Alternative approaches and Non-Individual psychopathology Flashcards
What was the DSM5 debate around Anti-Psychiatry in the 1960’s?
The nature vs nurture debate; british (european) focus on interpersonal context, american model focus on neurobiological functioning
The anti-psychiatry movement in the 60s
- lead by david cooper
- It rejected the idea that psychiatric illness was an exclusively biological phenomenon
- rejected the use of neuroleptic medication; saw the asylum/hospital/clinic as establishing a physical apartheid of the mad and the sane
- saw psychiatry as fairly brutal
What are some of the modern reinventions of the
anti-psychiatric movement?
McGorry; early intervention and risk based preventative model response to overly biological focus.
- Value in reducing severity, preventing onset
- However, problems with misdiagnosis, stigma, self-fulfilling prophecy
Multisystemic theory; used for juvenile deliquency
- highly effective intensive family- and community-based treatment program that focuses on addressing all environmental systems
- similar problems as McGorry - treatment without diagnosis
What was the 1973 Rosenhan Experiment?
Conducted by David Rosenhan to test the validity of psychiatric diagnosis
Stage 1: Rosenhan sent pseudopatients faking illness to a 12 psychiatric institutions.
- All were admitted and forced to sign a declaration that they had a mental illness and agree to take antipsychotics
- all but one were diagnosed with schizophrenia in remission
Stage 2: Hospitals found out and challenged Rosenhan to send them again
- 41 / 193 new patients were identified as potential fakes, Rosenhan hadn’t actually sent anyone
What is the Recovery Movement of the 90s/ 00s?
Origins in 12 step models. Based on the differentiation of outsider and insider knowledge
- ‘outsider knowledge’ or ‘global knowledge’ used by practitioners
- ‘insider knowledge’ or ‘local’ knowledge,’ based on the experience of people living with and having overcome problems
Recovery movement focuses on insider knowledge
Recovery is separate to the actual illness, focused on empowerment and self-management of symptoms
What is Social Constructivism?
Based on the concept that There is no such thing as an autnonomous isolated self - It is a construct created in dialogue
- Kenneth Gergen’s ‘The Relational Self’
- Meaning is not a possession of the individual, but of a collaborative process
What is the Hearing Voices Movement?
Distressing voices are understood as a manifestation of solvable emotional problems which may present in a figurative or literal manner
Two recovery typologies:
- turning toward/empowerment, (normalised account of voices, building voice-specific skills, integration of voices into daily life, transformation of identity)
- turning away/protective hibernation, (harnessing all available resources to survive the experience, medication in recovery being emphasised)
What is the Open Dialogue approach to psychosis?
Open Dialogue (or network therapy) involves intensive engagement with the client, the entire family and any other loved ones and professional stakeholders involved.
- meet in the home setting, to facilitate open and equal (polyphonic) dialogue
- focus on developing agency in the lives of the patient and family,
- Psychotic voices are respected as potentially meaningful
- Psychotic reactions are seen as pre-narrative or metaphorical
- medication and alternative therapies can be utilised if necessary but not hastily
80% experience functional recovery
What are the first order and second order cybernetics in family therapy?
First order; clinical stance of the therapist as observer, focus on behavioural change over emotional change
- Structural family therapy (FT)
- Strategic FT
- Milan systematic FT
Second order; therapist takes an active role, promoting change
- Post-milan systematic FT
- Brief solution focussed FT
- Narrative therapy
- Collaborative Therapy
- Open Dialogue
What is Structural Family therapy?
View that problems are rooted in an imbalance within the family hierarchical structure
Patterns of dysfunctional family structure:
- Enmeshment
- disengagement
- Triangulation (coalitions; alliances)
Therapy aims at re-establishing normative family structure
What is Strategic Family therapy?
Emphasises poor patterns of communication and incorrect problem solving
The problem is the families attempt to solve the problem with interactions that are not working
Aim to devise new or different strategies to disrupt the sequence (eg: paradoxical intervention)
What is Milan systemic family therapy?
Concept of circular, rather than linear, causality ( A causes B causes A)
- Families get stuck at nodal points
Introduced idea of homeostasis: views the problem as part of the re-organisation of family relationships to maintain stability
a problem is one step in the family dance, if you change one step the others will be perturbed
What is Post-Milan systemic family therapy?
continues to use a systemic lens as a basic framework
practice modified to reflect social constructivism
- reality is constructed between therapist and family
- interventive interviewing
Recognition of child abuse and power relations and the feminist critique draw neutrality into question
What is Brief solution focused therapy?
reject the idea that presenting problems are a symptom of family dysfunction
Solution-focussed therapy looks to the future and the present and has no interest in the past
Therapy focuses on helping a family what the future looks like without the problem
On the strengths within the family that can enable that to happen rather than the cause of the problem
What is Narrative Therapy?
Rejects the idea that presenting problems are a symptom of family dysfunction.
Based in social constructivism
Based on the perception that clients present to therapy with a problem-saturated (dominant) story of their lives
aim is to encourage families to view themselves as multi-storied and to privilege liberative narratives
- ‘re-authoring’ or ‘re-membering’
What are Collaborative therapies?
Based in the concept of the unspoken, of ‘not-knowing’
- The goal of therapy was seen to open space for new meaning through dialogic conversation
Using the expertise of the therapist as a basis for dialogue and tentative, open inquiry
Similar to Open dialogue
