History of Insane Treatment

Maltreatment of the insane throughout the ages was the result of irrational views. Many patients were subjected to strange, debilitating, Therapy and downright dangerous treatments.

Chapter 17 The Granger Collection The Granger Collection

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History of Insane Treatment Therapies

Philippe Pinel in France and Dorthea Dix in Psychotherapy involves an emotionally America founded humane movements to care charged, confiding interaction between a for the mentally sick. trained therapist and a patient/client. Biomedical therapy uses drugs or other procedures that act on the patient’s nervous system, with the aim of curing him or her of http://

wwwihm.nlm.nih.gov psychological disorders.

Culver Pictures An eclectic approach uses various forms of healing techniques depending upon the client’s unique problems. Philippe Pinel (1745-1826) Dorthea Dix (1745-1826) 3 4

Psychological Therapies Psychoanalysis

We will look at four major forms of The first formal psychotherapy to emerge was psychotherapies based on different theories of psychoanalysis, developed by Sigmund Freud. human nature:

. Psychoanalytical theory

. Humanistic theory Edmund

. Behavioral theory Engleman . Cognitive theory Sigmund Freud's famous couch

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1 Psychoanalysis: Aims Psychoanalysis: Methods

Since psychological problems originate from Dissatisfied with hypnosis, Freud developed childhood repressed impulses and conflicts, the the method of free association to unravel the aim of psychoanalysis is to bring repressed unconscious mind and its conflicts. feelings into conscious awareness where the patient can deal with them. The patient lies on a couch and speaks about whatever comes to his or her mind.

When energy devoted to id-ego-superego http:// conflicts is released, the patient’s anxiety www.english.upenn.edu lessens.

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Psychoanalysis: Methods Psychoanalysis: Criticisms

During free association, the patient edits his 1. Psychoanalysis is hard to refute because it thoughts, resisting his or her feelings to express cannot be proven or disproven. emotions. Such resistance becomes important in 2. Psychoanalysis takes a long time and is very the analysis of conflict-driven anxiety. expensive.

Eventually the patient opens up and reveals his or her innermost private thoughts, developing positive or negative feelings (transference) towards the therapist.

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Psychodynamic Therapies Psychodynamic Therapies

Influenced by Freud, in a face-to-face setting, Interpersonal psychotherapy, a variation of psychodynamic therapists seek to understand psychodynamic therapy, is effective in treating symptoms and themes across important depression. It focuses on symptom relief here relationships in a patient’s life. and now, not an overall personality change.

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2 Humanistic Therapies Person-Centered Therapy

Humanistic therapists aim to boost self- Developed by Carl Rogers, person-centered fulfillment by helping people grow in self- (client centered) therapy is a form of humanistic awareness and self-acceptance. therapy.

The therapist listens to the needs of the patient in an accepting and non-judgmental way, addressing problems in a productive way and building his or her self-esteem.

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Humanistic Therapy Behavior Therapy

The therapist engages in active listening and Therapy that applies learning principles (classical and echoes, restates, and clarifies the patient’s operant) to the elimination of unwanted behaviors. thinking, acknowledging expressed feelings.

To treat phobias or sexual disorders, behavior Michael therapists do not delve deeply below the Rougier surface looking for inner causes. / Life Magazine © Time Warner, Inc.

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Classical Conditioning Techniques Exposure Therapy

Counterconditioning is a procedure that conditions new responses to stimuli that trigger Expose patients to Reserved. Rights All Permission. with Reprinted FARWORKS. 1986 © Side Far The unwanted behaviors. things they fear and avoid. Through It is based on classical conditioning and repeated exposures, includes exposure therapy and aversive anxiety lessens conditioning. because they habituate to the things feared.

Like the VR spider therapy we saw in last week’s video

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3 Exposure Therapy Systematic Desensitization

Exposure therapy involves exposing people to A type of exposure therapy that associates a fear-driving objects in real or virtual pleasant, relaxed state with gradually increasing environments. anxiety-triggering stimuli commonly used to treat phobias. Both Photos: Bob Mahoney/ The Image Works N. Rown/ The The Image Works

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Aversive Conditioning Operant Conditioning

A type of Operant conditioning procedures enable therapists counterconditioning to use behavior modification, in which desired that associates an behaviors are rewarded and undesired behaviors unpleasant state with are either unrewarded or punished. an unwanted behavior. With this technique, temporary A number of withdrawn, uncommunicative 3-year- conditioned aversion old autistic children have been successfully trained to alcohol has been by giving and withdrawing reinforcements for reported. desired and undesired behaviors. See Clockwork Orange; sexual Not always effective! arousal paired with shock 21 22

Token Economy Cognitive Therapy

In institutional settings therapists may create a Teaches people adaptive ways of thinking and token economy in which patients exchange a token acting based on the assumption that thoughts of some sort (chips, points, etc.), earned for intervene between events and our emotional exhibiting the desired behavior, for various reactions. privileges or treats. Advantages are that immediate reinforcements can disrupt the flow of learning and the individual can habituate quickly to their reinforcing properties. Tokens require delay of reinforcement and reward saving, both ways to reduce habituation. 23 24

4 Cognitive Therapy for Depression Cognitive Therapy for Depression

Aaron Beck (1979) suggests that depressed Rabin et al., (1986) patients believe that failure means they can never trained depressed be happy (thinking) and thus associate minor patients to record failings (e.g. failing a test [event]) in life as major positive events each day, causes for their depression. and relate how they contributed to these Beck believes that cognitions such as “I can never events. Compared to be happy” need to change in order for depressed other depressed patients, patients to recover. This change is brought about trained patients showed by gently questioning patients. lower depression scores. Critique the method? 25 26

Stress Inoculation Training Cognitive-Behavior Therapy

Meichenbaum (1977, 1985) trained people to Cognitive therapists often combine the reversal restructure their thinking in stressful situations. of self-defeated thinking with efforts to modify behavior.

Instead of thinking “I’m going to fail,” he Cognitive-behavior therapy aims to alter the encourages people to think: way people act (behavior therapy) and alter the “Relax, the exam may be hard, but it will be way they think (cognitive therapy). hard for everyone else too. I studied harder than most people. Besides, I don’t need a This is the most popular form of therapy at the perfect score to get a good grade.” present. 27 28

Group Therapy Family Therapy

Group therapy normally consists of 6-9 people Family therapy treats the family as a system. attending a 90-minute session that can help If you do therapy with the alcoholic, but his more people and costs less. Clients benefit from family continues to do things that encourage knowing others have similar problems. drinking (enabling), then the therapy will fail.

Therapy guides family members toward © Mary Kate Denny/ positive relationships and improved communication. PhotoEdit , Inc., 29 30

5 Evaluating Therapies Evaluating Psychotherapies Within psychotherapies cognitive therapies are Who do people turn to for help with most widely used, followed by psychoanalytic psychological difficulties? and family/group therapies.

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Is Psychotherapy Effective? Client’s Perceptions

It is difficult to gauge the effectiveness of If you ask clients about their experiences of getting psychotherapy because there are different levels into therapy, they often overestimate its upon which its effectiveness can be measured. effectiveness. Critics, however, remain skeptical.

1. Does the patient sense improvement? 1. Clients enter therapy in crisis, but crisis may 2. Does the therapist feel the patient has improved? subside over the natural course of time 3. How do friends and family feel about the (regression to normalcy or, regression to the mean). patient’s improvement? 2. Clients may need to believe the therapy was worth the effort. 3. Clients generally speak kindly of their therapists. 33 34

Clinician’s Perceptions Outcome Research

Like clients, clinicians believe in therapy’s success. How can we objectively measure the They believe the client is better off after therapy than effectiveness of psychotherapy? if the client had not taken part in therapy.

1. Clinicians are aware of failures, but they believe Meta-analysis of a number of studies suggests failures are the problem of other therapists. that thousands of patients benefit more from 2. If a client seeks another clinician, the former therapist is therapy than those who did not go to therapy. more likely to argue that the client has developed a new psychological problem. 3. Clinicians are likely to testify to the efficacy of their therapy regardless of the outcome of treatment.

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6 The Relative Effectiveness of Outcome Research Different Therapies

Research shows that 80% of untreated people have Which psychotherapy would be most effective poorer outcomes than the average treated person. for treating a particular problem? Disorder Therapy Depression Behavior, Cognition, Interpersonal Anxiety Cognition, Exposure, Stress Inoculation Bulimia Cognitive-behavior Phobia Behavior Bed Wetting Behavior Modification Existential Insight Psychoanalysis? 37 38

Evaluating Alternative Therapies Evaluating Alternative Therapies Lilienfeld (1998) suggests comparing scientific therapies against popular therapies through electronic means. The results of such a search are below:

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Eye Movement Desensitization and Light Exposure Therapy Reprocessing (EMDR)

In EMDR therapy, the therapist attempts to Seasonal Affective unlock and reprocess previous frozen traumatic Disorder (SAD), a memories by waving a finger in front of the form of depression, eyes of the client. has been effectively treated by light exposure therapy. This

EMDR has not held up under scientific testing. form of therapy has Courtesy of Christine been scientifically supported. Brune

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7 Commonalities Among Culture and Values in Psychotherapy Psychotherapies

Three commonalities shared by all forms of Psychotherapists may differ from each other psychotherapies are the following: and from clients in their personal beliefs, values, and cultural backgrounds.

1. A hope for demoralized

people. © Mary Kate Denny/ A therapist search should include visiting two 2. A new perspective. or more therapists to judge which one makes 3. An empathic, trusting the client feel more comfortable.

and caring relationship. PhotoEdit , Inc.,

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Therapists & Their Training Therapists & Their Training

Clinical psychologists: They have PhDs mostly. Counselors: Pastoral counselors or abuse They are experts in research, assessment, and counselors work with problems arising from therapy, all of which is verified through a supervised internship. family relations, spouse and child abusers and their victims, and substance abusers. Clinical or Psychiatric Social Worker: They have a Masters of Social Work. Postgraduate Psychiatrists: They are physicians who supervision prepares some social workers to specialize in the treatment of psychological offer psychotherapy, mostly to people with disorders. Not all psychiatrists have extensive everyday personal and family problems. training in psychotherapy, but as MDs they can prescribe medications.

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The Biomedical Therapies Drug Therapies

These include physical, medicinal, and other Psychopharmacology is the study of drug effects forms of biological therapies. on mind and behavior.

1. Drug Treatments 2. Surgery 3. Electric-shock therapy

With the advent of drugs, hospitalization in mental 47 institutions has rapidly declined. 48

8 Drug Therapies Double-Blind Procedures

However, many patients are left homeless on the To test the effectiveness of a drug, patients are streets due to their ill-preparedness to cope tested with the drug and a placebo. Two groups independently outside in society. of patients and medical health professionals are unaware of who is taking the drug and who is taking the placebo. Les Snider/ The Image Works

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Schizophrenia Symptoms Antipsychotic Drugs

Classical antipsychotics [Chlorpromazine Inappropriate symptoms Appropriate symptoms (Thorazine)]: Remove a number of positive present (positive absent (negative symptoms associated with schizophrenia symptoms) symptoms) such as agitation, delusions, and Hallucinations, Apathy, expressionless hallucinations. disorganized thinking, faces, rigid bodies. delusions. Atypical antipsychotics [Clozapine (Clozaril)]: Remove negative symptoms associated with schizophrenia such as apathy, jumbled thoughts, concentration difficulties, and difficulties in interacting with others.

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Atypical Antipsychotic Antianxiety Drugs

Clozapine (Clozaril) blocks receptors for Antianxiety drugs (Xanax and Ativan) depress the dopamine and serotonin to remove the negative central nervous system and reduce anxiety and tension symptoms of schizophrenia. by elevating the levels of the Gamma-aminobutyric acid (GABA) neurotransmitter.

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9 Antidepressant Drugs Mood-Stabilizing Medications

Antidepressant drugs like Prozac, Zoloft, and Paxil are Lithium Carbonate, a common salt, has been used Selective Serotonin Reuptake Inhibitors (SSRIs) that to stabilize manic episodes in bipolar disorders. It improve the mood by elevating levels of serotonin by moderates the levels of norepinephrine and inhibiting reuptake. glutamate neurotransmitters.

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Brain Stimulation Alternatives to ECT

Electroconvulsive Therapy Transcranial Magnetic (ECT) Stimulation (TMS) ECT is used for severely depressed patients who do In TMS, a pulsating not respond to drugs. The magnetic coil is placed patient is anesthetized and over prefrontal regions given a muscle relaxant. of the brain to treat Patients usually get a 100 depression with volt shock that relieves minimal side effects. them of depression.

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Psychosurgery Psychosurgery

Psychosurgery was Psychosurgery is used as a last resort in popular even in alleviating psychological disturbances. Neolithic times. Psychosurgery is irreversible. Removal of brain Although used sparingly tissue changes the mind. today, about 200 such operations do take place in the US http:// alone. www.epub.org.br

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10 Psychosurgery Preventing Psychological Disorders

Modern methods use http://

www.epub.org.br “It is better to prevent than cure.” stereotactic Peruvian Folk Wisdom neurosurgery and radiosurgery (Laksell, 1951) that refine older Preventing psychological disorders means methods of removing the factors that negatively affect society. psychosurgery. Those factors may be poverty, meaningless work, http:// constant criticism, unemployment, racism, and www.epub.org.br sexism.

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Psychological Disorders are Biopsychosocial in Nature

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