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					TREATMENT OF PSYCHOLOGICAL DISORDERS

LECTURE OPENER SUGGESTIONS:
Opening quotes:
“Of that way, madness lies” Shakespeare (King Lear)
“As an experience, madness is terrific I can assure you . . . in its lava I still find most of the
things I write about.” Virginia Woolf (1882-1941)

Opening artwork:
Paul Gauguin (1848-1903) Portrait de l’artiste, 1893-94
Mark Rothko (1903-1970) Untitled, 1963

OPENING THEMES:
As was true for the unit on causes of and forms of psychopathology, this unit on treatment will
capture student interest. Following through on the format established for the perspectives on
abnormality in the previous unit, these modules can also be organized according to theoretical
perspective in psychology. It is important to emphasize the multiple routes that exist to treatment
and that most psychologists do not adhere to one form of therapeutic model. Instead, eclecticism
and empirically validated treatments have become the norm in the practice of clinical
psychology. It is also important to be sensitive to the fact that some students may be seeking
treatment for disorders involving symptoms of depression or anxiety. Finally, giving students
information about treatment, including campus resources, may be vital in helping students to
make decisions about seeking help should they be suffering symptoms.

KEY CONCEPTS
 Psychodynamic therapy
 Behavioral therapy
 Cognitive therapy
 Humanistic therapy
 Family therapy
 Effectiveness of psychotherapy
 Drug therapy
 ECT
 Psychosurgery
 Choosing a therapist

Prologue: Conquering Schizophrenia
Looking Ahead
MODULE 40: PSYCHOTHERAPY: PSYCHODYNAMIC, BEHAVIORAL, AND
COGNITIVE APPROACHES TO TREATMENT
Defining Abnormality
Psychodynamic Approaches to Therapy
Psychoanalysis: Freud’s Therapy
Contemporary Alternatives to Psychoanalysis
Behavioral Approaches to Therapy
Aversive Conditioning
      Systematic Desensitization
      Operant Conditioning Techniques
      How Does Behavior Therapy Stack Up?
Cognitive Approaches to Therapy

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What are the goals of psychologically and biologically based treatment approaches?
What are the basic kinds of psychotherapies?

Learning Objectives:
40-1 Define psychotherapy and identify the main approaches/types.
40-2 Describe the psychodynamic approach to the treatment of abnormal behavior, including
      the major techniques and concepts employed by psychodynamic therapists.
40-3 Describe the behavioral approaches to the treatment of abnormal behavior, including
      aversive conditioning, systematic desensitization, observational learning, and the use of
      operant conditioning principles.
40-4 Discuss the cognitive therapy approaches of rational-emotive and cognitive therapy.

Student Assignments:
Interactivity 67: Perspectives on Psychological Disorders
Students learn about different theoretical perspectives to treatment by observing clinicians from
different theoretical perspectives as they respond to an actual case of a woman suffering from
agoraphobia.

Interactivity 68: Systematic Desensitization
Interactivity in which students simulate the desensitization of a client who has a fear of rodents
followed by viewing a videotape of a client receiving desensitization for fear of heights.

InPsych CD: My Friend the Spider
Have students complete this activity, which involves a simulation of systematic desensitization.

Behavior Therapy
Ask students these questions:
Select a behavior that you would like to modify in yourself and design a reinforcement therapy
schedule to alter it. Choose an undesirable behavior such as shyness, biting your nails, snacking
too much, or some other nervous habit.
    1. What is this behavior?
    2. Identify a desired substitute behavior. Record your baseline, or normal frequency of
        showing the behavior.
    3. Decide on a reinforcer you find applicable. Reward yourself each time you show the
        desired behavior and withhold reinforcement when you show the undesired behavior.
        Record the results.
    4. How difficult is it to apply behavior therapy to your own behavior? Why?

Comparison of Therapy Models
Ask students the following questions:
   1. What are the common elements of psychoanalysis and behavioral therapy?
   2. In what ways are psychoanalysis and behavior therapy different?
   3. Compare how a psychoanalyst and a behaviorist would treat a person with an anxiety
       disorder.

Attitudes toward Therapy
Have students complete Handout 13-1.



                                                198
PowerWeb: Is Therapy Overprescribed?
“Are We Nuts?” Mary McNamara, Minneapolis Star Tribune, February 8, 2000.
Americans appear to be in love with psychotherapy. In a way, therapy has replaced religion as a
form of healing. Do we really need all of this treatment, and can therapy really help us? Mary
McNamara answers these questions and others in this interesting article.

Lecture Ideas:
Psychodynamic Therapy
Goal of psychodynamic therapy is to reduce anxiety by bringing conflicts and impulses out of
the unconscious and into conscious awareness.
     Free association—patients are told to say whatever comes to mind, regardless of its
       apparent irrelevance or senselessness (the “golden rule” of psychoanalysis).
     Anxiety-producing areas may be long-hidden crises, trauma, or conflict.
     Dream interpretation is another important tool of the therapist.
     Unconscious forces can produce repression, which produces resistance in free
       association.
     Transference occurs as patients view the therapist as a parent, lover, or significant other
       in their past and apply those feelings to the therapist.

Behavioral Therapy
According to the behavioral model, the causes of abnormal behavior are:
    Failure to acquire adaptive skills
    Faulty learning of adaptive skills

Modification of abnormal behavior involves:
   Learning new behavior
   Unlearning maladaptive patterns

Abnormal behavior is viewed as both a symptom and as the problem.

Classical conditioning approaches:
Systematic desensitization—Progressively closer encounters with feared stimulus using
counterconditioning (replacing fear with relaxation).
    Used for treating phobias, anxiety disorders, and sexual dysfunctions.
    Example in book is in treating fear of flying.

Operant conditioning approaches:
Token system—Person rewarded for desired behavior with a tangible reward.
Contingency contracting—Rewards given for achieving specific goals.

Cognitive Therapy
In this form of therapy, the focus is on changing the way people think and behave.
Rational emotive approach (Ellis)—One form of cognitive therapy that attempts to restructure a
person’s belief system (get rid of the “must’s”).
Cognitive-behavioral approach (Beck)—Attempts to change people’s illogical thoughts about
themselves.

Summary of steps leading from dysfunctional attitude to negative emotion:
Use to provide an example of cognitive theory:

                                               199
Dysfunctional attitude:
People will probably think less of me if I make a mistake.

Experience:
I gave the wrong answer in class.

Automatic thought:
People think I’m stupid.

Negative emotion:
I feel sad and useless.

Biography of Aaron T. Beck (from Pettijohn’s Connectext)
Aaron Beck was born in Providence, Rhode Island, on July 18, 1921. He graduated from Brown
University in 1942 and attended Yale University, where he earned his Ph.D. in psychiatry in
1946. He became interested in psychoanalysis and cognition during his residency in neurology.
        Beck served as Assistant Chief of Neuropsychology at Valley Forge Hospital during the
Korean War. He graduated from the Philadelphia Psychoanalytic Institute in 1956.
        After graduation, he launched into a research program to validate psychoanalytic
theories. However, after his research did not support his hypotheses, he rejected the
psychoanalytic approach and began to develop a cognitive therapy for depression. He developed
several well-known tests to assess depression, including the Beck Depression Inventory and the
Scale for Suicide Ideation.
        Beck wrote numerous influential books, including Cognitive Therapy and the Emotional
Disorders (1979), Depression: Clinical, Experimental, and Theoretical Aspects (1967), and
Cognitive Therapy of Depression (1980, with Rush, Shaw, and Emery).

Media Presentation Ideas:
Media Resources DVD: Freudian Interpretation of Dreams (3:03)
Explores Freudian symbols in dreams and the process of free association.

Media Resources DVD: Freud’s Contribution to Psychology (3:28)
Brief history of Freud’s contribution to psychology and a summary of his dream theory.

Popular Movies: Psychoanalysis and Psychotherapy
Although unrealistic, the film “Analyze This” (and the sequel, “Analyze That”) illustrates a type
of psychoanalysis. The humor of this film is that in addition to the therapy conducted by the
therapist, the client provides therapy to the therapist when he analyzes the reasons the therapist
chose this career path. The film “Good Will Hunting” also portrays (albeit, unrealistically) a
complex relationship between a therapist and a client.


Overhead Summarizing Psychoanalysis
Show this chart, which focuses on the main points in psychoanalytic treatment:

Component                           Definition                     Example
Free association                    Allow the client to say        Client relates a dream; the
                                    whatever comes to mind.        therapist asks the client to say
                                                                   what the events in the dream
                                                                   are a reminder of, and then
                                                                   goes on from there.
                                                200
Neutrality                       Therapist does not reveal         Client asks the therapist where
                                 personal information.             he or she was born; the
                                                                   therapist does not answer the
                                                                   question but attempts to
                                                                   examine why the client asked
                                                                   the question.
Interpreting resistance          Resistance occurs when the        Client forgets an appointment;
                                 client forgets, is unwilling to   the therapist attempts to
                                 talk about important issues, or   understand why.
                                 resists free association.
Transference                     The client projects feelings      The client accuses the
                                 about a parent on to the          therapist of being “critical.”
                                 therapist.
Working through process          Each major issue or conflict is   The client’s ambivalent
                                 examined and the unconscious      feelings regarding his or her
                                 elements are revealed.            father are examined and
                                                                   resolved.


Overhead Summarizing Behavioral Methods
Use this list of methods, definitions, and examples to provide more detail on behavioral therapy:

       Method                    Definition                      Example
Contingency management           Rewards are given that are      To help client quit smoking—
                                 “contingent” upon performing    for every 30 minutes without a
                                 specific behavior.              cigarette, put one dollar into a
                                                                 fund that can be used to buy
                                                                 something else that is
                                                                 desirable such as a CD.
Aversive conditioning            An unpleasant outcome is        To reduce eating of sweets by
                                 associated with a behavior.     a person with diabetes, a bitter
                                                                 flavor is added to foods such
                                                                 as donuts, cake, and candy.
Covert (de)sensitization         Rather than actually            A student learns to relax
                                 presenting the feared stimulus, during a test by imagining
                                 the therapist asks the subject  being in the test situation and
                                 to imagine the presence of it.  relaxing while thinking about
                                                                 that situation.
Systematic Desensitization       Relaxation is substituted for   Client who is afraid of spiders
                                 fear (or other undesirable      is taught to relax instead of
                                 response).                      feeling tense while being
                                                                 exposed in stages to the feared
                                                                 stimulus.
Token economy                    Tangible rewards are given for Children in a classroom are
                                 performing desired behavior.    given “coins” that they can
                                                                 trade for time in the
                                                                 playground.




                                               201
Overhead Summarizing Cognitive Theory
This set of boxes can be shown to illustrate the process described in the rational-emotive theory
of Albert Ellis:

Term                     Activating Experience    Belief                     Consequences
Definition               An event occurs that     Assumptions about          The feelings that
                         has relevance to the     the meaning of events      result from
                         individual’s self-       with regard to the self.   interpreting actions
                         concept.                                            according to one’s
                                                                             beliefs, and
                                                                             maladaptive behaviors
                                                                             that interfere with the
                                                                             individual’s ability to
                                                                             achieve desired goals.
Example                  A young man fails to   The young man                The young man
                         be promoted in his job believes that one’s          becomes depressed
                                                self-worth is                (negative emotion)
                                                determined by one’s          and becomes sluggish
                                                job.                         and nonproductive at
                                                                             work (maladaptive
                                                                             behavior).


MODULE 41: PSYCHOTHERAPY: HUMANISTIC AND GROUP APPROACHES TO
TREATMENT
Humanistic Therapy
      Person-centered Therapy
      Humanistic Approaches in Perspective
Interpersonal Therapy
Group Therapy
      Family Therapy
Evaluating Psychotherapy: Does Therapy Work?
      Is Therapy Effective?
      Which Kind of Therapy Works Best?

What are the humanistic approaches to treatment?
What is interpersonal therapy?
How does group therapy differ from individual types of therapy?
How effective is therapy, and which kind of therapy works best in a given situation?

Applying Psychology in the 21st Century Therapy Online: Is the Internet a Good Place to Get
Treatment?
Exploring Diversity Racial and Ethnic Factors in Treatment: Should Therapists Be Color-
Blind?

Learning Objectives:
41-1 Describe the application of humanistic theory in the approaches of Rogers’s client-
      centered therapy as well as gestalt therapy.
41-2 Describe group therapy, including family therapy.


                                               202
41-3   Discuss the methods used to evaluate psychotherapy and the arguments proposed to
       support and dispute the effectiveness of psychotherapies, and explain the eclectic
       approach to psychotherapy.

Student Assignments:
Interactivity 69: Effectiveness of Therapy
Students answer questions about meta-analyses of research on therapy’s effectiveness.

Comparison of Therapy Methods
Ask students the following questions:
   1. List three main differences between humanistic and psychoanalytic therapy (role of
       therapist, basic assumptions about human nature, interpretation of resistance and other
       “unconscious” phenomena).
   2. What advantages might there be for a therapist to be “genuine” rather than “neutral”?
       How would it make you feel to have a therapist who disclosed personal information?
   3. Why is humanistic therapy called “person centered”?
   4. Would you agree that psychoanalysis is person centered, even though it is not called this?
       Why or why not?

Lecture Ideas:
Humanistic Therapy
Three fundamental ideas are:
   1. We have control over our behavior.
   2. We decide what kind of life to live.
   3. We must solve the difficulties that we encounter in our daily lives.

In humanistic therapy, the therapist is seen as a guide or facilitator. Psychological disorders are
seen as resulting from lack of meaning in life and loneliness.

Humanistic approaches include:
Client centered therapy
    Nondirective methods
    Provide unconditional positive regard
    Goal is self-actualization

Gestalt therapy
   Theoretical basis is in Gestalt psychology—the person to complete unfinished conflicts and
   integrate feelings, thoughts, and behaviors.
   Goal is to experience life more directly.

Effectiveness of Psychotherapy
Overheads below show the effectiveness of psychotherapy and client satisfaction with therapy.
In addition, point out that:
     Psychotherapy is effective for most people.
     But its effects are not universal.
     Certain treatments are better for certain problems and certain people.
     Eclectic approach (i.e., using a combination of treatments) is becoming more popular.

Demonstration: “The Therapist Game”
This is a script of a class performance that can be staged by undergraduates in the class:

                                                203
Script of “The Therapist Game.”

The “host” introduces the contestant, Ms. Ann Chuss (i.e., “Anxious”) and the three therapists:

Therapist #1 was born ___ years ago (b. 1856) and lives in a central European city. Therapist #2
was born ___ years ago (1900) and lives in the Midwest. Therapist #3 was born ___ years ago
(1878) and taught children to be afraid of white, furry objects. The host then announces the rules
of the game, which are that the contestant asks the therapists various questions and then chooses
one.

Contestant begins by asking questions of the therapists:
(Throughout the skit, she bites her nails, acts as if she is nervous, drops her cards, pulls at her
hair, and looks uncomfortable.)

A: Therapist #1, what is your favorite cartoon?
T1: My favorite cartoon character is Linus from Peanuts. I find Linus amusing and intelligent.
        He sublimates often. He has a security blanket, and he often sucks his thumb, perhaps
        suggesting that he is going through his anal phase.
A: (twists hair) Therapist #3, what is your favorite cartoon?
T3: My favorite cartoon would be Jim, of Jim’s Journal. Jim is the type of person that observes
        everything. Reality constructs Jim; it is exclusively external. He does not think what he is
        doing nor does he think about what he is doing.
A: Therapist #2, what is your favorite cartoon?
T2: My favorite cartoon character is Marge Simpson. Marge provides unconditional positive
        regard for Bart. She provides a warm, caring atmosphere, demonstrating “I care.” Marge
        has acceptance of all her family’s feelings, be they negative, fearful, or painful feelings as
        well as positive and social feelings.
A: (squirms in seat) Therapist #1, if you could be any movie, what would it be?
T1: “Nightmare on Elm Street.” While on the surface this movie lacks substance, when you
        analyze it, it’s dealing with a topic of importance and depth—DREAMS! This movie
        shows the importance of dreams, and how people can use them to survive.
A: Therapist #2, if you could be any movie, what would it be?
T2: That would be “Field of Dreams.” The actors all search for meaning in their lives. Kevin
        Costner, who plays Ray, the main character, is not happy with his life. He builds a
        baseball field and finds meaning in his life.
A: Therapist #3, if you could be any movie, what would it be?
T3: I would be “A Christmas Carol.” Yes, that Scrooge has no emotions. At first he is in love
        with a young girl, then as he becomes more successful, money becomes more important.
        All he wants is money and in order to obtain money he becomes immersed in his work.
        His behavior is strictly driven by making money. Money is a positive reinforcer for
        Scrooge.
A: (fixes clothes). Therapist #3, describe your ideal date.
T3: An ideal date would be taking a beautiful woman out to dinner at an elegant restaurant. If
        during dinner our conversation is going well and she has a high degree of eye contact, it
        would bring me to believe she enjoys my company. By the end of the evening, if she
        behaves as though she enjoyed our date, that would be a positive reinforcer to ask her out
        again.
A: Therapist #2, describe your ideal date.
T2: My description of an ideal date would be going to a restaurant. Nothing fancy, but a place
        where my date and I could have one-to-one contact and leisurely talk. Of course, in order
                                                  204
       for there to be reality, I must be genuine. I must be willing to express the various attitudes
       and feelings which exist inside of me. In this way, my date would be able to express
       herself. Our relationship would then have potential for development . . . maybe a walk in
       the park would follow.
A: Therapist #1, describe your ideal date.
T1: I would enjoy taking a date to the city, where we could gaze upon the fascinating shapes of
       the buildings and skyscrapers. Perhaps have lunch at a hot dog stand. We could ride the
       subway or train together, perhaps allowing me to know her better.
A: (crosses legs, switches hands in lap) When I go out on a date and a guy tries to kiss me good-
       night, I run away and slam the door in his face. Therapist #2, why do I do this?
T2: Well, Ann, this doesn’t say anything bad about you. It seems to me that in time you will be
       able to recognize your feelings and you too would want to express yourself through a
       kiss. And if not that, you will find a way which truly expresses you.
A: Therapist #1, why do I do this?
T1: Perhaps you feel threatened by your dates. Are you perchance looking upon him as a father
       figure, therefore causing internal conflicts regarding affection? Or perhaps you fear
       harming an attachment and endangering the love of the one man you truly love—your
       father. Therefore you suffer anxiety and run away.
A: Therapist #3, why do I run away?
T3: Maybe this negative reaction is a result from a previous date that did not turn out so well.
       This negative emotion you feel is associated with a previous negative experience. Now
       (on a date) you are conditioned to feel this negative response because of the stimulus of a
       date that you are exposed to. The next step is to go about and desensitize your. . .
A: (stamps feet) Why can’t I relax on a date? How do I know where he will take me? What if I
       wear heels, and he takes me hiking? Maybe it will rain. What if he takes me somewhere
       nice, and I look like a slob? What if I wear a color he doesn’t like? Therapist #2, can you
       answer these questions?
T2: Uh, Ann, so what you’re saying is that if you wore one thing, you would behave differently
       than if you wore something else? Eh?
(Ann looks disgusted.)
A: Therapist #3, can you tell me why I do this?
T3: Maybe you had a bad experience wearing a certain article of clothing. So now when you go
       to get dressed, you become anxious, and picking out something to wear becomes a task.
       Could you please stop sliding your feet? If you continue, I will feel compelled to stop
       giving you my advice because I feel I am only reinforcing this negative behavior of
       yours.
A: Therapist #1, can you tell my why I act this way?
T1: You say you can’t choose an outfit. That may signify an internal conflict. You are torn
       between wanting to look like the Daddy’s little girl that you want to be, and at the same
       time, looking grown up. Perhaps you are regressing, remembering the simple times in
       your life when you didn’t choose your clothes, but had a parent do it for you. Or perhaps
       you have a hidden motive, perhaps you don’t WANT to go on a date and therefore refuse
       to prepare for it.
A: (shaking leg) Therapist #1, if your child spilled grape juice on your white rug, how would you
       react?
T1: I would try to see the real root behind this behavior. If I believed the child was acting on
       sexual aggression, or trying to punish the same sex parent for taking away his object of
       affection, I would suggest counseling. If I believed it to be a true accident, I would ignore
       it and simply deal with it appropriately.
A: Therapist #2, what would you do?

                                                205
T2: My child would feel very bad for his actions. Aside from the fact that I would have to
        replace the rug and it would cost me a large sum of money, I would reassure my child
        that I still love him and that he’s not a bad person as a consequence of the accident.
A: (squirms in seat restlessly) Therapist #3, why can’t I do well on tests? When I get into the
        room, I break out in a cold sweat.
T3: Well, let’s take a look at previous test situations. Were you anxious because you didn’t study
        enough? Or because you did poorly on a previous exam?
A: Well, I don’t really do well on any exams. When I was in fourth grade, I did really bad on a
        spelling bee. Everyone laughed. (drops cards)
T3: You become anxious in test situations because of this embarrassing experience you had in
        the fourth grade. This bad situation had a strong impact on you, that when you now take
        exams you become anxious. The test situation, for example, a classroom, is an aversive
        stimulus that is generalized so that any situation similar to a test situation would cause
        you to become anxious.
A: Therapist #2, what do you think?
T2: So, it seems you are doubting your ability to meet the high expectations of yourself;
        especially when you’re put into stressful situations.
A: Therapist #1, why am I afraid of tests?
T1: Your strong feelings of anxiety during a test could stem from a number of repressed
        emotions. Perhaps you are frightened by your parents’ expectations, say, your father’s.
        You must examine these feelings, look into your thoughts, before you will be able to
        relax. Tell me more about your father—what kind of relationship do you have?
A: I’m the one asking questions, not you! Therapist #2, I see myself as a very reliable person, but
        my friends don’t think so. They think just because I’m always nervous and always late. . .
        I spend so much time preparing, thinking about what I need to do, that there’s never
        enough time. (shakes nervously)
T2: It seems you are able to judge your emotions and reactions accurately, Ann. It is when you
        are dominated by others’ evaluations that you are not longer free.
A: Therapist #3, what do you think about this?
T3: A reliable person behaves responsibly. By your behaviors, others see you as being either
        reliable or unreliable. Your behavior can completely control your environment. Setting
        up a schedule of reinforcement will help you be more responsible. A positive
        reinforcement with a reward will strengthen your behavior of being reliable, and cause
        this positive behavior to act again.
A: Therapist #1, am I a reliable person?
T1: You realize that none of your friends have the same opinion of you that you do of yourself.
        While they could all be wrong, it is more likely that you are going through a period of
        denial. You are hiding your true self in order not to face the facts. Do not rationalize or
        intellectualize your actions, instead look into yourself, see who you really are. Only then
        can you react to your problems.
A: (bites nails) OK, Therapist #2, what seems to be the root of my problem?
T2: Trying to meet the high expectations of yourself may make you feel alienated, leading to
        feelings of anxiety and conflict, Ann Chuss, just as your name implies! By working with
        me, Ann, over time, you will find a way of life that is truly and deeply satisfying to you.
A: Therapist #3, what is the root of my problem?
T3: Behavior can be acquired through conditioning. Bad experiences where you experienced
        anxiety have conditioned you to act anxious. By never getting over these negative
        experiences, being anxious has stuck with you. Your anxious behavior can be changed
        through counterconditioning. I can help you become desensitized through my therapy.
A: Therapist #1, what is the root of my problem?

                                               206
T2: Your problem is very clear to me. You suffer from anxiety for many different reasons. It is
      obvious that you are aware of your love for your father, and that inhibits you when you
      try and form attachments. Perhaps you even project these feelings to others, and
      subsequently suffer irrational anger or denial. You must start delving into your mind,
      your hidden desires, your unconscious. Therapy with me would result in unlocking the
      secrets of your mind and analyzing them, so you can learn to deal with your anxiety. I
      would use free association, dreams, and inkblots as a means to accomplish this.

Announcer asks whom Ann would pick.

A: Therapist #2 talks too slow, Therapist #3 talks too much. I’ll take Therapist #1.



Media Presentation Ideas:
Humanistic Therapy

Component of Therapy             Definition                        Example
Genuineness                      Therapist attempts to reveal      Therapist states that when the
                                 his or her “real” feelings and    client says something, the
                                 encourages client to do the       therapist feels uncomfortable.
                                 same.
Empathy                          Therapist attempts to see the     The client feels anger toward
                                 situation from the client’s       her brother, and the therapist
                                 point of view.                    understands why the client
                                                                   feels this way (and
                                                                   communicates this to the
                                                                   client).
Unconditional positive regard    Accepting without                 The client loses his job but the
                                 “conditions” the client’s         therapist does not criticize
                                 behavior and attitudes.           him.
Nondirectiveness                 The client, not the therapist,    Rather than having a
                                 leads the session.                predetermined agenda, the
                                                                   therapist allows the client to
                                                                   bring up important issues.
Nonverbal communication          The therapist “reads” the         The client sits with arms
                                 client’s nonverbal signals.       folded and legs crossed; the
                                                                   therapist notices this and
                                                                   concludes that the client is
                                                                   anxious. Over time, the client
                                                                   may learn more effective ways
                                                                   to express himself or herself
                                                                   through body language.




                                               207
Evaluating Psychotherapy
Show this graphic illustrating the effectiveness of different forms of psychotherapy:




Show this graphic indicating the results of the 1999 Consumer Reports survey on client
satisfaction with therapy:



              100%
               90%
               80%
               70%
               60%
                                                            Helped
               50%                                          somewhat
               40%                                          Helped a lot
               30%
               20%
               10%
                0%
                        People who      People who
                         felt "very      felt "fairly
                          poorly"          poorly"




                                               208
MODULE 42: BIOMEDICAL THERAPY: BIOLOGICAL APPROACHES TO
TREATMENT
Drug Therapy
      Antipsychotic Drugs
      Antidepressant Drugs
      Lithium
      Antianxiety Drugs
Electroconvulsive Therapy (ECT)
Psychosurgery
Biomedical Therapies in Perspective
Community Psychology: Focus on Prevention

Becoming an Informed Consumer of Psychology Choosing the Right Therapist

Learning Objectives:
42-1 Name and describe drugs used in the treatment of abnormal behavior, and discuss the
      problems and controversies surrounding their use.
42-2 Describe electroconvulsive therapy and psychosurgery, and discuss the effectiveness of
      biomedical therapies.
42-3 Explain the concepts of community psychology and deinstitutionalization, and identify
      recommended guidelines for selecting a psychotherapist.

Student Assignments:
Interactivity 70: Biomedical Treatments
Students answer questions about medications and other somatic treatments for psychological
disorders.

Attitudes toward Biomedical Therapies
Ask students the following questions:
1. Under what conditions do you think that clinicians should use biomedical therapies?
2. How should biomedical therapies be combined, if at all, with psychotherapy?
3. Do you agree or disagree that psychologists should have prescription privileges? Why or why
not?

Deinstitutionalization
Ask students the following questions:
   1. What were the main causes of the deinstitutionalization movement?
   2. Some psychologists believe that clients were better treated in hospitals rather than
       community centers. Do you agree with this or do you think that community centers are
       preferable?
   3. What are some of the problems involved in the current community treatment of people
       with serious mental illness?

Comparison of Therapy Methods
Have students complete Handout 13-2.

Lecture Ideas:
Myths about Mental Illness
This web site contains a detailed presentation on “Debunking Myths” about mental illness—
http://www.pbs.org/pov/pov2003/west47thstreet/special_face_02.html
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Medications
Use this chart to summarize medications for major forms of psychological disorders:

Class of Drug           Primary Action of Drug           Examples
ANTIPSYCHOTIC
                        Block dopamine receptors         Chlorpromazine (Thorazine)
                                                         Haloperidol (Haldol)
                        Blocks serotonin and             Clozapine (Clozaril)
                        dopamine receptors
ANTIDEPRESSANT
Tricyclic               Permits rise in excitatory       Trazodone (Desyrel),
antidepressants         neurotransmitters                Amitriptyline (Elavil),
                        (norepinephrine and serotonin)   Desipramine (Norpramin)
Monoamine Oxidase       Prevent MAO from breaking        Phenelzine (Nardil)
Inhibitors (MAOIs)      down norepinephrine and          Tranylcypromine (Parnate)
                        serotonin
Selective Serotonin     Inhibit reuptake of serotonin    Fluoxetine (Prozac), Sertralene
Reuptake Inhibitors                                      (Zoloft), Buproprion
(SSRIs)                                                  (Wellbutrin), Paroxetine
                                                         (Paxil), Citalopram (Celexa)
MOOD
STABILIZERS
Lithium                 Decreases catecholamine          Lithium carbonate (Lithonate)
                        levels
ANTIANXIETY
Benzodiazepines         Increase activity of GABA        Diazepam (Valium),
                                                         Alprazolam (Xanax)


Electroconvulsive Therapy
Provide this brief summary of electroconvulsive therapy:
    Passing of 75-100 volts of electricity through the head
    Treatment must usually be repeated several times for one treatment, and then repeatedly
       after that
    Used for severe depression
    Side effects can include memory loss and permanent damage to the brain
    Only used for otherwise untreatable cases

Psychosurgery
Prefrontal lobotomy
    Used in early part of 20th century
    Sever connections to frontal lobes
    Had very negative side effects

Cingulotomy
        Used today for treatment of severe obsessive-compulsive disorder



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Summary of Therapy Methods
This chart summarizes the major approaches to therapy:

Model                        Treatment                     Focus of Treatment
Psychodynamic                Psychoanalysis                Unresolved past conflicts
                                                           and anxiety
Behavioral                   Classical conditioning        Maladaptive behaviors
                             Modeling
                             Operant conditioning
Cognitive                    Cognitive-behavioral          Dysfunctional thoughts
                             Rational emotive
Humanistic                   Client-centered               Disconnectedness
                             Gestalt therapy
Biological                   Drug therapy                  Biochemical abnormalities
                             Electroconvulsive therapy
                             Psychosurgery



Media Presentation Ideas:
Media Resources DVD: Depression Theories and Treatments (4:02)
Causes of and medication for depression.

Popular Movie: Electroconvulsive Therapy (ECT)
Show a segment from the movie “One Flew Over the Cuckoo’s Nest,” in which
electroconvulsive therapy was shown as punishment. Ask students whether they think the use of
ECT is justified or not. Scientists do not understand how it works, but it is shown to reduce
depression in people who might otherwise become suicidal.

Documentary: “West 47th Street”
Segments can be shown from this documentary from the PBS series P.O.V.
(http://www.pbs.org/pov/pov2003/west47thstreet/)




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