Introduction to Psychotherapy Definitions and Examples

Today’s Lecture Historical treatment of the mentally ill Psychotherapy definitions and examples Places of treatment Providers of treatment Recipients of treatment Next Class: Does psychotherapy work?

Historical background: Beliefs and treatment of the mentally ill Greek physician Hippocrates promoted humane treatment. Mentally ill patients were placed in pleasant surroundings and given soothing baths and massages. Lack of balance between positive and negative energies Disturbance in the balance of bodily fluids treatment

Middle Ages through 18 th century Middle Ages to 17th century 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 18th century mentally disordered people = degenerates keep them away from society

The 19th century: Attempts at reform Philippe Pinel ( ) reform in Paris mental hospitals removed restraints and treated mentally ill more humanely some patients got better enough to leave hospital

reform of U.S. system moral-treatment movement humane care led to large, state-supported public asylums But problems persisted Overcrowding Loss of public attention Effective treatments not yet available Dorothea Dix ( ) The 19th century: Attempts at reform

The 20th century New 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 Video available

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

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 temporary 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.

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 plannedactivity of the psychologist, 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).

20 th 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) Gestault (Perls) Cognitive therapy introduced in 1960s (Beck) Group therapy also gains popularity in 1960s Family Therapy comes in the 1970s

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 careerchoose 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 officea loud argument

Reasons for seeing a mental health professional (Murstein & Fontaine, 1993) Depression (21%) Relationship and couple problems (17%) Child rearing problems (19%) Difficulty in social and work relations (5%) Suicidal thoughts (5%) Alcohol/Drug dependence (3%) Obsessions (3%) Sexual dysfunctions (3%) Weight loss/Eating disorders (3%) Spousal/partner abuse (2%) Psychotic symptoms (2%) Relationship and couple problems

Modern Treatment Facilities Hospitalization Community Mental Health Centers Advances in psychotropic medication Deinstitutionalization Consequences of deinstitutionalization Out-patient mental health clinics Nursing homes Private offices

Who do people turn to for help?

Types of psychotherapists

Professionals Who Provide Psychotherapy Psychiatrists (M.D.) Psychoanalysts Psychologists Clinical (M.A., Ph.D., Psy.D.) Counseling (M.A., Ph.D.) School (M.A., Ph.D.) Social workers ( MSW ) Psychiatric nurses (B.A., M