1.2 What Is Treatment?

BETWEEN THE LINES

In Their Words

“Some seek the comfort of their therapist’s office, … but I chose running as my therapy.”

Dean Karnazes, Ultramarathon Man: Confessions of an All-Night Runner

Once clinicians decide that a person is indeed suffering from some form of psychological abnormality, they seek to treat it. Treatment, or therapy, is a procedure designed to change abnormal behavior into more normal behavior; it, too, requires careful definition. For clinical scientists, the problem is closely related to defining abnormality. Consider the case of Bill:

treatment A systematic procedure designed to change abnormal behavior into more normal behavior. Also called therapy.

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February: He cannot leave the house; Bill knows that for a fact. Home is the only place where he feels safe—safe from humiliation, danger, even ruin. If he were to go to work, his coworkers would somehow reveal their contempt for him. A pointed remark, a quizzical look—that’s all it would take for him to get the message. If he were to go shopping at the store, before long everyone would be staring at him. Surely others would see his dark mood and thoughts; he wouldn’t be able to hide them. He dare not even go for a walk alone in the woods—his heart would probably start racing again, bringing him to his knees and leaving him breathless, incoherent, and unable to get home. No, he’s much better off staying in his room, trying to get through another evening of this curse called life. Thank goodness for the Internet. Were it not for his reading of news sites and blog posts and online forums, he would, he knows, be cut off from the world altogether.

July: Bill’s life revolves around his circle of friends: Bob and Jack, whom he knows from the office, where he was recently promoted to director of customer relations, and Frank and Tim, his weekend tennis partners. The gang meets for dinner every week at someone’s house, and they chat about life, politics, and their jobs. Particularly special in Bill’s life is Janice. They go to movies, restaurants, and shows together. She thinks Bill’s just terrific, and Bill finds himself beaming whenever she’s around. Bill looks forward to work each day and to his one-on-one dealings with customers. He is taking part in many activities and relationships and more fully enjoying life.

Therapy … not Recently, a hotel in Spain that was about to undergo major renovations invited members of the public to relieve their stress by destroying the rooms on one floor of the hotel. This activity may indeed have been therapeutic for some, but it was not therapy. It lacked, among other things, a “trained healer” and a series of systematic contacts between healer and sufferer.

Bill’s thoughts, feelings, and behavior interfered with all aspects of his life in February. Yet most of his symptoms had disappeared by July. All sorts of factors may have contributed to Bill’s improvement—advice from friends and family members, a new job or vacation, perhaps a big change in his diet or exercise regimen. Any or all of these things may have been useful to Bill, but they could not be considered treatment or therapy. Those terms are usually reserved for special, systematic procedures for helping people overcome their psychological difficulties. According to clinical theorist Jerome Frank, all forms of therapy have three essential features:

  1. A sufferer who seeks relief from the healer.

  2. A trained, socially accepted healer, whose expertise is accepted by the sufferer and his or her social group.

  3. A series of contacts between the healer and the sufferer, through which the healer … tries to produce certain changes in the sufferer’s emotional state, attitudes, and behavior.

(Frank, 1973, pp. 2–3)

Despite this straightforward definition, clinical treatment is surrounded by conflict and confusion. Carl Rogers, a pioneer in the modern clinical field (you will meet him in Chapter 3), noted that “therapists are not in agreement as to their goals or aims…. They are not in agreement as to what constitutes a successful outcome of their work. They cannot agree as to what constitutes a failure. It seems as though the field is completely chaotic and divided.”

Some clinicians view abnormality as an illness and so consider therapy a procedure that helps cure the illness. Others see abnormality as a problem in living and therapists as teachers of more functional behavior and thought. Clinicians even differ on what to call the person who receives therapy: those who see abnormality as an illness speak of the “patient,” while those who view it as a problem in living refer to the “client.” Because both terms are so common, this book will use them interchangeably.

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Despite their differences, most clinicians do agree that large numbers of people need therapy of one kind or another. Later you will encounter evidence that therapy is indeed often helpful.