Chapter 13 Notes - Elementary Psychology

1. Approaches to Treating Psychological Disorders There are three broad approaches to the treatment of psychological disorders: psychological, biological, and sociocultural. All approaches share the goal of relieving the suffering of individuals. All approaches differ in their focus. A. The Psychological Approach to Therapy Clinical psychology is an area of psychology that integrates science and theory to prevent and treat psychological disorders. Psychotherapy is a nonmedical process that helps individuals with psychological disorders recognize and overcome their problems. Psychotherapy is practiced by a variety of mental health professionals, including clinical psychologists, counselors, and social workers. B. The Biological Approach to Therapy The biological approach to therapy adopts the medical model viewing psychological disorders as similar to diseases requiring specific treatments that are typically biological. Biological therapies, also called biomedical therapies, are treatments that reduce or eliminate the symptoms of psychological disorders by altering aspects of body functioning. Generally speaking, biological therapies are administered by medical doctors. A few states, however, do have prescription privileges for psychologists. C. The Sociocultural Approach to Therapy Sociocultural therapies are treatments that acknowledge the relationships, roles, and cultural contexts that characterize an individual’s life, often bringing them into the therapeutic context. The sociocultural approach recognizes and seeks to intervene within the social connections, recognizing the person as a member of a couple, family, and/or group. These approaches to therapy may be practiced by trained psychotherapists, social workers, psychiatric social workers, and paraprofessionals. Paraprofessionals are people who have been taught by a professional to provide some mental health services but who don’t have formal mental health training. 2. Psychotherapy A. Central Issues in Psychotherapy Does Psychotherapy Work? A large body of research and many meta-analyses support the conclusion that psychotherapy works. Does One Therapy Work Better Than Others? While studies show that therapy is effective, no one therapy has been shown to be significantly more effective than others. Some therapies might be more effective than others, depending on the type of disorder. Relying on empirical research in making treatment decisions is a challenge because the evidence is not always clear-cut. Sometimes the evidence is limited or nonexistent for many disorders. The American Psychological Association endorses evidence-based practice. Evidence-based practice is the integration of the best available research with clinical expertise in the context of client characteristics, culture, and preferences. Factors in Effective Psychotherapy Research has also addressed the factors playing an important role in determining the effectiveness of psychotherapy, including the therapeutic alliance, the therapist, and the client. Therapeutic Alliance The therapeutic alliance is the relationship between the therapist and the individual. The Therapist Whether psychotherapy works depends more on the particular therapies than on the type of therapy being used. Therapists with high expertise are those who have a great deal of knowledge, continue to learn, monitor the client progress, and make changes if necessary. Research also supports that a match between a therapist’s style and client personality can influence the effectiveness of therapy. The Client Research suggests that the quality of the client’s participation is the most important determinant of whether therapy is successful. It is the person’s strengths, abilities, skills, and motivation that centrally account for the therapeutic success. B. Psychodynamic Therapies The psychodynamic therapies stress the importance of the unconscious mind, extensive interpretation by the therapist, and the role of early childhood experiences in the development of an individual’s problems. The goal is to help individuals gain insight into the unconscious conflict that is the source of their problems. Psychoanalysis Psychoanalysis is Freud’s therapeutic technique for analyzing an individual’s unconscious thoughts. He believed that an individual’s problems could be traced back to a childhood experience, many of which were of a sexual nature. Free association involves encouraging individuals to say aloud whatever comes to their mind, no matter how trivial or embarrassing. Interpretation is the process wherein the therapist looks for hidden meanings in what an individual says and does. The therapist may suggest to the patient various possible meanings. Dream analysis is a psychoanalytic technique for interpreting a person’s dreams. Psychoanalysts believe dreams hold information about unconscious thoughts and conflicts. The manifest content of dreams is the remembered, conscious content of the dreams. The latent content is the unconscious, unremembered symbolic aspects of dreams. Transference is the process of an individual’s relating to the therapist in ways that reproduce or relive important relationships in the individual’s life. Resistance is an individual’s unconscious defense strategies that prevent the therapist from understanding the person’s problems. Contemporary Psychodynamic Therapies Psychodynamic therapy has changed over time. Contemporary psychoanalysts give more power to the conscious mind and a person’s current relationships and place less emphasis on sex. Contemporary psychodynamic approaches emphasize the development of the self in social contexts. C. Humanistic Therapies Humanistic therapies encourage people to understand themselves and grow personally. Carl Rogers developed client-centered therapy (also called Rogerian or nondirective therapy). In this type of therapy, the therapist provides a warm, supportive atmosphere to improve the client’s self-concept and encourage the person to gain insight into his or her problems. The goal of this therapy is to help the individual identify and understand their own genuine feelings and become more congruent, bringing their actual self closer to their ideal self. One way of doing this is through reflective speech, in which the therapist mirrors the individual’s own feelings back to that person. Rogers believed humans require three essential elements to grow. The therapist develops unconditional positive regard where the therapist constantly recognizes the inherent value of the client. With empathy, the therapist strives to put him- or herself in the client’s position. Finally, with genuineness, the therapist is a real person in his or her relationship with the client, sharing feelings and not hiding behind a facade. D. Behavior Therapies Behavior therapies use the principles of learning to reduce or eliminate maladaptive behavior. Behavior therapists assume that overt symptoms are the client’s central problem, and they try to eliminate the symptoms or behaviors rather than gain insight. Classical Conditioning Techniques Systematic desensitization is a behavior therapy that treats anxiety by teaching the client to associate deep relaxation with increasingly intense anxiety-producing situations. This technique is often used as an effective treatment for phobias. Aversive conditioning consists of repeated pairings of the undesirable behavior with aversive stimuli to decrease the behavior’s rewards. Electric shocks, nausea-inducing substances, and verbal insults are used as stimuli in aversive conditioning. Operant Conditioning Approaches The idea behind using operant conditioning is that just as maladaptive behaviors are learned, they can be unlearned. Therapy for operant conditioning involves conducting an analysis of the individual’s environment to determine which factors in it need to be modified. One technique is applied behavior analysis, in which the main goal is to replace unacceptable, maladaptive behaviors with acceptable, adaptive ones. Acceptable behaviors are reinforced; unacceptable ones are not. This technique has been proven effective in treating individuals on the autism spectrum. E. Cognitive Therapies Cognitive therapies emphasize that an individual’s cognitions, or thoughts, are the main source of abnormal behavior and psychological problems. Cognitive restructuring is the process of changing a pattern of thought that seems to be causing the problem behavior. Foundations of Cognitive Therapies All cognitive therapies involve two basic assumptions: (1) humans have control over feelings, and (2) how individuals feel about something depends on how they think about it. Cognitive therapy involves getting people to recognize the connections between their thoughts and feelings and helping them use thinking to change their feelings. Cognitive therapists guide individuals in identifying their irrational, self-defeating thoughts. They ask the individual questions to help them gain understanding about their negative thinking. Cognitive-Behavior Therapy Cognitive-behavior therapy (CBT) involves a combination of cognitive therapy, with an emphasis on reducing self-defeating thoughts, and behavior therapy, with an emphasis on changing behavior. The therapist takes a directive role, engaging in a dialogue to help clients identify automatic thoughts and feelings and work through to change thoughts and behaviors. Self-instructional methods are aimed at teaching individuals to modify their behavior. The therapist gives the individual examples of constructive statements, known as reinforcing self-statements, that they can repeat in order to take positive steps to cope with stress or meet a goal. An important aspect of CBT is self-efficacy. Self-efficacy is the concept that individuals can master a situation and produce desired outcomes. CBT is the most common form of therapy used today, and it is effective with a wide range of disorders. F. Therapy Integrations Integrative therapy is a combination of techniques from different therapies based on the therapist’s judgment of which particular techniques will likely provide the greatest benefit for the individual. Integrative therapy is characterized by openness to variety and technique. Borderline personality disorder responds to dialectical behavioral therapy (DBT), which takes into account early childhood experiences, assignment homework, cognitive interventions, individual therapy, group sessions, mindfulness, and emotion and interpersonal skill training. Combinations of psychotherapy and drug therapy are found to be effective in anxiety and depressive disorders, eating disorders, and schizophrenia. One criticism of integrative therapies is that their increased use may result in haphazard employment of them that would be comparable to a narrow, dogmatic approach. 3. Biological Therapies Biological (biomedical) therapies are treatments that reduce or eliminate a psychological disorder by altering bodily functions. Drug therapy is the most common form of biological therapy. An individual can also go through electroconvulsive therapy and psychosurgery. A. Drug Therapy Antianxiety Drugs Antianxiety drugs, also known as tranquilizers, make an individual calmer and less excitable. Benzodiazepines are the most common antianxiety drugs. Some popular benzodiazepines are Xanax, Valium, and Librium. Benzodiazepines are fast working, taking effect within hours after they are ingested. Some of benzodiazepine’s side effects are loss of coordination, drowsiness, fatigue, and mental slowing. BuSpar is a nonbenzodiazepine that is used to treat generalized anxiety. Antianxiety medications are best used only temporarily for symptomatic relief. Antidepressant Drugs Antidepressant drugs help to regulate mood. The four main classes of antidepressant drugs are tricyclics, tetracyclics, MAO inhibitors, and selective serotonin reuptake inhibitors (SSRIs). Tricyclics are believed to work by increasing the level of certain neurotransmitters, especially serotonin and norepinephrine. They bring relief to as many as 60 to 70 percent of patients with depression. Some of the side effects can be restlessness, faintness, trembling, sleepiness, and difficulty remembering. Tetracyclics have effects on increasing both norepinephrine and serotonin. The MAO inhibitors are not used as often as the tricyclics because they are much stronger. Their interactions with certain foods and drugs, such as cheese and other fermented foods, along with red wine, makes them riskier than the tricyclics. SSRIs work mainly by interfering with the reabsorption of serotonin in the brain. Prozac and Zoloft are two of the most widely used SSRIs. These two drugs have increased effectiveness in reducing depression and have fewer side effects than antidepressants. Some SSRI side effects are insomnia, anxiety, headache, and diarrhea. Antidepressants have been used to treat various personality disorders such as generalized anxiety disorder, panic disorder, obsessive–compulsive disorder, social phobia, and post-traumatic stress disorder. Medications for Bipolar Disorder Lithium is used to treat bipolar disorder. When a person is taking lithium, the amount circulating in the bloodstream must be closely monitored because the effective dosage is close to the toxic level. Lithium is thought to stabilize moods by influencing norepinephrine and serotonin. The effectiveness of lithium depends on the person staying on the medication. B. Antipsychotic Drugs Antipsychotic drugs diminish agitated behavior, reduce tension, decrease hallucinations, improve social behavior, and produce better sleep patterns. They are used especially in individuals with schizophrenia. The neuroleptics are the most widely used of the antipsychotic drugs because they block the dopamine system’s action in the brain. Neuroleptics do not cure schizophrenia; they only treat its symptoms. One side effect of the neuroleptics is tardive dyskinesia, a neurological disorder resulting in involuntary movements of the facial muscles and mouth, as well as twitching of the neck, arms, and legs. Atypical antipsychotic medications carry a much lower risk of this side effect. Clozapine and resiperidone are two of the most well-known of the atypical antipsychotic medications. C. Electroconvulsive Therapy Electroconvulsive therapy (ECT), sometimes called shock therapy, is mainly used to treat severe depression. The goal of ECT is to cause a seizure in the brain. ECT is mainly given to individuals who have not responded to drug therapy or psychotherapy. The patient receives anesthesia and muscle relaxants before the current is applied. This medication allows the individual to sleep through the procedure, minimizes convulsions, and reduces the risk of physical injury. D. Psychosurgery Psychosurgery is a biological intervention that involves the removal or destruction of brain tissue. Its effects are irreversible. One form of psychosurgery is a prefrontal lobotomy, in which a surgical instrument is inserted into the brain and rotated, severing fibers that connect to the frontal lobe. Thousands of these surgeries were performed between the 1930s and 1950s. Many individuals were cured, but others remained in a vegetable-like state. Prefrontal lobotomies are no longer performed. 4. Sociocultural Approaches and Issues in Treatment A. Group Therapy Group therapy is a sociocultural approach that brings together individuals who share a psychological disorder in sessions that are typically led by a mental health professional. There is good reason to believe that individuals who share a psychological problem may benefit from the empowering effect of observing others cope with a similar problem and that helping others cope can help improve an individual’s own feelings of competence and efficacy. The six features that make group therapy an attractive treatment are as follows: ● ● ● ● ● ● Information Universality Altruism Experiencing a positive family group Development of social skills Interpersonal learning B. Family and Couples Therapy Family therapy is group therapy among family members. Couples therapy is group therapy with married or unmarried couples whose major problem is within their relationship. Four of the most widely used family therapy techniques are validation, reframing, structural change, and detriangulation. Couples therapy proceeds similarly to family therapy. Conflict in marriages and in relationships between unmarried individuals frequently involves poor communication. Couples therapy addresses diverse problems such as alcohol abuse, jealousy, sexual issues, infidelity, gender roles, two-career families, divorce, remarriage, and the special concerns of stepfamilies. C. Self-Help Support Groups Self-help support groups are voluntary organizations of individuals that meet to discuss topics of common interest. These groups are run either by a paraprofessional or a member of the group itself. A paraprofessional is an individual who has been taught by a professional to provide some mental health services but who does not have formal mental health training. Such groups are important because they use community resources and are relatively inexpensive. They also serve people who are less likely to receive help otherwise. Social support, role modeling, and the sharing of concrete strategies for solving problems that unfold in self-help support groups are part of their effectiveness. Online support groups have also emerged. D. Community Mental Health The community mental health movement began in the 1960s when society recognized locking away individuals with psychological disorders was inhumane and inappropriate. Deinstitutionalization refers to the process of transferring large numbers of people with psychological disorders from mental institutions to community-based facilities. The community mental health approach includes training teachers, members of the clergy, family physicians, nurses, and others who are in direct contact with community members to offer counseling and workshops. The best way to treat a psychological disorder may well be to prevent it from happening in the first place. E. Cultural Perspectives Cross-cultural competence refers both to how skilled a therapist feels about being able to manage cultural issues that might arise in therapy and to how the client perceives the therapist’s ability. Ethnicity Many minority individuals prefer to discuss their problems with family members or friends rather than a therapist. When there is a match between the ethnicity of the individual and the ethnicity of the therapist, individuals are less likely to drop out of therapy and in many cases have better treatment outcomes. Ethnic-specific services include the practice of providing culturally appropriate greetings and arrangements, flexible hours for treatment, and a bicultural or bilingual staff. Gender Some psychologists believe that the goals of therapy should involve more emphasis on relatedness and connection with others, especially for women. Nontraditional therapies emphasize the importance of helping people break free from traditional gender roles and stereotypes. The goals of feminist therapists are no different than other therapists’ goals. They do, however, want their female clients to be aware of how the nature of the female role in U.S. society can contribute to the development of a psychological disorder.