* Treatments and Therapies *
Overview
Medical
Models
Drugs
and Symptoms
ECT
Psychosurgery
Major
Perspectives
Psychoanalysis & Ego-Analytical
Freudian Beginnings From Hypnosis to the "talking cure"
Catharsis
and Insight
Free Association
Resistance
Transference
Ego
Analytical Approaches
Controversies:
Repressed & Recovered Memory
Learning
/ Behaviour Modification
classical conditioning
Flooding
Systematic Desensitization
operant
conditioning
aversion therapy
token economies
biofeedback
social
learning / modeling
social skills training
Humanist
/ Gestalt
Rogers - person centred
Gestalt Therapy
Cognitive
/ Rational Emotive
cognitive therapy
brain plasticity
rational emotive therapy
Group Therapy Perspectives
Music Therapy
Controversies
and Questions
Does
it work?
Which approach is best?
What makes it happen?
Eclecticism and the Mixed Bag
Medical
Models
Biological
/ Organic
approach suggests that mental disorders are diseases that are genetic and or
biochemical or neurological in origin.
Early Treatments - Video#36
Psychosurgeryhas
most commonly been done in the form of prefrontal lobotomy which left people
with altered personalities or unable to function.
Electro Convulsive Therapy (ECT) is used for suicidally depressed people who cannot wait for anti depressant to take effect or they have not been helped by other treatments. Memory loss is expected. video#37
Today variations are used such as Transcranial Magentic Stimulation (TMS) to manipulate the brain and its function through surface magnets.
Deep Brain Stimulation - using thin electrodes inserted into the brain to target specific areas for stimulation or ablation.
Mirror Boxes (2:50) and virtual reality for pain and trauma related conditions.
Drugs and Symptoms have long been associated, both in terms of creating symptoms and in alleviating symptoms.
As pointed out in the video on Schizophrenia, the presence of excess dopamine (as by amphetamine), symptoms like schizophrenia arise. video#34
With dopamine
blockers (major tranquilizers) the symptoms of schizophrenia disappear.
However,
they do not always bring people 'back to normal'- possibly if caught early and then treated, but if slowly developed, may not...
Anti-psychotic drugs (i.e.,Haloperidol, Chlorpromazine) enable 'patients' to gain some freedoms and return to society, however the drugs may cease to work for some, while others will stop taking them because they feel better.
These drugs are also often associated with the development of tardive dyskinesia, a form of Parkinson's syndrome due to reduced levels of dopamine.
Anti-depressants
are used for mood and anxiety disorders, coming in three major classes:
MAO
inhibitors, Tricyclics, SSRIs.
Monoamine oxidase inhibitors elevate norepinepherine & serotonin levels by stopping or inhibiting the enzyme that breaks them down.
Tricyclic
anti depressants
have the same effect by through the re-uptake
blocking in the pre-synaptic
cells.
Selective
serotonin reuptake inhibitors (Prozac) stop only
serotonin reuptake, making it
available for reaction for longer periods of time (like ecstasy, although it
also has an effect on
dopamine
and norepinepherine. ) see
Minor
Tranquilizers
(i.e., Diazepam (Valium), Alprazolam (Xanax), Lorazepam (Ativan) are 'depressants'(Benzodiaepines) used for panic & anxiety-affecting GABA receptors. Are mild in effectiveness but
can develop tolerance and withdrawal problems (e.g., Xanax
cessation may lead to rebound panic attacks)
Lithium must be given in exact dosages to avoid toxicity but remain effective in treating bi-polar disorder. Today other drugs like Carbamazepine and Valproic Acid (Depakene) are used for bi-polar.
Psychedelic drugs (LSD, Ecstacy, Psilocybin & Ayahuasca) have also been used in controlled dosages for treating addiction (i.e. alcoholism)
Placebo
effects, high drop out rates due to side effects; need social and cognitive
training still to avoid relapse; dosage problems extended period prior to effect
& age, gender, race factors.
Long
term risks
are found for some, such as antipsychotics that produce tardive dyskinesia,
clozipine can lead to drop in white blood count. anti-Bi-polar drugs can lead to intestinal, cardiovascular and dermal issues.
Major Psychological Perspectives
I. Psychoanalysis
& Ego-Analytical
Freudian
Beginnings
Freud's
first techniques began with the use of hypnosis that he had learned from Charcot
while an Intern. Thought to be a form of self
hypnosis, hysteric symptoms had been demonstrated through the use of
hypnosis.
He later
found that this technique did not work for some people and while treating
"Anna O". The "talking
cure" was thus born, built upon insight and release.
The goal of psychoanalytical therapy is Insight into the issue or conflict that is the source of one's neurosis or symptoms. By coming to an awareness of this source it is said that one 'releases' the psychological energy trapped by that 'hidden memory'.
By releasing this held idea there is a
release of the emotion that is also trapped in with it. The resulting catharsis
is an out pouring of emotion.
Free
Association is
a technique used to find the points of emotional disturbance as the key to the
locked up energy that is causing neurosis.
Resistance
is a
defense mechanism that keeps one from making the progress towards insight. It
usually arises during psychotherapy.
Transference
is
the application of the emotional energy (libido) onto the therapist as he or she
assists the patient into making the necessary insights.
This is
also accompanied by counter transference where
the therapist also feels an emotional bonding with the patient. Where oedipal or
electra complexes are of concern, the therapist who symbolizes the love object
may have considerable challenges in providing therapy.
E.g., Joseph
Breuer, Freud's close friend quit the case of Anna O because he felt too
close to her and he reportedly was afraid of her transference (and his own
counter transference?)
Jung,
Adler, Fromm, Erikson each offered alternative models of therapy and diagnosis.
Jung centering on the archetypes of the collective unconscious where common symbols of relationship or meaning are found. Common symbolic meaning.
Also important are psychological complexes and the unification of the self.
Jung also developed art therapy tool to help his patients gain insight into the issues they face along with dream analysis of their archetypical struggles.
Beth Hedva makes use of archetypes in helping people understand the "betrayals" they have experienced and the means through which they can find healing.
Adler
focused on superiority striving and perfection.
Social feeling and other
positive potentialities were emphasized. Individual cures for individual
problems
Fromm
being more of a socialist came to emphasize the social and interpersonal realm
and its impact on the human psyche. Social cures for social problems.
Erikson
placed an emphasis on the communal and interpersonal interaction or
mutuality
of people. Inter-living or enmeshment of lives as we each turn each other through
the life cycles.
Disciplined
subjectivity
forms the core of his clinical method. Making use of the shared communicative
meaning between people as the source of healing and wellness. Sharing feelings
and interpretations of experiences gives rise to the recognition that come
between equals.
Not the
typical doctor patient relationship, but the equal guidance between persons in the
making is the key to disciplined subjectivity. It is in making the passive
patient into the active agent that resolution
of the crises of identity can come to be.
History
making
is the process of making into a case the lives of lived experience of persons as
identified in their social and cultural worlds.
False
Memory Syndrome Controversy
In 1992
the foundation was established by parents and John's Hopkins Medical Institute
to
"document
and study the problem of families that were being shattered when adult children
suddenly claimed to have recovered repressed memories of childhood sexual
abuse." FMSF
(2000)
It was
believed that certain therapists with an "abuse" agenda were coaching
clients into creating false memories of events that never actually happened.
Freud
(1895) published the seduction theory of neurosis,
two years later retracted the seduction
hypothesis because unconscious cannot distinguish reality from fantasy.
Remembering
Dangerously
Loftus
(1995) suggests that "Like witch-hunt trials of old, people are being
accused and even imprisoned on 'evidence' provided by memories of dreams and
flashbacks"
II. Learning
/ Behaviour Modification
Flooding
-
exposing an individual to a stimulus where they are forced to confront the
fearful situation
Systematic Desensitization - is a step by step process where phobias or fears are removed through gradual exposure to the feared.
Operant
conditioning
Aversion
Therapy
substitute punishment for positive reinforcer that keeps habit going. E.g.,
Smoking use bad taste and pictures of diseased tissue will smoking.
Token
Economies
- give tokens or credits that are redeemable for food, freedom, TV, cigarettes,
...
Behavioural
Records
are used to track behaviours and reinforcement schedules to change behaviour.
Biofeedback - is
a method for recording muscle of vital functions on the body to use for altering
relaxation or health promoting behaviour style. Also may use virtual reality (glasses) therapy, giving a sense of what things could be like.
Social
learning / modeling
social
skills training - role modeling or practicing specific skills for use in real
situations.
III. Humanist
/ Gestalt approches
In
response to the determinism of psychoanalysis and behavourism the humanistic
schools was an effort to move beyond the determined toward free-will as the Third force.
Humanism- Carl Rogers and Client (Person) Centred Therapy which focuses on the personal subjective aspects of being human. The client is important in and of her / himself.
Non-directive therapy offers the client (person) a chance to speak for him/her self and not be guided into some other form of therapy than that which is authentic to them.
Invovles paraphrasing, invitations for clarification and reflection on feelings...
Therapist
must be warm, genuine, empathic and non-directive or judgmental. Encourages
self-acceptance and how one is living in the here and now, moment.
Offers
Unconditional
Positive Regard - to encourage authentic being in client and to show
importance of client as person in and of him or herself.
Gestalt
Therapy
- Focussing on basic needs and becoming aware of one's instincts and looking at the unconscious and dreams along with dramatic and
confrontational techniques.
Fritz
Perls
made use of this technique in his gestalt therapy in order to 'pin down' the
client into finding him/herself. Getting to the point of what is important,
dealing with your sh#t. Used the empty chair technique and Encounter groups.
IV. Cognitive
/ Rational Emotive
Cognitive
therapy - aims to identify thoughts, beliefs, and expectations that may be involved in
the development and maintenance of psychological disorder. Try to change focus
of thought. Make use of 'objective evidence' rather than subjective feelings.
The Brain the Changes itself - Norman Doidge has been working on cognitive exercises that change the neural pathways of the
brain to help treat a range of disorders from anxiety through to schizophrenia.
Rational
Emotive Therapy - involves the therapist challenging the irrational or illogical beliefs with
rational arguments to identify best course of action
Ellis offers the ABCs
Activating event - what brings about concerns or issues
Beliefs - about the event, including
thoughts and emotions
Consequences - resulting from the beliefs
eg. REBT
Group/Social
Therapy Perspectives
Group
therapy used by therapists from all schools
Clients learn that their problems are not unique
Often used in institutional settings, but elsewhere
Different from self-help or personal growth groups
Family
Therapy - the problem is seen as being in the social network, not the
person, treat family.
observe family together- diagnosis
multidimensional approach: four targets-i.e.,
adolescent, parent, interaction between them, other influences outside home.
Make
use of family tree-genome
to identify important events and repetitive patterns of action.
Solution
focused
- specify goals & find ways to achieve them through strategies of
adjustment.
Family
systems approach
- recognizes that whole system of family mist change for any one person to have
changes
Music Therapy has been used for a variety of disorders including Autism Spectrum, Anxiety and Depression, PTSD, as well as dementia and other brain injuries. VCM - MTABC.
Controversies
and Questions
Does
it work?
Efficacy vs Effectiveness - does research support it or do people feel 'better' in everyday life.
Lambert & Ogles (2004) indicate about 75% of people in therapy have improvement.
Lilienfield (2007) reports on those who get worse (independent of therapy) while some therapies may be harmful; such as critical incident stress debriefing (CISD), recovered memory techniques, or boot-camp interventions.
Which approach is best? Therapy over nothing
What
makes it happen?
-Supportive
relationships (rapport)
-Community support is a good predictor of success, for small and large support
for schizophrenia: clubhouse, family support and emotional expression.
-A ray
of hope- optimism and having some feeling that there is a better life ahead.
-An opportunity to open up and let off some steam, get some things off your
chest
-Guidance through solving problems and altering one's perspective and developing skills.
Cultural issues also arise in counselling and therapy where therapists need to be sensitive to a variety of issues when working in a multicultural context.
Who does therapy?
Psychiatrists - medical doctors who specialize in psychological disorders and can prescribe drugs or medical treatments like ECT or psychosurgery.
Clinical Psychologists - psychologists trained in the science of psychology and specialized in clinical assessment and treatments.
Counselling psychologists - trained in various forms of psychotherapy often arising from a Rogerian perspective.
While many of these professionals will focus on one technique they will often make use of many techniques and perspectives, known as eclecticism.