What is Therapy?

Chapter 13 Introduction:
When you think of the term "therapy" you probably visualize a patient lying down on a couch with their therapist asking them questions and writing down notes. But what really happens during therapy? Why do people attend therapy? Are there different types of therapy? Therapy is used to help improve a person's mental, behavioral, and/or social functions, especially for those who are unable to solve their own problems and issues. Most therapy sessions follow a process of identifying the problem, identifying the cause of the problem or the conditions maintaining the problem, and deciding on an effective form of treatment to solve the problem. Therapy is used for a wide range of problems besides the DSM-IV disorders. Many people turn to trained professionals, like clinical psychologists, counseling psychologists, psychoanalysts, psychiatric nurse practitioners, social workers, pastoral counselors, and psychiatrists, when their problems are severe. Mental illness can be difficult for people to understand because there are no physical effects. People might make unkind remarks, such as "pull yourself together" or "it's all in your head", and make fun of their actions or moods. Those who are providing mental health care also face difficulties because they can't necessarily see what's going on.

Types of health care professionals
  • Psychiatrist - Deals with severe mental problems (usually) by prescribing drugs.
  • Clinical Psychologist - Trained to work with those who have more severe disorders; not licensed to prescribe drugs.
  • Counseling Psychologist - Helps those who are dealing with the common problems of normal living such as relationship problems, child rearing, and career choice.
  • School Psychologist - Identifies and assess the learning, development, characteristics and needs of individuals, as well as the environment that affects their learning. They use assessment data about the students and their environment to develop interventions, programs and determine placement.
  • Pastoral Counselor - Spiritual guidance with practical counseling.
  • Psychoanalyst - Private practice, based on Freud's theory of personality.
  • Psychiatric Nurse Practitioner - Licensed to prescribe drugs. Can work in private practice and/or hospitals.
  • Social Worker - Deals with mental disorders from a social and environmental point of view .
  • Paraprofessional- Unlicensed person who often works as if they were a professionals to help others solve their problems.

Throughout history many different practices have been used to treat mental disorders. In medieval Europe, people believed that demons were responsible for the actions of the mentally ill. They performed exorcisms, beat, and sometimes even drilled holes into the skull to release the "demons" within these individuals. More recently, asylums (mental hospitals) have been created to keep individuals with mental disorders away from the stresses of modern life. However, these asylums were often not as ideal as initially planned. In London, there was an insane asylum called Bethlehem Hospital, where patients often made loud and noisy "shows" and were put on display. Unfortunately, people in the insane asylums frequently received abuse and bad treatment from caregivers. Abuse included being forced to take a cold shower, being beaten, and being put into a straight jacket. As a result, many people used the word "Bedlam" (short for "Bethlehem") to describe any chaotic or crazy place.

Psychological therapies are focused on changing the thoughts, feelings, and behaviors of an individual. The modern approaches to therapy are insight therapies, which can help clients understand and fix problems with thoughts, feelings, and/or behaviors, biomedical therapies, which alter the brain's biology in order to treat mental problems, and behavior therapies , which change behavior through conditioning.

How do Psychologists Treat Psychological Disorders?

Insight Therapies

Insight Therapies focus on trying to change the way a person thinks and the way they feel from the inside to the outside. Insight therapies are labeled under the clinical perspective. Insight therapies are often referred to as talk therapies which emphasize verbal communication in order to understand the patient's emotions and motives. One form of insight therapy, called Freudian psychoanalysis, was created by Sigmund Freud. Freudians assume that the problem lies deep within the unconscious and they spend time and effort on elaborate plans to draw these problems out. Their major goal is to reveal and interpret the contents of the unconscious mind. Freud realized that he needed ways to uncover material from the unconscious mind by getting around the defenses of the ego. He did this through dream interpretation (from Chapter 3) and free association. Free association is when the patient relaxes and talks about whatever comes to their mind, while the therapist listens and looks for references to unconscious needs. In another type of Freudian psychoanalytic technique, the therapist relates how their relationship with the patient must reflect the patient's past. This projection of attributes and feelings is called analysis of transference. According to the psychoanalytic theory, a patient will recover when their repressive mental restraints are relieved.

Because Freud allowed for no fundamental changes to his doctrine, many neo-Freudians branched off and created theories of their own. The neo-Freudian psychodynamic therapies differ from Freud's therapies in a few main ways: they are shorter, are face-to-face, and they often include some sort of break from Freudian therapy with one or more important ideals (including the significance of the self or ego rather than the id, the influence of life experiences occurring after childhood as opposed to Freud's emphasis on early childhood experience, or the role of social needs and interpersonal relationships rather than sexual and aggressive desires).

One such neo-Freudian therapy is humanistic therapy. Humanists believe that people are motivated by healthy needs for growth and well-being. They focus on the concept of a whole person involved in continual change. Humanistic therapies help clients confront their problems by recognizing their freedom, enhancing their self-esteem, and realizing their full potential. It allows them to evaluate their true feeling in a healthy, positive way. One humanist, Carl Rogers, created client-centered therapy which assumes that people have a need to self actualize. This method creates a nurturing environment in which the person can do this. Another technique of humanists is the use of reflection of feeling, a method that involves mirroring what the patient says in order to get them to delve deeper into the insights they have given.
Cognitive therapy uses rational thinking as the key to treating mental disorders. This is based on the assumption that psychological problems comes from erroneous thinking. Differing from the rest of these therapies is group therapy, which is any therapy done with more than one client or patient. It can be done with families, couples, or people that share the same problems as each other.This is usually used to help treat problems with social behavior and relationships. One of the most important types of group therapy is self-help support groups, which have become very common and spread over a variety of issues. One final type of insight therapy is couples and family therapy, where an individual couple or multiple couples who are struggling with their relationships and trying to clarifry communication problems meet at a therapy session together.

Behavior Therapies

Behavior therapies , (a.k.a. behavior modification ) have the ability to change most behavioral terms such as overeating, bed-wetting, shyness, antisocial behavior or irrational fears. Theories in this field include Classical Conditioning Therapies, Aversion Therapy, Operant-conditioning Therapies, Participant Modeling, Systematic desensitization, and Group Therapies. Systematic desensitization is a technique in which anxiety is extinguished by exposing the patient to an anxiety-provoking stimulus. Sometimes therapists use more motivating techniques to enforce good behavior, in which they give the patient/client something to work for. This is known as a Token Economy and is often used in classrooms and institutions. When a client has a fear stressor, or obsession, psychologists are likely to use exposure therapy to try to help their patient overcome and/or relieve their specific stressor or anxiety. Participant modeling is a type of treatment where the appropriate and rational behavior is directly shown/modeled to the client.

Cognitive-Behavioral Therapy
Cognitive-behavioral therapy combines a cognitive emphasis on thoughts and attitudes with the basic behavioral approach. Cognitve therapy sees rational thinking as the key to therapeutic change. Of course there are many different broken-down types of therapies in this field. One type of therapy is known as Rational-Emotive Behavior Therapy , or (REBT). This specific type of therapy confronts certain irrational beliefs and behaviors. It is evident that in most behavioral and cognitive-behavioral therapies there is almost always an active listener there to guide and support the client. However, this person may also just be a friend or relative.

Types of Beneficial Therapies for Specific Disorders:

  • Behavior therapy is beneficial when trying to solve specific phobias, enuresis, autism, and addictions.
  • Cognitive-behavior therapy helps patients deal with chronic pain, eating disorders, agoraphobia, and depression
  • Insight therapies help couples deal with relationship problems.

Evaluating the Psychological Therapies

One major question that remains hard to answer is whether or not therapy works. Results from an experiment conducted on 7,000 patients revealed three things: Therapy helped clients diminish or eliminate psychological problems, Long-term therapy is better than short-term, All forms of therapy are equally effective for improving a client's condition. However, not everyone agreed that therapy worked. Psychologist Hans Eysenck claimed that about two-thirds of all people with non-psychotic problems recovered within two years of the onset of the problem, regardless if they received therapy. This claim became known as Eysenck's Proclaimation. His claims stimulated therapists to conduct research on the effectiveness of therapy. In the end, around 375 studies supported two major conclusions: Therapy is more effective than no therapy, and Eysenck overestimated the improvement rate of people who did not receive therapy. These studies led to more questions; such as, "are certain therapies best suited for treating specific disorders?" The American Psychological Association had a task force which evaluated the effectiveness of different therapies on different disorders. Recently, the American Psychological Association has been focused on the treatments for depression. Cognitive, family therapy, and behavorial treatments have proven effective. Some studies have hinted that cognitive-behavorial therapy combined with drug therapy can have a greater impact than just coginitive-behavioral or drug therapy by themselves. A discussion between therapists have suggested that a common idea to a successful therapy is having a caring/hopeful relationship. Also if the patient sees themselves and the world around them in a new way, can help with a successful therapy. A conclusion has been made that the effectiveness revolves around the quality of the relationship of the client and therapist rather than the type of treatment. A recent study shows that psychologists modify their ways of approaching the type of treatment to use by fitting the needs of their patient.

Where Do Most People Get Help?

The consensus is that most people who are or have experienced mental distress will not approach professional therapists for help. These people will look to friends or family for help instead. For the most common problems, a friends may be better than a professional therapist. A friend is more sympathetic and the people trust and value their friend's opinions. The most common psychological difficulty we are faced with are products from losing a job, marriages, children, loved ones deaths, etc. In simpler terms, our reoccurring problems are from chaos, confusion, frustration, choices, stress, and loss. Those who face these problems mainly need a person to help them sort out their problems with them.
What to do if asked to help a person like this?
1) Figure out if a professional needs to be involved. (Suicide threat or harm others)
2) Learn about cognitive-behavioral therapy techniques and psychodynamic interpretations
3) Listen- Sometimes all a person needs is someone to listen to them. Most of the time the person comes up with their own solution. Become an active listener.
4) Be Accepting- Have a nonjudgmental attitude. Most people with their problems do not want to be judged by those close to them and being a listener.
5) Explore alternatives- Those under stress only see one solution. By suggesting alternatives and their consequences are the way to go. In the end, the decision is up to the individual with the problem.

How is the Biomedical Approach Used to Treat Psychological Disorders?

The biological approach is used to find abnormalities in the biological balance of the brain. This can be caused by genes, hormones, enzymes, or damage from accidents or disease. The biomedical approach can treat psychological disorders by using drugs to change the brain's chemistry, change the circuitry of the brain with surgery, or change its patterns and activity with magnetic fields or pulses of electricity.This emerges from the Medical Model, and assumes an organic basis is needed with treatment.

Drug Therapy/Psychopharmacology

In 1953, a new therapeutic era begin with the new use of antipsychotic drugs called tranquilizers. The use of this drug allowed abusive, assaultive and unruly patients to become calm, cooperative, and sociable. Today, millions of people take drugs for anxiety, stress, depression, hyperactivity, insomnia, fears and phobias. Drug Therapy, also called psychopharmacology, includes four categories of drugs that are used today. These drugs reduced the number of people admitted into mental hospitals, and reduced the time patients were needed to stay.
  • The first category, Antipsychotic drugs, are used to treat symptoms of psychosis; such as delusions, hallucinations, social withdrawal, and agitation. Antipsychotic drugs reduce the activity nuerotransmitter dopamine in the brain. However, after a long term use, there are negative side effects, including tardive dyskinesia (motor control) and agranulocytosis which is a blood disease caused by bone marrow dysfunction. Examples of antipsychotic drugs include, chlorpromazine (aka Thorazine) and haloperidol (aka Haldol) block dopamine receptors in the synapse. The new antipsychotic drug, clozapine, (aka Clozaril) decreses dophamine activity but also increases nurotransmitters (serotonin).
  • The second category of drug therapy includes Antidepressants and Mood stabilizers. These drugs have revolutionized the treatment of how people feel who have bipolar disorder or depression. These drugs, antidepressant and mood stabilizers, can't provide a cure, they can though make a difference for people with mood disorders. One form of an antidepressant is an SSRI (selective serotonin reuptake inhibitor) which includes drugs like Prozac. SSRIs help make serotonin available at most times rather than having inactive times. SSRI's keep serotonin available in the synapse longer by preventing its inactivation and removal. However, SSRIs are not liked by many due to an encouragement of using SSRIs at other times than just depression. There are more prescriptions written for antidepressants than people who are clinically depressed. Tofranit and Elavil reduce the neurons, reabsorbing of neurotransmitters after they have been released in the synapse between the brain cells (Reuptake). This leads to a worry of side effects, like change in personality. Lithium carbonate is a mood stabilizer that treats people with bipolar disorder. What sets Lithium carbonate aside from everything else is that it doesn't just effect the depressed mood of people, but it can also reduce mania. A new alternative to lithium to treat bipolar disorder is Divalporex sodium, or Depakote. This is more effective than Lithium Carbonate and has less side effects. The bad things might be that it takes a few weeks to set in, also might get worse before it can get beter.
  • The third category of drug used in psychopharmacology is antianxiety drugs. These are prescribed if a patient is feeling an excess amount of stress or is having problems with anxiety in everyday life. The two most common forms of antianxiety medicine are barbiturates and benzodiazepines. Both of these drugs are also called minor tranquilizers because they can be used to calm little anxiety like flying in an airplane or prior to surgery nerves. Just like antidepressants, these drugs are over prescribed. Some dangerous side effects of these drugs include, sedating the user, convulsions, tremors, abdominal and muscle cramps, impair ones ability to drive or operate machinery, reduce alertness and lead to unconsciousness or death.
  • The fourth category of drugs is stimulants. Some stimulants are used to treat narcolepsy as well as Attention-Deficit/hyperactivity disorder (ADHD). Doctor's don't fully understand why a drug that stimulates the central nervous system is also able to get patients with ADHD to focus. It is thought that stimulants work because they increase the level of available dopamine, glutamate and serotonin in the brain. The worries that come along with this drug include interference with the patients Circadian Rhythm, slow child development, decreased appetite, aggression, and several other negative side-effects.
Drug Therapies include:
Antipsychotic drug -
delusions, hallucinations, social withdrawal, and agitation; decrease activity of dopamine
Antidepressants and mood stabilizers - SSRIs and Lithium carbonate; SSRI reduce serotonin reuptake and lithium is used to help symptoms of bipolar disorder
Antianxiey drugs - tranquilizers; barbiturates and benzodiazepines
Stimulants - increase levels of dopamine, glutamate, and serotonin in the brain

Evaluating the Drug Therapies:

Drug therapies have really caused a revolution when it comes to treating mental disorders. Starting in the 1950's with things like shock therapy, hospitalization, talk therapies and lobotomies. No drugs discovered so far can actually cure any mental disorders, but they do alter the brain to suppress symptoms.
Most people agree that treating bipolar disorder and schizophrenia need medical treatment. But studies also show cognitive-behavioral therapy is very effective in the areas of treating depression, anxiety disorders, and eating disorders. Sometimes it is most effective to combine cognitive-behavioral therapy and drug therapy.

Other Medical Therapies for Psychological Disorders
Other medical therapies for psychological disorders do exist. These include psychosurgery procedures such as lobotomies. The procedure known as psycho surgery is now usually a last resort method.Other brain stimulation therapies exist, including electroconvulsive therapy (ECT), which is used to treat patients who haven't responded to treatment for depression. ECT produces an electrical current to the patients temples. transcranial magnetic stimulation (TMS), produces a high-powered magnetic stimulation to particular parts of the brain, but doesn't not produce a seizure to patients. But unlike ECT, TMS is used to treat depression, bipolar disorder, and schizophrenia.

Hospitalization and Alternatives
Psychiatrist Maxwell Jones proposed the idea of a therapeutic community. He wanted to change the traditional mental hospital and provide a better environment for the patients. Jones wanted them to have private living areas and be able to make their own decisions regarding their day to day routines. He required that the patients take more responsibilities in assuming the tasks of laundry, housekeeping, and maintenance. The ultimate goal for mental health professionals was to remove patients from mental hospitals and return them to their communities, which is the process of deinstitutionalization; patients could live with their families, in foster homes, or group homes. The idea of a community health movement was the alternative method of treatment used, after that people believed that this therapy should exist in the community. Psychological and drug therapies could be given from outpatient clinics, and recovering patients could seek help from their families, foster homes, or group homes. However, this idea did not work as planned. Communities usually lacked the funding necessary to run the necessary programs for people that had been released from mental hospitals. When patients were released, some without families were forced to become homeless and could potentially harm the public. However, the benefits arising from this alternative method was that patients more often improved in the programs and were less likely to be hospitalized at a later date.

Before deciding on a particular type or therapist, there are a few things that you should consider. Do you need medical treatment? If you suspect that the problem involves psychosis, bipolar disorder, or mania, you may need a psychiatrist to employ both drug therapy and psychotherapy. Is there a behavior issue? If there is a behavior problem like a phobia or depression, the best choice would be behavioral therapy or cognitive-behavioral therapy. Would group therapy help? Some people find it helpful to have support from people with similar problems or in a group setting. Learning from not only a therapist, but other group members is often helpful. Is the problem one of stress, confusion, or choice? Although most people don't fall neatly into one of those categories, sorting through their lives and finding a pattern can help develop a plan.

Cautions of Therapies

There are some types of therapies for psychological disorders that should be avoided- Drug Therapies and Advice and Interpretations:

Drug Therapies:

  • Minor Tranquilizers prescribed for chronic stress in people's lives are often have very addicting and sedating effects and should only be taken for short periods of time.
  • Sleep inducing medications also have many dangers. These medications are used for those patients suffering from insomnia. They can cause the patient to carry the possibility of drug dependency and may also interfere with the patients ability to alter the conditions that may have caused the problems they originated with.

Advice and Interpretations:

  • Psychodymanic Therapy can be very useful and helpful for patients, but there are some therapists who give ill-advised counsel on problems that have to do with anger management.
  • It has been proven that advice given to patients, such as releasing the anger, has only lead to or increased the likelihood of later aggressive behavior. Anger is told to be vented or emptied through aggressive behavior such as shouting, punching or shouting at a pillow, etc.