Introduction to Psychotherapy

1. Introduction to Psychotherapy Definitions and Examples

2. The 5-minute lecture • Mental health “treatment” has a painful history • Contemporary psychotherapy works • The relationship is important • Therapist must be empathic • Therapy is an art (as well as a science) • There are many therapy modalities. People like to argue about which one is best. The 5-minute university [video link]

3. Today’s Lecture • Historical treatment of the mentally ill • Psychotherapy definitions and examples • Places of treatment • Providers of treatment • Recipients of treatment

4. Historical background: Beliefs and treatment of the mentally ill • Greek physician Hippocrates (ca. 400BC) promoted humane treatment. Tx based on healing powers of nature: Mentally ill patients were placed in pleasant surroundings and given soothing baths. • Lack of balance between positive and negative energies • Illness attributed to a disturbance in the balance of bodily fluids (humorism).

5. Middle Ages-17th century: A spiritual matter • Madness = in league with devil, possession by spirits • Diagnosis based on hearsay, unreliable “tests” • Treatment • Prayer, exorcism, magic incantation • Torture, starvation, and exile (sent to sea) • Treated like animals and sentenced to burn or hang

6. 18th century: Moderate enlightenment • Mentally disordered people = degenerates • Treatment: • Isolate mentally ill from society • Sometimes bloodletting

7. The 19th century: Attempts at reform • Philippe Pinel (1745-1826) • Reformed Paris mental hospitals: Removed restraints and treated mentally ill more humanely • Some patients got better enough to leave hospital

8. The 19th century (cont.) Dorothea Dix (1802-1887) • Reform of U.S. system • Moral-treatment movement advocating humane care • Led to large, state-supported public asylums • But problems persisted • Overcrowding • No effective treatments • Eventually…interest waned Freud introduces psychoanalysis in 1890s

9. The 20th century • New biological therapies introduced in 1930s • Insulin-coma therapy (ICT) video of Leonard Frank • Electro-shock therapy (ECT) video of early ECT • Frontal lobotomy video • Anti-psychotic drugs introduced in mid-1950s • Deinstitutionalization follows in early 1960s • get people out of asylums and back into community • general mood of optimism in country • Community mental health centers established in 1961 Additional video available from Scientific American Series

10. ECT Today Therapy for severely depressed patients in which a brief electric current is sent through the brain of an anesthetized patient Side effects of ECT include slowing of information processing speed and short-term memory loss, but it is painless and there is no risk for death or brain damage. 70% of depressed patients who did not respond to other treatment respond positively to ECT.

11. Somatic Treatments in the 1920s and 1930s

12. The 20th century • New biological therapies introduced in 1930s • Insulin-coma therapy (ICT) • Electro-shock therapy (ECT) • Frontal lobotomy • Anti-psychotic drugs introduced in mid-1950s • Deinstitutionalization follows in early 1960s • get people out of asylums and back into community • general mood of optimism in country • Community mental health centers established in 1961 Additional video available from Scientific American Series

13. Patients in Mental Hospitals. The number of patients cared for in the U.S. state and county mental hospitals has decreased dramatically since 1955.

14. 20th Century: Advances in psychotherapy • Psychoanalysis introduced by Freud in 1890s • Adler (1930s) and other neo-Freudians follow • Variety of new approaches introduced in 1950s • Behavioral (Wolpe, Watson, Skinner) • Rational Emotive Therapy (RET, Ellis) • Humanistic (Rogers) • Existential (May) • Gestalt (Perls) • Cognitive therapy introduced in 1960s (Beck) • Group therapy also gains popularity in 1960s • Family Therapy comes in the 1970s • Motivational Interviewing (1983) and MBCT (1991)

15. Today’s Lecture • Historical treatment of the mentally ill • Psychotherapy definitions and examples • Places of treatment • Providers of treatment • Recipients of treatment

16. What is psychotherapy? • Psychotherapy is a form of treatment for problems of an emotional nature in which a trained person deliberately establishes a professional relationship with a patient for the purpose of removing, modifying, or retarding existing symptoms, of mediating disturbed patterns of behavior, and of promoting positive personality growth and development (Wolberg, 1967). • Psychotherapy is a planned activity of the psychologist1, the purpose of which is to accomplish changes in the individual that make his/her life adjustments potentially happier, more constructive, or both (Frank, 1982). 1or other professional mental health service provider

17. Which of these is not psychotherapy? • A rabbi counseling a couple with marital difficulties • An abused child drawing pictures of his family for a psychologist • A woman presenting her testimony to her Alcoholic Anonymous group • A university Counseling Center psychologist with an M.A. helping a student choose a career • A man talking about his dreams and childhood experiences to a psychoanalyst in N.Y. • A police officer “talking down” a suicidal teenager from a tall building • A family having a loud argument in a therapist’s office

18. Today’s Lecture • Historical treatment of the mentally ill • Psychotherapy definitions and examples • Places of treatment • Providers of treatment • Recipients of treatment

19. Modern Treatment Facilities/Trends • Hospitals (2006 National Hospital Discharge Survey) • Mental disorders led to 2.4 million hospitalizations (6.9% of total) • Psychoses was the 3rd most common reason for hospitalization • Heart disease (4.2 million) • Child delivery (4.1 million) • Psychoses (1.7 million) • Pneumonia (1.2 million) • Malignant neoplasms (1.2 million) • Fractures (1.1 million) • Average length of st-hospital stay is about 7 days (see next slide) • Community Mental Health Centers • Out-patient mental health clinics • Nursing homes • Private offices

22. Hospitals from a patient's perspective • Rosenhan (1973): "On being sane in insane places” • sane people got into mental hospitals as patients • found very low interaction with staff • dehumanizing nature of interactions • normal behaviors interpreted pathologically Birth of modern psychiatry video • Rosenhan’s study spurned significant reform. Today’s hospitals are more humane, but… • Practically everyone is medicated • Restraints & padded rooms used if patient at risk of self-harm • Involuntary hospitalization legally permitted (though limited)

23. Modern Treatment Facilities/Trends • Hospitals (2004 National Hospital Discharge Survey) • Mental Disorders accounted for 2.3 million hospitalizations • Psychoses was the 3rd most common reason for hospitalization • Heart disease (4.4 million) • Child delivery (4.1 million) • Psychoses (1.6 million) • Pneumonia (1.3 million) • Malignant neoplasms (1.2 million) • Fractures (1.0 million) • Average length of hospital stay is about 7 days (see next slide) • Community Mental Health Centers • Out-patient mental health clinics • Nursing homes • Private offices

24. Today’s Lecture • Historical treatment of the mentally ill • Psychotherapy definitions and examples • Places of treatment • Providers of treatment • Recipients of treatment

25. Professionals who treat mental disorders • Psychiatrists (M.D.) • Psychiatric nurses (B.S, M.S.) • Physicians (M.D.) • Psychoanalysts (Ph.D. +) • Psychologists • Clinical (M.A., Ph.D., Psy.D.) • Counseling (M.A., Ph.D.) • School (M.A., Ph.D.) • Social workers (MSW) • Marriage and family counselors (M.A.)

26. Therapists and their training

27. Estimated Number of Clinically Trained Professionals Providing Mental Health Services in the U.S. (2010) Psychiatrists Clinical, Counseling, and School Psychologists Social Workers Current data available on the Occupational Outlook Handbook homepage

28. Self-help Groups

29. Referral sources

30. Who do people recommend?

31. Who do people turn to for help?

32. Types of psychotherapists

33. Norcross, Hedges, & Prochaska (2002) Types of psychotherapists (part 2) Adapted from Norcross, J. C., Hedges, M., & Castle, P. H. (2002). Psychologists conducting psychotherapy in 2001: A study of the Division 29 membership. Psychotherapy: Theory, Research, Practice, Training, 39(1), 97–102.

34. Today’s Lecture • Historical treatment of the mentally ill • Psychotherapy definitions and examples • Places of treatment • Providers of treatment • Recipients of treatment

35. Recipients of treatment • Most people who meet criteria for DSM diagnoses do not seek treatment • Variability due to sex, education, race & income level • women seek more treatment than men • college educated people seek more treatment than those with only a high school education • whites seek more treatment than nonwhites • people with higher income seek more treatment than those with lower income

36. Race-group Differences in Psychopathology

38. Distribution lacking health insurance by race and ethnicity (2004) Latest uninsured data from CFED The higher uninsured rate for Hispanics is not associated with higher poverty levels than other groups — the poverty rate for Hispanics is slightly lower than for African-Americans, 22.2% vs. 24.9% respectively. Rather, research has shown that Hispanics are more likely to be employed in jobs that do not offer health insurance…but when offered health insurance they accept at the same rates at whites and blacks (U.S. Department of Health and Human Services)

39. More research on health disparities

40. Reasons for seeing a mental health professionalMurstein & Fontaine (1993), random sample in Conn.

41. More information: • APA Psychology career page • Occupational Outlook Handbook • See “Professional Development” links on course website