Week 7: Treatment of Psychological Disorders


There are over 400 brands/types/approaches

Why so many?

No agreement on what is best theory to base treatment on

No clear evidence that one treatment is "best"

Some problems remain intractable; people keep coming up with new approaches in quest to improve success


NOTE: Usually tied to a particular theory of etiology


Psychoanalysis (Freud brand, lie on couch, takes years)

Psychodynamic psychotherapy (generic & many other brands, sit in chair)

Short term focused (12-50 sessions, sit in chair, goals)

Free association & insight "psychotherapeutic alliance"

(relationship) *transference*

[example insight/transference]

Intellectual understanding +

Emotional realization +

Replaying of relationships

(Learning by doing)

Etiology? Unconscious conflicts among drives, motives; conflict between conscious and unconscious. To address these conflicts, must first discover what they are.


Classical conditioning (behav)

Systematic desensitization (visualization)

Exposure (encounter)

[Example: limitations?]

Operant conditioning (behav)

Rewards and fines

Token economy

Modelling & Skills

Social learning


Cognitive therapy

Focus on present thoughts

Counter faulty thinking

Etiology? Behavioral analysis--problems are learned ways of acting that are dysfunctional. Example: bad event becomes associated with all kinds of other elements, and generalized. Desensitization reverses the process of learning. Cognitive analysis--negative self-defeating thoughts contribute to negative feelings and problems.



* Get in touch with emotions

* Listen to inner voice

* Focus on here & now

* Empty chair technique


Client instead of patient


Growth focus

Unconditional positive regard

Etiology? Socialization leads us to act in ways that cut us off from our true self.


Therapist/facilitator led

Learn from others like self

Self-help group (AA)


* Social support

Etiology? No formal etiology associated with this, but the understanding is certainly that your social network can reinforce negative ways of behaving (go out and get drunk) or can support healing and recovery.


Structural & Strategic

Analyse patterns of interaction

Interventions, directive

Intergenerational approach

Patterns passed down

Genogram (p. 640)

Marital or couples therapy

Etiology? Problems indicate a dysfunctional system: need to address the whole family system.


Drug treatment

Psychotropic drugs for:

Psychosis (schizophrenia)

Depression (many)

Bipolar (lithium is tricky, other drug combos also used)

Anxiety (Valium/Xanax & antidepressants)

Problem: relapse. Not a cure.

Electroconvulsive therapy (ECT)



Split brain

Etiology? Genetic, congenital, brain/nervous system malfunctioning leads to problems in feeling/thinking/action.


Bad news: Some problems [schizophrenia, bipolar] are treatable but not curable; even people receiving good treatment continue to suffer & die, often from suicide

Good news: Symptoms tend to improve over time for most patients, even without treatment. 30-40% of people recover with no treatment. Why?

Confusing news: Treatments based on radically different theories often have similar success rates

Qualification: If we look at particular problems, some approaches work better for some problems, some for others

Integration: Eclectic approach, "common factors" approach


8th leading cause of death (U.S.)

40-70% of suicides suffer from mood disorders

15% of people with mood disorders commit suicide (U.S.)

Suicide is leading cause of death for schizophrenics (U.S.)

Anxiety: 1/3 of deaths before age 70 due to suicide (Sweden)


More women than men attempt suicide (why?); more men are successful (why?)

19-24% of suicides have a prior attempt

Married people have lowest rate; divorced highest (by 3 times)

Relative match of problems to treatments:

Drugs clearly help with psychosis, depression, bipolar, anxiety. Controls symptoms instead of cure, however; often used in combination with some form of therapy.

ECT used for severe depression

Cog-behavioral works well for phobias and panic (better than humanistic), also helpful for depression (but not severe depression).

Psychodynamic: Longer treatments more effective than short treatments. Useful for mood disorders and adjustment disorders. Best match for serious personality disorders (?--poor success rate, typically screened out of studies)

NIMH study (1989)p. 652

N = 250 people, major depression


*cognitve therapy

*short psychodynamic

*drug with clinical management

*placebo with clinical support

DV: patient improvement


Drug & psychodynamic better than placebo

Cognitive higher than placebo, (not statistically significant) not statistically different from drug & psychodynamic

Cognitive also ineffective for severe depression

Most patients continued to improve; few recovered fully

Eclectic or integrative approaches combine techniques from several traditions.

Drug treatment of symptoms often combined with psychodynamic or cog-behavioral therapy

Group therapy often paired with individual therapy

Some researchers also have developed blended approaches that focus on common factors

Common factors in successful therapy:

Empathy; warm relationship; instill hope or efficacy