Treatment Methods

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.

Biomedical Therapies

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.

Electroconvulsive Treatment

(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

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, which 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 is 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.

Other Treatments

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.

The Helping Professionals

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.

Who They Are -- What They Do

Psychiatrists

A psychiatrist is a medical doctor who specializes in mental disorders, is licensed to practice medicine, and has completed a year of internship and three years of specialty training. A board-certified psychiatrist has, in addition, practiced for at least two years and passed the written and oral examinations of the American Board of Psychiatry and Neurology. Psychiatrists can evaluate and diagnose all types of mental disorders, carry out biomedical treatments and psychotherapy, and work with psychological problems associated with medical disorders. Of the mental health professionals, only psychiatrists can prescribe medications. Child psychiatrists specialize in working with children; geriatric psychiatrists concentrate on helping the aged.

Psychologists

Psychologists who conduct psychotherapy and work with individuals, groups, or families to resolve problems generally are called clinical psychologists, counseling psychologists, or school psychologists. They work in many settings -- for example, mental health centers, hospitals and clinics, schools, employee assistance programs, and private practice. In most states, a licensed clinical psychologist has completed a doctoral degree from a university program with specialized training and experience requirements and has successfully completed a professional licensure examination.

The field of psychology also includes those who specialize in such areas as testing, community organization, industrial relations, and laboratory research.

Psychiatric Nurses

Psychiatric nursing is a specialized area of professional nursing practice that is concerned with prevention, treatment, and rehabilitation of mental-health-related problems. These nurses are registered professional nurses who have advanced academic degrees at the master's degree level or above. They conduct individual, family and group therapy and also work in mental health consultation, education and administration.

Social Workers

Psychiatric (or clinical) social workers have master's or doctor's degrees in social work, have completed a field supervision program, and are licensed/certified. In addition to individual, family, and group counseling and psychotherapy, they are trained in client-centered advocacy. This includes information, referral, direct intervention with governmental and civic agencies, and expansion of community resources.

Mental Health Counselors

A clinical mental health counselor provides professional counseling services that involve psychotherapy, human development, learning theory, and group dynamics to help individuals, couples, and families. The promotion and enhancement of healthy, satisfying lifestyles are the goals of mental health counselors, whether the services are rendered in a mental health center, business, private practice, or other community agency. Clinical mental health counselors have earned at least a master's degree, had supervised experience, and passed a national examination before they can be certified by the National Board for Certified Counselors, Inc. (NBCC).

Case Managers and Outreach Workers

These individuals assist persons with severe mental illness, including some who may be homeless, to obtain the services they need to live in the community. Most persons with severe mental illness need medical care, social services, and assistance from a variety of agencies, including those dealing with housing, Social Security, vocational rehabilitation, and mental health. Because such services are uncoordinated in many areas, case managers provide a critical function to monitor a person's needs and assure that appropriate agencies get involved. In many instances they also act as advocates for the client. Case managers can be nurses, social workers, or mental health workers and can be associated with mental health centers, psychosocial rehabilitation programs, or other agencies. Case management and outreach services are frequently provided by teams that may include people who are recovering from a mental illness who function as peer counselors, case management aides, or outreach workers.

Mental Health Research and Services

The core mission of the National Institute of Mental Health is to understand, treat and prevent mental illness. Research into the kinds of mental health services that will support this mission plays an important role. The Center for Mental Health Services provides national leadership in mental health care delivery and policy development to facilitate accessible, comprehensive and quality mental health and support services. The institute and the center, in cooperation with consumer and family groups, professional organizations and other federal and state agencies, work to advance the application of scientific findings and practice-based knowledge to improve the range of effective prevention and treatment services.