Topic: Psychological Treatment

Transcription

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2 Topic: Psychological Treatment

3 Treatment of Psychological Disorders: True/false quiz True or false? 1. "Psychoanalysis" is another word for "psychotherapy". 2. All therapists agree that their most important task is to interpret their patients' problems and feelings. 3. Group therapy is used primarily because it saves time and money. 4. Regardless of their theoretical orientation, therapists agree that self-awareness is the key to overcoming psychological problems. 5. Most people who suffer psychological problems become worse without therapy. 6. The training and experience of the therapist is the crucial factor in determining therapeutic success.

4 Psychoanalysis and psychotherapy 1. "Psychoanalysis" is another word for "psychotherapy". False Psychotherapy means "psychological therapy"; many different kinds All involve a helping relationship between a professional with special training (therapist) and a person in need of psychological help (client)

5 Psychoanalysis and psychotherapy (cont.) Psychoanalysis refers to the specialized type of psychotherapy developed by Freud and his followers An insight therapy that emphasizes the recovery of unconscious conflicts, motives and defenses through techniques such as free association and transference. Psychoanalysis rarely practiced in the classical way anymore (i.e. with couch, several sessions a week, lasting several years) For a critique of modern psychoanalysis, see book by Jeffrey Masson Final Analysis. But modified forms are still practiced, and was the first and most influential type of modern psychotherapy.

6 The Psychoanalytic Perspective Psychoanalysis technique of treating psychological disorders by seeking to expose and interpret unconscious tensions Freud s psychoanalytic theory of personality sought to explain what he observed during psychoanalysis In traditional training, therapists must undergo psychoanalysis themselves as part of their training

7 The Psychoanalytic Perspective Dream analysis Looking for latent content Freud felt that dreams were the royal road to the unconscious Gave clues to hidden psychological truth Free Association method of exploring the unconscious person relaxes and says whatever comes to mind, no matter how trivial or embarrassing

8 The Psychoanalytic Perspective Two big concepts of psychoanalysis: Resistance: Periods of being uncooperative Unconscious attempt to resist or block therapy Inattention, skipping sessions, claiming no dreams or forgetting dreams, arguing with therapist Transference: Thoughts and feelings towards therapist that are actually about other significant people in patient s life Can be feelings of: love, hate, lust, dependence, Is significant usually means that hidden or repressed memories or feelings are trying to make themselves known. Feelings are symbolic; unethical for therapist to act on them Tracey Nigro s study

9 2. All therapists agree that their most important task is to interpret their patients' problems and feelings False Psychoanalytic psychotherapists (such as Freud) do offer interpretations of client's dreams, conflicts, etc, but most types of psychotherapy do not encourage the therapist to interpret hidden or unconscious messages of the client. E.g., humanistic therapy (such as Carl Roger's client-centered therapy) focuses on the client's perceptions and interpretations of their present situation and feelings - not the therapist s interpretations. Eliza

10 Therapy and the Recovery of Childhood Trauma To this day, I can hear my mother s voice - harsh, accusing, Lost your mittens? You naughty kittens! Then you shall have no pie!

11 3. Group therapy is used primarily because it saves time and money False Group therapy does save the therapist's time and the client's money But those are not the primary reasons for its popularity More importantly, the group situation allows clients to discover that other people may have similar problems, and to try out new ways of behaving socially. People can receive honest feedback about their social behaviour E.g., You react to most criticisms defensively or You do not appear to be as anxious as you think you do, etc The process of discovering that other's have gone through some of the same pain and feelings that you have, and of sharing your own experiences, can be very healing

12 Group therapy (cont.) It has been used for people with a variety of problems, e.g., alcoholism and other addictions spousal abuse anger management bereavement divorce support self-discovery among people with few if any actual psychological problems

13 Group Therapy video What does therapist Delores McCarthy say are some advantages of group therapy? Why does the therapist often not intervene when the group falls silent?

14 Group Therapy video What does therapist Delores McCarthy say are some advantages of group therapy? opportunity to see how clients actually behave with other people, rather than just hearing their reports of how they behave - can gain feelings of sharing; not being alone; not being different; hope about their situation - opportunity to practice relational skills such as talking about difficult things, being more open, or being less shy - can receive feedback from peers regarding problems and social behaviour Why does the therapist often not intervene when the group falls silent? can be a sign that people are processing important information, and talking at that time could be counter-therapeutic (could "push things away"); the group may need some time to work through what has just been said or experienced

15 Group Therapy: Illustration

16 4. Regardless of their theoretical orientation, therapists agree that self-awareness is the key to overcoming psychological problems False Do any types of psychotherapy emphasize self-awareness? Yes; insight therapies, These include psychoanalytic, client-centred and cognitive therapies What kinds do not? Behavioural therapies do not Behavioural therapies are designed to change unwanted or maladaptive behaviour through the application of basic learning principles" (Text p.615) Types: systematic desensitization; aversion therapy; social skills training; token economy

17 Behavioural Therapies (cont.) Behavioural therapists do not believe clients need to understand the origins or dynamics of their psychological problems in order to change their behaviours in a positive way Quite successful for conditions like phobias, addictions and some sexual problems

18 5. Most people who suffer psychological problems become worse without therapy. False The psychoanalyst Karen Homey said "Fortunately, [psychotherapy] is not the only way to resolve inner conflicts. Life itself still remains a very effective therapist"

19 Effectiveness of psychotherapy Study by Elkin (1989): 239 people with depression were assigned to four different groups: 1. Cognitive therapy 2. Interpersonal therapy (similar to client-centred) 3. Drug therapy (anti-depressants) 4. Control group: placebo medication, supportive attention, encouragement and advice After 16 weeks of treatment, about 50% of people receiving treatment (Groups 1, 2, 3) were better (depression had lifted) But 29% of Group 4 (control) were also better

20 Effectiveness of psychotherapy (cont) Conclusions of therapy outcome studies Several different types of therapy appear equally effective for treating depression There was a higher rate of recovery among people receiving treatment than among those not receiving treatment But almost half of those receiving treatment did not get better (in 16 weeks) And almost one-third of those not receiving treatment got better anyway

21 Does Therapy Work? (Figure) Number of persons Average untreated person Average psychotherapy client Poor outcome Good outcome 80% of untreated people have poorer outcomes than the average treated person

22 Therapy: Session Number Effect Figure

23 6. The training and experience of the therapist is the crucial factor in determining therapeutic success. False Classic summary of research by Mary Lee Smith and colleagues (Smith et al 1980) found that whether their was no systematic difference in effectiveness of therapy that was associated to either the training of the therapist (e.g., psychiatrist, psychologist, counsellor, psychiatric nurse) or the years of experience However, keep in mind that the Smith et al (1980) study is preliminary in many ways, and some differences due to training or experience may show up in future, more focused studies The Smith et al (1980) study also found few differences in effectiveness due to type of therapy; all were equally effective

24 Types of therapy - video 1. What does psychoanalytic psychotherapy have as its basic theoretical orientation? How does the client Hal s problem illustrate this? 2. What qualities do humanistic psychotherapists want to bring into psychotherapy? 3. What are the basic categories that cognitive therapists use to analyze and understand clients' problems?

25 Types of therapy - video 4. What are the three goals that Christine Padesky has in an initial therapy session? 5. What sources could you ask for advice in seeking a good therapist?

26 Types of therapy - video 1. What does psychoanalytic psychotherapy have as its basic theoretical orientation? How does the client Hal s problem illustrate this? People have both conscious and unconscious motivations, and unconscious motivations interfere with conscious wishes. -In Hal s case, some unconscious barrier (such as a fear of independence) may be interfering with Hal s conscious wish to be a producer 2. What qualities do humanistic psychotherapists want to bring into psychotherapy? -reflecting feelings to client -genuineness, openness, honesty -non-judgmental, accepting attitude (= non-possessive warmth and caring)

27 Types of therapy - video 3. What are the basic categories that cognitive therapists use to analyze and understand clients' problems? -situations, thoughts, feelings, and behaviours 4. What are the three goals that Christine Padesky has in an initial therapy session? 1. Establish rapport so client feels comfortable talking 2. Get basic understanding of client s problems 3. Give client basic understanding of cognitive [behavioural] therapy 5. What sources could you ask for advice in seeking a good therapist? - people who you trust, and who have some knowledge of professional services in your community i.e., your physician -mental health associations [or clinics] -university counseling departments

28 Therapy discussion question 5. Which of the therapists shown in the video would you prefer to go to, and why? Therapists: Susan Brown (psychodynamic), Steven Sultanoff (humanistic), or Christine Padesky (cognitive-behavioural).

29 Treatment of Psychological Disorders: True/false quiz True or false? 7. The various therapies are so different that it is difficult to find any commonalities. 8. The use of drugs has enabled thousands of schizophrenia patients who had been hospitalized to return to nearnormal lives. 9. Many people have found relief from the mood swings of bipolar disorder with a daily dose of a cheap salt. 10. Electroconvulsive therapy is no longer used in the treatment of psychological disorders. 11. Prozac (and other SSRI anti-depressants) were developed to fight depression, but have been reliably linked to increases in suicidal behaviour.

30 7. The various therapies are so different that it is difficult to find any commonalities. False At least three commonalities 1. Hope for demoralized people Expectation that things can get better May be partly a placebo effect, but useful nonetheless Placebo-treated people do improve more than untreated ones, but less than ones undergoing therapy Simply making to commitment to therapy may harness individual's own healing powers

31 Commonalities in therapies (cont.) 2. A new perspective on world and oneself E.g., reframing 3. An empathic, caring, trusting relationship More important than the techniques used in therapy is the attitude of the therapist People improve more when they feel their therapist is empathic, caring, respectful and warm

32 Commonalities in therapies (cont.) Some commonalities among people who benefit most from psychotherapy: Mature, articulate Specific rather than general problems E.g., phobias, unassertiveness, sexual performance problems Poorer response to psychotherapy: Chronic schizophrenia does respond well to other treatments E.g., drugs and family support, but not to psychotherapy Dissatisfaction with entire personality Anti-social personality disorder

33 8. The use of drugs has enabled thousands of schizophrenia patients who had been hospitalized to return to near-normal lives. True Antipsychotic drugs like chlorpromazine (=Thorazine) have helped people diminish the hallucinations and paranoia of schizophrenia Acts by blocking dopamine receptors (schizophrenia is associated with problems in dopamine activity) And clozapine (=Clozaril) helps people with negative symptoms, such as apathy

34 True 9. Many people have found relief from the mood swings of bipolar disorder with a daily dose of a cheap salt Lithium carbonate discovered by accident by Australian physician John Cade in 1940s effective in stabilizing mood swings in majority of people with bipolar disorder

35 10. Electroconvulsive therapy is no longer used in the treatment of psychological disorders False Works well for severely depressed patients After 3 treatments a week for 2 to 4 weeks, 80% of severely depressed patients improve markedly (and with no discernible brain damage) "A miracle had happened in two weeks" From Norman Endler Holiday of Darkness

36 11. Prozac (and other SSRI antidepressants) were developed to fight depression, but have been reliably linked to increases in suicidal behaviour True (regarding attempted suicides) Prozac (trade name of fluoxetine) is an antidepressant that works by blocking the reabsorbsion and removal of serotonin from the synapse

37 Biomedical Therapies: Prozac Message is sent across synaptic gap. Vesicles containing neurotransmitters Sending neuron Action potential Message is received; excess neurotransmitter molecules are reabsorbed by sending neuron. Prozac blocks normal reuptake of the neurotransmitter serotonin; excess serotonin in synapse enhances its mood-lifting effect. Synaptic gap Receptors Neurotransmitter molecule Receiving neuron Reuptake Serotonin Prozac

38 11. Prozac (and other SSRI antidepressants) were developed to fight depression, but has been reliably linked to increases in suicidal behaviour True (regarding attempted suicides) SSRIs are often effective, and studies have indicated they are generally safe. However, some people on SSRI antidepressants have completed suicide. Is this (by itself) evidence that SSRI antidepressants cause an increase in suicidal behaviour? Not necessarily; these are severely depressed people However, a recent meta-analysis (combining 702 smaller studies) by Dean Fergusson of the University of Ottawa indicates that SSRI antidepressants doubled the risk of attempted suicides, but did not effect the rate of completed suicide. Note the number of suicide attempts is still quite small (out of 87,000 people in the studies, only 143 suicide attempts) so most authorities would still recommend SSRI antidepressants, but with a caution to monitor any increases in suicidal ideation.