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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) 227 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. 228 Therapy 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. 229 Chapter Fifteen A. Person-Centered Therapy This type of humanistic therapy, developed by Carl Rogers, helps clients find their own answers to their problem. 230 Therapy 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. 231 Chapter Fifteen 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. 232 Therapy 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 233 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 234 Therapy 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: 235 Chapter Fifteen 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 236 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. 237 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. 238 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? 239 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. 240 Therapy 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. 241 Chapter Fifteen Dawes, R. M. (1996). 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