Psychotherapy and Psychosocial Treatments

Psychotherapy and psychosocial treatments may be part of an overall treatment plan for people living with psychiatric disorders or other mental health conditions. These treatments may also extend to their families. Psychosocial treatments include certain forms of psychotherapy (also known as “talk therapy”), psychoeducation, and even vocational and social training. Psychosocial treatments for mental illnesses can help individuals improve their functioning while lessening the negative effects of their illnesses. A licensed psychiatrist, psychologist, social worker, counselor or psychiatric nurse most commonly provides these therapies. The type, frequency or number of therapy sessions recommended for an individual will be tailored to his or her specific situation and treatment needs.

Psychotherapy

People with mental health conditions often find psychotherapy quite helpful. Psychotherapy involves talking with a psychiatrist, therapist or counselor to address the mental, emotional and behavioral issues that are causing symptoms and distress. The therapist listens to the client’s story to understand how they think and feel, assess their strengths, understand the stresses and past experiences that trouble them, and hear their hopes and dreams. Working through one’s thoughts, stresses and past experiences in therapy provides insight and practical approaches to dealing with difficult personal issues. Equally important, expressing what is in one’s heart and mind – and feeling truly understood and accepted – often brings hope and healing.

Benefits of therapy include:

  • Examining the connections between thoughts and feelings
  • Coping more effectively with stress and symptoms
  • Increasing feelings of self-worth
  • Learning healthy ways to deal with strong emotions, such as anger, fear and grief
  • Changing behaviors that make it difficult to move forward
  • Healing from painful experiences and past hurts
  • Improving problem-solving skills
  • Facing challenges more confidently

Types of therapy

Therapists offer many different types of psychotherapy, and may possess specific training in different treatments. In determining the most appropriate therapy or therapies for an individual, a psychotherapist will consider the problem to be treated and the individual's personality, cultural and family background, and personal experiences. Each type has certain characteristic techniques, which may be especially useful in treating people with particular conditions, but most are broadly effective, and all share many commonalities.

It is a good idea to discuss with one’s doctor or therapist how a particular therapy works and how it is expected to be helpful. A psychiatrist or psychotherapist (or both) may offer each of the following therapies to an individual, family, couple or group.

The most common types of therapy are:

Interpersonal Therapy (IPT)

Interpersonal therapy is primarily focused on improving relationships and enabling individuals to express emotions in healthy ways. IPT spotlights a person’s interactions with other people, troubling emotions and their triggers. Examining relationships in one’s past that may have been affected by distorted mood and behavior can help one learn to be more objective about current relationships. Similarly, identifying behaviors that may be causing problems can prompt positive change. The therapist offers advice and helps individuals make decisions about the best way to deal with other people. IPT also explores major issues that may contribute to depression, such as grief, personal transitions or periods of upheaval.

One-on-one IPT is often an effective approach for treating depression or dysthymia, a more persistent but less severe form of depression. A variation of IPT, “interpersonal and social rhythm therapy,” frequently works well in treating bipolar disorder because it supports recovery by developing a daily schedule. This psychosocial treatment is also used to help people with ADHD, eating disorders, and generalized anxiety disorder. Regular sessions may last for approximately 3 to 4 months and target specific symptoms over this time period.

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Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a treatment that focuses on the interplay of a person’s thoughts, feelings and actions. The cognitive part helps a person identify negative or unhealthy beliefs and shift these to positive beliefs or thoughts. The behavioral part helps a person take healthier actions and interact with others in more effective ways.

Through CBT, people first recognize negative thoughts or mindsets, which involve such mental processes as perceiving, remembering, reasoning, decision-making, and problem solving. Then, they learn how to replace them with positive thoughts, leading to more appropriate and productive behavior. 

CBT is considered a first-choice treatment for obsessive-compulsive disorder, anxiety disorders and post-traumatic stress disorder (PTSD). When coupled with medications, CBT is also used successfully to treat people with schizophrenia, bipolar disorder, ADHD, depression, eating disorders, substance abuse problems and other mental illnesses.

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Exposure Therapy

Exposure therapy (also known as exposure and response prevention) is another type of behavioral therapy particularly useful for treating obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD). In exposure therapy, an individual is systematically exposed – under controlled conditions – to the situation that triggers their obsessive thoughts or their fear reaction to a previous traumatic experience. He or she is taught specific techniques to avoid reacting, and the systematic exposure reduces the paralyzing power of the triggers. In cases of severe symptoms, exposure therapy may be coupled with prescribed medication.

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Dialectical Behavior Therapy

Dialectical behavior therapy (DBT), a form of CBT, was initially developed to treat people who were chronically suicidal and who had borderline personality disorder (BPD) . It has proven quite effective for these individuals and has evolved to help people with varied mental health struggles. Individuals learn new skills in one-to-one DBT sessions, then have the opportunity to practice them in a group therapy environment. Some techniques of behavioral therapy are paired with a philosophy that opposites may not really be opposites when looked at differently.

Within the DBT therapy model, there must be a strong and equal relationship between patient and therapist. The therapist assures the patient that the patient's behavior and feelings are valid and understandable. At the same time, the therapist coaches the patient to accept that it is his or her personal responsibility to change unhealthy or disruptive behavior. The positive reinforcement provided through dialectical behavioral therapy can boost motivation to change and reduce self-destructive behaviors by teaching practical coping skills related to the person’s own environment.

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Psychodynamic Therapy

Psychodynamic therapy helps people review early life experiences, thoughts and emotions, and the beliefs they developed as children. Being able to cope with these experiences enables them to better understand their current problems. It also allows them to see the patterns of behavior they developed as children that limit their adult lives. Through this process, psychodynamic therapy helps people become more aware of themselves and their own actions. The therapeutic relationship is an important workshop for this exploration.

Although not typically a first-line treatment, psychodynamic psychotherapy can be useful for some patients with depression, anxiety disorders, borderline personality disorder, and other mental illnesses. It is often used in conjunction with medication therapy.

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Family Therapy / Family-Focused Therapy

When an individual is struggling with a serious mental illness, his or her family members are often profoundly affected as well.  Therefore, it is equally important to acknowledge and address their needs. Family therapy helps family members communicate better, manage conflicts and solve problems together. It also helps them understand different ways in which love and loyalty can be expressed. Family therapy sessions generally include all affected family members as well as the patient. Specific forms of family therapy are commonly used to treat eating disorders and bipolar disorder.

Additionally, family therapy may approach those aspects of a patient's symptoms that are expressions of the pain and struggles of another family member, or of the family at large. In these situations, the patient's recovery may be slowed until the pain in the rest of the family has been brought to the surface and healed. Therapy then is focused on understanding the meaning of the symptom, and helping other family members express their own struggles, so the patient won't have to carry their pain.

Family-Focused Therapy

Family-focused therapy (FFT) is based on the premise that the individual’s relationship with family plays a crucial role in successfully managing his or her illness. When family members participate in therapy sessions to improve how they relate to the patient and each other, it can improve the results of treatment. Typically, the family and patient attend sessions together. While the specific treatment needs will vary with the patient and family, FFT generally incorporates education on the disorder, improving communication skills to better handle stress, and working together as a family to solve problems. During therapy, family members learn to express negative emotions in a more constructive way while the patient learns to take responsibility for his or her own actions and well-being to the degree possible.

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Psychoeducation

The purpose of psychoeducation is to help people understand mental disorders and ways to support recovery.

It involves teaching patients/clients and their family members about mental health conditions, how they are treated, and how to recognize the signs and symptoms. Psychoeducation also focuses on ways to prevent relapse so the individual can obtain treatment before their mental illness worsens or occurs again. Psychoeducation for families, friends and even employers includes teaching coping strategies and problem-solving skills to help them deal more effectively with the individual who has a mental disorder. This approach enables individuals to better support their loved ones through the treatment process. It also reduces distress, confusion and anxieties within the family, which can help the individual to recover.

Psychoeducation in combination with medication has been used successfully to treat people with schizophrenia, bipolar disorder, attention-deficit/hyperactivity disorder (ADHD), depression, and other mental illnesses.

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Dual Diagnosis and Integrated Treatment of Mental Illness and Substance Abuse Disorder

Dual diagnosis services are integrated treatments for people who have what’s called co-occurring disorders – a mental illness and substance abuse disorder. Studies have clearly demonstrated more complete recovery for individuals who receive treatment for both disorders. Dual diagnosis services integrate assistance for each condition, helping people recover from both in a single setting at the same time.

Assertive Community Treatment (ACT)

ACT is a highly effective team-based approach that provides comprehensive, adaptable treatment and support to individuals who have a serious mental illness. Treatment teams may include peer support specialists and practitioners with expertise in psychiatry, nursing, social work, substance abuse treatment and employment. Team members work closely together to provide integrated and outreach‐oriented services.

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Other types of therapies that may be incorporated in mental health treatment include:

Art Therapy or Expressive Therapy

Also known as creative arts therapy, this form of treatment can help people express difficult emotions and thoughts through drawing, painting, music, dance, writing or other art forms. These expressive acts are a useful way to promote healing.

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Bioenergetics

Bioenergetics is one of the most theoretically grounded of the body-oriented psychotherapies. It focuses on how the mind and the body store traumas that occur during childhood. This approach permits two different ways to access these traumas and the survival tools the individual used to help them endure the pain. Although these survival tools proved essential to them as children, they have been very limiting to them as adults. This therapy applies the insights of the mind combined with exercises to access the wisdom of the body.

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Animal-Assisted Therapy

Working with animals, such as horses, dogs or cats, may help some people cope with trauma or develop empathy, and encourage better communication. Companion animals are sometimes introduced to promote emotional well-being in hospitals, psychiatric wards, nursing homes and other settings where they may bring comfort and create a mild therapeutic effect. Animal-assisted therapy has also been used as an added therapy for children with mental disorders, for whom it may ease behavioral problems.

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Play Therapy

Used with children, this approach incorporates toys and games to help a child identify and talk about his or her feelings and communicate with a therapist. Watching how a child plays can sometimes help a therapist better understand a child's problems.

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Sources:

National Institute of Mental Health

National Alliance on Mental Illness

Mental Health America

 

Helpful Links

Learn more about types and applications of psychotherapy:

http://www.nimh.nih.gov/health/topics/psychotherapies/index.shtml

http://www.nami.org/factsheets/psychosocial_factsheet.pdf

http://www.mentalhealthamerica.net/therapy

http://psychcentral.com/psychotherapy/