Transcript 5.3 implementing treatment

Introduction - History

 “madness” was attributed to the supernatural forces,
or possession of evil spirits
 Treatment was drilling holes in the skull to release
the evil spirit, this is known as trepanation.
 Diagnosis was occurring and treatment was being
sought.
Possible relationship
between etiology and
treatment
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Pages 166 - 169
Contemporary approach
to treatment
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 Biomedical
 Individual or group therapy
 Biopsychosocial approach: Multifaceted approach is
know considered to be the most efficient.
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Includes drug therapy
cognitive therapy (individual)
or family therapy (group therapy)
Stress related environmental management
 ‘Client’ has replaced the term ‘patient’
Drug Therapy
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 Not all people will respond to drug therapy the same
 Side effects may occur
 Dosage levels take time to assess
 No conclusive data to pinpoint specific
biophysiology to behavior, but rather a general
knowledge that neurotransmitters and hormones
may contribute.
Individual therapy
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 Therapist work one-on –one with the client
 Most therapy involves some form of cognitive
 Works to change negative thought pattern
 Highly effective
 Personalized/individualized to the client.
Group Therapy
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 A group if clients with similar issues meet with one or two
therapist.
 Women who have experiences sexual abuse
 Abusive family
 Depression
 Group therapy allows individuals to openly discuss shared
experiences in a safe environment;
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It provides group support (collectivism),
Cost effective for client
Therapist can work with multiple clients at once
The group setting diminishes the role of the therapist and thus
buts the client on the path to self management.
 Many disorders are caused or promote poor social skills –
group works allows individuals to interact in a safe
environment.
Disadvantages of Group
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 Some individuals may not want to express
themselves
 Confidentiality
 Group dynamics
Culture Considerations
in treatment
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Pages 168-169
Culture and treatment
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 Not all cultures respond to all treatments the same.
 Mutlaq and Chaleby (1995) – problems with group
therapy with Arab culture
 Gender roles
 Deference to members in the group based on age or
tribal status
 Misperception that this is simply a social activity
Indigenous healing
practices
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 Indigenous healing practices – a combination of western
psychotherapy and therapeutic beliefs and practices that are
rooted within a given culture.
 Commonalities in nonwestern countries of indigenous practices
include:
 Heavy reliance on family and community networks.
 Incorporation of traditional, spiritual and religious beliefs
 Malaysia, religion has been incorporated into psychotherapy
 Chinese Taoist cognitive psychotherapy – verses from the Taoist
writings that highlight main principles, such as restricting selfish
desires, learning how to be content, and learning to let go, are read
and reflected.
 This was found to be more effective in the long term reduction of
anxiety disorders than drug therapy
Community Psychologist
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 Analyze psychological health from a community level.
 Ecological model – Miller (2000), looks at the relationship
between people and the settings they live in
 Identifies naturally occurring resource within the
community that can promote healing/healthy adaptations
 Enhancement of coping strategies/response to stress
 Development of collaborative, culturally grounded
community interventions that actively involve community
members in the process of solving their own problems.
The use of eclectic
approaches
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 Eclectic approach to therapy – an approach that
incorporates principles or techniques from various
systems and theories.
 Eclectic approach allows for an individualistic approach
to each client’s needs.
 Cognitive therapy may not be ideal based on the age of the
individual or the current state of mind of the individual.
 Group therapy is appropriate in all cases – the level of
development of the client must be considered.
 Drug therapy alone is not significant for long term success.
 Rush et al ( 1977) high relapse rate for patients only treated
with drug therapy (i.e. no cognitive therapy).
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 Cognitive therapies are more effective than drug
treatment alone at preventing relapse or
reoccurrence, except when drug treatment is long
term (Hollon and Beck 1994)
 A combination of drug and psychotherapy appears
to be moderately more successful than either therapy
alone (Klerman et al., 1994)
Measuring the
effectiveness of Therapy
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 Eysenck (1961) proposed the idea of spontaneous remission,
recovery that came about due to no treatment other than
time.
 How does one assess is a treatment works?
 How long must an individual be symptom free for
treatment to be successful?
 Should the total absence of symptoms be the only criteria?
 Should only observable behavior be the measuring stick?
 Can you gather both quantitative and qualitative data when
measuring the disorder?
 Who decides is the therapy is successful?
Determining
Effectiveness
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 Outcome Studies: focus on the results – did the
patient show improvements or not?
 Not all studies are equal - much depends upon the
interpretation and style of the therapist, and the
compliance of the patient.
 Most treatments have positive effect (Smith et al.,
1980) – meta analysis of 475 studies
 Some approaches work better for some disorders
while other approaches are best for others.
 Thus eclectic styles of treatment are often applied.