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CHAPTER 15
15.1 Psychodynamic therapy rests on two principles: insight (coming to an understanding of
one's own psychological processes) and the relationship between the patient and therapist. To
bring about change, therapists rely on three techniques: free association (exploring implicit
(unconscious) associational networks by having the patient say whatever comes to mind),
interpretation (efforts to help patients come to understand their experiences in a new light), and
analysis of transference (whereby people transfer emotions from past relationships onto the
therapist). The main contemporary forms of psychodynamic treatment are psychoanalysis (in
which the patient lies on the couch and meets with the therapist three or more times a week) and
psychodynamic psychotherapy (in which the patient and therapist sit face to face and usually
meet once or twice a week). A more contemporary form of short-term dynamic psychotherapies
focuses on a very specific issue and generally lasts a year or less.
15.2 Cognitive-behavioral therapists are typically more short term, use methods derived from
behaviorist and cognitive approaches, and focus on behavior and thought processes. Treatment
begins with a behavioral analysis of the symptom and the stimuli or thoughts associated with it.
Behavioral techniques relying on classical conditioning include systematic desensitization, in
which the patient is exposed to the phobic stimulus (through exposure techniques or virtual
reality exposure therapy), while learning to associate it with relaxation. This exposure can
involve graded exposure (graduated in intensity) or flooding (all at once and inescapable).
Operant techniques attempt to control maladaptive behavior by altering its consequences. Social
learning techniques include participatory modeling, in which the therapist models the desired
behavior and gradually induces the patient to participate in it, and skills training, which involves
teaching the behaviors necessary to accomplish relevant goals.
15.3 Cognitive therapy focuses on changing dysfunctional automatic thoughts that underlie
psychological disorders. Ellis’s ABC theory of psychopathology identifies A (activating
conditions), B (irrational belief systems), and C (consequential emotions). His rational-emotive
behavior therapy attempts to replace faulty belief systems with rational ones. Beck’s cognitive
therapy has similar goals, but targets more specific cognitive distortions (rather than entire
belief systems).
15.4 Humanistic therapies focus on the way individuals uniquely and consciously experience
themselves, relationships, and the world. They aim to help people get in touch with their
feelings, their “true selves,” grow, and a sense of meaning in life. Gestalt therapy tries to help
people acknowledge their feelings, and often uses the empty chair technique so they can learn
to act in accordance with them. Rogers’s client-centered therapy assumes that problems in
living result when people’s concept of self is incongruent with their actual experience.
Therapeutic change occurs as the therapist empathizes with the client’s experience,
demonstrating unconditional positive regard (an attitude of fundamental acceptance).
Examples of psychological and physical benefits associated with the use of therapy to grow and
find meaning in life include increased life satisfaction and immune system functioning.
15.5 A variety of other therapies exist, including group therapy, self-help groups, marital or
couples therapy and even pet therapy, any of which can involve psychodynamic, cognitive, or
behavioral techniques. In group therapy, multiple people meet together regularly, guided by a
professional, to work toward therapeutic goals that do not require individual instruction and/or
can best be met through the unique benefits of a group process. A variation on group therapy is
the self-help group, which is not guided by a professional, and in which members share a
specific problem. Self-help groups appear to be especially beneficial for stigmatized groups. The
aim of family therapy is to change maladaptive family interaction patterns. Family therapists
often construct a genogram (a map of family members and related feelings over three or four
generations) to pinpoint recurring family patterns. Marital or couples therapy focuses on the
relationship between members of a couple and often aim to reduce problematic interaction
patterns and increase acceptance and validation. Even pet therapy (in which patients take care
of, or receive visits from, a pet) has been associated with both physical and psychological health
benefits.
15.6 Eclectic psychotherapy involves combining techniques from different approaches to fit the
particular case. Integrative therapy involves developing a treatment approach using theories
from the different perspectives. Sand tray therapy (one type of play therapy) is an example of
integrated therapy. As with views of psychopathology, methods of treatment vary crossculturally (as well as within multicultural societies) depend on cultural value systems and beliefs.
15.7 Psychotropic medications act on the brain to affect mental processes. Most psychotropic
medications act at neurotransmitter sites. Some bind with postsynaptic receptors, hence
preventing neural transmission. Others increase the action of underactive or depleted
neurotransmitters, often by preventing them from being taken back into the presynaptic
membrane or preventing them from being stored once they do return. Others act at the
intracellular level. Although psychotropic medications have significant (and even life saving)
benefits, they are not without challenge and require professional monitoring because of issues
such side effects, dependence, and addictions.
15.8 Antipsychotic medications inhibit dopamine and are used to treat schizophrenia and other
acute psychotic states. Antidepressant medications increase norepinephrine and/or serotonin
activity and can be useful for treating depression and anxiety disorders, and Lithium (which
likely alters cellular mechanisms) is the treatment of choice for bipolar disorder. Antianxiety
medications called benzodiazepines can be useful for short-term treatment of anxiety
symptoms. Electroconvulsive therapy (ECT), also known as electroshock therapy is currently
used as a last resort in the treatment of severe depression. Another treatment of last resort, now
primarily used for severe cases of obsessive-compulsive disorder, is psychosurgery.
15.9 Pharmacotherapy is essential for some disorders (such as schizophrenia and bipolar
disorder) and can be extremely helpful for others (such as major depression and anxiety
disorders). Relapse rates, however, are high when medication is discontinued, and complete
cures are uncommon for most disorders. Research using meta-analysis has found that all
therapies are relatively effective (have significant benefits compared to non-therapy controls),
and efficacy studies have shown the most successful treatments thus far being cognitivebehavioral treatments for anxiety disorders. An important distinction is between efficacy studies
that assess treatment outcome under controlled experimental conditions and more controversial
effectiveness studies that assess treatment as practiced by clinicians under less controlled
conditions. Research shows a positive relationship between client’s satisfaction and length of
therapy. Long-term therapies may be the most useful for therapies involving multiple symptoms
or interpersonal patterns (which can take significant time to identify, let alone alter).