15. Therapy and Treatment

Describe the treatment of mental health disorders over time

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• Explain how people with psychological disorders have been treated throughout the ages and discuss deinstitutionalization

• Describe the ways in which mental health services are delivered today, including the distinction between voluntary and involuntary treatment

Describe cognitive and behavioral therapies

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• Describe psychoanalysis as a treatment approach

• Describe how cognitive and cognitive-behavioral therapy are used as treatment methods

• Explain the basic process and uses of behavior therapy

• Describe systematic desensitization

Describe humanistic and biomedical therapies

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• Explain the basic characteristics of humanistic therapy

• Explain the basic characteristics of mindfulness, treatment for addiction, and other emerging psychological treatments

• Explain and compare biomedical therapies

Explain reconsolidation therapy

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• Explain memory consolidation and how it can be manipulated using concepts from conditioning

• Describe how reconsolidation can be used to treat anxiety or PTSD

Explain and compare treatment modalities

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• Define and give examples of individual therapy

• Describe the types and benefits of different types of group therapies

• Explain why the sociocultural model is important in therapy and what type of cultural barriers prevent some people from receiving mental health services

Essential Concepts

Mental Health Treatment

It was once believed that people with psychological disorders, or those exhibiting strange behavior, were possessed by demons. These people were forced to take part in exorcisms, were imprisoned, or executed. Later, asylums were built to house the mentally ill, but the patients received little to no treatment, and many of the methods used were cruel. Philippe Pinel and Dorothea Dix argued for more humane treatment of people with psychological disorders. In the mid-1960s, the deinstitutionalization movement gained support and asylums were closed, enabling people with mental illness to return home and receive treatment in their own communities. Some did go to their family homes, but many became homeless due to a lack of resources and support mechanisms.

Today, instead of asylums, there are psychiatric hospitals run by state governments and local community hospitals, with the emphasis on short-term stays. However, most people who have mental illness are not hospitalized. A person suffering symptoms could speak with a primary care physician, who most likely would refer him to someone who specializes in therapy. The person can receive outpatient mental health services from a variety of sources, including psychologists, psychiatrists, marriage and family therapists, school counselors, clinical social workers, and religious personnel. These therapy sessions would be covered through insurance, government funds, or private (self) pay.

Cognitive and Behavioral Therapies

Psychoanalysis was developed by Sigmund Freud. Freud’s theory is that a person’s psychological problems are the result of repressed impulses or childhood trauma. The goal of the therapist is to help a person uncover buried feelings by using techniques such as free association and dream analysis.

Play therapy is a psychodynamic therapy technique often used with children. The idea is that children play out their hopes, fantasies, and traumas, using dolls, stuffed animals, and sandbox figurines.

In behavior therapy, a therapist employs principles of learning from classical and operant conditioning to help clients change undesirable behaviors. Counterconditioning is a commonly used therapeutic technique in which a client learns a new response to a stimulus that has previously elicited an undesirable behavior via classical conditioning. Principles of operant conditioning can be applied to help people deal with a wide range of psychological problems. Token economy is an example of a popular operant conditioning technique.

Cognitive therapy is a technique that focuses on how thoughts lead to feelings of distress. The idea behind cognitive therapy is that how you think determines how you feel and act. Cognitive therapists help clients change dysfunctional thoughts in order to relieve distress. Cognitive-behavioral therapy explores how our thoughts affect our behavior and aims to change cognitive distortions and self-defeating behaviors.

Humanistic and Biomedical Therapies

Humanistic therapy focuses on helping people achieve their potential. One form of humanistic therapy developed by Carl Rogers is known as client-centered or Rogerian therapy. Client-centered therapists use the techniques of active listening, unconditional positive regard, genuineness, and empathy to help clients become more accepting of themselves.

Often in combination with psychotherapy, people can be prescribed biologically based treatments referred to as biomedical therapies, such as psychotropic medications and/or other medical procedures such as electro-convulsive therapy.

Reconsolidation Therapy

Memory plays a crucial role in psychological disorders, such as overgeneralized autobiographical memory in depression and memory uncertainty in obsessive-compulsive disorder. Psychotherapy heavily relies on remembering and reflecting on past experiences. The process of memory consolidation, which occurs shortly after an experience, is essential for stabilizing memories, and recent research suggests that memories are more like computer files that can be modified rather than fixed books. According to the newer theory of memory, memories can be modified during retrieval and once reconsolidated, the modified version becomes the new memory without a backup of the original.

Therapy based on reconsolidation theory involves retrieving emotionally powerful memories and then reducing their impact through techniques such as extinction of fear response or the use of drugs like propranolol. Repetition of these steps across multiple sessions is necessary for effective treatment of deep-seated issues.

Treatment Modalities

There are several modalities of treatment: individual therapy, group therapy, couples therapy, and family therapy are the most common. In an individual therapy session, a client works one-on-one with a trained therapist. In group therapy, usually 5–10 people meet with a trained group therapist to discuss a common issue (e.g., divorce, grief, eating disorders, substance abuse, or anger management). Couples therapy involves two people in an intimate relationship who are having difficulties and are trying to resolve them. The couple may be dating, partnered, engaged, or married. The therapist helps them resolve their problems as well as implement strategies that will lead to a healthier and happier relationship. Family therapy is a special form of group therapy. The therapy group is made up of one or more families. The goal of this approach is to enhance the growth of each individual family member and the family as a whole.

The sociocultural perspective looks at you, your behaviors, and your symptoms in the context of your culture and background. Clinicians using this approach integrate cultural and religious beliefs into the therapeutic process. Research has shown that ethnic minorities are less likely to access mental health services than their White middle-class American counterparts. Barriers to treatment include lack of insurance, transportation, and time; cultural views that mental illness is a stigma; fears about treatment; and language barriers. Supporting mental health treatment involves speaking and listening openly about mental health, avoiding assumptions, being conscious about language, and encouraging others to get help when needed.

Therapy and Treatment Cheat Sheet from Lumen One Introduction to Psychology, Lumen Learning, https://lumenlearning.com/, CC BY.

Psychology, 2e, OpenStax, https://openstax.org/books/psychology-2e/, CC BY.

David Wiley