Introduction to Psychotherapy

Definitions and Examples

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.

Today’s Lecture

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

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).

Humour Season Organ Ancient name Modern MBTI Ancient characteristics

Blood spring liver sanguine artisan SP courageous, hopeful, amorous

Yellow bile summer spleen choleric idealist NF easily angered, bad tempered

Black bile autumn gall bladder melancholic guardian SJ despondent, sleepless, irritable

Phlegm winter brain/lungs phlegmatic rational NT calm, unemotional

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

18th century: Moderate enlightenment

Mentally disordered people = degenerates

Treatment: Isolate mentally ill from society Sometimes bloodletting

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

Dorothea Dix (1802-1887)

The 19th century (cont.)

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 Eventually…interest waned

Freud introduces psychoanalysis in 1890s

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 1961Additional video available from Scientific American Series

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.

Somatic Treatments in the 1920s and 1930s

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 1961Additional video available from Scientific American Series

Patients in Mental Hospitals. The number of patients cared for in the U.S. state and county mental hospitals has decreased dramatically since 1955.

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

Motivational Interviewing (1983) and MBCT (1991)

Today’s Lecture

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

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 planned activity of the psychologist1, 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).

1 or other professional mental health service provider

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 therapist’s office

Today’s Lecture

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

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

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

Brief interview with Rosenhan

Rosenhan’s study spurned significant reform. Today’s hospitals are more humane, but… Diagnosis rules the day (a critique) Practically everyone is medicated Restraints & padded rooms used if patient at risk of self-harm Involuntary hospitalization legally permitted (though limited)

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

Today’s Lecture

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

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.)

Therapists and their training

Estimated Number of Clinically Trained Professionals

Providing Mental Health Services in the U.S. (2010)

Clinical, Counseling, and School Psychologists

Psychiatrists

Social Workers

Current data available on the Occupational Outlook Handbook homepage

Self-help Groups

Referral sources

Who do people recommend?

Who do people turn to for help?

Types of psychotherapists

Norcross, Hedges, & Prochaska (2002)

PsychodynamicCBTH/G/ESystemsEclectic

Types of psychotherapists (part 2)

Adapted from Norcross, J. C., Hedges, M., & Castle, P. H. (2002). Psychologists conducting psychotherapy in 2001: A study of the Division 29 membership. Psychotherapy: Theory, Research, Practice, Training, 39(1), 97–102.

Today’s Lecture

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

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

Race-group Differences in Psychopathology

Distribution lacking health insurance by race and ethnicity (2004)

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 insurance…but when offered health insurance they accept at the same rates at whites and blacks (U.S. Department of Health and Human Services)

Latest uninsured data from CFED

More research on health disparities

Reasons for seeing a mental health professional

Murstein & Fontaine (1993), random sample in Conn.

More information:

APA Psychology career page

Occupational Outlook Handbook

See “Professional Development” links on course website