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One of the goals of therapy is to help a person stop repeating and reenacting destructive patterns and start looking for better solutions to difficult situations. This goal is reflected in the following poem:

Three types of therapy are: traditional therapies, psychotherapy, and biomedical therapy. All help people with psychological disorders such as depression, anxiety, and schizophrenia. Traditional therapies incorporate a variety of practices developed over centuries within different cultures, often using natural remedies and holistic approaches to mental health healing. These therapies may include the use of herbs, massage, and rituals aimed at balancing the individual’s physical, mental, and spiritual health. For example, Traditional Chinese Medicine utilises techniques like acupuncture and dietary therapy to correct imbalances in the body’s energy, or Qi, while Indigenous healing methods might involve ceremonies, spiritual healings, and the use of medicinal plants, reflecting deep connections to the community and the natural world. Psychotherapy is a psychological treatment that employs various methods to help individuals overcome personal problems or attain personal growth. In modern practice, psychotherapy has evolved into what is known as psychodynamic therapy, which will be discussed later. Biomedical therapy involves medication and/or medical procedures to treat psychological disorders. In this discussion, we will first explore two types of traditional therapies: Traditional Chinese Medicine and Indigenous healing methods.

Traditional Therapies

Traditional Chinese Medicine

Traditional Chinese Medicine (TCM) offers a diverse range of treatments that have been investigated for their potential benefits in managing psychological disorders such as depression and anxiety. TCM employs therapies such as acupuncture, herbal medicine, Tai Chi, and Qi Gong, each of which has been studied to varying extents for its effects on mental health.

Acupuncture (very thin needles are inserted into specific points on the body) is particularly notable for its application in treating psychological disorders. Research suggests that it can effectively reduce symptoms of depression and anxiety. Clinical trials have indicated that acupuncture is safe and can provide clinically relevant benefits in reducing the severity of depression, particularly in patients who also experience anxiety and somatic symptoms (Yanfen She, 2022).

Herbal medicine is another significant component of TCM with a rich tradition of use in treating emotional disorders. Herbal formulas like Xiao Yao San have been systematically reviewed and shown to produce antidepressant effects in clinical settings. Studies suggest that these effects may be mediated through pathways such as the JNK signaling pathway in the hippocampus (Zhang et al., 2012; Zhao et al., 2020). The JNK signaling pathway is a series of interactions within a cell that helps it respond to stress and inflammation. Think of it like a chain reaction that starts when the cell detects stress, leading to changes that help the cell survive or adapt to the situation. This pathway can influence how cells grow, repair themselves, or even how they die, which is important for keeping the body healthy and balanced.

Moreover, TCM practices such as Tai Chi and Qi Gong have been researched for their impact on mental health, with evidence suggesting that they can improve symptoms of anxiety and depression. These mind-body therapies are considered beneficial not only for general health but also for specific conditions such as Parkinson’s disease, where they help in managing symptoms and enhancing life quality (Kamieniarz et al., 2021).

However, the research on TCM emphasises the need for a holistic approach and often points out the limitations of studying isolated components of this traditional system. The effectiveness of TCM may not be fully captured by conventional research methodologies focused on single treatments, highlighting the importance of an integrated approach to understanding and applying these practices in clinical settings.

Overall, TCM provides a valuable array of treatments that can be considered for inclusion in comprehensive mental health care strategies, especially for patients interested in non-pharmaceutical alternatives or complementary therapies.

Indigenous Traditional Therapies

Indigenous healing practices for psychological disorders encompass a diverse array of traditional therapies deeply woven into the fabric of cultural identity and community. These practices often include medicinal plants, spiritual healing, physical therapies, and communal ceremonies such as sweat lodges, drumming, and storytelling, which are integral to maintaining community bonds and spiritual wellness. Recognised increasingly for their value in addressing the impacts of colonisation and cultural loss, these therapies are crucial not only for treating mental illness but also for cultural reclamation and identity restoration (Connors & Maidman, 2001).

Research highlights the “two-eyed seeing” approach, advocating for the integration of Indigenous and Western healing methods to enhance mental health care’s cultural competence. This integration has shown promise in improving resilience and effective coping during crises, suggesting that therapeutic practices aligning with an individual’s cultural perspective can significantly bolster mental health outcomes (Connors & Maidman, 2001). For instance, studies in Northern Ontario have demonstrated that combining Indigenous healing practices with harm reduction strategies markedly improves outcomes for patients with substance use disorders and intergenerational trauma (BMC Health Services Research, 2020).

Further research supports the integration of traditional Indigenous methods with Western therapies to address complex trauma, highlighting the importance of respecting historical and cultural dimensions in treatment approaches (Harm Reduction Journal, 2020). A comprehensive review also emphasises the potential of collaborative care models in primary healthcare, which facilitate the inclusion of Indigenous values and practices, thus promoting better health outcomes (BMJ Open, 2020). Additional studies, such as those conducted in rural Nepal, advocate for integrating traditional and biomedical care pathways to enhance mental well-being by incorporating local cultural practices (Sharma et al., 2021).

These findings collectively support the integration of Indigenous healing practices within modern healthcare frameworks, ensuring that treatments are culturally appropriate and respectful of traditional knowledge. Such approaches are gaining recognition for their effectiveness in not only addressing the symptoms of psychological disorders but also in healing the significant community and cultural wounds impacting Indigenous peoples’ mental health.

Psychotherapies

Next let’s consider the various psychotherapeutic orientations outlined in Table PY.1 (many of these orientations were discussed in the Introduction chapter).

Integrative Approach to Psychotherapy Treatment

Up to this point we have considered the different approaches to psychotherapy under the assumption that a therapist will use only one approach with a given patient. But this is not the case; the most commonly practiced approach to therapy is an integrative (eclectic) therapy, an approach to treatment in which the therapist uses whichever techniques seem most useful and relevant for a given patient. For bipolar disorder, for instance, the therapist may use both psychological skills training to help the patient cope with the severe highs and lows, and also suggest that the patient consider biomedical drug therapies (Newman, Leahy, Beck, Reilly-Harrington, & Gyulai, 2002). Treatment for major depressive disorder usually involves antidepressant drugs as well as CBT to help the patient deal with particular problems and a sociocultural approach to provide important context for the patient’s experiences (McBride, Farvolden, & Swallow, 2007).

Biomedical Therapies

Individuals can be prescribed biologically based treatments or psychotropic medications that are used to treat mental disorders. While these are often used in combination with psychotherapy, they also are taken by individuals not in therapy. This is known as biomedical therapy. Medications used to treat psychological disorders are called psychotropic medications and are prescribed by medical doctors, including psychiatrists. In Louisiana and New Mexico, psychologists are able to prescribe some types of these medications (American Psychological Association, 2014).

Different types and classes of medications are prescribed for different disorders. An individual with depression might be given an antidepressant, an individual with bipolar disorder might be given a mood stabiliser, and an individual with schizophrenia might be given an antipsychotic. A person suffering with complex post-traumatic stress disorder might be given a psychedelic. These medications treat the symptoms of a psychological disorder by altering the levels or effects of neurotransmitters. For example, each type of antidepressant affects a different neurotransmitter, such as SSRI (selective serotonin reuptake inhibitor) antidepressants that increase the level of the neurotransmitter serotonin, and SNRI (serotonin-norepinephrine reuptake inhibitor) antidepressants that increase the levels of both serotonin and norepinephrine. They can help people feel better so that they can function on a daily basis, but they do not cure the disorder. Some people may only need to take a psychotropic medication for a short period of time. Others with severe disorders like bipolar disorder or schizophrenia may need to take psychotropic medication for a long time.

Psychotropic medications are a popular treatment option for many types of disorders, and research suggests that they are most effective when combined with psychotherapy. This is especially true for the most common mental disorders, such as depressive and anxiety disorders (Cuijpers et al, 2014). When considering adding medication as a treatment option, individuals should know that some psychotropic medications have very concerning side effects. Table PY.2 (in the section Biological Approaches to Treatment) shows the commonly prescribed types of medications, how they are used, and some of the potential side effects that may occur.

Electroconvulsive therapy (ECT)

Another biologically based treatment that continues to be used, although infrequently, is electroconvulsive therapy (ECT) (formerly known by its unscientific name as electroshock therapy). It involves using an electrical current to induce seizures to help alleviate the effects of severe depression. The exact mechanism is unknown, although it does help alleviate symptoms for people with severe depression who have not responded to traditional drug therapy (Pagnin, de Queiroz, Pini, & Cassano, 2004). About 85% of people treated with ECT improve (Reti, n.d.). However, the memory loss associated with repeated administrations has led to it being implemented as a last resort (Donahue, 2000; Prudic, Peyser, & Sackeim, 2000). A more recent alternative is transcranial magnetic stimulation (TMS), a procedure approved by the FDA in 2008 that uses magnetic fields to stimulate nerve cells in the brain to improve depression symptoms; it is used when other treatments have not worked (Mayo Clinic, 2012).

Treatment Modalities

There are several modalities of treatment: individual therapy, group therapy, couples therapy, and family therapy are the most common. In an individual therapy session, a client works one-on-one with a trained therapist. In group therapy, usually 5–10 people meet with a trained group therapist to discuss a common issue (e.g., divorce, grief, eating disorders, substance abuse, or anger management). Couples therapy involves two people in an intimate relationship who are having difficulties and are trying to resolve them. The couple may be dating, partnered, engaged, or married. The therapist helps them resolve their problems as well as implement strategies that will lead to a healthier and happier relationship. Family therapy is a special form of group therapy. The therapy group is made up of one or more families. The goal of this approach is to enhance the growth of each individual family member and the family as a whole.

Inclusive Therapy Models: Sociocultural, Feminist, and Anti-Oppression Approaches

The sociocultural perspective examines behaviours and symptoms within the context of an individual’s culture and background, emphasising the integration of cultural and religious beliefs into the therapeutic process. This approach is supported by evidence suggesting that cultural competency in therapy can significantly affect treatment outcomes (Chu et al., 2019).

Research indicates that ethnic minorities are less likely to access mental health services compared to their white counterparts. Barriers to treatment include not only lack of insurance, transportation, and time but also cultural views that stigmatise mental illness, fears about treatment, language barriers, and concerns about not being understood or respected by practitioners (Gopalkrishnan, 2018).

Feminist and anti-oppression therapies actively address the power dynamics and systemic inequalities that affect mental health by acknowledging and confronting gender, racial, and socioeconomic disparities. These approaches aim to empower clients by validating their experiences and fostering an egalitarian therapeutic relationship. By striving to understand and dismantle the biases and structural barriers clients face, these models facilitate a more inclusive and accessible mental health practice, enhancing engagement and satisfaction among marginalised groups (Brown, 2018; Coleman et al., 2019).