Therapies - Concepts & Theories

Question 1

What is psychotherapy?

Answer 1

A systematic interaction between a therapist and a client that brings psychological principles to bear on influencing the client’s thoughts, feelings, and/or behavior to help that client overcome psychological disorders, adjust to problems in living, or develop as an individual.

Question 2

Asylums

Answer 2

An institution for the care of the mentally ill.

-originated in European monasteries. They were the first institutions meant primarily for people with psychological disorders. But their function was warehousing, not treatment. As their inmate populations mushroomed, the stresses created by noise, overcrowding, and disease aggravated the problems they were meant to ease. Inmates were frequently chained and beaten.

Question 3

Mental hospitals

Answer 3

In the United States, mental hospitals gradually replaced asylums. In the mid-1950s, more than a million people resided in state, county, Veterans Administration, or private facilities. (The number has dropped to about 200,000 today.) The mental hospital’s function is treatment, not warehousing. Still, because of high patient populations and understaffing, many patients receive little attention even today. Despite somewhat improved conditions, one psychiatrist may be responsible for the welfare of several hundred residents on a weekend when other staff members are absent.

Question 4

Community Health Movement

Answer 4

Since the 1960s, efforts have been made to maintain people with serious psychological disorders in their communities. Community mental health centers attempt to maintain new patients as outpatients and to serve patients who have been released from mental hospitals. Today, most people with chronic psychological disorders live in the community, not the hospital. Social critics note that many people who had resided in hospitals for decades were suddenly discharged to “home” communities that seemed foreign and forbidding to them. Many do not receive adequate follow-up care. Many join the ranks of the homeless.

Question 5

Psychodynamic Therapy

Answer 5

A type of psychotherapy that is based on Freud’s thinking and that assumes that psychological problems reflect early childhood experiences and internal conflicts.

Question 6

What is Psychodynamic Therapy based on?

Answer 6

The thinking of Sigmund Freud, the founder of psychodynamic theory. Such therapies assume that psychological problems reflect early childhood experiences and internal conflicts. According to Freud, these conflicts involve the shifting of psychic, or libidinal, energy among the three psychic structures—the id, ego, and superego. These shifts of psychic energy determine our behavior. When primitive urges threaten to break through from the id or when the superego floods us with excessive guilt, defenses are established to protect us from these feelings; yet they are not completely eliminated, so we may experience some distress. Freud’s psychodynamic therapy method—psychoanalysis—aims to modify the flow of energy among these structures, largely to bulwark the ego against the torrents of energy loosened by the id and the superego. With impulses and feelings of guilt and shame placed under greater control, clients are freer to develop adaptive behavior.

Question 7

Ego Analyst

Answer 7

A psychodynamically oriented therapist who focuses on the conscious, coping behavior of the ego instead of the hypothesized, unconscious functioning of the id.

Question 8

What are the essentials of Psychotherapy?

Answer 8

1. Systematic interaction: Psychotherapy is a systematic interaction between a client and a therapist. The therapist’s theoretical point of view interacts with the client’s to determine how the therapist and client relate to each other.
2. Psychological principles: Psychotherapy is based on psychological theory and research in areas such as personality, learning, motivation, and emotion.
3. Thoughts, feelings, and behavior: Psychotherapy influences clients’ thoughts, feelings, and behavior. It can be aimed at any or all of these aspects of human psychology.
4. Psychological disorders, adjustment problems, and personal growth: Psychotherapy is often used with people who have psychological disorders. Other people seek help for problems such as shyness, overeating, and adjusting to loss of a life partner. Still other clients want to learn more about themselves and to reach their full potential as individuals, parents, or creative artists.

Question 9

Psychoanalysis

Answer 9

Is the clinical method devised by Freud for plucking “from the memory a rooted sorrow,” for razing “out the written troubles of the brain.” It aims to provide insight into the conflicts that are presumed to lie at the roots of a person’s problems. Insight means many things, including knowledge of the experiences that lead to conflicts and maladaptive behavior, recognition of unconscious feelings and conflicts, and conscious evaluation of one’s thoughts, feelings, and behavior.

Question 10

Psychoanalysis

-Free Association (in depth)

Answer 10

Freud used free association to break through the walls of defense that block a client’s insight into unconscious processes. In free association, the client is made comfortable—for example, by lying on a couch—and asked to talk about any topic that comes to mind. No thought is to be censored—that is the basic rule. Psychoanalysts ask their clients to wander “freely” from topic to topic, but they do not believe that the process occurring within the client is fully free. Repressed impulses clamor for release.

Question 11

Psychoanalysis

-Free Association (basic definition)

Answer 11

In psychoanalysis, the uncensored uttering of all thoughts that come to mind.

Question 12

Psychoanalysis

-Resistance (in depth)

Answer 12

The ego persists in trying to repress unacceptable impulses and threatening conflicts. As a result, clients might show resistance to recalling and discussing threatening ideas. A client about to entertain such thoughts might claim, “My mind is blank.” The client might accuse the analyst of being demanding or inconsiderate. He might “forget” the next appointment when threatening material is about to surface.

Question 13

Psychoanalysis

-Resistance (basic definition)

Answer 13

The tendency to block the free expression of impulses and primitive ideas—a reflection of the defense mechanism of repression.

Question 14

Psychoanalysis

-Interpretation (in depth)

Answer 14

The therapist observes the dynamic struggle between the client’s compulsion to utter certain thoughts and, at the same time, her resistance to uttering them. Through discreet remarks, the analyst tips the balance in favor of utterance. A gradual process of self-discovery and self-insight ensues. Now and then, the analyst offers an interpretation of an utterance, showing how it suggests resistance or deep-seated feelings and conflicts.

Question 15

Psychoanalysis

-Interpretation (basic definition)

Answer 15

In psychoanalysis, an explanation of a client’s utterance according to psychoanalytic theory.

Question 16

Psychoanalysis

-Transference (in depth)

Answer 16

Freud believed that clients not only responded to him as an individual but also in ways that reflected their attitudes and feelings toward other people in their lives. He labeled this process transference. For example, a young woman client might respond to Freud as a father figure and displace her feelings toward her father onto Freud, perhaps seeking affection and wisdom.

Question 17

Psychoanalysis

-Transference (basic definition)

Answer 17

Responding to one person (such as a spouse or the psychoanalyst) in a way that is similar to the way one responded to another person (such as a parent) in childhood.

Question 18

Client Centered Therapy (basic definition)

Answer 18

Carl Rogers’s method of psychotherapy, which emphasizes the creation of a warm, therapeutic atmosphere that frees clients to engage in self-exploration and self-expression.

Question 19

Client Centered Therapy (in depth)

Answer 19

Carl Rogers (1902–1987) believed that we are free to make choices and control our destinies despite the burdens of the past. He also believed that we have natural tendencies toward health, growth, and fulfillment. Psychological problems arise from roadblocks placed in the path of self-actualization, which Rogers believed was an inborn tendency to strive to realize one’s potential. If, when we are young, other people approve of us only when we are doing what they want us to do, we may learn to disown the parts of ourselves to which they object. As a result, we may experience stress and discomfort and the feeling that we—or the world—are not real. Client-centered therapy aims to provide insight into the parts of us that we have disowned so that we can feel whole. It creates a warm, therapeutic atmosphere that encourages self-exploration and self-expression. The therapist’s acceptance of the client is thought to foster self-acceptance and self-esteem. Self-acceptance frees the client to make choices that develop his or her unique potential.

Question 20

Client Centered Therapy

-Empathy

Answer 20

In client-centered therapy, the ability to perceive a client’s feelings from the client’s frame of reference. Recognition of the client’s experiences and feelings. Therapists view the world through the client’s frame of reference by setting aside their own values and listening closely.

Question 21

Client Centered Therapy

-Genuineness

Answer 21

In client-centered therapy, openness and honesty in responding to the client. Openness and honesty in responding to the client. Client-centered therapists must be able to tolerate differentness, based on the belief that every client is different in important ways.

Question 22

Client Centered Therapy

-Active Listening

Answer 22

Is a communication technique that requires the listener to feed back what they hear to the speaker, by way of re-stating or paraphrasing what they have heard in their own words, to confirm what they have heard and moreover, to confirm the understanding of both parties.

Question 23

Behavior Therapy (in depth)

Answer 23

Also called behavior modification—applies principles of learning to directly promote desired behavioral changes. Behavior therapists rely heavily on principles of conditioning and observational learning. They help clients discontinue self-defeating behavior patterns such as overeating, smoking, and phobic avoidance of harmless stimuli. They also help clients acquire adaptive behavior patterns such as the social skills required to start social relationships or to say no to insistent salespeople.

Question 24

Behavior Therapy (basic definition)

Answer 24

Systematic application of the principles of learning to the direct modification of a client’s problem behaviors.

Question 25

Behavior Therapy

-Flooding

Answer 25

Flooding is a kind of exposure therapy in which the client is exposed to the fear-evoking stimulus until the fear response is extinguished. The rationale is that the fear-evoking stimulus is not causing pain or harm. Therefore, perception of the stimulus is not being associated with physically aversive stimulation and will fade with time. Examples include exposing a person to an actual spider or snake (a harmless snake!) or preventing a person with obsessive–compulsive disorder from washing her hands.

Question 26

Behavior Therapy

-Systematic Desensitization (in depth)

Answer 26

A method for reducing phobic responses originated by psychiatrist Joseph Wolpe (1915–1997). Systematic desensitization is a gradual process in which the client learns to handle increasingly disturbing stimuli while anxiety to each one is being counterconditioned. About 10 to 20 stimuli are arranged in a sequence, or hierarchy, according to their capacity to elicit anxiety. In imagination or by being shown photos, the client travels gradually up through this hierarchy, approaching the target behavior. In Adam’s case, the target behavior was the ability to receive an injection without undue anxiety.

Question 27

Behavior Therapy

-Systematic Desensitization (basic definition)

Answer 27

Wolpe’s method for reducing fears by associating a hierarchy of images of fear-evoking stimuli with deep muscle relaxation.

Question 28

Behavior Therapy

-Aversive Conditioning (in depth)

Answer 28

Aversive conditioning has been used with problems as diverse as cigarette smoking and sexual abuse. Rapid smoking is an aversive-conditioning method designed to help smokers quit. With this method, the would-be quitter inhales every 6 seconds. In another method, the hose of a hair dryer is hooked up to a chamber containing several lit cigarettes. Smoke is blown into the quitter’s face as he or she also smokes a cigarette. A third method uses branching pipes so that the smoker draws in smoke from several cigarettes at the same time. With these methods, overexposure makes once-desirable cigarette smoke aversive. The quitter becomes motivated to avoid, rather than seek, cigarettes.

Question 29

Behavior Therapy

-Aversive Conditioning (basic)

Answer 29

A behavior-therapy technique in which undesired responses are inhibited by pairing repugnant or offensive stimuli with them.

Question 30

Cognitive Therapy (in depth)

Answer 30

focuses on changing the beliefs, attitudes, and automatic types of thinking that create and compound their clients’ problems. Cognitive therapists, like psychodynamic and humanistic therapists, attempt to foster self-insight, but they aim to heighten insight into current cognitions as well as those of the past. Cognitive therapists also aim to directly change maladaptive cognitions to reduce negative feelings, provide insight, and help the client solve problems. Let’s look at the approaches and methods of some major cognitive therapists. Cognitive therapists aim to directly change maladaptive cognitions to reduce negative feelings, provide insight, and help the client solve problems. They may frankly challenge clients’ ways of looking at their lives and problems.

Question 31

Cognitive Therapy (basic definition)

Answer 31

A form of therapy that focuses on how clients’ cognitions (expectations, attitudes, beliefs, etc.) lead to distress and may be modified to relieve distress and promote adaptive behavior.

Question 32

Cognitive Therapy

-Beck

Answer 32

Beck focuses on clients’ cognitive distortions (see Butler et al., 2006). He encourages clients to become their own personal scientists and challenge beliefs that are not supported by evidence. Beck’s approach to therapy is active. He questions people in a way that encourages them to see the irrationality of their ways of thinking. For example, depressed people tend to minimize their accomplishments and to assume that the worst will happen. Both cognitive distortions heighten feelings of depression. Such distortions can be fleeting and automatic, difficult to detect (Walker & Bright, 2009). Beck’s therapy methods help clients become aware of these distortions and challenge them.

Question 33

Cognitive Therapy

-Beck notes how cognitive distortions or errors contribute to clients’ miseries:

Answer 33

1. Clients may selectively perceive the world as a harmful place and ignore evidence to the contrary.
2. Clients may overgeneralize on the basis of a few examples. For instance, they may perceive themselves as worthless because they were laid off at work or as unattractive because they were refused a date.
3. Clients may magnify, or blow out of proportion, the importance of negative events. They may catastrophize failing a test by assuming they will flunk out of college or catastrophize losing a job by believing that they will never find another and that serious harm will befall their family as a result.
4. Clients may engage in absolutist thinking, or looking at the world in black and white rather than in shades of gray. In doing so, a rejection on a date takes on the meaning of a lifetime of loneliness; an uncomfortable illness takes on life-threatening proportions.

Question 34

Cognitive Therapy

-Albert Ellis/ REBT (in depth)

Answer 34

Psychologist Albert Ellis (1913–2007) was originally trained in psychoanalysis but became frustrated with the slow rate of progress made by clients. He also found himself uncomfortable with the psychoanalyst’s laid-back approach. Instead, he took to confronting clients with the ways that their irrational beliefs—especially those that give rise to excessive needs for social approval and perfect performance—make them miserable. In rational-emotive behavior therapy (REBT), Ellis pointed out that our beliefs about events, not only the events themselves, shape our responses to them. Moreover, many of us harbor a number of irrational beliefs that can give rise to problems or magnify their impact. Two of the most important are the belief that we must have the love and approval of people who are important to us and the belief that we must prove ourselves to be thoroughly competent, adequate, and achieving.

Question 35

Cognitive Therapy

-Albert Ellis/ REBT (basic definition)

Answer 35

Albert Ellis’s form of therapy that encourages clients to challenge and correct irrational beliefs and maladaptive behaviors.

Question 36

Cognitive-Behavioral

Answer 36

Many theorists consider cognitive therapy to be a collection of techniques that are part of the overall approach known as behavior therapy. Some members of this group use the term “cognitive-behavioral therapy.” Others argue that the term behavior therapy is broad enough to include cognitive techniques. Many cognitive therapists and behavior therapists differ in focus, however. Behavior therapists deal with client cognitions to change overt behavior. Cognitive therapists also see the value of tying treatment outcomes to observable behavior, but they believe that cognitive change, not just behavioral change, is a key goal in itself. Cognitive-behavioral therapy has been effective in treating a wide range of psychological disorders, including anxiety disorders, depression, and personality disorders. It has been used to help individuals with anorexia and bulimia challenge their perfectionism and their attitudes toward their bodies. It has also been used to systematically reinforce appropriate eating behavior.

Question 37

Group Therapy

Answer 37

When a psychotherapist has several clients with similar problems—anxiety, depression, adjustment to divorce, lack of social skills—it often makes sense to treat them in a group rather than in individual sessions. The methods and characteristics of the group reflect the needs of the members and the theoretical orientation of the leader. In group psychoanalysis, clients might interpret one another’s dreams. In a client-centered group, they might provide an accepting atmosphere for self-exploration. Members of behavior therapy groups might be jointly desensitized to anxiety-evoking stimuli or might practice social skills together.

Question 38

Couple Therapy (in depth)

Answer 38

Helps couples enhance their relationship by improving their communication skills and helping them manage conflict. There are often power imbalances in relationships, and couple therapy helps individuals find “full membership” in the couple. Correcting power imbalances increases happiness and can decrease the incidence of domestic violence. Ironically, in situations of domestic violence, the partner with less power in the relationship is usually the violent one. Violence sometimes appears to be a way of compensating for an inability to share power in other aspects of the relationship.

Question 39

Couple Therapy (basic definition)

Answer 39

A form of therapy in which a couple is treated as the client and helped to improve communication skills and manage conflict.

Question 40

Family Therapy (in depth)

Answer 40

A form of group therapy in which one or more families constitute the group. Family therapy may be undertaken from various theoretical viewpoints. One is the systems approach, in which family interaction is studied and modified to enhance the growth of individual family members and of the family unit as a whole. Family members with low self-esteem often cannot tolerate different attitudes and behaviors in other family members. Faulty communication within the family also creates problems. In addition, it is not uncommon for the family to present an “identified patient”—that is, the family member who has the problem and is causing all the trouble. Yet family therapists usually assume that the identified patient is a scapegoat for other problems within and among family members. It is a sort of myth: change the bad apple—or identified patient—and the barrel—or family—will be functional once more. The family therapist—often a specialist in this field—attempts to teach the family to communicate more effectively and encourage growth and autonomy in each family member.

Question 41

Family Therapy (basic definition)

Answer 41

A form of therapy in which the family unit is treated as the client.

Question 42

Self-Help / Support Groups

Answer 42

Millions of people in the United States and elsewhere are involved in self-help and support groups that meet in person, online, or even by telephone. The best known of self-help and support groups is Alcoholics Anonymous (AA), whose 12-step program has been used by millions of people in the United States and around the world. The group has a religious orientation, with the initial members being Protestants. However, the members are now drawn from all religious or nonreligious backgrounds. Members meet regularly and call other members between meetings when they are tempted to “fall off the wagon” and drink. The 12 steps require admitting before the group that one’s drinking is out of control, calling upon a “higher power” for strength, examining errors and injurious behavior, and attempting to make amends for injurious behavior under the influence.

Question 43

Biological Treatments / Therapies

Answer 43

The kinds of therapy we have discussed are psychological in nature—forms of psycho-therapy. Psychotherapies apply psychological principles to treatment, principles based on psychological knowledge of matters such as learning and motivation. However, people with psychological disorders are also often treated with biological therapies. Biological therapies apply what is known of people’s biological structures and processes to the amelioration of psychological disorders. For example, they may work by altering events in the nervous system, such as by changing the action of neurotransmitters. In this section, we discuss three biological, or medical, approaches to treating people with psychological disorders: drug therapy, electroconvulsive therapy, and psychosurgery.

Question 44

Drug Therapy

Answer 44

Includes anti-depressents, SSRI’s, antianxiety drugs, antipsychotic drugs, Lithium.

Question 45

Drug Therapy

-Antianxiety

Answer 45

Valium and other antianxiety drugs depress the activity of the central nervous system (CNS). The CNS, in turn, decreases sympathetic activity, reducing the heart rate, respiration rate, and feelings of nervousness and tension. Many people come to tolerate antianxiety drugs very quickly. When tolerance occurs, dosages must be increased for the drug to remain effective.

Question 46

Drug Therapy

-Antipsychotic

Answer 46

People with schizophrenia are often given antipsychotic drugs (also called majortranquilizers). In most cases, these drugs reduce agitation, delusions, and hallucinations. Many antipsychotic drugs, including phenothiazines (for example, Thorazine) and clozapine (Clozaril) are thought to act by blocking dopamine receptors in the brain. Research along these lines supports the theory that schizophrenia is connected with overactivity of the neurotransmitter dopamine.

Question 47

Drug Therapy

-Antidepressant

Answer 47

People with major depression often take so-called antidepressant drugs. These drugs are also helpful for some people with eating disorders, panic disorder, obsessive–compulsive disorder, and social phobia. Problems in the regulation of noradrenaline and serotonin may be involved in eating and panic disorders as well as in depression. Antidepressants are believed to work by increasing levels of one or both of these neurotransmitters, which can affect both depression and the appetite.

Question 48

Drug Therapy

-SSRI’s

Answer 48

Selective serotonin-reuptake inhibitors (SSRIs) such as Lexapro, Prozac, and Zoloft also block the reuptake of serotonin by presynaptic neurons. As a result, serotonin remains in the synaptic cleft longer, influencing receiving neurons. SSRIs appear to be more effective than other antidepressants.

Question 49

Drug Therapy

-Lithium

Answer 49

The ancient Greeks and Romans were among the first to use the metal lithium as a psychoactive drug. They prescribed mineral water—which contains lithium—for people with bipolar disorder. They had no inkling as to why this treatment sometimes helped. A salt of the metal lithium (lithium carbonate), in tablet form, flattens out cycles of manic behavior and depression in most people. Lithium can also be used to strengthen the effects of antidepressant medication.

People with bipolar disorder may have to use lithium indefinitely, as a person with type 1 diabetes must use insulin to control the illness. Lithium has been shown to have side effects such as hand tremors, memory impairment, and excessive thirst and urination. Memory impairment is reported as the main reason people discontinue lithium.

Question 50

Electroconvulsive Therapy (in depth)

Answer 50

A biological form of therapy for psychological disorders that was introduced by the Italian psychiatrist Ugo Cerletti in 1939. Cerletti had noted that some slaughterhouses used electric current to render animals unconscious. The shocks also produced convulsions. Along with other European researchers of the period, Cerletti erroneously believed that convulsions were incompatible with schizophrenia and other major psychological disorders.

ECT was originally used for a variety of psychological disorders. Because of the advent of antipsychotic drugs, however, it is now used mainly for people with major depression who do not respond to antidepressants. People typically obtain one ECT treatment three times a week for up to 10 sessions. Electrodes are attached to the temples and an electrical current strong enough to produce a convulsion is induced. The shock causes unconsciousness, so the patient does not recall it. Nevertheless, patients are given a sedative so that they are asleep during the treatment.

Question 51

Why is ECT controversial?

Answer 51

ECT is controversial for many reasons, one being that many professionals are distressed by the thought of passing an electric current through a patient’s head and producing convulsions. There are also side effects, including memory problems. However, research suggests that for most people, cognitive impairment from ECT tends to be temporary. One study followed up ten adolescents who had received ECT an average of 3½ years earlier. Six of the ten had complained of memory impairment immediately after treatment, but only one complained of continued problems at the follow-up. Moreover, psychological tests did not reveal any differences in cognitive functioning between severely depressed adolescents who had received ECT and others who had not.

Question 52

ECT (basic definition)

Answer 52

Treatment of disorders like major depression by passing an electric current (that causes a convulsion) through the head.

Question 53

Psychosurgery (in depth)

Answer 53

Is more controversial than ECT. The most famous—or infamous—technique, prefrontal lobotomy, has been used with people with severe disorders. In this method, a picklike instrument severs the nerve pathways that link the prefrontal lobes of the brain to the thalamus. This method was pioneered by the Portuguese neurologist Antonio Egas Moniz and was brought to the United States in the 1930s. The theoretical rationale for the operation was vague and misguided, and Moniz’s reports of success were exaggerated. Nevertheless, by 1950, prefrontal lobotomies had been performed on more than a thousand people in an effort to reduce their violence and agitation. Anecdotal evidence of the method’s unreliable outcomes is found in an ironic footnote to history: one of Dr. Moniz’s “failures” shot the doctor, leaving a bullet lodged in his spine and paralyzing his legs. Thus, it is true that the originator of a surgical technique intended to reduce violence learned that it was not always successful…when one of his patients shot him.

Question 54

Psychosurgery (basic definition)

Answer 54

Surgery intended to promote psychological changes or to relieve disordered behavior.

Question 55

Evidence-based Practices

Answer 55

A method of therapy that has been shown effective in experiments in which participants are assigned at random to the treatment under investigation or to another treatment or placebo, and in which the methods being tested are clearly outlined.