Chapter 15

psychological therapies

psychology
fourth edition
Psychology, Fourth Edition Copyright ©2015, 2012, 2008 by Pearson Education, Inc.
Saundra K. Ciccarelli • J. Noland White All rights reserved.
 Treatment in the Past

• Mentally ill people began to be confined to

institutions called asylums in the mid-
1500s
• Treatments were harsh and often
damaging
• Philippe Pinel became famous for
demanding that the mentally ill be treated
with kindness, personally unlocking the
chains of inmates in France
 Therapy

• Therapy: treatment methods aimed at

making people feel better and function
more effectively
• Two broad categories:
– one based primarily in psychological theory
and techniques
– the other uses medical intervention to bring
symptoms under control
 Therapy

• Psychotherapy: therapy for mental

disorders in which a person with a problem
talks with a psychological professional
– insight therapies: psychotherapies in which
the main goal is helping people to gain insight
with respect to their behavior, thoughts, and
feelings
– action therapy: psychotherapy in which the
main goal is to change disordered or
inappropriate behavior directly
 Therapy

• Biomedical therapy: therapy for mental

disorders in which a person with a problem
is treated with biological or medical
methods to relieve symptoms
• Biomedical therapies are physical or medical treatments
such as drug therapy, electroconvulsive therapy
(electroshock), or surgery (i.e lobotomy) that are used to
treat mental or psychological disorders. Modern health
treatment contains many examples of drug therapies;
antidepressants, mood stabilizers, antipsychotics, etc.
 Freud’s Psychoanalysis

• Psychoanalysis: insight therapy based on

the theory of Freud, emphasizing the
revealing of unconscious conflicts
– dream interpretation
 manifest content: the actual content of one’s
dream
 latent content: the symbolic or hidden meaning of
dreams
 Freud’s Psychoanalysis
• Psychoanalysis (cont’d)
– free association: Freudian technique in which a
patient is encouraged to talk about anything that
comes to mind without fear of negative evaluations
– resistance: occurs when a patient becomes reluctant
to talk about a certain topic, either changing the
subject or becoming silent
– transference: the tendency for a patient or client to
project positive or negative feelings for important
people from the past onto the therapist
 Psychoanalysis Today

• Directive: actively giving interpretations of

a client’s statements in therapy, even
suggesting certain behavior or actions
– psychoanalysis today is generally directive
• Psychodynamic therapy: a newer and
more general term for therapies based on
psychoanalysis, with an emphasis on
transference, shorter treatment times, and
a more direct therapeutic approach
 Psychoanalysis Today
Interpersonal therapy (IPT): form of therapy for
depression which incorporates multiple approaches
and focuses on interpersonal problems
 Gestalt Therapy
• Gestalt therapy: form of directive insight therapy in which
the therapist helps clients accept all parts of their
feelings and subjective experiences, using leading
questions and planned experiences such as role-playing
• Gestalt therapy is an existential/experiential form
of psychotherapy that emphasizes personal
responsibility, and that focuses upon the
individual's experience in the present moment,
the therapist–client relationship, the
environmental and social contexts of a person's
life, and the self-regulating adjustments people
make as a result of their overall situation....
Rogers’s Person-Centered Therapy

• Person-centered therapy: a nondirective

insight therapy in which the client does all
the talking and the therapist listens
– based on the work of Carl Rogers
– nondirective: therapeutic style in which the
therapist remains relatively neutral and does
not interpret or take direct actions with regard
to the client, instead remaining a calm,
nonjudgmental listener while the client talks
Rogers’s Person-Centered Therapy

• Four elements:
1. authenticity: the genuine, open, and honest
response of the therapist to the client
2. unconditional positive regard: the warmth,
respect, and accepting atmosphere created by the
therapist for the client in person-centered therapy
3. empathy: the ability of the therapist to understand
the feelings of the client
4. reflection: the therapist restates what the client says
rather than interpreting those statements
Rogers’s Person-Centered Therapy

• Motivational interviewing (MI)

– In contrast to client-centered therapy, MI has
specific goals: namely, to reduce ambivalence
about change and to increase intrinsic
motivation to bring that change about
Today’s View of Humanistic Therapy
• Humanistic therapies are not based in
experimental research and work best with
intelligent, highly verbal persons
Behavioral Therapy and Classical Conditioning

• Behavior therapies: action therapies based

on the principles of classical and operant
conditioning and aimed at changing
disordered behavior without concern for
the original causes of such behavior
Behavioral Therapy and Classical Conditioning

• Behavior modification or applied behavior

analysis: use of learning techniques to
modify or change undesirable behavior
and increase desirable behavior
Behavioral Therapy and Classical Conditioning

• Systematic desensitization: behavioral

technique used to treat phobias, in which a
client is asked to make a list of ordered
fears and taught to relax while
concentrating on those fears
– counterconditioning: replacing an old
conditioned response with a new one by
changing the unconditioned stimulus
Behavioral Therapy and Classical Conditioning

• Aversion therapy: form of behavioral

therapy in which an undesirable behavior
is paired with an aversive stimulus to
reduce the frequency of the behavior
Behavioral Therapy and Classical Conditioning

• Exposure therapy: behavioral techniques

that introduce the client to situations
(under carefully controlled conditions) that
are related to their anxieties or fears
– flooding: technique for treating phobias and
other stress disorders in which the person is
rapidly and intensely exposed to the fear-
provoking situation or object and prevented
from making the usual avoidance or escape
response
Behavioral Therapy and Classical Conditioning
• Exposure therapy (cont’d)
– eye-movement desensitization reprocessing
(EMDR): controversial therapy for
posttraumatic stress disorder and similar
anxiety problems in which the client is
directed to move the eyes rapidly back and
forth while thinking of a disturbing memory
 needs more controlled studies
Behavioral Therapy and Operant Conditioning

• Modeling: learning through the observation

and imitation of others
– participant modeling: technique in which a
model demonstrates the desired behavior in a
step-by-step, gradual process while the client
is encouraged to imitate the model
Behavioral Therapy and Operant Conditioning

• Reinforcement: the strengthening of a

response by following it with a pleasurable
consequence or the removal of an
unpleasant stimulus
–token economy: the use of objects called
tokens to reinforce behavior in which the
tokens can be accumulated and exchanged
for desired items or privileges
Behavioral Therapy and Operant Conditioning

• Reinforcement (cont’d)
–contingency contract: a formal, written
agreement between the therapist and client
(or teacher and student) in which goals for
behavioral change, reinforcements, and
penalties are clearly stated
Behavioral Therapy and Operant Conditioning

• Extinction: the removal of a reinforcer to

reduce the frequency of a behavior
– time-out: an extinction process in which a
person (usually a child) is removed from the
situation that provides reinforcement for
undesirable behavior, usually by being placed
in a quiet corner or room away from possible
attention and reinforcement opportunities
Effectiveness of Behavioral Therapy

• Behavior therapies can be effective in

treating specific problems, such as
bedwetting, drug addictions, and phobias
• Behavior therapies can also help improve
some of the more troubling behavioral
symptoms associated with more severe
disorders
 Cognitive Therapy

• Cognitive therapy: therapy in which the

focus is on helping clients recognize
distortions in their thinking and replace
distorted, unrealistic beliefs with more
realistic, helpful thoughts
 Cognitive Therapy

• Cognitive distortions:
– arbitrary inference: drawing a conclusion
without any evidence
– selective thinking: focusing on only one
aspect of a situation while ignoring all other
relevant aspects
– overgeneralization: drawing sweeping
conclusions based on only one incident or
event and applying those conclusions to
events that are unrelated to the original
 Cognitive Therapy
LO 15.5 Goals of Cognitive Therapies

• Cognitive distortions (cont’d):

– magnification and minimization: blowing a
negative event out of proportion
(magnification) while ignoring relevant positive
events (minimization)
– personalization: taking responsibility or blame
for events that are unconnected to the person
Cognitive-Behavioral Therapies

• Cognitive-behavioral therapy (CBT):

action therapy in which the goal is to
help clients overcome problems by
learning to think more rationally and
logically
Cognitive-Behavioral Therapies

• Three goals:
1. Relieve the symptoms and solve the
problems.
2. Help develop strategies for solving future
problems.
3. Help change irrational, distorted thinking.
 Rational Emotive Therapy

• Rational emotive behavior therapy

(REBT): cognitive-behavioral therapy in
which clients are directly challenged in
their irrational beliefs and helped to
restructure their thinking into more rational
belief statements
 Success of CBT

• CBT has seemed successful in treating

depression, stress disorders, and anxiety.
• CBT has been criticized for focusing on
the symptoms, not the causes, of
disordered behavior.
 Types of Group Therapy

• Family counseling (family therapy): family

members meet together with a counselor
or therapist to resolve problems that affect
the entire family
 Types of Group Therapy

• Self-help group (support group): a group

composed of people who have similar
problems and who meet together without a
therapist or counselor for the purpose of
discussion, problem solving, and social
and emotional support
When Is Group Therapy Useful?

• Group therapy is most useful to persons

who:
– cannot afford individual therapy
– may obtain a great deal of social and
emotional support from other group members
 Group Therapy

• Advantages:
– low cost
– exposure to other people with similar
problems; social interaction with others
– social and emotional support from people with
similar disorders or problems
 Group Therapy

• Disadvantages:
– need to share the therapist’s time with others
in the group
– lack of a private setting in which to reveal
concerns
– inability of people with severe disorders to
tolerate being in a group
Effectiveness of Psychotherapy

• Psychotherapy is more effective than no

treatment at all
• Between 75 and 90 percent of people who
receive therapy feel it has helped them
– the longer a person stays in therapy, the
greater the improvement
– psychotherapy works as well alone as with
drugs
Effectiveness of Psychotherapy

• Some types of psychotherapy are more

effective for certain types of problems, and
no one psychotherapy method is effective
for all problems
– effective therapy should be matched to the
particular client and the particular problem
 Effectiveness of Psychotherapy
• Eclectic therapies: therapy style that results
from combining elements of several different
therapy techniques
• Common factors approach: modern
approach to eclecticism focusing on factors
seen as the source of success
Common Factors refers to aspects of psychotherapy that are
present in most, if not all, approaches to therapy. These
characteristics of treatment occur across all theoretical lines
and are present in all psychotherapeutic activities, resulting in
the name Common Factors.
Effectiveness of Psychotherapy
LO 15.7 The Effectiveness of Psychotherapy

• Common factors approach

– therapeutic alliance: the relationship between
therapist and client that develops as a warm,
caring, accepting relationship characterized
by empathy, mutual respect, and
understanding
– protected setting
– learning and practice of new behaviors
– positive experiences for the client
 Effectiveness of Psychotherapy
LO 15.7 The Effectiveness of Psychotherapy

• Evidence-based treatment (EBT) refers to

techniques or interventions that have
produced desired outcomes, or
therapeutic change in controlled studies
 Culture and Psychotherapy
• When the cultures, ethnic groups, or genders of
the therapist and the client differs,
misunderstandings and misinterpretations can
occur.
• Four barriers to effective psychotherapy exist
when culture the backgrounds of client and
therapist differ
1. culture-bound values
2. class-bound values
3. language
4. nonverbal communication
 Cybertherapy

• Cybertherapy: psychotherapy that is

offered on the Internet
– also called online, Internet, or Web therapy or
counseling
– offers the advantages of anonymity and
therapy for people who cannot otherwise get
to a therapist
 Drug Treatments

• Biomedical therapies: therapies that

directly affect the biological functioning of
the body and brain
 Drug Treatments

• Psychopharmacology: the use of drugs to

control or relieve the symptoms of
psychological disorders
– antipsychotic drugs: used to treat psychotic
symptoms such as delusions, hallucinations,
and other bizarre behavior
– antianxiety drugs: used to treat and calm
anxiety reactions
 typically minor tranquilizers
 Drug Treatments

• Psychopharmacology (cont’d)
– mood-stabilizing drugs: used to treat bipolar
disorder
 include lithium and certain anticonvulsant drugs
– antidepressant drugs: used to treat
depression and anxiety
– The SSRIs (selective serotonin reuptake inhibitors) are the most
commonly prescribed class of antidepressants. They act on a
chemical in the brain called serotonin. The SSRIs include drugs
such as Prozac, Zoloft, and Paxil. SSRIs are not atypical
antidepressants. Wellbutrin is.
 Electroconvulsive Therapy

• Electroconvulsive therapy (ECT):

biomedical treatment in which electrodes
are placed on either one or both sides of a
person’s head and an electric current
strong enough to cause a seizure or
convulsion is passed through the
electrodes
– still used to treat severe depression
 Psychosurgery

• Psychosurgery: surgery performed on

brain tissue to relieve or control severe
psychological disorders
– prefrontal lobotomy: the connections of
the prefrontal lobes of the brain to the
rear portions are severed
 Psychosurgery

• Psychosurgery (cont’d)
– Bilateral anterior cingulotomy: an electrode
wire is inserted into the anterior cingulated
gyrus area of the brain for the purpose of
destroying that area of brain tissue with an
electric current
 electrode is inserted with the guidance of a
magnetic resonance imaging (MRI) machine
 Psychosurgery
LO 15.9 Electroconvulsive Therapy and Psychosurgery

• Emerging techniques
– repetitive transcranial magnetic stimulation
(rTMS): magnetic pulses are applied to the
cortex
– transcranial direct current stimulation (tDCS):
uses scalp electrodes to pass very low
amplitude direct currents to the brain
 Virtual Reality – exposure therapy

• Virtual reality is a software-generated

three-dimensional simulated environment
with can be used in the treatment of PTSD
– like playing a video game - Virtual reality (VR)
integrates real-time computer graphics, body-
tracking devices, visual displays, and other
sensory input devices to immerse a
participant in a computer-generated virtual
environment that changes in a natural way
with head and body motion.
psychology
fourth edition
Psychology, Fourth Edition Copyright ©2015, 2012, 2008 by Pearson Education, Inc.
Saundra K. Ciccarelli • J. Noland White All rights reserved.