15 PSYCHOTHERAPY
There are many different types of PSYCHOTHERAPY, but all of them have three key elements. They all involve a helping relationship (the treatment) between a professional with special training (the therapist) and another person in need of help (the client). As varied as therapists' procedures are, approaches to treatment can be classified into three major categories:
1. INSIGHT THERAPIES- "talk therapy" in the tradition of Freud's psychoanalysis to increase self-insight.
2. BEHAVIORAL THERAPIES- based on the principles of learning and conditioning to alter problematic responses.
3. BIOMEDICAL THERAPIES- interventions into a person's physiological functioning such as with drug theory and electroconvulsive therapy.
People seek mental health treatment for a variety of reasons: anxiety, depression, unsatisfactory interpersonal relations, troublesome habits, poor self-control, low self-esteem, marital conflicts, etc. People vary considerable in their willingness to seek treatment, and unfortunately, many people who need therapy don't receive it because of the stigma associated with it.
Psychotherapy is provided by clinical psychologists and psychiatrists, primarily, but it is also provided by social workers, psychiatric nurses, counselors, and marriage and family therapists. CLINICAL PSYCHOLOGISTS and COUNSELING PSYCHOLOGISTS specialize in the diagnosis and treatment of psychological disorders and everyday problems and have a Ph.D. They tend to use insight and behavioral approaches and are not licensed to prescribe medications. PSYCHIATRISTS are physicians who specialize in the treatment of psychological disorders and have a M.D. They are more likely to use psychoanalysis and increasingly depend on medication as their principal mode of treatment.
INSIGHT THERAPIES involve verbal interactions intended to enhance clients' self-knowledge and thus promote healthful changes in personality and behavior. We'll delve into four types of insight therapy.
1. PSYCHOANALYSIS is an insight therapy that emphasizes the recovery of unconscious conflicts, motives, and defenses through techniques such as free association, dream analysis, and transference. In FREE ASSOCIATION, clients spontaneously express their thoughts and feeling exactly as they occur, with as little censorship as possible. In DREAM ANALYSIS, the therapist interprets the symbolic meaning of the client's dreams. A critical process throughout psychoanalysis is that the therapist must interpret the clients' dreams and free associations. Interpretation involves the therapist's attempts to explain the inner significance of the client's thoughts, feelings, memories, and behaviors. An almost inevitable part of the process is resistance, the client's unconscious defensive maneuvers to hinder the progress of therapy. Also, TRANSFERENCE occurs when the client starts relating to their therapist in ways that mimic critical relationships in their lives. Freud's style of psychoanalysis is not done so much anymore. The central feature of modern psychodynamic therapies include (1) a focus on emotional experience, (2) exploration of efforts to avoid distressing thoughts and feelings, (3) identification of recurring patterns in clients' life experiences, (4) discussion of past experiences, especially in childhood, (5) analysis of interpersonal relationships, (6) a focus on the therapeutic relationship itself, and (7) exploration of dreams and other aspects of fantasy life. See Figure 15.4 for more detail.
2. CLIENT-CENTERED THERAPY (aka, Person-Centered Therapy) is an insight therapy that emphasizes providing a supportive emotional climate for clients, who play a major role in determining the pace and direction of their therapy. According to Carl Rogers' theory, INCONGRUENCE (personal distress due to inconsistencies between a person's self-concept and reality) makes people prone to feel threatened by realistic feedback about themselves from others. Anxiety about such feedback often leads to reliance on defense mechanisms, distortions of reality, and stifled personal growth. Excessive incongruence is thought to be roots in clients' over-dependence on others for approval and acceptance. Client-centered therapy helps clients realize that they don't have to worry constantly about pleasing others and winning acceptance. It encourages, self-respect, self-acceptance, and personal growth. Client-centered therapy must provide three conditions: (1) genuineness (honest communication), (2) unconditional positive regard (nonjudgmental acceptance of the client), and (3) actuate empathy (understanding the client's point of view). The therapist's key task is clarification, helping clients clarify their feelings to become more aware of their genuine selves.
3. GROUP THERAPY is the simultaneous treatment of several or more clients in a group. Six to eight people is regarded as the ideal number of participants in a group. The therapist's job is to select participants, set goals for the group, initiate and maintain the therapeutic process, and protect clients from harm. Participants in group therapy essentially function as therapists for one another. They describe their problems, trade viewpoints, share experiences, and discuss coping strategies. Group members one to realize that their misery is not unique and they can work on their social skills in a safe environment.
4. COUPLES or MARITAL THERAPY involves the treatment of both partners in a committed, intimate relationship, in which the main focus is on relationship issues. FAMILY THERAPY involves the treatment of a family unit as a whole, in which the main focus is on family dynamics and communication. Both types of therapy seek to understand the patterns of interactions that produce distress and to improve communication and move toward healthier patterns of interaction.
Studies consistently indicate that insight therapies (1) are superior to no therapy at all or to placebo treatment, (2) are roughly equal to drug therapies, and (3) have the greatest improvements early in treatments.
BEHAVIOR THERAPIES involve the application of the principles of learning (classical conditioning, operant conditioning, and observational learning) to direct efforts to change clients' maladaptive behaviors. The two assumptions are, first, behavior is a product of learning, and second, what has been learned can be unlearned.
1. SYSTEMATIC DESENSITIZATION is a behavior therapy used to reduce clients' anxiety responses through counterconditioning. It involves three steps: (1) The therapist helps the client build an anxiety hierarchy. (2) The therapist trains the client in deep muscle relaxation. (3) The client tries to work through the hierarchy, learning to remain relaxed while imagining each stimulus. Gradually, the client works through the hierarchy, unlearning troublesome anxiety responses. In exposure therapy, clients are confronted with real-life situations that they fear so they learn that these situations are really harmless.
2. SOCIAL SKILLS TRAINING is a behavior therapy designed to improve interpersonal skills that emphasizes modeling (watching others who are socially skilled), behavioral rehearsal (practicing social techniques through role playing), and shaping (gradually working through more complicated and delicate social situations).
3. COGNITIVE-BEHAVIORAL TREATMENTS use varied combinations of verbal interventions and behavior modification techniques to help clients change their maladaptive patterns of thinking. Albert Ellis's rational-emotive therapy and Aaron Beck's cognitive therapy have been extremely influential. Cognitive therapy uses specific strategies to correct habitual thinking errors that underlie various types of disorders, including depression, which is believed to occur due to "errors" in thinking. The goal is to change the clients' negative thoughts and maladaptive beliefs.
There is ample evidence that behavioral therapies are effective, especially in the treatment of depression, anxiety, phobias, OCD, sexual dysfunction, schizophrenia, drug-related problems, eating disorders, hyperactivity autism, and mental retardation.