There are different kinds of modes of treatment, the most commonly
thought about, is you got a stereotype
in your head about what therapy is, right?
And the stereotype in your head probably involves a couch,
right? That would be normal because that's what the media portrays therapy
to be,
but we don't use couches. I might have a couch in an office I work in,
but you ain't gotta lay down on. In fact I would prefer that you don't.
I would like you to maintain your attention while we talk if you don't mind.
Laying down is not something we do. That was something way back in Freud's day,
literally, that was a Freud thing to do. Modern
mental health care involves no such thing. It no longer
requires also that you stay fifty minutes. The fifty-minute hour,
the idea is that ideally you would come once a week for 50 minutes where the last
10 minutes is the
provider writing up notes about what happened, so that's all confidentials put
into a chart,
so they remember what's going on the next time they see you, and you would go for as
many times as you deem necessary.
It might be one time, it might be fifty times,
whatever you think is necessary but the idea is that you see
a provider one on one in a confidential setting,
and that's individual psychotherapy, and that's
the typical thing that people think about, but
keep in mind that there's all kinds of misconceptions:
you can't fall in love with your therapist, or you can't date your therapist, your therapist
can't date you.
I saw that movie, what was that? "Fifty-Fifty," and the woman who was supposedly got a Doctorate is
now,
he's like is this your first patient ever? She's like, 'yeah.' Come on!
Seriously? That woman would have had 6 years of training probably
prior to a full-time position with multiple supervisors, multiple classes,
tons of experience and a code of ethics that says,
I'm sorry I cannot date you,
as a foundational precept, so all kinds misconceptions about
what these mental health care providers are. They're not paid friends,
they're not going to be your buddy, not going out for coffee, they are trained
professionals to help people work on their issues themselves,
and that's usually how it's done as In individual psychotherapy.
You can do it in group. Usually in groups you're looking to 4-10
clients, or patients, whatever you want to call them, who are usually strangers to each other,
in the typical group setting, but over time they're going to
learn to trust one another, they're going to share problems, get feed back,
improve interpersonal skills, and in so doing it can be more powerful it's hard
to get people
to go see an individual therapist, because it's already kinda awkward and weird
to go meet a stranger and start talking about deep issues.
Can you imagine going and doing it with five or six strangers
who were not trained professionals? That's the idea behind that but there is
research that shows that that could be a very helpful way to do it. Number one it's
cheaper for the patient.
Number two, there's some interesting kinds of effects that you can get in groups that you
just can't get
one on one. One is that you start to realize that you're not alone.
A lot of people who suffer think I'm the only one going through this, and when you get in a
group of four to five people that look normal,
you realize that lots of people go through stuff, and just looking at people doesn't
mean that they're not suffering.
Just because they don't appear to be suffering in day-to-day life does not
mean that they
are free from suffering, and that you can see that other people
go through the kinds of things that we go through as individuals.
So you get some kind of shared support, you also start building potential
relationships, although it's a confidential situation, you're
not supposed to have relationships with your group members outside but
people do, because they're not trained, they're not professional, they're not
bound to ethical codes, they can do what they want, but that's not the goal
and there's a a certain insight that can come from this that just can't be
provided by an individual
therapist. I have an anecdote to share with you that kidn of opened my eyes to
that.
I was working with the guy at a counseling center,
I can't remember how long it was, probably four or five sessions, he had massive
panic attacks.
He had been emotionally and physically abused by his father,
all his life that he could remember. He was now going to college and I was
seeing him in a college counseling center, and he had panic attacks all the time,
and he had a really low self esteem. I mean
terribly low, he just thought he was not worth anything more than his father thought he was
worth,
which was not much of anything according to him, and so he just had this terrible time of
life because his
thought patterns were, I'm piece of shit, nobody cares about me, and that makes total
sense because I'm not worth caring about.
So you don't have a whole lot of hope if that's your belief about yourself.
But I saw him as a smart guy,
a nice guy, a pretty decent looking guy,
and a guy that could be really friendly and helpful and engaging and
really all these positive qualities, that's what I saw, being objective,
not having an agenda, he didn't come across in any other way except
positive nice guy, and I gave him that feed back as an individual therapist. Im like well,
I see that you think of yourself this way, but this is, these are the perceptions
I'm having that don't line up with that at all, and he's like,
yea, I've been seeing therapists for a while, man, you're just my therapist, and you're paid to say that,
I'm like, I'm
actually not paid to say that, I'm just telling you what I perceived to be the case
given the time that we spent together, but he dismissed it,
as irrelevant or inaccurate,
or not genuine. I convinced the guy to get into a group,
it was really hard to convince him to do it, but he did it and after about five or
six sessions in the group,
these other people started telling him exactly the same thing,
and he started tearing up because you know what? They weren't paid to tell him anything,
and he couldn't get away from the fact that those were their genuine thoughts about
him,
and that they were really positive thoughts about him, and that they were
totally contrary to what he believed
about himself which made sense given the circumstances he grew up in, but
having grown past that, he didn't need to hold on to that
incorrect view any more. Couples therapy, that's when you work with two different
individuals that are in a relationship together.
That's a group right? It's more than one. A family therapy
that's when you work with the system. The system is the group you come
from.
The people that you are involved in in some level. Could be biological, could be
adopted, could be
just living together, roommates and things like that, people that
are working or living with you and are part of your life.
So it turns out it helps to talk to those people collectively and not just look
at one person as a problem,
but that we oftentimes find ourselves in systems that are problematic or
chaotic,
or difficult to navigate, and it might help to work on that whole system. So that's Milieu
therapy, where you are really working with
a team of professionals on a variety of treatment approaches.
Let's see what else we got here.
Alright.
We're getting right up on time we're still below our actual
time that we quit, so main treatment categories, know the difference between
inpatient
and outpatient. Inpatient is when you're basically staying for the night.
It could be a hospital, it could be
a lock down ward, but it's because somebody's needing mental health
treatment,
and they are a danger to themselves or others, or there are very intense
psychotic processes or they're trying to detox from
alcohol or drugs and they need that inpatient setting where you get
intensive services,
and you stay at the site until you're discharged, and outpatient would be
any other mode of therapy that you get. And then with regard to
inpatient treatment, it's really expensive. And so when we look at things and
we talked before in previous
sections of material about how hard it is for people to quit substance abuse.
Well it turns out that expensive
impatient remember might be equal to less expensive
outpatient care, and additionally,
we find that the twelve-step program is the one that is used most often
no matter whether you were inpatient or outpatient,
the twelve-step recovery model is the one that's used most frequently to help people with
substance abuse problems.
Its not a professional program. It is a non
professional program by definition. It is run by laypeople,
not professionally trained people. It's not even run by paraprofessionals,
it's run by people who are overcoming their own addictions,
so they become a network to each other,
they become a support system to each other. Now there's some difficulties with it, in
that its faith-based.
The faith is your choice, but it is faith based, so it doesn't fit everybody who might
not be faith-based.
And it's very social. So it's kinda hard for people who are really shy to do this,
and sometimes it can be clicky. That every group is not wide open and very
accepting,
and it's also based on a disease model where abstinence is the only goal
So you can't just reduce use, you have to quit use altogether.
But, for those it fits, it can be very helpful.
It can be very, very helpful, and sometimes it's the only thing
people have to offer, and so it's better than nothing. It was pioneered by Alcoholics
Anonymous'
bill and it's been applied to, cocaine, narcotics, marijuana, duel recovery,
sexual-compulses,over-eaters gamblers, debtors, workaholics, co dependence,
emotional difficulties, you name it, they've applied the model to it.
When people have difficulties, and it can be helpful, but abstinence is the goal.
Ya'll study hard, and I will see you in here on Wednesday
at 1:20 to do that final exam! Have a wonderful day and a great weekend!