Chapter 16 - Therapy and Treatment

History

Treatment in the Past

  • Medieval Europe:

    • Exorcism

    • Trephining (drill hole in skull, usually results in death)

    • Imprisonment

    • Execution

  • 1400-1600 (Witch Hunts)

The Rise of Asylums and the Call for Reform

  • 18th century

    • Philippe Pinel

    • He suggested that they be unchained and talked to, and that’s just what he did for patients at La Salpêtrière in Paris in 1795. Patients benefited from this more humane treatment, and many were able to leave the hospital.

  • 19th century

    • Dorothea Dix

    • Willard Psychiatric Center

Medical Advances and Deinstitutionalization

  • Mental Retardation Facilities and Community Mental Health Centers Construction Act (1963)

  • Deinstitutionalization

    • The closing of large asylums, by providing for people to stay in their communities and be treated locally.

Current Times

The Current State of Mental Health Treatment

  • Voluntary Treatment:

    • something the person WANTS to do to get mental health treatment

    • means the person chooses to attend therapy to obtain relief from symptoms.

  • Involuntary Treatment:

    • forced by courts, etc

    • therapy that is not the individual’s choice.

Modern Treatment Setting Types

  • School counselor

  • School psychologist

  • School social worker

  • An incarcerated person might receive group therapy in prison.

Mental Health Parity and Addication Equity Act (2008)

  • There are still Gaps, still access issues

  • Still a lot of funding issues

Deinstitutionalization

Incarceration

Unhoused Individuals

Types of Therapy

Psychotherapy

  • A psychological treatment

  • Employs various methods to help someone overcome personal problems, or to attain personal growth.

  • Focuses on how the unconscious mind and childhood conflicts influence current behavior.

  • Ex) Discussing past experiences to uncover hidden patterns.

Biomedical therapy

  • A medical treatment

  • Involves medication and/or medical procedures to treat psychological

    disorders

Psychotherapy Techniques:

Psychoanalysis

  • Therapists help their patients look into their past to uncover repressed feelings.

  • Free Association

    • the patient relaxes and then says whatever comes to mind at the moment.

  • Dream Analysis

    • a therapist interprets the underlying meaning of dreams.

  • Transference

    • the patient transfers all the positive or negative emotions associated with the patient’s other relationships to the psychoanalyst.

Play Therapy

  • Usually with kids

  • Uses toys and interaction rather than traditional talk; primarily for children.

  • EX) A child using dolls to act out scenes from their home life.

  • Non-directive Play Therapy

    • Children are encouraged to work through their problems by playing freely while the therapist observes

  • Directive Play Therapy

    • The therapist provides more structure and guidance in the play session by suggesting topics, asking questions, and even playing with the child

Behavior Therapy

  • A therapist employs principles of learning to help clients change undesirable

    behaviors, rather than digging deeply into one’s unconscious.

  • Uses learning principles (like conditioning) to replace undesirable behaviors.

  • Ex) Using relaxation techniques to systematically overcome a phobia.

Classical Conditioning Techniques:

  • Counterconditioning: a client learns a new response to a stimulus that has previously elicited an undesirable behavior

    • Aversive Conditioning: uses an unpleasant

      stimulus to stop an undesirable behavior.

    • Exposure Therapy: a therapist seeks to treat clients’ fears or anxiety by presenting them with the object or situation that causes their problem, with the idea that they will eventually get used to it.

  • Systematic Desensitization: Using this method, a person creates a hierarchy of anxiety, ranging from the least-anxiety-producing stimulus to the feared object.

Operant Conditioning Techniques:

  • Token Economy: involves a controlled setting where individuals are reinforced for desirable behaviors with tokens, such as a poker chip, that can be exchanged for items or privileges.

Cognitive-Behavioral Therapy (CBT)

  • helps clients examine how their thoughts affect their behavior. It aims to change cognitive distortions and self-defeating behaviors.

  • A form of psychotherapy that focuses on how a person’s thoughts lead to feelings of distress

  • A hybrid approach aimed at changing both cognitive distortions and self-defeating behaviors.

  • EX) Identifying triggers and behaviors to manage an eating disorder.

  • ABC Model

    • A - Activating Event

    • B - Beliefs about event

    • C - Consequences

  • Common Cognitive Distortions

    • All or nothing thinking

    • Overgeneralization

    • Jumping to conclusion

Cognitive Therapy

  • Focuses on identifying and eliminating distorted thought patterns that cause distress.

  • Ex) Learning to stop overgeneralizing a single failure as a total defeat.

Rational emotive therapy (RET):

  • Form of cognitive-behavioral therapy

Humanistic Therapy

  • to help people become more self-aware and accepting of themselves

  • Emphasizes self-awareness and acceptance by focusing on conscious thoughts and future goals.

  • EX) Learning to articulate internal barriers to personal achievement.

  • Rogerian, or client-centered therapy

    • Active listening

    • Unconditional Positive Regard

    • Genuineness and Empathy

Biomedical Therapies

Psychotropic Medications

  • Antidepressants

  • Mood Stabilizers

  • Antipsychotics

Other Biomedical Treatments:

  • Electroconvulsive Therapy (ECT)

    • can cause short term memory

    • involves using an electrical current to induce seizures to help alleviate the effects of severe depression

  • Transcranial Magnetic Stimulation (TMS)

Medications are often paired with therapy for treatments!!

Medication can have side effects such as: weight gain, drooling, etc that makes the patient NOT want to continue medication.

Type of medication

  • antipsychotic medications

    • Used to treat schizophrenia and other severe thought disorders by blocking the neurotransmitter dopamine.

    • Long-term use may cause tardive dyskinesia, characterized by involuntary movements and tremors similar to Parkinson's disease.

  • Atypical Antipsychotics

    • Used for Schizophrenia and severe thought disorders

    • Side effects: Obesity, diabetes risk, high cholesterol, dry mouth

  • Anti-depressants

    • Used for Depression and anxiety

    • Side effects: Nausea, weight gain, drowsiness, risk of suicide (Tricyclics)

  • Anti-anxiety Agents

    • Used for Anxiety, OCD, PTSD, panic disorder

    • Side effects: Drowsiness, dizziness, fatigue, lightheadedness

  • Mood Stabilizers

    • used for Bipolar disorder

    • Side effects: Excessive thirst, irregular heartbeat, nausea, loss of appetite

  • Stimulants

    • used for ADHD

    • Side effects Decreased appetite, difficulty sleeping, headache

Treatment Modalities

  • The therapy intake process and the types

Individual Therapy

  • also known as individual psychotherapy or individual counseling

  • Helps you take about goals and changes in life

  • Clients can attend a few sessions or more long term

  • Helps you understand your emotions and reactions

Group Therapy

  • Common topics:

    • Greif

    • Divorce

    • Eating disorders

    • Substance abuse

    • Anger management

  • Benefits

    • Helps with social skills

    • Members can confront each other about their patterns

    • Helps make client feel less shame about their condition

  • Limitations

    • Concerns about confidentiality

    • Arguments among group members

Couples Therapy

  • involves two people in an intimate relationship who are having difficulties and are trying to resolve them

  • non bais

  • Couples meet with a therapist to discuss conflicts and/or aspects of their relationship that they want to change.

Family Therapy

  • Special type of group therapy

  • Dysfunctional patterns of communication that develop between family members can lead to conflict

  • Sometimes one specific member can cause influence on other members with their behavior (substance use, alcohol, behavior in general, etc)

  • Structural family therapy:

    • focuses on boundaries and rules

    • who makes the rules, who sleeps in the bed with whom, how decisions are made, and what are the boundaries within the family.

  • Strategic family therapy:

    • More time limited and goal structured

    • Address specific problems within the family that can be dealt with in

      a relatively short amount of time.

Addiction and Treatments Modalities

  • Addiction is NOT moral failing, rather chronic disease

  • Treatments Goals and Approaches

    • To stop long term substance use

    • Treating both biological and psychological

  • Treatment typically involves:

    • Behavior therapy

    • Medication

  • What makes treatment effective

    • typically a month but its not enough most of the time

    • Treatment also usually involves medications to detox a person with addiction safely after an overdose, to prevent seizures and agitation that often occur in detox, to prevent reuse of the drug, and to manage withdrawal symptoms

    • Group therapy is the most effective!

    • Sometimes have to cut off people that influence addition

  • Treatment modalities and medications

    • Comorbid Disorders: means the individual has two or more diagnoses

    • Some medication can be addictive

    • Everyone different, so treatment is different for everyone (can be effective for some and not for others)

The Sociocultural Context

  • Culture plays a HUGE rule!!!

  • Cultural Competence

    • Ability to understand and respect clients cultures, race and background

  • Multicultural counseling and therapy

    • Aims to offer both a helping role and process that uses modalities and defines goals consistent with the life experiences and cultural values of clients.

Barriers to treatment:

  • Perceptions and stigma

    • Discrimination against minorities

  • Prejudice and shame

    • Doubt about therapy

    • Concerns about confidentiality, shame, etc

  • language

  • availability of culturally sensitive

  • Time, insurance, transportation, etc