Treatments
You must be able to describe and evaluate one treatment from each approach.
Social: Care in the Community
It involves caring for the patient in their own home or in sheltered accommodation. It is a way of preventing institutionalisation - over 80% of meetings occur in the patients home environment and hospitalisation is a last resort. They can call on Community Psychiatric Nurses for support. Care in the community uses drop-in centres, half way houses, and home medication. Drop-in centres that provide a 24/7 service and sheltered accommodation can provide 24 hour care for those who cannot cope living alone and have nowhere else to live. Support is provided so clients are able to deal with the environmental factors thought to trigger their mental illness. Care staff can provide help in day to day living, although residents are encouraged to make their own decisions. ACT is used by community mental health services and focuses on clients who have difficulties meeting personal goals, getting on with others, making and keeping friends and living independently. This is individualised. This is a multi-agency approach to provide a variety of services that aim to rehabilitate the patient and enable them to function normally in society.
Strengths
Potentially improves the quality of life for recipients as they are able to maintain a normal lifestyle (Trauer et al 2001)
Problems of institutionalisation tend to be reduced as a result of living in the community
Most patients prefer living in the community than being in hospital
Weaknesses
Some patients may find living in the community challenging and relapse
Underfunding can lead to poor provision such as emergency help lines being restricted
Services vary depending on area – poor and rural areas may lack facilities offered in urban and wealthy areas
By cutting hospital funding it may mean there is no hospital bed if needed
Patients may not take their medication if unsupervised – this is dangerous to the patient and society
If a client’s assessment/discharge from hospital has been rushed they may find living in the community very difficult because they are not prepared for it
Coping with a mentally ill person may put strain on families leading to further problems
Cognitive: Cognitive Behavioural Therapy
CBT focuses on understanding an individual’s beliefs about the world and changing their behaviour. The therapy session focuses on the individuals present thoughts and behaviour, for disorders such as schizophrenia this means the therapist must understand the patients perception of reality. Each session has a set agenda so that the patient and therapist know what they aim to get out of the session. It is not a cure, the therapist helps the patient identify their faulty interpretation of the world and correct them through questioning and challenging their perceptions, making the patient realise they are incorrect. Homework assignments can be set allowing them to engage and be rewarded. Sessions usually last 50 mins and patients attend a minimum of six.
Strengths
CBT is useful to patients who do not respond or comply with drug treatments
Studies have found CBT is useful in preventing relapse (Tarrier)
Kuyken (2008) found CBT was just as effective at treating depression as medication, had a lower relapse, was more cost effective and lead to a change in quality of life. CBT also lead to skills for life.
Chadwick (2000) found CBT was effective in treating schizophrenia and reduced the effects of hearing voices
Government funding has been introduced which recognises the importance of CBT as improving mental health
Patient has control and is involved in their treatment, can be considered ethical
Weaknesses
Stiles (2006) compared CBT to person centred and psychodynamic therapies and found no difference in improvements between the therapies
CBT data is often self report, making it unreliable
Time consuming and requires motivation, something which someone with a mental health disorder may be unwilling to do
Studies focus on short term effects – follow up studies are needed
Biological: Drug Therapy
Drug treatment began in the 1950’s and was seen as a more ethical treatment method than those used previously. Drug treatments focus on altering neurotransmitter levels – this might be increasing or reducing them. Drug treatment therefore may be used to block receptor sites so that neurotransmitters cannot bind; or activate receptor sites to increase activity. Neurotransmitters commonly involved in mental disorders include dopamine, serotonin and noradrenaline. In treating schizophrenia, antipsychotics are used which work by blocking dopamine receptors. For depression, antidepressants are used which increase serotonin levels. Different types of drugs are available for disorders, and a clinician needs to ensure they monitor the effects the drug is having and review regularly
Strengths
Drugs are more ethical than treatments used previously such as ECT
No need to be institutionalised, can be used in the home alongside other therapies – so fit into everyday routine
Clear process of how they work – understanding that if the cause is biological, then a biological treatment would seem appropriate
Drugs can be used alongside CBT – this may help encourage a patient to use talking therapies as an increase in mood may be necessary
Newer drugs are continually being researched and developed in order to reduce the side effects older drugs result in
Weaknesses
Side effects
Patients do not always respond to treatment
May lead to dependence – need to continue taking
Revolving door – not taking drugs could lead to relapse and hospitalisation.
Non compliance – Rosa found only 50% of patients comply
Treats symptoms but may not treat the cause. Kuyken (2008) found CBT was just as effective at treating depression as medication, had a lower relapse, was more cost effective and lead to a change in quality of life. CBT also lead to skills for life.
Needs to be monitored e.g. dosage
If injections are given, this could be seen as a form of control and taking away individual rights
Psychodynamic: Dream Analysis
Carried out as part of psychoanalysis –an intensive therapy where the client visits around 3 times per week. The client is the focus of the session, so the analyst sits behind them. The purpose of dream analysis is to access the unconscious, as dreams may be a way of revealing hidden anxieties. Freud believed dreams act as a form of wish fulfilment; and are a symbolic form of repressed material. By interpreting these symbols the unconscious thoughts can then be dealt with. The therapist uses dreamwork where they listen to the material the client describes – this is the manifest content. They then analyse this to identify the hidden meaning of the dream – this is the latent content. Dreams involve displacement which is when we turn the object of anger into something else. e.g. using a cow as a symbol for your annoying mother; Condensation – When you combine all the things that you’re angry at into one and Secondary Elaboration – This is stringing together the symbols to make a story. This logical version of the symbols may further confuse analysis
Strengths
Case studies e.g Freud’s Little Hans
Stiles (2006) compared CBT to person centred and psychodynamic therapies and found no difference in improvements between the therapies
Dream therapy serves the purpose of accessing the unconscious, and therefore questions whether a scientific rationale is necessary
Dream analysis and the role of the unconscious have led to the development of other branches of psychotherapy.
Problems of a sexual nature even today are often viewed as embarrassing and so dream analysis may well be a unique opportunity to unveil something that a person is uncomfortable talking about.
Weaknesses
Case studies cannot be generalised
Shapiro (1991) found psychodynamic therapies have limited success e.g. patients with depression lack motivation to take part in the sessions.
Time consuming and expensive - at around £50 per session and 3 times per week it is more expensive than most forms of therapy. Requires the individual being committed.
Issue of power and ethics – Masson (1989) criticised Freud’s treatments as it places the power with the therapist and the client may transfer feelings onto them.
Subjective - Storr (1987) says that analysts use their own subjective personal opinion in analysis.
It also may be that an individual does not recall all of their dream or retell it accurately.
Crick and Mitchison claim that we dream to forget and get rid of all the unwanted memories that we have collected as the day has gone on. If this is the case then analyzing the meanings seems a fairly pointless exercise
Learning: Token Economy Programmes
Token economy can be used in psychiatric wards as a way of encouraging the patient to show desirable behaviour. The patient and the clinician initially decide what the desired behaviour is e.g. eating in the case of anorexia, and what the token will be e.g. a counter. The individual must then decide on the reward – this must be desired e.g. extra visiting hours or a trip home. The exchange rate is established e.g. 5 tokens = 1 extra hour of visit. The reinforcement schedule is set e.g. the frequency tokens will be given e.g. each meal time or at the end of the day. This can be altered as the patient progresses. A review should be held to see whether the goals are being met and if these need to be reviewed
Strengths
Milby (1975) found TEP were successful in controlling behaviour in psychiatric hospitals and in preparing someone to leave the hospital
Dickerson (2003) found TEP were successful for schizophrenics in obtaining desired behaviour
Cheap and less time consuming in comparison to therapies such as CBT which require a trained therapist to run sessions
Weaknesses
Studies need to be followed up to see if the effects were long lasting and also identify whether drug treatments can be used alongside
Staff training is not necessary but desirable – this is to ensure consistency and the token system is not open to abuse – staff giving the token could be considered to have power over the patient which is unethical
Generalisability to the outside world is an issue – TEP work best in institutions where they can be carefully managed
Rewards must be desirable
Can lead to learned helplessness where the patient becomes dependent on getting the rewards
You must be able to describe and evaluate one treatment from each approach.
Social: Care in the Community
It involves caring for the patient in their own home or in sheltered accommodation. It is a way of preventing institutionalisation - over 80% of meetings occur in the patients home environment and hospitalisation is a last resort. They can call on Community Psychiatric Nurses for support. Care in the community uses drop-in centres, half way houses, and home medication. Drop-in centres that provide a 24/7 service and sheltered accommodation can provide 24 hour care for those who cannot cope living alone and have nowhere else to live. Support is provided so clients are able to deal with the environmental factors thought to trigger their mental illness. Care staff can provide help in day to day living, although residents are encouraged to make their own decisions. ACT is used by community mental health services and focuses on clients who have difficulties meeting personal goals, getting on with others, making and keeping friends and living independently. This is individualised. This is a multi-agency approach to provide a variety of services that aim to rehabilitate the patient and enable them to function normally in society.
Strengths
Potentially improves the quality of life for recipients as they are able to maintain a normal lifestyle (Trauer et al 2001)
Problems of institutionalisation tend to be reduced as a result of living in the community
Most patients prefer living in the community than being in hospital
Weaknesses
Some patients may find living in the community challenging and relapse
Underfunding can lead to poor provision such as emergency help lines being restricted
Services vary depending on area – poor and rural areas may lack facilities offered in urban and wealthy areas
By cutting hospital funding it may mean there is no hospital bed if needed
Patients may not take their medication if unsupervised – this is dangerous to the patient and society
If a client’s assessment/discharge from hospital has been rushed they may find living in the community very difficult because they are not prepared for it
Coping with a mentally ill person may put strain on families leading to further problems
Cognitive: Cognitive Behavioural Therapy
CBT focuses on understanding an individual’s beliefs about the world and changing their behaviour. The therapy session focuses on the individuals present thoughts and behaviour, for disorders such as schizophrenia this means the therapist must understand the patients perception of reality. Each session has a set agenda so that the patient and therapist know what they aim to get out of the session. It is not a cure, the therapist helps the patient identify their faulty interpretation of the world and correct them through questioning and challenging their perceptions, making the patient realise they are incorrect. Homework assignments can be set allowing them to engage and be rewarded. Sessions usually last 50 mins and patients attend a minimum of six.
Strengths
CBT is useful to patients who do not respond or comply with drug treatments
Studies have found CBT is useful in preventing relapse (Tarrier)
Kuyken (2008) found CBT was just as effective at treating depression as medication, had a lower relapse, was more cost effective and lead to a change in quality of life. CBT also lead to skills for life.
Chadwick (2000) found CBT was effective in treating schizophrenia and reduced the effects of hearing voices
Government funding has been introduced which recognises the importance of CBT as improving mental health
Patient has control and is involved in their treatment, can be considered ethical
Weaknesses
Stiles (2006) compared CBT to person centred and psychodynamic therapies and found no difference in improvements between the therapies
CBT data is often self report, making it unreliable
Time consuming and requires motivation, something which someone with a mental health disorder may be unwilling to do
Studies focus on short term effects – follow up studies are needed
Biological: Drug Therapy
Drug treatment began in the 1950’s and was seen as a more ethical treatment method than those used previously. Drug treatments focus on altering neurotransmitter levels – this might be increasing or reducing them. Drug treatment therefore may be used to block receptor sites so that neurotransmitters cannot bind; or activate receptor sites to increase activity. Neurotransmitters commonly involved in mental disorders include dopamine, serotonin and noradrenaline. In treating schizophrenia, antipsychotics are used which work by blocking dopamine receptors. For depression, antidepressants are used which increase serotonin levels. Different types of drugs are available for disorders, and a clinician needs to ensure they monitor the effects the drug is having and review regularly
Strengths
Drugs are more ethical than treatments used previously such as ECT
No need to be institutionalised, can be used in the home alongside other therapies – so fit into everyday routine
Clear process of how they work – understanding that if the cause is biological, then a biological treatment would seem appropriate
Drugs can be used alongside CBT – this may help encourage a patient to use talking therapies as an increase in mood may be necessary
Newer drugs are continually being researched and developed in order to reduce the side effects older drugs result in
Weaknesses
Side effects
Patients do not always respond to treatment
May lead to dependence – need to continue taking
Revolving door – not taking drugs could lead to relapse and hospitalisation.
Non compliance – Rosa found only 50% of patients comply
Treats symptoms but may not treat the cause. Kuyken (2008) found CBT was just as effective at treating depression as medication, had a lower relapse, was more cost effective and lead to a change in quality of life. CBT also lead to skills for life.
Needs to be monitored e.g. dosage
If injections are given, this could be seen as a form of control and taking away individual rights
Psychodynamic: Dream Analysis
Carried out as part of psychoanalysis –an intensive therapy where the client visits around 3 times per week. The client is the focus of the session, so the analyst sits behind them. The purpose of dream analysis is to access the unconscious, as dreams may be a way of revealing hidden anxieties. Freud believed dreams act as a form of wish fulfilment; and are a symbolic form of repressed material. By interpreting these symbols the unconscious thoughts can then be dealt with. The therapist uses dreamwork where they listen to the material the client describes – this is the manifest content. They then analyse this to identify the hidden meaning of the dream – this is the latent content. Dreams involve displacement which is when we turn the object of anger into something else. e.g. using a cow as a symbol for your annoying mother; Condensation – When you combine all the things that you’re angry at into one and Secondary Elaboration – This is stringing together the symbols to make a story. This logical version of the symbols may further confuse analysis
Strengths
Case studies e.g Freud’s Little Hans
Stiles (2006) compared CBT to person centred and psychodynamic therapies and found no difference in improvements between the therapies
Dream therapy serves the purpose of accessing the unconscious, and therefore questions whether a scientific rationale is necessary
Dream analysis and the role of the unconscious have led to the development of other branches of psychotherapy.
Problems of a sexual nature even today are often viewed as embarrassing and so dream analysis may well be a unique opportunity to unveil something that a person is uncomfortable talking about.
Weaknesses
Case studies cannot be generalised
Shapiro (1991) found psychodynamic therapies have limited success e.g. patients with depression lack motivation to take part in the sessions.
Time consuming and expensive - at around £50 per session and 3 times per week it is more expensive than most forms of therapy. Requires the individual being committed.
Issue of power and ethics – Masson (1989) criticised Freud’s treatments as it places the power with the therapist and the client may transfer feelings onto them.
Subjective - Storr (1987) says that analysts use their own subjective personal opinion in analysis.
It also may be that an individual does not recall all of their dream or retell it accurately.
Crick and Mitchison claim that we dream to forget and get rid of all the unwanted memories that we have collected as the day has gone on. If this is the case then analyzing the meanings seems a fairly pointless exercise
Learning: Token Economy Programmes
Token economy can be used in psychiatric wards as a way of encouraging the patient to show desirable behaviour. The patient and the clinician initially decide what the desired behaviour is e.g. eating in the case of anorexia, and what the token will be e.g. a counter. The individual must then decide on the reward – this must be desired e.g. extra visiting hours or a trip home. The exchange rate is established e.g. 5 tokens = 1 extra hour of visit. The reinforcement schedule is set e.g. the frequency tokens will be given e.g. each meal time or at the end of the day. This can be altered as the patient progresses. A review should be held to see whether the goals are being met and if these need to be reviewed
Strengths
Milby (1975) found TEP were successful in controlling behaviour in psychiatric hospitals and in preparing someone to leave the hospital
Dickerson (2003) found TEP were successful for schizophrenics in obtaining desired behaviour
Cheap and less time consuming in comparison to therapies such as CBT which require a trained therapist to run sessions
Weaknesses
Studies need to be followed up to see if the effects were long lasting and also identify whether drug treatments can be used alongside
Staff training is not necessary but desirable – this is to ensure consistency and the token system is not open to abuse – staff giving the token could be considered to have power over the patient which is unethical
Generalisability to the outside world is an issue – TEP work best in institutions where they can be carefully managed
Rewards must be desirable
Can lead to learned helplessness where the patient becomes dependent on getting the rewards