Suffering and looking for Help: Which Way to Go
You may be suffering mentally and wonder: Where do I go from here? This is a question most people have to deal with when they realize they have mental health or relational problems and they cannot arrive at solutions themselves. Sometimes, you are distraught–not because of you, but because of a family member you love who is having mental issues–and you are at a loss as to what to do next. This is the first post on a series aimed at guiding you in the jungle of the mental health field so that you can find your path to healing.
This series will help you by:
- Guiding you to determine if you are in need of psychiatric or psychological care.
- Finding out if you are in need of help; determine the kind of problem/s you have; and the type of professional and treatment form you need to look for to get the best help.
- Presenting the different forms of treatments modalities (psychotherapies) available today in the US; when they are indicated, and for whom.
A brief overview of the mental health field
Here I will start by describing three sets of factors you need to know to arrive at an informed decision when seeking mental health help.
1-The types of treatments available and the types of approach to treatment.
2-The types of professionals that have the credentials to take care of those problems and render those services. You need to know the type of professional degree for the type of problem you are dealing with.
3-The non-specific factors affecting therapeutic relationships and quality of care beyond their professional degrees. In future posts I will address the pros and cons of every type of professional, their abilities and limitations–and their level and quality of training–in this broad field known today as “the mental health field.”
The types of treatment available in mental health today
There are over 50 different types of psychotherapy in existence in 2021. Historically, over 200 therapies have been developed most of which are not used today. They had all different names; and very few of them have resisted the test of time. But only a few treatment modalities are common in our current clinical environment in the US.
Many forms of therapy have come and gone in the last century. Some had their heyday in the past and have virtually disappeared. Other forms of therapy have been given fancy and refurbished names along the way (they are “old wine in new wineskins”), although they still apply the same strategies as the old ones.
There are only a few types of psychotherapy currently in use in the United State. And they vary by region–and even by city. In general, the North Eastern seaboard has the largest variety of therapy supply in the country. In this regard, New York and Boston have the best array of therapeutic options, which include more traditional and other modern forms of psychotherapy.
This means that the type of therapists–and the forms of treatments available to you–will vary according to where you live in the country.
The classification of forms of treatment in mental health
Grossly speaking, we can divide treatments into four camps:
1-Biological (medications, Light therapy, Electroconvulsive Therapy (ECT), Transcranial Magnetic Stimulation (TMS) , psychosurgery, and other uncommon ones.
2-Psychological: They include different forms of psychotherapy/counselling that take place by talking. These are the “talking therapies.”
3-Experiential (such as psychodrama, dance and music therapies, Yoga, animal therapies, etc.)
4-Miscellaneous (shamanic, religious, spiritual approaches, etc.)
In terms of the numbers of individuals treated during the intervention we have:
2-Couples therapies
3-Family therapies
4-Group therapies
Different psychotherapy approaches
1 “Deep” psychotherapies are also known as “psychodynamic therapies.” They use the concept of the Unconscious and of “psychical conflict” as elements to take into account in treatment. These therapies give weight to the person’s past–not just to the present.
In these “deep psychotherapies,” we find Psychoanalysis (with a variety of different schools of thought that put their emphasis on different aspects of the “Transference” [the analyst-analysand relationship]). More modern derivatives of psychoanalysis are insight-oriented and dynamic psychotherapies (long and short-term). These shorter-term, less intense forms of therapy, still use the concept of the Unconscious, but they are less prolonged and expensive than psychoanalysis.
Dynamic therapies require less frequent visits and intensity than psychoanalysis. They are carried out, not on a couch, but face to face. These therapies have become much more common than traditional psychoanalysis in the last four decades. Traditional “couch psychoanalysis” is rarely practiced in the United States today, particularly in most part of the country outside of the East coast.
And a third group of therapies that still takes into account the notion of an Unconscious mind is hypnotherapy. An adjourned variant of Hypnosis is called EMDR (Eye Movement Desensitization Processing). Hypnotherapy, in turn, is divided into traditional “suggestive hypnosis” and “hypnoanalysis.”
2-Cognitive Psychotherapies. These are more modern forms of therapy than psychodynamic ones, although they hark back to stoic techniques developed in ancient Greece four centuries before Christ.
These cognitive therapies do not use the Unconscious as a theoretical model. They do not focus on the understanding of the Self or on past personal history. Instead, cognitive therapists speak of “automatic negative cognitions” (distorted thoughts) that need to be “corrected” to improve how people feel in the present.
The basis of cognitive therapies
Cognitive therapies do not care to look for the past root of the patients/clients suffering. They center on changing the individual’s thinking in the here and now. They aim to effect this change by teaching people how to change the way they think using “cognitive techniques.”
The assumption in this group of therapies is that feelings and emotions are “a response to erroneous thought patterns”–and not the other way around. Therefore, the cognitive assumption states that–if you learn how to change your thought patterns by challenging your old ones with logic–your feelings and emotions will follow and improve.
The most commonly known form of Cognitive Behavioral Therapy (CBT) is the one developed in the late sixties by Aaron Beck, a former psychoanalyst. This treatment modality is used predominantly for depression and anxiety. Beck abandoned psychoanalysis to develop a cognitively-based shorter-term psychotherapy model. Beck’s work was based on other clinicians and theoreticians such as Albert Ellis. Ellis can be considered the “father” of cognitive therapies in the late fifties. He created the first cognitive psychotherapy known as RET (Rational Emotive Therapy).
3-Mixed types of therapy in the present use a variety of cognitive and behavioral techniques. A good example of this eclectic trend in therapy is Marsha Lyneham’s Dialectical Behavioral Therapy (DBT). This is a research-based, cognitive/behavioral form of psychotherapy. It was developed in the University of Washington in the late 1980s.
The basis of DBT as a form of symptom-oriented treatment
DBT was developed in an academic setting to treat Borderline Personality Disorder and as a treatment strategy to decrease their suicidal behavior. Currently, DBT is applied to other forms of complicated cases. They include severe anxiety disorders, personality disorders, and post-traumatic stress disorder.
DBT uses individual and group approaches in a formalized way. It is a form of the many newer academic “manualized” forms of treatment. It also uses psychoeducation strategies (teaching patients about their symptoms and giving them “tools” to deal with them as they arise).
4-Humanistic, existential, religious, and Spiritual therapies. These include therapies such as Carl Roger’s Client Oriented Psychotherapy, Martin Seligman’s Positive Psychotherapy, Victor Frankl’s Logo therapy and others. These humanistic psychotherapies have been more popular in the past, especially in the sixties and seventies. But, there is still a number of clinicians who utilize their principles in their therapeutic current bag of tools.
All of these–and many more forms of therapies in existence–constitute what is known in the mental health field as “the therapeutic approach.” The “therapeutic approach” is also known as the “school of thought” that leads the particular treatment approach. And these “thoughts” are based on the central theory of human behavior and of Mind upheld by their practitioners. They vary in the aspects of the interventions emphasized in the therapists’ therapeutic efforts.
For instance, psychodynamic psychotherapies (those that derive from psychoanalysis and that take into account the past, “internal conflict,” and the Unconscious) aim at helping patients understand themselves (gain insight) to effect change in their lives. Why Cognitive therapies emphasize thinking pattern changes in the here and now regardless of the past.
The focus of Humanistic Psychology
Humanistic psychologies focus on client change based on unconditional positive acceptance of the client. They center on creating a strong trust bond between the client and the therapist. In these forms of therapy, the therapist (counsellor) is more personally involved. He/she takes a warmer attitude towards the client than in the classical psychoanalytic approach. These are more relationship-oriented forms of therapy (they are based on the healing effect of the therapist-client relationship), rather than on the techniques-oriented therapies.
I will develop further each of the most common therapeutic approaches in upcoming posts; and I will point out their indications in different disorders. The next post will deal with the use of pharmacological approaches to the treatment of mental conditions.
Pharmacological Treatments (medications for mental disorders)
In the last three decades–with the great advances in neuroscience and psychopharmacology–medication treatments for mental health disorders have become more widespread and ever more sophisticated.
So, we find that in the 1960s most people used some form of psychotherapy for treatment (except for the very severe forms of psychosis such as Schizophrenia and Manic-Depressive Illness today known as “Bipolar Disorder”). Medications were not the first line of treatment then. Since the 1980s, however, medication treatment for mental conditions in the US has become the most popular and effective way of treating most mental health conditions.
In spite of medications efficacy, cost, time effectiveness, and ease of administration—pharmacological treatments are still not curative. They rather alleviate the mental health conditions they are used for as long as people take them.
Psychotherapies of different kinds are still very important tools to deal with mental health disorders besides medications.
In synthesis, in the XXI century, a judicious combination of medications and psychotherapy are the most effective approach for the treatment of most mental health problems. In the next post I will go into more detail as to what type of therapy and intervention is the most useful in each clinical situation.
Keep in mind that many therapists use a number of theories to treat their patients/clients. They are eclectic or holistic in their approach. This means that they use different techniques or approaches with different patients.
Ideally, patients should be treated as unique individuals. This means that treatment strategies should be tailored to their own particular needs. This personalized approach is always preferable to the cookie-cutter manualized (standardized) approach to mental health care.
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I hope to see you in my next post,
Till then,
Dr T