chapter 16

Treatment of Psychological Disorders

1. Psychoanalysis

Psychoanalysis is the oldest form of psychotherapy, pioneered by Sigmund Freud, and has led to the development of many different branches which, while diverse, share the same core assumptions. The primary aim of psychoanalysis is to facilitate insight into the unconscious mind, enriching the therapeutic process through several key components:

1.1 Psychodynamic Principles

The psychodynamic approach emphasizes that many psychological issues stem from unconscious conflicts. Key concepts include:

  • Psychoanalysis: A treatment that utilizes insight gained from the unconscious.

  • Insight Development: Therapists work to uncover insights through various techniques, including:
      - Transference: The process where patients project unconscious feelings and thoughts onto the neutral therapeutic relationship.
      - Interpretation of Resistance: Recognizing and addressing the patient’s self-censoring behaviors during therapy, which often manifest as resistance to discussing certain topics.

1.2 Defense Mechanisms

Defense mechanisms are unconscious strategies employed by individuals to protect themselves from anxiety or uncomfortable thoughts. Main types include:

  • Rationalization: Providing excuses for behavior.

  • Projection: Attributing one's unwanted feelings or thoughts onto someone else.

  • Repression: Involuntarily keeping disturbing thoughts from entering consciousness.

  • Denial: Refusing to accept reality or facts.

  • Reaction Formation: Converting unwanted or dangerous thoughts into their opposites.

  • Displacement: Redirecting emotions to a safer outlet.

  • Regression: Returning to behaviors characteristic of an earlier stage of development.

  • Sublimation: Channeling unacceptable impulses into socially approved activities.

  • Compartmentalization: Maintaining separate beliefs or feelings in different contexts.

  • Intellectualization: Focusing on the intellectual components of a situation to avoid emotional distress.

1.3 Countertransference

Initially viewed as a potential contaminant to effective therapy, countertransference (the therapist's emotional responses to the patient) is now recognized as a valuable tool. It provides insight into the therapist's unconscious and can enhance understanding of the patient’s psyche.

2. Person-Centered Approach

2.1 Overview

Developed by Carl Rogers (1902-1987), the Person-Centered Approach (also known as Client-Centered Therapy) is a non-directive therapy that focuses on individuals' subjective experiences. It is grounded in phenomenological principles.

2.2 Core Principles

  • Conditions of Worth: Rogers posited that self-actualization in individuals is often constrained by conditions of worth imposed by society. This leads to the development of an inauthentic self, which is at odds with one's authentic self.

  • Authentic Self: Represents the inherent qualities of a person.

  • Inauthentic Self: Represents the self shaped by external pressure and societal expectations.

  • Psychological health is correlated with the degree to which one functions out of their authentic self rather than the inauthentic self.

2.3 Necessary Conditions for Effective Psychotherapy

Rogers identified three essential conditions for successful therapy:

  • Unconditional Positive Regard: Accepting and valuing the client without judgment.

  • Empathy: Understanding and feeling for the client’s experiences.

  • Congruence: Therapists must be genuine and transparent rather than pretending.

3. Behaviorism

Behaviorism focuses solely on observable behaviors, discounting the importance of feelings and thoughts.

3.1 Core Concepts

  • Outcome Measurement: Success in therapy is judged by the ability to achieve measurable behavioral goals.

  • Learning Principles: Therapy often employs classical conditioning and operant conditioning to effect behavioral change.

  • Flooding and Graduated Exposure: Techniques utilized to delay and prevent avoidant responses.

4. Cognitive Therapy

4.1 Overview

Prominent figures in cognitive therapy include Aaron Beck (1921-2021) and Albert Ellis (1913-2007). This approach aims to counter cognitive distortions—erroneous assumptions that generate disruptive feelings.

4.2 Core Assumptions

  • Key premise: Feelings follow thoughts, meaning by changing cognitive assumptions and beliefs about oneself and the world through logical discussion, negative feelings can be altered.

  • Treatment Example: Ellis's approach, depicted in "A Guide to Rational Living", illustrates strategies for managing dysfunctional thoughts effectively.

5. Group Therapy and Family Therapy

5.1 Group Therapy

Involves 8 to 12 individuals and can be open or closed groups. Group therapy aims to recreate and address life problems collectively within the group context.

5.2 Family Therapy

Considered a systemic approach to psychological issues. The premise is that the system (family) has the problem, rather than any single individual. Thus, treatment targets the family system rather than individual members.

5.3 Support Groups

These groups focus on specific issues, providing peer support rather than structured psychotherapy. Examples include:

  • Alcoholics Anonymous (AA): Originating for alcoholics and applied to various compulsive behaviors.

  • Narcotics Anonymous (NA): Support for individuals with narcotic dependencies.

  • Other variants include Shoppers Anonymous (SA), Sex Addicts Anonymous (SAA), and Overeaters Anonymous (OA).

6. Psychiatry

Psychiatry involves the medical treatment of mental health disorders, which typically falls into four broad categories of medications:

  • Neuroleptics: Also known as antipsychotics, used primarily for psychosis.

  • Anxiolytic: Medications aimed at reducing anxiety.

  • Antidepressants: Targeting mood disorders, aiding in alleviating depression.

  • Anticonvulsants: Utilized in the treatment of bipolar disorder.