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 Granger The The Granger Collection Granger The 1 2 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 Culver 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 5 6 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. 7 8 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. 9 10 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. 11 12 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. 13 14 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 Michael therapists do not delve deeply below the Rougier surface looking for inner causes. / Life Life Magazine © Time Warner, Inc. Warner, Time © Magazine 15 16 Classical Conditioning Techniques Exposure Therapy Counterconditioning is a procedure that conditions new responses to stimuli that trigger Expose patients to The Far Side © 1986 FARWORKS. Reprinted with Permission. All Rights Reserved. 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 17 18 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 Image The Mahoney/ Bob Photos: Both N. N. Rown/ Rown/ The Image Works Image The 19 20 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/ Denny/ Kate Mary © 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. 31 32 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