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An unintended problem of deinstitutionalization is today’s homeless population. A substantial proportion of this group is thought to be made up of schizophrenic patients, mostly off their medications and in serious need of care. Families and communities have failed to meet the needs of these people.

Treatment Approaches

No one approach for treating people with psychopathologies has been shown to be ideal. Multiple approaches can often be more helpful than using one specific approach. For example, a depressed patient might benefit from cognitive therapy, social skills training, and antidepressant drugs. Research is being conducted to determine the most effective (efficacious) treatments for clients with different disorders. One method for evaluating outcome research is meta-analysis. Meta-analysis, the systematic statistical method for synthesizing the results of numerous research studies dealing with the same variables, indicates that clients who receive psychotherapy are better off than most of those who receive no treatment. Treatments that appear more effective than others for particular disorders are noted in the following sections.

Insight Therapies

Insight therapies include psychoanalysis, psychodynamic therapy, interpersonal psychotherapy; humanistic client-centered; and Gestalt psychotherapy. They all agree that their goal is to help clients develop insight about the cause of their problems, and that insight will lead to behavior change; problems will decrease as self-awareness increases.

Psychoanalysis

Sigmund Freud believed that abnormal behavior was the result of unconscious conflicts from early childhood trauma experienced during the psychosexual stages of development. He thought that the way to relieve the anxieties is to resolve the unconscious conflicts, which are covered by layers of experience. Psychoanalysis involves going back to discover the roots of problems, then changing one’s misunderstandings and emotions after identifying the problem. His treatment plan to bring the conflict into the conscious mind, enabling the client to gain insight and achieve personality change, includes the techniques of free association and dream interpretation.

In traditional psychoanalysis, the client participates in several sessions every week for 2 or 3 years, during which the therapist sits behind the patient and asks him/her to say whatever comes to mind, called free association. If clients do not censor what they say, key thoughts will make unconscious conflicts accessible. Since threatening experiences and feelings can be revealed when controls of the ego and superego are relaxed during sleep, the analyst may ask the client to recall his/her dreams. The recalled dream—the surface meaning—is called the manifest content. The therapist works with the client to find the hidden, underlying meaning (the latent content), by analyzing symbols within the dream. Hypnosis and Freudian slips, Freud’s “faulty actions,” for which his editor/translator adopted the term parapraxes, may also reveal hidden conflicts. Resistance—blocking of anxiety-provoking feelings and experiences, evidenced by behavior such as talking about trivial issues or coming late for sessions—is a sign that the client has reached an important issue that needs to be discovered. Although the analyst’s behavior is neutral, the client may respond to the analyst as though he/she is a significant person in the client’s emotional life. Known as transference, this behavior can allow the client to replay previous experiences and reactions, enabling him/her to gain insight about current feelings and behaviors. Catharsis, the release of emotional tension after remembering or reliving an emotionally charged experience from the past, may ultimately result in relief of anxiety. Traditional psychoanalysis requires too much time and is too expensive for the vast majority of people seeking help.

Psychodynamic and Interpersonal Psychotherapy

Psychoanalytic theory