Mental Health Therapies - Nontraditional mental health therapy techniques
Thus far this chapter has reviewed several of the more conventional forms of mental health therapy. Nontraditional medicine, however, also has a wide variety of therapies that are effective in treating many different kinds of mental illness and their symptoms.
First practiced in India thousands of years ago, yoga experienced a resurgence in popularity in the 1990s. The different kinds of yoga are countless, and include Hatha yoga, Iyengar yoga, Sahaja yoga, and Kundalini yoga (one type of yoga made popular in the late 1990s by celebrities like Madonna).
Although often seen as a form of exercise, yoga is also used in many cultures as a way of maintaining physical as well as mental health. The benefits of yoga are found in the asanas, or poses, and in pranayama, or the breathing exercises. Both of these, if done properly and practiced regularly, can bring positive changes in the body. Although they may look easy, asanas are a challenge: in a subtle relationship between body and mind, they utilize several muscle groups at once and require a huge amount of concentration, focus, and strength.
Yoga is usually taught in small, intimate classes where close instructor-student interactions are encouraged. Under the instructor's guidance, the class is led through a series of asanas, usually ending in a pranayama or similar meditation-type form (sometimes called savasana) of relaxation.
There are obvious physical benefits to practicing yoga, such as an increase in muscle tone, strength, and flexibility, but this centuries-old practice also regulates and brings oxygen to all areas of the body. If there are problems in certain parts of the body, specific poses can be done to expedite the healing process in that area.
The breathing-exercise, meditative (pranayama) stage of the class may precede or follow the asanas. Sometimes a meditation or relaxation-like phase will occur both at the beginning and at the end of the class.
Yoga's main goal is to attain harmony and peace between the body, mind, and spirit; yoga means "union" in the ancient language of Sanskrit, and each pose is created to harmonize specific body systems and parts with the mind and spirit. One pose, for example, may have the benefits of strengthening the back muscles, but, if done properly, may also release repressed fear held in the body. Another pose urges along the cleaning process of the liver while it also lengthens the spine and carries fresh blood to the liver and brain.
Pharmacotherapy, or drug therapy, is often used to treat those afflicted with mental illness. Whether to treat anxiety or depression or another more serious condition such as schizophrenia, there seems to be a pill for every affliction.
Drug therapy, when conducted under a doctor's supervision, can be a very effective way of combating many types of mental illness. Often, medication is used in conjunction with regular therapy sessions; to ensure that this safety step is taken, many insurance companies will not cover prescription costs unless the patient is under the care of a mental health professional. Also, drug therapy is often much more effective when combined with hard work done in a therapist's office: as a medication smoothes out and/or regulates the chemical imbalances in the brain, the patient is often better able to tackle difficult topics during therapy.
The field of drug therapy has progressed rapidly over a relatively short period of time. In the past, most antidepressants and antipsychotic drugs (often prescribed for conditions such as multiple personality disorder and psychosis), were slow to take effect and often left patients feeling zonked out and uncommunicative. The past decade or so has seen huge advancements in the distribution of new and improved drugs that are faster acting and more friendly on the patient.
After the initial excitement about drug therapy died down, however, people started to realize that antidepressants were being prescribed faster than pharmacists could keep them on the shelves. Doctors began to realize that a pill is not always the answer but that drug therapy can be very effective for some people when therapy alone does not work.
Generally the patient remains on the initial prescription until the therapist sees a marked improvement or decline in the patient's condition over a period of time, usually a few months. Then the therapist may suggest a change in medication (if a decline in mental health is experienced) or a decrease in dosage to test whether the patient's mental stability remains or fluctuates. A positive mood change can mean either the beginning of the end of the patient's drug therapy or the need for a change. Sometimes it takes a few tries with different medications until the right one is found. Sometimes the medication works for a while, but then becomes ineffective. Sometimes it's a matter of adjusting the patient's dosage or adding a supplementary medication to the therapy plan.
Drug therapy can produce positive results if done correctly. Whatever the case, patience, an open mind, and a comfortable doctor-patient relationship are keys to finding the right drug therapy.
How, then, does yoga work as a form of therapy? As yoga students practice yoga, incorporating both the asanas, and the meditation or breathing exercises, they will realize, over a few weeks, a decrease in anxiety levels, and a calming, "at peace" feeling. Studies have shown that people battling anxiety disorders, depression, and even psychosis have experienced an improvement in their mental health from practicing yoga. Of course, an improvement in one's physical appearance from the practice of yoga can boost one's selfconfidence, but yoga can also bring a healthy feeling of order to the inside of the body as well.
The goals of yoga are a union of body, mind, and spirit. This can take years of discipline, and people looking for a way to lessen depression may not care about attaining that union. One can take from a yoga class whatever part one wants, whether it is a break from chronic anxiety attacks during pranayama or a lift in depression during an asana.
[For more information on yoga, see Chapter 10: Alternative Medicine.]
Contrary to popular belief, meditation is much more than just sitting quietly. In fact, learning how to meditate is hard work. The benefits of what looks like just sitting still, however, can have lasting effects. This age-old practice has even found popularity among those looking for help with their mental illnesses.
Therapists report that people who meditate have felt decreases in their anxiety and stress levels, addictive behaviors, and depressions. Sometimes meditation is practiced in conjunction with other nontraditional therapy techniques, such as yoga. However it is practiced, the most important aspect of meditation is concentration.
To attain the intense concentration needed for effective meditation, patients will often choose an object, word, or phrase on which to focus, and center all attention on that thing. Some kinds of meditation incorporate props, such as lit candles, for focusing. Other kinds suggest repeating a word or phrase over and over, such as "ohm," which is used in Hindu traditions. Any word, though, will do; some people will repeat the word "love" or "peace." One should choose a word that supports an intense focus and full concentration; what is important is that one remains focused on the repetition. Once concentration is attained, the next step, or unbroken attention (meditation), should follow. (It is important to note here that getting to this point is a challenge. With meditation, patience is a virtue. Also, if the person finds his thoughts wandering from the chosen focus, which is normal, he should allow the uninterrupted thoughts to enter and then leave the mind, followed by a gentle self-guide back to the original word, phrase, or object.) Once this state of meditation is reached, a higher state of consciousness, sometimes called contemplation, is the next level. This may not be necessary for the beginner; benefits will still be felt if this higher consciousness is not immediately attained.
For those seeking help with their mental health, meditation can be a great way to increase focus and reduce anxiety and other mood disorders. Meditation is not something that can be practiced once with expected results; yoga and other nontraditional medical techniques require focus, patience, and dedication. The benefits, though, can greatly outweigh the hard work for someone who would like to add it to a mental health therapy plan.
[For more information on meditation, see Chapter 10: Alternative Medicine and Chapter 14: Habits and Behaviors.]
Bioenergetics (Body/Mind Therapy)
Bioenergetics, also called body/mind therapy, is a body-related psychotherapy developed by American doctor Alexander Lowen. Lowen was a student of Wilhelm Reich, who was a famous Austrian psychotherapist.
Influenced by Reich's theories, Lowen argued that the body, mind, and spirit are all interdependent and reflective. By practicing special exercises and verbal therapy, the body and mind can free itself from negative actions, called restrictive holding patterns. Bioenergetic therapists try to help their patients reach this freedom of body and mind.
IT IS IMPORTANT TO NOTE THAT ALTHOUGH YOGA AND MEDITATION CAN BE VERY BENEFICIAL IN MAINTAINING AND IMPROVING MENTAL HEALTH, THEY ARE NOT SUBSTITUTES FOR MENTAL HEALTH THERAPY CONDUCTED UNDER MEDICAL SUPERVISION.
Bioenergetics is based on a belief that personality is made of biological urges and conscious thought, or will. Lowen believed that emotional problems develop when a person fails to follow biological impulses except when there is a personal sense of desire. In other words, emotional problems can erupt when biological impulses are not consciously expressed because of fear. Lowen thought that neuroses were a form of defense, but with those neuroses comes a restraint of the true self. Through bioenergetic exercises meant to loosen rigid muscles, the defenses can be broken down and the true self can emerge. This also increases the amount of psychophysical energy (energy from the body and the mind); Lowen calls this bioenergy.
Breaking down this defense occurs gradually and, as the body feels more alive, repressed feelings are released and the neurosis is lessened. The verbal therapy aspect of the technique happens throughout the defense-lifting process, allowing the person to combine new thoughts and physical feelings into his life.
CHOOSING A THERAPIST
Deciding to begin therapy can be a big enough decision, but deciding whom to use as a therapist can be just as difficult. Talking to someone one hardly knows, about personal subjects, is difficult for anyone. Finding the right therapist can take time and patience until one feels the right connection.
Finding a therapist may require a bit of detective work. One's general practitioner is a good person to ask for the names of prospective therapists, as well as school guidance counselors, ministers, or rabbis. Some universities and colleges also have graduate therapy programs where, as part of their studies, graduate students offer quality psychotherapy for milder cases of emotional upset. This is a more affordable form of therapy, and these graduate programs will also often have lists of therapists in the area.
There are options, too, when deciding what kind of therapist to choose. A psychiatrist, along with being a therapist, is also a medical doctor, and can prescribe medication. Someone with "CSW" or "MSW" after his or her name has a master's degree in social work, and also works as a therapist, but cannot prescribe medication. Both kinds of therapists are board-certified and capable of providing quality care to the person in need. Sometimes a patient develops a need for medication while seeing a therapist; then an additional relationship may be introduced between the patient and a psychiatrist who can prescribe and monitor a drug therapy plan for the patient. The psychiatrist and therapist will work together, along with the patient, toward improving the patient's well-being.
The important thing to remember when choosing a therapist is that it is okay to be selective; this relationship requires trust, mutual respect, sensitivity, and understanding. Only then can a patient's goals be reached.
The bioenergetics technique begins with the therapist and patient engaging in some conversation, but then moving directly into the exercises, or bodywork. Patients work in close-fitting clothing so the therapist can see how the body changes as it moves. The exercises include lying, sitting, and standing in ways that increase the areas of stress in the body. Deep breathing during the session is encouraged because it pulls a large amount of bioenergy into the body, releasing repressed emotions. This energy is compared to an electric current, and can actually be seen by both therapist and patient as vibrations in muscles.
Throughout the exercises, the bioenergetic therapist might touch or massage certain areas of the patient's body that seem to resist release. At certain points during the session, the patient is also reminded to make sounds (as part of the verbal therapy); the release of sounds sends more bioenergy through the body.
Since the release of defenses in the body happens over a period of time and not all at once, bioenergetics is a long-term therapy, but for many it is the answer to controlling or combating feelings of anxiety, depression, or other kinds of emotional upset.
Creative Arts Therapies
A creative arts therapy is a technique that utilizes some form of creative expression as a way of producing a change in one's mental health. Some of these therapies include art, drama, dance, poetry, and music. Through these mediums one can express oneself in nonverbal ways. The results of this form of therapy are an increase in self-esteem, self-expression, and improved social interactions.
The quality of the patient's expression, whether it is a painting or a dance routine, does not matter in these creative therapies; what matters is the significance learned from the work for both therapist and patient and how this new knowledge can help the patient. To this end, creative arts therapists do not participate too much in sessions so as not to interrupt the patient's self-expression and self-realization.
Creative therapies are usually conducted in hospitals and institutions for the mentally challenged. Some creative arts therapists work together with other psychotherapists; in fact, these therapies were influenced to an extent by psychoanalysis and take a psychoanalytic angle in their techniques. In addition, all of them can be used in conjunction with other, more conventional therapy techniques.
ART THERAPY. Art therapy is used to help patients overcome emotional conflicts and become more self-aware. To do this, the art therapist will guide patients in the use of certain art materials, such as pastels or crayons, to express themselves, but clay, paper, or finger paints may also be used, depending on the issue being addressed. These specially selected materials can be used to express what is in patients' minds before they are able to put it into words. (Sometimes art is an easier form of expression for patients than verbalizing their pain.)
Art therapy can provide a positive feeling of expression within patients as well as allow a physical release of creative energy as work is being created. If a specific topic is not immediately apparent, the therapist might suggest a topic for expression, such as one's family or a vivid childhood memory.
Over the past decade, art therapists have added other mediums to their techniques, such as music or movement. These additions have been helpful with the recent inclusion of creative art therapy work with incest survivors, prisoners, and victims of war. An ever-expanding therapy form, art therapy can be a constructive alternative to conventional mental health therapies.
[For more information on art therapists, see Chapter 6: Health Care Careers.]
DANCE THERAPY. Using the freedom of movement, dance therapy can help patients interrelate psychological and physiological processes. Actual dance techniques are not usually taught, though; instead, patients are urged to express themselves through virtually any form of movement, no matter how spontaneous. Therapists' approaches to patients have to be creative, but must also result from observation of patients' immediate needs through signs like physical tension. The dance or art therapist may also copy patients' actions to relay understanding over certain situations. Following that, patients may be asked to respond verbally or to keep moving. The use of rhythm and energy can also be helpful for patients who need to remove both physical and emotional tension.
Dance therapy has shown success with everyone from professional dancers to autistic children. It allows patients to feel emotional and physiological feelings at the same time and to convey them in a secure, constructive setting.
MUSIC THERAPY. Music has been part of human culture more or less since the beginning of time. It has played an integral part in the history of mankind. It has also been associated in the past as having power; in ancient Greece, for example, it was thought to have a special force over one's physical and emotional self. In addition, music has also played a significant role in cultural and religious services. It makes sense, then, that music could be used in therapy.
Today, the calming effect from music is still a by-product of music therapy. Music therapists use the power of music to identify and deal with a wide range of emotional disturbances—everything from drug abuse to schizophrenia and Alzheimer's disease.
There is a wide variety of music therapy approaches; the one to choose is a personal preference. Most music therapists have musical instruments available for patients to use during sessions in their quest for self-expression. Using these instruments, exercises are conducted, led by the therapist, which aid in the process of uncovering conflict. Often, patients are encouraged to act out spontaneous expressions, even if they might interfere with an exercise. The instruments can also be used as props to describe and act out certain situations. In a classic example, a patient might be asked to choose and then manipulate instruments that remind him or her of family members or difficult situations or feelings.
As this therapy technique grows, music therapists continue to learn more about music and its therapeutic benefits. New age music, for example, has been found to help those engaged in self-destructive behavior. Undoubtedly, more is to come from this creative art therapy.
PSYCHODRAMA. Psychodrama, another creative arts therapy technique, has shown to be a very effective therapy when used with other forms of psychotherapy and in crisis intervention.
In psychodrama, the therapist and patient approach a problem as if they were director and playwright, which allows the patient more interactions with the issue and the conquering of the conflict. By acting out their problems, patients also experience a deeper level of awareness.
Developed in the 1930s by Viennese psychiatrist J. L. Moreno (1889–1974), psychodrama has been found to show positive effects on posttraumatic stress disorder, substance abuse, and other conditions requiring long-term hospitalization. The range of materials used can be anything from classic forms of playwriting, such as Shakespeare, to simpler forms of theater, such as puppet shows. In psychodrama sessions, the therapist keeps close tabs on patients and establishes just the right relationship with them. A patient, for example, might act out a submissive character, such as a mouse, whereas the therapist chooses to be a dominant animal, such as a cat, and acts out that character while observing the patient's reactions. The drama therapist works hard in sessions and goes beyond classic role-playing techniques to work as actor and director.
The goal of psychodrama is for the patient, through acting, to enact life conflicts and derive self-awareness and growth from this acting. Other benefits of psychodrama include an increase in creativity and interpersonal skills and an increased awareness in one's feelings and emotions.
Hypnosis is an altered state of awareness, much like daydreaming or being so involved in a task that one loses track of time; these are altered states into which all our minds occasionally fall. Hypnosis can be beneficial in therapy, and, in a therapeutic setting, is often accompanied by physical relaxation, which can be very helpful when uncovering topics that produce stress.
There are two approaches to hypnotherapy: the permissive and the indirect. The hypnotherapist using the permissive technique treats patients as equals, gently instructing them that they may move along with the hypnosis process if desired (for example, "You may take a deep breath now, if you wish"). The hypnotherapist using the indirect approach, however, would say, "Take a deep breath now." The indirect technique is different from the permissive one in another way: it does not use a formal hypnosis procedure (see below) and the patient is usually unaware that the procedure is happening.
After the initial interview between therapist and patient and an explanation of the realities of hypnosis (for example, that the therapist does not have complete control over the patient's brain, as the media often portrays), the therapist will induce the hypnotic state. This is done through visual imagery; the patient pictures a relaxing situation and is instructed to relive that situation and feeling as much as possible. When the patient reaches some level of trance (often reached while listening to the therapist verbalize the visualization techniques), depending on the level of hypnosis, the patient can recall certain repressed memories. Some patients need deep levels of hypnosis to recall past experiences; others can benefit from light hypnosis.
Although not a form of psychotherapy itself, hypnotherapy can be used with other forms of psychotherapy to combat anxiety disorders, multiple personality disorder, psychosis, and other mental disturbances.