Psychological and Biological Treatments: Helping People Change (Chapter 16 Study Notes)

Psychological and Biological Treatments

Introduction

This chapter explores the major approaches to psychological and biological treatments for mental health disorders. It covers who seeks and benefits from psychotherapy, the roles of various mental health professionals, and the effectiveness of different therapeutic modalities.

Psychotherapy

Definition and Scope

• Psychotherapy is a psychological intervention designed to help individuals resolve emotional, behavioural, and interpersonal problems, thereby improving their quality of life.

• There are over 600 distinct "brands" of psychotherapy, reflecting a wide range of theoretical orientations and techniques.

Who Seeks and Benefits from Psychotherapy?

Demographics and Effectiveness

• Approximately 20% of Americans have received psychotherapy at some point in their lives.

• Females are more likely than males to seek therapy; Caucasians more than minority groups.

• Research indicates that therapy can benefit all demographic groups equally.

Who Practices Psychotherapy?

Mental Health Professionals

• Main practitioners include clinical psychologists, psychiatrists, counsellors, and social workers.

• Individuals with non-advanced degrees may also provide psychological services, often in social service agencies or crisis intervention centers.

Mental Health Professionals Table

Occupation	Degree/Licence	Settings/Role
Clinical psychologist	Ph.D., Psy.D., M.A.	Private practice, hospitals, schools, community agencies, medical settings, academic, other
Psychiatrist	M.D. or D.O.	Physician, private office, hospitals, medical centers, schools, academic
Counseling psychologist	Ph.D., Ed.D., M.A., M.S., M.C.	University clinics, mental health centers; treat people with less severe psychological problems
School psychologist	Ph.D., Psy.D., Ed.D., Ed.S., M.A., M.S., M.Ed.	School systems; work with teachers, students, and parents
Clinical social worker	Training varies widely; L.C.S.W., L.M.S.W., D.S.W.	Private practice, hospitals, community agencies, often with less severe psychological problems
Mental health counsellor	M.S.W., M.S., M.C.	Private practice, community agencies, hospitals, other
Psychiatric nurse	Training varies; often more advanced degrees	Hospitals, residential treatment programs, group, family, couple therapy
Pastoral counsellor	Training varies; often more advanced degrees	Churches, religious settings, spiritual support, counseling

Paraprofessionals

• Individuals without professional training who provide mental health services.

• Receive agency-specific training and attend workshops to enhance their education.

• Research shows little to no difference in effectiveness between experienced and novice therapists, though professionals can select more effective treatments.

Effective Therapists

Characteristics

• Warm and direct communication style.

• Ability to establish a positive working relationship.

• Avoids contradicting clients unnecessarily.

• Selects important topics to focus on during sessions.

• Matches treatments to the specific needs of clients.

Checklist for Selecting a Good Therapist

• Can talk freely and openly with the therapist.

• Therapist listens carefully and understands feelings.

• Therapist is warm, direct, and provides useful feedback.

• Therapist explains their methods and qualifications upfront.

• Encourages confronting challenges and problem-solving.

• Uses scientifically based approaches and discusses pros/cons.

• Regularly monitors progress and is willing to adjust treatment.

Warning Signs: Defensive or angry therapist, one-size-fits-all approach, excessive small talk, lack of clear treatment plan, unwillingness to discuss scientific support, and lack of professional boundaries.

Insight Therapies

Overview

• Goal is to expand awareness or insight.

• Includes psychodynamic, humanistic, and group approaches.

Psychodynamic Therapy

Central Beliefs

• Abnormal behaviours often stem from traumatic or adverse childhood experiences.

• Therapy involves analyzing avoided thoughts, feelings, wishes, fantasies, and significant past events.

• Insight into unconscious material can reveal the causes and significance of symptoms, often leading to symptom relief.

Psychoanalysis

• Developed by Sigmund Freud, one of the earliest forms of therapy.

• Goal: Decrease guilt and frustration by bringing the unconscious into conscious awareness.

• Focuses on repressed impulses, conflicts, and memories.

Key Aspects of Psychoanalysis

• Free association: Clients express themselves without censorship.

• Interpretation and dream analysis are used to uncover unconscious material.

• Resistance: Attempts to avoid confrontation and anxiety associated with uncovering repressed thoughts and emotions.

• Transference: Projecting intense, unrealistic feelings onto the therapist.

• Working through: Processing and integrating insights gained during therapy.

Neo-Freudian Tradition

• Focuses more on conscious aspects of functioning.

• Emphasizes needs for power, love, and status, not just sex and aggression.

• Highlights cultural and interpersonal influences on behaviour.

• Interpersonal therapy (Sullivan): Strengthens social skills and targets interpersonal problems, conflicts, and life transitions. Originally developed for depression, also effective for substance abuse and eating disorders.

Evaluation of Psychodynamic Therapies

• Insight is not always necessary for distress relief.

• Weak scientific support for repressed memories.

• Many concepts are difficult to falsify and research.

• Brief psychodynamic therapy is better than no treatment, but less effective than cognitive-behavioural therapy (CBT).

• Not effective for psychotic disorders.

Humanistic Psychotherapy

Core Principles

• Emphasizes development of human potential and the belief that human nature is basically positive.

• Stresses the importance of personal responsibility and living in the present.

Person-Centred Therapy

• Developed by Carl Rogers.

• Centers on the client's goals and problem-solving strategies.

• Therapist must be authentic, express unconditional positive regard, and show empathic understanding.

• Therapist does not focus on diagnosis; sessions are structured by the patient.

• Aims to increase self-awareness and self-acceptance, leading to more realistic thinking, tolerance of others, and adaptive behaviours.

Gestalt Therapy

• Aims to integrate differing and sometimes opposing aspects of personality into a unified sense of self.

• Recognizes the importance of awareness, acceptance, and expression of feelings.

• Utilizes the two-chair technique to facilitate self-integration.

Evaluation of Humanistic Therapies

• Core concepts are difficult to falsify scientifically.

• Therapist traits such as empathy are related to positive treatment outcomes.

• More effective than no treatment, but results are mixed compared to other therapies.

Group Therapies

Overview

• Treats more than one person at a time (typically 3-20 people).

• Efficient, time-saving, and less costly than individual therapy.

• Effective for a wide range of problems and about as helpful as individual treatments.

Alcoholics Anonymous (AA)

• Self-help groups composed of peers with similar problems; often no professional therapists.

• Based on the "12 Steps" method.

• Little research evidence demonstrating its effectiveness.

AA Alternatives

• Controlled drinking programs: Encourage moderate drinking and setting limits; can be effective for many people.

• Relapse prevention treatment: Assumes people will "slip up" and plans accordingly; a lapse does not equal a relapse.

Family Therapies

Overview

• Views psychological problems as rooted in a dysfunctional family system.

• The "patient" is the entire family system, not just one individual.

• Focuses on interactions among family members.

Types of Family Therapy

• Strategic family interventions: Remove barriers to effective communication.

• Structural family therapy: Therapist immerses themselves in the family to facilitate change.

• Both approaches are more effective than no treatment and at least as effective as individual therapy.

Behavioural Approaches

Principles and Methods

• Behavioural therapists focus on specific problem behaviours and the variables that maintain them.

• Assume behaviour is governed by basic principles of learning.

• Tracking behaviours is key, often using ecological momentary assessment (real-time assessment of thoughts, emotions, and behaviours in everyday life).

Exposure Therapies

• Clients confront what they fear to reduce anxiety.

• Systematic desensitization (Joseph Wolpe, 1958): Gradual exposure to anxiety-producing situations paired with relaxation (counter-conditioning).

• Relaxation is incompatible with anxiety; repeated pairing leads to reduced anxiety.

Systemic Desensitization

• Very effective for phobias, speech disorders, insomnia, and other conditions.

• Dismantling: Research procedure to examine effectiveness of isolated components; no single element found to be key.

• Led to development of flooding therapies.

Flooding

• Repeated exposure to feared stimuli for long periods in a safe environment.

• Extinction of fear occurs without aversive consequences.

• Response prevention: Patient cannot use normal anxiety-reducing behaviours during exposure.

• New varieties include virtual reality exposure therapy.

Modelling in Therapy

• Participant modelling: Therapist models a calm encounter with the feared object/situation and guides the client through steps until they can cope unassisted.

• Used in assertion and social skills training, and behavioural rehearsal.

Other Operant Procedures

• Applied behaviour analysis: Used to treat children with autism.

• Token economies: Reward desirable behaviours with tokens exchangeable for items.

• Aversion therapies: Use punishment to decrease undesirable behaviours (e.g., Antabuse for alcohol); mixed support for effectiveness.