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Psychology in
Action (8e)
by
Karen Huffman
PowerPoint  Lecture Notes Presentation
Chapter 12: Therapy
Karen Huffman, Palomar College
©John Wiley & Sons, Inc. 2007
Huffman: Psychology in Action (8e)
Lecture Overview
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Insight Therapies
Behavior Therapies
Biomedical Therapies
Therapy and Critical Thinking
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Huffman: Psychology in Action (8e)
Introductory Definitions

Psychotherapy: techniques employed to
improve psychological functioning and
promote adjustment to life

Three Major Approaches to Therapy:
 Insight (personal understanding)
 Behavior (maladaptive behaviors)
 Biomedical (mental illness and medical
treatments, such as drugs)
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Huffman: Psychology in Action (8e)
©John Wiley & Sons, Inc. 2007
Huffman: Psychology in Action (8e)
Four Major Forms of Insight Therapy
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Psychoanalysis/
psychodynamic
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Cognitive
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Humanistic
Group,
Family,
and
Marital
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Huffman: Psychology in Action (8e)
Insight Therapies:
Psychoanalysis/Psychodynamic
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Psychoanalysis:
Freudian therapy
designed to bring
unconscious conflicts
into consciousness
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Huffman: Psychology in Action (8e)
Insight Therapies:
Psychoanalyis/Psychodynamic
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Five Major Techniques of
Psychoanalysis:
1.
Free association
Dream analysis
Analyzing resistance
Analyzing transference
Interpretation
2.
3.
4.
5.
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Huffman: Psychology in Action (8e)
Insight Therapies:
Psychoanalysis/Psychodynamic
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Evaluation of psychoanalysis: Limited
applicability and lack of scientific credibility
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Psychodynamic Therapy: briefer, more
directive, and more modern form of
psychoanalysis that focuses on conscious
processes and current problems
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Huffman: Psychology in Action (8e)
©John Wiley & Sons, Inc. 2007
Huffman: Psychology in Action (8e)
Insight Therapies: Cognitive
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Cognitive Therapy: focuses on
faulty thinking and beliefs
Improvement comes from insight into
negative self-talk (unrealistic things a
person has been telling himself or herself)
 Cognitive Restructuring (process of
changing destructive thoughts or
inappropriate interpretations)

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Huffman: Psychology in Action (8e)
Insight Therapies: Cognitive (Continued)
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1.
2.
Two Major Cognitive Therapies:
Albert Ellis’s Rational-Emotive Behavior
Therapy (REBT)
Aaron Beck’s Cognitive-Behavior Therapy
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Huffman: Psychology in Action (8e)
Insight Therapies: Cognitive (Continued)
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Ellis’s Rational-Emotive Behavior Therapy
(REBT): eliminates self-defeating beliefs
through rational examination
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Huffman: Psychology in Action (8e)
Insight Therapies: Cognitive (Continued)
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Beck’s Cognitive-Behavior Therapy:
confronts and changes behaviors
associated with destructive cognitions
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Depressive Thinking Patterns:
 selective perception
 overgeneralization
 magnification
 all-or-nothing thinking
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Huffman: Psychology in Action (8e)
Insight Therapies: Cognitive (Continued)
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Evaluation of cognitive therapy:

Pro: Considerable success with a
range of problems

Con: Criticized for overemphasizing
rationality, ignoring unconscious
dynamics, minimizing importance of
the past, etc.
©John Wiley & Sons, Inc. 2007
Huffman: Psychology in Action (8e)
Insight Therapies: Humanistic

Humanistic therapy:
Maximizes personal growth
through affective restructuring
(emotional readjustment)
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Key assumption: People with problems
are suffering from a blockage or disruption
of their normal growth potential, which
leads to a defective self-concept.
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Huffman: Psychology in Action (8e)
Insight Therapies: Humanistic (Cont.)
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Rogers’s Client-Centered Therapy:
emphasizes client’s natural tendency to
become healthy and productive
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Techniques include:
 Empathy
 Unconditional positive regard
 Genuineness
 Active listening
©John Wiley & Sons, Inc. 2007
Huffman: Psychology in Action (8e)
Insight Therapies: Humanistic (Continued)
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Evaluation of humanistic therapy:
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Pro: Evidence for success
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Con: Basic tenets, such as selfactualization, difficult to test scientifically
©John Wiley & Sons, Inc. 2007
Huffman: Psychology in Action (8e)
Insight Therapies:
Group, Family, and Marital Therapies

Group Therapy: a number of people meet
together to work toward
therapeutic goals

Family and Marital
Therapies: work to change
maladaptive family and couple
interaction patterns
©John Wiley & Sons, Inc. 2007
Huffman: Psychology in Action (8e)
Behavior Therapies

Behavior Therapy: group of techniques
based on learning principles used to
change maladaptive behaviors
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Three foundations of behavior therapy:
 Classical conditioning
 Operant conditioning
 Observational learning
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Huffman: Psychology in Action (8e)
Behavior Therapies:
Classical Conditioning
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Systematic Desensitization:
gradual process of
extinguishing a learned fear
(or phobia) by working through
a hierarchy of fearful stimuli
while remaining relaxed
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Huffman: Psychology in Action (8e)
Behavior Therapies: Classical Conditioning
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Huffman: Psychology in Action (8e)
Behavior Therapies:
Classical Conditioning

Aversion Therapy: pairing an aversive (unpleasant)
stimulus with a maladaptive behavior
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Huffman: Psychology in Action (8e)
Behavior Therapies:
Operant Conditioning
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Operant Conditioning Techniques Used
to INCREASE Adaptive Behaviors:
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Shaping--successive approximations of
target behavior are rewarded (includes
role-playing, behavior rehearsal,
assertiveness training)
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Tokens: symbolic rewards used to
immediately reinforce desired behavior
©John Wiley & Sons, Inc. 2007
Huffman: Psychology in Action (8e)
Behavior Therapies:
Operant Conditioning
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Operant Conditioning Techniques
Used to DECREASE Maladaptive
Behaviors:
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Extinction: withdrawal of attention

Punishment: adding or taking away
something (e.g., time-out)
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Huffman: Psychology in Action (8e)
Behavior Therapies:
Observational Learning

Modeling: watching and imitating models
that demonstrate desirable behaviors
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Participant Modeling: combining live
modeling with direct and gradual practice
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Huffman: Psychology in Action (8e)
Behavior Therapies (Continued)

Evaluation of behavior therapies:

Pro: Strong evidence for success with a
wide range of problems

Con: Questioned and criticized for
generalizability and ethics
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Huffman: Psychology in Action (8e)
Biomedical Therapies

Biomedical Therapy: uses physiological
interventions, such as drugs, to reduce or
alleviate symptoms of psychological disorders

Three forms of biomedical therapy:
 Psychopharmacology
 Electroconvulsive therapy (ECT)
 Psychosurgery
©John Wiley & Sons, Inc. 2007
Huffman: Psychology in Action (8e)
Biomedical Therapies:
Psychopharmacology

Four major categories of drugs:
•
Antianxiety (increases relaxation,
reduces anxiety and muscle tension)
Antipsychotic (treats hallucinations
and other symptoms of psychosis)
Mood Stabilizer (treats manic
episodes and depression)
Antidepressant (treats symptoms of depression)
•
•
•
©John Wiley & Sons, Inc. 2007
Huffman: Psychology in Action (8e)
Biomedical Therapies: Psychopharmacology
©John Wiley & Sons, Inc. 2007
Huffman: Psychology in Action (8e)
Psychopharmacology—
How Antidepressants Work
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Huffman: Psychology in Action (8e)
Biomedical Therapies (Continued)

Electroconvulsive Therapy: based on
passing electrical current through the brain
and used when other methods have not
been successful

Psychosurgery: operative procedures on
the brain designed to relieve severe mental
symptoms that have not responded to
other forms of treatment
©John Wiley & Sons, Inc. 2007
Huffman: Psychology in Action (8e)
Therapy and Critical Thinking

Therapy Essentials--Five Common Goals
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Huffman: Psychology in Action (8e)
Therapy and Critical Thinking
©John Wiley & Sons, Inc. 2007
Huffman: Psychology in Action (8e)
Therapy and Critical Thinking:
Gender and Cultural Diversity
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•
•
•
•
•
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Cultural Similarities in Therapy:
naming a problem
qualities of the therapist
establishing credibility
placing the problems in a familiar framework
applying techniques to bring relief
a special time and place
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Huffman: Psychology in Action (8e)
Therapy and Critical Thinking:
Gender and Cultural Diversity (Cont.)
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Cultural Differences:

Therapies in individualistic cultures
emphasize independence, the self, and
control over one’s life.

Therapies in collectivist cultures
emphasize interdependence.
©John Wiley & Sons, Inc. 2007
Huffman: Psychology in Action (8e)
Therapy and Critical Thinking:
Gender and Cultural Diversity (Cont.)
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Key considerations for women and therapy:
1.
Higher rate of diagnosis and treatment of
mental disorders
Stresses of poverty
Stresses of multiple roles
Stresses of aging
Violence against women
2.
3.
4.
5.
©John Wiley & Sons, Inc. 2007
Huffman: Psychology in Action (8e)
Therapy and Critical Thinking:
Institutionalization
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Institutionalization—
Criteria for involuntary commitment:
–
Dangerous to self or others
Believed to be in serious need of
treatment
No reasonable alternatives
–
–
©John Wiley & Sons, Inc. 2007
Huffman: Psychology in Action (8e)
Therapy and Critical Thinking:
Institutionalization (Continued)

Deinstitutionalization: discharging as many
people as possible from state hospitals
and discouraging admissions
•
Community services such as community
mental health (CMH) centers work to
cope with the problems of
deinstitutionalization.
©John Wiley & Sons, Inc. 2007
Huffman: Psychology in Action (8e)
Therapy and Critical Thinking:
Evaluating and Finding Therapy

Forty to 90 % who receive
therapy are better off than
people who do not.

Guidelines for Finding a Therapist:
Take time to “shop around.”
If in a crisis, call 24-hour hotlines or college counselin
centers.
•
•
•
If others’ problems affect you, get help yourself.
©John Wiley & Sons, Inc. 2007
Huffman: Psychology in Action (8e)
Overestimating the Effectiveness of
Psychotherapy.
Clients tend to overestimate the effectiveness of
psychotherapy because they enter therapy in
crisis.
With the normal ebb and flow of events, the crisis
passes and people attribute their improvement
to the therapy.
Clients may also need to believe that the
investment of time and money has been worth
it.
40
Overestimating the Effectiveness of
Psychotherapy.
Finally, clients generally speak positively of
therapists who have been very
understanding and who have helped them
gain a new perspective.
Research has generally not supported clients’
estimates of therapy’s effectiveness.
41
Overestimating the Effectiveness of
Psychotherapy.
Clients enter therapy when they are extremely
unhappy, usually leave when they are less
extremely unhappy, and stay in touch only if
satisfied.
Thus, therapists, like most clients, testify to
therapy’s success. Clinicians are mostly aware
of other therapists’ failures as clients seek new
therapists for their recurring problems.
42
Overestimating the Effectiveness of
Psychotherapy.
Two phenomena that contribute to perceived value
in ineffective therapies are the
1.
placebo effect (the belief a treatment will
work) and
2.
regression toward the mean (the tendency
for extremes of unusual scores to fall back
toward the average). Feeling low tends to be
followed by our return to a more normal state
and anything we tried in the interim may seem
effective.
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Overestimating the Effectiveness of Psychotherapy.
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A common error made by clinicians involves
illusory correlations (perceived expected
associations)
Hindsight bias
Overconfidence
Client’s induced to give information that
fulfills clinician’s expectations- self-fulfilling
prophecy
44
Outcome Studies
Randomized clinical trials assign people on a
waiting list to therapy or no therapy.
Research that includes use of meta-analysis
reveals that
(1) people who remain untreated often improve;
(2) those who receive psychotherapy are more
likely to improve, and
(3) when people seek psychological treatment,
their search for other medical treatment
declines, compared with their counterparts
on waiting lists.
45
Clients who expressed greatest satisfaction with
their care and who had the best outcomes
were more likely to:
• Research their problem before seeking
help.
• Interview with more than one professional.
• Ask therapists if they had experience
treating
their problem.
• Bring a friend or family member along to
an
office visit.
• Keep a written record of their treatment
and
emotional state.
• Deliberately apply what they were
learning in treatment to their daily lives. 46
Effective Therapies
No one therapy has been shown to be best in
all cases, nor is there any relationship
between clinicians’ experience, training,
supervision, and licensing and their clients’
outcomes.
47
Effective Therapies
Some therapies are, however, well suited to
particular disorders such as:

cognitive, interpersonal, and behavior
therapies for depression;

cognitive, exposure, and stress
inoculation therapies for anxiety;

cognitive-behavior therapy for bulimia;

behavior modification for bedwetting.
48
Effective Therapies
In addition, behavioral conditioning
therapies achieve especially favorable
results in treating phobias, compulsions,
marital problems, and sexual disorders.
Therapy is most effective when the problem
is clear-cut.
49
Effective Therapies
In contrast, the light exposure therapies
(exposure to daily doses of light that
mimics outdoor light) have proven
effective in treating people with seasonal
affective disorder, a form of depression
linked to periods of decreased sunlight.
50
Effective Therapies
Writing About Emotional Experience
the mere act of disclosure may be a powerful
therapeutic agent. Research indicates that
writing about personally upsetting
experiences produces consistent and
significant health benefits.
Talking and writing about emotional
experiences are both superior to writing
about superficial topics. Most interesting is
the finding that social feedback seems
unnecessary to produce beneficial results.
51
Effective Therapies
To the degree that a problem has biological
underpinnings because it is predisposed
or heritable, it will be harder to change.
To the degree it is a learned habit, it is easier
to change.
52
Three Benefits of the Therapies
1.
2.
They all offer the expectation that, with
commitment from the patient, things can
and will get better.
Every therapy offers people a plausible
explanation of their symptoms and an
alternative way of looking at themselves
and responding to their worlds.
53
Three Benefits of the Therapies
3.
Regardless of their therapeutic technique,
effective therapists are
empathic people who seek to understand
another’s experience,

who care and have concern about how the client
feels, and

Who demonstrate respectful listening,
reassurance, and advice earn the client’s trust and
respect.
In short, all therapies offer hope for demoralized
people, a new perspective on oneself and the
world, and an empathic, trusting, caring
relationship.

54
Values and Cultural Differences
Psychotherapists’ personal beliefs and values
influence their therapy.
While nearly all agree on the importance of
encouraging clients’ sensitivity, openness,
and personal responsibility, they differ
sharply on the pursuit of self-gratification,
self-sacrifice, and interpersonal
commitment.
55
Psychology in
Action (8e)
by
Karen Huffman
PowerPoint  Lecture Notes Presentation
End of Chapter 15:
Therapy
Karen Huffman, Palomar College
©John Wiley & Sons, Inc. 2007
Huffman: Psychology in Action (8e)