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57 Cards in this Set

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Dorothea Dix (1802-1887)
reform of U.S. system
moral-treatment movement
kindly care
led to large, state-supported public asylums
overcrowding, loss of public attention
Deinstitutionalization (mid-1950s)
get people out of asylums and back into community
effective antipsychotic medication
general mood of optimism in country
1963: establishment of community mental health centers
Remain largely under funded
Managed Care influence
Preference for drug therapy and short-term treatment
Places of treatment
community mental health centers
private offices
public or private mental hospitals
general hospitals
nursing homes for older patients with mental health needs
halfway houses/group homes
Psychiatrists
medical degree (M.D.)
special training/residency in psychiatry
mainly hospitals & private practice
can prescribe drugs
Clinical/Counseling psychologists
doctoral degree (Ph.D.) in psychology
training in research & practice
universities, private practice, community mental health
Counselors
master's degree in psychology
schools & institutions
school-or job-related problems
Psychiatric social workers
master's degree in social work
public agencies, home visits
Who Gets Treatment?
Most people who meet criteria for DSM diagnoses do not seek treatment
Variability due to sex, education, race & income level
*women seek more treatment than men
*college educated seek more treatment than high school educated
*whites seek more treatment than nonwhites
*higher income seek more treatment than lower income
Psychotherapy
an emotionally charged, confiding interaction between a trained therapist and someone who suffers from psychological difficulties
Eclectic Approach
an approach to psychotherapy that, depending on the client’s problems, uses techniques from various forms of therapy
Psychodynamic Therapy
Sigmund Freud
Psychological problems result from inner mental conflicts (unconscious)
Must make these conflicts conscious to adjust behavior
Repressed memories
Psychoanalysis
Freud believed the patient’s free associations, resistances, dreams, and transferences – and the therapist’s interpretations of them – released previously repressed feelings, allowing the patient to gain self-insight
use has rapidly decreased in recent years
Resistance
unconscious material causes anxiety
patients resist attempts to bring unconscious into conscious
“forgetting” appointments, no showing
refusing to discuss certain topics
Transference
patient’s unconscious feelings about person in their life experienced as feelings toward therapist
Free association
patient relaxes and reports everything that comes to mind
Dream analysis
Recognition of themes and symbols
Mistakes
slips of the tongue
Insight & Cure
*Analyst’s job is to make inferences about patient’s unconscious conflicts
*Once patient experiences them consciously, can modify or express them
*Patient must accept insights of therapist
*Analyst leads patient to insight so patient comes to insight themselves
Humanistic Therapy
Emphasis on inner potential for positive growth
*Similarity to psychodynamic
help clients become more aware of inner feelings & desires
Differences from psychodynamic
*inner feelings & desires are seen as positive & life-promoting
*main goal is to help client take control of own life
Carl Rogers
Client-centered therapy
focus on thoughts, abilities, cleverness of client
not focused on insights of therapist
therapist as a sounding board for client’s thoughts
Problems caused by denial of own feelings & distrust of ability to make decisions
Empathy
Unconditional positive regard
Genuineness
Empathy
attempt to comprehend feelings from client’s point of view
use of reflection, rephrasing
Unconditional positive regard
client is worthy & capable no matter what client does or says
creates safe, nonjudgmental atmosphere
Behavior Therapy
Therapy that applies learning principles to the elimination of unwanted behaviors
Exposure Therapy
Uses principles of extinction to decrease anxiety
Types of Behavior Therapy
Exposure Therapy
Uses principles of extinction to decrease anxiety
Systematic Desensitization (counterconditioning)
Aversion Therapy
Behavioral Treatments
Used for phobia treatment
Systematic desensitization
Flooding
Used for phobia treatment
treat anxieties by exposing people (in imagination or reality-in vivo) to the things they fear and avoid
Systematic desensitization
train client in muscle relaxation
then combine imagery of feared object with relaxation
use increasingly frightening scenes
highly effective for treating phobias
Flooding
expose person to feared stimulus and allow them to experience accompanying fear
Fear gradually declines & disappears
Counterconditioning
procedure that conditions new responses to stimuli that trigger unwanted behaviors
based on classical conditioning
Systematic Desensitization
type of counterconditioning
associates a pleasant, relaxed state with gradually increasing anxiety-triggering stimuli (stimulus hierarchy)
Initial training in progressive muscle relaxation techniques, because relaxation is incompatible to anxiety
commonly used to treat phobias
Aversion Therapy
Used for bad habits
Use of operant conditioning principles
*painful or unpleasant stimulus follows the unwanted

Example
Antabuse (induces nausea) for alcohol usage
Controversial treatment
Limited generalizability of results
Other Behavioral Techniques
Token economies
exchange system
often used in inpatient treatment
Contingency contracts
formal written agreement
Assertiveness & social skills training
Modeling
therapist models adaptive behaviors for client
Beck’s Cognitive Therapy
Treatment of depression
Depressed people
distort experiences & maintain negative views of themselves, the world, their future
minimize positive & maximize negative experiences
misattribute negative experiences to own deficiencies
Cognitive Therapy
teaches people new, more adaptive ways of thinking and acting
based on the assumption that thoughts intervene between events and our emotional reactions
Cognitive-Behavioral Therapy
a popular integrated therapy that combines cognitive therapy (changing self-defeating thinking) with behavior therapy (changing behavior)
Group Therapy
Psychodynamic
Humanistic
Cognitive & Behavioral
Psychodynamic
interactions among group members provide clues to hidden motives
gain insight into how unconscious affects relations with others
Humanistic
members gain opportunity to express selves honestly
Cognitive & Behavioral
clients can practice new skills, new ways of thinking
Couple & Family Therapy
Problem not in individual but interaction between individuals
Family therapy
Family systems perspective
Intergenerational approach
Family Therapy
see whole family together, observe interactions
help members gain perspective
Family systems perspective
each person accommodates to the family
fix family problems by offering insight into how each affects others
Intergenerational approach
considers influence of previous generations
General conclusions about therapy effectiveness
People in treatment do better than those not
Each type of therapy as effective as the others
Some types of therapy work better for specific problems
cognitive-behavioral best for fear & anxiety
humanistic best for self-esteem
psychodynamic best for work/school achievement
Some therapists are better than others
warm, understanding, motivated
Nonspecific factors in therapy effectiveness
Nonspecific = unrelated to specific principles but critical to outcome
Support
acceptance, empathy, encouragement, guidance
Hope
sense of faith in therapy process
placebo effect = improvement from belief, rather than actual effect
Biomedical Therapies
Psychopharmacology
Psychotropic Medication
Psychopharmacology
study of the effects of drugs on mind and behavior
Psychotropic Medication
Drug used to treat psychological disorder
Common Types
Anti-psychotic
Effective, but side effects can often be marked

Anti-anxiety
Valium, Xanax, Beta blockers, BuSpar

Anti-depressants
Older tricyclics and MAO inhibitors (worse side effects)

New drugs more effective and fewer side effects
Prozac, Paxil, Zoloft, Celexa
Often successful in treating anxiety as well
Biomedical Therapies
Electroconvulsive Therapy (ECT)
Psychosurgery
lobotomy
Electroconvulsive Therapy (ECT)
therapy for severely depressed patients in which a brief electric current is sent through the brain of an anesthetized patient
Psychosurgery
surgery that removes or destroys brain tissue in an effort to change behavior
lobotomy
now-rare psychosurgical procedure once used to calm uncontrollably emotional or violent patients