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Therapy –
General term for any treatment process.
People who seek
treatment are referred
to as patients or
clients.
The Components of Therapy
In addition to the relationship between the therapist and
the patient/client, the therapeutic process typically
involves some or all of the following processes:
1. Identify the problem
2. Identify the cause of the problem
3. Make a prognosis (prediction)
4. Decide upon treatment
Modern Approaches to Therapy
1. Psychological Therapies
Based on psychological principles (rather
than biomedical approach)
The psychological therapies are often
collectively called psychotherapy
2. Biomedical Therapies
Treatments that focus on altering the
brain, especially with drugs,
psychosurgery, or electroconvulsive
therapy.
Copyright © Allyn & Bacon 2007
Types of Mental Health Care
Professionals
Counseling psychologist
Clinical psychologist
Psychiatrist
Psychoanalyst
Psychiatric nurse practitioner
Clinical social worker
Pastoral counselor
Professional Title
Counseling psychologist
Specialty:
Clinical psychologist
Problems of
normal living
Psychiatrist
Work setting:
Psychoanalyst
Schools, clinics,
other institutions
Psychiatric nurse practitioner
Credentials:
Clinical social worker
Master’s in
counseling, PhD,
EdD, or PsyD
Pastoral counselor
Professional Title
Counseling psychologist
Specialty:
Clinical psychologist
Those with severe
disorders
Psychiatrist
Work setting:
Psychoanalyst
Private practice,
mental health
agencies,
hospitals
Psychiatric nurse practitioner
Clinical social worker
Pastoral counselor
Credentials:
PhD or PsyD
Professional Title
Counseling psychologist
Clinical psychologist
Psychiatrist
Psychoanalyst
Psychiatric nurse practitioner
Clinical social worker
Pastoral counselor
Specialty:
Severe mental
disorders (often
by means of drug
therapies)
Work setting:
Private practice,
clinics, hospitals
Credentials:
MD
Professional Title
Counseling psychologist
Clinical psychologist
Specialty:
Psychiatrist
Psychoanalyst
Freudian therapy
Work setting:
Psychiatric nurse practitioner
Private practice
Clinical social worker
Credentials:
Pastoral counselor
MD
Copyright © Allyn & Bacon 2007
Professional Title
Counseling psychologist
Clinical psychologist
Psychiatrist
Psychoanalyst
Psychiatric nurse
practitioner
Clinical social worker
Pastoral counselor
Specialty:
Nursing specialty;
licensed to
prescribe drugs
Work setting:
Private practice,
clinics, hospitals
Credentials:
RN – plus special
training in treating
mental disorders
and prescribing
drugs
Professional Title
Counseling psychologist
Clinical psychologist
Psychiatrist
Specialty:
Social worker with
specialty in
dealing with
mental disorders
Psychoanalyst
Work setting:
Psychiatric nurse practitioner
Often employed
by government
Clinical social worker
Pastoral counselor
Credentials:
MSW
Professional Title
Counseling psychologist
Clinical psychologist
Psychiatrist
Psychoanalyst
Psychiatric nurse practitioner
Clinical social worker
Pastoral counselor
Specialty:
Combines
spiritual guidance
with practical
counseling
Work setting:
Religious order or
ministry
Credentials:
Varies
Forensic Psychology
The application of psychology to the criminal
justice system.
Forensic Psychology
Forensic psychologists
often deal with legal
issues, such as public
policies, new laws,
competency, and also
whether a defendant
was insane at the time
a crime occurred.
They may also pursue
a related task, in
which they “profile”
offenders.
Copyright © Allyn & Bacon 2007
Insight Therapies
Psychotherapies in which the therapist
helps patients/clients understand (gain
insight into) their problems.
Also known as ‘talk therapies”
Freudian
Psychoanalysis
Neo-Freudian
Therapies
Humanistic Therapies
Cognitive Therapies
Group Therapies
Copyright © Allyn & Bacon 2007
Insight Therapies:
Freudian Psychoanalysis
As you learn this, think “what
psychopathologies would
this work best with”
Copyright © Allyn & Bacon 2007
Psychodynamic Therapies
Insight therapies based on the assumption
that mental disorder is caused by
powerful (dynamic) mental forces and
conflicts
Psychoanalysis
The form of psychodynamic therapy developed by
Sigmund Freud. Its goal is to release conflicts and
memories form the unconscious
Accomplished through analysis of transference
Analyzing and interpreting the patient’s relationship with
the therapist…
…based on the assumption that this relationship mirrors
unresolved conflicts in the patient’s past
Styles of Psychoanalysis
Traditional Approach
Modern Approach
Free Association
Briefer…less intense
Hypnosis
Focus on revealing
unconscious material
Interpretation of revealed
ideas that reflect deep
seated feelings and conflicts
Dream Analysis
Client-therapist sit face to
face…no client on the couch
Usually more focus on
ego…less on id
Therapist is directive
Copyright © Allyn & Bacon 2007
Neo-Freudian Psychodynamic
Therapies
Therapies developed by
psychodynamic theorists
who embraced some of
Freud’s ideas, but
disagreed with others.
Humanistic Therapies: based on the
motto that you can be your best YOU.
Client-Centered Therapy
Emphasizes healthy psychological growth
through self-actualization.
• Its main technique is reflection of feeling.
• Paraphrasing a client’s words to capture the emotional tone
expressed.
“You seem as if you’re upset.”
“You look as if you’re a bit down.”
“You act as if you are irritated”
“So what I hear you saying is…”
The tone of voice accompanying the words must be
compassionate, gentle and accepting.
Developed by Other techniques used are empathy, genuineness, and
unconditional positive regard .
Carl Rogers.
Cognitive Therapy
Emphasizes rational
thinking as the key to
treating mental
disorder
For example…cognitive
therapy for depression
involves
Evaluating evidence
Situational factors
Alternative solutions
Group Therapy
Advantages:
Psychotherapy
with more than
one client
Economical, support of the group, non-threatening
atmosphere, provides more information and life
experiences for clients to draw upon.
Couples Counseling or Family Therapy
These can often be more effective than individual
therapy with one individual at a time.
Self-Help Support Groups
Groups that provide social support and an
opportunity for sharing ideas about dealing with
common problems; typically organized/run by
laypersons
Copyright © Allyn & Bacon 2007
Behavior Therapies
• Any form of psychotherapy based on the
principles of behavioral learning, (especially
operant conditioning and classical conditioning)
Behavior Modification
is another term for Behavior Therapy
Therapies using Classical
Conditioning
Therapies using Operant
Conditioning
Systematic
Desensitization
Participant
Modeling
Exposure
Therapy
Token
Economies
Aversion
Therapy
Contingency
Copyright © Allyn & Bacon 2007Management
Classical Conditioning Therapies:
Systematic Desensitization
Technique in which anxiety is extinguished by exposing the
patient to an anxiety-provoking stimulus.
Copyright © Allyn & Bacon 2007
Classical Conditioning Therapies:
Exposure Therapy
• Desensitization
therapy
in which patient
It’s based
on habituation
directly
confronts
the anxiety-provoking
It also
counteracts
Anxiety
Disorders’ avoidance
stimulus (as opposed to imagining it)
Copyright © Allyn & Bacon 2007
Classical Conditioning Therapies
Aversion Therapy
• Involves presenting individuals with an attractive
stimulus (smoking) paired with unpleasant
stimulation (A foul odor) in order to condition a
repulsive reaction…so one stops smoking.
UCS
(foul odor)
UCR
(nausea)
CS
(cigarette smoke)
Copyright © Allyn & Bacon 2007
CR
Operant Conditioning Therapies
Contingency Management
• Approach to
changing behavior by
altering the
consequences of
behavior, especially
rewards and
punishments.
Copyright © Allyn & Bacon 2007
Operant Conditioning Therapies
Token Economies
• Applied to groups (e.g.
classrooms, mental hospital wards)
involving distribution of
“tokens” dependent on
desired behaviors
Tokens can later be
exchanged for
privileges, food, or
other reinforcers
Participant Modeling:
An Observational-Learning Therapy
•
Therapist demonstrates and encourages a
client to imitate a desired behavior
Cognitive-Behavioral Therapy:
A Synthesis
A form of psychotherapy that combines
the techniques of cognitive therapy
and behavioral therapy .
Seeks to help the client develop a sense of
self-efficacy
(The belief that one is capable of performing in a certain manner to
attain certain goals. )
The MOST popular type of CBT is known as REBT: Rational Emotive
Behavior Therapy
REBT
Rational-Emotive Behavior Therapy
Based on the idea that irrational thoughts and
behaviors are the cause of mental disorders.
Proposed by Albert Ellis
Copyright © Allyn & Bacon 2007
The ABC’s of REBT
A = Activating Event/Adversity
What do you think happened?
What would a camera see?
B = Beliefs about Activating Event
What did you tell yourself?
C = Consequences
How did you act?
How did you feel?
While it may seem odd at the beginning, you want to start somewhat
backwards. Start with the (C).
Ellis’ REBT provides 12 irrational
thoughts and their rational counterparts
Irrational Thoughts
•We should be thoroughly
competent, intelligent, and
achieving in all possible respects
•It is a dire necessity for adults to
be loved by significant others for
almost everything they do,
everyday.
•We must have certain and
perfect control over things
•If something is or may be
dangerous or fearsome we should
be terribly upset and endlessly
obsess about it
Rational Thoughts
•No one can be perfect.
•It is not possible for
everyone to love and
approve of us
•No matter how evil an
act, there are reasons for
it.
•You can't change the
past but you can learn
from it
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Active Listener
Someone who gives the speaker feedback
(nodding, affirmation, paraphrasing, asking question,
showing interest…)
This is REQUIRED of a CBT
Not listening at all!
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Different Therapeutic techniques are
effective for different disorders
Behavior Therapies: specific phobias, bedwetting,
autism, alcoholism
Cognitive –Behavioral Therapies: chronic pain,
anorexia, bulimia, agoraphobia
Insight Therapies: relationship/marriage problems
Depression is best treated with a variety of therapies
Copyright © Allyn & Bacon 2007
Mental “First Aid”
If someone asks you for help, keep in mind
that serious problems (especially those
involving suicide or threats) require
immediate professional treatment
Otherwise, your best tools may be…
Listening
Acceptance
Exploring alternatives
Copyright © Allyn & Bacon 2007
How Is the Biomedical
Approach Used to
Treat Mental Disorders?
Biomedical therapies seek to
treat mental disorders by
1. changing the brain’s
chemistry with drugs, its
2. circuitry with surgery, or its
3. patterns of activity with
pulses of electricity or powerful
magnetic fields
Copyright © Allyn & Bacon 2007
Psychopharmacology
The prescribed use of drugs to help treat
symptoms of mental illness…
The psychological approach would use these to
ensure that individuals are more receptive to talk
therapies.
Antipsychotic Drugs
Medicines that diminish psychotic symptoms
such as agitation, delusions, or hallucinations.
These include chlorpromazine,
haloperidol, and clozapine They may have
side effects like..
Diminish symptoms
usually by their
effect on dopamine
pathways in the brain.
Tardive dyskinesia
blurred vision
dizziness
drowsiness
dry mouth
light sensitivity
Tardive Dyskinesia
An incurable
disorder of motor
control resulting
from long-term use
of antipsychotic
drugs
Copyright © Allyn & Bacon 2007
Antidepressants
and mood stabilizers
• Include Prozac, monoamine
oxidase (MAO) inhibitors, and
lithium carbonate (effective
against bipolar disorder)
• Treat depression and
bipolar disorder
• Usually affects serotonin
and/or norepinephrine by
increasing their reuptake or
production
• May take weeks to get to
therapeutic levels
Paxil
Zoloft
Luvox
Effexor
Wellbutrin
Drugs used to treat depression usually fall in
TWO types:
1. MAOs: monoamine oxidase inhibitors
Monoamine oxidase…inhibitors that block the
activity of an enzyme that breaks down
serotonin
2. SSRIs: selective serotonin reuptake initiators
Dangerous side effects can include an increase
in suicidal thoughts or actions, changes in
appetite or sleep patterns, withdrawals if
stopped unexpectedly etc…
Copyright © Allyn & Bacon 2007
Anti-Anxiety Drugs
• Include barbiturates and benzodiazepines
• May include some antidepressant drugs
which work on certain anxiety disorders
• Are intended to decrease extreme anxiety
and PAs by increasing the inhibitory effects
of the neurotransmitter GABA
• These are heavy depressants which can
cause fatigue and a disconnection from
reality. CANNOT be taken with regularity or
while trying to perform most tasks
• Should not be used to relieve
ordinary anxieties of everyday life
• Should not be taken for more than a
few days at a time
• Should not be combined with alcohol
Copyright © Allyn & Bacon 2007
Stimulants
Suppress activity level in persons with
attention-deficit/hyperactivity disorder
(ADHD).
Work by increasing the
activity of the thalamus,
thereby increasing the
“filter” with which we
focus.
Side effects include
fatigue/”crash”, decrease
in appetite, weight loss,
etc…
Since 1991 prescriptions
for all drugs to treat
ADHD have quintupled.
This year about six million
children, will take Ritalin
or other forms of
methylphenidate.
Copyright © Allyn & Bacon 2007
Psychosurgery
The general term for surgical intervention in the
brain to treat psychological disorders
Prefrontal Lobotomy
aka the "Ice pick lobotomy"
The infamous prefrontal lobotomy, introduced
in 1935, is no longer performed for mental
disorders treatment.
By 1951, almost 20,000 lobotomies had been
performed in the United States
Copyright © Allyn & Bacon 2007
Prefrontal Lobotomy
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Split Brain
Severing the corpus callosum, however, can
reduce life-threatening seizures… usually used
as a last resort to treat difficult epilepsy.
Split-brain is a lay term to
describe the result when
the corpus
callosum connecting the two
hemispheres of the brain is
severed
Copyright © Allyn & Bacon 2007
Electroconvulsive Therapy
Also known
as electroshock
Introduced in the 1930’s,it is a
treatment in which seizures are
electrically induced in
anesthetized patients for
therapeutic effect.
Copyright © Allyn & Bacon 2007
Electroconvulsive Therapy
ECT is most often used as
a treatment for
severe major
depression ,
mania (often in bipolar
disorder), and catatonia.
Today, an estimated 1 million people
worldwide receive ECT every
year,usually in a course of 6–12
treatments administered 2 or 3
times a week.
Copyright © Allyn & Bacon 2007
Transcranial Magnetic Stimulation
Weak electric
currents are induced in
the tissue by rapidly
changing magnetic
fields
It can be used for the
treatment of
depression,
schizophrenia, and
bipolar disorder
A form
of psychiatric treatment in
which patients were
repeatedly injected with
large doses of insulin in
order to produce
daily comas over several
weeks.
Insulin Shock
Therapy
It was introduced in 1933 and used
extensively in the 1940s and 1950s,
mainly to induce remission
in schizophrenia.
There were no standard guidelines for
treatment; different hospitals and
psychiatrists developed their own
protocols.
Copyright © Allyn & Bacon 2007
3 Newer Types of Psychosurgery
Capsulotomy
The surgeon inserts probes through the top of the skull and down into
the capsule, which is deep in the brain near the thalamus.
By leading the tips of the probes, the doctor can burn away small
portions of tissue, each about the size of a raisin. Used in OCD
Cingulotomy
Probes are inserted through the skull into the cingulum, a bundle of
connections located near the capsule.
The probes' tips are heeded and tissue is burned, as the
capsulotomy. Used with Chronic Pain, OCD or depression
Deep brain stimulation
The surgeon inserts a “brain pacemaker” through the skull and into
the capsule no tissue is destroyed. Helps control tremors ie:
Parkinson’s. Has also been helpful in treating chronic pain
Copyright © Allyn & Bacon 2007
Hospitals
Provide an immediate solution to an
immediate danger: suicidal/homicidal
thoughts, psychosis, etc
BUT this is not a good long term solution.
Instead…
Copyright © Allyn & Bacon 2007
Therapeutic Community
Program of treating
mental disorder by
making the institutional
environment supportive
and humane for patients.
Deinstitutionalization
Policy of removing patients, whenever
possible, from mental hospitals.
1950’s state hospital ward
Copyright © Allyn & Bacon 2007
Community Mental Health Movement
Effort to
deinstitutionalize
mental patients and to
provide therapy from
outpatient clinics
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Homeless in America
23% of Homeless in America are diagnosed with Mental
Illness
45% of homeless veterans have mental disorders
Copyright © Allyn & Bacon 2007