C hapter Fifteen Therapy © 2012 John Wiley & Sons, Inc. All rights reserved.

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Chapter FifteenTherapy

Psychotherapy

Techniques employed to improve psychological functioning and promote adjustment to life

Myths About Therapy

• There is one best therapy• Therapists can read your mind• People who go to therapists are crazy or weak• Only the rich can afford therapy• If I am taking meds, I don’t need therapy

Major Approaches to Therapy

ANIMATIONCognitive Behavior Therapy

INSIGHT THERAPIES

Insight Therapies

DefinitionVariety of therapies seeking to

improve psychological functioning by increasing awareness of underlying motives and improvement in thoughts, feelings, and/or behavior

Types• Psychoanalysis/Psychodyna-

mic therapies• Cognitive therapy• Humanistic therapy• Group, family, and marital

therapies

Psychoanalysis

Freudian therapy designed to bring unconscious conflicts into conscious awareness

Psychoanalysis

Major Criticisms Limited applicabilityLack of scientific

credibility

Modern Psychodynamic Therapy

A briefer, more directive, and more modern form of psychoanalysis focusing more on conscious processes and current problems

Cognitive Therapies

Cognitive TherapyTherapy that treats problem behaviors and

mental processes by focusing on faulty thought processes and beliefs

Self-TalkInternal dialogue; the things people say to

themselves when they interpret events

Cognitive Therapies

Cognitive RestructuringProcess in cognitive therapy to change

destructive thoughts or inappropriate interpretations

Cognitive-Behavior TherapyCombines cognitive therapy (changing faulty

thinking) with behavior therapy (changing faulty behaviors)

Cognitive Restructuring

Rational-Emotive Behavior Therapy (REBT)

Cognitive therapy to eliminate emotional problems through rational examination of irrational beliefs (e.g. “musts” and “shoulds”)

Albert Ellis

Overcoming Irrational Misconceptions1. Identify and confront your belief system2. Evaluate consequences3. Practice effective ways of thinking and

behaving

Beck’s Cognitive Therapy

Distorted Thinking Patterns1. Selective perception—focus on negative events2. Overgeneralization 3. Magnification—exaggerating undesirables and

shortcomings4. All-or-nothing thinking—seeing things in black or

Recognize and track thoughts, then test these thoughts against reality ANIMATION

Cognitive Behavior Therapy

Evaluating Cognitive Therapies

Highly effective for:• Depression• Anxiety disorders• Bulimia nervosa• Anger management• Addiction• Procrastination• Some forms of

schizophrenia• Insomnia

Criticisms • Ignoring unconscious

processes• Overemphasis on rationality• Minimizing the importance

of the past• Uses behavior techniques

rather than changing cognitive structure

Humanistic Therapies

Therapy that focuses on removing obstacles that block personal growth and potential

Client-Centered TherapyRogers’s therapy emphasizing theclient’s natural tendency tobecome healthy and productive.Clients (not “patients”) are in charge.

Client-Centered Therapy

Therapeutic Qualities of Communication1. Empathy—insightful awareness and ability to

share another’s inner experience2. Unconditional Positive Regard—love and

acceptance with no contingencies3. Genuineness/Authenticity4. Active Listening—involves reflecting,

paraphrasing, and clarifying

Evaluating Humanistic Therapies

Support• Evidence for efficacy of

client-centered therapy

Criticisms• Core concepts are difficult

to empirically test• Data on outcomes rely on

self-reports of clients• Mixed results on specific

therapeutic techniques

Group, Family, and Marital Therapies

Group TherapyA number of people meet together to work

toward therapeutic goals; guided by a therapist

Self-Help GroupLeaderless or nonprofessionally guided groups in

which members assist one another with a specific problem

Group Therapy

Advantages1. Less expense2. Group support3. Insight and information4. Behavior rehearsal

Can supplement individual therapy

Family and Marital Therapies

Goal is to change maladaptive family interaction patterns

Most useful for treatment of marital infidelity, anger management, adolescent drug abuse, schizophrenia

Informal “Counseling” Skills

• Active listening• Acceptance• Avoid advice

BEHAVIOR THERAPIES

Behavior Therapies

Group of techniques based on learning principles used to change maladaptive behaviors

Focus on problem behavior rather than underlying causes

• Classical conditioning• Operant conditioning• Observational learning ANIMATION

Classical Conditioning

Systematic DesensitizationGradual process of extinguishing a learned fear

(phobia) by working through a hierarchy of fear-evoking stimuli while staying deeply relaxed; replace anxiety with relaxation

Aversion TherapyPairing an aversive (unpleasant) stimulus with a

maladaptive behavior; learn negative associations

Systematic Desensitization

Aversion Therapy

Operant Conditioning

• Increase desired behaviors through reinforcement and shaping; may use tokens

• May use some punishment and extinction to eliminate undesired behavior

• Role playing/behavior rehearsal

WILEY VIDEOExercise and Depression

Observational Learning

Modeling therapy—watching and imitating models that demonstrate desirable behaviors

Useful for treatingphobias andtraining in socialskills andassertiveness

Evaluating Behavior Therapies

Support for use in• Phobias• Obsessive-compulsive

disorder• Eating disorders• Autism• Intellectual disabilities• Delinquency

Criticisms• Generalizability—to the

“real world” outside of therapy

• Ethics—related to control

BIOMEDICAL THERAPIES

Biomedical Therapies

Using biological interventions to treat psychological disorders

• Drugs• Electroconvulsive therapy• PsychosurgeryBased on the premise that chemical imbalances

or disturbed nervous system function are involved in mental health problems

WILEY VIDEOImaging

Antidepressant Accuracy

WILEY VIDEOBuzzedBrain

Psychopharmacology

Study of drug effects on brain and behaviorFour major categories:• Antianxiety• Antipsychotic• Mood stabilizer• Antidepressant

WILEY VIDEOPlacebo

Effect

WILEY VIDEOBrain

Viagra

Drug Treatments

WILEY VIDEOPost-Trauma

Drug Treatments

WILEY VIDEOAntidepressant Suicide Genes

Electroconvulsive Therapy (ECT)

Biomedical therapy based on passing electrical current through the brain

Used almost exclusively to treat serious depression when drug therapy fails

Likely affects moodcontrolling neurotransmitters

Psychosurgery

Surgical alteration of the brain to bring about desirable behavioral, cognitive, or emotional changes

Generally used when patients have not responded to other forms of treatment

Lobotomy—outmoded medical procedure for mental disorders that involved cutting nerve pathways between the frontal lobes and the thalamus and hypothalamus

Evaluating Biomedical Therapies

PsychopharmacologyMay provide relief but not a curePhysical dependenceSide and long-term effectsTardivedyskinesia—movement disorder

involving facial muscles, tongue, and limbs; possible side effect of long-term use of antipsychotic medications

Overuse

Evaluating Biomedical Therapies

ECT and PsychosurgeryECT is controversial; seizures, memory lossRepetitive Transcranial Magnetic Stimulation

(rTMS) may replace ECTPsychosurgery is controversial, with potentially

serious or fatal side effects and complications

THERAPY ESSENTIALS

Common Goals of Therapy

Eclectic Approach

Combining techniques from various theories to find the most appropriate treatment

Mental Health Professionals

Institutionalization

Involuntary CommitmentGenerally can occur if people are believed to be:• of danger to themselves or others• in serious need of treatmentor if there is no reasonable, less restrictive alternativeDeinstitutionalizationDischarging patients from mental hospitals as

soon as possible and discouraging admissions

Evaluating Therapy

Controlled research and meta-analyses40 to 80% of those who receive treatment are

better off than those who do notShort-term treatments can be as effective as

long-term treatmentsCombination of therapy with medication is more

effective than drugs aloneSome therapies more effective for specific

problems

Finding Therapy

Critical/Urgent NeedHospital emergency servicesHotlinesHave time to searchAsk for referralsUniversity/college counseling centerSeek therapist best suited to your goals

Culture and Therapy

Similarities• Naming the problem• Qualities of the therapist• Therapist credibility• Familiar framework• Techniques that bring relief• Special time and place

Differences• Emphasis on self or

interdependence• Types of therapies• Perceptions of the therapist

Gender and Therapy

Unique concernsRates of diagnosis and treatment of mental

disordersStresses of povertyStresses of agingViolence against womenStresses of multiple roles

WILEY VIDEOSmoking,

Stress, and Gender

C hapter Fifteen Therapy © 2012 John Wiley & Sons, Inc. All rights reserved.

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