PSYCHOTHERAPY AND BEHAVIOR MODIFICATION

GROUP 8Geronimo, Cherry P.

Geronimo, Maria Angelica M.Geronimo, Ralph Ernesto R.

Go, Camille Marie A.Go, Crystal Karen O.

Go, Ferranti D.Go, Jill Irvette C.

MENTAL SICKNESS

Mental Sickness:

How is psychological illness or mental illness different from

physiological illness?

• Europe– Middle Ages:

• mixture of the divine, diabolical, magical and humoral• been victims of the witch-hunts

– 18th Century:• Madness - organic physical phenomenon• Asylum care• Moral treatment movement – end of 18th century

– 19th Century:• Industrialization and population growth• classification schemes and diagnostic terms • term psychiatry was coined• medical superintendents – alienists

– 20th Century:• Development of psychoanalysis• Kraepelin's classification scheme• Asylum “inmates” – “patients” • asylums - hospitals

• Anti-psychiatry psychiatrists– Concept of mental illness is completely invalid– Social maladjustments:

• Behavior of non-conformist individual• Demands of social system

– Modern Social System unable to deal with individual differences

• Ken Kesey’s One Flew Over the Cuckoo’s Nest– The individuals are not sick, just the system

• Richard M. Restak (Pre-Meditated Man)– “Most problems in bioethics are not really

ethical, but political”

• Mental Illness– Behavioral dysfunction:

• Caused by organic and physiological defects• Not just CNS lesions• May be genetic

– Faulty development and use of human cognitive and affective capacities

Medical Model• Psychiatric care that is impossible without

hospitalization• Extreme caution:

– Protect patient’s human rights– Right of treatment– Right to refuse some forms of treatment

• Effort to help patients develop skills to cope

Medical Model• Psychotherapy is different than those used

in physical disease– Talking and guiding in recalling and

reenacting past experiences– Education or reeducation– Mentally disturbed person has at least some

capacities for normal mental life:• Not properly developed• Malfunctioning• Poorly used - fears and perceptions about the

reality

PSYCHOTHERAPEUTIC METHODS AND GOALS

Psychotherapy• Interpersonal relationship between a

Psychotherapist and a client/patient• It deals with psychic processes less

conscious• Basic goals:

– Increase patient’s well-being– Behavior change– Improve mental health

Mental Health

• Psychological freedom based on realistic perception and understanding of the world

• Involves self-understanding, self-consistency and self-control

Mental HealthIs a prior condition requisite for dealing with

ethical problems of moral right and wrong, since only to the degree that a person is free can there be the possibility of moral choice and moral responsibility

Psychotherapeutic Methods• Overlap but based on different theoretical and clinical sources• Not necessarily contradictory

Insight Therapy Action Therapy

Psychotherapeutic Methods

Insight Therapy Action Therapy

• Psychoanalytical School of Thought (S. Freud)

• Deterministic assumption

• Aims to help patient understand and their own behavior (“have insight into”)

• Make the unconscious conscious and strengthen the ego (Free Association)

• Behaviorist School of Thought (B.F. Skinner)

• Person is the producer and the product of his/her environment

• Deals with current problems and factors influencing them

• Remove undesirable behavior patterns and developing new ones (Operant Conditioning)

Goals of Therapy• Relief of undesirable symptoms (e.g.,

excessive anxiety)• Increased productivity in the person’s work• Adjustment and satisfaction in sexual

relations• Better interpersonal relations• Increased ability to endure the stresses of

life

Success of Therapy(Robert Harper)

• The patient’s weak ego is supported by the therapist’s stronger ego

• The patient’s lack of realism is corrected by the therapist’s more realistic attitude

• The patient’s comes to see that many things he or she fears are not so terrible

• The patient learns to be more patient in solving problems, and less impulsive and panicky

Success of Therapy(Robert Harper)

• The patient acquires a greater or new faith or “life-myth” from the example of the therapist, who represents a hope for health

• The patients gets a more objective perspective on his or her problems from discussing them with the therapist or with a therapy group

• The patient focuses his or her floating anxieties on the outcome of the therapy process, so as to feel less isolated and helpless

Limitations and Criticism of the Insight Therapy

• No clear record of efficiency• Time-consuming and expensive• No objective proof of therapeutic success (ex.

Projective tests)• Therapeutic success mainly dependent upon the

personal relation with the therapist who is sensitive, realistic and caring person (Transference)

• Failure in establishing client/patient autonomy/self-reliance

HUMAN FREEDOM

How free are we?

Freedom• No human being is

totally free• We are limited by

– Innate biological structure

– Unconscious conditioning of the mind

– One’s knowledge of the world and the self

http://riponpolitics.files.wordpress.com/2009/03/freedom.jpg

Psychotherapy• Deals with limitations

on human freedom that arise from the level of unconscious conditioning

www.cartoonstock.com/directory/p/psychotherapist

Psychotics vs Neurotics

Psychotics• Area of freedom is limited

in the psychotic• Have some areas of

freedom reached • Schizophrenia, bipolar

disorders, psychoactive drugs

Neurotics• More free• Have some areas of

unfreedom that do not occur in normal persons

• Obsessive compulsive, phobias, severe anxiety

Normal Person• Also has limited area

of freedom• Limits lie near the

level of necessary determinisms of automatic and routine behavior compatible with normal freedom

http://www.psychologytoday.com/files/u89/psychotherapy.jpg

Psychotherapy• Deals with neuroses of emptiness or lack of

meaning as a result of society’s failure to recognize the aspects of personhood

• Awakens the person’s full capacity for freedom

• Psychotherapists– Act as a catalyst in liberating the creative

potentials for life inherent in their patients, potentials that are blocked by certain pathologies

Freedom in PsychotherpySusan K. Deri, Ph.D.http://www.pep-web.org/document.php?id=PSAR.048C.0097A

Freedom and Society• Trust between persons

and society• Mental illness is in part

a disturbance of social relations

• Group therapy– learning social

communication skills• Family therapy• Issues: confidentiality

and adequate professional control

http://www.birchmore.org/html/shame.html&usg

ETHICAL ISSUES IN PSYCHOTHERAPY

Punishment

• Reject psychotherapy as punishment• Some neurotic px may perceive it as such

Punishment• Penological reform by the court

– Decide first on the facts of criminal action – Secondly: moral responsibility of the person– * Moral freedom can be destroyed by mental

confusion• Based on expert testimony from psychiatrist

– Should be directed to determining the defendant’s freedom limited by the psychological factors

– Why the accused chronic or temporary psychological condition did or did not render him so unfree

– Whether he cant be held responsible for the act– If he is partially responsible, in what degree or in what

respect

• It is unjust to punish someone for acts for which he or she was not MORALLY responsible

• Role of the psychiatrist in the process of punishment – Limited to 2:

1. diagnose inmates who develop mental illness and thus treatment

2. As consultants to penologists in setting up routines that make good for mental health and discipline

Informed consent

• Issue of comptency• Mentall disturbed pxs:

– Unable to understand the risk or purpose of treament

– May not be truly free to make a decision• Fear• Masochistic tendecies (desire to suffer or to be

humiliated)• Narcississm

Informed consent

• If impossible for the patients: patient’s guardian with observance of legal process

• Treatment without consent:– Must have the objective to bring the patient as

as soon as possible to the level of mental integration

• Use of drugs or psychosurgery

Transference• Primarily in therapy • Termination of therapy: patient is sufficiently

autonomous and under self control• Issue of responsibility by the therapist

– Must be trustworthy– Maintain secrecy– True concern for the px– Prompt in appoinments*avoid manipulating the patient for personal

gratification

Abreaction

The expression and consequent release of a previously repressed emotion, achieved by reliving the

experience that caused it

• Dangers– Former tempations and sins– Illicit sexual activity– Hostility and destruction

“ Is it legitimate to put oneself in the “occasion of sin” where sinful consent is possible?”

• Purpose– To return to some error of the past where the

patient failed to resolve a problem correctly and to help the patient now face it in a clearer light.

VALUE SYSTEMS

Change AdjustXExcept:

Underlying disorder

Superego

Reinforced in therapy• More trustful• More honest• More hopeful• More courageous• More patient• More realistic

Therapist:Extend area of freedom

Give ethical adviceX

Psychoanalysis and Hedonism

Pleasure (in the sense of desire gratification) is the highest good

and proper aim of human life

Problems• Philip Reiff

– Built in system of values and ideology that it inculcates?

– Product of middle class in opulent capitalist countries?

Freud• Saw all of of civilization as the imposition

of social controls on man’s infinite and even contradictory drives.

Repressive control

Explosive drive

Reiff

Autonomous

Hedonistic

Goalless

Conscienceless

Selfish

Loveless

Empty

Emphasis: Social life is always repression, not fulfillment of fundamental human needs.

• Social conscience• Purification of theory,

training and practice• Higher social and

spiritual goals

• Trust therapists as with limited skills

• Also receive guidance from others

Therapists: Clients:

BEHAVIOR CONTROL

BEHAVIOR CONTROL

• Any medically intended therapy, with or without a person’s consent, to cause a person to discontinue a personally and socially undesirable activity

BEHAVIOR CONTROL

• Therapeutic purpose

ETHICAL ISSUES GOVERNING BEHAVIOR CONTROL

• No form of treatment may be used that will destroy human freedom

• The benefit to the patient must be the purpose of the action

ETHICAL ISSUES GOVERNING BEHAVIOR CONTROL

• Long term effect of the treatment must be considered as well as the short-term alleviation of some particular difficulty

• Rules of free and informed consent apply, including the right to refuse treatment

ETHICAL ISSUES GOVERNING BEHAVIOR CONTROL

• Professional confidentiality applies• Experimental research should conform to

the norms of human experimantation

ETHICAL ISSUES GOVERNING BEHAVIOR CONTROL

• Human betterment or human improvement is ethically acceptable and beneficial

• Care is required in the use of any behavior-modifying substance

ADDICTION

Definition

• Habituation to some harmful practice• Usually refers to habituation to drugs, but

can also be addicted to other substances or activities.

Effects of Addiction• Many people use all these things in ways that

do not destroy human equilibrium• But some persons become addicted to them

so that their whole life is more and more absorbed by a single activity that distorts the personality and consumes physical and psychic energy

• Results in being self-centered, personality deterioration, and inability to communicate with others

Hedonsim

• Philosophy which argues that pleasure has an ultimate importance and is the most important pursuit of humanity

• A component of chemical addiction• Being used as an excuse by chemically

addicted persons because they lack healthy pleasures in their lives

• In the face of difficulty of life, the chemically dependent person runs away from the loss of normal satisfaction and achievement by indulging in the physical pleasure, relaxation, and euphoria of the addicting experience.

• The search for pleasure alone does not constitute addiction, but rather the increasing sense of guilt and helplessness that begin to accompany each overindulgence.

• A common feature of addicted persons is excessive dependency needs

• Chemical dependency can affect people of all backgrounds often the gifted, talented, wealthy, and successful.

Classification of Addiction

• Physiological Addiction– Causes modification or need in the addict’s

physiological system, usually requires increasing doses of the addicting substance to obtain the same physiologic effect

– Example:• Drugs (Heroin, Marijuana)• Medications (Pain killers)

Classification of Addiction

• Psychological Dependency– Results from a learned conditioned behavior

pattern that leads the victim to anticipate the pleasure and release of tension

– Example:• Gambling• Internet Addiction

Solutions

• Voluntary acts must be distinguished from free acts

• Addictive behavior is voluntary in the sense that it proceeds from an inner compulsion but it always involves a restriction of freedom since the addict becomes less and less able to perceive alternatives of action or to choose among them.

Solutions

• An important part of therapy is to get addicts to accept moral responsibility for the harm they have done to themselves and others.

Solutions

• The real moral responsibility of the addicted person lies in the obligation to ask and receive help from others when this is offered since therapy cannot be effective until the addict accepts help.

• Students of addiction emphasize that the earlier the addiction therapy takes place, the better

Solutions

• Family, friends, and co-workers can be both a positive and negative agent to the addict

• But these people can contribute to the problem by covering up, excusing, or attempting to endure addictive behavior, hoping that the addict will finally come to his/her senses

Solutions

• Intervention is best done by those who can be supportive rather than judgmental but who can also face the addict with detailed evidence of the seriousness of his/her condition.

Solutions

• Alcoholics Anonymous– Led the way in the most successful method of therapy

for chemical dependency – Has always emphasized that the addict cannot

recover without a reaching out for a Higher Power and willingness to repair damage done to others and to be of service to them, especially to fellow victims of addiction

CONCLUSION

• Simply because one has ethical goals does not mean that one will always use ethical means to reach those goals.

• Psychotherapy and behavior modification have the ethical goals of helping people overcome mental illness or harmful behavior.

• Both forms of therapy must be analyzed carefully lest individuals rights be violated or the freedom of the person be weakened or destroyed.

• Care must be exercised when helping the mentally ill regain their health so that the person’s higher needs and functions are considered.

THANK YOU

References

• Corey, G(2005). Theory and Practice of Counseling and Psychotherapy. 7th ed. Brooks/Cole – Thomson Learning. USA. p. 56, 69, 231, 236