Understanding Abnormal Behavior Chapter Seventeen

1. Understanding Abnormal BehaviorChapter Seventeen Therapeutic Interventions

2. Therapeutic Interventions Biology-based approaches Individual psychotherapy: Insight approaches Action approaches Group approaches: Group therapy Family therapy Couples therapy

3. Biology-Based Treatment Biological/somatic techniques use physical means to alter the patient�s physiological and psychological state Goes back to ancient times (trephining [boring a hole in the heads of mentally ill patients to allow demons to escape], bleeding and purging) Modern techniques: Electroconvulsive therapy Psychosurgery Psychopharmacology

4. Biology-Based Treatment (cont�d) Electroconvulsive therapy (ECT): The application of electric voltage to the brain to induce convulsions Application of electric voltage to the brain to induce convulsions Particularly useful for severe depression Patient is first given a muscle relaxant, then 65-140 volts of electricity are applied causing convulsions and coma. Confusion and memory loss occurs for events immediately before and after the ECT ECT is controversial because: Animals who have undergone ECT show brain damage A small % of patient fracture or dislocate bones Patients expect it to be horrible Abuses have been dramatized It is now illegal to use ECT as a form of patient management ECT is now only used when absolutely necessary � it acts faster than medications can take effect. ECT is controversial because: Animals who have undergone ECT show brain damage A small % of patient fracture or dislocate bones Patients expect it to be horrible Abuses have been dramatized It is now illegal to use ECT as a form of patient management ECT is now only used when absolutely necessary � it acts faster than medications can take effect.

5. Biology-Based Treatment (cont�d) Use of ECT declined in 1960�s-1970�s because: Concerns about permanent brain damage Fracture/dislocation of bones Beneficial effects not long-term Abuses and side effects Advances in medication diminished the need for ECT Not sure why it works.

6. Biology-Based Treatment (cont�d) Psychosurgery: Brain surgery performed to correct severe mental disorders Prefrontal lobotomy Transorbital lobotomy Lobectomy Cauterization During the 40s and 50s patients with schizophrenia and severed depression, as well as smaller number of those with personality and anxiety disorders had psychosurgery 1930s: Egas Moniz suggested that destroying certain parts of the brain might correct severe mental disorders Prefrontal lobotomy: holes are drilled in the skull and a hollow tube (leukotome) is used to cut nerve fibers between frontal lobes and thalamus or hypothalamus Transorbital lobotomy: through the eye sockets Lobectomy: some or all of the frontal lobe s removed Cauterization: electrically burning or searing selected brain tissue Use of original methods caused cognitive and intellectual impairment, listlessness and uninhibited, impulsive behavior � as well as little or no actual improvement in symptoms. Currently, psychosurgery involves very precise and small regions of the brain and is only used in extreme cases During the 40s and 50s patients with schizophrenia and severed depression, as well as smaller number of those with personality and anxiety disorders had psychosurgery 1930s: Egas Moniz suggested that destroying certain parts of the brain might correct severe mental disorders Prefrontal lobotomy: holes are drilled in the skull and a hollow tube (leukotome) is used to cut nerve fibers between frontal lobes and thalamus or hypothalamus Transorbital lobotomy: through the eye sockets Lobectomy: some or all of the frontal lobe s removed Cauterization: electrically burning or searing selected brain tissue Use of original methods caused cognitive and intellectual impairment, listlessness and uninhibited, impulsive behavior � as well as little or no actual improvement in symptoms. Currently, psychosurgery involves very precise and small regions of the brain and is only used in extreme cases

7. Biology-Based Treatment (cont�d) Criticisms of psychosurgery: Patient improvement/lack of improvement is independent of psychosurgical treatment Serious negative and irreversible side effects, e.g., impaired cognitive and intellectual functioning, listlessness, uninhibited impulsive behavior, death Continuing seizures for some Humanitarian grounds: Psychosurgery always produces permanent brain damage

8. Biology-Based Treatment (cont�d) Psychopharmacology: Study of the effects of drugs on the mind and on behavior Advantages (reducing institutionalization) and disadvantages (e.g., addiction and abuse; gender bias, side effects) Four major categories: Antianxiety (minor tranquilizers) Antipsychotic (major tranquilizers) Antidepressant (MAOIs, tricyclics, SSRIs) Antimanic (lithium)

9. Table 17.1: Drugs Most Commonly Used in Drug Therapy

10. Barbiturates Barbiturates: highly addictive sedatives that have a calming effect and were used before the 1950s. Result in tolerance Overdose can be deadly Withdrawal occurs with abrupt discontinuance Even appropriate doses can cause muscular incoordination and mental confusion Were replaced by

11. Antianxiety Drugs (minor tranquilizers) During the 1940s and 50s, the propanediols and benzodiazepines became preferred Can be addictive and can cause withdrawal symptoms, but are safer than the barbiturates Must be carefully monitored to prevent overuse and overreliance

12. Antipsychotic Drugs (Major Tranquilizers) Thorazine was developed as a sedative in the 1950 and had the side effect of reducing psychotic symptoms. Drugs such as Thorazine, Stelazine, Prolixin and others increase social interaction and self-management, and decrease agitation for psychotic patients. Do not always reduce anxiety May lead to psychomotor symptoms (including tardive dyskinesia), sensitivity to light, dry mouth, drowsiness or liver disease. Do not lead to social recovery and patients must keep taking them to prevent resurgence of symptoms

13. Antidepressant Drugs Discovered accidentally in the 1950s. Iponiazid (antitubercolosis medication) made people happier and more optimistic Three classes of antidepressants MAOIs: Monoamineoxiydase Inhibitors � work by inhibiting monoamineoxydase (an enzyme that breaks down dopamine, norepinephrine and serotonin). Short-acting but can produce toxic effects. Tricyclics: work like MAOIs but with fewer side effects SSRIs: work by inhibiting reuptake of serotonin (Prozac, Zoloft). Fewer side effects and less likely to lead to overdose than tricyclics. Associated with jitteriness and stomach irritation.

14. Antimanic Drugs Lithium: mood-controlling (anti-manic) drug that controls about 70-80% of bipolar disorders Little is known about how it works. May limit availability of serotonin and norepinephrine� however, it also decreases depression, which is inconsistent with this effect Lithium is administered as a salt and appears to have no known physiological function. Lithium is largely preventive and must be taken before symptoms begin. It is extremely difficult to determine an effective yet non-toxic dose. Toxic doses of lithium can cause convulsions, delirium and other bad effects. Overall, medications still do not treat passive (negative) sx and do not facilitate better relationships or coping skills.Toxic doses of lithium can cause convulsions, delirium and other bad effects. Overall, medications still do not treat passive (negative) sx and do not facilitate better relationships or coping skills.

15. Biology-Based Treatment (cont�d) Psychopharmacological considerations: Which medication to use with which kind of patient under which circumstances Increases effectiveness of other types of treatment Medications reduce active symptoms and hospitalizations, but do not cure mental disorders Women receive twice as many anti-anxiety prescriptions, and 73% of all psychiatric prescriptions, although they make up half of all clients seen by psychiatrists. Not effective with passive symptoms and do not improve living skills Lack of compliance is a problem

16. Psychotherapy Psychotherapy: Systematic application, by a professional therapist, of techniques derived from psychological principles, for the purpose of helping psychologically troubled people Common therapeutic factors: Development of a therapeutic alliance Opportunity for catharsis Acquisition and practice of new behaviors Clients� positive expectancies Most therapists use the same warmth, empathy and nonjudgmental attitude that any good listener would use, but they also use psychologically planned interventions - deliberately planned and systematically guided by theoretical principles. Several hundred therapies exists - and managed care seems to be working to �streamline� the world of psychotherapy as therapies which cannot objectively prove their effectiveness are not considered for reimbursement. In most cases, biomedical therapies are used in addition to psychotherapy. Most therapists use the same warmth, empathy and nonjudgmental attitude that any good listener would use, but they also use psychologically planned interventions - deliberately planned and systematically guided by theoretical principles. Several hundred therapies exists - and managed care seems to be working to �streamline� the world of psychotherapy as therapies which cannot objectively prove their effectiveness are not considered for reimbursement. In most cases, biomedical therapies are used in addition to psychotherapy.

17. Psychotherapy (cont�d) Korchin�s characteristics of psychotherapy: A chance for the client to relearn Help generating the development of new, emotionally important experiences Therapeutic relationship Clients in psychotherapy have certain motivations and expectations

18. Psychotherapy�s Goals: Change maladaptive behavior Minimize or eliminate environmental conditions that may be causing or maintaining such behavior Improveinterpersonal (and other) skills Resolve disabling conflicts among motives Modify dysfunctional beliefs Reduce or remove distress Foster a clear sense of identity

19. Why do people seek therapy? Sudden and highly stressful situations Referred by a physician for �physical� symptoms Referred by a spouse or attorney Chronic unhappiness and an inability to feel confident and secure Vague dissatisfaction with self/life Intolerable mental states The text mentions that men are more likely to be reluctant to enter therapy than women are and that: Certain family members (any members) enter into therapy only when other members refer them - or enter into treatment themselves, and other members are addressed as part of the family system. (ex., parents may bring their problem child to therapy only to discover they actually need treatment themselves. Also, THERE IS NO TYPICAL CLIENT. Nor is there any mode of therapy which is appropriate for all clients. -and all of the standard therapies can provide proof of at least some success. Physicians and clergy provide therapy - but they are trained to recognize and refer clients who need more formal treatment. Clinical psychologists, psychiatrists and psychiatric social workers also provide treatment. A team of medical, psychological, social work and other mental health personnel often work with one patient/client. The text mentions that men are more likely to be reluctant to enter therapy than women are and that: Certain family members (any members) enter into therapy only when other members refer them - or enter into treatment themselves, and other members are addressed as part of the family system. (ex., parents may bring their problem child to therapy only to discover they actually need treatment themselves. Also, THERE IS NO TYPICAL CLIENT. Nor is there any mode of therapy which is appropriate for all clients. -and all of the standard therapies can provide proof of at least some success. Physicians and clergy provide therapy - but they are trained to recognize and refer clients who need more formal treatment. Clinical psychologists, psychiatrists and psychiatric social workers also provide treatment. A team of medical, psychological, social work and other mental health personnel often work with one patient/client.

20. Psychodynamic Therapies 2 basic forms: Classical psychoanalysis Psychoanalytically oriented therapy Five basic techniques: Free association Dream analysis Analysis of resistance Analysis of transference Interpretation 2 basic forms: Classical psychoanalysis: 3+ sessions per week for several years aimed at uncovering repressed thoughts, memories, fears and conflicts presumably stemming from problems in early psychosexual development. Psychoanalytically oriented therapy: Loosely based on psychoanalytic principles - sessions are less frequent, therapist faces the client, has a more active conversational style and is more likely to focus on interpersonal relationships as a source of current distress. Four basic techniques: Free association: lie in a relaxed position and say whatever comes to mind. Therapist ties together the client�s disconnected thoughts to meaningful explanation. Dream analysis: defenses are thought to be lower while a person is asleep, therefore dreams may represent the window to the unconscious-examine manifest content (the dream as it appears to the dreamer) and latent content (painful or unacceptable content which may not be obvious to the dreamer. Analysis of resistance: therapist analyzes times when the client seems unwilling to talk about certain subjects. Analysis of transference: when the client seems to apply feelings or attitudes actually directed at someone else to the therapist. The client may then react to the therapist in the same way - the therapist can observe this process and work through it -helping the client understand reactions to others. It is important for the therapist to avoid countertransference.2 basic forms: Classical psychoanalysis: 3+ sessions per week for several years aimed at uncovering repressed thoughts, memories, fears and conflicts presumably stemming from problems in early psychosexual development. Psychoanalytically oriented therapy: Loosely based on psychoanalytic principles - sessions are less frequent, therapist faces the client, has a more active conversational style and is more likely to focus on interpersonal relationships as a source of current distress. Four basic techniques: Free association: lie in a relaxed position and say whatever comes to mind. Therapist ties together the client�s disconnected thoughts to meaningful explanation. Dream analysis: defenses are thought to be lower while a person is asleep, therefore dreams may represent the window to the unconscious-examine manifest content (the dream as it appears to the dreamer) and latent content (painful or unacceptable content which may not be obvious to the dreamer. Analysis of resistance: therapist analyzes times when the client seems unwilling to talk about certain subjects. Analysis of transference: when the client seems to apply feelings or attitudes actually directed at someone else to the therapist. The client may then react to the therapist in the same way - the therapist can observe this process and work through it -helping the client understand reactions to others. It is important for the therapist to avoid countertransference.

21. Insight-Oriented Approaches to Individual Psychotherapy Psychoanalysis: Freud: People are born with instinctual drives that constantly seek to discharge/express themselves As personality structure develops, conflicts occur among the id, ego, and superego Unresolved conflicts resurface in adulthood Psychoanalysis seeks to overcome defenses (repressed unacceptable thoughts/impulses)

22. Insight-Oriented Approaches to Individual Psychotherapy (cont�d) Psychodynamic Therapy since Freud Interpersonal Therapy Harry Stack Sullivan Examine all of a client�s relationships We are likely to react in stereotypical ways with others, reflecting early learning experiences Object Relations Therapy Focus is on interactions with (real and imagined) other people The original type of psychoanalysis is only rarely practiced today. Briefer versions seem not to lose any effectiveness. Interpersonal Therapy: consider transference and counter-transference and relationships with everyone the client interacts with (not just the therapist). Harry Stack Sullivan Examine all of a client�s relationships We are likely to react in stereotypical ways with others, reflecting early learning experiences-we are likely to interpret our current relationships in terms of schemas acquired from our earliest relationships with others (for example, parents) Object Relations Therapy Focus on interactions with (real and imagined) other people-where object is the symbolic representation (usually of a parent) of another person in the child�s environment-eg., child might introject (incorporate symbolically) an image of a parent�s scowling face) Self Psychology Other Interpersonal Interventions Most psychodynamically oriented therapies seem to entertain, to some degree, the idea that the effects of the client�s past on the client�s present situation. Criticisms of psychoanalysis: time consuming, expensive, based on an untestable theory of human nature and little evidence of effectiveness - however many people do believe they have developed a deeper understanding of themselves as a result of psychoanalysis. The original type of psychoanalysis is only rarely practiced today. Briefer versions seem not to lose any effectiveness. Interpersonal Therapy: consider transference and counter-transference and relationships with everyone the client interacts with (not just the therapist). Harry Stack Sullivan Examine all of a client�s relationships We are likely to react in stereotypical ways with others, reflecting early learning experiences-we are likely to interpret our current relationships in terms of schemas acquired from our earliest relationships with others (for example, parents) Object Relations Therapy Focus on interactions with (real and imagined) other people-where object is the symbolic representation (usually of a parent) of another person in the child�s environment-eg., child might introject (incorporate symbolically) an image of a parent�s scowling face) Self Psychology Other Interpersonal Interventions Most psychodynamically oriented therapies seem to entertain, to some degree, the idea that the effects of the client�s past on the client�s present situation. Criticisms of psychoanalysis: time consuming, expensive, based on an untestable theory of human nature and little evidence of effectiveness - however many people do believe they have developed a deeper understanding of themselves as a result of psychoanalysis.

23. Insight-Oriented Approaches to Individual Psychotherapy (cont�d) Modern psychodynamic therapy (cont�d): Therapists are more active in the sessions, restrict the number of sessions with a client, put more emphasis on current than past factors, and use client-centered techniques

24. Insight-Oriented Approaches to Individual Psychotherapy (cont�d) Effectiveness of psychoanalysis: Criticisms: Limited selection of clients (young, white, highly educated) Difficulty with operational definitions (e.g., unconscious, libido) makes it difficult to test the theory Symptom substitution

25. Humanistic-Existential Therapies See psychological problems as stemming from alienation, depersonalization, loneliness, lack of meaning and unfulfillment. Stress freedom of choice and personal responsibility, as well as expanding the client�s awareness Client (person)-centered therapy Existential therapy Gestalt therapy Our impersonal, self-interested, bureaucratic computerized society makes many people feel bad� Client (person)-centered therapy: people become psychologically distressed when they place unrealistic demands on their self-worth (for example, that they should never feel selfish or hostile) and lose touch with their genuine experience - point of therapy is to help client�s accept themselves; therapist is nondirective and helps client feel free to explore real thoughts and feelings. In its pure form, this type of therapy is rarely practiced in North America, but is practiced in other parts of the world (European countries). Newer versions incorporate more directive techniques. Existential therapy: emphasizes the client�s perception of the human experience - eg, breakdown of traditional faith, lack of meaning, people are free to do something about this predicament and are confronted with their own mortality. Therapists are encouraged to be authentic and share themselves. Focus is on here and now. Gestalt therapy:focus is on integrating thought, feeling and action -goal is to increase self-awareness and acceptance -often used in a group setting Humanistic therapies have been criticized for lack of clearly defined techniques or even the goals/therapeutic relationship. But have significantly impacted current views about human nature. Our impersonal, self-interested, bureaucratic computerized society makes many people feel bad� Client (person)-centered therapy: people become psychologically distressed when they place unrealistic demands on their self-worth (for example, that they should never feel selfish or hostile) and lose touch with their genuine experience - point of therapy is to help client�s accept themselves; therapist is nondirective and helps client feel free to explore real thoughts and feelings. In its pure form, this type of therapy is rarely practiced in North America, but is practiced in other parts of the world (European countries). Newer versions incorporate more directive techniques. Existential therapy: emphasizes the client�s perception of the human experience - eg, breakdown of traditional faith, lack of meaning, people are free to do something about this predicament and are confronted with their own mortality. Therapists are encouraged to be authentic and share themselves. Focus is on here and now. Gestalt therapy:focus is on integrating thought, feeling and action -goal is to increase self-awareness and acceptance -often used in a group setting Humanistic therapies have been criticized for lack of clearly defined techniques or even the goals/therapeutic relationship. But have significantly impacted current views about human nature.

26. Insight-Oriented Approaches to Individual Psychotherapy (cont�d) Existential analysis: One�s experience/ involvement in the world as a consciousness/ self-consciousness being The inability to accept death/nonbeing restricts self-actualization Existential crisis Philosophical and difficult to test

27. Insight-Oriented Approaches to Individual Psychotherapy (cont�d) Gestalt therapy: Person�s total experience is important and should not be fragmented or separated Here and now Dream analysis Statements to act out emotions, exaggerate feelings to gain greater awareness, role-play

28. Table 17.2: A Systematic Desensitization Fear Hierarchy for a Client with a Fear of Flying

29. Action-Oriented (Behavioral) Approaches to Individual Psychotherapy Classical conditioning techniques: Systematic desensitization is used for anxiety. Relaxation, fear hierarchy, and combination of relaxation and imagined scenes from fear hierarchy Flooding and implosion to extinguish fear: Client is placed in real-life anxiety-provoking situation at full intensity (flooding) Client imagines the anxiety-provoking situation at full intensity (implosion)

30. Action-Oriented (Behavioral) Approaches to Individual Psychotherapy (cont�d) Classical conditioning techniques: Aversive conditioning pairs undesirable behavior with an unpleasant stimulus to suppress the undesirable behavior.

31. Action-Oriented (Behavioral) Approaches to Individual Psychotherapy (cont�d) Operant conditioning techniques: Token economy: Treatment program that rewards patients with tokens for appropriate behaviors; tokens may be exchanged for such things as hospital privileges, food, etc. Punishment: Used to treat children with autism and schizophrenia when less drastic methods don�t work Observational learning techniques (modeling): Acquisition of new behaviors by watching them being performed

32. Action-Oriented (Behavioral) Approaches to Individual Psychotherapy (cont�d) Cognitive-behavioral therapy: Based on the belief that psychopathology stems from irrational, faulty, negative, and distorted thinking or self-statements Common elements: Cognitive restructuring, skills training, problem solving No exclusive set of techniques exists Therapy often includes �experiments� which involve changing thoughts and behaviors and evaluating results. Rational-emotive therapy (RET)/Albert Ellis Cognitive triad (Aaron Beck) Stress inoculation therapy

33. Rational Emotive Behavior Therapy Albert Ellis (beginning in 1958) Attempts to change a client�s maladaptive thought process, which determine emotions and behavior Unrealistic beliefs and perfectionistic values cause people to behavior irrationally and undervalue themselves Task of therapy is to restructure the person�s belief system and self-evaluation. Works to change shoulds, oughts and musts One technique which is used is rational confrontation, in which the client�s false beliefs are disputed. -therapist teaches the client to identify and confont his or her own false beliefs. Aims at increasing self-worth and clearing the way for self-actualization (like humanistic therapy where the false beliefs are the obstacle)/ Works to change shoulds, oughts and musts One technique which is used is rational confrontation, in which the client�s false beliefs are disputed. -therapist teaches the client to identify and confont his or her own false beliefs. Aims at increasing self-worth and clearing the way for self-actualization (like humanistic therapy where the false beliefs are the obstacle)/

34. Stress Inoculation Therapy Self-instructional training focused on altering self-statements an individual normally makes in stress-producing situations. Three stages: Explore beliefs and attitudes about problem situations (cognitive preparation) Learning and practicing adaptive self-statements (skill acquisition and rehearsal) Applying principles in actual situations (application and practice)

35. Beck�s Cognitive Therapies Psychological problems result from illogical thinking about self, world and future. Therapy consists of identifying connections between thoughts and emotions, and learning to challenge automatic thoughts. Therapy DOES NOT involve a debate about the client�s irrational beliefs, but rather, teaching the client to identify and test false beliefs. Cognitive behavioral therapies do seem to be effective, although not enough research has been done on all the different types. Cognitive behavioral therapies do seem to be effective, although not enough research has been done on all the different types.

36. Action-Oriented Approaches to Individual Psychotherapy (cont�d) Health psychology: Integration of behavioral and biomedical sciences acknowledging that psychological factors are often related to the cause and treatment of physical illnesses Biofeedback: Patient receives information (feedback) regarding autonomic functions and is rewarded for influencing those functions in a desired direction Type-A behavior (Meyer Friedman)

37. Evaluating Individual Psychotherapy Hans Eysenck: There is no evidence that psychotherapy facilitates recovery. 100s of studies prove that Eysenck was wrong; the more psychotherapy people receive, the more they improve and the fewer symptoms they report. Persons: Contemporary outcome studies did not accurately represent psychotherapy, which is difficult to measure Efficacy studies: Brief, well-controlled, well-designed research investigations into the outcome of a treatment

38. Evaluating Individual Psychotherapy (cont�d) Effectiveness studies: Examine the outcome of treatment as it is delivered in real life Effectiveness studies demonstrate greater patient improvement than efficacy studies and improvements across different kinds of therapies

39. Figure 17.1: Predictions of the Theoretical Orientations of the Future

40. Evaluating Individual Psychotherapy (cont�d) Meta-analysis and effect size: Meta-analyses analyze a large number of different studies at one time by looking at effect size, or treatment-produced change Meta-analyses support a conclusion that psychotherapy is effective Meta-analyses: Empirically supported treatments (ESTs): Clearly specified psychological treatments shown to be efficacious in controlled research with a delineated population

41. Figure 17.2: Effect Sizes for Psychotherapy, Placebo, and No-Treatment Groups

42. Group, Family, and Couples Therapy Simultaneous treatment of 2 or more clients and may involve more than one therapist Members may be related or may be strangers, but they share various characteristics Therapists can provide more mental health service to the community The cost to each person is reduced Many psychological difficulties involve relationships with others and are best treated in a group rather than individually

43. Group, Family, and Couples Therapy (cont�d) Features of successful groups: Clients are involved in social situations and see how their behavior affects others Therapist see how clients respond in real-life social and interpersonal contexts Clients develop communication skills, social skills, and insights Less isolated and fearful about problems Groups can provide members with social/ emotional support

44. Group, Family, and Couples Therapy (cont�d) Disadvantages of group therapy: Little attention to individual problems Clients may not want to share problems with a group Loss of intimacy with therapist Group pressures may be too strong or group values too deviant Leaderless groups may not be able to recognize or treat people with psychotic or suicidal impulses Clients may be treated in groups and in individual therapy simultaneously. Disruptive people are generally excluded. Little substantial research on the effectiveness of group therapy. Clients may be treated in groups and in individual therapy simultaneously. Disruptive people are generally excluded. Little substantial research on the effectiveness of group therapy.

45. Group, Family, and Couples Therapy (cont�d) Family therapy: Group therapy that seeks to modify relationships within a family to achieve harmony Based on three assumptions: It is logical and economical to treat people together who exist and operate in a system of relationships The problems of the �identified patient� are only symptoms; the family itself is the client. The task of the therapist is to modify relationships within the family system. Two Aprroaches: Communications approach: Assumes that family problems arise from communication difficulties Systems approach: Emphasizes the interlocking roles of family members, assuming it is the family system that contributes to pathological behavior in the family

46. Group, Family, and Couples Therapy (cont�d) Family therapy: Couples therapy: Treatment aimed at helping couples understand and clarify their communications, role relationships, unfulfilled needs, and unrealistic/unmet expectations

47. Systematic Integration and Eclecticism Therapeutic eclecticism: The �process of selecting concept, methods, and strategies from a variety of current theories which work� Integrative approach: No one theory/approach is sufficient to explain and treat the complex human organism Goal: Integrate the therapies that work best with specific clients who show specific problems under specific conditions

48. Culturally Diverse Populations and Psychotherapy Western psychology and mental health concepts are based on an assumption that they are universal and the human condition is governed by universal principles. Surgeon General�s Report on Mental Health: It is dangerous to use European American standards to judge normality and abnormality and may result in denying appropriate treatment to minority groups.

49. Culturally Diverse Populations and Psychotherapy (cont�d) African Americans: Prevalence of mental disorders is higher than that of the general population Underrepresented in privately financed care, overrepresented in public care Poverty rate is 3 times that of whites Many barriers to effective treatment: Historical hostility, therapists� bias and lack of knowledge of African American cultural values

50. Culturally Diverse Populations and Psychotherapy (cont�d) Asian Americans/Pacific Islanders: Underutilize mental health facilities possibly because of low rates of mental disorders, discriminatory mental health practices, and/or cultural values Many problems are hidden but there are problems associated with past traumas and current resettlement problems and racism High levels of PTSD and depression Barriers to effective therapy: Process and goals of therapy may be antagonistic to cultural values

51. Culturally Diverse Populations and Psychotherapy (cont�d) Latino/Hispanic Americans: Value family unity and loyalty to entire �extended� family Subject to poverty and prejudice Therapists need to understand the psychosocial, economic, and political needs of Hispanic clients and should be bilingual/ bicultural. Understand issues of patriarchal system

52. Culturally Diverse Populations and Psychotherapy (cont�d) Native Americans: Heterogeneous group: 550 tribes High poverty, high rates of death among children, less education, high unemployment Value cooperation rather than independence, present rather than future, harmony with nature High rates of suicide and substance abuse U.S. oppression has caused disrupted families, poverty, prejudice, and discrimination

53. Community Psychology Community psychology: Takes into account the influence of environmental factors Encourages the use of community resources and agencies to eliminate conditions that produce psychological problems Promotes well-being and prevention of mental disturbance

54. Figure 17.3: Use of Mental Health Services Among Individuals with Mental or Addictive Disorders

55. Community Psychology (cont�d) Managed health care: Changes are needed in the mental health system to make services accessible, available, and affordable HMOs: Turn to managed-care companies to administer benefit plans Emphasize short-term treatment Use of MAs and MSs instead of MDs, PhDs, and PsyDs Emphasize accountability and quality assurance

56. Community Psychology (cont�d) Concerns about managed care: Quality/extent of services sacrificed for cost APA endorses training clinical psychologists to prescribe medications �Manualized� treatment Computer-generated psychotherapy

57. Community Psychology (cont�d) Prevention of psychopathology: Primary prevention: Effort to lower the incidence of new cases of behavioral disorders by strengthening or adding to resources that promote mental health and eliminating community characteristics that threaten mental health

58. Community Psychology (cont�d) Prevention of psychopathology: Secondary prevention: Attempt to shorten the duration of mental disorders and reduce their impact Tertiary prevention: Facilitates the readjustment of individuals to community life after hospital treatment for mental disorders