiatrists Doctors who have extra training in

psychology

Psychologists Holders of doctorate degree whoconcentrate on psychotherapy


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Psychodynamic psychotherapy

Classical psychoanalysis The talking cure using free association to cure

hysteria, which is also conversion disorder

Focus of treatment the unconscious becoming

conscious sexual and aggressive impulses goneunderground cause symptoms

Dream analysis Manifest content obvious meaning

Latent content hidden meaning, exploring theunconscious

Transference unconscious childhood feelings andwishes towards parents transferred towards therapist.Analysis of this transference is an importantpsychoanalytic method


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Psychodynamic psychotherapy

Contemporary psychodynamic therapy

Short-term psychodynamic therapy

Object relations most of the problems come

from relationship with others, especially parents


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Humanistic psychotherapy

Basic assumptions

Treatment is an encounter between equals

help clients restart growth

Clients will improve on their own, given the right

conditions

Ideal condition of therapy client feels fully

accepted and supported, no matter how horribletheir behaviour is

Client fully responsible for their choices


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Client-centered therapy Unconditional positive regard accept the client, so that

the client can overcome conditions of worth

Conditions of worthI am accepted because I am

worthy (intelligent, successful, attractive, etc.) and notbecause I am a human being and has INHERENTWORTH.

Empathy feelings WITH the client

Reflectionparaphrased summary of clients feelings,so that the client would feel heard

Congruence therapists need to be honest with theirfeelings. I am confused by what youre saying. Nopretensions


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Gestalt therapy

Goal so that clients could become more self-

aware, self accepting, and unified.

Use dramatic techniques client talk to an

imaginary person, therapist points out

difference between what they say and how they

act (eg. Smiling while talking about a sad

event).


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Behavior therapy

Psychological problems are LEARNED

behaviors and therefore can be

UNLEARNED

Basic assessment:

Identify signals / triggers

What are the rewards for continuing behavior


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Behavior therapy

Principles

Develop rapport with client client should haveconfidence that change is possible

Careful listing of bx and thoughts to be changed Therapist is a teacher, giving homework

assignments, active planning on how toovercome the problem, etc

Continuous monitoring and adjustment of plan


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Behavior therapy

Behavior modification

Systematic desensitization

Progressive relaxation training

Imagine thing that is scary from least scary to

most scary (desensitization hierarchy)

Virtual reality graded exposure replaces in vivo

therapy


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Behavior therapy

Exposure techniques

Flooding keeps people in feared but harmless

situations, at the same time preventing them from

escaping (their rewarding behavior). Modelling

Follow what the therapist does

Social skills training

Assertiveness training


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Behavior therapy

Positive reinforcement

Token economy system get coincs or tokens that

could be exchanged for video game time, snacks,

etc. Extinction, punishment, aversion conditioning

Aversion therapy when you think of what you

should not think of, you get electric shocks,

nauseated, etc.


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Cognitive behavioral therapy (CBT)

Rational Emotive Behavioral Therapy Ellis

All problems are caused by how people think about

events, not the events themselves

shoulds and musts. Replace upsetting thoughts with new thoughts which are

more adaptive cognitive restructuring

Meichenbaums stress inoculation training

imagine being in a stressful situation, then use newly

learned cognitive skills to remain calm


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Zick Rubin, Lelitia Anne Peplau, and Peter Salovey, Psychology.

Copyright 1993 by Houghton Mifflin Company. Reprinted by permission.

Ellis Model of

Maladaptive Behavior

Continue


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Cognitive behavioral therapy (CBT)

Cognitive therapy Beck

Cognitive distortions like

catastrophizing

all-or-none thinking

personalization

recognizing and correcting distortions


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Group therapy therapy with

unrelated clients

Benefits:

Therapist see clients interacting with one another

Clients discover they are not alonelift clients

expectation for improvement Boost self confidence and self acceptance

Learn from one another how they come across to

others

Try out new skills assertiveness

Self-help groups AA


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Family therapy therapy with

related family members

Identified patient of the family black sheep

VS. Seeing the problem as resulting from

the interactions among ALL family

members.


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Couples therapy husband and

wife


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Effectiveness of therapy

Eysenck (1952) those who received therapy

are worse than those who received no

treatment

Empirically supported therapies (ESTs) Use experimental research to evaluate result you

can choose them with confidence

Criticism:

Some studies have not yet been validated Experimental studies not the same as real-life clinical

settings


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Rules and rights of therapeutic

relationship

Confidentiality (dont tell anyone)

maintained EXCEPT

Client so disturbed and suicidal that

hospitalization is needed

client uses mental condition to defend in court

therapist sued by client

client talks about sexual/physical abuse of child Therapist believes client will harm others


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Rules and rights of therapeutic

relationship

Patients rights

Cannot be committed unless there is clear and

convincing reason that they are an imminent harm to

others and themselves, and gravely disabled

Have the right to receive treatment, and the right not to

receive treatment, EXCEPT hospital patients who are a

danger to themselves and others

Subjected to minimal restriction to their freedom


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Biological treatments

Psychosurgery lobotomy 1940s, 1950s

Electroconvulsive therapy

Patients anesthesized, administered to half the

brain

Used for patients who are deeply depressed

but do not respond to medication.

Cure temporarily, but relapse soon afterwards


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Psychoactive drugs

Neuroleptics/antipsychotics reduce

hallucinations, delusions

Old generation Thorazine and Haldol

New generationatypical neuroleptics

Clorazil, Risperdal, Zyprexa, Seroquel, Geodon,

Abilify


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Antidepressants reduce depression, obsessivethoughts, panic

Effective only after 2 weeks

Monoamine oxidase inhibitors MAOIs

Tricyclic antidepressants (TCAs) SSRIs Prozac, Zoloft, Anafranil

Lithium mood stabilizer control manic &depressive episodes

Anticonvulsants alternative to lithium

Depakote, Lamictal Anxiolytics reduce anxiety

Benzodiazepines Highly addictive

Buspirone alternative to benzodiazepines


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Choosing between psychotherapy vs. drugs

Psychotherapy and drugs both useful

Psychotherapy superior when

Dropout rate lower

long-term benefits


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Combination

Recommended for patients who are too

distressed to receive psychotherapy initially

Effective for long-term depression, ADHD,OCD, panic disorder, alcoholism.

For those who are not exhibiting psychotic

symptoms, CBT first, then medication + CBT

when CBT is not effective

chapter 16 psychtx basic

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