Therapy and Treatment

Chapter 16
16.1 Mental Health Treatment: Past and
Present
By the end of this section, you will be able to:
• Explain how people with psychological disorders have been treated
throughout the ages
• Discuss deinstitutionalization
• Discuss the ways in which mental health services are delivered today
• Distinguish between voluntary and involuntary treatment
Introduction
• The percentage of
Adults who received
mental health
treatment in 2004-2008
is shown.
• Adults seeking
treatment increased
slightly from 2004-2008
Introduction
• About one-third to
one-half of U.S.
adolescents (ages
8-15) with mental
disorders receive
treatment.
• Behavior-related
disorders are more
likely to be treated
than anxiety
disorders.
TREATMENT IN THE PAST
• Asylums were the first institutions
created for the specific purpose of
housing people with psychological
disorders, but the focus was ostracizing
them from society rather than treating
their disorders.
• Philippe Pinel argued for more human
treatment of the mentally ill.
• Deinstitutionalization the closing of
large asylums, by providing for people
to stay in their communities and be
treated locally
• Dorothea Dix lead reform efforts for
mental health care in the U.S.
Mental Health Treatment Today
• Involuntary treatment
refers to therapy that is
not the individual’s choice.
Other individuals might
voluntarily seek treatment.
• Voluntary treatment
means the person chooses
to attend therapy to obtain
relief from symptoms
16.2 Types of Treatment
By the end of this section, you will be able to:
• Distinguish between psychotherapy and biomedical therapy
• Recognize various orientations to psychotherapy
• Discuss psychotropic medications and recognize which medications
are used to treat specific psychological disorders
Types of Treatment
• Psychotherapy-(also,
psychodynamic psychotherapy)
psychological treatment that
employs various methods to
help someone overcome
personal problems, or to attain
personal growth
• Biomedical therapy- treatment
that involves medication and/or
medical procedures to treat
psychological disorders
 Psychotherapy Techniques: Psychoanalysis
Psychoanalysis -(also, psychodynamic psychotherapy)
psychological treatment that employs various methods to
help someone overcome personal problems, or to attain
personal growth; problem is that can take years to work
Techniques of Psychoanalysis:
 Free association: technique in psychoanalysis in which the
patient says whatever comes to mind at the moment
 Dream analysis: technique in psychoanalysis in which
patients recall their dreams and the psychoanalyst
interprets them to reveal unconscious desires or struggles
 Transference: process in psychoanalysis in which the patient
transfers all of the positive or negative emotions associated
with the patient’s other relationships to the psychoanalyst
Psychotherapy: Play Therapy
• Play Therapy- therapeutic
process, often used with
children, that employs toys to
help them resolve psychological
problems
• This technique uses a
therapeutic process of play to
“help clients prevent or resolve
psychosocial difficulties and
achieve optimal growth”
Psychotherapy: Behavior Therapy
• Behavior therapy- therapeutic orientation
that employs principles of learning to help
clients change undesirable behaviors
• Counterconditioning: classical conditioning
therapeutic technique in which a client learns
a new response to a stimulus that has
previously elicited an undesirable behavior
• Aversive conditioning: counterconditioning
technique that pairs an unpleasant stimulant
with an undesirable behavior; if want to stop
biting nails may put bitter polish on them so
when bite taste is unpleasant
Psychotherapy: Behavior Therapy
• Exposure therapy- counterconditioning
technique in which a therapist seeks to treat
a client’s fear or anxiety by presenting the
feared object or situation with the idea that
the person will eventually get used to it
• Systematic desensitization-form of
exposure therapy used to treat phobias and
anxiety disorders by exposing a person to
the feared object or situation through a
stimulus hierarchy ; idea is that cannot be
nervous and relaxed at the same time
Psychotherapy: Behavior Therapy Continued
• Virtual reality exposure
therapy-uses a simulation rather
than the actual feared object or
situation to help people conquer
their fears; this has been used to
treat PTSD in the military
• Token economy-controlled
setting where individuals are
reinforced for desirable
behaviors with tokens (e.g.,
poker chip) that be exchanged
for items or privileges
Psychotherapy: Cognitive Therapy
• Cognitive therapy-form of psychotherapy that focuses on how a
person’s thoughts lead to feelings of distress, with the aim of helping
them change these irrational thoughts
• Aaron Beck- goal recognize dysfunctional thinking
Psychotherapy: Cognitive-behavioral Therapy
• Rational emotive therapy (RET) form of
cognitive-behavioral therapy
• Cognitive-behavioral therapy (CBT) - form of
psychotherapy that aims to change cognitive
distortions and self-defeating behaviors; often
catastrophize; this leads the person to feel
bad about him/herself; the principle that
underlies the therapy is that thoughts affect
behavior
ABC Model-
Activating event- (OR ACTION)
Belief about the event
Consequences of this belief.
Psychotherapy: Humanistic Therapy
• Humanistic therapy-therapeutic orientation aimed at helping
people become more self-aware and accepting of themselves;
increases self awareness by focusing on conscious thoughts
• Rogerian (client-centered therapy) non-directive form of
humanistic psychotherapy developed by Carl Rogers that
emphasizes unconditional positive regard and self-acceptance
• Nondirective therapy-therapeutic approach in which the
therapist does not give advice or provide interpretations but
helps the person identify conflicts and understand feelings
• Unconditional positive regard-fundamental acceptance of a
person regardless of what they say or do; term associated with
humanistic psychology
Evaluating Various Forms Of Psychotherapy
• No studies have found on psychotherapeutic
approach more effective than another.
• According to the American Psychological
Association, three factors work together to
produce successful treatment.
1. Use of evidence based treatment that is
deemed appropriate for your particular issue
2. Clinical expertise of the psychologist or
therapist
3. Your own characteristics, values, preferences,
and culture
Biomedical Therapies
• Biomedical Therapy- treatment that
involves medication and or a medical
procedures to treat psychological
disorders.
• Psychotropic medications (prescribed by
MD usually a Psychiatrist)
• In Louisiana and New Mexico psychologist are
able to prescribe some drugs.
• Electroconvulsive Therapy
• Transcranial Magnetic Stimulation
 Modified Medication Table
Type of Medication/Brand Names Used to Treat How They Work

Antipsychotics (developed in the Schizophrenia and other types of Treat positive psychotic symptoms
1950s) severe thought disorders such as auditory and visual
hallucinations, delusions, and
Haldol, Mellaril, Prolixin, Thorazine paranoia by blocking the
neurotransmitter dopamine
Atypical Antipsychotics (developed in Schizophrenia and other types of Treat the negative symptoms of
the late 1980s) severe thought disorders schizophrenia, such as withdrawal
and apathy, by targeting both
Abilify, Risperdal, Clozaril dopamine and serotonin receptors;
newer medications may treat both
positive and negative symptoms:
problem in that can increase risk of
obesity and diabetes as well as
increase cholesterol levels
Anti-depressants Depression and increasingly for SSRIs: headache, nausea, weight
anxiety gain, drowsiness, reduced sex drive
Paxil, Prozac, Zoloft (selective
serotonin reuptake inhibitors, Tricyclics: dry mouth, constipation,
[SSRIs]); Tofranil and Elavil (tricyclics) blurred vision, drowsiness, reduced
 Modified Medication Table
Type of Medication/Brand Names Used to Treat How They Work

Anti-anxiety agents Anxiety and agitation that occur in Depress central nervous system
OCD, PTSD, panic disorder, and social activity
Xanax, Valium, Ativan phobia

Mood Stabilizers Bipolar disorder Treat episodes of mania as well as

depression
Lithium, Depakote, Lamictal, Tegretol

Stimulants ADHD, Narcolepsy, and in some cases Improve ability to focus on a task and
Binge Eating Disorder (Vyvanse) maintain attention, help control
Adderall, Ritalin, Vyvanse impulses. Problem in that can
decreased appetite cause sleep
problems, stomachaches and
headaches.
 Biomedical Therapies
Electroconvulsive therapy (ECT)-
type of biomedical therapy that
involves using an electrical
current to induce seizures in a
person to help alleviate the
effects of severe depression
16.3 Treatment Modalities
By the end of this section, you will be able to:
• Distinguish between the various modalities of treatment
• Discuss benefits of group therapy
Treatment Modalities
• Intake-therapist’s first meeting with the client in which the
therapist gathers specific information to address the client’s
immediate needs.
• Confidentiality-therapist cannot disclose confidential
communications to any third party, unless mandated or permitted
by law
Individual Therapy
• Individual therapy-treatment modality
in which the client and clinician meet
one-on-one
• The clinician will work with clients to
help them explore their feelings, work
through life challenges, identify aspects
of themselves and their lives that they
wish to change, and set goals to help
them work towards these changes.
Group Therapy
• Group therapy- treatment modality in
which 5–10 people with the same
issue or concern meet together with a
trained clinician

• A clinician meets together with

several clients with similar problems
• Ocean Therapy has been used with
veteran, in addition to group therapy,
the veteran learns to surf (picture on
the first page of PP)
Couples Therapy
Family Therapy
• Couples therapy-two people in an
intimate relationship, such as husband
and wife, who are having difficulties and
are trying to resolve them with therapy
• Family therapy- special form of group
therapy consisting of one or more families
• Strategic family therapy-therapist guides
the therapy sessions and develops
treatment plans for each family member
for specific problems that can addressed
in a short amount of time
16.4 Substance-Related and Addictive
Disorders: A Special Case
By the end of this section, you will be able to:
• Recognize the goal of substance-related and addictive disorders
treatment
• Discuss what makes for effective treatment
• Describe how comorbid disorders are treated
Addiction
• The goal of substance-related treatment is to
help an addicted person stop compulsive drug-
seeking behaviors
• Relapse-repeated drug use and/or alcohol use
after a period of improvement from substance
abuse
• What makes Treatment Effective?
• Duration of treatment
• Addict receives behavior therapy
• Group therapy is most widely used treatment.
• Safe Detox
Comorbid Disorders
• Comorbid disorders individual
who has two or more diagnoses,
which often includes a substance
abuse diagnosis and another
psychiatric diagnosis, such as
depression, bipolar disorder, or
schizophrenia
• In cases of comorbidity, the best
treatment is thought to address
all disorders simultaneously.
16.5 The Sociocultural Model and Therapy
Utilization
By the end of this section, you will be able to:
• Explain how the sociocultural model is used in therapy
• Discuss barriers to mental health services among ethnic minorities
Sociocultural Model
• The sociocultural perspective looks at you, your behaviors, and your
symptoms in the context of your culture and background
• cultural competence-therapist’s understanding and attention to
issues of race, culture, and ethnicity in providing treatment
Barriers To Treatment
• Statistically, ethnic minorities tend to utilize mental health services
less frequently than White, middleclass Americans (Alegría et al.,
2008; Richman, Kohn-Wood, & Williams, 2007).
• Lack of Insurance
• Transportation
• Time
• Access to care
• Perceptions and attitudes