* Treatments and Therapies *

Medical Models
Drugs and Symptoms

 Major Perspectives
Psychoanalysis & Ego-Analytical
Freudian Beginnings From Hypnosis to the "talking cure"

Catharsis and Insight
Free Association

Ego Analytical Approaches

Controversies: Repressed & Recovered Memory

Learning / Behaviour Modification
classical conditioning
Systematic Desensitization

operant conditioning
aversion therapy
token economies

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. video#36

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 https://dancesafe.org/drug-information/ecstasy-slideshow/

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) PTSD and end of life anxiety.

  Issues around Drugs

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. youtube

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?)

  Ego Analytical Approaches

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.

  Masson (1984) suggested that Freud was trying to 'cover up' for his own father and his friend Fleiss in retraction.

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"

  Memory is easily altered through misinformation, as was the case for 29% of subjects with "lost in mall story" in two follow up interviews.  

II. Learning / Behaviour Modification  
Classical conditioning

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, ... Rick Mercer's Behaviour Mod for Politicians

Behavioural Records are used to track behaviours and reinforcement schedules to change behaviour. Eg.   Behaviour Therapy

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.

Relaxation activities (Tai Chi, Yoga,..) have been shown to help with Anxiety disorders while more aerobic exercise can be of some help for Depression

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... Eg. PCT

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. Eg. Cog Beh

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.

Service Dogs or pets can also help with anxiety disorders and with PTSD

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.

Eclecticism and the Mixed Bag g

While many of these professionals will focus on one technique they will often make use of many techniques and perspectives, known as eclecticism.

Diagnosis and Therapy Game