1. Introduction to Psychotherapy Definitions and Examples

2. The 5-minute lecture The 5-minute university The 5-minute university [video link] Mental health “treatment” has a painful history Contemporary psychotherapy works The relationship is important Therapist must be empathic Therapy is an art (as well as a science) There are many therapy modalities. People like to argue about which one is best.

3. Today’s Lecture Historical treatment of the mentally ill Psychotherapy definitions and examples Places of treatment Providers of treatment Recipients of treatment

4. Historical background: Beliefs and treatment of the mentally ill Greek physician Hippocrates (ca. 400BC) promoted humane treatment. Tx based on healing powers of nature: Mentally ill patients were placed in pleasant surroundings and given soothing baths. Lack of balance between positive and negative energies Illness attributed to a disturbance in the balance of bodily fluids (humorism). HumourSeasonOrganAncient nameModernMBTIAncient characteristics BloodspringliversanguineartisanSPcourageous, hopeful, amorous Yellow bilesummerspleencholericidealistNFeasily angered, bad tempered Black bileautumngall bladdermelancholicguardianSJdespondent, sleepless, irritableirritable Phlegmwinterbrainbrain/lungslungsphlegmaticrationalNTcalm, unemotional

5. Middle Ages-17 th century: A spiritual matter Madness = in league with devil, possession by spirits Diagnosis based on hearsay, unreliable “tests” Treatment Prayer, exorcism, magic incantation Torture, starvation, and exile (sent to sea) Treated like animals and sentenced to burn or hang

6. 18 th century: Moderate enlightenment Mentally disordered people = degenerates Treatment: Isolate mentally ill from society Sometimes bloodletting

7. The 19th century: Attempts at reform Philippe Pinel (1745-1826) Reformed Paris mental hospitals: Removed restraints and treated mentally ill more humanely Some patients got better enough to leave hospital

8. Dorothea Dix (1802-1887) The 19th century (cont.) Reform of U.S. system Moral-treatment movement advocating humane care Led to large, state-supported public asylums But problems persisted Overcrowding No effective treatments Eventually…interest waned Freud introduces psychoanalysis in 1890s

9. The 20th century New biological therapies introduced in 1930s Insulin-coma therapy (ICT) video of Leonard Frankvideo of Leonard Frank Electro-shock therapy (ECT) video of early ECTvideo of early ECT Frontal lobotomy videovideo Anti-psychotic drugs introduced in mid-1950s Deinstitutionalization follows in early 1960s get people out of asylums and back into community general mood of optimism in country Community mental health centers established in 1961 Additional video available from Scientific American Series

10. ECT Today Therapy for severely depressed patients in which a brief electric current is sent through the brain of an anesthetized patient Side effects of ECT include slowing of information processing speed and short- term memory loss, but it is painless and there is no risk for death or brain damage. 70% of depressed patients who did not respond to other treatment respond positively to ECT.

11. Somatic Treatments in the 1920s and 1930s

12. The 20th century New biological therapies introduced in 1930s Insulin-coma therapy (ICT) Electro-shock therapy (ECT) Frontal lobotomy Anti-psychotic drugs introduced in mid-1950s Deinstitutionalization follows in early 1960s get people out of asylums and back into community general mood of optimism in country Community mental health centers established in 1961 Additional video available from Scientific American Series

13. Patients in Mental Hospitals. The number of patients cared for in the U.S. state and county mental hospitals has decreased dramatically since 1955.

14. 20 th Century: Advances in psychotherapy Psychoanalysis introduced by Freud in 1890s Adler (1930s) and other neo-Freudians follow Variety of new approaches introduced in 1950s Behavioral (Wolpe, Watson, Skinner) Rational Emotive Therapy (RET, Ellis) Humanistic (Rogers) Existential (May) Gestalt (Perls) Cognitive therapy introduced in 1960s (Beck) Group therapy also gains popularity in 1960s Family Therapy comes in the 1970s Motivational Interviewing (1983) and MBCT (1991)

15. Today’s Lecture Historical treatment of the mentally ill Psychotherapy definitions and examples Places of treatment Providers of treatment Recipients of treatment

16. What is psychotherapy? Psychotherapy is a form of treatment for problems of an emotional nature in which a trained person deliberately establishes a professional relationship with a patient for the purpose of removing, modifying, or retarding existing symptoms, of mediating disturbed patterns of behavior, and of promoting positive personality growth and development (Wolberg, 1967). Psychotherapy is a planned activity of the psychologist 1, the purpose of which is to accomplish changes in the individual that make his/her life adjustments potentially happier, more constructive, or both (Frank, 1982). 1 or other professional mental health service provider

17. Which of these is not psychotherapy? A rabbi counseling a couple with marital difficulties An abused child drawing pictures of his family for a psychologist A woman presenting her testimony to her Alcoholic Anonymous group A university Counseling Center psychologist with an M.A. helping a student choose a careerchoose a career A man talking about his dreams and childhood experiences to a psychoanalyst in N.Y. A police officer “talking down” a suicidal teenager from a tall building A family having a loud argument in a therapist’s officea loud argument

18. Today’s Lecture Historical treatment of the mentally ill Psychotherapy definitions and examples Places of treatment Providers of treatment Recipients of treatment

19. Modern Treatment Facilities/Trends Hospitals (2006 National Hospital Discharge Survey)2006 National Hospital Discharge Survey Mental disorders led to 2.4 million hospitalizations (6.9% of total) Psychoses was the 3 rd most common reason for hospitalization Heart disease (4.2 million) Child delivery (4.1 million) Psychoses (1.7 million) Pneumonia (1.2 million) Malignant neoplasms (1.2 million) Fractures (1.1 million) Average length of st-hospital stay is about 7 days (see next slide) Community Mental Health Centers Out-patient mental health clinics Nursing homes Private offices

22. Hospitals from a patient's perspective Rosenhan (1973): "On being sane in insane places” sane people got into mental hospitals as patients found very low interaction with staff dehumanizing nature of interactions normal behaviors interpreted pathologically Brief interview with Rosenhan Rosenhan’s study spurned significant reform. Today’s hospitals are more humane, but… Diagnosis rules the day (a critique)a critique Practically everyone is medicated Restraints & padded rooms used if patient at risk of self-harm Involuntary hospitalization legally permitted (though limited)

23. Modern Treatment Facilities/Trends Hospitals (2004 National Hospital Discharge Survey) Mental Disorders accounted for 2.3 million hospitalizations Psychoses was the 3 rd most common reason for hospitalization Heart disease (4.4 million) Child delivery (4.1 million) Psychoses (1.6 million) Pneumonia (1.3 million) Malignant neoplasms (1.2 million) Fractures (1.0 million) Average length of hospital stay is about 7 days (see next slide) Community Mental Health Centers Out-patient mental health clinics Nursing homes Private offices

24. Today’s Lecture Historical treatment of the mentally ill Psychotherapy definitions and examples Places of treatment Providers of treatment Recipients of treatment

25. Professionals who treat mental disorders Psychiatrists (M.D.) Psychiatric nurses (B.S, M.S.) Physicians (M.D.) Psychoanalysts (Ph.D. +) Psychologists Clinical (M.A., Ph.D., Psy.D.) Counseling (M.A., Ph.D.) School (M.A., Ph.D.) Social workers (MSW) Marriage and family counselors (M.A.)

26. Therapists and their training

27. Estimated Number of Clinically Trained Professionals Providing Mental Health Services in the U.S. (2010) Clinical, Counseling, and School Psychologists Psychiatrists Social Workers Current data available on the Occupational Outlook Handbook homepage Occupational Outlook Handbook

28. Self-help Groups

29. Referral sources

30. Who do people recommend?

31. Who do people turn to for help?

32. Types of psychotherapists

33. Norcross, Hedges, & Prochaska (2002) Types of psychotherapists (part 2) Adapted from Norcross, J. C., Hedges, M., & Castle, P. H. (2002). Psychologists conducting psychotherapy in 2001: A study of the Division 29 membership. Psychotherapy: Theory, Research, Practice, Training, 39(1), 97–102.

34. Today’s Lecture Historical treatment of the mentally ill Psychotherapy definitions and examples Places of treatment Providers of treatment Recipients of treatment

35. Most people who meet criteria for DSM diagnoses do not seek treatment Variability due to sex, education, race & income level women seek more treatment than men college educated people seek more treatment than those with only a high school education whites seek more treatment than nonwhites people with higher income seek more treatment than those with lower income

36. Race-group Differences in Psychopathology

38. Distribution lacking health insurance by race and ethnicity (2004) The higher uninsured rate for Hispanics is not associated with higher poverty levels than other groups — the poverty rate for Hispanics is slightly lower than for African-Americans, 22.2% vs. 24.9% respectively. Rather, research has shown that Hispanics are more likely to be employed in jobs that do not offer health insurance…but when offered health insurance they accept at the same rates at whites and blacks (U.S. Department of Health and Human Services) Latest uninsured data from CFED

39. More research on health disparities

40. Reasons for seeing a mental health professional Murstein & Fontaine (1993), random sample in Conn.

41. More information: APA Psychology career page Occupational Outlook Handbook See “Professional Development” links on course website