Psyc 2621

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Psyc 2621

• Therapy and Treatment

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Psychotherapy

• The systematic interaction between
  client/therapist based on psychological
  principles to bring change in behavior, thoughts,
  feelings to overcome abnormal behavior.

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Other features

• Attentive listener
• Aware of nonverbal cues
• Convey empathy
• Instill hope

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Types of Mental Health Professionals

• Psychiatrists
• Clinical Psychologists
• Psychiatric social workers
• Professional counselors

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Major types of therapy

• Psychodynamic therapies
• Traditional Psychoanalysis
• The goal of psychoanalysis Where the id, there
  shall ego be or replace defensive behavior with
  adaptive behavior
• Primary techniques
• Free association
• Resistance
• Dream analysis manifest/latent content
• Interpreting transference/countertransference

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Modern Psychodynamic Approaches

• Ego psychology by Heinz Harmann
• Object-relations by Margaret Mahler

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Humanistic/existential therapies

• Person-centered therapy by Carl Rogers
• Therapist has
• unconditional positive regard
• empathic understanding
• genuineness
• congruence

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• Existential therapy
• The goal is to help clients increase their
  awareness of conscious experiences and make
  personal choices to give meaning/fulfillment
• Key theorists Rollo May, Victor Frankl, Ludwi
  Binswanger, Medard Boss.
• Use
• analysis of defenses.

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Cognitive therapies

• Change maladaptive cognitions
• Key theories
• Rational Emotive Behavior Therapy by Albert
  Ellis.
• Focuses on irrational beliefs such as
• must have love and approval
• must be thoroughly competent
• life must be fair.

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• REBT recognizes that irrational beliefs may come
  from childhood, therefore the therapy must focus
  on finding a rational alternative in the
  here-and-now.
• Utilizes homework assignments in-between sessions.

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• Becks Cognitive therapy by Aaron Beck
• Utilizes homework to record thoughts of upsetting
  event/connect them with their emotional
  responses.
• In comparing cognitive therapy to REBT, REBT
  therapists tend to be more confrontational and
  forceful in their approach to disputing
  irrational beliefs

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Behavior therapy

• Focuses on the here-and-now
• Tries to understand the circumstances in which
  the problem behavior occurs.
• Methods
• systematic desensitization
• gradual exposure (in vivo)
• modeling
• aversive conditioning

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• Operant conditioning
• social skills training
• self-control

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Other therapies

• Electicism
• Group therapy
• Advantages
• less cost
• treat more people
• learn from others
• group support
• problem not unique
• hope

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• Learn to get along
• Family/Marital therapy
• Look at family issues rather than individual
• Types
• Virginia Satir and Conjoint Family therapy
  (communication family therapy)
• Salvador Minuchin and Structural Family Therapy
• Murray Bowen/Extended family systems therapy
• Triangulation/genograms
• Mara Selvini-Palazzoli/Milan systemic family
  therapy
• Circular patterns of action/reaction.

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Evaluating the effectiveness of psychotherapy

• Determined by a statistical process called
  meta-analysis.
• Smith and Glass (1977) show psychotherapy to be
  effective.
• Greatest gains occurs in the first several months
  of treatment.

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Comparing different therapeutic approaches

• Results of meta-analysis show only negligible
  differences between therapies.
• It is difficult to research for ethical reasons.
  Clients and administrators do not want to consent
  to random assignment to different therapies
  therefore, use meta-analysis to compare relative
  effectiveness of different therapies when each is
  compared against control groups.

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Common features among the therapies

• Empathy, support, and attention shown by the
  therapist.
• Therapeutic alliance.
• Working alliance.

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A better question

• Rather than ask, Which therapy works best? must
  as, Which therapy works best for which type of
  problem or client?

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Behavior therapy works best for

• Anxiety
• Sleep disorders
• sexual dysfunction
• Adaptive functioning of people with schizophrenia
  or mental retardation.

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Psychodynamic therapy works best for

• Fostering self-insight
• Personality growth

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Cognitive therapy works best for

• Depression
• Anxiety

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Empirically validated treatments criteria

• Therapy must be more effective than drug or
  placebo control group.
• Effective in a large series of well-designed
  studies in which the treatment was compared to
  another treatment or placebo condition.

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Multicultural Issues

• Evidence is accumulating suggesting the
  effectiveness of psychotherapy with low income
  groups and people of color.
• Cultural mistrust can negatively impact therapy
  addressing racial issues early may increase
  effectiveness.

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Specific issues with African-Americans

• Due to history, there may be a tendency to
  minimize their vulnerability by being less
  self-disclosing.
• Cultural characteristics strong family bond,
  strong spirituality, flexibility of gender roles
  and distribution of child-care responsibilities.

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Specific issues with Asian-Americans

• Mental health issues carry a severe social
  stigma.
• Their tradition is to refrain from the display of
  emotions.
• May prefer structured problem-solving and want
  the therapist to give direct advice.
• Most psychological complaints are expressed as
  physical symptoms.
• Emphasize group needs over individual needs.

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Specific issues with Hispanic-Americans

• Strong patriarchal family structure.
• Value interdependency with the family, not
  independence.

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Specific issues with Native Americans

• There are vast differences among the various
  tribes.
• Tend to pause for longer intervals when engaged
  in a dyadic conversation. Therapist will do most
  of the talking.
• Differences in gestures, eye contact, facial
  expression.
• Preventive therapy should focus on cultural
  cohesion ethnic pride.

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Biological therapies

• These emphasize the biological basis of abnormal
  behavior and biological treatment of those
  disorders.
• Types of biological therapies
• Drug therapy
• Electroconvulsive therapy
• Psychosurgery

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Drug Therapy

• Minor tranquilizers
• Valium
• Xanax
• Major tranquilizers
• Stelazine
• Clozapine

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Cont. Drug therapy

• Antidepressants
• Tricyclics
• Elavil
• MAO Inhibitors
• Nardil
• SSRI
• Prozac
• Lithium

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Electroconvulsive Therapy

• Controversial because
• concern for cognitive deficits though there is no
  current evidence.
• Not sure of the effectiveness compared to
  therapy.
• Not sure why it works.

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Psychosurgery

• No longer perform prefrontal lobotomies.
• Some surgeries performed to treat depression,
  aggression, psychotic behavior, chronic pain, and
  some forms of epilepsy.

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Ethnic differences in response to medications

• African-A show better response to
  antidepressants/phenothiazines.
• Hispanic-A show lower effective dosage levels.
• African-A show greater resistance to taking pills.

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Hospitalization/community based care

• Some studies have indicated higher levels of
  mental illness among Af-A but when controlled for
  SES, no differences.
• Af-A tend to underutilize aftercare services in
  the community following discharge from hospital.
• As-A and Hispanic-A may also underutilize.

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Barriers for minority use of mental health
services.

• Structural
• The institution will not meet the need.
• Cultural
• different concept of mental health problems.
• Language
• Economic

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Hospital vs CMH

• Deinstitutionalization
• Factors contributing to the failure of
  deinstitutionalization
• Lack of community support
• Community resistance
• Lack of public housing
• Limits of medication.