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Therapies for Psychological Disorders Chapter 13


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Title: Therapies for Psychological Disorders Chapter 13

Therapies for Psychological DisordersChapter 13
  • AP Psychology
  • Juarez Community Academy
  • Ms. Drew

Vocab Quiz on Friday!
  • Active listening
  • Token economy
  • Placebo effect
  • Lobotomy
  • Lithium
  • Psychopharmacology
  • Double-blind procedure
  • Xanax
  • Free Association
  • Stress inoculation training
  • Evidence based practice
  • Regression toward the mean
  • Meta-analysis
  • Cognitive therapy
  • Behavior therapy
  • Systematic desensitization
  • Cognitive-behavioral therapy
  • Client-centered therapy
  • Exposure therapy

What are Therapists
  • Therapists are trained professionals who know
    the art of establishing a helping relationship
    and know how to apply the knowledge of psychology
    to an individual struggling with problems and

  • We often hear that someone was in therapy, but
    what is therapy?
  • There are many stereotypes about therapy, like
    the picture of a bearded therapist taking notes
    while a patient lies on a couch and spills his or
    her guts. This is a very Freudian image.

  • Therapy is a term used for any treatment
    process in psychology and psychiatry, therapy
    refers to a variety of techniques used to deal
    with mental disorders or cope with problems of
  • There are endless reasons why people go to see a
    therapist or counselor including making difficult
    decisions, dealing with academic problems, coping
    with the loss of a loved one, or dealing with an
    unhappy relationship.

  • There are a variety of techniques and methods
    therapists and counselors use, but all center on
    developing a strong, supportive relationship with
    the patient.
  • Another similarity amongst all therapy
    techniques is their end goal of changing a
    persons functioning in some way.

Components of Therapy
  • In addition to developing a strong relationship
    between client/patient and counselor, the
    therapeutic process generally involves some or
    all of the following processes
  • Identifying the problem
  • Identifying the cause of the problem or the
    current conditions that maintain the problem
  • Deciding on and carrying out some form of

7 Main Types of Professional Help
Professional Title Specialty and common work setting Credential and qualifications
Counseling Psychologist Provides help in dealing with the common problems of normal living-relationships, child rearing, school problems. Typically counselors in schools clinics or other institutions Depends on the state minimum masters in counseling, but most commonly a PhD
Clinical Psychologist Trained primarily to work with those who have more severe disorders, but may also work with clients having less severe problems. Usually private practice Usually required to hold a PhD and state certificate
Psychiatrist A specialty of medicine deals with sever mental problems-most often prescribes drugs. May be private practice or employed by clinics and mental hospitals MD licensed by medical board
Psychoanalyst Practitioners of Freudian therapy. Usually in private practice MD
Psychiatric Nurse Practitioner A nursing specialty licensed to prescribe drugs for mental disorders. May work in private practice or in clinics and hospitals Requires RN credential plus specialty training
Clinical or Psychiatric Social Worker Social workers with a specialty in dealing with mental disorders, especially from the viewpoint of social and environmental contexts MSW-Masters of Social Work
Pastoral Counselor A member of a religious order or ministry who specializes in treatment of psychological disorders Varies
Current Movements
  • The world of psychology is constantly changing.
    One of the current movements is clinical
    psychologists who are seeking to obtain the
    privilege to give prescriptions to clients.
  • New Mexico became the first state to allow this,
    putting psychologists through a rigorous program,
    including 850 hours of of course work and a
    supervised internship.
  • Not surprisingly this is hotly contested in the
    medical profession.

History of Therapy
  • Much like the history of psychology itself and
    psychological disorders, therapy has had its fair
    share of misguided theories.
  • In medieval Europe, people often thought mental
    disorders were the work of the devil and other
    demons. The job the therapists was to perform

Bedlam and its Origins
  • One of the most well known asylums was that of
    Bethlehem Hospital in London. On the weekend, a
    person could pay a few pence to go sightseeing
    and watch the inmates who often put on a noisy
    and wild show. As a result, Bedlam, the
    shortened term Londoners used for Bethlehem,
    became a word used to describe any noisy, chaotic
    place (Zimbardo et al.)

Medieval Asylums
  • In the medieval asylums, patients, at most only
    custodial care at worst, they were neglected and
    put in cruel restraints such as cages and
  • Some received other forms of torture like
    beatings and cold showers.

Modern Approaches to Therapy
  • There are two main modern approaches
  • Psychological therapies (psychotherapy) focus on
    changing disordered thoughts, feelings and
    behaviors using psychological techniques. They
    come in two main forms
  • Insight therapy focuses on helping people
    understand their problems and change their
    thoughts, motives or feelings.
  • Behavior therapy focuses primarily on changing

Modern Approaches to Therapy
  • Biomedical therapies focus on treating mental
    problems by changing the underlying biology of
    the brain. To do so, a physician or nurse
    practitioner can use a variety of drugs,
    including antidepressants, tranquilizers and

Disorders and Therapies are Cultural
  • The way a disorder is treated relies on the way
    it is viewed. The way it is viewed is heavily
    dependent on the culture is is being treated in.
  • Individualistic Western views generally regard
    psychological disorders to be a result of disease
    process, abnormal genetics, disordered thinking,
    unhealthy environments or stressors.
  • Collectivist cultures often think of mental
    disorders as a disconnect between the person and
    the group. In such cultures, treating mentally
    disturbed people by removing them from society is

How do Psychologists Treat Disorders?
  • Treatment of disorders falls into one of the two
    categories we just discussed. Insight therapies
    were the first truly psychological treatments
    used. In recent years, behavioral therapies have
    also become common and effective.

Insight Therapies
  • Insight therapies attempt to change people on
    the inside-changing the way they think and feel.
    These are sometimes called think therapies. These
    therapies share the assumption that distressed
    persons need to develop an understanding of the
    disordered thoughts, emotions and motives that
    underline their mental difficulties.

Freudian Psychoanalysis
  • In the classical Freudian view, psychological
    problems arise from tension in the unconscious
    mind by forbidden impulses and threatening
  • Psychoanalysis, therefore, probes the
    unconscious in an attempt to bring these issues
    into the light of day or into consciousness.
    The major goal of psychoanalysis, then, is to
    reveal and interpret the contents of the
    unconscious mind.

  • In the final stages of psychoanalysis, patients
    learn how their relationship with the therapist
    mirrors the unresolved issues they have with
    their parents. This is referred to as analysis of
  • According to this theory, people will recover
    when they are finally released from the
    repressive mental restraints established in the
    relationship with their parents during early

Neo-Freudian Psychodynamic Therapies
  • These therapies were developed by psychologists
    why embraced some of Freuds ideas, but disagreed
    with others.
  • While they follow many of the same techniques,
    their emphasis is on the conscious, rather than
    the unconscious, mind. Basically they spend less
    time probing for hidden conflicts and repressed

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Humanistic Therapies
  • Many people struggle with the problems of
    everyday existence. These are commonly called
    existential crises.
  • This term underscores the idea that many
    problems deal with questions about the meaning
    and purpose of ones existence.
  • Humanistic psychology developed theories to
    specifically address these problems

Humanistic Therapies
  • Humanistic psychology believes that people are
    generally motivated by healthy needs for growth
    and psychological well being. Problems only occur
    when conditions interfere with normal development
    and produce low self esteem.
  • These therapies, then, try to help clients
    confront their problems by recognizing their own
    freedom, enhancing their self-esteem and
    realizing their fullest potential.

Client-Centered Therapy
  • This therapy assumes that people all have a need
    to realize their fullest potential (self
    actualization). But, development can be hindered
    by a conflict between ones desire for a positive
    self image and criticism by self and others.
  • One therapy technique called reflection of
    feeling, or reflective listening, is where the
    therapist paraphrases the clients words, making
    sure to capture the emotional tone, so the client
    can see and hear themselves.

Listening Empathetically
  • Empathy is the act of adopting the clients
    perspective, of walking in the clients shoes.
  • Carl Rogers encouraged therapists to exhibit
  • When they accurately sense and reflect their
    clients feelings, clients increase in
    self-understanding and self-acceptance.
  • An empathetic, trusting, caring relationship is
    key to being an effective psychotherapist

13-3 Listening Empathetically
  • As you listen to me role-play a client, pretend
    you are a counselor or a therapist. Your task is
    to adopt my (or the clients) perspective. Try
    to see the world through my eyes. Circle only
    the statements that demonstrate empathy.
    (adopting the patients point of view.)

  • In your groups, try to reach a consensus.

13-4 Role Playing Practice with Pat, then with
a friend.
  • Client-centered approach
  • 1st repeat what the person said as you understand
  • What I hear you saying is
  • 2nd reflect back the persons feelings.
  • It seems you are feeling about the situation.

Empathic Listening
  • What was good about empathic listening in
    everyday life?
  • What are some possible obstacles about empathic
    listening in everyday life?

Humanistic vs. Psychoanalysis
  • In stark contrast to psychoanalysis, humanistic
    therapists assume that people are generally good
    and healthy, but can be negatively effected by
    pressure from oneself and society.
  • Humanistic therapists accomplish treatment
    through genuineness, empathy, and unconditional
    regard and acceptance for their clients.

Cognitive Therapies
  • Cognitive Therapies see rational thinking as the
    key to therapeutic change. The assumption is that
    psychological problems arise from erroneous
  • Cognitive therapists help the individuals
    confront the destructive thoughts that support

The Way I Think
  • Samples of cognitive therapy techniques
  • Fill in the blank
  • 1) I often worry that I _______________.

  • 2. If this worry of yours was indeed true, what
    does it mean to you and why does it bother you so
  • In other words, If what you JUST wrote was
    indeed true, what does it mean to you and why
    does it bother you so much?
  • If what you JUST wrote was indeed true, what
    does it mean to you and why does it bother you so

Look back over the various things you wrote so
far and answer this question
  • 3. Whats the worst thing that could possibly
    happen? What do you fear most of all?

  • 4. When you think of the worst thing that could
    happen, do you really think that its likely to
    happen? If so, how could you learn to cope with

Look back over the worrisome thoughts that you
have written about so far, and answer this
  • 5. What do you (perhaps secretly) get out of
    thinking like this? How does it work to your

6. Persuade a Friend
  • Pretend that your friend has some of the same
    worrisome beliefs that you do. Look back over
    the things you wrote for questions 1-3. Pick out
    one of those statements and write it down, as if
    your friend just said it. Now skip a line, and
    write a response to your friends statement. In
    that response, be a compassionate, rational, and
    realistic thinker. After you write your
    response, skip a line and have your friend reply.

6. Persuade a Friend
  • Maybe your friend is a bit stuck in her/his
    thinking. Then skip a line, and respond again to
    your friend. Keep this conversation going for 10
    lines or so.

7. Positive imagery anecdotes
  • Select 3 positive images, real memory or
    imagination, related to
  • confidence strength in your life
  • Safety peacefulness in your life
  • Love in your life
  • Make sure you can see each one clearly.

  • Now imagine a real or imaginary scene related to
    one of their negative thoughts.
  • When the time feels right, move from the negative
    image to the positive one that feels like the
    right anecdote, then back again to the negative
    image, repeating the cycle until you feel
    comfortable ending the exercise with the positive
    image firmly in mind.

  • 8. I accept myself even though I ___________
    (Do not use the word Am)
  • By not using the word am give yourself a global
    label and it should encourage you to focus on
    specific trait or behaviors.
  • Write this sentence 10 times!

Behavior Therapies
  • Behavior therapy, or behavior modification, is
    based on the assumption that undesirable
    behaviors have been learned, and therefore, can
    be unlearned.
  • Behavior therapist focus on the problem
    behaviors rather than inner thoughts, motives or
    emotions. Their goal is to determine how these
    behaviors were learned and see if they can
    eliminate them.

Systematic Desensitization
  • One behavioral technique to extinguish anxiety
    is systematic desensitization. In this, a patient
    is exposed to an anxiety producing stimulus
    gradually. Over time, the anxiety will become

Steps of Systematic Desensitization
  • For a fear of public speaking
  • Seeing a picture of a person giving a speech
  • Watching another person give a speech
  • Preparing a speech to give
  • Having to introduce oneself to a large group
  • Waiting to be called upon to speak at a meeting.
  • Being introduced as a speaker to a group
  • Walking to the podium to make a speech
  • Making a speech to a large group

13-7 Systematic desensitization
  • 1. What is one thing that gives you anxiety?
  • 2. Adapt handout 13-7 to fit your own fear.

  • Then train yourself in progressive relaxation.

Aversion Therapy
  • Aversion therapy takes on the psychological
    problems with a conditioning procedure designed
    to make tempting stimulus less provocative by
    pairing them with an unpleasant (aversive)
  • In time, the negative reaction (UCR) associated
    with the averse stimuli come to be associated
    with the conditioned stimuli.
  • This is usually a last resort type of therapy,
    though it has been shown to be successful.

Operant Conditioning Therapies
  • These therapies rely on the tools of operant
    conditioning reward and punishment.
  • Contingency Management An approach to changing
    behavior by changing the consequences associated
    with a behavior.
  • Token Economy A technique involving the
    distribution of tokens or indicators of
    reinforcement contingent on desired behaviors

Cognitive-Behavioral Therapy
  • This therapy combines a cognitive emphasis on
    thoughts and attitudes with the behavioral
  • This approach assumes that an irrational
    self-statement often underlies maladaptive

Cognitive-Behavioral Therapy
  • In this form of treatment, therapist and client
    work together to modify irrational self-talk, set
    attainable behavioral goals and develop realistic
    strategies for attaining them.
  • In this way, people change the way they approach
    problems and gradually develop new skills and a
    sense of self-efficacy.

Does Therapy Actually Work?
  • In 1952, Hans Eysenck shook the psychology world
    by releasing a study that suggested 2/3 of all
    people with nonspychotic problems recovered
    within two years if the onset of the problem,
    whether they got therapy or not.
  • Essentially he was arguing that therapy was
    worthless, and no better than having no treatment
    at all.

Response to Eysenck
  • As you can imagine, this set off a fire storm of
    studies on this subject.
  • Overall (375 studies) research supports two
    major conclusions
  • Therapy is more effective than nontherapy.
  • Eysenck overestimated the improvement rate in
    no-therapy control groups.

Biomedical Approach
  • Biomedical therapies seek to treat psychological
    disorders by changing the brains chemistry with
    drugs, its circuitry with surgery or its patterns
    of activity with pulses of electricity or
    magnetic fields.

Drug Therapy/Psychopharmacology
  • The first psychological drugs were administered
    in 1953 with the antipsychotic drugs.
  • In 1955, over ½ a million Americans were living
    in mental institutions, each staying an average
    of a few years. Then, with the introduction of
    tranquilizers, the number declined. By 1965, the
    number of patients was down to ¼ million, with
    most patients staying for only a few months.

Antipsychotic Drugs
  • Antipsychotic drugs are used to treat the
    symptoms of psychosis delusions, hallucinations,
    social withdrawal and agitation.
  • Most work by reducing the activity of the
    neurotransmitter dopamine. Although the exact
    reason why this has an antipsychotic effect,
    these drugs have proven to be quite effective.

/- of Antipsychotic Drugs
  • While these drugs reduce the overall brain
    activity, they do not simple put the patient in a
    trance. Instead they simply reduce the positive
    symptoms of psychosis.
  • Unfortunately, long-term use can cause problems
    like tardive dyskinesia, which produces an
    uncontrollable disturbance of motor control,
    especially in the facial muscles.

Positive and Negative Categories
  • Often times, researchers now simply characterize
    symptoms of schizophrenia into positive and
    negative categories.
  • Positive symptoms refer to active process such
    as delusions, and hallucinations while negative
    symptoms refer to passive processes like social

Antidepressant Drugs
  • There are three major classes of antidepressant
    drugs, and all three work by turning up the
    volume on messages transmitted over certain
    brain pathways, especially those using
    norepinephrine and serotonin.
  • The major downside of these drugs is that it
    often takes a few weeks for them to have an
    effect. In some cases, time is not a luxury a
    mentally ill patient has.

Antianxiety Drugs
  • Antianxiety drugs most commonly fall into two
    categories barbiturates and benzodiazepines.
  • Barbiturates act as a central nervous system
    depressant, so they have a relaxing effect.
    Benzodiazepines work by increasing the activity
    of certain neurotransmitters.

  • Stimulants is a broad category that includes
    everything from caffeine to nicotine to
    amphetamines to cocaine-they are any drugs that
    produce excitement or hyperactivity.
  • These drugs are prescribed for a variety of
    disorders including narcolepsy and ADHD.

Truths About Drugs
  • Cannot cure any mental illness
  • Can alter the brain to suppress some symptoms
  • Can have negative long term effects
  • Can be habit forming
  • Often over prescribed

  • Psychosurgery is the general term given for any
    surgical intervention in the brain to treat a
    psychological disorder.
  • These surgeries were far more common in the
    past, and today have become a method of last

Brain-Stimulation Therapies
  • Electroconvulsive Therapy (ECT)-
  • A treatment used primarily for depression that
    involves the application of an electric current
    to head, producing a generalized seizure.
  • Transcranial Magnetic Stimulation (TMS)-
  • A treatment that involves magnetic stimulation
    of specific regions of the brain, but unlike ECT,
    it does not produce a seizure.

Study for the Free Response!
  • Electroconvulsive therapy (ECT)
  • Transference
  • Token economy
  • Systematic desensitization
  • Resistance
  • Psychopharmacology
  • Psychoanalytic perspective
  • Learning perspective
  • Biological perspective

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