Critical Analysis of the Types of Psychiatric Therapy

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Psychiatric therapy was created in order to help people suffering from various mental disorders or emotional problems in coping and improving their everyday lives (NYU School of Medicine, n.d.). The following psychological critical analysis was constructed by one of the world class writers at Ultius and examines several of these disciplines. The different types of psychiatric therapy include:

• Behavior therapy
• Cognitive behavior therapy (CBT)
• Cognitive therapy (CT)
• Group psychotherapy 
• Individual psychotherapy
• Inpatient services
• Intensive short-term dynamic psychotherapy (ISTDP)
• Pharmacotherapy
• Psychiatric evaluation
• Psychoanalytic treatment
• Psychotherapy
• Electroconvulsive therapy (ECT)

Types of Psychiatric Therapy

The National Institute of Mental Health (NIMH) recognizes CBT (which can be different for different disorders), dialectical behavior therapy (DBT), interpersonal therapy (IPT), and family-focused therapy. There are also different types of therapies associated with releasing pent up feelings and companionship, such as light therapy, expressive or creative arts therapy, animal-assisted therapy, humor therapy, and play therapy (NIMH, n.d.). 

1. Behavior therapy

Behavior therapy attempts to help the patient understand that changing behavior positively can lead to more positive emotions (Herkov, 2013). Increased patient engagement in socially reinforcing or positive activities and events is the ultimate goal of this type of therapy. The therapist will use a structured approach to measure the patient’s activities and seek a way to increase positive experiences in the patient’s life. Herkov uses an example of a depressed patient to demonstrate how behavior therapy works:

1. The first stage is patient self-monitoring, during which the patient keeps a detailed log of daytime and nighttime activities for a week (in this case the patient went to work, came home, watched five hours of television and then went to bed with little or no social interaction).
2. The therapist can then examine the list, with the patient’s permission, and determine whether or not there is a lack of positive activity to address.
3. At this point, the patient and therapist work together to define and introduce new, positive activities for the patient to participate in.
4. The therapist and patient examine the activities in the self-monitoring log, determining that some of the activities have a negative impact on the social life or happiness of the patient.

In this way, the patient becomes aware that his or her activities can affect mood and happiness directly. Role playing is often used to help patients in behavior therapy determine and practice how they should act in order to develop new social skills and anticipate issues. The therapist and patient may work together to modify behavior through knowledge and a reward system for avoiding negative activities and participating in new activities.

2. Cognitive-behavioral therapy(CBT)

Cognitive behavioral therapy or CBT is associated with behavioral therapy, and derived from it. It is an effective tool to help people think about their situations before they act, or better manage stressful life situations. CBT allows a patient to work with a psychotherapist or therapist by attending structured and limited sessions with a goal of quickly resolving a mental health problem through awareness.

CBT is based on increasing patient awareness of negative or inaccurate thinking patterns which allows him or her to become more in control of situations that might have previously proven confusing, threatening, or frightening. CBT is helpful for managing and coping with symptoms of mental disorders, as well as preventing a relapse. It is often used in conjunction with other types of therapy, such as pharmacotherapy (medicine). Also, when medications are not available or could cause health problems – such as during pregnancy – CBT is an excellent option for patients. Other situations in which CBT is useful are:

• Coping with grief
• Overcoming abuse or violence in society
• Coping with a physical medical condition or chronic illness
• Managing chronic physical illness pain

3. Group psychotherapy 

The American Group Psychotherapy Association is an organization consisting of the AGPA (a professional and educational organization), the Group Foundation for Advancing Mental health, and the International Board for Certification of Group Psychotherapists. Its 3,000 plus members include:

• Psychiatrists
• Psychologists
• Social workers
• Mental health counselors
• Nurses
• Doctors
• Many other types of therapists

Group psychotherapy consists of treatment in a group setting, and has been used for over 50 years. A small number of patients meet with a professional therapist to discuss an issue or mental health problem and try to find ways to resolve the problem. The group is representative of a family, a support group, or a supportive environment that a patient may not have elsewhere in his or her life, or which is inaccessible due to one reason or another.

Improving interpersonal relationships is part of the goal of group therapy, as is allowing the patients to see that others are having the same issues. Sharing solutions is one way to discover help for problems in group therapy. Mental health issues that can be addressed well in group therapy settings include:

• Isolation
• Anxiety
• Depression
• Substance abuse or alcoholism

Group therapy can also be applied in businesses, academic organizations, and community organizations. AGPA noted that group therapy increases both mental illness and physical illness coping skills which may increase patient life expectancy.

4. Individual psychotherapy

Individual psychotherapy, or talk therapy, is a process between a therapist and a patient that is collaborative and attempts to improve the quality of the patient’s life through change facilitation (Good Therapy, 2013). In general, when distress manifest in a person, individual psychotherapy can help through:

1. Facilitation of lifestyle changes
2. Identifying underlying symptoms
3. Designing and implementing strategies, techniques, or tools to change the unwanted behavior.

It is important to note when researching therapists, that most have at least a master’s degree, some may have additional licenses such as LMFT (Licensed Marriage and Family Therapist); LCSW (Licensed Social Worker); or LPC (Licensed Professional Counselor).

5. Intensive short-term dynamic psychotherapy (ISTDP)

According to the ISTDP website (2015), intensive short-term dynamic psychotherapy, or ISTDP, is a:

“unique form of psychodynamic treatment that facilitates the rapid resolution of a broad spectrum of emotional disorders.”

The therapy is evidence-based, and is supported by research. ISTDP involves interventions which are meant to deter:

• General and social anxiety
• Somatization
• Personality disorders
• Depression
• Self-defeating behaviors which occur in the patient due to unstable, childhood-oriented relationships (ISTDP, 2015).

ISTDP usually works in under 40 hours, and changes patient character traits when necessary. ISTDP treats psychoneurosis or environmentally acquired mental illness by focusing on unconscious perceptions, events in the patient’s past, feelings about those events, and distorted beliefs. ISTDP uses core emotional experience in order to transform the patient and relieve the distress he or she is suffering. Uncovering repressed emotions or complex feelings about past “attachment failures”, patients are discouraged from using punitive self-structures they have put into place to deal with the unresolved emotions as they age.

6. Pharmacotherapy

Pharmacotherapy ensures the safe, appropriate, and economical use of drugs for psychotherapy patient care. Pharmacotherapy can be used in conjunction with other types of therapy for help with:

• Substance abuse patient transitions
• Biopolar disorder
• Depression
• Personality disorders

Pharmacotherapy is not effective for all patients under all conditions; however it may aid patients suffering from psychological disorders through allowing more clear perception or elevating mood in order to create a more receptive environment for other psychotherapies. Pharmacology Weekly (2015) stated that:

“Pharmacotherapy is the appropriate use of drug therapy for the purpose of preventing and treating a disease or illness”.

The uniqueness of each patient, the drug history, and the side effects of each drug must be carefully considered and monitored for in this version of psychotherapy.

7. Psychoanalytic treatment

This type of psychotherapy is based on psychodynamic psychotherapy and uses

“theories and practices of analytical psychology and psychoanalysis”.

The goal is to aid the patient in deep seated personality and emotional change through understanding and problem-resolving. In order to do this, therapists work toward “increasing awareness of their inner world and its influence” over past and present relationships. Through this technique, distress and symptoms are often reduced in sufferers of serious mental illness, those who have lost meaning in their lives, or who are seeking more fulfillment.

8. Electroconvulsive therapy (ECT)

Electroconvulsive therapy, or ECT, was developed in 1938 and was found to be effective in treating:

“multiple psychiatric illnesses, especially depression” (UM, 2015).

Psychiatric medication development as well as overuse and stigma associated with ECT caused a decline in this type of patient treatment. Improved treatment delivery methods, increased safety, and increase comfort have helped ECT become more acceptable again, particularly in depression treatment. ECT is a much faster method than medications, and does not come with the side effects of medications, which may be intolerable or dangerous for some people with mental disorders. Candidates for ECT if no other solution is working may include those who are:

• Severely agitated 
• Clearly delusional
• Suicidal
• Homicidal
• Unable or unwilling to eat or drink or other eating disorders
• Catatonic

ECT can also stabilize bipolar patients in the depths of extreme depression or mania, and can stop the progression of schizophrenic psychotic episodes in some patients, including those with dementia. 

Modern ECT

Today ECT is only administered to patients under general anesthesia, and it consists of sending controlled electrical currents through a patient’s brain in an effort to quickly reverse symptoms of certain mental illnesses through a brief seizure induction. ECT may be used:

• During pregnancy
• In older adults
• For patients who prefer this method to medicating

ECT can and may cause confusion just after a treatment. This confusion can last up to several hours, and is more noticeable in older adults. Memory loss may occur concerning events that happened before treatment began (retrograde amnesia) or during treatment; some patients report trouble recalling memories that happened even after the treatments have been discontinued.

Side affects of ECT

Physical side effects include:

• Nausea
• Vomiting
• Headaches
• Jaw or muscle pain

All can be treated with medication. ECT can also:

• Elevate heart rate
• Elevate blood pressure
• Cause serious heart problems, so it is not recommended for those with previous heart issues.

An electrocardiogram (ECG) is required before treatment to measure the heart health of the patient. ECT takes about five to ten minutes, not including preparation and recovery time; it can be done in a hospital or as an outpatient procedure. Anesthesia, a brief physical exam, IV insertion, and electrode attachment to the patient’s head all occur prior to the actual ECT.

Works Cited

“Cognitive Behavioral Therapy.” Mayo Clinic, 2013. Web. 17 August 2015.

“Electroconvulsive Therapy (ECT).” Mayo Clinic, n.d. Web. 17 August 2015.

“Electroconvulsive Therapy Program: A Brief History of ECT.” Department of Psychiatry, University of Michigan Health System, 2015. Web. 17 August 2015.

“Individual Therapy (Psychotherapy).” Good Therapy, 2013. Web. 17 August 2015.

“Pharmacotherapy.” Board of Pharmacy Specialties, 2015. Web. 18 August 2015.

“Welcome to ISTDP.” ISTDP, 2015. Web. 18 August 2015.

“What is Group Therapy?” AGPA, n.d. Web. 17 August 2015.

“What is Pharmacotherapy and why should all Healthcare Providers Understand it?” Pharmacology Weekly, 21 January 2009. Web. 18 August 2015.

“What is Psychoanalytic Psychotherapy?” British Psychoanalytic Council, n.d. Web. 18 August 2015.

“What is Psychotherapy?” NIMH, n.d. Web. 15 August 2015.

Herkov, Michael. “About Behavior Therapy.” PsychCentral, 2013. Web. 17 August 2015.

NYU School of Medicine. “Psychiatry.” NYU School of Medicine, n.d. Web. 15 August 2015.