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Chapter 13
Therapies for
Psychological Disorders
Copyright © Allyn & Bacon 2007
What is Therapy?
Therapy –
General term for any treatment process;
a variety of psychological and biomedical
techniques aimed at dealing with mental
disorders or coping with problems of
living
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The Components of Therapy
In addition to the relationship between the
therapist and the patient/client, the
therapeutic process typically involves the
following processes:
• Identifying the problem
• Identifying the cause of the problem or the
conditions that maintain the problem
• Deciding on and carrying out some form of
treatment
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Types of Mental Health Care
Professionals
Counseling psychologist
Clinical psychologist
Psychiatrist
Psychoanalyst
Psychiatric nurse practitioner
Clinical social worker
Pastoral counselor
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Professional Title
Counseling psychologist
Specialty:
Clinical psychologist
Adjustment
disorders
Psychiatrist
Work setting:
Psychoanalyst
Schools, clinics,
other institutions
Psychiatric nurse practitioner
Credentials:
Clinical social worker
Pastoral counselor
At least a
Master’s in
counseling
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Professional Title
Counseling psychologist
Specialty:
Clinical psychologist
Those with severe
disorders
Psychiatrist
Work setting:
Psychoanalyst
Psychiatric nurse practitioner
Clinical social worker
Pastoral counselor
Private practice,
mental health
agencies,
hospitals
Credentials:
PsyD
Copyright © Allyn & Bacon 2007
Professional Title
Counseling psychologist
Clinical psychologist
Psychiatrist
Psychoanalyst
Psychiatric nurse practitioner
Clinical social worker
Pastoral counselor
Specialty:
Severe mental
disorders (often
uses drug
therapies)
Work setting:
Private practice,
clinics, hospitals
Credentials:
MD
Copyright © Allyn & Bacon 2007
Professional Title
Counseling psychologist
Clinical psychologist
Specialty:
Psychiatrist
Psychoanalyst
Freudian therapy
Work setting:
Psychiatric nurse practitioner
Private practice
Clinical social worker
Credentials:
Pastoral counselor
PhD
Copyright © Allyn & Bacon 2007
Professional Title
Counseling psychologist
Clinical psychologist
Psychiatrist
Psychoanalyst
Psychiatric nurse
practitioner
Clinical social worker
Pastoral counselor
Specialty:
Nursing specialty;
licensed to
prescribe drugs
Work setting:
Private practice,
clinics, hospitals
Credentials:
RN – plus special
training in treating
mental disorders
and prescribing
drugs
Copyright © Allyn & Bacon 2007
Professional Title
Counseling psychologist
Clinical psychologist
Psychiatrist
Specialty:
Social worker with
specialty in
dealing with
mental disorders
Psychoanalyst
Work setting:
Psychiatric nurse practitioner
Often employed
by government
Clinical social worker
Pastoral counselor
Credentials:
MSW
Copyright © Allyn & Bacon 2007
Professional Title
Counseling psychologist
Clinical psychologist
Psychiatrist
Psychoanalyst
Psychiatric nurse practitioner
Clinical social worker
Pastoral counselor
Specialty:
Combines
spiritual guidance
with practical
counseling
Work setting:
Religious order or
ministry
Credentials:
Varies
Copyright © Allyn & Bacon 2007
How Do Psychologists
Treat Mental Disorders?
Psychologists employ two
main forms of treatment:
insight therapies
and behavioral therapies
Copyright © Allyn & Bacon 2007
Insight Therapies
Insight therapies –
Psychotherapies in which the therapist
helps patients understand (gain insight
into) their problems
Freudian
psychoanalysis
Neo-Freudian
therapies
Humanistic therapies
Cognitive therapies
Group therapies
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Insight Therapies
Talk therapies –
focus on verbalizing emotions and
motives to understand patient behavior
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Insight Therapies:
Psychodynamic Therapies
Psychoanalysis –
The form of psychodynamic therapy
developed by Sigmund Freud
Analysis of transference –
Analyzing the patient’s relationship with the
therapist, based on the assumption that this
relationship mirrors unresolved conflicts in
the patient’s past
Copyright © Allyn & Bacon 2007
Insight Therapies:
Humanistic therapies
Humanistic therapies (Carl Rogers)
– (aka client-centered therapy)
based on the assumption that people can
grow and self actualize; people may be
blocked by an unhealthy environment
Reflection of feeling –
Paraphrasing client’s words to capture the
emotional tone expressed
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Insight Therapies:
Cognitive therapies
Cognitive therapy – (Aaron Beck)
Emphasizes rational thinking as the key
to treating mental disorder
CT for depression/anxiety involves
Challenging faulty thinking
Testing and modifying beliefs
Copyright © Allyn & Bacon 2007
Insight Therapies:
Group therapies
Group therapy –
Psychotherapy with more than one client
Very effective for depression and PTSD
Self-help support groups –
Groups that provide social support and a
forum to share common problems;
typically NOT run by professional
therapists
“Anonymous” groups: AA
Copyright © Allyn & Bacon 2007
Insight Therapies:
Group therapies
For many issues, couples counseling or
family therapy can often be more
effective than individual therapy with one
individual at a time
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Behavior Therapies
Behavior therapy –
Therapy based on the principles of
behavioral learning, especially operant
conditioning and classical conditioning
Systematic
desensitization
Exposure
Therapy
Aversion
therapy
Contingency
management
Participant
modeling
Token
economies
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Classical Conditioning Therapies
Exposure therapy –
patient directly confronts the anxietyprovoking stimulus (as opposed to
imagining it) – aka flooding
Systematic desensitization –
anxiety is extinguished by gradually
exposing the patient to increasing levels
of an anxiety-provoking stimulus (aka
graduated exposure therapy)
Copyright © Allyn & Bacon 2007
Classical Conditioning Therapies
Aversion therapy –
Pairing a pleasant and unpleasant
stimulus to condition a repulsive reaction
UCS
(foul odor)
UCR
(nausea)
CS
CR
(cigarette smoke)
Copyright © Allyn & Bacon 2007
Operant Conditioning Therapies
Contingency management –
changing behavior by altering the
consequences, (rewards and
punishments) of behavior
-e.g. shaping, timeouts, contracts, voucher
systems (WDFY), token economies
Copyright © Allyn & Bacon 2007
Operant Conditioning Therapies
Token economies –
Applied to groups (e.g. classrooms,
mental hospital wards) involving
distribution of “tokens” contingent on
desired behaviors; tokens can later be
exchanged for privileges, food, or other
reinforcers
Copyright © Allyn & Bacon 2007
Participant Modeling: An
Observational-Learning Therapy
Participant modeling –
Therapist demonstrates and encourages
a client to observe and imitate a desired
behavior
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Cognitive-Behavioral Therapy:
A Synthesis
Cognitive-behavioral therapy
Combines cognitive emphasis on thoughts
with behavioral strategies that alter
reinforcement contingencies
Assumes irrational self-statements cause
maladaptive behavior
Seeks to help the client develop a sense of
self-efficacy
Copyright © Allyn & Bacon 2007
Cognitive-Behavioral Therapy:
A Synthesis
Rational-emotive behavior therapy –
a type of CBT developed by Albert Ellis
a person is not affected emotionally by outside
things but rather by ‘perceptions and
attitudes about outside things.‘
Hamlet: “Nothing is good or bad, but…”
Ellis’s style was confrontational, the
opposite of Carl Rogers’s
Copyright © Allyn & Bacon 2007
Differences between Rogers & Ellis
Carl Rogers
Albert Ellis
Client (person) centered therapy
REBT
Supportive
Confrontational
Client has answers
Therapist has answers
Mostly cognitive
Cognitive-behavioral
Copyright © Allyn & Bacon 2007
Evaluating the Psychological
Therapies
Eysenck proposed that people with nonpsychotic problems recover just as well
with or without therapy
Reviews of evidence have shown:
That therapy is better than no therapy
It is best to match specific therapies with
specific conditions—i.e., not all therapies
work for all conditions
Copyright © Allyn & Bacon 2007
Quiz
1. What are some differences between psychologists and
psychiatrists?
2. What is the difference between group therapy & self-help
support groups?
3. What is the main difference between insight and
behavioral therapies?
4. Give an example of a behavioral therapy
Copyright © Allyn & Bacon 2007
Short Film
Note what therapeutic techniques the
therapist uses over the course of the film.
http://www.youtube.com/watch?v=Osnz
GqIWXDE
Copyright © Allyn & Bacon 2007
How Is the Biomedical
Approach Used to
Treat Mental Disorders?
Biomedical therapies treat
mental disorders by changing
the brain’s chemistry with
drugs, its circuitry with
surgery, or its patterns of
activity with pulses of
electricity or powerful
magnetic fields
Copyright © Allyn & Bacon 2007
Drug Therapy
Psychopharmacology –
Using prescription drugs to treat mental
disorders (often to make people more
receptive to talk therapies)
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Drug Therapy
Antipsychotic drugs
Include Thorazine and Haldol
Usually affect dopamine pathways
May have side effects
Tardive dyskinesia –
Incurable disorder of motor control
resulting from long-term use of
antipsychotic drugs
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Drug Therapy
Antidepressants (in order of usage)
• SSRIs like Prozac (inhibit serotonin
reuptake)
• Include tricyclics like Elavil (inhibit reuptake)
• monoamine oxidase (MOA) inhibitors
(inhibit reuptake of norepinephrine)
• Mood stabilizers (for bipolar disorder):
• Lithium (carbonate)
Copyright © Allyn & Bacon 2007
Drug Therapy
Antianxiety drugs
• Include [rarely] barbiturates (CNS
depressants) and benzodiazepines (Valium
and Xanax)
• Should not be:
• taken for more than a few days at a time
• combined with alcohol
Copyright © Allyn & Bacon 2007
Drug Therapy
Stimulants (Ritalin and Adderall) suppress
activity level in persons with attentiondeficit/hyperactivity disorder (ADHD)
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Psychosurgery
Psychosurgery –
The general term for surgical intervention
in the brain to treat psychological
disorders
The infamous prefrontal lobotomy is no longer
performed
Severing the corpus callosum, however, can
reduce life-threatening seizures
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Brain-Stimulation Therapies
Electroconvulsive therapy is used for the
treatment of severe depression
Peter’s ECT session
Transcranial magnetic stimulation, a
possible alternative to ECT, can also be
used for the treatment of addiction,
depression, schizophrenia, and bipolar
disorder
Copyright © Allyn & Bacon 2007
Hospitalization and
the Alternatives
Deinstitutionalization –
Policy of removing patients, whenever
possible, from mental hospitals
Community mental health movement –
Effort to deinstitutionalize mental patients
and to provide therapy from outpatient
clinics
Copyright © Allyn & Bacon 2007
Let’s practice identifying therapies
http://bcs.worthpublishers.com/gray/conten
t/psychsim5/Mystery%20Therapist/Myste
ryTherapist.htm
Copyright © Allyn & Bacon 2007
Let’s look at the diagnosis chart
Identify the likely disorder, and speculate
about what the best course of therapy
would be.
Copyright © Allyn & Bacon 2007
End of Chapter 13
The worst therapy ever
https://www.youtube.com/watch?v
=RzERjKiyoHc
Copyright © Allyn & Bacon 2007