1. Introduction to Psychotherapy
Definitions and Examples

2. The 5-minute lecture Psychotherapy is good for you
The 5-minute university [video link]
Psychotherapy is good for you
Psychotherapy is an art, a science, and a relationship
There are many therapy modalities. People don’t agree about which one is best.

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).
Humour
Season
Organ
Ancient name
Modern
MBTI
Ancient characteristics
Blood
spring
liver
sanguine
artisan SP
courageous, hopeful, amorous
Yellow bile
summer
spleen
choleric
idealist NF
easily angered, bad tempered
Black bile
autumn
gall bladder
melancholic
guardian SJ
despondent, sleepless, irritable
Phlegm
winter
brain/lungs
phlegmatic
rational NT
calm, unemotional

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
The video is from the Multimedia Manager CD for Introductory Psychology (purple CD)
Drilling holes in head to let the evil spirits out.
Picture scanned in from Gray, page 651, NOT on CD Rom

6. 18th century: Moderate enlightenment
Mentally disordered people = degenerates
Treatment:
Isolate mentally ill from society
Sometimes bloodletting
The video is from the Multimedia Manager CD for Introductory Psychology (purple CD)

7. The 19th century: Attempts at reform
Philippe Pinel ( )
Reformed Paris mental hospitals:
Removed restraints
Treated mentally ill more humanely
Some patients got better enough to leave hospital
Stressed “moral” understanding
Developed individualized therapies based on diagnosis and life history
Insisted on drugs only as last resort
picture scanned in from Gray, page 642, NOT on CD Rom

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
Photo scanned in from Myers text, page 488, NOT on CD Rom
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
Video is on the psychology video sampler DVD (Scientific American series)
Treatment of last resort
1930s to 1950s
prefrontal lobotomy
incapacitated patients
not utilized anymore
Cingulotomy
partial destruction of structure in limbic system
results show some success with fewer side effects
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.
Permanent brain damage?
no evidence to support
do find temporary disruptions in cognition, including memory [Journal of ECT. Vol 23(3), Sep 2007, pp ] and information processing speed [Journal of Affective Disorders. Vol 103(1-3), Nov 2007, pp ]
Bilateral ECT can result in loss of memory for events a day or two previous to treatment
usually returns in a month
Right ultra-brief Unilateral ECT produces little apparent memory loss or other side effects but takes longer to work (i.e., more ECT sessions) Journal of Affective Disorders. Vol 103(1-3), Nov 2007, pp

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
Video is on the psychology video sampler DVD (Scientific American series)
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).
1 or 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
St = short term

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
On Being Sane video | Brief Rosenhan interview
Rosenhan’s study spurned significant reform. Today’s hospitals are more humane, but…
Diagnosis rules the day (a critique)
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 turn to for help?

31. Types of psychotherapists

32. Norcross, Hedges, & Prochaska (2002)
Types of psychotherapists (part 2)
Norcross, Hedges, & Prochaska (2002)
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.

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

34. 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

35. Race-group Differences in Psychopathology

37. 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)

38. More research on health disparities

39. Reasons for seeing a mental health professional Murstein & Fontaine (1993), random sample in Conn.

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