2008-04-07

We are going to watch a short Zimbardo video on psychotherapy today. He's interviewing the head therapists for each of the theories of psychotherapy: Albert Ellis, Daniel Bem, and you're going to read about these guys and do a lecture too. Then we'll do the mental paperwork exercise. Then we have three chapters of case studies, which needs to be read by Friday, when we have the test, and we notecards due. Tonight is movie night, start at 4:30, and no, Puckett will not say what the movie is.

Discovering Psychology with Philip Zimbardo

When our car breaks down, we take it to a mechanic. What happens when we break down? When our behavior becomes erradic, self-defeating, our thoughts and feelings painful? Who do we turn to, then? We might talk to a friend, family, or if the problem worsens, we turn to professional help. Professional treatment for mental illness is available from a wide range of specialists: clinical psychologists, psychiatrics, psychological counselors, and psychological social workers. The vast majority of the professionals are practicing therapists. The disorders can be from phobias to completely disruptive problems. There are over 250 different types of therapies. There are two major groups: the biomedical approach and the psychological approach. Biomedical therapy focuses on changing some aspect of our physical functioning. This approach is based on the premise that certain mental disorders are 'diseases' and that treatments must be biological to erradicate them. Biomedical therapists are psychiatrists and neurobiologists, and they specialize in isolating disease states. Because the ecology of the mind is in such a delicate balance, it can be upset by mental disorders. One of the most radical treatments has been psychosurgery. The best known form is the prefrontal lobe lobotomy. It cuts the prefrontal lobes off from the thalamus. Symptoms were intense anxiety. "After-labotomy" -> took away ability to plan ahead, lack of concern for the opinions of others, these replaced the earlier symptoms. The use is now restricted to the most extreme cases where no other treatment has helped. Another type is ECT - electroconvulsive therapy. It has been hailed as the most powerful antidepressant treatment. ECT misuse causes memory loss in some patients. As effective as shock therapy can be, it can only help a limited number of people. The real revolution in biomedical therapy has been the use of drugs and molecules. Before the advent of drug therapy, patients would scream and exhibit constantly, they would smear excrement in the walls, some withdrew into zombie-like states, while others would be put into straight-jackets to stop them from hurting others. Tranquilizing drugs changed all of this in the 1950s. What was the first schizophrenia-miracle-drug?

Another antipsychotic drug, lithium, regulates the extremes of bipolar affective disorders. Drug therapy suppress the mental disorders, and they also make it possible to cope with patients through psychotherapy to patients who can now be reached. But the problem is that some people might over-medicate themselves (like with Valium, people who have given up on other problems). Genetic counseling is the next revolution: the probability of passing on defective genes. This does not matter any more: just rewrite your genome with DNA synthesis. Recently, a team of researchers identified the actual gene on chromosome 11 that when changed, causes a type of depression. The results were complicated by the fact that at least half of those with the effected gene, did not have the disorder. People who are genetically primed for a disorder are much more likely to get the mental disorder if they are under prolonged stress.

What about the psychological approach? How do they deal with depression? That depends on what kind of therapy they practice. We can start to simplify things a bit by dividing it into four major types:
  1. (1) Psychodynamic/psychoanalytical - all behavior has the source of powerful inner forces, caused by unresolved tensions in childhood. Hans Strupp is a leading practicioner of psychotherapy. The patient must be motivated to work in therapy, that means they must be willing to come, they must be willing to invest themselves, they must be willing to put forth some work. Psychoanalyticism is as bad as scientology, if not worse. They try to immerse themselves in the inner world of the patient. Psychotherapy is basically a human relationship, it is not a treatment in the medical sense, or in the way that 'treatment' is ordinarily understood, it's a relationship in which the two work together and the result of which, we hope, results in an improvement in the patient's mental health. It was Sigmund Freud who developed the psychodynamic perspective over in Vienna. The adult's problem is explored among the symbols of the task. What makes this difficult is that, in Freud's view, you have unconscious thoughts that can't be brought to the surface because ... yadda yadda yadda. Develop insights into those symptoms and the root causes in childhood ... focus is on the development of the ego ... one of the basic techniques is free-association, thus reflecting their unconscious thoughts. There's also analysis of their patient's resistence and analysis of their dreams. Talks are three to five times a week, for at least a year, and then the therapist helps to organize the material available, to gain insight into the patient's present anxiety, feelings, guilt. Psychodynamicists have modified Freud's emphasis on infantile sexualism. They change the patient's personality, which takes time and money, and good verbalization. There is also another form of therapy where they practice an intermediate form of therapy: not formal psychoanalysis (which is just about dying out anyway). What about Freud's notion of excavating the past? What if we stop worrying about the underlying causes, and instead concentrate on the symptoms? Behavior therapists try to change the symptoms, the behavior, and the client will function more effectively. Sometimes, patients are taught alternative behaviors. Behavior modification therapies - strategies to extinguish bad behaviors, and sources of reinforcements to increase desirable behaviors. But what if the problem is not behavior? But how we think and what we think? What if we get in to trouble for our ability to visualize situations of failure? Intense anxiety? Or negative interpretations? Cognitive biases? Setting up self-defeating expectations? What do we do then?
  2. (2) Cognitive therapy, from the 1960s, Albert Ellis. Cognitive therapists teach their clients how to recognize and change unreasonable attitudes and expectations of failure. He calls his therapy, RET - rational emotive therapy. Play the Devil's Advocate: even if the client is 100% correct about the injustices of the world which are being hoisted upon him, he still doesn't have a good reason to get upset, and he can still be shown how to go beyond what his problem is. And then we get on to why it occured and other aspects, but this is very common in children and adults, and it's common to deliberately assume you are correct about the situation, and why are you upsetting yourself, and how could you make sure this does not occur again? In the late 1960s, one of Ellis' actual therapy sessions was filmed.
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  4. (4) Another, alternative perspective is humanistic therapy, focusing on people searching for greater fulfillment: power, love, aims, potentialities, and humanism, to me, is the great tradition, say that began in the Renaissance, and went to affirm all of the potentialities of our fellow human beings, helping the person to discover his own being and potentialities, and then to live on that basis. Ministers used to do it. But they have to stay in their religious side. Doctors used to do it, but doctors have with new inventions become concerned with the techniques, so they miss the person. Humanistic therapies focus on people and their growth in their contexts. This includes families, couples, and groups. How do we know what kinds of treatments are best for which problems? Clinical psychologists - Enrico Jones. What kinds of treatments might be most effective for depression? Psychodynamic/Freudian-principle, cognitive behaviorial therapy, or do drug treatments work most effectively? It is this matching of treatment-type to a particular disorder that will field the ahead. This is complex. Even when you isolate a problem like depression, there are many kinds of depression, it's not just simply "measles", there are at least a dozen kinds of depression, and it's not just a particular kind of illness, it is within who they are (their brain/mind). So it depends on the person as well as the disorder, that they are suffering from.
The new direction in mental health care is preventive -- including public health models. For a new breed of specialists, called health psychologists, they find ways to change the physical and social environment to help minimize mental disorder development.