Psycho Therapies

Copyright 2010 Pearson Education, Inc.
All rights reserved

Understanding Psychology
9
th
Edition
Charles G. Morris and Albert A. Maisto
Chapter 13
Therapies
Copyright 2010 Pearson Education, Inc. All rights reserved
Psychotherapy refers to the use of psychological
techniques to treat personality and behavior
disorders.
ENDURING ISSUES
StabilityChange
The underlying assumption behind
psychotherapy is the belief that people
are capable of changing.

ENDURING ISSUES (cont)
MindBody
Biological treatments for psychological
disorders are an aspect of the mind-
body enduring issue.

ENDURING ISSUES (cont)
DiversityUniversality
The challenges therapists face when
treating people from cultures other
than their own.

INSIGHT THERAPIES
LEARNING OBJECTIVES
Describe the common goal of all insight
therapies. Compare and contrast
psychoanalysis, client-centered therapy, and
Gestalt therapy.
Explain how short-term psychodynamic
therapy and virtual therapy differ from the
more traditional forms of insight therapy.
INSIGHT THERAPIES
Insight therapies are a variety of individual
psychotherapies designed to give people a better
awareness and understanding of their feelings,
motivations, and actions in the hope that this will
help them to adjust.
Three major insight therapies:
psychoanalysis
client-centered therapy
Gestalt therapy.
Psychoanalysis
Psychoanalysis is designed to bring hidden feelings
and motives to conscious awareness so that the
person can deal with them more effectively.
In Freudian psychoanalysis, the client is instructed to
talk about whatever comes to mind. This process is
called free association.
Freud believed that the resulting stream of
consciousnesswould provide insight into the
persons unconscious mind.
Clients transfer to their analyst feelings they have
toward authority figures from their childhood. This
process is known as transference.
As therapy progresses, the analyst takes a more
active role and begins to interpret or suggest
alternative meanings for clients feelings, memories,
and actions. The goal of interpretation is to help
people to gain insight to become aware of what was
formerly outside their awareness.
Psychodynamic personality theory has changed
significantly. Many of these changes have led to
modified psychoanalytic techniques as well as to
different therapeutic approaches.
Client-Centered Therapy
Client-centered (or person-centered) therapy is a
nondirectional form of therapy developed by Carl
Rogers that calls for unconditional positive regard of
the client by the therapist with the goal of helping
the client become fully functioning.
Rogers called his approach to therapy client centered
because he placed the responsibility for change on
the person with the problem.
Rogers believed that peoples defensiveness,
anxiety, and other signs of discomfort stem from
their experiences of conditional positive regard.
The cardinal rule in person-centered therapy is
for the therapist to express unconditional positive
regardthat is, to show true acceptance of
clients no matter what they may say or do.
Rogers felt that this was a crucial first step
toward clients self-acceptance.

Gestalt Therapy
Gestalt therapy is largely an outgrowth of the work
of Frederick (Fritz) Perls at the Esalen Institute in
California.
By emphasizing the present and encouraging face-to-
face confrontations, Gestalt therapy attempts to help
people become more genuine in their daily
interactions. The therapist is active and directive, and
the emphasis is on the whole person.
Gestalt therapists use various techniques such as the
empty chair technique to try to make people aware
of their feelings.
Recent Developments
Others have developed hundreds of variations on
this theme. Most involve a therapist who is far more
active and emotionally engaged with clients than
traditional psychoanalysts thought fit.
These therapists give clients direct guidance and
feedback, commenting on what they are told rather
than just neutral listening.
The most dramatic and controversial change in
insight therapies is virtual therapy.
The delivery of health care over the Internet or
through other electronic means is part of a rapidly
expanding field known as telehealth.
Although most therapists believe that online therapy
is no substitute for face-to-face. interactions
evidence suggests that telehealth may provide cost-
effective opportunities for delivery of some mental
health services.
Another general trend in recent years is toward
shorter-term dynamic therapy. For most people,
this usually means meeting once a week for a fixed
period. In fact, short-term psychodynamic therapy is
increasingly popular among both clients and mental
health professionals
Insight remains the goal, but the course of treatment
is usually limitedfor example, to 25 sessions.

BEHAVIOR THERAPIES
LEARNING OBJECTIVES
Explain the statement that Behavior
therapies sharply contrast with insight-
oriented approaches.
Describe the processes of desensitization,
extinction, flooding, aversive conditioning,
behavior contracting, token economies, and
modeling.
BEHAVIOR THERAPIES
Behavior therapies sharply contrast with insight-
oriented approaches.
They are focused on changing behavior, rather than
on discovering insights into thoughts and feelings.
Behavior therapies are based on the belief that all
behavior, both normal and abnormal, is learned.
Therapies Based on Classical Conditioning
Several variations on classical conditioning have been
used to treat psychological problems:
Systematic desensitization is a behavioral technique
for reducing a persons fear and anxiety by gradually
associating a new response (relaxation) with stimuli
that have been causing the fear and anxiety.
The key to success may not be the learning of a new
conditioned relaxation response, but rather the extinction of
the old fear response through mere exposure.
The technique of flooding is a less familiar and more
frightening desensitization method. It involves full-intensity
exposure to a feared stimulus for a prolonged period of time.

Aversive conditioning is a type of behavioral therapy
technique aimed at eliminating undesirable behavior
patterns by teaching the person to associate them
with pain and discomfort.
Therapies Based on Operant Conditioning
In operant conditioning, a person learns to behave a
certain way because that behavior is reinforced:
One therapy based on the principle of reinforcement
is called behavior contracting.
Another therapy based on operant conditioning is
called the token economy.
Token economies are usually used in schools and hospitals,
where controlled conditions are most feasible.
People are rewarded with tokens or points for appropriate
behaviors, which can be exchanged for desired items and
privileges.
Therapies Based on Modeling
Modeling Learning a behavior by watching someone
else perform it - can also be used to treat problem
behaviors.
Albert Bandura and colleagues helped people to
overcome a snake phobia by showing films in which
models gradually moved closer and closer to snakes.
Modeling techniques have also been successfully
used as part of job training programs.
COGNITIVE THERAPIES
LEARNING OBJECTIVES
Describe the common beliefs that underlie all
cognitive therapies.
Compare and contrast stress-inoculation
therapy, rational-emotive therapy, and Becks
cognitive therapy.
COGNITIVE THERAPIES
Cognitive therapies are based on the belief
that if people can change their distorted ideas
about themselves and the world, they can also
change their problem behaviors and make
their lives more enjoyable.

Stress-Inoculation Therapy
Stress-inoculation therapy is a type of cognitive
therapy that trains clients to cope with stressful
situations by learning a more useful pattern of self-
talk.
Stress-inoculation therapy works by turning the
clients thought patterns into a kind of vaccine
against stress-induced anxiety.
Rational-Emotive Therapy
Rational-emotive therapy (RET) is a directive
cognitive therapy based on the idea that clients
psychological distress is caused by irrational and self-
defeating beliefs and that the therapists job is to
challenge such dysfunctional beliefs.
Rational-emotive therapists confront such
dysfunctional beliefs vigorously, using a variety of
techniques, including persuasion, challenge,
commands, and theoretical arguments.
Studies have shown that RET often enables people to
reinterpret negative beliefs and experiences more
positively, decreasing the likelihood of depression.

Becks Cognitive Therapy
One of the most important and promising forms of
cognitive therapy for treating depression is known
simply as cognitive therapy, sometimes referred to
as Becks cognitive therapy.
Beck believes that depression results from
inappropriately self-critical patterns of thought. Self-
critical people have unrealistic expectations, magnify
failures, make sweeping negative generalizations
based on little evidence, notice only negative
feedback from the outside world, and interpret
anything less than total success as failure.
Cognitive therapists are much less challenging and
confrontational than rational-emotive therapists.

GROUP THERAPIES
LEARNING OBJECTIVES
Describe the potential advantages of group
therapy compared to individual therapy.
Compare and contrast family therapy, couple
therapy, and self-help groups.
GROUP THERAPIES
Group therapy is a type of psychotherapy in which
clients meet regularly to interact and help one
another achieve insight into their feelings and
behavior.
Group therapy allows both client and therapist to see
how the person acts around others.

Group therapies also have the advantage of social
support - a feeling that one is not the only person in
the world with problems.
Group members can help one another learn useful
new behaviors, like how to disagree without
antagonizing others.
Group interactions can lead people toward insights
into their own behavior, such as why they are
defensive or feel compelled to complain constantly.
Family Therapy
Family therapy is a form of group therapy that sees
the family as at least partly responsible for the
individuals problems and that seeks to change all
family members behaviors to the benefit of the
family unit as well as the troubled individual.
Although family therapy is appropriate when there
are problems between husband and wife or parents
and children, it is increasingly used when only one
family member has a clear psychological disorder.
The goal of treatment in these circumstances is to
help mentally healthy members of the family cope
more effectively with the impact of the disorder
on the family unit, which in turn helps the
troubled person.
Family therapy is also called for when a persons
progress in individual therapy is slowed by the
family (often because other family members have
trouble adjusting to that persons improvement).

Couple Therapy
Couple therapy is a form of group therapy intended
to help troubled partners improve their problems of
communication and interaction.
Previously termed marital therapy, the term couple
therapy is considered more appropriate today
because it captures the broad range of partners who
may seek help.
Most couple therapists concentrate on improving
patterns of communication and mutual expectations.
In empathy training, each member of the couple is
taught to share inner feelings and to listen to and
understand the partners feelings before responding.
This technique requires more time spent listening,
grasping what is really being said, and less time in
self-defensive rebuttal.
Other couple therapists use behavioral techniques,
such as helping a couple develop a schedule for
exchanging specific caring actions.
Self-Help Groups
Since individual treatment can be expensive, more
and more people faced with life crises are turning to
low-cost self-help groups.
Most groups are small, local gatherings of people
who share a common problem and who provide
mutual support.
Alcoholics Anonymous is perhaps the best-known
self-help group, but self-help groups are available for
virtually every life problem.
Studies have demonstrated that self-help can
indeed be effective.
Such groups also help to prevent more serious
psychological disorders by reaching out to people
who are near the limits of their ability to cope with
stress.

EFFECTIVENESS OF PSYCHOTHERAPY
LEARNING O B J E C T I V E S
Summarize the research evidence that psychotherapy
is, in fact, more effective than no therapy at all.
Briefly describe the five major results of the
Consumer Reports study.
Describe the common features shared by all forms of
psychotherapy that may account for the fact that
there is little or no overall difference in their
effectiveness. Explain the statement that Some kinds
of psychotherapy seem to be particularly appropriate
for certain people and problems; include examples.
EFFECTIVENESS OF PSYCHOTHERAPY
Researchers have found that roughly twice as many
people (two-thirds) improve with formal therapy
than with no treatment at all.
Many people who do not receive formal therapy get
therapeutic help from friends, clergy, physicians, and
teachers. Thus, the recovery rate for people who
receive no therapeutic help at all is quite possibly
even less than one-third.
Psychotherapy works best for relatively mild
psychological problems and seems to provide the
greatest benefits to people who really want to
change.
A very extensive study designed to evaluate the
effectiveness of psychotherapy under the direction
of psychologist Martin E. P. Seligman (1995) was
reported by Consumer Reports.
The vast majority of respondents reported significant overall
improvement after therapy.
There was no difference in the overall improvement score
among people who had received therapy alone and those
who had combined psychotherapy with medication.
No differences were found between the various forms of
psychotherapy.
No differences in effectiveness were indicated between
psychologists, psychiatrists, and social workers, although
marriage counselors were seen as less effective.
People who received long-term therapy reported more
improvement than those who received short-term therapy.
Which Type of Therapy is Best for Which
Disorder?
Are some forms of psychotherapy are more effective
than others?
Most of the benefits of treatment seem to come
from being in some kind of therapy, regardless of the
particular type.
Some psychologists have focused their attention on
what the various forms of psychotherapy have in
common, rather than emphasizing their differences.
All forms of psychotherapy provide people with an
explanation for their problems. Along with this explanation
often comes a new perspective, providing people with specific
actions to help them cope more effectively.
Most forms of psychotherapy offer people hope. Because
most people who seek therapy have low self-esteem and feel
demoralized and depressed, hope and the expectation for
improvement increase their feelings of self-worth.
All major types of psychotherapy engage the client in a
therapeutic alliance with a therapist. Although their
therapeutic approaches may differ, effective therapists are
warm, empathetic, and caring people who understand the
importance of establishing a strong emotional bond with their
clients that is built on mutual respect and understanding.
BIOLOGICAL TREATMENTS
LEARNING O B J E C T I V E S
Explain why some clients and therapists opt for
biological treatment instead of psychotherapy.
Describe the major antipsychotic and antidepressant
drugs including their significant side effects.
Describe electroconvulsive therapy and
psychosurgery, their effectiveness in treating specific
disorders, and their potential side effects. Explain
why these are last resort treatments that are
normally used only other treatments have failed.
BIOLOGICAL TREATMENTS
Biological treatments - a group of approaches
including medication, electroconvulsive therapy, and
psychosurgery - may be used to treat psychological
disorders in addition to, or instead of, psychotherapy.
Clients and therapists opt for biological treatments
for several reasons:
some people are too agitated, disoriented, or
unresponsive to be helped by psychotherapy.
biological treatment is virtually always used for disorders
with a strong biological component.
biological treatment is often used for people who are
dangerous to themselves and to others.
Traditionally, the only mental health professionals
licensed to offer biological treatments were
psychiatrists, who are physicians.
However, some states now permit specially trained
psychologists to prescribe drugs.
Therapists without such training often work with
physicians who prescribe medication for their clients.

In many cases where biological treatments are used,
psychotherapy is also recommended.
Medication and psychotherapy used together are generally
more effective for treating major depression.
Drug Therapies
Medication is frequently and effectively used to treat a
number of psychological problems:
Antipsychotic drugs are drugs used to treat very
severe psychological disorders, particularly
schizophrenia.
Antipsychotic medications sometimes have dramatic
effects. People with schizophrenia who take them
can go from being perpetually frightened, angry,
confused, and plagued by auditory and visual
hallucinations to being totally free of such
symptoms.

Antipsychotic drugs can have a number of
undesirable side effects - blurred vision, weight gain,
and constipation are among the common
complaints, as are temporary neurological
impairments such as muscular rigidity or tremors.
A very serious potential side effect is tardive
dyskinesia, a permanent disturbance of motor
control, particularly of the face (uncontrollable
smacking of the lips, for instance), which can be only
partially alleviated with other drugs.
A second group of drugs, known as antidepressants,
is used to combat depression.
Until the end of the 1980s, there were only two main
types of antidepressant drugs; monoamine oxidase
inhibitors (MAO inhibitors) and tricyclics.
Both drugs work by increasing the concentration of
the neurotransmitters serotonin and norepinephrine
in the brain.
Both are effective for most people with serious
depression, but both produce a number of serious
and troublesome side effects.
Another group of psychoactive drugs, known as
selective serotonin reuptake inhibitors (SSRIs), work
by reducing the update of serotonin by the nervous
system, thus increasing the amount of serotonin
active in the brain.
A number of SSRIs are available to treat depression,
including Paxil (paroxetine), Zoloft (sertraline), and
Effexor (venlafaxine HCl).
Antidepressant drugs are not only used to treat
depression, but also have shown promise in treating
generalized anxiety disorder, panic disorder,
obsessive-compulsive disorder, social phobia, and
posttraumatic stress disorder.
Bipolar disorder is frequently treated with lithium
carbonate.
Lithium is not a drug, but a naturally occurring salt
that is generally quite effective in treating bipolar
disorder and in reducing the incidence of suicide in
bipolar patients.

Psychostimulants heighten alertness and arousal.
Some psychostimulants, such as Ritalin, are
commonly used to treat children with attention-
deficit hyperactivity disorder (Ghuman, Arnold, &
Anthony, 2008). In these cases, they have a calming,
rather than stimulating, effect.
Some professionals worry that psychostimulants are
being overused, especially with young children (S.
Rose, 2008).
Antianxiety medications, such as Valium, are
commonly prescribed as well. Quickly producing
a sense of calm and mild euphoria, they are often
used to reduce general tension and stress.
Because they are potentially addictive, however,
they must be used with caution.
Sedatives produce both calm and drowsiness,
and are used to treat agitation or to induce sleep.
These drugs, too, can become addictive.

Electroconvulsive Therapy
Electroconvulsive therapy (ECT) is most often used
for cases of prolonged and severe depression that do
not respond to other forms of treatment
The technique involves briefly passing a mild electric
current through the brain or, more recently, through
only one of its hemispheres.
Treatment normally consists of 10 or fewer sessions
of ECT.
No one knows exactly why ECT works, but its
effectiveness has been clearly demonstrated.
In addition, the fatality rate for ECT is markedly
lower than for people taking antidepressant
drugs.
Side effects include brief confusion,
disorientation, and memory impairment,
though research suggests that unilateral ECT
produces fewer side effects and is only slightly
less effective than the traditional method.

Psychosurgery
Psychosurgery is a type of brain surgery performed
to change a persons behavior and emotional state.
It is rarely used today.
In a prefrontal lobotomy, the frontal lobes of the
brain are severed from the deeper centers beneath
them.
The assumption is that in extremely disturbed
people, the frontal lobes intensify emotional
impulses from the lower brain centers (chiefly, the
thalamus and hypothalamus).
Unfortunately, lobotomies can work with one person
and fail completely with another - possibly producing
permanent, undesirable side effects, such as the
inability to inhibit impulses or a near-total absence of
feeling.
INSTITUTIONALIZATION
AND ITS ALTERNATIVES
LEARNING OBJECTIVE
Describe the process of deinstitutionalization
and the problems that have resulted from it.
Identify alternatives to deinstitutionalization
including the three forms of prevention.
INSTITUTIONALIZATION
AND ITS ALTERNATIVES
For persons with severe mental illness,
hospitalization has been the treatment of choice in
the United States for the past 150 years.
Several different kinds of hospitals offer such care.
General hospitals admit many affected people, usually for
short-term stays until they can be released to their families
or to other institutional care.
Private hospitalssome nonprofit and some for profit
offer services to people with adequate insurance.
Veterans Administration hospitals admit veterans with
psychological disorders.
The development of effective drug therapies starting
in the 1950s led to a number of changes in state
hospitals
People who were agitated could now be sedated
with drugs, which was considered an improvement
over the use of physical restraints.
The second major, and more lasting, result of the
new drug therapies was the widespread release of
people with severe psychological disorders back into
the communitya policy called
deinstitutionalization.
Deinstitutionalization
The practice of placing people in smaller, more
humane facilities or returning them under
medication to care within the community intensified
during the 1960s and 1970s.
By 1975, 600 regional mental health centers
accounted for 1.6 million cases of outpatient care.
In recent years, however, deinstitutionalization has
created serious challenges:
Discharged people often find poorly funded community
mental health centersor none at all.
Many are not prepared to live in the community. Those
who return home can become a burden to their families,
especially when follow-up care is inadequate.
The quality of residential centers such as halfway houses
can vary, with many providing poor care.
The patients are further burdened by the social stigma of
mental illness.
Many released patients have been unable to obtain follow-
up care or housing and are incapable of looking after their
own needs.
Consequently, many have ended up literally on the streets.
Without supervision, they have stopped taking the drugs
that made their release possible in the first place and their
psychotic symptoms have returned.

Alternative Forms of Treatment
Kiesler (1982b) examined 10 controlled studies in
which seriously disturbed people were randomly
assigned either to hospitals or to an alternative
program.
Even though the hospitals to which some people in
these studies were assigned provided very good
patient careprobably substantially above average
for institutions in the United States9 out of the 10
studies found that the outcome was more positive
for alternative treatments than for the more
expensive hospitalization.
Prevention
Primary prevention refers to efforts to improve the
overall environment so that new cases of mental
disorders do not develop.
Secondary prevention involves identifying high risk
groupsfor example, abused children, people who
have recently divorced, those who have been laid off
from their jobs, veterans, and victims of terrorist
incidents.
Intervention is the main thrust of secondary
preventiondetecting maladaptive behavior early
and treating it promptly.


One form of intervention is crisis intervention, which
includes such programs as suicide hotlines or short-
term crisis facilities where therapists can provide
face-to-face counseling and support.
The main objective of tertiary prevention is to help
people adjust to community life after release from a
mental hospital.
For example, granting passes for patients to leave the
institution for short periods prior to release, halfway
houses for the transition period, outpatient
programs and community education.
CLIENT DIVERSITY AND TREATMENT
LEARNING OBJECTIVE
Explain how gender and cultural differences
can affect the treatment of psychological
problems and the training of therapists.
Gender and Treatment
There are significant gender differences in the
prevalence of many psychological disorders.
In part, this is because women have traditionally
been more willing than men to admit that they have
psychological problems and need help to solve them,
and because psychotherapy is more socially accepted
for women than for men.
However, the number of males willing to seek
psychotherapy and counseling has increased .
Researchers attribute this growth to the changing
roles of men in todays society: Men are increasingly
expected to provide emotional as well as financial
support for their families.
In most respects, the treatment given to women is
the same as that given to men, a fact that has
become somewhat controversial in recent years.
Critics of equal treatment have claimed that
women in therapy are often encouraged to adopt
traditional, male-oriented views of what is
appropriate; male therapists may urge women to
adapt passively to their surroundings.
Culture and Treatment
When psychotherapist and client come from
different cultures, misunderstandings of speech,
body language, and customs are almost inevitable.
Even when client and therapist are of the same
nationality and speak the same language, there can
be striking differences if they belong to different
racial and ethnic groups.

One of the challenges for U.S. therapists in recent
years has been to treat immigrants, many of whom
have fled such horrifying circumstances that they
arrive in the United States exhibiting PTSD.
Ultimately, the best solution to the difficulties of
serving a multicultural population is to train
therapists of many different backgrounds so that
members of ethnic, cultural, and racial minorities
can choose therapists of their own group if they
wish to do so.

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