TREATMENT OF PSYCHOLOGICAL

DISORDERS

TYPES

• Mental Health Services

• Psychodynamic therapies

• Cognitive-behavioural therapies

• Humanistic, group and family therapies

• Biological treatments

Mental Health Services

• Multidisciplinary teams- more prevalent with the move away from institutionalised care and towards community-based services- Usually in community health facilities, grouping professionals from a range of specialties. E.g. Nurse + Psychiatrist + Social Worker + Clinical Psychologist = Team!

• Clinical Psychologists- much of the practice takes place in hospital/mental health facility- much of the work involves assessing the conditions and development of intervention strategies

Where Clinical Psychologists work (Martin, 1989)

Place of work

Psychiatric/mental health servicesUniversitiesPrivate PracticeCommunity/welfare servicesIntellectual disability servicesOther

Psychodynamic therapies

• Two key principles: role of insight and therapist-patient relationship.

• Insight – understanding of one’s own psychological processes- symptoms result from: maladaptive ways of viewing the self and relationships, unconscious conflicts, maladaptive ways of dealing with unpleasant emotions.

• Therapist-patient- patient must feel comfortable with the therapist (therapeutic alliance).- empathy more therapeutic than criticism

Psychodynamic techniques

• Free association:- therapist instructs the patient to say whatever comes to mind and censor nothing.- patient and therapist collaborate to solve the mystery of the symptoms

• Interpretation:- central element in psychodynamic technique is interpretation of conflicts, defences, etc.

• Analysis of transference:- transference refers to the process whereby people experience similar thoughts, feelings, fears, wishes and conflicts in new relationships as they did in past relationships.

Varieties of Psychodynamic Therapy

• Psychoanalysis – patient lies on the couch and the analyst sits behind. Patients usually undergo psychoanalysis three to five times a week for several years.

• Psychodynamic psychotherapy – face-to-face, more conversational, more goal directed due to limited time. One to three times a week.

Cognitive-behavioural therapies

• Basic principles: focus on the individual’s present behaviour and cognitions.

• Much more directive – assigning homework to change their thinking and behaviour.

• Starts with behavioural analysis – examining the stimuli or thoughts associated with a symptom. They then tailor procedures to address the issues.

• Classical conditioning techniques: - systematic desensitisation (used to treat anxiety-related disorders)- exposure techniques (response prevention is key)

Cognitive-behavioural therapies

• Operant conditioning – use of reinforcement and punishments.

• Participatory modeling – therapist models the behaviour and encourages the patient to participate in it.

• Skills training – therapist teaches behaviours necessary to accomplish goals, as in social skills or assertiveness training. Requires conscious awareness and practise until it becomes a routine.

Cognitive therapy

• Targets automatic thoughts, the things individuals spontaneously say to themselves and their assumptions.

• E.g. Ellis - REBT

Ellis’s Rational-Emotive Behaviour Therapy

• According to Ellis, what people think and say to themselves about a situation affects the way they respond.

• Proposed ABC theory of psychopathology.

• A = activating conditions; B = belief systems; C = emotional consequences

• REBT – focus on maximising their rational and minimising their irrational thinking.

Humanistic, group and family therapies

• Focus on the way each person consciously experiences the self, relationships and the world.

• Aim is to get in touch with their feelings, their ‘true selves’ and with a sense of meaning in life.

• E.g. Gestalt therapy and Client-centred therapy

Gestalt therapy

• Emphasises awareness of feelings.

• Developed in response to the belief that people had become too socialised – that thoughts, behaviours and feelings were controlled by social expectations.

• Focuses on ‘here and now’ rather than ‘then and there’ – avoids explanations of current difficulties as it leads people away from their emotions, not toward them.

• Common technique – empty-chair technique

Empty Chair Technique

• Therapist places an empty chair near the client and asks him/her to imagine that the person to whom he/she would like to express his feelings is in the chair.

• The client can then safely express their feelings by ‘talking’ with the person without consequences.

Group Therapies

• Multiple people meet together to work towards therapeutic goals.

• Typically 5-10 meet with a therapist on a regular basis, usually once a week for two hours.

• Benefits: presence of others who have made progress instills hope and discovers others with similar problems may relieve shame, anxiety and guilt.

• Variation: self-help groups- often has more people and is not guided by a professional.

Family Therapies

• Aim: to change maladaptive family interaction patterns.

• Focus is often on process as well as content – i.e transference reactions, sibling-like competitive relationship, accusations, etc is just as important as what the patient says.

• Therapist is relatively active and often assigns family tasks between sessions.

Biological Treatments

• Uses medication to restore the brain to as normal functioning as possible (pharmacotherapy).

• If medications are ineffective, clinicians may use electroconvulsive therapies (ECT) or in extreme cases, psychosurgery.

Psychotropic medications

Symptom Type of medication

Examples

Psychosis Antipsychotics Chlorpromazine (Thorazine, Largactil)

Depression Tricyclic antidepressants

Selective serotonin reuptake inhibitors (SSRI)

Imipramine (Tofranil)Mianserin (Tolvon)Amitriptyline (Tryptanol)

Fluoxetine (Prozac)Sertraline (Zoloft)

Mania Mood stabilisers Lithium (Lithicarb)

Anxiety Anxiolitics

Antidepressants

Benzodiazepines (Valium, Xanax)

Fluoxetine (Prozac)

ECT and Psychosurgery

• ECT is currently used as a last resort in the treatment of severe depression (e.g. delusional depressions, with psychotic features).

• Psychosurgery is now primarily used for severe cases of obsessive-compulsive disorder.

Psychotherapy Integration

• The use of theory or technique from multiple therapeutic perspectives.

• Can be:

• Eclectic Psychotherapy

• Integrative Psychotherapy

Eclectic Psychotherapy

• Combination of techniques from different approaches to fit a particular case.

• E.g. Intensive, comprehensive treatment for schizophrenia combined education about the disorder, medication, weekly group therapy, family therapy and close monitoring of symptoms.

Integrative Psychotherapy

• Developing an approach based on theories that cut across theoretical lines.

• Difficult in practice – how to integrate theories of unconscious conflict with conditioning or cognitive distortions?

• E.g. A recovering anorexic finds weigh ins embarrassing. Her therapist agrees that if she maintains her weight for several weeks, he would stop asking to see her weight unless she obviously appeared to be losing again – behavioural (-ve reinforcement) + psychodynamic (anger at feeling controlled).