# Introduction to psychology/Psy102/Tutorials/Therapies for psychological disorders

Therapies for psychological disorders

## Goals

* To explain and understand the main psychological disorders and the main types of psychological therapies
* To examine the application of one particular psychologist therapy, transactional analysis, in more detail

## Tutor preparation

* Revise Gerrig et al. (2008) Chapter 15: Therapies for psychological disorders (and possibly also Ch 14: Psychological disorders) so that you can reiterate relevant key points from the reading. Remember, the corresponding lecture/reading isn't until Week 6.

## What you will need

* Watsford's (2008) wounded healer study abstract (handout)
* Psychological paradigm assumptions and example therapies (handout)
* List of psychological therapies (handout)
* Summary of transactional analysis (handout)
* Chocolates for those who survived the operant conditioning exercise from the previous tutorial

## What are the main types of psychological disorders? (5 mins)

What are the main types of psychological disorders and what are their main/typical symptoms?
| Disorder | Examples |
| Anxiety disorders | Generalised Anxiety Disorder, Panic Disorders, Phobias, Obsessive-Compulsive Disorder, Post-traumatic Stress Disorder |
| Mood disorders | Major Depressive Disorder, on, Bipolar Disorder |
| Personality disorders | Borderline Personality Disorder, Antisocial Personality Disorder |
| Somatoform and dissociative disorders | Hypochondria, Dissociative Identity Disorder (multiple personality disorder) |
| Schizophrenic disorders | Disorganised, Catatonic, Paranoid, Undifferentiated, Residual Schizophrenia |
| Childhood disorders | ADHD, Autism |
What is the prevalence of mental disorders?
* More than one in three people report sufficient criteria for at least one diagnosis at some point in their life up to the time they were assessed.
* Anxiety disorders are the most common, followed by mood disorders, while substance disorders and impulse-control disorders are less prevalent. Rates varied by region.
* Such statistics are widely believed to be underestimates, due to poor diagnosis and low reporting rates

## What is psychological therapy? (15 mins)

* Invite the class to define therapy, and more specifically, psychological therapy. Consider/discuss:
** Does psychological therapy necessarily need to be provided by a qualified clinical psychologist?
** Could/should a good friend or some other relationship provide psychological therapy? Why or why not?
** What are the pros and cons of psychological therapy provided by clinical psychology qualified vs. non-qualified therapists?
** Does one need to have a psychological problem in order to benefit from therapy?
* Ask class to distinguish between (explain the differences/commonalities between):
** Psychiatry: The branch of medicine which deals with the treatment of mental disorders. A psychiatrist has a medical degree and specialist psychiatric training.
** Counseling: Seeks to listen to clients' life difficulties and reflecting back to the client that he or she is being heard. Usually helps guide clients' towards solution strategy e.g., relationship counseling. Counselors can come from a variety of backgrounds e.g., telephone crisis counselors.
** Social work: Social workers are concerned with social problems, their causes, their solutions and their human impacts. They work with individuals, families, groups, organizations and communities.
** Psychotherapy: Intentional interpersonal relationship used to aid a client in problems of living and to increase individuals' well-being. Psychotherapy may be performed by practitioners with a number of different qualifications, including psychologists, marriage and family therapists, occupational therapists, licensed clinical social workers, counselors, psychiatric nurses, psychoanalysts, and psychiatrists.
** Clinical psychology: In many countries clinical psychology is a regulated mental health profession. It focuses on the scientific study and application of psychology for the purpose of understanding, preventing, and relieving psychologically-based distress or dysfunction and to promote subjective well-being and personal development. Central to its practice are psychological assessment and psychotherapy - see also about psychologists (Australian Psychological Society)
* Should psychologists be able to prescribe medication? (Note: Gerrig et al. (2008) Ch15 reviews psychopharmacology)
** Some have argued that it is ludicrous that general medical practitioners, who may have no psychological training at all, are able to prescribe the entire range of psychoactive drugs for treating psychological problems, while psychologists, who specialise in treating psychological issues, cannot prescribe any medications.
** Historically, most psychologists have not had training in pharmacology, however in recent years, many graduate programs in psychology have added coursework in physiology and pharmacology.
** While most would agree that psychologists probably should not be able to prescribe nonpsychoactive medications, the wisdom of prohibiting them from prescribing any medications seems doubtful. How do students feel about this issue?

## The wounded healer (10 mins)

* Explain the wounded healer hypothesis (Jung derived the term "wounded healer" from the ancient Greek legend of Asclepius, a physician who in identification of his own wounds creates a sanctuary at Epidaurus in order to treat others) and invite comment/discussion, perhaps considering:
** Is it desirable for psychological "healers" themselves to be have been or currently be psychologically "wounded"? Why or why not?
** Provide the one page handout of Watsford (2008)'s wounded healer study and discuss. Note: In addition to the content of this abstract, handing it out is also intends to provide an example of a good abstract for the essay - although for a 1,500 word essay the abstracts should be ~ 150 words (this one is ~ 250 words)
** Use this discussion to also explain Transference and counter-transference during psychotherapy:
*** Transference: Redirection of a client's feelings from a significant person to the therapist.
*** Countertransference: Redirection of a therapist's feelings toward a client, or more generally as a therapist's emotional entanglement with a client.
* Mention the university's health and counseling centre as the recommended place to go if/when students themselves are having psychological difficulties

## Psychological therapy paradigms (10 mins)

Firstly, consider what is a paradigm? Possible answers include:
* The set of practices that define a scientific discipline during a particular period of time (Kuhn)
* A pattern of thinking which induces bias.
* A conceptual framework for analysis of observations (Kuhn).
* A set of assumptions that govern our observation processes and analyses.
* A set of rules that a group of researchers/practitioners follow in observation and analysis.
Then consider:
* What are the major psychological therapy paradigms?
* What are the main assumptions made by these therapeutic paradigms?
* How does each of these paradigms approach psychological therapy?
| Paradigm | Assumptions | Examples |
| Psychodynamic | Memories of childhood and unresolved developmental challenges (repressions) influence adult relations and individual psychological phenomena | Psychotherapy, Transactional analysis |
| Behaviour therapies | All thinking, feeling, and emotion is learned; acquired and extinguishable through classical and operant conditioning | Behaviour modification |
| Cognitive therapies | Mental representations of concepts (thought structures) determine how people think, feel, and behave; thus, if thinking is changed, so does feeling and behaviour | CBT, Rational Emotive Therapy |
| Humanistic therapies | Humans are best understood and treated as whole individuals who are in search of meaning and self-actualisation. | Client-centered therapy, Gestalt therapy, Logotherapy |
| Group therapies | Psychological problems are to be understood and treated as a result of dysfunctions in the family and social context. | Family systems therapy |
| Biomedical therapies | Psychological problems arise from physiological and particularly neurochemical imbalance that can be treated via techniques which restore and optimise brain chemistry balance. | Physical exercise, nutritional therapy, psychopharmacology: e.g., Lithium for Bipolar, Anti-depressants such as (Selective Serotonin Reuptake Inhibitors) for anxiety and depression, stimulants for ADHD |

## Therapies and paradigms (20 mins)

Participants arrange themselves in groups of 3 to 4 and then attempt to sort this list of therapies into the most appropriate paradigm categories.
* Acceptance and commitment therapy
* Analytical psychology
* Animal-assisted therapy
* Art therapy
* Attachment therapy
* Aversion therapy
* Behavior modification
* Bibliotherapy
* Biofeedback
* Cognitive behavior therapy
* Dance therapy
* Drama therapy
* Family therapy
* Group therapy
* Hypnotherapy
* Logotherapy
* Mindfulness-based Cognitive Therapy
* Narrative Therapy
* Parent-Child Interaction Therapy
* Play therapy
* Primal therapy / Rebirthing-Breathwork
* Rational Emotive Behavior Therapy
* Recovered Memory Therapy
* Relationship counseling
* Relational Empowerment Therapy
* Reality therapy
* Solution focused brief therapy
* Somatic Psychology
* T Groups and Encounter groups
* Transactional Analysis
* Twelve-step programs
* Wilderness therapy
(from List of psychotherapies; see also list of therapies)
Not all of these will fit neatly into one of the paradigms
* Perhaps they relate to several of the paradigms?
* Perhaps they represent entirely different assumption?

## Patient-therapist scenarios and treatment paradigms (30 mins)

* Invite each participant to nominate a (hypothetical or real) psychological problem for themselves - it can be big or small - that they would like to address/improve/resolve.
* On a piece of paper, briefly describe the problem and the symptoms.
* Divide the class into therapists and patients/clients.
* Invite the class to mingle and for each therapist to find a patient (i.e., pair off).
* Therapists should seek to find out:
** What is the patient's problem? (Descriptively rather than diagnostically)
** Discuss with the patient how the problem could be addressed therapeutically from each of the major perspectives.
* Ask the clients to identify to the therapist what kind of therapeutic paradigm they think would be most appropriate in their situation.
If there is enough time and it seems appropriate, swap roles, re-mingle and repeat.

## Transactional analysis (20 mins)

* Explain transactional analysis - e.g., by summarising key points from and Thomas Harris' I'm OK, You're OK and Eric Berne's Games People Play - hand around these books for students to look at - in this day and age its important to introduce students to books!
* TA is an example of a systems approach to analysis and treatment of psychological problems (e.g., it focuses on dynamic relationships), but it has a strong grounding in and emerges from the psychodynamic tradition (e.g., the P-A-C model) and reflects aspects of humanistic psychology (e.g., focus on self-esteem). Summary of key ideas of transactional analysis.
   that emotionally intense memories from childhood are ever-present in adults. Their influence can be understood by carefully analysing the verbal and non-verbal interchanges (‘transactions’) between people... TA defines basic units through which human behaviour can be analysed — the ‘strokes’ that are given and received in a ‘transaction’ between two or more people. A standardised language for describing those strokes makes the model more easily understandable by non-specialists, compared with earlier abstract models such as that put forward by Freud.
   — I'm OK, You're OK
* Freud's ego-structure: id, ego, super-ego
* Ego-states (Parent-Adult-Child (PAC) model) - also see PAC model and functions of the ego states (ta-tutor.com)
| Paradigm | Assumptions |
| Parent | A state in which people behave, feel, and think in response to an unconscious mimicking of how their parents (or other parental figures) acted, or how they interpreted their parent's actions. For example, a person may shout at someone out of frustration because they learned from an influential figure in childhood the lesson that this seemed to be a way of relating that worked. |
| Adult | A state of the ego which is most like a computer processing information and making predictions absent of major emotions that cloud its operation. Learning to strengthen the Adult is a goal of TA. While a person is in the Adult ego state, he/she is directed towards an objective appraisal of reality. |
| Child: | A state in which people behave, feel and think similarly to how they did in childhood. For example, a person who receives a poor evaluation at work may respond by looking at the floor, and crying or pouting, as they used to when scolded as a child. Conversely, a person who receives a good evaluation may respond with a broad smile and a joyful gesture of thanks. The Child is the source of emotions, creation, recreation, spontaneity and intimacy. |
* Ego-states can create various relationship patterns (transactions), e.g.,
** Complimentary (reciprocal and likely to be sustained)
** Crossed
** Ulterior (it looks reciprocal, but there is ulterior motive (hidden game) which becomes apparent later)
* Example "complimentary" transactions:
** Adult-Adult
*** -ve: Adult giving dull and dry data
*** +ve: Adult giving interesting data
** Child-Child
*** -ve: Child whining and sniveling
*** +ve: Child curious & fun cooperation
** Parent-Parent
*** -ve: Parent fighting with another Parent about “proper” values
*** +ve: Parent discussing with another Parent about “proper” values
** Parent-Child
*** -ve: Parents nagging children
*** +ve: Parents nurturing children
* Hooks e.g., being in Child tends to hook Parent
* Strokes - our need to feel OK - we need many more positive strokes than negative strokes
* Games and scripts e.g.,
** I'm OK - You're not OK
** I'm not OK - You're not OK
** I'm not OK - You're OK
** I'm OK - You're OK
* Invite examples of relationship problems and consider these from a TA perspective and ways that TA might be used to help change the relationship