Psychotherapy & Treatment
•	Types of treatment
•	Effectiveness of treatment
•	Mental health careers
Treatment depends on theory
•	Underlying problems
•	How to fix
–	Fixing is not always opposite of building
–	And may be harder
Types of treatment
•	Biologically oriented
•	Psychologically oriented
Biological treatments
•	Medications
•	Non-invasive physical
•	Invasive physical – surgery
Medications
•	Have for most major problems
•	Advantages
–	More humane for serious problems
–	Often quite effective in relieving symptoms
•	Disadvantages
–	Often lose effectiveness
–	Only partially effective
–	Treat only symptoms
–	Getting dosage correct is problem
–	Side effects
–	Compliance
Non-invasive biological treatments
•	Electro-convulsive shock
–	Effective for severe depression
–	Memory loss
–	Long-term?
•	Transcranial magnetic stimulation
–	Less invasive than ECS
–	Effectiveness?
Invasive treatments
•	Surgery
–	Only for severe – usually epilepsy
–	Side effects often profound
–	Permanent
•	Pre-frontal lobotomies
–	Used in 1950s and 1960s
–	Easy to perform
–	Calm patients before drugs
–	Major side effects
Psychological treatments
•	Treat symptoms or underlying causes?
•	Treating causes requires theory
–	Psychoanalytic spectrum reduces all problems to simple causes
–	And all such models require that the theory be correct
•	Treating symptoms is usually easier
•	Symptom substitution?
Types of therapy
•	Behavioral
–	Reduce behavioral problems
–	No concern with underlying causes
•	Cognitive
–	Similar to behavioral in focus on symptoms
–	Focus on cognitions underlying behavioral symptoms
•	Insight
–	Deeper analysis of underlying problems
Behavior therapy
•	Problems with insight therapies
–	Often ineffective
–	Inefficient
–	Flawed theories
•	Initially (1950s) based on idea that all behaviors are learned
–	Therefore changing reinforcement contingencies ought to work
–	And some focus on relearning
•	Behavior therapy is often quite effective ofr  minor problems
Cognitive therapies
•	Change symptoms 
•	Corrupt thinking cause of problems
•	Some examples
–	Beck’s model of depression as illogical thinking
–	Ellis’s Rational-emotional therapy
Insight therapies
•	Psychoanalytic is paradigm
–	Expensive
–	Long-term
–	Dubious assumptions
–	Effectiveness?
•	Client-centered therapy – Carl Rogers
–	Therapist provides accepting environment
–	People have conditional self-regard
–	Teach people to accept self
Disclosure
•	Pennebaker 
–	Inhibition of emotional issues bad for health
–	Disclosure through writing is good for behavioral and health outcomes
•	Possibility that effectiveness of therapy is due to disclosure
Mental control
•	One common sense solution is to quit thinking about problems
•	Wegner
–	Active suppression makes thoughts more accessible
–	Depression – Wenzlaff
Why self therapy is often not effective
•	Person not able to reevaluate situation
•	Suppression of symptoms does not work
Researching Psychotherapy
•	Outcome research
•	Difficulties
–	Defining disorder
–	Therapy well-defined?
–	Who measures outcomes? When?
–	Proper control groups
–	Ethics of placebo and no-therapy
Psychotherapy versus Medication
•	Depression
•	Anxiety disorders
•	Major disorders
•	Combining psychotherapy and medication
Effectiveness of therapy
•	Hard to evaluate
•	Most studies find moderate effectiveness
–	Compared to controls
–	Most people get better spontaneously
•	Severe mental illness tend to to respond to psychotherapy
•	Matching patient and problem to therapist
The Consumer Reports Study
•	Treatment outcome
–	54% “much better”
–	33% “somewhat better”
–	Active patients had better outcomes
–	When treatment duration was limited by insurance, patients did worse
–	No form of therapy did better than others
Mental health careers
•	Many paths to therapy
–	Psychiatrist
–	Psychologist
•	Clinical
•	Counseling
–	Social Worker
–	Nurse
–	Pastoral -- religion
•	State laws on licensing vary
•	Only psychiatrists can prescribe drugs
•	Career paths?