Chapter 17: Treatment of Psychological Disorders
Treatment in Today’s World
LEARNING OBJECTIVE 1 Explain who receives treatment for psychological problems today, how they enter treatment, and what general features characterize different types of treatment.
• More than 20 million North Americans receive therapy for psychological problems in the course of a year. Almost half suffer from anxiety and depression.
• Therapy was once primarily a privilege of the wealthy, but today people at all socio-economic levels receive treatment. Similarly, while women once outnumbered men in therapy by four to one, men today are more willing to enter therapy.
• People may enter therapy on their own or may be forced into treatment. Many never seek treatment at all.
• A variety of professionals conduct therapy, including psychologists, psychiatrists, counsellors, and psychiatric social workers.
• Most clients are treated in the community as outpatients, but some people with severe problems are treated as inpatients in private or public institutions.
• All forms of therapy have three essential features: a sufferer who seeks relief, a trained healer, and a series of contacts between the two in which the healer tries to bring about changes in the sufferer’s emotional state, attitudes, and behaviour.
Biological Treatments What Happens in the Brain?
LEARNING OBJECTIVE 2 Describe the major biological treatments for psychological disorders.
• Drug therapy, electroconvulsive therapy (ECT), and psychosurgery are the three major categories of biological treatments.
• Psychotropic drugs, including antianxiety, antidepressant, antibipolar, and antipsychotic drugs, have brought relief to many, but they do not work for everyone and may have undesired side effects.
• Electroconvulsive therapy (ECT), used primarily to treat depression, is administered less often today than in the past. Two more recently developed brain stimulation treatments, vagus nerve stimulation and transcranial magnetic stimulation, have less wide-ranging and traumatic side effects than ECT.
• Psychosurgery today is much more precise than the lobotomies of the past, in which the connections between the frontal lobe and the lower brain centres were severed.
• Biological treatments for psychological disorders, particularly drug treatments, are highly regarded today. However, more often than not, biological interventions alone are not enough.
Psychodynamic Therapies How We Develop
LEARNING OBJECTIVE 3 Describe the psychodynamic treatments for psychological disorders.
• Psychodynamic therapies range from classical Freudian psychoanalysis to modern therapies. All share the goals of helping clients to uncover past traumatic events and the inner conflicts that have resulted from them, and to resolve those conflicts.
• Psychodynamic therapy techniques include free association; therapist interpretation of resistance, transference, and dreams; catharsis; and repeatedly working through issues.
• Recent developments in psychodynamic therapy include short-term psychodynamic therapy and relational psychoanalytic therapy.
• The psychodynamic approach has had a lasting influence on the conduct of treatment and was the first to offer an alternative to biological explanations of abnormal functioning. But the effectiveness of psychodynamic therapy is not well supported by research.
Behavioural Therapies
LEARNING OBJECTIVE 4 Describe the behavioural treatments for psychological disorders.
• Behavioural treatments, aimed at replacing abnormal behaviours with more functional ones, are based on learning processes. Behavioural techniques fall into three categories: classical conditioning, operant conditioning, and modelling.
• Systematic desensitization and aversion therapy rely on classical conditioning. Systematic desensitization is especially effective in treating phobias, while aversion therapy has been used to treat people who want to eliminate problem behaviours, such as drinking.
• Token economies follow the principles of operant conditioning and use rewards to encourage desired behaviours.
• Social skills training uses modelling to help clients acquire desired social behaviours.
• Research suggests that behavioural therapies are often effective. They do not always bring lasting change outside therapy, however, and do not appear particularly effective with disorders that are broad or vaguely defined.
Cognitive-Behavioural Therapies
LEARNING OBJECTIVE 5 Describe cognitive-behavioural therapies for psychological disorders.
• Cognitive-behavioural therapists try to help people recognize and change their faulty thinking processes. Most such therapies use some behavioural techniques. Three influential cognitive-behavioural approaches are those of Albert Ellis, Aaron Beck, and the “second-wave” cognitive-behavioural therapists.
• Ellis’s rational-emotive behavioural therapy focuses on helping clients to identify their maladaptive assumptions, test them, and change them.
• Beck’s cognitive therapy guides clients to challenge their maladaptive attitudes, automatic thoughts, and illogical thinking. Research supports the effectiveness of cognitive therapy for depression and certain other disorders.
• Second-wave cognitive-behavioural therapies help clients to accept their problem behaviours rather than judge them, act on them, or try fruitlessly to change them.
• The cognitive view is quite popular today, and research suggests that cognitive treatment is often effective. It is still not clear, however, whether psychological disorders create or result from maladaptive thoughts.
Humanistic and Existential Therapies
LEARNING OBJECTIVE 6 Describe the humanistic and existential therapies for psychological disorders.
• Humanistic and existential therapists try to help clients look at themselves and their situations more accurately and acceptingly.
• Therapists practising Carl Rogers’ client-centred therapy try to provide unconditional positive regard, accurate empathy, and genuineness, so that clients come to value their own emotions, thoughts, and behaviours.
• Gestalt therapists use skillful frustration, role playing, and rules to help clients recognize and accept their needs and goals.
• Existentialist therapies focus on helping clients discover their personal freedom of choice and take responsibility for making choices.
• Only recently have humanistic and existential therapies begun to undergo systematic research. Early research suggests they can be beneficial for some clients.
Formats of Therapy
LEARNING OBJECTIVE 7 Describe commonly used formats of therapy.
• Individual therapy, in which practitioners meet with one client at a time, is the oldest of the modern therapy formats.
• In group therapy, several clients with similar problems meet with a single therapist at the same time. Self-help groups are similar, but conducted without the leadership of a therapist. Both types of groups can be helpful for certain clients.
• Family therapy treats all members of a family, together or individually, and therapists usually consider the family as a system.
• Two people in a long-term relationship can seek couple therapy to help address issues in their relationship.
• Community mental health treatment focuses on preventing abnormal functioning through (1) primary prevention—policies that reduce psychological risk in a community; (2) secondary prevention—treating minor problems before they become serious; and (3) tertiary prevention—providing prompt treatment for moderate and severe disorders so they do not become long-term problems.
Does Therapy Work?
LEARNING OBJECTIVE 8 Summarize research on the effectiveness of therapy.
• In general, receiving therapy is more likely to help people with psychological disorders than going without treatment. Research has found that each of the major forms of therapy is of some help to clients, although research also indicates that particular therapies are often best suited for certain disorders.
• Successful therapists often share similar effective elements in their approaches, regardless of their particular orientations. They provide feedback, help clients focus on their own thoughts and behaviour, pay careful attention to the way they interact with clients, and try to build a sense of self-mastery in their clients.
• Women and members of ethnic minority groups face pressures that sometimes contribute to psychological dysfunctioning. Culture-sensitive and gender-sensitive therapy approaches help clients become aware of and react adaptively to the gender-related and cultural pressures and issues they face.
• The empirically supported or evidence-based treatment movement seeks to identify which therapies have received clear research support for particular disorders, to propose corresponding treatment guidelines, and to spread such information to clinicians.