16.E: Therapy and Treatment (Exercises)

16.1: Mental Health Treatment - Past and Present

Before we explore the various approaches to therapy used today, let’s begin our study of therapy by looking at how many people experience mental illness and how many receive treatment. According to the U.S. Department of Health and Human Services (2013), \(19\%\) of U.S. adults experienced mental illness in 2012. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), in 2008, \(13.4\%\) of adults received treatment for a mental health issue.

Review Questions

Q1

Who of the following does not support the humane and improved treatment of mentally ill persons?

1. Philippe Pinel
2. medieval priests
3. Dorothea Dix
4. All of the above

Q2

The process of closing large asylums and providing for people to stay in the community to be treated locally is known as ________.

1. deinstitutionalization
2. exorcism
3. deactivation
4. decentralization

Q3

Joey was convicted of domestic violence. As part of his sentence, the judge has ordered that he attend therapy for anger management. This is considered ________ treatment.

1. involuntary
2. voluntary
3. forced
4. mandatory

Q4

Today, most people with psychological problems are not hospitalized. Typically they are only hospitalized if they ________.

1. have schizophrenia
2. have insurance
3. are an imminent threat to themselves or others
4. require therapy

Critical Thinking Questions

Q5

People with psychological disorders have been treated poorly throughout history. Describe some efforts to improve treatment, include explanations for the success or lack thereof.

Q6

Usually someone is hospitalized only if they are an imminent threat to themselves or others. Describe a situation that might meet these criteria.

Personal Application Questions

Q7

Do you think there is a stigma associated with mentally ill persons today? Why or why not?

Q8

What are some places in your community that offer mental health services? Would you feel comfortable seeking assistance at one of these facilities? Why or why not?

Solution

S1

B

S2

A

S3

A

S4

C

S5

Beginning in the Middle Ages and up until the mid-\(20^{th}\) century, the mentally ill were misunderstood and treated cruelly. In the 1700s, Philippe Pinel advocated for patients to be unchained, and he was able to affect this in a Paris hospital. In the 1800s, Dorothea Dix urged the government to provide better funded and regulated care, which led to the creation of asylums, but treatment generally remained quite poor. Federally mandated deinstitutionalization in the 1960s began the elimination of asylums, but it was often inadequate in providing the infrastructure for replacement treatment.

S6

Frank is severely depressed. He lost his job one year ago and has not been able to find another one. A few months after losing his job, his home was foreclosed and his wife left him. Lately, he has been thinking that he would be better off dead. He’s begun giving his possessions away and has purchased a handgun. He plans to kill himself on what would have been his \(20^{th}\) wedding anniversary, which is coming up in a few weeks.

16.2: Types of Treatment

Two types of therapy are psychotherapy and biomedical therapy. Both types of treatment help people with psychological disorders, such as depression, anxiety, and schizophrenia. Psychotherapy is a psychological treatment that employs methods to help someone overcome personal problems, or to attain personal growth. In modern practice, it has evolved into what is known as psychodynamic therapy. Biomedical therapy involves medication and/or medical procedures to treat psychological disorders.

Review Questions

Q1

The idea behind ________ is that how you think determines how you feel and act.

1. cognitive therapy
2. cognitive-behavioral therapy
3. behavior therapy
4. client-centered therapy

Q2

Mood stabilizers, such as lithium, are used to treat ________.

1. anxiety disorders
2. depression
3. bipolar disorder
4. ADHD

Q3

Clay is in a therapy session. The therapist asks him to relax and say whatever comes to his mind at the moment. This therapist is using ________, which is a technique of ________.

1. active listening; client-centered therapy
2. systematic desensitization; behavior therapy
3. transference; psychoanalysis
4. free association; psychoanalysis

Critical Thinking Question

Q4

Imagine that you are a psychiatrist. Your patient, Pat, comes to you with the following symptoms: anxiety and feelings of sadness. Which therapeutic approach would you recommend and why?

Personal Application Question

Q5

If you were to choose a therapist practicing one of the techniques presented in this section, which kind of therapist would you choose and why?

Solution

S1

A

S2

C

S3

D

S4

I would recommend psychodynamic talk therapy or cognitive therapy to help the person see how her thoughts and behaviors are having negative effects.

16.3: Treatment Modalities

Once a person seeks treatment, whether voluntarily or involuntarily, he has an intake done to assess his clinical needs. An intake is the therapist’s first meeting with the client. The therapist gathers specific information to address the client’s immediate needs, such as the presenting problem, the client’s support system, and insurance status. The therapist informs the client about confidentiality, fees, and what to expect in treatment.

Review Questions

Q1

A treatment modality in which \(5-10\) people with the same issue or concern meet together with a trained clinician is known as ________.

1. family therapy
2. couples therapy
3. group therapy
4. self-help group

Q2

What happens during an intake?

1. The therapist gathers specific information to address the client’s immediate needs such as the presenting problem, the client’s support system, and insurance status. The therapist informs the client about confidentiality, fees, and what to expect in a therapy session.
2. The therapist guides what happens in the therapy session and designs a detailed approach to resolving each member’s presenting problem.
3. The therapist meets with a couple to help them see how their individual backgrounds, beliefs, and actions are affecting their relationship.
4. The therapist examines and discusses with the family the boundaries and structure of the family: For example, who makes the rules, who sleeps in the bed with whom, and how decisions are made.

Critical Thinking Question

Q3

Compare and contrast individual and group therapies.

Personal Application

Q4

Your best friend tells you that she is concerned about her cousin. The cousin—a teenage girl—is constantly coming home after her curfew, and your friend suspects that she has been drinking. What treatment modality would you recommend to your friend and why?

Solution

S1

C

S2

A

S3

In an individual therapy session, a client works one-on-one with a trained therapist. In group therapy, usually \(5-10\) people meet with a trained group therapist to discuss a common issue, such as divorce, grief, eating disorder, substance abuse, or anger management.

16.4: Substance Related and Addictive Disorders - A Special Case

Addiction is often viewed as a chronic disease. The choice to use a substance is initially voluntary; however, because chronic substance use can permanently alter the neural structure in the prefrontal cortex, an area of the brain associated with decision-making and judgment, a person becomes driven to use drugs and/or alcohol. This helps explain why relapse rates tend to be high. About \(40\%-60\%\) of individuals relapse, which means they return to abusing drugs and/or alcohol.

Review Questions

Q1

What is the minimum amount of time addicts should receive treatment if they are to achieve a desired outcome?

1. \(3\) months
2. \(6\) months
3. \(9\) months
4. \(12\) months

Q2

When an individual has two or more diagnoses, which often includes a substance-related diagnosis and another psychiatric diagnosis, this is known as ________.

1. bipolar disorder
2. comorbid disorder
3. codependency
4. bi-morbid disorder

Q3

John was drug-free for almost six months. Then he started hanging out with his addict friends, and he has now started abusing drugs again. This is an example of ________.

1. release
2. reversion
3. re-addiction
4. relapse

Critical Thinking Question

Q4

You are conducting an intake assessment. Your client is a \(45\)-year-old single, employed male with cocaine dependence. He failed a drug screen at work and is mandated to treatment by his employer if he wants to keep his job. Your client admits that he needs help. Why would you recommend group therapy for him?

Personal Application Question

Q5

What are some substance-related and addictive disorder treatment facilities in your community, and what types of services do they provide? Would you recommend any of them to a friend or family member with a substance abuse problem? Why or why not?

Solution

S1

A

S2

B

S3

D

S4

The rationale behind using group therapy for addiction treatment is that addicts are much more likely to maintain sobriety when treatment is in a group format. It has been suggested that it’s due to the rewarding and therapeutic benefits of the group, such as support, affiliation, identification, and even confrontation. Because this client is single, he may not have family support, so support from the group may be even more important in his ability to recover and maintain his sobriety.

16.5: The Sociocultural Model and Therapy Utilization

Multicultural counseling and therapy aims to offer both a helping role and process that uses modalities and defines goals consistent with the life experiences and cultural values of clients. It strives to recognize client identities to include individual, group, and universal dimensions, advocate the use of universal and culture-specific strategies and roles in the healing process, and balances the importance of individualism and collectivism in the assessment, diagnosis, and treatment.

Review Questions

Q1

The sociocultural perspective looks at you, your behaviors, and your symptoms in the context of your ________.

1. education
2. socioeconomic status
3. culture and background
4. age

Q2

Which of the following was not listed as a barrier to mental health treatment?

1. fears about treatment
2. language
3. transportation
4. being a member of the ethnic majority

Critical Thinking Question

Q3

Lashawn is a \(24\)-year-old African American female. For years she has been struggling with bulimia. She knows she has a problem, but she is not willing to seek mental health services. What are some reasons why she may be hesitant to get help?

Personal Application Question

Q4

What is your attitude toward mental health treatment? Would you seek treatment if you were experiencing symptoms or having trouble functioning in your life? Why or why not? In what ways do you think your cultural and/or religious beliefs influence your attitude toward psychological intervention?

Solution

S1

C

S2

D

S3

One reason may be that her culture views having a mental illness as a stigma. Additionally, perhaps she doesn’t have insurance and is worried about the cost of therapy. She could also be afraid that a White counselor would not understand her cultural background, so she would feel uncomfortable sharing things. Also, she may believe she is self-reliant and tell herself that she’s a strong woman who can fix this problem on her own without the help of a therapist.

Contributor

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