Introduction to Psychotherapy

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Introduction to Psychotherapy

• Definitions and Examples

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The 5-minute lecture
The 5-minute university video link

• Mental health treatment has a painful history
• Contemporary psychotherapy works
• The relationship is important
• Therapist must be empathic
• Therapy is an art (as well as a science)
• There are many therapy modalities. People like to
  argue about which one is best.

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Todays Lecture

• Historical treatment of the mentally ill
• Psychotherapy definitions and examples
• Places of treatment
• Providers of treatment
• Recipients of treatment

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Historical background Beliefs and treatment of
the mentally ill

• Greek physician Hippocrates (ca. 400BC) promoted
  humane treatment. Tx based on healing powers of
  nature Mentally ill patients were placed in
  pleasant surroundings and given soothing baths.
• Lack of balance between positive and negative
  energies
• Illness attributed to a disturbance in the
  balance of bodily fluids (humorism).

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Middle Ages-17th century A spiritual matter

• Madness in league with devil, possession by
  spirits
• Diagnosis based on hearsay, unreliable tests
• Treatment
• Prayer, exorcism, magic incantation
• Torture, starvation, and exile (sent to sea)
• Treated like animals and sentenced to burn or hang

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18th century Moderate enlightenment

• Mentally disordered people degenerates
• Treatment
• Isolate mentally ill from society
• Sometimes bloodletting

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The 19th century Attempts at reform

• Philippe Pinel (1745-1826)
• Reformed Paris mental hospitals Removed
  restraints and treated mentally ill more humanely
• Some patients got better enough to leave hospital

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The 19th century (cont.)
Dorothea Dix (1802-1887)

• Reform of U.S. system
• Moral-treatment movement advocating humane care
• Led to large, state-supported public asylums
• But problems persisted
• Overcrowding
• No effective treatments
• Eventuallyinterest waned

Freud introduces psychoanalysis in 1890s
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The 20th century

• New biological therapies introduced in 1930s
• Insulin-coma therapy (ICT) video of Leonard Frank
  
• Electro-shock therapy (ECT) video of early ECT
• Frontal lobotomy video
• Anti-psychotic drugs introduced in mid-1950s
• Deinstitutionalization follows in early 1960s
• get people out of asylums and back into community
• general mood of optimism in country
• Community mental health centers established in
  1961

Additional video available from Scientific
American Series
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ECT Today

• Therapy for severely depressed patients in which
  a brief electric current is sent through the
  brain of an anesthetized patient
• Side effects of ECT include slowing of
  information processing speed and short-term
  memory loss, but it is painless and there is no
  risk for death or brain damage.
• 70 of depressed patients who did not respond to
  other treatment respond positively to ECT.

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Somatic Treatments in the 1920s and 1930s
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The 20th century

• New biological therapies introduced in 1930s
• Insulin-coma therapy (ICT)
• Electro-shock therapy (ECT)
• Frontal lobotomy
• Anti-psychotic drugs introduced in mid-1950s
• Deinstitutionalization follows in early 1960s
• get people out of asylums and back into community
• general mood of optimism in country
• Community mental health centers established in
  1961

Additional video available from Scientific
American Series
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• Patients in Mental Hospitals. The number of
  patients cared for in the U.S. state and county
  mental hospitals has decreased dramatically since
  1955.

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20th Century Advances in psychotherapy

• Psychoanalysis introduced by Freud in 1890s
• Adler (1930s) and other neo-Freudians follow
• Variety of new approaches introduced in 1950s
• Behavioral (Wolpe, Watson, Skinner)
• Rational Emotive Therapy (RET, Ellis)
• Humanistic (Rogers)
• Existential (May)
• Gestalt (Perls)
• Cognitive therapy introduced in 1960s (Beck)
• Group therapy also gains popularity in 1960s
• Family Therapy comes in the 1970s

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Todays Lecture

• Historical treatment of the mentally ill
• Psychotherapy definitions and examples
• Places of treatment
• Providers of treatment
• Recipients of treatment

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What is psychotherapy?

• Psychotherapy is a form of treatment for problems
  of an emotional nature in which a trained person
  deliberately establishes a professional
  relationship with a patient for the purpose of
  removing, modifying, or retarding existing
  symptoms, of mediating disturbed patterns of
  behavior, and of promoting positive personality
  growth and development (Wolberg, 1967).
• Psychotherapy is a plannedactivity of the
  psychologist, the purpose of which is to
  accomplish changes in the individual that make
  his/her life adjustments potentially happier,
  more constructive, or both (Frank, 1982).

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Which of these is not psychotherapy?

• A rabbi counseling a couple with marital
  difficulties
• An abused child drawing pictures of his family
  for a psychologist
• A woman presenting her testimony to her Alcoholic
  Anonymous group
• A university Counseling Center psychologist with
  an M.A. helping a student choose a career
• A man talking about his dreams and childhood
  experiences to a psychoanalyst in N.Y.
• A police officer talking down a suicidal
  teenager from a tall building
• A family having a loud argument in a therapists
  office

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Todays Lecture

• Historical treatment of the mentally ill
• Psychotherapy definitions and examples
• Places of treatment
• Providers of treatment
• Recipients of treatment

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Modern Treatment Facilities/Trends

• Hospitals (2006 National Hospital Discharge
  Survey)
• Mental disorders led to 2.4 million
  hospitalizations (6.9 of total)
• Psychoses was the 3rd most common reason for
  hospitalization
• Heart disease (4.2 million)
• Child delivery (4.1 million)
• Psychoses (1.7 million)
• Pneumonia (1.2 million)
• Malignant neoplasms (1.2 million)
• Fractures (1.1 million)
• Average length of st-hospital stay is about 7
  days (see next slide)
• Community Mental Health Centers
• Out-patient mental health clinics
• Nursing homes
• Private offices

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Hospitals from a patient's perspective

• Rosenhan (1973) "On being sane in insane places
• sane people got into mental hospitals as patients
• found very low interaction with staff
• dehumanizing nature of interactions
• normal behaviors interpreted pathologically
• Birth of modern psychiatry video
• Rosenhans study spurned significant reform.
  Todays hospitals are more humane, but
• Practically everyone is medicated
• Restraints padded rooms used if patient at risk
  of self-harm
• Involuntary hospitalization legally permitted
  (though limited)

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Modern Treatment Facilities/Trends

• Hospitals (2004 National Hospital Discharge
  Survey)
• Mental Disorders accounted for 2.3 million
  hospitalizations
• Psychoses was the 3rd most common reason for
  hospitalization
• Heart disease (4.4 million)
• Child delivery (4.1 million)
• Psychoses (1.6 million)
• Pneumonia (1.3 million)
• Malignant neoplasms (1.2 million)
• Fractures (1.0 million)
• Average length of hospital stay is about 7 days
  (see next slide)
• Community Mental Health Centers
• Out-patient mental health clinics
• Nursing homes
• Private offices

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Todays Lecture

• Historical treatment of the mentally ill
• Psychotherapy definitions and examples
• Places of treatment
• Providers of treatment
• Recipients of treatment

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Professionals who treat mental disorders

• Psychiatrists (M.D.)
• Psychiatric nurses (B.S, M.S.)
• Physicians (M.D.)
• Psychoanalysts (Ph.D. )
• Psychologists
• Clinical (M.A., Ph.D., Psy.D.)
• Counseling (M.A., Ph.D.)
• School (M.A., Ph.D.)
• Social workers (MSW)
• Marriage and family counselors (M.A.)

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Therapists and their training
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Estimated Number of Clinically Trained
Professionals Providing Mental Health Services in
the U.S. (2010)
Psychiatrists
Clinical, Counseling, and School Psychologists
Social Workers
Current data available on the Occupational
Outlook Handbook homepage
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Self-help Groups
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Referral sources
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Who do people recommend?
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Who do people turn to for help?
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Types of psychotherapists
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Norcross, Hedges, Prochaska (2002)
Types of psychotherapists (part 2)
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Todays Lecture

• Historical treatment of the mentally ill
• Psychotherapy definitions and examples
• Places of treatment
• Providers of treatment
• Recipients of treatment

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Recipients of treatment

• Most people who meet criteria for DSM diagnoses
  do not seek treatment
• Variability due to sex, education, race income
  level
• women seek more treatment than men
• college educated people seek more treatment than
  those with only a high school education
• whites seek more treatment than nonwhites
• people with higher income seek more treatment
  than those with lower income

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Race-group Differences in Psychopathology
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Distribution lacking health insurance by race and
ethnicity (2004)
Latest uninsured data from CFED
The higher uninsured rate for Hispanics is not
associated with higher poverty levels than other
groups  the poverty rate for Hispanics is
slightly lower than for African-Americans, 22.2
vs. 24.9 respectively. Rather, research has
shown that Hispanics are more likely to be
employed in jobs that do not offer health
insurancebut when offered health insurance they
accept at the same rates at whites and blacks
(U.S. Department of Health and Human Services)
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More research on health disparities
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Reasons for seeing a mental health
professionalMurstein Fontaine (1993), random
sample in Conn.
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More information

• APA Psychology career page
• Occupational Outlook Handbook
• See Professional Development links on course
  website