Psychopathology, Ch 2 pt. 3
Identify the major types of helping professionals and describe their training backgrounds and professional roles.
Clinical psychologists: have earned a doctoral degree in psychology, either a PhD (Doctorate of Philosophy), a PsyD (Doctorate of Psychology), or an EdD (Doctorate of Education) from an accredited college or university. Training in clinical psychology typically involves four years of graduate coursework, followed by a year-long internship and completion of a doctoral dissertation. Clinical psychologists specialize in administering psychological tests, diagnosing psychological disorders, and practicing psychotherapy. Until recently, they were not permitted to prescribe psychiatric drugs. However, as of this writing, five states (Idaho, Illinois, Iowa, Louisiana, and New Mexico) have enacted laws granting prescription privileges to psychologists who complete specialized training programs. The granting of prescription privileges to psychologists remains a hotly contested issue between psychologists and psychiatrists and within the field of psychology itself.
Counseling psychologists: also hold doctoral degrees in psychology and have completed graduate training preparing them for careers in college counseling centers and mental health facilities. They typically provide counseling to people with psychological problems falling in a milder range of severity than those treated by clinical psychologists, such as difficulties adjusting to college or uncertainties regarding career choices.
Psychoanalysts: typically are either psychiatrists or psychologists who have completed extensive additional training in psychoanalysis. They are required to undergo psychoanalysis themselves as part of their training.
Psychiatrists: have earned a medical degree (MD) and completed a residency program in psychiatry. Psychiatrists are physicians who specialize in the diagnosis and treatment of psychological disorders. As licensed physicians, they can prescribe psychiatric drugs and may employ other medical interventions, such as electroconvulsive therapy (ECT). Many also practice psychotherapy based on training they receive during their residency programs or in specialized training institutes.
Psychiatric nurses: typically are registered nurses (RNs) who have completed a master’s program in psychiatric nursing. They may work in psychiatric facilities or in group medical practices where they treat people suffering from severe psychological disorders.
Clinical or psychiatric social workers: have earned a master’s degree in social work (MSW) and use their knowledge of community agencies and organizations to help people with severe mental disorders receive the services they need. For example, they may help people with schizophrenia make a more successful adjustment to the community once they leave the hospital. Many clinical social workers practice psychotherapy or specific forms of therapy, such as marital or family therapy.
Counselors: have earned a master’s degree by completing a graduate program in a counseling field, such as mental health counseling or rehabilitation counseling. Counselors work in many settings, including private practices, schools, college testing and counseling centers, and hospitals and health clinics. Many specialize in vocational evaluation, marital or family therapy, rehabilitation counseling, or substance abuse counseling. Counselors may focus on providing psychological assistance to people with milder forms of disturbed behavior or those struggling with a chronic or debilitating illness or recovering from a traumatic experience. Some are clergy members who are trained in pastoral counseling programs to help parishioners cope with personal problems.
Describe the goals and techniques of the following forms of psychotherapy: psychodynamic therapy, behavior therapy, person-centered therapy, cognitive therapy, cognitive-behavioral therapy, eclectic therapy, group therapy, family therapy, and couples therapy.
Psychotherapy: a structured form of treatment derived from a psychological framework that consists of one or more verbal interactions or treatment sessions between a client and a therapist.
- used to treat psychological disorders, help clients change maladaptive behaviors or solve life’s problems, or to help them develop their unique potentials.
Psychoanalysis: the method of psychotherapy developed by Sigmund Freud.
Psychodynamic therapy: therapy that helps individuals gain insight into and resolve deep-seated conflicts in the unconscious mind.
Free association: the method of verbalizing thoughts as they occur without a conscious attempt to edit or censor them.
Transference relationship: in psychoanalysis, the client’s transfer or generalization to the analyst of feelings and attitudes the client holds toward important figures in their life.
Countertransference: in psychoanalysis, the transfer of the analyst’s feelings or attitudes toward other persons in their life onto the client.
Behavior therapy: the therapeutic application of learning-based techniques to resolve psychological disorders.
Systematic desensitization: a behavior therapy technique for overcoming phobias by means of exposure to progressively more fearful stimuli (in imagination or by viewing slides) while remaining deeply relaxed.
Gradual exposure: in behavior therapy, a method of overcoming fears through a stepwise process of exposure to increasingly fearful stimuli in imagination or in real-life situations.
Token economy: a behavioral treatment program that creates a controlled environment in which desirable behaviors are reinforced by dispensing tokens that may be exchanged for desired rewards.
Person-centered therapy: the establishment of a warm, accepting therapeutic relationship that frees clients to engage in self-exploration and achieve self-acceptance.
Empathy: the ability to understand someone’s experiences and feelings from that person’s point of view.
Genuineness: the ability to recognize and express one’s true feelings.
Congruence: the coherence or fit among one’s thoughts, behaviors, and feelings.
Cognitive therapy: a form of therapy that helps clients identify and correct faulty cognitions (thoughts, beliefs, and attitudes) believed to underlie their emotional problems and maladaptive behavior.
Rational emotive behavior therapy (REBT): a therapeutic approach that focuses on helping clients replace irrational, maladaptive beliefs with alternative, more adaptive beliefs.
Cognitive behavioral therapy (CBT): a form of psychotherapy incorporating cognitive and behavioral techniques.
Eclectic therapy: an approach to psychotherapy that incorporates principles or techniques from various systems or theories.
Group therapy: a form of therapy in which a group of clients with similar problems meets together with a therapist.
Family therapy: a form of therapy in which the family, not the individual, is the unit of treatment.
Couples therapy: a form of therapy that focuses on resolving conflicts in distressed couples.
Evaluate the effectiveness of psychotherapy and the role of non-specific factors in therapy.
Nonspecific treatment factors: factors not specific to any one form of psychotherapy, including
empathy, support, and attention shown by the therapist
the therapeutic alliance = attachment the client develops toward the therapist and the therapy process
the working alliance = effective working relationship in which the therapist and client work together identifying and confronting the important problems and concerns the client faces
Telehealth: delivery or facilitation of treatment services via telecommunication or digital technology.
Evaluate the role of multicultural factors in psychotherapy and barriers to use of mental health services by ethnic minorities.
- Cultural sensitivity involves more than good intentions. Therapists must have accurate knowledge of cultural factors and the ability to apply that knowledge when developing culturally sensitive approaches to treatment.
- Just because a given therapy works with one population group does not mean that it will necessarily work with other groups. Therapists using established treatments should consider how they can incorporate culturally specific elements to boost treatment benefits in working with people from different ethnic or racial groups.
- Some of the barriers to mental health services for marginalized communities include…
Cultural mistrust: People from minority groups often fail to use mental health services because they don’t trust mental health institutions/professionals. Mistrust may stem from a cultural and/or personal history of oppression and discrimination, or experiences in which service providers were unresponsive to their needs. When minority clients perceive white therapists and white-dominated institutions to be cold or impersonal, they are less likely to place their trust in them.
Mental health literacy: A person may not make use of mental health services because they lack knowledge of mental disorders and how to treat them.
Institutional barriers: Facilities may be inaccessible to marginalized people because they are located at a considerable distance from their homes or because public transportation is lacking. Marginalized people are often overwhelmed or intimidated by bureaucratic red tape and/or protocol around health procedures.
Cultural barriers: Many recent immigrants have had little or no previous contact with mental health professionals. They may hold different conceptions of mental health problems or view mental health problems as less severe than physical problems. In some cultures, the family is expected to take care of members who have psychological problems and may resist outside assistance. Other cultural barriers include cultural differences between socio-economically disadvantaged clients and majority white + middle-class mental health staff, and the stigma often associated with seeking mental health treatment.
Language barriers: Mental health facilities may lack the resources to hire mental health professionals who are fluent in the languages of the communities they serve.
Economic and accessibility barriers: Financial burdens are often a major barrier to use of mental health services. Living in a rural or isolated area where mental health services may be lacking or inaccessible is also a big hurdle.
Psychopharmacology: the field of study that examines the effects of therapeutic or psychiatric drugs.
Identify the major categories of psychotropic or psychiatric drugs and examples of drugs in each type and evaluate their strengths and weaknesses.
Anti-anxiety drugs: drugs that combat anxiety and reduce states of muscle tension.
~ also called anxiolytics
~ examples include benzodiazepines (Valium, Xanax) as well as hypnotic sedatives (Halcion)
+ can be safe and effective in treating anxiety and insomnia
- potential for psychological and/or physical dependence, so they tend to be better for short term or occasional relief, not long term or daily use
Rebound anxiety: the experiencing of strong anxiety following withdrawal from a tranquilizer.
Antipsychotic drugs: drugs used to treat schizophrenia or other psychotic disorders.
~ also called neuroleptics
~ examples include Thorazine, Mellaril, Prolixin, Clozapil (atypical)
+ drastically reduced the need for long-term hospitalization, physical restraints, and confinement
- unpleasant side effects, such as muscular rigidity and tremors; long-term use of antipsychotic drugs (with exception of Clozapine) can produce tardive dyskinesia, a potentially irreversible and disabling motor disorder
Antidepressants: drugs used to treat depression that affect the availability of neurotransmitters in the brain.
~ four major classes: tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), selective serotonin-reuptake inhibitors (SSRIs), and serotonin-norephinephrine reuptake inhibitors (SNRIs)
~ examples include Tofranil, Elavil, Sinequan (tricyclics), Nardil (MAOI), Prozac, Zoloft (SSRI), Effexor (SNRI)
+ antidepressants provide beneficial effects for a wide variety of psychological disorders
- however, there are side effects for each category, and in the case of MAOIs, a patient’s diet is heavily restricted
Electroconvulsive therapy (ECT): a method of treating severe depression by administering electrical shocks to the brain.
+ significant improvement for patients experiencing severe epileptic seizures or major clinical depression that has not responded to other treatment
- high relapse rates and memory loss for events occurring around the time of treatment; for these reasons, ECT is a last resort
Describe the use of psychosurgery and evaluate its effectiveness.
~ Previously, the prefrontal lobotomy was the most common form of psychosurgery. This procedure involved surgically severing nerve pathways linking the thalamus to the prefrontal lobes of the brain.
~ The premise of this operation was the belief that severing the connections between the thalamus and the frontal lobe of the cerebral cortex would control a patient’s violent or aggressive tendencies.
- This procedure was abandoned because (1) there was insufficient evidence of its effectiveness and (2) it often produced serious complications or even death.
- When anti-psychotic drugs became available during the 1950s, psychosurgery was all but eliminated.
+ In recent years, more sophisticated psychosurgery techniques have been introduced which target much smaller parts of the brain and produce far less damage than the prefrontal lobotomy. These techniques have been used to treat patients with severe OCD, bipolar, and/or major clinical depression who have failed to respond to other treatments.
~ Another experimental technique is deep brain stimulation (DBS), a surgical procedure in which electrodes are implanted in the brain and used to electrically stimulate deeper brain structures.
+ DBS shows promise in treating severe forms of depression and OCD that have failed to respond to more conservative treatments.
- However, DBS may have serious complications and its effectiveness needs to be investigated further. Thus, it is still an experimental treatment.
Evaluate biomedical treatment approaches.
~ Overall, a combination of medication and talk therapy seems to be more helpful for most mental health patients than either treatment alone.
~ The benefits and risks/side effects of each medication need to be carefully considered and discussed by the provider and the patient.
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