Chapter 15

Psychological Therapies
 Humanistic Therapy: To Err is Human
• Person-centered therapy: a nondirective insight
therapy in which the client does all the talking and
the therapist listens
– Based on the work of Carl Rogers
– Real self and ideal self
– Nondirective: therapeutic style in which therapist
remains relatively neutral and does not interpret or take
direct actions with regard to the client
 Humanistic Therapy: To Err is Human
• Three elements of Roger’s therapy:
– Authenticity: the genuine, open, and honest response
of the therapist to the client
– Unconditional positive regard: the warmth, respect, and
accepting atmosphere created by the therapist for the
client in person-centered therapy
– Empathy: the ability of the therapist to understand the
feelings of the client
• Reflection: the therapist restates what the client
says rather than interpreting those statements
 Humanistic Therapy: To Err is Human

• Gestalt therapy: form of directive insight therapy in

which the therapist helps clients accept all parts of
their feelings and subjective experiences, using
leading questions and planned experiences such
as role-playing
– Hidden past instead of denied past
Humanistic Therapy: To Err is Human
• Humanistic therapies are not based in
experimental research and work best with
intelligent, highly verbal persons
– Somewhat less practical choice for treating the more
serious mental disorders such as schizophrenia
Behavioral Therapies: Learning One’s
Way to Better Behavior
• Behavior therapies: action therapies based on the
principles of classical and operant conditioning
and aimed at changing disordered behavior
without concern for the original causes of such
behavior
Behavioral Therapies: Learning One’s
Way to Better Behavior

• Behavior modification or applied behavior

analysis: use of learning techniques to modify or
change undesirable behavior and increase
desirable behavior
Behavioral Therapies: Learning One’s
Way to Better Behavior
• Systematic desensitization: behavioral technique
used to treat phobias, in which a client is asked to
make a list of ordered fears and taught to relax
while concentrating on those fears
– Counterconditioning: replacing an old conditioned
response with a new one by changing the
unconditioned stimulus
 Table 15.1 Fear Hierarchy
Situation Fear Level
Being bitten by a rabbit 100
Petting a rabbit on the head 90
Petting a rabbit on the back 80
Holding a rabbit 70
Touching a rabbit held by someone else 60
Seeing someone I trust hold a rabbit 50
Being in a room with a rabbit 40
Thinking about petting a rabbit 30
Looking at pictures of a rabbit 20
Watching the movie “Hop” 10
• Items are ranked by level of fear from most fearful, Fear = 100, to least fearful, Fear = 0.
Behavioral Therapies: Learning One’s
Way to Better Behavior
• Aversion therapy: form of behavioral therapy in
which an undesirable behavior is paired with an
aversive stimulus to reduce the frequency of the
behavior
 Behavioral Therapies: Learning One’s
Way to Better Behavior
• Exposure therapy: behavioral techniques that
introduce client to controlled situations that are
related to their anxieties or fears
– Flooding: technique in which person is rapidly and
intensely exposed to fear-provoking situation or object
and prevented from making usual avoidance or escape
response
– Eye-movement desensitization reprocessing (EMDR):
controversial therapy for PTSD and similar problems in
which client is directed to move the eyes rapidly back
and forth while thinking of a disturbing memory
Behavioral Therapies: Learning One’s
Way to Better Behavior
• Modeling: learning through the observation and
imitation of others
– Participant modeling: technique in which a model
demonstrates the desired behavior in a step-by-step,
gradual process while the client is encouraged to
imitate the model
Behavioral Therapies: Learning One’s
Way to Better Behavior
• Reinforcement: the strengthening of a response
by following it with a pleasurable consequence or
the removal of an unpleasant stimulus
– Token economy: use of objects called tokens to
reinforce behavior in which tokens can be accumulated
and exchanged for desired items or privileges
– Contingency contract: a formal, written agreement
between the therapist and client in which goals for
behavioral change, reinforcements, and penalties are
clearly stated
Behavioral Therapies: Learning One’s
Way to Better Behavior
• Extinction: the removal of a reinforcer to reduce
the frequency of a behavior
– Time-out: an extinction process in which a person is
removed from situation that provides reinforcement for
undesirable behavior, usually by being placed in a quiet
corner or room away from possible attention and
reinforcement opportunities
Behavioral Therapies: Learning One’s
Way to Better Behavior
• Behavior therapies can be effective in treating
specific problems, such as bedwetting, drug
addictions, and phobias
• Behavior therapies can also help improve some of
the more troubling behavioral symptoms
associated with more severe disorders
Cognitive Therapies: Thinking is Believing

• Cognitive therapy: therapy in which the focus is on

helping clients recognize distortions in their
thinking and replace distorted, unrealistic beliefs
with more realistic, helpful thoughts
Cognitive Therapies: Thinking is Believing

• Beck’s Cognitive Therapy:

– Arbitrary inference: drawing a conclusion without any
evidence
– Selective thinking: focusing on only one aspect of a
situation while ignoring all other relevant aspects
– Overgeneralization: drawing sweeping conclusions
based on only one incident or event and applying those
conclusions to events that are unrelated to the original
Cognitive Therapies: Thinking is Believing

• Beck’s Cognitive Therapy continued

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

• Cognitive-behavioral therapy (CBT): action

therapy in which the goal is to help clients
overcome problems by learning to think more
rationally and logically
• Three goals:
1. Relieve the symptoms and solve the problems.
2. Help develop strategies for solving future problems.
3. Help change irrational, distorted thinking.
Cognitive Therapies: Thinking is Believing

• Evaluation of Cognitive and Cognitive-Behavioral

Therapies
– CBT has seemed successful in treating depression,
stress disorders, and anxiety
– CBT has been criticized for focusing on the symptoms,
not the causes, of disordered behavior
Table 15.2
Characteristics of Psychotherapies
Type of Therapy (Key People) Goal Methods
Psychodynamic therapy (Freud) Insight Aims to reveal unconscious conflicts through dream
interpretation, free association, resistance and
transference
Humanistic therapy Insight Non-directive therapy; client does most of the
Person-centered therapy (Rogers) talking; key elements are authenticity, unconditional
Gestalt therapy (Perls) positive regard, and empathy.
Directive therapy; therapist uses leading questions
and role-playing to help client accept all parts of
their feelings and experiences
Behavior therapy (Watson, Jones, Action Based on principles of classical and operant
Skinner, Bandura) conditioning; aimed at changing behavior without
concern for causes of behavior
Cognitive therapy (Beck) Action Aims to help clients overcome problems by learning
CBT (various professionals) to think more rationally and logically
REBT (Ellis) Clients are challenged in their irrational beliefs and
helped to restructure their thinking
 Types of Group Therapies
• Family counseling (family therapy): family
members meet together with a counselor or
therapist to resolve problems that affect the entire
family
Types of Group Therapies
• Self-help group (support group): a group
composed of people who have similar problems
and who meet together without a therapist or
counselor for the purpose of discussion, problem
solving, and social and emotional support
 Evaluation of Group Therapy
• Group therapy most useful to persons those who
cannot afford individual therapy or obtain a great
deal of social and emotional support from other
group members
 Evaluation of Group Therapy
• Advantages: • Disadvantages:
– Low cost – Need to share the
– Offers social therapist’s time with
interaction with others others in the group
– Social and emotional – Lack of a private setting
support from people in which to reveal
with similar disorders concerns
or problems – Inability of people with
severe disorders to
tolerate being in a group
Studies of Psychotherapy Effectiveness
• Psychotherapy more effective than no treatment
at all
• Between 75 and 90 percent of people who receive
therapy feel it has helped them
– The longer a person stays in therapy, the greater the
improvement
– Psychotherapy works as well alone as with drugs
Studies of Psychotherapy Effectiveness

• Some types of psychotherapy are more effective

for certain types of problems, and no one
psychotherapy method is effective for all problems
– Effective therapy should be matched to the particular
client and the particular problem
Studies of Psychotherapy Effectiveness
• Cybertherapy: psychotherapy that is offered on
the Internet
– Also called online, Internet-based, web therapy, e-
counseling and distance counseling
– Offers the advantages of anonymity and therapy for
people who cannot otherwise get to a therapist
– Therapist should be trained specifically in distance
counseling
 Characteristics of Effective Therapy
• Common factors approach: modern approach to
eclecticism focusing on factors seen as the source
of success
– Therapeutic alliance: the relationship between therapist
and client that develops as a warm, caring, accepting
relationship characterized by empathy, mutual respect,
and understanding
– Protected setting
– Opportunity for catharsis
– Learning and practice of new behaviors
– Positive experiences for the client
Characteristics of Effective Therapy
• Evidence-based treatment (EBT) refers to
techniques or interventions that have produced
desired outcomes, or therapeutic change in
controlled studies
• Neuroimaging of Psychotherapy – studies looking
at the functional changes occurring during
treatment and as a result of treatment
 Characteristics of Effective Therapy
• Five barriers to effective psychotherapy exist when
culture or ethnic backgrounds of client and
therapist differ
1. Culture-bound values
2. Class-bound values
3. Language
4. “American” cultural assumptions
5. Communication style
 Psychopharmacology

• Biomedical therapies: therapies that directly affect

the biological functioning of the body and brain
• Psychopharmacology: the use of drugs to control
or relieve the symptoms of psychological
disorders
 Psychopharmacology
• Psychopharmacology drug options:
– Antipsychotic drugs: used to treat psychotic symptoms
such as delusions, hallucinations, and other bizarre
behavior
– Antianxiety drugs: used to treat and calm anxiety
reactions
▪ Typically minor tranquilizers
– Mood-stabilizing drugs: used to treat bipolar disorder
▪ Include lithium and certain anticonvulsant drugs
– Antidepressant drugs: used to treat depression and
anxiety
ECT and Psychosurgery
• Electroconvulsive therapy (ECT): biomedical
treatment in which electrodes are placed on either
one or both sides of a person’s head and an
electric current strong enough to cause a seizure
or convulsion is passed through the electrodes
– Still used to treat severe depression
– Side effects include memory disruption
 ECT and Psychosurgery

• Psychosurgery: surgery performed on brain tissue

to relieve or control severe psychological
disorders