Section B

Lesson 5
Psychological Disorders and Psychotherapy
(iv) Psychotherapy

Psychologically Based Therapies

Most therapists, like all good listeners, rely on a repertoire of receptiveness,
warmth, empathy, and take a non-judgemental approach to the problems their
clients present. Most, however, also introduce into the relationship
psychological interventions that are designed to promote new understanding,
behaviours, or both on the client’s part. Psychotherapy involves the use of
psychological procedures for people with mental disorders, who interact
with a trained psychotherapist, who helps them change certain behaviours,
thoughts and emotions, so that they feel and function better – in other
words, the treatment of mental illness by psychological methods. The fact
that these interventions are deliberately planned and systematically guided by
certain theoretical preconceptions is what distinguishes professional
psychotherapy – the treatment of mental disorder by psychological methods –
from more informal helping relationships.
The belief that people with psychological problems can change – can learn more
adaptive ways of perceiving, evaluating, and behaving – is the conviction
underlying all psychotherapy. Achieving these changes is by no means easy.
Sometimes a person’s view of the world and self concept are distorted as a result
of a faulty parent-child relationship reinforced by many years of life
experiences. In other instances, unsatisfying or inadequate occupational, marital,
or social functioning requires major changes in a person’s life situation, in
addition to psychotherapy. It often seems easier to hold to one’s present
problematic but familiar course than to risk change and the unpredictability it
entails. Therapy often takes time. Even a highly skilled and experienced
therapist cannot undo an individual’s entire past history and prepare him or her
to cope with difficult life situations in a fully adequate manner in a short time.
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Psychotherapists offer no magical transformations of either selfhood or the
realities in which people live their lives. Nevertheless, psychotherapy holds
promise in even the most severe mental disorder, and indeed for certain of them,
such as the Axis II personality disorders, may provide the only realistic hope for
significant and lasting change. Contrary to common opinion, psychotherapy
often proves to be less expensive in the long run than alternative modes of
intervention.
To help a person achieve constructive change, a psychotherapist may attempt to
(1) change maladaptive behaviour patterns; (2) minimize or eliminate
environmental conditions that may be causing or maintaining such behavior; (3)
improve a person’s interpersonal and other competencies; (4) resolve disabling
conflicts among motives; (5) modify individual’s dysfunctional beliefs about
themselves and their world; (6) reduce or remove distressing or disabling
emotional reactions; and (7) foster a clear-cut sense of identity. All these
strategies can open pathways to a more meaningful and fulfilling existence.
[*** Why Do People Seek Therapy?: People who receive psychotherapy vary
widely in the problems and their motivations to solve them. Perhaps, the most
obvious candidates for psychological treatment are individuals experiencing
sudden and highly stressful situations such as divorce or unemployment, people
who feel so overwhelmed by the crisis conditions which they find themselves in
that they cannot manage on their own. These people typically feel quite
vulnerable and tend to be open to psychological treatment because they are
motivated to alter their present intolerable mental states.
Some people enter psychological therapy somewhat as a surprise to themselves.
Perhaps they had consulted a physician for their headache or stomach pain, only
to be told that there was nothing physically wrong with them. Such individuals,
referred to a therapist, may at first resist the idea that their physical symptoms
are emotionally based especially if the referring physician has been brusque or
unclear as to the rationale for his or her judgement. Motivation to enter
treatment differs widely among psychotherapy clients. Reluctant clients may
come from many sources – for example, an alcoholic whose spouse threatens
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“either therapy or divorce”, or a suspected felon whose attorney advises that
things will go better at trial if it can be announced that the suspect has “entered
therapy.” In general, males are far more reluctant to enter therapy than are
females, probably for the same reasons that they resist asking for directions
when lost. A substantial number of angry parents bring their children to
therapists with demands that their child’s “uncontrollable behaviour,” viewed as
independent of the family context, be fixed.” These parents may be surprised
and reluctant to recognize their role in their child’s behaviour patterns.
Many people entering therapy have experienced long-term psychological
distress and have had lengthy histories of maladjustment. They may have had
interpersonal problems, such as an inability to be comfortable with intimacy, or
may have felt susceptible to low moods that are difficult for them to dispel.
Chronic unhappiness and inability to feel confident and secure may finally
prompt them to seek outside help. These people seek psychological assistance
out of dissatisfaction and despair. They may enter treatment with a high degree
of motivation, but, as therapy proceeds, their persistent patterns of maladaptive
behaviour may become resistant forces with which a therapist must contend.
Some people who enter therapy have problems that would be considered
relatively normal. That is, they appear to have achieved success, have financial
stability, generally accepting and loving families, and have accomplished many
of their life goals. They enter therapy not out of personal despair or impossible
interpersonal involvements, but out of a sense that they have not lived up to
their own expectations and realized their own potential. These people, partly
because their problems are more manageable than the problems of others, may
make substantial gains in personal growth. Much of these therapeutic gains can
be attributed to their high degree of motivation and personal resources.
Individuals who seem to have the best prognosis for personality change,
according to repeated research outcomes, have been described in terms of the
so-called YAVIS pattern (Schofield, 1964) - they are Young, Attractive, Verbal,
Intelligent, and Successful. Ironically, those who tend to do best in
psychotherapy are those who seem objectively to need it the least.

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Psychotherapy, however, is not just for people who have clearly defined
problems, high levels of motivation, and an ability to gain ready insight into
their behaviour. Psychotherapeutic interventions have been applied to a wide
variety of chronic problems. Even a severely disturbed psychotic client may
profit from a therapeutic relationship that takes into account his or her level of
functioning and maintains therapeutic sub goals that are within the client's
present capabilities.
It should be clear from this brief description of individuals in psychological
therapy that there is indeed no "typical" client, nor, is there a "model" therapy.
No currently used form of therapy is applicable to all types of clients, and all of
the standard therapies can document some successes. Most authorities agree that
client variables, such as motivation and the seriousness of the problem, are
exceedingly important to the outcome of therapy.
Who Provides Psychotherapeutic Services? Members of many different
professions have traditionally provided advice and counsel to individuals in
emotional distress. Physicians, in addition to caring for their clients' physical
problems, often become trusted advisers in emotional matters as well. In past
eras, before the advent of health maintenance organizations and highly
differentiated medical specialties, the family physician was called on for
virtually all health questions. Even today, the medical practitioner - although he
or she may have little psychological background and limited time to spend with
individual clients - may be asked to give consultation in psychological matters.
Many physicians are trained to recognize psychological problems that are
beyond their expertise and to refer patients to psychological specialists.
Another professional group that deals extensively with emotional problems is
the clergy. Members of the clergy are usually in intimate contact with the
emotional needs and problems of their congregations. A minister, priest, or rabbi
is frequently the first professional to encounter a person experiencing an
emotional crisis. Although some clergy are trained mental health counsellors,
most limit their counselling to religious matters and spiritual support and do not
attempt to provide psychotherapy. Rather, like general-practice physicians, they
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are trained to recognize problems that require professional management and
refer seriously disturbed people to mental health specialists.
The three types of mental health professionals who most often administer
psychological treatment in mental health settings are clinical psychologists,
psychiatrists, and psychiatric social workers.
In a clinic or hospital, as opposed to an individual practice setting, a wide range
of medical, psychological, and social work procedures may be used. These
range from the use of drugs to individual or group psychotherapy and to home,
school, or job visits aimed at modifying adverse conditions in a client's life - for
example, helping a teacher become more understanding and supportive of a
child client's needs. Often the latter is as important as treatment directed toward
modifying the client's personality makeup, behaviour, or both.
This willingness to use a variety of procedures is reflected in the frequent use of
a team approach to assessment and treatment, particularly in group practice and
institutional settings. This approach ideally involves the coordinated efforts of
medical, psychological social work, and other mental health personnel working
together as the needs of each case warrant. Also of key importance is the current
practice of providing treatment facilities in the community. Instead of
considering maladjustment as an individual's private misery, which in the past
often required confinement in a distant mental hospital, this approach integrates
family and community resources in the total treatment approach.
The Therapeutic Relationship: The therapeutic relationship is formed out of
what both a client and a therapist bring to the therapeutic situation. The outcome
of psychotherapy will normally be dependent on whether the client and therapist
are successful in achieving a productive working alliance. The client's major
contribution is his or her motivation. Just as physical medicine, if properly used,
essentially frees and cooperates with the body's own healing mechanisms, an
important ally for a psychotherapist is the client's own drive toward wholeness
and toward the development of unrealized potentialities. Although this inner
drive is often obscured in severely disturbed clients, most anxious and confused

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people are sufficiently discouraged with their situation to be eager to cooperate
in any program that holds hope improvement.
The Therapeutic Alliance: The establishment of an effective psychotherapeutic
"working alliance" between client and therapist is seen by most investigators
and practitioners as the bedrock of psychotherapeutic gain. Obviously, a primary
and essential element in building such an alliance is that of accurate and broad-
band communication.
Other Qualities Enhancing Therapy: The client's motivation to change is a
crucial element in determining the quality of the therapeutic alliance and hence
the level of success likely to be achieved in the therapeutic effort. A wise
therapist is appropriately cautious about accepting an unmotivated client. Not all
prospective clients, regardless of their need for treatment are ready for the
temporary discomfort that effective therapy may entail. Many men, in particular,
have difficulty in bringing themselves to accept the conditions good therapy
may impose, such as the requirement of reporting their innermost feelings. Even
the motivation of self-referred clients may dissipate in the face of the painful
confrontations with self and past experiences that good therapy may require.
Almost as important as motivation is a client's expectation of receiving help.
This expectancy is often sufficient in itself to bring about substantial
improvement. Just as a placebo often lessens pain for someone who believes it
will do so, a person who expects to be helped by psychotherapy is likely to be
helped, almost regardless of the particular methods used by a therapist. The
downside of this fact is that if a therapy or a therapist fails for whatever reason
to inspire client confidence, that treatment effort is likely to be compromised in
effectiveness.
To the art of therapy, a therapist brings a variety of professional skills and
methods intended to help individuals see themselves and their situations more
objectively – that is, to gain a different perspective. Besides helping provide a
new perspective, most therapy situations also offer a client a protected setting in
which he or she is helped to practice new ways of feeling and acting, gradually

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developing both the courage and the ability to take responsibility for acting in
more effective and satisfying ways.
To bring about such changes, an effective psychotherapist must interact with a
client in such a manner as to discourage old and dysfunctional behaviour
patterns and to induce new and more functional ones in their place. Because
clients will present varying challenges in this regard, the therapist must be
flexible enough to use a variety of interactive styles. Effective therapy depends,
at least to some extent, on a good match between client and therapist. Hence, a
therapist's own personality is necessarily a factor of some importance in
determining therapeutic outcomes, quite aside from his or her background and
training or the particular formal treatment plan adopted.
Despite general agreement among psychotherapists on these aspects of the
client-therapist relationship, professionals can and do differ in their assessments
and treatments of psychological disorders. This statement should not be
surprising, of course. Even in the treatment of physical disorders, we sometimes
find that physicians disagree. ln, psychopathology, such disagreements are even
more common.
Many forms of psychotherapy exist, ranging from the famous procedures
devised by Freud through modern techniques that rest firmly on basic principles
of learning and cognition. Alternatives to individual psychotherapy - group
therapies, in which several persons interact with a therapist and with each other;
marital therapies, which focus on problems experienced by couples (married or
otherwise); and family therapies which focus on changing patterns of family
interaction to correct family disturbances or conflicts. In addition, self-help
groups, in which individuals who share specific problems attempt to assist one
another, and a new approach known as psychosocial rehabilitation, which
focuses on teaching individuals with serious mental disorders how to cope with
these disorders and crises they often produce.
Psychotherapy, as it is currently practiced by psychologists and other
professionals, actually takes many different forms, uses a tremendously varied

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range of procedures, and can be conducted with groups as well as with
individuals. Read, understand, take out the essence/gist from the different
subheadings ***]

1. Psychodynamic Therapies
From Repression to Insight
Psychodynamic therapy is a psychological treatment approach that focuses
on individual personality dynamics, usually from a psychoanalytic or some
psychoanalytically derived perspective.
Psychodynamic therapies are based on the idea that mental disorders stem
primarily from the kind of hidden inner conflicts first described by Freud – for
instance, conflicts between our primitive sexual and aggressive urges (id
impulses) and the ego. More specifically, psychodynamic therapies assume that
mental disorders occur because something has gone seriously wrong in the
balance between these inner forces. Several forms of therapy are based on these
assumptions, but the most famous is psychoanalysis, the approach developed by
Freud.
The therapy is mainly practiced in two basic forms: classical psychoanalysis,
and psychoanalytically oriented psychotherapy.
Freudian Psychoanalysis: Psychoanalysis is a system of therapy that evolved
over a period of years during Freud's long career. It is not an easy system of
therapy to describe, and the problem is complicated by the fact that many people
have inaccurate conceptions of it based on cartoons and other forms of
caricature.
As developed by Freud and his immediate followers, classical psychoanalysis is
an intensive (at least three sessions per week), long-term procedure for
uncovering repressed memories, thoughts, fears, and conflicts presumably
stemming from problems in early psychosexual development - and helping
individuals come to terms with them in light of the realities of adult life. For
example, excessive orderliness and a grim and humourless focus on rigorous
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self-control would likely be viewed as deriving from difficulties in early toilet
training.
Freud believed that personality consists of three major parts: id, ego and
superego, which correspond roughly to desire, reason, and conscience. Freud
believed that mental disorders stem from the fact that many impulses of the id
are unacceptable to the ego or the superego and are therefore repressed – driven
into the depths of the unconscious. There these urges persist, and individuals
must devote a considerable portion of their psychic energy to keeping them in
check and out of consciousness. In fact, people often use various defense
mechanisms to protect the ego from feelings of anxiety generated by these inner
conflicts and clashes.
Freud felt that the crucial task, was for people to overcome repression and
recognize – and confront – their hidden feelings and impulses. Having gained
such insight, he believed, they would experience a release of emotion known as
abreaction; then with their energies at last freed from the task of repression,
they could direct these energies into healthy growth. The figure summarizes

D
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Hidden inner
conflicts;
repressed wishes M Insight into the causes
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how psychoanalysis works – psychoanalysis focuses on helping individuals gain
insight into their hidden inner conflicts and repressed wishes. Freud believed

that once awareness of these conflicts penetrated patient’s defense mechanisms

and moved into consciousness, disorders would fade away.
It is thought that gaining insight into such repressed material frees individuals
from the need to keep wasting their energies on repressing the urge to “let go”
and other defense mechanisms. Instead, they can bring their personality
resources to bear on consciously resolving the anxieties that prompted the
repression in the first place. Freed from the effort of keeping threatening
thoughts out of consciousness (so the theory states), they can turn their energies
to better personality integration and more effective living.
These ideas concerning the causes and cure of mental illness are reflected in
psychoanalysis, the type of therapy developed by Freud. The four basic
techniques of this form of therapy are: (1) free association, (2) analysis of
dreams, (3) analysis of resistance, and (4) analysis of transference.
Free Association: Freud for a time used hypnosis in his early work to free
repressed thoughts from his clients’ unconscious. Later, he stopped using
hypnosis in favour of free association – a more direct method of gaining access
to a person’s hidden thoughts and fears.
The basic rule of free association is that an individual must say whatever
comes into his or her mind, regardless of how personal, painful, or
seemingly irrelevant it may be. Usually a client lies in a relaxed position on a
couch and gives a running account of all the thoughts, feelings, and desires that
come to mind as one idea leads to another. The therapist normally takes a
position behind the client so as not to in any way distract or disrupt the free flow
of associations.
As popular images suggest, the patient undergoing psychoanalysis lies on a
couch in a partly darkened room and engages in free association – he or she
reports everything that passes through his or her mind. Freud believed that
the repressed impulses and inner conflicts present in the unconscious would
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ultimately be revealed by these mental wanderings, at least to the trained
ear of the analyst.

Although such a running account of whatever comes into one’s mind may seem
random, Freud did not view it as such; rather, he believed that associations are
determined like other events. He also thought that the conscious represents a
relatively small part of the much larger portions of the preconscious and the
unconscious. The purpose of free association is to explore thoroughly the
contents of the preconscious. The preconscious contents, it is thought, contain
derivates of repressed unconscious material, which if properly “interpreted” can
lead to an uncovering of the latter. Analytic interpretation involves a therapist’s
tying together of a client’s often disconnected ideas, beliefs, actions, and so
forth into a meaningful explanation to help the client gain insight into the
relationship between his or her maladaptive behaviour and the repressed
(unconscious) events and fantasies that drive it.
Analysis of Dreams: Another important, related procedure for uncovering
unconscious material is the analysis of dreams. When a person is asleep,
repressive defenses are said to be lowered and forbidden desires and
feelings may find an outlet in dreams. For this reason, dreams have been
referred to as the “royal road to the unconscious.” Some motives, however,
are so unacceptable to an individual that even in dreams they are not
revealed openly but are expressed in disguised or symbolic form. Thus a
dream has two kinds of content; (1) manifest content, which is the dream as
it appears to the dreamer, and (2) latent content, which is composed of the
actual motives that are seeking expression but are so painful or
unacceptable that they are disguised.
It is a therapist’s task to uncover these disguised meanings by studying the
images that appear in the manifest content of a client’s dream and his or her
preconscious associations to them. Freud felt that dreams were especially useful
in this respect, because they often represented inner conflicts and hidden
impulses in disguised form. But every day events, too, could be revealing.
“Slips of the tongue” (such as "I hurt you rather than "I heard you") and
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seemingly accidental events (e.g., spilling a drink on someone or dropping
papers into the mud) could aid the analyst in making interpretations concerning
the patient’s hidden inner conflicts.

Analysis of Resistance: Freud noted that during psychoanalysis several

intriguing events often occur. The first of these is resistance. During the process
of free association or of associating to dreams, an individual may evidence
resistance - an unwillingness or inability to talk about certain thoughts,
motives, or experiences. For example, a client may be talking about an
important childhood experience and then suddenly switch topics, perhaps
stating, "It really isn't that important," or "It is too absurd to discuss." Resistance
may also be evidenced by the client's giving a too-glib interpretation of some
association, or coming late to an appointment, or even "forgetting" an
appointment altogether. Because resistance prevents painful and threatening
material from entering awareness, its sources must be sought if an individual is
to face the problem and learn to deal with it in a realistic manner.
Resistance can be defined as a patient’s stubborn refusal to report certain
thoughts, motives, and experiences or overt rejection of the analyst's
interpretations. Presumably, resistance occurs because patients wish to avoid
the anxiety they experience as threatening or painful thoughts come closer and
closer
Analysis of Transference: As client and therapist interact, the relationship
between them may become complex and emotionally involved. Often people
carry over and unconsciously, apply to their therapist attitudes and feeling
that they had in their relations with a parent or other person close to them
in the past, - a process known as transference. Thus clients may react to
their analyst as they did to that earlier person and feel the same love,
hostility, or rejection that they felt long ago. If the analyst is operating
according to the prescribed role of maintaining an impersonal stance of detached
attention, the often affect-laden reactions of the client can be interpreted, it is
held, as a type of projection - inappropriate to the present situation, yet highly
revealing of central issues in the client's life. For example, should the client
vehemently (but actually incorrectly) condemn the therapist for a lack of caring
and attention to the client's needs, this would be seen as a "transference" to the
12
therapist of attitudes acquired (possibly on valid grounds) in childhood
interactions with parents or other key relationships.

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Thus, transference - intense feelings of love or hate toward the
analyst on the part of patient undergoing psychoanalysis occurs.
Often, patients react toward their analyst as they did to someone who
played a crucial role in their early lives - for example, one of their
parents. Freud believed that transference could be an important tool
for helping individuals work through conflicts regarding their parents,
this time in a setting where the harm done by disordered early
relationships could be effectively encountered. As patients’ insight
increased, Freud believed, transference would gradually fade away.
In addition, the problems of transference are not confined to the
client, for the therapist may also have a mixture of feelings toward the
client. This phenomenon is known counter-transference (the
therapist reacts in accordance with the client’s transferred attributions
rather than objectively) and must be recognized and handled properly
by the therapist. For this reason, it is considered important that
therapists have a thorough understanding of their own motives,
conflicts, and “weak spots”; in fact, all psychoanalysts themselves
undergo psychoanalysis before they begin independent practice.
Evaluating Psychodynamic Therapy / Psychoanalysis:
Classical psychoanalysis is routinely criticized by outsiders for being
relatively time-consuming and expensive; for being based on a
questionable, stultified, and sometimes cult like approach to human
nature; for neglecting a client’s immediate problems in the search for
unconscious conflicts in the remote past; and for inadequate proof of
general effectiveness.
Psychoanalysis is probably the most famous form of psychotherapy.
What accounts for its fame? Certainly not its proven effectiveness. It
is fair to say that the reputation of psychoanalysis far exceeds its
success in alleviating mental disorders. In the form proposed by
Freud, psychoanalysis suffers from several major and obvious
weaknesses that lessen its value. First, it is a costly and time
consuming process. Several years and large amounts of money are
usually required for its completion - assuming it ever ends. Second,

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psychoanalysis is based largely on Freud's theories of personality and
psychosexual development, theories that are provocative but difficult
to test scientifically, so psychoanalysis rests on a shaky scientific
ground. Third Freud designed psychoanalysis for use with highly
educated persons with impressive verbal skills - persons who could
describe their inner thoughts and feelings with ease. Fourthly, and
perhaps and most important, psychoanalysis has often adopted the
posture of a close logical system. You don't believe in
psychoanalysis? That's a clear sign that you are showing resistance -
or are suffering from serious mental disorders that prevent you from
seeing the truth. Finally, this theory's major assumption - that once
insight is acquired, mental health will follow automatically - is
contradicted by research findings. Over and over again, psychologists
have found that insight into one's thoughts and feelings does not
necessarily change those thoughts or feelings or prevent them from
influencing behaviour.
Nevertheless, many people do feel that they have profited from
psychonalysis – particularly in terms of greater self-understanding,
relief from inner conflict and anxiety, and improved interpersonal
relationships. Psychodynamic psychotherapy remains the treatment of
choice for many individuals who are seeking extensive insight into
themselves and broad-based personality change.
[***Psychodynamic Therapy Since Freud
The original version of psychoanalysis is practiced only rarely today.
Arduous and expensive in time, money and emotional commitment, it
may take several years until both analyst and client are satisfied that
all major issues in the client’s life have been satisfactorily resolved.
In light of these heavy demands most psychoanalytic/psychodynamic
therapists have worked out modifications in procedure designed to
shorten the time and expense required.
Interpersonal Therapy
Contemporary psychodynamic approaches to therapy tend to have a
strongly interpersonal focus.
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Beyond psychoanalysis: Psychodynamic therapy today: Because
of such problems, classical psychoanalysis is rarely practiced today.
However, modified (and less lengthy) versions introduced by Freud's
students and disciples, including the neo-Freudians are used more
frequently.
For instance, in psychoanalytically oriented psychotherapy, client and
therapist sit facing each other, and conversations focus on current
problems rather than on the distant past. The therapist attempts to help
the client re-experience old conflicts so that they can be resolved in a
more adaptive manner.
Alfred Adler, one famous neo-Freudian, emphasized the importance
of feelings of inferiority in mental disorders. He believed that people
often show basic mistakes in their thinking - false beliefs that interfere
with their mental health, such as “Life is very dangerous” or "I have
to please everybody". Adler developed procedures for changing these
beliefs that are similar in some ways to more modern forms of
therapy.
Another example of alternative forms of psychodynamic therapy is
the type devised by Henry Stack Sullivan. Sullivan felt that mental
disorders stem not from unconscious conflicts but rather from
disturbances in interpersonal relationships problems that develop out
of early interactions between children and their parents or peers.
Sullivan's approach to therapy focuses on helping the client identify
his or her maladaptive interpersonal styles - actions that provoke
others into treating the person in ways that reinforce maladaptive
behaviours. In sum, psychoanalysis is just one of the several types of
psychodynamic therapy, and today it is practiced by a relatively small
number of therapists, primarily psychiatrists. *** extra information -
read and understand]
In psychoanalytically oriented psychotherapy the treatment and the
ideas guiding it may depart substantially from the principles and
procedures laid out by orthodox Freudian theory, yet the therapy is
usually still loosely based on psychoanalytic concepts. For example,

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many psychoanalytically oriented therapists schedule less frequent
sessions, such as once per week, and sit face-to-face with the client
instead of having the latter recline on a couch with the analyst out of
sight behind them. Likewise, the relatively passive stance of the
analyst (primarily listening to the client's "free associations," and
rarely offering "interpretations") is replaced with an active
conversational style in which the therapist attempts to clarify
distortions and gaps in the client’s construction of the origins and
consequences of his or her problems, thus challenging client
"defenses" as they present themselves. It is widely believed that this
more direct approach significantly shortens total treatment time.

2. Phenomenological/Experiential Therapies: Emphasizing the

Positive
Freud was something of a pessimist about basic human nature. He felt
that we must struggle constantly with primitive impulses from the id.
However, many psychologists reject this view. They contend that
people are basically good and that our strivings for growth, dignity,
and self-control are just as strong as the powerful aggressive and
sexual urges that Freud described. According to such psychologists,
mental disorders do not stem from unresolved inner conflicts. Rather,
they arise because the environment we live in somehow interferes
with personal growth and fulfilment.
The phenomenological/experiential therapies (often known as
humanistic therapies) are based on this view and on the following
three principles:
(1) understanding other people requires trying to see the world
through their eyes (a phenomenological approach);
(2) clients should be treated as equals
(3) the therapeutic relationship with the clients is central to the
benefits of therapy.

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The goal of phenomenological/ experiential therapy is to help clients
(not "patients") to become more truly themselves - to find meaning in
their lives and to Iive in ways truly consistent with their own traits
and values. Unlike psychoanalysts, humanistic therapists believe that
clients, not they, must take essential responsibility for the success of
therapy. The therapist is mainly a guide and facilitator, not the one
who runs the show. Humanistic-experiential therapies see
psychopathology as stemming in many cases from problems of
alienation, depersonalization, loneliness, and a failure to find meaning
and genuine fulfilment. Problems of this sort, it is held, are not likely
to be solved either by delving into forgotten memories or by
correcting specific maladaptive behaviours.
Client-Centered Therapy: The Benefits of Being Accepted:
Perhaps the most influential humanistic approach is client-centered
therapy, developed by Carl Rogers.
The Client-Centered (person-centered) therapy of Carl Rogers
(1902-1987) focuses on the natural powers of the organism to heal
itself. Rogers rejected both Freud's view of the primacy of irrational
instinct and of the therapist's role as prober, interpreter, and director
of the therapeutic process. Rogers strongly rejected Freud's view that
mental disorders stem from conflicts over the expression of primitive,
instinctive urges. On the contrary, he argued, such problems arise
mainly because clients' efforts to attain self-actualization - growth and
development - are thwarted early in life by judgements and ideas
imposed by other people. According to Rogers, these judgments lead
individuals to acquire what he terms unrealistic conditions of worth.
That is, they learn that they must be something other than what they
really are in order to be loved and accepted - to be worthwhile as a
person. For example, children may come to believe that they will be
rejected by their parents if they are not always neat and submissive or
if they do not live up to various parental ideals. Such beliefs block
people from recognizing large portions of their experience and
emotions. This, in turn, interferes with normal development of the self
and causes people to experience maladjustment.

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He saw psychotherapy as a process of removing the constraints and
hobbling restrictions that often prevent this process from operating.
These constraints, he believed grow out of unrealistic demands that
people tend to place on themselves when they believe, as a condition
of self-wroth, that they should not have certain kinds of feelings, such
as hostility. By denying that they do in fact have such feelings, they
become unaware of their actual “gut” reactions. As they lose touch
with their own genuine experience, the result is lowered integration,
impaired personal relationships, and various forms of maladjustment.
The primary objective of Rogerian therapy is to resolve this
incongruence - to help clients become able to accept and be
themselves.
Client-centered therapy focuses on eliminating such unrealistic
conditions of worth through creation of a psychological climate in
which clients feel valued as persons. Client-centered therapists offer
unconditional positive regard, or unconditional acceptance, of the
client and her feelings; a high level of empathetic understanding;
and accurate reflection of the client’s feelings and perceptions. In this
warm, caring environment, freed from the threat of rejection,
individuals can come to understand their own feelings and accept
even previously unwanted aspects of their own personalities.
To end this, client-centered therapists establish a psychological
climate in which clients can feel unconditionally accepted, understood
and valued as people. Within this context, the therapist employs
nondirective techniques such as empathetic reflecting or restatement
of the client’s descriptions of life difficulties. If all goes well, clients
begin to feel free for perhaps the first time to explore their real
feelings and thoughts and to accept hates and angers and ugly feelings
as parts of themselves.
As their self-concept becomes more congruent with their actual
experiencing, they become more self-accepting and more open to new
experience and new perspectives; in short, they become better
integrated people. As a result, they come to see themselves as unique
19
human beings with many desirable characteristics. To the extent such
changes occur, Rogers suggests, many mental disorders disappear and
individuals can resume their normal progress toward self-fulfilment
(refer to figure below)

Client-
Unrealistic Distorted self centred
conditions of worth concept therapy

Enhanced
adjustment,
progress toward
self-fulfilment

{Client-Centered Therapy: An overview - explanation of the

figure above: Rogers believed that mental disorders stem from
unrealistic conditions of worth acquired early in life. Client-centered
therapy seeks to change such beliefs, primarily by placing individuals
in an environment where they receive unconditional acceptance from
the therapist.}
In contrast to most other forms of therapy, the client centered therapist
does not give answers or interpret what a client says or probe for
unconscious conflicts or even steer the client onto certain topics.
Rather he or she simply listens attentively and acceptingly to what the
client wants to talk about, interrupting only to restate in different
words what the client is saying. Such statements, without any
judgment or interpretation by the therapist, help the client clarify
further the feelings and ideas that he or she is exploring – really to
look at them and acknowledge them.

20
Introducing a practice of systematic recording of therapy sessions,
Roger was later able to make objective analysis of what was said, of
the client-counsellor relationship, and of the ongoing processes in
these therapy sessions. He was also able to compare a client’s
behaviour and attitudes at different stages of therapy. These
comparisons revealed a typical sequence: Early sessions were
dominated by negative feelings and discouragement. Then, after a
time, tentative statements of hope and greater self-acceptance began
to appear. Eventually, positive feelings, a reaching out toward others,
greater self-confidence, and interest in future plans appeared. This
characteristic sequence gave support to Rogers’s hypothesis that, once
freed to do so individuals have the capacity to lead themselves to
psychological health.
Humanistic Therapies: An Overview:
Phenomenological/ experiential therapies certainly have a much more
optimistic flavour than psychoanalysis; they don't assume that human
beings must constantly struggle to control dark internal forces. In this
sense, they cast bright sunshine into the shadowy world envisioned by
psychoanalysis.
In addition, several techniques devised by humanistic therapists are
now widely used, even by psychologists who do not share this
perspective. For instance, Carl Rogers was one of the first therapists
to tape-record therapy sessions so that therapists could study the tapes
at a later time. This tactic not only helps therapists to assist their
clients; it also provides information about which techniques are most
effective during therapy. Finally, some of the assumptions underlying
humanistic therapies have been subjected to scientific test and found

to be valid. For instance, research findings tend to confirm Rogers's

view that the gap between an individual's self image and his or her

21
"ideal self" plays a crucial role in maladjustment. In these ways, then,
humanistic therapies have made lasting contributions to the practice
of psychotherapy.
On the other side of the coin, such therapies have been criticized for
their lack of a unified theoretical base and for being vague about
precisely what is supposed to happen between clients and therapists.
So although they are more widely used at present than
psychoanalysis, they are subject to important criticism.

3. Behaviour Therapies: Mental Disorders and Faulty Learning

Although psychodynamic and phenomenological/experiential
therapies differ in many ways, they both place importance on early
events in clients’ lives as a key source of current disturbances. In
contrast, another major group of therapies, known collectively as
behaviour therapies, focus primarily on individuals' current behaviour.
These therapies are based on the belief that many mental disorders
stem from faulty learning. Either the persons involved have failed to
acquire the skills and behaviours they need for coping with the
problems of daily life, or they have acquired maladaptive habits and
reactions. Within this context, the key task for therapy is to change
current behaviour, not to correct faulty self-concepts or to resolve
inner conflict.
Thus a behaviour therapist specifies in advance the precise
maladaptive behaviours to be modified and adaptive behaviours to be
achieved, as well as the specific learning principles or procedures to
be used in producing the desired results. Thus, instead of exploring
past traumatic events or inner conflicts, behaviour therapists attempt
to modify problem behaviours directly by extinguishing or counter-
conditioning maladaptive reactions, such as anxiety, or by
manipulating environmental contingencies - that is, by the use of
reward, suspension of reward, or, occasionally, punishment to shape
overt actions. Indeed, for the strict behaviourist, “personality" does
not exist except in the form of a collection of modifiable habits.
22
Behaviour therapy techniques seem especially effective in altering
maladaptive behaviour when a reinforcement is administered
contingent on a desired response, and when a person knows what is
expected and why the reinforcement is given. The ultimate goal, of
course, is not only to achieve the desired responses but to bring them
under the control and self-monitoring of the individual.
Behaviour therapies employ techniques base on three major kinds of
learning: Classical Conditioning, Operant Conditioning and
Modelling.
1. Therapies Based on Classical Conditioning:
Classical conditioning is a process in which organisms learn that the
occurrence of one stimulus will soon be followed by the occurrence of
another. As a result, reactions at first produced only by the second
stimulus gradually come to be evoked by the first as well.
What does classical conditioning have to do with mental disorders?
According to behaviour therapists, quite a bit. Behaviour therapists
suggest, for example, that many phobias are acquired in this manner.
Stimuli that happen to be present when real dangers occur may
acquire the capacity to evoke intense fear because of this association.
As a result, individuals experience intense fears in response to these
conditioned stimuli, even though they pose no threat to their well-
being.
i. To eliminate such reactions, behaviour therapists sometimes use the
technique of flooding. This involves exposure to the feared stimuli, or
to mental representations of them, under conditions in which the
person with the phobias can't escape from them. These procedures
encourage extinction of such fears; and the phobias may soon fade
away.
ii. Guided Exposure
Most people with anxiety disorders are reacting to factually benign
internal or external stimuli with the acquired (learned, classically
conditioned) response of anxiety. Since the days of Pavlov, it has
23
been known that one can remove ("extinguish") such a classically
conditioned response by repeated presentations of the pertinent
stimuli in the absence of reinforcement which in this case would be
some dreadful event (e.g. death) whose imminence is signalled by the
occurrence of the evoking stimuli. One might logically wonder, if this
is the case, why anxiety disorders don't cure themselves since such
dreadful events as a phobic's fear of a bridge collapsing are highly
unlikely to happen should these evoking stimuli (the bridge) present
themselves? The problem is that anxiety-disordered clients also learn
artful and often complicated ways of avoiding confrontation with
these disturbing stimuli, being reinforced in that effort by a relatively
prompt reduction in anticipatory distress. But, in so doing they
deprive themselves of the opportunity to unlearn (extinguish) the
anxiety response. Guided exposure (to these anxiety-provoking
stimuli) is the technique behaviour therapists have developed to
ensure the unlearning of the anxiety reaction. It has two basic
variations systematic desensitization and in vivo exposure:
a. Systematic Desensitization: The process of extinguishing
maladaptive reactions can be applied to behaviour that is positively or
negatively reinforced. Of the two, behaviour that is negatively
reinforced - reinforced by the successful avoidance of a painful
situation - is harder to deal with because, the avoidant client never
gets a chance to find out that the expected aversive consequences do
not in fact come about.
In systematic desensitization, individuals, first learn how to induce a
relaxed state in their own bodies – often by learning how to relax their
muscles. Then, while in a relaxed state, they are exposed to stimuli
that elicit fear. Because they are now experiencing relaxation, which
is incompatible with fear, the conditioned link between these stimuli
and fear is weakened.
The method of systematic desensitization is aimed at teaching a
person to relax or behave in some other way that is inconsistent with
anxiety while in the presence (real or imagined) of the anxiety-
24
producing stimuli. It may therefore be considered a type of counter-
conditioning procedure. The term systematic refers to the carefully
graduated manner in which the person is exposed to the feared
stimulus, the procedure opposite of some forms of in vivo exposure.
[***The prototype of systematic desensitization is the classical
experiment of Mary Cover Jones (1924), in which she successfully
eliminated a small boy's fears of a white rabbit and other furry
animals. She began by bringing the rabbit just inside the door at the
far end of the room while the boy, Peter, was eating. On successive
days, the rabbit was gradually brought closer until Peter could pat it
with one hand while eating with the other. Joseph Wolpe elaborated
on the procedure developed by Jones and devised the term systematic
desensitization to refer to it. On the assumption that most anxiety-
based patterns are, fundamentally, conditioned responses, Wolpe
worked out a way to train a client to remain calm and relaxed in
situations that formerly produced anxiety. Wolpe's approach is elegant
in its simplicity and his method is equally straightforward.
Experiment need not be mentioned in an answer ***]
A client is first taught to enter a state of relaxation typically by
progressive concentration on relaxing various muscle groups.
Meanwhile, in collaboration with the therapist, an anxiety hierarchy is
constructed consisting of imagined scenes graded as to their capacity
to elicit anxiety.
Active therapy sessions consist of repeatedly imagining the scenes in
the hierarchy under conditions of deep relaxation, beginning with the
minimum anxiety items and gradually working toward those rated in
the more extreme ranges. A session is terminated at any point where
the client reports experiencing significant anxiety, the next session
resuming at a lower point in the hierarchy.
Treatment continues until all items in the hierarchy can be imagined
without notable discomfort, at which point the client's real-life

25
difficulties will typically have shown substantial improvement. The
usual duration of a desensitization session is about 30 minutes, and
the sessions are often given two or three times per week. The overall
therapy program may, of course, take a number of weeks or even
months. Typically, however, clients begin to make significant real-life
therapeutic gains early in treatment.
Several variants of systematic desensitization have been devised. One
variation involves the use of a tape recorder to enable a client to carry
out the desensitization process at home. Another utilizes group
desensitization procedures - as in marathon desensitization groups, in
which the entire program is compressed into a few days of intensive
treatment. Perhaps the most important contemporary variation is "in
vivo" desensitization, which typically involves graduated exposure to
actual (unrealistically) feared situations.
b. In vivo exposure: Following the introduction and rapidly
established success of Wolpe’s systematic desensitization procedure,
behaviour therapy researchers turned their attention to discovering the
differential contribution to therapeutic success of the several
components of this technique (i.e., relaxation training, graduated
introduction of anxiety-inducing stimuli, imaginal exposure to the
latter). By the mid-1980s it had become apparent that the central
ingredient was in fact exposure to the here-to-fore avoided anxiety-
provoking stimuli, the remaining components being seen largely as
facilitating that exposure. (Relaxation training, by itself, can be a
useful procedure for many stress-related disorders.)

With the recognition that exposure is the key element in treating many
forms of anxiety disorders, therapists were freed to explore a variety
of quite direct approaches to having clients repeatedly experience the
actual - not merely imaginal - internal (e.g., heartbeat irregularities) or
external (e.g., high places) stimuli that had been identified as

26
producing anxiety reactions. Such approaches are often referred to as
in vivo (as opposed to in vitro, or imaginal) exposure.

Imaginal procedures have some limitations, an obvious one being that

not all persons are capable of vividly imagining the required scenes.
Studies have concluded that prolonged exposure to in vivo plainly
proved superior to simple reliance on the imagination, and in recent
years the in vivo exposure procedure seems to have gained a definite
ascendancy over that of in vitro imagining, wherever it is possible to
identify in concrete terms those situations evoking anxiety, and to
induce the client to confront them directly. However, some anxiety
inducing situations are not readily or judiciously reproducible in real
life, as when they refer to memories of unique past events such as
natural disasters, or when an exposure to them might be objectively
dangerous. For example, it is desirable for the traumatized rape victim
to confront the circumstances surrounding the attack, but it would
obviously be foolish to recommend that she walk around crime-
infested neighbourhoods at night. In addition, an occasional client is
so fearful that he or she cannot be induced to confront directly the
anxiety-arousing situation. Imaginal procedures remain, therefore, a
vital part of the therapeutic exposure armamentarium.

Where a therapist has a choice - that is, depending on the nature of the
problem and on client cooperation and tolerance - in vivo procedures
seem to have an edge in efficiency and possibly in ultimate efficacy
over those employing imagery as the mode of confrontation.

iii. Aversion Therapy:

Aversion therapy involves modifying undesirable behaviour by the
old-fashioned method of punishment. Punishment may involve either
the removal of highly desired reinforcers or the use of aversive
stimuli, but the basic idea is to reduce the "temptation value" of
27
stimuli that elicit undesirable behaviour. Probably the most
commonly used aversive stimuli today are drugs having noxious
effects, such as Antabuse, which induces nausea and vomiting when
the person ingests alcohol. In another variant, the offending client is
instructed to wear a substantial elastic band on the wrist and to "snap"
it when temptation arises, thus administering self-punishment. In the
past, painful electric shock was commonly employed in programs that
paired it with the occurrence of the undesirable behaviour,
contributing to aversion therapy's "negative image" among some
segments of the public. Aversion therapy has been used in the
treatment of a wide range of maladaptive behaviours, including
smoking, drinking, overeating, drug dependence, gambling, sexual
deviance and bizarre psychotic behaviour.

Another variant of aversion therapy is called covert or vicarious

sensitization, in which an attempt is made to induce unpleasant
feelings such as disgust or fear in association with tempting stimuli
through a process of classical conditioning. Aversion therapy is
primarily a way - sometimes quite an effective one - of stopping
maladaptive responses for brief period of time. With this interruption,
an opportunity exists for substituting new behaviour or for changing a
lifestyle by encouraging more adaptive alternative patterns that will
prove reinforcing in themselves. This point is particularly important
because otherwise a client may simply refrain from maladaptive
responses in unsafe therapy situations, where such behaviour leads to
immediate aversive results, but keep making them in safe real-life
situations, where there is no fear of immediate discomfort. Also, there
is little likelihood that the previously gratifying but maladaptive
behaviour pattern will be permanently relinquished unless alternative
forms of gratification are learned during the aversion therapy. A
therapist who believes it possible to take away something without
giving something back is likely to be disappointed. This is an

28
important point in regard to the treatment of addictions, one often not
appreciated in otherwise well-designed treatment programs.

2. Therapies Based on Operant Conditioning:

Behaviour is often shaped by the consequences it produces; actions

are repeated, if they yield positive outcomes or if they permit
individuals to avoid or escape from negative ones. In contrast, actions
that lead to negative results are suppressed. These basic principles of
learning are incorporated in several forms of therapy based on operant
conditioning. These therapies differ considerably in their details, but
all include the following steps:
(1) clear identification of undesirable or maladaptive behaviours
currently shown by individuals,
(2) identification of events that reinforce and maintain such responses,
and
(3) efforts to change the environment so that these maladaptive
behaviours are no longer followed by reinforcement.

i. Systematic Use of Reinforcement: Often referred to as

contingency management, systematic programmes involving the
management of reinforcement to suppress (extinguish) unwanted
behaviour or to elicit and maintain effective behaviour have achieved
notable success, particularly but by no means exclusively in
institutional settings.

The suppression of problematic behaviour may be as simple as

removing the reinforcements supporting it, provided of course the
latter can be identified. Sometimes the identification is relatively easy.
In other instances, it may require extremely careful attention to details
that maintain a particular behaviour. On other occasions therapy is
required to establish desired behaviours that are missing. Response

29
shaping, token economies, and behavioural contracting are among the
most widely used of such techniques.

ii. Token economies have been used to establish adaptive behaviours

ranging from elementary responses, such as eating and making one's
bed, to the daily performance of responsible hospital jobs. In the latter
instance, the token economy resembles the outside world where an
individual is paid for his or her work in tokens (money) that can later
be exchanged for desired objects and activities. The use of tokens
reinforces for appropriate behaviour has a number of distinct
advantages: (1) the number of tokens earned depends directly on the
amount of desirable behaviour shown; (2) tokens, like money in the
outside world, may be made a general medium of currency in terms of
what they will “purchase;” hence they are not readily subject to
satiation and tend to maintain their incentive value; (3) tokens can
reduce the delay that often occurs between appropriate performance
and reinforcement; (4) the number of tokens earned and the way in
which they are "spent" are largely up to the client; and (5) tokens
tend to bridge the gap between the institutional environment and the
demands and system of payment that will be encountered in the
outside world.

The ultimate goal in token economics, as in other programs involving

initially extrinsic reinforcement, is not only to achieve desired
responses but to bring such responses to a level where their adaptive
consequences will be reinforcing in their own right - intrinsically
reinforcing - thus enabling natural rather than artificial rewards to
maintain the desired behaviour. For example, extrinsic reinforcers
may be used initially to help children overcome reading difficulties,
but once a child becomes proficient in reading, this skill will
presumably provide intrinsic reinforcement as the child comes to
enjoy reading for its own sake. Approval and other intangible
reinforcers may be ineffective in behaviour modification programs,
30
especially those dealing with severely maladaptive behaviour. In such
instances, appropriate behaviours may be rewarded with tangible
reinforcers in the form of tokens that can later be exchanged for
desired objects or privileges. In ground-breaking work with
hospitalized schizophrenic clients, for example, Ayllon and Azrin
(1968) [do not have to mention the authors of this study] found
that listening to records, and going to movies were considered highly
desirable activities by most clients. Consequently, these activities
were chosen as reinforcers for socially appropriate behaviours. To
participate in any of them, a client had to earn a number of tokens by
demonstrating appropriate ward behaviour.

Operant principles have sometimes been used in hospital settings,

where a large degree of control over patients' reinforcements is
possible. Several projects have involved the establishment of token
economies - systems under which patients earn tokens they can
exchange for various rewards, such as television-watching privileges,
candy, or trips to town. These tokens are awarded for various forms of
adaptive behaviour, such as keeping one's room neat, participating in
group meetings or therapy sessions, coming to meals on time, and
eating neatly. The results have often been impressive. When
individuals learn that they can acquire rewards by behaving in
adaptive ways, they often do so, with important benefits to them as
well as to hospital staff. [provide only a gist of the section on Token
economies]

iii. Response shaping: Positive reinforcement is often used in

response shaping – that is, establishing by gradual approximation a
response that is actively resisted or is not initially in an individual’s
behaviour repertoire. This technique has been used extensively in
working with children’s behaviour problems.

31
iv. Behavioural Contracting: A technique called behavioural
contracting is used in some types of psychotherapy and behaviour
therapy to identify the behaviours that are to be changed and to
maximize the probability that these changes will occur and be
maintained. By definition, a contract is an agreement between two or
more parties – such as a therapist and a client, a parent and a teenager,
or a husband and a wife – that governs the nature of an exchange.
The agreement, often in writing, specifies a client’s obligations to
change as well as the responsibilities of the other party to provide
something the client wants in return, such as tangible rewards,
privileges, or therapeutic attention. Behaviour therapists frequently
make behavioural contracting an explicit focus of treatment, thus
helping establish the treatment as a joint enterprise for which both
parties have responsibility.

Behavioural contracting can facilitate therapy in several ways: (1) the

structuring of the treatment relationship can be explicitly stated,
giving the client a clear idea of each person’s role in the treatment; (2)
the actual responsibilities of the client are outlined and a system of
rewards is built in for the changed behaviour; (3) the limitations of the
treatment, in terms of the length and focus of the sessions, are
specified; (4) by agreement some behaviour (for example, the client’s
sexual orientation) may be eliminated from the treatment focus,
thereby establishing the appropriate content of the treatment session;
(5) clear treatment goals can be defined; and (6) criteria determining
success or failure in achieving these goals can be built into the
program.
Sometimes a contract is negotiated between a disruptive child and a
teacher, according to which the child will maintain or receive certain
privileges as long as he or she behaves in accordance with the
contract. Usually the school principal is also a party to such a contract
to ensure the enforcement of certain conditions that the teacher may

32
not be in a position to enforce, such as removing the child from the
classroom for engaging in certain types of misbehaviour.
We know of no therapist who seriously believes in the long-term
feasibility of such formal therapeutic contracts as a means of
regulating interpersonal behaviour. Rather, as in the case of aversion
therapy, contracts provide an opportunity to interrupt for a time self-
sustaining dysfunctional behaviour, thus permitting the emergence of
new responses that may prove more adaptive and satisfying.
v. Biofeedback Treatment: Historically, it was generally believed
that voluntary control over physiological processes, such as heart rate,
and blood pressure, was not possible. In the early 1960s, however,
this view began to change. A number of investigators, aided by the
development of sensitive electronic instruments that could accurately
measure physiological responses, demonstrated that many of the
processes formerly thought to be involuntary were modifiable by
operant learning procedures.
The importance of the automatic nervous system in the development
of abnormal behaviour has long been recognized. For example,
automatic arousal is an important factor in anxiety states. Thus many
researchers have applied techniques developed in the autonomic
conditioning studies in an attempt to modify the internal environment
of troubled persons to bring about more adaptive behaviour – for
instance, to modify heart rates in clients with irregular heartbeats, to
treat stuttering by feeding back information on the electric potential of
muscles in the speech apparatus, and to reduce lower-back pain and
chronic headaches.
The treatment approach – in which a person is taught to influence his
or her own physiological processes – is referred to as biofeedback.
Several steps are typical in the process of biofeedback treatment; (1)
monitoring the physiological response that is to be modified (perhaps
blood pressure); (2) converting the information to a visual or auditory

33
signal; and (3) providing a means of prompt feedback – indicating to
a subject as rapidly as possible when the desired change is taking
place. Given this feedback, the subject may then seek to reduce his or
her emotionality, as by lowering the skin temperature. For the most
part, biofeedback is oriented to reducing the reactivity of some organ
system innervated by the automatic nervous system – very often a
physiological component of the anxiety response.
The effects of biofeedback procedures are generally small and often
do not generalize to situations outside the laboratory, where the
biofeedback devices are not present.
There is a good evidence nevertheless that tension headache victims
may respond quite favourably to biofeedback.

3. Observational Learning: Benefiting from Exposure to

Others
MODELLING
As the name implies, modelling involves the learning of skills through
imitating another person, such as a parent or therapist, who performs
the behaviour to be acquired. A younger client may be exposed to
behaviours or roles in peers who act as assistants to the therapist and
then be encouraged to imitate and practice the desired new responses.
For example, modelling may be used to promote the learning of
simple skills, such as self-feeding in a profoundly mentally retarded
child, or more complex ones, such as being more effective in social
situations for a shy, withdrawn adolescent. In work with children,
especially, effective decision making and problem solving may be
modelled where the therapist “thinks out loud” about everyday
choices that present themselves in the course of therapy.
Modelling techniques have also been used, with impressive success in
the treatment of phobias. Many studies indicate that individuals who

34
experience intense fear of relatively harmless objects can be helped to
overcome these fears through exposure to an appropriate social model
who demonstrates lack of fear and show that no harm occurs as a
result of contact with these objects. Such procedures have been found
to be effective in reducing a wide range of phobias – excessive fears
of dogs, snakes, and spiders, to mention just a few. In sum,
behavioural therapies have been shown to be useful in alleviating
many types of mental disorders.
Many people who come to psychologists for help appear to be lacking
in basic social skills – they don’t know how to interact with others in
an effective manner. They don’t know how to make a request without
sounding pushy, or how to refuse one without making the requester
angry. They don’t know how to express their feelings clearly, how to
hold their temper in check, or how to hold an ordinary conversation
with others. As a result, such individuals experience difficulties in
forming friendships or intimate relationships, and they encounter
problems in many everyday situations. These difficulties, in turn, can
leave them feeling helpless, depressed, anxious, and resentful.
Behaviour therapists have developed techniques for helping people
improve their social skills through observational learning. These
often involve modelling – showing individuals live demonstrations or
videotapes of how people with good social skills behave in many
situations. For instance, modelling (as well as other techniques) is
often used in assertiveness training, which focuses on helping clients
learn how to express their feelings and desires more clearly and
effectively. Being assertive doesn’t mean being aggressive; rather, it
means being able to state one’s preferences and needs rather than
simply surrendering to those of others.
Modelling and imitation are adjunctive aspects of various forms of
behaviour as well as other types of therapy. For example, in an early
classic work Bandura (1964) found that live modelling of fearlessness
combined with instruction and guided exposure was the most
35
effective treatment for snake phobia, resulting in the elimination of
phobic reactions in over 90 percent of the cases treated.
Evaluating Behaviour Therapy: Compared with psychodynamic
and other psychotherapies, behaviour therapy appears to have three
distinct advantages: First, the treatment approach is precise. The
target behaviours to be modified are specified, the methods to be used
are clearly delineated, and the results can be readily evaluated.
Second, the use of explicit learning principles is a sound basis for
effective interventions as a result of their demonstrated scientific
validity. Third, the economy of time and costs is quite good. Not
surprisingly, then, the overall outcomes achieved with behaviour
therapy compare very favourably with those of other approaches.
Behaviour therapy usually achieves results in a short period of time
because it is generally directed to specific symptoms, leading to faster
relief of a client’s distress and to lower costs.
The range of effectiveness of behaviour therapy is not unlimited, and
it works better with certain kinds of problems than with others.
Generally, the more pervasive and vaguely defined the client’s
problem, the less likely that behaviour therapy will be useful.
Quantitative reviews of therapeutic outcomes confirm the expectation
that behaviour therapy has a particular place in the treatment of
anxiety disorders. Although behaviour therapy is not a cure-all, it has
earned in a relatively brief period a highly respected place among the
available psychosocial treatment approaches.

36