REVIEW Introduction to Therapy and the Psychological Therapies

Learning Objectives

Test Yourself by taking a moment to answer each of these Learning Objective Questions (repeated here from within the module). Research suggests that trying to answer these questions on your own will improve your long-term memory of the concepts (McDaniel et al., 2009).

Question

44-1 How do psychotherapy and the biomedical therapies differ?

ANSWER: Psychotherapy is treatment involving psychological techniques; it consists of interactions between a trained therapist and someone seeking to overcome psychological difficulties or achieve personal growth. The major psychotherapies derive from psychology's psychodynamic, humanistic, behavioral, and cognitive perspectives. Biomedical therapy treats psychological disorders with medications or procedures that act directly on a patient's physiology. An eclectic approach combines techniques from various forms of therapy.

Question

44-2 What are the goals and techniques of psychoanalysis, and how have they been adapted in psychodynamic therapy?

ANSWER: Through psychoanalysis, Sigmund Freud tried to give people self-insight and relief from their disorders by bringing anxiety-laden feelings and thoughts into conscious awareness. Psychoanalytic techniques included using free association and interpretation of instances of resistance and transference. Psychodynamic therapy has been influenced by traditional psychoanalysis but differs from it in many ways, including the lack of belief in id, ego, and superego. This contemporary therapy is briefer, less expensive, and more focused on helping the client find relief from current symptoms. Psychodynamic therapists help clients understand how past relationships create themes that may be acted out in present relationships.

Question

44-3 What are the basic themes of humanistic therapy? What are the specific goals and techniques of Rogers' client-centered approach?

ANSWER: Both psychoanalytic and humanistic therapists are insight therapies—they attempt to improve functioning by increasing clients' awareness of motives and defenses. Humanistic therapy's goals have included helping clients grow in self-awareness and self-acceptance; promoting personal growth rather than curing illness; helping clients take responsibility for their own growth; focusing on conscious thoughts rather than unconscious motivations; and seeing the present and future as more important than the past. Carl Rogers' client-centered therapy proposed that therapists' most important contributions are to function as a psychological mirror through active listening and to provide a growth-fostering environment of unconditional positive regard, characterized by genuineness, acceptance, and empathy.

Question

44-4 How does the basic assumption of behavior therapy differ from the assumptions of psychodynamic and humanistic therapies? What techniques are used in exposure therapies and aversive conditioning?

ANSWER: Behavior therapies are not insight therapies. Their goal is to apply learning principles to modify problem behaviors. Classical conditioning techniques, including exposure therapies (such as systematic desensitization or virtual reality exposure therapy) and aversive conditioning, attempt to change behaviors through counterconditioning—evoking new responses to old stimuli that trigger unwanted behaviors.

Question

44-5 What is the main premise of therapy based on operant conditioning principles, and what are the views of its proponents and critics?

ANSWER: Operant conditioning operates under the premise that voluntary behaviors are strongly influenced by their consequences. Therapy based on operant conditioning principles uses behavior modification techniques to change unwanted behaviors through positively reinforcing desired behaviors and ignoring or punishing undesirable behaviors. Critics maintain that (1) techniques such as those used in token economies may produce behavior changes that disappear when rewards end, and (2) deciding which behaviors should change is authoritarian and unethical. Proponents argue that treatment with positive rewards is more humane than punishing people or institutionalizing them for undesired behaviors.

Question

44-6 What are the goals and techniques of cognitive therapy and of cognitive-behavioral therapy?

ANSWER: The cognitive therapies, such as Aaron Beck's cognitive therapy for depression, assume that our thinking influences our feelings, and that the therapist's role is to change clients' self-defeating thinking by training them to view themselves in more positive ways. The widely researched and practiced cognitive-behavioral therapy (CBT) combines cognitive therapy and behavior therapy by helping clients regularly act out their new ways of thinking and behaving in their everyday life. A newer CBT variation, dialectical behavior therapy (DBT), combines cognitive tactics for tolerating distress and regulating emotions with social skills training and mindfulness meditation.

Question

44-7 What are the aims and benefits of group and family therapies?

ANSWER: Group therapy sessions can help more people and cost less per person than individual therapy would. Clients may benefit from exploring feelings and developing social skills in a group situation, from learning that others have similar problems, and from getting feedback on new ways of behaving. Family therapy views a family as an interactive system and attempts to help members discover the roles they play and to learn to communicate more openly and directly.

Question

44-8 Does psychotherapy work? How can we know?

ANSWER: Clients' and therapists' positive testimonials cannot prove that psychotherapy is actually effective, and the placebo effect makes it difficult to judge whether improvement occurred because of the treatment. Using meta-analyses to statistically combine the results of hundreds of randomized psychotherapy outcome studies, researchers have found that those not undergoing treatment often improve, but those undergoing psychotherapy are more likely to improve more quickly, and with less chance of relapse.

Question

44-9 Are some psychotherapies more effective than others for specific disorders?

ANSWER: No one type of psychotherapy is generally superior to all others. Therapy is most effective for those with clear-cut, specific problems. Some therapies—such as behavior conditioning for treating phobias and compulsions—are more effective for specific disorders. Psychodynamic therapy has been effective for depression and anxiety, and cognitive and cognitive-behavioral therapies have been effective in coping with anxiety, posttraumatic stress disorder, and depression. Evidence-based practice integrates the best available research with clinicians' expertise and patients' characteristics, preferences, and circumstances.

Question

44-10 How do alternative therapies fare under scientific scrutiny?

ANSWER: Abnormal states tend to return to normal on their own, and the placebo effect can create the impression that a treatment has been effective. These two tendencies complicate assessments of alternative therapies (nontraditional therapies that claim to cure certain ailments). Eye movement desensitization and reprocessing (EMDR) has shown some effectiveness—not from the eye movement but rather from the exposure therapy nature of the treatments. Light exposure therapy does seem to relieve depression symptoms for those with a seasonal pattern of major depressive disorder by activating a brain region that influences arousal and hormones.

Question

44-11 What three elements are shared by all forms of psychotherapy?

ANSWER: All psychotherapies offer new hope for demoralized people; a fresh perspective; and (if the therapist is effective) an empathic, trusting, and caring relationship. The emotional bond of trust and understanding between therapist and client—the therapeutic alliance—is an important element in effective therapy.

Question

44-12 How do culture and values influence the therapist-client relationship?

ANSWER: Therapists differ in the values that influence their goals in therapy and their views of progress. These differences may create problems if therapists and clients differ in their cultural or religious perspectives.

Question

44-13 What should a person look for when selecting a therapist?

ANSWER: A person seeking therapy may want to ask about the therapist's treatment approach, values, credentials, and fees. An important consideration is whether the therapy seeker feels comfortable and able to establish a bond with the therapist.

Terms and Concepts to Remember

Test yourself on these terms.

Question

psychotherapy (p. 570)
biomedical therapy (p. 570)
eclectic approach (p. 570)
psychoanalysis (p. 570)
resistance (p. 571)
interpretation (p. 571)
transference (p. 571)
psychodynamic therapy (p. 572)
insight therapies (p. 572)
client-centered therapy (p. 573)
active listening (p. 573)
unconditional positive regard (p. 574)
behavior therapy (p. 574)
counterconditioning (p. 575)
exposure therapies (p. 575)
systematic desensitization (p. 575)
virtual reality exposure therapy (p. 576)
aversive conditioning (p. 576)
token economy (p. 577)
cognitive therapy (p. 578)
cognitive-behavioral therapy (CBT) (p. 581)
group therapy (p. 582)
family therapy (p. 582)
evidence-based practice (p. 587)
therapeutic alliance (p. 589)
therapy that applies learning principles to the elimination of unwanted behaviors.
therapy that teaches people new, more adaptive ways of thinking; based on the assumption that thoughts intervene between events and our emotional reactions.
a type of counterconditioning that associates an unpleasant state (such as nausea) with an unwanted behavior (such as drinking alcohol).
Freud's therapeutic technique used in treating psychological disorders. Freud believed the patient's free associations, resistances, dreams, and transferences—and the therapist's interpretations of them—released previously repressed feelings, allowing the patient to gain self-insight.
a type of exposure therapy that associates a pleasant, relaxed state with gradually increasing anxiety-triggering stimuli. Commonly used to treat phobias.
prescribed medications or procedures that act directly on the person's physiology.
a caring, accepting, nonjudgmental attitude, which Carl Rogers believed would help clients develop self-awareness and self-acceptance.
a popular integrative therapy that combines cognitive therapy (changing self-defeating thinking) with behavior therapy (changing behavior).
behavior therapy procedures that use classical conditioning to evoke new responses to stimuli that are triggering unwanted behaviors; include exposure therapies and aversive conditioning.
an approach to psychotherapy that uses techniques from various forms of therapy.
an operant conditioning procedure in which people earn a token of some sort for exhibiting a desired behavior and can later exchange their tokens for various privileges or treats.
clinical decision making that integrates the best available research with clinical expertise and patient characteristics and preferences.
a variety of therapies that aim to improve psychological functioning by increasing a person's awareness of underlying motives and defenses.
treatment involving psychological techniques; consists of interactions between a trained therapist and someone seeking to overcome psychological difficulties or achieve personal growth.
behavioral techniques, such as systematic desensitization and virtual reality exposure therapy, that treat anxieties by exposing people (in imagination or actual situations) to the things they fear and avoid.
a humanistic therapy, developed by Carl Rogers, in which the therapist uses techniques such as active listening within a genuine, accepting, empathic environment to facilitate clients' growth. (Also called person-centered therapy.)
therapy that treats the family as a system. Views an individual's unwanted behaviors as influenced by, or directed at, other family members.
empathic listening in which the listener echoes, restates, and clarifies. A feature of Rogers' client-centered therapy.
a bond of trust and mutual understanding between a therapist and client, who work together constructively to overcome the client's problem.
in psychoanalysis, the analyst's noting supposed dream meanings, resistances, and other significant behaviors and events in order to promote insight.
therapy conducted with groups rather than individuals, permitting therapeutic benefits from group interaction.
in psychoanalysis, the patient's transfer to the analyst of emotions linked with other relationships (such as love or hatred for a parent).
therapy deriving from the psychoanalytic tradition; views individuals as responding to unconscious forces and childhood experiences, and seeks to enhance self-insight.
in psychoanalysis, the blocking from consciousness of anxiety-laden material.
an anxiety treatment that progressively exposes people to electronic simulations of their greatest fears, such as airplane flying, spiders, or public speaking.

Experience the Testing Effect

Test yourself repeatedly throughout your studies. This will not only help you figure out what you know and don’t know; the testing itself will help you learn and remember the information more effectively thanks to the testing effect.

Question 15.1

1. A therapist who helps patients search for the unconscious roots of their problem and offers interpretations of their behaviors, feelings, and dreams is drawing from

A.
B.
C.
D.

Question 15.2

2. therapies are designed to help individuals discover the thoughts and feelings that guide their motivation and behavior.

Question 15.3

3. Compared with psychoanalysts, humanistic therapists are more likely to emphasize

A.
B.
C.
D.

Question 15.4

4. A therapist who restates and clarifies the client's statements is practicing .

Question 15.5

5. The goal of behavior therapy is to

A.
B.
C.
D.

Page 593

Question 15.6

6. Behavior therapies often use techniques, such as systematic desensitization and aversive conditioning, to encourage clients to produce new responses to old stimuli.

Question 15.7

7. The technique of teaches people to relax in the presence of progressively more anxiety-provoking stimuli.

Question 15.8

8. After a near-fatal car accident, Rico developed such an intense fear of driving on the freeway that he takes lengthy alternative routes to work each day. Which psychological therapy might best help Rico overcome his phobia, and why?

ANSWER: Behavior therapies are often the best choice for treating phobias. Viewing Rico's fear of the freeway as a learned response, a behavior therapist might help Rico learn to replace his anxious response to freeway driving with a relaxation response.

Question 15.9

9. At a treatment center, people who display a desired behavior receive coins that they can later exchange for other rewards. This is an example of a(n) .

Question 15.10

10. Cognitive therapy has been especially effective in treating

A.
B.
C.
D.

Question 15.11

11. therapy helps people to change their self-defeating ways of thinking and to act out those changes in their daily behavior.

Question 15.12

12. In family therapy, the therapist assumes that

A.
B.
C.
D.

Question 15.13

13. The most enthusiastic or optimistic view of the effectiveness of psychotherapy comes from

A.
B.
C.
D.

Question 15.14

14. Studies show that ________ therapy is the most effective treatment for most psychological disorders.

A.
B.
C.
D.

Question 15.15

15. What are the three components of evidence-based practice?

ANSWER: research evidence, clinical expertise, and knowledge of the patient

Question 15.16

16. How does the placebo effect bias patients' attitudes about the effectiveness of various therapies?

ANSWER: The placebo effect is the healing power of belief in a treatment. When patients expect a treatment to be effective, they may believe it was.

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