In-Depth Notes on Therapy & Treatment

Treatment in the Past

• Historical Beliefs: Mental illness was viewed as caused by supernatural forces (e.g., witchcraft, demonic possession).
  • Consequences: Cruel treatments were common.
• Supernatural Treatments:
  • Exorcism: Incantations and prayers.
  • Trephining: Making holes in the skull to release spirits; often fatal.
  • Execution/Imprisonment: Many were killed or imprisoned as witches.

The 18th Century

• Asylums: First institutions for housing individuals with psychological disorders.
  • Focused on ostracization rather than treatment.
  • Conditions: windowless dungeons, chains, minimal contact with caregivers.
• Philippe Pinel (Late 1700s):
  • French physician advocating for humane treatment.
  • Suggested unchaining and talking to patients, leading to successful outcomes.

The 19th Century

• Dorothea Dix:
  • Social reformer and advocate for the insane.
  • Investigated poor conditions and campaigned for funding of asylums in the U.S.
• Conditions:
  • American asylums were dirty with little treatment.
  • Common treatments included cold baths and electroconvulsive therapy until the late 20th century.

The 20th Century

• Antipsychotic Medications (1954):
  • Improved treatment of psychosis symptoms (hallucinations, delusions).
• Deinstitutionalization:
  • Closing of large asylums, transitioning to community-based care.
  • Issues: Underfunded centers, untrained staff, increase in homelessness.

Mental Health Treatment Today

• Current Statistics:
  • Approximately 25% of homeless individuals in U.S. shelters have severe mental illnesses.
• Modern Treatment Settings:
  • Psychiatric hospitals and community hospitals replacing asylums.
  • Short-term stays; hospitalization mainly for imminent threats.
• Types of Therapy:
  • Involuntary vs. voluntary treatment.
  • Sources include community centers, private practitioners, school counselors, etc.

Types of Treatment

• Psychodynamic Psychotherapy: Talk therapy focusing on unconscious conflicts; e.g., discussing the patient’s past.
• Play Therapy: Uses toys to help children express emotions; includes nondirective and directive play.
• Behavior Therapy: Applies learning principles to change behavior; e.g., desensitization techniques for phobias.
• Cognitive Therapy: Focuses on changing negative thought patterns; e.g., awareness of cognitive processes to eliminate distress.
• Cognitive-Behavioral Therapy (CBT): Combines cognitive and behavior therapies to change self-defeating behaviors.
• Humanistic Therapy: Centers on self-awareness and growth; e.g., Rogerian therapy emphasizing unconditional positive regard.

Treatment Modalities

• Individual Therapy: One-on-one sessions lasting 45-60 mins, exploring feelings and setting goals.
• Group Therapy: Clients meet with a therapist to discuss common issues; can reduce shame and isolation.
• Couples Therapy: Focuses on improving relationship dynamics through communication.
• Family Therapy: Views family as a system, enhancing the growth of individual members and the whole.

The Sociocultural Model

• Cultural Competence: Understanding cultural issues and creating strategies for diverse populations.
  • Aims for a balance between individualism and collectivism in treatment settings.

Cognitive-Behavioral Therapy (CBT)

• Focuses on present issues, aiming to change thought patterns and behaviors.
  • Integrates cognitive therapy (addressing negative thoughts) and behavior therapies (promoting healthy behaviors).

Cognitive Distortions

• Definition: Irrational thoughts that can significantly affect emotional states; can become debilitating.

Thought Records

• Example Log Structure:
  • Situation, Emotional Response, Thought, Cognitive Distortion, Alternative Thought
  • Example: Loss of job leading to feelings of anger and self-blame; use of thought record to reframe thinking.

Treatment Barriers

• Access Issues: Lack of insurance, transportation, time.
• Ethical Disparities: Stigma, fear of not being understood, lack of education on mental illness.
• Perceptions: Self-sufficiency belief, doubts about therapy efficacy, concerns about confidentiality.