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MODULE 49 PREVIEW Research on the effectiveness of therapy indicates that people who receive therapy are more likely to improve than the untreated. However, the friendly counsel of paraprofessionals also tends to produce more improvement than occurs with untreated people. Alternative therapies are becoming increasingly popular. However, there is almost no controlled research to prove or disprove their effectiveness. Preventive mental health experts aim to change oppressive, esteem-destroying environments into more benevolent, nurturing environments that foster individual growth and self-confidence. GENERAL INSTRUCTIONAL OBJECTIVES 1. To evaluate the effectiveness of the major psychotherapies. 2. To introduce the rationale and strategy of preventive mental health. MODULE GUIDE Is Psychotherapy Effective? and The Relative Effectiveness of Different Therapies 1. Discuss the findings regarding the effectiveness of the psychotherapies. In addition to the sheer power of positive expectation, regression toward the mean may lead clients and therapists to perceive value in ineffective therapies. Feeling low tends to be followed by our return to a more normal state and anything we tried in the interim may seem effective. Research that includes use of meta-analysis reveals that (1) people who remain untreated often improve; (2) those who receive psychotherapy are more likely to improve, regardless of what kind of therapy they receive and for how long; (3) mature, articulate people with specific behavior problems often receive the greatest benefits from therapy; but (4) placebo treatments or the friendly counsel of paraprofessionals also tend to produce more improvement than occurs with untreated people. Although advocates of different types of therapy claim superiority, no one therapy has been shown to be best in all cases. Some therapies are, however, well suited to particular disorders. For example, behavioral conditioning therapies achieve especially favorable results in treating phobias, compulsions, and sexual dysfunctions. With depression, the cognitive therapies seem to be the most successful. Lectures: The Consumer Reports Study; Fringe Medicine; Thinking Errors and Clinical Judgment; Can Self-Help Materials Provide Effective Therapy?; Therapy and the Nature of the Problem; Writing About Emotional Experiences as Therapy Transparency: 161 The Effectiveness of Psychotherapy Evaluating Alternative Therapies 2. Explain why ineffective therapies are often mistakenly perceived to be of value. Although there is little empirical support for the value of alternative therapies such as therapeutic touch or EMDR, light-exposure therapy helps to relieve seasonal affective disorder. Project: Evaluating Alternative Therapies Videos: Module 3 of The Mind Series, 2nd ed., Alternative Therapies Commonalities Among Psychotherapies and Culture and Values in Psychotherapies 3. Describe the commonalities among the psychotherapies, and discuss the role of values and cultural differences in the psychotherapeutic process. Despite their differences, all therapies offer at least three benefits. First, they all offer the expectation that, with commitment from the patient, things can and will get better. Second, every therapy offers people a plausible explanation of their symptoms and an alternative way of looking at themselves and responding to their worlds. Third, regardless of their therapeutic technique, effective therapists are empathic people who seek to understand another’s experience, whose care and concern the client feels, and whose respectful listening, reassurance, and advice earn the client’s trust and respect. In short, all therapies offer hope for demoralized people, a new perspective on oneself and the world, and an empathic, trusting, caring relationship. Psychotherapists’ personal beliefs and values influence their therapy. While nearly all agree on the importance of encouraging clients’ sensitivity, openness, and personal responsibility, they differ sharply on the pursuit of self-gratification, self-sacrifice, and interpersonal commitment. Value differences also become important when a client from one culture meets a therapist from another. For example, clients from a collectivist culture may have difficulty with a therapist who requires them to think independently. Such differences may help explain the reluctance of some minority populations to use mental health services. Most agree that therapists should divulge their values more openly. Film: Psychotherapy 4. (Close-Up) Explain the rationale of preventive mental health programs. Preventive mental health experts view many psychological disorders as an understandable response to a disturbed and stressful society. It is not only the person who needs treatment but also the person’s social context. Thus, the aim of preventive mental health programs is to change oppressive, esteem-destroying environments into more benevolent, nurturing environments that foster individual growth and selfconfidence. Lectures: From a Disease Focus to a Wellness Model; Prevention Science Film: Mental Health—New Frontiers of Sanity