Therapies in Psychology

Historical Approaches to Mental Health Treatment

The treatment of mental illness has evolved significantly over the centuries, moving from inhumane institutionalization to more humane and effective interventions. Early asylums were often overcrowded and used harsh treatments, while the discovery of medications in the 20th century led to deinstitutionalization and the development of community-based care.

• 1400s: First institutions for the mentally ill were established, often with brutal conditions.

• Late 1800s: Overcrowded asylums and ineffective treatments such as cold water submersion and electroshock therapy.

• 1960s: Introduction of antipsychotic medications, deinstitutionalization, and the rise of residential treatment centers.

Example: Deinstitutionalization led to many individuals with mental illness living in the community, but also contributed to increased rates of homelessness and justice involvement among this population.

Mental Health and Homelessness

Mental health challenges are prevalent among homeless populations, with youth and Indigenous individuals experiencing particularly high rates. Deinstitutionalization has contributed to the intersection of mental illness, homelessness, and involvement with the justice system.

• 85% of homeless individuals report at least one health challenge.

• Youth (13-24) have the highest prevalence of mental health issues (67%).

• Indigenous respondents have higher rates of substance use compared to non-Indigenous.

• Former youth in care have significantly higher rates of mental health and substance use issues.

The Courts and Mental Health

The legal system sometimes mandates mental health treatment for individuals whose behavior is highly erratic or disturbing. Community treatment orders require individuals to live in the community under legally mandated treatment conditions, such as taking medication or attending psychiatric appointments. This is a controversial issue, balancing individual rights and public safety.

Modern Mental Health Treatment Settings

Today, mental health treatment is provided in a variety of settings, including psychiatric hospitals, community hospitals, and outpatient clinics. Hospitalization is typically reserved for individuals who are an imminent threat to themselves or others, and may be voluntary or involuntary.

• Involuntary admission: Used when there is a risk of serious harm or inability to care for oneself. Legal rights include access to legal representation and review boards.

• Sources of treatment: Family doctors, psychiatrists, psychologists, community mental health services, and crisis/emergency services.

Types of Therapists

There are several types of mental health professionals, each with different qualifications and roles:

• Clinical Psychologists: Hold a PhD or PsyD, specialize in assessment and treatment of psychological difficulties.

• Counselling Psychologists: Typically treat day-to-day adjustment problems.

• Psychiatrists: Medical doctors who can prescribe medication and treat severe disorders.

• Psychoanalysts: Specialize in psychoanalysis, often with medical or psychology backgrounds.

• Registered Psychotherapists: Provide therapy for a range of issues, with varying educational backgrounds.

• Licensed Professional Counsellors/Clinical Mental Health Counsellors: Hold a master’s degree and certification.

• Clinical or Psychiatric Social Workers: Hold a master’s degree and provide therapy for common family and personal problems.

Barriers to Psychological Treatment

Many factors can prevent individuals from seeking or receiving effective mental health care:

• Ambiguity of disorders

• Stigma about mental illness

• Attitudes toward treatment

• Gender roles and cultural expectations

• Geographical and financial barriers

Cultural and Gender Barriers

Cultural background and gender norms can significantly influence attitudes toward mental health treatment. For example, Asian Canadians and Indigenous people are less likely to seek therapy compared to Canadians of European background. Men may face additional barriers due to masculinity norms, symptom recognition, attitudinal barriers, stigma, and service fit.

Insight Therapies

Psychoanalysis and Psychodynamic Therapy

Psychoanalysis, developed by Freud, aims to uncover unconscious thoughts and feelings to reduce their influence on behavior. Modern psychodynamic therapy is typically shorter in duration and focuses on early childhood experiences and emotional attachments.

• Techniques: Free association, dream analysis, interpretation of resistance and transference.

• Resistance: Inability or unwillingness to discuss certain memories or thoughts.

• Transference: Transferring feelings toward significant others onto the therapist.

Person-Centered Therapy

This humanistic approach, developed by Carl Rogers, emphasizes the importance of the therapeutic relationship, self-actualization, and empathy. The therapist provides unconditional positive regard and helps the client explore their subjective experience.

• Non-directive: The client leads the discussion.

• Core conditions: Congruence, unconditional positive regard, and empathy.

Behavioral Approaches

Classical Conditioning Techniques

Behavioral therapies apply principles of learning to change undesirable behaviors. Classical conditioning techniques include aversive conditioning, systematic desensitization, and flooding.

• Aversive conditioning: Pairing an unpleasant stimulus with an unwanted behavior.

• Systematic desensitization: Gradual exposure to anxiety-provoking stimuli paired with relaxation techniques.

• Flooding: Rapid and intense exposure to the feared stimulus.

Operant Conditioning Techniques

Operant conditioning techniques reinforce desirable behaviors and extinguish negative ones through rewards, contracts, and modeling.

• Token systems: Rewarding desirable behaviors with tokens.

• Contingency contracting: Written agreements outlining goals and consequences.

• Observational learning: Modeling appropriate behaviors (e.g., "Fearless Peer").

Evaluation of Behavioral Therapy

• Advantages: Effective for phobias, compulsions, impulse control, and social skills.

• Disadvantages: Does not address underlying thoughts or severe disorders.

Cognitive-Behavioral Therapies (CBT)

Principles and Techniques

CBT, developed by Aaron Beck, assumes that negative emotions stem from faulty thinking. It helps clients identify and restructure negative beliefs, face avoided situations, and practice relaxation techniques.

• Cognitive restructuring: Challenging and changing negative thoughts.

• Exposure: Facing avoided situations.

• Relaxation: Regaining emotional control.

Dialectical Behavioral Therapy (DBT)

DBT focuses on acceptance and change, teaching behavioral skills for emotional regulation, distress tolerance, mindfulness, and interpersonal effectiveness. It is especially effective for some personality disorders.

Interoceptive Exposure Therapy

Used to treat panic disorder by exposing clients to physical sensations associated with panic attacks, helping them perceive these sensations as harmless.

Mindfulness-Based Cognitive Therapy

This approach combines mindfulness meditation with CBT tools, encouraging clients to "decenter" and observe their thoughts and feelings objectively.

Evaluation of CBT

• Advantages: Effective for anxiety, depression, substance abuse, and eating disorders.

• Disadvantages: May not address irrational aspects of life or be helpful in all cases.

Group and Family Therapies

Group therapy involves multiple clients meeting with a therapist, providing support and advice. Family therapy aims to improve family dynamics and roles. Self-help groups like Alcoholics Anonymous are also common.

Effectiveness of Therapy

Psychotherapy is generally effective for most people, though not universally so. Different treatments are suited to different problems, and therapists often use an eclectic approach.

Biomedical Therapies

Antipsychotic Drugs

Antipsychotic medications reduce psychotic symptoms by blocking dopamine receptors. Newer drugs may increase dopamine in certain brain areas. They are not a cure-all and can have serious side effects.

Antianxiety Drugs

Benzodiazepines (e.g., Xanax, Valium, Ativan) reduce excitability and increase well-being by affecting GABA activity. There are concerns about dependence and interactions with alcohol.

Antidepressant Drugs

Antidepressants improve mood and are also used for anxiety disorders. Types include tricyclics, MAO inhibitors, and selective serotonin reuptake inhibitors (SSRIs) like Prozac and Zoloft. Not all patients respond, and side effects vary.

Herbal Remedies

St. John’s Wort is a supplement shown to reduce depression in some studies, but quality is not standardized and it can interact with other medications.

New Directions in Psychopharmacology

• Ketamine therapy: Blocks NMDA receptors, promising for treatment-resistant depression but with side effects and addiction concerns.

• Transcranial Magnetic Stimulation (TMS): Uses magnetic pulses to activate brain regions, effective for depression but can cause seizures.

• Electroconvulsive Therapy (ECT): Used for severe depression, involves electrical stimulation of the brain, but is controversial due to side effects like memory loss.

• Psychosurgery: Rarely used today, involves altering brain tissue for severe cases of OCD, depression, or bipolar disorder.

Other Therapies

• Eye Movement Desensitization and Reprocessing (EMDR): Involves recalling traumatic events while performing eye movements. Its effectiveness and mechanism are controversial.

Classic Study: On Being Sane in Insane Places (Rosenhan, 1970s)

Rosenhan's study involved "sane" individuals gaining admission to psychiatric hospitals by feigning auditory hallucinations. Once admitted, they behaved normally but were still diagnosed with schizophrenia and received little attention from staff. The study highlighted issues of depersonalization and the reliability of psychiatric diagnoses.