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Prof. Millie Roqueta
CHAPTER 16 SUMMARY
Chapter 16
PSYCHOTHERAPY
LEARNING OBJECTIVES
1. Identify the three major categories of therapy.
2. Describe the various types of mental health professionals involved in the provision of
therapy.
3. Explain the logic of psychoanalysis and describe the techniques used to probe the
unconscious.
4. Explain the logic of client-centered therapy.
5. Describe therapeutic climate and process in client-centered therapy.
6. Discuss the logic, goals, and techniques of cognitive therapy.
7. Describe how group therapy is generally conducted.
8. Identify some advantages of group therapy.
9. Summarize the general approach and principles of behavior therapies.
10. Describe the three steps in systematic desensitization and the logic underlying the
treatment.
11. Describe the use of aversion therapy and social skills training.
12. Discuss the merits of blending approaches to therapy.
The Elements of the Treatment Process
Treatments:
How Many
Types are
There?
Types and approaches are numerous and varied, however, there
are 3 major categories:
1. Insight therapies, or "talk therapy" in tradition of Freud’s
psychoanalysis.
2. Behavior therapies, based on principles of learning and
conditioning.
3. Biomedical therapies, which focus on biological interventions.
Therapists: Who
Provides
Professional
Treatment?
1.
2.
Psychologists
a. Clinical psychologists and counseling
psychologists specialize in the diagnosis and
treatment of psychological disorders and everyday
behavioral problems.
b. Much overlap in training, skills, clientele
c. Both must earn doctoral degree.
d. Use either insight or behavioral approaches.
Psychiatrists
a.
Psychiatrists are physicians who specialize in the
treatment of psychological disorders.
b. Devote more time to relatively severe disorders.
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c. Have M.D. degree
d. Tend to emphasize biomedical treatments.
Other mental health professionals
a. Psychiatric social workers, psychiatric nurses often
work as part of treatment team with psychologist or
psychiatrist.
b. Counselors also provide therapeutic services. In
Florida, there are three types of licensed mental health
professionals (see Florida Statute 491.005):
1) Mental Health Counselors – Master’s Degree in
psychology or related field and 2 years
supervised field placement (internship) which
was part of the applicant's advanced
concentration in direct practice, during which the
applicant provided clinical services directly to
clients. Must pass a theory and practice
examination provided by State of Florida (a
licensing exam).
2) Marriage and Family Therapists – Master’s
Degree in psychology or related field, 2 years
supervised field placement, and licensing exam.
3) Clinical Social Workers - Master’s Degree in
psychology or related field, 2 years supervised
field placement, and licensing exam.
Insight Therapies
Psychoanalysis
Insight therapies (involve verbal interactions intended to
enhance clients' self-knowledge and thus promote healthful
changes in personality and behavior).
1.
2.
3.
4.
Psychoanalysis is an insight therapy that emphasizes the
recovery of unconscious conflicts, motives, and defenses
through techniques such as free association, dream
analysis, and transference.
Developed by Sigmund Freud
Dominance has eroded in recent decades, but diverse array of
psychoanalytic approaches continue to remain influential.
Probing the unconscious
a. Free association: clients spontaneously express their
thoughts and feelings exactly as they occur, with as
little censorship as possible.
b. Dream analysis: the therapist interprets the symbolic
meaning of the client's dreams.
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5.
6.
7.
Interpretation involves the therapist's attempt to explain the
inner significance of the client's thoughts, feelings,
memories, and behaviors.
Resistance involves largely unconscious defensive
maneuvers intended to hinder the progress of therapy.
Transference occurs when clients start relating to their
therapist in ways that mimic critical relationships in their
lives.
a. In a sense, clients transfer conflicting feeling about
important people onto therapist.
b. Psychoanalysts often encourage transference as a way
to bring repressed feelings, conflicts to the surface.
c. Undergoing psychoanalysis can be slow, painful process
of self-examination.
d. Classical psychoanalysis, as done by Freud, is not widely
practiced anymore.
Client-Centered
Therapy
Client-centered therapy (an insight therapy that emphasizes
providing a supportive emotional climate for clients, who
play a major role in determining the pace and direction of
their therapy)
1. Stimulated by work of Carl Rogers, who took a humanistic
perspective.
2. Therapeutic climate
a. Climate is more important than process.
b. Therapist must provide three conditions:
1) Genuineness
2) Unconditional positive regard
3) Empathy
3. Therapeutic process
a. Client, therapist work together as equals.
b. Therapist's key role is clarification of client's true
feelings.
Cognitive Therapy
Cognitive therapy (an insight therapy that emphasizes
recognizing and changing negative thoughts and
maladaptive beliefs)
1. Exemplified by work of Aaron Beck, Albert Ellis
2. Goals and techniques
a. Goal is to change way clients think, to help them
use more reasonable standards of evaluation.
b. Therapist is actively involved, looking for unrealistic
assumptions that underlie client's negative thinking.
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3.
Group Therapy
Kinship with behavior therapy (see Cognitive-Behavioral
therapies section below)
a. Cognitive therapists often use "homework
assignments" that focus on patterns of behavior.
b. A blend of "talk therapy" and behavior therapy
c. Was originally designed for treatment with
individuals, but has been adapted for use with
groups.
Group therapy (the simultaneous treatment of several or
more clients in a group)
1. Participants' roles
a. Therapist usually screens participants, excluding
potentially disruptive people.
b. Clients and therapist are on much more equal footing
with groups than with individual therapy.
c. Clients functions as therapists for each other.
2. Advantages of the group experience
a. Can save time and money.
b. Participants often realize that their misery is not
unique.
c. Provides opportunities for clients to work on social
skills in safe environment.
d. Certain kinds of problems especially well suited to
group treatment (e.g., drug groups, Alcoholics
Anonymous).
Behavior Therapies
General
Principles
Behavior therapies (involve the application of the principles
of learning to direct efforts to change clients' maladaptive
behaviors).
1. General principles
a. Assumed that behavior is a product of learning
b. Assumed that what has been learned can be
unlearned.
c. Behavior therapies are close cousins of selfmodification procedures (described in Chapter 4
Application)
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Systematic
Desensitization
Systematic desensitization: a behavior therapy used to reduce
clients' anxiety responses through counterconditioning.
1. Devised by Joseph Wolpe
2. Involves three steps
1) Therapist helps client build an anxiety hierarchy.
2) Therapist trains client in deep muscle relaxation
3) Client tries to work through hierarchy, learning to
remain relaxed while imagining each stimulus.
3. Desensitization to imagined stimuli generally followed by
exposure to real anxiety-arousing stimuli.
4. Goal is to counter-condition new response (relaxation) to
original stimulus (object of anxiety).
5. Has been effective in eliminating specific anxieties.
Aversion
Therapy
Aversion therapy is a behavior therapy in which an aversive
stimulus is paired with a stimulus that elicits an undesirable
response
1. Most controversial of behavior therapies.
a. Used only as treatment of last resort.
b. Client has to endure unpleasant stimuli (e.g., shock,
drug-induced nausea)
2.
Behaviors treated successfully include drug abuse, sexual
deviance, gambling, etc.
Social Skills
Training
Social skills training is a behavior therapy designed to improve
interpersonal skills that emphasizes shaping, modeling, and
behavioral rehearsal
1. Many psychological problems grow out of interpersonal
difficulties.
2. Has yielded promising results in treatment of depression,
shyness, social anxiety, even schizophrenia.
3. Can be conducted with individual clients or in groups.
4. Depends on principles of operant conditioning, observational
learning
a. Modeling - such as encouraging clients to watch
socially skilled friends, colleagues
b. Behavioral rehearsal - client practices social techniques
in role-playing exercises.
c. Shaping- clients gradually handle more complicated
and delicate social situations.
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Cognitive-Behavioral Therapies
CognitiveBehavioral
Therapies
What is Cognitive-Behavioral Therapy?
According to the National Association of Cognitive Behavioral
Therapists, Cognitive-Behavioral Therapy (CBT) is a form of
psychotherapy that emphasizes the important role of thinking in how
we feel and what we do. Therapists with this orientation believe that
when our brains are healthy, it is our thinking that causes us to feel
and act the way we do. As a result, it follows that if we are
experiencing unwanted feelings and behaviors, our thinking is what
causes those feelings and behaviors. The purpose of CBT is to
identify the thinking that is causing the unwanted feelings and
behaviors and to learn how to replace this thinking with thoughts that
lead to more desirable reactions.
There are several approaches to cognitive-behavioral therapy,
including Rational Emotive Behavior Therapy, Rational Behavior
Therapy, Rational Living Therapy, Cognitive Therapy, and Dialectic
Behavior Therapy.
However, most cognitive-behavioral therapies have the following
characteristics:
1. CBT is based on the Cognitive Model of Emotional Response
which maintains that it is our thoughts that cause our feelings and
behaviors, not external things, like people, situations, and events. The
truly beneficial aspect of this orientation is that we can change the
way we think in order to feel and act better even if the situation has
not changed.
2. CBT is short term and time-limited – most therapy using this
model lasts between 3 to 16 sessions. This makes CBT one of the
forms of therapy covered by medical insurance.
3. CBT is structured and directive - Cognitive-behavioral therapists
have a specific agenda for each session. Specific techniques and
concepts are taught during each session. CBT focuses on helping the
client achieve the goals they have set. CBT therapists do not tell their
clients what to do -- rather, they teach their clients how to do.
4. CBT is based on an educational model – the underlying
assumption is that most emotional and behavioral reactions are
learned and can therefore be unlearned. The goal of CBT is to help
clients unlearn their unwanted reactions and to learn a new way of
reacting. This is accomplished with the aid of homework and in
structured sessions.
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Discussion
Questions
1. If you or someone close to you were going to seek therapy, which type of
mental health professional would you seek out (e.g., psychologist,
psychiatrist, or other mental health professional)? Why?
2. If you thought you could benefit from therapy but were reluctant to seek it,
who would you talk to? Parents? Friends? Clergy?
3. Do you think, as Freud did, that our unconscious conflicts and motives
can be uncovered through dream analysis? If so, why do you think these
motives and feelings are presented in the form of symbols in our dreams,
rather than in a more obvious form that would be easier to interpret?
4. Do you think it's possible that the resistance that psychoanalysts believe
is an important element of the therapy process is simply a reluctance to
engage in a process (i.e., therapy) that has been stigmatized to a degree
by our society?
5. According to your textbook, psychoanalysts often encourage transference
such that clients begin to reenact relations with crucial people in the
context of therapy. What do you see as the main advantages of this
approach? What are the drawbacks?
6. Which of the main approaches to insight therapy (psychoanalysis, clientcentered, cognitive, group therapy) do you think is the most reasonable
way to deal with psychological problems? Why?
7. If you had a close friend or relative who had a serious problem with
anxiety, which of the insight approaches to therapy (psychoanalysis,
client-centered, cognitive, group therapy) would you recommend? Why?
8. One of the main assumptions of behavior therapies is that behavior is a
product of learning. On the surface, this seems like a straightforward and
reasonable assumption, but do you think that some psychological
disorders may develop as a result of genetic factors rather than learning?
Why or why not?
Chapter Summary References:
Adapted by Roqueta, M. (2002), from Weiten, W., & Lloyd, M. A. (2003), Psychology
applied to modern life: Adjustment in the 21st Century. Belmont, CA:
Wadsworth/Thomson Learning.
Table References:
Tables and PowerPoint Slides adapted by Roqueta, M. (2002) from Hutchens PowerPoint
Series for Weiten, W., & Lloyd, M. A. (2003), Psychology applied to modern life: Adjustment in
the 21st Century. Belmont, CA: Wadsworth/Thomson Learning.
Websites:




http://www.guidetopsychology.com/ This site contains Dr. R. Richmond’s “Guide to
Psychology and its Practice,” which provides information on numerous aspects of
psychotherapy.
AmoebaWeb Psychology: Therapies This site contains AmoebaWeb’s links to numerous sites
with information on psychotherapy.
http://www.apa.org/ The home page of the American Psychological Association.
http://www.apsa.org/index.htm The home page of the American Psychoanalytic Association.
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http://www.aabt.org/ The home page of the Association for the Advancement of Behavior
Therapy.
http://www.nacbt.org/ The home page of the National Association of Cognitive Behavioral
Therapists.
http://home.earthlink.net/~stevecurtin/page2.html The home page of the ExistentialHumanistic Therapy Institute.
http://dmoz.org/Science/Social_Sciences/Psychology/Humanistic/ This page has a
comprehensive list of resources related to Humanistic Psychotherapy.
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