Therapeutic Setting

Video Transcription

Hello, class. Now, since we've talked a lot about how therapy has actually worked, let's talk about some of the settings or the places where therapy actually takes place. And we're going to go over four distinct categories of therapeutic settings in our class today. So the first one is what we'll call private settings. And these are where you can facilitate more of a private, away-from-the-public sort of therapy session, either by yourself or with a small group.

And these occur, generally, in private practice offices. This is where one or more psychologists or psychiatrists come together and create an office where people can come and get away from other types of settings, like get away from home or work, and come specifically to deal with their mental health issues And this is, again, one of the most common sorts of settings that you're going to be seeing. However, a lot of mental health professionals are also looking towards a home setting, where they come specifically to your home where you're able to feel a little bit more comfortable and a little more open, which can help out a lot in establishing that sort of therapeutic alliance or relationship and help you to open up so that you can overcome some of those mental health issues.

Now, the next type of setting we're going to talk about and probably the most controversial of the bunch is an institutional setting. Institutional settings are specific settings or organizations that are set up to help people with mental health issues. One example is an existing hospital or clinic which might have a wing or a section that's devoted specifically to mental health care. And the benefit of this, instead of dealing with, say, a private practice, is that you have access to all sorts of medical tools which might be helpful, particularly in cases where there are more severe issues that are occurring-- things like brain scanning tools, surgery, or pharmaceuticals, biological therapies that can help out with psychotherapies.

Along with that, we've got private homes and centers where people that have behavioral or mental health needs can go and live and receive more assistance on a daily or a regular basis. An example of one of these places is Devereux, which is a nonprofit organization that spans the country. It's one that I've had dealings with personally. And what they do is they help people with severe behavioral problems or mental retardation to come and live in a setting with others in similar situations and also with experienced staff that can help them on a daily basis.

Now, the next one we'll talk about-- and again, most controversial-- is mental hospitals. And these are private or state-run institutions. They're specifically dealing with psychiatric issues.

People inside of them are generally hospitalized, which is to say that they're placed in a protected, therapeutic environment that's staffed by mental health professionals. Now, these types of stays in a mental hospital can be either short-- and in fact, most of them are 20 days or less-- or they could be more long-term. They can also be voluntary or involuntary, which is to say that they can be mandated by a court or something like that. However, a person who's in a mental hospital can ask to leave. And if there's no other reason for them to stay, state laws in most states require that within two to seven days they should be allowed to leave.

Now, the circumstances that require them to stay in a hospital, if they're mandated to stay there or to stay for a longer period of time, is that the person is either a danger to themself or to other people. And that's the key phrase to remember when we're talking about a mental hospital. If a person is a danger to themselves or others, they're required to stay in an institution like that. However, if they are staying voluntarily or not, they always have a right to be informed about why they're there and about what kind of treatments they're receiving. And they also have a right to refuse if they think that a certain type of treatment is either experimental or unnecessary for them.

Since around the 1980s, there has been an ongoing trend it what we call deinstitutionalization, which is to say the reduction in the use of full-time commitment to mental hospitals and mental institutions, patients with serious mental problems. There's been, historically, some issues that go along with the use of mental hospitals. For example, some of the hospitals are viewed as more of a prison-like setting. There has been very poor treatment historically, as well. People are treated inhumanely while they're a part of the mental hospitals. And also, a lot of times, the settings can exacerbate problems that people originally had because patients are exposed only to other patients with other mental problems.

However, this deinstitutionalization trend and actually the shutting down of a lot of mental hospitals has also led to a series of other problems because a lot of these people are being removed from settings that are dangerous or self-destructive to themselves. Now these patients are being released without adequate care. They don't have the support that they otherwise would get inside of a mental hospital. And a lot of these patients are also ending up in prisons, where the focus is not on their mental health and rehabilitation, but rather on the crimes that may have committed. So you can see that this trend is dangerous and that there is actually a need for institutions like this.

Now, going along with that, helping people make transitions from mental hospitals and other institutions like prisons, we have things called halfway houses. Halfway houses are community-based institutions that help people to make the transitions from one institution to the community and to independent living. And this goes along with the next category that we'll be taking a look at as well.

Community mental health centers are able to provide mental health care to specific areas and populations within cities and towns. They can also provide preventative measures to a lot of these areas-- things like consultations, education about issues within mental health care, and crisis intervention. They can also deal with wider issues that are troubling the community-- things like unemployment, drug abuse, gang activity, anything that might be specifically influencing the mental health of the people within the community.

So in a lot of ways, community health centers can be very effective as therapeutic settings because they consider the wider context of what's occurring. They can consider the culture. They can consider the backgrounds of the people living within the community. This makes mental health care a bit more accessible to people because it's at a community level.

And it can also make it more personalized to the community specifically. A lot of people that are working within a community health care center come from similar situations to the ones that they're dealing with. They understand the people and the situations. They can relate. It's also important to know that, in the community, a lot of religious organizations also provide mental health care assistance.