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Psyc 2621

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The systematic interaction between client/therapist based on ... Mara Selvini-Palazzoli/Milan systemic family therapy. Circular patterns of action/reaction. ... – PowerPoint PPT presentation

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Title: Psyc 2621


1
Psyc 2621
  • Therapy and Treatment

2
Psychotherapy
  • The systematic interaction between
    client/therapist based on psychological
    principles to bring change in behavior, thoughts,
    feelings to overcome abnormal behavior.

3
Other features
  • Attentive listener
  • Aware of nonverbal cues
  • Convey empathy
  • Instill hope

4
Types of Mental Health Professionals
  • Psychiatrists
  • Clinical Psychologists
  • Psychiatric social workers
  • Professional counselors

5
Major types of therapy
  • Psychodynamic therapies
  • Traditional Psychoanalysis
  • The goal of psychoanalysis Where the id, there
    shall ego be or replace defensive behavior with
    adaptive behavior
  • Primary techniques
  • Free association
  • Resistance
  • Dream analysis manifest/latent content
  • Interpreting transference/countertransference

6
Modern Psychodynamic Approaches
  • Ego psychology by Heinz Harmann
  • Object-relations by Margaret Mahler

7
Humanistic/existential therapies
  • Person-centered therapy by Carl Rogers
  • Therapist has
  • unconditional positive regard
  • empathic understanding
  • genuineness
  • congruence

8
  • Existential therapy
  • The goal is to help clients increase their
    awareness of conscious experiences and make
    personal choices to give meaning/fulfillment
  • Key theorists Rollo May, Victor Frankl, Ludwi
    Binswanger, Medard Boss.
  • Use
  • analysis of defenses.

9
Cognitive therapies
  • Change maladaptive cognitions
  • Key theories
  • Rational Emotive Behavior Therapy by Albert
    Ellis.
  • Focuses on irrational beliefs such as
  • must have love and approval
  • must be thoroughly competent
  • life must be fair.

10
  • REBT recognizes that irrational beliefs may come
    from childhood, therefore the therapy must focus
    on finding a rational alternative in the
    here-and-now.
  • Utilizes homework assignments in-between sessions.

11
  • Becks Cognitive therapy by Aaron Beck
  • Utilizes homework to record thoughts of upsetting
    event/connect them with their emotional
    responses.
  • In comparing cognitive therapy to REBT, REBT
    therapists tend to be more confrontational and
    forceful in their approach to disputing
    irrational beliefs

12
Behavior therapy
  • Focuses on the here-and-now
  • Tries to understand the circumstances in which
    the problem behavior occurs.
  • Methods
  • systematic desensitization
  • gradual exposure (in vivo)
  • modeling
  • aversive conditioning

13
  • Operant conditioning
  • social skills training
  • self-control

14
Other therapies
  • Electicism
  • Group therapy
  • Advantages
  • less cost
  • treat more people
  • learn from others
  • group support
  • problem not unique
  • hope

15
  • Learn to get along
  • Family/Marital therapy
  • Look at family issues rather than individual
  • Types
  • Virginia Satir and Conjoint Family therapy
    (communication family therapy)
  • Salvador Minuchin and Structural Family Therapy
  • Murray Bowen/Extended family systems therapy
  • Triangulation/genograms
  • Mara Selvini-Palazzoli/Milan systemic family
    therapy
  • Circular patterns of action/reaction.

16
Evaluating the effectiveness of psychotherapy
  • Determined by a statistical process called
    meta-analysis.
  • Smith and Glass (1977) show psychotherapy to be
    effective.
  • Greatest gains occurs in the first several months
    of treatment.

17
Comparing different therapeutic approaches
  • Results of meta-analysis show only negligible
    differences between therapies.
  • It is difficult to research for ethical reasons.
    Clients and administrators do not want to consent
    to random assignment to different therapies
    therefore, use meta-analysis to compare relative
    effectiveness of different therapies when each is
    compared against control groups.

18
Common features among the therapies
  • Empathy, support, and attention shown by the
    therapist.
  • Therapeutic alliance.
  • Working alliance.

19
A better question
  • Rather than ask, Which therapy works best? must
    as, Which therapy works best for which type of
    problem or client?

20
Behavior therapy works best for
  • Anxiety
  • Sleep disorders
  • sexual dysfunction
  • Adaptive functioning of people with schizophrenia
    or mental retardation.

21
Psychodynamic therapy works best for
  • Fostering self-insight
  • Personality growth

22
Cognitive therapy works best for
  • Depression
  • Anxiety

23
Empirically validated treatments criteria
  • Therapy must be more effective than drug or
    placebo control group.
  • Effective in a large series of well-designed
    studies in which the treatment was compared to
    another treatment or placebo condition.

24
Multicultural Issues
  • Evidence is accumulating suggesting the
    effectiveness of psychotherapy with low income
    groups and people of color.
  • Cultural mistrust can negatively impact therapy
    addressing racial issues early may increase
    effectiveness.

25
Specific issues with African-Americans
  • Due to history, there may be a tendency to
    minimize their vulnerability by being less
    self-disclosing.
  • Cultural characteristics strong family bond,
    strong spirituality, flexibility of gender roles
    and distribution of child-care responsibilities.

26
Specific issues with Asian-Americans
  • Mental health issues carry a severe social
    stigma.
  • Their tradition is to refrain from the display of
    emotions.
  • May prefer structured problem-solving and want
    the therapist to give direct advice.
  • Most psychological complaints are expressed as
    physical symptoms.
  • Emphasize group needs over individual needs.

27
Specific issues with Hispanic-Americans
  • Strong patriarchal family structure.
  • Value interdependency with the family, not
    independence.

28
Specific issues with Native Americans
  • There are vast differences among the various
    tribes.
  • Tend to pause for longer intervals when engaged
    in a dyadic conversation. Therapist will do most
    of the talking.
  • Differences in gestures, eye contact, facial
    expression.
  • Preventive therapy should focus on cultural
    cohesion ethnic pride.

29
Biological therapies
  • These emphasize the biological basis of abnormal
    behavior and biological treatment of those
    disorders.
  • Types of biological therapies
  • Drug therapy
  • Electroconvulsive therapy
  • Psychosurgery

30
Drug Therapy
  • Minor tranquilizers
  • Valium
  • Xanax
  • Major tranquilizers
  • Stelazine
  • Clozapine

31
Cont. Drug therapy
  • Antidepressants
  • Tricyclics
  • Elavil
  • MAO Inhibitors
  • Nardil
  • SSRI
  • Prozac
  • Lithium

32
Electroconvulsive Therapy
  • Controversial because
  • concern for cognitive deficits though there is no
    current evidence.
  • Not sure of the effectiveness compared to
    therapy.
  • Not sure why it works.

33
Psychosurgery
  • No longer perform prefrontal lobotomies.
  • Some surgeries performed to treat depression,
    aggression, psychotic behavior, chronic pain, and
    some forms of epilepsy.

34
Ethnic differences in response to medications
  • African-A show better response to
    antidepressants/phenothiazines.
  • Hispanic-A show lower effective dosage levels.
  • African-A show greater resistance to taking pills.

35
Hospitalization/community based care
  • Some studies have indicated higher levels of
    mental illness among Af-A but when controlled for
    SES, no differences.
  • Af-A tend to underutilize aftercare services in
    the community following discharge from hospital.
  • As-A and Hispanic-A may also underutilize.

36
Barriers for minority use of mental health
services.
  • Structural
  • The institution will not meet the need.
  • Cultural
  • different concept of mental health problems.
  • Language
  • Economic

37
Hospital vs CMH
  • Deinstitutionalization
  • Factors contributing to the failure of
    deinstitutionalization
  • Lack of community support
  • Community resistance
  • Lack of public housing
  • Limits of medication.
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