Chapter Fourteen
-Therapy Through the Ages

History of Therapy


Types of Therapy & Therapist Orientations

Types of Therapy:

Biomedical
Drug Therapy
Electroconvulsive Therapy
Psychosurgery

Psychological
Psychoanalytic
Humanistic
Cognitive
Behavioral

Therapist orientations

Types of Therapists

Clinical psychologists Have earned a degree (Ph.D., Psy.D., or Ed.D.), which usually takes 4 or more years after earning an undergraduate degree. Their training includes completion of a dissertation based on research and a 1-year internship in a mental hospital or community mental health center. During their schooling they take courses on the diagnosis and treatment of psychological disorders. They must meet state certification requirements that typically require doctoral training, an internship, a number of hours of supervised clinical work in addition to the internship, and a national licensing examination.

Counselors Have a range of educational backgrounds, from a bachelor's degree to a doctorate. They may be members of the clergy (pastoral counselors) or professional educators; some counselors are trained to work with specific populations such as drug and alcohol abusers. However, some individuals who identify themselves as counselors have little formal training in providing psychotherapeutic services.

Marriage and family therapists Usually, but not always, complete a 2-year master's program. Their training focuses on therapy with couples and families and is typically followed by 2 or more years of supervised clinical work. These therapists are specially trained to deal with marital problems and child-parent conflicts. Some states license marriage and family therapists.

Psychiatric nurses Are registered nurses who usually have earned a master's degree from a psychiatric nursing program, which usually takes about 2 years. Psychiatric nurses are especially proficient in evaluating the effects of a person's environment and physical functioning on his or her mental state.

Psychiatrists Are medical doctors (holders of an M.D. degree) who have completed a 3-year residency in psychiatry, usually in a mental hospital or community mental health center. As physicians, they can prescribe drug treatments and hospitalize patients. They treat problems ranging from mild emotional problems to severe psychotic disorders. In addition to drug and other medical treatments, they can use a full range of individual and group psychotherapies, some psychiatrists also use behavior therapy.

Psychoanalysts Are often (but not always) individuals with an M. D. degree who have additional training in the psychoanalytic tradition of therapy developed by Sigmund Freud. An individual without an M. D. degree can qualify as a psychoanalyst by completing the required training and undergoing psychoanalysis, a costly and time-consuming process.

Social workers Constitute the largest group of professionals in the mental health field. Most have earned a master's degree in social work (M.S.W.), which usually takes 2 years of full-time study; a few social workers have earned a doctorate. Their course work includes a practical experience (called "field placement") in social work agencies or mental health facilities. As part of their training , they learn to use the services of social support systems, agencies, and groups to meet their clients' needs. They may direct clinics or have private practices. licensing requirements vary from state to state. Psychiatric social workers specialize in working with mentally ill individuals.


-Psychologically Based Therapies


A). Psychoanalytic Therapy


B). Humanistic Therapy

Humanistic Psychotherapy

Source of Problem: Incongruence between true self and the self which is presented to others. Stems from conditions of worth.

Goal of Therapy: Help people become more truly "themselves" by increasing self-awareness and self acceptance.

Therapeutic Methods:
Unconditional Positive Regard
Accurate Empathy
Genuineness

C). Cognitive Therapies

Cognitive Therapy

Source of Problem: Maladjustment occurs because of faulty irrational ideas and negative sefl-defeating thinking.

Goal of Therapy: To identify the erroneous ways people think about themselves and the world, and then correct them.

Therapeutic Method: Rational examination of negative thought patterns; consciously replacing negative thoughts with positive coping thoughts.

For example:




D). Behavior Therapies

Behavior Therapy

Source of Problem: Person has learned maladaptive behavior patterns or failed to learn adaptive behavior patterns.

Goal of Therapy: To replace maladaptive behavior with adaptive behavior or acquire behavior patterns that had not been learned. Occurs through changes in environmental consequences.

-Therapy Contexts

Individual

Group

There are several advantages to group therapy:

Group therapy allows the therapist to work with several clients simultaneously.

Group therapy allows members to draw on the life experiences of many.

Appropriate behavior receives group support -- an outburst of approval from peers.

Group members learn that other people have had similar problems, similar self-doubts, similar failure experiences.

Group members who show improvement provide hope for other members.

Members of groups have the opportunity to rehearse social skills with one another in a relatively non-threatening atmosphere.

Marital Therapy

Family Therapy

Self-Help


-Effectiveness of Psychotherapy

A). Meta-Analysis

Evaluating Psychotherapies: Psychotherapy Works: On average, people in treatment improve more than do those not in treatment.

No single type of psychotherapy stands out as better although
some types may be better for specific kinds of problems.

Various nonspecific factors such as support and hope which are
common to all therapies seen to contribute to outcome.

B). Consumer Reports Study
http://www.apa.org/journals/seligman.html

Consumer Reports Study Results:
90% of respondents reported significant improvement following therapy.

No difference in overall improvement scores of people who received therapy only and those who received therapy and medication.

No differences found between various forms of therapy.

No differences in effectiveness found between psychologists, social workers, and psychiatrists.

Respondents who had received long term therapy reported more improvement than those who had received short term therapy.

C). Psychotherapy and Diversity

High rate of early termination by minority clients

Therapists need to develop greater cultural understanding & knowledge Example: Some African-American families have extended kinship networks & it may be necessary to include non-family members in group therapy

D). When to Begin and What to Expect

Is your level of distress intense enough that you want to do something about it now?

Are you no longer able to handle problems on your own?

Is your distress affecting your personal life, family or work?

E). Choosing a Therapist

-Biomedical Therapies

A). Overview

Source of Problem: Physiological malfunction and/or structural abnormality
of CNS.

Goal of Therapy: Use physical and chemical methods to help people
overcome their psychological problems.

Therapeutic Methods:
Drug Therapy
Electroconvulsive Therapy
Psychosurgery

B). Drug Therapy

Antianxiety
Antidepressants
Mood stabilizers
Antipsychotics

C). Evaluating Drug Therapy

Clinical trials of most drugs used in the treatment of abnormal behavior have an effectiveness rate of about 70%.

D). Ethnic Factors in Drug Response

There are ethnic group differences in the concentration of a drug in the blood after taking similar doses (pharmacokinetic differences). Ex: levels of Xanax & Halodol reach significantly higher concentrations in East Indian pts. & remain in the body longer than in caucasian pts.

E). Drug Response and Sex

Sometimes women require higher levels of a drug than do men & sometimes they require lower levels.

F). Electroconvulsive Therapy (ECT)

An electric current is passed through the brain to induce a seizure lasting 25 seconds. Usually 3 treatments a week for a total of 8-10 treatments. Used in cases of major depression that have not responded to other treatments & where there is a high risk of suicide. (patient)

G). Psychosurgery

Surgical alteration of brain tissue. Last resort, rarely used.