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Essential Concepts

Mental Health Treatment

It was once believed that people with psychological disorders, or those exhibiting strange behavior, were possessed by demons. These people were forced to take part in exorcisms, were imprisoned, or executed. Later, asylums were built to house the mentally ill, but the patients received little to no treatment, and many of the methods used were cruel. Philippe Pinel and Dorothea Dix argued for more humane treatment of people with psychological disorders. In the mid-1960s, the deinstitutionalization movement gained support and asylums were closed, enabling people with mental illness to return home and receive treatment in their own communities. Some did go to their family homes, but many became homeless due to a lack of resources and support mechanisms.

Today, instead of asylums, there are psychiatric hospitals run by state governments and local community hospitals, with the emphasis on short-term stays. However, most people who have mental illness are not hospitalized. A person suffering symptoms could speak with a primary care physician, who most likely would refer him to someone who specializes in therapy. The person can receive outpatient mental health services from a variety of sources, including psychologists, psychiatrists, marriage and family therapists, school counselors, clinical social workers, and religious personnel. These therapy sessions would be covered through insurance, government funds, or private (self) pay.

Cognitive and Behavioral Therapies

Psychoanalysis was developed by Sigmund Freud. Freud’s theory is that a person’s psychological problems are the result of repressed impulses or childhood trauma. The goal of the therapist is to help a person uncover buried feelings by using techniques such as free association and dream analysis.

Play therapy is a psychodynamic therapy technique often used with children. The idea is that children play out their hopes, fantasies, and traumas, using dolls, stuffed animals, and sandbox figurines.

In behavior therapy, a therapist employs principles of learning from classical and operant conditioning to help clients change undesirable behaviors. Counterconditioning is a commonly used therapeutic technique in which a client learns a new response to a stimulus that has previously elicited an undesirable behavior via classical conditioning. Principles of operant conditioning can be applied to help people deal with a wide range of psychological problems. Token economy is an example of a popular operant conditioning technique.

Cognitive therapy is a technique that focuses on how thoughts lead to feelings of distress. The idea behind cognitive therapy is that how you think determines how you feel and act. Cognitive therapists help clients change dysfunctional thoughts in order to relieve distress. Cognitive-behavioral therapy explores how our thoughts affect our behavior and aims to change cognitive distortions and self-defeating behaviors.

Humanistic and Biomedical Therapies

Humanistic therapy focuses on helping people achieve their potential. One form of humanistic therapy developed by Carl Rogers is known as client-centered or Rogerian therapy. Client-centered therapists use the techniques of active listening, unconditional positive regard, genuineness, and empathy to help clients become more accepting of themselves.

Often in combination with psychotherapy, people can be prescribed biologically based treatments referred to as biomedical therapies, such as psychotropic medications and/or other medical procedures such as electro-convulsive therapy.

Reconsolidation Therapy

Memory plays a crucial role in psychological disorders, such as overgeneralized autobiographical memory in depression and memory uncertainty in obsessive-compulsive disorder. Psychotherapy heavily relies on remembering and reflecting on past experiences. The process of memory consolidation, which occurs shortly after an experience, is essential for stabilizing memories, and recent research suggests that memories are more like computer files that can be modified rather than fixed books. According to the newer theory of memory, memories can be modified during retrieval and once reconsolidated, the modified version becomes the new memory without a backup of the original.

Therapy based on reconsolidation theory involves retrieving emotionally powerful memories and then reducing their impact through techniques such as extinction of fear response or the use of drugs like propranolol. Repetition of these steps across multiple sessions is necessary for effective treatment of deep-seated issues.

Treatment Modalities

There are several modalities of treatment: individual therapy, group therapy, couples therapy, and family therapy are the most common. In an individual therapy session, a client works one-on-one with a trained therapist. In group therapy, usually 5–10 people meet with a trained group therapist to discuss a common issue (e.g., divorce, grief, eating disorders, substance abuse, or anger management). Couples therapy involves two people in an intimate relationship who are having difficulties and are trying to resolve them. The couple may be dating, partnered, engaged, or married. The therapist helps them resolve their problems as well as implement strategies that will lead to a healthier and happier relationship. Family therapy is a special form of group therapy. The therapy group is made up of one or more families. The goal of this approach is to enhance the growth of each individual family member and the family as a whole.

The sociocultural perspective looks at you, your behaviors, and your symptoms in the context of your culture and background. Clinicians using this approach integrate cultural and religious beliefs into the therapeutic process. Research has shown that ethnic minorities are less likely to access mental health services than their White middle-class American counterparts. Barriers to treatment include lack of insurance, transportation, and time; cultural views that mental illness is a stigma; fears about treatment; and language barriers. Supporting mental health treatment involves speaking and listening openly about mental health, avoiding assumptions, being conscious about language, and encouraging others to get help when needed.

 

Glossary

asylum

institution created for the specific purpose of housing people with psychological disorders

aversive conditioning

a technique that uses an unpleasant stimulus to stop an undesirable behavior by associating the behavior with the unpleasant stimulus

behavior therapy

a form of therapy that focuses on changing unwanted behaviors using principles of learning

biomedical therapy

treatment that involves medication and/or medical procedures to treat psychological disorders

classical conditioning therapies

behavior therapy techniques that utilize classical conditioning principles to change behavior by reconditioning responses to stimuli

cognitive-behavioral therapy

form of psychotherapy that aims to change cognitive distortions and self-defeating behaviors

cognitive bias modification

using exercises (e.g., computer games) to change problematic thinking habits

cognitive therapy

form of psychotherapy that focuses on how a person’s thoughts lead to feelings of distress, with the aim of helping them change these irrational thoughts

comorbid disorder

individual who has two or more diagnoses, which often includes a substance abuse diagnosis and another psychiatric diagnosis, such as depression, bipolar disorder, or schizophrenia

confidentiality

therapist cannot disclose confidential communications to any third party, unless mandated or permitted by law

consolidation

the neural processes that occur between an experience and the stabilization of the memory

counterconditioning

a technique in which a client learns a new response to a stimulus that previously elicited an undesirable behavior

couples therapy

two people in an intimate relationship, such as spouses, who are having difficulties and are trying to resolve them with therapy

cultural competence

therapist’s understanding and attention to issues of race, culture, and ethnicity in providing treatment

deinstitutionalization

process of closing large asylums and integrating people back into the community where they can be treated locally

dream analysis

technique in psychoanalysis in which patients recall their dreams and the psychoanalyst interprets them to reveal unconscious desires or struggles

eclectic psychotherapy

also called integrative psychotherapy, this term refers to approaches combining multiple orientations (e.g., CBT with psychoanalytic elements)

electroconvulsive therapy (ECT)

type of biomedical therapy that involves using an electrical current to induce seizures in a person to help alleviate the effects of severe depression

exposure therapy

a therapy approach that treats fears or anxiety by gradually exposing clients to the feared object or situation, aiming to reduce their emotional response.

family therapy

special form of group therapy consisting of one or more families

free association

technique in psychoanalysis in which the patient says whatever comes to mind at the moment

group therapy

treatment modality in which 5–10 people with the same issue or concern meet together with a trained clinician

humanistic therapy

therapeutic orientation aimed at helping people become more self-aware and accepting of themselves

individual therapy

treatment modality in which the client and clinician meet one-on-one

intake

therapist’s first meeting with the client in which the therapist gathers specific information to address the client’s immediate needs

involuntary treatment

therapy that is mandated by the courts or other systems

lobotomy

a form of psychosurgery in which parts of the frontal lobe of the brain are destroyed or their connections to other parts of the brain severed

mindfulness

a process that tries to cultivate a nonjudgmental, yet attentive, mental state. It is a therapy that focuses on one’s awareness of bodily sensations, thoughts, and the outside environment

nondirective therapy

therapeutic approach in which the therapist does not give advice or provide interpretations but helps the person identify conflicts and understand feelings

operant conditioning therapies

behavior therapies that employ principles of operant conditioning, focusing on reinforcing desirable behaviors and punishing unwanted behaviors

psychoanalysis

therapeutic orientation developed by Sigmund Freud that employs free association, dream analysis, and transference to uncover repressed feelings

psychotherapy (also, psychodynamic psychotherapy)

psychological treatment that employs various methods to help someone overcome personal problems, or to attain personal growth

rational emotive therapy (RET)

form of cognitive-behavioral therapy

reconsolidation

the process of replacing or disrupting a stored memory with a new version of the memory

relapse

repeated drug use and/or alcohol use after a period of improvement from substance abuse

Rogerian (client-centered therapy)

non-directive form of humanistic psychotherapy developed by Carl Rogers that emphasizes unconditional positive regard and self-acceptance

strategic family therapy

therapist guides the therapy sessions and develops treatment plans for each family member for specific problems that can addressed in a short amount of time

structural family therapy

therapist examines and discusses with the family the boundaries and structure of the family: who makes the rules, who sleeps in the bed with whom, how decisions are made, and what are the boundaries within the family

systematic desensitization

a technique in which a calm and pleasant state is gradually associated with increasing levels of anxiety-inducing stimuli to eliminate unwanted fear responses

token economy

an operant conditioning intervention where individuals are reinforced for desirable behaviors with tokens that can be exchanged for items or privileges

transference

process in psychoanalysis in which the patient transfers all of the positive or negative emotions associated with the patient’s other relationships to the psychoanalyst

unconditional positive regard

fundamental acceptance of a person regardless of what they say or do; term associated with humanistic psychology

voluntary treatment

therapy that a person chooses to attend in order to obtain relief from their symptoms