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Psychotherapy
Therapy Comes in Many Forms
 Many sources and types of treatment are
available
 There are two broad categories of therapy
• Somatic therapy
 Treating psychological disorders by treating the
body
 Somatic therapy often involves methods that
affect hormone levels and brain chemistry
Therapy Comes in Many Forms
• Psychotherapy
 Treatment of psychological problems
through psychological techniques
 It is a change-oriented process
 Its goal is to teach people to cope better
and lead more fulfilling lives
 It does so by teaching people to relieve
stress, improve interpersonal
communication, understand previous life
events, and/or modify their thinking
Is Psychotherapy Necessary and
Effective?
 Does psychotherapy simply create
placebo effect?
• A placebo effect is a nonspecific
improvement as a result of a person’s
expectations of change
 It is not a result of a therapeutic
treatment
 Some patients in psychotherapy may
show relief from their symptoms simply
because they are in therapy and may
expect change
Is Psychotherapy Effective?
 Some patients in psychotherapy may show
relief from their symptoms simply because
they are in therapy and may expect
change
 The placebo effect complicates research on
therapy
effectiveness
• Researchers must determine if
improvements are due to expectations or
real benefits of therapy
•
The double-blind technique helps
distinguish between improvements due to
expectations or therapy
Is Psychotherapy Effective?
 The double-blind technique helps
distinguish between improvements due to
expectations or therapy
 In the double-blind technique neither the
experimenter nor participants know who is in the
experimental or control groups
• The double-blind eliminates any potential
bias by reducing demand characteristics
Is Psychotherapy Effective?
 The double-blind eliminates any potential
bias by reducing demand characteristics
• Demand characteristics are elements of an
experiment that might bias the participant
to act in a certain way
 By perceiving the situation in a certain way,
or becoming aware of the purpose of the
study
 Demand characteristics distort the results
of a study
Is Psychotherapy Effective?
 Demand characteristics distort the
results of a study
 Research studies that compare
psychotherapy and placebo
treatment show the therapies are
consistently more effective
Research on Psychotherapy

In a 1952 paper, Hans Eysenck
challenged the effectiveness of
psychotherapy
•
He claimed that it produced no greater
change in maladjustment than natural life
experiences
•
Thousands of studies investigating the
effectiveness of therapy followed
•
These studies, and analyses using
sophisticated statistical techniques, found
psychotherapy to be effective
Research on Psychotherapy
 These studies, and
analyses using
sophisticated
statistical
techniques, found
psychotherapy to
be effective
 Effectiveness and
the client’s speed
of response vary
with the type of
problem
 Is one type of
therapy more
effective?
• Many researchers
contend that most
psychotherapies are
equally effective
• If most therapies
are effective, there
must be a common
underlying
component making
them successful
Research on Psychotherapy

If most therapies are effective, there must
be a common underlying component
making them successful
• Researchers are seeking to systematize
research strategies to investigate the
effectiveness of therapies
• This research will lead to a clearer picture of
which approaches are best for certain
disorders and clients of various ages and
ethnic groups
Which Therapy, Which Therapist?
 There are hundreds of types of
therapy
• Some focus on individuals, some on
groups (group therapy) and others on
families (family therapy)
• Community psychologists focus on whole
communities
Which Therapy?


Community
psychologists
focus on whole
communities
They try to
develop actionoriented
approaches to
individual and
social problems


A therapist’s
training usually
determines the
approach taken
Many therapists
take an eclectic
approach,
combining
different
techniques
Which Therapy?
 A number of specific
psychotherapeutic approaches are in
use today
• Psychodynamically based approaches
are based on Freud’s ideas
 Psychodynamic approaches aim to help
patients understand the motivations
underlying their behavior
 They assume abnormal behavior occurs
when people do not understand
themselves
Which Therapy?
• Humanistic approaches assume
people are essentially good
 Humanistic approaches try to help
people realize their full potential and
find meaning in life
• Behavior therapy is based on the
assumption most behaviors are
learned
 Behavior therapists encourage clients
to learn new adaptive behaviors
Which Therapy?
• Cognitive therapy focuses on changing
a client’s behavior by changing
thoughts and perceptions

A new approach, psychotherapy
integration, is now emerging
• It is more than an eclectic approach,
because the goal is to integrate theories
into a new approach
• Research on psychotherapy integration is
relatively scarce
Which Therapy?


The effectiveness
of different kinds of
therapy depends
on two things, the
disorder treated
and the goals of
the client
Research to
discover the best
treatment usually
focuses on specific
disorders


Research on
psychotherapy
integration is
relatively scarce
This is because it is
difficult to generate
hypotheses based on
the new points of
view it creates
Which Therapy?
 Research to discover the best treatment
usually focuses on specific disorders
 Besides therapeutic approaches, some
characteristics of the therapist affect
treatment
• These include ethnicity, personality, level of
experience, and degree of empathy
• While there are differences among therapists,
there are also commonalities
Which Therapy?
 While there are differences among
therapists, there are also commonalities
• Clients receive attention, which helps them
maintain a positive attitude
• Good therapists communicate interest,
understanding, respect, tact, and maturity
• Good therapists use suggestions,
interpretation, encouragement, and
perhaps rewards to help clients change
Which Therapy?


Good therapists use suggestions,
interpretation, encouragement, and
perhaps rewards to help clients change
But clients must be willing to make some
changes in their lifestyles and ideas

The therapist and client must form an
alliance to work together purposefully
Culture and Therapy
 The therapy process and its outcome
are effected by the client’s ethnicity
• Care must be taken to be culturally
congruent
 Have a match between therapist and
client
 At a minimum, the therapist must
respect multiculturalism
Culture and Therapy
 At a minimum, the therapist must respect
multiculturalism
• The acceptance of and celebration of distinct
cultural heritages
• Therapists must also see beyond the
distinct margins of a specific culture
• Therapists must see individuals as made up
of a confluence of different influences
Culture and Therapy
 Therapists must see individuals as made
up of a confluence of different influences
• This view is called transculturalism
 This view reflects changes that have
occurred in the world through
globalization, mobility, improved
communication, and intermarriage
 Therapists need to be well informed
about clients’ backgrounds
Culture and Therapy
 Therapists need to be well about clients’
backgrounds
• They should provide interventions based
upon and using cultural symbols and
rituals meaningful to the client
 Asian culture reflects family and roles in
the family, so they must be taken into
account
 Some cultures have prohibitions against
self-disclosure, or toward control
Culture and Therapy

Some cultures have prohibitions
against self-disclosure, or toward
control
Some Arab cultures resist emotional
exploration
 Such cultures are more likely to value
and adapt to cognitive therapies


Cultural mistrust of therapy situations
is common among African-Americans
Culture and Therapy


Cultural mistrust of therapy situations is
common among African-Americans
By contrast, many Hispanic cultures have
a high regard for experts like therapists


The therapists ethnicity is also
important
Latino, African-American, and AsianAmerican therapists are viewed
differently than European-American
therapists
Culture and Therapy
 Latino, African-American, and Asian-
American therapists are viewed
differently than European-American
therapists
 It must be remembered that culture is
dynamic, contextual,
and even political
 Stereotypes
and oversimplifications
also
abound
 Therapists must recognize that
members of other groups may not share
their own cultural values
Culture and Therapy
 Therapists must recognize that
members of other groups may not
share their own cultural values
 They must also realize that their
preconceived ideas can affect the
outcome of therapy
• They may be oppressive to their clients
• This may constrain their effectiveness as
therapists
Gender and Therapy
 Not only is ethnicity important, gender is
also a significant factor in therapy
• Women seek out therapy more often than men
• They also respond differently to therapy, and
to drug therapy
• Communication differences may also affect
therapy (Tannen, 2001)
Gender and Therapy
 Communication differences may also
affect therapy
• Men tend to give reports while women try to
establish rapport
• Clients may also experience gender bias in
their families that affects their gender
assumptions
• Gender differences can be compounded by
ethnicity
Gender and Therapy
 Gender differences can be compounded by
ethnicity
• People from different cultural backgrounds
may view masculinity differently
• Gay men and lesbians bring still another
view to gender roles in the therapeutic
situation
• Therapists must also understand how their
own gender socialization affects therapy
Gender and Therapy


Therapists must also understand
how their own gender socialization
affects therapy
They must avoid gender
stereotypes, and recognize the
diversity of men’s and women’s
experiences
Managed Care and Psychology
 “Managed care” emphasizes active
coordination and arrangement of health
care services
• It usually involves three components:
 Oversight of the care given
 Contractual relationships with, and
organization of, the providers giving care
 Determines the covered benefits
Managed Care and Psychology


The aim of managed care is to control
costs
There are two major difficulties with
managed care
• First, insurance companies seek to limit
the time or type of psychotherapy a
person may access
• The second problem is that insurance
companies limit who a client can see

Both deal with access to timely and
Managed Care



Insurance
companies limit
who a client can
see
Many HMOs
require reapproval of
therapy every six
sessions
This tends to


It also means the
therapist must
continually justify
a person’s
treatment
Edwards (1999)
believes that
these factors
compromise the
practitioner/client
alliance
Managed Care
 Edwards (1999) believes that these
factors compromise the practitioner/client
alliance
 Managed care has led to brief therapy
• Six weeks is common, and 16 is considered
lengthy
• One objective of brief therapy is saving clients
time and money
Managed Care


One objective of
brief therapy is
saving clients time
and money
Clients may remain
in therapy longer if
they feel it is
needed and can
continue to pay

Clients can also
return to therapy if
they feel they need
it in the future
Brief Therapy
 Practitioners of brief therapy think in
terms of planned short-term treatments
• They make sure treatment begins in the
first session
 An operational diagnosis is made
 The operational diagnosis answers the
question “Why is the client here today?”
Brief Therapy


The operational 
diagnosis answers
the question
“Why is the client
here today?”
During the first
session, the client
also makes a
“therapeutic
contract” with the
therapists
The answer helps
pinpoint the
specific problem
for which the
client is seeking
help
The therapeutic
contract
establishes precise
goals for the
therapy

Brief Therapy
 The therapeutic contract establishes
precise goals for the therapy
 Research on brief therapy suggests that it
is effective and has long-lasting effects
• Especially when tailored to the clients needs
and time
• Brief therapy is highly effective with couples
and when combined with cognitive
restructuring
Brief Therapy


Brief therapy is
highly effective
with couples and
when combined
with cognitive
restructuring
However, research
has been limited to
relatively few
clients and a
narrow range of


Further research
on brief therapy is
being conducted
But, it is inaccurate
and misleading to
say no one gets
appropriate care
from managed
care
Managed Care
 It is inaccurate and misleading to say
no one gets appropriate care from
managed care
 Still, many practitioners worry that care
is terminated too quickly
• They also fear it is managed by people with
little or no training who never meet patients
• It poses a social policy question whether our
society wants to provide psychotherapy for
those in need
Choosing a Therapist
 The best way to choose a therapist is to
ask around
• Ask family and friends
• Talk to one’s doctor
 Many doctors work with a team of health
care providers, including psychotherapists
 Doctors can suggest someone they know to
be effective
Choosing a Therapist



Doctors can suggest someone they
know to be effective
Consult the psychology department of
local colleges or the staff of community
health care centers
Once one has a list of several
practitioners, find out if they are licensed
Choosing a Therapist
 Once one has a
list of several
practitioners, find
out if they are
licensed
 Ask what kind of
treatment
procedures they
use
 Find out if they
have a specialty
• Such as working
with children or
teens
• Working with
eating disorders
 In the end, one
must choose a
therapist with
whom one is
Psychoanalysis
And Psychodynamic Therapies
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Psychoanalysis
 Psychoanalysis is a lengthy insight
therapy developed by Freud
• It aims at uncovering unconscious conflicts
• It uses techniques such as free association
and dream analysis
 Psychodynamically based therapies use
techniques derived from Freud, but
reject or modify parts of his theory
Psychoanalysis
 Psychodynamically based therapies use
techniques derived from Freud, but
reject or modify parts of his theory
 Freud’s therapy is an insight therapy
•
It attempts to discover relationships
between unconscious motivation and
abnormal behavior
•
Any insight therapy has two basic
assumptions
Psychoanalysis
 Any insight therapy has two basic
assumptions:
• First, becoming aware of one’s motivations
helps one change and become more
adaptive
• Second, the causes of maladjustment are
unresolved conflicts
 The person is unaware of these conflicts,
and therefore cannot deal with them
Goal of Psychoanalysis
 The goal is to help patients understand
the unconscious motivations that direct
their behaviors
• Only by becoming aware of these motivations
can they choose behaviors that lead to more
fulfilling lives
• During analysis, patients are encouraged to
express healthy impulses, strengthen day-today functioning based on reality, and perceive
the world as a positive place
Copyright © Allyn & Bacon 2003
Techniques of Psychoanalysis

Psychoanalysis is geared toward the
exploration of early experiences

Two major techniques are free association
and dream analysis

In free association, the patient is asked to
report whatever comes to mind, no
matter how disorganized or trivial
Techniques of Psychoanalysis
 In free association, the patient is asked to report
whatever comes to mind, no matter how
disorganized or trivial
• One purpose is to help patients recognize connections
and patterns among their thoughts
• It also allows free expression of the
unconscious
 In dream analysis, patients are asked to
describe their dreams in detail
Techniques of Psychoanalysis
 In dream analysis, patients are asked to
describe their dreams in detail
• The dreams are interpreted to provide insight
into unconscious motivation
• Freud believed dreams represent some
element of the unconscious seeking
expression
 Both free association and dream analysis
involve the therapist’s interpretations
Techniques of Psychoanalysis
 Both free association and dream
analysis involve the therapist’s
interpretations
 Interpretation involves providing a
context, meaning, or cause, for an idea,
feeling, or set of behaviors
• The therapist attempts to find a common thread in a
patient’s behaviors and thoughts
• Patients’ use of defense mechanisms may point to areas
that need to be explored
Techniques of Psychoanalysis
 Defense mechanisms may point to areas
that need to be explored
 Two processes in psychoanalysis are
resistance and transference
•
Resistance is an unwillingness to cooperate
•
In resistance, the patient may be unwilling
to provide information, or help in
interpretation
Techniques of Psychoanalysis
 Resistance shows one
of two things
• The patient wishes to
avoid talking about a
topic
• Or, a difficult stage of
therapy has been
reached
 To minimize
resistance, analysts
try to accept a
patient’s behavior
 In resistance, the
patient may be
unwilling to
provide
information, or
help in
interpretation
 Resistance may
sometimes reach
the point of
belligerence
Techniques of Psychoanalysis
 To minimize resistance, analysts try to
accept a patient’s behavior
 During transference, the therapist
becomes the object of a patient’s
emotional attitudes about an important
person
in the of
patient’s
lifeis that the therapist will
• The importance
transference
respond differently than the important person
• This allows the patient to experience conflict differently
Techniques of Psychoanalysis


The therapist can
also guide the
person to explore
repressed ideas
Examining
previously
unacceptable
thoughts and
feelings helps
patients identify
underlying


This allows the
patient to
experience conflict
differently
This gives patients
a new opportunity
to explore their
feelings
Techniques of Psychoanalysis


Examining
previously
unacceptable
thoughts and
feelings helps
patients identify
underlying conflicts
Psychoanalysis
involves slowly
gaining insights into
the unconscious


These insights
allow the patient to
learn new ways of
coping with
instinctual urges
The patient also
develops mature
ways of dealing
with anxiety and
guilt
Techniques of Psychoanalysis
 The patient also develops mature ways of dealing
with anxiety and guilt
 The cycle of interpretation, resistance, and
transference occurs repeatedly during
psychoanalysis
 It is sometimes referred to as working
through
Ego Analysis
 Ego analysts are psychoanalysts who
assume the ego has greater control
over behavior than Freud suggested
• They focus more on a person’s reality
testing and control over the environment
• They place less emphasis on unconscious
motivation and processes
 A major disagreement between
“traditional” and “ego” analysts has to
do with the role of the id and the ego
Ego Analysis


A major
disagreement
between
“traditional” and
“ego” analysts has
to do with the role
of the id and the
ego
Traditional analysts
feels the ego grows
out of the id and is
controlled by it


An ego analyst
asserts the ego is
independent of
the id
The ego is
assumed to
control memory
and perception,
and is not in
constant conflict
with the id
Ego Analysis



The ego is assumed to control memory and
perception, and is not in constant conflict with
the id
Traditional analysis focuses on unconscious
material in the id before trying to increase a
person’s ego control
Ego analysts begin by trying to strengthen
the ego
Ego Analysis


Ego analysts begin
by trying to
strengthen the ego
They may ask a
client to be
assertive and take
control of a
situation


A weak ego is seen
to cause
maladjustment as
it fails to perceive,
understand, and
control the id
By learning to
master and
develop their ego,
people gain greater
control of their
lives
Criticisms of Psychoanalysis
 Critics of psychoanalysis contend it is
unscientific, imprecise, and subjective
• They assert concepts such as id, ego, and
superego are not linked to reality
• Other critics object to Freud’s biologically
oriented approach
• These critics object to the notion that we
are bundles of energy caught in conflict
Criticisms of Psychoanalysis


These critics
object to the
notion that we
are bundles of
energy caught in
conflict
They also object
to the idea we are
driven toward
hedonistic goals


Freud’s ideas
have been
criticized as sexist
The effectiveness
of psychoanalysis
is open to
question
Criticisms of Psychoanalysis
 The effectiveness of psychoanalysis is
open to question
• It is more effective for some people than
others
• In general, it can be as effective as other
therapies, but not more effective
 Psychoanalysis has certain inherent
disadvantages
Criticisms of Psychoanalysis

Psychoanalysis has certain inherent
disadvantages
• The patient must be highly motivated
and articulate
• It is also typically extremely expensive
• Many people cannot afford the time or
money for this type of treatment
Humanistic Therapies
Focusing on the Present
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Humanistic Therapies



Humanistic therapies emphasize the ability
to reflect on conscious experience
They also emphasize that humans have
free will
Unlike psychoanalysis, humanistic
therapies tend to focus on the present and
future
Humanistic Therapies
 To some extent,
humanistic
therapies are
insight therapies
• They focus on
 Unlike
psychoanalysis,
humanistic therapies
tend to focus on the
present and future
helping people see
the causes of their
 They also assert
behavior
• Client-centered
therapy is a major
humanistic
therapy
that people are
creative and born
with a desire to
fulfill themselves
Client-Centered Therapy
 Client-centered therapy is also known as
person-centered therapy
• It is an insight therapy
 It helps people evaluate the world and
themselves from their own perspective
 Client-centered therapy was developed by Carl
Rogers (1902 – 1987)
 Rogerian therapists hold that problems occur
when a person is kept from developing his or
her unique potential
Copyright © Allyn & Bacon 2003
Techniques of Client-Centered
Therapy
 The goal of client-centered therapy is to
help people discover their ideal selves
• This is then reconciled with their real selves
• The word client rather than patient is
important in Roger’s form of therapy
 In psychoanalysis, the analyst directs a
patient toward a “cure”
 In client-centered therapy, the therapist
guides clients to help them find what they
feel is right for themselves
Techniques
 First, the therapist
must show
unconditional
positive regard
• Be an accepting
person who projects
positive feelings
• Unconditional
positive regard
counteracts a client’s
negative encounters
with unaccepting
people
 In client-centered
therapy, the therapist
guides clients to help
them find what they
feel is right for
themselves
 Rogers felt a therapist
must have certain
characteristics in
order for therapy to
be successful
Techniques
 Congruence is another component
• Therapists are honest and aware of their own feelings
• Counselors’ congruence allows them to communicate
more effectively and help clients be more aware and
open
Techniques
 The final ingredient is empathic
listening
• Therapists must sense how their client feels and
communicate these feelings to the client
• Therapists help their clients organize their thoughts and
ideas
Techniques
 Therapists help their clients organize
their thoughts and ideas
• Three techniques can be used to do
this:
 The therapist can paraphrase a client’s
ideas
 The client can be asked to rephrase an idea
or feeling
 The client can reflect back what they had
said
Techniques
 The client can reflect back what they had
said
 At the beginning of therapy, clients tend
to express attitudes adopted from other
•people
They are defensive, and show disorganized behavior
• Over time, the client begins to use her or his own
ideas as standards for self-evaluation
Techniques
 Over time, the client begins to use her or
his own ideas as standards for selfevaluation
• Two things may occur as a result
 The client may adjust the ideal self so it is in line
with his or her own goals, rather than those of
others
 Behavior may change so it is more adaptive and
positive
Criticisms of Client-Centered Therapy
 No other therapy makes clients feel so
warm, accepted, and safe
• Critics argue this may not be enough to
bring about long-lasting change
• Critics also argue that lengthy discussions
about problems do not necessarily help
people with present difficulties
• It is also said that client-centered therapy
focuses on concepts that are hard to define,
such as self-actualization
Behavior Therapy
From the Behavioral
Perspective
Behavior Therapy
 Behavior therapy has become especially
popular in the last 30 years
• This has occurred for three reasons:
 People sometimes have problems that may not
require insights or in-depth discussions of feelings
 Managed care organizations see it as quicker and
less expensive than other approaches
 Finally, behavior therapy can be highly effective
Goals of Behavior Therapy
 Behavior therapy focuses on
changing overt behavior
• It is also called behavior modification
 It uses learning principles to help people
replace maladaptive behaviors with more
effective ones
 Behavior therapists assume changes in the
environment affect people’s responses
Goals of Behavior Therapy

Behavior therapists assume changes in
the environment affect people’s
responses

Unlike psychoanalysis, behavior
therapy does not try to discover the
origins of behavior
•
It only tries to alter behavior
•
Behavior therapists try to help people unlearn
faulty behaviors and learn more effective
ones
Goals of Behavior Therapy
 Behavior therapists try to help people unlearn
faulty behaviors and learn more effective ones
 They do not always focus on the problem leading
the client to seek therapy
 If behavior therapists see the problem is
associated with another situation, they
may try to change that situation
Goals of Behavior Therapy
 If behavior therapists see the problem
is associated with another situation,
they may try to change that situation
 Unlike psychodynamic and humanistic
therapies, behavior therapy does not
encourage clients to interpret past
events
 Behavior therapists are dissatisfied with
psychodynamic and humanistic therapies
for three basic reasons
Goals of Behavior Therapy


Behavior
therapists are
dissatisfied with
psychodynamic
and humanistic
therapies for
three basic
reasons
First, those
therapies use
concepts difficult
to define and
measure


Second, some
studies show that
people who do not
receive those
therapies improve
anyway
Finally, once a
person is labeled
“abnormal” the
label itself may lead
to maladaptive
behavior
Goals of Behavior Therapy

Once a person is labeled “abnormal”,
the label itself may lead to
maladaptive behavior

Behavior therapists assume people do
not display maladaptive behavior
because they are “abnormal”
•
They display maladaptive behavior
because they are having trouble adjusting
to the environment
•
If they are taught how to cope,
maladjustment will disappear
Behavior Therapy: A Criticism
 Most insight therapists believe that if only
overt behavior is treated, symptom
substitution will occur
• In symptom substitution, a new overt
symptom appears to replace one eliminated by
treatment
• Research does show, however, that behavior
therapy is at least as effective as insight
therapies
Techniques of Behavior Therapy
 The techniques of behavior therapy
include operant conditioning, modeling,
and counterconditioning
• A therapist will use whatever combination of
techniques is needed to help a client
• Behavior therapy usually involves three
general procedures
Techniques of Behavior Therapy
 Behavior therapy usually involves
three general procedures:
• First, the problem behavior and its
frequency is examined
• Next, a treatment strategy is used,
individually tailored to the client
• Finally, there is continual assessment
as to whether behavior has changed
Operant Conditioning
 Operant conditioning to establish a new
behavior often depends on a reinforcer
• An event or circumstance that increases the
probability a response will occur
• One method of rewarding adaptive behavior
is through a token economy
Token Economies

In a token economy people who
display appropriate behaviors
receive tokens
• These can be exchanged for desirable
items and activities
• Token economies are used to modify
behavior in social settings
Token Economies


Token economies 
are used to modify
behavior in social
settings
They have been
used successfully in
schools and hospital
settings
The aim is to
strengthen
behaviors
compatible with
norms
Other operant
techniques include
extinction,
punishment, and
time out

Extinction
 Extinction occurs when reinforcers are
withheld
• This eventually leads a previously reinforced
behavior to stop
• It can be used in conjunction with a token
economy, or separately, to stop an
undesirable behavior
Punishment
 Another way to stop an undesirable
behavior is to use punishment
• This often involves the presentation of an
aversive stimulus
 It only suppresses a behavior
 Punishment does not establish new, desired
behaviors
Punishment
 Punishment does not establish new,
desired behaviors
 Thus, it is often combined with positive
reinforcement for desirable behaviors
 Punishment has other drawbacks
 People (especially young people)
sometimes imitate aggression
Punishment
 People (especially young people) sometimes
imitate aggression
 Punishment can lead to generalized aggression
 Punishment can be harmful
Time-Out
 Time-out is the removal of a person from
sources of reinforcement
• It is used to decrease behavior
• Time-out is principally used with children
• It is especially effective when combined with
positive reinforcers for appropriate behavior
Counterconditioning
 In Counterconditioning, a person is taught
a new, more adaptive response to a
stimulus
• It is a process of reconditioning
• Joseph Wolpe (1915 – 1997) was one of the
original proponents of counterconditioning
• Wolpe used counterconditioning to inhibit
anxiety as a response
Counterconditioning
 Wolpe used
counterconditioni
ng to inhibit
anxiety as a
response
 Therapy using the
technique begins
with a specific
stimulus (S1) that
elicits a specific
response (R1)
 After therapy, S1
should elicit a new
response (R2)
 Two approaches
use
counterconditioning
:
• Systematic
desensitization
• Aversive
conditioning
Systematic Desensitization
 Systematic desensitization is a three-stage
counterconditioning procedure
• The client is first taught to relax
 The client then describes the specific
situations that arouse anxiety
 While deeply relaxed, the client imagines
increasingly vivid scenes of the situations
causing anxiety
Systematic Desensitization
 While deeply relaxed, the client imagines
increasingly vivid scenes of the situations
causing anxiety
• This gradually exposes the client to the
source of the anxiety
• With each successive experience, the client
learns relaxation rather than fear as a
response
Systematic Desensitization
 With each successive experience, the
client learns relaxation rather than fear as
a response
 Systematic desensitization is most
successful
for people with two types of
• Problems with impulse control
problems
• Particular forms of anxiety such as phobias
 It is not effective for people with psychotic
symptoms, or situations of interpersonal
conflict
Aversive Conditioning
 Another method using
counterconditioning is aversive
conditioning
• A noxious stimulus is paired with a
stimulus that elicits an undesirable
behavior
 This will cause the undesirable behavior
to stop
 The goal is to teach a new response to
the aversive stimulus
Modeling
 Bandura (1997) believes modeling can
be used effectively for:
• Teaching a new behavior
• Helping eliminate fears
• Enhancing already existing behavior
 One problem is that people may imitate
the behavior of inappropriate models
Cognitive Therapy
An Outgrowth of Behavior
Therapy
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Cognitive Therapy
 Cognitive therapists assume that
distorted, undeveloped ideas prevent
people from establishing effective coping
behaviors
 Cognitive therapy focuses on changing
client behavior by changing the person’s
thoughts or perceptions
 Cognitive therapy is derived from three
propositions
Cognitive Therapy
 Cognitive therapy is derived from
three propositions:
• Cognitive activity affects behavior
• Cognitive activity can be monitored
• Behavior can be changed by altering
cognitive patterns
Cognitive Therapy
 Many behavior therapists currently
incorporate thought processes into
treatment
• This is called cognitive behavior therapy
• Cognitive therapy is also known as cognitive
restructuring
• Cognitive therapy is effective for people who
have attached narrow or inappropriate labels
to certain behaviors or situations
Cognitive Therapy
 Cognitive therapy focuses on
current behaviors and thoughts
• It is not especially concerned with uncovering
childhood experiences
• It is especially effective if combined with
techniques such as use of reinforcement
Rational Emotive Therapy
 The best known cognitive therapy is
rational emotive therapy
• It emphasizes the importance of logical,
rational, thought processes
 It was developed by Albert Ellis over 30
years ago
 Ellis assumed abnormal behavior is caused
by faulty and irrational thinking patterns
Rational Emotive Therapy
 Ellis assumed abnormal behavior is
caused by faulty and irrational thinking
patterns
 A major goal is to help people examine
•
past events that produce irrational
beliefs
Clients
adopt different behavior patterns based on more
rational thought processes
• Research supports the effectiveness of the approach
Beck’s Approach
 Aaron Beck developed another cognitive
therapy
• Beck assumes depression is caused by
people’s distorted thoughts about reality
 These lead to negative views of the world,
the self, and the future
 A goal of Beck’s therapy is to help people
develop realistic appraisals of situations
Copyright © Allyn & Bacon 2003
Beck’s Approach
 A goal of Beck’s therapy is to help people
develop realistic appraisals of situations
 The therapist acts as a trainer and
coinvestigator
• Providing data to be examined
• The therapist also guides the client in
understanding how cognitions influence
behavior
Beck’s Approach
 Beck says a successful client passes
through four stages in moving toward
mental health
• First the client becomes aware of her/his thoughts
• The client recognizes what thoughts are awry
• Accurate judgments then need to be substituted for
inaccurate ones
• Finally, the client needs feedback as to whether the
changes are correct
Meichenbaum’s Approach
 Meichenbaum developed a third
cognitive therapy
• He believes that what people say to
themselves determines what they do
 A goal of his therapy is to change what
people say to themselves
 The therapist must change the client’s
appraisal of situations and the client’s use of
self-instructions
Meichenbaum’s Approach


The therapist
must change the
client’s appraisal
of situations and
the client’s use of
self-instructions
A strength of the
approach is that it
can be used in
many settings for
many problems


No attempt is
made to change
irrational beliefs
Clients learn a
repertoire of
activities they can
use to make their
behavior more
adaptive
Meichenbaum’s Approach
 Clients learn a repertoire of activities they
can use to make their behavior more
adaptive
• They may learn to conduct a private
monologue in which they work out adaptive
ways of coping
• They may learn to organize their responses
to specific situations in orderly steps
Cognitive Therapy
 Cognitive therapy is influencing an
increasing number of therapists who
conduct long-term, as well as brief,
therapy
 It can be applied to a variety of problems
including anxiety, depression, marital
difficulties, and chronic pain
 Cognitive therapy in its many forms has
been used with adults and children
Cognitive Therapy


Cognitive therapy in its many
forms has been used with adults
and children
It can be used with groups having
particular characteristics
Group Therapy
Group Therapy
 In group therapy, several people meet
together with a therapist to receive
treatment
• This allows a therapist to see more clients
• Since fees are shared, it is also less expensive
• Group therapy can also be more effective than
individual therapy
Group Therapy
 Group therapy can also be more effective
than individual therapy
• The social pressure in the group can help
shape members’ behavior
• Group members can also act as useful models
• Mutual reinforcement and support can also be
provided
Techniques and Formats of
Group Therapy
 The techniques used are determined by
the nature of the group
 It is also determined by the theoretical
orientation of the therapist
 In traditional group therapy, 6 to 12
clients meet once a week
Techniques and Formats
 In traditional group therapy, 6 to 12
clients meet once a week
• Members are chosen on the basis of what they
can gain from and offer to the group
• The aim is to construct a group whose
members are compatible in terms of age,
needs, and problems
Techniques and Formats
 The format of traditional group therapy
varies
• Generally, each member describes his or
her problems to the other members
 The other members relate their
experiences with similar problems, and
how they coped
 Thus, each member expresses their fears
and anxieties to people who are
accepting
Techniques and Formats
 Thus, each member expresses their fears
and anxieties to people who are accepting
 Group members have an opportunity to
role play new behaviors in a safe
environment
 Sometimes the therapist is directive in helping
to address problems
 At other times, the therapist has the group
resolve a problem independently
Family Therapy
 A family is a group of people who are
committed to one another’s wellbeing, preferably for life
• In family therapy, two or more people
who are committed to each other’s wellbeing are treated together
• Family therapists often attempt to
change family systems
Family Therapy
 Family therapists often attempt to change
family systems
• Treatment takes place within the dynamic
social system of the marriage or family
• Therapists assume there are multiple
sources of psychological influence
 Individuals in a family affect family
interactions
 Family interactions affect individuals
Family Therapy


Family interactions
affect individuals
Sometimes family
therapy is called
relationship
therapy, because
relationships are a
focus of
intervention


A useful technique
is to restructure
the family’s
interactions
For example, a son
may be responding
passively to a
domineering
mother
Family Therapy


A son may be responding passively to a
domineering mother
The therapist may suggest he only be
assigned chores by his father

An issue in family therapy is how all
members of a family may become
enmeshed in one member’s problems
Family Therapy
 An issue in family therapy is how all
members of a family may become
enmeshed in one member’s problems
• This problem is called codependence
• A family member may be alcoholic, but
codependence may be an additional
adjustment problem
• Codependents are often plagued by feelings
of shame, fear, anger, and pain
Family Therapy


Codependents are
often plagued by
feelings of shame,
fear, anger, and
pain
However, they feel
obligated to care
for the person with
the disorder or
addiction


This prevents them
from expressing
their feelings
In some cases,
people need the
person to stay
disordered
Family Therapy
 In some cases, people need the
person to stay disordered
 This allows them to maintain a
controlling position
Family Therapy: Assessment
 Some researchers believe family
therapy to be as effective as individual
therapy
• In some situations they say it is more
effective
• However, not all families profit equally
 It is difficult with families that are
disorganized
 Outcomes are not as good when
depression is involved
Family Therapy: Assessment


Outcomes are not
as good when
depression is
involved
If family members
drop out or refuse
to participate, the
outcome is almost
always negative


Younger couples
seem to have
better outcomes
There is no one
solution to family
problems
Biologically Based
Therapies
Medical Therapies
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Biologically Based Therapy

The usual approach to a
psychological problem is “talking
therapy”
• For some patients, this is not enough
 They may be exhibiting symptoms of bipolar
disorder or schizophrenia
 Some people may be suicidal
Biologically Based Therapy

Some people may be suicidal
• These are cases where biologically
based therapies come into play
 These therapies often involve medication, or
hospitalization
 Biological therapies are often used in
combination with traditional psychotherapy
Biologically Based Therapy


Biological therapies are often used in
combination with traditional
psychotherapy
Most practitioners and theoreticians
believe the most effective treatment
is drugs in combination with
psychotherapy
Drug Therapy

Clinicians who use drug therapy must
be aware of several key issues
•
Dosages are important and must be
monitored
•
Long-term use of many drugs is ill advised
•
No drug will permanently cure the
maladjustment of people who are not
coping well
Drug Therapy



No drug will permanently cure the
maladjustment of people who are not
coping well
Drugs for the relief of mental problems
are sometimes called psychotropic
drugs
Psychotropic drugs are grouped into four
categories
Drug Therapy

Psychotropic drugs are grouped
into four categories
• Antidepressant drugs
• Antianxiety drugs
• Antimania drugs
• Antipsychotic drugs
Antianxiety Drugs

Librium, Xanax, and Valium are trade
names of widely prescribed antianxiety
drugs
•
They are also known as tranquilizers
•
They reduce feelings of stress, and have a
calming effect
•
Abuse and overreliance can be a problem
with antianxiety drugs
Antidepressant Drugs

Antidepressants (thymoleptics)
work by altering levels of brain
chemicals
• Selective serotonin reuptake
inhibitors (SSRIs) relieve depression
by affecting the neurotransmitter
serotonin
• Depression is believed to occur
when serotonin does not bind to
receptors on the next neuron
Antidepressant Drugs


Depression is
believed to occur
when serotonin
does not bind to
receptors on the
next neuron
After release,
neurotransmitters
are neutralized,
or re-uptake
occurs


SSRIs prevent the
neutralization or
reuptake of
serotonin
SSRIs thus allow
serotonin to
remain in the
synapse so it can
be effective
Antidepressant Drugs

SSRIs allow
serotonin to
remain in the
synapse so it can
be effective

Two other
categories of
antidepressants
are:
• Tricyclics

Prozac, Zoloft, and
Paxil are SSRIs
• Monoamine oxidase
(MAO) inhibitors
Tricyclics and MAO Inhibitors


Tricyclics block neurotransmitter
reuptake
MAO inhibitors break down monoamine
oxidase (MAO)
•
MAO is an enzyme that destroys
neurotransmitters
•
Tricyclics pose less of a danger of
complications than MAO inhibitors
Tricyclics and MAO Inhibitors


Tricyclics pose less of a danger of
complications than MAO inhibitors
Therefore, they are used more
frequently
Prozac

About 31 million people have taken the
SSRI Prozac since its introduction in
1987
•
Yearly sales of Prozac and other SSRIs such
as Zoloft and Paxil amount to more than $4
billion
•
Earlier antidepressants could cause increased
heart rate and blood pressure, nausea, and
sleeplessness
Prozac


Earlier antidepressants could cause
increased heart rate and blood pressure,
nausea, and sleeplessness
Prozac has fewer side effects
• However, Prozac does not help everyone
• Psychologists worry that Prozac is so
effective that the original problems leading
to depression may be overlooked
Prozac


Psychologists worry that Prozac is so
effective that the original problems
leading to depression may be
overlooked
Most psychologists feel SSRIs should
be part of a full treatment program
that also includes psychotherapy
Antidepressants: Research


Research on the effectiveness of
antidepressants is contradictory
Some studies show strong effects,
others report only modest help
from the drugs
Antimania Drugs


Lithium carbonate has long been
used as an effective antimania drug
The dosage is vital
• Too much produces noxious side effects
• Too little has no effect
Antipsychotic Drugs

Schizophrenia is treated using
antipsychotics
• Technically called neuroleptics
 The most common are the
phenothiazines
 Chlorpromazine (Thorazine) is the most
common phenothiazine
Antipsychotic Drugs


Chlorpromazine
(Thorazine) is the
most common
phenothiazine
Other drugs,
called “atypical
antipsychotics,”
have been
introduced in the
last decade

Clozapine
(Clozaril) is one of
these new drugs
• It is effective, but
has severe side
effects
• Newer drugs such
as Risperidone
(Risperdal) may be
as effective with
fewer side effects
Antipsychotic Drugs



Newer drugs such as Risperidone
(Risperdal) may be as effective with
fewer side effects
Antipsychotics are often very effective
at treating hallucinations and delusions
Antipsychotics are less effective at
reducing other symptoms, such as
problems of emotions
Antipsychotic Drugs

Antipsychotics are
less effective at
reducing other
symptoms, such as
problems of
emotions



As with other
drugs, dosages are
crucial
If patients are
maintained on
antipsychotics for
too long, problems
may emerge
One problem with
antipsychotics is
tardive dyskinesia
Antipsychotic Drugs

One problem with antipsychotics is
tardive dyskinesia
• A nervous system disorder
• It involves involuntary, spasmodic
movements of the upper body,
especially the face and fingers
Psychosurgery

Psychosurgery is brain surgery
• In the 1940s and 50s, a common type
was the prefrontal lobotomy
 Removal of parts of the brain’s frontal lobes
would alleviate symptoms of mental
disorders
 However, prefrontal lobotomies made some
people become unnaturally calm and
completely unemotional
Psychosurgery



Prefrontal
lobotomies made
some people
become unnaturally
calm and

completely
unemotional
Others became
unable to control
their impulses
Today, despite
advances,
psychosurgery is
rare
Drug therapy has
proven more
effective than
surgical procedures
Psychosurgery


Most important,
psychosurgery is
irreversible
Therefore, it is
morally
objectionable to
many patients and
their families


Drug therapy has
proven more
effective than
surgical
procedures
The long-term
effects of
psychosurgery
are also
questionable
Electroconvulsive Therapy

Electroconvulsive therapy (ECT) was
once widely employed with depressed
people
•
It is a treatment for severe mental illness
•
An electric current is briefly applied to the
head to produce a generalized seizure
(convulsion)
•
The duration of the shock is less than a
second
Electroconvulsive Therapy



The duration of the shock is less than a second
Patients are treated in 3 to 12 sessions over
several weeks
In the 1940s and 50s, ECT was routinely
given to severely disturbed patients in
mental hospitals
Electroconvulsive Therapy



In the 1940s and 50s, ECT was routinely
given to severely disturbed patients in
mental hospitals
Unfortunately, it was often used with
patients who did not need it, or as a
means of control
Today, ECT is not a widely used treatment
Electroconvulsive Therapy


Today, ECT is not a
widely used
treatment
ECT is effective in
short-term
management of
severe depression


It is sometimes
used when there
is a risk of suicide
However, the
effects of ECT are
temporary
Electroconvulsive Therapy

The effects of ECT are temporary

Use of ECT should be followed by
psychotherapy and drug therapy

ECT should also be used only as a
last option
Electroconvulsive Therapy


ECT is not
appropriate for
treating
schizophrenia
It is also
inappropriate for
managing unruly
behavior



Risk of death due
to ECT is low
However, it may
cause memory
loss
Law requires that
the patient be
given the option to
refuse ECT
treatment, as is
true for any