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Chapter 17 – Therapy and Change
Section 1 – What is Psychotherapy
A wide range of treatments to help troubled individuals overcome their problems
1. Involves 3 things
a. Verbal interaction between therapist and client
b. Development of a supportive and trusting relationship
c. Analysis by the therapist of the client’s problems
2. Nature of Psychotherapy
i. “Healing of the Soul”
ii. Usually thought of a moral or religious problem
1. Inhabited by demons
2. Treatments included exorcisms
a. Religious ceremonies or physical punishment
iii. Mental illness not a good term because it leaves the person
feeling passive and helpless
b. Functions of Psychotherapy
i. Help people realize that they are responsible for their own
problems
ii. Only they can solve those problems
iii. Major task of psychotherapist to help patient:
1. Examine their way of living
2. Understand how that way causes problems
3. Start living in a new beneficial way
c. Main Kinds of Therapy
i. Each based on a theory of how human personality works
ii. Each is carried out in a different style
iii. Many stick to one single approach, while others are eclectic
d. Goals of Therapy
i. Primary Goal - Strengthen a person’s control over their life
ii. One of the biggest factors in treatment is a patient’s hope and
belief that they will get better – placebo effect
3. Who are Therapists
a. Chart 17.3
b. What Makes a Good Therapist
i. More skillful than friends in encouraging a person to examine
uncomfortable feelings and problems
ii. 3 Characteristics found in effective therapists
1. Be psychologically healthy
2. Have empathy – capacity for warmth and
understanding
3. Experienced in dealing with people and understanding
their complexities
4. Group Therapies
a. Patient is in the company of others not alone
b. Chance to see others struggling with similar problems
c. Sees others recovering and gets hope from that
d. Family Therapy
i. Focus is on the interactions among family members
ii. Untangles the twisted webs of relationships in the families
iii. Psychologist is an objective viewpoint and can suggest ways of
improving communications
e. Self-Help Groups
i. Voluntary groups of people that share similar problems
ii. Discuss difficulties and provide one another with support and
possible solutions
iii. Alcoholism, overeating, drug addiction, child abuse, cancer
survivors, etc.
iv. Most famous is AA
5. Does Psychotherapy Work?
a. Studies clash yes and no
b. Therapy can improve the quality of life for patients and is better than
no treatment at all
Section 1 Review
Section 2 – Psychoanalysis and Humanistic Therapy
A. What is Psychoanalysis
a. Based on the theories of Sigmund Freud
b. Psychoanalysis – therapy aimed at making patients aware of their
unconscious motives so that they can gain control over their behavior
c. Psychological disturbances are caused by hidden conflicts
d. Make patient aware of unconscious impulses, desires and fears that cause
anxiety
e. Insight – the apparent sudden solution to a problem, first step to gaining
control of their behavior and problems
f. Free Association
i. Psychoanalysis is a slow procedure
ii. Years of 50 minute sessions, several times a week
1. Average of 600 sessions and years of meeting
iii. Begins with the analyst having the patient relax and talk about
everything that comes to mind – Free Association
1. Everything should be expressed, nothing inconsequential,
nothing to unimportant or embarrassing
2. Describe dreams, private thoughts, long-forgotten
experiences
a. Analyst says nothing, most of the work is done by
the patient
3. Any behavior that impedes the course of therapy (painful
feelings or not examining long-standing behavior patterns)
is called resistance
g. Dream Analysis
i. Freud also believed that dreams expressed unconscious thoughts
and feelings
ii. Dream Analysis – analyst interprets the dreams of the patient to
find the unconscious thoughts and feelings
iii. Freud believed that dreams contained two types of content
1. Manifest content
a. What you remember about your dream
2. Latent Content
a. Refers to the hidden meanings represented
symbolically in the dream that the analyst interprets
from the manifest content
h. Transference – the process experienced by the patient of feeling towards
the analyst the way they feel toward some other important figure in their
life
i. Can be good or bad
ii. Analyst can’t let this happen
B. Humanistic Therapy
i. Focuses on the value, dignity and worth of each person. It holds
that healthy living is the result of realizing one’s full potential
ii. Can be reached through personal responsibility, freedom of choice
and authentic relationships
b. Client-Centered Therapy
i. Based on theories of Carl Rogers
ii. Uses “client” to imply an equal relationship (returns: positive
regard, empathy and genuineness)
iii. Assumes that people are good and that they are capable of
handling their own lives
iv. One goal: to help a person recognize their own strength and
confidence, this way they will learn to be true to their standards
and ideas about how to live effectively
v. Techniques of Client-Centered Therapy
1. Topics are entirely up to the patient – nondirective
therapy
2. Therapist listens and encourages but avoids giving opinions
3. Therapist echoes back what they hear – active listening
4. Client and therapist work together to see how the client
feels about themselves, their life and others.
5. Session held in an Unconditional positive regard –
therapists consistent expression of acceptance of the client
no matter what the client says or does
a. No opinions are made or spoken
b. All speech and actions are accepted
c. No emotion showed
Section 2 Review
Section 3 - Cognitive and Behavior Therapies
Behavior Modification – a systematic method of changing the way a person
acts and feels
A. Cognitive Therapy
a. Focuses on changing the way people think
b. To improve our lives, we must work to change our pattern of
thinking
c. Disconfirmation – clients may be confronted with evidence that
directly contradicts their existing beliefs
d. Reconceptualization – clients work toward an alternative belief
system to explain their experiences or current observations
e. Insight – clients work toward understanding and deriving new or
revised beliefs
f. Rational-Emotive Therapy – form of help aimed at changing
unrealistic assumptions about oneself and other people
i. Goal is to correct false and self-defeating beliefs
1. Use of role-playing, modeling, humor, persuasion
or a homework type approach
2. See Figure 17.8
g. Beck’s Cognitive Therapy – Focuses on illogical thought processes
i. Maladaptive Thought Patterns – Overgeneralization,
Polarized Thinking and Selective Attention
ii. See Figure 17.9
B. Behavior Therapies – changing undesirable behavior through conditioning
techniques
a. Counterconditioning – pairs the stimulus that triggers an
unwanted behavior (or fear) with a new, more desirable behavior
i. Systematic Desensitization – technique used to overcome
irrational fears and anxieties that patient has learned
1. Encourages people to imagine a feared situation
while relaxing thus extinguishing the fear response.
ii. Flooding – therapist exposes the client to a feared object or
situation
iii. Modeling – therapist models/demonstrates behavior
iv. Aversive Conditioning – links an unpleasant state with an
unwanted behavior in an attempt to eliminate that behavior
b. Operant Conditioning
i. Based on the assumption that behavior that is reinforced
tends to be repeated, whereas behavior that isn’t reinforced
tends to be extinguished
ii. Contingency Management – therapist and patient decide
what old, undesirable behavior needs to be eliminated and
which new, desirable behavior needs to appear.
1. Old behavior is unrewarded and desired behavior is
positively reinforced
2. If you do X, I will give you Y
iii. Token Economies – desirable behavior is reinforced with
valueless objects or points, which can be accumulated and
exchanged for various rewards
C. Cognitive-Behavior Therapy – based upon a combination of substituting
healthy thoughts for negative thoughts and beliefs and changing disruptive
behaviors in favor of healthy behaviors
Section 3 Review
Section 4 – Biological Approaches to Treatment
A. Biological Therapy
- Assumes that there is an underlying physiological reason
for disturbed behavior, faulty thinking and inappropriate
emotions
- Medication, shock therapy and surgery are examples
- Psychologists may decide that a biological approach is
necessary but a physician or psychiatrist administer them
b. Drug Therapy – biological therapy that uses medications
- Usually only treats the symptoms but doesn’t cure the
cause
ii. Anti-Psychotic Drugs – medication to reduce agitation, delusions
and hallucinations by blocking the activity of dopamine in the
brain, tranquilizers
- Long time use for dangerous and overactive schizophrenics
was straightjacket, wet-sheet wrapping or isolation
- Calmed by ECT or lobotomy
- Now (with meds) become less withdrawn, confused and
agitated, fewer auditory hallucinations, less irritable and
hostile
- Theory
a. When a person’s dopamine neurotransmitter
becomes overactive, the person develops
schizophrenia
- Side effects
a. Muscular rigidity, impaired coordination and
tremors
- Best Known
a. Thorazine
b. Haldol
c. Closaril
iii. Anti-Depressant Drugs – medication used to treat major
depression by increasing the amount of one or both of the
neurotransmitters noradrenaline and serotonin
- Side effects
a. Dizziness, fatigue, forgetfulness, weight gain
-
Best Known
a. Nadril
b. Prozac
iv. Lithium Carbonate – Chemical used to counteract mood swings
of bipolar disorder (natural compound)
v. Anti-Anxiety Drugs – Medication that relieves anxiety and panic
disorders by depressing the activity of the central nervous system
- Best used for acute not chronic anxiety
- Side effects
a. Short term – drowsiness
b. Long term – dependence and with alcohol death
results
- Best Known
a. Xanax
b. Librium
c. Valium
c. Electroconvulsive Therapy – electrical shocks sent through the brain to
try to reduce symptoms of mental disturbance
i. No one understands how it works, it induces a convulsion like an
epileptic seizure that may last up to a minute
ii. Used lots in the past
iii. Very little pain today due to sedatives and muscle relaxants
iv. Drastic treatment, used with great caution today
v. Current was run through both hemispheres of the brain, now only
through the right hemisphere
vi. Side effects
- Extensive amnesia
- Language and verbal abilities
vii. Highly effective for depression
d. Psychosurgery – medical operation that destroys part of the brain to make
the patient calmer and freer of symptoms
i. Prefrontal Lobotomy – section of the frontal lobe of the brain is
destroyed
- Contains the nerve connections that control emotions
“Freeman developed the ice pick lobotomy in 1947. In the procedure, he put the sharp point of the
pick in the tear duct. Then, with a light tap of a hammer, plunged it two inches inside, pulled it 30
degrees backward, and then moved it up and down in a 20 degree arc, in order to cut the nerves at
the base of the frontal lobes. The procedure took only a few minutes. Within several years, the
procedure had been preformed on over 20,000 individuals.”
Section 4 Review
Chapter 17 review – Review Vocabulary, Recalling Facts, Critical Thinking