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Who Goes to Therapy?- People with psychological disorders (ex. Clinical Depression, Anxiety and/or Panic Attacks, Post Traumatic StressDisorder)- People with everyday problems (ex. Academic stress, Marital conflicts, A sense of emptiness) 3 Approaches to Therapy:1) Insight therapies: “Talk therapy” to enhance self-knowledge & insight. Includes supportive therapy, which isbasic emotional support focused on current life difficulties2) Behaviour therapies: Change maladaptive behavior using learning principles3) Biomedical interventions: Physiological interventions - Freud 1856-1939 “father of psychoanalysis”- bring unconscious conflicts and motives into awareness- Conflicts  anxiety and negative emotions- Psychological disorders: unresolved conflicts (childhood  adulthood)- Unconscious defense mechanisms: used to cope with the anxiety- BUT, defense mechanisms can be ineffective or too rigid Self-defeating behaviours, problems in relationships, psychological disorders - Psychoanalysts : “Psychological detectives”, “Psychological archeologists”- Techniques a) free associationb) dream analysisc) interpretations Major elements of Psychoanalysis: Resistance Transference/CountertransferenceORIGINALLY: Psychoanalysis: long-term, intensive, several sessions a weekNOW: Psychodynamic Psychotherapy: short-term, one session a week, different forms - Carl Rogers 1940s- Stems from a humanistic approach- Only the client can know and feel what is right- Goal: To facilitate a self-propelled and self-generated growth process in the client- The therapist, therefore, does not: - Interpret the meaning of the client’s experience - Rogers’ Necessary & Sufficient Conditions for Change a) Genuineness: Therapist must not be fakeb) Unconditional Positive Regard: Therapist must show acceptance, warmth and caringc) Empathy: Therapist must understand the world from the client’s point view - Communication during a therapy session: Reflections, Clarifications - emphasizes recognizing & changing negative thoughts and maladaptive beliefs- Increased vulnerability to depression - Blame setbacks on personal inadequacies- Focus selectively on negative events- Make unduly pessimistic projections about the future- Draw negative conclusions about personal worth - Main Goal: To change thinking “errors”- Clients are taught to detect their self-defeating automatic thoughts- Then they do a reality test with these thoughts (hypothesis testing)- Usually short-term goal-directed treatment- Therapist is directive- Often “homework” is given Evaluating Insight Therapies- Research reveals interesting results: - spontaneous remission- insight therapies do work- similar results found with different methods - therapeutic relationship- emotional support & empathy- cultivating hope and sense of future- self-understanding and coping- working through - Not insight therapy – not concerned with the source of problems- Focus on changing maladaptive behaviours in very specific contexts- Assume that behaviour results from learning- Use learning principles to direct change TYPES OF BEHAVIOUR THERAPIES1) Systematic Desensitization Use counter-conditioning to eliminate phobias – build an anxiety hierarchy– client is trained in muscle relaxation on command– work through anxiety hierarchy and imagine each stimulus **NOW the stimuli are paired with a relaxed response2) Aversion Therapy: - treat addictions and negative behaviours- e.g., alcohol is paired with drug causing nausea to create an aversion to alcohol 3) Social Skills Training:- modelling- behavioural rehearsal- shaping Evaluating Behaviour Therapies- Research on behaviour therapies: only effective for specific types of problems- Versus: insight therapies: can be used for many different types of problems or disorders - Physiological interventions- Biological malfunctions  psychological disorders Biomedical Therapy #1: Psychopharmacotherapy - Treatment of mental disorders with medication- 3 main categories of drugs: 1. Antianxiety Drugs- to relieve tension, anxiety & nervousness- benzodiazepines, tranquilizers- ex. Valium, Xanax- very commonly prescribed- common side effects: drowsy, lightheaded, dry mouth, depressed (Table 15.1)- also patients can experience withdrawal- potential for abuse and overdose has been exaggerated- newer drug: Buspar 2. Antipsychotic Drugs- mainly used to treat schizophrenia - effective for 70% of patients to some degree - common side effects: drowsy, constipation, cotton mouth, Parkinson’s-type symptoms, tardive dyskinesia - newer drug class: atypical antipsychotics 3. Antidepressant Drugs- to elevate mood and relieve depression- classes: tricyclics, MAO inhibitors, selective serotonin reuptake inhibitors- SSRIs most popular nowadays- they slow the reuptake at serotonin synapses- ex. Prozac, Paxil, Zoloft- side effects: weight gain, sleep problems, sexual dysfunctionLithium & Mood Stabilizers- lithium mainly used to treat bipolar disorder- it stops and prevents manic & depressive episodes- high concentrations of lithium are toxic, so it must be monitored very carefully- mood stabilizers were developed as alternatives to lithium- the most popular mood stabilizer is valproic acid, also effective for bipolar disorder and with less adverseeffects Criticisms:- superficial, short lived effects- relapse often occurs when drugs are discontinued- overmedication/overprescription- damage of side effects*Controversial issue: the pharmaceutical companies and the drug industry Biomedical Therapy #2: Electroconvulsive Therapy (ECT) - light anesthesia- electrodes attached to the skull over temporal lobes of the brain- electrical current applied for about 1 sec- triggers a convulsive seizure (~30 sec)- usually the patient wakes up after 1-2 hours with some confusion and nausea which clear up in a couple of hours- usually 6-12 treatments are givenThere are many misconceptions about ECT, a lot of stigma.
- Used most in the 1940s-1950s due to a lack of effective drug therapies- Common short-term side effect: memory loss- With the discovery of the effects of various drugs, the use of ECT declined- Nowadays it is starting to be used more once again- It is still controversial Blending Approaches to Treatment- Eclecticism: Theoretical integration, Technical eclecticism- Most psychologists nowadays describe their approach as eclectic Empirically Supported Treatments:- Do studies show treatment is superior to placebo or no treatment?Criticisms:- Real world vs “artificial” research setting- Insurance companies- What about eclecticism? Mental Health Institutions- 1840s: Dorothea Dix- Provide care and proper treatment- BUT: overcrowded, isolated, underfunded- 1950s: revolving door problem- 1960s: Community Mental Health Movement -local community based care- less inpatient hospitalization- prevention of psychological disorders Deinstitutionalization: effective drug therapies emerged- TODAY: inpatient care - local general hospitals– specialized mental hospitals– briefer period of time– more personalized care Continuing Problems in Mental Health Care:In Canada (vs. United States)- homelessness (psychiatric survivors)- lack of government funding for community care and local hospitals (** Ontario)- over-reliance on drug therapy for mild disorders- third-party insurance companies Therapeutic Services – WHERE?- Schools and Universities- Social Services- Community Mental Health Centres- Local Hospitals- Private Practice Therapeutic Services – WHO?- Psychologists- Psychological Associates- Psychiatrists- Social Workers- Psychotherapists- Family Doctors Considerations when looking for a therapist- Theoretical orientation- Gender- Sensitivity to minority issues (i.e., sexual orientation, ethno-cultural)- Area of specialization- A good therapeutic relationship York’s Counselling & Development Centre:- Free as a York student www.yorku.ca/cdc/, 416-736-5297 Other Resources:- Gerstein Centre (24-hour crisis line)

Source: http://www.psych.yorku.ca/smurtha/intro_psych_a/Treatment.pdf