METHODS OF THERAPY
Therapy, from a psychologist’s viewpoint, has many different meanings. It can be physical or psychological, or even both. In this paper, several different aspects of therapy will be discussed. First the word therapy will be defined more clearly, and then psychotherapy and how it differs from other interactions yet is also similar. Next therapy will be examined from the Psychodynamic, Cognitive and Humanistic-Existential points of view, as well as the differences in their methods and content. I will then address Behavior therapy and some of its uses, as well as the advantages and disadvantages of Group Therapy. Finally I will look at the role of medication in treatment and when it is appropriate, as well as examining the helpfulness and utility of ECT, (Electroconvulsive Therapy) and Psychosurgery.
First of all it would be very helpful if there was a definition of what therapy is. According to Webster’s Dictionary the word therapy means a “remedial treatment of bodily disorder”. The disorders with which psychologists deal, are usually that of the brain although the problems caused by this area are in no way limited to mental areas; mental problems almost always cause physical ailments. When we think of therapy after an accident of some sort such as an automobile collision, we generally tend to term this physical therapy. Following a similar thought process then, would lead us to believe that there is a term for mental therapy, and there is, Psychotherapy. The text book defines psychotherapy as “a systematic interaction between a therapist and a client that brings psychological principles to bear on influencing the client’s thoughts, feelings or behavior to help that client overcome abnormal behavior or adjust to problems in living”. With this definition in mind, we are now in a position to answer the first question posed in the introduction, which asks how psychotherapy and other interactions differ and how they are similar. Well first of all, what I meant by “other interactions”? Some of these are Asylums, Mental Hospitals and Community Mental Health Centers. Asylums began hundreds of years ago in medieval Europe. Originating in monasteries, they were the “first institutions meant primarily for persons with psychological disorders”. The big difference however between these and any psychotherapeutic ideas is that no therapy was offered. The sole purpose of these establishments was to get the people off the streets and out of the public view. Some of the residents were chained and many of them beaten. As they became more crowded the situation became worse as did the conditions of those that lived there and so the psychological disorders quickly became more acute. Asylums had nothing in common with modern ideas of psychotherapy.
The next form of interaction we will discuss is that of Mental Hospitals. Over the ensuing years, these hospitals became the more accepted practice with after efforts for Humanitarian Reform, which began in the eighteenth century, became the norm. They too were well filled, indeed by Rathus states that ” by the mid-1950’s, more than a million people resided in state, county, Veterans Administration, or private facilities”. The purposes of these Hospitals were far different than those of the old asylums and similarities can be made between these establishments and ideas of psychotherapy. As has been previously noted, psychotherapy is a form of therapy. These hospitals were designed not just as mental prisons, but as places where treatments were offered. There were still many problems however. Unlike psychotherapy where there is actual communication between the therapist and the client, patients would have been very lucky to have received such one-on-one treatment. The hospitals were overcrowded and it was not uncommon for there to be one doctor or psychiatrist to be responsible for a two or three hundred people (Ibid.). Although they were better than the asylums of old, they were still a far cry from today’s forms of psychotherapy.
The final form of interaction which I shall mention began in the 1960’s and was called the Community Mental Health Movement. The basic idea of this movement was that people with mental problems be able to live in the community. Community Mental Health Centers were set up. With government funding, these centers made it possible for individuals to leave more normal lives and served as a transition point for those who were released from mental hospitals. According to the text, “the majority of the people with chronic psychological disorders live in the community; not the hospital”. In my mind, this is the closest of the three to psychotherapy.
Next we shall look at three other therapies to note their differences. These would be the Psychodynamic, Cognitive and Humanistic-Existential therapies. We shall begin with psychodynamic therapy. The method used in this form of therapy is known as psychoanalysis. The goal of psychoanalysis is to pull from someone’s memory a hidden, often traumatic and depressing memory. It depends on the patient to “express emotions and impulses that …..have been damned up by the forces of repression”. Some of the contents or aspects of this therapy include free association- the uncensored uttering of all thoughts that come to mind (Ibid), dream analysis as well as the interpretation of a statement or dream. This is psychodynamic therapy.
In contrast to Freud’s aforementioned ideas, we find Cognitive Therapies. The idea behind these therapies is that people, in trying to attain their own expectations and follow their personal views of right and wrong, consciously make choices and develop accordingly. Distress and depression therefore are the results of one’s failure to live up to one’s own expectations. In order to help their clients then, Cognitive therapists must “focus on the beliefs and attitudes” of the client. In order to decrease or eliminate negative thoughts, therapists employ several methods including rational-emotive therapy, which pinpoints negative attitudes or beliefs and encourages the client to “correct” these attitudes. Another technique would be Cognitive Restructuring. Rathus explains, “In cognitive restructuring, clients are shown how their interpretations of events can lead to maladaptive responses”. This helps the clients to see the consequences of their beliefs and encourages them to change their expectations and attitudes so that a more preferable reaction is obtained.
The last of these three is the Human-Existential view. The main idea of this form of therapy is to focus on the present and center on the person himself. Some of the methods include empathetic understanding, Transactional Analysis, or TA, and Gestalt Therapy. Empathetic understanding is one of the trademarks of a good person-centered therapist. To do this well, the therapist must “accurately reflect[ing] the client’s experiences and feelings”. They must put themselves in the shoes of their client. Transactional Analysis concerns itself with “how people interact and how their interactions reinforce attitudes, expectations, and life positions’”(Ibid.). The third method mentioned was Gestalt Therapy which “attempts to integrate conflicting parts of the personality through directive methods designed to help clients perceive their whole selves” (Ibid.). It makes conflict more recognizable to the client.
In all three of these therapies, there are many differences so I will outline the major ones. As was noted previously, Freud’s psychodynamic therapy with its psychanalysis concentrates not only on the past, but on the forgotten and repressed, essentially the unknown. On the other hand, cognitive therapy depends on the known, such as the clients personal attitudes beliefs and expectations and then attempts to alter them so as to relieve concerns and fears. The Humanistic-Existential therapies, like psychodynamic therapies, also concentrate on the unconscious. The difference is that unlike Freud and his followers, these therapists concentrate on the present and not the past focusing on “the here and now”.
The third area to be examined looks at the uses of Behavior Therapy. The author of our text, Spencer Rathus, describes this form of therapy as “the direct promotion of desired behavioral change by means of systematic application of principles of learning”. One use of this kind of therapy would be in fear reduction. For example, it is not uncommon to be afraid of flying. In the television series Cheers, one of the characters, Frasier Crane, a psychiatrist, held a class for such people. By using several techniques, people in his class became more relaxed with the idea and eventually took a plane trip to finalize the treatment. Although this particular example was fictitious, the idea is real. People can take such classes to overcome the fear of animals, situations and other people. Another use of behavioral therapy would be breaking addictions and habits. There are many different ways of doing this, even controversial ones. Many a client has approached therapist in an attempt to quit smoking or lose weight, and many have succeeded. Many places such as a Juvenile Detention Center, where a friend of mine once worked, use what has been termed a Token Economy. Here the youth were encouraged to exhibit preferred behavior with the promise of a reward which was usually in the form of a card. Different privileges such as television or outings, could be purchased with these cards. This too is a form of behavioral therapy.
The next topic mentioned in the introduction was Group Therapy. This has its advantages and disadvantages. The idea behind group therapy is that by putting people with similar problems in one group, they can help each other to adjust and provide additional insight into their own personal situation. This however has its advantages and disadvantages. Some of the advantages are as follows: First of all, it is economical. If a particular therapist is busy or in constant demand, group sessions provide easier access and this often cuts costs for the both the therapist and the client. It also provides, as I stated earlier and as the author reiterates, that their is a greater depth of experience and understanding, and this often provides for a more comfortable atmosphere. It can also be a good source of support. For example, if someone has now had an alcoholic drink in three weeks, and belongs to a group where this goal is common, then he is able to receive far more support from his peers than he might have been able to get from his weekly visit to his therapist. In turn, those who show this improvement provide an example to the others and give hope to encouragement to those who are struggling. So far everything sounds good, but this is not the case. If I needed to seek help for something, I would have a hard time admitting it to a psychiatrist, let alone to a complete stranger. Another disadvantage is more obvious if we think of couple or family therapy. When help is needed because of trouble at home, I agree that in order to solve it, you must first talk it out. This is why we have such counselors. One of the problems that can arise is that members of the family might view it as embarrassing and as betrayal when a member of the family opens up about their problems to an “outsider”. This was definitely the case for a family I knew. One of the daughters did not feel that the mother had any right to tell the therapist what she had about the father, while the other daughter thought the complete opposite. This family had a completely negative experience and all except the mother and one of the daughters found it to be nothing but a complete waste of time and money. Therefore while the idea behind it is sound, the practice is not always perfect and depends greatly upon the clients themselves.
The final subjects to be examined is the role of medication in treatment, and when it is appropriate as well as the usefulness of ECT and psychosurgery. Medication has plays an important role in treatment. Many of the therapies which we have discussed up until now are not the end itself. In other words, there must be additional influence also. For example, my father- in-law has bi-polar depression which therapists have traced to Vietnam and his exposure to Agent Orange. So far the only treatment which has been effective, has been medication. In the medical world, doctors diagnose the illness and usually prescribe a drug or a treatment to remedy it. In the world of psychology, the therapist also diagnoses the problem and if treatment is not enough then drugs or medication can be used also. When all other avenues have been explored, medication is as appropriate as anything a medical doctor might prescribe.
When drugs and therapy sessions are not enough there are other possibilities, such as ECT or Psychosurgery. ECT or Electroconvulsive therapy is the “treatment of disorders…like major depression by passing an electric current, (that causes a convulsion), through the head”. On the same page of the text we can find the definition of psychosurgery. It states that it is “intended to promote psychological changes or to relieve disordered behavior”. One example of this would be a Prefrontal Lobotomy in which the nerves in the frontal lobe of the brain are severed in an effort to decrease violent and aggressive tendencies. Both of these treatments have many side-effects and so are not immediately desirable. The lobotomy has been for the most part discontinued in the United States, because its side-effects are too serious and new drugs have better success rates and are therefore more preferable. The ECT has been very effective in reducing depression and decreasing the suicide rate and so it can be a last resort when other drugs and forms of psychotherapy have not been successful.
In conclusion, psychotherapy in its many forms has been very successful and has helped millions of people. The topics which have been discussed have been psychotherapy and how differs from other interactions. Psychodynamic, Cognitive and Humanistic-Existential Therapies have been explained, compared and contrasted. Also presented were some of the uses of Behavior Therapy as well as the advantages and disadvantages of Group Therapy. Then, the role of medication in psychotherapy was examined and its appropriateness was discussed. Finally Electroconvulsive Therapy and Psychosurgery was explained and discussed. With all these areas, examined a greater understanding of the many various methods of therapy was reached.