Psychological Foundations

1. Psychological Foundations Therapy and Treatment

2. History of Mental Health Treatment • 18th century – asylums (right) were created to house people with psychological disorders and keep them away from society. People were often mistreated. • 1950s and 60s - antipsychotic medications introduced. • 1963 – Deinstitutionalization closed large asylums with the goal of treating people in their communities.

3. How Common is Mental Illness? • 19% of U.S. adults experienced mental illness in 2012 • In 2008, 13.4% of adults received treatment for a mental health issue • People with mental illness are over-represented in homeless (a) and prison (b) populations

4. Where Do People Get Mental Health Treatment? • Primary care physician then referred to a mental health practitioner • Community mental health centers  • Psychiatric hospitals • Schools • Prison

5. Why do people seek treatment? • Voluntary treatment: A person chooses to seek treatment in order to obtain relief from her symptoms • Involuntary treatment: A person is required by the courts or other systems to seek treatment

6. Types of Therapy Psychotherapy is a psychological treatment that employs various methods to help someone overcome personal problems, or to attain personal growth • In modern practice, it has evolved into what is known as psychodynamic therapy, which will be discussed later. Biomedical therapy involves medication and/or medical procedures to treat psychological disorders

7. Psychotherapy Techniques

8. Psychoanalysis Therapeutic orientation developed by Sigmund Freud (his couch is at right) that employs free association, dream analysis, and transference to uncover repressed feelings

9. Behavioral Therapy Uses principles of classical and operant conditioning to change behavior • Aversive conditioning   • Exposure therapy (right)

10. Cognitive Therapy • Cognitive therapists help their clients change dysfunctional thoughts in order to relieve distress • Emotional reactions are the result of your thoughts about the situation rather than the situation itself. • By changing your thoughts about the situation, you can improve your mental health

11. Cognitive Behavioral Therapy Cognitive-behavioral therapy (CBT) helps clients examine how their thoughts affect their behavior. It aims to change cognitive distortions and self-defeating behaviors. Effective for depression, PTSD, anxiety disorders, eating disorders, bipolar disorder, and substance abuse. Cognitive distortions include: • All-or-nothing thinking • Overgeneralization • Jumping to conclusions

12. Humanistic Therapy Goal of humanistic therapy is to help people become more self-aware and accepting of themselves. Focus on conscious thoughts and the patient’s present and future Client-centered therapy: • Nondirective therapy • Active listening • Unconditional positive regard

13. Evaluating Psychotherapy According to the APA three factors work together to produce successful treatment • Use of evidence-based treatment that is deemed appropriate for your particular issue • Clinical expertise of the psychologist or therapist • You rowncharacteristics, values, preferences, and culture No studies have found one psychotherapeutic approach more effective than another One critical factor is the person’s relationship with the psychologist or therapist

14. Biomedical Therapy Treatment that involves psychotropic medication and/or medical procedures to treat the symptoms of psychological disorders If other treatments don’t work, electroconvulsive therapy (ECT) uses an electrical current to induce seizures in a person to help alleviate the effects of severe depression

15. Commonly Prescribed Psychotropic Medications

16. How is Addiction Treated? Goal: to help an addicted person stop compulsive drug-seeking behaviors Treatment usually includes behavioral therapy and/or medication, depending on the individual  About 40%–60% of individuals relapse, which means they return to abusing drugs and/or alcohol after a period of improvement

17. Effective Treatment for Addiction • 3 months or more is best • Address communication, stress management, relationship issues, parenting, vocational concerns, and legal concerns • Group or family therapy to offer support, affiliation, identification, and even confrontation • Addresses other mental health disorders at the same time (Substance abusers are twice as likely to have a mood or anxiety disorder)

18. Modalities of treatment: • Individual therapy • Group therapy • Couples therapy • Family therapy

19. Starting Therapy Intake: therapist’s first meeting with the client in which the therapist gathers specific information about symptoms, support, and goals to address the client’s immediate needs Confidentiality means the therapist cannot share what is said with any third party unless mandated or permitted by law to do so

20. Risks and Benefits of Group Therapy Benefits: • Can help decrease a client’s shame and isolation about a problem while offering needed support • Members can confront each other about their patterns. • Economical  Risks: • Members of the group may be afraid to speak in front of other people. • Personality clashes and arguments among group members. • Concerns about confidentiality

21. Couples Therapy • The couple may be dating, partnered, engaged, or married. • The primary therapeutic orientation used is cognitive-behavioral therapy • Some couples seek therapy to work out their problems, while others attend therapy to determine whether staying together is the best solution

22. Family Therapy • Systems approach • Structural family therapy • Strategic family therapy

23. Cultural Competence in Mental Health Treatment Mental health professionals must understand and address issues of race, culture, and ethnicity The sociocultural model integrates the impact of cultural and social norms into treatment

24. Barriers to Treatment • Ethnic minorities and individuals of low socioeconomic status report that barriers to services include lack of insurance, transportation, and time • Even controlling for income levels and insurance, ethnic minorities are far less likely to use mental health services • Non-financial barriers include self-sufficiency and not seeing the need for help, not seeing therapy as effective, concerns about confidentiality, language differences, and the many effects of stigma and shame

25. Practice Question A friend is thinking about seeking therapy to get some tools for managing anxiety. What types of treatment should she consider?

26. Quick Review • How are mental health services delivered today? • What are psychoanalysis, play therapy and behavior therapy? • How cognitive and cognitive-behavioral therapy used? • What are the characteristics of humanistic therapy? • Compare and evaluate various forms of psychotherapy • Explain and compare biomedical therapies

27. More Quick Review • What are treatments for addictive disorders? What makes them effective? Consider the role of comorbid disorders. • What are the different modalities of therapy and what are the benefits of each? • Why is the sociocultural model is important in therapy and what type of cultural barriers prevent some people from receiving mental health services?