Mental Health Therapies

What usually comes to mind when one hears the words "mental illness" or "mental health"? Many people might think of the stereotypical images of "crazy people" or of mental institutions. While this may be the case for many afflicted with mental illness, huge advancements have been made in the field of mental health therapies.

Today, many people who suffer from some form of mental illness can enjoy relatively normal lives with the help of certain therapy treatments and other aids. Strides in different branches of mental health therapies as well as considerable advances in drug therapy have contributed to the effectiveness of psychology (the scientific study of mental processes and behaviors) and psychiatry (the branch of medicine that relates to the study and treatment of mental illness).

There is no easy answer as to what kind of therapy might be the best for someone who is in need. The choice will vary from person to person since each person and his or her mental illness is different. Talking to one's doctor or another trustworthy adult and conducting a little research are good ways to gain the knowledge needed to make the right choices regarding therapy's road to recovery.

PSYCHOTHERAPY

Psychotherapy is, like many aspects in the field of mental health, a theory, but it is one widely believed and accepted worldwide. Psychotherapy is the general term for an interaction in which a trained professional, usually a therapist or analyst, tries to help a patient by following a certain psychological theory or school of thought, to address problems based on emotional suffering, behavioral problems, or a disorder. Through a bond of trust that is developed between therapist and patient, the patient can achieve goals in therapy, such as the elimination of negative behavior and an improvement in well-being.

The numerous mental health therapy techniques and therapies available today are used to tackle a wide variety of conditions such as depression, anxiety disorders, eating disorders, and phobias, as well as borderline disorders, multiple personality disorder, and schizophrenia. These conditions can be treated, often successfully, with the help of psychotherapy and, sometimes, supplementary drug therapy.

Today, therapists are becoming more and more concerned with finding the most appropriate form of therapy for an individual. There are numerous mental health techniques available, and their effectiveness varies from patient to patient. A positive therapy experience, where success is gained, must comprise a constructive relationship between therapist and patient. Often, a patient's problems cannot be trimmed to fit into one category; sometimes an individual's problems overlap as a result of years of unaddressed and accumulated inner and outer conflict. In these cases the treatment becomes more complicated. The key, however, starts with a good match between an informed, understanding, sensitive therapist and the patient.

Mental Health Therapies: Words to Know

Art therapy:

The use of art forms and craft activities to treat emotional, mental and physical disabilities.

Bioenergetics:

Body/mind therapy that stresses the body and the mind being freed of negative actions.

Biofeedback:

The technique of making unconscious or involuntary bodily processes (as heartbeats or brain waves) perceptible in order to manipulate them by conscious mental control.

Classic conditioning:

Learning involving automatic response to a certain stimulus that is acquired and reinforced through association.

Cognition:

The grouping of the mental processes of perception, recognition, conception, judgment, and reason.

Dance therapy:

The use of dance and movement to treat or alleviate symptoms associated with mental or physical illness.

Dream analysis:

A technique of Freudian therapy that involves looking closely at a patient's dreams for symbolism and significance of themes and/or repressed thoughts.

Ego:

The part of one's personality that balances the drives of the id and the exterior world that is the center of the superego.

Existential therapy:

Therapy that stresses the importance of existence and urges patients to take responsibility for their psychological existence and well-being.

Gestalt therapy:

A humanistic therapy that urges individuals to satisfy growing needs, acknowledge previously unexpressed feelings, and reclaim facets of their personalities that have been denied.

Humanistic:

A philosophy that places importance on human interests and dignity, stressing the individual over the religious or spiritual.

Hypnosis:

A trance-like state of consciousness brought about by suggestions of relaxation, which is marked by increased suggestibility.

Id:

According to Sigmund Freud, the biological instincts that revolve around pleasure, especially sexual and aggressive impulses.

Insight therapy:

A group of different therapy techniques that assume that a person's behavior, thoughts, and emotions become disordered as a result of the individual's lack of understanding as to what motivates him or her.

Modeling:

Learning based on modeling one's behavior on that of another person with whom an individual strongly identifies.

Music therapy:

The use of music to treat or alleviate symptoms associated with certain mental or physical illnesses.

Operant conditioning:

Learning involving voluntary response to a certain stimuli based on positive or negative consequences resulting from the response.

Pharmacotherapy:

The use of medication to treat emotional and mental problems.

Psychiatry:

The branch of medicine that relates to the study and treatment of mental illness.

Psychoanalysis:

A theory of psychotherapy, based on the work of Sigmund Freud, involving dream analysis, free association, and different facets of the self (id, ego, superego).

Psychodrama:

A therapy that involves a patient enacting or reenacting life situations in order to gain insight and alter behavior. The patient is the actor while the therapist is the director.

Psychodynamics:

The forces (emotional and mental) that develop in early childhood and how they affect behavior and mental well-being.

Psychology:

The scientific study of mental processes and behaviors.

Psychotherapy:

The general term of an interaction in which a trained mental health professional tries to help a patient resolve emotional and mental distress.

Rational-emotive behavior therapy:

Therapy that seeks to identify a patient's irrational beliefs as the key to changing behavior rather than examining the cause of the conflict itself.

Reality therapy:

A therapy that empowers people to make choices and control their destinies.

Superego:

According to Sigmund Freud, the part of one's personality that is concerned with social values and rules.

INSIGHT THERAPY

Insight therapy is the umbrella term used to describe a group of different therapy techniques that have some similar characteristics in theory and thought. Insight therapy assumes that a person's behavior, thoughts, and emotions become disordered because the individual does not understand what motivates him, especially when a conflict develops between the person's needs and his drives. The theory of insight therapy, therefore, is that a greater awareness of motivation will result in an increase in control and an improvement in thought, emotion, and behavior. The goal of this therapy is to help an individual discover the reasons and motivation for his behavior, feelings, and thinking. The different types of insight therapies are described below.

Psychoanalysis

Labeled by some as the "Father of Psychoanalysis," Sigmund Freud (1856–1939) laid the groundwork for many forms of mental health therapies with his introduction of psychoanalysis and the psychoanalytic or psychodynamic paradigm, which states that psychopathology (the study of the nature and development of mental disorders) is a result of "unconscious conflicts" within a person.

Freud believed that personal development is based on inborn, and particularly sexual, drives that exist in everyone. He also believed that the mind, which he renamed the psyche, is divided into three parts. Functioning together as a whole, these three parts represent specific energies in a person.

THE ID. Present at birth, the id is the part of the mind in charge of all the energy needed to "run" the psyche. It comprises the basic biological urges for food, water, elimination, warmth, affection, and sex. (Originally trained as a neurologist, Freud believed that the source of all of the id's energy is biological.) Later, as a child develops, the energy from the psyche, or the libido, is converted into unconscious psychic energy. The id works on immediate gratification and operates on what Freud called the pleasure principle: A primary process, the id strives to rid the psyche of developing tension by utilizing the pleasure principle, which is the tendency to avoid or reduce pain and obtain pleasure. A classic example describes an infant who, when hungry, works under the pleasure principle to overcome his discomfort when he reaches for his mother's breast.

THE EGO. A primarily conscious part of the psyche, the ego develops during the second half of an infant's first year, and deals with reality and the conscious situations surrounding an individual. Through planning and decision making, which is also called secondary process thinking, the ego learns that operating on the id level is generally not very effective in the long term. The ego, then, operates through realistic thinking, or on the reality principle. The ego gets its energy from the id, which it is also in charge of directing.

THE SUPEREGO. The superego, which develops throughout childhood, operates more or less as a person's conscience. According to Freud, the superego is the part of the mind that houses the rules of the society in which one lives (the conscience), a person's goals, and how one wants to behave (called the ego-ideal). While the id and ego are considered characteristics of the individual, the superego is based more on outside influences, such as family and society. For example, as children grow up, they will learn what actions and behaviors are or are not acceptable; from this new knowledge, they learn how to act to win the praise or affection of a parent.

Freud believed that the superego develops from the ego much as the ego develops from the id. Both the id's instincts and many superego activities are unknown to the mind, while the ego is always conscious of all the psyche's activities. These three parts of the psyche work together in a relationship called psychodynamics.

Psychoanalytic theory and psychoanalysis are based on Freud's second theory of neurotic anxiety, which is the reaction of the ego when a previously repressed id impulse pushes to express itself. The unconscious part of the ego, for example, encounters a situation that reminds it of a repressed childhood conflict, often related to a sexual or aggressive impulse, and is overcome by an overwhelming feeling of tension. Psychoanalytic therapy tries to remove the earlier repression and helps the patient resolve the childhood conflict through the use of adult reality. The childhood repression had prevented the ego from growing; as the conflict is faced and resolved, the ego can reenter a healthy growth pattern.

FREE ASSOCIATION. Raising repressed conflicts occurs through different psychoanalytic techniques, one of which is called free association. In free association, the patient reclines on a couch, facing away from the analyst. The analyst sits near the patient's head and will often take notes during a session. The patient is then free to talk without censoring of any kind. Eventually defenses held by the patient should lessen, and a bond of trust between analyst and patient is established.

DREAM ANALYSIS. Another analytic technique often used in psychoanalysis is dream analysis. This technique follows the Freudian theory that ego defenses are relaxed during sleep, which allows repressed material to enter the sleeper's consciousness. Since these repressed thoughts are so threatening they cannot be experienced in their actual form; the thoughts are disguised in dreams. The dreams, then, become symbolic and significant to the patient's psychoanalytic work.

TRANSFERENCE. Yet another ingredient in psychoanalysis is transference, a patient's response to the analyst which is not in keeping with the analyst-patient relationship but seems, instead, to resemble ways of behaving toward significant people in the patient's past. For example, as a result of feeling neglected as children, patients may feel that they must impress the analyst in order to keep the analyst present. Through observation of these transferred attitudes, the analyst gains insight into the childhood origin of repressed conflicts. The analyst might find that patients who were often home alone as children due to the hardworking but unaware parents could only gain the parental attention they craved when they acted in extreme ways.

One focus of psychoanalysis is the analysis of defenses. This can provide the analyst with a clearer picture of some of the patient's conflict. The therapist studies the patient's defense mechanisms, which are the ego's unconscious

way of warding off a confrontation with anxiety. An example of a defense mechanism would occur when a person who does not want to discuss the death of a close friend or relative during her session might experience a memory lapse when the topic is introduced and she is forced to discuss it. The analyst tries to interpret this patient's behavior, pointing out its defensive nature in order to stimulate the patient to realize that she is avoiding the topic.

Psychoanalytic sessions between patients and their analysts may occur as frequently as five times a week. This frequency is necessary at the beginning of the relationship in order to establish trust between patient and analyst and therefore bring the patient to a level of comfort where repressed conflicts can be uncovered and discussed.

Humanistic and Existential Therapies

Humanistic and existential therapies are therapy techniques that also fall under the category of insight therapies. These therapies are insight-focused, that is, they are based on the assumption that disordered behavior can be overcome by increasing patients' own awareness of their motivations and needs. Whereas psychoanalysis assumes that human nature (the id) is something in need of restraint, humanistic and existential therapists place more emphasis on a person's freedom of choice. Humanistic and existential therapists believe that free will is a person's most valuable trait and is considered a gift to be used wisely. Existential theorists agreed with Freud on some counts, but disagreed on others, which led many to branch out and develop their own therapy techniques.

ANALYTICAL PSYCHOLOGY. Carl Gustav Jung (1887–1961) was one of the theorists who decided to branch out on his own. He defined analytical psychology, which is a mixture of Freudian and humanistic psychology. Jung believed that the role of the unconscious was very important in human behavior. In addition to our unconscious, Jung said there is a collective unconscious as well, which acts as a storage area for all the experiences that all people have had over the centuries; it also, he said, contains positive and creative forces rather than sexual and aggressive ones, as Freud argued. Carl Jung believed that we all have masculine and feminine traits that can be blended within a person; he also thought our spiritual and religious needs are just as important as our libidinal, or physical, sexual needs.

Analytical psychology organizes personality types into groups; the familiar terms "extroverted," or acting out, and "introverted," or turning oneself inward, are Jungian terms used to describe personality traits. Developing a purpose, decision-making, and setting goals are other components of Jung's theory. Whereas Freud believed that a person's current and future behavior is based on experiences of the past, Jungian theorists often focus on dreams, fantasies, and other things that come from or involve the unconscious. Jungian therapy, then, focuses on an analysis of the patient's unconscious processes so the patient can ultimately integrate them into conscious thought and deal with them. Much of the Jungian technique is based on bringing the unconscious into the conscious.

In explaining personality, Jung said there are three levels of consciousness: the conscious, the personal unconscious, and the collective unconscious.

PSYCHODYNAMIC THERAPY

In 1946, psychodynamic therapy was developed in part through the work of Franz Gabriel Alexander, M.D., and Thomas Morton French, M.D., who were supporters of a briefer analytic therapy than Freud's psychoanalytic theory, using a present and more future-oriented approach. Influenced by such Freudian concepts as the defense mechanism and unconscious motivation, psychodynamic therapy is more active than Freudian therapy and focuses more on present problems and relationships than on childhood conflicts. A briefer, less intensive therapy form, the session frequency and the patient's body position in this therapy matter less than what the patient says and does. With support from the therapist, patients in psychodynamic therapy slowly examine the true sources of their tension and unhappiness by facing repressed feelings and eventually lifting that repression.

The conscious is the only level of which a person is directly aware. This awareness begins right at birth and continues throughout a person's life. At one point, the conscious experiences a stage called individuation, in which the person strives to be different from others and assert himself as an individual. The goal of individuation is to know oneself wholly and completely. This is accomplished, in part, by bringing unconscious material to the conscious.

The personal unconscious is the landing area of the brain for the thoughts, feelings, experiences, and perceptions that are not picked up by the ego. Repressed personal conflicts or unresolved issues are also stored here. Jung wove this concept into his psychoanalytic theory: often thoughts, memories and other material in the personal unconscious are associated with each other and form an involuntary theme. Jung assigned the term "complex" to describe this theme. These complexes can have an extreme emotional effect on a person.

The idea of the collective unconscious is one that separates Jung's theory of psychotherapy from other theories. Jung said the collective unconscious is made up of images and ideas that are independent of the material in one's personal consciousness. Also present in the collective unconscious are instincts, or strong motivations that are present from birth, and archetypes, which are universally known images or symbols that predispose an individual to have a specific feeling or thought about that image. Archetypes will often show themselves in the form of archetypal images, such as the archetype of death or the archetype of the old woman; death's definition is pretty clear (death equals death) and the archetype of the old woman is often used as a representation of wisdom and age.

Jung believed that to fully understand people, one has to appreciate a person's dreams and not just his or her past experiences. Through analytical psychology, the therapist and patient work together to uncover both parts of the person and address conflicts existing in that person.

ADLERIAN PSYCHOLOGY. After a childhood full of traumatic events and serious illness, Alfred Adler (1870–1937) first experienced an interest in psychology while working as a general medical practitioner. After working in this position for a few years, Adler realized he wanted to learn about his patients' social and psychological situations, so he became a psychiatrist (a medical doctor who specializes in the area of the mind). This interest in the whole person was to affect his future work for years to come.

Although at first a member of Freud's psychoanalytic circle, Adler soon branched out on his own and found an interest in the study of the subjectivity of perception as well as the importance of social factors on an individual, as opposed to the importance of biological factors asserted by Freud. Adler's view of personality stressed the importance of the person as a whole but also of the individual's interaction with surrounding society. He also saw the person as a goal-directed, creative individual responsible for his own future.

Because he had been quite ill as a child, Adler had to overcome his own feelings of extreme inferiority (feeling less worthy than others) throughout his childhood. As a result, he emphasized in his own theories of working toward superiority, but not in an antisocial sense. Instead, he viewed people as tied to their surroundings; Adler claimed that a person's fulfillment was based on doing things for the "social good." Like Jung, Adler also argued the importance of working toward personal goals in therapy.

The main factor in Adler's work was a focus on individual psychology, or individual phenomenology—working to help patients get over the "illogical expectations" made on themselves and their lives. He believed that to feel better one must increase one's focus on rational thinking. This belief followed the Jungian theory that the goal of one's life should be individuation, or the conscious realization of one's psychological reality—a reality unlike any other, unique to only that person. As patients become more and more aware of themselves, they combine the unconscious and conscious parts of themselves, thereby becoming stronger and more emotionally whole.

Believing that a person's growth was based on relationships with family during the early years of development, Adler's interest in psychological growth, the prevention of problems, and the improvement of society influenced the creation of child development centers and parent education.

TECHNIQUES AND GOALS OF ADLERIAN THERAPY. Crucial to the Adlerian therapy technique is the establishment of a good therapeutic relationship between therapist and patient, particularly one based on respect and mutual trust. In order for this to happen, therapists and patients must share the same goals for their relationships, which are often uncovered to patients by the therapists. This often includes encouragement by the therapists that the patients can indeed reach their goals through working together with their therapists.

Therapists may also introduce to patients any signs of self-abusive behaviors on the part of the patients, such as resisting or missing therapy sessions. Above all, Adlerian therapists are supportive and empathetic (understanding) to patients; as patients gradually discuss more and more with their therapists, the Adlerians develop knowledge of the lifestyles of their patients. Empathetic responses on the therapists' part often reflect a developed understanding of patients' lifestyles. One of the most important goals of Adlerian therapy is the patient's increase in social interests, as well as an increase in self-awareness and self-confidence.

Adlerian therapy is a practical, humanistic therapy method that helps individuals to identify and change the dysfunction in their lives.

Existential therapy

Another insight therapy, existential therapy is based on the philosophical theory of existentialism, which emphasizes the importance of existence, including one's responsibility for one's own psychological existence. One important component of this theory is dealing with life themes instead of techniques; more than other therapies, existential therapy looks at a patient's self-awareness and his ability to look beyond the immediate problems and events in his or her life and focus instead on problems of human existence.

The first existential therapists were trained in Freud's theories of psychoanalysis, but they disagreed with Freud's stress on the importance of biological drives and unconscious processes in the psyche. Instead, these therapists saw their patients as they were in reality, not as subjects based on theory.

The concepts of existential therapy developed out of the writings of European philosophers, such as Soren Kierkegaard, Friedrich Nietzsche, Karl Jaspers, philosopher and theologian Martin Heidegger, and the writer and philosopher Jean-Paul Sartre.

TECHNIQUES AND GOALS OF EXISTENTIAL THERAPY. With existential therapy, the focus is not on technique but on existential themes and how they apply to the patient. Through a positive, constructive therapeutic relationship between therapist and patient, existential therapy uncovers common themes occurring in the patient's life. Patients discover that they are not living their lives to the full potential and learn what they must do to realize their full capacity.

The existential therapist must be fully aware of patients and their needs in order to help them attain that position of living to the full of their existence. As patients become more aware of themselves and the results of their actions, they take more responsibility for life and become more "active."

Person-centered Therapy

Once called nondirective therapy, then client-centered therapy, person-centered therapy was developed by American psychologist Carl Rogers. Drawing from years of in-depth clinical research, Rogers's therapy is based on four stages: the developmental stage, the nondirective stage, the client-centered stage, and the person-centered stage.

Person-centered therapy looks at assumptions made about human nature and how people can try to understand these assumptions. Like other humanistic therapists, Rogers believed that people should be responsible for themselves, even when they are troubled. Person-centered therapy takes a positive view of patients, believing that they tend to move toward being fully functioning instead of wallowing in their problems.

TECHNIQUES AND GOALS OF PERSON-CENTERED THERAPY. Person-centered therapy is based more on a way of being rather than a therapy technique. Focusing on understanding and caring instead of diagnosis and advice, Rogers believed that change in the patient could take place if only a few criteria were met: 1. The patient must be anxious or incongruent (lacking harmony) and be in contact with the therapist. 2. The therapist must be genuine; that is, a therapist's words and feelings must agree. 3. The therapist must accept the client and care unconditionally for the client. In addition, the therapist must understand the patient's thoughts and experiences and relay this understanding to the patient.

Rogerian therapists follow the nondirective approach. Although they may want to aid the patient in making decisions that may prove difficult for the patient to realize alone, the therapist cannot provide the answers because a patient must come to conclusions alone. The therapist does not ask questions in a person-centered therapy session, as they may hamper the patient's personal growth, the goal of this therapy.

If the patient is able to perceive these conditions offered by the therapist, then the therapeutic change in the patient will take place and personal growth and higher consciousness can be reached.

Gestalt Therapy

Gestalt psychology rose from the work of Frederich S. Perls, who felt that a focus on perception, and on the development of the whole individual, were important. This was attained by increasing the patient's awareness of unacknowledged feelings and becoming aware of parts of the patient's personality that had been previously denied.

Gestalt therapy has both humanistic and existential aspects; Perls's contemporaries primarily rejected it because Perls disagreed with some of the basic concepts of psychoanalytic theory, such as the importance of the libido and its various transformations in the development of neurosis (mental disorders). Originally developed in the 1940s, the overall concepts of the Gestalt theory state that people are basically good and that this goodness should be allowed to show itself; also, psychological problems originate in frustrations and denials of this innate goodness.

TECHNIQUES AND GOALS OF GESTALT THERAPY. Gestalt therapists focus on the creative aspects of people, instead of their problematic parts. There is a focus on the patient in the therapy room, in the present, instead of a launching into the past; what is most important for the patient is what is happening in that room at that time. If the past enters a session and creates problems for the Gestalt patient, it is brought into the present and discussed. The question of "why" is discouraged in Gestalt therapy, because trying to find causes in the past is considered an attempt to escape the responsibility for decisions made in the present. The therapist plays a role, too: Patients are sometimes coerced (forced) or even bullied into an awareness of every minute detail of the present situation.

Perls believed that awareness acted as a curative, so it is an integral part of this therapy process. He created quite a few techniques for patients, but one well-known practice is the empty chair technique, where a patient projects and then faces those projections. When a patient projects, the ego rejects characteristics or thoughts that are unacceptable or difficult to focus on consciously. For example, a patient may have unresolved feelings about a parent's early death. The patient in Gestalt therapy will sit facing an empty chair and pretend that he is facing the dead parent. The patient can then consciously face, and eventually overcome, the unresolved feelings or conflicts toward that parent.

The goal of Gestalt therapy is to help patients understand and accept their needs and fears as well as increase awareness of how they keep themselves from reaching their goals and taking care of their needs. Also, the Gestalt therapist strives to help the patient encounter the world in a nonjudgmental way. Concentration on the "here and now" and on the patient as responsible for his or her actions and behavior is an end result.

COGNITIVE AND BEHAVIOR THERAPIES

Cognition is the term used for the grouping of the mental processes of perceiving, recognizing, conceiving, judging, and reasoning. Cognition is based on how not just humans but all living creatures adjust their experiences, how they make sense of these experiences, and how they relate present experiences to past ones embedded in memory. This is called the cognitive paradigm and is commonly accepted by psychologists. Cognitive theory is based on the idea that the learning process is very complex and one's belief system and ways of thinking are very important when it comes to determining and affecting behavior and feelings.

Psychoanalyst Aaron Beck (1921–) developed cognitive therapy. Beck was intrigued by how people spoke to themselves through their own self-communication system. When his patients experienced thoughts that they were hardly aware of and these thoughts did not seem to stem from the free association technique practiced in sessions, Beck stressed that the patient focus on these thoughts, which he renamed automatic thoughts. These unformed thoughts were often connected to unpleasant feelings or memories within the patient.

Through the isolation of and focus on these unformed thoughts, Beck was able to identify negative themes that characterized the way patients considered both present and past situations. From these unformed thoughts, patients formed rules for themselves, which Beck called schemas. These schemas, especially within depressed people, were self-defeating and often leaned toward the negative.

Techniques and Goals of Cognitive Therapy

Like Alfred Adler, Aaron Beck believes in an active approach to therapy, including the use of direct dialogue with the patient. Another significant approach to cognitive therapy is based on the ideas of cognitive therapist Albert Ellis, who asserted that negative feelings and activities are caused by irrational beliefs within a person. For example, a child may believe that in order to win the love of his parents he must be a "perfect" son. This, of course, is an irrational thought—no one can be absolutely perfect.

Through a technique called rational-emotive therapy, Ellis and other cognitive therapists who follow his beliefs guide their patients in challenging their irrational beliefs and assist them in replacing such thoughts with new, more positive ones. In the case of the "perfect" son, a cognitive therapist would help him see that although it would be great if he could be perfect, he doesn't have to be without fault to win the love of his parents.

Cognitive therapists see the patient as active in the situation, with the patient's past knowledge imposing a "perceptual funnel" on his experience. The patient is guided into fitting new information into an organized network of already accumulated knowledge, called schema. New life information may fit the schema; if not, the patient reorganizes the new information to fit the schema. In this way, conflicts and issues are unearthed, discussed, and conquered.

Behavior Therapy

The idea of behaviorism was developed primarily by American psychologist John B. Watson, who said that psychology was the study of observable behavior instead of an examination of the patient's subjective experiences. Behaviorism focuses on the study of this observable behavior instead of on consciousness. This is a switch in previous focus from learning to thinking.

Behavior therapy has its history in the experimental psychology and learning processes of humans and animals. Its main focus is to change certain behaviors instead of uncovering unconscious conflicts or problems. The learning/behavioral paradigm states that abnormal behavior is made up of responses learned the same way that normal behavior is learned. Through behaviorism, therapists use ways of learning as part of their technique in helping a patient.

CLASSIC CONDITIONING. Classic conditioning, also called respondent conditioning, was actually discovered by accident by Russian physiologist Ivan Pavlov (1849–1936). One day, while studying the digestive system of his subject (a dog), Pavlov realized that when a bell was rung right before feeding the dog, the dog would salivate before the food was even brought out. The food, then, becomes an unconditioned stimulus (UCS), and the dog's response, salivating, is an unconditioned response (UCR). When the food is preceded by a neutral stimulus, or the ringing of a bell, the sound of the bell, called the conditioned stimulus, or CS, makes the dog salivate, which is the conditioned response (CR).

Extinction is another aspect of this classic conditioning; it refers to what happens to the CR when the repeated sound of the bell is not followed by the food. From this, the dog salivates fewer and fewer times until the CR eventually disappears.

There seems to be no limit, then, to the wide array of stimuli that could be introduced to subjects and followed with the study of different conditioned responses. The study of classical conditioning showed psychologists that there might be a relationship between classical conditioning and the development of emotional disorders.

OPERANT CONDITIONING. Whereas classical conditioning focuses on the introduction of a conditioned stimulus on the subject before introducing an unconditioned stimulus, operant conditioning focuses on the background and results of behavior. The operant theory, based on the work of E.L. Thorndike (1874–1949) and B.F. Skinner (1904–1990), actually formed the roots of much of behavior therapy today.

Operant conditioning is a type of learning based on the effects of consequences on behavior, where one's behavior is changed by systematically changing the surrounding circumstances. Through study, Thorndike developed a principle called the law of effect, which says that behavior followed by consequences that are satisfying to the subject will be repeated, and that behavior followed by negative consequences will be discouraged.

Skinner introduced the concept of operant conditioning. He adjusted Thorndike's law of effect by shifting the focus from the linking of stimuli and responses to the relationships between those responses and their consequences. He also introduced the concept of a discriminative stimulus, or an external event that tells an organism that if it performs a certain behavior, a certain consequence will occur.

A classic example of operant conditioning involves the Skinner box, wherein a subject, often a small animal such as a pigeon, is placed into a closed box with a box of lighted knobs. The psychologist will record the number of the subject's pecks at each light according to what each lighted knob corresponds; for example, if the pigeon has been deprived of water, it will peck at the knob corresponding to water more times than it pecks at the other knobs. The subject can even be trained to peck at specific colored lights by reinforcing one knob over another.

Operant conditioning, like classical conditioning, is useful in behavior therapy's study of emotional disorders or abnormalities, but is also helpful in the study of conduct disorder, autism (see Chapter 12: Mental Illness), and children and their behaviors as they age (the concept of a child's "time out"—where a child is sent to his room or asked to sit quietly after misbehaving—for example, is an operant tool).

MODELING. Modeling, another behavior therapy tool, is the learning of a behavior by observing and imitating it. This is especially apparent in children, who learn a significant amount through modeling. Modeling is also a very effective treatment for severely disturbed patients, such as schizophrenics (see Chapter 12: Mental Illness), because it teaches them new social behavior that can improve their functioning in the outer world.

Modeling utilizes cognitive behaviors (perception, reasoning, etc.) to effectively absorb the modeled behavior. Modeling has developed and has been effectively used as a form of cognitive behavior therapy because it provides the subject with a "code" or plan in which to learn the new behavior. Researchers have learned that when subjects have a model or plan to follow, the new information is better retained. Also, the use of this code or plan helps subjects to pattern their own actions on what they have seen modeled. What was at first seen as a simple form of learning has been realized as an effective form of cognitive behavior therapy.

Cognitive Behavior Therapy

Cognitive behavior therapy is just one mode of therapy that falls under the larger umbrella of cognitive and behavior therapies. Cognitive behavior therapy combines pieces of cognitive therapy, which aims to change a person's thinking to affect a change in behavior, and pieces of behavior therapy, which aims to change a person's behavior. Cognitive restructuring is a term utilized by therapists to define a changing thought pattern that is thought to cause an emotional disturbance. This restructuring is administered in many ways by cognitive behavior therapists.

Rational-Emotive Behavior Therapy

The basis of rational-emotive behavior therapy comes from cognitive behavior therapist Albert Ellis, who believed that antisocial, negative feelings and activity are caused by irrational beliefs based on a code one makes for oneself about how to live. Mistakenly, people put extreme demands on themselves and those around them, as when a person who strives to be perfect makes a mistake and feels overwhelmingly terrible; the person will use that internal communication system to punish himself. In addition, people will occasionally attempt to decipher what occurs around them, and these discoveries sometimes cause conflict. Ellis stressed the importance of the therapist's attention on the patient's beliefs instead of what is causing the conflict.

Those who practice rational-emotive behavior therapy differ in the ways in which they persuade patients to adopt new ways of communicating with oneself. Some therapists have been known to tease, coerce, or bully their patients into realizing new forms of self-communication. Others take a different approach and suggest that patients discuss their irrational beliefs and then gently guide them toward a more rational way of living. With this behavior therapy technique, Ellis and his supporters helped their patients rethink their original, negative beliefs and guided them into restructuring those thoughts or beliefs. For example, the man who made the mistake is coached into rethinking the scenario and inserts a realistic thought: although it would be nice to be perfect, everybody makes mistakes at some point.

Rational-emotive behavior therapy (REBT) is a relatively young technique in the field of mental health therapy, and studies about it are still being conducted. The technique has been shown to reduce anxiety and to help patients gain control of some forms of excessive anger and depression, but it has also worked as a preventive tool for untroubled people to help them deal with everyday stress. It has also been used experimentally in classrooms to delay and possibly reduce the amount of emotional problems later in life.

Behavioral Medicine

Behavioral medicine, also called health psychology, is another developing mental health therapy technique in the field of medicine. It is the interdisciplinary study of ideas and knowledge taken from medicine and behavior science (psychology). It is called interdisciplinary because it incorporates the knowledge of many different medical practitioners, from social workers to psychiatrists and researchers. It is used to understand physical and mental illness as well as to prevent and treat psychophysiological disorders, or physical maladies caused by emotional distress, such as stress and other illnesses that involve the psyche. Behavioral medicine has also been used to study and treat acute and chronic pain.

BIOFEEDBACK. One of the first behavioral medicine techniques finding great success is biofeedback, which uses extremely sensitive machines to provide patients with information on their blood pressure, skin temperature, brain waves, and other bodily functions. The patient, painlessly hooked up to these machines, is given an auditory or visual sign when there is a change in the patient's condition. Learning the signal before one's blood pressure raises, for example, can lead a patient to train himself to identify what behaviors or situations might be causing his raise in blood pressure. The patient, then, can eventually teach himself to control his blood pressure if he has learned from biofeedback to recognize when a raise might occur.

Biofeedback can be a very effective way to combat other stress-induced conditions, such as anxiety, hives, and tension headaches, but it has also proven helpful for patients with attention-deficit disorder (ADD), depression, and other "minor" emotional disturbances (see Chapter 13: Mental Illness).

REALITY THERAPY

Based on the control theory, which states that people are responsible for their lives and actions, reality therapy was established to help people make choices, both simple and difficult, and ultimately control their behavior.

Psychiatrist William Glasser (1925–), who developed this form of therapy, was not satisfied with psychoanalysis' belief that patients should deny responsibility for their behavior and instead blame others and their past for their problems. Glasser stresses that the relationship between therapist and patient should be friendly, open, and accepting. As the patient commits to therapy and what it uncovers, Glasser believes he can guide the patient toward altering his ways of thinking and feeling.

In reality therapy, talking about one's feelings is accepted, but is not a major focus of the therapy. Instead, Glasser stresses helping clients make changes in their lives and maintaining those changes. The therapist, according to Glasser, should not accept excuses on the patient's part, as this would hinder the healing process.

This therapy technique has attracted interest with professionals in many fields, including therapists, school counselors, substance abuse counselors, and corrections employees. Institutional populations such as mental hospitals and prisons, with their more challenging populations, have also had success with the use of reality therapy.

Reality therapy has specific goals. Its aim is to help patients find what they psychologically lack, such as feelings of belonging, freedom, power, and fun. The therapist meets with the patient to assess if his needs are being met, and works with him to attain these things, reestablishing or perhaps even establishing for the first time a positive life experience.

PAIN MANAGEMENT. The adapting of pain into one's life does not seem like something one would want to learn at all, but for many people pain is a part of every day. Dealing with that maladaptive pain (pain that does not fit with one's situation and seriously limits one's enjoyment of life) without its taking over can be difficult. Researchers have learned that if patients are distracted from their pain, the pain may be lessened when it occurs or may not even be felt at all. Cognitive psychologists have also found that, since everyone has a limited amount of attention to channel toward one stimulus, distracting the patient away from the pain and toward something else guides the patient into focusing all attention on the other stimulus. This human limitation can actually prove beneficial to the sufferer of pain.

The importance of distraction in pain management is consistent with studies done in cognitive psychology, and there is more to come in the field of pain management as new ways of healing are increasingly chosen over more conventional forms of medicine.

NONTRADITIONAL MENTAL HEALTH THERAPY TECHNIQUES

Thus far this chapter has reviewed several of the more conventional forms of mental health therapy. Nontraditional medicine, however, also has a wide variety of therapies that are effective in treating many different kinds of mental illness and their symptoms.

Yoga

First practiced in India thousands of years ago, yoga experienced a resurgence in popularity in the 1990s. The different kinds of yoga are countless, and include Hatha yoga, Iyengar yoga, Sahaja yoga, and Kundalini yoga (one type of yoga made popular in the late 1990s by celebrities like Madonna).

Although often seen as a form of exercise, yoga is also used in many cultures as a way of maintaining physical as well as mental health. The benefits of yoga are found in the asanas, or poses, and in pranayama, or the breathing exercises. Both of these, if done properly and practiced regularly, can bring positive changes in the body. Although they may look easy, asanas are a challenge: in a subtle relationship between body and mind, they utilize several muscle groups at once and require a huge amount of concentration, focus, and strength.

Yoga is usually taught in small, intimate classes where close instructor-student interactions are encouraged. Under the instructor's guidance, the class is led through a series of asanas, usually ending in a pranayama or similar meditation-type form (sometimes called savasana) of relaxation.

There are obvious physical benefits to practicing yoga, such as an increase in muscle tone, strength, and flexibility, but this centuries-old practice also regulates and brings oxygen to all areas of the body. If there are problems in certain parts of the body, specific poses can be done to expedite the healing process in that area.

The breathing-exercise, meditative (pranayama) stage of the class may precede or follow the asanas. Sometimes a meditation or relaxation-like phase will occur both at the beginning and at the end of the class.

Yoga's main goal is to attain harmony and peace between the body, mind, and spirit; yoga means "union" in the ancient language of Sanskrit, and each pose is created to harmonize specific body systems and parts with the mind and spirit. One pose, for example, may have the benefits of strengthening the back muscles, but, if done properly, may also release repressed fear held in the body. Another pose urges along the cleaning process of the liver while it also lengthens the spine and carries fresh blood to the liver and brain.

PHARMACOTHERAPY

Pharmacotherapy, or drug therapy, is often used to treat those afflicted with mental illness. Whether to treat anxiety or depression or another more serious condition such as schizophrenia, there seems to be a pill for every affliction.

Drug therapy, when conducted under a doctor's supervision, can be a very effective way of combating many types of mental illness. Often, medication is used in conjunction with regular therapy sessions; to ensure that this safety step is taken, many insurance companies will not cover prescription costs unless the patient is under the care of a mental health professional. Also, drug therapy is often much more effective when combined with hard work done in a therapist's office: as a medication smoothes out and/or regulates the chemical imbalances in the brain, the patient is often better able to tackle difficult topics during therapy.

The field of drug therapy has progressed rapidly over a relatively short period of time. In the past, most antidepressants and antipsychotic drugs (often prescribed for conditions such as multiple personality disorder and psychosis), were slow to take effect and often left patients feeling zonked out and uncommunicative. The past decade or so has seen huge advancements in the distribution of new and improved drugs that are faster acting and more friendly on the patient.

After the initial excitement about drug therapy died down, however, people started to realize that antidepressants were being prescribed faster than pharmacists could keep them on the shelves. Doctors began to realize that a pill is not always the answer but that drug therapy can be very effective for some people when therapy alone does not work.

Generally the patient remains on the initial prescription until the therapist sees a marked improvement or decline in the patient's condition over a period of time, usually a few months. Then the therapist may suggest a change in medication (if a decline in mental health is experienced) or a decrease in dosage to test whether the patient's mental stability remains or fluctuates. A positive mood change can mean either the beginning of the end of the patient's drug therapy or the need for a change. Sometimes it takes a few tries with different medications until the right one is found. Sometimes the medication works for a while, but then becomes ineffective. Sometimes it's a matter of adjusting the patient's dosage or adding a supplementary medication to the therapy plan.

Drug therapy can produce positive results if done correctly. Whatever the case, patience, an open mind, and a comfortable doctor-patient relationship are keys to finding the right drug therapy.

How, then, does yoga work as a form of therapy? As yoga students practice yoga, incorporating both the asanas, and the meditation or breathing exercises, they will realize, over a few weeks, a decrease in anxiety levels, and a calming, "at peace" feeling. Studies have shown that people battling anxiety disorders, depression, and even psychosis have experienced an improvement in their mental health from practicing yoga. Of course, an improvement in one's physical appearance from the practice of yoga can boost one's selfconfidence, but yoga can also bring a healthy feeling of order to the inside of the body as well.

The goals of yoga are a union of body, mind, and spirit. This can take years of discipline, and people looking for a way to lessen depression may not care about attaining that union. One can take from a yoga class whatever part one wants, whether it is a break from chronic anxiety attacks during pranayama or a lift in depression during an asana.

[For more information on yoga, see Chapter 10: Alternative Medicine.]

Meditation

Contrary to popular belief, meditation is much more than just sitting quietly. In fact, learning how to meditate is hard work. The benefits of what looks like just sitting still, however, can have lasting effects. This age-old practice has even found popularity among those looking for help with their mental illnesses.

Therapists report that people who meditate have felt decreases in their anxiety and stress levels, addictive behaviors, and depressions. Sometimes meditation is practiced in conjunction with other nontraditional therapy techniques, such as yoga. However it is practiced, the most important aspect of meditation is concentration.

To attain the intense concentration needed for effective meditation, patients will often choose an object, word, or phrase on which to focus, and center all attention on that thing. Some kinds of meditation incorporate props, such as lit candles, for focusing. Other kinds suggest repeating a word or phrase over and over, such as "ohm," which is used in Hindu traditions. Any word, though, will do; some people will repeat the word "love" or "peace." One should choose a word that supports an intense focus and full concentration; what is important is that one remains focused on the repetition. Once concentration is attained, the next step, or unbroken attention (meditation), should follow. (It is important to note here that getting to this point is a challenge. With meditation, patience is a virtue. Also, if the person finds his thoughts wandering from the chosen focus, which is normal, he should allow the uninterrupted thoughts to enter and then leave the mind, followed by a gentle self-guide back to the original word, phrase, or object.) Once this state of meditation is reached, a higher state of consciousness, sometimes called contemplation, is the next level. This may not be necessary for the beginner; benefits will still be felt if this higher consciousness is not immediately attained.

For those seeking help with their mental health, meditation can be a great way to increase focus and reduce anxiety and other mood disorders. Meditation is not something that can be practiced once with expected results; yoga and other nontraditional medical techniques require focus, patience, and dedication. The benefits, though, can greatly outweigh the hard work for someone who would like to add it to a mental health therapy plan.

[For more information on meditation, see Chapter 10: Alternative Medicine and Chapter 14: Habits and Behaviors.]

Bioenergetics (Body/Mind Therapy)

Bioenergetics, also called body/mind therapy, is a body-related psychotherapy developed by American doctor Alexander Lowen. Lowen was a student of Wilhelm Reich, who was a famous Austrian psychotherapist.

Influenced by Reich's theories, Lowen argued that the body, mind, and spirit are all interdependent and reflective. By practicing special exercises and verbal therapy, the body and mind can free itself from negative actions, called restrictive holding patterns. Bioenergetic therapists try to help their patients reach this freedom of body and mind.

IT IS IMPORTANT TO NOTE THAT ALTHOUGH YOGA AND MEDITATION CAN BE VERY BENEFICIAL IN MAINTAINING AND IMPROVING MENTAL HEALTH, THEY ARE NOT SUBSTITUTES FOR MENTAL HEALTH THERAPY CONDUCTED UNDER MEDICAL SUPERVISION.

Bioenergetics is based on a belief that personality is made of biological urges and conscious thought, or will. Lowen believed that emotional problems develop when a person fails to follow biological impulses except when there is a personal sense of desire. In other words, emotional problems can erupt when biological impulses are not consciously expressed because of fear. Lowen thought that neuroses were a form of defense, but with those neuroses comes a restraint of the true self. Through bioenergetic exercises meant to loosen rigid muscles, the defenses can be broken down and the true self can emerge. This also increases the amount of psychophysical energy (energy from the body and the mind); Lowen calls this bioenergy.

Breaking down this defense occurs gradually and, as the body feels more alive, repressed feelings are released and the neurosis is lessened. The verbal therapy aspect of the technique happens throughout the defense-lifting process, allowing the person to combine new thoughts and physical feelings into his life.

CHOOSING A THERAPIST

Deciding to begin therapy can be a big enough decision, but deciding whom to use as a therapist can be just as difficult. Talking to someone one hardly knows, about personal subjects, is difficult for anyone. Finding the right therapist can take time and patience until one feels the right connection.

Finding a therapist may require a bit of detective work. One's general practitioner is a good person to ask for the names of prospective therapists, as well as school guidance counselors, ministers, or rabbis. Some universities and colleges also have graduate therapy programs where, as part of their studies, graduate students offer quality psychotherapy for milder cases of emotional upset. This is a more affordable form of therapy, and these graduate programs will also often have lists of therapists in the area.

There are options, too, when deciding what kind of therapist to choose. A psychiatrist, along with being a therapist, is also a medical doctor, and can prescribe medication. Someone with "CSW" or "MSW" after his or her name has a master's degree in social work, and also works as a therapist, but cannot prescribe medication. Both kinds of therapists are board-certified and capable of providing quality care to the person in need. Sometimes a patient develops a need for medication while seeing a therapist; then an additional relationship may be introduced between the patient and a psychiatrist who can prescribe and monitor a drug therapy plan for the patient. The psychiatrist and therapist will work together, along with the patient, toward improving the patient's well-being.

The important thing to remember when choosing a therapist is that it is okay to be selective; this relationship requires trust, mutual respect, sensitivity, and understanding. Only then can a patient's goals be reached.

The bioenergetics technique begins with the therapist and patient engaging in some conversation, but then moving directly into the exercises, or bodywork. Patients work in close-fitting clothing so the therapist can see how the body changes as it moves. The exercises include lying, sitting, and standing in ways that increase the areas of stress in the body. Deep breathing during the session is encouraged because it pulls a large amount of bioenergy into the body, releasing repressed emotions. This energy is compared to an electric current, and can actually be seen by both therapist and patient as vibrations in muscles.

Throughout the exercises, the bioenergetic therapist might touch or massage certain areas of the patient's body that seem to resist release. At certain points during the session, the patient is also reminded to make sounds (as part of the verbal therapy); the release of sounds sends more bioenergy through the body.

Since the release of defenses in the body happens over a period of time and not all at once, bioenergetics is a long-term therapy, but for many it is the answer to controlling or combating feelings of anxiety, depression, or other kinds of emotional upset.

Creative Arts Therapies

A creative arts therapy is a technique that utilizes some form of creative expression as a way of producing a change in one's mental health. Some of these therapies include art, drama, dance, poetry, and music. Through these mediums one can express oneself in nonverbal ways. The results of this form of therapy are an increase in self-esteem, self-expression, and improved social interactions.

The quality of the patient's expression, whether it is a painting or a dance routine, does not matter in these creative therapies; what matters is the significance learned from the work for both therapist and patient and how this new knowledge can help the patient. To this end, creative arts therapists do not participate too much in sessions so as not to interrupt the patient's self-expression and self-realization.

Creative therapies are usually conducted in hospitals and institutions for the mentally challenged. Some creative arts therapists work together with other psychotherapists; in fact, these therapies were influenced to an extent by psychoanalysis and take a psychoanalytic angle in their techniques. In addition, all of them can be used in conjunction with other, more conventional therapy techniques.

ART THERAPY. Art therapy is used to help patients overcome emotional conflicts and become more self-aware. To do this, the art therapist will guide patients in the use of certain art materials, such as pastels or crayons, to express themselves, but clay, paper, or finger paints may also be used, depending on the issue being addressed. These specially selected materials can be used to express what is in patients' minds before they are able to put it into words. (Sometimes art is an easier form of expression for patients than verbalizing their pain.)

Art therapy can provide a positive feeling of expression within patients as well as allow a physical release of creative energy as work is being created. If a specific topic is not immediately apparent, the therapist might suggest a topic for expression, such as one's family or a vivid childhood memory.

Over the past decade, art therapists have added other mediums to their techniques, such as music or movement. These additions have been helpful with the recent inclusion of creative art therapy work with incest survivors, prisoners, and victims of war. An ever-expanding therapy form, art therapy can be a constructive alternative to conventional mental health therapies.

[For more information on art therapists, see Chapter 6: Health Care Careers.]

DANCE THERAPY. Using the freedom of movement, dance therapy can help patients interrelate psychological and physiological processes. Actual dance techniques are not usually taught, though; instead, patients are urged to express themselves through virtually any form of movement, no matter how spontaneous. Therapists' approaches to patients have to be creative, but must also result from observation of patients' immediate needs through signs like physical tension. The dance or art therapist may also copy patients' actions to relay understanding over certain situations. Following that, patients may be asked to respond verbally or to keep moving. The use of rhythm and energy can also be helpful for patients who need to remove both physical and emotional tension.

Dance therapy has shown success with everyone from professional dancers to autistic children. It allows patients to feel emotional and physiological feelings at the same time and to convey them in a secure, constructive setting.

MUSIC THERAPY. Music has been part of human culture more or less since the beginning of time. It has played an integral part in the history of mankind. It has also been associated in the past as having power; in ancient Greece, for example, it was thought to have a special force over one's physical and emotional self. In addition, music has also played a significant role in cultural and religious services. It makes sense, then, that music could be used in therapy.

Today, the calming effect from music is still a by-product of music therapy. Music therapists use the power of music to identify and deal with a wide range of emotional disturbances—everything from drug abuse to schizophrenia and Alzheimer's disease.

There is a wide variety of music therapy approaches; the one to choose is a personal preference. Most music therapists have musical instruments available for patients to use during sessions in their quest for self-expression. Using these instruments, exercises are conducted, led by the therapist, which aid in the process of uncovering conflict. Often, patients are encouraged to act out spontaneous expressions, even if they might interfere with an exercise. The instruments can also be used as props to describe and act out certain situations. In a classic example, a patient might be asked to choose and then manipulate instruments that remind him or her of family members or difficult situations or feelings.

As this therapy technique grows, music therapists continue to learn more about music and its therapeutic benefits. New age music, for example, has been found to help those engaged in self-destructive behavior. Undoubtedly, more is to come from this creative art therapy.

PSYCHODRAMA. Psychodrama, another creative arts therapy technique, has shown to be a very effective therapy when used with other forms of psychotherapy and in crisis intervention.

In psychodrama, the therapist and patient approach a problem as if they were director and playwright, which allows the patient more interactions with the issue and the conquering of the conflict. By acting out their problems, patients also experience a deeper level of awareness.

Developed in the 1930s by Viennese psychiatrist J. L. Moreno (1889–1974), psychodrama has been found to show positive effects on posttraumatic stress disorder, substance abuse, and other conditions requiring long-term hospitalization. The range of materials used can be anything from classic forms of playwriting, such as Shakespeare, to simpler forms of theater, such as puppet shows. In psychodrama sessions, the therapist keeps close tabs on patients and establishes just the right relationship with them. A patient, for example, might act out a submissive character, such as a mouse, whereas the therapist chooses to be a dominant animal, such as a cat, and acts out that character while observing the patient's reactions. The drama therapist works hard in sessions and goes beyond classic role-playing techniques to work as actor and director.

The goal of psychodrama is for the patient, through acting, to enact life conflicts and derive self-awareness and growth from this acting. Other benefits of psychodrama include an increase in creativity and interpersonal skills and an increased awareness in one's feelings and emotions.

Hypnotherapy

Hypnosis is an altered state of awareness, much like daydreaming or being so involved in a task that one loses track of time; these are altered states into which all our minds occasionally fall. Hypnosis can be beneficial in therapy, and, in a therapeutic setting, is often accompanied by physical relaxation, which can be very helpful when uncovering topics that produce stress.

There are two approaches to hypnotherapy: the permissive and the indirect. The hypnotherapist using the permissive technique treats patients as equals, gently instructing them that they may move along with the hypnosis process if desired (for example, "You may take a deep breath now, if you wish"). The hypnotherapist using the indirect approach, however, would say, "Take a deep breath now." The indirect technique is different from the permissive one in another way: it does not use a formal hypnosis procedure (see below) and the patient is usually unaware that the procedure is happening.

After the initial interview between therapist and patient and an explanation of the realities of hypnosis (for example, that the therapist does not have complete control over the patient's brain, as the media often portrays), the therapist will induce the hypnotic state. This is done through visual imagery; the patient pictures a relaxing situation and is instructed to relive that situation and feeling as much as possible. When the patient reaches some level of trance (often reached while listening to the therapist verbalize the visualization techniques), depending on the level of hypnosis, the patient can recall certain repressed memories. Some patients need deep levels of hypnosis to recall past experiences; others can benefit from light hypnosis.

Although not a form of psychotherapy itself, hypnotherapy can be used with other forms of psychotherapy to combat anxiety disorders, multiple personality disorder, psychosis, and other mental disturbances.

THERAPY FORMATS

After deciding that therapy fits one's needs, the next step is deciding what form of therapy is best. There are a few types, and their characteristics are featured below.

Individual Therapy

Often the first form of counseling encountered by first-time therapy seekers, individual therapy is made up of sessions between a therapist and patient. The sessions are usually held on a regular basis, and, depending on the kind of therapy chosen, sessions can occur anywhere from one to four times a week. Details of individual therapy sessions (that is, the positions of the patient and therapist in the room, the duration of a session, the nature of the therapist-patient relationship, etc.) vary across different therapy types.

Many patients prefer individual therapy to other forms of therapy because of the one-on-one attention received from the therapist. For others, it may be hard enough for them to express themselves with their therapist, but add a few more people in the room and the patient may feel very uncomfortable and not at all like talking.

Individual therapy is often suggested for first-time patients to fully introduce the therapy experience in a gentle, personal manner. The patient may then move on to other forms (discussed below) or even add a second therapy form to his or her initial therapy plan.

Couples Therapy/Family Therapy

Couples or marital (marriage) therapy is often paired with family therapy because of the similar topics discussed in both forms. Today, the term "couples" is used more often than "marital," however, to include the growing number of people who live together in a committed relationship but are not yet married or choose not to marry. Couples therapy and family therapy will be discussed together here because of their similarities.

In both couples and family therapy, the relationship between therapist and patient is not as important as the relationship and interaction between the couple or family members. The goal is to allow the patient to see the partner or family member as he or she really is and not as a product of the patient's repressed emotions about that person. Usually, a conflict between a couple or between family members is a sign of an emotional difficulty in one member of the couple or family; the therapist works to figure out what that conflict might be. Sex therapy, too, is often part of couples therapy, as sexual problems between partners are a common problem; when other conflicts arise within the relationship, a couple's sex life will likely be affected.

In couples and family sessions, patients are encouraged to listen to each other with empathy and to be clear in relaying what they think is being said by the other patient(s) and what feelings surround this. The therapist's awareness of which stage each patient is in in the relationship (at the beginning of a conflict versus being at a point where a partner or family member is considering leaving the relationship), is also important in planning the therapy strategy. Despite who in the relationship is suffering the most, it is the therapist's duty to be sensitive to the needs of all patients involved.

Group Therapy

Group therapy was first introduced in 1905 by American internist Joseph A. Pratt, who developed this therapy technique for patients suffering from tuberculosis (an infectious lung disease) so they could share concerns and support one another. The concept gained popularity through the 1930s, and in 1948 the American Group Psychotherapy Association was formed.

Before entering group therapy, the interested patient meets with the group therapist so the therapist can get to know the patient and learn his background, and the patient can get a feel for what the group sessions will be like. Groups usually meet once a week for one to two hours. (Groups meeting within a larger institution gather for shorter periods, however, because persons in these facilities are often severely disturbed and cannot focus for long periods of time.)

Once in the group meeting, the hour begins either with one person opening the conversation or with an opening from the therapist. Much less involved than in other therapy forms, the group therapist acts more as mediator, referee, and time clock than anything else. What is important is to get group members to interact among themselves in a constructive manner. Sometimes all members of the group participate, sometimes not, depending on the topic or group members' attitudes that session.

The dynamics of group therapy sessions are in themselves part of the healing process for a patient. Often patients can learn about themselves

through other patients' experiences. Also, social pressures are at their strongest in these sessions. For example, the therapist's suggesting that patient A is acting aggressive is more believable to that patient if patients B, C, and D agree with the therapist. It is also comforting for many patients to be engaged with those who are sharing their problems and life upheavals.

For many people, group therapy is just as effective as individual therapy. Researchers have found that since one's personality is based primarily on interactions with others, therapists can learn about the patients in a group therapy session by observing their interactions with other patients. Treatment, then, for one patient in the group can be based on the therapist's observations of that patient during the group session.

Support Groups

Created out of a need to educate and protect, a support group exists as a way to help people afflicted with the same or similar problems and conditions in a group setting. Countless support groups have surfaced in recent years. Some are not as serious as others, but many have enlightened and provided support for hundreds of thousands of people.

ALCOHOLICS ANONYMOUS (AA). Based partly on the studies of cognitive therapists and techniques of rationalemotive behavior therapy (REBT), Alcoholics Anonymous (AA) has provided help to millions of people who suffer from alcoholism. AA is based on a twelve-step program for restructuring one's life as an addict; in these twelve steps addicts admit to, come to terms with, and hopefully conquer their addictions. AA also acts as a comforting support network for alcoholics and recovering alcoholics in the effort to become, and stay, clean and sober.

AA and the twelve-step program paved the way for numerous substance-abuse or other kinds of support groups, such as Narcotics Anonymous, Gamblers Anonymous, Overeaters Anonymous, and Bulimics Anonymous. Offshoot support groups, such as Al-Anon, for alcoholics' loved ones, have also developed for the families, partners, and friends of addicts. (See Chapter 14: Habits and Behaviors, for more information on AA.)

Both the support and offshoot support groups can be very helpful for those battling addictive behaviors, whether it is the addicts or their families and friends. As with so many other therapy forms and techniques, joining a support group requires dedication, time and patience.

SELF-HELP

Battling and living with a mental illness or other emotional upset can be overwhelming and sometimes very painful. Even with therapy and other helpful techniques in the field of mental health, individuals can still feel alone and out of control of their emotions. This can be alleviated, however, by taking control of the situation and adopting additional practices in life that can help to soften the edges of the daily struggle:

• Exercise: Exercise can greatly improve one's symptoms when dealing with emotional disturbance. Not only does it promote good overall health and increase self-esteem and the quality of one's appearance, but it has also been shown to decrease levels of anxiety and depression in people who adopt a regular exercise plan.
• Sleep: Adequate sleep is crucial when living with a mental illness. During sleep one's body systems have a chance to rebuild, replenish, and rest themselves, which is vital in maintaining a healthy body and mind.
• Eat properly: This can be tough; today's busy schedules make it difficult to get five fruits and vegetables into a diet each day. But just as sleep is essential to maintaining the body, a healthful diet can provide the brainpower and physical energy needed to live life fully.
• Follow a mental health plan: Whether one lives with an anxiety disorder or full-blown clinical depression, it is important to follow the mental health plan arranged between patient and therapist.

FOR MORE INFORMATION

Books

Gorman, Jack M. The Essential Guide to Mental Health: The Most Comprehensive Guide to the Psychiatry for Popular Family Use. Griffith Trade Paperback, 1998.