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Chapter 13: Treatment of Psychological Disorders
History
Researchers theorize that the making of the holes, a process called trephining, was an early form of treatment that was supposed to let the harmful spirits escape.
Following the development of drugs in the 1950s that could moderate the effects of severe disorders, many people were released from mental institutions.
This phenomenon, called deinstitutionalization, was intended to save money as well as benefit the former inpatients.
Preventative efforts can be described as primary, secondary, or tertiary.
Primary prevention efforts attempt to reduce the incidence of societal problems, such as joblessness or homelessness, that can give rise to mental health issues.
Secondary prevention involves working with people at-risk for developing specific problems.
Tertiary prevention efforts aim to keep people’s mental health issues from becoming more severe, for instance, working with earthquake survivors who are already suffering from an anxiety disorder in the hopes of preventing the disorder from becoming more severe.
Types of Therapy
Psychoanalytic, humanistic, behavioral, and cognitive psychologists share a belief in the power of psychotherapy to treat mental disorders.
On the other hand, psychologists who subscribe to a biomedical model assert that such problems require somatic treatments such as drugs.
Both psychologists with a biomedical orientation and psychoanalysts generally refer to the people who come to them for help as patients.
Other therapists, humanistic therapists in particular, prefer the term clients.
Psychoanalytic Therapy
Psychoanalysis is a therapeutic technique developed by Sigmund Freud.
A patient undergoing traditional psychoanalysis will usually lie on a couch while the therapist sits in a chair out of the patient’s line of vision.
Symptom substitution is when, after a person is successfully treated for one psychological disorder, that person begins to experience a new psychological problem.
Free associate—to say whatever comes to mind without thinking.
In dream analysis, what the patient reports is called the manifest content of the dream.
What is really of interest to the analyst is the latent or hidden content.
Sometimes patients may disagree with their therapists’ interpretations.
Psychoanalysts may see such objections as signs of resistance.
One final aspect of psychoanalysis involves transference.
Transference is when, in the course of therapy, patients begin to have strong feelings toward their therapists.
Insight therapies highlight the importance of the patients/clients gaining an understanding of their problems.
Humanistic Therapies
Humanistic therapies focus on helping people to understand and accept themselves, and strive to self-actualize.
Self-actualization means to reach one’s highest potential.
Humanistic therapists operate from the belief that people are innately good and also possess free will.
Determinism is the opposite belief.
It holds that people have no influence over what happens to them and that their choices are predetermined by forces outside of their control.
One of the best known humanistic therapists is Carl Rogers.
Rogers created client-centered therapy, also known as person-centered therapy.
This therapeutic method hinges on the therapist providing the client with what Rogers termed unconditional positive regard.
Unconditional positive regard is blanket acceptance and support of a person regardless of what the person says or does.
Active listening - They encourage the clients to talk a lot about how they feel and sometimes mirror back those feelings (“So, what I’m hearing you say is . . .”) to help clarify the feelings for the client.
Another type of humanistic therapy is Gestalt therapy, developed by Fritz Perls.
Gestalt psychologists emphasize the importance of the whole.
These therapists encourage their clients to get in touch with their whole selves.
Existential therapies are humanistic therapies that focus on helping clients achieve a subjectively meaningful perception of their lives.
Existential therapists see clients’ difficulties as caused by the clients having lost or failed to develop a sense of their lives’ purpose.
Behavioral Therapies
One such technique is counterconditioning, a kind of classical conditioning developed by Mary Cover Jones in which an unpleasant conditioned response is replaced with a pleasant one.
One behaviorist method of treatment involving counterconditioning has had considerable success in helping people with anxiety disorders, especially phobias.
It was developed by Joseph Wolpe and is called systematic desensitization.
This process involves teaching the client to replace the feelings of anxiety with relaxation.
An anxiety hierarchy is a rank-ordered list of what the client fears, starting with the least frightening and ending with the most frightening.
In the process of in vivo desensitization, the client confronts the actual feared objects or situations, while in covert desensitization, the client imagines the fear-inducing stimuli.
A method of treating anxiety disorders that uses classical conditioning techniques is called flooding.
Flooding, like systematic desensitization, can be in vivo or covert.
Another way that classical conditioning techniques can be used to treat people is called aversive conditioning.
This process involves pairing a habit a person wishes to break such as smoking or bedwetting with an unpleasant stimulus such as electric shock or nausea.
Operant conditioning can also be used as a method of treatment.
This process involves using the principles developed by B. F. Skinner such as reinforcement and punishment to modify a person’s behavior.
In a token economy, desired behaviors are identified and rewarded with tokens.
The tokens can then be exchanged for various objects or privileges.
Cognitive Therapies
As cognitive therapists locate the cause of psychological problems in the way people think, their methods of therapy concentrate on changing these unhealthy thought patterns.
Cognitive therapy is often quite combative as therapists challenge the irrational thinking patterns of their clients.
Aaron Beck created cognitive therapy, a process most often employed in the treatment of depression.
This method involves trying to get clients to engage in pursuits that will bring them success.
Beck explains depression using the cognitive triad: people’s beliefs about themselves, their worlds, and their futures.
People suffering from depression often have irrationally negative beliefs about all three of these areas.
Cognitive therapy aims to make these beliefs more positive.
Cognitive Behavioral Therapies
One popular group of therapies combines the ideas and techniques of cognitive and behavioral psychologists.
This approach to therapy is known as cognitive behavioral therapy or CBT.
An example of a specific type of CBT is rational emotive behavior therapy (also known as REBT and sometimes referred to as RET).
REBT was developed by Albert Ellis.
Therapists employing REBT look to expose and confront the dysfunctional thoughts of their clients.
Group Therapy
Psychotherapy can involve groups of people in addition to one-on-one client-therapist interactions.
This form of treatment is known as family therapy.
Somatic Therapies
The most common type of somatic therapy is drug therapy or psychopharmacology, also known as chemotherapy.
Schizophrenia is generally treated with antipsychotic drugs such as Thorazine or Haldol.
These drugs generally function by blocking the receptor sites for dopamine.
Mood disorders often respond well to chemotherapy.
The three most common kinds of drugs used to treat unipolar depression are tricyclic antidepressants, monoamine oxidase (MAO) inhibitors, and serotonin selective reuptake inhibitor (most notably Prozac).
Anxiety disorders are also often treated with drugs.
Two main types of antianxiety drugs are barbiturates, such as Miltown, and benzodiazepines, including Xanax and Valium.
Another kind of somatic therapy is electroconvulsive therapy (ECT).
In bilateral ECT, electric current is passed through both hemispheres of the brain.
Unilateral ECT involves running current through only one hemisphere.
The most intrusive and rarest form of somatic therapy is psychosurgery.
Psychosurgery involves the purposeful destruction of part of the brain to alter a person’s behavior.
Eclectic Therapies
Somatic cognitive therapy is another very common combination eclectic therapy.
Many therapists combine drug therapy along with cognitive talk therapy for mood and other disorders.
Kinds of Therapists
Psychiatrists are medical doctors and are therefore the only therapists permitted to prescribe medication in most U.S. states.
Clinical psychologists earn doctoral degrees (PhDs) that require four or more years of study.
Counseling therapists or counseling psychotherapists typically have some kind of graduate degree in psychology.
Psychoanalysts are people specifically trained in Freudian methods.