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Introduction • Today, mental illness is recognized as a health problem. This has not always been the case. Until the eighteenth century, those with mental health disorders were viewed as “witches”, and the problem was one of purity. By the late eighteenth century, having attributed ‘insanity’ to have come from evil, a transformation of thought regarding mental illness occurred from one of a supernatural origin to one of some human ailment. The first public mental asylum opened in the United States in 1773, and within the next 100 years, 73 mental hospitals were constructed. Insanity and commitment development determinations were made by the local judiciary. Prior to the development of the mental asylum, the mentally ill were treated as paupers and confined in almshouses and, in the case of the violently mentally ill, imprisoned and punished as criminals.
Introduction Continued • The birth of psychiatry was the dominant force in defining insanity as a medical condition. The Association of Medical Superintendents of American Institutions for the Insane was formed in 1844 who began the publication of the American Journal of Psychiatry which reported remarkable success rates in psychiatric treatment of the mentally ill. This allowed the association to legitimize psychiatry as a medical specialty and to “justify the exclusion of others without formal training in this specialty.” Asylums or psychiatric hospitals became the primary response to mental illness and continued to increase in number until 1955 when the population of the hospitalized reached an all time high of 558, 922 patients.
Counseling v. Psychotherapy Divide • It was largely in response to the US prejudice against lay therapists that Carl Rogers adopted the word 'counseling', • Rogers was not originally permitted by the psychiatry profession to call himself a 'psychotherapist'. • In the field as it now stands, the argument as to whether counseling differs significantly from psychotherapy is largely academic. • Others use 'psychotherapy' to refer to longer-term work and 'counseling' to refer to shorter term work • The two terms are commonly used interchangeably in the US, with the obvious exception of 'guidance counseling', which is often provided in educational settings and focuses on career and social issues.
Counseling v. Psychotherapy Cont. • Rejecting the notion of ‘hidden’ aspects of the psyche which cannot be examined empirically, practitioners in the behavioral tradition began to focus on what could actually be observed in the outside world. • Finally, under the influence of Adler and Rank, a 'third way' was pioneered by the US psychologist Carl Rogers. Originally called 'client-centred' and later 'person-centred', Rogers's approach focuses on the experience of the person, neither adopting elaborate and empirically untestable theoretical constructs of the type common in psychodynamic traditions, nor neglecting the internal world of the client in the way of early behaviorists. Other approaches also developed under what came to be called the 'humanistic' branch of psychotherapy, including Gestalt therapy and the psychodrama of J.L. Moreno.
Mary Richmond (1861-1928) • The first professional Social Work person and brought about indirect and direct practice and she was the one who conceived the idea of PERON-IN-ENVIRONMENT! • Richmond believed that the environment had a bigger part of what was wrong with a person than anything else.
Lightner Witmer (1867-1956) • Regarded as the inventor of the term "Clinical Psychology“. • Co-founder of the world's first Psychological Clinic in 1896 at the University of Pennsylvania.
Granville Stanley Hall (1844-1924) • Psychologist and educator who pioneered American psychology. • Interests focused on childhood development and evolutionary theory. • The first president of the American Psychological Association and the first president of Clark University. • In 1887, he founded the American Journal of Psychology and in 1892 was appointed as the first president of the American Psychological Association, a position he held until his death.
Gestalt Psychology • Gestalt psychology is a theory of mind and brain that proposes that the operational principle of the brain is holistic, parallel, and analog, with self-organizing tendencies; or, that the whole is greater than the sum of its parts. • Although Max Wertheimer is credited as the founder of the movement, the concept of Gestalt was first introduced in contemporary philosophy and psychology by Christian von Ehrenfels. • “The whole is greater than the sum of its parts.”
Psychosocial Development Theory Erik Erikson (1902 – 1994) was a German developmental psychologist and psychoanalyst known best for his theory on social development of human beings. Erik Erikson also coined the phrase identity crisis. Psychosocial development as expressed by Erik Erikson describes eight stages of development through which developing humans should pass from infancy to late adulthood. In each stage the person confronts, and expectantly masters, new challenges. Each stage builds on the successful completion of earlier stages. Stages not successfully completed may reappear as problems in the future.
Life Stages Infancy: (Birth - 18 months) Trust v. Mistrust Post Infancy: (18 months – 3 years) Autonomy v. Shame and Doubt Preschool: (3 – 6 years) Initiative v. Guilt School: (6-12 years) Industry v. Inferiority Adolescents: (12 – 20 years) Identity v. Role Confusion Early Adulthood: (20 – 34 years) Intimacy v. Isolation Middle Adulthood: (35 – 65 years) Generativity v. Stagnation Late Adulthood: (65 + years) Integrity v. Despair
Historic Overview • Modern psychological therapies trace their history back to the work of Sigmund Freud in Vienna in the 1880’s.
Psychoanalytic/Psychodynamic Theory Sigmund Freud (1856-1939) was commonly referred to as “The Father of Psychoanalysis”. Freud has been influential in two significant ways. He simultaneously developed a theory about how the human mind is organized and operates internally, and how human behavior conditions and results particular theoretical understanding.
Psychoanalytic/Psychodynamic Theory Psychodynamics is the study of human behavior from the point of view of motivation and drives, depending largely on the functional significance of emotion, and based on the assumption that an individual's total personality and reactions at any given time are the product of the interaction between their conscious/unconscious mind, genetic constitution and their environment.
Structural categories Level of consciousness: Includes 3 levels of thought 1. Unconscious 2. Conscious 3. Preconscious
Structures of Mind Include 3 personality structures Id Ego Superego
Behaviorism/Learning Theory Ivan Pavlov conducted research on classical conditioning; Edward Thorndike, John Watson, and B.F. Skinner conducted research on operant conditioning were the most influential to this theory. Behaviorism is concerned with apparent behavior. A behavior is a fact and thus a point of departure for attempting to explain it. The determinants are to be found in the external situation of the person, not in the person’s inner life. The individual’s “personality” is the sum of acquired behaviors and learned behavioral-environment relations.
5 fundamental assumptions to this line of Theoretical Development There is continuity of the species. Functional relationships between animal behavior and the environment also hold true for human beings. The conditions of environment are the principle determinants of both animal and human behavior. The procedures of natural science are the best way to understand behavior-environment relationships. Both normal and abnormal behaviors are the product of behavior-environment relationships and can be modified by the manipulation of these relationships. The individual’s “personality” is the sum of acquired behaviors and learned behavioral-environment relations
B. F. Skinner (1904-1990) His focus in operant conditioning is on the response and its consequences, not the antecedent stimulus. Behavior is determined by its consequences and the behavior precedes the stimulus.
Albert Bandura 1925 - present Bandura was initially influenced by Robert Sears' work on familial antecedents of social behavior and identity learning. Directed his initial research to the role of social modeling in human motivation, thought, and action. In collaboration with Richard Walters, his first doctoral student, Bandura engaged in studies of social learning and aggression. Their joint efforts illustrated the critical role of modeling in human behavior and led to a program of research into the determinants and mechanisms of observational learning.
Bandura Cont… Shaping: As used in operant conditioning, is a method for establishing new behaviors. Shaping helps illustrate that conditioning typically occurs through a gradual process rather than all at once. A desired behavior can be achieved though a series of steps, with each step representing progress toward achievement of the sought after behavior.
Aaron Beck (1921-present) The cognitive model especially emphasized in Aaron Beck's cognitive therapy says that a person's core beliefs (often formed in childhood) contribute to 'automatic thoughts' that pop up in every day life in response to situations. Cognitive Therapy practitioners hold that clinical depression is typically associated with negatively biased thinking and irrational thoughts.
Cognitive-Behavioral Theory CBT is commonly based on the idea that how we think (cognition), how we feel (emotion), and how we act (behavior) are all entwined and acting together. This states that our thoughts influence our feelings and behavior, our feelings influence our behavior and thoughts, and our behaviors influence our emotions and thoughts.
Rational Emotive Behavior Therapy Rational Emotive Behavior Therapy (REBT) is a comprehensive, active-directive, philosophically and empirically based psychotherapy which focuses on resolving cognitive, emotional and behavioral problems. REBT was created and developed by the American psychotherapist and psychologist Albert Ellis (1913-2007). REBT is one of the first forms of Cognitive Behavior Therapy (CBT), first expounded by Ellis in the mid-1950s. The fundamental premise of REBT is that people to a large degree disturb, upset and defeat themselves through how they construct their view of reality by the means of their evaluations, beliefs and philosophies about negative events in addition to the events themselves.
Cognitive Development Theory • Jean Piaget (1896–1980) Provided many central concepts in the field of developmental psychology and concerned the growth of intelligence. The theory concerns the emergence and acquisition of schemes in "developmental stages", times when children are acquiring new ways of mentally representing information. • The theory is considered "constructivist", meaning that it asserts that we construct our cognitive abilities through self-motivated action in the world. • For his development of the theory, Piaget was awarded the Erasmus Prize.
4 Main Periods • Piaget divided schemes that children use to understand the world through four main periods, roughly correlated with and becoming increasingly sophisticated with age: • Sensorimotor period (years 0–2) • Preoperational period (years 2–7) • Concrete operational period (years 7–11) • Formal operational period (years 11–adulthood)
Humanism Theory • Humanistic psychology is a school of psychology that emerged in the 1950’s in reaction to both behaviorism and psychoanalysis. • The position of the Humanist is that a person has the capacity for self-awareness; that he does have control over his behavior. The Humanist allows that a person has freedom of choice, self-determination and is responsible for his self-direction.
Abraham Maslow (1908-1970) • Among the earliest approaches we find the developmental theory of Abraham Maslow, emphasizing a hierarchy of needs and motivations.
Postmodern Theories • Postmodern psychology says that the experience of reality is a subjective construction built upon language, social context, and history, with no essential truths. Since "mental illness" and "mental health" are not recognized as objective, definable realities, the postmodern psychologist instead views the goal of therapy strictly as something constructed by the client and therapist.
Examples of Postmodern Theories • Strength Based Therapy • Narrative Therapy • Feminism
Postmodern Therapy • Forms of postmodern psychotherapy include Narrative Therapy, Strength Based Therapy, and Coherence Therapy. • Solution Focused Therapy (SFT) is a type of talking therapy that is based upon social constructionist philosophy.
Strength Based Therapy • Focuses on what clients want to achieve through therapy rather than on the problem(s) that made them seek help. • Focus is on the present and future. • The therapist/counselor uses respectful curiosity to invite the client to envision their preferred future and then therapist and client start attending to any moves towards it whether these are small increments or large changes. • To support this, questions are asked about the client’s story, strengths and resources, and about exceptions to the problem.
Examples of Strength Based Questions • The miracle question • Scaling Questions • Exception seeking Questions • Coping Questions • Resources
Narrative Therapy • Narrative therapy holds that our identities are shaped by the accounts of our lives found in our stories or narratives. • A narrative therapist is interested in helping others fully describe their rich stories and trajectories, modes of living and possibilities associated with them. • By focusing on problems' effects on people's lives rather than on problems as inside or part of people, distance is created. This externalization or objectification of a problem makes it easier to investigate and evaluate the problem's influences. • Another sort of externalization is likewise possible when people reflect upon and connect with their intentions, values, hopes, and commitments. • Once values and hopes have been located in specific life events, they help to “re-author” or “re-story” a person's experience and clearly stand as acts of resistance to problems
Feminism • Feminism is an ideology focusing on equality of the sexes. Feminism comprises a number of social, cultural and political movements, theories and moral philosophies concerned with gender inequalities and discrimination against women. • Some feminists, such as Simone de Beauvoir and Judith Butler, have argued that gendered and sexed identities, such as "man" and "woman", are social constructs.
Insurance Coverage • The Paul Wellstone Mental Health and Addiction Equity Act is legislation that would end the practice of insurance companies discriminating against people suffering from mental illness. Sponsored by Representative Patrick Kennedy (D-RI) and Wellstone's friend Representative Jim Ramstad (R-MN), the bill would compel insurance companies to treat mental illness the same as physical illness, given the overwhelming scientific evidence that mental illness is a disease every bit as real and serious as physical illness. This practice is often referred to as "mental health parity."
Insurance Coverage Continued • The Mental Health Parity Act was signed on September 26, 1996. This Act required that annual or lifetime dollar limits on mental health benefits equaled those of surgical benefits. This applies to group health plans for plan years beginning on or after January 1, 1998. The current extension runs through December 31, 2007. • This act does not apply to benefits for substance abuse or chemical dependency. • This act allowed insurance companies to cover the cost of mental health services and that insurance companies ensure all plans provide mental health coverage to some minimal degree.
Insurance Coverage Continued • The Mandated Insurance Benefits Law, WI Statute 632.89, was developed in 1973 as a way of handling reimbursement and overseeing professionals who were not licensed. This law was progressive in its time as it advocated mental health parity by requiring insurance companies to provide a minimum amount of first dollar coverage for mental health - both inpatient and outpatient; however, this law is outdated. • Clinical social workers obtained licensure in 2002. They are regulated by the Wisconsin Department of Regulation and Licensing and have the right to practice psychotherapy independently.
How Psychological aspects are used in Social Work • Psychological Theories are used in the practice of Social Work. • These are integrated in the assessment, planning, intervention, and evaluation stages of the Generalist Intervention Model (GIM).
General Systems Theory • Proposed in 1936 by biologist Ludwig von Bertanlanffy and further developed by Ross Ashby. • He emphasized that real systems are open to, and interact w/ their environments, and that they can acquire qualitatively new properties thru emergence, resulting in continual evolution. • Rather than reducing an entity to the properties of its parts, systems theory focuses on the arrangement of and relations between the parts which connect them into a whole. This particular organization determines a system, which is independent of the concrete substance of the elements.
General Systems Theory Continued • General systems theory is based on the assumption that there are universal principles of organization, which hold for all systems, be they physical, chemical, biological, mental or social. • Systems concepts include: system-environment boundary, input, output, process, state (homeostasis or dynamic; entropy), hierarchy, goal-directedness, and information. • The systemic world view, contrary to the mechanistic view, seeks universality by ignoring the concrete material out of which systems are made, so that their abstract organization comes into focus
Generalist Intervention Model • Engagement • Assessment • Goals • Planning • Intervention • Evaluation • Termination • Follow Up
Analytic vs. Systemic Approaches • The analytic approach seeks to reduce a system to its basic elements in order to study in detail.
References • Chess, Wayne A. Dale, Orren. Norlin, Julia M. Smith, Rebeca. Human Behavior and the Social Environment: Social Systems Theory. 5th ed Pearson Education. 2006. • F. Heylighen (2000): "Analytic vs. Systemic Approaches", in: F. Heylighen, C. Joslyn and V. Turchin (editors): Principia Cybernetica Web (Principia Cybernetica, Brussels). Retrieved October 29, 2007, from: http://cleamc11.vub.ac.be/REFERPCP.html. • Liska, A.E. (1992). Social Threat and Social Control. Albany: State University of New York. • Woods, M.E., & Hollis, F. (2000). Casework: A Psychosocial Therapy (5th ed.). Boston: McGraw-Hill. • York University IS Research. (2007). Theories used in IS research. Retrieved October 29, 2007, from: http://www.istheory.yorku.ca/generalsystemstheory.htm
