History of Insane Treatment

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

Chapter 15 PSY12000.003 The Granger Collection The Granger Collection

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History of Insane Treatment Therapies

Philippe Pinel in France and Dorthea Dix in America Psychotherapy involves an emotionally charged, founded humane movements to care for the mentally ill. confiding interaction between a 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 reducing or eliminating psychological disorders. http://wwwihm.nlm.nih.gov

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

Psychological Therapies Psychoanalysis

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

. Psychoanalytical theory

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

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1 Psychoanalysis: Psychoanalysis: Methods Aims Dissatisfied with hypnosis, Freud developed the method of free association to unravel the Because psychological problems originate from unconscious mind and its conflicts. childhood repressed impulses and conflicts, the aim of psychoanalysis is to bring repressed feelings into The patient lies on a couch and speaks about conscious awareness where the patient can deal with whatever comes to his or her mind. them. http://www.english.upenn.edu

When energy devoted to id-ego-superego conflicts is released, the patient’s anxiety lessens. 7 8

Psychoanalysis: Methods Modern Psychodynamic Therapies

During free association, the patients edits their Influenced by Freud, in a face-to-face setting, thoughts, resisting their feelings to express emotions. psychodynamic therapists seek to understand symptoms Such resistance becomes important in the analysis of and themes across important relationships in a patient’s conflict-driven anxiety. life (e.g., interpersonal therapy for depression). Eventually, patients open up and reveal their innermost private thoughts, developing positive or negative feelings (transference) towards the therapist. Initially, Freud thought transference was an obstacle; later felt this was a crucial step toward discovery of conflict/problem. 9 10

Psychoanalysis: Criticisms Humanistic Therapies 1. Psychoanalysis is hard to refute because it cannot be proven or disproven. Humanistic therapists aim to boost self-fulfillment 2. Psychoanalysis takes a long time and is very expensive. 3. But, some folks really like it, and they find it to be a good, yet by helping people grow in self-awareness and self- expensive, journey of self-discovery. acceptance.

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2 Person-Centered Therapy Humanistic Therapy The therapist engages in active listening and echoes, Developed by Carl Rogers, person-centered (client restates, and clarifies the patient’s thinking, centered) therapy is a form of humanistic therapy. acknowledging expressed feelings. http://www.youtube.com/watch?v=m30jsZx_Ngs&feature=related

The therapist listens to the needs of the patient in an Michael Rougier/ accepting and non-judgmental way, addressing

problems in a productive way and building his or her Life self-esteem. Magazine © Time Warner, Inc.

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Behavior Therapy Critique of Humanistic Therapies Therapy that applies learning principles (classical, • May require particularly articulate clients. social, operant) to the elimination of unwanted behaviors. • Slow, but steady improvements • Again, like psychoanalysis, difficult to test To treat phobias or sexual disorders, behavior the effectiveness of the therapy. therapists do not delve deeply below the surface • Still, as with psychotherapy, some folks feel looking for inner causes. that they improve and feel better about themselves.

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Classical Conditioning Techniques Exposure Therapy

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

*video on real-life (in vivo) therapy to treat phobias 17 18

3 Exposure Therapy Systematic Desensitization

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

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Aversive Conditioning Aversive Conditioning A type of counterconditioning that • See Clockwork Orange; associates an unpleasant sexual arousal paired with state with an unwanted shock behavior. With this • http://www.youtube.com/ technique, temporary watch?v=Jv1Bmne20l4 conditioned aversion to alcohol has been reported.

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Operant Conditioning Token Economy

Operant conditioning procedures enable therapists to use In institutional settings therapists may create a token behavior modification, in which desired behaviors are economy in which patients exchange a token of some rewarded and undesired behaviors are either unrewarded sort (chips, points, etc.), earned for exhibiting the or punished. desired behavior, for various privileges or treats.

A number of withdrawn, uncommunicative 3-year-old Advantages are that immediate reinforcements can disrupt autistic children have been successfully trained by giving the flow of learning and the individual can habituate and withdrawing reinforcements for desired and quickly to their reinforcing properties. undesired behaviors. Tokens require delay of reinforcement and reward saving, both ways to reduce habituation. 23 24

4 Cognitive Therapy Cognitive Therapy for Depression

Teaches people adaptive ways of thinking and acting Aaron Beck (1979) suggests that depressed patients based on the assumption that thoughts intervene believe that failure means they can never be happy between events and our emotional reactions. (thinking) and thus associate minor failings (e.g. failing a test [event]) in life as major causes for their depression.

Beck believes that cognitions such as “I can never be happy” need to change in order for depressed patients to recover. This change is brought about by gently questioning patients.

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Cognitive Therapy for Depression Stress Inoculation Training

Rabin et al., (1986) Meichenbaum (1977, 1985) trained people to trained depressed restructure their thinking in stressful situations. patients to record Instead of thinking “I’m going to fail,” he positive events each day, encourages people to think: and relate how they contributed to these “Relax, the exam may be hard, but it will be hard for events. Compared to everyone else too. I studied harder than most people. other depressed patients, Besides, I don’t need a perfect score to get a good trained patients showed grade.” lower depression scores. Critique the method? Motivation Framing: Promotion vs. Prevention 27 28

Cognitive-Behavior Therapy Group Therapy

Cognitive therapists often combine the reversal of Group therapy normally consists of 6-9 people self-defeated thinking with efforts to modify attending a 90-minute session that can help more behavior. people and costs less. Clients benefit from knowing others have similar problems. Cognitive-behavior therapy aims to alter the way people act (behavior therapy) and alter the way they

think (cognitive therapy). © Mary Kate Denny/ PhotoEdit, Inc.

This is the most popular form of therapy at the present. 29 30

5 Family Therapy Evaluating Therapies

Family therapy treats the family as a system. To whom do people turn for help with If you do therapy with the alcoholic, but his family psychological difficulties? continues to do things that encourage drinking (enabling), then the therapy will fail.

Therapy guides family members toward positive relationships and improved communication.

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Evaluating Psychotherapies The Relative Effectiveness of Different Therapies Within psychotherapies cognitive therapies are most widely used, followed by psychoanalytic and Which psychotherapy would be most effective for family/group therapies. 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? 33 34

Is Psychotherapy Effective? Client’s Perceptions

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

1. Does the patient sense improvement? 2. Does the therapist feel the patient has improved? 1. Clients enter therapy in crisis, but crisis may subside 3. How do friends and family feel about the patient’s over the natural course of time (regression to normalcy improvement? or, regression to the mean). Read on for your 2. Clients may need to believe the therapy was worth the effort. own interest 3. Clients generally speak kindly of their therapists. 35 36

6 Clinician’s Perceptions Outcome Research

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

1. Clinicians are aware of failures, but they believe failures are Meta-analysis of a number of studies suggests that the problem of other therapists. thousands of patients benefit more from therapy than 2. If a client seeks another clinician, the former therapist is 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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Outcome Research Evaluating Alternative Therapies Lilienfeld (1998) suggests comparing scientific Research shows that 80% of untreated people have poorer therapies against popular therapies through outcomes than the average treated person. electronic means. The results of such a search are below:

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Eye Movement Desensitization and Evaluating Alternative Therapies Reprocessing (EMDR)

In EMDR therapy, the therapist attempts to unlock and reprocess previous frozen traumatic memories by waving a finger in front of the eyes of the client.

EMDR has not held up under scientific testing.

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7 Light Exposure Therapy Commonalities Among Psychotherapies

Seasonal Affective Three commonalities shared by all forms of Disorder (SAD), a form psychotherapies are the following: of depression, has been effectively treated by light exposure therapy. 1. A hope for demoralized people. This form of therapy has © Mary Kate Denny/ PhotoEdit, Inc. 2. A new perspective. been scientifically Courtesy of Christine Brune 3. An empathic, trusting and supported. caring relationship.

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Culture and Values in Psychotherapy Therapists & Their Training

Psychotherapists may differ from each other and Clinical psychologists: They have PhDs mostly. from clients in their personal beliefs, values, and They are experts in research, assessment, and therapy, all of which is verified through a supervised cultural backgrounds. internship.

Clinical or Psychiatric Social Worker: They have a A therapist search should include visiting two or Masters of Social Work. Postgraduate supervision more therapists to judge which one makes the client prepares some social workers to offer psychotherapy, feel more comfortable. mostly to people with everyday personal and family problems.

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Therapists & Their Training The Biomedical Therapies

Counselors: Pastoral counselors or abuse counselors These include physical, medicinal, and other forms work with problems arising from family relations, of biological therapies. spouse and child abusers and their victims, and substance abusers. 1. Drug Treatments Psychiatrists: They are physicians who specialize in the treatment of psychological disorders. Not all 2. Surgery psychiatrists have extensive training in 3. Electric-shock therapy psychotherapy, but as MDs they can prescribe medications.

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8 Drug Therapies Drug Therapies

Psychopharmacology is the study of drug effects on However, many patients are left homeless on the mind and behavior. streets due to their ill-preparedness to cope independently outside in society. Les Snider/ The Image Works

With the advent of drugs, hospitalization in mental institutions has rapidly declined. 49 50

Double-Blind Procedures Schizophrenia Symptoms

To test the effectiveness of a drug, patients are tested with the drug and a placebo. Two groups of patients Inappropriate symptoms Appropriate symptoms absent and medical health professionals are unaware of who is present (positive symptoms) (negative symptoms) taking the drug and who is taking the placebo. Hallucinations, disorganized Apathy, expressionless faces, thinking, delusions. rigid bodies.

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Antipsychotic Drugs Atypical Antipsychotic

Classical antipsychotics [Chlorpromazine Clozapine (Clozaril) blocks receptors for dopamine (Thorazine)]: Remove a number of positive and serotonin to remove the negative symptoms of symptoms associated with schizophrenia such as schizophrenia. agitation, delusions, and hallucinations.

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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9 Antianxiety Drugs Antidepressant Drugs

Antianxiety drugs (Xanax and Ativan) depress the central Antidepressant drugs like Prozac, Zoloft, and Paxil are nervous system and reduce anxiety and tension by elevating Selective Serotonin Reuptake Inhibitors (SSRIs) that improve the levels of the Gamma-aminobutyric acid (GABA) the mood by elevating levels of serotonin by inhibiting neurotransmitter. reuptake.

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Mood-Stabilizing Medications Brain Stimulation

Lithium Carbonate, a common salt, has been used to Electroconvulsive Therapy stabilize manic episodes in bipolar disorders. It (ECT) moderates the levels of norepinephrine and glutamate ECT is used for severely neurotransmitters. depressed patients who do not respond to drugs. The patient is anesthetized and given a muscle relaxant. Patients usually get a 100 volt shock that relieves them of depression.

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Alternatives to ECT Psychosurgery

Transcranial Magnetic Psychosurgery was popular Stimulation (TMS) even in Neolithic times. Although used sparingly In TMS, a pulsating today, about 200 such operations do take magnetic coil is placed place in the US alone. over prefrontal regions of http://www.epub.org.br the brain to treat depression with minimal side effects.

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10 Psychosurgery Psychosurgery http://www.epub.org.br Psychosurgery is used as a last resort in alleviating Modern methods use psychological disturbances. Psychosurgery is stereotactic neurosurgery irreversible. Removal of brain tissue changes the mind. and radiosurgery (Laksell, 1951) that refine older methods of psychosurgery. http://www.epub.org.br

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Psychological Disorders are Preventing Psychological Disorders Biopsychosocial in Nature “It is better to prevent than cure.” Peruvian Folk Wisdom

Preventing psychological disorders means removing the factors that negatively affect society. Those factors may be poverty, meaningless work, constant criticism, unemployment, racism, and sexism.

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