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Counseling and Psychological Therapies
Many people are not sure how to judge when professional help for mental problems may be needed. There are some behaviors that may be signs of trouble:
Is the person acting differently than usual? Could this change be linked to something that has happened recently? Any event, such as the death of a close relative, loss of a job, marital break-up, or even something positive — like a job promotion — can trigger a troublesome emotional reaction.
Does the person complain of episodes of extreme, almost uncontrollable, anxiety or "nervousness"? One sign of an emotional problem is "free floating" anxiety that is unrelated to a normal concern, such as a child's illness or a backlog of bills.
Does the person become aggressive, rude, and abusive over minor incidents or talk about groups or individuals "out to get me"? If such remarks are made in all seriousness, and if violent behavior occurs, it is likely that help is needed and should be sought.
Any of these symptoms, if they persist or become severe, may suggest a need for professional help. Fortunately, early identification and treatment of the problems causing this behavior often can make these symptoms disappear.
The goals of treatment are to reduce symptoms of emotional disorders; improve personal and social functioning; develop and strengthen coping skills; and promote behaviors that make a person's life better. Biomedical therapy, psychotherapy, and behavioral therapy are basic approaches to treatment that may help a person overcome problems. There are many specific types of therapies that may be used alone or in various combinations.
Treatment with medications has benefited many patients with emotional, behavioral, and mental disorders and is often combined with other therapy. The medication that a psychiatrist or other physician prescribes depends on the nature of the illness being treated as well as on an assessment of the patient's general medical condition. During the past 35 years, many psychotherapeutic medications have been developed and have made dramatic changes in the treatment of mental disorders. Today there are specific medications to alleviate the symptoms of such mental disorders as schizophrenia, bipolar disorder, major depression, anxiety, panic disorder, and obsessive-compulsive disorder.
(ECT) is another biomedical treatment that can help some patients. It is generally reserved for patients with severe mental illnesses who are unresponsive to or unable to tolerate medications or other treatments. While ECT is most commonly indicated in the treatment of major depression, often with psychosis (delusions or hallucinations), it is also used in selected cases of schizophrenia. Severe reduction in food and fluid intake with little physical movement (catatonia), or overwhelming suicidal ideation, where urgency of response is important, are reasons for considering ECT as treatment of choice. Modern methods of administering ECT employ low "doses" of electric shock to the brain along with general anesthesia and muscle relaxants to minimize the risk and unpleasantness to patients.
Psychotherapy is accomplished through a series of face-to-face discussions in which a therapist helps a person to talk about, define, and resolve personal problems that are troubling. Psychotherapies generally appear to be more effective and appropriate than medications or ECT for less severe forms of emotional distress.
Short-term psychotherapy, lasting for several weeks or months, is used when the problem seems to result from a stressful life event such as a death in the family, divorce, or physical illness. The goal of the therapist is to help the patient resolve the problem as quickly as possible. Often this takes only a few visits. Long-term psychotherapy, lasting from several months to several years, emphasizes the study of underlying problems that started in childhood.
The following is a list of a few types of psychotherapy:
Psychodynamic psychotherapy » may be either long- or short-term, examines important relationships and experiences from early childhood to the present in an effort to analyze and change unsettling or destructive behaviors and to resolve emotional problems. One form of psychodynamic psychotherapy is psychoanalysis, a long-term, intensive therapy that emphasizes how the patient's unconscious motivations and early patterns of resolving issues are important influences in his or her present actions and feelings.
Interpersonal therapy » focuses on the patient's current life and relationships within the family, social, and work environments.
Family therapy » involves discussions and problem-solving sessions with every member of a family — sometimes with the entire group, sometimes with individuals.
Couple therapy » aims to develop a more rewarding relationship and minimize problems through understanding how individual conflicts get expressed in the couple's interactions.
Group therapy » involves a small group of people with similar problems who, with the guidance of a therapist, discuss individual issues and help each other with problems.
Play therapy » a technique used for establishing communication and resolving problems with young children.
Cognitive therapy » aims to identify and correct distorted thinking patterns that can lead to troublesome feelings and behaviors. Cognitive therapy is often combined effectively with behavioral therapy.
Behavioral therapy » uses learning principles to change troublesome thinking patterns and behaviors systematically. The individual can learn specific skills to obtain rewards and satisfaction. Such an approach may involve the cooperation of important persons in the individual's life to give praise and attention to desirable changes. Behavioral therapy includes an array of methods such as stress management, biofeedback, and relaxation training.
Some treatments, called "adjunctive," are used in combination with other therapies, and sometimes they are used alone. They include occupational, recreational, or creative therapies, as well as some that focus on special education. A mental health professional can help a client find the kind of therapy, or combination of therapies, that is best suited to his or her situation.
Rehabilitation Services — Community Support Programs
Many individuals with severe mental illness find it difficult to work, learn, socialize, and live independently outside a controlled setting. To help in these matters, community support programs offer rehabilitation services, either through freestanding programs that are similar to clubs, or through mental health centers. These agencies offer a variety of activities to assist clients in learning skills that will help them to live and work independently and productively in the community. For information on community support programs, contact your local or state mental health agency.
Helping professionals work in a variety of settings, such as mental health centers, outpatient clinics, private and group practice, general hospitals, psychiatric hospitals, nursing homes, jails, and prisons. They also work in residential treatment centers, partial care organizations, family or social service agencies, and the psychiatric departments of university medical centers or teaching hospitals.
Frequently Asked Questions
Twenty percent of adult Americans — or one in five — will have a mental illness during their lifetime that is severe enough to require treatment, and many more have problems that prevent them from enjoying their lives. Often these people suffer in silence, rather than admit they need help. Asking for help is not an easy thing for many people to do, but it is a wise move when a person feels that something is wrong. This page is a guide to locating mental health services. Many individuals who are looking for help for themselves or a loved one ask the same questions. Following are some of the most commonly asked questions and their answers.
When I need help, where can I go? For information about resources available in your community, contact your local mental health center or one of the local affiliates of national self-help organizations. These agencies can provide you with information on services designed to meet the needs of those suffering from mental disorders such as depression, schizophrenia, panic disorder, and other anxiety conditions. In addition, they will have information regarding services designed for specific cultural groups, children, the elderly, HIV-infected individuals, and refugees.
I don't have adequate personal finances, medical insurance, or hospitalization coverage — where would I get the money to pay for the service I may need? In publicly funded mental health centers, such as those funded by state, city or county governments, the cost of many services is calculated according to what you can afford to pay. So, if you have no money, or very little, services are still provided. This is called a sliding-scale or sliding-fee basis of payment. Many employers make assistance programs available to their employees, often without charge. These programs — usually called Employee Assistance Programs — are designed to provide mental health services, including individual psychotherapy, family counseling, and assistance with problems of drug and alcohol abuse.
Are there other places to go for help? Yes, there are alternatives. Many mental health programs operate independently. These include local clinics, family service agencies, mental health self-help groups, private psychiatric hospitals, private clinics, and private practitioners. If you go to a private clinic or practitioner, you will pay the full cost of the services, less the amount paid by your insurer or some other payment source. There are also many self-help organizations that operate drop-in centers and sponsor gatherings for group discussions to deal with problems associated with bereavement, suicide, depression, anxiety, phobias, panic disorder, obsessive-compulsive disorder, schizophrenia, drugs, alcohol, eating disorders (bulimia, anorexia nervosa, obesity), spouse and child abuse, sexual abuse, rape, and coping with the problems of aging parents — to name a few. In addition, there are private practitioners who specialize in treating one or more of these problems. You may contact local chapters of self-help organizations to learn about various services available in your community.
I don't like to bother other people with my problems. Wouldn't it be better just to wait and work things out by myself? That's like having a toothache and not going to the dentist. The results are the same — you keep on hurting and the problem will probably get worse.
Suppose I decide to go ahead and visit a mental health center. What goes on in one of those places? A specially trained staff member will talk with you about the things that are worrying you.
Talk? I can talk to a friend for free — why pay someone? You're quite right. If you have a wise and understanding friend who is willing to listen to your problems, you may not need professional help at all. But often that's not enough. You may need a professionally trained person to help you uncover what's really bothering you. Your friend probably does not have the skills to do this.
How can just talking make problems disappear? When you're talking to someone who has professional training and has helped many others with problems similar to yours, that person is able to see the patterns in your life that have led to your unhappiness. In therapy, the job is to help you recognize those patterns — and you may try to change them. There may be times, however, when you will need a combination of "talk" therapy and medication.
Are psychiatrists the only ones who can help? No. A therapist does not have to be a psychiatrist. A number of psychologists, social workers, nurses, mental health counselors, and others have been specially trained and licensed to work effectively with people's mental and emotional difficulties. However, only a psychiatrist is a medical doctor and therefore qualified to prescribe medication.
Since I work all day, it would be hard to go to a center during regular working hours. Are centers open at night or on weekends? Often centers offer night or weekend appointments. Just contact the center for an appointment, which may be set up for a time that is convenient for both you and the center.
And how about doctors in private practice — do they sometimes see their patients after working hours? Many doctors have evening hours to accommodate their patients. Some even see patients very early in the morning before they go to work.
I feel that I would be helped by going to a mental health center. Actually, I think my spouse could be helped too. But the idea of going to a "mental health center" would seem threatening to my spouse. Could I just pretend that it's something else? No indeed. It's better to talk your spouse into it than to lie. Don't jeopardize trust by being deceptive. However, you may want to discuss it first with the center. Marital or family therapy is available when a problem exists that involves more than one family member.
If I go to a mental health center, what kind of treatment will I get? There are many kinds of treatment. A professional at the center will work with you in determining the best form for your needs. Depending on the nature of the illness being treated, psychotherapy and/or treatment with medication may be recommended. Sometimes, joining a group of people who have similar problems is best; at other times, talking individually to a therapist is the answer.
Does taking therapy for mental and emotional problems always work? Sometimes it does, and sometimes it doesn't. It primarily depends on you and the therapist. It is important to share your concerns in a serious, sincere, and open manner. Only if you are completely honest and open can you expect to receive the best support and advice.
What if I really try, but I still can't feel comfortable with the therapist? There should be a "fit" between your personality and that of the therapist. Someone else — or some other method — may be more suitable for you. You can ask your therapist for a referral to another mental health professional, or, if you prefer, you can call one of the mental health associations for the names of other therapists in your area.
What if I am receiving medication and don't think it is helping? If there is little or no change in your symptoms after five to six weeks, a different medication may be tried. Some people respond better to one medication than another. Some people also are helped by combining treatment with medications and another form of therapy.
Does a mental health center provide services for children? Yes. Children's services are an important part of any center's program. Children usually respond very well to short-term help if they are not suffering from a severe disorder. Families often are asked to participate and are consulted if the child is found to have a serious disorder — such as autism, childhood depression, obsessive-compulsive disorder, attention deficit hyperactivity disorder, or anorexia nervosa or bulimia — and long-term treatment is needed.
I have an elderly parent who has trouble remembering even close members of the family. He is physically still quite active and has wandered off a number of times. Could someone help with this? A staff person at a center can advise you about ways you can best care for your parent. You may be referred to a special agency or organization that provides services designed especially to meet the needs of elderly people. The department of public welfare in your county can give you addresses and telephone numbers for both your county and state agencies on aging. These agencies provide information on services and programs for the elderly.
I have a friend who says she could use some professional help, but she is worried about keeping it confidential. She needn't worry. Confidentiality is basic to therapy, and the patient has the right to control access to information about her treatment. Professional association guidelines plus federal and state laws underscore the importance of confidentiality in therapist-client relationships and govern the release of records. Some insurance companies require certain information from the therapist as a condition for payment, but that information can be released only if the patient gives written permission. If your friend wants to know exactly who gets information and what kind of information is released, she should ask her insurance provider and discuss it in detail with the therapist.
I have a relative with a severe mental problem. Should I urge this person to go to the hospital? A person who is mentally ill should be in a hospital only if it is absolutely necessary. In general, most mental health professionals believe that persons with mental illness should live in the community and be treated there. That's why mental health centers and community support and rehabilitation programs stress the importance of having many different services available: day, night, and weekend care, and outpatient treatment through regular visits to an office or clinic.
Do emergency cases wind up as long-term patients in mental hospitals? Generally no. Mental hospitals are used today for short-term crisis intervention when there are no other community services available or when a person needs extra care to stabilize a drug treatment regimen. Also they serve the small percentage of patients who need long-term, structured, supervised care and treatment in a protective setting.
I have heard people use the term "involuntary commitment." What does this mean? In an emergency (for example, where a person is considered a danger to self or others), it is possible for someone to be admitted to a hospital for a short period against his or her will. The exact procedures that must be followed vary from one area to another, according to state and local laws. At the end of the emergency commitment period, the state must either release the individual, obtain his or her voluntary consent to extend commitment, or file with the court an extended commitment petition to continue to detain the person involuntarily. Most states require an emergency commitment hearing to be held within two to four days after hospital admission to justify continued involuntary confinement.
Whom can I call if I feel that my rights have been violated or if I want to report suspected violation of rights, abuse, or neglect? Federal law provides that each state have a Protection and Advocacy (P&A) System. These agencies, partially funded by the Center for Mental Health Services, investigate reports of abuse and neglect in public or private mental health or treatment facilities for current residents or those admitted or discharged during the past 90 days. For the name of the P&A agency in your state, contact the National Association of Protection and Advocacy Systems.
Source: U.S. Department of Health and Human Services » National Mental Health Information Center
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