Chapter 17 – Treatment and Therapy

 

I.  What is Mental Health Treatment?

        A.  Range of treatment methods

        B.  Connection to etiology

        C.  Selecting an intervention

 

II.  Biological Approaches to Treatment

        A.  Medication

1.  theory:  mental illness is caused by chemical imbalance

                        a.  Neuroleptic (antipsychotic) medication

                        b.  Antidepressants

                                i.  tricyclics

                                ii.  MAOIs (monoamine oxidase inhibitors)

                                iii.  SSRIs (selective serontonin reuptake inhibitors)

                        c.  Anxiolytics (tranquilizers)

                        d.  Mood stabilizers (e.g., Lithium)

                2.  Advantages

                        a.  can be quite effective

                        b.  require less time/effort on patient’s and therapist’s part

                        c.  can be less expensive than therapy

                        d.  for some disorders, meds are the best tx

                3.  Disadvantages and Cautions

                        a.  Placebo effect

                        b.  Relapse after stopping meds

                        c.  Side effects

                        d.  Dosage issues/ Therapeutic window

                        e.  Long-term risks

                        f.  Off-label use

 

        B.  Psychosurgery

                1.  theory:  structural defects can ŕ mental illness

                2.  lobotomy

                3.  cingulotomy

 

        C.  Electroshock therapy

                1.  theory:  ???

                2.  historical use vs. modern approach

 

III.  Psychosocial Approaches to Treatment

        A.  Psychodynamic (insight-oriented) Therapy

                1.  theory:  unconscious underlying conflict ŕ problems

                2.  techniques

                        a.  free association

                        b.  interpretation of transference

                        c.  interpretation of resistance

 

        B.  Behavior Therapy

                1.  theory:  maladaptive learning patterns ŕ problems

                2.  techniques

                        a.  systematic desensitization (counterconditioning)

                        b.  aversive conditioning

                        c.  exposure

                        d.  reinforcement-based programs

                        e.  relaxation training

                        f.  skills training programs

 

        C.  Cognitive Therapy

                1.  theory:  irrational/maladaptive thoughts ŕ problems

                2.  techniques

                        a.  rational-emotive (behavior) therapy

                        b.  cognitive restructuring/challenging (Beck’s approach)

            D.  Humanistic Therapy

                1.  theory:  we all strive for betterness but sometimes get stuck

                2.  techniques

                        a.  client-centered therapy (Rogers’ approach)

                                i.  unconditional positive regard

                                ii.  reflective listening

 

        E.  Existential Therapy

                1.  theory:  refusal to accept that we will die ŕ problems

                2.  techniques

                        a.  focus on here and now

                        b.  confront even grimmest elements of existence

 

        F.  Family Therapy

                1.  theory:  family is a system in which members impact each other

                2.  techniques

                        a.  genograms

                        b.  family systems approach

 

        G.  Group Therapy

                1.  group format of any of above approaches

                2.  using the group itself as an agent of change

 

IV.  The Scientist-Practitioner Approach to Treatment

        A.  Importance of empiricism in selecting intervention

                1.  Role of randomized clinical trials and other controlled studies

        B.  Importance of empiricism in evaluating what one is doing

                1.  Single-subject methodology

        C.  The “Scientist-Practitioner Gap”

        D.  Role of managed care, practice guidelines, etc.

V.  Factors Affecting Outcome

        A. Likely to increase helpfulness:

1.  Client variables (eg, YAVIS; motivation level, support)

                2.   Therapist variables

3.   Therapeutic alliance

4.   Cultural sensitivity

5.  Proper selection of intervention

        B.  Likely to increase potential for harm:

1.  Therapist variables – bias, hostility, ignorance, etc.

2.  Boundary violations and other unethical behavior

3.   Iatrogenic interventions

4.  Coercion or undue/uninformed use of influence

5.  Continuing with treatment that isn’t working

 

VI.  In Considering Therapy:

        A.  Choice of therapist

        B.  Choice of therapy

        C.  Choice of duration