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Therapy
15 Therapy
• Learning Objectives
• Chapter Outline
• Key Concepts
• Key Contributors
• Teaching the Chapter
• Lecture/Discussion Suggestions
• Classroom Activities
• Experiencing Psychology
• Critical Thinking Questions
• Video/Media Suggestions
• References
• Sources of Biographical Information
Learning Objectives
After studying this chapter, the student should be able to:
15.1 Summarize the history of the treatment of psychological disorders from its ancient origins to modern
times, showing the connection between beliefs and treatment choice. (p. 429-431)
15.2 Define psychoanalysis, and list and describe four psychoanalytic treatment techniques and
summarize how psychodynamic therapy differs from classic psychoanalysis. (p. 431-433)
15.3 Describe the general principle underlying all behavioral therapy and then list and describe three
classical-conditioning therapies, three operant-conditioning therapies, and a social-learning therapy.
(p. 433-437)
15.4 Describe the general principle underlying all the cognitive orientation to therapy and describe the
important features of rational-emotive behavior therapy and cognitive therapy. (p. 437-438)
15.5 Describe the general distinguishing perspective of all the humanistic therapies, and then list and
describe the important characteristics of two types of humanistic therapy systems. (p. 439-440)
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Chapter Fifteen
15.6 Describe the core concept of the social-relations orientation and the reasons for the development of
the group approach to therapy, and list and describe the important features of four types of grouporiented forms of therapy. (p. 440-442)
15.7 Describe the core concept underlying all biopsychological therapies and then list and describe the
important features of and controversy surrounding both psychosurgery and ECT. (p. 442-444)
15.8 Describe the principle underlying all drug therapies and then describe the important features of four
groups of medications for the treatment of psychological disorder. (p. 444-445)
15.9 Define deinstitutionalization and then summarize the strengths and weaknesses of this important
social policy, and list and describe the three main goals of the community mental-health movement.
(p. 445-447)
15.10 Summarize the relevant issues in selecting a therapist and discuss bibliotherapy as an alternative.
(p. 447)
15.11 Explain what sparked the debate on the effectiveness of psychotherapy. (p. 448)
15.12 Describe the issues surrounding the criteria of success in determining the effectiveness of
psychotherapy and summarize the findings of the major research studies. (p. 448-449).
15.13 Summarize what is known about the characteristics that are important factors in the effectiveness of
psychotherapy. (p. 449-451)
Extended Chapter Outline
I. The History of Therapy
Treatment practices have been influenced by their cultural, religious, and scientific contexts.
II. The Psychoanalytic Orientation to Therapy
Psychoanalysis grew out of Breuer’s case study of Anna O. through Freud’s efforts.
A. The Nature of Psychoanalysis
Traditional psychoanalysis takes place with the client reclining on a couch and the
therapist sitting nearby, just out of sight.
B. Techniques in Psychoanalysis
The main procedures in psychoanalysis are the analysis of free associations, resistances,
dreams, and transferences.
1. Analysis of Free Associations
In free association, the client is urged to report any thoughts or feelings that come
to mind.
2. Analysis of Resistance
In the analysis of resistance, the psychoanalyst notes behaviors that interfere with
therapeutic progress.
3. Analysis of Dreams
Freud claimed that dreams symbolize unconscious sexual and aggressive conflicts.
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4. Analysis of Transference
Transference is the client’s tendency to act toward the therapist in the way she or he
acts toward important people in everyday life.
C. Offshoots of Psychoanalysis
Psychodynamic therapists rely more on discussions of past and present social
relationships than on trying to uncover unconscious emotional conflicts.
III. The Behavioral Orientation to Therapy
The behavioral orientation emphasizes changing maladaptive behaviors rather than providing
insight into unconscious conflicts.
A. Classical-Conditioning Therapies
Therapies based on classical conditioning stress the importance of stimuli in controlling
behavior.
1. Counterconditioning
This technique applies the principles of classical conditioning to replace unpleasant
emotional responses to stimuli with more pleasant ones.
2. Systematic Desensitization
This form of counterconditioning trains the client to maintain a state of relaxation in
the presence of imagined anxiety-inducing stimuli.
3. Aversion Therapy
This form of behavior therapy inhibits maladaptive behavior by pairing a stimulus
that normally elicits a maladaptive response with an unpleasant stimulus.
B. Operant Conditioning Therapies
Treatments based on operant conditioning change maladaptive behaviors by controlling their
consequences.
1. Positive Reinforcement
One of the most important uses of positive reinforcement is the token economy, used often in
institutional settings.
2. Punishment
The therapist provides aversive consequences for maladaptive behavior.
3. Extinction
Both imaginal flooding and in vivo flooding are techniques used to extinguish maladaptive
behavior.
C. Social Learning Therapies
Social learning theory has contributed participant modeling as a way to overcome phobias.
IV. The Cognitive Orientation to Therapy
The cognitive orientation assumes that our interpretation of events, rather than events themselves,
cause psychological problems.
A. Rational-Emotive Behavior Therapy
In Ellis’s rational-emotive behavior therapy, psychological disorders are treated by forcing the
client to give up irrational beliefs.
B. Cognitive Therapy
The goal of Beck’s cognitive therapy is to change exaggerated beliefs in treating psychological
disorders, most notably, depression.
V. The Humanistic Orientation
The humanistic orientation stresses the present, the conscious, subjective mental experience, and
expression of emotion.
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A. Person-Centered Therapy
This type of humanistic therapy, developed by Carl Rogers, helps clients find their own answers
to their problem.
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B. Gestalt Therapy
This type of humanistic therapy, developed by Fritz Perls, encourages clients to become aware of
their true feelings and to take responsibility for their own actions.
VI. The Social Relations Orientation
The social relations orientation assumes that because many psychological problems involve
interpersonal relationships, additional people must be brought into the therapeutic process.
A. Group Therapy
1. Transactional Analysis
This is a form of psychoanalytic group therapy, developed by Eric Berne, that helps clients
change their immature or inappropriate ways of relating to other people.
2. Social-Skills Training
This is a form of behavioral group therapy that improves the client’s social relationships by
improving her or his interpersonal skills. Assertiveness training is a form of social skills
training that teaches clients to express their feelings directly, instead of passively or
aggressively.
B. Self-Help Groups
Self-help groups are conducted by people who have experienced those problems.
C. Family Therapy
This form of group therapy encourages the constructive expression of feelings and the
establishment of rules that family members agree to follow.
VII. The Biopsychological Orientation
The biopsychological approach is based on the assumption that psychological disorders are
associated with brain dysfunctions and consequently will respond to treatments that alter brain
activity.
A. Psychosurgery
Although psychosurgery, the treatment of psychological disorders by destroying brain tissue,
was once considered a humane alternative to locking agitated patients in rooms, its contemporary
use has declined markedly.
B. Electroconvulsive Therapy
While ECT, a biomedical therapy that uses brief electric currents to induce brain seizures, was
originally used for treating agitated patients, it proved more successful in elevating the mood of
severely depressed patients who failed to respond to drug therapy.
C. Drug Therapy
Since its introduction in the 1950s, drug therapy has become the most widely used form of medical
therapy.
1. Antianxiety Drugs
Today, the most widely prescribed antianxiety drugs are the benzodiazepines, such as Xanax
and Valium.
2. Antidepressant Drugs
The MAO inhibitors work by blocking enzymes that normally breakdown the
neurotransmitters serotonin and norepinephrine. The tricyclic antidepressants increase
serotonin and norepinephrine levels by preventing their reuptake by neurons that release
them. More recently, drugs known as serotonin-reuptake inhibitors, such as Prozac, Zoloft
and Paxil, have become widely used.
3. Antimania Drugs
The drug lithium carbonate is frequently prescribed to prevent the extreme mood swings of
bipolar disorder.
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4. Antipsychotic Drugs
Commonly used antipsychotic drugs, the phenothiazines, work by blocking brain receptor
sites for the neurotransmitter dopamine. A newer drug, clozapine, produces fewer side effects
than traditionally prescribed antipsychotic drugs.
VIII. Community Mental Health
Psychologists involved in community psychology have been involved in deinstitutionalization and
the prevention of psychological disorders.
A. Deinstitutionalization
This is the movement toward treating people with psychological disorders in community settings
instead of mental hospitals.
B. Prevention of Psychological Disorders
Community mental-health centers have three main goals in the prevention of psychological
disorders: primary prevention, secondary prevention, and tertiary prevention.
IX. Finding the Proper Therapy
You could receive from a psychologist, a psychiatrist, or a variety of other kinds of therapists. You
may choose to read self-help books, called bibliotherapy.
A. Selecting the Right Therapist
The therapist should be warm, open, concerned, and empathetic.
B. Bibliotherapy as an Alternative
If you choose high-quality books written by credible authors, bibliotherapy can be effective.
X. The Effectiveness of Psychotherapy
In 1952, Hans Eysenck challenged psychotherapists by claiming that people who received
psychotherapy improved no more than those who did not receive therapy.
A. Evaluation of Psychotherapy
One of the basic issues concerns what criteria to use in evaluating the success of psychotherapy.
1. Criteria of Success
Overall, psychotherapy is more effective than placebo treatment, which in turn, is more
effective than no-treatment control conditions.
2. Major Research Studies
Psychotherapy works, but no single kind stands out as clearly more effective than the others.
One study found that many of the participants relapsed, indicating that 16 weeks of therapy
might be insufficient to produce lasting relief from depression.
B. Factors in the Effectiveness of Psychotherapy
Researchers study the characteristics of therapies, clients, and therapists.
1. Therapy Characteristics
Research suggests that the only important therapy characteristic is the number of therapy
sessions—the more sessions, the greater the improvement.
2. Client Characteristics
According to research conducted by Luborsky, clients were more likely to improve if they
had more education, higher intelligence, and higher socioeconomic status.
3. Therapist Characteristics
The client’s perception of therapis t empathy has been consistently identified as an important
factor in the effectiveness of psychotherapy.
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Key Concepts
The History of Therapy
catharsis
moral therapy
psychotherapy
trephining
The Psychoanalytic
Orientation to Therapy
analysis of dreams
analysis of free associations
analysis of transference
psychoanalysis
The Behavioral Orientation to
Therapy
aversion therapy
behavior therapy
counterconditioning
flooding
in vivo desensitization
participant modeling
systematic desensitization
token economy
The Cognitive Orientation to
Therapy
cognitive therapy
rational-emotive-behavior
therapy (R-E-B-T)
The Humanistic Orientation to
Therapy
Gestalt therapy
person-centered therapy
The Social-Relations
Orientation to Therapy
assertiveness training
family therapy
social-skills training
transactional analysis (TA)
The Biopsychological
Orientation to Therapy
antianxiety drugs
antidepressant drugs
antimania drugs
antipsychotic drugs
electroconvulsive therapy
(ECT)
psychosurgery
Community Mental Health
deinstitutionalization
Is Psychotherapy
Effective?
spontaneous remission
Key Contributors
The History of Therapy
Bertha Pappenheim (Anna O.)
Dorothea Dix
Hippocrates
Philippe Pinel
Benjamin Rush
The Psychoanalytic
Orientation to Therapy
Josef Breuer
Sigmund Freud
The Behavioral Orientation
to Therapy
Mary Cover Jones
Joseph Wolpe
The Social-Relations
Orientation to Therapy
Eric Berne
Virginia Satir
The Cognitive Orientation to
Therapy
Aaron Beck
Albert Ellis
The Biopsychological
Orientation to Therapy
Ugo Cerletti
Egas Moniz
The Humanistic Orientation
to Therapy
Fritz Perls
Carl Rogers
Is Psychotherapy Effective?
Hans J. Eysenck
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Chapter Fifteen
Teaching the Chapter
The chapter on therapy, like the preceding chapter on psychological disorders, holds a special interest for
most students. Virtually every student knows somebody who has been to a therapist or some may have
been in therapy themselves; thus, most students know something about therapy and may have formed
some strong opinions about the therapy process. For many students, the only ideas they have about
therapy they learned from television or movies. You may want to open the chapter by giving the students
an opportunity to say what they know or what they think they know about therapy.
Emphasize that psychotherapy refers to the general process of therapy and not exclusively to
psychoanalysis. Students may be interested to know why psychoanalysts generally use a couch (it is
relaxing for clients) and sit away from their clients’ view (to avoid disturbing the free association process).
Note that this is the setup generally depicted in the mass media.
In contrasting the varying approaches to therapy, emphasize the relationship between the theories of
personality discussed earlier and the implications they have for therapy. Thus, the material in these two
chapters can help reinforce each other. Students may be interested in knowing which therapy is the “best.”
This will allow you to indicate that each client has unique needs, problems, levels of motivation, etc. (and
so does the therapist). Therefore, no single approach will always be the best.
The excerpts from the various therapy sessions provide a good way to illustrate the differences between
the approaches. As you discuss each one, ask the class how the g oals for each session differ, why the
therapist used the approach he or she did, etc.
In discussing community mental health centers and the improvement over the “dreary, regimented, lifeless”
institution, students may be interested in the Rosenhan study conducted in 1972 (see New York Times,
January 21, 1973, p. 26).
Lecture/Discussion Suggestions
1.
The History of Therapy for a Single Disorder. One of the earliest recorded psychological disorders is
hysteria, which we now refer to as a somatoform disorder, or conversion, to be more specific. The disorder
can be traced as far back as Hippocrates (c. 460-377 B.C.), who wrote about it in a paper entitled de
virginibus in which he described the symptoms, such as blindness, paralysis, or loss of sensation, and
attributed these symptoms, since there was no other evidence of physical disorder, to the womb
(hysteria), thus giving the disorder its name. Hippocrates believed that, in the young female, the
population afflicted with the disorder, the uterus wandered about in the body. If it became lodged in a
joint or behind a sensory structure, it interfered with that structure or joint, and the symptoms resulted.
Hippocrates recommended marriage as treatment, since it would make use of the uterus, and most of his
patients recovered.
In the middle ages, Galen wrote of hysteria, also attributing the disorder to disuse of the uterus. By now it
was known that the uterus did not wander about in the body but was held in place by the cervix and the
great ligament. Galen treated his patients by massage of the cervix and clitoris, and most of them
recovered. In the seventeenth century, anesthesias and other symptoms associated with hysteria were
considered manifestations of demonic possession or witchcraft. During the nineteenth century, Jean
Charcot, one of Freud’s teachers, demonstrated that these symptoms could be relieved or produced by
hypnosis, but Charcot ascribed the symptoms to an organic defect. Near the end of the nineteenth
century, Pierre Janet, another French physician, suggested that hysteria resulted from a weakening of
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psychic tension brought on by exhaustion or emotional experiences and suggested long periods of
isolation and rest, often weeks at a time. Most of his patients also recovered.
A major turning point was the advancement by Sigmund Freud of the notion that the manifestations are a
release of repressed impulses in disguised form, particularly sexual impulses. Today we do not emphasize
sexual impulses, but many psychiatrists and particularly psychoanalysts still regard the repressed impulse
theory as valid. Freud coined the term conversion hysteria to reflect his notion of a conversion of
emotional problems into physical symptoms. Freud’s therapy, of course, was aimed at catharsis of the
repressed impulses, followed by insight and working through of the impulses, so repression would not be
necessary, thus releasing both tension and symptoms. Freud and Brewer were quite successful at treating
people suffering from this disorder, as are modern therapists. Of course, with DMS-IV we no longer
conceptualize disorders in terms of repression or other defense mechanisms that allude to the
unconscious and simply describe conversion reactions as symptoms without organic pathology. It is
interesting to speculate how we will conceptualize this type of disorder or reaction in 50 or 100 years.
2.
What Is Involved in Psychoanalysis? The text reports that psychoanalytic psychotherapy, in the Freudian
tradition, involves certain practices, such as dream analysis and free association.
Singer (1981) has suggested that there are at least the following eight components to be considered:
• Free association or some form of client-generated self-expressions
• A relative neutral, empathic, and nondictatorial therapist
• Interpretation initially of resistances and defenses
• Revival with appropriate emotions of significant childhood experiences
• Identification and analysis of transference phenomena and exploration of dreams and fantasies
• Encouragement of the patient’s gaining insights about early childhood fantasies and the
accurate nature of fantasies or distorted sibling or child-parent relationships
• Working through of recurrent defenses and maladaptive reactions
• Termination when the client can identify with the unique qualities of the therapist and can go
on to independent self-analysis or working through for the rest of his or her life
Neo-Freudian or ego-psychology approaches, in contrast to the traditional psychoanalytic model, have
generally involved the following four modifications:
• A more direct confrontation of the patient concerning transference distortions and more
openness about countertransference possibilities
• A greater focus on the communication process and on variations in communication between
the client and significant others
• More emphasis on current relationships as reflections of childhood distortions
• A more direct use of warmth, concern, or other personality characteristics of the therapist as
part of the treatment process. Indeed, it has been demonstrated that the working alliance
between therapist and client may be the single most important predictor of therapeutic success
Singer, J. L. (1981). Clinical intervention: New developments in methods and evaluation. G. Stanley Hall
Lecture Series, 1, 101-128.
3.
Common Aspects of the Psychotherapies. As a part of the distinction between the various therapies
(humanistic, behavioral, and cognitive, for example), it should be emphasized to the student that there are
also common aspects to the therapies. The three common aspects to psychotherapies, as outlined by
Liechtenstein, are as follows:
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4.
•
Training: Regardless of the orientation of the therapist almost all practicing
psychotherapists hold advanced degrees. In almost all states, the title of
“psychologist” requires both an advanced educational background (master’s or
doctoral degree) and state certification through the administration of tests to
determine the breadth and depth of the therapist’s training.
•
Client-therapist relationship: No matter what psychotherapy is being attempted, it
is necessary to develop an air of trust between the therapist and client. All forms
of psychotherapy require self-disclosure and honesty on the part of the client,
and the development of the trusting relationship almost always precedes this selfdisclosure and honesty. Liechtenstein also points out that since clients can
usually discontinue treatment at their leisure, the degree to which the client will
follow prescriptive advice is often determined by this relationship. In addition, the
therapist must remain a professional, not a friend—a very fine line indeed.
•
Ethics of treatment: The therapist must provide complete attention to the client
and act in the client’s best interest at all times. For example, it is now almost
universally held that sexual contact between therapist and client is not in the
client’s best interest under any circumstances. For the same reason, the
communications of the therapy sessions must remain privileged and confidential.
This is true unless written consent to the contrary is obtained or it is deemed that
the client is dangerous to him- or herself, other individuals, or community
property. In these exceptions, information is protected as much as is possible,
providing information on a need-to-know basis only.
Beyond Warm Fuzziness. A study conducted by Gary M. Burlingame and Sally H. Barlow, both
of Brigham Young University, sheds some light on the importance of therapists’ training versus
providing simple warmth and caring. Eight experimental therapy groups met for 15 weekly
sessions. Half the groups were run by therapists and half by nonprofessionals to whom BYU
students said in a survey they most often turn to for personal help. The results indicated that
group members led by both professionals and nonprofessionals improved significantly more
than a comparison group of people awaiting therapy. At the midpoint of the 15-week sessions,
however, members of the nonprofessionals’ groups had improved significantly, whereas the
professional-run groups had actually deteriorated. By the end of the 15-week sessions, the
professional-run group had caught up with the members in the nonexperts’ groups. Six months
after the final group session, however, the members of the nonexpert-led groups had
deteriorated, whereas those led by professionals maintained their gains.
The researchers concluded that the nonprofessionals’ warmth and supportiveness helped elicit
powerful emotional experiences, but the leaders lacked the training to channel these experiences
productively. While the nonprofessionals were supporting and nurturing their clients, the
professionals were engaging in the sometimes painful process of therapy, and their clients
showed the wear and tear for a time. The professional-led groups, however, ultimately provided
for long-lasting improvement as they helped group members make their pain work for them.
Bergin, S. (1988, April). Therapy: Beyond warm fuzziness. Psychology Today, p. 14.
5.
Can Psychosurgery Be Justified? With all our knowledge about the relationship between
“states of the brain” and behavior, do we know enough to modify the process through surgical
insult? (One could, of course, extend this argument to the use of drugs but this is best left until
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Therapy
psychotherapy is studied.) An excellent source for the major arguments of this controversy is a
little book found to be invaluable in teaching introductory courses. In Taking Sides: Clashing
Views on Controversial Psychological Issues, Joseph Rubinstein and Brent Slife have compiled
a group of controversial issues in psychology. Each topic is introduced briefly and then a yes
and a no opinion are presented by notable authors — notable in the sense that they are at least
holders of multiple publications on the topic.
Vernon Mark, a brain surgeon, presents the following points to argue that psychosurgery is
justified: (1) All behavior involves central nervous system function. (2) We know that some
people who are dangers to themselves and society can be treated effectively with relatively
simple surgery. (3) The persons who diagnose and make the prescription for psychosurgery are
the best equipped, informationally, to make this decision. (4) Psychopathology is curable
through these techniques. (5) (This may be the most important issue.) Psychosurgery gives
control of the patient’s behavior back to the patient.
The no position is presented by Stephen Chorover, who makes his arguments from the
perspective of a physiological psychologist: (1) Behavior is also affected by the environment
and it is much less intrusive to change the environment than to insult a patient’s CNS. (2) Social
deviance suggests the need for social change, not change in the deviates themselves.
(3) Medically oriented psychiatrists are too eager (might be read “prepared to accept”) to find
brain pathology simply because that is what they look for. (4) In many ways, psychosurgery
may be said to destroy important characteristics that make a person unique; some even say it
destroys the personality and “creates” a new one. (5) Psychosurgery is basically a “politically
repressive tool” used to destroy freedom and dignity, to force compliance of the individual to
the prevailing opinion.
6.
Cognitive -Behavioral Therapy and Insomnia. For persistent primary insomnia, the most
common treatments are drugs, either an antidepressant or sedative hypnotic. Since these drugs
are not recommended as a long-term solution, other approaches have been investigated.
One approach, cognitive-behavioral therapy, has shown promising results. Therapists work
with clients to change attitudes about sleep, then they work on changing sleep behavior, such
as going to bed at the same time each night and getting up at the same time each day.
In one study, “Those receiving cognitive therapy saw a 54 percent reduction in their wake time
after sleep onset as compared to a 16 percent reduction for the group receiving relaxation
therapy and 12 percent for the placebo group.”
Koepke, T. (2001, Apr. 10). Behavioral therapy effective in treatment of insomnia. Chapel
Hill, NC: Duke University Medical Center. Retrieved April 13, 2001, from the World Wide
Web: http://www.dukenews.duke.edu/Med/sleep1.htm
7.
Electroconvulsive Therapy. Electroconvulsive therapy (ECT) has been used for several
decades, however, its mechanism of action remains unclear. Typically, after receiving ECT
several times over a one-month period, the client will be placed on an antidepressant.
A recent study reveals an 84% relapse rate within 6 months for those who received ECT with no
antidepressants following the ECT treatment. Those who received nortriptyline, a tricyclic
antidepressant, following ECT exhibited a 60% relapse rate. Those who received a combination
of nortriptyline and lithium exhibited a 39.11% relapse rate.
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Chapter Fifteen
The authors of the study suggest t hat tapering off ECT treatments rather than stopping
suddenly after one month and beginning antidepressants when ECT is begun may reduce the
relapse rate.
Others question the validity of ECT treatment altogether.
Sackeim, H.A., Haskett, R.F., Mulsant, B.H., & Thase, M.E. (2001). Continuation
pharmacotherapy in the prevention of relapse following electroconvulsive therapy: A
randomized controlled trial. JAMA, 285(10). Chicago: American Medical Association.
Tanner, L. (2001, Mar. 13). Study focuses on shock therapy. Associated Press. Retrieved
January 25, 1996, from the World Wide Web:
http://news.excite.com/news/ap/010313/16/biz-shock-treatment
Classroom Activities
1.
Is Psychotherapy Effective? The controversy over the effectiveness of psychotherapy seems to reduce to
those issues presented by Meltzoff and Kornreich (Yes, it works) and Gross (No, it doesn’t work) in the
Taking Sides book.
Yes A.
B.
C.
D.
Research has shown that psychotherapy works in the majority of cases.
A skilled therapist can be quite effective at providing help to mentally ill patients.
The techniques of many psychotherapeutic systems have been shown to be helpful.
Some techniques are better than others; some therapists are better than others.
No
Research shows that psychotherapy is no better or not much better than just the passage of
time.
Untrained and nonprofessionals are often as good as or better than professionals at
providing therapy.
Placebos (the patients think they are getting treatment when they are not) have often yielded
improvement close to or even better than actual treatment.
The “type” of therapy seems to make little or no difference.
A.
B.
C.
D.
Divide the class in half and have them investigate the facts to support the ideas presented here. Discuss:
Which of the arguments are best supported by evidence? Are the arguments presented aimed at different
problems, i.e., can mental illness and/or the treatment of it be lumped into one category? In particular,
have the students note that the first argument for both sides is related to what research has shown—with
opposite results. Have them find the research that supports both sides and determine if different
questions are being asked.
2.
Which Therapy? Divide the class into six groups. Assign each group a different orientation to therapy:
psychoanalytic, behavioral, cognitive, humanistic, social-relations, and biopsychological.
Ask students to imagine that they are therapists. Their job is to discern a treatment plan for a 30-year-old
woman who has come into their office complaining of feelings of anxiety. In developing the treatment
plan, what questions need to be asked of the client? What lines of thought might be followed?
When the groups have finished, ask each group to report the results of their discussion to the class.
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Therapy
Experiencing Psychology: How do the media portray drug therapy?
Rationale
Drug therapy is a major approach to the treatment of psychological disorders. Drugs such as Prozac have
inspired abundant media coverage. In this activity, you will examine the nature of drug-therapy coverage in
popular magazines and newspapers.
Method
Use your library and the Internet to find articles in popular magazines and newspapers about drug therapy
from the past five years. Possible sources to peruse are Time, Newsweek, the Washington Post, and the New
York Times. Note which drugs are covered, the tone of the articles, and the positive and negative information
presented.
Results and Discussion
Discuss the kinds of drugs that were covered, how sober or sensational the articles were, and any biases you
came across. Based on what you read, what seem to be the disorders and drugs that are greatest interest to
the media? Why do you think this is so?
Critical Thinking Questions
1.
A client goes to a psychotherapist seeking help for an incapacitating phobia toward almost all
members of the opposite sex. Describe what the therapeutic approach might be like if the
therapist is a:
• psychoanalyst.
• client-centered therapist.
• behavior therapist.
• Gestalt therapist.
• cognitive therapist.
2.
Although the use of psychosurgery has declined, advocates of psychosurgery might argue
that, through the continued performance of these procedures and the evaluation of results,
psychosurgery will become more and more successful. Although the first psychosurgery cases
were not completely successful, the same could be true of heart transplants and other types of
surgery. How would you respond to these comments?
3.
Why have psychologists developed so many different psychotherapeutic techniques to treat
the same kinds of problems?
4.
Why do you suppose that contemporary psychodynamic therapists have modified the
traditional Freudian approach?
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Chapter Fifteen
5.
In addition to fees and therapy techniques, what other information should therapists be
required to disclose to clients at the start of a therapist-client relationship?
6.
How much research should exist in support of a type of therapy before it is used by a
practitioner?
7.
What advice would you give a friend who is interested in finding a therapist? Why?
Video/Media Suggestions
Approaches to therapy (Insight Media, 1990, 30 minutes) In this video, one client is seen in three oneon-one sessions that demonstrate the psychodynamic, humanistic, and cognitive-behavioral
approaches to therapy.
Brief psychotherapy in a managed-care environment (Insight Media, 1999, 120 minutes) As managedcare arrangements cover an increasing percentage of Americans, they stimulate the need for
effective short-term therapy. This video illustrates several short-term therapy models, showing
methods for finding a focus, ways of facilitating patients’ strengths, and ethical and practical
issues of communication with managed-care companies. It also considers treatment planning and
coordination of efforts with case managers. Produced by Distance Learning Network.
Carl Rogers: The essence of client-centered therapy (Insight Media, 1998, 45 minutes) In this video,
Ramon Corrales interprets the therapeutic approach of Carl Rogers and explains the assumptions,
central hypothesis, and main techniques of client-centered therapy. The program puts Rogers in
modern perspective, examining his focus on the therapeutic relationship and illustrating ways of
connecting his approach to family systems therapy.
Conflict management: The art of making peace (Insight Media, 1999, 55 minutes) Transactional
analysis is a psychology designed to improve human relationships. Hosted by George Kohlrieser,
this video demonstrates the application of transactional analysis to conflict situations. It addresses
the theory, practice, and problems of dialogue and negotiation as they relate to conflict resolution
in personal, professional, and community settings.
Discovering psychology 22: Psychotherapy (Annenberg/CPB Project, 1990, 30 minutes, color)
Describes how research, theory, and practice come together in the treatment of psychological
disorders. Shows how attitudes have been influenced by historical, cultural, and social forces.
Ethical issues in action (Insight Media, 1998, 45 minutes) Student Ve rsion: This video demonstrates an
integrative approach to common ethical dilemmas through vignettes of ethical situations. It
discusses how a counselor’s values regarding race, religion, or abortion can influence the quality
of care.
Family systems therapy (Insight Media, 1998, 100 minutes) This video with Kenneth Hardy is an
exploration of family systems therapy, which posits that there is a balance of influence between
individuals and systems such as families, communities, or workplaces. The program includes a
sample family systems therapy session.
Integrative therapy (Insight Media, 1998, 100 minutes) Integrative therapists combine techniques from
numerous therapeutic methods in order to match a client’s level of understanding and approach to
the world. Hosted by Allen Ivey, this video explores the nature of integrative therapy, showing an
integrative counseling session and demonstrating the adaptability of the approach to a broad
spectrum of individuals.
Learning psychotherapy (Insight Media, 1999, 80 minutes) Presenting vignettes that illustrate basic
counseling skills, this video teaches a time-efficient, research-based approach to psychotherapy.
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Association for Academic Psychiatry Education Award. “A helpful tool for trainees getting their
feet wet in the art and science of psychotherapy.” — Psychiatric Times
Models of psychotherapy and clinical practice (Insight Media, 1996, 30 minutes) This video looks at
the theoretical approaches of psychotherapy. It examines the different components of the treatment
process and the use of self in the therapeutic relationship. HSTN.
Multimodal therapy (Insight Media, 1997, 44 minutes) This video features Arnold Lazarus
demonstrating the techniques of multimodal therapy in an unrehearsed session with a professional
actor. The improvised exchange provides viewers with an understanding of the methodology of the
approach and Lazarus’ closing analysis contextualizes his decisions in terms of the needs of the
client. Produced by APA Video.
Phobias: Overcoming the fear (Filmmakers Library, 1993, 60 minutes) Depicts eight individuals and their
struggles to overcome panic attacks or phobias. Among the treatments shown are psychotherapy,
behavior modification, acupuncture, self-help groups, and homeopathy.
Psychopathology and psychotherapy: Diagnosis and treatment (Insight Media, 1997. 120 minutes)
This video shows the use of Adlerian techniques for the diagnosis and treatment of psychological
disorders. It teaches how to integrate the three major interview styles — psychodynamic,
descriptive, and systemic — using DSM-IV criteria.
Sigmund Freud (Insight Media, 1995, 50 minutes) This video examines the life and work of Sigmund
Freud, from his boyhood to his medical training to the development of his theories. It discusses his
studies of hypnosis with Jean Charcot and his collaboration with Joseph Breuer on the case of
Anna O. The program examines Freud’s development of the concept of transference and explains
how through self-analysis he discovered the value of dream analysis and free association. It also
explores his collaboration and falling out with Carl Jung and his theories of drives and the Oedipus
complex.
Subtle boundary dilemmas: Ethical decision making for helping professionals (Insight Media, 1995,
24 minutes) Designed to trigger discussion of various ethical issues, this program helps
professionals explore the complex nature of setting limits and provides a concrete approach for
ethical decision making. It teaches how to focus on the context of a situation when determining
appropriate boundaries.
Therapy choices (Insight Media, 1990, 30 minutes) This program explores three group approaches to
therapy, including family systems therapy, group therapy, and self-help approaches. Clients are
seen interacting in these therapeutic settings and experts discuss each approach.
When I say no, I feel guilty (Cally Curtis Company, 1991, 30 minutes) A revised and updated video on
assertiveness training, based on the best-selling book of the same name.
The world of abnormal psychology (Insight Media, 1992, 13 volumes, 60 minutes each) This series
examines the etiology and characteristics of stress, anxiety disorders, substance abuse, sexual
disorders, mood disorders, organic mental disorders, schizophrenia, and behavior disorders. It also
explores a wide range of approaches to treating abnormal behavior.
Please note: Films for the Humanities and Sciences has a catalog detailing many programs devoted to
various aspects of abnormal behavior. Among the newer entries is the 1996 six-program series entitled
Anxiety-Related Disorders: The Worried Well, and the 1994 three-program series entitled Diagnosis
According to the DSM-IV. To review the available films, visit http://www.films.com.
References
Beck, J. S. (1995). Cognitive therapy: Basics and beyond. New York: Guilford Press.
Clarkson, P. (1999). Gestalt counselling in action. Thousand Oaks, CA: Sage Publications.
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Dawes, R. M. (1996). House of cards: Psychology and psychotherapy built on myth. New York: Free
Press.
Ellis, A. & MacClaren, C. (1998). Rational emotive behavior therapy: A therapist’s guide. San Luis
Obispo, CA: Impact Publishers.
Harman, R. L. (1996). Gestalt therapy techniques: Working with groups, couples, and sexually
dysfunctional men. Northvale, NJ: J. Aronson.
McMullin, R. E. (2000). The new handbook of cognitive therapy techniques. New York: W.W. Norton.
Phillips, F. B. (1990). NTU psychotherapy: An Afrocentric approach. Journal of Black Psychology,
17(1), 55-74.
Pressman, J. D. (1998). Last resort: Psychosurgery and the limits of medicine. New York: Cambridge
University Press.
Reppen, J. (Ed.) (1994). Analysts at work: Practice, principles, and techniques. London: J. Aronson.
Szasz, T. S. (1988). The myth of psychotherapy: Mental healing as religion, rhetoric, and repression.
Syracuse, NY: Syracuse University Press.
Valenstein, E. S. (1986). Great and desperate cures: The rise and decline of psychosurgery and other
radical treatments for mental illness. New York: Basic Books.
Wolman, B. B. (1995). Diverse techniques of analysis by 27 eminent clinicians. London: J. Aronson.
Sources of Biographical Information
Bond, E. D. (1950/1979). Thomas W. Salmon, psychiatrist. Salem, NH: Ayer.
Borch-Jacobson, M. (1991). Lacan: The absolute master. Stanford, CA: Stanford University Press.
Clarkson, P., & Mackewn, J. (1993). Fritz Perls. Newbury Park, CA: Sage.
Dewey, R., & Dewey, E. L. (1936/1973). Recollections of Richard Dewey: Pioneer in American
psychiatry. Salem, NH: Ayer.
Dorsey, J. M. (1976). An American psychiatrist in Vienna, 1935-1937. Detroit: Wayne State University
Press.
Federn, E. (1990). Witnessing psychoanalysis. New York: Brunner/Mazel.
Friedman, L. J. (1990). Menninger: The family and the clinic. New York: Knopf.
Gaines, J. (1979). Fritz Perls, here and now: An oral biography of the father of Gestalt therapy.
Tiburon, CA: Integrated Press.
Gardiner, M. (1983). Code name “Mary”: Memoirs of an American woman in the Austrian
underground. New Haven, CT: Yale University Press.
Gollaher, D. (1995). A voice for the mad: The life of Dorothea Dix. New York: Free Press.
Graham, T. F. (1966). Parallel profiles: Pioneers in mental health. Chicago: Franciscan Herald Press.
Grossman, C. M., & Grossman, S. (1965). The wild analyst: The life and work of Georg Groddeck. New
York: Brazilier.
Guttmann, M. G. (2000). The enigma of Anna O. Wakefield, RI: Moyer Bell.
Hawke, D. F. (1971). Benjamin Rush: Revolutionary gadfly. New York: Irvington.
Hirschmuller, A. (1978). The life and work of Josef Breuer: Physiology and psychoanalysis. New York:
New York University Press.
Jones, E. (1959). Free associations: Memoirs of a psychoanalyst. New York: Basic Books.
Jorgensen, E. W., & Jorgensen, H. I. (1984). Eric Berne: Master gamesman—A transactional
biography. New York: Grove-Atlantic.
MacLean, G., & Rappen, U. (1991). Hermine Hug-Hellmuth: Her life and work. New York: Routledge.
Mackler, B. (1969). Philippe Pinel: Unchainer of the insane. New York: Watts.
Mahler, M. (1988). The memoirs of Margaret Mahler (P. E. Stepansky, Ed.). New York: Free Press.
Marineau, R. F. (1989). Jacob Levy Moreno. New York: Tavistock/Routledge.
Marshall, H. E. (1937/1967). Dorothea Dix: A forgotten samaritan. Fenwick, WV: Russell.
242
Therapy
Masson, J. M. (1990). Final analysis: The making and unmaking of a psychoanalyst. Boston:
Addison-Wesley.
Masson, J. M. (1992). My father’s guru: A journey through spirituality and disillusion. Boston:
Addison-Wesley.
Menaker, E. (1989). Appointment in Vienna: An American psychoanalyst recalls her student days in
pre-war Austria. New York: St. Martin’s Press.
Menninger, K. A. (1988). The selected correspondence of Dr. Karl A. Menninger, 1919-1945 (edited by
H. J. Faulkner & V. D. Pruitt). New Haven, CT: Yale University Press.
Roazen, P. (1985). Helene Deutsch: A psychoanalyst’s life. Garden City, NY: Anchor/Doubleday.
Rush, B. (1948). The autobiography of Benjamin Rush. Westport, CT: Greenwood.
Schlaifer, C., & Freeman, L. (1991). Heart’s work: The life of Civil War heroine and champion of the
mentally ill, Dorothea Dix. New York: Paragon House.
Schneiderman, S. (1983). Jacques Lacan: The death of an intellectual hero. Cambridge, MA: Harvard
University Press.
Sterba, R. (1982). Reminiscences of a Viennese psychoanalyst. Detroit: Wayne State University Press.
Stewart, I. (1992). Eric Berne. Newbury Park, CA: Sage.
Tiffany, F. (1890). Life of Dorothea Lynde Dix. Boston: Houghton-Mifflin.
Walker, C. E. (1991). The history of clinical psychology in autobiography, Vol. 1. Pacific Grove, CA:
Brooks/Cole.
Walker, C. E. (1992). The history of clinical psychology in autobiography, Vol. 2. Pacific Grove, CA:
Brooks/Cole.
Weishaar, M. (1992). Aaron Beck. Newbury Park, CA: Sage.
White, W. A. (1938/1979). William Alanson White: The autobiography of a purpose. Salem, NH: Ayer.
Wiener, D. N. (1988). Albert Ellis: Passionate skeptic. Westport, CT: Praeger.
Wilson, D. C. (1975). Stranger and traveler: The story of Dorothea Dix, American reformer. Boston:
Little, Brown.
Young-Breuhl, E. (1982). Hannah Arendt: For love of the world. New Haven, CT: Yale University Press.
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