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Abnormal Psychology,
Psychopathology & Psychotherapy
What should be labeled deviant?
 What psychiatrists, clinical psychologists or other trained
professionals label deviant? (DSM-IV)
Or,
Only organically based behavioral disorders (Szasz).
Treating Insanity
• Hippocrates – recognized depression and epilepsy as
medical problem.
• Middle ages – deviant people were locked up
•Bedlam (Bethlehem hospital, London)
• Reform movement
•Pinel (1790)
•Dorothea Dix (1850)
•Medical Model (late 19th century)
Trephination
Exorcizing the Devil to alleviate madness
An old-fashioned straight-jacket
St. Mary’s of Bethlehem Hospital
(“Bedlam”)
Dorothea Dix
Medical Model of Mental Illness
• Psychiatry an offshoot of neurology (Charcot (1860), Breuer & Freud (1896),
Bleuler (1911).
• Freud: Too little was known about the brain; opted for psychoanalysis.
Classified mental illness into two major categories: neuroses and psychoses.
• “General paresis” discovered by Krafft-Ebbing to have a physical cause in
1905 (syphilis).
• Pavlov (1904). Concept of conditioning and experimental neurosis that was
mediated by specific brain circuits.
Reactions to the Medical Model
• Harry Stack Sullivan (broke with psychoanalytic tradition).
• Clinical (lay) psychologists allowed to treat patients with
“mental” disorders.
• Carl Rogers, Ph.D. Published first transcript of a therapeutic session.
• Behavior Therapy (Wolpe, Lazarus). Began in 50’s.
• Cognitive Therapy (Seligman). Began in 60’s.
• Thomas Szaz: Mental illness should only refer to behavioral deviations
that have a well defined organic basis. Other deviant behaviors the product
of “problems of living”.
• DSM-III (1983) & IV (1994)
What is a normal personality?
•Least deviant?
•What is deviant?
•Statistical (does 1/10 of population have mental
illness?)
•Adaptive sublimation?
•Self-actualization?
•Quantitative vs. qualitative differences between
normal and abnormal.
DSM III (1983)
•Disorders first evident in childhood (e.g., mental retardation, hyperactivity).
•Organic mental disorders: symptoms directly related to injury to brain or to
abnormality (syphilis, Alzheimer’s disease, extreme alcoholism, brain tumor).
•Substance use disorders.
•Schizophrenic disorders.
•Paranoid disorders.
•Affective disorders (manic and/or depressed moods).
•Somatoform disorders (hysteria, hypochodriasis).
•Dissociative disorders (amnesia, multiple personalities).
•Psychosexual disorders (transsexualism, frigidity, exhibitionism, sexual sadism,
homosexuality-but only if individual is unhappy).
•Personality disorders (anti-social behavior, narcissistic personality).
•Anxiety disorders (generalized anxiety or panic, phobias,posttraumatic stress
disorder, obsessive-compulsive disorder).
•Leftovers (marital problems, family therapy).
DSM IV (1994)
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Anxiety disorders.
Mood disorders.
Somatoform disorders.
Dissociative disorders.
Schizophrenia and other psychotic disordcrs (delusional).
Substance-related disorders
Eating disorders (aneroxia nervosa, bulimia nervosa).
Sleep disorders.
Impulse control disorders (kleptomania, pyromania, pathological
gambling)
Personality disorders (anti-social behavior, narcissistic personality).
Disorders first evident in childhood (e.g., mental retardation,
hyperactivity).
Delerium, dementia, amnestic and other cognitive disorders.
Adjustment disorder (Maladaptive, excessive emotional reaction to a
stressful event within previous 6 months).
DSM III (1983)
Childhood mental retardation,
hyperactivity
Organic mental disorders: symptoms
directly related to injury to brain or to
abnormality
Substance use
DSM IV (1994)
Childhood (e.g., mental retardation,
hyperactivity).
Delerium, dementia, amnestic and
other cognitive disorders.
Substance-related disorders
Schizophrenic
Schizophrenia and other psychotic
disordcrs (delusional
Paranoid
Affective disorders (manic and/or
depressed moods).
Somatoform disorders (hysteria,
hypochodriasis).
Dissociative disorders (amnesia, multiple
personalities).
Psychosexual disorders transsexualism,
frigidity, exhibitionism, sexual sadism,
homosexuality-but
only(anti-social
if individual is
Personality
disorders
behavior, narcissistic personality)
Anxiety disorders (generalized anxiety or
panic, phobias, posttraumatic stress
disorder, obsessive-compulsive disorder.
Leftovers (marital problems, family
therapy).
Mood disorders.
Somatoform disorders
Dissociative disorders.
Personality disorders (anti-social
behavior, narcissistic personality).
Anxiety disorders
Adjustment disorder (Maladaptive,
excessive emotional reaction to a
stressful
event within
previous
6 ,
Eating disorders
(aneroxia
nervosa
bulimia nervosa).
Sleep disorders.
Impulse control disorders
(kleptomania, pyromania, pathological
gambling)
Psychoanalysis
• Based on Freud’s theory of personality
– Many varieties, e.g., Jung, Adler, Sullivan
• M.D. usually required; Ph.D. in clinical psychology now acceptable
(lay analysts)
• Training performed by certified institutes in three stages:
– formal courses
– personal analysis with an institute analyst
– control analyses supervised by a training analyst.
• Patients: usually brighter than average; in most cases neurotic.
Typically excluded are homosexuals, alcoholics, psychotics,
patients with character disorders.
Sheldon’s Body Types
Types of Personality Tests
• Objective
– MMPI (Minnesota Multi Phasic Inventory)
•Projective
–TAT (Thematic Apperception Test)
–Rorschach Test
MMPI Categories
MMPI Categories (cont’d)
Interpretation of Sample MMPI Score
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•
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Overly self-critical
Personality disorder
Poor social adjustment
Unusual thinking and behavior
High level of anxiety
Sample Tat Card
Sample Tat Card
Sample Responses On TAT Test
1.
1.
My first thought is that it looks like a mother coming to the
door.
.
2.
--the doorbell just rang and she’s expecting someone
probably pretty dear.
3.
maybe it’s her son--that shows I’m homesick.
4.
stuff in the room--furniture, flowers, bookshelves and
books--looks roughly like the middle-class home I came from
5.
she doesn’t look like my mother, but somebody’s mother
6.
even if she has one nude leg.
TAT STORIES IN RESPONSE TO
“BOY LOOKING AT VIOLIN”
• 45-year old business man:
• This is a child prodigy dreaming over his violin, thinking more
of the music that anything else. But of wonderment that so
much music can be in an instrument and in the fingers of his
own hand. . . .I would say that possibly he is in reverie about
what he can do with his music in the times that lay ahead. He
is dreaming of concert halls, tours, and . . . the beauty he will
be able to express and even now can express with his own
talents.
TAT STORY 2
• 45-Year old clerk:
• . . . This is the son of a very well-known, a very good
musician. . . . The father has probably died. The only thing
the son has left is this violin which is undoubtedly a very
good one. . . . To the son, the violin is the father and the
son sits there daydreaming of the time that he will
understand the music and interpret is on the violin that his
father had played.
Administering a Rorschach Test
Sample Rorschach Card
Incidence of Mental Illness
Incidence of Depression by Country
Percentage of population aged 18-24 experiencing
major depression at some point in life
Conditions for Psychoanalysis
• MD originally required
• No psychotics, alcoholics, homosexuals, sociopaths
• Time commitment: ~ 5 years
• Financial commitment: $150 x 4; $600/week; $27,000/year.
• Life decisions placed on hold. No marriage, divorce, moving,
changing jobs without consulting analyst.
Freud’s couch
Psychoanalytic Method
• Treatment consists of three to five 50 minute sessions per
week .
• Patient is instructed to free associate. He does this while
lying on a couch that is facing away from the analyst.
– less fatiguing to the analyst than face-to-face
relationships
– facilitated free association.
• Basic goal is to have awareness of one’s motives and
memories.
• Dream interpretation
• Transference
Goals of Psychoanalysis
• Genetic progression - bring the patient from his point of fixation in
the psychosexual development to the genital stage.
• Structural - the ego should be strengthened in satisfactory
relationships with the super ego.
• Dynamic - direct energy from the defense mechanism to more
productive outlets.
• Topographic - makes the unconscious conscious - specifically, the
defense mechanisms.
Client-centered Therapy
• Does not assume medical model (client vs. patient;
counselor vs. therapist/doctor
• Brief duration (~ 10 visits)
• Non-directive
– Counselor “reflects” rather than “interprets”
– No dream analysis
– No specific retracing of psychosexual history
Process of Client-Centered Therapy
1. Rigidity - little desire to change. Little recognition of feelings.
2. Perception of problems, externally dispassionate display of feeling.
Little recognition of contradictory feelings...
3. Free expression of feelings. Source of feelings considered. Increased
awareness of the “real me.” Awareness of contradictions.
4. Immediacy of feelings. Real direct experience. High self-regard.
Less intellectualization about self.
5. Acceptance of self and problem.
Excerpts from the first interview in
Rogerian Therapy
• P (patient): I hesitate to meet people - I hesitate to canvas for my
photographic business. I feel a terrific aversion to any kind of
activity, even dancing. I normally enjoy dancing very much. But
when my inhibition, or whatever you wish to cal it, is on me
powerfully, it is an ordeal for me to dance. I notice a difference in
my musical ability. On my good days I can harmonize with other
people singing.
• C (counselor): M-hm.
Excerpts from the first interview in
Rogerian Therapy (cont’d)
• P: I have a good ear for harmony then. But when I’m blocked, I seem
to lose that, as well as my dancing ability. I feel very awkward and
stiff.
• C: M-hm. So that both in your work and in your recreation you feel
blocked.
• P: I don’t want to do anything. I just lie around. I get no gusto for
any activity at all.
• C: You just feel rather unable to do things, is that it?
• ************************
Excerpts from the first interview in
Rogerian Therapy (cont’d)
• P: Well, it’s just reached the point where it becomes unbearable. I’d
rather be dead than alive as I am now.
• C: You’d rather be dead than alive as you are now? Can you tell me a
little more about that?
• P: Well, I hope. Of course, we always live on hope.
• C: Yes.
Excerpts from the eighth and final
interview in Rogerian Therapy
• P: Well, I’ve been noticing something decidedly new. Rather than
have fluctuations, I’ve been noticing a very gradual and steady
improvement. It’s just as if I have become more stabilized and my
growth had been one of the hard way and the sure way rather than
the wavering and the fluctuating way.
• C: M-hm.
Excerpts from the eighth and final
interview in Rogerian Therapy
• P: I go into situations, and even though it’s an effort, why, I go
ahead and make progress, and I find that when you sort of seize
the bull by the horns, as it were, why it isn’t so bad as if you
deliberate and perhaps - well, think too long about it, like I used
to. I sort of say to myself, “Well, I know absolutely that avoiding
the situation will leave me in the same rut I’ve been talking,” and
I realize that I don’t want to be in the same old rut, so I go ahead
and go into the situation, and even when I have disappointments in
the situation, I find that they don’t bring me down as much as they
used to.
Excerpts from the eighth and final
interview in Rogerian Therapy (cont’d)
• C: That sounds like very real progress.
• P: And what pleases me is that my feelings are on an
even keel, steadily improving, which gives me much more
of a feeling of security than if I had fluctuations. You
see, fluctuations lead you from the peaks to the valleys,
and you can’t get as much self-confidence as when you’re
having gradual improvement.
• C: M-hm.
• P: So that the harder way is really the more satisfactory
way.
• C: Then you’re really finding a step-by-step type of
improvement that you hadn’t found before.
Phobia
Descripion
Phobia
Description
Acrophobia
Heights
Monophobia
Being alone
Aerophobia
Flying
Mysophobia
Dirt & Germs
Agoraphobia
Public places
Nyctophobia
Darkness
Aichmophobia
Sharp pointed
objects
Ophidiophobia
Snakes
Arachnophobia
Spiders
Parthenophobia
Virgins
Brontophobia
Thunder-storms
Porphyrophobia
The color
purple
Claustrophobia
Closed spaces
Triskaidekaphobia
#13
Entomophobia
Insects
Xenophobia
Strangers
Hematophobia
Blood
Zoophobia
Animals
Relative Frequency of Phobias
How Phobias Vary With Age
Behavioral Therapy
Treatment of a
Phobia
(Sensitization)
Behavior Therapist’s Instructions
“Let all your muscles go loose and heavy. Just settle
back quietly and comfortably. Wrinkle up your
forehead now; wrinkle it tighter....
tighter....And now stop
wrinkling your forehead, relax and smooth it out.
Picture the entire forehead and scalp becoming
smoother as the relaxation increases....
Behavior Therapist’s Instructions
Now frown and crease your brows and study the tension....Let
tension....
go
of the tension again. Smooth out the forehead once more....
more....Now, close your eyes tighter and tighter...feel the
tension...and relax your eyes. Keep your eyes closed, gently,
comfortably, and notice the relaxation .... Now clench your
jaws, bite your teeth together; study the tension throughout
the jaws....
jaws....Relax your jaws now. Let your lips part
slightly....Appreciate the relaxation....
Behavior Therapist’s Instructions
Now press your tongue hard against the roof of your mouth.
Look for the tension....All
tension....
right, let your tongue return to a
comfortable and relaxed position .... Now purse your lips,
press your lips together tighter and tighter....Relax
tighter....
your lips.
Note the contrast between tension and relaxation. Feel the
relaxation all over your face, all over your forehead and
scalp, eyes, jaws, lips, tongue and throat. The relaxation
progresses further and further...”. [from Wolpe and Lazarus
(1966), p. 178]
BEHAVIOR THERAPY TRANSCRIPT
“The patient, a 14-year-old boy, suffered from an intense fear of
dogs which lasted for two and one-half to three years. He
would take two buses on a roundabout route to school rather
than risk exposure to dogs on a direct 300-yard walk. He was
rather a dull (IQ = 93), sluggish person, very large for his age,
trying to be cooperative, but sadly unresponsive---especially
to attempts at training in relaxation.
BEHAVIOR THERAPY TRANSCRIPT (cont’d.)
In his desire to please, he would state that he had been perfectly
relaxed even though he had betrayed himself by his intense
fidgetiness. Training in relaxation was eventually abandoned,
and an attempt was made to establish the nature of his
aspirations and goals. By dint of much questioning and after
following many false trails because of his inarticulateness, a
topic was eventually tracked down that was absorbing enough
to form the subject of his fantasies, namely, racing motorcars.
BEHAVIOR THERAPY TRANSCRIPT (cont’d.)
He had a burning ambition to own a certain Alfa Romeo sports car and race it
at the Indianapolis 500. Emotive imagery was induced as follows: “Close
your eyes. I want you to imagine, clearly and vividly, that your wish has
come true. The Alfa Romeo is now in your possession. It is your car. It is
standing in the street outside your house. You are looking at it now.
Notice the beautiful, sleek lines. You decide to go for a drive with some
friends of yours. You sit down at the wheel, and you feel a thrill of pride
as you realize that you own this magnificent machine.
BEHAVIOR THERAPY TRANSCRIPT (cont’d.)
You start up and listen to the wonderful roar of the exhaust. You let
the clutch in and the car streaks off. You are out in a clear open
road now; the car is performing like a pedigree; the speedometer is
climbing into the nineties; you have a wonderful feeling of being in
perfect control; you look at trees whizzing by and you see a little
dog standing next to one of them-- if you feel any anxiety, just raise
your finger....” An item fairly high up on the hierarchy was: “You
stop at a cafe in a little town, and dozens of people crowd around to
look enviously at this magnificent car and its lucky owner; you swell
with pride; and at this moment a large boxer comes up and sniffs at
your heels. If you feel any anxiety....”
Abramovitz (1962)].
[from Lazarus and
Comparisons of Different Approaches to Psychotherapy
Behavior Modification
Psychoanalysis
What is to be modified?
Learned behavior
Symptoms
Role of therapist:
Deliberate
None - minimal
Active
Indirect
Direct
Passive
Philosophy of treatment:
Scientific
Intuitive
Interpretation of behavior:
Real
Symbolic
Aim:
Goal directed
General restructuring
Basis of change:
Training
What is dealt with:
Present behavior
Insight
Past behavior
Comparisons of Different Approaches to Psychotherapy
Behavior Modification
Psychoanalysis
What is to be modified?
Learned behavior
Symptoms
Role of therapist:
Deliberate
None - minimal
Active
Indirect
Direct
Passive
Philosophy of treatment:
Scientific
Intuitive
Interpretation of behavior:
Real
Symbolic
Aim:
Goal directed
General restructuring
Basis of change:
Training
What is dealt with:
Present behavior
Insight
Past behavior