Ch. 16 Therapy and Treatments

TYPES OF TREATMENT

• Psychotherapy

• Behavior Therapy

• Cognitive Therapy

• Cognitive-Behavioral Therapy

• Humanistic Therapy

PSYCHOANALYSIS Techniques

• the first form of psychotherapy created by Sigmund Freud.

• It focuses on uncovering hidden, unconscious feelings, usually from childhood, that influence current behavior.

Main Techniques

• Free Association

  • The patient relaxes and says anything that comes to mind, without filtering.
    The idea: unconscious thoughts and feelings will “slip out.”

• Dream Analysis

  • therapist interprets the hidden meaning (latent) behind the patient’s dreams because Freud believed dreams reveal unconscious desires or fears.

  • Example:
    A patient dreams of being chased → the therapist might interpret this as the patient avoiding a stressful issue in real life.

• Resistance

  • When the patient tries to block or avoid painful or unacceptable thoughts during therapy.

  • Freud believed resistance showed the therapy was getting close to important unconscious material.

  • Example:
    A patient keeps changing the subject whenever childhood issues are mentioned.

• Transference

  • The patient transfers feelings they had toward important people in their life (parents, partners, etc.) onto the therapist.

  • Example:
    A patient begins treating the therapist like their father—feeling anger or seeking approval—allowing them to work through unresolved emotions.

Free association

• psychoanalytic technique

• where the patient relaxes and says whatever comes to mind, without filtering or censoring their thoughts.

• Freud believed this helps uncover unconscious feelings, memories, and conflicts.

Example:

A therapist says:
“Just say anything that comes to your mind.”

The patient responds:
“I see a blue room… reminds me of school… my mom yelled at me… I feel nervous…”

Even if the thoughts seem random, the therapist uses them to discover deeper emotional issues.

Dream analysis

• psychoanalytic technique

• where the therapist interprets the hidden, unconscious meaning behind a patient’s dreams. (Latent)

• Freud believed dreams reveal desires, fears, and conflicts that the person may not be aware of while awake.

Example:

• A patient dreams they are falling.It seeks to uncover unconscious desires and fears.

• The therapist might interpret this as the patient feeling out of control in their real life (such as school, relationships, or stress).

• The dream gives clues about emotions the patient may not openly recognize.

Resistance

• patient unconsciously blocks or avoids talking about painful, uncomfortable, or threatening thoughts during psychoanalytic therapy.

• Freud believed resistance happens because the ego tries to protect the person from upsetting unconscious material.

  • Resistance appears during free association, when the patient avoids certain topics or suddenly goes blank.

  • It signals that the therapy is getting close to important unconscious conflicts.

• Example:

  The therapist asks about the patient’s childhood.
  The patient suddenly:

  • changes the subject,

  • laughs it off,

  • “forgets,”

  • becomes silent,

  • or gets irritated.

  These behaviors show resistance—the mind is trying to avoid painful memories.

Transference

• when a patient projects or transfers feelings they have toward important people in their life (like a parent, partner, or sibling) onto the therapist during psychoanalytic therapy.

• Freud believed this helps reveal unresolved childhood conflicts and emotional patterns.

  • Feelings transferred can be positive (affection, admiration) or negative (anger, resentment).

  • It occurs naturally as the patient opens up during therapy.

  • Therapists use transference to understand the patient’s deeper emotional issues.

Example:

• A patient begins treating the therapist like their father, showing the same anger, fear, or desire for approval they feel toward their real father.

• This helps the therapist understand unresolved family conflicts that influence the patient’s current behavior.

Behavior Therapy

• is a type of psychotherapy that uses principles of learning (classical conditioning + operant conditioning) to change unwanted or unhealthy behaviors.

• It focuses on current behavior, not past experiences.

  • The idea:
    If a behavior is learned, it can be unlearned and replaced with a healthier one.

1. Classical Conditioning Techniques

• These help people change behaviors by creating new associations.

a. Counterconditioning

• Learning a new response to replace an undesired one.
  Includes aversive conditioning and exposure therapy.
  

b. Aversive Conditioning

• Uses an unpleasant stimulus to stop an undesirable behavior.
  Example: Using Antabuse (substance that causes negative side effects such as vomiting when combined with alcohol) to make alcohol cause nausea.
  

c. Exposure Therapy

• Gradually exposing someone to what they fear so they get used to it.
  Used for phobias and anxiety.
  

Counterconditioning

• behavior therapy technique where a person learns a new, healthier response to a stimulus that used to cause an unwanted or unhealthy response.

• You replace a bad reaction with a good or neutral reaction.

  Counterconditioning includes:

  • Aversive conditioning

  • Exposure therapy

Examples

• Fear of Dogs → Relaxation Instead of Fear

  • A person scared of dogs practices deep breathing while being gradually exposed to calm, friendly dogs.

    • Eventually the fear response is replaced with calmness.

• Treating Alcohol Addiction (Aversive Conditioning)

  • A person takes Antabuse, which causes nausea when alcohol is consumed.

    • The pleasant feeling of drinking is replaced with discomfort.

• Bedwetting Alarm

  • A child learns to wake up when feeling a full bladder because the alarm goes off when bedwetting starts.

    • The old response (urinating in sleep) is replaced with waking up

Aversive conditioning

• a type of counterconditioning where an unpleasant stimulus is paired with an unwanted behavior to help a person stopthat behavior.

• The goal:
  Make the unwanted behavior feel unpleasant so the person avoids it.

Examples

Treating Alcohol Addiction with Antabuse

A person takes Antabuse, a medication that causes:

• nausea

• vomiting

• headache

• increased heart rate

when alcohol is consumed.
Eventually, drinking becomes associated with feeling sick, not pleasure.

Nail-Biting

• A bitter-tasting nail polish is applied.

• The unpleasant taste becomes linked to nail-biting, so the person stops.

Smoking

• A therapist pairs smoking with a foul odor or discomfort, making cigarettes less appealing.

Exposure therapy

• a behavior therapy technique where a person is gradually and repeatedly exposed to the object or situation that causes fear or anxiety, so they eventually become less afraid and more comfortable with it.

Examples

• Fear of Elevators

A therapist helps a client by:

1. Thinking about an elevator

2. Standing near an elevator

3. Pressing the button

4. Riding one floor

5. Eventually riding calmly to higher floors

Over time, the anxiety decreases.

Example 2: Fear of Spiders

• A person with arachnophobia is gradually exposed to spiders in a controlled setting while learning to relax.

Systematic desensitization

• a type of exposure therapy where a person learns to stay relaxed while facing gradually increasing levels of a feared object or situation.

• The idea:
  You cannot be relaxed and afraid at the same time.
  So if you learn to stay calm during the fear, the fear response weakens and eventually disappears.

• Example 1: Fear of Elevators

  • A person practices deep breathing while imagining pressing an elevator button.
    Once they can stay calm, they move on to riding one floor, then several floors.
    Over time, the fear fades.

• Example 2: Fear of Spiders

  • A client first looks at pictures of spiders while relaxed → then watches videos → then sees a real spider from far away → eventually holds a small spider.
    Each step is paired with calm breathing.

• Example 3: Fear of Flying

  • The client visualizes walking into an airport while relaxed → then sitting in a plane seat → then watching takeoff videos → eventually taking a short flight.
    

COGNITIVE THERAPY

• How you think determines how you feel and act

• a type of psychotherapy that focuses on how a person’s thoughts lead to their feelings and behaviors.

  • The goal is to help people identify and change distorted or irrational thinking patterns that create distress.

  • Encourages clients to find more logical ways of interpreting situations and positive ways of thinking.

• Cognitive Distortions

  • 1. Overgeneralizing

    Taking a small situation and making it huge.
    Example: “I got one question wrong → I’m terrible at school.”

    2. Polarized / Black-and-White Thinking

    Seeing things as all good or all bad.
    Example: “I am either perfect, or a failure.”

    3. Jumping to Conclusions

    Assuming people think negatively about you without evidence.
    Example: A friend doesn’t answer → “They must be mad at me.”

  • 4. Mind Reading

Overgeneralizing

• a cognitive distortion

• taking a small situation and making it huge

  • It leads to negative emotions like hopelessness, anxiety, or depression.

• where a person takes one negative event and assumes it will always happen or applies it to everything in their life.

Example 1: School

You miss one question on a quiz and think:
“I’m terrible at this class. I’ll never understand anything.”
→ One small mistake becomes a global conclusion.

Example 2: Social

You invite one friend to hang out and they can’t go.
You think:
“No one ever wants to spend time with me.”
→ A single event becomes “everybody” and “always.”

Example 3: Work or Daily Tasks

You burn dinner and think:
“I mess up everything I try.”
→ One cooking mistake becomes a statement about your whole lif

Polarized (“black & white”) thinking

• cognitive distortion

• where a person sees things in extreme, all-or-nothing terms, with no middle ground or gray area.

• Seeing things as all good or all bad.
  Example: “I am either perfect, or a failure.”

Example 1: Schoolwork

“I didn’t get an A on the test, so I’m a complete failure.”
→ There is no room for “good enough” or improvement.

Example 2: Relationships

“If my friend doesn’t agree with me, she must hate me.”
→ Differences are seen as rejection.

Example 3: Personal Standards

“I made one mistake at work. I can’t do anything right.”
→ One slip = total incompetence.

Example 4: Self-Worth

“I didn’t reach my goal perfectly, so I’m worthless.”
→ Worth is measured only by extremes.

Jumping to conclusions

• cognitive distortion

• assuming that people are thinking negatively about you or reacting negatively to you, without evidence.

  • Mind reading → assuming you know what someone else thinks

• Example 1: Text Message

  Someone doesn’t respond right away.
  You think:
  “They’re ignoring me. I must have done something wrong.”
  → No evidence, just assumption.

• Example 2: School/Work

  You make a small mistake and think:
  “I’m probably going to get fired.”
  → Automatically assuming the worst.

• Example 3: Social Situation

  You walk past a group of people who laugh.
  You think:
  “They’re laughing at me.”
  → Assuming their behavior is about you.

• Example 4: New Experience

  You think:
  “I’ve never tried this before. I know I’ll fail.”
  → Predicting failure without trying.

Mind Reading

• cognitive distortion

• where a person assumes they know what someone else is thinking, usually assuming it’s negative, even though there is no real evidence.

  • It is a form of jumping to conclusions

• Example 1: Texting

  Your friend doesn’t reply right away.
  You think:
  “She must be upset with me.”
  → No evidence—just assuming her thoughts.

• Example 2: School / Class

  You answer a question wrong and think:
  “Everyone thinks I’m stupid.”
  → Believing you can read everyone’s minds.

• Example 3: Social Situation

  Someone looks serious while you are talking.
  You assume:
  “He probably thinks what I'm saying is boring.”
  → You treat your guess as fact.

• Example 3: Social Situation

  Someone looks serious while you are talking.
  You assume:
  “He probably thinks what I'm saying is boring.”
  → You treat your guess as fact.

COGNITIVE-BEHAVIORAL THERAPY

• form of psychotherapy that helps people change negative thinking patterns (cognitive) and change unhealthy behaviors (behavioral) at the same time.

• focuses more on present issues rather than on a patient’s past.

Uses the ABC model to reveal cognitive distortions

• Action – “triggering” event.

• Belief about the event (what are the negative beliefs)

  • Im stupid, I may also give up, all other students do better than me

• Challenge the distortions (beliefs) …Consequences

  • should, must, need to —> change it to “I hope that… but if not, everything is still okay.”

HUMANISTIC THERAPY

• Client-centered therapy

• a type of psychotherapy that focuses on helping people become more self-aware, self-accepting, and able to reach their full potential.

• It emphasizes conscious thoughts, personal growth, and the client’s ability to take charge of their life.

• Non-directive therapy – therapist does not give advice or provide interpretations but helps client identify conflicts and understand feelings

Techniques:

• Active listening – therapist acknowledges, restates, and clarifies what the client

  expresses.

• Unconditional positive regard – therapist does not judge clients and simply accepts

  them for who they are.

• Genuineness, empathy, and acceptance towards clients – Rogers felt that

  therapists should demonstrate these because it helps the client become more accepting

  of themselves, which results in personal growth.

• Goal:
  Help the client become more accepting of themselves → leading to personal growth and healthier functioning.

BIOMEDICAL THERAPIES

• Psychotropic medications – medications used to treat psychological disorders.

  • Treat the symptoms of psychological disorders but do not cure the disorder.

• Antipsychotics – treat positive psychotic symptoms such as hallucinations, delusions, and paranoia by blocking dopamine.

• Atypical antipsychotics – treat the negative symptoms of schizophrenia such as withdrawal and apathy, by targeting both dopamine and serotonin receptors.

  • Antipsychotics and atypical antipsychotics both treat schizophrenia and other types of severe thought disorders.

• Anti-depressants – alter levels of serotonin and norepinephrine.

  • Depression and anxiety.

• Anti-anxiety agents – depress central nervous system activation.

  • Anxiety, OCD, PTSD, panic disorder and social phobia.

• Mood stabilizers – treat episodes of mania as well as depression (Bipolar disorder).

• Stimulants – improve ability to focus on a task and maintain attention (ADHD).

• Electroconvulsive therapy – induces seizures to help alleviate severe depression.

• Transcranial magnetic stimulation – magnetic fields stimulate nerve cells to improve depression symptom.

Psychotropic medications

• medications used to treat psychological disorders.

• treat the symptoms of psychological disorders but do not cure the disorder.

Antipsychotics

• treat positive psychotic symptoms such as hallucinations, delusions, and paranoia by blocking dopamine.

Atypical antipsychotics

• treat the negative symptoms of schizophrenia such as withdrawal and apathy, by targeting both dopamine and serotonin receptors.

Anti-depressant

• alter levels of serotonin and norepinephrine.

  • Depression and anxiety.

Anti-anxiety agent

• depress central nervous system activation.

  • Anxiety, OCD, PTSD, panic disorder and social phobia.

Mood stabilizers

• treat episodes of mania as well as depression (Bipolar disorder).

Stimulants

• improve ability to focus on a task and maintain attention (ADHD).

Electroconvulsive therapy

• induces seizures to help alleviate severe depression.

Transcranial magnetic stimulation

• magnetic fields stimulate nerve cells to improve depression symptom.

Individual Therapy

• In an individual therapy session, a client works one-on-one with a trained therapist.

• to discuss problems, develop coping strategies, and work toward mental and emotional well-being.

Group Therapy

• In group therapy, several clients meet with a trained therapist to discuss a common issue such as divorce, grief, an eating disorder, substance abuse, or anger management.

  • Can help decrease shame and isolation.

  • helps people be accountable

  • learn social etiquette

  • Clients may have concerns about confidentiality or feel uncomfortable sharing problems with strangers.

Family Therapy

• Aims to enhance growth of each family member as well as that of the family as a whole.

• The goal is to improve communication, solve problems, and help family members understand each other better.

Couples Therapy

• Therapist helps people work on difficulties in their relationship - aims to help them resolve problems and implement strategies that will lead to a healthier and happier relationship.

• E.g. how to listen, how to argue, and how to express feelings.

  • Primarily uses cognitive-behavioral therapy

ADDICTION

• chronic (long-lasting) condition in which a person cannot stop using a substance or engaging in a behavior, even when it causes serious problems in their life.

• People with addiction feel strong cravings, lose control, and continue the behavior despite harmful physical, emotional, or social consequences.

Key Features of Addiction

1. Loss of Control

• The person tries to cut back or stop but can’t.

2. Cravings

• Strong urges or desires to use the substance or do the behavior.

3. Tolerance

• Needing more of the substance to feel the same effect.

4. Withdrawal Symptoms

• Feeling sick, anxious, moody, or uncomfortable when the substance is not used.

5. Continued Use Despite Harm

• The person keeps using even though it harms their health, relationships, work, or school.