CHAPTER 14 Therapy

• Psychotherapy is treatment involving psychological techniques. It consists of interactions between a trained therapist and a person seeking to overcome 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 and other biological treatments.

• Therapists who take an eclectic approach combine different techniques tailored to the client’s problems.

The Psychological Therapies

• Sigmund Freud’s psychoanalysis aimed to give people self-insight and relief from their disorders by bringing anxiety-laden feelings and thoughts into conscious awareness.

• Techniques included free association, dream analysis, and interpretation of instances of resistance and transference.

• Like psychoanalysis, psychodynamic therapy focuses on childhood experiences, therapist interactions, unconscious feelings, and unresolved conflicts. Yet it is briefer, less expensive, and focuses primarily on current symptom relief. Exploring past relationship troubles may help clients understand the origin of their current difficulties.

• Both psychoanalytic and humanistic therapies 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’ person-centered therapy proposed that therapists’ most important contribution is 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.

• The psychodynamic and humanistic therapies seek to provide insight to help clients address problems. The behavior therapies instead assume that problem behaviors are the problem. The goal of behavior therapists 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.

• A basic operant conditioning concept is that consequences drive our voluntary behaviors. Therapy based on operant conditioning principles therefore uses behavior modification techniques to change unwanted behaviors by positively reinforcing desired behaviors and ignoring or punishing undesirable behaviors.

• Therapists may use a token economy, in which desired behavior earns privileges.

• Cognitive therapies, such as Aaron Beck’s 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 think in healthier 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.

• Group therapy can help more people with less cost than individual therapy. Clients may benefit from learning that others have similar problems and from getting feedback on new ways of behaving.

• Family therapy treats a family as an interactive system and attempts to help family members discover the roles they play and how to learn to communicate more openly and directly.

Evaluating Psychotherapies

• Clients’ and therapists’ positive testimonials cannot prove that psychotherapy is actually effective. Clients justify their investment, tend to speak kindly of their therapists, and often enter therapy in crisis. Sometimes they are healed by time alone. Therapists tend to track only their “success” stories.

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• Outcome research has found that people who remain untreated often improve, but those who receive psychotherapy are more likely to improve, to improve more quickly, and to improve with less chance of a relapse.

• No one psychotherapy is superior to all others. Therapy is most effective for those with clear-cut, specific problems.

• Behavior therapies work best with specific behavior problems, such as bed-wetting, phobias, compulsions, marital problems, and sexual dysfunctions.

• Psychodynamic therapy has been effective for depression and anxiety, nondirective (person-centered) counseling often helps with mild to moderate depression, and cognitive-behavioral therapies have been effective in helping people cope with anxiety, depression, and posttraumatic stress disorder.

• Evidence-based practice integrates the best available research with clinicians’ expertise and patients’ characteristics, preferences, and circumstances.

• All effective psychotherapies offer (1) new hope; (2) a fresh perspective; and (3) an empathic, trusting, caring relationship.

• An emotional bond of trust and understanding between therapist and client (the therapeutic alliance) is an important element in effective therapy.

• Therapists differ from one another and from their clients. These differences may create problems if therapists and clients differ in their cultural or religious perspectives.

• College health centers are generally good starting points for counseling options, and they offer some free services.

• 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.

The Biomedical Therapies

• Our lifestyle influences our brain and body, which affects our mental health.

• Depressed people who undergo a program of aerobic exercise, adequate sleep, light exposure, social engagement, negative-thought reduction, and better nutrition have gained some relief. The biomedical therapies assume that mind and body are a unit: Affect one and you will affect the other.

• Drug therapy is the most widely used biomedical therapy by far.

• Antipsychotic drugs are used in treating schizophrenia and other forms of severe thought disorders; some 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, often in combination with psychotherapy. These drugs can reinforce a person’s tendency to take drugs and can also cause physical problems.

• Antidepressant drugs, which often increase the availability of various neurotransmitters, are used to treat depression, but also anxiety disorders, obsessive-compulsive disorder, and posttraumatic stress disorder, with modest effectiveness. Given their widening use, some professionals prefer the term SSRIs (selective serotonin reuptake inhibitors) for drugs such as Prozac.

• Mood-stabilizing drugs, such as lithium and Depakote, are often prescribed for those with bipolar disorder.

• Studies may use a double-blind procedure to avoid the placebo effect and researchers’ and patients’ potential bias.

• In electroconvulsive therapy (ECT), a brief electric current is sent through the brain of an anesthetized patient. ECT is an effective treatment for severely depressed people who have not responded to other therapy.

• Newer alternative treatments for depression include repetitive transcranial magnetic stimulation (rTMS) and deep brain stimulation.

• Psychosurgery (including very precise micropsychosurgery) removes or destroys brain tissue in hopes of modifying behavior. These irreversible psychosurgical procedures are used only as a last resort. Lobotomies are no longer performed.

Preventing Psychological Disorders and Building Resilience

• Preventive mental health programs are based on the idea that many psychological disorders could be prevented by changing stressful social contexts and teaching people to cope better with stress. This may help them become more resilient, enabling recovery from adversity.

• Community psychologists work to prevent psychological disorders by turning destructive environments into more nurturing places that foster competence, health, and well-being.