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Franzoi Chapter 14

Franzoi Chapter 14

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Chapter 14


Copyright Atomic Dog Publishing, 2007

14-1a There Are Both Psychological and Biomedical Therapies
‡ In treating psychological disorders, there are two broad categories of therapy:  

Psychotherapy is the treatment of psychological disorders by employing psychological methods that include a personal relationship between a trained therapist and a client. Biomedical therapies are the treatment of psychological disorders by altering brain functioning with physical or chemical interventions.

Copyright Atomic Dog Publishing, 2007

14-1b Three Primary Mental Health Professions Provide Therapy
Medical doctors (M.D.) who have been trained in treating mental and emotional disturbances. They can prescribe medication. Most obtain master¶s degrees in social work (M.S.W.), while a smaller percentage have their doctorate (D.S.W.). Clinical and psychiatric social workers provide psychotherapy and coordinate with social support agencies. Work with either a master¶s degree or a doctoral degree (Ph.D.). Some doctoral degrees are in psychology (Psy. D.) or educa tion (Ed.D). Psychologists who receive training in psychotherapy also receive extensive training in conducting research. (This is less true for Psy. D.)

Social workers


Copyright Atomic Dog Publishing, 2007

14-1b Three Primary Mental Health Professions Provide Therapy (cont.)
‡ Two specialty areas in psychology provide psychotherapy.  

Clinical psychology is the field that works with psychological disorders±their assessment, explanation, and treatment Counseling psychology is the field that works with essentially ³normal´ individuals who experience problems in living and so could benefit from educational, vocational, or personal counseling

Copyright Atomic Dog Publishing, 2007

14-1b Three Primary Mental Health Professions Provide Therapy (cont.)
‡ Training in one profession does not restrict individual practitioners from specializing in any theoretical approach to therapy. 

Therapists who combine techniques from various theoretical perspectives in treating psychological disorders are known as having an eclectic approach (Stricker, 1996).

‡ Other health professionals may also become involved with patients who have psychological disorders. For example, nurses, occupational therapists, physical therapists, speech therapists, and other health professionals may work in mental health settings.
Copyright Atomic Dog Publishing, 2007

Copyright Atomic Dog Publishing. 2007 .14-2 Psychodynamic Therapies ‡ Psychodynamic therapies are a diverse group of psychotherapies based on the work of Sigmund Freud that assert that psychological disorders stem primarily from unconscious forces. ‡ All variations of Freudian therapy stress the importance of understanding the psychological dynamics underlying behavior.

people repress the troubling material. it continues to have an effect on functioning and eventually causes psychological symptoms. Although this material is now unconscious. often of a sexual or aggressive nature.     To manage the resulting anxiety. The release of pent-up emotion is called catharsis. leaves people with troubling memories or feelings. The goal of therapy is to bring the troubling material into conscious awareness. 2007 . Copyright Atomic Dog Publishing.14-2a Psychoanalysis Laid the Groundwork for Psychodynamic Therapies ‡ Freud asserted that some traumatic childhood event.

‡ The psychodynamic therapist also draws inferences from Freudian slips. without making any effort to inhibit their speech. ‡ The primary technique in Freudian therapy is free association. 2007 .  Free association is a psychodynamic therapy technique developed by Freud. Copyright Atomic Dog Publishing.14-2b Free Association Is the Primary Psychodynamic Technique ‡ All Freudian-based therapy techniques are directed toward helping the client gain insight. in which clients say whatever comes to mind. which are instances in which the client means to say one thing but actually says something else.

and so on. ‡ Psychodynamic therapists interpret the client¶s relationship with the therapist and should be aware of transference and countertransference. poetry.) ‡ The psychodynamic therapist interprets the underlying meaning in other forms of expression: dreams.   Transference involves feelings the client develops for the therapist that are presumed to reflect the client¶s feelings for significant others early in life. Countertransference involves feelings the therapist develops for the client that are presumed to reflect feelings the therapist had for others early in life. artwork. Copyright Atomic Dog Publishing.14-2b Free Association Is the Primary Psychodynamic Technique (cont. 2007 . daydreams.

‡ This type of behavior is referred to as resistance.  Resistance is anything the client does to interfere with the therapeutic process. or bringing up significant issues only at the very end of a session so that there is no time to address them. talking only about trivial issues. Copyright Atomic Dog Publishing. 2007 .14-2b Free Association Is the Primary Psychodynamic Technique (cont.) ‡ Over the course of therapy. the client may begin to sabotage therapy by missing or coming late to sessions.

Copyright Atomic Dog Publishing. 2007 .000 to $120.14-2c Psychodynamic Therapy Is Lengthy and Expensive ‡ Psychodynamic therapy is lengthy.  For example. and a client could pay between $40.000 after five years. ‡ Interpretations can never be disproved. the client¶s attempt to disagree may be perceived as further proof of the initial interpretation. if a therapist interprets a client's tardiness as a sign of resistance.

Copyright Atomic Dog Publishing.) ‡ Though still available. ‡ However. even those who reject Freud¶s theoretical basis for mental illness often use his technique of developing a one-to-one therapist-client relationship aimed at increasing client insight. classic psychoanalysis is not widely practiced today.14-2c Psychodynamic Therapy Is Lengthy and Expensive (cont. 2007 .

insight is not important in the treatment of psychological disorders. and thus.14-3 Behavior Therapies ‡ Behavior therapies are psychotherapies that apply learning principles to the elimination of unwanted behaviors. psychological disorders and ³healthy´ behaviors are thought to both develop through learning. 2007 . Copyright Atomic Dog Publishing. ‡ Behaviorists do not believe in the unconscious. Instead.

elicits the response. However.  Counterconditioning involves conditioning new responses to stimuli that trigger unwanted behaviors. 2007 . after repeated pairings of the two stimuli. the previously neutral stimulus. an unconditioned stimulus (UCS) automatically elicits an unconditioned response (UCR). The UCS is paired with a neutral stimulus that initially has no effect on the response.14-3a Some Behavioral Therapies Rely upon Classical Conditioning ‡ In classical conditioning. ‡ The most widely used form of psychotherapy that is based on classical conditioning is counterconditioning. now called the conditioned response (CR). Copyright Atomic Dog Publishing. now called the conditioned stimulus (CS).

‡ Response prevention:  Copyright Atomic Dog Publishing. 2002). Wolpe & Plaud. 1958.) ‡ Systematic desensitization:  Commonly used to treat people suffering from phobias by gradually exposing the phobic client to the feared object without arousing anxiety and fear (Wolpe.14-3a Some Behavioral Therapies Rely upon Classical Conditioning (cont. but they are prevented from engaging in the compulsive behaviors. clients are exposed to situations that trigger the distressing thoughts and feelings. 1997) Commonly used to treat compulsive behaviors (Abramowitz. 2007 .

I see a line drawing of a snake. Fear Level 10 20 25 30 40 50 60 70 80 90 95 100 Scene I imagine seeing a snake. A review of 375 therapy outcome studies indicates that systematic desensitization is the most effective therapy for treating phobias (Smith & Glass. 2007 . Other reviews have concluded. I see a photograph of a large python. 2002). North et al. I see a photograph of a small. harmless garden snake. I am standing next to a person holding a snake. The numbers to the left of each statement represent one patient¶s subjective rating of how anxiety-provoking a situation is. I am standing next to the snake cage. 1986. such as sexual dysfunction (Emmelkamp. I am looking into the top of the snake cage with the lid open. I am in the same room with a snake in a cage.that desensitization is also effective in treating other problems that may occur as a result of anxiety. I watch a nature video on snakes. I am holding a snake. 1977). on a scale from 0 (³not at all anxious´) to 100 (³uncontrollable anxiety´).. I touch a snake held by someone else. I hold a rubber snake in my hands.Table 14-2 A Sample Desensitization Hierarchy The scenes in this hierarchy are typical of those used in the systematic desensitization of a fear of snakes. Copyright Atomic Dog Publishing.

2002)..14-3a Some Behavioral Therapies Rely upon Classical Conditioning (cont. 2007 . Copyright Atomic Dog Publishing.) ‡ Aversive conditioning  Clients are classically conditioned to react with aversion to a harmful or undesirable stimulus (Hermann et al.

Copyright Atomic Dog Publishing. 2007 . naturally evoking a pleasant unconditioned response. alcohol is an unconditioned stimulus for alcoholics.Figure 14-1(a) Aversive Conditioning for Alcoholism (a) Before therapy.

2007 . Copyright Atomic Dog Publishing.Figure 14-1(b) Aversive Conditioning for Alcoholism (b) During therapy. which causes severe nausea. the Antabuse drug is mixed with alcohol given to the alcoholic.

Figure 14-1(c) Aversive Conditioning for Alcoholism (c) After repeated pairings. Copyright Atomic Dog Publishing. 2007 . evoking the conditioned nausea response. the alcohol becomes a conditioned stimulus.

2002) that involves reinforcing desirable behaviors with tokens (Ayllon & Azrin. such as snacks or television privileges ‡ Critics charge that this type of behavior modification makes people too dependent on the external rewards earned in the token economy. 1999.  The token economy is a technique often used to modify the behavior of severely disturbed people in institutional settings (Bellus et al. 1968) that can be exchanged for other forms of reinforcement.14-3b Operant Conditioning Is Used in Token Economies ‡ Operant conditioning involves learning through reinforcement and punishment. 2007 .. ‡ One therapeutic application of operant conditioning principles is the token economy. Copyright Atomic Dog Publishing. Kopelowicz et al..

‡ The therapeutic application of observational principles is called modeling. 2007 .14-3c Observational Learning Is Used in Modeling and Social Skills Training ‡ Observational learning is learning by observing and imitating the behavior of others. the therapist or someone else models more effective ways of behaving. who are called models.   Modeling is a behavioral method of psychotherapy in which desirable behaviors are demonstrated as a way of teaching them to clients. and gradually the client is invited to participate in the behavior. Copyright Atomic Dog Publishing. In participatory modeling.

1999). 2007 .Role-playing various problematic social encounters Copyright Atomic Dog Publishing. Social skills training programs employ various learning techniques: .14-3c Observational Learning Is Used in Modeling and Social Skills Training (cont.Modeling of socially skilled trainers .   Social skills training is a behavioral method of psychotherapy in which clients are taught how to interact with others more comfortably and effectively (Hersen & Bellack.) ‡ Another therapeutic technique that involves observational learning is social skills training.

cognitive therapies tend to be short term. and highly directive. 2007 .14-4 Cognitive Therapies ‡ The cognitive perspective suggests that the immediate cause of psychological problems is inaccurate or ineffective thinking. problem-focused. Copyright Atomic Dog Publishing.   Cognitive therapies seek to identify and then modify dysfunctional patterns of thought. Unlike psychodynamic therapies.

2007 ..14-4a Rational-Emotive Behavior Therapy Confronts Clients¶ Irrational Assumptions ‡ Rational-emotive behavioral therapy (REBT) is the cognitive therapy of Albert Ellis. Clients are encouraged to ³step out of character´ and try new behaviors that directly challenge their irrational beliefs (Ellis et al. 2002). in which people are confronted with their irrational beliefs and persuaded to develop a more realistic way of thinking. REBT therapists are blunt and confrontational in challenging clients¶ negative and unrealistic assessments of their present conditions. Copyright Atomic Dog Publishing.    Irrational beliefs are thought to be caused by ³all-or-none´ types of thinking.

accurate. 1985). Copyright Atomic Dog Publishing. and effective.14-4b Cognitive-Behavior Therapy Focuses on Emotional Problems ‡ Cognitive-behavior therapy (CBT) is the cognitive therapy of Aaron Beck that identifies and then changes negative thinking and behavior by using both cognitive and behavioral principles ‡ CBT was originally developed to treat depression but was later applied to anxiety and other emotional problems (Beck & Emery. 2007 . ‡ Clients are encouraged to keep a diary of their thoughts before and after sad episodes. Therapists then discuss these episodes with clients and help them develop new thinking patterns that are more positive.

with their ³true selves.   Humanists believe that psychological problems develop when outside forces stifle people¶s natural tendency to seek personal growth.´ and with their purpose in life. 2007 . Copyright Atomic Dog Publishing.14-5 Humanistic Therapies ‡ Humanistic therapies are psychotherapies that help people get in touch with their feelings. One of the primary goals of humanistic therapies is to help clients actualize their basically good nature.

warmth.14-5a Client-Centered Therapy Focuses on Clients¶ Conscious Self-Perceptions ‡ Client-centered therapy is a humanistic therapy in which the client and not the therapist directs the course of therapy.´ To counteract the effects of conditional positive regard. and empathy. .   Therapists are viewed as facilitators of personal growth by providing a supportive environment where clients can discover their ³true selves.Key ingredients in unconditional positive regard are genuineness. psychotherapy should be built around the principle of unconditional positive regard. 2007 . Copyright Atomic Dog Publishing.

   Open-ended statements encourage clients to speak. Copyright Atomic Dog Publishing. Paraphrasing: The therapist summarizes the expressed verbal content of the client¶s statements. ‡ Therapists from many theoretical schools use some or all of these client-centered techniques to build rapport with their clients. reflection.14-5a Client-Centered Therapy Focuses on Clients¶ Conscious Self-Perceptions (cont. therapists use open-ended statements.) ‡ In expressing unconditional positive regard. 2007 . without limiting the topic of conversation. and paraphrasing. Reflection: The therapist acknowledges some emotion that the client has expressed verbally or nonverbally.

2007 . clients engage in emotional expression by imagining that the person whom they would like to speak to is sitting in an empty chair facing them.A client¶s frown following a comment by the therapist would be met with the therapist directly confronting this by asking the client if he or she is aware of the facial expression.With the empty-chair technique.14-5b Gestalt Therapy Encourages Clients to Get in Touch with Their Feelings ‡ Gestalt therapy is a humanistic psychotherapy that stresses awareness of feelings in the here and now. so that clients can gain insight. . Copyright Atomic Dog Publishing.  Perhaps the most popular technique used in Gestalt therapy to help clients gain insight into their true feelings is the empty-chair technique.  Gestalt therapy employs a very directive approach. .

14-5c Existential Therapy Helps Clients Deal with the Fundamental Problems of Existence ‡ Existential therapy is a philosophical approach to treating clients who are experiencing distress principally related to a lack of meaning in their lives. ‡ Meaning can be found for one¶s self through:    Your life contributions (what you ³give´ to the world) Your life experiences (what you ³take´ from the world) Your attitudes in facing difficult situations Copyright Atomic Dog Publishing. 1969) contends that a fundamental human motive is to find meaning in life and that emotional problems develop when such meaning cannot be found. 1963. ‡ A form of existential therapy called logotherapy (Frankl. 2007 .

therapists must keep in mind that children differ from adults:   Children¶s vocabulary is fairly simple and underdeveloped. Copyright Atomic Dog Publishing. 2007 . 2000. 2003) to overcome some of difficulties associated with providing psychotherapy to children. on the assumption that whatever is troubling them will be expressed in their play. ‡ Child therapy includes the use of techniques like play therapy (Booth & Lindaman. Gil.  Play therapy is a therapeutic technique in which the therapist provides children with toys and drawing materials. Children¶s thinking is much more concrete and oriented to present events.14-6a Child Therapies Use Techniques Designed for Younger Minds ‡ In offering therapy to a child.

Valbak. 2003. 2003. Group therapy is more cost-effective than individual therapy. Group therapy helps clients realize that others also struggle with many of the same problems.        Some groups can consist of relatively well-functioning clients in an outpatient setting. Many groups are organized around one kind of problem (such as alcoholism or depression) or one kind of client (such as adolescents or police officers). 1995). Therapists can observe how clients interact with one another. Copyright Atomic Dog Publishing. 2007 . Group members can become an important support group..14-6b Group Therapy Involves Clients Discussing Their Problems with One Another Under a Therapist¶s Guidance ‡ Group therapy is the simultaneous treatment of several clients under the guidance of a therapist. All of the major theoretical schools of psychotherapy have some sort of group format (Edelman et al. Yalom.

covering a wide range of problems. including mood disorders. 2000) . and spouse abuse (Lieberman. 1990). Copyright Atomic Dog Publishing. drug addiction..Alcoholics Anonymous (AA) was founded as a group run by and for alcoholics and provides information about the consequences of alcoholism and the opportunity to learn from the experiences of other alcoholics.  Self-help groups: Several people regularly meeting and discussing their problems with one another without the guidance of a therapist (Davison et al. .AA is based on a series of 12 steps that help alcoholics attain and maintain sobriety. compulsive gambling. childhood sexual abuse.14-6b Group Therapy Involves Clients Discussing Their Problems with One Another Under a Therapist¶s Guidance (cont.) ‡ One variation of group therapy is the self-help group.Many other self-help programs have been developed on the AA model. . 2007 .

1995. 1984). 1966). 1960. 1966. which is based on the assumption that the ³whole is greater than the sum of its parts´ (Ackerman.  Family systems therapy is a form of family therapy in which the family is treated as a dynamic system. Copyright Atomic Dog Publishing. 2007 . Levant. ‡ Family therapists often base their work on systems theory. an individual family member¶s problems cannot be understood and treated in isolation but must be examined and treated within the family system (Clarkin & Carpenter. Bowen.14-6c Family and Couples Therapies Try to Change Dysfunctional Interaction Patterns ‡ Family therapies are designed to constructively modify the dysfunctional relationships among family members. ‡ According to family systems therapy. with each member being an important interacting element in that system.

1992).) ‡ A variant of family therapy is couples therapy.. Over half the couples entering therapy state that their number one problem involves faulty communication (O¶Leary et al. Copyright Atomic Dog Publishing. 2007 .   Couples therapy is therapy designed to help couples improve the quality of their relationship.14-6c Family and Couples Therapies Try to Change Dysfunctional Interaction Patterns (cont.

extremely socially anxious. disabled. Fink.  Online therapy can provide help to people who are geographically isolated.14-6d Therapy Is Sometimes Offered through the Internet ‡ A growing number of therapists are interacting with their clients. or fearful that others will discover that they are seeing a mental health professional (J. through email. 2007 . 1999). and message boards. and providing therapy. Copyright Atomic Dog Publishing. chat rooms.

Information.) ‡ Potential benefit of using online therapy  Clients may feel more at ease more quickly. 1998). and thus reveal the most troubling and important problems sooner and with greater honesty (Grohol. like physical appearance.14-6d Therapy Is Sometimes Offered through the Internet (cont. and body language. 2007 . ‡ Drawback for the therapist  Copyright Atomic Dog Publishing. is missing. tone of voice.

Figure 14-2 Use of Drugs in Treating Psychological Disorders Copyright Atomic Dog Publishing. 2007 .

such as auditory hallucinations and paranoia (Lehman et al. ‡ Chlorpromazine and other antipsychotic medications are thought to work by blocking dopamine receptor sites in the brain. Copyright Atomic Dog Publishing. ‡ Antipsychotic medications do not actually ³cure´ schizophrenia ²they merely help control its severe symptoms. Remington et al. 1995. 1998).. 2007 .14-7a Antipsychotic Drugs Affect Dopamine Neurotransmitters ‡ In the 1950s. thereby reducing dopamine activity (Bernstein. ³uncontrollable´ psychotic symptoms of schizophrenia. certain drugs used for other medical purposes were discovered to reduce the positive. 2001)..

even these new drugs are not risk free.    These drugs also have some very unpleasant side effects. antipsychotic drugs do not relieve negative symptoms that may be related to structural defects in the brain. Recent medical advances have led to the development of newer replacement drugs that do not appear to have some of the dangerous side effects.14-7a Antipsychotic Drugs Affect Dopamine Neurotransmitters (cont.) ‡ Although they reduce positive schizophrenic symptoms. 2007 . However. Copyright Atomic Dog Publishing.

14-7b Antidepressant Drugs Affect Serotonin and Norepinephrine Neurotransmitters ‡ Monoamine oxidase inhibitors (MAOI) drugs work by inhibiting the monoamine oxidase (MAO) enzyme involved in breaking down the neurotransmitters norepinephrine and serotonin. ‡ A second class of antidepressant medications is composed of the tricyclics (Bernstein. Copyright Atomic Dog Publishing. which has the effect of elevating mood. 1995).  These drugs increase the available supply of serotonin and norepinephrine by decreasing their reuptake at the neuron¶s receptor sites.  By inhibiting MAO. the available supply of norepinephrine and serotonin is increased. 2007 .

making it easier for neural impulses to be transmitted along serotonin pathways in the brain.   With lithium. 2007 . It is unclear how lithium works.  SSRIs inhibit the reuptake of the neurotransmitter serotonin.14-7b Antidepressant Drugs Affect Serotonin and Norepinephrine Neurotransmitters (cont. manic attacks occur as infrequently as once every 9 years. Copyright Atomic Dog Publishing. ‡ Lithium is used to treat bipolar disorder. which increases the available supply of serotonin in the body.) ‡ The most popular antidepressants are those that affect only serotonin²the selective serotonin reuptake inhibitors (SSRIs).

14-7c Antianxiety Drugs Are the Most Widely Used Legal Drugs ‡ A class of antianxiety drugs²the benzodiazepines² is the most frequently prescribed anxiety medication in the United States (Roy-Byrne & Crowley. 2002). 2007 .    These drugs seem to produce their effects by facilitating the action of the neurotransmitter gammaamino-butyric acid (GABA). These drugs can also lead to physical dependence. Benzodiazepines are dangerous when combined with alcohol. which has an inhibitory effect on the central nervous system. Copyright Atomic Dog Publishing.

ECT is generally used only when severely depressed patients either cannot tolerate or have not responded to drug therapy.. 2007 .14-7d Electroconvulsive Therapy Is Sometimes Used to Treat Depression ‡ Electroconvulsive therapy (ECT) is a physiological treatment for severe depression in which a brief electric shock is administered to the brain of an anesthetized patient. Sackheim et al. 1993. Copyright Atomic Dog Publishing. Recent evidence suggests that ECT may be effective in treating severe depression by promoting new cell growth in the brain. 2000).    While ECT is effective in treating severe depression. no one is sure why (Coffey.

1948). Copyright Atomic Dog Publishing. 2007 . . severing the neural connections between the prefrontal lobes and the rest of the brain (Egas Moñiz.  Prefrontal lobotomy: Two small holes are drilled in the skull. and a sharp instrument is inserted and moved from side to side. It focuses on much smaller brain areas than those involved in lobotomies.14-7e Psychosurgery Involves Removing Portions of the Brain ‡ Psychosurgery is a rarely used surgical procedure to treat psychological disorders in which brain tissue thought to be the cause of the disorder is destroyed.This treatment profoundly altered patients¶ personalities. MRI-guided precision psychosurgery is performed only in extreme cases when other types of treatment have been ineffective.  Today. with some patients becoming extremely apathetic and others becoming excitable and impulsive.

. 2001. 2001). Copyright Atomic Dog Publishing. 2007 .14-8 Economic and Social Trends in Mental Health Treatment ‡ The system of insured health care known as a managed care system has had a significant impact on the treatment of psychological disorders (Alegria et al. Sharfstein.

more effective drugs (Docherty. 1999) Cutbacks in combining drug therapy with psychological treatment. thus reducing effectiveness (Duckworth & Borus.14-8a Managed Health Care Involves a Trade-Off in Treating Psychological Disorders ‡ Cost-cutting measures introduced by health maintenance organizations or HMOs have had the following effects:     Long-term therapies are rare. less effective drugs prescribed due to reduced costs over newer. Greater number of referrals to less well-trained therapists (master¶s degree) (Pope & Vasquez. 2007 . 1999) Copyright Atomic Dog Publishing. 2001) Older.

Seligman. 2007 . Brief therapy helps many clients.14-8b Efforts to Document Treatment Effectiveness Are Increasing ‡ Managed care has encouraged efforts to document treatment effectiveness:     Psychotherapy generally has a positive effect (Lambert & Bergin. Different types of therapy are often about equally effective for many disorders. with about 50 percent improving by the eighth session. Copyright Atomic Dog Publishing. 1995). The more treatment clients receive. 1992. the more they improve.

. 1998).14-8c Minorities Underutilize Therapeutic Services ‡ A number of studies indicate that ethnic minorities in the United State are less likely to seek mental health treatment and more likely to drop out of therapy than Whites (Vega et al. Wierzbicki & Pekarik. 1993. Zhang et al. 1998. Copyright Atomic Dog Publishing. 2007 .

Dropout rates for therapy are higher among poorer clients.14-8c Minorities Underutilize Therapeutic Services (cont. 2007 . While ethnic minorities make-up about one-fourth of the population.) ‡ Sociocultural factors provide some insight into this social problem. Many ethnic minorities turn to more culturally comfortable sources of help.      The belief system in a person¶s culture can influence that person¶s willingness to seek psychotherapy. Copyright Atomic Dog Publishing. only about 10 percent of mental health providers are ethnic minorities. Minorities are more mistrustful of the medical and mental health professions than White Americans.

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