Therapy and Treatment Lecture Overview

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THERAPY AND TREATMENT

Chapter 16 | PBSI 107-511 Fall 2025

Instructor: Yanai Otero La Porte

Today’s Agenda

  1. History of Mental Health Treatment

  2. Types of Treatment

  3. Treatment Modalities

  4. Substance-Related and Addictive Disorders

  5. The Sociocultural Model and Therapy Utilization

THERAPY & TREATMENT

Overview

  • Many forms of therapy have been developed to treat a wide array of problems.

  • Example: The Ocean Therapy program at Camp Pendleton combines surfing with group discussions, helping veterans, especially those suffering from PTSD.

MENTAL HEALTH TREATMENT

Prevalence

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

  • Between 2004-2008, there was a slight increase in the percentage of adults seeking treatment.

  • About one-third to one-half of U.S. adolescents with mental disorders receive treatment, particularly those with behavior-related disorders.

History of Mental Health Treatment

Treatment in the Past

  • Supernatural beliefs dominated early perceptions of mental illness, leading to cruel treatment such as:

    • Exorcism: Priestly incantations and prayers performed over individuals.

    • Trephining: Drilling holes in the skull to release spirits, often leading to death.

    • Execution or Imprisonment: Many were burnt at the stake when accused of witchcraft.

18TH CENTURY

Asylums

  • Early 1800s saw people with unusual behaviors being institutionalized in asylums.

    • Focus was more on ostracizing rather than treating individuals.

    • Conditions included being kept in windowless dungeons, chained to beds with little caregiver contact.

  • Philippe Pinel:

    • Late 1700s; advocated for humane treatment, such as unchaining patients and engaging them in conversation, which showed benefits for patients.

19TH CENTURY

Dorothea Dix

  • American social reformer advocating for the indigent insane.

    • Investigated and highlighted the state of neglect and abuse in mental health facilities, leading to the establishment of the first American mental asylums through her lobbying efforts.

American Asylums

  • Facilities were generally filthy and provided minimal treatment, leading to decades-long institutionalization.

  • Common treatments included:

    • Cold bath submersion

    • Electroshock treatment (now known as electroconvulsive therapy) which induces seizures to treat severe mental symptoms.

20TH CENTURY

Medication Introduction

  • 1954 marked the introduction of antipsychotic medications, successful in treating psychosis with symptoms like hallucinations and delusions.

  • 1975, the Mental Retardation Facilities & Community Mental Health Centers Construction Act aimed at deinstitutionalization, allowing patients to remain within their communities for treatment.

    • Although patients were released, the new systems faced challenges like underfunding and untrained staff, leading to increased homelessness.

MENTAL HEALTH TREATMENT TODAY

Current Landscape

  • A considerable number of the homeless population face mental illness, with about one-quarter in shelters suffering severe mental disorders (HUD, 2011).

  • Treatment shifted from asylums to psychiatric hospitals and community hospitals focused on short-term care (average stay < 2 weeks).

    • Hospitalization is typically reserved for those posing imminent threats to themselves or others.

Treatment Choices

  • Involuntary Treatment: Non-voluntary therapy, e.g., mandated counseling sessions.

  • Voluntary Treatment: Therapy is sought by individuals themselves to alleviate symptoms.

Sources of Psychological Treatment

  • Available through community mental health centers, private practitioners, school counselors, psychologists, social workers, and group therapy.

  • Treatment providers include psychologists, psychiatrists, clinical social workers, marriage/family therapists.

Types of Treatment

Type

Description

Example

Psychodynamic psychotherapy

Based on the belief that unconscious conflicts impact behavior

Patient discusses past experiences

Play therapy

Psychoanalytical approach where toys facilitate communication

Child engages in play with dolls to express feelings

Behavior therapy

Learning principles applied to change undesirable behaviors

Patient learns relaxation techniques to overcome phobias

Cognitive therapy

Awareness of cognitive processes to eliminate distressing thoughts

Patient reframes negative experiences

Cognitive-behavioral therapy

Focuses on changing cognitive distortions and behaviors

Patient identifies and changes self-defeating thoughts

Humanistic therapy

Enhances self-awareness and acceptance through conscious thoughts

Patient articulates thoughts blocking their goals

PSYCHOANALYSIS

Overview

  • Developed by Sigmund Freud, it aims to uncover repressed feelings.

Techniques

  • Free Association: Patient relaxes and reports thoughts to uncover unconscious blocks.

  • Dream Analysis: Interpretation of dreams to discover underlying meanings.

  • Transference: Transfer of emotions related to other relationships onto the analyst.

PSYCHOANALYSIS TODAY

  • While it’s less popular, Freud’s ideas evolved into modern psychodynamic therapy, maintaining an exploration of unconscious influences on behavior.

PLAY THERAPY

Definition

  • Utilizes toys for therapy, allowing children to express feelings and conflicts through play.

Techniques

  • Toys and figurines: Used for children to express their hopes and traumas.

  • Nondirective Play Therapy: Encouraging free play to explore feelings while the therapist observes.

  • Directive Play Therapy: Therapist guides play with specific interventions.

BEHAVIOR THERAPY

Fundamentals

  • Based on the principles of learning to alter dysfunctional behaviors.

Techniques

  • Classical Conditioning: Applying conditioning principles to change responses to stimuli.

    • Counterconditioning: Associating a new response to previously eliciting stimuli, includes aversive conditioning and exposure therapy.

Exposure Therapy

  • Developed by Mary Cover Jones (1924) to replace fears with relaxation responses, a method refined by Joseph Wolpe (1958).

COGNITIVE THERAPY

Principles

  • Developed by Aaron Beck, focusing on thought patterns leading to emotional distress.

Techniques

  • Help clients recognize cognitive distortions such as overgeneralizing and polarized thinking.

COGNITIVE-BEHAVIORAL THERAPY

Focus

  • Combines cognitive and behavioral approaches to change thoughts and actions.

  • Utilizes the ABC model:

    • A: Activating event

    • B: Belief about the event

    • C: Consequences of the belief

HUMANISTIC THERAPY

Overview

  • Aims to help individuals reach their potential through self-awareness and acceptance.

Carl Rogers’ Contribution

  • Developed client-centered therapy emphasizing personal empowerment.

  • Techniques include active listening, unconditional positive regard, empathy, and genuineness.

BIOMEDICAL THERAPIES

Psychotropic Medications

  • Used to treat symptoms of psychological disorders without curing them.

  • Categories of Medications:

    • Antipsychotics: Block dopamine, treating hallucinations and delusions.

    • Atypical Antipsychotics: Target dopamine and serotonin for treating negative symptoms.

    • Antidepressants: Affect serotonin and norepinephrine for mood disorders.

    • Anti-anxiety Agents: Depress CNS, used for anxiety disorders.

    • Mood Stabilizers: Used for bipolar disorder.

    • Stimulants: Aid attention in ADHD.

    • Electric Therapies: ECT and TMS are used for treatment-resistant depression.

TREATMENT MODALITIES

Initial Assessment

  • An intake meeting includes assessing client needs, discussing therapy goals, and establishing treatment plans, covering topics such as confidentiality and expectations.

INDIVIDUAL THERAPY

Session Dynamics

  • Clients work one-on-one in a confidential space to explore personal issues.

GROUP THERAPY

  • Multiple clients discuss shared issues under therapist guidance, promoting support.

    • Psycho-educational groups provide educational support related to specific topics (e.g., cancer in the family).

COUPLES THERAPY

Purpose

  • Aims to resolve relational conflicts and improve communication, primarily using cognitive-behavioral techniques.

FAMILY THERAPY

Objectives

  • Targets growth and healthy dynamics within family systems.

Approaches

  • Systems approach: Viewing families as organized systems with interdependent members.

    • Structural Family Therapy: Examines family boundaries.

    • Strategic Family Therapy: Addresses specific, time-limited problems.

SUBSTANCE-RELATED AND ADDICTIVE DISORDERS

Definition of Addiction

  • Initial voluntary substance use can lead to chronic changes in brain structure associated with decision-making.

Relapse

  • Approximately 40%-60% of individuals relapse after experiencing improvement in their addiction.

Comorbid Disorders

  • Addiction often co-occurs with other psychological disorders, doubling the likelihood of mood or anxiety disorders among substance abusers.

PREVALENCE OF DRUG USE

  • National Survey on Drug Use and Health illustrates various drug usage trends among demographic groups.

SUBSTANCE-RELATED TREATMENT

Goals

  • Aims to help individuals cease compulsive substance-seeking behaviors through long-term treatment strategies.

    • Substance abuse costs the U.S. > $600 billion yearly.

WHAT MAKES TREATMENT EFFECTIVE?

Critical Factors

  • Duration (3+ months recommended), holistic approaches, group therapy support improve outcomes, especially when parents are involved.

THE SOCIOCULTURAL MODEL

Definition

  • Examines behaviors and symptoms based on cultural context and backgrounds and includes cultural competence as a necessary aspect of therapy.

Cultural Competence

  • The necessity for mental health professionals to understand racial, cultural, and ethnic issues and use appropriate strategies in treatment.

TREATMENT BARRIERS

  • Factors that limit access to care include:

    • Lack of insurance

    • Transportation issues

    • Time constraints

    • Ethnic disparities and stigma also present significant barriers against utilizing mental health services.

SUMMARY QUESTIONS

  • What is the history of mental health treatment?

  • What are the types of treatments?

  • What are the modalities of treatment?

  • What are substance-related and addictive disorders?

  • What is the sociocultural model and how does it apply to therapy?

  • What are the barriers to treatment?

FURTHER REVIEW MATERIAL

  • Episode 30: Depressive & Bipolar Disorders

  • Episode 32: Schizophrenia & Dissociative Disorders

  • Episode 33: Eating & Body Dysmorphic Disorder

  • Episode 34: Personality Disorders