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Psychotherapy refers to the use of psychological techniques to treat personality and behavior disorders. Psychoanalysis is designed to bring hidden feelings and motives to conscious awareness. Client-centered therapy and Gestalt therapy are examples of insight therapies.
Psychotherapy refers to the use of psychological techniques to treat personality and behavior disorders. Psychoanalysis is designed to bring hidden feelings and motives to conscious awareness. Client-centered therapy and Gestalt therapy are examples of insight therapies.
Psychotherapy refers to the use of psychological techniques to treat personality and behavior disorders. Psychoanalysis is designed to bring hidden feelings and motives to conscious awareness. Client-centered therapy and Gestalt therapy are examples of insight therapies.
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. Copyright 2010 Pearson Education, Inc. All rights reserved ENDURING ISSUES StabilityChange The underlying assumption behind psychotherapy is the belief that people are capable of changing.
Copyright 2010 Pearson Education, Inc. All rights reserved ENDURING ISSUES (cont) MindBody Biological treatments for psychological disorders are an aspect of the mind- body enduring issue.
Copyright 2010 Pearson Education, Inc. All rights reserved ENDURING ISSUES (cont) DiversityUniversality The challenges therapists face when treating people from cultures other than their own.
Copyright 2010 Pearson Education, Inc. All rights reserved 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. Copyright 2010 Pearson Education, Inc. All rights reserved 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. Copyright 2010 Pearson Education, Inc. All rights reserved 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. Copyright 2010 Pearson Education, Inc. All rights reserved 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. Copyright 2010 Pearson Education, Inc. All rights reserved 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. Copyright 2010 Pearson Education, Inc. All rights reserved 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.
Copyright 2010 Pearson Education, Inc. All rights reserved 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. Copyright 2010 Pearson Education, Inc. All rights reserved 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. Copyright 2010 Pearson Education, Inc. All rights reserved 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. Copyright 2010 Pearson Education, Inc. All rights reserved 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.
Copyright 2010 Pearson Education, Inc. All rights reserved 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. Copyright 2010 Pearson Education, Inc. All rights reserved 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. Copyright 2010 Pearson Education, Inc. All rights reserved 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. Copyright 2010 Pearson Education, Inc. All rights reserved
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. Copyright 2010 Pearson Education, Inc. All rights reserved 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. Copyright 2010 Pearson Education, Inc. All rights reserved 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. Copyright 2010 Pearson Education, Inc. All rights reserved 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. Copyright 2010 Pearson Education, Inc. All rights reserved 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.
Copyright 2010 Pearson Education, Inc. All rights reserved 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. Copyright 2010 Pearson Education, Inc. All rights reserved 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.
Copyright 2010 Pearson Education, Inc. All rights reserved 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.
Copyright 2010 Pearson Education, Inc. All rights reserved 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. Copyright 2010 Pearson Education, Inc. All rights reserved 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.
Copyright 2010 Pearson Education, Inc. All rights reserved 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. Copyright 2010 Pearson Education, Inc. All rights reserved 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. Copyright 2010 Pearson Education, Inc. All rights reserved 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).
Copyright 2010 Pearson Education, Inc. All rights reserved 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. Copyright 2010 Pearson Education, Inc. All rights reserved 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. Copyright 2010 Pearson Education, Inc. All rights reserved 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. Copyright 2010 Pearson Education, Inc. All rights reserved 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.
Copyright 2010 Pearson Education, Inc. All rights reserved 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. Copyright 2010 Pearson Education, Inc. All rights reserved 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. Copyright 2010 Pearson Education, Inc. All rights reserved 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. Copyright 2010 Pearson Education, Inc. All rights reserved Copyright 2010 Pearson Education, Inc. All rights reserved 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. Copyright 2010 Pearson Education, Inc. All rights reserved 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. Copyright 2010 Pearson Education, Inc. All rights reserved 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. Copyright 2010 Pearson Education, Inc. All rights reserved 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. Copyright 2010 Pearson Education, Inc. All rights reserved 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. Copyright 2010 Pearson Education, Inc. All rights reserved 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.
Copyright 2010 Pearson Education, Inc. All rights reserved 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. Copyright 2010 Pearson Education, Inc. All rights reserved Copyright 2010 Pearson Education, Inc. All rights reserved 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. Copyright 2010 Pearson Education, Inc. All rights reserved 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. Copyright 2010 Pearson Education, Inc. All rights reserved 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.
Copyright 2010 Pearson Education, Inc. All rights reserved 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). Copyright 2010 Pearson Education, Inc. All rights reserved 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.
Copyright 2010 Pearson Education, Inc. All rights reserved 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. Copyright 2010 Pearson Education, Inc. All rights reserved 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.
Copyright 2010 Pearson Education, Inc. All rights reserved Copyright 2010 Pearson Education, Inc. All rights reserved 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. Copyright 2010 Pearson Education, Inc. All rights reserved 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. Copyright 2010 Pearson Education, Inc. All rights reserved 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. Copyright 2010 Pearson Education, Inc. All rights reserved 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. Copyright 2010 Pearson Education, Inc. All rights reserved 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: Copyright 2010 Pearson Education, Inc. All rights reserved 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.
Copyright 2010 Pearson Education, Inc. All rights reserved 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. Copyright 2010 Pearson Education, Inc. All rights reserved 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.
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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. Copyright 2010 Pearson Education, Inc. All rights reserved CLIENT DIVERSITY AND TREATMENT LEARNING OBJECTIVE Explain how gender and cultural differences can affect the treatment of psychological problems and the training of therapists. Copyright 2010 Pearson Education, Inc. All rights reserved 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. Copyright 2010 Pearson Education, Inc. All rights reserved 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. Copyright 2010 Pearson Education, Inc. All rights reserved 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.
Copyright 2010 Pearson Education, Inc. All rights reserved 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.