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OF mental health care and mentally ill

Types of therapeutic approaches

A therapy is a deliberate intervention which aims to treat mental disorder and make it more manageable. A therapy may be an attempt to ‘cure’ or it may be an attempt to teach the individual how to cope with the problem. What follows is an overview of the range of therapies available. Therapies can be divided broadly into somatic therapies (based on the medical model) and psychotherapies (based on the other models). Somatic therapy began in the early days of asylums, when ‘therapy’ was often purely custodial, inmates being kept in chains for the protection of themselves and others. This was changed by Pinel in 1792, whose first move on taking over a Paris asylum called the Bicêtre was to remove all chains and restraints. Even in the early nineteenth century, however, treatments were frequently barbaric. One example is the ‘whirling chair’, a device into which inmates were strapped and rotated at speed, allegedly until blood ran from their ears. Currently, somatic therapy has a three-pronged approach, using drugs (known as chemotherapy), electro-convulsive shock therapy (ECT) and/or destruction or functional isolation of brain tissue (psychosurgery).

Psychodynamic therapies originate from Freud’s system of psychoanalysis. In its original form, the aim was to bring into consciousness those unconscious conflicts which were at the root of the mental disorder, where they could be dealt with by the therapist. To do this required the use of the techniques of free association and dream interpretation, as well as an analysis of the ways in which the client related to the therapist. The latter was thought to reveal, through a process of transference, the problems that had occurred in other significant relationships. More recent procedures derived from this include psychoanalytically oriented psychotherapy, and group psychodynamic therapies. There are also psychodynamic therapies based on theorists other than Freud; Klein, for example, has developed her own therapy for adults and play therapy for use with children.

Behavioural therapies will be described. They fall into two main groups. The first group consists of those based on classical conditioning. These are known as behaviour therapies, and they aim to remove maladaptive behaviours by using conditioning procedures. Examples include systematic desensitisation (in which people with irrational fears—of spiders, for example—may be helped to be less fearful) and aversion therapy (in which people who like things that they should not, such as alcohol, will be taught to avoid them).

The second group, behaviour modification techniques, is based on operant conditioning procedures. In this case, selective reinforcement is used to encourage desired behaviours and to eliminate undesirable behaviours. The best-known example of this is the token economy system (Allyon and Azrin 1968) where tokens are given as rewards for behaviours that are to be increased, such as being sociable. Cognitive therapies, can be quite diverse, reflecting as they do a range of different theoretical approaches. They share the common aim of bringing rational thought processes to bear on behaviour and the possibility of change. For example, based on Bandura’s (1969) social learning theory, modelling of desired behaviours may be used and imitation encouraged.

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