Download Chapter 17 Answers to Before You Go On Questions What trends

Chapter 17
Answers to Before You Go On Questions
1. What trends have changed who tends to receive treatment for psychological disorders? The
increased availability of third-party coverage for therapy has meant that people of all socioeconomic levels (and not just the wealthy) now receive both outpatient and inpatient therapy.
Women used to outnumber men in therapy 4 to 1, but now that societal sex-role expectations
have changed (men do not have to be tough and self-sufficient) men account for more than
1/3 of therapy patients.
2. How does inpatient therapy differ from outpatient therapy? People being treated as
outpatients live in the community and make regular visits to their therapists’ offices for their
treatment. Individuals treated as inpatients typically have severe psychological problems and
are treated in the residential psychiatric wards of general hospitals or in psychiatric hospitals.
3. What are the three key features common to all forms of therapy? All forms of therapy
involve three essential features: a sufferer who seeks relief, a trained healer, and a series of
contacts between the two in which the healer tries to bring about changes in the sufferer’s
emotional state, attitudes, and behaviour.
4. What are the three main categories of biological treatments? Biological therapies can be
divided into treatments using psychotropic drugs, electroconvulsive shock therapy and
psychosurgery.
5. What are some new methods of direct brain stimulation, and how are they used? Vagus nerve
stimulation via an implanted pacemaker can influence the mood centres of the brain.
Transcranial magnetic stimulation involves placing a magnetic coil on or over a patient’s
head. The procedure appears to increase neuron activity in the prefrontal cortex, sometimes
helping to alleviate depression. In deep brain stimulation electrodes are implanted deep in the
patient’s brain and a pacemaker delivers small electric currents into those brain areas for the
treatment of depression, Parkinson’s disease, or seizure disorders.
6. Contrast three types of psychodynamic therapy. Short-term psychodynamic therapies involve
the client working on a single focused problem over a small number of sessions. Relational
psychoanalytic therapy involves the therapist playing a more active role in interactions with
clients, disclosing personal experiences and feelings. Standard psychodynamic therapy, by
contrast, involves a distant, aloof therapist and can go over many, many sessions.
7. List and describe psychodynamic therapy techniques. Free association requires the client to
say whatever thoughts or feelings come to mind. Therapists provide interpretations of the
client’s associations looking especially for instances of resistance (the client seems to be
avoiding a thought or an idea), transference (the client expresses an emotion toward the
therapist that is likely actually aimed at someone in their own life), and dream interpretation.
Catharsis occurs when a client is led to see and experience a previously unconscious
emotional event or experience, releasing the pent up psychic energy associated with the
feeling or event. Working through involves the client going over and over the event or events
that arose through catharsis, gaining more and more clarity each time through.
8. What are systematic desensitization and aversion therapy? Systematic desensitization is used
to treat phobias. Individuals construct a fear hierarchy related to their phobic object or
situation and then, through training in relaxation, gradually work their way up through their
fear hierarchy. Aversion therapy involves using a form of punishment to change maladaptive
behaviour. For example, a drug could be administered that makes the client violently ill if
they drink alcohol along with the drug as a means of limiting alcohol use.
9. What principles and procedures are involved in a token economy program? A token
economy is a means for using positive reinforcement to support positive behaviour. A child
with attention issues in school can be given stars for each hour in which they stay on task and
the stars can be turned in at the end of the day or week for more tangible rewards (toys,
gaming privileges, etc.).
10. How does social skills training work? In social skills training a therapist may make use of
modelling, rehearsal, feedback, and practice to assist a client in more consistently using
effective/adaptive social behaviours.
11. What do therapists help clients to do in rational-emotive behavioural therapy? Rationalemotive therapists first help clients identify the irrational assumptions that seem to govern
their behavioural and emotional responses. Next, they help clients change those assumptions
into constructive ways of viewing themselves and the world.
12. What is cognitive therapy? Beck’s cognitive therapy involves therapists helping clients to
identify the negative thoughts and errors in logic that pervade their thinking and that help
give rise to feelings of depression.
13. What are the goals of second-wave cognitive-behavioural therapies? Second-wave cognitive
therapy approaches help clients to accept many of their problematic thoughts rather than
judge them, act on them, or try fruitlessly to change them. The hope is that by recognizing
such thoughts for what they are—just thoughts—clients will eventually be able to let them
pass through their awareness without being particularly troubled by them.
14. What are the key characteristics therapists should display in client-centred therapy? (1)
Unconditional positive regard—full and warm acceptance for the client. (2) Accurate
empathy—skillful listening, including restatements of the client’s own comments. (3)
Genuineness—realness, sincere communication, no professional front or facade.
15. What techniques are used in Gestalt therapy? (1) Skillful frustration—the therapist
consistently refuses to meet their clients’ expectations or demands. The aim here is to help
the clients see how often they try to manipulate others into meeting their needs. (2) Roleplaying—the client may be instructed to be another person, an object, an alternate self, or
even a part of the body. Through this experience, clients are eventually expected to “own,” or
accept, feelings that previously made them uncomfortable. (3) Rules—the therapist insists
that the client use the word “I,” as in “I am sad” rather than “the situation is depressing.”
16. What are the main goals of existential therapy? Existential therapists encourage clients to
accept responsibility for their lives and their problems. They help clients recognize their
freedom so that they may choose different paths and live more meaningful lives. Existential
therapists also place great emphasis on the relationship between therapist and client and try to
create an atmosphere of honesty, shared learning, and growth.
17. What are self-help groups? Self-help groups are made up of people who have similar
problems or who may be at different places in a life process (e.g., supporting a loved one
with Alzheimer’s) and come together to help and support one another without the direct
leadership of a professional clinician.
18. What is the main assumption of family systems therapy? Family systems therapy holds that
each family has its own implicit rules, relationship structure, and communication patterns
that shape the behaviour of the individual members, including dysfunctional behaviour. For
one family member to change, the family system must be changed (for therapy to succeed).
19. Describe primary, secondary, and tertiary prevention. Primary prevention consists of efforts
to improve community functioning and policies. Secondary prevention consists of detecting
and treating psychological disorders in the early stages, before they reach serious levels.
Tertiary prevention aims to provide effective treatment immediately so that moderate or
severe disorders do not become chronic problems.
20. What does research show about whether or not therapy is generally effective? Studies reveal
that therapy is often more helpful than no treatment or placebo treatments. A large-scale
meta-analytic study showed that the average person who received treatment was better off
than 75 percent of the untreated control clients.
21. What do effective therapists have in common? Successful therapists tend to do similar things:
(1) They provide feedback to clients; (2) they help clients focus on their own thoughts and
behaviour; (3) they pay careful attention to the way they and their clients interact; (4) they try
to build a sense of self-mastery in their clients.
22. What does research show about the effectiveness of particular therapies for certain
problems? Research has indicated that particular therapies are particularly effective in
treating certain disorders. For example, behavioural therapies seem to be the most effective
of all treatments for phobias. Cognitive-behavioural therapies are particularly helpful in cases
of social anxiety disorder, generalized anxiety disorder, panic disorder, and depression. And
drug therapy is the single most helpful treatment for schizophrenia and bipolar disorder.
23. Is therapy equally effective across race and gender? Members of ethnic and racial minority
groups typically show less improvement in clinical treatment, make less use of mental health
services, and stop therapy sooner than members of majority groups. Culturally sensitive
therapies seek to address the unique issues faced by members of cultural minority groups.
Therapies geared to the pressures of being female, called gender-sensitive or feminist
therapies, follow similar principles.
Answers to Your Brain and Behaviour Questions (p. 670)
1. Which area of the cerebral cortex often shows reduced activity in people who are depressed?
The prefrontal cortex often shows reduced activity in people with depression.
2. What does it mean to say that a particular drug is a “serotonin reuptake inhibitor”?
Reuptake is the process by which excess neurotransmitter molecules are absorbed by the
sending neuron. Serotonin reuptake inhibitors slow down reuptake, leaving more serotonin
molecules in the synapse to activate particular brain regions, such as the hippocampus and
prefrontal cortex.
3. What is the role of the hippocampus in the recovery of someone taking antidepressant
medication to relieve depression? The use of antidepressants stimulates the hippocampus,
which may be one mechanism by which antidepressant medications reduce anxiety and
improve cognitive function in a person with depression.