LO 1 Outline the history of the treatment of psychological disorders. (p. 518)

One theory suggests that during the Stone Age, trephination, in which holes were drilled through the skull, was done to allow evil spirits to exit the body. In the late 1700s, Philippe Pinel, horrified by the conditions of asylums in Paris, removed the inmates’ chains and insisted they be treated more humanely. In the mid to late 1800s, Dorothea Dix supported the “mental hygiene movement,” a campaign to reform asylums in America. She helped establish and upgrade many state mental hospitals. Deinstitutionalization in the mid-1900s helped reduce the social isolation of people with psychological disorders, resulting in patients integrating into the community.

LO 2 Discuss how the main approaches to therapy differ and identify their common goal. (p. 520)

Insight therapies include psychoanalysis, psychodynamic therapy, and humanistic therapy, which aim to increase awareness of self and the environment. Behavior therapies focus on behavioral change, with the belief that the key to resolving problems is not understanding their origins, but changing the thoughts and behaviors that precede them. Biomedical therapy targets the biological basis of disorders, often using medications. All these approaches share a common goal: They aim to reduce symptoms and increase the quality of life for individuals, whether they seek help for debilitating psychological disorders or simply want to lead happier lives.

LO 3 Describe how psychoanalysis differs from psychodynamic therapy. (p. 521)

Psychoanalysis, the first formal system of psychotherapy, attempts to uncover unconscious conflicts, making it possible to address and work through them. Psychodynamic therapy is an updated form of psychoanalysis; it incorporates many of Freud’s core themes, including the notion that personality characteristics and behavior problems often can be traced to unconscious conflicts. With psychodynamic therapy, therapists see clients once a week for several months rather than many times a week for years. And instead of sitting quietly off to the side, therapists sit facing clients and engage in a two-way dialogue.

LO 4 Outline the principles and characteristics of humanistic therapy. (p. 524)

Humanistic therapy concentrates on the positive aspects of human nature: our powerful desires to form close relationships, treat others with warmth and empathy, and grow as individuals. Humanistic therapists concentrate on current problems and the everyday factors that may contribute to them. Instead of digging up unconscious thoughts and feelings, humanistic therapy emphasizes conscious experience.

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LO 5 Describe person-centered therapy. (p. 525)

Person-centered therapy focuses on achieving one’s full potential. The focus is not therapeutic techniques, but rather creating a warm and accepting client–therapist relationship using a nondirective approach. Sitting face-to-face with the client, the therapist’s main job is to “be there” for the client through empathy, unconditional positive regard, genuineness, and active listening, all important components of building a therapeutic alliance. The main goal of treatment is to reduce the incongruence between the ideal self and the real self.

LO 6 Outline the principles and characteristics of behavior therapy. (p. 527)

Using the learning principles of classical conditioning, operant conditioning, and observational learning, behavior therapy aims to replace maladaptive behaviors with more adaptive behaviors. It incorporates a variety of techniques, including exposure therapy, aversion therapy, systematic desensitization, and behavior modification. Behavior therapy covers a broad range of treatment approaches, and focuses on observable behaviors in the present.

LO 7 Outline the principles and characteristics of cognitive therapy. (p. 531)

The goal of cognitive therapy is to identify maladaptive thinking and help individuals change the way they view the world and relationships. Aaron Beck believed patterns of automatic thoughts and cognitive distortions, such as overgeneralization (thinking that self-contained events will have major repercussions in life), are at the root of psychological disturbances. The aim of cognitive therapy is to help clients recognize and challenge cognitive distortions and illogical thought in short-term, action-oriented, and homework-intensive therapy sessions. Albert Ellis created rational-emotive behavior therapy (REBT), another form of cognitive therapy, to help people identify their irrational or illogical thoughts and convert them into rational ones.

LO 8 Summarize the biomedical interventions and identify their common goal. (p. 534)

Psychopharmacology is the scientific study of how psychotropic medications alter perception, mood, behavior, and other aspects of psychological functioning. Psychotropic drugs include antidepressant, mood-stabilizing, antipsychotic, and antianxiety medications. When severe symptoms do not improve with medication and psychotherapy, other biomedical options are available: electroconvulsive therapy (ECT), which causes seizures in the brain, for cases of severe depression; and neurosurgery, which destroys some portion of the brain or connections between different areas of the brain, only as a last resort. The common goal of biomedical interventions is to treat the biological basis of psychological disorders through physical interventions.

LO 9 Describe how culture interacts with the therapy process. (p. 541)

One challenge of providing therapy is to meet the needs of clients from vastly different cultures. Every client has a unique story and a singular set of psychological needs, but therapists should know the cultural context in which they work and be mindful of the client’s cultural experience. This includes being respectful of cultural norms and sensitive to the many forms of prejudice and discrimination that people can experience. All these personal and cultural factors must be considered in determining which approach will be most effective for a given client.

LO 10 Identify the benefits and challenges of group therapy. (p. 543)

Some of group therapy’s benefits include cost-effectiveness, identification with others, accountability, support, encouragement, and a sense of hope. Challenges include potential conflict among group members and discomfort in expressing oneself in the presence of others.

LO 11 Evaluate the effectiveness of psychotherapy. (p. 544)

In general, psychotherapy “works,” especially if it is long-term. All approaches perform equally well across all disorders. But individuals who are limited by their insurance companies in terms of their choice of therapists and how long they can attend therapy do not see the same improvement as those who are less restricted by their insurance. In addition, people who start therapy but then quit prematurely experience less successful outcomes. The Mental Health Parity and Addiction Equity Act of 2010 requires group health insurance plans to provide mental health treatment benefits equal to those provided for medical treatment.

LO 12 Summarize the strengths and weaknesses of online psychotherapy. (p. 546)

As more people gain access to the Internet and as more therapists try to specialize and make themselves marketable, online therapies have multiplied. E-therapy can mean anything from an e-mail communication between client and therapist to real-time sessions via a webcam. These digital tools are valuable for serving rural areas and providing services to those who would otherwise have no access. Videoconferencing is useful for consultation and supervision. However, online psychotherapy raises many concerns, including licensing and privacy issues, lack of nonverbal cues, and potential problems with developing therapeutic relationships.