Saturday night 25 people in their 30 s were at their best dancing around the floor jamming with the band

and singing their favorite songs. They have missed the prom of their youth and all the exciting years of adolescence. Their memories of those years were too dreary too fragmented to recall This better-late-than-never prom was organized to celebrate awakening to reality after years of being lost in the darkness of schizophrenia.

Treatment of Psychological Disorders

Psychotherapy

Biomedical Therapy

psychotherapy

psychodynamic treatment

behavioral approaches to therapy

cognitive approches to therapy

humanistic approach to therapy

group therapy

talking cures

pychoanalysis

classical conditioning

observational learning

operant conditioning approaches

rational-emotive therapy

client-centered therapy

existential therapy

gestalt therapy

couples counselling

repression*

free association

dream interpretation

contemporary alternatives

aversive conditioning

modeling

token system

Aaron Beck's cognitive therapy

unconditional positive regard

family therapy

resistance*

transference+

here-and-now approach

systematic desensitization

contingency contracting

talking cures

repression*

psychodynamic treatment

free association

resistance*

pychoanalysis

dream interpretation contemporary alternatives aversive conditioning

transference+

here-and-now approach

classical conditioning systematic desensitization behavioral approaches to therapy observational learning

modeling

token system psychotherapy operant conditioning approaches rational-emotive therapy Aaron Beck's cognitive therapy client-centered therapy humanistic approach to therapy existential therapy unconditional positive therapy

contingency contracting

cognitive approches to therapy

gestalt therapy

couples counselling group therapy family therapy

biomedical therapy

antipsychotic drugs

psychosurgery

antidepressant

lithium carbonate

prefrontal lobotomy

cingulotomy

stimulants

electroconvulsive therapy

all treatment approaches have a common objective:

the relief of psychological disorder, with the ultimate aim of enabling individuals to achieve richer, more meaningful, and more fulfilling lives

Eclectic Approach to Therapy

y course of action where a therapist use a variety of

methods with a given person, assuming that abnormal behavior is often the product of both psychological and biological processes
y eclectic therapists may draw from several

perspectives simultaneously, in an effort to address both the psychological and the biological aspects of a person s problems

Psychotherapy

psychodynamic treatment

Psychotherapy
y the process in which a patient (client) and a professional attempt to remedy psychological difficulties y the emphasis is on change as a result of discussions and interactions between therapist and client y all psychological approaches see treatment as a way of solving psychological problems by modifying people s behavior and helping them gain a better understanding of themselves and their pasts, presents, and futures

behavioral approaches

cognitive approaches

humanistic approach

group therapy

Psychodynamic Treatment
y is based on the premise that the primary sources of abnormal behavior are unresolved past conflicts and the possibility that unacceptable unconscious impulses enter consciousness y to guard against this anxiety-producing possibility, individuals employ ego defenses or defense mechanisms psychological strategies that protect themselves from the unconscious impulses

Repression
y threatening conflicts and impulses are pushed back into

the unconscious
y unacceptable conflicts and impulses can never be

completely buried and some of anxiety associated with them may produce abnormal behavior in the form of neurotic symptom

Talking Cures
y a technique developed by Freud whereby anxiety

produced by the unconscious unwanted impulses and drives can be confronted

y the technique consists of leading the individual to discuss

in detail their past experiences from the time of their first memories. It is also assumed that while individuals talk they would eventually stumble upon the anxiety producing conflicts. They would then be able to work through their difficulties

Psychoanalysis
y tends to be lengthy and expensive y patients typically meet their therapists an hour a day, four

to six days a week, for several years

Free Association
y a technique where patients are told to say aloud

whatever comes to mind, regardless of its apparent irrelevance or senselessness

y the psychologist s job is to recognize and label the

connections between what is said and the patient s unconscious

Dream Interpretation
y an examination of the patient s dreams to find clues to

the unconscious conflicts and problems they are experiencing

..dreams provide a closer look at the unconscious because

peoples defenses tend to be lowered when they are asleep. But even in dreams there is censoring of thoughts; events and people in dreams are usually represented by symbols..
-S. Freud

The Therapist
y must move beyond the surface description of the dream

(manifest content of dreams) and consider its underlying meaning (the latent content of dreams), which reveals the true message of the dream

Resistance
y the inability or unwillingness to discuss or reveal a

childhood memory and suddenly forget what they were saying or they may completely change the subject
y the therapist must pick up instances of resistance and to

interpret their meaning, as well as to ensure that patients return to the subject which is likely to hold difficult or painful memories for them

Transference
y a phenomenon where the patient may come to see the

therapist as symbolic significant others in their pasts, perhaps a parent, a lover, and apply the same feelings for that person to the therapist
y this can be used by the therapist to help the patient

recreate past relationships that were psychologically difficult

Contemporary Alternatives to Psychoanalysis

y there is less emphasis on the patient s past account and

childhood
y a more here-and-now approach is used, concentrating on

an individual s current relationships, emotions, and specific complaints

y the therapist takes a more active role: controlling the

course of the therapy, and prodding and advising the patient with considerable directness

Behavioral Approaches to Treatment

y good behavior is maintained by reinforcement, and

unwanted behavior can be eliminated by punishment

y both normal and abnormal behavior are learned y people who display normal and abnormal behavior either

have failed to learn the skills needed to cope with the problems of everyday living or have acquired faulty skills and patterns that are being maintained through some form of reinforcement

y to modify abnormal behavior, this approach propose that

people must learn new behavior to replace the faulty skills they have developed and unlearn their maladaptive behavior patterns
y it is not necessary to search deeply into people s pasts or

their psyches. Rather than viewing abnormal behavior as a symptom of some underlying problem
y they consider the abnormal behavior to allow them to

function more effectively solves the problem with no need for concern about the underlying cause

Classical Conditioning Approaches Aversive Conditioning

y technique where the therapist may create a unpleasant

reactions to stimuli that an individual previously enjoyed

For example
y in treating an alcoholic, a therapist offers an appealing

drink laced with a drug that produces severe nausea. By linking the drinking of alcohol with violent nausea, the therapist seeks to transform the alcoholic s reaction to alcohol from positive to negative

Systematic Desensitization
y in this treatment, a person is taught relax and then is

gradually exposed to an anxiety-producing stimulus and order to extinguish the response of anxiety
y the patient would first be trained in relaxation techniques

by a behavior therapist

next, construction of a hierarchy of fears in order of increasing severity associated with fears
1. Watching a plane fly overhead 2. Going to an airport 3. Buying a ticket 4. Stepping into the plane 5. Seeing the plane door close 6. Having the plane taxi down the runway 7. Taking off 8. Being in the air

y the therapist will ask the client to himself in a relaxed

state and then imagine himself in the first situation identified in the hierarchy
y after being able to consider the first step while being

relaxed, the patient will move on to the next situation, eventually moving up in gradual stages until the end of the hierarchy without experiencing anxiety

bservational Learning and Modeling

y If we had to be hit by a car in order to learn the

importance of looking both ways before crossing the street, the world would probably suffer from a serious under population.
y Fortunately, this is not necessary, for we learn a

significant amount through observation learning, by modelling the behaviour of other people.

Modeling
y the process of observing and imitating a specific behavior y through this, people are taught systematically of new

skills and ways of handling their fears and their anxiety

y can play an effective role in resolving some kinds of

behavior difficulties, especially if the model is rewarded for the behavior

perant Conditioning Approaches

y this technique demonstrates the effects of rewards and

punishments on future behavior, the notion that we should reward people for carrying out desirable behavior and extinguish behavior that we wish to eliminate by either ignoring or pushing it

Token System
y in this systematic application, a person is rewarded for

desired behavior with a token such as a poker chip or some kind of play money
y the earned tokens can be exchanged for some desired

object or activity

Contingency Contracting
y it is a variant of the more extensive token system that has

proved to be quite effective in producing behavior modification

y a written agreement is drawn up between therapist and

client, it states a series of behavioral goals that the client hopes to attain. It also specifies the positive consequences for the client if the goal are reachedusually some explicit reward such as money or additional privileges

Cognitive Approaches to Therapy

y GOAL: change people s faulty cognition about themselves

and the world

y because of their reliance in basic principles of learning,

these strategies have often been called the cognitivebehavioral approach

y they have the ability to incorporate additional treatment

approaches which made it particularly effective

y Meichenbaum emphasized the importance of

changes in self-instruction for changes in behavior

Rational-Emotive Therapy
y attempts to restructure a person s belief system into a more realistic rational and logical sets of view

According to Albert Ellis ..

y many people lead unhappy and sometimes even

psychologically disordered lives because they harbor such irrational, unrealistic ideas as these:
y it is necessary to have the love and approval of virtually

every significant other person for everything we do y we should be thoroughly competent, adequate, and successful in all possible aspects if we are to consider ourselves worthwhile

y in order to lead their clients to eliminate such

maladaptive cognitions and adopt more effective thinking, rational-emotive therapists take an active, directive role during the therapy, openly challenging patterns of thought that appear to be dysfunctional

Aaron Beck developed another form of

therapy that builds on a cognitive perspective
y it has the same goal with the rational-emotive therapy

but is considerably less confrontational and challenging

y clients are urged to obtain information on their own that

will lead them to discard their inaccurate thinking

y they are helped to discover new ways of thinking more

appropriately about themselves and others

Humanistic Approach to Therapy

y draws upon the philosophical perspective of self-

responsibility in developing treatment techniques

y in this view, psychological disorders are the result of

people s inability to find meaning in life and of feeling lonely and unconnected to others

there are many diff types of therapy..

that fit into this type of category yet their ideas that underlie them are the same:
y we have control of our own behavior y we can make choices about the kind of lives we want to live y it is up to us to solve the difficulties that we encounter in

our daily lives

humanistic therapists
y view themselves as guides or facilitators instead of being

the directive figures in the previous approaches

y they seek to lead the people to realizations about

themselves
y help them find ways to come closer to the ideal they hold

for themselves

Client-Centered Therapy
y GOAL: enable people to reach their potential for selfactualization y first practiced by Carl Rogers y the best-known and most frequently used type of humanistic therapy y therapists hope to motivate clients to air their problems and feelings, which, in turn will enable the clients to make realistic and constructive choices and decisions about the things that bother them in their current lives.

y instead of directing the choices that the clients make, the therapist provides what Rogers called unconditional positive regard expressing acceptance and understanding, regardless of the feelings and attitudes the client expresses. In doing so, the therapist hopes to create an atmosphere in which clients are able to come to decisions that can improve their lives

y furnishing unconditional positive regard does not mean that the therapist approve of everything the client says or does. Rather, it means that the therapist must convey that the client s thoughts and behaviors are seen as genuine reflections of what the client is experiencing

Existential Therapy
y in contrast to other humanistic approaches that view human s unique freedom and potential as a positive force, existential therapy is based on the premise that the inability to deal with such freedom can produce anguish, fear and concern y GOAL: make the individual aware of the importance of free choice and the fact that they have the ultimate responsibility for making their own choices about their lives

Existential Therapists
y are exceedingly directive, probing and challenging their client s view of the world. In addition, they try to establish a deep and binding relationship with their clients. y their objective is to allow client to see that they share in the difficulties and experiences that arise in trying to deal with the freedom that is part of being human

Gestalt Therapy
y The rationale for this approach to treatment is that it is necessary for people to integrate their thoughts, feelings and behaviours into gestalt (Ger. whole ) y GOAL: experience life in a more unified and complete way

According to Fritz Perls ..

y the way for people to do this is to examine their earlier experience and to complete any unfinished business from their past that still affects a colors present-day relationships. Specifically, people should re-enact during therapy the specific conflicts that they experienced earlier.

For instance
y a client must first play the part of his angry father and then play himself when his father yelled at him. Gestalt therapists claim that by increasing their perspective on a situation, clients are better able to understand the source of their psychological disorders

Group Therapy
y several unrelated people meet with a therapist to discuss

some aspect of their psychological functioning

y their problems are discussed with the group which is

often centered on a common difficulty, such as lack of social skills

y the other members of the group provide emotional

support ad dispense advice on ways which they have coped effectively with similar problems

y groups vary greatly in terms of particular model they employ and differ in the degree of guidance the therapists provide y participants are able to gain self-knowledge regarding their maladaptive behaviors and develop empathy for others

y because several people are treated simultaneously, it is a much more economical means of treatment than individual psychotherapy y on the other hand, critics argue that group settings do not afford the individual attention inherent in one-to-one therapy, and especially shy and withdrawn individuals may not receive the attention they need in this kind of setting

Marital and Family Therapy Couples Counseling

y GOAL: clarify the typical communication patterns of the partners and then to improve the quality of interaction.

y a therapist can help both partners appreciate the verbal and non verbal styles they used to dominate, control, or confuse each other y each party is taught how to reinforce desired responses in the other and withdraw reinforcement for undesirable actions; they are also taught nondirective listening skills to help the other person clarify and express feelings and ideas

y couples therapy focuses not on the personalities involved but on the process of their relationship, particularly their patterns of conflict and communication. y ideally, both partners are made willing to make some changes in the ways they think and behave and to take responsibility for their part in the relationship y difficult as this may be, couples therapy can be much easier and more effective than efforts to change the basic personalities of the people involved

y and, because both participants work together and support each other in reaching mutually desired goals, couples therapy is more effective in resolving marital problems and keeping marriages intact than is individual therapy with only one partner

Family therapy
y Involves two or more members of the same family, one (or more) of whose problems led to treatment. y GOAL: get the family members to adopt a new more constructive roles and patterns of behavior and not to consider family therapy meeting as a gripe session free-for-all of complaints

Family Therapists
y consider the family as a whole unit, to which each

member contributes; not focusing simply on members of the family who present the initial problem
y attempt to obtain a sense of how the family members

interact with one another

y view the family as a system , and they assume that the

separate individuals in the family cannot improve without understanding the conflicts that are to be found in the interactions of the family members

y they focus on the situational rather than the dispositional aspects of the family s problem y thus, each member is expected to contribute to the resolution of the problem being addressed y many family therapists assume that family members fall into rigid roles or set patterns of behavior, with one person acting as the scapegoat, another as a bully and so forth. In their view, family disturbances are perpetuated by this system of roles.

Biomedical y The basic model suggests that rather than focusing Therapy on a patient s psychological conflicts or past traumas antipsychotic or on environmental variables that may support drugs abnormal behavior, it is more appropriate in certain cases to treat brain chemistry and other biological electroconvulsive factors directly. This can be done through the use of therapy drugs, electric shock or surgery y AIM: change the structure and function of the brain
psychosurgery

Biomedical Therapy

Antipsychotic Drugs
y introduced in the mid 1950 s to alleviate severe symptoms of disturbance such as loss touch with reality, agitation and over activity y unlike before, the typical bizarre hospital environment became considerably calmer in which professionals could do more than just try to get the patients through the day without causing harm to themselves or others

y this dramatic change was brought about by the introduction of a drug called chlorpromazine. this drug, and others of a similar nature, rapidly became the most popular and successful treatment for schizophrenia y antipsychotic drugs operate by blocking the dopamine receptors of the brain s synapses. Some newer drugs, like clozapine, amplify the release of dopamine in certain parts of the brain, such as those related to planning and goal-directed activity

y despite of the effectiveness of these drugs, they do not

produce a cure in the same way penicillin cures an infection

y as soon as the drug is withdrawn, the original symptoms

reappear and they could have long-term side effects such as dryness of the mouth and throat, dizziness and sometimes tremors and loss of muscle control that may continue even after drug treatments are stopped - a permanent condition called tardive dyskenesia

Tardive dyskenesia
y A central nervous system disorder characterized by

involuntary, spasmodic movements of the upper body, especially the face and the fingers, and including leg jiggling and tongue protrusions, facial tics, and involuntary movement of the mouth and shoulders

y Even more devastating than these physical side effects are

the numbing effects on the emotional responses of some patients

Antidepressant Drugs
y a class of medications used in cases of severe depression

to improve the moods of patients

y discovered by accident: it was found out that patients

suffering from tuberculosis who were given the drug iproniazid suddenly became happier and more optimistic

Other anti depressant drugs

y Tricyclic drugs modify the amount of norepinephrine

and serotonin in the synapses of the neurons

y Bupropion operates by affecting the neurotransmitter

dopamine
y Fluoxetine (Prozac, Zoloft and Paxil) works by blocking

reabsorption of the neurotransmitter serotonin

y may produce side effects such as drowsiness and

faintness
y their overall success rate is quite good y can produce lasting, long-term recoveries from

depression

Lithium Carbonate
y a form of simple mineral salts y a drug that has been used in cases of bipolar disorders y no one knows definitely why it works and works only in

certain cases
y it is effective in reducing manic episodes some 70

percent of the time

y can produce a number of side effects but it has a quality

that sets it apart from other drug treatments

y more than any other drug, it represents a preventive

treatment, forestalling episodes of manic depression

y people who have been subject to bipolar disorder

episodes in the past can take a daily dose of lithium that prevents the recurrence of symptoms

Antianxiety Drugs
y reduce the level of anxiety a person experiences by

reducing excitability and in part by increasing drowsiness

y not only to reduce general tension but also to aid in the

treatment of more serious anxiety disorders

The use of these drugs can produce a number of serious side effects
y Can cause fatigue y Long term use can lead to dependence y Can become lethal if taken in combination with alcohol y More importantly: continuous use masks anxiety and

hide difficulties

Anxiety Disorders
y are dealt with more effectively by a combination of

antianxiety drugs and behavioral or cognitive therapy than by drugs alone

Stimulants
y y

treatment for narcolepsy acepted treatment for ADHD

y

they may work on children by increasing the availability of dopamine and/or serotonin in their brains. It has a calming effect on these hyperactive children

Some side effects:

y drug will interfere with normal sleep patterns y when the dosage is too high, patients will become y more withdrawn y engage in repetitive, autistic-like behaviors. y there are some controversial evidence that it might slow

the growth of children

Electroconvulsive Therapy
y y

introduced in the 1930s a procedure in which an electrical current of 70 to 150 volts is briefly administered to a patient s head, causing a loss of consciousness and often seizures usually the patient is sedated and receives muscle relaxants prior to administration of the current the typical patient receives about ten treatments in a month, but some continue with treatments months afterwards

ECT is a controversial technique because of the following reasons:

1. Aside from being distasteful treatment, t evokes

images of capital punishment by electrocution 2. There are frequent side effects, such as disorientation, confusion, and sometimes memory loss that may remain for months 3. Many patients fear ECT even though they experience no pain 4. How or why ECT works is still unknown and critics suggest that treatment may produce permanent damage to the brain

Given the drawbacks..

y it is still being used because in many cases it seems to be

an effective treatment for severe cases of depression. It can act quickly than antidepressant medications. y Still, ECT tends to be used only when other treatments have proved ineffective

Psychosurgery
y Is a brain surgery in which the object is to alleviate

symptoms of mental disorders y It is rarely used and was introduced as a treatment of last resort in the 1930s

Prefrontal Lobotomy
y is the initial form of psychosurgery consisting of

surgically destroying or removing parts of a patient s frontal lobes that are thought to control emotionality
y in 1930s and 1940s, the procedure was performed on

thousands of patients, often with little precision

Psychosurgery often improved a patients behavior BUT with drastic side effects
y patients sometimes y suffered personality changes y became bland y colorless y unemotional y In other cases y became aggressive y unable to control their impulses

in worst cases treatment resulted in the death of the patient

Cingulotomy
y a more precise form of psychosurgery sometimes

employed in rare cases of OCD

y The advent of effective drug treatments made

psychosurgery became nearly obsolete.

y However, it is still used in very rare cases when all the

procedures have failed and the patient s behavior presents a high risk to self and others.

y Psychosurgery is also used in dying patients with severe,

uncontrollable pain. Still, even these cases raise important ethical issues and psychosurgery remains a highly controversial treatment

unconscious
y mind's hidden part y the part of the mind containing memories, thoughts, feelings, and ideas that the person is not generally aware of but that manifest themselves in dreams and dissociated acts

neurotic
y overanxious or obsessive: y overanxious, oversensitive, or obsessive about everyday things

narcolepsy
y condition with uncontrollable sleeping:
y a condition characterized by frequent, brief, and

uncontrollable bouts of deep sleep, sometimes accompanied by hallucinations and an inability to move