Abnormal Psychology, Psychopathology & Psychotherapy. What should be labeled deviant? What psychiatrists, clinical psychologists or other trained professionals label deviant? (DSM-IV) Or, Only organically based behavioral disorders (Szaz). Treating Insanity.
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What should be labeled deviant?
Dorothea Dix (1850)
Medical Model (late 19th century)
MMPI (Minnesota Multi Phasic Inventory)
TAT (Thematic Apperception Test)
Disorders first evident in childhood (e.g., mental retardation, hyperactivity).
Organic mental disorders: symptoms directly related to injury to brain or to abnormality (syphilis, Alzheimer’s disease, extreme alcoholism, brain tumor).
Substance use disorders.
Affective disorders (manic and/or depressed moods).
Somatoform disorders (hysteria, hypochodriasis).
Dissociative disorders (amnesia, multiple personalities).
Psychosexualdisorders (transsexualism, frigidity, exhibitionism, sexual sadism, homosexuality-but only if individual is unhappy).
Personality disorders (anti-social behavior, narcissistic personality).
Anxiety disorders (generalized anxiety or panic, phobias, posttraumatic stress disorder, obsessive-compulsive disorder).
Leftovers (marital problems, family therapy).
Many varieties, e.g., Jung, Adler, Sullivan
-personal analysis with an institute analyst
-control analyses supervised by a training analyst.
moving, changing jobs without consulting analyst.
- less fatiguing to the analyst than face-to-face relationships
-facilitated free association.
1. Rigidity - little desire to change. Little recognition of feelings.
2. Perception of problems, externally dispassionate display of feeling. Little recognition of contradictory feelings...
3. Free expression of feelings. Source of feelings considered. Increased awareness of the “real me.” Awareness of contradictions.
4. Immediacy of feelings. Real direct experience. High self-regard. Less intellectualization about self.
5. Acceptance of self and problem.
Phobia THERAPY (cont’d.)DescripionPhobiaDescription
“Let all your muscles go loose and heavy. Just settle back quietly and comfortably. Wrinkle up your forehead now; wrinkle it tighter....And now stop wrinkling your forehead, relax and smooth it out. Picture the entire forehead and scalp becoming smoother as the relaxation increases....
Now frown and crease your brows and study the tension....Let go of the tension again. Smooth out the forehead once more....Now, close your eyes tighter and tighter...feel the tension...and relax your eyes. Keep your eyes closed, gently, comfortably, and notice the relaxation .... Now clench your jaws, bite your teeth together; study the tension throughout the jaws....Relax your jaws now. Let your lips part slightly....Appreciate the relaxation....
Now press your tongue hard against the roof of your mouth. Look for the tension....All right, let your tongue return to a comfortable and relaxed position .... Now purse your lips, press your lips together tighter and tighter....Relax your lips. Note the contrast between tension and relaxation. Feel the relaxation all over your face, all over your forehead and scalp, eyes, jaws, lips, tongue and throat. The relaxation progresses further and further...”. [from Wolpe and Lazarus (1966), p. 178]
Behavioral THERAPY (cont’d.)
“The patient, a 14-year-old boy, suffered from an intense fear of dogs which lasted for two and one-half to three years. He would take two buses on a roundabout route to school rather than risk exposure to dogs on a direct 300-yard walk. He was rather a dull (IQ = 93), sluggish person, very large for his age, trying to be cooperative, but sadly unresponsive---especially to attempts at training in relaxation.
In his desire to please, he would state that he had been perfectly relaxed even though he had betrayed himself by his intense fidgetiness. Training in relaxation was eventually abandoned, and an attempt was made to establish the nature of his aspirations and goals. By dint of much questioning and after following many false trails because of his inarticulateness, a topic was eventually tracked down that was absorbing enough to form the subject of his fantasies, namely, racing motor-cars.
He had a burning ambition to own a certain Alfa Romeo sports car and race it at the Indianapolis 500. Emotive imagery was induced as follows: “Close your eyes. I want you to imagine, clearly and vividly, that your wish has come true. The Alfa Romeo is now in your possession. It is your car. It is standing in the street outside your house. You are looking at it now. Notice the beautiful, sleek lines. You decide to go for a drive with some friends of yours. You sit down at the wheel, and you feel a thrill of pride as you realize that you own this magnificent machine.
You start up and listen to the wonderful roar of the exhaust. You let the clutch in and the car streaks off. You are out in a clear open road now; the car is performing like a pedigree; the speedometer is climbing into the nineties; you have a wonderful feeling of being in perfect control; you look at trees whizzing by and you see a little dog standing next to one of them-- if you feel any anxiety, just raise your finger....” An item fairly high up on the hierarchy was: “You stop at a cafe in a little town, and dozens of people crowd around to look enviously at this magnificent car and its lucky owner; you swell with pride; and at this moment a large boxer comes up and sniffs at your heels. If you feel any anxiety....” [from Lazarus and Abramovitz (1962)].
Behavior Modification Psychoanalysis
What is to be modified? Learned behavior Symptoms
Role of therapist: Deliberate None - minimal
Philosophy of treatment: Scientific Intuitive
of behavior: Real Symbolic
Aim: Goal directed General
Basis of change: Training Insight
What is dealt with: Present behavior Past behavior