Treatments

Psychoanalytic / Psychodynamic Approaches

• The Classical Freudian Approach

  • Psychological problems stem from unconscious conflicts, often rooted in early childhood experiences (especially sexuality and aggression).

  • Uses techniques like free association, dream interpretation, and analysis of transference/resistance to uncover hidden thoughts.

    • Free Association: Think of it as stream of consciousness. You talk about whatever comes to mind, no matter how weird or random it seems.

    • Dream Interpretation: Analyzing dreams to uncover symbolic meanings.

    • Analysis of Transference/Resistance: Observing how you relate to the therapist to understand hidden dynamics.

  • In a nutshell, the classical Freudian approach focuses on uncovering unconscious conflicts from childhood to resolve psychological issues through various therapeutic techniques.

• The Therapist-Client Relationship

  • Therapist maintains a neutral stance to allow transference to occur.

  • Transference: Client redirects feelings for important figures (e.g., parents) onto therapist—seen as a window into unconscious dynamics.

  • e.g. If a client grew up with an authoritarian father, they might react to the therapist with similar feelings of resentment or fear, even if the therapist isn't being authoritarian. This reaction reveals the client's unconscious feelings and patterns.

• Goals of Psychoanalytic Therapy

  • To achieve insight into unconscious motivations, resolve repressed conflicts, and strengthen the ego.

  • Resolve the unconscious conflicts that stem from early childhood experiences

  • Focus is long-term, aiming for deep personality change rather than symptom reduction.

• Application: Mood Disorders

  • Used for depression, especially when linked to internalized anger or unresolved loss.

  • Emphasis on gaining awareness of emotional patterns, past trauma, and relational dynamics.

• Evaluation

  • Strengths: Insightful for self-understanding, emphasizes deep causes of dysfunction.

  • Weaknesses: Not time-efficient, expensive, difficult to empirically test, and less effective for acute or severe psychiatric disorders. ex. it is not ideal for immediate symptom relief during an anxiety attack

Behavioural Therapies

• Maladaptive Behaviours Model

  • Psychological symptoms are learned behaviours that can be unlearned.

  • Rejects the notion of “underlying causes”—focus is on observable behaviours (changing what you do)

• Behaviour First Approach

  • Based on classical conditioning: learned associations between stimuli (e.g., Pavlov) and operant conditioning: learning through rewards and punishments (e.g., Skinner).

  • Change behaviour → change emotional state and functioning.

• Application: Phobias

  • Techniques like:

  • systematic desensitization (gradual exposure to the phobia-inducing stimuli + relaxation techniques to counter anxiety) ex. someone afraid of heights starting with looking at a picture, then standing on a balcony

  • flooding (intense exposure to the phobia until anxiety subsides) ex. Someone afraid of dogs spending time in a room with several dogs at once

  • exposure with response prevention (exposure to phobia while preventing avoidance behaviours) ex. Someone with OCD touching a doorknob without washing their hands immediately

• Behavioural Exercises

  • Token economies: Reward systems for desired behaviour. ex. Offering stickers to children for completing homework on time.

  • Modeling: Learning through observation of others. ex. Learning public speaking skills by watching a skilled presenter.

  • Aversion therapy: Pairing unwanted behaviour with unpleasant stimulus. ex. Using a foul-tasting liquid to deter nail biting.

  • Behavioural activation: Increasing engagement with pleasurable or goal-oriented activities (used in depression). ex. Scheduling time to read a favourite book or attend a social event.

• Evaluation

  • Strengths: Empirically supported, fast-acting, effective for specific behaviours (phobias, addictions, OCD).

  • Weaknesses: May not address thoughts or emotions; focuses primarily on behaviour; criticized for being too mechanistic or superficial.

Humanistic Therapies

• Client-Centred Therapies (Carl Rogers)

  • Emphasizes personal growth, not curing illness.

  • Therapist provides non-directive support, allowing clients to find their own solutions in a safe environment.

• Self-Realization / Self-Actualization

  • Based on Maslow’s hierarchy of needs—goal is to help clients fulfill their potential.

  • Encourages authentic living and personal meaning.

• Empathy and Positive Regard

  • Empathy: Understanding the client's experience from their perspective; connect and validate client experiences; listen and reflect feelings

  • Unconditional Positive Regard: Accepting and valuing the client without judgment; create a safe and supportive environment

• Self-Acceptance and Congruence

  • Psychological distress arises from incongruence between self-image and actual experience.

    • incongruence: feeling shy but pretending to be outgoing

    • congruence: expressing your shyness when appropriate

  • Therapy promotes self-acceptance and alignment between internal experience and outward behavior.

• Evaluation and Range of Application

  • Strengths: Emphasizes the human side of therapy, strong alliance with clients, supportive environment.

  • Weaknesses: Less structured, difficult to measure effectiveness, limited in treating severe psychopathology.

Cognitive-Behavioural Therapies (CBT)

• Karen Horney

  • Neuroses stem from unrealistic inner demands—the “tyranny of the shoulds.”

  • refers to the pressure individuals put on themselves to meet unattainable standards

  • addresses internal demands

  • Therapy focuses on helping clients reject unrealistic standards and develop a compassionate self-view.

• George Kelly

  • People interpret the world through personal constructs—mental templates or frameworks to interpret the world

  • ex. someone might have a construct that categorizes people as either “trustworthy” or “untrustworthy”

    • rigid = they automatically distrust everyone

  • Psychological problems arise from rigid or faulty constructs; therapy helps clients revise their thinking patterns and change how people perceive and categorize their experiences

• Albert Ellis: Rational Emotive Therapy (RET)

  • A confrontational approach: challenges irrational thoughts and beliefs.

  • Irrational Cognitions: Unrealistic, rigid beliefs that lead to distress.

  • The 3 Major “Musts”:

    1. “I must do well and win others’ approval.”

    2. “Others must treat me kindly and fairly.”

    3. “The world must be easy and without discomfort.”

  • Common Irrational Beliefs: Catastrophizing, overgeneralization, demand for perfection.

• Application to Anxiety Disorder

  • CBT reduces anxiety by challenging distorted thinking and promoting exposure to feared situations.

  • Often used in panic disorder, GAD, OCD, and PTSD.

• Evaluation and Range of Application

  • Strengths: Highly structured, goal-oriented, and effective across many disorders.

  • Backed by extensive research; adaptable for group or individual settings.

  • Weaknesses: May overlook emotional depth, and is less focused on early-life causes.

Medical & Neurological Treatments

• Context: 1960s and Antipsychotic Medication

  • Major shift in mental health treatment—chlorpromazine and other typical antipsychotics reduced psychotic symptoms (especially positive symptoms like hallucinations).

  • Led to deinstitutionalization but also new challenges (e.g., homelessness, lack of support).

• Anti-Depressants and Mood Stabilizers

  • SSRIs (e.g., Prozac, Zoloft): Increase serotonin levels; used for depression, anxiety.

  • SNRIs: (effexor) increases serotonin and norepinephrine; used for depression and anxiety

  • MAOIs: (nardil) prevents breakdwon of serotonin, norepinephrine, dopamine; used for severe depression

  • tricyclics: (amitriptyline) blocks reuptake of serotonin and norepinephrine; used for severe depression

  • Mood stabilizers (e.g., Lithium, valproate): Used for bipolar disorder to reduce manic and depressive episodes.

• Beyond Medication: Seasonal Affective Disorder (SAD)

  • Related to light exposure during darker months; disrupts body’s natural rhythms

  • Treated with light therapy, which regulates melatonin and serotonin levels to regulate mood and sleep

• Neurosurgery and Electroconvulsive Therapy (ECT)

  • Neurosurgery involves surgical interventions on the brain to treat various conditions. It is reserved for cases where medication and other therapies fail to provide relief. side effect include severe and long term

    • ECT: Controlled seizures induced for treatment-resistant depression; often effective when medications fail. Side effects include memory loss and confusion; highly effective

    • Psychosurgery (e.g., lobotomy): Rare today; reserved for extreme cases due to severe side effects and ethical concerns; surgical removal of frontal lobes; side effects include personality changes and reduced cognitive abilities