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Unit 8: Clinical Psychology

Disorder Treatment I
Notebook Page 32
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Therapy and Medication

The first stage of treating a psychological disorder is psychotherapy – psychological treatment that
consists of interactions between a trained therapist and someone seeking to overcome psychological
difficulties or achieve personal growth. These interactions are centered around talking and talk therapy as
the therapist helps to identify the issue and treat or help the patient cope with the stressor or disorder. A
clinician may stick to therapy or go the route of biochemical therapy – medication or other biological
treatments designed to alleviate symptoms or remedy the disorder. It is not uncommon for clinicians to take
an eclectic approach, which is the combined use of therapy and biological treatments. This can be to
address multiple symptoms and causes, or, in some cases, the medication can enhance the therapy.

The approach of the therapist may depend on their preferred psychological field, or the approach from a
particular field that best-addresses the psychological disorder in question. There are three basic approaches
to treating psychological disorders with therapy: behavioral, cognitive, and humanistic. Behavioral
approaches see the problems as learned behaviors that can be replaced by constructive behaviors via
learning principles (such as in the case of behavioral modification and taste aversion). Cognitive
approaches seek new, more adaptive ways of thinking based on the assumption that thoughts intervene
between events and our physiological and emotional states (such as in the case
of rumination and pessimism). Lastly, humanistic approaches seek to boost
people’s self-fulfillment by helping grow in self-awareness and self-acceptance;
they favor promoting personal growth as a means of curing the illness.
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Behavioral Approach
One of the primary tactics for behaviorists when attempting to correct behavior
or bad habits is counter-conditioning: the use of classical conditioning to
evoke new responses to stimuli that are triggering unwanted behaviors. This
can be applied by forming positive associations with stimuli we find upsetting.
For example a child’s fear of rabbits can be counter-conditioned by having the
child eat good food within visual range of a rabbit. This pleasurable experience
of eating their favorite food is then associated with the sight of the rabbit. Each
meal, the rabbit is moved closer and closer to the child until the fear of the rabbit
is gone, and only a positive association remains.

In a similar manner, exposure therapies can aid people in the recovery or coping with fears. Exposure therapy
works by progressively exposing people to what they normally avoid or escape. This in turn reduces their anxiety
each time until they can fully, voluntarily face their fear. For example, if one is afraid of elevators, an exposure
therapist would join the patient in voluntarily getting as close to the elevator as possible. If the patient is calm at
voluntarily facing the elevator from 15 feet, next time would be 10 feet, then 5 feet, then 2 feet. With each
approximation the patient gets less and less anxious and closer and closer to directly facing their fear. After 1 or 2
feet, they could then touch the key pad, then open the door next time, then put on foot in next time, etc., etc., until
they’re able to use the elevator. The particularly awesome part about exposure therapy (or voluntarily facing any
fear) is that patients often see a positive feedback loop and are better able to face or eliminate other anxieties.
 © Morgan AP Teaching

Continued
Additional behaviorist strategies include systematic desensitization, aversive
conditioning, and the token economy. Developed by Joseph Wolphe,
systematic desensitization is forming relaxed associations with fearful
stimuli or situations; you are essentially attempting to replace the stressor’s
associated anxiety and stress with a state of relaxation. This can be
accomplished by repeatedly thinking of fears when in a state of complete
relaxation, such as during an relaxing activity like hypnosis, massage, medit-
ation, or talk therapy. The associated anxiety is then replaced by relaxation.

One cause also use associations to get rid of bad habits such as smoking, drinking excessively, biting
one’s nails, etc. Aversive conditioning can be utilized to associate an unpleasant state or experience
with an unwanted behavior. For example, if trying to rid oneself of a nail-biting habit, one could line their
fingernails with bad-tasting polish. To address drinking, one could line their drinks with nausea-inducing
agents (much like the irradiating of rat food by John Garcia). Lastly, one can employ behavioral
modification through the use of the token economy. The token economy is any set of secondary
reinforcers that can be used to encourage new, positive behaviors by offering a token (such as money or
an agreement) to gain a reward for a good behavior. For example, you could reward your kids with money
for completing household chores.
 Cognitive Approach
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The cognitive approach is based on the assumption that thoughts intervene between events and our
emotional and physiological states. Thoughts themselves can alter our physiology, resulting in physical
changes in brain chemistry and vulnerability or resistance to psychological disorders. As such, the intention
is to change thinking to help emotions and even biology by shifting one away from rumination or
pessimism. One of the founding members of the cognitive approach and movement was Albert Ellis. Ellis
developed rational-emotive behavior therapy (REBT) which was designed to challenge a person’s
illogical, self-defeating attitudes and assumptions in the hopes of making a positive change in one’s
physiology by replacing self-defeating thoughts and attitudes with healthy or productive feelings. It
essentially helps you to identify underlying thought patterns that are negative or self-defeating and cause
you to make poor decisions or engage in damaging behaviors that obstruct your life.

For example, take the case of a woman who feels undeserving of anyone because
she was rejected and left by her husband. REBT would seek to expose the absurdity
of the self-defeating idea that simply because one person may have lost interest in or
rejected you, that you are therefore unworthy of anyone else. After this, the person
could recognize and redirect or reframe negative thoughts and decide to start looking
for someone else. It would, essentially, assert the worth of the individual, and this
sense of worth and self-respect would end the negative and self-defeating thoughts.
 Continued
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Aaron Beck took a lighter approach as he organized more gentle questioning to reveal irrational thinking.
Beck aided in the development of cognitive-behavioral therapy (CBT) which sought to change behavior
by identifying self-defeating thoughts that altered our perceptions of the world. Metaphorically speaking,
the purpose of CBT is to persuade or show people how to remove the dark glasses through which they
view life and view things more positively. With a therapist, one would analyze a negative outlook or set of
thoughts to determine if they were indeed accurate, or unrealistic depictions of reality. If they were found
unrealistic, steps and strategies would be employed to help overcome them. CBT has been shown to help
OCD patients recognize irrational compulsive thoughts, and, instead of acting on them, engage in another
pleasant activity rather than give into their compulsion. Adding merit to CBT is the fact that such strategies
have led to changes in brain activity, as shown by PET scans of OCD patients before and after CBT.

While CBT may sound identical to REBT, there is one primary difference: CBT deals with the negative
thoughts themselves and replacing them while REBT seeks to fix the underlying
problems that causes the thoughts (more akin to psychoanalysis). For example, in
the case of an OCD patient’s compulsive desire to wash their hands over and over,
CBT would address the thought and actions of hand washing, calling for the patient to
pursue an enjoyable activity. REBT, however, would seek the underlying cause of the
compulsion: why are you so concerned with being clean or afraid of bacteria?
Once the person realizes they are a normally-functioning and healthy person, their
compulsion for cleanliness and fear of bacteria will likely fade.
 Humanistic Approach
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The humanistic approach focuses far more on the idea that empathy and acceptance
can result in one being comfortable with themselves and improve many psychological
issues. Again, humanism’s focus isn’t curing psychological orders—it is to give patients
the opportunity to find and pursue meaningful lives. While this may seem odd, when one
sets their target on a long-tern goal or set of goals and works towards it, psychological
disorders (like mood disorders) have a tendency to fade. The preferred tactic of humanists
is client-centered therapy (CCP) which was developed by Carl Rogers. Client-centered
therapy focuses on finding and fulfilling the needs of the individual and setting their lives
in motion towards meaningful goals. To accomplish this, CCP employs the tactics of active
listening and unconditional positive regard in the hopes of the client reaching a personal insight.

Humanists believe that in order for one accept oneself, they must be genuine, accepted, and receive empathy. In order to
achieve this, the therapist must first employ active listening – empathetic listening in which the listener echoes, restates, and
clarifies the message of the client. This lets the client know they are being seriously listened to and understood, thus establishing
trust between the two parties. When listening, the therapist must listen with unconditional positive regard, meaning they must
listen without judgement so as to allow the client to feel comfortable communicating genuinely. This doesn’t mean that the
therapist has to approve of the client’s methods or actions, but he or she must certainly respect the effort with which the client is
communicating or trying to act in their life. This series of discussions that involve active listening and unconditional positive
regard are designed to allow the patient to realize and develop solutions to their own life by determining their needs and setting
fulfilling goals to meet their needs and/or realize their full potential. The act of discovering these problems and solutions on their
own is known as personal insight or insight therapy. The hope is that by insightfully realizing their own problems and setting
and pursuing their own solution or goals that any associated depression, anxiety, stress, etc., will fade as the client has bolstered
their self-confidence and has set on a targeted journey to accomplish their goals.