Treatments & therapies
By Jordan Stevens
Cognitive behavioural therapy (Cognitive approach)
• This therapy is a combination of both the cognitive and behavioural approaches.
The cognitive assumption being that our beliefs about the world affect how we
see the world and ourselves; the behavioural part aims to change our behaviour.
• CBT focuses on present behaviour and thoughts instead of focusing on how those
thoughts developed. The therapist has to accept the patient’s perception of
reality and then use this misperception to help the patient manage. It aims to
allow the patient to use information from the world to make adaptive rather than
maladaptive decisions. It does not aim to cure disorders but to allow the patient
to function somewhat normally.
• An agenda is set so that both therapist and patient know what they aim to get
out of the sessions. The therapist helps the patient identify their faulty
interpretations of the world and correct them. This is done by questioning and
challenging maladaptive thoughts so that the patient realises they are incorrect
and can change them to more realistic thoughts.
Strengths:
• The therapist works with the client to help them learn new strategies to cope with
negative automatic thoughts. The client does homework focused on their thinking
and behaviour, so learning tools that can help them in the future. They are therefore
in charge of the therapy- which means it is more likely to last quite a long time even
without the therapists support.
• It is said that CBT is a scientific approach as it draws on empirical evidence. From
that evidence the client draws their own conclusions about their thoughts and
feelings. There is objectivity in that the therapist explores the client’s meanings and
does not impose their own frames of reference.
Weaknesses:
•A client has to be able to consider their thoughts, carry out homework and
remember their early experience. They have to be cognitively able to so these
things, so the therapy may not work for everyone.
•If the client believes the therapist is responsible for the outcome, CBT might not
work. A study in Switzerland (Delsignore et al. 2008) looked at 49 people suffering
from social anxiety disorder. At a 3-month follow-up, clients who felt they were
responsible for their progress were more likely to feel the continued benefits of CBT
than those who thought the therapist was responsible. Long-term outcomes of CBT
seem to depend on the expectations of the client at to how far they are responsible
for their own improvements.
Ethical Issues & social control
• Challenging what someone believes
to be true could cause some distress,
although it could be argued that this
is required for CBT to actually work.
• CBT can be seen as unethical as it is
attempting to make the individual
believe that their own thoughts and
beliefs are wrong. This is done as a
social control by normalizing socially
deviant behaviour.
• This therapy directly confronts the
patients faulty thought processes, to
try to change their behaviour and
thought processing.
• This is clearly a form of social control
as we are telling the individual what
society views as being right.
Family therapy (Social approach)
• Sometimes called the Maudsley approach, family therapy uses the patients family
as a resource for recovery, with the therapist merely offering guidance and
advice.
• Family therapy is often used to treat anorexics. The families take charge of
refeeding the patient (usually and adolescent) and siblings offer support. Blame is
not placed on the patient for their disorder, the disorder is separated from the
patient, externalising the illness.
• There are three phases of treatment; first focusing on weight restoration;
returning independent eating; then re-engaging in life (having a healthy
adolescent development).
• Lock & Le Grange (2001) carried out an investigation into whether family therapy
can be manualized by studying the impact it had on anorexics. He came to the
conclusion that such a manual can easily be developed and that the idea of a
manualized family based treatment is widely accepted.
Strengths:
• The treatment makes sure that the individual is not to blame for their illness.
Instead, there is a separation of the illness and the adolescent, this is otherwise
known as externalizing the illness.
•This treatment enables the individual to overcome the disorder in their natural
environment, rather than being institutionalized/ hospitalized for a long period of
time.
Weaknesses:
•It can be difficult for some parents to keep the persistence and consistency needed
for the treatment which can make it ineffective.
•This treatment does not help to resolve the issue which manifested into the
disorder, as it only focuses on altering the individuals eating habits.
Ethical Issues & social control
• This treatment is ethical and is not used as a form of social control. Even though
the behaviour associated with eating disorders do deviate from the social norm,
the treatments main concern is to help the individual return to a healthier state
as eating disorders have a high mortality rate.
Dream analysis (Psychodynamic approach)
• Dream analysis is concerned with studying the unconscious mind, usually
repressed thoughts/ emotions from early childhood. When we sleep our ego’s
defences are more relaxed, so material that usually stays in our unconscious
enters our conscious in the form of a dream.
• However, because the material is still threatening our peace of mind it can’t be
allowed into our conscious in its true form. The material is therefore disguised
and it is merely symbols in dreams that represent the real content of the dream.
The content of the dream that we remember is called the manifest content,
whilst what the dream actually means is called the latent content.
• It is the analyst’s job to uncover the true meaning of the dream which can take
some time, as the analyst needs a number of recorded dreams rather than just
the one.
Strengths:
• Heaton et al. (1998) found that clients who had therapists interpreting their dreams
felt that they gained more insight and depth from the interpretation than when they
had to interpret their dreams on their own.. They also found that 88% of the clients
preferred the therapist to interpret their dreams, so dream analysis does seem to
help its clients.
• Kolchakian and Hill (2002) found that females in heterosexual relationships gained
more insight into their relationships through dream interpretation, improving their
own well-being in their relationship when compared with females who didn’t have
dream interpretation. Dream analysis however, did not have any effect on improving
the quality of relationships for men.
Weaknesses:
• Dream analysis is subjective, with the interpretation of the dream dependent on
the analyst. Different analysts may have different interpretations of the same dream.
• The Eysenk (1952) review looked at early studies on psychoanalysis (including
dream analysis) and found that psychodynamic therapy was no more effective than
having no therapy or treatment at all.
Ethical Issues & social control
• This method is seen as a way of social control and can be unethical as it is
encouraging the individuals to challenge what they think they know and
understand about the world i.e. The analyst is telling the individual that what
they think is correct, is actually false or that it means something else based on
the analysts own opinions.
Chemotherapy (Biological approach)
• Chemotherapy or drug therapy can be used to control behaviour by restoring the
chemical balance within the brain.
• Drug therapy has been used to treat mental disorders such as schizophrenia.
Patients are given antipsychotic drugs designed to fit and block dopamine
receptors (e.g. Clozapine), as an overproduction of dopamine is speculated to be
the cause of the disorder, in order to reduce the symptoms and allow them to
function as normal members of society, without being institutionalised.
• Rosenhan’s study (1973), showed how his pseudo-patients were prescribed drugs
to control their ‘schizophrenia’ (not that they took the drugs). Usually, those with
schizophrenia are prescribed and presumably take such drugs.
Strengths:
• Pickar et al. (1992) compared the effectiveness of clozapine with other neuroleptics
and a placebo drug. He found that clozapine was most effective at treating
schizophrenic symptoms, even in patients who previously did not respond to drugs,
and the placebo was the least effective.
• Emsley (2008) studied the effect of injecting risperidone into schizophrenics. He
found that those who had the injection early in the course of their disorder had high
remission rates and low relapse rates. In 84% of the patients there was at least 50%
reduction in positive and negative symptoms, and over the two years of the study,
64% of the patients went into remission.
Weaknesses:
• Drug treatment cannot be seen as a cure, as patients have to be kept on
maintenance doses of the drug to maintain the therapeutic effect.
•One problem with all drugs is that there are side effects. These side effects may be
enough to put the people off taking the drug.
Ethical Issues & social control
• The main ethical issue is about who
has the power to make a decision to
control someone else's behaviour, as
the individual might not be able to
make that decision themselves.
• It is often thought that the
professionals are in a better position
to make such decisions. Often there
is a multi-agency working which
means a group of professionals. Such
conferences can help to ensure
ethical practice, however the
questions of power over an
individual still remains.
• There are special guidelines for
dealing with the mentally ill ethically,
not only when researching but also in
institutions. Issues tend to focus on
confidentiality and consent.
• Drugs help to control behaviour and
are used by those who are ‘normal’
to make those who are ‘abnormal’
more like them.
• Rosenhan’s study (1973), showed
how his pseudo-patients were
prescribed drugs to control their
‘schizophrenia’ (not that they took
the drugs). Usually, those with
schizophrenia are prescribed and
presumably take such drugs.
• Drug therapy is also used as social
control when prescribed for heroin
addiction. Methadone is a suitable
substitute for heroin and does not
give the strong withdrawal symptoms
so is more likely to be taken away by
an addict.
Token economy (Learning approach)
• Token economy programmes (TEPs) are used to encourage positive pro-social
behaviour and are often used in prisons and community-based projects.
• Based on operant conditioning principles, TEPs involve imposing a reward system
that can be gained if a desired behaviour is performed. In a prison for example,
management draws up a list of appropriate behaviours and, if an offender
complies, they will receive a token. Tokens are then exchanged for rewards which
are wants rather than needs e.g. Time watching TV or time speaking to family on
the phone etc.
• Hobbs & Holt (1976) conducted an observational experiment in a young offenders
institute, to investigate the effectiveness of TEPs. From their experiment they
found that there was a hugely significant increase in appropriate behaviours after
the introduction of the TEP- 30.6% in cottage A, 34.1% in B and 21% in C.
Strengths:
• When used in prisons, it gives prisoners a sense of control over their behaviour and
the rewards they earn.
• No specialist training is required to implement a TEP e.g. Parents may implement a
TEP to control their child's behaviour.
Weaknesses:
• Although no specialist training is needed to implement a TEP, most experts
recommend training for all staff as the system is open to abuse, particularly in a
prison environment.
•It is disputed whether this is actually a treatment, as it only improves behaviour for
a reward i.e. The positive behaviour is likely to stop if the reward is removed. In a
prison for example, prisoners are likely to behave more appropriately if a TEP is
present. Once out of prison, they will no longer have the positive reinforce and so
will revert back to inappropriate behaviour.
•Pearson et al. (2002) conducted a meta-analysis to review and compare the
effectiveness of behavioural techniques (e.g. TEPs) and cognitive-behavioural
techniques (e.g. Anger management). They examined the findings of 69 studies and
concluded that cognitive-behavioural therapies helped reduce recidivism whilst
behavioural treatments did not work. It seems that behaviour can’t be changed
without a change in thinking.
Ethical Issues & social control
• As with drug therapies, one problem
is the question of who has the power
to control someone else’s behaviour.
To mitigate this, individual staff
should not stand out as having power
in the programme- the system of
rewards must be very clear,
predictable and reliable for the
programme to work.
• It must also be very clear as to what
the behaviour is, why it is desired,
and by whom.
• Is used in schools, prisons and other
institutions to help with controlling
behaviour.
• Required behaviour is broken down
into steps that are achievable and
observable.
• When the required behaviour is
observed, it is rewarded using a
system of tokens, which can, at an
agreed time, be exchanged for
something the individual desires.
• The principles are: rewarding the
required behaviour; ignoring any
undesired behaviour; offering a form
of positive reinforcement; using
shaping.