Identify the limiting and the excess reactant in each reaction. a. Wood burns in a campfire. b. Airborne sulfur reacts with the silver plating on a teapot to produce tarnish (silver sulfide). c. Baking powder in batter decomposes to produce carbon dioxide
Chapter 15 Treatment of Psychological Disorders There are different types of mental health professionals: • Clinical psychologist-‐ PhD or PsyD, 5-‐7 years after undergraduate, deal with psychological testing, diagnosis, and treatment with insight or behavior therapy. • Counseling psychologist-‐ PhD, PsyD, or EdD, 5-‐7 years after undergraduate, similar to clinical psychologist, but there is more focus on work career, and adjustment problems. • Psychiatrist-‐ MD, 8 years after undergraduate, focuses on the diagnosis and treatment primarily with biomedical therapies, but also with insight therapies. • Clinical social worker-‐ MSW, DSW, 2-‐5 years after undergraduate, deals with insight and behavioral therapy and helps inpatients with their return to the community. • Psychiatric nurse-‐ RN, MA, or PhD, 0-‐5 years after undergraduate, deals with inpatient care, insight and behavior therapy. • Counselor-‐ BA or MA, 0-‐2 years after undergraduate, deals with vocational counseling, dug counseling, and rehabilitation counseling. • Marriage and family therapist-‐ MA or PhD, 2-‐5 years after undergraduate, deals with martial/couples therapy and family therapy. Insight Therapy All insight therapies involve verbal interactions with the purpose of enhancing the client’s self-‐knowledge and promoting healthful changes in their personality and behavior. There are different methods that fall under insight therapy. They are psychoanalysis, client-‐centered therapy, group therapy, and couples and family therapy. Psychoanalysis Sigmund Freud is one of the most well known psychotherapists. This type of insight therapy emphasizes the recovery of unconscious conflicts, motives, and defenses by using techniques such as free association and transference. Most of the disturbances that Freud dealt with were phobias, OCD, and conversion disorders. Freud would probe the client’s unconscious in order to determine what was causing their behavior. In free association, clients express their thoughts and feelings with as little censorship as possible. The client talks about anything that comes to their mind, no matter how silly or embarrassing it may be. In dream analysis the therapist interprets the client’s dreams. Freud believed that a person’s dreams were the number one way to get into their unconscious. Sometimes it is hard for a client to accept the meaning of their dreams. Freud said that he expected some clients to be resistant. Resistance refers to mostly unconscious defense maneuvers with the intent to hinder the therapy. Clients might do this because they don’t want to face the painful conflicts that they have stored in their unconscious. Therapists have to deal with transference. Transference is when the client starts to relate to the therapist in ways that mimic slightly negative relationships in their lives, such as an overprotective mother or a rejecting brother. This allows repressed feelings and conflicts to be brought to the surface during the therapy session, and possibly worked through. Freud believes that once a client recognizes the unconscious sources of their conflict they will be able to resolve the conflict. Client-‐Centered Therapy Carl Rogers came up with this type of therapy. It is an insight therapy that emphasizes providing a supportive emotional climate for clients. The clients plays a major role in determining the pace and direction that the therapy goes. Rogers believed that most personal distress is caused by incongruence between a person’s self-‐concept and reality. These therapists help their clients realize that they do not always have to please others and get acceptance from everyone. Rogers believed that the process of therapy is not as important as the emotional climate where therapy takes place. It is important for there to be a warm, supportive climate where the client feels safe. He said that the best therapeutic climate is one that is genuine, has unconditional positive regard (nonjudgmental), and accurate empathy (understanding the client’s point of view). In this type of insight therapy, the client and the therapist work together as equals. The therapist tries to make the client aware of their true feelings by not offering much advice or interpretation. Their key task is clarification. This is all part of the therapeutic process. Group Therapy This involves the treatment of several clients at once, by dealing with them in a group setting. As a result of economically reasons, this type of therapy has increased over the years. Usually the group will consist of 4-‐12 people. Members of the group talk about their problems, share their viewpoints, and share their experiences. They give each other emotional acceptance and support. The therapist chooses the members of the group, sets goals for the group, and makes sure that no harmful interactions take place. They usually are just like a part of the background unless they have to step in. Couples and Family Therapy In couples or marital therapy both partners in a committed, intimate relationship are involved and the relationship issues are the focus. Family therapy involves the whole family being treated as one. The main focus of this therapy is the family dynamics and communication. All extensions of couple and/or family therapy share two common goals: understand the entrenched patterns of interaction that produce distress and to help couples and families improve their communication and have better, more healthy patterns of interaction. It is hard to tell exactly how well an insight therapy is working. One of the reasons why is because of spontaneous remission. This is when a client’s disorder clears up by itself. This means that if a client experiences recovery after treatment that does not imply it was as a result of the treatment. Insight therapies have been proved to be better than no treatment at all, but they are equally as effective as drug therapies. Behavioral Therapies These therapists believe that it is not necessary to help the client achieve grand insights about themselves. The therapist doesn’t care if the behavior comes from the unconscious or from another source. They just care about stopping the behavior. Behavior therapies involve the application of the principles of learning and conditioning to direct efforts to change client’s maladaptive behavior. It is based off of the assumption that behavior is a product of learning and that what has been learned can be unlearned. Joseph Wolpe is a major figure in this type of therapy. He came up with systematic desensitization. This is a behavior therapy in which the therapist attempts to reduce a client’s phobic response. This assumes that phobias are brought on by classical conditioning. There are three steps to systematic desensitization: build the client an anxiety hierarchy, give the client training in deep muscle relaxation, and helping the client work through the hierarchy while learning to remain relaxed while imaging each stimulus. This method has proved to be effective. Another method is exposure therapy. In this therapy the client is exposed to the situation in which they fear so they can be shown that is not actually harmful to them. Usually the client will learn that the situation is harmless, and the fear will be decreased. Another method is social skills training. In this method the therapist works to improve the client’s interpersonal skills by modeling, behavioral rehearsal, and shaping. With modeling, the client watches socially skilled friends and colleagues so that they can develop more appropriate responses to situations. In behavioral rehearsal, the client practices more socially accepted behaviors in role-‐playing exercises. In shaping, clients are given tasks to complete starting with easy things like making friends. Cognitive-‐behavioral treatments use verbal interventions as well as behavior modification techniques to help clients change maladaptive patterns of thinking. Aaron Beck came up with one of these treatments called cognitive therapy. This type of therapy uses specific strategies to correct habitual thinking errors that underlie various types of disorders. These therapists believe that depression and other disorders are caused by errors in thinking. They say that people blame their setbacks on personal inadequacies, focus solely on negative events, make pessimistic projections about the future, and think negative thoughts about themselves. The goal of this therapy is to change the client’s negative thoughts about themselves. Behavioral therapies are not well suited to some types of problems, but for the problems that they are specifically suited for, they prove to be very effective. Biomedical Therapies Biomedical therapies are physiological interventions intended to reduce the symptoms associated with psychological disorders. They have the belief that these disorders are caused at least in part by biological malfunctions. Drug Treatments There are four major groups for drugs that are given to people with psychological disorders. • Antianxiety drugs-‐ reduces tension, apprehension, and nervousness. The most popular are Valium and Xanax. The effects of these drugs start almost immediately after they’re taken. They are effective but only for shortly after the drug is taken. The most common side effects are drowsiness, lightheadedness, depression, cottonmouth, nausea, and constipation. • Antipsychotic drugs-‐ mostly used in the treatment of schizophrenia. They gradually reduce psychotic symptoms like hyperactivity, mental confusion, hallucinations, and delusions. Some side effects include drowsiness, constipation, tremors, muscular rigidity, impaired coordination, and cottonmouth. They can also cause the problem of tardive dyskinesia. This is a neurological disorder that is marked by involuntary writhing, and tic-‐like movements of the mouth, tongue, face, hands, or feet. • Antidepressant drugs-‐ they gradually elevate mood and help bring people out of depression. They are the most frequently prescribed drugs for disorders. Some of these drugs are Prozac, Paxil, and Zoloft. Side effects include nausea, dry mouth, drowsiness, sexual difficulties, weight gain, feeling emotionally numb, agitation, and increased thoughts of suicide. • Mood stabilizers-‐ these drugs are used to control mood swings in patients with bipolar mood disorders. Two main drugs are lithium and valproate. They have been shown to prevent future episodes and also to bring patients out of a current episode they’re having. Lithium can be toxic if the levels are not monitored. Drug therapies have proven to be effective, but there is still some controversy surrounding them. People argue that the drug does not do exactly what it is advertised to do. People also argue that drugs are overprescribed and patients are overmedicated. Some also believe that the side effects from the drugs are often worse than the actual disorder itself. Electroconvulsive therapy is a biomedical treatment in which electric shock is used to produce a cortical seizure accompanied by convulsions. The basis for this was the fact that epilepsy and schizophrenia could not exist in the same body. This is not rare, but its use has been declining. Some critics believe that it is still overused. Some people believe that this method is very effective, but relapse rates for patients who receive this treatment are very high. Memory loss, impaired attention, and other cognitive deficits are side effects to this treatment. The blended treatment approach is treating one client with multiple therapies. Eclecticism involves drawing ideas from two or more systems of therapy rather than just one system. A mental hospital is a medical institution that is specialized in providing inpatient care for psychological disorders. Deinstitutionalization is the transfer of the treatment of the mental illness from inpatient institutions to community-‐based facilities that have outpatient care. The main reasons for this are the emergences of effects drug therapies have for severe disorders and the anticipated deployment of community mental health centers to coordinate local care. People are still placed into mental hospitals, but there has been a shift towards placing them in local general hospitals rather than distant psychiatric hospitals. The goal is to get the patient stabilized and back into the community as quickly as possible. This is a positive thing because unnecessary hospitalization is avoided, but it is a negative thing because sometimes once the patient is released, they have nowhere to go and have not been trained well on how to live on their own. There is problem with mental illness known as the problem of the revolving door and the homeless. The patient will stop to qualify for the drugs that were making them better once they begin to be stabilized. They will be sent back into the community and sometimes the community will not have the correct outpatient care that they need. Their condition will soon come back, and they will soon have to be readmitted. Studies have also shown that many homeless people have a mental illness. Critical Thinking Application: From Crisis to Wellness-‐ But Was It the Therapy • Clients go into therapy expecting to get positive results from it. • Sometimes it is hard to tell is the person gets better because of the therapy or because of the placebo effect or because of regression towards the mean.