Psychotherapy

Anyone who has tried to help a friend, family member, or anyone in need has played the role of therapist. Does this mean that anyone can be a "therapist" or that we ARE all "therapists"? No, it means that we understand, at least at a very basic level, the underlying premise of being a therapist.

Trained, qualified therapists, however, have some advantages since they learn precisely how to help those in need. In addition, there is not one type of therapeutic approach that is appropriate for all situations; there are many different types of therapies, therapeutic styles, theoretical perspectives, etc. that go into therapy, and a trained therapist should know many different styles and which is appropriate for which situation. We will look at several of these as we explore the topic of psychotherapy.

I. Introduction

Not so long ago, it was believed that demons or possession were the causes of psychological dysfunction. This perspective held for centuries, and there are still those whose understanding and beliefs of mental illness are founded in these archaic views.

Others took this perspective one step further, believing that people became mentally ill as a result of sins they committed or from witchcraft.

The early forms of mental facilities were basically prisons, in which patients/prisoners were restrained with chains, restraint jackets, and padded cells. It seems that the idea was not to cure these sick people, but to confine them and keep them out of the public eye.

However, in 1905 it was discovered that General Paresis was caused by a physical infection (syphilis), rather than by witchcraft or demonic possession. This finding gave rise to the belief that mental illness was more like physical illness in the sense that there were organic causes.

1940s began the era of utilizing drugs for treatment of mental illness. These drugs were somewhat successful and were used more regularly as time passed. Drug therapy is still a huge part of therapy.

Today, treatment is a very diverse, very complex process with many issues. Drugs have become an integral part of therapy, but we now have talk therapy, behavioral therapy, cognitive therapy, and others which can be used in combination or in the place of drug therapies.

A. Why seek "treatment?"

There are many reasons why people do or should seek out therapy. Mental problems vary in type and severity, but when something begins to alter a person's life in a negative way, is something that is on the mind quite often, etc., it may be time to seek therapy. Here are just a few issues that prompt people to seek therapy:

suicidal, depression, hallucinating, etc.

problems with life choices, marital conflict

picking a major, test anxiety

time management problems, social skill training

People often think that you must be really mentally ill or "out of it" to seek help from a psychologist or other expert, but this is not true. Therapists can provide assistance with all sorts of problems from the struggles of "regular" daily life, to parenting, relationships, to the more extreme psychological illnesses such as schizophrenia, agoraphobia, and more. Therapists are there to help with problems of varying levels, not just with the extreme.

There are also times when people need assistance but not necessarily the help of a professional. For example, what if you must make a big decision (e.g., career choice, divorce, marriage, and you are distressed by the magnitude?). What if you have tried to solve a personal problem for several months, and think that now is the time to see if others can help? These "others" can be people such as friends and loved ones, but you may also need to seek professional help. If so, you may seek out Psychotherapy.

B. What Exactly is psychotherapy? As is often the case in psychology, there isn't agreement on a single definition, but there are some common elements:

1. All psychotherapies involve a helping relationship between a professional and a person in need of help.

a) helping relationship = Treatment

b) professional = Therapist

c) person in need = Client

C. What types of treatment are available?

1. Insight or Talk Therapy: these are the classic psychotherapeutic approaches that most people think of automatically when they think of therapy. These therapeutic approaches were pioneered by Freud and involve the following:

a) client engages in lengthy, complex interactions with the therapist

b) the goal is to increase insight into the nature or causes of the client's difficulties. Then, and only then, can the therapist look at possible solutions. (can be done on individual or group level) It is important to note that the focus here is on determining the causes of the problems.

2. Behavior Therapy: much more direct and problem solving oriented than talk or insight

a) the focus is on finding a solution to the problem, not gaining insight into causes. So, for example, a behavioral therapist is not concerned with what type of childhood you had, or why you smoke, just figuring out a way to get you to stop smoking (if that is why you are seeing the therapist, that is).

b) the primary goal is to alter problematic responses (e.g., phobias) and maladaptive habits (e.g., drug use, smoking).

c) there are many different procedures used in behavior therapy, such as classical conditioning, operant conditioning, observational learning. As you can see, all the approaches have some element of "associations" - meaning the therapist tries to change negative associations into more positive ones. For example, a person who is afraid of going over bridges has made the association between going over a bridge and fear. The therapist attempts to change the association so that now the client associates going over bridges with feelings of relaxation. We'll discuss how this is done a little later.

3. Biomedical Therapy: seek a medical cause for a problem and medical remedy to this problem

a) most common approach is to find the drugs that create the proper chemical change in the client. For example, manic depression is a chemical imbalance in the brain that cause a person to swing from states of euphoria to states of depression. Using drugs, a therapist can correct the chemical imbalance so that the mood swings do not occur as often. In cases such as this, other types of therapy may be less effective or ineffective.

D. Who provides treatment?

1. psychologists - clinical psychologists and counseling psychologists are the ones whom most often provide therapy to clients; at least most common from the field of psychology.

2. psychiatrists and physicians - in order for drugs to be prescribed for use in drug therapy, a psychiatrist or physician must be involved. Recently there has been a push to allow clinical psychologists to prescribe drugs, but for now, a person must have a medical degree to prescribe drugs.

3. others - social workers, guidance counselors, etc.