Evaluate Three Approaches To Treating A Mental Disorder Psychology Essay

Despite the development and increased involvement of medications within the treatment of mental disorder, Psychological therapies remain vital in order to aid in the effective and long term treatment of such conditions. It is with these treatments, that patients can undergo substantial if not full recoveries to allow for independent and healthy function within society.

When looking at effective treatments of mental disorder, there are three main approaches that outline the direction of such therapies. These are the behavioural, psychodynamic and cognitive models.

One such therapy used within the treatment of mental disorder is rationale emotive therapy. Rationale emotive therapy or R.E.T, works along the cognitive model of abnormality’s principle, that a person’s maladaptive and destructive behaviours are a result of faulty cognitions. R.E.T, created by Ellis (1962) is based on the Ellis ABC model which looks at how activating events lead to a person’s developed belief and thus create a consequence or behaviour. The idea of the therapy is by challenging a person’s irrational and faulty thoughts (cognitions), they can be replaced with more rational and positive beliefs. The aim is that in challenging and changing these faulty thought processes, it will modify a person’s resulting behaviour.

R.E.T is mainly used within the treatments of anxiety based illness such as depression and eating disorders, and has proven to be an extremely effective treatment. Knaus and Noker (1975) evaluated R.E.T as a treatment for both anxiety and self-belief by completing a study involving students at an American college. Their study subjected 54 students to 85 sessions of R.E.T (consisting of 10 to 30 minutes each) over 23 weeks. To aid in the understanding of the effectiveness of R.E.T, another group undertaking placebo sessions (consisting of semi-organised discussion) was also carried out. Results found that one month after the treatment had ceased, the group treated with R.E.T had significantly higher self-esteem scores and low anxiety scores when tested compared to that of the placebo group. This study proved that when compared to talk based therapy or no therapy at all, R.E.T is effective at improving cognition based illness.

Despite this research study however, this proves that R.E.T is only effective when treating anxiety based disorder, and when used against other illness such as schizophrenia, studies like that of Engles (1993) have found it ineffective. His study showed that R.E.T was more effective at treating the anxiety brought on by the maladaptive consequences of the illness such as visual and auditory hallucinations than the illness itself. As a result, R.E.T cannot be seen as a versatile treatment for all mental disorders. Another issue relating to this therapy is that of patient involvement. The therapy itself is based on the therapist challenging the thoughts and cognitions of the patient to cause them to come to the realisation that these are negative and unrealistic. However, patients who are especially vulnerable and lack assertive self-esteem may get angry or defensive when subjected to the idea that their views and thoughts are wrong. This may lead to a large drop-out rate during treatment.

One of the most important things to take into account when looking at and evaluating therapies is that of ethics. The British Psychological Society (B.P.S) and British Association of Counselling and Psychotherapy (B.A.C.P) created and introduced a guideline of Ethics to be followed by all therapists in order to protect the interest of both themselves and their patients when under treatment. These ethical guidelines include four main principles that focus on respect, competence, responsibility and integrity.

One of the significant ethnical issues with R.E.T is in label of what is an irrational belief. When treating people from different cultures, in particular those with strong religious beliefs, what may been an irrational thought to the therapist maybe a significantly religious one to the patient. When referring this to the ethical guidelines it states “A psychologist should respect individual, cultural and role differences of the client” (As sighted in B.P.S. code of ethical guidelines 1.1- standards of general respect). This means that due the fact R.E.T can have large moral impacts on a person’s fundamental religious faith by challenging them as irrational cognitions; this therapy is in danger of breaking this ethical guideline.

This treatment overall can be extremely useful and also cost effective compared to other therapies, as little else is required in the treatment process other than a trained therapist and the patient. However it’s important to note, that in some cases, depending on the individual patient and the extent of their mental disorder, R.E.T maybe required over several years and therefore costs can significantly increase.

Due to the aim of R.E.T being the replacement of faulty cognitions with more productive and rational ones, R.E.T can be extremely effective in the treatment of mood disorders and eating disorders such as depression and anorexia. This is because in such disorders, there is a clear underlying faulty thinking process that leads to the behaviour, such as a patient suffering from anorexia thinking “if I eat that I’ll get fat and no one will like me”. As a result, the challenging and changing of these thought process can produce effective results. However, in some more complex forms of mental disorder such as schizophrenia, R.E.T is much less effective. This is because within schizophrenia, the illness often manifests itself in the form of audio and visual hallucinations and therefore there is no clear thinking process that leads to such symptoms. This means R.E.T is unable to locate a faulty thought process to challenge and as a result, R.E.T is not an appropriate therapy to use in such circumstances.

When looking at the behavioural approach, one such therapy used is that of aversion therapy. Aversion therapy is based on the classical conditioning concept that behaviour is learnt through association. The idea of aversion therapy is to link the particular behaviour that requires changing to a negative cognition, response or involuntary action. In doing this, the patients mind learns to associate the behaviour with the negative response given and thus the behaviour ceases. This form of therapy is effective in the treatment of things such as alcohol and sex addiction. The therapy itself uses several different methods in order to make the link between behaviour and negative response. One such method, used with alcohol addiction is emetic drugs. The aim of this to get the patient to drink alcohol containing this emetic drug that’s induces nausea, vomiting and cramping of the stomach. After periods of time the patients mind will associate alcohol with the negative responses of the drug and thus craving of this substance will stop. In cases of sex addiction (used in American prisons for treatment of paedophilia), a person is shown images of people. When one’s appear that are unclothed or sexual in nature, an electric shock is given to the patient when sexual arousal is shown. Again similar to the alcohol addiction, the patient will associate sexual thoughts with pain from the shocks and thus change the behaviour.

Aversion therapy can be most effective when looking at the treatment of addictions and habits that affect a person’s ability to function productively, such as gambling, sex and alcohol. Once such case study, demonstrating aversion therapy’s effectiveness was that of a patient suffering from trichotillomania (excessive hair pulling). Patient A had attempted several forms of therapy including a behavioural self-control programme but without success. After 16 years of this disorder patient A was given aversion therapy, subjecting her to minor electric shocks when attempting to pull her hair. The effects were almost immediate and follow up checks continued to show improvement apart from periods of extreme stress. This case study provides us with evidence that when compared to other treatments, aversion therapy can be extremely effective for some individuals. However, while a strong indication as to the effectiveness of aversion therapy, case studies only give us an insight into individual cases and thus we cannot get an clear understanding of the effectiveness of such a therapy on a wider scale. As a result, case studies like this one do not give us reliable, valid and scientifically testable data.

Despite case studies proving the effectiveness of this therapy, there are many therapists that argue the lasting effects of this treatment are poor, and soon after it is concluded, patients often deviate back to the maladaptive behaviours fist exhibited. As well as this, it’s important to take into account the appropriateness of such a treatment. The use of aversion therapy has seen significant changes in groups of people suffering from addiction or behavioural difficulties (habits) as behavioural modifiers such as electric shocks can be applied when the undesirable behaviour is shown. However aversion therapy will be ineffective against such mental disorders like schizophrenia, personality disorder or depression where the undesired behaviour is shown consistently and to some extent is built into the personality of the patient, to the point where they are unaware of its existence. As a result, applying shocks to a person who doesn’t understand what they doing wrong would simply increase anxiety and stress to the patient rather than cure them.

Another important factor when looking at aversion therapy is cost. Due to the behavioural modifiers used such as chemical drugs and electric shocks, the cost of such a therapy, especially when confronting minor addictions can be extremely high.

When looking at the ethical implications of aversion therapy, the guidelines state “Psychologists should avoid harming clients, but take into account that interests of different clients may conflict” (As sighted in B.P.S. code of ethical guidelines 3.1- standards of general responsibility). However by exposing patients to electric shocks and chemicals that induce stomach cramps and vomiting, the increase in both stress and anxiety within patients, as well as the physical harm they are placed in both challenges and risks breaking this ethical guideline.

Another therapy that has been used in the treatment of mental disorder is psychoanalysis. Developed by Freud (1910), psychoanalysis was created as a result of the psychodynamic model of abnormality. This model states that a person’s abnormal behaviour is a direct result of repressed unconscious conflict or trauma. The idea of psychoanalysis is to make the unconscious repressed thoughts conscious and thus be able to identify the cause and root to the behaviour and understand it. The therapy itself involves a trained therapist creating a therapeutically strong relationship with the patient to develop trust. The therapist then allows the patient to express themselves and their feelings (known as transference) while remaining neutral and unbiased (showing no emotions or judgement). The final aim for the therapy is to then allow the therapist to interpret the significance of these unconscious events and feelings, allowing the patient to have considerably stronger self-knowledge and insight, allowing them to alter their behaviours.

Psychoanalysis was one of the first ‘talking therapies’ created and since its birth this concept has been used and developed into many therapies including the likes of C.B.T (cognitive behavioural therapy). As a result, studies like that of Bergin are able to support the effectiveness of psychoanalysis. Bergin (1971) analysed 10,000 patient histories of those who entered treatment and classified them into several groups including cured, improved, slightly improved and not improved/left treatment. His results found that 80% improved under psychoanalysis compared to 65% under other treatments. This study clearly supports the effectiveness of psychoanalysis as a treatment by identifying its results compared to that of other therapies.

However, studies such as Bergin’s (1971) hold biased due to what is classed as improved and what is classed as slightly improved are completely open to interpretation. This means there is no accurate scientific measurement available to identify what is categorized as improved, slightly improved and not improved. As a result of this, each therapist will hold their own individual ideas of what is classed as improved and thus these results are not reliable.

As well as this, other studies, including that of Smith et al (1980) who looked at over 475 studies of therapy, found psychoanalysis when compared to other therapies as a cure for depression was no more effective than placebo treatments. This study alone disputes Bergin’s claim that psychoanalysis is an effective treatment. Despite these arguments against psychoanalysis, there are positive rationales for its use. One such reason is that of face validity. While there is little evidence to support Freud’s theory that unconscious conflicts have impacts on conscious behaviour, the idea that being able to talk to someone in order to express your feelings and emotions can help you feel better in yourself makes sense, thus holding face validity. It also promotes the idea that it is okay to talk about your problems and ‘open up’ to people in order to increase your own self-understanding.

One of the largest impacts on the use of psychoanalysis however is its ethics. As humans, our minds can sometimes lock away previous and historical trauma in order to allow for normal function. This means that a person may witness or be involved in trauma so horrific, that the mind locks it away in our unconscious to prevent it regressing and protecting the mind of the person. As a result, without a clear patient history available, psychoanalysis may open up this past unconscious trauma, bringing it to the conscious causing the patient to re-live it without the skills or abilities to handle such a situation and placing them under emotional and psychological harm. When looking at the ethical guidelines put in place it states “therapists should be alleviating personal distress and suffering” (as sighted in B.A.C.P Values of counselling and psychotherapy). As a result, by bringing such trauma to the surface, a therapist will be breaking these ethical guidelines.

All in all, psychoanalysis has very little strong supporting evidence to demonstrate its effectiveness as a therapy, however as discussed, it does hold face validity as a concept. As well as this, the therapy itself, compared to that of others is predominately in-expensive, however one might argue that treatment under psychoanalysis may take years depending on the issues arising and individual, so cost could increase over longer duration. One of the biggest positives of this treatment however, is that it can be used for almost any mental illness and thus is very diverse. Whether its schizophrenia, depression or an eating disorder, being able to sit with a trained therapist and talk about your past and present feelings and issues makes this therapy both appropriate and therapeutic to almost any condition.

Despite the strengths and weaknesses to these treatments, without psychological input and therapy, many patients would fail to make recoveries. When coupled with the ever evolving world of drug based medications, therapies such as these continue to prove successful in the treatment of mental disorders.