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Chapter 13
Therapies for
Psychological
Disorders
Copyright © Allyn & Bacon 2007
What is Therapy?
Therapy for psychological
disorders takes a variety of
forms, but all involve some
relationship focused on
improving a person’s mental,
behavioral, or social
functioning.
Copyright © Allyn & Bacon 2007
What is Therapy?
Therapy –
General term for any treatment
process; in psychology and
psychiatry, therapy refers to a variety
of psychological and biomedical
techniques aimed at dealing with
mental disorders or coping with
problems of living.
Copyright © Allyn & Bacon 2007
The Components of Therapy
• In addition to the relationship between
the therapist and the patient/client, the
therapeutic process typically involves:
• 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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Contemporary Approaches to Therapy
Psychological therapies –
Based on psychological principles (rather
than biomedical approach).
• The psychological therapies
are often collectively
called psychotherapy.
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Contemporary Approaches to Therapy
Biomedical therapies –
Treatments that focus on altering the
brain, especially with drugs,
psychosurgery, or electroconvulsive
therapy.
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Types of Mental Health Care
Professionals
Counseling psychologist
Clinical psychologist
Psychiatrist
Psychoanalyst
Psychiatric nurse practitioner
Clinical social worker
Pastoral counselor
Copyright © Allyn & Bacon 2007
Professional Title
Counseling psychologist
Specialty:
Clinical psychologist
Problems of
normal living
Psychiatrist
Work setting:
Psychoanalyst
Schools, clinics,
other institutions
Psychiatric nurse practitioner
Credentials:
Clinical social worker
Master’s in
counseling, PhD,
EdD, or PsyD
Pastoral counselor
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Professional Title
Counseling psychologist
Specialty:
Clinical psychologist
Those with severe
disorders
Psychiatrist
Work setting:
Psychoanalyst
Private practice,
mental health
agencies,
hospitals
Psychiatric nurse practitioner
Clinical social worker
Pastoral counselor
Credentials:
PhD or 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
by means of 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
MD
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:
the insight therapies
and the 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
Copyright © Allyn & Bacon 2007
Insight Therapies
Talk therapies –
Psychotherapies that focus on
communicating and verbalizing
emotions and motives to
understand their behavior.
Psychodynamic therapies –
Insight therapies based on the
assumption that mental disorder is
caused by powerful (dynamic) mental
forces and conflicts.
Copyright © Allyn & Bacon 2007
Insight Therapies:
Psychodynamic Therapies
Psychoanalysis –
The form of psychodynamic therapy
developed by Sigmund Freud.
Analysis of transference –
Analyzing and interpreting 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 –
Techniques based on the assumption that
people have a tendency for positive
growth and self actualization, which may
be blocked by an unhealthy environment.
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Insight Therapies:
Humanistic Therapies
Client-centered therapy –
Emphasizes healthy psychological
growth through self-actualization.
- developed by Carl Rogers
Reflection of feeling –
Paraphrasing client’s words to
capture the emotional tone
expressed.
(page 534)
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Reflection of Feeling
Example:
• The patient says, "I get sick of working so
much overtime!"
• The therapist might respond, "I hear you
feeling angry and resentful at being asked to
work so much overtime."
• Feeling reflections are perhaps the most
difficult active listening responses to make. Not
only do you actively listen to what is being said
but you also actively listen for what is being
felt.
Copyright © Allyn & Bacon 2007
Insight Therapies:
Cognitive Therapies
Cognitive therapy –
Emphasizes rational thinking as the key to
treating mental disorder.
Aaron Beck’s cognitive therapy for depression
(page 536)
• Proven to be as effective as
medication
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Cognitive Therapy
Example:
• When walking down the hallway at work, John says
hello to the company CEO. The CEO does not respond
and keeps walking.
• John interprets this as the CEO’s lack of respect for
him. He gets demoralized and feels rejected.
• However, the CEO’s behavior may have nothing to do
with John. He may have been preoccupied about an
upcoming meeting, or had a fight with his wife that
morning.
• If John considered that the CEO’s behavior may not be
related to him personally, he is likely to avoid this
negative mood.
Copyright © Allyn & Bacon 2007
Insight Therapies:
Group Therapies
Group therapy –
Psychotherapy with more than one client.
Self-help support groups –
Groups that provide social
support and an opportunity for sharing
ideas about dealing with common
problems; typically organized/run by
laypersons (not professional therapists).
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.
• Therapist helps them
to perceive the issues
or patterns that are
creating problems.
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Psychotherapy
Insight Therapies
Behavior Therapies
Psychodynamic
Humanistic
Cognitive
Operant Conditioning
Observational Learning
Classical Conditioning
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Behavior Therapies
Behavior therapy –
Any form of psychotherapy based on the
principles of behavioral learning,
especially operant conditioning and
classical conditioning.
Systematic
desensitization
Aversion
therapy
Contingency
management
Token
economies
Participant
modeling
Copyright © Allyn & Bacon 2007
Classical Conditioning Therapies
Systematic desensitization –
Technique in which anxiety is
extinguished by exposing the
patient to an anxiety-provoking
stimulus.
Exposure therapy –
Desensitization therapy in which patient
directly confronts the anxiety-provoking
stimulus (as opposed to imagining it).
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Big Bang Theory
https://www.youtube.com/watch?v=Z3z_yZ
1G1Og
Sheldon’s Compulsive Closure Therapy
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Classical Conditioning Therapies
Aversion therapy –
Involves presenting individuals with an
attractive stimulus paired with unpleasant
stimulation in order to condition a
repulsive reaction.
UCS
(foul odor)
UCR
(nausea)
CS
CR
(cigarette smoke)
Copyright © Allyn & Bacon 2007
Operant Conditioning Therapies
Contingency management –
Approach to changing
behavior by altering the
consequences, especially
rewards and punishments,
of behavior.
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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
Observational-Learning Therapies
Participant modeling –
Therapist demonstrates and encourages
a client to imitate a desired behavior.
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Cognitive-Behavioral Therapy
Cognitive-behavioral therapy (CBT)
• 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.
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Cognitive-Behavioral Therapy
Rational-emotive behavior therapy
(REBT) –
Based on the idea that irrational thoughts
and behaviors are the cause of mental
disorders.
• “Don’t ‘should’ on yourself.”
- Albert Ellis
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:
• Therapy is better than no therapy!
• It appears advantageous to match specific
therapies with specific conditions.
• Quality of relationship between therapist and
client is important.
Copyright © Allyn & Bacon 2007
Most Effective Therapies?
Specific Phobias
Behavior Therapy
OCD
Alcoholism
CognitiveBehavioral Therapy
(CBT)
Depression
Eating Disorders
Couples Counseling
Insight Therapy
Relationship Problems
Copyright © Allyn & Bacon 2007
THERAPY
Biomedical
Psychotherapy
Copyright © Allyn & Bacon 2007
How Is the Biomedical
Approach Used to
Treat Mental Disorders?
Biomedical therapies seek to
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.
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Drug Therapy
Psychopharmacology –
The prescribed use of drugs to help treat
symptoms of mental illness to ensure that
individuals are more receptive to talk
therapies.
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Drug Therapy
Antipsychotic drugs – medicine that diminishes
psychotic symptoms, usually by their effect on
the dopamine pathways in the brain.
• Reduce positive symptoms of psychosis
• May have side effects
Tardive dyskinesia –
Incurable disorder of motor control,
especially involving muscles of the
face, resulting from long-term use of
antipsychotic drugs.
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Drug Therapy
Antidepressants – medicines that
affect depression, usually by their effect on
serotonin and/or norepinephrine.
Mood stabilizers:
• Lithium carbonate – highly effective in dampening
extreme mood swings (effective against bipolar
disorder)
• In high concentrations lithium can be toxic!
*The use of antidepressants to deal with general
feelings of unease is highly controversial.
Copyright © Allyn & Bacon 2007
Drug Therapy
Antianxiety drugs - drugs that diminish
feelings of anxiety.
• Include barbiturates and benzodiazepines.
• Valium and Xanax
• Should not be used to relieve ordinary
anxieties of everyday life.
• Should not be combined with alcohol!
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Drug Therapy
Stimulants – drugs that increase
activity level by encouraging
communication among neurons in the
brain.
• Stimulants actually suppress activity level
in persons with ADHD.
• There is controversy from concern that the
causes and boundaries of ADHD are vague
and the potential exists for overdiagnosis.
Copyright © Allyn & Bacon 2007
Psychosurgery
Psychosurgery – the general term for
surgical intervention in the brain to
treat psychological disorders.
• Prefrontal lobotomy – involves severing
the nerve fibers connecting the frontal lobe
with deep brain structures, especially the
thalamus and hypothalamus.
• Split-brain operation Severing the corpus callosum
can reduce life-threatening
seizures.
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Brain-Stimulation Therapies
Electroconvulsive therapy (ECT)
- A treatment used primarily for depression
and involving the application of an
electric current to the head, producing a
generalized seizure (called shock
treatment).
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Brain-Stimulation Therapies
Transcranial magnetic stimulation (TMS)
A treatment that involves magnetic
stimulation of specific regions of the brain
(an alternative to ECT).
- Can be used for the treatment of
depression, schizophrenia,
and bipolar disorder.
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Mental Hospitals
Prior to the 1950s:
•Understaffed
•Poorly funded
•Prisonlike
FEW PATIENTS
EVER LEFT!
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Deinstitutionalization
• The removal of
patients from
mental hospitals.
• Advances in psychotic
drugs and
psychotherapy.
• Provide the least
restrictive care.
• Receive outpatient
care.
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Hospitalization and
the Alternatives
Community mental health movement –
Effort to deinstitutionalize mental patients
and to provide therapy from outpatient
clinics.
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