The long history of efforts to treat psychological disorders has included a bewildering mix of harsh and gentle methods. Well-meaning individuals have cut holes in people’s heads and restrained, bled, or “beat the devil” out of them. But they also have given warm baths and massages and placed people in sunny, serene environments. They have administered drugs. And they have talked with their patients about childhood experiences, current feelings, and maladaptive thoughts and behaviors.

16-1 How do psychotherapy and the biomedical therapies differ?

Reformers Philippe Pinel (1745–1826) and Dorothea Dix (1802–1887) pushed for gentler, more humane treatments and for constructing mental hospitals. Since the 1950s, the introduction of effective drug therapies and community-based treatment programs have emptied most of those hospitals.

Modern Western therapies can be classified into two main categories:

Some psychologists consider psychotherapy to be a biological treatment, because changing the way we think and behave can prompt physical changes in the brain (Kandel, 2013). Effective psychotherapy is a brain-changing experience.

The care provider’s training and expertise, as well as the disorder itself, influence the choice of treatment. Psychotherapy and medication are often combined. Kay Redfield Jamison received psychotherapy in her meetings with her psychiatrist, and she took medications to control her wild mood swings.

Let’s look first at the psychotherapy options for those treated with “talk therapies.” Each is built on one or more of psychology’s major theories: psychodynamic, humanistic, behavioral, and cognitive. Most of these techniques can be used one-on-one or in groups. Some therapists combine techniques. And like Jamison, many patients also receive psychotherapy combined with medication. Many psychotherapists describe themselves as taking an eclectic approach, using a blend of psychotherapies.

16-2 What are the goals and techniques of psychoanalysis, and how have they been adapted in psychodynamic therapy?

The first major psychological therapy was Sigmund Freud’s psychoanalysis. Although few clinicians today practice therapy as Freud did, his work deserves discussion. It helped form the foundation for treating psychological disorders, partly by influencing modern therapists working from the psychodynamic perspective.

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Freud believed that in therapy, people could achieve healthier, less anxious living by releasing the energy they had previously devoted to id-ego-superego conflicts (Chapter 14). Freud assumed that we do not fully know ourselves. There are threatening things that we seem to want not to know—that we disavow or deny. “We can have loving feelings and hateful feelings toward the same person,” notes Jonathan Shedler (2009), and “we can desire something and also fear it.” Psychoanalysis was Freud’s method of helping people to face such unwelcome facts.

Freud’s therapy aimed to bring patients’ repressed or disowned feelings into conscious awareness. By helping them reclaim their unconscious thoughts and feelings, and by giving them insight into the origins of their disorders, he aimed to help them reduce growth-impeding inner conflicts.

Psychoanalysis is historical reconstruction. Psychoanalytic theory emphasizes the power of childhood experiences to mold the adult. Thus, it aims to unearth one’s past in the hope of unmasking the present. After discarding hypnosis as an unreliable excavator, Freud turned to free association.

Imagine yourself as a patient using free association. You begin by relaxing, perhaps by lying on a couch. As the psychoanalyst sits out of your line of vision, you say aloud whatever comes to mind. At one moment, you’re relating a childhood memory. At another, you’re describing a dream or recent experience. It sounds easy, but soon you notice how often you edit your thoughts as you speak. You pause for a second before uttering an embarrassing thought. You omit what seems trivial, irrelevant, or shameful. Sometimes your mind goes blank or you find yourself unable to remember important details. You may joke or change the subject to something less threatening.

To the analyst, these mental blocks indicate resistance. They hint that anxiety lurks and you are defending against sensitive material. The analyst will note your resistances and then provide insight into their meaning. If offered at the right moment, this interpretation—of, say, your not wanting to talk about your mother—may illuminate the underlying wishes, feelings, and conflicts you are avoiding. The analyst may also offer an explanation of how this resistance fits with other pieces of your psychological puzzle, including those based on analysis of your dream content.

Over many such sessions, your relationship patterns surface in your interaction with your therapist. You may find yourself experiencing strong positive or negative feelings for your analyst. The analyst may suggest you are transferring feelings, such as feelings of dependency or mingled love and anger, that you experienced in earlier relationships with family members or other important people. By exposing such feelings, you may gain insight into your current relationships.

Relatively few North American therapists now offer traditional psychoanalysis. Much of its underlying theory is not supported by scientific research (Chapter 14). Analysts’ interpretations cannot be proven or disproven. And psychoanalysis takes considerable time and money, often years of several sessions per week. Some of these problems have been addressed in the modern psychodynamic perspective that has evolved from psychoanalysis.

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Although influenced by Freud’s ideas, psychodynamic therapists don’t talk much about id, ego, and superego. Instead they try to help people understand their current symptoms. They focus on themes across important relationships, including childhood experiences and the therapist relationship. Rather than lying on a couch, out of the therapist’s line of vision, patients meet with their therapist face-to-face. These sessions take place once or twice a week (rather than several times per week), and often for only a few weeks or months.

In these sessions, patients gain perspective by exploring defended-against thoughts and feelings. Therapist David Shapiro (1999, p. 8) illustrates this with the case of a young man who had told women that he loved them, when he knew that he didn’t. His explanation: They expected it, so he said it. But with his wife, who wishes he would say that he loves her, he finds he “cannot” do that—“I don’t know why, but I can’t.”

Further interactions reveal that he can’t express real love because it would feel “mushy” and “soft” and therefore unmanly. He is “in conflict with himself, and he is cut off from the nature of that conflict.” Shapiro noted that with such patients, who are estranged from themselves, therapists using psychodynamic techniques “are in a position to introduce them to themselves. We can restore their awareness of their own wishes and feelings, and their awareness, as well, of their reactions against those wishes and feelings.”

Psychodynamic therapists may also help reveal past relationship troubles as the origin of current difficulties. Jonathan Shedler (2010a) recalls his patient Jeffrey’s complaints of difficulty getting along with his colleagues and wife, who saw him as hypercritical. Jeffrey then “began responding to me as if I were an unpredictable, angry adversary.” Shedler seized this opportunity to help Jeffrey recognize the relationship pattern, and its roots in the attacks and humiliation he experienced from his alcohol-abusing father—and to work through and let go of this defensive responding to people.

Interpersonal psychotherapy, a brief (12- to 16-session) variation of psychodynamic therapy, has effectively treated depression (Cuijpers, 2011; Markowitz & Weissman, 2012). Although interpersonal psychotherapy aims to help people gain insight into the roots of their difficulties, its goal is symptom relief in the here and now. Rather than focusing mostly on undoing past hurts and offering interpretations, the therapist concentrates primarily on current relationships and on helping people improve their relationship skills.

The case of Anna, a 34-year-old married professional, illustrates these goals. Five months after receiving a promotion, with accompanying increased responsibilities and longer hours, Anna experienced tensions with her husband over his wish for a second child. She began feeling depressed, had trouble sleeping, became irritable, and was gaining weight. A typical psychodynamic therapist might have helped Anna gain insight into her angry impulses and her defenses against anger. An interpersonal therapist would do the same, but would also engage her thinking on more immediate issues—how she could balance work and home, resolve the dispute with her husband, and express her emotions more effectively (Markowitz et al., 1998).

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16-3 What are the basic themes of humanistic therapy? What are the specific goals and techniques of Rogers’ client-centered approach?

The humanistic perspective (Chapter 14) emphasizes people’s inherent potential for self-fulfillment. Like psychodynamic therapies, humanistic therapies have attempted to reduce growth-impeding inner conflicts by providing clients with new insights. Indeed, the psychodynamic and humanistic therapies are often referred to as insight therapies. But humanistic therapies differ from psychoanalytic therapies in many other ways:

Carl Rogers (1902–1987) developed the widely used humanistic technique he called client-centered therapy, which focuses on the person’s conscious self-perceptions. In this nondirective therapy, the therapist listens, without judging or interpreting, and seeks to refrain from directing the client toward certain insights.

Believing that most people possess the resources for growth, Rogers (1961, 1980) encouraged therapists to exhibit genuineness, acceptance, and empathy. When therapists drop their facades and genuinely express their true feelings, when they enable their clients to feel unconditionally accepted, and when they empathically sense and reflect their clients’ feelings, the clients may deepen their self-understanding and self-acceptance (Hill & Nakayama, 2000). As Rogers (1980, p. 10) explained,

Hearing has consequences. When I truly hear a person and the meanings that are important to him at that moment, hearing not simply his words, but him, and when I let him know that I have heard his own private personal meanings, many things happen. There is first of all a grateful look. He feels released. He wants to tell me more about his world. He surges forth in a new sense of freedom. He becomes more open to the process of change.

I have often noticed that the more deeply I hear the meanings of the person, the more there is that happens. Almost always, when a person realizes he has been deeply heard, his eyes moisten. I think in some real sense he is weeping for joy. It is as though he were saying, “Thank God, somebody heard me. Someone knows what it’s like to be me.”

“Hearing” refers to Rogers’ technique of active listening—echoing, restating, and seeking clarification of what the person expresses (verbally or nonverbally) and acknowledging the expressed feelings. Active listening is now an accepted part of therapeutic counseling practices in many schools, colleges, and clinics. The counselor listens attentively and interrupts only to restate and confirm feelings, to accept what is being expressed, or to seek clarification. The following brief excerpt between Rogers and a male client illustrates how he sought to provide a psychological mirror that would help clients see themselves more clearly.

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Can a therapist be a perfect mirror, without selecting and interpreting what is reflected? Rogers conceded that one cannot be totally nondirective. Nevertheless, he believed that the therapist’s most important contribution is to accept and understand the client. Given a nonjudgmental, grace-filled environment that provides unconditional positive regard, people may accept even their worst traits and feel valued and whole.

If you want to listen more actively in your own relationships, three Rogers-inspired hints may help:

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?

The insight therapies assume that many psychological problems diminish as self-awareness grows. Psychodynamic therapists expect problems to subside as people gain insight into their unresolved and unconscious tensions. Humanistic therapists expect problems to diminish as people get in touch with their feelings. Proponents of behavior therapies, however, doubt the healing power of self-awareness. (You can become aware of why you are highly anxious during exams and still be anxious.) They assume that problem behaviors are the problems, and the application of learning principles can eliminate them. Rather than delving deeply below the surface looking for inner causes, behavior therapists view maladaptive symptoms— such as phobias or sexual dysfunctions—as learned behaviors that can be replaced by constructive behaviors.

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One cluster of behavior therapies derives from principles developed in Ivan Pavlov’s early twentieth-century conditioning experiments (Chapter 7). As Pavlov and others showed, we learn various behaviors and emotions through classical conditioning. Could maladaptive symptoms be examples of conditioned responses? If so, might reconditioning be a solution? Learning theorist O. H. Mowrer thought so and developed a successful conditioning therapy for chronic bed-wetters. The child sleeps on a liquid-sensitive pad connected to an alarm. Moisture on the pad triggers the alarm, waking the child. With sufficient repetition, this association of bladder relaxation with waking up stops the bed-wetting. In three out of four cases the treatment is effective, and the success provides a boost to the child’s self-image (Christophersen & Edwards, 1992; Houts et al., 1994).

Another example: If a claustrophobic fear of elevators is a learned aversion to being in a confined space, then might one unlearn that association by reconditioning to replace the fear response? Counterconditioning pairs the trigger stimulus (in this case, the enclosed space of the elevator) with a new response (relaxation) that is incompatible with fear. Two specific counterconditioning techniques—exposure therapy and aversive conditioning—have successfully counterconditioned people with such fears.

Exposure Therapies Picture this scene reported in 1924 by behaviorist psychologist Mary Cover Jones: Three-year-old Peter is petrified of rabbits and other furry objects. Jones plans to replace Peter’s fear of rabbits with a conditioned response incompatible with fear. Her strategy is to associate the fear-evoking rabbit with the pleasurable, relaxed response associated with eating.

As Peter begins his midafternoon snack, Jones introduces a caged rabbit on the other side of the huge room. Peter, eagerly munching away on his crackers and drinking his milk, hardly notices. On succeeding days, she gradually moves the rabbit closer and closer. Within two months, Peter is tolerating the rabbit in his lap, even stroking it while he eats. Moreover, his fear of other furry objects subsides as well, having been countered, or replaced, by a relaxed state that cannot coexist with fear (Fisher, 1984; Jones, 1924).

Unfortunately for those who might have been helped by her counterconditioning procedures, Jones’ story of Peter and the rabbit did not immediately become part of psychology’s lore. It was more than 30 years later that psychiatrist Joseph Wolpe (1958; Wolpe & Plaud, 1997) refined Jones’ technique into what are now the most widely used types of behavior therapies: exposure therapies, which expose people to what they normally avoid or escape (behaviors that get reinforced by reduced anxiety). Exposure therapies have them face their fear, and thus overcome their fear of the fear response itself. As people can habituate to the sound of a train passing their new apartment, so, with repeated exposure, can they become less anxiously responsive to things that once petrified them (Barrera et al., 2013; Foa et al., 2013).

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One widely used exposure therapy is systematic desensitization. Wolpe assumed, as did Jones, that you cannot be simultaneously anxious and relaxed. Therefore, if you can repeatedly relax when facing anxiety-provoking stimuli, you can gradually eliminate your anxiety. The trick is to proceed gradually. Imagine yourself afraid of public speaking. A behavior therapist might first ask for your help in constructing a hierarchy of anxiety-triggering speaking situations. Yours might range from mildly anxiety-provoking situations, perhaps speaking up in a small group of friends, to panic-provoking situations, such as having to address a large audience.

Next, using progressive relaxation, the therapist would train you to relax one muscle group after another, until you achieve a blissful state of complete relaxation and comfort. Then the therapist would ask you to imagine, with your eyes closed, a mildly anxiety-arousing situation: You are having coffee with a group of friends and are trying to decide whether to speak up. If imagining the scene causes you to feel any anxiety, you would signal your tension by raising your finger, and the therapist would instruct you to switch off the mental image and go back to deep relaxation. This imagined scene is repeatedly paired with relaxation until you feel no trace of anxiety.

The therapist would progress up the constructed anxiety hierarchy, using the relaxed state to desensitize you to each imagined situation. After several sessions, you move to actual situations and practice what you had only imagined before, beginning with relatively easy tasks and gradually moving to more anxiety-filled ones. Conquering your anxiety in an actual situation, not just in your imagination, raises your self-confidence (Foa & Kozak, 1986; Williams, 1987). Eventually, you may even become a confident public speaker. Often people fear not just a situation, such as public speaking, but also being incapacitated by their own fear response. As their fear subsides, so also does their fear of the fear.

When an anxiety-arousing situation is too expensive, difficult, or embarrassing to re-create virtual reality exposure therapy offers an efficient middle ground. Wearing a head-mounted display unit that projects a three-dimensional virtual world, you would view a lifelike series of scenes that would be tailored to your particular fear and that shift as your head turns. Experiments led by several research teams have treated many different people with many different fears—flying, heights, particular animals, and public speaking (Parsons & Rizzo, 2008). People who fear flying, for example, can peer out a virtual window of a simulated plane, feel vibrations, and hear the engine roar as the plane taxis down the runway and takes off. In studies comparing control groups with people experiencing virtual reality exposure therapy, the therapy has provided relief from real-life fear (Gonçalves et al., 2012; Opriş et al., 2012).

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Aversive Conditioning In systematic desensitization, the goal is substituting a positive (relaxed) response for a negative (fearful) response to a harmless stimulus. In aversive conditioning, the goal is substituting a negative (aversive) response for a positive response to a harmful stimulus (such as alcohol). Thus, aversive conditioning is the reverse of systematic desensitization—it seeks to condition an aversion to something the person should avoid.

The procedure is simple: It associates the unwanted behavior with unpleasant feelings. To treat nail biting, one can paint the fingernails with a nasty-tasting nail polish (Baskind, 1997). To treat alcohol use disorder, an aversion therapist offers the client appealing drinks laced with a drug that produces severe nausea. By linking alcohol with violent nausea (recall the taste-aversion experiments with rats and coyotes in Chapter 7), the therapist seeks to transform the person’s reaction to alcohol from positive to negative (FIGURE 16.1).

Does aversive conditioning work? In the short run it may. Arthur Wiens and Carol Menustik (1983) studied 685 hospital patients with alcohol use disorder who completed an aversion therapy program. One year later, after returning for several booster treatments of alcohol-sickness pairings, 63 percent were still successfully abstaining. But after three years, only 33 percent had remained abstinent.

The problem is that in therapy (as in research), cognition influences conditioning. People know that outside the therapist’s office they can drink without fear of nausea. Their ability to discriminate between the aversive conditioning situation and all other situations can limit the treatment’s effectiveness. Thus, therapists often use aversive conditioning in combination with other treatments.

16-5 What is the main premise of therapy based on operant conditioning principles, and what are the views of its proponents and critics?

The work of B. F. Skinner and others teaches us a basic principle of operant conditioning: Voluntary behaviors are strongly influenced by their consequences. Knowing this, some behavior therapists practice behavior modification. They reinforce desired behaviors, and they withhold reinforcement for undesired behaviors. Using operant conditioning to solve specific behavior problems has raised hopes for some otherwise hopeless cases. Children with intellectual disabilities have been taught to care for themselves. Socially withdrawn children with autism spectrum disorder (ASD) have learned to interact. People with schizophrenia have been helped to behave more rationally in their hospital ward. In such cases, therapists use positive reinforcers to shape behavior in a step-by-step manner, rewarding closer and closer approximations of the desired behavior.

In extreme cases, treatment must be intensive. One study worked with 19 withdrawn, uncommunicative 3-year-olds with ASD. Each participated in a 2-year program in which their parents spent 40 hours a week attempting to shape their behavior (Lovaas, 1987). The combination of positively reinforcing desired behaviors, and ignoring or punishing aggressive and self-abusive behaviors, worked wonders for some. By first grade, 9 of the 19 children were functioning successfully in school and exhibiting normal intelligence. In a group of 40 comparable children not undergoing this effortful treatment, only one showed similar improvement. (Ensuing studies focused on the effective aspect—positive reinforcement.)

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Rewards used to modify behavior vary. For some people, the reinforcing power of attention or praise is sufficient. Others require concrete rewards, such as food. In institutional settings, therapists may create a token economy. When people display appropriate behavior, such as getting out of bed, washing, dressing, eating, talking coherently, cleaning up their rooms, or playing cooperatively, they receive a token or plastic coin as a positive reinforcer. Later, they can exchange their accumulated tokens for various rewards, such as candy, TV time, trips to town, or better living quarters. Token economies have been successfully applied in various settings (homes, classrooms, hospitals, institutions for juvenile offenders) and among members of various populations (including disturbed children and people with schizophrenia and other mental disabilities).

Critics of behavior modification express two concerns. The first is practical: How durable are the behaviors? Will people become so dependent on extrinsic rewards that the appropriate behaviors will stop when the reinforcers stop? Proponents of behavior modification believe the behaviors will endure if therapists wean patients from the tokens by shifting them toward other, real-life rewards, such as social approval. They also point out that the appropriate behaviors themselves can be intrinsically rewarding. For example, as a withdrawn person becomes more socially competent, the intrinsic satisfactions of social interaction may help the person maintain the behavior.

The second concern is ethical: Is it right for one human to control another’s behavior? Those who set up token economies deprive people of something they desire and decide which behaviors to reinforce. To critics, this whole process has an authoritarian taint. Advocates reply that some patients request the therapy. Moreover, control already exists; rewards and punishers are already maintaining destructive behavior patterns. So why not reinforce adaptive behavior instead? Treatment with positive rewards is more humane than being institutionalized or punished, advocates argue, and the right to effective treatment and an improved life justifies temporary deprivation.

16-6 What are the goals and techniques of cognitive therapy and of cognitive-behavioral therapy?

We have seen how behavior therapists treat specific fears and problem behaviors. But how do they deal with depressive disorders? Or with generalized anxiety, in which anxiety has no focus? Behavior therapists treating these less clearly defined psychological problems have had help from the same cognitive revolution that has profoundly changed other areas of psychology during the last half-century.

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The cognitive therapies assume that our thinking colors our feelings (FIGURE 16.2). Between an event and our response lies the mind. Self-blaming and overgeneralized explanations of bad events are often an integral part of the vicious cycle of depression. The depressed person interprets a suggestion as criticism, disagreement as dislike, praise as flattery, friendliness as pity. Ruminating on such thoughts sustains the negative thinking. If such thinking patterns can be learned, then surely they can be replaced. Cognitive therapies therefore teach people new, more constructive ways of thinking. If people are miserable, they can be helped to change their minds.

Cognitive therapist Aaron Beck believes that changing people’s thinking can change their functioning. When Beck analyzed depressed people’s dreams, he found recurring negative themes of loss, rejection, and abandonment that extended into their waking thoughts. Such negativity even extends into therapy, as clients recall and rehearse their failings and worst impulses (Kelly, 2000). With cognitive therapy, Beck and his colleagues (1979) sought to reverse clients’ catastrophizing beliefs about themselves, their situations, and their futures. Gentle questioning seeks to reveal irrational thinking, and then to persuade people to remove the dark glasses through which they view life (Beck et al., 1979, pp. 145–146):

We often think in words. Therefore, getting people to change what they say to themselves is an effective way to change their thinking. Perhaps you can identify with the anxious students who, before an exam, make matters worse with self-defeating thoughts: “This exam’s probably going to be impossible. All these other students seem so relaxed and confident. I wish I were better prepared. Anyhow, I’m so nervous I’ll forget everything.” To change such negative self-talk, Donald Meichenbaum (1977, 1985) offered stress inoculation training: teaching people to restructure their thinking in stressful situations. Sometimes it may be enough simply to say more positive things to oneself: “Relax. The exam may be hard, but it will be hard for everyone else, too. I studied harder than most people. Besides, I don’t need a perfect score to get a good grade.” After being trained to dispute their negative thoughts, depression-prone children, teens, and college students exhibit a greatly reduced rate of future depression (Reivich et al., 2013; Seligman et al., 2009). To a large extent, it is the thought that counts. TABLE 16.1 provides a sampling of techniques commonly used in cognitive therapy.

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It’s not just depressed people who can benefit from positive self-talk. We all talk to ourselves (“Where did I leave the keys?” “I wish I hadn’t said that”). The findings of nearly three dozen sport psychology studies show that self-talk interventions can enhance the learning of athletic skills (Hatzigeorgiadas et al., 2011). For example, novice basketball players may be trained to think “focus” and “follow through,” swimmers to think “high elbow,” and tennis players to think “look at the ball.”

Cognitive-behavioral therapy (CBT) today’s most widely practiced psychotherapy, aims not only to alter the way people think (cognitive therapy), but also to alter the way they act (behavior therapy). It seeks to make people aware of their irrational negative thinking, to replace it with new ways of thinking, and to practice the more positive approach in everyday settings. Behavioral change is typically addressed first, followed by sessions on cognitive change; the therapy concludes with a focus on maintaining both and preventing relapses.

Anxiety, depressive disorders, and bipolar disorder share a common problem: emotion regulation (Aldao & Nolen-Hoeksema, 2010). An effective CBT program for these emotional disorders trains people both to replace their catastrophizing thinking with more realistic appraisals, and, as homework, to practice behaviors that are incompatible with their problem (Kazantzis et al., 2010a,b; Moses & Barlow, 2006). A person might, for example, keep a log of daily situations associated with negative and positive emotions, and engage more in activities that lead them to feeling good. Or those who fear social situations might be assigned to practice approaching people.

CBT may also be useful with obsessive-compulsive disorder. In one study, people learned to prevent their compulsive behaviors by relabeling their obsessive thoughts (Schwartz et al., 1996). Feeling the urge to wash their hands again, they would tell themselves, “I’m having a compulsive urge,” and attribute it to their brain’s abnormal activity, as previously viewed in their PET scans. Instead of giving in to the urge, they would then spend 15 minutes in an enjoyable, alternative behavior, such as practicing an instrument, taking a walk, or gardening. This helped “unstick” the brain by shifting attention and engaging other brain areas. For two or three months, the weekly therapy sessions continued, with relabeling and refocusing practice at home. By the study’s end, most participants’ symptoms had diminished and their PET scans revealed normalized brain activity. Many other studies confirm CBT’s effectiveness for treating anxiety, depression, and anorexia or bulimia nervosa (Covin et al., 2008; Zalta, 2011).

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Studies have also found that cognitive-behavioral skills can be taught and therapy can be effectively conducted over the Internet (Andersson et al., 2012; Stross, 2011). To make psychological treatment more accessible and affordable, some mental health experts advocate phone-based interventions, web-based skill training, work-setting treatment, and self-help efforts facilitated by groups, books, and even phone apps (Kazdin & Blase, 2011a,b; Merry et al., 2012; Teachman, 2014). Skype therapy may lack eye contact, but it means “the therapist can see you now”—anywhere and anytime.

16-7 What are the aims and benefits of group and family therapies?

Except for traditional psychoanalysis, most therapies may also occur in small groups. Group therapy does not provide the same degree of therapist involvement with each client. However, it offers many benefits:

One special type of group interaction, family therapy, assumes that no person is an island: We live and grow in relation to others, especially our families. We struggle to differentiate ourselves from our families, but we also need to connect with them emotionally. Some of our problem behaviors arise from the tension between these two tendencies, which can create family stress.

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Unlike most psychotherapy, which focuses on what happens inside the person’s own skin, family therapists work with multiple family members to heal relationships and to mobilize family resources. They tend to view the family as a system in which each person’s actions trigger reactions from others, and they help family members discover their role within their family’s social system. A child’s rebellion, for example, affects and is affected by other family tensions. Therapists also attempt—usually with some success, research suggests—to open up communication within the family or to help family members discover new ways of preventing or resolving conflicts (Hazelrigg et al., 1987; Shadish et al., 1993).

Many people also participate in self-help and support groups (Yalom, 1985). One analysis of online support groups and more than 14,000 self-help groups reported that most support groups focus on stigmatized or hard-to-discuss illnesses (Davison et al., 2000). AIDS patients, for example, are 250 times more likely than hypertension patients to be in support groups. Those struggling with anorexia and alcohol use disorder often join groups; those with migraines and ulcers usually do not. People with hearing loss have national organizations with local chapters; people with vision loss more often cope on their own.

The grandparent of support groups, Alcoholics Anonymous (AA), reports having 2.1 million members in 115,000 groups worldwide. Its famous 12-step program, emulated by many other self-help groups, asks members to admit their powerlessness, to seek help from a higher power and from one another, and (the twelfth step) to take the message to others in need of it. In one eight-year, $27 million investigation, AA participants reduced their drinking sharply, although so did those assigned to cognitive-behavioral therapy or to an alternative therapy (Project Match, 1997). Other studies have similarly found that 12-step programs such as AA have helped reduce alcohol use disorder comparably to other treatment interventions (Ferri et al., 2006; Moos & Moos, 2005). Those whose personal stories include a “redemptive narrative”—who see something good as having come from their experience—more often sustain sobriety (Dunlop & Tracy, 2013). Also, the more meetings members attend, the greater their alcohol abstinence (Moos & Moos, 2006). In one study of 2300 veterans who sought treatment for alcohol use disorder, a high level of AA involvement was followed by diminished alcohol problems (McKellar et al., 2003).

In an individualistic age, with more and more people living alone or feeling isolated, the popularity of support groups—for the addicted, the bereaved, the divorced, or simply those seeking fellowship and growth—seems to reflect a longing for community and connectedness. More than 100 million Americans belong to small religious, interest, or self-help groups that meet regularly—and 9 in 10 report that group members “support each other emotionally” (Gallup, 1994).

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For a synopsis of the modern forms of psychotherapy we’ve been discussing, see TABLE 16.2 below.

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LEARNING OBJECTIVES

RETRIEVAL PRACTICE Take a moment to answer each of these Learning Objective Questions (repeated here from within this section). Then click the 'show answer' button to check your answers. Research suggests that trying to answer these questions on your own will improve your long-term retention (McDaniel et al., 2009).

16-1 How do psychotherapy and the biomedical therapies differ?

16-2 What are the goals and techniques of psychoanalysis, and how have they been adapted in psychodynamic therapy?

16-3 What are the basic themes of humanistic therapy? What are the specific goals and techniques of Rogers’ client-centered approach?

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?

16-5 What is the main premise of therapy based on operant conditioning principles, and what are the views of its proponents and critics?

16-6 What are the goals and techniques of cognitive therapy and of cognitive-behavioral therapy?

16-7 What are the aims and benefits of group and family therapies?

TERMS AND CONCEPTS TO REMEMBER

RETRIEVAL PRACTICE Match each of the terms on the left with its definition on the right. Click on the term first and then click on the matching definition. As you match them correctly they will move to the bottom of the activity.

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