Psychology – Therapies

ESSENTIAL QUESTIONS:

  • What is the difference between a psychologist and psychiatrist?
  • What is the major therapeutic goal of the following therapies:
    1. psychoanalysis
    2. humanistic
    3. behavioral
    4. cognitive
  • Why are certain therapies better aligned to specific disorders?
  • How does gender and culture impact the diagnosis and treatment of disorders?
  • Describe the issues one should address when making the decision to seek therapy?

 

DSM-V

  • Schizophrenia & Other Psychotic Disorders [see schizophrenia under “key concepts”]
  • Mood Disorders [Mood disorders are severe and persistent rather than occasional bouts of sadness, such as when we are grieving. During these periods we might even say we are “depressed”; however, this is just part of normal human behavior and not a mental disorder. Examples of mood disorders are: “major depressive disorder” and “bipolar disorder”. Neurotransmitters have been implicated in mood disorders, including “norepinephrine” and “serotonin”. These two are often linked together into what is called the monoamine theory of depression. This theory holds that too much norepinephrine and serotonin leads to mania, while too little leads to depression.]
  • Anxiety Disorders [There are approximately ten disorders listed under the anxiety disorders section of the DSM. One example is “phobias” – an irrational fear of something that results in a compelling desire to avoid it. “obsessive compulsive disorder (OCD) is characterized by repeated obsessions (persistent irrational thoughts) that produce tension and/or compulsions (irrational and repetitive impulses to perform certain acts) that cause significant impairment in a person’s life. Loosely speaking, obsessions are thoughts and compulsions are behaviors.]
  • Somataform Disorders [involves the presence of physical symptoms that suggest a medical condition but which are not fully explained by a medical condition. The afflicted person is not faking but really believes that he or she has a medical condition. Examples are: “conversion disorders” and “hypochondriasis”]
  • Dissociative Disorders [the person avoids stress by dissociating, or escaping from his or her identity. The person otherwise still has intact sense of reality. Examples include: “dissociative amnesia”, “dissociative fugue”, “dissociative identity disorder (formerly multiple personality disorder) and “depersonalization disorder”.]
  • Eating Disorders [look-up “anorexia nervosa” & “bulimia nervosa”]
  • Personality Disorders [a personality disorder is a pattern of behavior that is inflexible and maladaptive, causing distress and/or impaired functioning in at least two of the following: cognition, emotions, interpersonal functioning, or impulse control. The DSM lists ten personality disorders such as: “schizoid” (not the same as schizophrenia), Narcissistic”, “borderline”, and “antisocial”. Antisocial personality disorder has previously been referred to as psychopathic disorder and sociopathic disorder. The essential feature of this disorder is a pattern of disregard for and violation of the rights of others. This is evidenced by repeated illegal acts, deceitfulness, aggressiveness, and/or lack of remorse for said actions.

TREATMENTS:

  • Psychotherapies:
    1. Psychoanalysis [behavior is a result of unconscious conflicts, repression, defense mechanisms. Treatment is an intense and long-term for uncovering repressed memories, motives and conflicts stemming from problems in psychosexual development. By gaining insight into repressed material, the energy being utilized to deal with the repressed conflict would be freed up and made available for further development. Strategies include: “free-association”, “dream interpretation”]
    2. Humanistic (social-existentialist) [looks at people as wholes that have free will. People are inherently good-at-heart. Thus, treatment focus on that which distinguishes us from other animals, internal processes, and may emphasize existential concepts, human dynamism, self actualization, and finding the overall meaning in one’s life by making one’s own choices. Mental disorders tend to be viewed as stemming from problems of alienation, depersonalization, loneliness and a lack of meaningful existence. Humanistic therapy facilitates exploration into a client’s thoughts and feelings. Existential components to therapy include empathy toward the client as well as understanding, affirmation and positive regard.]
    3. Behavioral [behaviors are learned as people interact with their environment and thus learn faulty coping patterns that are maintained by some kind of reinforcement. Behaviorists consider one’s symptoms to be the disorder and thus treatment revolves around re-training and re-learning and has been shown to be quite effective with phobias, impulse control problems and personal care maintenance.
    4. Cognitive [humans think, believe and are creative. Treatment tries to change and restructure patient’s distorted and/or irrational thoughts. Albert Ellis’s “Rational-Emotive Therapy (RET) might challenge an irrational belief that the client has, helping him or her to recognize these beliefs and change them to more rational ones. The tasks of the therapist or counselor include understanding the client’s concerns from his/her point of reference and to work as a facilitator, teacher and encourager.In traditional RET, the client together with the therapist, in a structured active-directive manner, often work through a set of target problems and establish a set of therapeutic goals.]
  • Biomedical Therapy:
    1. Biomedical/Biochemical [Biomedical treatments may involve medication, surgical procedures, and/or electroconvulsive methods. Medication or “pharmacotherapies” are used for things like schizophrenia, bipolar disorder and perhaps even major depressive disorder. Psychologists using this treatment method may try a combination of pharmacotherapy and cognitive-behavioral interventions.]

KEY CONCEPTS:

  • DSM-V [American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th Edition – a classification system for mental disorders, based on a theoretical descriptions of symptoms of the various disorders]
  • Rational-Emotive Therapy (RET) [In therapy, the first step often is that the client acknowledges the problems, accepts emotional responsibility for these and has willingness and determination to change. This normally requires a considerable amount of insight. The intent is to help the client challenge, dispute and question their destructive and self-defeating cognitions, emotions and behaviors.]
  • Diathesis-Stress Model [Psychologists are not interested in just describing the various types of mental disorders, they’re also interested in “why” these disorders occur. The “diathesis-stress model” is a framework that can be used to examine the causes of mental disorders. A diathesis is a predisposition toward developing a specific mental disorder. It could be a genetic or anatomic abnormality or a biochemical disorder that predisposes an individual to mental illness. Excessive stress operating on a person with a predisposition (diathesis) may lead to the development of the specific mental disorder. According to this model, an individual whose brain is oversensitive to dopamine and who also experiences excessive stress may be likely to develop schizophrenia. This model reminds us that causal factors at the biological and psychological levels interact with each other.]
  • Schizophrenia [Schizophrenia, meaning “split-mind”, and is characterized by gross distortions of reality and disturbances in the content and form of thought, perception, and affect. However, do not confuse schizophrenia with “multiple personality disorder” (a dissociative disorder). Thus, schizophrenia means “split from reality”. A person with schizophrenia may have any or all of the following symptoms: delusions, hallucinations, disorganized thought, inappropriate affect, and catatonic behavior. Symptoms of schizophrenia are divided into “positive symptoms” and “negative symptoms”. Positive symptoms are behaviors, thoughts, or affects added to normal behavior such as delusions and hallucinations, disorganized speech, and disorganized or catatonic behavior. Negative symptoms are those symptoms that involve the absence of normal or desired behavior such as flat affect – where the individual’s emotional expression is blunted.]
  • Dopamine Hypothesis [the etiology of schizophrenia remains unclear. The leading biochemical explanation for schizophrenia is the dopamine hypothesis. Dopamine, a neurotransmitter, plays an important role in movement and posture in certain brain pathways. Thus, this hypothesis suggests that the delusions, hallucinations and agitation associated with schizophrenia arise from an excess of dopamine activity at certain sites in the brain. A variant of this hypothesis is that the amount of dopamine is normal but that there is an oversensitivity to dopamine in the brain or that there are too many receptors that receive the dopamine. The effectiveness of antipsychotic drugs in treating schizophrenia provides supporting evidence of this hypothesis.]
  • David Rosenhan (1973) [studied whether or not it is possible to be judged sane if you are in an “insane place” (a psychiatric hospital). Rosenhan and seven other “sane” people were admitted into different psychiatric hospitals by reporting auditory hallucinations. Each of these pseudo-patients was diagnosed to have either paranoid schizophrenia or bipolar disorder and each was admitted. Once admitted, they acted normally in every way. Yet, because of they had already been labeled as mentally ill, even normal activities were interpreted by the staff as evidence of mental illness. The pseudo-patients remained in the hospitals an average of three weeks. Not one was identified as sane. In fact, when they were finally released (and they were only able to be released with the help of spouses and friends), the discharge diagnoses were either paranoid schizophrenia or bipolar disorder in remission. Rosenhan concluded that clinicians need to exercise greater care when judging normality and abnormality. Once someone is labeled mentally ill, the label never really goes away. Additionally, this study demonstrated that mental illness could be feigned as well as misdiagnosed.]
  • Pharmacotherapy [also sometimes called, “psychopharmacology” deals with treating disorders based on medications due to biochemical disruptions in the brain.]
  • Systematic Desensitization [systematic desensitization, also known as graduated exposure therapy, is a type of behavior therapy used in the field of psychology to help effectively overcome phobias and other anxiety disorders by slowly increasing the clients interaction with the item, idea, behavior that is causing distress until the client is able to encounter the fear completely.]
  • Free Association [The importance of free association is that the patient speaks for themselves regarding whatever ideas come to mind, rather than repeating the ideas of the analyst; they work through their own material, rather than parroting another’s suggestions’.]
  • Transference [to transfer; Transference is a phenomenon characterized by unconscious redirection of feelings from one person to another. In a therapy context, transference refers to redirection of a patient’s feelings for a significant person to the therapist. Transference is often manifested as an erotic attraction towards a therapist, but can be seen in many other forms such as rage, hatred, mistrust, parentification, extreme dependence, or even placing the therapist in a god-like or guru status.]
  • Selective Serotonin Reuptake Inhibitors (SSRI’s) [Selective serotonin re-uptake inhibitors or serotonin-specific reuptake inhibitors are a class of compounds typically used as antidepressants in the treatment of major depressive disorder and anxiety disorders.]