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Chapter 14: Therapies
What Is Psychotherapy?
• -- *Any psychological technique used to
facilitate positive changes in personality,
behavior, or adjustment
Types of Psychotherapy
• -- *Individual: Involves only one client and
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one therapist
– Client: Patient; the one who participates in
psychotherapy
– Rogers used “client” to equalize therapistclient relationship and de-emphasize
doctor-patient concept
-- *Group: Several clients participate at the
same time
More Types of Psychotherapy
• Insight: Goal is for clients to gain deeper
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understanding of their thoughts, emotions,
and behaviors
-- *Directive: Therapist provides strong
guidance (vs. *non-directive)
Time-Limited: Any therapy that limits number
of sessions
– Partial response to managed care and to
ever-increasing caseloads
• Caseload: Number of clients a therapist
actively sees
Key Features of Psychotherapy
• Therapeutic Alliance: Caring relationship
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between the client and therapist
Therapy offers a protected setting where
emotional catharsis (release) can occur
All the therapies offer some explanation or
rationale for the client’s suffering
Provides clients with a new perspective about
themselves or their situations and a chance
to practice new behaviors
Origins of Therapy
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*Trepanning:
– Patient unlikely to
survive
– To relieve pressure
or rid the person of
evil spirits
People in Therapy
• -- *Phillippe Pinel: French physician who
initiated humane treatment of mental patients
in 1793
– Created the first mental hospital
• Freud:
– Hysteria (--somatoform disorders)
• caused by deeply hidden unconscious
conflicts
– Goal of Psychoanalysis: To resolve internal
conflicts that lead to emotional suffering
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Freudian techniques
(Psychodynamic/psychoanalysis)
-- *Free Association: saying whatever comes
to mind, regardless of how embarrassing it is.
– Allows unconscious material to emerge
-- *Dream Analysis:
– *Latent content
– *Manifest content
– Symbols
Directive
Brief psychodynamic therapy: designed to
produce insights more quickly; uses direct
questioning to reveal unconscious conflicts
Humanistic Therapies
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-- *Client-Centered Therapy (Carl Rogers)
--Nondirective and based on insights
from conscious thoughts and feelings;
accept one’s true self (optimistic!)
– *Unconditional Positive Regard: Unshakable
acceptance of another person.
– Empathy: Ability to feel what another person is
feeling
– Authenticity: Therapist is genuine and honest
about his or her feelings
– Reflection: Rephrasing or repeating thoughts and
feelings of the clients
Cybertherapy and Psychotherapy at a
Distance
• -- *Media Psychologists: Radio,
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newspaper, and television
psychologists; give advice,
information, and social support, e.g., Dr. Phil (OK),
Dr. Laura (bad)
Telephone Therapists: 900 number therapists
– May be nothing more than telephone operators
who have never even taken a psychology course!
(True in practice, too.)
Cybertherapy and Psychotherapy at a
Distance Concluded (Continued)
• Cybertherapy: Internet therapists in chat
rooms.
– Patient/client can remain anonymous
– Good if client can not drive a distance to a
therapist or cannot leave the house
(agoraphobic)
– Cheaper than traditional psychotherapy
Behavior Therapy
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Use of learning principles to
make constructive changes
in behavior
-- *Behavior Modification: Using
any classical or operant conditioning
principles to directly change human
behavior
– Deep insight is often not necessary
– Focus on the present; cannot change the past,
and no reason to alter that which has yet to occur
Positive/negative Reinforcement and punishment
Behavior Therapy (Continued)
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Conditioned Aversion: Learned dislike or negative
emotional response to a stimulus
-- *Aversion Therapy
– Associate a strong aversion to an undesirable
habit like smoking, overeating, drinking alcohol, or
gambling
– E.g., Rapid Smoking: Prolonged smoking at a
forced pace
– Designed to cause aversion to smoking
Response-Contingent Consequences
– Reinforcement, punishment, or other
consequences that are applied only when a
certain response is made
Behavioral Therapies (Continued)
• -- *Systematic Desensitization
– Hierarchy: Rank-ordered series of steps,
amounts, levels, or degrees
– Uses reciprocal Inhibition: One emotional
state is used to block another (e.g.,
impossible to be anxious and relaxed at
the same time)
Operant Therapies
• *Operant Conditioning:
Learning based on
consequences of making a response
– -- *Shaping: Rewarding actions that are
closer and closer approximations to a
desired response
– Stimulus Control: Controlling responses in
the situation in which they occur
– Time Out: Removing individual from a
situation in which reinforcement occurs
Tokens
• Tokens: Symbolic rewards like poker chips or
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gold stars that can be exchanged for real
rewards
– Can be used to immediately reinforce
positive responses
– Effective in psychiatric hospitals and
sheltered care facilities
Target Behaviors: Actions or other behaviors
a therapist seeks to change
Token Economy
• Patients get tokens for many socially
desirable or productive behaviors; they can
exchange tokens for tangible rewards and
must pay tokens for undesirable behaviors
Cognitive Therapy
• -- Therapy that helps clients change thinking
patterns that lead to problematic behaviors or
emotions
Cognitive Therapy
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Therapy that helps clients change thinking patterns
that lead to problematic behaviors or emotions
Beck: Three Major Distortions in Thinking:
– Selective Perception: Perceiving only certain
stimuli in a larger array of possibilities
– Overgeneralization: Blowing a single event out of
proportion by extending it to a large number of
unrelated situations
– All-or-Nothing Thinking: Seeing objects and
events as absolutely right or wrong, good or bad,
and so on
Rational Emotive Behavior Therapy (REBT)
• Attempts to change irrational beliefs that
cause emotional problems
– Theory created by Albert Ellis
– For example, Anya thinks, “I must be liked
by everyone; if not, I’m a rotten person.”
Group Therapy
• Psychodrama (Moreno): Clients act out
personal conflicts and feelings with others
who play supporting roles
– Role Playing: Re-enacting significant life
events
– Role Reversal: Taking the part of another
person to learn how he or she feels
– Mirror Technique: Client observes another
person re-enacting the client’s behavior
Family Therapy
• Family Therapy: All family members work as
a group to resolve the problems of each
family member
– Tends to be brief and focuses on specific
problems (e.g., specific fights)
– Modality views problems experienced by
one family member are the entire family’s
problem
Group Awareness Training
• Sensitivity Groups: Group experience
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consisting of exercises designed to increase
self-awareness and sensitivity to others
Encounter Groups: Emphasize honest
expression of feelings
Large-Group Awareness Training: Increases
self-awareness and facilitates constructive
personal change
-- Therapy Placebo Effect: Improvement is
based on client’s belief that therapy will help
Basic Counseling Skills
• Active listening
• Clarify the problem
• Focus on feelings
• Avoid giving advice
• Accept the client’s frame of reference
• Reflect thoughts and feelings
• Silence: Know when to use
• Questions
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– Open: Open-ended reply
– Closed: Can be answered “Yes” or “No”
Maintain confidentiality
Table 14.3
*Medical (Somatic) Therapies
• Pharmacotherapy: Use of drugs to alleviate
emotional disturbance; three classes:
– Anxiolytics (Antianxiety): Like Valium;
produce relaxation or reduce anxiety
– Antidepressants: Elevate mood and
combat depression
– Antipsychotics (Major Tranquilizers):
Tranquilize and also reduce hallucinations
and delusions in larger dosages
Problems with Drug Therapy
• *Clozaril (clozapine): Relieves schizophrenic
symptoms; however, two out of one hundred
patients may suffer from a potentially fatal
white blood cell disease
Electroconvulsive Therapy
• -- *Electroconvulsive Therapy (ECT): Electric
shock is passed through the brain inducing a
convulsion; treatment for severe depression
– Based on belief that seizure alleviates
depression by altering brain chemistry
• Produces only temporary improvement
• Causes permanent memory loss in
some patients
• Should only be used as a last resort
• Should be followed by antidepressant
medications to further prevent relapse
*Psychosurgery
• Any surgical alteration of the brain
• Prefrontal Lobotomy: Frontal lobes in brain
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are surgically cut from other brain areas
– Supposed to calm people who did not
respond to other forms of treatment
– Was not very successful
Deep Lesioning: Small target areas in the
brain are destroyed by using an electrode
Hospitalization
• Mental Hospitalization: Involves placing a
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person in a protected, therapeutic
environment staffed by mental health
professionals
Partial Hospitalization: Patients spend only
part of their time in the hospital and go home
at night
Deinstitutionalization: Reduced use of fulltime commitment to mental institutions
Half-Way Houses
• Short-term group living facilities for
individuals making the transition from an
institution (mental hospital, prison, etc.) to
independent living
Community Mental Health Centers
• Offer many health services like prevention,
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education, therapy, and crisis intervention
– Crisis Intervention: Skilled management of
a psychological emergency
Paraprofessional: Individual who works in a
near-professional capacity under supervision
of a more highly trained person
Other Therapy Options
• Peer Counselor: Nonprofessional person who
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has learned basic counseling skills
Self-Help Group: Group of people who share
a particular type of problem and provide
mutual support to each other (e.g.,
“Alcoholics Anonymous”)
Evaluating a Therapist: Danger Signals
• Therapist makes sexual advances
• Therapist makes repeated verbal threats or is
physically aggressive
• Therapist is excessively hostile, controlling,
blaming, or belittling
• Therapist talks repeatedly about his/her own
problems
• Therapist encourages prolonged dependence
on him/her
• Therapist demands absolute trust or tells
client not to discuss therapy with anyone else
Evaluating a Therapist: Questions to be
Answered During the Initial Meeting
• Will the information I reveal in therapy remain
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confidential?
What risks do I face if I begin therapy?
How long do you expect treatment to last?
What form of treatment do you expect to use?
Are there alternatives to therapy that might
help as much or more?