Unit 8: clinical Psychology

Miss Crossman

Chapter 15: Abnormality, therapy, and social issues

Essential Questions: What is the DSM V?
How have psychological disorders been viewed historically and in modern times?

How does psychology mix with the legal system?

15.1 Abnormal Behavior and Overview

Caution!

What is abnormal behavior?

You may find that you have share some of the symptoms of some of the disorders we are about to learn

A diagnosis of a psychological disorder should be reserved for people whose problems seriously interfere with their lives.

The APA defines it as any behavior that leads to distress, disability, an increased risk of death, pain, and loss of freedom

We may want to only include undesirable behaviors

Cultural & historical influences on abnormality

• In the middle ages, many treated mental illness as demonic possessions and they were treated with religious rituals

• Sudanese women example-women did not have rights, only the husbands. If a woman was demon possessed, he could not punish her because it was the demon talking not the wife. This led to quite an increase in demonic possession

• Running amok: in Southeast Asia, someone runs around engaging in indiscriminate violent behavior

Dissociative Identity Disorder

• DID, previously called Multiple Personality Disorder is when someone alternates among two or more distinct personalities.

• The DSM 5 lists the following criteria must be met to in order to have a diagnosis of Dissociative Identity Disorder

• The individual experiences two or more distinct identities or personality states (each with its own enduring pattern of perceiving, relating to, and thinking aboutthe environmentand self). Some cultures describe this as an experience of possession.

• The disruption in identity involves a change in sense of self, sense of agency, and changes in behavior, consciousness, memory, perception,cognition, and motor function.

• Frequent gaps are found in the individual’s memories of personal history, including people, places, and events, for both the distant and recent past. These recurrent gaps are not consistent with ordinary forgetting.

• The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D.I.D Continued…

• Before the 1950s, this wasnot a common diagnosis AT ALL

• The popularity of several books and movies drove diagnoses through the roof in the 70s and 90s

• Suggestion could be causing some of the symptoms:

• Some therapists suggested to patients with vague symptoms that perhaps they had other personalities.

• In some cases they used hypnosisto explore that possibility, inadvertently implanting a suggestion while people were in a state of increased suggestibility

• Still a hotly contested diagnosis.

The Bio-psycho-social model

•Biopsychosocial model: abnormal behavior has three major aspects: biological, psychological, and sociological.
• Biological-genetic factors, lack or excess neurotransmitters, abnormal brain development, brain damage, tumors, infectious disease, poor diet, sleep, drugs, etc

• Psychological-a person’s vulnerability to stressful events • Ex: child abuse→morelikely to develop mental illness later
• Social: looking at a person’s behavior in its social and cultural context • Ex: family dynamics

Classifying Psychological disorders

• To create a standardized way of diagnosing patients, psychologists created theDiagnostic Statistical Manual (DSM), which sets specific criteria for eachpsychological diagnosis.

• Currently, we are in the 5th edition, so it is called the DSM V

• Current diagnostic criteria:

• Neurodevelopmental disorders • Bipolar and Related Disorders • Anxiety disorders
• Traumaand stressor-related disorders • Somatic symptomdisorders
• Elimination disorders

• Sexual dysfunctions

-Schizophrenia spectrum & other psychotic disorders -Depressive disorders
-Obsessive Compulsive-and related disorders -Dissociative Disorders
-Feeding/eatingdisorders -Sleep-wake disorders
-Gender dysphoria

• Disruptive, impulse control and conduct disorder -Substance-related and addictive disorders

• Neurocognitive disorders

• Paraphilia disorders

-Personality disorders

-Other mental disorders

Criticisms of the Dsm v

•Criticisms of DSM-V

• The distinction between normal and abnormal can seem arbitrary at times (5 months of a problem is not a disorder, but 6 months is).

• Is it an adjustment to a life stressor, or is it a mental illness?

• Statistics on prevalence of disorders are uncertain and at times seem inflated. • To what extent is the situation the problem, rather than the person?
• How much and how often?

DSM continued

-There is a stigma associated with receiving a mental health diagnosis.

-It is possible that as many as 50% of the population has a diagnosable mental illnessat some time in their lives (according to the standards of the DSM-V).
Most common: mood disorders, anxiety disorders, impulse control disorders, adhd, conduct disorders, substance abuse disorders

-If this is true, people with psychological disorders are not different from the rest of us.

Is anyone normal?

15.2-Psychotherapy-an overview

• Psychotherapy: a treatment of disorders with methods that include a personal relationship between the therapist and the client

• Can be helpful for:

• People with mental health issues

• People who want to improve their lives

• People who have mild worry/stress in their lives

Trends in psychotherapy

•Prior to WWII, almost all psychotherapists were psychiatrists too

•In the 40s and 50s, most were Freudians, who saw their patients frequently, if not daily
• Health insurance did not cover psychiatric issues, so really only the wealthy people saw psychotherapists

•Research was not done at this time to check for the helpfulness of these treatments

•Diagnoseswould be vague: “neurotic” or “psychotic”

Psychotherapy today

•Insurance companies today have introduced procedures that ensure people are getting evidence-based treatment practices, and not spending money needlessly

•Results of this shift:
• Therapists have listed more diagnoses so more patients can get help covered under insurance
• Therapists try to make a more streamlined process, so that patients get the best care in the smallest amount of sessions
• There has been extensive research on the effectiveness of psychotherapy
• Sometimes, HMOs want the quickest, cheapest option, that doesn’t always maximize proper treatment for the patients

• Ex: drug addict only gets 30 days covered in a treatment facility, really needs 3 months

Types of therapies

• PSYCHOANALYSIS:

• Psychodynamic therapies attemptto relate personalityto theinterplay of conflicting impulses within theindividual, including some that the individual may not consciously recognize.

• Adler and Freud bothlooked for unconscious motives (sexual, power, superiority) so they are bothconsidered psychodynamic

• Psychoanalysis: a method based on identifying unconscious thoughts and emotions and bringing them to consciousness to help people understand their thoughts and actions.

• “an insight orientedtheory”-doesn’t try to change the behaviors or thoughts

• Freud believed to rid yourself of your problems, you just needed to make your unconscious processes conscious

• Point was catharsis

Psychoanalysis cont.

• Free association: a patient thinking about a particular symptomor problem and then reports everything that comes to mind—a word, a phrase, a visual image
• Therapists listen to the things they say and try to uncover a theme

• Transference: Someclients express love or hatred for their therapist because he or she unconsciously reminds them of someone else.

• Psychoanalysts try to interpret the meaning of their patients’ words and behaviors, which they hope to uncover the unconscious process

Behavior therapy

• Behaviorists assume that behavior is learned and so then a behavior can be unlearnedor a different, better behavior can be reinforced

• Behavior therapy: begins with clear, well defined behavior goals, and then attempts to achieve those goals through learning

• By setting clear goals, the therapist can determine the effectiveness of the treatment

• Ex: helping a child to stop wetting the bed • Loud noise (UCS)→waking up (UCR)
• Full bladder (NS) + Loud noise (UCS)→Waking up (UCR) • Full bladder (CS)→waking up (CR)

Cognitive therapy

• Cognitive therapy: tries to help a person by changing their thoughts and beliefs • Patient: “Nobody likes me.”
• Therapist: “Where’s the evidence that that is true?

• Works to help a patient with particular problems, gain social skills, and be more active in their life (internal locus)

• Rational-emotive therapy:assumes that thoughts lead to emotions. The problem is not the emotions, but the irrational thoughts leading to them.

• Therapists try to identify patients’ irrational beliefs and help them to contradict them

Cognitive-Behavior therapy (cbt)

• CBT: CBT therapists set explicit goals for changing people’s behavior, but they place more emphasis than most behavior therapists do on changing people’s interpretation of their situation.

• Try tohelp patients understand the differences between serious and trivial problems

• help clients change their interpretations of past events, current concerns, and future possibilities

• One of the most widely used methods in the UnitedStates

Humanistic therapy

• Humanist therapists try to reduce the incongruencea person feels between their real self and ideal self

• Carl Rogers developed person-centered therapy: The therapist listens to the clientwith total acceptance and unconditional positive regard

• The therapist will restate what the patient is saying in order to provide empathy and understanding

• Person-centered therapists mainly listen, and rarely offer any advice or interpretation. Just genuine, caring listening

• Therapist tries to convey that the patient can make their own decisions

• Very few people use this alone today. Many therapists do try to adopt this method of developing a caring, empathetic relationship though

Family systems therapy

• Family systems: guiding assumptions are that most people’s problemsdevelop in a family setting and that thebest way to deal with themis to improve family relationships and communication.

• It is not an alternative method:uses cognitive, behavioral, and other techniques to conduct family therapy

• Ex: anorexic daughter has demanding parents

Eclectic therapy: therapists who use a variety of different therapiesto treat patients

Group therapy: therapy given to more than one person at a time

Brief therapy: therapist and client reach an agreement about what they can expect from each other and how long the treatment will last (ex: 2 times a week for 2 months)

• Most people do not requiredlong lasting therapy

• ½ of people report improvement after 8 sessions

• 75% of people report improvement within 26 sessions

Self-Help Groups: operates like group therapy, but without a therapist (ex: Alcoholics Anonymous)

• Can be very beneficial for people (lessexpensive too)

Psychotherapy trends

Effectiveness of psychotherapy

• Most people improve their psychological condition within a year or two without therapy: spontaneous remission

• To determine effectiveness, psychologists have conducted a meta-analysis, taking the results of many experiments, weighting each one in proportion to the number of participants, and determining the overall average effect.

• One meta-analysis found that the average person improves significantly more with therapy than 80% of people with similar troubles who don’t get therapy

Comparing therapies and therapists

•Research suggests that the various methods of therapy and professionals who provide services are about equally effective. There is no “best” type of therapist or best method.

•But no one way of doing psychotherapy is right for every client. You need to use your knowledge to “shop” for the therapist who will work best with you.

•Consulting a therapist does not mean that something is wrong with you. Many people merely want to talk with someone about difficulties they are facing.

Module 15.3-Social and legal aspects

What is de-institutionalization? What were its effects?

What wastheTarasoff case and

why is it important?

of treatment

How canwepreventmental

illness?

deinstitutionalization

• In the 1800s and 1900s, many people with severe mental problems were confined to state-run mental hospitals • These hospitalswereovercrowdedandunderstaffed

• Since the1950s,thepushhas been towards deinstitutionalization: the removal of patients from mental hospitals

• Results: many of the patients discharged from mental hospitals became homeless, especially those who had lost contact with their relatives and those with substance-abuse problems
• Some went to nursing homes, others prison

Involuntary commitment

• In the case of people with severe mental health problems, the right to live freely among others can come into conflict with the rights of others.

• If a person’s mental state represents a serious dangerto self, others or causes the individual to be completely unable to care for him or herself, serious ethical issues are raised.

• In most states, a judge can order a mental patient who is dangerous to be involuntarily confined to a mental hospital
• Also, if a person becomes incompetentthey can be involuntarily committed

Commitment cont.

•Problems with involuntary commitment:

• some seriously disordered people fail to recognize that they have a problem

• People have been committed to mental hospitals just to be put “out of the way.”

• It is extremely difficult to determine which patients should be committed.

•Usually the opinion of one or more trained professionals plus court action must be obtained in order to commit a person with a mental illness.

•Even after commitment, the patient is always given the right to refuse specific treatments.

Confidentiality and duty to protect

•Tarasoff case: a therapist who has reason to believe that a client is dangerous must break the pledge of confidentialityand warn the endangered person

•Judging dangerousness is not a clear-cut matter and the therapist must often weigh carefully the factors. Breach of confidentialityis a serious violation of the patient’s rights.

The insanity defense

• Insanity is a legal term, not a psychological or medical term, and its definition is based on politics more than science.

• Its definition is more judicial than scientific.

• Bizarre crimes in and of themselves do not demonstrate insanity.

• The most famous definition of insanity is based on the M’Naghtenrule, from 19th Century British law.

• people must be so disordered that they do not understand what they are doing

• Psychologists and psychiatristsare used as expert witnesses to determine “sanity”

• the only insanity cases that come to a jury trial are the difficult ones in which the experts disagree

Preventing mental illness

Some psychologists, especially community psychologistshave started to create movement towards preventing mental illness

• Community psychologists focus on the needs of groups rather than individuals

Interventioninvolves identifying a disorder in its early stages and relievingit.

Prevention methods are aimed at stoppingmental illness before it begins.

• Ban toxins, educatepregnant women about prenatal care, outlaw smoking in public areas, deal with unemployment, provide child care, improve educational opportunities

Maintenance is taking steps to prevent an illness from becoming more serious.