|PSY 101 Treatment of Psychological D/Os I: General Issues, Verbal (Insight) Therapies|
The Western notion of "Psychotherapy" began at the turn of the 20th century with Sigmund Freud. In 1880, his colleague, Josef Breuer, treated a patient, Anna O. (Bertha Pappenheim), for "hysteria" -- a set of physical symptoms like headaches and numbness and paralysis of her right arm. He found that she got better -- her symptoms cleared -- when he had her talk about her emotional experiences in the past. Freud used this insight and developed a "talking cure" which he called psychoanalysis. He treated patients with various physical and psychological difficulties by having these patients talk about their fantasies, memories, dreams, and other emotionally-charged subjects.
To this day, we often think of the treatment of psychological disorders as an extension of Freud's work. But, in actuality, there are many alternative ways of treatment besides the psychoanalyst's couch and talking about dreams!
Many would say that the 1990s brought a new approach to the treatment of psychological disorders in the experience of many Americans: the widespread use of medications (drugs) which require very little professional time (which is costly) and can be easily administered.
|Treatment: General Issues|
There are at least 400 recognized forms of "therapy" for the treatment of mental disorders. These represent one or more of the following general modalities of treatment
- Insight Therapies: Treatment by thinking
- Psychoanalysis and psychodynamic psychotherapy (a close cousin to psychoanalysis) are only two of many insight therapies
- Cognitive-Behavioral Therapy (which uses both cognitive & behavioral approaches) is the most widely-used "thinking" based therapy in the United States.
- Use of verbal exchange to promote insight in the thinking of a client
- Behavior Therapies: Treatment by doing (learning)
- Grounded in learning theory (classical conditioning, operant conditioning, social learning)
- Focuses upon what people actually do and what happens to them as a result
- Biomedical Therapies: Treatment by affecting the body
- Medications (Drugs)
- Electroconvulsive Therapy (ECT) = "Shock Therapy" (mostly used for severe forms of depression)
- Roughly 15% of the US population seeks treatment for mental health issues every year (even though almost 30% experience a disorder).
- Roughly 50% of visits to physicians (medical doctors) involve psychological issues.
Who treats psychological disorders?
- Psychologists: Ph.D. or Psy.D. degree (4-6 years post college which includes 1 year of internship; afterwards, usually at least 1 post-doctoral year of supervised work)
- Clinical Psychologists: Tend to treat more serious or difficult disorders
- Counseling Psychologists: Tend to treat somewhat less serious disorders or difficulties of everyday life
- Psychiatrists: MD = physician who specializes in diagnosing and treating mental disorders. Medical school (4 years) + 1 year internship + 2-4 years psychiatric residency.
- Psychiatric Social Worker: MSW. Social worker has 2+ years post college training which includes both classroom work and supervised clinical experience
- Other professionals: psychiatric nursing, counselors, marriage and family therapists, clergy, drug counselors and others
Cognitive Therapy - Developed by several therapists including Aaron Beck (on right) in the 1960s and 1970s. This is one variant of several which are collectively called "Cognitive Behavioral Therapy"
Goal: help the client identify, challenge, and change maladaptive beliefs and negative thinking.
The therapist works with the client
- to identify automatic negative thinking, e.g., I always fail tests; I can never do well in school; people don't like me
- to substitute more reasonable forms of thinking, e.g., I'm prepared for this test so that I'll probably do okay; school may be challenging, but most people like me actually do well; while some people might not like me, a whole lot of others do.
Cognitive therapists do not automatically dismiss what their clients think or believe. However, they work with the clients to test out their assumptions and beliefs and suggest many of ways of dealing with or understanding their situation. The therapist is a very active participant in therapy.
Cognitive therapy has proven quite effective with a wide variety of problems like mild to moderate depression and takes a relatively short time, e.g., perhaps 1 or 2 sessions per week for 3 to 6 months (10-30 sessions).
Martha: A Case of Fearfulness
Living in Los Angeles, CA, Martha, a 55-year-old widow, has been following the news on television almost without stop ever since the terrorists in Paris on the night of Nov. 11, 2015 carried out their coordinated attacks on both street cafés and, especially, the concert by the rock band, Eagles of Death Metal, in the Bataclan theater. She also has been looking online at various websites that show the results of these attacks as well as receiving Twitter feeds, too. Then, the murders in San Bernadino, CA happened on December 2 and ever since then, Martha has increasingly felt very fearful in her own home. She decided not to go the movies of the weekend with her friends by claiming to be coming down with a cold. But, really, the thought of going into a public place like a mall or theater makes her feel anxious. She pictures something bad happening. Similarly, rather than going to sleep at night at her regular bedtime, she has been staying up and prowling news online. Her late husband, who died three years ago at Christmas time, left her financially secure so that she doesn’t have to work. But, she also misses her two married children and her grandchildren who live in Phoenix, AZ and Austin, TX. Unfortunately, they will not be able to come to California this year for the holidays and right now Martha hasn’t any plans for Christmas or New Years.
- What automatic negative thoughts might be coming to Martha that lie behind her behavior? List 3 to 5 such possible thoughts.
- What type of automatic negative thoughts might each of these be:
- Filtering (Selective abstraction
- All or Nothing Thinking (Dichotomous reasoning)
- Emotional reasoning
- Mind reading
- Fortune telling error
- “Should” statements
- How could any of these thoughts be challenged? (All examples below quoted from Sharp, 2006)
- Is this thought helpful?
- Am I being realistic?
- Is this an example of an automatic negative thought?
- What is the evidence for and against this thought?
- Am I focusing on the negative and ignoring other information?
- Am I jumping to conclusions without looking at all the facts?
- Are there any other possible explanations?
- Is there another way of looking at this?
- Is it as bad as I am making it out?
- How likely is it that the worst will happen?
ReferenceSharp, T. J. (2006). Challenging automatic negative thoughts (ANTs). Sydney, Australia: The Happiness Institute. Retrieved from http://www.thehappinessinstitute.com/freeproducts/docs/Managing%20Unhelpful%20Thinking.pdf
This page was originally posted on 12/01/03 and last updated on December 9, 2015