Intro to Therapy and Psychological Therapies

Module 54: Treating Psychological Disorders

History of Treatment of Psychological Disorders

  • Historical Approaches:

    • Treatment of psychological disorders has varied widely, featuring both oppressive and compassionate methods.

    • Notable historical methods include:

    • Trephination: Cutting holes in the skull to release evil spirits.

    • Restraint and physical aggression: Restraining and beating individuals to 'beat the devil out of them.'

  • Reform Movements:

    • Philippe Pinel (1745-1826) and Dorothy Dix (1802-1888) advocated for humane treatment methods and the establishment of psychiatric hospitals.

  • Modern Developments:

    • Since the 1950s, effective drug therapies and community treatment programs have led to a decrease in institutionalization, resulting in an emptying of psychiatric hospitals.

    • This de-institutionalization trend has resulted in many mental health patients remaining untreated, contributing to increased rates of homelessness and incarceration.

  • Exploitation in History:

    • Bedlam (St. Mary's of Bethlehem Hospital):

    • Visitors paid to observe patients as a form of entertainment, reflecting a lack of dignity in mental health treatment.

Modern Treatment Approaches to Psychological Disorders

  • Primary Forms of Therapy:

    • Psychotherapy: Incorporates psychological techniques to assist individuals in overcoming difficulties and achieving personal growth.

    • Techniques derived from various psychological perspectives.

    • Biomedical Therapy: Involves prescribed medications or procedures that directly affect the individual's physiology.

    • A combination of psychotherapy and medication is often used.

  • Prevalence of Mental Health Services:

    • Approximately 1 in 5 Americans receive some form of mental health therapy annually.

  • Treatment Influences:

    • Treatment choice depends on the caregiver's expertise and the specific disorder at hand.

  • Eclectic and Integrative Approaches:

    • Many practitioners describe their methods as eclectic, blending techniques from various therapy forms.

Major Therapy Approaches

  • Categories:

    • Psychodynamic

    • Humanistic

    • Behavioral

    • Cognitive

Psychodynamic Therapy

  • Origins:

    • Psychoanalysis developed by Sigmund Freud.

  • Core Techniques:

    • Patient's free association, resistance, dreams, transference, and therapist interpretation aimed at revealing repressed feelings.

    • Bringing repressed feelings into conscious awareness to help patients feel less anxious and gain insight.

  • Key Concepts:

    • Interpretation: The therapist's judgments on dream meanings, resistances, and behaviors enhancing client insight.

    • Resistance: The blocking of anxiety-laden material from consciousness (e.g., avoidance of certain topics).

    • Transference: Emotions linked to significant relationships (e.g., parental figures) are transferred onto the therapist.

  • Psychodynamic Therapy:

    • Derives from psychoanalytic tradition; seeks to enhance client's self-awareness and explores current symptoms and their origins in childhood encounters.

    • Therapy is currently focused on the present, helping clients understand current issues by exploring past relationships.

Humanistic Therapy

  • Focus:

    • Enhances psychological functioning by improving self-awareness and understanding of motives and defenses.

    • Aims to reduce inner conflicts that hinder personal development and growth.

  • Key Figures:

    • Carl Rogers and Abraham Maslow.

  • Main Themes:

    • Focus on growth, present awareness, and conscious experience.

    • Emphasizes potential for self-fulfillment.

    • Clients are referred to as "persons" or "clients" instead of patients, emphasizing an equal therapeutic relationship.

  • Techniques:

    • Person-Centered Therapy:

    • Developed by Carl Rogers, emphasizes active listening and creates an empathetic environment to facilitate growth.

    • Techniques include paraphrasing, seeking clarification, and reflecting feelings to promote self-understanding.

    • Unconditional Positive Regard:

    • The therapist's caring and accepting attitude that aids in developing self-awareness and self-acceptance.

Behavioral Therapy

  • Assumptions:

    • Problematic behaviors are viewed as the primary issue; emphasis on observable behavior rather than introspective thought.

    • Behavioral therapists do not seek inner causes for problems.

  • Approaches:

    • Use of classical conditioning principles (e.g., Pavlov’s techniques in learning theory).

    • Counter Conditioning:

    • Pairing a stimulus that triggers fear with a new, positive stimulus to reduce the fearful response.

    • Exposure Therapies:

    • Systematic Desensitization: Associating a relaxed state with anxiety-triggering stimuli progressively.

    • Virtual Reality Exposure Therapy: Simulates real life scenarios to help patients confront fears in a controlled environment (e.g., fear of flying).

  • Aversive Conditioning:

    • A technique to create a negative reaction to a harmful stimulus (e.g., associating alcohol with nausea).

    • Involves creating a conditioned aversion to undesired behaviors through negative consequences.

  • Operant Conditioning Techniques:

    • Focus on modifying behavior through consequences (rewards and punishments).

    • Token Economy:

    • A behavior modification system where clients earn tokens for desired behaviors, which can be exchanged for privileges.

  • Critiques of Behavioral Therapies:

    • Concerns about durability of learned behaviors after therapy ends.

    • Ethical considerations around the control of human behavior and the implications for free will.

    • Advocates argue that behaviors can remain through intrinsic satisfaction and social approval.

Cognitive Therapies

  • Focus on teaching people new and more adaptive ways of thinking.

    • Based on the assumption that thoughts intervene between events and emotional reactions.

    • Aim to help individuals change their mindset to perceive and interpret events constructively.

Aaron Beck and Cognitive Therapy

  • A significant figure in cognitive therapy.

    • Noted that individuals with depression often report negative themes in dreams:

    • Common themes include loss, rejection, and abandonment.

    • These negative themes influenced their waking thoughts and therapy sessions where clients revisited their failures and worst impulses.

  • Beck and colleagues utilized cognitive therapy in the late 70s to combat negative thinking:

    • Aimed to reverse client negativity regarding self, situations, and future.

    • Employed gentle questioning to uncover irrational thoughts and persuade clients to alter their perceptions of events.

    • Defined catastrophizing as interpreting a small setback as a catastrophe, impeding progress.

Cognitive Therapy Techniques

  • Recognizing Catastrophizing:

    • Clients learn to identify when they are catastrophizing and modify negative self-talk.

  • Stress Inoculation Training:

    • Goal is to reduce stress and identify triggers.

    • Example scenario: Job loss is interpreted through negative beliefs leading to depression.

    • Negative belief: "I'm worthless; it's hopeless."

    • Constructive re-framing: "It wasn't a good fit; I deserve something better. This is an opportunity."

Techniques in Cognitive Therapy

  1. Reveal Beliefs:

    • Question interpretations and explore beliefs.

    • Identify faulty assumptions (e.g., "I must be liked by everyone").

  2. Rank Thoughts and Emotions:

    • Gain perspective by ranking emotions from mild to extremely upsetting.

    • Acknowledge that not all thoughts are catastrophes.

  3. Test Beliefs:

    • Examine actual consequences of situations challenging faulty reasoning.

    • Engage in de-catastrophizing thinking to confront worst-case scenarios.

  4. Change Beliefs:

    • Take appropriate responsibility for problems: differentiate between what is controllable versus uncontrollable.

    • Encourage movement away from extremes in thoughts:

      • From: "I'm a total failure"

      • To: "I received a failing grade, but I can learn and improve next time."

Cognitive Behavioral Therapy (CBT)

  • Integrates cognitive therapy with behavior modification.

    • Cognitive therapy focuses solely on thoughts, while behavioral therapy considers actions.

  • Aims to alter both how individuals act and think, fostering realistic evaluations.

  • Variants of CBT include:

    • Dialectical behavior therapy (DBT).

    • Mindfulness-based therapy.

    • Acceptance and commitment therapy (ACT).

Group Therapies

  • Cognitive therapies can be conducted one-on-one or in groups.

    • Group therapy benefits include:

    • Reduced time for therapists and decreased costs for clients compared to individual therapy.

    • Acts as a social laboratory for practicing social skills and interactions.

  • Group settings can help clients realize shared problems, enhancing empathy and support.

    • Encourages observational learning among participants.

Specific Types of Group Therapy

  • Family Therapy:

    • Focuses on improving family interactions, especially for younger members with mood challenges.

    • Treats family dynamics as a connected system, examining roles and improving communication.

  • Couples Therapy:

    • Addresses challenges in romantic relationships; helps partners alter interactions.

    • Can be conducted in groups for emotional support and relational satisfaction.

  • Self-Help Groups:

    • Gaining popularity in individualistic societies where isolation is common.

    • Serves those recovering from addiction, grieving, or seeking emotional growth.

    • Nearly 100 million Americans participate in support groups.

    • Shared experience fosters mutual emotional support and addresses stigmatized issues.

    • Often based on models like the 12-step program of Alcoholics Anonymous.