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Chapter 14
Not to
Defining Therapy
 Psychotherapy is the treatment of
are my arms
so short?
emotional and behavioral
problems through psychological
Uses psychological rather than
exclusively biological approaches to
Involves conversation between an
individual with psychological issues
and someone trained to help
correct the problem known as a
History of Treatment
 In early Stone Age society, trepanning was
used – many did not survive the procedure
During Middle Ages, supernatural forces
were blamed for mental illness
(demonology) and exorcism was used
During the French Revolution, more humane
treatment started with the work of Philippe
By the mid-19th century, people began to
connect abnormal behavior to damage to
the brain/central nervous system
Sigmund Freud helped to popularize the
“talking cure” in the early 20th century
Since then there has been an explosive
growth in available therapies
Insight Therapies
 Designed to bring repressed feelings and thoughts to
conscious awareness developed by Freud
 Techniques
Therapist must maintain a neutral relationship with the
client so that client may project unresolved
feelings/issues upon him/her
Dream analysis
Hypnosis and post-hypnotic suggestions
Free association
Transference and resistance
Analysis of defense mechanisms
Insight and working through
 Developed by Carl Rogers
 Goal is to help clients become fully
Therapist expresses unconditional positive
regard and empathy
Therapist strives to be authentic, trying to be
genuine and real rather than formal
Therapy is nondirective but engages in active
Therapist reflects or mirrors clients’
Gestalt Therapy
Ya, you
are in ze
hot seat!
 Outgrowth of the work of Fritz Perls
 Emphasizes the wholeness of personality
 Attempts to reawaken people to their emotions
and sensations in the here-and-now
Draws attention to what exists rather than what
is absent, and draws attention to client’s voice,
posture, and movements
Encourages confrontation with issues
Therapist is active and directive
“Empty Chair” and “Hot Seat” technique
Recent Developments
 Short-term psychodynamic
Focused on trying to help people correct the
immediate problems in their lives
Forego long process of completely excavating
 Virtual therapy
Therapy delivered via chat room, phone or video
Client given techniques to use on their own after
session ends
Behavior Therapies
Behavior Therapies
 Based on the belief that all behavior –
adaptive and maladaptive - is learned
 Objective of therapy is to teach people
new ways of behaving
 Focuses on observable, measurable
Using Classical Conditioning
Say hello to Mr.
 Systematic desensitization
 Gradually associating relaxation with what
was feared
 Extinction through counterconditioning
 Ending of old fears or reactions through
repeated exposure to new stimulus pairs
 Flooding
 Full-intensity exposure to feared object
 Aversive conditioning
 Eliminate undesirable behavior by
associating it with pain and discomfort
 Virtual reality exposure therapy
 Expose client to fears in safe, virtual setting
Operant Conditioning
 Behavior contracting
 Client and therapist set behavioral goals
and agree on reinforcements the person
will receive
Client engages in desired behaviors to
attain reinforcement
 Token economy
Clients earn tokens for desired behaviors
and exchange them for desired items or
Often used in schools and hospitals
 Person learns new behaviors by
watching others perform those behaviors
 Sometimes used in conjunction with
operant conditioning
 Therapist him/herself may model
desirable behaviors for client
Cognitive Therapies
Meichenbaum’s StressInoculation Therapy
 Type of cognitive therapy that trains
people to cope with stressful situations
by learning a more useful patterns of
 Taught to suppress negative and
anxiety-provoking thoughts in times of
 Particularly effective for treating anxiety
Ellis’ Rational-Emotive Therapy
 A directive, confrontational therapy
based on the idea that psychological
distress is caused by irrational and selfdefeating beliefs
 Core problem is belief in “musts” and
“shoulds” that leave no room for making
mistakes (no more “musterbation”)
 Therapist’s job is to challenge client’s
irrational beliefs
Beck’s Cognitive Therapy
 Aimed at identifying and changing
inappropriately negative and self-critical
patterns of thought
 Therapist points out automatic
thoughts (instantaneous, habitual, and
unconscious thoughts that impact mood
and action) and catastrophizing beliefs
and forces client to substantiate them
 Good treatment for depression
Cognitive Distortions List
 All or nothing thinking (“always”,
“every”, “never”
Mental filter (focus on negative
aspects while ignoring positive
Disqualifying the positive
(shooting down positive
experiences for no reason)
Jumping to conclusions
(drawing conclusions with
little/no evidence)
Overgeneralization (isolated
case assumed for all)
 Magnification/minimization (making
mountains out of molehills,
 Emotional reasoning (decision
making based on feelings, not
 Personalization (attributing
personal responsibility when
individual has no control over
event) Should statements
(emphasizing what should be
rather than what is; what Ellis
called “musterbation”)
Group Therapies
Family Therapy
 Form of group therapy that sees the
family as at least partly responsible for
the individual’s problems
 Seeks to change all family members’
behavior to the benefit of the family and
the individual
Self-Help Groups and Couple
 Self Help Groups
 Small, local gatherings of people who
share common problems and provide
mutual assistance at very low cost
 Alcoholics Anonymous is an example
 Good for empathy, but may trigger
temptation to relapse
 Couple Therapy
 A form of group therapy intended to
help troubled partners improve their
communication and interaction
 Empathy training: partners taught to
share feelings and listen to and
understand partner’s feelings
Overall Effectiveness of
 Does Psychotherapy Work?
 Psychotherapy helps about 2/3rd of people
 Approximately 1/3 would improve without therapy
 Which Type of Therapy is Best for Which
No one type of therapy is better
Key is to match the problem with the appropriate
Effectiveness of Insight and
Cognitive Therapies
 Difficult to judge as spontaneous remission
may occur
 Who should be asked to judge the effectiveness
of therapy? Therapist or client?
 Meta-analysis may be the best bet to evaluate
these therapies
 75-80% result in improvement vs. no therapy
at all
 Only 10% were worse after therapy
 Works best with those who are not severely
Effectiveness of Behavior Therapies
 Work well for certain problems such as phobias,
compulsive behaviors, impulse control, and
learning new social skills to displace
maladaptive ones
 Criticized for ignoring internal thoughts and
expectations and just treating symptoms rather
than underlying causes
 Not well suited for some types of problems
Biological Treatments
Biological Treatments:
Overall Trends
 View abnormal behavior as a symptom
of an underlying physical disorder
 Typically favor biological therapy (drugs,
psychosurgery, ECT, etc.)
Drug Therapies
 Psychopharmacotherapy is the
treatment of mental disorders with
medication – also known as drug therapy
 Major reasons for widespread use of
Drugs are effective at treating disorders –
especially serious disorders
Drug therapies are often less expensive
that psychotherapy
Antipsychotic Drugs
 Used for schizophrenia or psychosis
(hallucinations, delusions, paranoia, disordered
thinking, incoherence)
All antipsychotics block dopamine receptors in
the brain
Side effects include drowsiness, dry mouth,
muscular rigidity, and Tardive Dyskinesia
Examples include Thorazine, Haldol, Mellaril,
Clozapine, and Risperidone
60-70% show improvement in symptoms when
these drugs are used
Antidepressant Drugs
 Tricyclics and MAO (monoamine oxidase) inhibitors
 Most common antidepressants prior to late 1980s
 Work by increasing amount of the neurotransmitters
serotonin and norepinephrine
 Effective, but have serious side effects such as heart
complications and weight gain
 Examples: Tofranil, Elevil (Tricyclics), Nardil (MAOi)
 Selective Serotonin Reuptake Inhibitors (SSRIs)
 Work by blocking the reuptake of serotonin
 Examples: Prozac, Paxil, Zoloft, Effexor
 Side effects: sleepiness, reduced sex drive
 60-70% show improvement though it may take two
weeks for changes to take effect
Action of SSRIs
Antimania Drugs:
 A naturally occurring salt (lithium
carbonate) that is used to treat bipolar
disorder (manic depression) with 80%
 Nobody knows how lithium works to
alleviate symptoms
 Problem with establishing proper dosage
and with people stopping medication
when symptoms ease
 Examples: lithium carbonate, Eskalith
Antianxiety Drugs (Anxiolytics)
 Use to treat anxiety disorders and are
often referred to as tranquilizers
 Most widely prescribed of all legal drugs
 Produce a feeling of calm and mild
 Side effects include physical
dependence and withdrawal symptoms
is abruptly discontinued
 Examples: Valium, Librium, Xanax,
 Used to treat disorders such as AD/HD
 Concern that psychostimulants are being
 Side effects: lethargy, depression,
Electroconvulsive Therapy
 Commonly known as “shock therapy”
 1938 Italian physicians Ugo Cerletti and Lucio
Bini created seizures in patients by passing an
electric current through their brains
During 1940s and 50s, used as a treatment for
depression, schizophrenia and sometimes
mania; now used only for severe depression
Causes brief convulsions and temporary loss of
Side effects include memory loss and difficulty
learning following the procedure
Up to 100,000 people receive ECT each year
 Brain surgery performed to change a
person’s behavior or emotional state
 History of Lobotomy: Egas Moniz and
Walter Freeman
Prefrontal lobotomy (EM)
Transorbital lobotomy (WF)
 Psychosurgery is rarely used today and
removes far less brain tissue
Alternatives to
 Releasing people with severe psychological
disorders into the community
 Can cause problems
Some people are ill-prepared to deal with life
outside of a hospital
 Up to 40% of homeless are mentally ill
 Alternative forms of treatment (many)
 Half-way houses
 Family-crisis interventions
 Day-care
 Primary prevention
 Improve the social environment so that new cases of
mental disorders do not develop
e.g. Family planning, Genetic counseling
 Secondary prevention
Interventions with high risk groups
e.g., suicide hot-lines, job training in economically
depressed areas
 Tertiary prevention
 Help people adjust after they are released from the
hospital in order to help prevent a relapse
 e.g. halfway houses, long-term outpatient care
 Community psychology attempts to minimize or
prevent mental disorders – not just treat them