C.17 Chapter 16
Introduction to Therapy and the Psychological Therapies
16-1 How do psychotherapy and the biomedical therapies differ?
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.
16-2 What are the goals and techniques of psychoanalysis, and how have they been adapted in psychodynamic therapy?
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. Interpersonal therapy is a brief 12- to 16-session form of psychodynamic therapy that has been effective in treating depression.
16-3 What are the basic themes of humanistic therapy? What are the specific goals and techniques of Rogers’ client-centered approach?
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.
16-4 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?
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.
16-5 What is the main premise of therapy based on operant conditioning principles, and what are the views of its proponents and critics?
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.
16-6 What are the goals and techniques of cognitive therapy and of cognitive-behavioral therapy?
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 talking in their everyday life.
16-7 What are the aims and benefits of group and family therapies?
Group therapy sessions can help more people and costs 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.
Evaluating Psychotherapies
16-8 Does psychotherapy work? How can we know?
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.
16-9 Are some psychotherapies more effective than others for specific disorders?
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.
16-10 How do alternative therapies fare under scientific scrutiny?
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.
16-11 What three elements are shared by all forms of psychotherapy?
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.
16-12 How do culture and values influence the therapist-client relationship?
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.
16-13 What should a person look for when selecting a therapist?
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.
Biomedical Therapies and Preventing Psychological Disorders
16-14 What are the drug therapies? How do double-blind studies help researchers evaluate a drug’s effectiveness?
Psychopharmacology, the study of drug effects on mind and behavior, has helped make drug therapy the most widely used biomedical therapy. Antipsychotic drugs, used in treating schizophrenia, block dopamine activity. Side effects may include tardive dyskinesia (with involuntary movements of facial muscles, tongue, and limbs) or increased risk of obesity and diabetes. Antianxiety drugs, which depress central nervous system activity, are used to treat anxiety disorders, obsessive-compulsive disorder, and posttraumatic stress disorder. These drugs can be physically and psychologically addictive. Antidepressant drugs, which increase the availability of serotonin and norepinephrine, are used for depression, with modest effectiveness beyond that of placebo drugs. The antidepressants known as selective serotonin reuptake inhibitors (often called SSRI drugs) are now used to treat other disorders, including strokes and anxiety disorders. Lithium and Depakote are mood stabilizers prescribed for those with bipolar disorder. Studies may use a double-blind procedure to avoid the placebo effect and researcher’s bias.
16-15 How are brain stimulation and psychosurgery used in treating specific disorders?
Electroconvulsive therapy (ECT), in which a brief electric current is sent through the brain of an anesthetized patient, is an effective, last-resort treatment for severely depressed people who have not responded to other therapy. Newer alternative treatments for depression include repetitive transcranial magnetic stimulation (rTMS) and, in preliminary clinical experiments, deep-brain stimulation that calms an overactive brain region linked with negative emotions.
Psychosurgery removes or destroys brain tissue in hopes of modifying behavior. Radical psychosurgical procedures such as lobotomy were once popular, but neurosurgeons now rarely perform brain surgery to change behavior or moods. Brain surgery is a last-resort treatment because its effects are irreversible.
16-16 How, by taking care of themselves with a healthy lifestyle, might people find some relief from depression? How does this reflect our being biopsychosocial systems?
Depressed people who undergo a program of aerobic exercise, adequate sleep, light exposure, social engagement, negative-thought reduction, and better nutrition often gain some relief. In our integrated biopsychosocial system, stress affects our body chemistry and health; chemical imbalances can produce depression; and social support and other lifestyle changes can lead to relief of symptoms.
16-17 What is the rationale for preventive mental health programs, and why is it important to develop resilience?
Preventive mental health programs are based on the idea that many psychological disorders could be prevented by changing oppressive, esteem-destroying environments into more benevolent, nurturing environments that foster growth, self-confidence, and resilience. Struggling with challenges can lead to posttraumatic growth. Community psychologists are often active in preventive mental health programs.