Psychology : Semester I : Stress and Mental Illness |
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Introduction | Section 1 | Section 2 | Section 3 | Section 4 |
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Psychology : Stress and Mental Illness : Section 4 Treatment of Psychological Disorders When psychological disorders get so serious that they interfere in everyday functioning, treatment may become necessary. People can be treated as in-patients (24 hour a day care in a hospital-like setting) or as outpatients (periodic appointments in a clinic-like setting). There are four general types of professionals that provide therapy. They are:
Make sure that if you ever need a professional they are licensed. That means that they meet rigorous standards. The treatment of mental disorders follows the same path as you studied in the tutorial for the causes of the disorders. Historically the treatments ranged from lack of care to extreme cruelty. Early treatment, (1300-1900 AD), consisted primarily of imprisonment and removal of the person from society. Asylums were built to house the mentally ill and treatment, if any, was barbaric at best. People like Philippe Pinel and Dorthea Dix initiated reforms to treat the mentally ill with dignity and respect. In the early 1900’s, harsh medical treatments were still employed to deal with mental disorders, prefrontal lobotomies and electroconvulsive therapy being two of the most common. The 1950’s saw the closing of the asylums and deinstitutionalization resulted in the release of many patients back to society. Psychopharmacology, the use of drugs to treat mental illness, became available and replaced the harsh treatments of the past.
We will study the treatments through the perspectives of the different approaches. The five approaches that we will look at are the psychoanalytic, humanistic, cognitive, behavioral and biomedical. From this point on, a therapist will mean anyone who administers the treatment. The first approach to the treatment of psychological disorders is the psychoanalytic approach. This was given to us by Sigmund Feud and for a long time was the only method of treatment. It is much less popular today but it is minimally around. If you can remember, Freud believed that disorders come from childhood experience and inner conflicts. These conflicts produced unconscious sexual and aggressive urges that caused anxiety. Psychoanalytic psychologists try to reduce the anxiety by having the patient become aware of their unconscious conflicts and Freud called this gaining insight. Three techniques are used to gain this insight, they are: free association, dream analysis and transference. Free association is a technique where the patient relaxes and then responds to words from the therapist with whatever comes to mind. The therapist looks for resistance or the hesitation or unwillingness of the patient to respond to the therapist or to change the subject or make a joke of it. The therapist’s role is to point out what the associations mean and how they reveal the patient’s unconscious. Dream analysis does the same thing in that, according to Freud, dreams reveal the unconscious. Freud talked about the manifest content of the dream which was the retelling of the dream as it was told by the patent. The latent content of the dream was the therapist telling the patient what the dream meant. Transference is the technique where the patient takes out unconscious feelings that are meant for other people and directs them to the therapist.
As a treatment, psychoanalysis is an intensive and long term therapy. The treatment time can be several times a week for several years and therefore a very costly treatment. Many psychologists believed that Freud spent too much effort looking into unconscious sexual and aggressive reasons for behavior. Psychoanalysis appears to work best with verbal, educated people and with the anxiety and mild depression disorders. The second form of insight therapy is the Humanistic approach. This approach tries to help the patient (called a client) reach their fill potential. This is accomplished by helping individuals develop self-awareness and self-confidence. The therapist and the client are equals in the relationship. The therapist only directs the client to develop insights into their problems and then decide to change behavior if they want because of free will. Carl Rogers’s program of Client-centered therapy insures the client of three conditions: genuineness, unconditional positive regard and empathy. Genuineness is the therapist having to be completely open and honest with the client. The second condition is unconditional positive regard which is fully accepting the worth of the client. The final condition is empathy or an emotional understanding of the client. This is accomplished by active listening or the therapist repeating, rephrasing and asking for the clarification of the statements made by the client. This type of treatment is most useful with well educated people who are willing to talk, since insights are gained into their situations. It works well with anxiety disorder, mild depression and social disorders. Humanistic therapy has good success record and over half of the people that seek humanistic therapy showed greater well-being.
The cognitive approach helps people change their thoughts about their problems. The two most used cognitive methods are Rational Emotive Therapy as proposed by Albert Ellis and Cognitive Restructuring Therapy as proposed by Aaron Beck. Rational Emotive Therapy is based on Ellis’s belief that people engage in self-talk that is false. Since most of the false concepts are learned, Ellis believes that clients need to be confronted with their irrational beliefs so that they can be changed. The therapist acts like a teacher to help the client develop skills that will allow the client to think more rationally. Beck’s Cognitive Restructuring Therapy does not use the technique of challenging the client’s thoughts but guides clients in testing the logic of their thoughts and developing more logical ways of thinking. Clients have homework to do as in filling out forms about their responses to every day life events.
The goal of behavior therapy or modification is to help people acquire more adaptive behaviors. Since the behaviors were learned, this therapy believes that behaviors can be changed by changing the consequences of the behavior. There are four basic therapies considered in this approach: systematic desensitization, aversion therapy, extinction, and token economies. Mary Covert-Jones pioneered systematic desensitization or counterconditioning as a method of treating phobias. Later, Joseph Wolpe popularized this treatment. This therapy uses the principles of classical conditioning by creating new associations for the original phobic stimulus. A hierarchy is developed that rank orders anxiety producing situations from the least fearful to the actual object or situation most feared. Then the client is taught relaxation techniques and finally the items in the hierarchy are paired with the relaxation techniques until the client is relaxed in the face of the feared stimulus. The last technique of behavior therapy is token economies. People are put into organized settings and appropriate behaviors are rewarded usually with some type of coin, points system or other material reward. These then accumulate to “earn” larger special rewards. Biological therapies rely on methods such as drugs, electric shock and surgery. Drug therapy is the most used biological treatment for disorders. There are four major types of drugs: antianxiety drugs, antidepressant drugs, lithium and the antipsychotic drugs. Antianxiety drugs work by depressing the activity of the nervous system. They reduce the symptoms of anxiety but they do not cure anxiety. Antidepressant drugs are used to treat depression and also in some types of eating and panic disorders. Antidepressant drugs work by increasing the production of the neurotransmitters, serotonin and norepinephrine. The drug must build up to a specific level in the body to be effective. This can take several days to weeks. Depressed people have to be watched so that they do not overdose. Lithium carbonate helps to flatten out the cycle of depression and mania. Lithium has side effects of shakiness, memory impairment and excessive thirst. The antipsychotic drugs, also called major tranquilizers are effective in reducing agitation, delusions and hallucinations. Some of the antipsychotic drugs block the activity of dopamine and reduce schizophrenic symptoms. The final biological therapy is psychosurgery which is brain surgery performed to treat psychological disorders. The most common one is the prefrontal lobotomy and it is the separating of the frontal cortex from the thalamus. Numerous side effects occur, including distractibility, apathy and seizures. This technique is even more controversial than electroconvulsive therapy and is rarely used today.
Look at the chart below and ask yourself this question.Which of the strategies listed here involve an active attempt to reduce stress?Active coping strategies involve changing our environment or modifying a situation to remove stressors or reduce the level of stress.
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Try this crossword puzzle concerning the psychoanalytic, humanistic and cognitive approach:
Discussion 5-4: The number of people being treated for mental illness keeps increasing but there are less people in hospitals or institutions. Deinstitutionalization was an attempt to return people to society so that they could lead productive lives. Some people believe that deinstitutionalization has made the lives of the mentally ill worse since they often live in substandard living conditions and are the victim of crime. Post a discussion as to what you feel about deinstitutionalization. Also respond to another student. 
Assignment 5-4: Read: Counseling Center of the University of Florida: