Contemporary Psychology: Psychological Treatment in a Hospital Setting

Hospital based psychiatry departments tend to address a variety of problems in several fields. First, the department is usually divided into different units depending on the severity of the condition that is presented by the patient. Inpatient units usually serve patients whose conditions are more severe. Such patients are usually those who present a potential danger to themselves and/or others. If a new patient is screened and hospital staff members find that the patient has either suicidal or homicidal tendencies that he/she is likely to act on, the patient will be admitted to an inpatient unit. In this unit, the patient can be kept safe while he/she is being treated. Patients who become very disorganized and are unable to function by themselves will often be referred to an inpatient unit. Similarly if a patient needs to be detoxified from drugs and the process requires considerable medical supervision, the patient will be admitted to an inpatient substance abuse unit. In this unit, the patient can be closely monitored, physically and medically. The less severe conditions which require less medical supervision are referred to outpatient clinics, where the patient comes to the hospital for specific appointments to address the specific problem which he/she presented during the intake process.

Non drug-related outpatient clinics, which are based in hospitals, usually serve patients who present with symptoms associated with depression, anxiety and psychosis. Such patients usually present with problems at work, in their relationship with loved ones and with overall coping ability. Many of these patients had very difficult childhoods with issues of deprivation and abuse.

If these patients are manageable with medication and psychotherapy, treatment will continue on an outpatient basis. If, however, a regression occurs and the patient no longer can be treated on an outpatient basis, he or she will be referred to an inpatient unit.

Children with psychiatric problems are also served in the outpatient clinic. Individual, group and family treatment is available.

Some outpatient psychiatry services also have special treatment units which address the needs of AIDS patients who also have mental health issues.

Partial Hospitalization Program

There is a level of care which is in between inpatient and outpatient clinic care. This is partial hospitalization, where the patient comes for the day and then goes home after a day of treatment. This kind of treatment is designed for individuals who have severe problems but who are not dangerous to themselves or others.

Intensive Psychiatric Rehabilitation Treatment (IPRT)

This is a five-day-a-week program where patients return home every day.

This unit provides support to patients who need help with re-entering life. Such help can focus, for example, on skills that are required to find a new job. Patients are primarily given educational training.

Inpatient Substance Abuse Treatment Programs

Inpatient substance abuse treatment programs are divided into short-term detoxification units, and those of longer duration called rehabilitation units or, in short, rehab. In the short-term units, the patient spends a few days to help him/her stop abusing illicit drugs. In the rehabilitation unit, the patient spends about a month. In both the detox and rehab programs, a considerable amount of individual and group treatments are used. Patients are also given educational seminars about drug abuse, and, if appropriate, given medication to help them with the detoxification process.

Outpatient Drug Treatment Services

Chemically Dependent Outpatient Services (CDOS)

This program is designed to help chemically dependent individuals who require a minimally restrictive environment. The program accepts patients who have only minor psychiatric problems. Patients come five days a week. The program is usually completed within nine months to a year.

Mentally Ill Chemically Addicted (MICA)

This program is designed for patients who are diagnosed with having drug problems and mental health issues. Patients come to the program every day and go home in the afternoon. The goal is to relieve the patients of drug addiction and help them become psychologically stable. Patients complete the program in approximately one year.

Methadone Maintenance Treatment Program (MMTP)

This is a program designed for patients who have been addicted to heroin or other opiate- type drugs. The program involves the dispensing of methadone at different dosages to patients. Patients come to the clinic between two and six days a week depending on how cooperative they are. The more cooperative they are, the less they need to come to the clinic and the more they are trusted to take the medication independently. Patients stay on this program for as long as necessary.

Psychiatric Emergency Room.

Some hospitals have an emergency room which is specific to patients with mental health problems in addition to the regular emergency room. Such an emergency room is equipped with staff who are highly trained to deal with psychiatric emergencies and to refer patients to appropriate follow-up care.

Mobile Crisis Team

This is a small, mobile unit which makes visits to the residences of patients who either cannot or do not want to come to the hospital. Clinical interventions are made right at the residence of the patient. A psychiatrist, psychologist and social worker make up the team. The team also makes follow-up appointments for the patient at various clinics.

The Process of Psychotherapy

As part of the treatment process, patients come to individual as well as group psychotherapy. In psychotherapy they are encouraged to talk about everything: about the past, the present and the future; about the stress they had to endure at various times during their lives; about difficult and abusive relationships; about what they think got them ill and what they believe will get them better; about what their aspirations are for themselves, their spouses and children.

The talking helps them hear their own thoughts and helps them think of their lives in a different way. New connections are made between causes and effects. A new understanding develops, and with it, a chance to chart a new course in life that could lead to more happiness and less frustration.

The therapeutic relationship that develops in the treatment with the therapist and the other group members helps the patients develop new approaches to those around them. Such relationships serve to improve the patients’ ability to relate to those they encounter in everyday life. This can lead to less stress and alleviation of symptoms that the patients came to the hospital for.

In addition to the above techniques, staff members may use behavior modification, relaxation techniques and cognitive-behavioral therapy, among others, to help patients overcome their difficulties.

In summary, psychological and psychiatric treatment in a hospital setting provides individuals with a wide range of treatments and a wide variety of treating staff.

The success of the treatment depends, for the most part, on the dedication of the staff and the cooperation of the patient.

Dr. Gideon Freudenthal is a Psychologist at Interfaith Medical Center. He is also in private practice in Manhattan and Brooklyn, NY

Contemporary Psychology: The Facts of Psychological Assessments

Dr. Barbara Principe is an adjunct professor of psychology at Teachers College, Columbia University.
She coordinates the literacy services at The Center for Educational & Psychological Services at Teachers College.
Dr. Barbara Principe is also a psychologist and a clinical supervisor at Interfaith Medical Center, Center for Mental Health.

Psychological assessments are used in many areas: education, industry, the military and the legal system, to name a few. In the area of education, the need for psychological assessments usually arises when a teacher or parent wants to understand why a child is not functioning well relative to his or her peers. For example, the child may exhibit problems with reading or the child may not be motivated to learn at school.

Psychological assessments can serve an important function in changing how the child is perceived. The actions of the child may seem deliberate but may actually have their root in particular problems that may be revealed through an assessment. For example, a child who has an attention deficit-hyperactivity disorder may appear to his or her parents and teacher as someone who intentionally disrupts the class by walking around the room and not focusing on class work. This incorrect perception may cause the teacher or parent to see the child as uncooperative and reprimand the child. This, in turn, can cause the child to devalue his/her own worth. This may lead to problems with low self-esteem.

If such a child is assessed it is likely that the existence of an attention deficit-hyperactivity disorder will be revealed. This will then help the parents and the teacher realize that the child’s behavior is not intentional and therefore, there will not be a need to blame the child or reprimand him/her for the behavior. This, in turn, will reduce the likelihood that the child will attack his/her self worth. Instead the teacher and the parent, based on the recommendations included in the assessment report, may seek remedial help for the child.

Additional remedial work from outside sources, such as a learning center or tutor, may be suggested. Sometimes an assessment may point to a need to administer additional assessments in a related field such as speech pathology and audiology to correct speech and hearing problems that may have been discovered during the psychological assessment.

If it is suspected that emotional factors are part of the presenting problem, it is important for the psychologist to assess such factors as part of the comprehensive psychological assessment. For example, if the child appears sad, could it be that the child is not expecting anything good to happen? Has the child never been praised for good work? Does the child feel that he/she cannot do well academically or that he/she has not learned the skills necessary to make friends? Emotional factors such as these need to be fully identified and understood since they can have a significant effect on how the child performs skills which are involved in academic performance.

There are other examples where psychological assessment can drastically change one’s life. Several years ago, this writer became aware of how an individual was placed in an institution for the developmentally disabled as a young adult. He lived there for years. Later on, when this adult was properly assessed, it was found that while he had some emotional problems, he was not developmentally disabled. Hence, he never needed to be in an institution. The change that was triggered by the psychological assessment led to a life of a normal adult with all the potentials one can imagine.

Placement issues are also common in the case of custody and foster care decisions. Psychological assessments can help determine which home the child should be placed in and can be used to make a good match between a foster child and a prospective foster family.

In the field of industrial psychology, the psychologist may assess the situation in a work place to find out why workers are not productive and what can be done to help them become more productive. The military psychologist may want to assess soldiers to find out which soldiers would perform better in a specific job, such as gunner, radio operator, pilot and so forth.

In the field of psycho-neurological assessment, psychologists can pinpoint how brain injury has affected the functioning of an individual. It can be determined exactly what is not functioning well. Various types of memory loss, perceptual abilities, executive functions, attention and concentration can all be affected by brain injury. The neuro-psychologist can come up with recommendations for remedial work that can restore or ameliorate the effect of the damage caused by brain injury. There are many cases where even severe injury can be corrected to such a degree that functioning is significantly restored.

In the legal system, the work of psychologists is very important, at times, in deciding on the degree of damage an individual sustained in an accident within the context of a court settlement.

There is an interesting case of how a combination of neuropsychological issues and legal issues helped to make a determination about The Last Will and Testament of a brain injured patient. Some years ago, an elderly woman was placed in a rehabilitation center after a brain injury. She was also cared for by her home health aid, who apparently was very dedicated and kind to her. The brain injured woman decided after a while to bequeath her house to the home health aid.

After the woman died, the home health aid claimed the house. Family members of the deceased woman, who were never around before and never visited her, objected and moved to block the transfer of the house to the home health aid. They wanted the house to be given to them, as they claimed that their relative was brain injured and hence, mentally incompetent at the time she wrote the Will.

A legal battle ensued where the District Attorney’s office asked for the help of the psychologist, who conducted an evaluation of the woman prior to her death.The psychologist determined at the time of the evaluation that the woman was competent and that she made the decision about the house in sound mind. The District Attorney’s office removed the block on the transfer of the house and the house went to the loyal home health aid, who stayed with the woman until her death.

As we can see, reliable assessment can make an important difference in many areas. In fact, there are few cases where psychological assessments are not useful. In the end, assessments are as good as the organization or professionals that conduct them. Therefore, choosing the right organization or professionals to carry out the assessment is very important in obtaining the desired information.

Gideon Freudenthal Ph.D. is a clinical Psychologist and Host of “Contemporary Psychology”