Intervention

Photo by: marco mayer

Definition

A standard dictionary defines intervention as an influencing force or act that occurs in order to modify a given state of affairs. In the context of behavioral health, an intervention may be any outside process that has the effect of modifying an individual's behavior, cognition, or emotional state. For example, a person experiencing stress symptoms may find a variety of interventions effective in bringing relief. Deep breathing, vigorous exercise, talking with a therapist or counselor, taking an anti-anxiety medication, or a combination of these activities are all interventions designed to modify the symptoms and potentially the causes of stress-related discomfort.

The term is also used to describe a specific process designed to break through denial on the part of persons with serious addictive disorders. Interventions in this sense of the word involve carefully orchestrated confrontations in which friends, family members, and (in many cases) employers confront the person with the negative impact and consequences of his or her addiction . The goal of an intervention is to bring the addicted person to acknowledge that he or she suffers from a disorder and agree to treatment. This goal, however, is not always realized.

Description

According to the Report of the Surgeon General on Mental Health published in 1999, one in five Americans in a given year will experience behavioral health difficulties of sufficient magnitude and discomfort as to benefit from some form of therapeutic intervention. Unfortunately, only a small number of these persons seek help. The report goes on to state that the efficacy of mental health treatments is now well documented and a range of treatment interventions exist for even the most serious mental disorders.

There is no one-size-fits-all-intervention for behavioral health disorders. Recent research advances and greater understanding of behavioral health problems have provided an expanded range of treatments that promise better outcomes than those available in the past. For people who overcome the barriers of stigma , discrimination, and limited access, there is a broad variety of helpful interventions from which to choose. Both personal preference and the severity of discomfort may influence the choice of "talk therapy," the use of medications, participation in self-help or support groups , or even inpatient treatment. In most cases, a combination of different interventions has proven to be most effective. As a result, many therapists tend to be eclectic in their practice and use a combination of approaches to in order to be as effective as possible with a wide variety of people.

Psychotherapy or "talk therapy" involves face-to-face meetings with a therapist who may specialize in a certain approach to treatment.

Psychoanalysis is the oldest form of "talk therapy." It is a long-term form of treatment intended to uncover a person's unconscious motivations and early patterns in order to resolve present issues.
Behavioral therapy is designed to change thinking patterns and behavior. Exposure therapy is a subtype of behavioral therapy that is useful in treating obsessive-compulsive disorder and post-traumatic stress disorder . The client is deliberately exposed to stimuli that trigger the painful thoughts or feelings under carefully controlled conditions that include support from the therapist. The individual is then taught techniques to avoid performing the compulsive behaviors or to work through the traumatic event.
Cognitive therapy seeks to identify and correct dysfunctional thinking patterns that lead to troublesome feelings or behavior.
Family therapy includes discussion and problem-solving sessions that include all members of the family.
Group therapy takes place in a small group with the guidance of a therapist. The focus is on individual issues; group members assist each other in problem solving.
Movement, art, and music therapists use these forms of creative expression to help people deal with strong emotions that are less easily handled in a "talk therapy" format.

Drug therapy involves the use of prescribed medications to treat the symptoms of certain mental or emotional disorders. It is important for patients to be aware of possible side effects of the medications; to inform the doctor of all other medications and alternative remedies that they are taking; and to have their blood, blood pressure, or other vital signs monitored regularly by the prescribing physician.

Electroconvulsive therapy (ECT) is used to treat depression and a few other specific conditions that have not responded to other interventions. It involves a controlled series of electric shocks to certain areas of the brain . It has been proven effective for some people despite the fact that it continues to be controversial. Patients should be fully aware of the side effects of ECT and assure themselves that the professional has been properly trained to administer ECT.

Psychosocial treatments may include talk therapy and medication in combination with social and vocational training to assist people recovering from severe mental illnesses. Psychosocial interventions may also include education about the illness itself, techniques for managing its symptoms, and ways in which friends and family members can help.

Psychoeducation is a word used to describe the process of teaching people about their illness, its treatment, and early warning signs of relapse, so that they can seek treatment before the illness worsens. Psychoeducation may also include learning about coping strategies, problem solving, and preparation of a crisis plan in the event of a relapse or future episode.

Self-help groups and support groups are another form of intervention that has become increasingly common in recent years. They exist for almost all disorders and are often based on the basic principles and values of the Alcoholics Anonymous movement founded in the 1930s. Although they are not led by professionals, these groups may be therapeutic because members give one another ongoing support and assistance. Group members share frustrations and successes, recommendations about specialists and community resources, and helpful tips about recovery. They also share friendship and hope for themselves, their loved ones, and others in the group. Unqualified acceptance by other people can be a powerful intervention for people recovering from a mental illness or addictive disorder.

Preparation

A common question about interventions concerns sources of help or further information. Many communities have a local hotline number that provides referrals and resources, or a mental health association that can direct callers to appropriate clinics, agencies, or groups. Helping resources may include the following:

A community mental health center, usually a part of the state's department of mental health.
Local mental health organizations with which the reader may be familiar.
Family physicians.
Clergy or spiritual counselors.
Family service agencies, including charities and family or social services sponsored by various churches, synagogues, or other religious groups.
High school or college guidance counselors.
Marriage and family counselors.
Child guidance counselors.
Accredited psychiatric hospitals.
Hotlines, crisis centers, and emergency rooms.

There are several categories of mental health professionals who have been specially trained to provide a range of interventions to relieve suffering, treat specific symptoms, or improve overall mental health. Competent professionals are licensed or certified by a particular specialty board or state licensing body. Their credentials imply a certain level of education, training, experience, and subscription to a code of ethics. Mental health professionals include:

Psychiatrists . Psychiatrists are medical doctors with specialized training in the diagnosis and treatment of behavioral and emotional illnesses. They are qualified to prescribe medications. They may also specialize in certain fields within psychiatry, such as child/adolescent or geriatric psychiatry.
Psychologists . These professionals are counselors with a doctoral degree (Ph.D. or Psy.D.) and two or more years of supervised work experience. They are trained to make diagnoses, administer and interpret psychological tests, and provide individual, family and group therapy.
Clinical social workers . Clinical social workers have completed a master's degree in social work from an accredited graduate program. They are trained to make diagnoses and provide individual, family and group therapy.
Licensed professional counselors and mental health counselors also hold a master's degree with supervised work experience and are trained to make diagnoses and provide individual, family and group therapy.
Certified alcohol and drug abuse counselors. These professionals have specialized training in the treatment of alcohol and drug abuse. They are able to diagnose and provide counseling to individuals, families and groups.
Nurse psychotherapists. Nurse psychotherapists are registered nurses (RNs) with specialized training in psychiatric and mental health nursing. They can diagnose disorders and provide counseling to individuals, families and groups.
Marital and family therapists. These counselors have completed a master's or doctor's degree with specialized training in marital and family therapy. They are also trained to diagnose and provide individual, family and group counseling.
Pastoral counselors. These counselors are ordained clergy with advanced training and certification in Level II clinical pastoral education as well as the master's degree in theology (M. Div.) required by most American denominations for ordination. In addition to offering psychological counseling to individuals, families and groups, pastoral counselors have been trained to offer spiritual and sacramental ministry to those who request it.

Resources

ORGANIZATIONS

American Psychological Association. 750 First Street, NE, Washington, DC 20002. (800) 374-2721. <www.apa.org> .

National Alliance for the Mentally Ill (NAMI). Colonial Place Three, 2107 Wilson Blvd., Suite 300, Arlington, VA 22201. <http://www.nami.org> .

National Mental Health Association. 1021 Prince St., Alexandria, VA 22314. <http://www.nmha.org> .

National Mental Health Consumers' Self-Help Clearinghouse. 1211 Chestnut St, Suite 1207, Philadelphia, PA 19107. <www.mhselfhelp.org> .

Judy Leaver, M.A.