How Is Mental Illness Treated?
The first section of the chapter presents the principles of the major approaches to treatment. Historically, much of what was done in psychotherapy was based on the practitioner's theoretical orientation. One's views about the causes of psychological disorders heavily influenced one's approach and the techniques used.

Table 17.1: Treatment Theories
Approach to Treatment	Basic Principles of Treatment
Psychodynamic	uncover unconscious conflicts that give rise to maladaptive behaviors
Humanistic	help people fulfill potential for growth through self-understanding
Behavioral	maladaptive behavior is unlearned through conditioning principles
Cognitive-behavioral	eliminate distorted thoughts that cause maladaptive behaviors
Group	use group for social skills, interpersonal learning, and social support
Systems	improve family interactions as issues arise in larger social context
Biological	directly treat abnormalities in neural and bodily processes

Psychodynamic therapists employ free association and dream analysis to achieve insight about unconscious influences. Humanistic therapists use reflective listening as in client-centered therapy to facilitate greater self-understanding and personal growth. Behavioral therapists use specific techniques such as social-skills training and systematic desensitization to learn more adaptive behavior through the principles of operant and classical conditioning. Cognitive-behavioral therapy (CBT) incorporates these learning principles as well as addresses the faulty cognitions that lead to maladaptive behaviors and emotions.

Practitioners from different theoretical approaches use the social support and interpersonal learning found in group therapy to address their clients' issues. The systems approach to psychotherapy considers that one's individual problems arise in a larger family context and that one must address how the family interacts to achieve a more durable result. Finally, biological therapies recognize that some psychological disorders result from abnormalities in neural and bodily processes. They attempt to change these processes, most commonly through the use of psychotropic medications such as antianxiety drugs, antidepressants, and antipsychotics.

It is noteworthy that numerous research studies have found these approaches to be effective. It is equally interesting that, overall, no one approach has been found to be clearly superior to the others. Part of this may be attributable to the fact that there are some common factors that contribute to the effectiveness of all approaches despite the specific techniques used. Common factors include a strong relationship between the therapist and client and the powerful emotional reaction of confession (i.e., catharsis).

What Are the Most Effective Treatments?
The next section presents research findings on what are the most effective treatments for anxiety, mood, and schizophrenic disorders. One of the major changes in psychological treatment in recent years has been the shift of therapists from an allegiance to one approach to the more eclectic use of multiple approaches, depending on the person and problem. For specific phobias, behavioral techniques based on exposure (e.g., systematic desensitization) are the treatment of choice. CBT and medication (e.g., imipramine) have been found to be useful in the treatment of panic disorder. For those who have panic disorder with agoraphobia, the combination of CBT and drugs is significantly better than either treatment alone. CBT and medication (e.g., clomipramine) have also been helpful in the treatment of obsessive-compulsive disorder (OCD). Exposure and response prevention are the critical components of the behavioral intervention for OCD.

Can Personality Disorders Be Treated?
Since personality disorders are, by definition, chronic maladaptive ways of interacting with the world, they are extremely difficult to treat. Individuals with these disorders tend to see the environment rather than their own behaviors as the cause of their problems, thus they are unmotivated to change. Treatments for two well-researched personality disorders are presented.

Dialectical behavior therapy (DBT) has been the most successful treatment program to date for borderline personality disorder. In DBT, the therapist targets the client's most extreme and dysfunctional behaviors, explores past traumatic experiences that may be at the root of emotional problems, and facilitates the development of self-respect and independent problem solving. Despite many varied attempts, little has been found to help individuals with antisocial personality disorder. One can hope for a reduction in antisocial behaviors after age 40, perhaps due to a reduction in biological drives. It appears that efforts in this area are better spent in prevention and support for the individual's family.

How Should Childhood Disorders Be Treated?
The final section of the chapter looks at treatments for two of the childhood disorders. Although autism is considered a biological disorder, biological interventions have been largely ineffective. Autistic children seem to benefit the most from highly structured behavioral therapies based on principles of operant conditioning; however, the long-term prognosis for autism remains poor. More options are available for children with attention-deficit/hyperactivity disorder (ADHD). Pharmacological treatment (e.g., methylphenidate) is beneficial for many; however, its use has sparked much controversy. As with most medications, Ritalin is not a magic bullet that removes all problems. Its effect is significantly enhanced when children also receive some type of behavior modification. Recent research indicates that medication plus behavioral therapy is more effective in treating ADHD than either treatment approach alone.