1. Pre-Discussion Writing
Before we begin, I would like you to take the next 5 minutes and complete the following:
Before you read an article on mental health care, in a paragraph or so, describe how you feel about mental health care and anything relevant. Describe what you think is available at this exact moment, who may be getting help or not, etc.

2. Treatment of Psychological Disorders
Elements of the Treatment Process

3. Psychoanalysis Sigmund Freud – Modern Psychotherapy
Case of Anna O: “The Talking Cure”

4. Treatment Types Insight Therapies Behavior Therapies
“Talk therapy” in tradition of Freud
Conducted w/ individual or group (family & marital counseling)
Behavior Therapies
Based on principles of learning, change clients’ overt behavior (phobias, substance abuse)
Biomedical Therapies
Drugs & ECT (shock) therapy.
M.D.s (psychiatrists)…psychologists campaigning for prescription privileges.

5. Who Seeks Therapy? Most common: depression & anxiety disorders (15%)
1/2 of people undergoing treatment meet criteria for a disorder; the rest deal with everyday problems.
Women > men
Whites > other races
Insured > uninsured
Educated > uneducated
Only 1/3 of people who need treatment get it.

6. Therapists: Who Provides Professional Treatment?
Psychologists
Clinical & Counseling psychologists specialize in the diagnosis and treatment of psych disorders and everyday behavioral problems.
Ph.D, Psy.D, or Ed.D. (5-7 years post bach. Degree)
Insight or behavioral approaches (more likely to use behavioral over psychoanalysis)
Psychiatrists - Physicians who specialize in the diagnosis and treatment of psych disorders.
The severe disorders
M.D. degree
Psychoanalysis over group/behavioral therapies
Others:
clinical social workers, psychiatric nurses (B.A. or M.A.)
Counselors (M.A.) of many kinds
Marriage and Family Therapists (MFTs)

7. Insight Therapies
Involve verbal interactions intended to enhance clients’ self-knowledge and this promote healthful changes in personality and behavior.

8. Psychoanalysis - Stages
Insight therapy that emphasizes the recovery of unconscious conflicts, motives, and defense through techniques such as free association and transference.
Freud: Act as a “psychological detective”
Free Association – clients spontaneously express their thoughts and feelings exactly as they occur, with as little censorship as possible.
Pour out trivial, silly, embarrassing details with no filter.
Dream Analysis – therapist interprets the symbolic meaning of the clients’ dreams (manifest v. latent)
Interpretation – refers to the therapists attempts to explain the inner significance of the clients’ thoughts feelings, memories, and behaviors.
Move forward inch by inch.
Resistance – refers to largely unconscious defensive maneuvers intended to hinder the progress of therapy.
Transference – occurs when clients unconsciously start relating to their therapist in ways that mimic critical relationships in their lives.
(reenactments)

9. Modern Psychodynamic Therapies
Freud’s psychoanalysis is not that widely practiced now.
Current variations = psychodynamic therapies
Carl Jung, Alfred Adler
New central focuses include:
Focus on emotional exp.
Exploration of efforts to avoid distressing thoughts/feelings.
Identification of recurring patterns in patients life exp.
Discussion of early childhood exp.
Analysis of interpersonal relationships
Focus on therapeutic relationship itself
Exploration of dreams/fantasy life

10. Insight Therapy Continued…

11. Client-Centered Therapy (Carl Rogers)
Emphasizes providing a supportive emotional climate for clients, who play a major role in determining the pace and direction of their therapy.
minimize incongruence and foster self acceptance/personal growth
Positive emotional climate > therapy (Rogers)
Genuineness = honest w/ no phonyness
Unconditional Positive Regard = nonjudgmental acceptance
Empathy (client’s p.o.v.)
Therapeutic Process
Client/therapist work as equals
Key task: clarification (human mirror)

12. Group Therapy – simultaneous psych treatment of several clients in a group.
Origins: WWII and 1950s
4-12 members, 6-8 ideal (therapist-screened)
function as therapists for one another (accountability)
therapist role: screen members, set goals, maintain therapeutic environment, protect clients.
Benefits:
save time/money...more affordable
can be just as effective as individual therapy
clients realize that their misery is not unique
social support/development of social skills

13. Couples & Family Therapy
Couples/Marital Therapy – focus on relationship issues.
Family Therapy – treat family unit as a whole, main focus on family dynamics and communication.

14. Insight Therapy Evaluation
effectiveness difficult to determine:
spontaneous remission – recovery from a disorder that occurs without formal treatment.
subjective evaluations
 *better than no treatment/placebo treatment; greatest improvements found early on.

15. End

16. Behavior Therapies
Involve the application of learning principles to direct efforts to change clients’ maladaptive behaviors.

17. Behavior Therapies make no attempt to achieve grand insights
application of learning principles to change clients maladaptive behaviors
B.F. Skinner (US), Hans Eysenck (GB), Joseph Wolpe (SA) s
assumptions:
1. behavior is a product of learning
2. what has been learned can be unlearned

18. Types of Behavior Therapy
systematic desensitization: reduce anxiety/phobias through classical conditioning (Joseph Wolpe)
 1. anxiety hierarchy (list)
 2. muscle relaxation training
 3. work through hierarchy and remain relaxed
 *counter-conditioning*
Exposure Therapies: clients are confronted with situations that they fear so that they learn that these situations are really harmless.

19. Aversion Therapy: last resort, most controversial; aversive stimulus is paired with a stimulus that elicits an undesirable response (i.e. emetic drug)
Social Skills Training – designed to improve interpersonal skills that emphasizes modeling, rehearsal, and shaping.

20. Cognitive-Behavioral Treatments
verbal interactions and behavior modification to help clients change maladaptive patterns of thinking and behaving.
Albert Ellis's Rational Emotive Therapy
Aaron Beck's Cognitive Therapy: attempts to correct thinking errors that underlie various disorders “cognitive restructuring”
originally designed as a treatment of depression
What are our negative thought tendencies?
1. blame themselves
2. selective focus on negative
3. pessimistic projections about future
4. negative conclusions about personal worth
teach clients to detect these tendencies and reality-test them
homework assignments

21. Evaluating Behavioral Therapies
strong evidence...focus on results
but:
not suited to all types of problems
highly diverse...can't make generic statement about efficacy
Primal Fear

23. Biomedical Therapies
Physiological interventions intended to reduce symptoms associated with psychological disorders

24. Psychopharmacology: treatment of mental disorders with medication
Antianxiety drugs – relieve tension, apprehension, and nervousness
Antipsychotic drugs – gradually reduce psychotic symptoms, including hyperactivity, mental confusion, hallucinations, and delusions.
Antidepressant drugs – gradually elevate mood and help bring people out of depression
Mood Stabilizers – drugs used to control mood swings in patients with bipolar mood disorders.

25. Psychopharmacology: treatment of mental disorders with medication
1. Antianxiety: -benzodiazepine family: tranquilizers (Valium, Xanax)...use in decline -side effects: drowsiness, depression, nausea, confusion... -abuse, dependence, overdose risks -Busper: slower acting, fewer side effects 2. Antipsychotic: -schizophrenia/severe mood disorders...decrease dopamine activity -Therazine, Mellaril, Haldol -side effects: drowsiness, etc.; may mirror Parkinson's -quit taking meds = relapse -tardive diskinesia: involunatary writhing/ticlike movements [long term use] -atypical antipsychotics: clozapine, elarizapine, quetiapine; less side effects 3. Antidepressent: -trycyclics (Elavil) & MAO inhibitors (Nardil) -today: selective serotonin reuptake inhibitors (SSRIs)...Prozac, Paxil, Zoloft -increased risks for suicide? 4. Mood Stabilizers: -bipolar disorder -lithium; dangerous if not used carefully -newer: valproate; less side effects

26. Current & New Therapy Information & Trends

27. ElectroConvulsive Therapy (ECT)
ECT shocks serotonin levels into a higher state.
Used more often than you might think:
- hospitals may do 6-8 treatments per day
- 1 patient may be treated 2-3 times per week

28. New Brain Stimulation Techniques
Transcranial Magnetic Stimulation (TMS) – technique that permits scientists to temporarily enhance or depress activity in specific area of the brain.
Depression treatment
Deep Brain Stimulation (DBS) – thin electrode is surgically implanted in the brain, hooked to implanted pulse generator to send electric current to targeted areas.
Parkinson’s disease, tardive dyskinesia, seizure disorders

29. Transcranial Magnetic Stimulation

30. Blending Approaches to Treatment
Eclecticism – practice of therapy involves drawing ideas from two or more systems of therapy instead of committing to just one.
Theoretical integration(2 therapies)
Technical eclectism (borrow ideas, tailor needs to unique client)

31. Increasing Multicultural Sensitivity in Treatment
Psych disorders attributed to supernatural forces (non-western nations).
Vast majority of therapists trained almost exclusively in the treatment of white middle-class Americans.

32. Institutional Treatment In Transition
Mental hospital – medical institution specializing in inpatient care for psych disorders.
Community Mental Health Movement (1960s)
Local community care
Reduce dep. on hospitalization
Prevention of psych disorders

33. “revolving door of chronic patients” Homelessness
Deinstitutionalization – transferring the treatment of mental illness from inpatient institutions to community-based facilities that emphasize outpatient care.
Drug therapy emerges
Mental health centers/nursing homes
“revolving door of chronic patients”
Homelessness
30% severe mental illness
30% or more: drugs/alcohol
Shelter = de facto mental health facility

34. Thinking the Unthinkable
Before you read this article, in a paragraph or so, describe how you feel about mental health care and anything relevant. Describe what you think is available at this exact moment.
Read the Article
Now update your paragraph with a new one. How do you feel about your former statements?