1. The Elements of the Treatment Process
The professional treatment of psychological disorders and problems is called psychotherapy. Although therapeutic procedures are exceedingly diverse approaches to treatment, they can be classified into three broad categories: insight therapies, behavioral therapies, and biomedical therapies.
The Elements of the Treatment Process
Insight Therapies
Behavior Therapies
Biomedical Therapies
Current Trends and Issues in Treatment
Institutional Treatment in Transition

2. Percent of Population (28%) with Disorder (In One Year)
Percent of Population (15%) Receiving Mental Health Services (In One Year)
Treatment and No Diagnosis (7%)
Diagnosis and No Treatment (20%)
According to the recent U.S. Surgeon General’s report on mental health (1999), about 15% of the population uses mental health services in a given year.
The two most common presenting problems are anxiety and depression. People vary considerably in their willingness to seek treatment, with women more likely to seek help than men, and people with higher educational levels doing so more frequently. Medical insurance is also related to treatment-seeking; having it increases the likelihood.
Many people who need help don’t seek it, and the Surgeon General reports that the biggest roadblock is the “stigma surrounding the receipt of mental health treatment."
Diagnosis and Treatment (8%)
The Elements of the Treatment Process
Insight Therapies
Behavior Therapies
Biomedical Therapies
Current Trends and Issues in Treatment
Institutional Treatment in Transition

3. There are a variety of “helping professions” available:
Psychologists who provide psychotherapy may have degrees in clinical or counseling psychology, specializing in the diagnosis and treatment of psychological disorders and everyday behavioral problems.
Psychiatrists are medical doctors who specialize in the diagnosis and treatment of psychological disorders. They are, at present, the only psychotherapy administering profession to be able to prescribe drugs, although psychologists are lobbying for prescription rights (given appropriate training).
Clinical social workers generally have a master’s degree and are increasingly providing a wide range of therapeutic services as independent practitioners.
Psychiatric nurses may hold a bachelor’s or master’s degree and often play a large role in hospital inpatient treatment.
Counselors are usually found working in schools, colleges, and assorted human service agencies. They typically have a master’s degree and often specialize in specific areas, such as vocational or marital counseling.
The Elements of the Treatment Process
Insight Therapies
Behavior Therapies
Biomedical Therapies
Current Trends and Issues in Treatment
Institutional Treatment in Transition

4. Sigmund Freud
Insight therapies involve verbal interactions intended to enhance clients’ self-knowledge and thus promote healthful changes in personality and behavior.
The original insight therapy was psychoanalysis, which was devised over 100 years ago by Sigmund Freud. To appreciate the logic of psychoanalysis, we have to look at Freud’s thinking about the roots of mental disorders. He mostly treated anxiety-dominated disturbances that were than called neuroses.
The Elements of the Treatment Process
Insight Therapies
Behavior Therapies
Biomedical Therapies
Current Trends and Issues in Treatment
Institutional Treatment in Transition

5. Intrapsychic conflict (between id, ego, and superego) Anxiety
Reliance on defense mechanisms
Freud theorized that people depend on defense mechanisms to avoid confronting conflicts between the id, ego, and superego, but he asserted that defenses tend to be only partially successful, leaving neurotic individuals troubled by anxiety and guilt.
In psychoanalysis, the analyst attempts to probe the depths of the unconscious to discover the unresolved conflicts causing the client’s neurotic behavior. To accomplish these goals, the therapist works with four concepts and techniques; free association, dream analysis, resistance, and transference.
The Elements of the Treatment Process
Insight Therapies
Behavior Therapies
Biomedical Therapies
Current Trends and Issues in Treatment
Institutional Treatment in Transition

6. Conscious Preconscious Unconscious
In free association, clients spontaneously express their thoughts and feelings exactly as they occur, with as little censorship as possible, regardless of how trivial, silly, or embarrassing their thoughts might be. The analyst studies these free associations for clues about what is going on in the client’s unconscious.
When dream analysis is used, clients are trained to remember their dreams, which they describe in therapy. The therapist then analyzes the symbolism in these dreams to interpret their meaning.
The Elements of the Treatment Process
Insight Therapies
Behavior Therapies
Biomedical Therapies
Current Trends and Issues in Treatment
Institutional Treatment in Transition

7. Resistance Transference
Resistance refers to largely unconscious defensive maneuvers intended to hinder the progress of therapy. Clients exhibit resistance because they don’t want to face up to the painful, disturbing conflicts that they have buried in their unconscious. The analyst must manage resistance very carefully.
Transference occurs when clients relate to their therapist, in ways that mimic critical relationships in their lives. Thus, a client might start relating to a therapist as if the therapist were an overprotective mother or a passive spouse.
Psychoanalysts often encourage transference so that clients can reenact crucial relationships in the context of therapy. These reenactments can bring repressed feelings and conflicts to the surface, allowing the client to work through them.
The Elements of the Treatment Process
Insight Therapies
Behavior Therapies
Biomedical Therapies
Current Trends and Issues in Treatment
Institutional Treatment in Transition

8. Carl Rogers
Using a humanistic perspective, Carl Rogers developed client-centered therapy in the 40s and 50s.
Client-centered therapy is an insight therapy that emphasizes providing a supportive emotional climate for clients, who play a major role in determining the pace and direction of their therapy.
The Elements of the Treatment Process
Insight Therapies
Behavior Therapies
Biomedical Therapies
Current Trends and Issues in Treatment
Institutional Treatment in Transition

9. Believe affection from others is conditional
Need to distort shortcomings to feel worthy of affection
Relatively incongruent self-concept
Recurrent Anxiety
Defensive behavior protects inaccurate self-concept
According to Roger’s theory, incongruence makes people feel threatened by realistic feedback about themselves, leading to recurrent anxiety. This anxiety often spawns defensive behavior intended to protect one’s inaccurate self-concept. Hence, client-centered therapists try to help clients restructure their self-concept to correspond better to reality.
Rogers held that there are 3 main elements to creating this atmosphere: genuineness, or the therapist being completely honest and spontaneous with the client; unconditional positive regard, or a complete nonjudgmental acceptance of the client as a person; and empathy, an understanding of the client’s point of view.
The Elements of the Treatment Process
Insight Therapies
Behavior Therapies
Biomedical Therapies
Current Trends and Issues in Treatment
Institutional Treatment in Transition

10. Video: Breast Cancer Groups
Group therapy involves the simultaneous treatment of several clients in a group, where the group members work to assist each other in their treatment. The role of the therapist in group therapy includes screening potential participants, facilitating the therapeutic process, and preventing potentially harmful interactions. Group therapy is not just a less costly alternative to individual therapy--it has strengths of its own.
The Elements of the Treatment Process
Insight Therapies
Behavior Therapies
Biomedical Therapies
Current Trends and Issues in Treatment
Institutional Treatment in Transition

11. Recovery as a Function of Number of Therapy Sessions80 70
Percentage of Patients Recovered 60 50 40 30 20
Evaluating any therapy is difficult business: some disorders go into spontaneous remission even without treatment.
Studies of insight therapies’ effectiveness generally show that clients often see early improvement, within the first weeks of treatment.
The most important factors in therapy seem to be (1) the development of a therapeutic alliance between client and therapist, (2) emotional support and empathy from the therapist, (3) hope, or positive expectation of a good outcome, (4) provision of a rationale that makes sense of the client’s problem and outlines a course of treatment, and (5) opportunity for the client to express feelings and “try out” new ideas, new insights, and possible solutions. 10 5 10 15 20 25 30 35 40 45
Therapy Session
The Elements of the Treatment Process
Insight Therapies
Behavior Therapies
Biomedical Therapies
Current Trends and Issues in Treatment
Institutional Treatment in Transition

12. ABC Video: Rapid Behavioral Treatment of a Specific Phobia
Behavior therapies are based on the principles of learning and conditioning. Behavior therapists use classical conditioning, operant conditioning, and observational learning to change clients’ overt behaviors.
The original behavior therapy, systematic desensitization, was devised by Joseph Wolpe in Systematic desensitization is used to reduce phobic clients’ anxiety responses.
In this video, systematic desensitization is taken a step further for a patient with PTSD with direct exposure to the anxiety-arousing stimuli through a virtual reality re-creation.
The Elements of the Treatment Process
Insight Therapies
Behavior Therapies
Biomedical Therapies
Current Trends and Issues in Treatment
Institutional Treatment in Transition

13. CS Alcohol CR UCS Emetic drug Nausea UR
Aversion therapy is the most controversial of the behavior therapies, where an aversive stimulus is paired with a stimulus that elicits an undesirable response.
Alcoholics, for example, have had emetic drugs paired with their favorite drinks, with the subsequent vomiting creating a conditioned aversion to alcohol.
This technique has been used with alcohol and drug abuse, sexual deviance, smoking, shoplifting, gambling, stuttering, and overeating.
The Elements of the Treatment Process
Insight Therapies
Behavior Therapies
Biomedical Therapies
Current Trends and Issues in Treatment
Institutional Treatment in Transition

14. ABC Video: Curing Insomnia with Cognitive-Behavioral Therapy
Cognitive-behavioral therapy is an insight therapy that emphasizes recognizing and changing negative thoughts and maladaptive beliefs.
Researcher Aaron Beck devised cognitive oriented therapies. The goal of these therapies is to change the way clients think, detecting and recognizing negative thoughts, reality testing, and devising behavioral “homework assignments” that focus on changing overt behaviors.
This video shows how cognitive behavioral therapy can be used to alter behaviors in insomniacs
The Elements of the Treatment Process
Insight Therapies
Behavior Therapies
Biomedical Therapies
Current Trends and Issues in Treatment
Institutional Treatment in Transition

15. Electroconvulsive (Shock) Therapy
Drug Therapy
Electroconvulsive (Shock) Therapy
Brain Stimulation
Biomedical therapies are physiological interventions intended to reduce symptoms associated with psychological disorders. They assume that these disorders are caused, at least in part, by biological malfunctions.
Drug therapy, electroconvulsive (shock) therapy, and brain stimulation are three biomedical approaches to psychotherapy.
The Elements of the Treatment Process
Insight Therapies
Behavior Therapies
Biomedical Therapies
Current Trends and Issues in Treatment
Institutional Treatment in Transition

16. Psychopharmaco- therapy
Antianxiety drugs
Antipsychotic drugs
Antidepressant drugs
Valium, Xanax, Librium, Ativan, Buspar (and others)
Drugs used in the treatment of psychological disorders fall into three major groups: antianxiety drugs, antipsychotic drugs, and antidepressant drugs.
Antianxiety drugs, such as Valium and Xanax, relieve tension, apprehension, and nervousness. These drugs can alleviate anxiety almost immediately, but their effects are measured in hours.
Valium and similar drugs bind to benzodiazepine receptor sites within GABA synapses, where they facilitate the binding of GABA to its receptors. The net result is that these drugs indirectly increase inhibitory activity in the GABA system, which helps keep a lid on anxiety.
The Elements of the Treatment Process
Insight Therapies
Behavior Therapies
Biomedical Therapies
Current Trends and Issues in Treatment
Institutional Treatment in Transition

17. Dopamine Synapse Receptor Sites
Antipsychotic drugs, such as Thorazine and Haldol, are used primarily in the treatment of schizophrenia. Antipsychotic drugs are used to gradually reduce psychotic symptoms, including hyperactivity, mental confusion, hallucinations, and delusions.
Traditional antipsychotic drugs dampen activity at dopamine synapses. They appear to do so by binding to dopamine receptor sites without causing a postsynaptic potential, thus blocking normal dopamine activity at these sites.
Receptor Sites
The Elements of the Treatment Process
Insight Therapies
Behavior Therapies
Biomedical Therapies
Current Trends and Issues in Treatment
Institutional Treatment in Transition

18. Mean Severity of Illness Scores
Severe Illness
6.00
Placebo
Marked Illness
5.00
Mean Severity of Illness Scores
Moderate Illness
4.00
Mild Illness
3.00
Borderline
2.00
Antipsychotic medication does not work for everyone, but about 70% of psychotic patients respond.
Normal
1.00 1 2 3 4 5 6
Time (Weeks)
The Elements of the Treatment Process
Insight Therapies
Behavior Therapies
Biomedical Therapies
Current Trends and Issues in Treatment
Institutional Treatment in Transition

19. Impaired Coordination
Some Side Effects of Anitpsychotic Drugs
Drowsiness
Constipation
Tremors
Muscular Rigidity
Impaired Coordination
Some antipsychotic drugs produce unfortunate side-effects such as symptoms of Parkinson’s disease and tardive dyskinesia, an incurable neurological disorder marked by involuntary writhing and tic-like movements of the mouth, tongue, face, hands, or feet.
Newer drugs, which have a different mechanism of action, such as clozapine, have fewer motor side effects but are costly, and not risk free.
The Elements of the Treatment Process
Insight Therapies
Behavior Therapies
Biomedical Therapies
Current Trends and Issues in Treatment
Institutional Treatment in Transition

20. ABC Video: Treating Depression
Antidepressant drugs gradually elevate mood and help bring people out of a depression.
The most frequently prescribed antidepressants are selective serotonin reuptake inhibitors (SSRIs), which slow reuptake at the serotonin synapse. A newer type of drug, SNRIs, have stronger antidepressant effects than SSRIs, but with more side effects.
This video shows various antidepressant drugs available and how each of them work.
The Elements of the Treatment Process
Insight Therapies
Behavior Therapies
Biomedical Therapies
Current Trends and Issues in Treatment
Institutional Treatment in Transition

21. Months Before or After Starting Treatment
Probability of a Suicide Attempt in Relation to the Initiation of Prescription Drug Treatment
900
800 -1
700
Beginning of Treatment
600
Suicide Attempts per 100,000
500
400
300 1
There has been concern regarding SSRIs and an increased risk of suicide - data suggest that the risk of suicidal behavior is slightly elevated, especially in adolescents.
This graph indicates that the risk of suicide declines with the onset of treatment, however the issue is complex, and people, particularly adolescents, taking SSRIs should be monitored closely.
200 -2 2 3 5 -3
100 6 4
Months Before or After Starting Treatment
The Elements of the Treatment Process
Insight Therapies
Behavior Therapies
Biomedical Therapies
Current Trends and Issues in Treatment
Institutional Treatment in Transition

22. Bipolar Disorder Treatment
Lithium
Valproate
Lithium and valproate are common mood stabilizers used to treat bipolar patients.
Lithium is very successful at preventing future episodes of mania and depression, but it can be toxic and requires careful monitoring. Valproate has become more common than lithium, has fewer side effects, and is better tolerated by patients.
The Elements of the Treatment Process
Insight Therapies
Behavior Therapies
Biomedical Therapies
Current Trends and Issues in Treatment
Institutional Treatment in Transition

23. Electroconvulsive therapy (ECT) is a biomedical treatment in which electric shock is used to produce a cortical seizure accompanied by convulsions. Although the use of ECT peaked in the 1940s and 1950s, there has been a recent resurgence in this therapy.
While there is evidence to suggest that it is helpful in the treatment of major depressive disorder, some researchers claim that it is in fact no better than a placebo. Right now, the evidence justifies conservative use of ECT for depression.
The Elements of the Treatment Process
Insight Therapies
Behavior Therapies
Biomedical Therapies
Current Trends and Issues in Treatment
Institutional Treatment in Transition

24. Motor-control Brain Region
Electrode
Electrical Pulse
Motor-control Brain Region
Implanted Wire
Electroconvulsive therapy (ECT) is a biomedical treatment in which electric shock is used to produce a cortical seizure accompanied by convulsions. Although the use of ECT peaked in the 1940s and 1950s, there has been a recent resurgence in this therapy.
While there is evidence to suggest that it is helpful in the treatment of major depressive disorder, some researchers claim that it is in fact no better than a placebo. Right now, the evidence justifies conservative use of ECT for depression.
Implanted Pacemaker
The Elements of the Treatment Process
Insight Therapies
Behavior Therapies
Biomedical Therapies
Current Trends and Issues in Treatment
Institutional Treatment in Transition

25. ABC Video: Deep Brain Stimulation
Deep brain stimulation is also being explored to treat depression and OCD - this video shows the process of deep brain stimulation to treat depression.
The Elements of the Treatment Process
Insight Therapies
Behavior Therapies
Biomedical Therapies
Current Trends and Issues in Treatment
Institutional Treatment in Transition

26. ABC Video: Transcranial Magnetic Stimulation
Transcranial magnetic stimulation is a technique where a magnetic coil mounted on a paddle is held over specific areas of the head to increase or decrease brain activity.
In this video, you can see the TMS process and how it is used to treat a patient with depression, its most common application.
The Elements of the Treatment Process
Insight Therapies
Behavior Therapies
Biomedical Therapies
Current Trends and Issues in Treatment
Institutional Treatment in Transition

27. Unable to choose provider Unable to choose treatment
Lower cost
Unable to choose provider
Unable to choose treatment
Ambiguity around medical necessity
Many clinicians and their clients believe that managed care, or health-care systems that involve pre-paid plans with small copayments that are run by health maintenance organizations (HMOs), is negatively impacting psychological care.
Managed care involves a tradeoff: consumers pay lower prices but give up freedom to choose providers and obtain whatever treatments they believe necessary. Further, in the mental health domain, the question of what is “medically necessary” is more ambiguous.
The Elements of the Treatment Process
Insight Therapies
Behavior Therapies
Biomedical Therapies
Current Trends and Issues in Treatment
Institutional Treatment in Transition

28. Another issue in treatment is that the highly-culture bound origins of Western therapies have raised doubts about their applicability to other cultures and even ethnic groups in Western society.
The Elements of the Treatment Process
Insight Therapies
Behavior Therapies
Biomedical Therapies
Current Trends and Issues in Treatment
Institutional Treatment in Transition

29. Deinstitutionalization refers to the movement away from inpatient treatment in mental hospitals to more community based treatment. The negative effects of mental hospitals have fueled this movement, as has the ability to treat serious mental problems with effective drug therapy, and long-term hospitalization for mental disorders is largely a thing of the past.
The Elements of the Treatment Process
Insight Therapies
Behavior Therapies
Biomedical Therapies
Current Trends and Issues in Treatment
Institutional Treatment in Transition

30. Resident Patients (Thousands)
600
500
Resident Patients (Thousands)
400
300
200
100
Unfortunately, many people with serious mental problems receive short-term inpatient treatment, are sent back to communities that aren’t prepared to provide adequate outpatient care, and end up back in inpatient treatment; the revolving door problem. Some researchers argue that this has significantly increased homelessness, while others see the homelessness problem as primarily an economic one.
1920
1930
1940
1950
1960
1970
1980
1990
2000
Year
The Elements of the Treatment Process
Insight Therapies
Behavior Therapies
Biomedical Therapies
Current Trends and Issues in Treatment
Institutional Treatment in Transition