Psychological Disorders and Treatments

Marshall High School Mr. Cline Psychology Unit Five AD * Psychological Disorders

• Personality Disorders

• It's another typical, stress-filled day at the headquarters of the Personality Disorder Crime Force (PDCF).

• This dysfunctional crime-fighting unit is made up of superheroes who all suffer from one of the major personality disorders.

• These are problems with patterns of behavior and interpretations of experience that are stable, but different than how most people think and act.

• Imagine a car with wheels that are ovals instead of circles; the car can still roll along, but not nearly as smoothly or efficiently.

• Only on a rare day do the PDCF actually get out and fight crime; they are usually derailed early in the day by something going wrong in the office and spend the rest of the day arguing about how to fix it.

• This morning, it's the donuts.

• It's 10AM, and the donuts haven't arrived.

• Members of the PDCF sit around nervously sipping coffee and listening to the police scanner, unsure of what to do. * Psychological Disorders

• Personality Disorders

• Borderline Bob is the first to say something. 'Well, that's the last time I ever order from Dirk's Donuts,' he growls. 'The food isn't even very good!'

• The rest of the PDCF sit silently, remembering that only last month, Bob was praising Dirk's for having the best donuts in the city.

• Since Bob has borderline personality disorder, he often engages in this type of black-and-white thinking, or splitting.

• Everything is either all-good or all-bad, and Borderline Bob swings wildly between the two.

• As a result, many of his relationships with people tend to be unstable.

• He's actually been known to go out and get a beer or two with Dirk, but is now ranting and calling him a 'donut-shilling dirtbag!'

• Not to miss an opportunity, Histrionic Harry pipes up, saying, 'Well, if we're looking for a new donut shop, I know of one that's actually closer and better than Dirk's. I went there once, and it was really funny, there was this girl there and she was checking me out...' * Psychological Disorders

• Personality Disorders

• He continues, but the rest of the PDCF has tuned him out.

• Harry suffers from histrionic personality disorder, which leads him to exhibit attention-seeking behavior.

• Even though he's very social, his colleagues suspect that he doesn't form really deep emotional attachments because he's more concerned with being entertaining and getting attention for himself than he is with finding real friends.

• Histrionic Harry is still talking: 'and then, there was this homeless guy outside - 'when Narcissistic Nora interrupts him: 'I could make a better donut than any of those bozos.'

• Nora's claimed things like this before - 'I can leap tall buildings better than any of these nitwits,' 'I can waterski better than any of these yahoos' - to often disastrous results, so no one in the PDCF is eager to try her baking.

• But Nora's narcissistic personality disorder leads her to have an inflated sense of her self-worth and little regard for the feelings of others. * Psychological Disorders

• Personality Disorders

• The PDCF starts to really fight. How long should they wait? Should they call Dirk's? Should they write a nasty Yelp review? If so, who should do it?

• Schizoid Sam prefers not to participate, and sits at his desk reading online fan fiction.

• As someone with schizoid personality disorder, not to be confused with the psychotic disorder 'schizophrenia,' Sam is socially withdrawn, cold and indifferent.

• But he has an active internal fantasy world, which he fuels by reading and writing World of Warcraft fan fiction.

• Since his colleagues are so dysfunctional, he spends much of his day in his own head.

• He hasn't even noticed that the donuts haven't arrived; he's too busy imagining a new type of battle armor.

• Finally, Antisocial Annie offers a suggestion: 'Why don't we all write negative reviews, and pretend that they each relate to a separate incident of donuts being late?' * Psychological Disorders

• Personality Disorders

• The PDCF falls silent.

• They're not sure they want to sink to that level.

• Antisocial Annie continues: 'Dirk's really let us down. Listen Bob, he was your friend; you trusted him. And let's be real; Nora probably could make better donuts than Dirk's balls of grease.'

• Bob and Nora are swayed by Antisocial Annie's charismatic manipulation, which, along with her loose sense of right and wrong, is a symptom of her antisocial personality disorder.

• She's happy to lie and cheat to win a positive outcome for herself; she doesn't see a problem with exaggerating the failings of Dirk's Donuts in order to put Dirk out of business.

• People with antisocial personality disorder used to be known as psychopaths, who were primarily defined as people who had no empathy for others at all. * Psychological Disorders

• Personality Disorders

• Antisocial Annie isn't violent - most people with antisocial personality disorder aren't - but the disorder is popularly associated with violence.

• Violence against animals and friends during childhood is one marker for the disorder, but not all antisocial people do this.

• Antisocial Annie does, however, break the law often; she shoplifts a lot, and while visiting her grandmother she stole her grandmother's handicap pass so that she could park more conveniently.

• Borderline Bob and Narcissistic Nora agree to Antisocial Annie's plan; Histrionic Harry makes a big speech about why he won't do it, and Schizoid Sam is oblivious to the conversation.

• Antisocial Annie decides that she'll just write two more reviews herself, to round out the contribution from the PDCF. * Psychological Disorders

• Personality Disorders

• They spend all day posting negative Yelp reviews, sulking and reading superhero fan fiction; another productive day at the office!

* Therapy

• What are the different approaches to individual therapy?

• Let’s watch as Mary tries to find the type of individual therapy that works best for her.

• Mary just started college. She's been feeling sad and anxious because she's been doing really badly in a class that was her best subject in high school - chemistry.

• She hasn't made as many friends as she'd hoped she would, and staying in touch with friends from home has been harder than she thought it would be.

• She knows she just needs to keep trying, but she's having trouble finding the energy and motivation to do it; her mother suggests that she might be depressed, and that she should try some individual therapy to figure out how to feel better. * Therapy

• If this was a realistic story, someone like Mary would probably head over to the student health center and be recommended to a therapist from there; but in our story, she searches for therapists online and is attracted to a simple website promising 'traditional Viennese methods with outstanding results' and featuring a photograph of a single, enigmatic cigar.

• She takes down the address and gets on her bike; soon she arrives at a solid brick building and is greeted by an old, bearded man in a suit. The therapist invites her into his office, invites her to lie down on a musty couch, and declares, in a thick Germanic accent: 'Tell me about your dreams!'

• Mary has stumbled upon the psychodynamic approach to therapy, pioneered by the Austrian psychologist Sigmund Freud.

• This approach rests on the assumption that psychological problems are caused by the interaction between the three parts of the personality: the id, the impulsive, childish part; the superego, the mature part concerned with long-term decision-making; and the ego, which works as a kind of mediator between the two.

• Imagine three friends, one who's really cautious, one who's really impulsive and a third who takes both suggestions and comes up with a compromise; that's basically the superego, the id and the ego. • * Therapy

• Freud asks Mary about her dreams in order to figure out what kinds of internal conflicts are going on in her unconscious mind.

• This is known as dream analysis.

• She replies hesitantly, 'I…dreamed I woke up in my bed at home because our cat had licked my face. But then I walked out in the hallway and I was in the dorm again, but then I got to the bathroom and my mom was in there brushing her teeth and the cat was watching.'

• Freud strokes his beard thoughtfully. 'And tell me vat you sink of ven you hear zese vords?'

• This is a technique called free association.

• He begins barking words: 'Apple!'

• Mary hesitates before replying tentatively, 'Pie?'

• Freud continues: 'Hammer!' • * Therapy

• 'Father.'

• 'Cat!'

• 'Home.'

• 'Square!'

• 'Peg?'

• Freud frowns at this. '…square peg in a round hole?' Mary clarifies.

• 'Ah!' he announces. 'Your dreams and your free associations lead me to interpret that the problem is you are ambivalent about leaving home! You miss your family! You miss your cat!'

• He encourages Mary to talk about this, and during the conversation she realizes that she's talking to Freud as if he were her father; this is a process known as transference, or beginning to think of the therapist as someone important in your life. • * Therapy

• Other terms associated with the therapeutic process are resistance and catharsis.

• When Mary suggests at the end of their session that she may try out a few therapists before settling on a particular method, Freud accuses her of showing resistance, or interfering with treatment just as it gets close to revealing a hidden inner conflict.

• 'You'll never reach catharsis if you quit now!' Freud calls as she leaves, referring to the release of tension a patient undergoes when they identify and solve inner conflicts.

• Next, Mary goes to see an old, friendly-looking man wearing a red bow tie.

• This particular psychologist, Aaron Beck, developed cognitive therapy with the specific goal of treating depression, so Mary thinks he might be a perfect match.

• 'It sounds like you're worried about making friends,' Beck says after listening to Mary for a while. • * Therapy

• 'Yes!' Mary says. 'And it makes me feel bad about myself, like I'm not likable. I leave my door open and only a few people come to see me.'

• Beck nods sympathetically, then says, 'You seem to have some self- defeating assumptions about what it means to have trouble making friends in college.

• You assume that your difficulties mean something negative about you as a person, which you are focusing on instead of working to improve the situation.'

• 'It just seems like it's going to go on forever,' Mary says sadly.

• Beck replies, 'I have a colleague, Albert Ellis, who would call that an irrational belief. He practices a variant of cognitive therapy called rational emotive therapy, and he'd say that your irrational belief that your friendless state will go on forever makes you much more worried about it than if you accepted that eventually, things will get better.' • * Therapy

• Mary's feeling a little overwhelmed. She thinks Beck has made some valuable points, but thinks she'll still get another opinion.

• Mary's not sure behavioral therapy is for her.

• She's researched Joseph Wolpe, its founder, and it seems like he mainly intends it for people with specific negative behaviors like phobias.

• She doesn't think she would benefit from exposure therapy, in which a specific stressful object - like a spider to someone who was really afraid of them - is approached in slow steps.

• First, the patient would think about a spider, then see one, then let one crawl on his sleeve; these are all stages of systematic desensitization.

• A therapist might also try a less gradual method called flooding, in which the patient is suddenly exposed to the stressful object while in the controlled, calm environment of therapy where the therapist can help with relaxation techniques. • * Therapy

• She's pretty sure that aversion therapy isn't for her either; she doesn't think she has any specific inappropriate behaviors that need to be discouraged.

• Aversion therapy is usually used for behaviors like substance abuse and overeating, as well as sexual deviance.

• The therapist pairs unpleasant stimuli, like violent images or bad smells, with the behavior he's trying to eliminate in an effort to make the patient no longer enjoy that behavior.

• Though aversion therapy is still used successfully to treat addictions, its use for other behavior modification has been questioned due to its association with attempts to 'cure' homosexuality.

• Mary is attracted to one aspect of behavioral therapy: social skills training.

• During her session with Wolpe, he role-plays social situations like dorm meetings and frat parties to help Mary build confidence in her ability to make friends. • * Therapy

• He also gives her specific social goals - some easy, like striking up a conversation while waiting for food in the dining hall, and others more difficult, like asking someone from class out to lunch.

• Having seen Freud, Beck, Ellis and Wolpe, Mary is starting to feel better about her situation. But she still feels like she's missing something from therapy, so she goes to see a final therapist: Carl Rogers, who practices a humanistic approach.

• Rogers makes a point of referring to her as a client rather than a patient, and uses active listening to try and help her reach self-awareness.

• Most importantly, he gives her unconditional positive regard; he makes it clear that he's on her side. This helps her to feel comfortable discussing problems and solutions.

• Mary found that each of the four approaches to individual therapy brought out a different side of her problems and helped her come to terms with her situation so she could make specific plans about how to improve her situation.

• Freud's psychodynamics held that Mary's problems rested with her unconscious worry about leaving home; • * Therapy

• Beck's and Ellis's cognitive therapies sought to change her assumptions and beliefs about social interaction.

• Wolpe's behavioral approach tried to improve specific behaviors.

• Rogers's humanistic approach helped Mary come to terms with herself by supporting her and giving her room to grow.

• Though many patients choose to see a therapist individually, sometimes a patient's particular problems are better served by group therapy.

• Groups can be made up of people who already know each other, like couples or families, or of people whose primary connection is through the group itself.

• The therapists leading the groups use a variety of therapeutic approaches, sometimes adjusting the style depending on the developing needs of the group.

• Mary's been happily seeing a humanistic therapist like Carl Rogers for about 20 years. • * Therapy

• In that time, she's gotten married to a used-car salesman named Larry and had a son, Chris, who is now a teenager.

• She's concerned because Chris has been smoking a lot of marijuana.

• She's tried to get him to stop, but he doesn't listen.

• He's smoking enough to interfere with his schoolwork, and he doesn't have many friends outside of some stoner buddies.

• He says that he smokes because Mary is 'too uptight' and puts pressure on him.

• The situation with Chris is putting stress on her marriage to Larry as well, since he doesn't seem to think it's as big of a deal as she does.

• Mary decides that it's time the family went in for some group therapy.

• In family therapy, a therapist will see more than one family member at a time. • * Therapy

• Sometimes Mary, Larry and Chris will all go; sometimes it will just be Chris with one of his parents.

• Family therapy aims to help them work out conflicts that stem from their family roles and their relationships with each other; Chris links his drug problem to his relationship with his parents, so the therapist works on resolving that.

• Mary and Larry also decide to try couples therapy, or relationship counseling, to work out problems that have cropped up in how they interact with each other.

• Larry's dismissiveness of Mary's concerns about Chris makes her think they really need to work on communicating about values and goals.

• A couple's therapist can help them to practice active listening instead of being defensive when they criticize each other. • * Therapy

• Though the family therapist thinks they're making progress in dealing with the stressful relationships that caused Chris to start smoking pot, she also thinks that Chris could benefit from attending a support group like Marijuana Anonymous.

• While family and couples therapy were kinds of group therapy for people who already have established relationships with one another, MA is an example of a kind of group therapy made up of strangers who share certain psychological disorders or problems.

• Some of these groups are led by a therapist who admits people to the group based on how they'll fit.

• Members may be at different stages in dealing with their problem; it can be helpful for those who are less far along to see others who have dealt with and gotten through similar problems. • * Therapy

• Freud's concept of transference, in which the patient begins to interact with the therapist as if he were an important person in his life, like his father, comes into play a little differently in group therapy.

• Group members are encouraged to view each other as siblings, friends - whichever relationships are troubling them in real life - and practice communication styles among each other.

• Members typically share experiences and get feedback from each other, with the therapist serving as a facilitator.

• Support groups are organized like group therapy but do without the therapist leader.

• Like in therapist-led group therapy, members share their experiences and help each other work through problems. • * Therapy

• Mary, Larry and Chris' family therapist thinks that Marijuana Anonymous will help supplement Chris', and the family's, recovery.

• So to sum things up, for families like Mary's, talk-therapy among a group instead of one-on-one makes sense.

• Therapists sometimes work with groups who already know each other, like family members and couples, and sometimes with groups that share a common goal.

• Group therapy allows the therapy session to focus on interpersonal interaction and communication strategies more than individual therapy.

• It can also help to see others who are going through the same problem as you - this is a founding principle of non-therapist led, self-help style therapy groups like Alcoholics Anonymous and its offshoots like Marijuana Anonymous.

• Group therapy can make a therapy session more like a real-world interaction.