54 Introduction to Therapy and the Psychological Therapies

54.1 Treating Psychological Disorders

54-1 How do psychotherapy and the biomedical therapies differ?

Reformers Philippe Pinel (1745–1826) and Dorothea Dix (1802–1887) pushed for gentler, more humane treatments and for constructing mental hospitals. Since the 1950s, the introduction of effective drug therapies and community-based treatment programs have emptied most of those hospitals.

Modern Western therapies can be classified into two main categories:

In psychotherapy, a trained therapist uses psychological techniques to assist someone seeking to overcome difficulties or achieve personal growth. The therapist may seek to uncover hidden meaning from a client’s early relationships, to encourage the client to adopt new ways of thinking, or to replace old behaviors with new ones.
Biomedical therapy offers medications and other biological treatments. For example, a person with severe depression, as we will see, may receive antidepressants, electroconvulsive shock therapy (ECT), or deep-brain stimulation.

The history of treatment Visitors to eighteenth-century mental hospitals paid to gawk at patients, as though they were viewing zoo animals. William Hogarth’s (1697–1764) painting captured one of these visits to London’s St. Mary of Bethlehem hospital (commonly called Bedlam).

Some psychologists consider psychotherapy to be a biological treatment, because changing the way we think and behave can prompt physical changes in the brain (Kandel, 2013). Effective psychotherapy is a brain-changing experience.

The care provider’s training and expertise, as well as the disorder itself, influence the choice of treatment. Psychotherapy and medication are often combined. Kay Redfield Jamison received psychotherapy in her meetings with her psychiatrist, and she took medications to control her wild mood swings.

Let’s look first at the psychotherapy options for those treated with “talk therapies.” Each is built on one or more of psychology’s major theories: psychodynamic, humanistic, behavioral, and cognitive. Most of these techniques can be used one-on-one or in groups. Some therapists combine techniques. And like Jamison, many patients also receive psychotherapy combined with medication. Many psychotherapists describe themselves as taking an eclectic approach, using a blend of psychotherapies.