Treatment of Psychological Disorders

 

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Treatment of Psychological Disorders I. Introduction and Overview A. Definition of psychological treatment 

When a psychological disorder disorder becomes serious enough to cause problems in every day functioning, functioning, the client client may seek to have the disorder treated. treated. Clients can be treated as inpatients (24-hour care in a treatment center or hospital) or ou tpatients (periodic appointments in an 1. Psychotherapy

office/clinic setting).



This therapy applies psychological psychological principles and techniques to treatment of a psychological disorder. Ps Psychotherapy ychotherapy includes discussion discussion of the psychological problem and specific exercises/techniques exercises/techniques that are designed to help a client fu nction better in everyday life. 2. Biological 

This is the term when physiological physiological methods are used to treat psychological ill ill ness. Examples Examples of medically medically based treatments include include medication and electroconv ulsive therapy (ECT). 3. Combined treatments 

The combined use of medication medication and psychotherapy ng psychological disorders (Sammons &

is a com common mon approach to treati

Schmidt, 2001).

B. History of treatment 

Historically, treatment of people with psychological disorders disorders ranged from lack of care to extreme and often violent mistreatment mistreatment of individuals with serious psychological disorders. 1. Early treatment approaches (circa 1300 

1900) 

Early psychological psychological treatment consisted primarily primarily of imprisonment, rather than specific techniques techniques to help people with mental illness. illness. Bethlam (or the more co mmon name of Bedlam) is locat located ed in London and is considered considered the oldest hospital caring for people with mental illness. illness. The term term bedlam aptly describes describes the co con n ditions that were present in hospitals at that time. Treatment facilities, facilities, call ed asylums or mental hospitals, were built to house people with mental illness in the mid-1500s. Patients Patients often were chained and mistreated in the early early attem pts to treat psychological illness. a. Phillipe Pinel (1745 

1826) was the first physician to remove the chains from seriously mentally mentally ill patients, which which resulted in calmer patients. In the 1840s, in the United States , Dorothea Dix (1802 

1887) also initiated freeing freeing the mentally mentally ill from mistreatment mistreatment in jails and ot her locations. locations. She was instrumental in helping to establish state-funded state-funded mental hospitals (Weiten, 1994). b. The precursor to modern psychotherapy psychotherapy began with a physician, Josef Breuer ( 1845 

1925), who used used hypnosis to get his patients patients to

talk about their their problems or wh

 

at became became known known as cathartic therapy (Sternberg, 1995). 2. Contemporary treatment approaches (1900 

2000) 

Early twentieth twentieth century treatments also also included harsh medical interventions (e (e .g., ECT, prefrontal lobotomy), which were performed in mental hospitals. Althou gh these hospitals remained remained operational, they failed to reach their full potent ial, and in the 1950s, efforts efforts were undertaken undertaken to close m many any large mental hospi tals. Deinstitutionalization of patients resulted in release of many patients. Treatment of psychological disorders now includes hospital inpatient inpatient treatment s and community mental health or outpatient treatments. treatments. Several specific specific treatm ent modalities were introduced in the second half of the twentieth Freud s (1856  1939) approachcentury. approach to therapy, therapy, or psychoanalysis, is perhaps the most well-known co ntemporary approach to therapy. Freud Freud emphasized emphasized understanding understanding the unconscious mind as a central tenet of treating psychological disorders. Freud s patients would lie on a couch and talk about their problems through free association or reporting dream s. Humanistic therapy, which consists of more egalitarian behavioral treatments that emphasize change in actions; cognitive therapy, designed to change a persons thought processes; and biomedical treatments are among the specific techniques that will be outlined. C. Those who provide treatment 

Professionals who treat people with psychological problems have training as med ical doctors doctors (psychiatrists), (psychiatrists), psychologists, psychologists, or or other professions with speciali speciali zed mental mental health training (e.g., (e.g., social workers, 1. Psychiatrist

nurses, counselors). counselors).

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A psychiatrist psychiatrist is a medical doctor who specializes in treating psychological di di sorders. A psychiatrist can can diagnose a mental illness, prescribe medication, medication, or administer other biomedical treatments. 2. Psychologist 

A clinical or counseling psychologist has a doctoral degree (PhD or PsyD) that i ncludes training training in diagnosis and treatment treatment of psychological illnesses. 3. Psychiatric social worker or psychiatric nurse 

This social worker or nurse works as part of a team of people in a hospital sett ing. Services include monitoring treatments treatments that are prescribed by a psychiatri psychiatri st or psychologist. 4. Counselor 

A counselor provides limited psychotherapy for individuals who do not have a ser ious mental illness. D. Ethical issues in treatment 

Professionals should adhere to a s set et of ethical ethical standards issued issued by their their respe ctive organizations. organizations. For example, psychologists psychologists should adhere to the e ethical thical pr inciples of the American Psychological Association. In addition to ethical stan dards, professionals professionals must adhere to legal stipulations stipulations governing the practice o f psychology. One example of the nexus of law and ethical code relates to the r ight to privacy, which is granted by the U.S. U.S. Constitution. Constitution. Although this right to privacy is a legal mandate, mandate, specific application application of this right to privacy i s specified in the ethics code (Koocher & Keith-Speigel, 1998). 1998). Essentially, Essentially, pr actitioners should be sure that they keep all information confidential. Informat ion about a client should be released only under very specific circumstances, a

 

nd the client has a right to know, know, in advance, about the conditions conditions under whic which h information will be released. For example, if a client tells a psychologist th th at (s)he plans to hurt someone, the psychologist must break confidentiality. Add itional reference reference materials related to the application application of eth ethics ics are included included a t the end of this lesson plan. II. PsychoanalyticTreatment Approaches A. Introduction and overview 

Psychoanalytic, humanistic, an and d cognitive approaches to therapy are often calle d insight therapies. Insight Insight therapy helps patients patients develop an understanding understanding of their inner conflicts. It is through understanding himself himself or herself that a p atient can begin to solve the problems of daily living. B. Psychoanalytic approaches 

Sigmund Freud (1856 

1939) pioneered pioneered work in psychodynamic therapies. His particular type of therapy has been labeled psychoanalysis. 1. Psychoanalysis Psychoanalysis emphasizes the importance importance of the unconscious mind. mind. Freud atte mpted to help people understand, or or develop insight, into their unconscious con con flicts as a way to to relieve neurotic anxiety anxiety (Dryden & Mytton, 1999). Techniques 

Psychoanalysis is an i intensive ntensive and long-term therapy therapy that may include several s essions per week week over a period period of several years. A psychoanalyst helps the pati ent to discover unconscious unconscious conflicts, yet the therapist remains remains neutral, does not reveal reveal personal information, and does not give advice. advice. (1) Free association 

During a therapy session, psychoanalysts encourage patien patients ts to verbalize verbalize any th oughts or feelings that come into their consciousness. Resistance occurs occurs when p atients unconsciously try to censor their thoughts/feelings or sabotage therap y by missing appointments appointments or holding holding back their thoughts. Transference occurs occurs w hen patients treat the psychoanalyst like like someone from their past (e.g., a pare nt). For example, a patient may have unconscious unconscious hostile feelings toward an ove rly domineering parent. When the patient was a young child, a parent may have required the patient to continue continue an unpleasant set of piano lessons. If, in the course of therapy, therapy, the therapist asks the patient why he or she has not comple comple ted a project or similar task, then the patient patient might get ang angry ry with the therap therap ist, thus engaging in transference. (2) Dream analysis 

According to Freud, dreams reflect symbolic symbolic or unconscious desires. desires. A psychoana lyst asks a patient to describe describe a dream in as much detail as possible. Then, th th e psychoanalyst psychoanalyst interprets the underlying meaning meaning of the dream. Freud believed that unfulfilled desires that are not expressed consciously during waking hour s may be represented in latent content of dreams. 2. Other psychoanalytic therapies 

Carl Jung, Erik Erikson, and Karen Horney are neo-Freudians neo-Freudians who believed believed that t herapy should include consciou conscious s and unconscious aspects aspects of the patient. A neo-F reudian psychoanalyst seeks to understand the patients past and helps to understand the patient s future. This type of therapy is usually shorter in duration compared compared to traditional traditional psy choanalysis. Ego analysis, interpersonal therapy, therapy, and individual analysis analysis are a mong some of the neo-Freudian therapies therapies that include both conscious and unconsc

 

ious aspects. According to the newest neo-Freudian approach, approach, object relations t heory, children children should form a secure relationship relationship with a caregiver in order to feel secure as adults. In this case, the object is the ?relationship with the parent.? If a secure bond is not formed, the child may not be able to form strong social relationships as an adult. An object relation s therapist treats treats a pati patient ent with the underlying perspective that object relati ons are influential influential in the development development of the patient. patient. III. Humanistic Treatment Approaches A. Introduction and overview 

Humanistic or client-centered therapies repres represent ent the

second set of insight the

rapies views psychothe psychologists logists use. However, the emphasis ond humanism changes chang es person how th the e the rapist person who enters therapy. Instead Instea of calling the a ?patient? as a psychoanalyst might, the humanistic -oriented therapist would call the person a ?client.? The client and the therapist are mor e equal in the therapeutic relationship. Humanistic therapies emphasize free will of th e client and encourage growth or self-actualization. In other words, if the cli ent can understand or develop develop insight into into his or her problems of living, living, then the client client can choose to change his or her behavior. B. Client-centered or nondirective therapy 

Carl Rogers developed client-centered client-centered therapy that allowed clients clients to dire direct ct th e therapeutic process. Rogeria Rogerian-oriented n-oriented therapists want to help clients to dev elop insight into themselves as as valuable human beings and to worry less about w hat others think of them. Client-centered Client-centered therapis therapists ts must ensure the following conditions for therapy. 1. Genuineness 

The therapist has to b be e completely honest and genuine. In essence, therapists m odel the type of openness they expect from their clients. clients. 2. Unconditional positive regard 

The therapist emphasizes the value of the client by fully accepting the worth of the client. Sometimes clients do things to please others. Unconditional positiv e regard suggests that the client does not have to please the therapist. 3. Empathy 

The therapist has an emotional understanding of the client. In other words, the therapist can truly understand the perspective of the client. C. Gestalt therapy 

Fritz Perls and his wife, Laura, developed Gestalt Gestalt therapy from the perspective that people create create their own understanding of the world and continue to grow a s long as they have insight into their feelings. Gestalt therapy is more directi ve and confrontational confrontational than client-centered therapy. A Gestalt approach approach may inc inc lude helping clients to identify inconsistencies between the statements they ma ke about how they see themselves and how they really interact with the world. D. Other humanistic therapies 

Group therapy and family therapy are treatment modalities. Often Often they are consi dered within the context of humanistic therapies because an emphasis is placed o n growth of the individual. However, it is possible that the therapist therapist may appr oach treatment from any of the perspectives that have been outlined in this uni

 

t. 1. Group therapy 

A group of clients who may be experiencing similar problems (e.g., alcoholism, d omestic abuse, violence) meet under the direction of one or more therapists who help them work through their problems. Advantages of group therapy include helpi ng clients to understand that they are not alone and identifying possible mechan isms for dealing with difficult situations. 2. Family therapy 

Rather than treating an individual for a specific problem, a family therapist co nsiders the person within the context of a system (family) and treats the entire system. The goal of family therapy is to improve the functioning of the family system as a whole through a better understanding of interactions that occur with in the system. IV. Behavior Therapy Treatment A. Introduction and overview 

Behavior therapy emphasizes emphasizes changing changing learned behaviors rather rather than understandin g feelings. This relatively relatively new ap approach proach (1970) evolved out of general principl es of classical and operant conditioning conditioning that were studied by Watson, Pavlov, a nd Skinner. Behavior therapy therapy generally attempts to alter the behavior of the cl cl ient through specific techniques techniques that are administered during a brief period of time. Common applications of behavior therapy include the treatment of phobias and anxiety disorders. B. Behavior therapy techniques 

Traditional behavior behavior therapy techniques use use conditioning (refer students to cla ssical conditioning principles and operant conditioning examples) to alter the clients behavior. 1. Systematic desensitization 

Mary Cover Cover Jones pioneered systematic systematic desensitization or counterc counterconditioning onditioning as as a method for treating phobias. Later, Joseph Wolpe popularized the the treatment. Systematic desensitization desensitization used used the principles of classical condi conditioning tioning by cre ating new associations for the original phobi phobic c stimulus. Although this treatmen t was originally developed developed using the classical conditioning conditioning paradigm, it is imp imp ortant to emphasize emphasize that it is unclear why why the treatment works (Bernstein, et a l., 2003). A transparency master is included included in this lesson plan for purposes o f illustration. a. First, an anxiety hierarchy must be developed. developed. This hierarc hierarchy hy is a rank orde ring of the anxiety-provoking anxiety-provoking situatio situation n beginning with the least fearful stimul us and ranging ranging to the actual actual item or situation situation most 14 feared by the client. b. c. ed 2.

Second, the client is then trained in relaxation techniques. Finally, the stimuli identified in the hierarchy are then progressively with the relaxation techniques that the client has learned. Aversion therapy

pair



This therapy is the opposite opposite of systematic desensitization. desensitization. With systematic systematic des ensitization, the client learns to become less fearful of a situation or stimul us. An unpleasant unpleasant stimulus is introduced at the the same time as an undesirable undesirable res ponse. Aversion Aversion therapy seeks to increase the unpleasant reac reaction tion to a stimulus . The most common form of aversion therapy is illustrated in alcoholism treatmen t. Antabuse is is a drug that makes people feel physically physically ill if they drink alcoh alcoh ol. This form of aversion ther therapy apy pairs a negative negative outcome with a previously pl pl

 

easant stimulus. 3. Extinction techniques 

Principles of operant conditio conditioning ning are applied to reduce or eliminate a behavio r. a. Extinction can occur if reinforcements reinforcements are removed after an undesirable beh beha a vior is exhibited. For example, a student may receive attention attention from a teacher for being disruptive in class. In this case, the reinforcement was was the attentio attentio n received for for acting out in class. If, inste instead ad of receiving attention, the per per son is asked to leave, the reinforcement is removed, and this may result in ext inction of behavior. b. Flooding is is a second method method of effecting effecting extinction. If someone who is fearf ul of needles is inundated wit with h repeated mild finger pricks, a after fter a period of time, the person will able to receive injections without without the ar associated with thebe phobia. 4. Token economies

debilitating fe fe



Positive reinforcement, reinforcement, or operant conditioning, conditioning, can be used to encourage peopl peopl e to engage in in appropriate appropriate behaviors. behaviors. Token ec onomies involve giving people a ?token,? such as play money, for performing a desired behavior. behavior. The to tokens kens can be exchanged for a desired rewar d at a later later point in time. A pleasant stimulus is introduced introduced after a desirable response occurs. 5. Punishment 

Operant conditioning conditioning principles principles can be used to reduce unwanted behavior. behavior. An unp unp leasant stimulus stimulus is introduced after an undesirable response occurs. V. Cognitive Cognitive Therapy Treatment Treatment 

Cognitive therapy techniques

Cognitive therapy therapy techniques are designed to help people change the way that th ey think about their problems. Sternberg Sternberg (1994) suggests that cognitive approac hes are grounded grounded in the theory theory of modeling or that people can learn from watch watchi i ng the behavior behavior of other people. people. People can can deal with problems by learning to c hange their thoughts or cognitions. Cognitive therapy evolved from two perspecti ves: rational emotive behavior therapy and cognitive cognitive therapy. A. Rational emotive behavior therapy (REBT) 

Albert Ellis is credited with introducing REBT. REBT. The p premise remise of REBT or rational emotive therapy (RET) is that people engage engage in self-talk that is false. If peo ple can change change their beliefs, then, according to Ellis, this will produce a cha nge in emotion. The therapist confronts irrational irrational beliefs of the client. For e xample, the client client might believe believe that he or she must must perform perfectly perfectly on an ex ex am. The therapist confronts confronts this belief, the client becomes aware of the i irrati rrati onality of the the thought and begins to create create a more realis realistic tic perspective. The t herapist acts primarily as a teacher who helps helps the client develop develop skills that w ill allow the client to think more rationally. B. Cognitive therapy 

Aaron Beck is credited with developing cognitive therapy, therapy, and his approach is w idely used in the treatment of depression. Cognitive schemas, methods for organi zing the way that we view the world, have evolved into a distorted perception. Examples of these beliefs include minimizing personal personal accomplishm accomplishments. ents. In other words, after a major accomplishme nt, a client may state that ?anybody could have succeeded,? thus minimizing his or her her own success. success. A cognitive therapist therapist would draw atten tion to this faulty reasoning of the client. In other words, words, the therapist woul d challenge the validity of the statement. Therapy Therapy often includes a combination

 

of homework assignments and a series of sessions. In the treatment of depressi on, a cognitive therapist therapist would assign homework requiring requiring the client to write d own automatic thoughts, or the habitual thoug thoughts, hts, that precede feelings feelings of depr depr ession (Young, (Young, Weinberger, & Beck, 2001). A structured form requires the client to write down the situation, emotion, automatic automatic thought, rational response, response, an d outcome. In this way, the cognitive schema schema is brought brought to the fore front of the clients awareness. Clients often are asked to find support for the automatic thought, and this discussion

VI. Biomedical Treatments A. Introduction to biomedical treatments  Biomedical treatments include specific specific

medical procedures procedures and medications that can help to alleviate symptoms of psychological disorders. disorders. Often, biomedical tr eatments are used in conjunction conjunction with talk therapies and are described as combi ned approaches to treatment. B. Psychopharmacological treatments 

Medications have have been developed to treat many psychological disorders. disorders. Generall Generall y, these medications work by altering neurochemical systems in the brain. Four broad classes of drugs are used for treatment. 1. Neuroleptics (antipsychotics) 

This class of drugs, also referred to as antipsychotics, helps to reduce seriou s symptoms (e.g., hallucinations, hallucinations, delusions, paranoia) paranoia) of schizophrenia in part icular. These These medications medications are moderately successfully in reducing hallucination s and similar serious expressions of altered behavior. behavior. Essentially, these drugs act as dopamine blockers. The most most common trade names of these drugs are Thora Thora zine and Haldol. Side effects, ranging from dryness of mouth mouth to involuntary je rking movements, typically typically accompany the use of these drugs. Long-term use of these drugs can result in a condition called tardive dyskinesia. This condition is characterized by uncontrollabl uncontrollable e repetitive movements, such as facial tics. Clozaril is a newer medication that does not have these side effects. 2. Antidepressants 

This group of medications is u used sed to treat people who are severely depressed. A ntidepressants increase the presence of serotonin and norepinephrine. It usuall y takes several several weeks before these drugs have have a positive effect on the patient. patient.   a. Monoamine oxidase inhibitors (MAOIs) 

This class of antidepressants is used infrequently because people have to re to a strict diet, or the drug can cause a toxic reaction. b. Tricyclic antidepressants (TCAs)

adhe



This class is more effective than MAOIs, with fewer side effects. Alcohol shoul d not be used in conjunction with this medication. c. Selective serotonin reuptake inhibitors (SSRIs) 

This medication, medication, also known under the trade name Prozac (fluoxetine), (fluoxetine), is widely widely used because it is b both oth effective in treatment of depression, and it does not have severe side effects. SSRIs also are used to treat panic disorders (Hollan (Hollan der & Simeon, 2003). 3. Lithium and anticonvulsants 

Lithium helps to reduce the severity of th the e highs and lows lows that someone with bi polar disorder disorder typically experiences. Lithium does not act immediately on the s

 

ymptoms and must be carefully monitored so that the patient does not experience side effects. Immediate treatment of a manic episode might include an anticonv ulsant, known by the trade name name of Depakote. 4. Anxiolytics (antianxiety) 

Tranquilizers or anxiolytics are used to treat anxiety disorders. Common Common drugs used today are usually benzodiazepines (e.g., Librium and Valium). These drugs produce an immediate calming calming effect for a person who may be experiencing experiencing anxiet anxiet y. Xanax has become popular for treating panic panic disorders. Patients can become d ependent on these drugs. C. Electroconvulsive therapy (ECT) 

When ECT was t originally introduced, the thebrain, approach was g somewhat barbaric. barbaric. Today, An elec elea c trical curren current was passed passed through the resulting resultin in convulsions. convulsions. nesthetic is administered prior prior to delivering delivering the shock to make the client more relaxed and to reduce the severity severity of the convulsions. One of the side effects of this treatment is temporary memory loss of the time period immediately prec prec eding the treatment. treatment. This treatment treatment is used only as a last resort for patients who are severely depressed.