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CHAPTER

13 Therapies

Links to Learning Objectives

ENDURING ISSUES IN THERAPIES

INSIGHT THERAPIES

Common goal; comparing therapies

Recent developments

BEHAVIOR THERAPIES

Contrast with insight therapies

Therapies based on principles of learning

COGNITIVE THERAPIES

Common beliefs

Comparing therapies

GROUP THERAPIES

Advantages

Comparing therapies

EFFECTIVENESS OF

PSYCHOTHERAPY

Summary of research evidence

Different types of therapy

BIOLOGICAL TREATMENTS

Why people choose biological treatments

Drug therapies

Electroconvulsive therapy & psychosurgery

INSTITUTIONALIZATION

AND ITS ALTERNATIVES

Deinstitutionalization

CLIENT DIVERSITY AND TREATMENT

Impact of gender & cultural differences

Diversity-

Universality

Stability-Change

Mind-Body

Nature-Nurture

Person-Situation

Enduring Issues

Can people with

psychological disorders

change significantly, and

can they change without

intervention?Diversity-

Universality

Stability-Change

Mind-Body

Nature-Nurture

Person-Situation

Enduring Issues

What are the

challenges therapists face

when treating people from

cultures other than their

own?

Diversity-

Universality

Stability-Change

Mind-Body

Nature-Nurture

Person-Situation

Enduring Issues

How do some

treatments for psychotherapy

underscore the highly

complex relationship

between mind

and body?

The use of

psychological

techniques to treat

personality and

behavior disorders

sychotherapy

2

InsightTherapies

Insight Therapies

• 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

LEARNING OBJECTIVE: Describe the common goal of all insight therapies. Compare and contrast

psychoanalysis, client-centered therapy, and Gestalt therapy.

Psychoanalysis

Gestalt

Therapy

Client-Centered

Therapy

Psychoanalysis

• Designed by Freud to bring hidden feelings and motives to conscious awareness so that the person can deal with them more effectively

– Free association

– Transference

– Insight

Client-Centered Therapy

• Calls for unconditional positive regard of the client by the therapist, with the goal of helping the client become fully functioning

– Developed by Carl Rogers

– Nondirective

– Places the responsibility for change on the person with the problem

– Therapist expressesunconditional positive regard as a crucial first step toward clients’ self-acceptance

• Emphasizes the wholeness of a personality

and attempts to reawaken people to their

emotions and sensations in the present

– Outgrowth of the work of

Frederick (Fritz) Perls

– Empty-chair technique

Gestalt Therapy Recent Developments

• Short-term psychodynamic therapy

– Increasingly popular among

both clients and mental

health professionals

– Usually means meeting

once a week for a fixed

period

– Course of treatment is

usually limited

LEARNING OBJECTIVE: Explain how short-term psychodynamic therapy and virtual therapy differ

from the more traditional forms of insight therapy.

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Recent Developments

Perhaps the most dramatic and

controversial change in insight therapies is

virtual therapy.

BehaviorTherapies

Behavior Therapies

• Focused on changing behavior, rather than on

discovering insights into thoughts and feelings

• Based on the belief and all behavior, both normal

and abnormal, is learned

LEARNING OBJECTIVE: Explain the statement that “Behavior therapies sharply

contrast with insight- oriented approaches.”

Therapies Based on

Modeling

Therapies Based on

Classical Conditioning

Therapies Based on

Operant Conditioning

Therapies Based on Classical Conditioning

Systematic desensitization: Gradually associates a new

response (relaxation) with

stimuli that have been causing

fear and anxiety.

• Hierarchy of fears

• Extinction

• Flooding

Aversive conditioning: Aims at eliminating

undesirable behavior patterns

by associating them with pain

and discomfort.

LEARNING OBJECTIVE: Describe the

processes of desensitization, extinction,

flooding, aversive conditioning, behavior

contracting, token economies, and

modeling.

Therapies Based on Operant Conditioning

• A person learns to behave a

certain way because that

behavior is reinforced

– Behavior contracting

– Token economy

Therapies Based on Modeling

• Modeling: Learning a behavior

by watching someone

else perform it

– Can be used to treat

problem behaviors,

as part of job

training programs

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CognitiveTherapies

Beck’s

Cognitive

Therapy

Cognitive Therapies

• 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 Rational-

Emotive

Therapy

LEARNING OBJECTIVE: Describe the common beliefs that underlie all cognitive

therapies.

• Trains clients to cope with

stressful situations by

learning a more useful

pattern of self-talk

• Turns the client’s thought

patterns into a kind of

vaccine against stress-

induced anxiety

Stress-Inoculation Therapy

LEARNING OBJECTIVE: Compare and contrast

stress-inoculation therapy, rational-emotive

therapy, and Beck’s cognitive therapy. Negative

thoughts…

Positive

thoughts…

Rational-Emotive Therapy (RET)

• Clients’ psychological distress is caused by irrational and self-defeating beliefs.

• The therapist’s job is to challenge such dysfunctional beliefs.

Beck’s Cognitive Therapy

• Depends on identifying and

changing inappropriately

negative and self-critical

patterns of thought

• Similar to but less

challenging/confrontational

than RET; examines the

client’s dysfunctional

thoughts in a supportive

and objectively scientific

manner

Group Therapies

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Group Therapies

• Group therapy: A type of psychotherapy in which clients

meet regularly to interact and help one another achieve

insight into their feelings and behavior

LEARNING OBJECTIVE: Describe the potential advantages of group therapy compared

to individual therapy.

Self-HelpGroups

FamilyTherapy Couple

Therapy

Family Therapy

• Sees the family as at least

partly responsible for the

individual’s problems

• Seeks to change all family

members’ behaviors to the

benefit of the family unit

as well as the troubled

individual

LEARNING OBJECTIVE: Compare and contrast family therapy, couple therapy,

and self-help groups.

Couple Therapy

• Intended to help troubled partners

improve their problems of

communication and

interaction

– Empathy training

– Behavioral techniques

Self-Help Groups

• More informal, low-cost form of group

therapy where people who share a common

problem gather and provide mutual support

• Can be effective, according to research

Applying Psychology

• College and university counseling services

• Mental health programs within communities

• Resources listed in your textbook (p. 438)

Effectiveness ofPsychotherapy

6

Effectiveness of Psychotherapy

• Roughly twice as many people (two-thirds) improve with formal therapy than with no treatment at all.

• Psychotherapy works best for relatively mild psychological problems.

• It seems to provide the greatest benefits to people who really want to change.

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.

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5

Five Major Results of the Consumer Reports Study

Duration of Therapy and Improvement

One of the most dramatic

results of the Consumer

Reports (1995) study on

the effectiveness of

psychotherapy was the

strong relationship

between reported

improvement and the

duration of therapy.

Source: Adapted from “The Effectiveness of Psychotherapy: The Consumer Reports Study” by M.E.P. Seligman, American

Psychologist, 50 (1995), pp. 965–974. Copyright © 1995 by American Psychological Association.

• Common features of different forms of psychotherapy:

Which Type of Therapy is Best for Which Disorder?

• Most of the benefits of treatment seem to come from being in some kind of therapy, regardless of the particular type.

LEARNING OBJECTIVE: 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.

Hope

Explanation of problems

Therapeutic alliance

Eclecticism

The psychotherapeutic approach that recognizes the value of a broad treatment package over a rigid commitment to one particular form of therapy

Cognitive

Therapy

GroupTherapy

Insight

Therapy

BehaviorTherapy

BiologicalTreatments

7

Biological Treatments

• A group of approaches that are sometimes used to

treat psychological disorders in addition to, or instead

of, psychotherapy

LEARNING OBJECTIVE: Explain why some clients and therapists opt for biological

treatment instead of psychotherapy.

Psychosurgery

Drug Therapies

ElectroconvulsiveTherapy

Drug Therapies

Antipsychotic Drugs

Used to treat severe

psychological disorders,

particularly schizophrenia;

reduce psychotic symptoms,

such as hallucinations and

delusions

• Example: Neuroleptics

• Serious potential side effect:

Tardive dyskinesia

LEARNING OBJECTIVE: Describe the major antipsychotic and antidepressant drugs

including their significant side effects.

Drug Therapies

Antidepressant Drugs

Combat depression and

sometimes anxiety, panic,

and obsessive compulsive

disorders

• Examples:

– Monoamine oxidase inhibitors

(MAO inhibitors) and tricyclics

– Selective serotonin reuptake

inhibitors (SSRIs)

Drug Therapies

Lithium

• A naturally occurring salt

• Generally quite effective in

treating bipolar disorder and

in reducing the incidence of

suicide in bipolar patients

Drug Therapies

Other Medications

• Psychostimulants:

Heighten alertness and

arousal

• Antianxiety medications:

Reduce general tension and

stress

• Sedatives: Treat agitation

or induce sleep

Major Types of Psychoactive Medications

8

Combining Drugs and Psychotherapy“For some disorders a combination of drugs and psychotherapy works better

than either approach used independently. This underscores the fact that the

relationship between the mind and the body is highly complex.”

– Page 443 (Morris & Maisto)

Electroconvulsive Therapy (ECT)

LEARNING OBJECTIVE: LEARNING OBJECTIVE: 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.

• A mild electrical current is

passed through the brain for a

short period, often producing

convulsions and temporary

coma

– Not known why ECT works, but

it is effective

– Side effects include brief

confusion, disorientation,

and memory impairment

Psychosurgery

• Brain surgery performed to change a person’s behavior and emotional state

– Usually conducted only after

all other treatment options

have been exhausted

– Can work well with one

person and not work at all

with another

– Side effects can be severe

and permanent

Major Perspectives on Therapy

Institutionalizationand ItsAlternatives

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.

• For persons with severe mental

illness, hospitalization has been

the treatment of choice in the U.S.

for the past 150 years.

• The development of effective drug

therapies starting in the 1950s led

to a number of changes

in state hospitals:

– Sedation rather than physical restraints

– Deinstitutionalization

9

Deinstitutionalization

• In recent years, deinstitutionalization has created a number of serious challenges.

• Poorly funded community mental health centers and other support systems have proved inadequate.

• Many patients stop taking their medication, resulting in the return of psychotic symptoms and homelessness.

Alternative Forms of Treatment

• Kiesler (1982b):9 out of the 10 studies found that the outcome was more positive for patients in alternative treatments than for the more expensive hospitalization.

Prevention

Primary

Prevention

Secondary

Prevention

Tertiary Prevention

Techniques and programs to

improve the social environment so

that new cases of mental disorders

do not develop

Programs to identify groups that are at

high risk for mental disorders and to

detect maladaptive behavior in these

groups and treat it promptly

Programs to help people adjust to

community life after release from a mental

hospital

Client Diversityand Treatment

Gender and Treatment

There are significant

gender differences in

the prevalence of many

psychological disorders,

in part because:

• Women have traditionally

been more willing than

men to admit that they

have psychological

problems and need help

to solve them.

• Psychotherapy is more

socially accepted for

women than for men.

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.

• Feminist therapists

LEARNING OBJECTIVE: Explain how gender and cultural differences can affect the treatment of

psychological problems and the training of therapists.

Culture and Treatment

When psychotherapist

and client come from

different cultural

backgrounds or

belong to different

racial or ethnic

groups,

misunderstandings

can arise in therapy.

The best solution 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.

10

Lecture Activities

On your paper, list one personal characteristic

that you feel would make you a good therapist.

Then, list another characteristic that you feel

would make you a poor therapist. Be prepared to

share your thoughts.

Reflective Listening

Let’s practice a little client-centered

therapy. First, find a partner. Decide who

will be the “therapist” and who will be the

“client.”

For your role-play, the client is having

trouble with his/her schoolwork and other

related issues. He/she will briefly explain.

The therapist should provide empathic

reflection and unconditional positive

regard as the client discusses the

problem.

How might the elements of

client-centered therapy be

useful outside of a therapist’s

office? In your relationships

with friends? Loved ones?

Employers or employees?

Acknowledgments

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33 Figure 13-1 Duration of Therapy and Improvement

Morris/Maisto, 9/e p. 440

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42 table 13-1 Major Types of Psychoactive Medications

Morris/Maisto, 9/e p. 442

42 tabletop ©istockphoto.com/Andrew Cribb

43 Open Your Book - textbook cover Shutterstock

43 Open Your Book - textbook background From Ciccarelli, Psychology, 1/e pp. 213-214

43 Open Your Book - open textbook From Ciccarelli, Psychology, 1/e pp. 114-115

44 electric current ©istockphoto.com/Scot Spencer

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46 Summary Table: Major Perspectives on Therapy Morris/Maisto, 9/e p. 445

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50 paper Charlie Levin

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