by Sandi Mann
SOLUTION-FOCUSED BRIEF THERAPY (SFBT)
Also known as solution-focused therapy or brief therapy, this approach focuses on solution-building rather than problem-solving like most other approaches. Other therapists can spend a great deal of time thinking, talking and analysing problems, while the problems simply continue. The aim with SFBT is to stop analysing the problems and work on developing solutions instead, using the client’s strengths and skills. Typically, this therapy involves only three to five sessions, which is far less than most other therapies. During sessions the therapist asks questions that encourage the client to find their own solutions to problems. Types of questions used include:
• The miracle question: this is where the client is asked to imagine a miracle occurring at night while they are asleep that solves the current problem; the client is asked to think about how they will know that the problem is solved when they wake up in the morning – what will be different? What would you notice? This helps the client see a clear picture of how a future without the problem might look – and it is this vision that drives the client forward. This paves the way for a solution in small, practical steps.
• Exception questions: problems do not always remain with the same intensity all the time for everyone – sometimes we feel better or have brief periods of respite. Often, those better times are caused by us mobilizing our own coping resources. Exception questions, such as ‘Tell me about a time when you felt happy’, allow people to identify these times and to think about what resources they used to help. By exploring how these exceptions to the current difficult times happened, and highlighting the strengths and resources they used to move into an ‘exception period’, a therapist can help the client to find their own solution.
ECT (Electro-convulsive therapy)
Although this therapy is little used today, it is worth a mention here as it was once used quite commonly for severe depression and other mental health illnesses. Nowadays, more effective treatments have been developed, and between 1985 and 2002 its use in England, for example, more than halved.
The treatment developed in the 1930s when doctors noticed that some people with depression or schizophrenia, who also had epilepsy, seemed to feel better after having a fit. Based on this idea, ECT operates by passing an electrical current through the brain to produce an epileptic fit. ECT might be offered today if medications for treating severe depression have not helped or if the patient cannot tolerate the side effects. ECT is not, however, without risk of side effects, which is why it is now rarely used.
Eye movement desensitization and reprocessing (EMDR)
EMDR is increasingly being proved an effective treatment for a range of conditions – primarily PTSD (post-traumatic stress disorder) but also phobias and other anxiety conditions. Developed by the American clinical psychologist Francine Shapiro in the 1980s, it uses a natural function of the body, rapid eye movement (REM – see Chapter 18), as its basis.
EMDR requires clients to firstly focus on the main aspects of the traumatic event that is causing the problem – the visual image that usually pertains to the most disturbing part of the trauma and the negative thoughts that relate to the trauma.
The client then tracks the therapist’s finger across their visual field in rapid abrupt eye movements (the eye movements can also be created using a ‘light bar’, in which you follow a light that moves back and forth across a metal bar). During this procedure, a decrease in the emotional impact of the traumatic memory usually occurs. It is thought that the alternating left–right stimulation of the brain by the eye movements made during EMDR activates the frozen or blocked information-processing system. There is some evidence that the eye movements during EMDR perform a similar function to those that occur during REM sleep (when we dream), which we already know to have a vital information-processing function. When trauma is extreme, this process breaks down and REM sleep doesn’t bring the usual relief from distress. EMDR is thought to be like an advanced stage of the REM processing. Using eye movement, the brain processes troubling images and feelings, so that resolution of the issue can be achieved.
Mindfulness therapy
Mindfulness therapy is a rather new approach that helps clients pay attention to the present moment without judgement, using techniques such as meditation, breathing and yoga. Mindfulness training can help individuals become more aware of thoughts, feelings and their body so that these are no longer overwhelming.
Mindfulness-based stress reduction (MBSR) is a mindfulness-based cognitive therapy programme developed by Jon Kabat-Zinn at the University of Massachusetts Medical Center, which uses a combination of mindfulness meditation, body awareness and yoga to help people become more mindful. Mindfulness-based cognitive therapy (MBCT) is a psychological therapy designed to help prevent a relapse of depression, and uses traditional cognitive behavioural therapy (CBT) methods combined with mindfulness and mindfulness meditation.
A particular type of mindfulness is acceptance and commitment therapy (ACT), which is based on the two key ideas of accepting what is out of your personal control and committing to make changes to improve. The focus is on creating a rich and meaningful life without actually trying to reduce symptoms – recognizing that sometimes those symptoms need to be accepted in order to enhance one’s existence.
Medication
There are different medications to treat a range of other mental health conditions and psychiatrists or general practitioners usually prescribe them, rather than psychologists. Often psychological therapies will be carried out in conjunction with drug interventions.
Dig deeper
Website of the Human Givens Institute:
http://www.hgi.org.uk/archive/human-givens.htm#.VXimC0_BwXA
Be mindful:
http://bemindful.co.uk/
Institute for Solution-Focused Therapy:
http://www.solutionfocused.net/
Fact-check
1 Which of the following is not a form of behaviour therapy?
a Token economy
b Modelling
c Thought-stopping
d Systematic desensitization
2 CBT works by breaking seemingly overwhelming problems down into smaller parts. Which of the following is not one of these parts?
a Thoughts
b Feelings
c Actions
d Self-esteem
3 Which of the following is a CBT technique?
a Token economy
b Questioning
c Thought-stopping
d Aversion therapy
4 Maladaptive or distorted thoughts that CBT tries to change are:
a Unhelpful
b Summoned up consciously by the patient
c Implausible
d Within the patient’s control
5 Which of the following is a thinking error?
a Realizing that things can change
b Recognizing the positives
c Being kind to oneself
d Mindreading
6 The basic assumptions underlying the psychodynamic approach are:
a None of our behaviour has its root in the unconscious
b Different parts of the unconscious mind (e.g. the id, ego and superego) work in harmony with one another
c We develop defences in order to avoid the unpleasant consequences of conflict
d Our behaviour and feelings as adults (including psychological problems) are completely independent of our childhood experiences
7 Which of the following is not a humanistic therapy?
a Human givens
b Person-centred
c Gestalt
d Mindfulness
8 Which of the following is a need in human givens approaches?
a Intimacy
b Memory
c Imagination
d Emotions
9 Which of the following statements about therapies is true?
a Solution-focused brief therapy analyses a client’s childhood experiences
c CBT and mindfulness are often used in conjunction with each other
d Mindfulness involves providing solutions to problems
10 Which of the following statements about medication therapies is true?
a Psychologists tend to be against the use of prescribed medication to treat psychological problems
b Psychological therapies are often used alongside medication
c Medications are good because they have no side effects
d Psychologists often prescribe medications
17
The brain and nervous system
The brain and nervous system are the hardware that are responsible for every single human function. It is thus useful to have some understanding of how these systems are structured and how they operate. This chapter will thus outline the most important parts of the brain to be aware of as well as the structure of nerves and neurotransmitters. A brief exploration into the endocrine system is also useful to understand some of the ways that the brain exerts its effects on the body.
The brain and the nervous system make up the body’s ‘command centre’ and are responsible for its every function (see the diagram below). These are made up of two main systems: the central nervous system (CNS) and the peripheral nervous system (PNS). The CNS contains the brain and the spinal cord while the PNS contains the nerves, which leave the brain and the spinal cord and travel to different areas of the body. The PNS also sends information (via sensory nerves) gathered by the body’s sensory receptors to the CNS as quickly as possible. Once the CNS has interpreted this information, the PNS will relay the specific orders back out to the body (via motor nerves).
Diagrammatic representation of the nervous system
The central nervous system
The central nervous system (CNS) is so named because it gathers and integrates information it receives from all parts of the body and sends this information to the PNS. The brain processes and interprets sensory information sent from the spinal cord. The brain consists of three main components: the forebrain, the midbrain and the hindbrain (see the diagram below).
The forebrain is responsible for a range of functions including receiving and processing sensory information, thinking, language and motor function. The forebrain contains structures such as the thalamus (a relay station for all sensory stimuli), hypothalamus (which controls the body’s internal environment, eating, drinking, sexual behaviour and emotional arousal), amygdala and hippocampus (together these structures make up the limbic system that is often referred to as the ‘emotional brain’) and it also contains the largest part of the brain, the cerebrum or cerebral hemispheres.
Diagrammatic representation of the brain
The cerebrum or cortex is the largest part of the human brain, associated with higher brain function such as thought and action. The cerebral cortex is divided into four sections, called lobes, and is highly wrinkled to make the brain more efficient, because it can increase the surface area of the brain and the number of neurons.
Case study: Hippocampus and memory
Henry Molaison, known as ‘HM’, was 27 years old in 1953 and had suffered from severe epileptic seizures for many years. In an attempt to cure his epilepsy, a Hartford neurosurgeon, William Beecher Scoville, removed the hippocampus that lay within each temporal lobe. The operation was successful in that it significantly reduced Henry’s seizures, but it left him with severe memory loss. He was unable to remember new words, songs or faces after his surgery; he would forget who he was talking to as soon as he moved away; he didn’t know how old he was or if his parents were alive or dead; and he could not remember any events that had occurred, such as parties. He could learn at a subconscious level (his working memory and procedural memory were intact) and he learned to use a walking frame, but had no conscious memories of having used the frame, even though he retained the ability. As an experimental subject, HM was ideal, because he never grew bored of the repetitive memory tasks he was set because they always seemed new to him.
Unitl then it had not been known that the hippocampus was essential for memory. Once this was realized, HM’s story was widely publicized so that this operation to remove both hippocampi would never be done again. HM has been mentioned in almost 12,000 journal articles, making him the most studied case in medical or psychological history. Henry died in 2008, at the age of 82. Until then, he was known to the world only as ‘HM’ for his own protection, but on his death his name was revealed. After his death his brain was dissected into slices and digitized as a three-dimensional brain map that could be searched by zooming in from the whole brain to individual neurons.
Lobe of the cerebrum Function
Frontal lobe containing the motor cortex Reasoning, planning, parts of speech, movement, emotions and problem solving
Parietal lobe containing the somatosensory cortex Movement, orientation, recognition, perception
Occipital lobe containing the visual cortex Visual processing
Temporal lobe containing the auditory cortex Auditory processing, memory and speech
‘The brain is a monstrous, beautiful mess. Its billions of nerve cells – called neurons – lie in a tangled web that displays cognitive powers far exceeding any of the silicon machines we have built to mimic it.’
W. F. Allman, Apprentices of Wonder: Inside the Neural Network Revolution (New York: Bantam, 1989)
The cerebrum is divided into two halves, known as the left and right hemispheres. Each of these has a slightly different function; the corpus callosum connects the two.
The midbrain and the hindbrain together make up the brainstem. The midbrain is the portion of the brainstem that connects the hindbrain and the forebrain. The midbrain is the smallest region of the brain and it acts as a sort of relay station for auditory and visual information. The midbrain contains the reticular activating system, which is the portal through which nearly all information enters the brain.
Spotlight: Parkinson’s disease
Parkinson’s disease is one of the most common disorders of the midbrain. This progressive illness develops when dopamine-producing nerve cells in this area die off in large numbers. The midbrain may also be involved in some forms of mental illness; the dopamine hypothesis of psychosis is so called because dopamine production is often abnormally high in people with certain mental illnesses, including schizophrenia.
The hindbrain extends from the spinal cord and contains structures such as the pons and cerebellum. The cerebellum, which is associated with movement, posture and balance, is similar to the cerebrum in that it has two hemispheres and a highly folded surface or cortex. The pons is partly made up of tracts connecting the spinal cord with higher brain levels. The hindbrain also contains the medulla oblongata, which transmits signals between the spinal cord and the higher parts of the brain and is responsible for controlling such autonomic functions as respiration, heart rate and digestion. Damage to this area would thus be catastrophic.
Case study: Phineas Gage
Phineas P. Gage (1823–60) was an American railroad construction foreman remembered for his survival of a horrific accident in 1848 in which a large iron rod was driven completely through his head, destroying much of his brain’s left frontal lobe. Phineas Gage influenced nineteenth-century discussions about the mind and brain, and was perhaps the first case to suggest that damage to specific parts of the brain might induce specific personality changes.
Gage’s initial survival would have ensured him fame enough, but what really turned him into a celebrity were the observations made by John Martyn Harlow, the doctor who treated him for a few months afterward. ‘Here is business enough for you,’ a still-conscious Gage told the first doctor to treat him after his accident, in what is probably the greatest understatement in medical history.
Cage became the most famous patient in the annals of neuroscience, because his case was the first to propose a link between brain trauma and personality change. Gag
e certainly displayed some kind of change in behaviour after his injury although the exact nature, extent and duration of this change have been difficult to establish. Harlow described the pre-accident Gage as hardworking, responsible and ‘a great favorite’ with the men in his charge, his employers having regarded him as ‘the most efficient and capable foreman in their employ’. But these same employers, after Gage’s accident, ‘considered the change in his mind so marked that they could not give him his place again’ since he was reportedly unreliable, partial to swearing and often making inappropriate remarks – a description that would later be termed ‘disinhibited’, a classic term for what can occur after damage to the frontal lobes.
Gage survived for 12 years following the accident but became ill with epilepsy (a condition now thought to be related to his injury). When he died, Phineas was buried with the tamping iron that, once removed from his head, had accompanied him wherever he went. Seven years later, he was exhumed at Dr Harlow’s request – and now both his skull and the tamping iron are on display at the Harvard Medical School.