Abnormal Psychology Lecture Notes

4/19/99

Directive therapy à therapist takes an active role in guiding the patient

Psychotherapy: science or art form?

1. Psychoanalysis

• first to formalize assumptions and treatment – set of hypotheses about how it worked
• 4 principal procedures: free association (patient says whatever comes to mind), dream analysis (relationship between manifest and latent content), analysis of resistance (figure out why the patient is blocking responses), analysis of transference (bring patient back to childhood and transfers authority role to therapist)
• make dynamics of ego and id conscious à insight
• if the patient can’t accept the interpretations, it means that the therapist can’t fulfil the role of interpreter – has to be resolved and reflect growing up and maturation of patient

1. Ego Therapy (neo-Freudians)

• use is made of the conscious content of the ego
• more active
• focus on relationship between mother and child
• problems are not necessarily conflicting with the id

1. Humanistic Therapy

• client-centered psychotherapy = more egalitarian
• therapist is used like a sounding board = empathic
• client is the one to move the therapy along
• process is counseling, not therapy; customers are clients, not patients
• client has the capacity to solve his own problems with the help of the counselor
• reflective listening, open-ended questions, client has the floor and controls the pace of the counseling

1. Existential Therapy

• be sure that the client is encouraged to be free
• no regression is attempted
• therapist sees the world as the patient sees it
• less empathic than humanistic à sees things from someone else’s perspective

1. Gestalt Therapy

• "gestalt" = form
• therapist tries to steer patient into dealing with current situation, not the past
• deal with past trauma as an adult in an adult-like fashion
• strong emotions as an adult is encouraged = catharsis thereby releasing it from producing symptoms

4/21/99

1. Behavioral (Learning)

1. Contingency management à reinforcement through rewards; from operant conditioning
2. Systematic desensitization à how to control anxiety; conditioned responses; extinction; stimulus generalization; in vivo vs. systematic desensitization
3. flooding à get the response out of the person’s system
4. aversion therapy à uses stimuli that are highly disagreeable (shock, nausea) and evoke response in the presence of undesired reaction

1. Cognitive

• educational process
• quite effective for depressed patients
• add new ways of thinking and doing

• high profile cases = public policy has a huge role
• 1981 – Hinkley attempts assassination of President Reagan – found not guilty by reason of insanity (can’t be held responsible for his actions) – caused controversy because it was on live television – family got high profile psychiatrists to show continual insanity since a child – actual diagnosis was lost sight of

How do patients interact with criminal justice system?

• certain degree of cooperation necessary for defense – understand charges and interact with players
• breaks down in active delusional, developmentally disabled
• do they know right from wrong?
• example of mentally retarded worker accused and convicted of sexual abuse – was he coerced into confession because he didn’t understand his rights?
• was the person free to act or constrained to act criminally?
• what does mental illness have to do with this?
• may not be competent to stand trial
• long history for insanity defense = moral and legal responsibility
• 2 verdicts: not guilty by reason of insanity, guilty and mentally ill
• prosecutor has to prove case = guilty beyond a reasonable doubt

Who is responsible for establishing insanity?

• must show at the time of crime
• burden of proof is on the defendant to prove insanity (recent shift in view)

Committed? -- possibly for rest of life with sometimes no review

• could be longer than a prison sentence
• involuntary commitment à can’t leave at will, requires testimony of at least 2 professionals, dangerous to themselves or others, go before a judge
• should that person have rights? there has to be due process for committing someone
• if a person submits to a mental status exam, is that self-incriminating?

Patients’ Rights – new and developed out of recent cases

1. right to treatment
2. right to refuse treatment
3. right to humane environments
4. right to treatment in the least restrictive environment possible
5. sexual rights

• what kind of therapy? Largely a public policy issue
• some have outlawed ECT, some behavioral therapies and cruel and unusual punishment

Issues concerning dangerousness of patients:

• ex of patient who made death threats, psychologist notified police, let him go eventually, murdered target of death threat
• what responsibility does the psychologist have? Court: If psychologist feels that patient is a danger to someone, has duty to warn the target
• brings up issues of confidentiality
• one side: maybe patient wasn’t serious – no need to break confidentiality and trust of patient
• how do you know if person is dangerous?