Therapy & Treatment – High-Yield Exam Notes

Mental Health Prevalence

• U.S. adults w/ mental illness: 19\% per yr; adolescents 13\% (ages 8{-}15)
• Treatment use (2004–2008) rose slightly; only \approx 33{-}50\% of adolescents treated

Historical Treatment Overview

• Supernatural era: exorcism, trephining, execution/imprisonment
• 18th C.: asylums focused on isolation; harsh conditions
  • Philippe Pinel → humane reform (unchain, talk)
• 19th C.: Dorothea Dix → U.S. state hospitals; conditions still poor (cold baths, early ECT)
• 20th C.: 1954 antipsychotics; 1975 Community Mental Health Act → deinstitutionalization → underfunded care, homelessness increase

Modern Mental Health Treatment

• Psychiatric/community hospitals: short stays (<2 wks); admit if imminent danger
• Voluntary vs. involuntary treatment
• Providers: psychologists, psychiatrists, clinical social workers, MFTs, etc.

Major Therapy Types

Psychodynamic / Psychoanalysis

• Uncover unconscious, childhood conflicts (Freud)
• Techniques: free association, dream analysis, transference; resistance indicates conflict

Play Therapy (children)

• Toys/sandtray to express & resolve issues
• Nondirective (free play) vs. directive (therapist-guided)

Behavior Therapy

• Change behavior via learning principles
  • Classical: counter-conditioning
    • Aversive conditioning (e.g., Antabuse)
    • Exposure therapy → systematic desensitization (Wolpe); virtual reality variants
  • Operant: applied behavior analysis, token economy

Cognitive Therapy (Beck)

• Thoughts → feelings/behavior; identify & correct cognitive distortions
  • Overgeneralizing, polarized thinking, jumping to conclusions

Cognitive-Behavioral Therapy (Ellis/Beck)

• Present-focused; change thoughts & behaviors
• ABC model: Activating event → Belief → Consequence

Humanistic Therapy (Rogers)

• Increase self-awareness & growth; client-centered, nondirective
• Core conditions: genuineness, unconditional positive regard, empathy; active listening

Biomedical Therapies

• Psychotropic meds treat symptoms, not cure
  • Antipsychotics (↑ dopamine blockade), atypical antipsychotics (dopamine & serotonin)
  • Antidepressants (serotonin/norepinephrine), anti-anxiety agents (CNS depressants)
  • Mood stabilizers (bipolar), stimulants (ADHD)
• Other: Electroconvulsive therapy, transcranial magnetic stimulation

Treatment Modalities

• Intake → assess needs, confidentiality, fees, goals
• Individual therapy: 45{-}60 min, private
• Group therapy: shared issue; supports, lowers isolation; confidentiality concerns
• Family therapy: systems approach (structural, strategic)
• Couples therapy: CBT skills (communication, conflict)

Addiction & Substance-Related Treatment

• Brain changes in PFC → compulsion; relapse 40{-}60\%
• Comorbidity common (MICA)
• Effective programs: ≥3 mo, holistic (medical, social, legal), group support, parental involvement (teens)
• Interventions: behavior therapy for motivation/relapse prevention; meds for detox, withdrawal, relapse block

Sociocultural Considerations & Barriers

• Cultural competence: integrate race/ethnicity, values, individual & collective contexts
• Barriers: lack of insurance, transport, time; language; stigma; confidentiality fears; low perceived need/effectiveness