Test: Therapeutic Approaches- 1

The two major approaches to treatment of psychological disorders are biological and psychological.

Electroconvulsive therapy is very controversial for the treatment of severe depression; it includes several significant side effects including memory loss, disorientation, and possibly brain damage. Its effects are short term and it is unclear how it improves symptoms even in the short-term. Lobotomy is a form of psychosurgey very rarely used anymore. Psychoanalysis, aversion therapy and rational-emotive therapy are different types of psychotherapy that are not necessarily used to treat severe depression and are not particularly controversial.

Anti-psychotics can have potent side-effects, including constipation, blurred vision, restlessness and difficulty sitting still (akathisia), cardiac arrhythmia, diminished spontaneity and difficulty initiating usual activities (akinesia). Prolonged treatment can lead to ‘rabbit syndrome’ (rapid movement of the lips that mimics the chewing movement of rabbits). Prolonged use of anti-psychotics can result in tardive dyskinesia, ‘tardive’ meaning ‘late developing’ and ‘dyskinesia’ meaning ‘disturbance in movement’. This serious disorder is characterized by involuntary movements of the face, trunk or extremities.

Pharmacotherapy involves the use of drug treatments to control and/or reduce the symptoms of psychological disorders, and is not a form of psychotherapy. Depending on the disorder, it is used in conjunction with psychotherapeutic treatments (cognitive, humanistic, behavioural, psychodynamic) to produce the most improvement in patients.

Self-selection, true control groups and the magnitude of comparisons to be made represent major difficulties for the evaluation of psychotherapeutic treatments. Informed consent from patients is not particularly problematic for research that evaluates psychotherapeutic effectiveness.

Just as behaviourism was a rejection of existing systems in psychology, behaviour therapy represented a rejection of psychoanalytic and psychodynamic thinking. Behaviour therapy is concerned with what the person does that causes distress. The problematic behaviour is seen to be learned, just like any other behaviour, and is not viewed as a symptom of an underlying ‘illness’.
The therapist uses techniques based on the principles of learning to change the maladaptive behaviour. Consistent with its roots in the work of Pavlov, Thorndike and Skinner, behaviour therapy is highly pragmatic and focuses on the ‘here and now’ rather than early experiences. And yet it would be a mistake to conclude that behaviour therapy is a completely mechanistic, impersonal procedure. Like other psychotherapists, behaviour therapists emphasize the need for a strong, supportive therapeutic relationship between the therapist and the client in their work.

Behavioural therapy uses the techniques of flooding, reciprocal inhibition, and covert sensitization to treat psychological disorders, such as anxiety disorders. Cognitive, humanistic and family therapies do not rely on these techniques to treat psychological disorders.

Client-centered therapy, developed by Carl Rogers, emphasizes that therapists must show patients unconditional positive regard in order for therapy to be effective. Family, rational-emotive and gestalt therapy do not consider unconditional positive regard to be a key component of the therapy.

Because many family therapies have been developed by highly skilled, charismatic therapists, some critics argue that the attraction of these therapies may reflect little more than this charisma. This concern is reinforced by the relative lack of research on many of these therapies. Indeed, when 15 different approaches to family and couples therapy were cross-tabulated across 10 different psychological disorders, it was found that systematic evaluations of the efficacy of these therapies had been conducted on only 35 of the 150 method-by-problem combinations (Gurman et al., 1986).
This is a circumstance that has improved only slightly since this time. Nevertheless, it has been reported that bona fide treatments produce beneficial outcomes for about two-thirds of cases in 20 sessions or fewer, and these treatments are probably as effective or even more effective than many individual treatments for problems relating to family or relationship conflict (Alexander, Holtzworth-Munroe & Jameson, 1994).

Data certainly seem to point to the fact that psychotherapy is effective, but there are still some concerns. For example, some treated clients end up worse off than the average untreated client. So you might justifiably wonder whether psychotherapy can be harmful. It is estimated that about 5–10 per cent of clients deteriorate after psychotherapy, but the causes of such changes are poorly understood (Shapiro & Shapiro, 1982; Smith et al., 1980).
In addition to a bad therapist–client relationship and therapist incompetence (Hadley & Strupp, 1976; Smith et al., 1980), it is also possible that for some clients psychotherapy disrupts a stable pattern of functioning without offering a clear substitute (Hadley & Strupp, 1976). Clearly much remains to be learned if we are to answer the ‘ultimate question’ about psychotherapy: ‘What treatment, by whom, is most effective for this individual with that specific problem, under what set of circumstances?’ (Paul, 1969, p. 44