Therapy and Treatment in Psychology

THERAPY & TREATMENT

• Many forms of therapy: Various therapies have been developed to address a wide range of mental health problems.

• Ocean Therapy Program at Camp Pendleton:

  • Participants: Marines who served in Iraq and Afghanistan and community mental health volunteers.

  • Therapeutic approach: Learning to surf combined with group discussions.

  • Objectives: Aiming to help veterans recover, particularly those suffering from Post-Traumatic Stress Disorder (PTSD).

MENTAL HEALTH TREATMENT

• Prevalence of Mental Illness:

  • Approximately 19% of U.S. adults and 13% of adolescents (ages 8-15) experience mental illness in a given year.

• Treatment Trends (2004–2008):

  • Slight increase in adult individuals seeking mental health treatment.

  • Treatment rates for adolescents with mental disorders range from one-third to one-half, with behavior-related disorders having higher treatment likelihood.

TREATMENT IN THE PAST

• Historical beliefs about mental illness:

  • Thought to be caused by supernatural forces (witchcraft, demonic possession).

  • People with mental illnesses often faced cruelty and poor treatment.

• Treatment methods used:

  • Exorcism: Involvement of incantations and prayers by a priest or religious figure.

  • Trephining: Making a hole in the skull to release spirits, often leading to death.

  • Execution or Imprisonment: Accused individuals were often burnt at the stake for witchcraft allegations.

18TH CENTURY

• Institutionalization:

  • By the 18th century, people exhibiting unusual behaviors were increasingly institutionalized in asylums,

  • Asylums served primarily to isolate individuals from society rather than to treat them.

  • Inhumane conditions: Individuals often confined in windowless dungeons and chained to beds with minimal caregiver interaction.

• Philippe Pinel's Contributions:

  • A French physician advocating for humane treatment of the mentally ill in the late 1700s.

  • Proposed unchaining patients and engaging them in conversation.

  • Implemented in Paris in 1795; many patients benefited and were released from hospitals.

19TH CENTURY

• Dorothea Dix:

  • A social reformer who advocated for the mentally ill, particularly the indigent insane.

  • Investigated state care for the mentally ill, discovering widespread abuse and neglect in underfunded systems.

  • Instrumental in establishing the first American mental asylum through advocacy.

• American Asylums:

  • Conditions were typically filthy, with little to no treatment offered.

  • Institutionalization could last for decades.

  • Common treatments included:

  • Submersion in cold baths for extended periods.

  • Electroshock treatment (now known as electroconvulsive therapy): Brief electric stimulus induces generalized seizures.

20TH CENTURY

• Introduction of Antipsychotic Medications (1954):

  • Significant in treating psychosis symptoms including hallucinations and delusions.

• Mental Retardation Facilities and Community Mental Health Centers Construction Act (1975):

  • Federal support and funding for community mental health centers initiated deinstitutionalization.

  • Deinstitutionalization aimed to close large asylums, allowing patients to be treated within communities.

  • Shortcomings: Many released patients struggled due to inadequate community support leading to an increase in homelessness.

MENTAL HEALTH TREATMENT TODAY

• Homelessness and Mental Illness:

  • Among U.S. homeless shelter populations, approximately one-quarter have a severe mental illness (HUD, 2011).

• Current Institutions:

  • Psychiatric hospitals and community hospitals have replaced asylums, focusing primarily on short-term care.

  • Average stays are less than two weeks due to high treatment costs and insurance limitations.

• Types of Treatment:

  • Involuntary Treatment: Not chosen by the individual (e.g., parole conditions).

  • Voluntary Treatment: Chosen by the individual to relieve symptoms.

  • Sources of Treatment: Community mental health centers, private practitioners, school counselors, school psychologists, etc.

  • Providers: Psychologists, psychiatrists, clinical social workers, marriage and family therapists.

TYPES OF TREATMENT

• Categories of Therapy:

  • Psychodynamic Psychotherapy:

  • Focus on unconscious influence and childhood conflicts.

  • Example: Patient discussing past events.

  • Play Therapy:

  • Interaction with toys instead of talk, often used in child therapy.

  • Example: Child acts out family dynamics with dolls.

  • Behavior Therapy:

  • Applies learning principles to change behaviors (e.g., overcoming fears).

  • Example: Learning to manage fear of elevators via relaxation techniques.

  • Cognitive Therapy:

  • Focus on recognizing and altering cognitive patterns leading to distress.

  • Example: Patient learns not to overgeneralize failures.

  • Cognitive-Behavioral Therapy:

  • Targets cognitive distortions and modifies behaviors.

  • Example: Identifying self-defeating behaviors related to an eating disorder.

  • Humanistic Therapy:

  • Emphasizes self-awareness and acceptance.

  • Example: Patient expresses thoughts hindering goals.

PSYCHOANALYSIS

• Sigmund Freud's Influence:

  • The first form of psychotherapy aimed to uncover repressed feelings.

  • Techniques include:

  • Free Association: Patient expresses thoughts freely, revealing unconscious barriers.

  • Dream Analysis: Interpretation of dreams to uncover hidden meanings.

  • Transference: Emotional transfer from patient to therapist regarding past relationships.

• Modern Adaptations:

  • Psychoanalysis is less commonly practiced today; modern therapies integrate and expand upon Freud's methodologies.

PLAY THERAPY

• Use of Toys in Therapy:

  • Assists children in preventing or resolving psychosocial difficulties.

  • Techniques:

  • Use of toys allows children to express emotions and experiences.

  • Sandplay Therapy: Children create a three-dimensional representation of their inner world.

  • Nondirective Play Therapy: Children explore their thoughts through free play.

  • Directive Play Therapy: Therapist guides play through suggestions and active participation.

BEHAVIOR THERAPY

• Principles of Learning in Therapy:

  • Aims to change dysfunctional behaviors through learning.

  • Classical Conditioning:

  • Counterconditioning: Response to stimulus is modified (includes aversive conditioning).

  • Example: Using Antabuse to treat alcoholism by creating aversion.

  • Exposure Therapy:

  • Treatment for fears and anxiety through repeated exposure.

  • Mary Cover Jones' study with Peter and the rabbit demonstrated this method.

  • Joseph Wolpe refined exposure therapy into systematic desensitization.

COGNITIVE THERAPY

• Aaron Beck's Development:

  • Centers on how thoughts influence feelings and actions.

  • Identification of cognitive distortions:

  • Overgeneralizing: Extrapolating a small event into an overarching negative belief.

  • Polarized Thinking: Viewing scenarios in extremes.

  • Jumping to Conclusions: Assuming how others view oneself without evidence.

COGNITIVE-BEHAVIORAL THERAPY

• Focus on Present Issues:

  • Combines cognitive therapy with behavioral therapy principles.

  • Uses the ABC model for cognitive distortions:

  • A = Activating event, B = Belief about the event, C = Consequences of that belief.

HUMANISTIC THERAPY

• Focus on Individual Potential:

  • Goals include increasing self-awareness through conscious thought engagement.

  • Rogerian/Client-Centered Therapy:

  • Emphasizes client control in overcoming challenges.

  • Techniques include active listening and providing non-judgmental support.

  • Unconditional Positive Regard: Key therapeutic component to promote self-acceptance and growth.

BIOMEDICAL THERAPIES

• Psychotropic Medications:

  • Used for symptomatic treatment of psychological disorders without curing them.

  • Types of Medications:

  • Antipsychotics: Block dopamine to treat psychotic symptoms.

  • Atypical Antipsychotics: Target both dopamine and serotonin for symptoms of schizophrenia.

  • Antidepressants: Alter serotonin and norepinephrine levels for depression and anxiety issues.

  • Anti-anxiety Agents: Depress central nervous system activity for anxiety-related disorders.

  • Mood Stabilizers: Manage bipolar disorder by treating mania and depression episodes.

  • Electroconvulsive Therapy: Induces seizures for severe depression alleviation.

  • Transcranial Magnetic Stimulation: Uses magnetic fields to stimulate nerve cells for improved symptoms.

TREATMENT MODALITIES

• Intake Process:

  • Initial meeting to assess specific clinical needs, including: presenting problems, support systems, and insurance status.

  • Discuss confidentiality, treatment expectations, and fees.

• Types of Therapy:

  • Individual Therapy: One-on-one sessions to explore feelings and set personal goals.

  • Group Therapy: Several clients discuss common issues, creating community support.

  • Couples Therapy: Focuses on relationship dynamics and improving communication and conflict resolution.

  • Family Therapy: Works to understand family dynamics and enhance each member's growth and overall family function.

ADDICTION

• Substance Use Dynamics:

  • Initial voluntary use can lead to compulsive drug-seeking behavior due to changes in the brain.

• Relapse Rates:

  • Approximately 40%-60% experience relapse after periods of improvement.

• Comorbid Disorders:

  • High prevalence of additional psychological disorders among substance abusers (e.g., mood or anxiety disorders).

PREVALENCE OF DRUG USE

• National Survey on Drug Use and Health:

  • Tracks usage trends in various demographics (ages 12-17, 18-25, 26 and older).

SUBSTANCE-RELATED TREATMENT

• Goals:

  • Help individuals discontinue compulsive drug-seeking behaviors through long-term treatment strategies.

  • More cost-effective than incarceration with annual costs of substance abuse exceeding $600 billion in the U.S.

• Behavior Therapy Applications:

  • Motivates participation and teaches craving management.

  • Medication Uses:

  • Detoxification after overdose, prevent seizures, withdrawal management, and reusage prevention.

WHAT MAKES TREATMENT EFFECTIVE?

• Duration of Treatment:

  • Typically requires at least three months for successful outcomes.

• Holistic Treatment Approach:

  • Addresses multiple needs, including psychological, physiological, social, and behavioral aspects.

• Group Therapy Benefits:

  • Peer support often enhances recovery success.

THE SOCIOCULTURAL MODEL

• Cultural Context:

  • Examines behaviors and symptoms within cultural and social backgrounds.

  • Importance of cultural competence among mental health professionals in addressing diverse client needs.

• Multicultural Counseling and Therapy:

  • Incorporates cultural nuances into therapy goals, recognizing varied identities that affect treatment outcomes.

TREATMENT BARRIERS

• Access to Services:

  • Limited by factors including lack of insurance, transport difficulties, and time constraints.

• Ethical and Perceptual Barriers:

  • Combat stigma, fears about seeking help, misunderstandings, and biases against certain populations.