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Mental Health and Psychosocial Treatments in the Nursing Home

Aug 17, 2007
Psychosocial treatments, an important form of mental health intervention includes certain forms of psychotherapy (often called talk therapy) and social skills training. They are helpful in providing support, education, and guidance to emotionally troubled residents and their families. Studies tell us that psychosocial treatments can help residents keep their moods more stable, stay out of the hospital, and generally function better.

A licensed psychologist, social worker, or counselor typically provides these therapies. The therapist and a psychiatrist may work together as the psychiatrist prescribes medications and the therapist treats the resident and monitors his/her progress.

The number, frequency, and type of psychotherapy sessions a resident has should be based on his or her individual needs. As with medication, it is important to follow the treatment plan for psychosocial treatments to gain the greatest benefit.

Individual Psychotherapy

Individual psychotherapy involves regularly scheduled sessions between the patient and a mental health professional such as a psychologist, psychiatric social worker, or psychiatric nurse. The goal of this treatment is to help residents understand why they are acting and thinking in ways that are troubling or dangerous to themselves or others so they have more control over their behaviors and can correct them.

Talk-therapy sessions may focus on a residents current or past problems, experiences, thoughts, feelings, or relationships. By sharing experiences with a trained, knowledgeable, and understanding person--by talking about his/her world with someone outside it--people with emotional disorders may gradually understand more about themselves and their problems.

Individual psychotherapy is used successfully to treat emotional, behavioral, and social problems in residents with schizophrenia, bipolar disorder, attention-deficit/hyperactivity disorder, depression, eating disorders, and anxiety disorders among many others.


Psycho-education involves teaching residents about their illness, how to treat it, and how to recognize signs of relapse so that they can ask for necessary treatment before their symptoms worsen. Family psycho-education includes teaching coping strategies and problem-solving skills to families of residents with psychiatric dysfunctions to help them deal more effectively with their troubled family member. Family psycho-education reduces distress, confusion, and anxieties within the family, which may help the resident, recover faster.

Psycho-education in combination with medication has been used successfully to treat people with schizophrenia, bipolar disorder, attention-deficit/hyperactivity disorder (ADHD) and depression as well as to help their loved ones.

What are examples of specific psychotherapies?

Mental health therapists offer several different types of psychotherapy. In general no one type of therapy is necessarily better than another type.

When deciding which therapy (or therapies) will likely be the most successful treatment option for an individual resident, a psychotherapist considers the nature of the problem to be treated and the consumer's personality, cultural and family background, and personal experiences. Note that a psychiatrist or psychotherapist (or both) may offer each of the following therapies to an individual, family, couple, or group.

Interpersonal Therapy

Interpersonal therapy focuses on the relationships a resident has with others. The goal of interpersonal therapy is, of course, to improve interpersonal skills. The therapist actively teaches residents to evaluate their interactions with others and to become aware of self-isolation and difficulties getting along with, relating to or understanding others. He or she also offers advice and helps residents make decisions about the best way to deal with others.

Interpersonal therapy is a relatively new psychosocial mental health treatment used most frequently to help residents with bipolar disorder, attention-deficit/hyperactivity disorder (ADHD), depression, eating disorders, and generalized anxiety disorder.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) helps residents learn to change inappropriate or negative thought patterns and behaviors associated with their illness. The goal is to recognize negative thoughts or mind-sets (mental processes such as perceiving, remembering, reasoning, decision making, and problem solving) and replace them with positive thoughts, which will lead to more appropriate and beneficial behavior.

For instance, cognitive behavioral therapy tries to replace thoughts that lead to low self-esteem (I can't do anything right) with positive expectations (I can do this correctly). Combined with effective medication, CBT can successfully treat residents with schizophrenia, bipolar disorder, ADHD, depression, eating disorders, generalized anxiety disorder and panic disorder.

Exposure Therapy

A type of behavioral therapy known as exposure therapy or exposure and response prevention is very useful for treating obsessive compulsive disorder (OCD) and post-traumatic stress disorder (PTSD). During exposure therapy, a resident is deliberately exposed to whatever triggers the obsessive thoughts or reaction to a previous traumatic experience under controlled conditions. S/he is then taught techniques to avoid performing the compulsive rituals or to work through the trauma.

Dialectical Behavior Therapy (DBT)

Dialectical behavior therapy (DBT) was developed to treat chronically suicidal individuals, but it has evolved into a treatment for multi-disordered residents with borderline personality disorder (BPD) as one of their diagnoses. DBT has also been adapted for behavioral disorders involving emotion dysfunction (such as substance dependence in individuals with BPD and binge eating) and for treating people with severe depression and suicidal thoughts.

DBT combines the basic strategies of behavior therapy with a philosophy that focuses on the idea that opposites may really not be opposite when looked at differently.

As a comprehensive mental health treatment, DBT:

improves destructive behaviors,

improves motivation to change (by modifying inhibitions and providing positive reinforcement,

ensures that new capabilities generalize to the natural environment

provides a treatment environment that emphasizes what patients and therapist are best at when working together

enhances the therapists motivation and ability to treat patients effectively.

In standard DBT, different types of mental health and psychosocial therapies--including individual psychotherapy, group skills training, and even phone consultations--are used.
About the Author
Dr Shery is in Cary, IL, near Algonquin, Crystal Lake, Marengo and Lake-in-the-Hills. He's an expert geriatric psychologist. Call 1 847 516 0899 and make an appt orlearn more about counseling at: http://www.nextdayappointment.com
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