1. Treatments & therapies
By Jordan Stevens

2. Cognitive behavioural therapy (Cognitive approach)
This therapy is a combination of both the cognitive and behavioural approaches. The cognitive assumption being that our beliefs about the world affect how we see the world and ourselves; the behavioural part aims to change our behaviour.
CBT focuses on present behaviour and thoughts instead of focusing on how those thoughts developed. The therapist has to accept the patient’s perception of reality and then use this misperception to help the patient manage. It aims to allow the patient to use information from the world to make adaptive rather than maladaptive decisions. It does not aim to cure disorders but to allow the patient to function somewhat normally.
An agenda is set so that both therapist and patient know what they aim to get out of the sessions. The therapist helps the patient identify their faulty interpretations of the world and correct them. This is done by questioning and challenging maladaptive thoughts so that the patient realises they are incorrect and can change them to more realistic thoughts.

3. Strengths: Weaknesses:
The therapist works with the client to help them learn new strategies to cope with negative automatic thoughts. The client does homework focused on their thinking and behaviour, so learning tools that can help them in the future. They are therefore in charge of the therapy- which means it is more likely to last quite a long time even without the therapists support.
It is said that CBT is a scientific approach as it draws on empirical evidence. From that evidence the client draws their own conclusions about their thoughts and feelings. There is objectivity in that the therapist explores the client’s meanings and does not impose their own frames of reference.
Weaknesses:
A client has to be able to consider their thoughts, carry out homework and remember their early experience. They have to be cognitively able to so these things, so the therapy may not work for everyone.
If the client believes the therapist is responsible for the outcome, CBT might not work. A study in Switzerland (Delsignore et al. 2008) looked at 49 people suffering from social anxiety disorder. At a 3-month follow-up, clients who felt they were responsible for their progress were more likely to feel the continued benefits of CBT than those who thought the therapist was responsible. Long-term outcomes of CBT seem to depend on the expectations of the client at to how far they are responsible for their own improvements.

4. Ethical Issues & social control
Challenging what someone believes to be true could cause some distress, although it could be argued that this is required for CBT to actually work.
CBT can be seen as unethical as it is attempting to make the individual believe that their own thoughts and beliefs are wrong. This is done as a social control by normalizing socially deviant behaviour.
This therapy directly confronts the patients faulty thought processes, to try to change their behaviour and thought processing.
This is clearly a form of social control as we are telling the individual what society views as being right.

5. Family therapy (Social approach)
Sometimes called the Maudsley approach, family therapy uses the patients family as a resource for recovery, with the therapist merely offering guidance and advice.
Family therapy is often used to treat anorexics. The families take charge of refeeding the patient (usually and adolescent) and siblings offer support. Blame is not placed on the patient for their disorder, the disorder is separated from the patient, externalising the illness.
There are three phases of treatment; first focusing on weight restoration; returning independent eating; then re-engaging in life (having a healthy adolescent development).
Lock & Le Grange (2001) carried out an investigation into whether family therapy can be manualized by studying the impact it had on anorexics. He came to the conclusion that such a manual can easily be developed and that the idea of a manualized family based treatment is widely accepted.

6. Strengths: Weaknesses:
The treatment makes sure that the individual is not to blame for their illness. Instead, there is a separation of the illness and the adolescent, this is otherwise known as externalizing the illness.
This treatment enables the individual to overcome the disorder in their natural environment, rather than being institutionalized/ hospitalized for a long period of time.
Weaknesses:
It can be difficult for some parents to keep the persistence and consistency needed for the treatment which can make it ineffective.
This treatment does not help to resolve the issue which manifested into the disorder, as it only focuses on altering the individuals eating habits.

7. Ethical Issues & social control
This treatment is ethical and is not used as a form of social control. Even though the behaviour associated with eating disorders do deviate from the social norm, the treatments main concern is to help the individual return to a healthier state as eating disorders have a high mortality rate.

8. Dream analysis (Psychodynamic approach)
Dream analysis is concerned with studying the unconscious mind, usually repressed thoughts/ emotions from early childhood. When we sleep our ego’s defences are more relaxed, so material that usually stays in our unconscious enters our conscious in the form of a dream.
However, because the material is still threatening our peace of mind it can’t be allowed into our conscious in its true form. The material is therefore disguised and it is merely symbols in dreams that represent the real content of the dream. The content of the dream that we remember is called the manifest content, whilst what the dream actually means is called the latent content.
It is the analyst’s job to uncover the true meaning of the dream which can take some time, as the analyst needs a number of recorded dreams rather than just the one.

9. Strengths: Weaknesses:
Heaton et al. (1998) found that clients who had therapists interpreting their dreams felt that they gained more insight and depth from the interpretation than when they had to interpret their dreams on their own.. They also found that 88% of the clients preferred the therapist to interpret their dreams, so dream analysis does seem to help its clients.
Kolchakian and Hill (2002) found that females in heterosexual relationships gained more insight into their relationships through dream interpretation, improving their own well-being in their relationship when compared with females who didn’t have dream interpretation. Dream analysis however, did not have any effect on improving the quality of relationships for men.
Weaknesses:
Dream analysis is subjective, with the interpretation of the dream dependent on the analyst. Different analysts may have different interpretations of the same dream.
The Eysenk (1952) review looked at early studies on psychoanalysis (including dream analysis) and found that psychodynamic therapy was no more effective than having no therapy or treatment at all.

10. Ethical Issues & social control
This method is seen as a way of social control and can be unethical as it is encouraging the individuals to challenge what they think they know and understand about the world i.e. The analyst is telling the individual that what they think is correct, is actually false or that it means something else based on the analysts own opinions.

11. Chemotherapy (Biological approach)
Chemotherapy or drug therapy can be used to control behaviour by restoring the chemical balance within the brain.
Drug therapy has been used to treat mental disorders such as schizophrenia. Patients are given antipsychotic drugs designed to fit and block dopamine receptors (e.g. Clozapine), as an overproduction of dopamine is speculated to be the cause of the disorder, in order to reduce the symptoms and allow them to function as normal members of society, without being institutionalised.
Rosenhan’s study (1973), showed how his pseudo-patients were prescribed drugs to control their ‘schizophrenia’ (not that they took the drugs). Usually, those with schizophrenia are prescribed and presumably take such drugs.

12. Strengths: Weaknesses:
Pickar et al. (1992) compared the effectiveness of clozapine with other neuroleptics and a placebo drug. He found that clozapine was most effective at treating schizophrenic symptoms, even in patients who previously did not respond to drugs, and the placebo was the least effective.
Emsley (2008) studied the effect of injecting risperidone into schizophrenics. He found that those who had the injection early in the course of their disorder had high remission rates and low relapse rates. In 84% of the patients there was at least 50% reduction in positive and negative symptoms, and over the two years of the study, 64% of the patients went into remission.
Weaknesses:
Drug treatment cannot be seen as a cure, as patients have to be kept on maintenance doses of the drug to maintain the therapeutic effect.
One problem with all drugs is that there are side effects. These side effects may be enough to put the people off taking the drug.

13. Ethical Issues & social control
The main ethical issue is about who has the power to make a decision to control someone else's behaviour, as the individual might not be able to make that decision themselves.
It is often thought that the professionals are in a better position to make such decisions. Often there is a multi-agency working which means a group of professionals. Such conferences can help to ensure ethical practice, however the questions of power over an individual still remains.
There are special guidelines for dealing with the mentally ill ethically, not only when researching but also in institutions. Issues tend to focus on confidentiality and consent.
Drugs help to control behaviour and are used by those who are ‘normal’ to make those who are ‘abnormal’ more like them.
Rosenhan’s study (1973), showed how his pseudo-patients were prescribed drugs to control their ‘schizophrenia’ (not that they took the drugs). Usually, those with schizophrenia are prescribed and presumably take such drugs.
Drug therapy is also used as social control when prescribed for heroin addiction. Methadone is a suitable substitute for heroin and does not give the strong withdrawal symptoms so is more likely to be taken away by an addict.

14. Token economy (Learning approach)
Token economy programmes (TEPs) are used to encourage positive pro-social behaviour and are often used in prisons and community-based projects.
Based on operant conditioning principles, TEPs involve imposing a reward system that can be gained if a desired behaviour is performed. In a prison for example, management draws up a list of appropriate behaviours and, if an offender complies, they will receive a token. Tokens are then exchanged for rewards which are wants rather than needs e.g. Time watching TV or time speaking to family on the phone etc.
Hobbs & Holt (1976) conducted an observational experiment in a young offenders institute, to investigate the effectiveness of TEPs. From their experiment they found that there was a hugely significant increase in appropriate behaviours after the introduction of the TEP- 30.6% in cottage A, 34.1% in B and 21% in C.

15. Strengths: Weaknesses:
When used in prisons, it gives prisoners a sense of control over their behaviour and the rewards they earn.
No specialist training is required to implement a TEP e.g. Parents may implement a TEP to control their child's behaviour.
Weaknesses:
Although no specialist training is needed to implement a TEP, most experts recommend training for all staff as the system is open to abuse, particularly in a prison environment.
It is disputed whether this is actually a treatment, as it only improves behaviour for a reward i.e. The positive behaviour is likely to stop if the reward is removed. In a prison for example, prisoners are likely to behave more appropriately if a TEP is present. Once out of prison, they will no longer have the positive reinforce and so will revert back to inappropriate behaviour.
Pearson et al. (2002) conducted a meta-analysis to review and compare the effectiveness of behavioural techniques (e.g. TEPs) and cognitive-behavioural techniques (e.g. Anger management). They examined the findings of 69 studies and concluded that cognitive-behavioural therapies helped reduce recidivism whilst behavioural treatments did not work. It seems that behaviour can’t be changed without a change in thinking.

16. Ethical Issues & social control
As with drug therapies, one problem is the question of who has the power to control someone else’s behaviour. To mitigate this, individual staff should not stand out as having power in the programme- the system of rewards must be very clear, predictable and reliable for the programme to work.
It must also be very clear as to what the behaviour is, why it is desired, and by whom.
Is used in schools, prisons and other institutions to help with controlling behaviour.
Required behaviour is broken down into steps that are achievable and observable.
When the required behaviour is observed, it is rewarded using a system of tokens, which can, at an agreed time, be exchanged for something the individual desires.
The principles are: rewarding the required behaviour; ignoring any undesired behaviour; offering a form of positive reinforcement; using shaping.