15.1 The Origins and Effectiveness of Psychotherapy

• Psychotherapy: Any psychological technique used to facilitate positive changes in a person’s personality, behavior, or adjustment.

  Psychoanalysis

• Psychoanalysis: Freudian approach to psychotherapy emphasizing exploration of the unconscious using free association, dream interpretation, resistances, and transference to uncover unconscious conflicts.

• Therapeutic Techniques to Uncover Unconscious Roots of Neurosis:

  1. Free Association

  2. Dream Analysis

  3. Analysis of Resistance

  4. Analysis of Transference

• Free association: The psychoanalytic technique of encouraging a patient to say whatever comes to mind without censoring.

• Resistance: Blockage in the flow of free association around topics the client avoids thinking or talking about.

• Transference: The tendency of patients to transfer to a therapist feelings that correspond to those the patient had for important persons in his or her past.

  Characteristics That Distinguish Psychotherapies

• Insight therapy: Any therapy that stresses the importance of understanding the origins of a psychological disorder, usually unresolved unconscious conflicts.

• Action therapy: Any therapy that stresses directly changing troublesome thoughts and/or behaviors without regard for their origins, unconscious or otherwise.

• Directive therapy: Any therapy that stresses the need for the therapist to lead the patient toward a resolution of his or her psychological distress.

• Nondirective therapy: Any therapy in which the therapist supports the client while the client gains insight into his or her own problems and their resolution.

• Group therapy: Psychological treatment involving several unrelated clients.

• Psychodrama: A therapy in which clients act out personal conflicts and feelings in the presence of others who play supporting roles.

• Role rehearsal: Taking the role of another person to learn how one’s own behavior appears from the other person’s perspective.

• Mirror technique: Observing another person reenact one’s own behavior appears from the other person’s perspective.

• Family therapy: Treatment of a group of related individuals that focuses on interpersonal dynamics and communication.

  Core Features of Effective Psychotherapy

• Therapeutic alliance: A caring relationship that unites a therapist and a client in working to solve the client’s problems.

• Culturally skilled therapist: A therapist who has the awareness, knowledge, and skills necessary to treat clients from diverse cultural backgrounds.

  Effectiveness of Psychotherapy

• Spontaneous Remission: Improvement of symptoms due to the mere passage of time.

• Therapy Placebo Effect: Improvement caused not by the actual process of therapy but by a client’s expectation that therapy will help.

  15.2 Behavior Therapies

• Behavior therapy: Any therapy designed to actively change behavior.

• Behavior modification (applied behavior analysis): The application of learning principles to change human behavior, especially maladaptive behavior.

  Therapies Based on Classical Conditioning

• Aversion therapy: Treatment to reduce unwanted behavior by pairing it with an unpleasant stimulus.

• Exposure therapy: Alleviating fears and phobias (conditioned emotional responses) by using classical conditioning extinction.

• Flooding: A form of exposure therapy in which clients are exposed to the object of their fears beginning with examples that provoke the most extreme responses.

• Systematic desensitization: A reduction in fear, anxiety, or aversion brought about by planned exposure that provoke the most extreme responses.

• Reciprocal inhibition: The presence of one emotional state can inhibit the occurrence of another, such as joy preventing fear or anxiety inhibiting pleasure.

• Tension-release method: A procedure for systematically achieving deep relaxation of the body.

• Fear hierarchy: A list of fears, arranged from least fearful to most fearful, for use in systematic desensitization.

• Virtual reality exposure: Use of computer-generated images to present fear stimuli while responding to a viewer’s head movements and other input.

• Modeling: A form of exposure therapy in which clients observe models displaying adaptive behavior toward their feared object.

  Therapies Based on Operant Conditioning

  1. Positive Reinforcement

  2. Nonreinforcement and extinction

  3. Punishment

  4. Shaping

  5. Time-out

• Token economy: Behavior modification in which desired behaviors earn objects that can be exchanged for positive reinforcers.

  15.3 Cognitive and Humanistic Therapies

  Cognitive Therapies

• Cognitive therapy: Treatment of emotional and behavioral problems by changing maladaptive thoughts, beliefs, and feeling.

• Selective perception: Perceiving only certain stimuli among a larger array of possibilities.

• Overgeneralization: Blowing a single event out of proportion by extending it to a large number of unrelated situations.

• All-or-nothing thinking: Classifying objects or events as absolutely right or wrong, good or bad, acceptable or unacceptable, and so forth.

  Cognitive Behavior Therapy

• Cognitive behavior therapy (CBT): Any therapy that combines elements of cognitive therapy and behavior therapy.

• Rational-emotive behavior therapy (REBT): Type of treatment designed to identify and change self-defeating thoughts.

• Thought stopping: The use of aversive stimuli to interrupt or prevent upsetting thoughts.

  Humanistic Therapies

• Humanistic therapies: Insight-oriented therapies that help clients better understand themselves with the goal of maximizing their potential.

• Client-centered (person-centered) therapy: Individual being treated talks without direction, judgement, or interpretation from the therapist.

• Unconditional positive regard: Complete, unqualified acceptance of another person as he or she is.

• Empathy: A capacity for taking another’s point of view; the ability to feel what another is feeling.

• Authenticity: In Carl Rogers’s terms, the ability of a therapist to be genuine and honest about his or her own feelings.

• Reflection: In client-centered therapy, the process of rephrasing or repeating thoughts and feelings expressed by clients so that they can become aware of what they are saying.

• Existential therapy: An insight therapy that focuses on the elemental problems of existence, such as death, meaning, choice, and responsibility; emphasizes making courageous life choices.

• Gestalt therapy: An approach that focuses on immediate experience and awareness to help clients rebuild thinking, feeling, and acting into connected wholes; emphasizes the integration of fragmented experiences.

  15.4 Medical Therapies

  Drug Therapies

• Pharmacotherapy: The use of drugs to treat psychopathology.

• Antipsychotic drugs (major tranquilizers): Medications that may alleviate hallucinations and delusional thinking associated with mental disorders.

• Antianxiety drugs (anxiolytics or minor tranquilizers): Medications that produce relaxation or reduce anxiety.

• Antidepressant drugs: Medications that combat depression by affecting the levels or activity of neurotransmitters.

• Mood stabilizers: Medications that combat bipolar disorder by leveling mood swings.

• Stimulants (as drugs to treat ADHD): Medications used to calm attention deficit hyperactivity disorder even though they arouse the nervous system.

  Brain Stimulation Therapies

• Electroconvulsive therapy (ECT): Treatment for severe depression in which electrical current is applied to the brain, causing a seizure.

• Deep brain stimulation (DBS): Electrical stimulation of precisely targeted brain regions; a surgical procedure is necessary to implant electrodes in the brain that allow for the stimulation.

• Transcranial magnetic stimulation (TMS): A device that uses magnetic pulses to temporarily block activity in specific parts of the brain.

  Psychosurgery

• Psychosurgery: Any surgical alteration of the brain designed to bring about desirable behavioral or emotional changes.

  Hospitalization

• Psychiatric hospitalization: Placing a person in a protected, therapeutic environment staffed by mental health professionals.

• Deinstitutionalization: The reduced use of full-time commitment to mental institutions to treat mental disorders.

• Halfway house: A community-based facility for individuals making the transition from an institution (mental hospital, prison, and so forth) to independent living.

  Community Mental Health Programs

• Community mental health center: A facility offering a wide range of mental health services, such as prevention, counseling, consultation, and crisis intervention.

• Crisis intervention: The skilled management of a psychological emergency.

• Paraprofessional: An individual who works in a near-professional capacity under the supervision of a more highly trained person.

  15.5 Psychology and Your Skill Set: Managing Mental Health Issues

  Basic Counseling Skills

  • Be an active listener

  • Reflect thoughts and Feelings

  • Don’t be afraid of silence

  • Ask open-ended questions

  • Clarify problems

  • Focus on feelings

  • Avoid giving advice

  • Accept the Person’s Frame of Reference

  • Maintain confidentiality

  Therapeutic Options

• Somatic therapy: Any bodily therapy, such as drug therapy, electroconvulsive therapy, or psychosurgery.

• Peer counselor: A nonprofessional person who has learned basic counseling skills.

• Self-help group: A group of people who share a particular type of problem and provide mutual support to one another.

Chapter in Review

15.1 The Origins and Effectiveness of Psychotherapy

15.1.1 Briefly describe how mental health problems were treated before the 1900s

All psychotherapy aims to facilitate positive changes in personality, behavior, or adjustment. Early approaches to mental illness were dominated by superstition and moral condemnation. Demonology attributed mental disturbance to demonic possession and prescribed exorcism as the cure. More human treatment began in 1973 with the work of Philippe Pinel in Paris.

15.1.2 Describe the main elements of psychanalysis

Sigmund Freud developed psychoanalysis, the first psychotherapy, a little more than a hundred years ago. As the first true psychotherapy, Freud’s psychoanalysis gave rise to modern psychodynamic therapies, although traditional psychoanalysts are now hard to find. The main elements of psychoanalysis include free association, dream analysis, and analysis of resistance and transference, each of which is believed to reveal health-producing insights.

15.1.3 Describe five characteristics that distinguish different psychotherapies

First, therapies may be insight or action-oriented. Insight therapies rely on gaining a conscious understanding of one’s challenges; action therapies focus on changing problematic thoughts and behaviors. Second, therapy can be directive or non-directive. The former refers to techniques in which the therapist leads a client through the therapeutic process while the latter involves therapists working to create conditions that allow clients to resolve their own issues. Third, therapy can be open-ended or time-limited. Fourth, psychotherapies may be conducted with individuals or groups. Fifth, therapies may be effectively conducted either face-to-face or at a distance, via telephone and the Internet.

15.1.4 Name four features of effective psychotherapy

The success of any particular therapy depends on the characteristics of the client, characteristics of the therapist, the relationship between the therapist and the client (I.e., the therapeutic alliance), and the nature of the problem for which therapy is being provided.

15.2 Behavior Therapies

15.2.1 Describe the main elements of behavior therapies

Behavior therapies use the learning principles of classical or operant conditioning to directly change human behavior. This type of psychotherapy does not rely on clients achieving deep insight into their problems but instead focuses on altering maladaptive thoughts and behaviors.

15.2.2 Describe two therapies that are based on classical conditioning

Two therapies based on classical conditioning include aversion therapy and exposure therapy. In aversion therapy, classical conditioning is used to associate maladaptive behavior (such as smoking or drinking) with pain or other aversive events to inhibit undesirable responses. In exposure therapy, clients are exposed to situations or objects that cause them to feel intense fear. This type of contact allows the client to eliminate conditioned emotional responses originally acquired through classical conditioning by learning that their anxiety is unwarranted. Three types of exposure therapy are flooding, systematic desensitization, and modeling.

15.2.3 Describe two therapies that are based on operant conditioning

Operant principles, such as positive reinforcement, non-reinforcement, extinction, punishment, shaping, stimulus control, and time-out, are used to extinguish undesirable responses and to promote constructive behavior. Non-reward can also help extinguish troublesome behaviors. Often, this is done by simply identifying and eliminating reinforcers, particularly attention and social approval.

Two types of therapy that employ operant principles are intensive behavioral intervention (IBI) and token economies. IBI uses positive reinforcement and shaping to bring about new behaviors, and is often used with children diagnosed with autism. Tokens are often used to reinforce selected target behaviors; the tokens can be exchanged for other benefits (material goods or privileges) when a sufficient number are accumulated. Full-scale use of tokens in an institutional setting produces a token economy.

15.3 Cognitive and Humanistic Therapies

15.3.1 Describe the main elements of cognitive therapies

Cognitive therapies emphasize changing thought patterns that underlie emotional or behavioral problems. Its goals are to correct distorted thinking, teach improved coping skills, or both. For example, Aaron Beck’s cognitive therapy focuses on changing several major distortions in thinking: selective perception, overgeneralization, and all-or-nothing thinking. Cognitive and behavior therapies can also be combines, resulting in cognitive behavior therapy (CBT). Albert Ellis’s early version of cognitive behavior therapy, called rational-emotive behavior therapy (REBT), requires that clients learn to recognize and challenge the irrational beliefs that are at the core of their maladaptive thinking patterns.

15.3.2 Describe the main elements of humanistic therapies

Humanistic therapies are insight-oriented therapies that are focused on helping clients to gain a deeper understanding of their thoughts, emotions, and behaviors.

15.3.3 Describe three humanistic therapies

Client-centered (or person-centered) therapy is non-directive, based on insights gained from conscious thoughts and feelings, and dedicated to creating an atmosphere of growth. Unconditional positive regard, empathy, authenticity, and reflection are combined to give the client a chance to solve his or her own problems. Existential therapies focus on the end result of the choices one makes in life. Clients are encouraged through confrontation and encounter to exercise free will and to take responsibility for their choices. Gestalt therapy emphasizes immediate awareness of thoughts and feelings. Its goal is to rebuild thinking, feeling, and acting into connected wholes and to help clients break through emotional blockages.

15.4 Medical Therapies

15.4.1 Name three medical therapies

Three medical, or somatic, approaches to treatment are pharmacotherapy (that is, the use of drugs), brain stimulation therapy (including electroconvulsive therapy [ECT}), and psychosurgery.

15.4.2 Explain how hospitalization and community mental health programs can be used to support medical therapies

Hospitalization, including partial hospitalization, involves placing a person in a protected setting where medical therapy is provided. Community mental health centers seek to avoid or minimize hospitalization. They also seek to prevent mental health problems through education, consultation, and crisis intervention.

15.5 Psychology and Your Skill Set: Managing Mental Health Issues

15.5.1 Create a plan that will allow you to provide effective help to someone who is experiencing mental health issues

There are many things that you can do to help when listening to someone else describe their mental health issues. These include: being an active listener, reflecting the person’s thoughts and feelings, welcoming silence, asking open-ended questions clarifying problems, focusing on feelings, avoiding advice, accepting their frame of reference, and maintaining their confidence.

15.5.2 Create a plan that will allow you to find help if you are experiencing mental health issues

There are many places to find counselors, including university and community health centers, family doctors, crisis hotlines, and the Yellow Pages. There are various types of counseling options, including psychologists, psychiatrists, peer counselors, and self-help groups. Practical considerations such as cost and qualifications enter into choosing a therapy. However, the therapist’s personal characteristic are of equal importance.