1 therapy chapter 17. types of mental health care professionals counseling psychologist clinical...

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Therapy

Chapter 17

Types of Mental Health Care Types of Mental Health Care ProfessionalsProfessionals

Counseling psychologistCounseling psychologist

Clinical psychologistClinical psychologist

PsychoanalystPsychoanalyst

Clinical social workerClinical social worker

PsychiatristPsychiatrist

Psychiatric nurse Psychiatric nurse practitionerpractitioner

Pastoral counselorPastoral counselor

Therapy• Because of new

drugs and better therapy, the U.S. went to a policy of deinstitutionalization.

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Psychological Therapies

We will look at four major forms of psychotherapies based on different

theories of human nature:

1. Psychoanalytical theory

2. Humanistic theory3. Behavioral theory4. Cognitive theory

Psychoanalytic Therapy• Freud• Bring repressed feeling from

the unconscious out through– hypnosis – free association– Dream– Interpretation

• When energy devoted to id-ego-superego conflicts is released, the patient’s anxiety lessens.

• Transference• Resistance

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Psychoanalysis: Criticisms

1. Hard to refute because it cannot be proven or disproven.

2. Takes a long time and is very expensive.

The goal of psychoanalytical therapy is

a) to change maladaptive behavior to more socially acceptable behavior

b) to change negative thinking into more positive attributions

c) to attain self-actualization

d) to bring unconscious conflicts to conscious awareness and gain insight

Treating the therapist as though he were a very important person from one’s past, such as a parent, defines

a) resistance

b) transference

c) frustration

d) reaction formation

Humanistic Therapy• Client-Centered Therapy by Carl Rogers• Aim to promote self-fulfillment by

increasing self-acceptance & self awareness

• Free will – clients makes the decisions and finds the solutions

• Active/reflective listening• Unconditional positive regard • Therapist responds with empathy

Gestalt Therapy by Fritz Perls – Patient experienced problems because his or

her perception of reality was not consistent with what actually was occuring.

. Vic is encouraged to take charge of the therapy session and his therapist uses an active listening approach to mirror back the feelings he hears from him. Which therapy is most likely being described?

a) client-centered therapyb) cognitive therapyc) psychodynamic therapyd) existential therapy

Behavioral Therapies• Applies learning principles to the

elimination of unwanted behaviors • Classical Conditioning

Counterconditioning –Mary JonesAversive ConditioningSystematic desensitizationExpoure/flooding techniquesBell & Pad treatment –bed wetting

(NS)Alcohol + drug (UCS) = nausea (UCR)

Behavioral Therapies• Operant conditioning

Token economy- positive reinforcement

Extinction/nonreinforcement

Modeling

Systematic desensitization is a technique based on

a) classical conditioning

b) instrumental conditioning

c) operant conditioning

d) aversive conditioning

Cognitive (Thinking) Therapy

• Aaron Beck• Teaches people new

methods of thinking & acting. (change our schemas)

• Patient’s negative thoughts are responsible for psychological problem

• Albert Ellis & Rational Emotive Therapy- anxiety is causing their beliefs

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Cognitive Therapy for Depression

Rabin et al., (1986) trained depressed patients to record

positive events each day, and relate how they contributed to

these events. Compared to other depressed patients, trained

patients showed lower depression scores.

Albert Ellis Rational Emotive Therapy

• vigorously challenges people’s illogical, self-defeating attitudes and assumptions; a confrontational therapy

• A-B-C theory of dysfunctional behavior

• A – Activating event

• B – Belief

• C – emotional Consequence based on that belief.

Example of Rational Thinking

• A= fail a midterm examination

• B=It’s unfortunate that I failed-I did not study hard enough and I must make sure that I study harder for the final

• C=no consequences (no emotional disturbance)

A= Fail exam

B= I’m stupid, I’ll never be able to pass this course and I will fail this course

C=depression

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Evaluating PsychotherapiesWithin psychotherapies cognitive

therapies are most widely used, followed by psychoanalytic and family/group

therapies.

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The Relative Effectiveness of Different Therapies

Which psychotherapy would be most effective for treating a particular problem?

Disorder Therapy

Depression Behavior, Cognition, Interpersonal

Anxiety Cognition, Exposure, Stress Inoculation

Bulimia Cognitive-behavior

Phobia Behavior

Bed Wetting

Behavior Modification

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Evaluating Alternative Therapies

Lilienfeld (1998) suggests comparing scientific therapies against popular

therapies through electronic means. The results of such a search are below:

Group Therapy

• Is cheap, effective. • 1 therapist, 6-8 clients,

90 minutes• It allows people to

gain insight into their own behaviors and thoughts

• People don’t feel like they are the only one with their problem

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Light Exposure Therapy

Seasonal Affective Disorder (SAD)

•light exposure therapy

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The Biomedical Therapies

1. Drug Treatments2. Surgery3. Electric-shock

therapy

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Drug Therapies

Psychopharmacology is the study of drug effects on mind and behavior.

With the advent of drugs, hospitalization in mental institutions has rapidly declined.

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Antipsychotic DrugsClassical antipsychotics (ThorazineThorazine): Remove a number of positive symptoms associated with schizophrenia such as agitation, delusions, and hallucinations.

Atypical antipsychotics (Clozapine): (Clozapine): Remove negative symptoms associated with schizophrenia such as apathy, jumbled thoughts, concentration difficulties, and difficulties in interacting with others.

blocks receptors

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Antidepressant Drugs

Antidepressant drugs like Prozac, Zoloft, and Paxil are Selective Serotonin Reuptake Inhibitors (SSRIs) that improve the mood by elevating levels of serotonin by inhibiting reuptake.

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Mood-Stabilizing Medications

Lithium Carbonate, a common salt, has been used to stabilize manic episodes in bipolar disorders. It moderates the levels of norepinephrine and glutamate neurotransmitters.

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Brain Stimulation

Electroconvulsive Therapy (ECT)

Used for severely depressed patients who do not respond to drugs. The patient is anesthetized and given a muscle relaxant.

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Alternatives to ECT

Transcranial Magnetic

Stimulation (TMS)

a pulsating magnetic coil is placed over prefrontal regions of the brain to treat depression with minimal side effects.

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Psychosurgery

Although used sparingly today, about 200 such operations do take place in the US alone.

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