Psychology Psychological Treatment Family, Group & Biomedical Therapies
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Family Therapies
In family therapy, a therapist sees two or more members of a family at the same time. Family therapies work on the assumption that people do not live in isolation but as interconnected members of families. A problem that affects one person in the family must necessarily affect the whole family, and any change a person makes will inevitably affect the whole family. Family therapists help people to identify the roles they play in their families and to resolve conflicts within families. Family therapists sometimes use family trees to help family members identify intergenerational patterns of behavior.
In couples therapy, therapists help couples identify and resolve conflicts. Therapists usually see both members of a couple at the same time. Family and couples therapists may use psychodynamic, cognitive, behavioral, or humanistic approaches.
Group Therapies
In group therapy, a therapist meets with several people at once. Psychotherapy groups usually have between four and fifteen people. Group therapies are cost-effective for clients and time saving for therapists.
Self-Help Groups
Self-help groups, such as Alcoholics Anonymous, resemble therapy groups except that they do not have a therapist. These groups allow people to feel less alone in dealing with their problems. Self-help group participants both give and receive help and can usually attend the group free of charge. Self-help groups are used very widely.
Features of Psychotherapy Groups
Groups may be homogeneous or heterogeneous. In homogeneous groups, all members share one or more key characteristics. For example, a group may be composed of people who are all suffering from depression or people who are between the ages of twenty and thirty. Many groups are heterogeneous and contain people who differ in age, type of problem, gender, and so on.
The Therapist’s Role
The therapist usually screens people to determine whether they would be suitable for a group, excluding people who are likely to be highly disruptive. In the group, the therapist’s role is to promote a supportive environment, set goals, and protect the clients from harm.
The Role of Group Members
Group members discuss their problems and experiences with one another and consider different ways of coping. They provide each other with acceptance, support, and honest feedback. A therapy group is a place where people can practice coping strategies and ways of relating to others. Therapy groups also help people to realize they are not alone in their suffering.
Biomedical Therapies
Biomedical therapies include drug therapy, electroconvulsive therapy, and psychosurgery.
Drug Therapies
Drug therapy, or psychopharmacotherapy, aims to treat psychological disorders with medications. Drug therapy is usually combined with other kinds of psychotherapy. The main categories of drugs used to treat psychological disorders are antianxiety drugs, antidepressants, and antipsychotics.
Antianxiety Drugs
Antianxiety drugs include a class of drugs called benzodiazepines, or tranquilizers. Two commonly used benzodiazepines are known by the brand names Valium and Xanax. The generic names of these drugs are diazepam and alprazolam, respectively:
- Effects: Benzodiazepines reduce the activity of the central nervous system by increasing the activity of GABA, the main inhibitory neurotransmitter in the brain. Benzodiazepines take effect almost immediately after they are administered, but their effects last just a few hours. Psychiatrists prescribe these drugs for panic disorder and anxiety.
- Side effects: Side effects may include drowsiness, light-headedness, dry mouth, depression, nausea and vomiting, constipation, insomnia, confusion, diarrhea, palpitations, nasal congestion, and blurred vision. Benzodiazepines can also cause drug dependence. Tolerance can occur if a person takes these drugs for a long time, and withdrawal symptoms often appear when the drug use is discontinued.
Antidepressant Drugs
Antidepressants usually take a few weeks to have an effect. There are three classes of antidepressants: monoamine oxidase inhibitors, tricyclics, and selective serotonin reuptake inhibitors.
- Monoamine oxidase inhibitors(MAOIs): Include phenelzine (Nardil).
- Tricyclics: Include amitriptyline (Elavil). Tricyclics generally have fewer side effects than the MAOIs.
- Selective serotonin reuptake inhibitors(SSRIs): The newest class of antidepressants, including paroxetine (Paxil), fluoxetine (Prozac), and sertraline (Zoloft).
Antidepressants are typically prescribed for depression, anxiety, phobias and obsessive-compulsive disorder.
- Effects: MAOIs and tricyclics increase the level of the neurotransmitters norepinephrine and serotonin in the brain. SSRIs increase the level of serotonin.
- Side effects: Although antidepressants are not addictive, they often have side effects such as headache, dry mouth, constipation, nausea, weight gain, and feelings of restlessness. Of the three classes of antidepressants, MAOIs generally have the most side effects. People who take MAOIs also have to restrict their diet, because MAOIs interact negatively with foods that contain the amino acid tyramine, such as beer and some cheeses and meats. SSRIs have fewer side effects than the other two classes of antidepressants. However, SSRIs can cause sexual dysfunction, and if they are discontinued abruptly, withdrawal symptoms occur.
Antipsychotic Drugs
Antipsychotic drugs are used to treat schizophrenia and other psychotic disorders. They include chlorpromazine (Thorazine), thioridazine (Mellaril), and haloperidol (Haldol). Antipsychotic drugs usually begin to take effect a few days after they are administer ed.
- Effects: Antipsychotic drugs, or neuroleptics, reduce sensitivity to irrelevant stimuli by limiting the activity of the neurotransmitter dopamine. Many antipsychotic drugs are most useful for treating positive symptoms of schizophrenia, such as hallucinations and delusions. However, a new class of antipsychotic drugs, called atypical antipsychotic drugs, also help treat the negative symptoms of schizophrenia. They reduce the activity of both dopamine and serotonin. Atypical antipsychotic drugs include clozapine (Clozaril), olanzapine (Zyprexa), and quetiapine (Seroquel). Atypical antipsychotic drugs can sometimes be effective for schizophrenia patients who have not responded to the older antipsychotic drugs.
- Side effects: Side effects include drowsiness, constipation, dry mouth, tremors, muscle rigidity, and coordination problems. These side effects often make people stop taking the medications, which frequently results in a relapse of schizophrenia. A more serious side effect is tardive dyskinesia, a usually permanent neurological condition characterized by involuntary movements. To avoid tardive dyskinesia, the dosage of antipsychotics has to be carefully monitored. The atypical antipsychotics have fewer side effects than the older antipsychotic drugs and are less likely to cause tardive dyskinesia. In addition, relapse rates are lower if people continue to take the drug. However, the relapse rate is higher with these drugs if people discontinue the drug.
Lithium
One drug used in the treatment of bipolar disorders is lithium.
Effects: Lithium prevents mood swings in people with bipolar disorders. Researchers have suggested that lithium may affect the action of norepinephrine or glutamate.
Side effects: Lithium can cause tremors or long-term kidney damage in some people. Doctors must carefully monitor the level of lithium in a patient’s blood. A level that is too low is ineffective, and a level that is too high can be toxic. Discontinuing lithium treatment abruptly can increase the risk of relapse.
Recently developed alternatives to lithium include the drugs carbamazepine (Tegretol) and divalproex (Depakote).
Criticisms of Drug Therapies
Drug therapies are effective for many people with psychological disorders, especially for those who suffer from severe disorders that cannot be treated in other ways. However, drug therapies have been criticized for several reasons.
