2008-04-08
Chapter 15: Treatment of Psychological Disorders
- Apparently Puckett drives a (Scion/Toyota) box. 36 mpg.
A Beautiful Mind - last night
In the beginning of disorders, the approach was really a more spiritual approach. If somebody had odd behavior, society assumed they were possessed by demons, or had some type of psychospiritual crisis, and the way they managed that was burning them at the stake, flogging them, cutting holes in their head, etc. But we want to help them get better. But prior, the idea was to "help them transition into a holier life" -- into the next life. We're going to say that therapy started with Freud. The rest is history-of-disorders. In the beginning, Freud was the therapist. He was very interested in what he saw as anxieties and maladjustments. The first client is Anna O. That's to preserve her anonymity. She showed had a somatoform conversion disorder - feeling and movement, in a particular part of the body. Freud would not have looked at it this way. He looked at id, ego, superego, the psychosexual stages, and so on. Although Freud was the first therapist, not a lot of stuff lasts beyond his cultural time period.
There are 400 approaches to psychoterhapy, there's discussion, advice, emotional support, persuasion, conditioning procedures, relaxation training, role play, drugs, and biofeedback. Function is to help people realize they are responsible for their own actions, even if the patient is completely gone: like taking some medication and so on. Therapy is never the therapist doing all of the work. Because the idea is to work with them. The focus is that everybody has to take responsibility, or else no progress can be made.
Dorothea Dix - started treating people with disorders as human by unchaining them from cells 1841, she was an activist for human rights of the mentally ill. This was during the Second Great Awakening. She's one of those folks who they do the multiple choice trivia question.
Insight therapies - "talk therapy" - complex verbal interactions, goal being to increase insight regarding the nature of clients idfficulties, group or individual (family, martial, ...). In some other insight therapies, the patient just talks constantly. The idea is to provide insight.
Behavior therapy - Skinner said everything is learned, so either learn or unlearn.
Biomedical therapy - physiological and biochemical.
Involuntary confinement/commitment - our system is set up so that you can be in confinement for 72 hours without questioning.
Who seeks treatment? About 15% of the U.S. population actually looks for and receives treatment for some type of mental issue. Most often anxiety and depression. Also situational anxiety and depression. It's because our life is pretty stressful. Women tend to seek therapy more than men. Some people suspect that it's the stigma that says that women should do it more, thus they do. The fact that people do not have good medical/mental health, this affects the percent of the population that seeks it. If you can't afford it, you don't go looking for it. Education level plays a big factor - higher education.
People in the late 30s early 40s, that deomgraphic group can actually afford therapy. Ethnicity: white v. other. Why do you think there's that level of disparity? Money and education, socioeconomic influences, which says a lot about our society: we are still polarized over race. 17 years or more of education? Well yeah, that's 17 years of education, no kidding.
apa.org
Clinical psychologists
Counseling psychologists
Psychiatrists
Clinical social workers
Psychiatric nurses
Counselors
Psychiatrist have an MD, 4 years of undergrad, 4 years of grad school, 4 year of apprenticeship. They've done 12 years after high school, they have an MD, they are the only practicioner that can prescribe medication for mental health -- the only. They don't do much in the way in therapy. They don't talk to you much. They might talk to you about 15 minutes, maybe. They do use some shreds of psychoanalysis. They ask how you are feeling, you go from there, how are your side effects, and from there it's to are you feeling like you are doing alright, and then they either prescribe or make adjustments. You will see your psychiatrist for about 15 minutes total. In and out. The psychiatrist is expected to have communication with your psychologist.
Clinical & counseling psychologists - SciD or PhD. 2 years for MS and 2 years for a PhD (a doctorate). They cannot prescribe medication. Their job is to treat the psychological disorder, anything but chemically. The difference between them? The clinical psychologist works closely with a psychiatrist, and a counseling psychologist is more like insider talk therapy. Clinical - work with full-fledged disorders. Counseling - treatment of everyday adjustment problems. LSW - licensed social worker - 2 years after college. Masters in social work. Licensed certified practicioner. Psychiatric nurse degree (RN - nursing degree in a specialty in psychology). There's also different levels of income. Psychiatrist is above $100K. The clinical and counseling psychologists? Their own practice, well, that's $100-$120K. In groups, it can be much much more if they are the anchor, and they have a bunch of social workers and clinicians working with them, that's near $300K. And then LSWs and so on - they might make around teacher salaries, 30-40K a year. Don't get into social work to get rich, just go into to do it. Psychiatrists pay a lot to get to where they are, and then they are paid after that (12 years of school ... several hundred thousand dollars in debt when you come out).
Insight therapies - like psychotherapies. Psychoanalysis v. psychodynamics. Freud was the first on the scene. Goal: discover unresolved unconscious conflicts. Freud's intent was to help people become adjustment. The problem is that psychoanalysis takes a very long time. Once a twice a week for 5 years, talking about dreams and urges, your anger, your relationships, and the whole time you're going through this insight therapy, the therapist has to act like a detective, pulling together clues from your unconscious, they want to unravel problems. Then there's free-association. Freud's success was with anxiety. He did not have success with schizophrenic, but yes with somatforms.
Free association - clients spontaneously express their thoughts and feelings exactly as they occur, no or little censorship. Study them as clues into the mind.
Dream analysis - interprets the symbolic meaning of clients dreams.
Interpretation - refers to therapist's attempt to explain the inner significance of the client's thoughts, feelings, memories and behavior.
Resistance - unconscious defense maneuvers intended to hinder the progress of therapy.
Transference - clients unconsciously start relating to their therapist in ways that mimic critical relationships in their lives. For example, if you have issues with your dad, then you might treat your therapist as your dad.
According to Freud: internal conflicts -> anxiety -> that anxiety creates a defense mechanism. Reaction formation is the opposite.
Humanistic approach to insight therapies: therapists help clients realize not to worry about pleasing others or winning acceptance. They help to restructure the self-concept. A humanist has this opinion that who you are, right now, as you are, right now, is absolutely fine, and if you want to make changes and go somewhere else, then they will provide an environment to make that happen. They do, however, point out behavior deficiencies, but they try to reinforce your choices and integrity and character traits. They make a clean split between those two. This is a big relief. They help you reconstruct your own concept of who you are. They provide an emotional climent that allows you to get therapy. There's genuineness. If your therapist is not genuine, then your BS meter will go off. Unconditional positive regard - nonjudgmental acceptance of clients and their emotions. Empathy - understand client's world from their point of view. Empathizing means "although I haven't been there, oh boy". Sympathizes means "I've been there, let's talk about it".
Non-directive therapy - where a therapist does not direct the therapy and only listens and encourages.