treatment of psychology disorders

1. P R E P A R E D B Y
M U S H O P E R I T I N A S H E
TREATMENT OF
PSYCHOLOGICAL PROBLEMS

2. PSYCHOTHERAPY
 This is a treatment of individuals with emotional problems, behavioural
problems or mental illness primarily through verbal communication.
 Human ailments are organic or non-organic.
 Psychotherapy is a way of solving non-organic or psychological
problems by utilising different psychological approaches.
 Psychotherapy is the treatment of problems of an emotional nature by
psychological means.
 Psychotherapy is conducted by a trained, certified or licensed therapist.
In addition, treatment methods in psychotherapy are guided by well-
developed theories about the sources of personal problems.

3. Objectives of Psychotherapy
 Ego strength
 Self-integration
 Self-direction
 Therapy is directed toward modifying maladaptive
behaviour and fostering adaptive behaviour.
 The primary goal of therapy is to help the client
achieve more effective coping behaviour. The process
is a professional relationship between the therapist
and the client.

4. TREATMENT TECHNIQUES OF
PSYCHOLOGICAL DISORDERS

5. C L A S S I C A L P S Y C H O A N A L Y S I S
E G O A N A L Y S I S
P L A Y T H E R A P Y
PSYCHODYNAMIC THERAPY

6. Classical Psychoanalysis
 It is based on the idea suggested by Freud which says that the basic
sources of abnormal behaviour are unresolved past conflicts and
anxieties.
 According to classical psychoanalysis, individuals use defense
mechanisms to protect themselves from anxiety provoking conditions.
But these conflicts cannot be completely resolved by means of defense
mechanisms; because defense mechanisms are temporary strategies to
resolve psychological problems.
 To get rid of the anxiety-producing situations, individuals should bring
unwanted impulses out of the unconscious part of the mind into the
conscious part.
 Psychoanalysis uses a technique called free-association to explore and
understand the unconscious. In this technique, the patient (client) is
asked by the therapist to say aloud whatever thoughts or ideas that
come to his or her mind freely.

7. Cont’d
 The psychoanalyst recognises all forms of
information and makes connections between what
the client says and the repressed feelings.
 Dream analysis is another technique. Freud assumed
that during sleep hours, the use of defense
mechanisms is low. This allows the repressed wants
and desires to surface. The psychoanalyst moves
beyond the surface description of the client’s dream
and examines its underlying meaning.

8. Ego Analysis
 The goal of this therapy is to bring ego strength so
that individuals take active part in trying to control
their environment.
 The therapist assists the client in recognising his/her
conscious aims and capabilities and control the id.
 The process enables the client to select an optimum
means to change himself/ herself by active
interaction with the environment.

9. Play Therapy
 It is the application of psychoanalytic therapy on
children who cannot speak out their problems.
 In play therapy, the therapist observes the child in a
playroom. The therapist never criticises the child or
stops the child from displaying any varieties of play.
 From series of observations, the therapist tries to
determine the root cause of the child’s problems.

10. Comment on the Psychoanalytic Therapy
 Psychoanalysis is time consuming and expensive. A
client meets with his or her therapist an hour a day,
four to six days in a week, for several days.

11. BEHAVIOURAL THERAPY
 It is concerned with behavioural changes. It involves the
application of the principles of learning theories of operant
or classical conditioning.
 From behaviourist point of view all positive and negative
behaviours are primarily learned.
 Behaviourists’ theory employ the following four principles
of learning:
a) Every response is modifiable by the use of an appropriate system of
reinforcement.
b) Unlike psychoanalysis, behaviourism is least concerned with the past.
c) The past for the behaviourist is something which cannot be modified.
d) The behavioural therapy is not concerned with case history.

12. S Y S T E M A T I C D E S E N S I T I S A T I O N
A V E R S I O N T H E R A P Y
BEHAVIOURIST THERAPY
BASED ON CLASSICAL
CONDITIONING

13. Systematic Desensitisation
 It is the most successful treatment based on classical conditioning.
 Phobias, anxiety disorders, impotence and fear of sexual contact are
often treated successfully using this technique.
 Patients are taught to relax and then are shown pictures of their feared
object or problem, to desensitise them or reduce their unfavourable
response patterns.
 The threatening stimuli are systematically paired with less threatening
stimuli and proceed to more threatening representation of the real
object.
 The steps in relaxation technique are:
i. Relax one muscle group at a time.
ii. Then progressively the entire muscle groups are relaxed.
iii. Develop a list in order of increasing severity of the things that are associated with the
fears.

14. Aversion Therapy
 It is mainly used for addictions or unwanted
behaviours.
 In this technique, a negative feeling is attached to
stimuli, which are supposed to bring undesirable
behaviours.
 e.g for a person with drinking problem, an alcoholic
drink is paired with a drug that causes severe nausea
and vomiting.

15. BEHAVIOURAL MODIFICATION
THERAPY BASED ON OPERANT
CONDITIONING

16. General Remark
 It is a process for changing behaviour through the
application of operant conditioning principles.
 The goal is to shape behaviour, not to alleviate the problem.
 Different kinds of childhood problems e.g bedwetting,
thumb sucking, hyperactivity, poor school performance,
extreme social withdrawal are dealt using operant
conditioning techniques. The techniques are also effectively
used with autistic and mentally retarded children to
improve social skills.
 Reinforcers include praise, attention, financial
compensation, special foods, sweets or toys.

17. Biofeedback
 It is the process of providing information about the status of one’s
biological system.
 Electronic instruments measure biological responses and the status of
these responses is immediately available to the person being tested.
 This feedback allows the person to change his physiological responses
that cannot voluntarily be controlled without the biofeedback
information.
 The feedback can be supplied by way of auditory (dial), tactile
(temperature), or visual signals (flash light).
 The most common kind of biofeedback in clinical use is
electromyography (EMG) biofeedback.
 The EMG measures the level of electrical discharge which shows the
degree of tension or relaxation of the muscles.
 It is used to treat spasmodic disorders, facial tics, low back pain and
headaches.

18. Effectiveness of Behaviour Modification
 Turner and Chapman (1982) found that treatment
programs based on operant conditioning seemed to
increase patients’ level of physical activity and
decrease their use of medication.

19. Evaluation of Behavioural Therapies
 Behavioural therapies are criticised on the ground
that they only change overt behaviour and do not
consider underlying causes.

20. COGNITIVE APPROACHES TO THERAPY
 According to this approach, a person’s behaviour is strongly
affected by:
 That person’s beliefs
 Personal standards
 Feelings of efficacy
 Cognitive therapies concentrate on changing the
understanding of oneself and the environment rather
than changing the behaviour of the client.
 Therapists assist clients to change their perceptions,
to use reasoning and change thought-processes to
modify their behaviour.

21. Rational Emotive Therapy
 Albert Ellis (1962), who developed the Rational
Emotive Therapy noted that thoughts are the roots of
behavioural problems.
 According to him the goal of cognitive therapy is to
change irrational beliefs and thoughts to rational
ones. Logic and reasoning will enable clients to deal
effectively with their problems.
 Rational Emotive Therapy is used to help a person
develop rational statements regarding stressful
situations rather than eliciting statements that
worsen the situation

22. Beck’s Cognitive Therapy
 In Beck’s view, depressed people tend to have
negative views of themselves, interpret their
experiences negatively and feel hopeless about their
future. He sees these tendencies as a problem of
faulty thinking.
 Practitioners of Beck’s technique challenge the
client’s absolute extreme statements. They try to help
the client identify distorted thoughts and then
suggest ways of changing this thinking.

23. Pain Management Technique
 As applied to pain management technique, perceived self-
efficacy can relieve pain by decreasing stress and tension.
To achieve this, patients can pass through three stages:
The Conceptualisation Stage
• Patients are encouraged to accept that their problem has a
psychological component and therapy can help them in
alleviating their problem
Acquisition and Rehearsal of Skills
• Patients are taught relaxation and controlled breathing
skills.
• Patients are encouraged to direct their attention away from
the pain experience by concentrating on a pleasant scene.

24. Cont’d
Follow Through Phase of Treatment
• Clients are encouraged to undertake physical
activity and exercise greater feeling of self-efficacy.
• Clients receive medication on the basis of time
(schedule) rather than on reporting pain.
• Spouses and family members are taught how to
ignore pain behaviour.
• Developing a post treatment plan for coping with
future pain.

25. Evaluation of Cognitive Approaches to
Therapy
 The cognitive-behavioural therapists pay attention to
what their clients perceive to be.

26. HUMANISTIC THERAPY
 This therapeutic technique is based on the philosophical perspective of
self-responsibility in developing treatment techniques.
 The underlying ideas are :
 We have control of our own behaviour
 We can make choices about the kinds of lives we want to live.
 It is up to us to solve the difficulties that we encounter in our daily lives.
 The role of the therapist in this technique is to facilitate the therapeutic
procedure so that people could come closer to the ideal condition for
themselves e.g Rogers’ Person-Centred Therapy.
 Accordingly, psychological disorders are the result of people’s inability
to find meaning in life and of feeling lonely and unconnected with
others.

27. E X I S T E N T I A L T H E R A P Y
P E R S O N - C E N T R E D T H E R A P Y
G E S T A L T T H E R A P Y
Influential Forms of
Humanistic Therapy

28. Existential Therapy
 Based on a philosophical approach to people and their existence,
existential therapy deals with important life themes which include
living and dying, freedom, responsibility to self and others, finding
meaning in life and dealing with a sense of meaningless.
 Existential therapists help their clients confront and explore anxiety,
loneliness, despair, fear of death and the feeling that life is meaningless.
 Existential therapists draw on techniques from a variety of therapies.
One common existential therapy is logotherapy developed by Viktor E.
Frankl (logos is Greek for meaning)

29. Person Centred Therapy
 Originally called client-centred therapy.
 Was developed by Carl Rogers.
 Rogers believed that every individual has free will and the capacity for
growth, maturity and life enrichment. Within each person, Rogers
believed, is the capacity for self understanding and constructive change.
 This therapy emphasises understanding and caring rather than
diagnosis, advice and persuasion. Rogers strongly believed that the
quality of the therapist-client relationship influences the success of
therapy. He felt that effective therapists must be genuine, accepting and
empathic.
 A genuine therapist expresses true interest in the client and is open and
honest.
 An accepting therapist demonstrates a deep understanding of the
client’s thoughts, ideas, experiences, feelings and communicates this
empathic understanding to the client.

30. Cont’d
 Rogers believed that when clients feel unconditional positive regard
from a genuine therapist and feel empathically understood, they will be
less anxious and more willing to reveal themselves and their
weaknesses.
 This leads clients to better understand their own lives, move toward
self-acceptance and can make progress in resolving a variety of
personal problems.
 Person-centred therapy uses an approach called active listening to
demonstrate empathy- letting clients know that they are being fully
listened to and understood.

31. Gestalt Therapy
 Was developed by Frederick (Fritz) Perls.
 Gestalt therapy tries to make individuals tale responsibility for their
own lives and personal growth and to recognise their capacity for
healing themselves. However Gestalt therapists are willing to use
confrontational questions and techniques to help clients express their
true feelings.
 The general goal of Gestalt therapy is awareness of self, others and the
environment that brings about growth, wholeness and integration of
one’s thoughts, feelings and actions.
 One of the best known Gestalt techniques is the empty-chair technique
in which an empty chair represents another person or another part of
the client’s self.
 The empty-chair technique reflects Gestalt therapy’s strong emphasis
on dealing with problems in the present.

32. GROUP THERAPY
 All of the individual therapies can also be used with
groups.

33. Advantages of group Therapy
 Cheap – group members share the cost.
 Efficient- group therapy allows a therapist to provide
treatment to more people than would be possible
otherwise.
 It allows people to hear and see how others deal with
their problems.
 Group members receive vital support and
encouragement from others in the group. They can
try out new ways of behaving in a safe, supportive
environment and learn hoe others perceive them.

34. Disadvantages
 Individuals spend less time talking about their own
problems than they would in one-on-one therapy.
 Certain group members may interact with other
group members in hurtful ways like yelling at them
or criticising them harshly.
 Confidentiality – though group members promise
confidentiality some group members may not trust
this thus leading them to become reluctant to
disclose all of their problems hence lessening the
effectiveness of therapy to them.

35. Format of Group Therapy
 Groups vary widely in how they work.
 Typical group size is from six to ten people with one or two therapists.
 Some groups are open or drop-in groups where new clients may join at
any time and members may attend or skip whatever sessions they
desire.
 Other groups are close and admit new members only when all members
agree. Regular attendance is required. Explanation for missing a
session is required by therapist and group members.
 Therapists clarify goals of the group and for whom it is appropriate.
 Sometimes therapists prefer diversity among group members in terms
of age, gender and problem. In other cases, group membership is
limited to individuals with similar problems and backgrounds.
 Techniques used in group therapy depend with the theoretical
orientation of the therapists (humanistic, cognitive-behavioural,
psychoanalytic)

36. P S Y C H O D R A M A
S E L F H E L P G R O U P S / S U P P O R T G R O U P S
Forms of Group Therapy

37. Psychodrama
 Was developed by Jacob L. Moreno, Austrian
psychiatrist in the 1920s.
 Participants in psychodrama act out their problems
often on a real stage and with props as a means of
heightening their awareness of them. The therapist
serves as the director, suggesting how participants
might act out problems and assigning roles to other
group members.
 Groups who use psychodrama may do so weekly or
simply as a one-time demonstration.

38. Self Help Groups/ Support Groups
 This involves people with a common problem who meet
regularly to share their experiences, support each other
emotionally and encourage change or recovery. They are
usually free of charge to interested participants.
 Self-help groups are not strictly considered psychotherapy
because they are not led by a license mental health
professional. However, they can serve as an important
source of help for people in emotional distress.
 Examples: Alcoholics Anonymous, Self Help Groups for
PLWHAs, cancer patients, parents whose children have
been murdered, compulsive gamblers, battered women,
obese people e.t.c.

39. FAMILY THERAPY
 It involves the participation of one or more members
of the same family who seek help for troubled family
relationships or the problems of individual family
members.
 Typical problems that bring families into therapy are
child or adolescent delinquent behaviour, child’s
poor academic performance, hostilities between a
parent and a child or between siblings and severe
psychological disturbance or mental illness in a
parent or child

40. Family Systems Therapy
 It views the family as a single, complex system or unit. Individual
members are interdependent parts of the system.
 Rather than treating one’s person’s symptoms in isolation, therapists
try to understand the symptoms in the larger context of the family.
 Therapists work from the rationale that current family relationships
profoundly affect and are affected by an individual family member’s
psychological problems. Thus most family therapists prefer to work
with the entire family during a session, rather than meeting with family
members individually.
 In most family therapy sessions, the therapist encourages family
members to air their feelings, frustrations and hostilities. By observing
how they interact, the therapist can help them recognise their roles and
relationships with each other. The therapist avoids assigning blame to
any particular family member. Instead, the therapist makes suggestions
about how family members might adjust their roles and prevent future
conflict.

41. INTEGRATIVE OR ECLECTIC THERAPY
 It involves using ideas and techniques from a variety of
therapies.
 Many therapists like the opportunity to draw from many
theories and not limit themselves to one or two.
 Most therapists who adopt this approach have a rationale
for which techniques they use with specific clients rather
than just choosing an approach randomly or because it
suits them at the time.
 One of the most influential eclective approaches is cognitive
behavioural therapy. Other eclectic approaches use other
combinations of therapies.

42. C O G N I T I V E - B E H A V I O U R A L T H E R A P Y
O T H E R E C L E C T I C A P P R O A C H E S
Forms of Eclectic/ Integrative
Approach

43. Cognitive-Behavioural Therapy
 There are almost no pure cognitive or behavioural
therapists.
 Cognitive-behavioural therapy is a combination of cognitive
and behavioural techniques in therapy.
 Cognitive-behavioural therapy has rapidly become one of
the most popular and influential forms of psychotherapy, in
part because it takes a relatively short period of time
compared to humanistic and psychoanalytic therapies and
also because of its ability to treat a wide range of problems.

44. Other Eclectic Approaches
 Some therapists adhere to one theory of personality but use many
techniques from a variety of theories.
 Some use two or three theories of personality and only use techniques
to bring about change that are consistent with those theories.
 Some have combined psychodynamic and behavioural therapies in
ways to help their clients deal with fears and anxieties but also
understand their causes.
 Therapists may use different approaches to treat different problems e.g
for grieving clients, a therapist may realise that a client may respond
best to a humanistic approach, in which they can share their grieving
and their hurts with the therapist. However the same therapist may use
a cognitive –behavioural approach with a person who reports being
anxious most of the time.

45. D R U G T H E R A P Y
E L E C T R I C A L S T I M U L A T I O N
P S Y C H O S U R G E R Y
MEDICAL
THERAPIES/PSYCHIATRIC
CARE

46. DRUG THERAPY
 Drugs for psychological problems were introduced in the mid 1950s
leading to deinstitutionalisation. People with mental problems could
now return to the community and live productive lives. Since then
drugs have been manufactured even some of great effectiveness.
 These drugs often relieve symptoms of schizophrenia, depression,
anxiety and other disorders. However they may produce undesirable
and sometimes serious effects. In addition relapse may occur when they
are discontinued so long-term use may be required.
 Drugs that control symptoms of mental illnesses are called
psychotherapeutic drugs. The major categories include antipsychotic
drugs, anti-anxiety drugs, antidepressant drugs and anti-manic drugs.

47. Antipsychotic Drugs/Neuroleptics/Major
Tranquilisers
 Control symptoms of psychosis e.g hallucinations and
delusions which characterise schizophrenia and related
disorders.
 Prevent such symptoms from returning.
Side Effects
• Dry mouth
• Blurred vision
• Tardive dyskinea, a permanent condition that produces
involuntary movements of the lips, mouth and tongue.

48. Anti-anxiety Drugs/ Minor Tranquilisers
 Reduce high levels of anxiety.
 May help people with generalised anxiety disorder,
panic disorder and other anxiety disorders.
 The most widely prescribed antianxiety drugs are
benzodiazepines.
Side Effects
• Can be addictive
• May cause drowsiness and impaired coordination
during the day

49. Antidepressant Drugs
 Help relieve symptoms of depression.
 Some can relieve symptoms of other disorders such as panic disorder
and obsessive-compulsive disorder.
 There are three classes of antidepressant drugs namely tricyclics,
monoamine oxidase inhibitors (MAO inhibitors) and selective
serotonin reuptake inhibitors (SSRIs).
Side Effects of Tricyclics
• Dizziness upon standing
• Blurred vision
• Dry mouth
• Difficulty urinating
• Constipation
• Drowsiness

50. contd
Side Effects of MAO Inhibitors
• Some effects are similar to those of tricyclics
• People who take them must follow a special diet that excludes certain
foods.
Side Effects of SSRIs
 Generally have fewer side effects
 Anxiety
 Drowsiness
 Sexual Dysfunction
Prozac is the most widely prescribed anti-depressant drug.

51. Antimanic Drugs
 Help control the mania that occurs as part of bipolar
disorder.
Common Side Effects
 Nausea
 Stomach upset
 Vertigo (sensation of spinning around or of seeing nearby objects revolve)
 Long term use of lithium can damage the kidneys.
 One of the most effective antimanic drugs is lithium
carbonate.

52. ELECTRICAL STIMULATION
 Electroconvulsive therapy (ECT) is a treatment for severe
depression in which an electrical current is passed through
a patient’s brain for one or two seconds to induce a
controlled seizure. The treatments are repeated over a
period of several weeks.
 ECT often relieves severe depression even when drug
therapy and psychotherapy have failed but reasons are
unknown.
Side Effects of the Treatment
 Confusion and memory loss which are usually temporary.

53. PSYCHOSURGERY
 This is more controversial than the ECT..
 It is the surgical removal or destruction of sections of
the brain in order to reduce severe and chronic
psychiatric symptoms. The best known example of
psychosurgery is the lobotomy developed by Antonio
Egas Moniz that was widely performed in the 1940s
and early 1950s.
 Psychosurgery is now rarely performed because no
research has proven it effective and because it can
produce drastic changes in personality and
behaviour

54. HOSPITALISATION
 Treatment of mental illness takes place in a number of settings. Mental
hospitals or psychiatric wards in general hospitals are used to treat
patients in acute phases of their illnesses and when the severity of their
symptoms requires constant supervision. Most individuals who suffer
from severe mental illness, however do not require close attention and
the can usually receive treatment in community settings.
 Often patients who have just completed a period of hospitalisation go to
group homes or halfway homes before turning to independent living.
These facilities offer patients the opportunity to take part in group
activities and to receive training in social and job skills.
 In supportive housing, mentally ill individuals can live independently
in an environment that offers an array of mental health and social
services. Some people with chronic and severe mental illnesses require
care in long-term facilities such as nursing homes, where they can
receive close supervision.

55. contd
 Unfortunately, many areas lack treatment centres
especially community mental health centres and
supportive housing environments. This shortage may
partly account for the homelessness of many
mentally ill people.

56. TREATMENT IN NON-WESTERN
COUNTRIES
 Most non-western countries still lack adequate
treatment facilities and services for the mentally ill.
 Psychiatrists are few. Most treatment come from
general physicians.
 Traditional healers, spiritual leaders and prophets
play a significant role in the treatment of
psychological disorders.

57. END