Talk Therapies
Talk Therapies
Describe the core treatment techniques in psychoanalysis and modern psychodynamic treatments.
Describe the core treatment techniques in psychoanalysis and modern psychodynamic treatments. Freudian psychoanalysis works to bring unconscious conflicts into consciousness. The five major techniques of psychoanalysis are free association, dream analysis, analysis of resistance, analysis of transference, and interpretation. Modern psychodynamic therapy is briefer, more directive, and more focused on conscious processes and current problems.
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Summarize the four key qualities of communication in Rogerian therapy.
Summarize the four key qualities of communication in Rogerian therapy. Rogers's client-centered therapy emphasizes empathy (sensitive understanding of another), unconditional positive regard (genuine caring for another based on his or her innate value as an individual), genuineness (therapists' honest sharing of thoughts and feelings), and active listening (reflecting, paraphrasing, and clarifying what the client is saying).
Explain the principles underlying cognitive therapies.
Explain the principles underlying cognitive therapy. Cognitive therapy focuses on changing faulty thought processes and beliefs to treat problem behaviors. Through insight into negative self-talk (the unrealistic things people say to themselves), the therapist can use cognitive restructuring to challenge and change destructive thoughts or inappropriate behaviors. Cognitive-behavior therapy focuses on changing both self-destructive thoughts and self-defeating behaviors.
Free association
According to Freud, when you let your mind wander and remove conscious censorship over thoughts—a process called free association—interesting and even bizarre connections seem to spring into awareness. Freud believed that the first thing to come to a patient's mind is often an important clue to what the person's unconscious wants to conceal. Having the patient recline on a couch, with only the ceiling to look at, is believed to encourage free association (Figure 14.1).
Dream analysis
Recall from Chapter 5 that, according to Freud, our psychological defenses are lowered during sleep. Therefore, our forbidden desires and unconscious conflicts are more freely expressed during dreams. Even while dreaming, however, these feelings and conflicts are recognized as being unacceptable and must be disguised as images that have deeper symbolic meaning. Thus, according to Freudian dream theory, a therapist might interpret a dream of riding a horse or driving a car (the surface description or manifest content) as a desire for, or concern about, sexual intercourse (the hidden, underlying meaning or latent content).
Analysis of resistance
During free association or dream analysis, Freud found that patients often show an inability or unwillingness to discuss or reveal certain memories, thoughts, motives, or experiences. For example, suddenly "forgetting" what they were saying or completely changing the subject. It is the therapist's job to identify these cases of resistance and to help patients face their problems and then learn to deal with them realistically.
Analysis of transference
During psychoanalysis, patients disclose intimate feelings and memories, and the relationship between the therapist and patient may become complex and emotionally charged. As a result, patients often apply (or transfer) some of their unresolved emotions and attitudes from past relationships onto the therapist. The therapist uses this process of transference to help the patient "relive" painful past relationships in a safe, therapeutic setting so that he or she can move on to healthier relationships.
Interpretation
The core of all psychoanalytic therapy is interpretation. During free association, dream analysis, resistance, and transference, the analyst listens closely and tries to find patterns and hidden conflicts. At the right time, the therapist explains (or interprets) the underlying meanings to the client.
Evaluating psychoanalysis/psychodynamic therapies
As you can see, most of psychoanalysis rests on the assumption that repressed memories and unconscious conflicts actually exist. But, as noted in Chapters 7 and 12, this assumption is the subject of a heated, ongoing debate. Critics also point to two other problems with psychoanalysis (Messer & Gurman, 2011; Miltenberger, 2011; Siegel, 2010):

Limited applicability
Psychoanalysis is time consuming (often lasting several years with four to five sessions a week) and expensive. In addition, critics suggest it only applies to a select group of highly motivated, articulate patients with less severe disorders versus more complex disorders, such as schizophrenia.

Lack of scientific credibility
According to critics, it is difficult, if not impossible, to scientifically document the major goals of psychoanalysis. How do we prove (or disprove) the importance of unconscious conflicts or symbolic dream images?

Humanistic Therapies
In contrast to the rather aloof doctor-to-patient approach of the psychoanalytic and psychodynamic therapies, the humanistic approach emphasizes the human characteristics of a person's potential, free will, and self-awareness.
Humanistic therapy assumes that people with problems are suffering from a disruption of their normal growth potential and, hence, their self-concept. When obstacles are removed, the individual is free to become the self-accepting, genuine person everyone is capable of being.
One of the best-known humanistic therapists is Carl Rogers (Rogers, 1961, 1980), who developed an approach that encourages people to actualize their potential and to relate to others in genuine ways. His approach is referred to as client-centered therapy (Rogers used the term client because he believed the label patient implied that one was sick or mentally ill, rather than responsible and competent)
Client-centered therapy, like psychoanalysis and psychodynamic therapies, explores thoughts and feelings as a way to obtain insight into the causes for behaviors. For Rogerian therapists, however, the focus is on providing an accepting atmosphere and encouraging healthy emotional experiences. Clients are responsible for discovering their own maladaptive patterns.
Rogerian therapists create a therapeutic relationship by focusing on four important qualities of communication: empathy, unconditional positive regard, genuineness, and active listening.
Empathy
Using the technique of empathy, a sensitive understanding and sharing of another person's inner experience, therapists pay attention to body language and listen for subtle cues to help them understand the emotional experiences of clients. To help clients explore their feelings, the therapist uses open-ended statements such as "You found that upsetting" or "You haven't been able to decide what to do about this," rather than asking questions or offering explanations.
Unconditional positive regard
Whatever the clients' problems or behaviors, humanistic therapists offer them unconditional positive regard, a genuine caring and nonjudgmental attitude toward people based on their innate value as individuals. They avoid evaluative statements such as "That's good" and "You did the right thing" because such comments imply the therapist is judging the client. Rogers believed that most of us receive conditional acceptance from our parents, teachers, and others, which leads to poor self-concepts and psychological disorders (Figure 14.4).
Genuineness
Humanists believe that when therapists use genuineness and honestly share their thoughts and feelings with their clients, their clients will in turn develop self-trust and honest self-expression.
Active listening
Using active listening, which involves reflecting, paraphrasing, and clarifying what the client is saying, the clinician communicates that he or she is genuinely interested and paying close attention (Figure 14.5). You can use active listening to improve your personal relationships. To reflect is to hold a mirror in front of the person, enabling that person to see him- or herself. To paraphrase is to summarize in different words what the other person is saying. To clarify is to check that both the speaker and listener are on the same wavelength.
Evaluating humanistic theories
Supporters say that there is empirical evidence for the efficacy of client-centered therapy (Benjamin, 2011; Hardcastle et al., 2008; Hazler, 2011; Messer & Gurman, 2011), but critics argue that outcomes such as self-actualization and self-awareness are difficult to test scientifically. In addition, research on specific therapeutic techniques such as "empathy" and "active listening" has had mixed results
Cognitive Therapies
Cognitive therapy assumes that faulty thought processes—beliefs that are irrational, overly demanding, or that fail to match reality—create problem behaviors and emotions.

Like psychoanalysts, cognitive therapists believe that exploring unexamined beliefs can produce insight into the reasons for disturbed thoughts, feelings, and behaviors. However, instead of believing that a change occurs because of insight, cognitive therapists suggest that negative self-talk (the unrealistic things a person tells himself or herself) is most important. Through a process called cognitive restructuring, this insight allows clients to challenge their thoughts, change how they interpret events, and modify maladaptive behaviors

Ellis's REBT
One of the best-known cognitive therapists, Albert Ellis, suggested that irrational beliefs are the primary culprit in problem emotions and behaviors. He proposed that most people mistakenly believe they are unhappy or upset because of external, outside events, such as receiving a bad grade on an exam. Ellis suggested that, in reality, these negative emotions result from faulty interpretations and irrational beliefs (interpreting the bad grade as a sign of your incompetence and an indication that you'll never qualify for graduate school or a good job).
To deal with these irrational beliefs, Ellis developed rational-emotive behavior therapy (REBT)
Ellis's Rational-Emotive Behavior Therapy (REBT)
If you receive a poor performance evaluation at work, you might directly attribute your bad mood to the negative feedback. Psychologist Albert Ellis would argue that the self-talk ("I always mess up") between the event and the feeling is what actually upsets you. Furthermore, ruminating on all the other bad things in your life maintains your negative emotional state, and may even lead to anxiety disorders, depression, and other psychological disorders.
To treat these disorders Albert Ellis developed an A-B-C-D approach: A stands for activating event, B the person's belief system, C the emotional and behavioral consequences, and D disputing erroneous beliefs. During therapy, Ellis helped his clients identify the A, B, C's underlying their irrational beliefs by actively arguing, cajoling, and teasing them—sometimes in very blunt, confrontational language. Once clients recognized their self-defeating thoughts, he worked with them on how to dispute these beliefs and how to create and test out new, rational ones. These new beliefs then change the maladaptive emotions—thus breaking the vicious cycle.
Beck's cognitive-behavior therapy
Another well-known cognitive therapist is Aaron Beck (1976, 2000; Beck & Grant, 2008). Like Ellis, Beck believes that psychological problems result from illogical thinking and destructive self-talk. But Beck seeks to directly confront and change the behaviors associated with destructive cognitions. Beck's cognitive-behavior therapy is designed to reduce both self-destructive thoughts and self-destructive behaviors.
One of the most successful applications of Beck's theory has been in the treatment of depression. (Beck, 1976, 2000; Hollon, 2011; Rosner, 2011; Wright, Thase, & Beck, 2011). Beck has identified several thinking patterns that he believes are associated with depression-prone people:

Selective perception
Focusing selectively on negative events while ignoring positive events. ("Why am I the only person alone at this party?")

Overgeneralization
Overgeneralizing and drawing negative conclusions about one's own self-worth. ("I'm worthless because I failed that exam.")

Magnification
Exaggerating the importance of undesirable events or personal shortcomings, and seeing them as catastrophic and unchangeable. ("She left me, and I'll never find someone like her again!")

All-or-nothing thinking
Seeing things as black-or-white categories—everything is either totally good or bad, right or wrong, a success or a failure. ("If I don't get straight A's, I'll never get a good job.")

Evaluating cognitive therapies
Cognitive therapies are highly effective treatments for depression, anxiety disorders, bulimia nervosa, anger management, addiction, and even some symptoms of schizophrenia and insomnia
Behavior Therapies
LEARNING OBJECTIVES
Identify a key difference between these two classical conditioning techniques: systematic desensitization and aversion therapy.
Identify a key difference between these two classical conditioning techniques: systematic desensitization and aversion therapy. In systematic desensitization, the client replaces a maladaptive response (e.g., anxiety, fear) with an adaptive one (e.g., relaxation). In aversion therapy, an aversive stimulus (e.g., nausea inducing drug) is paired with a maladaptive behavior (e.g., excessive drinking).
Explore how operant conditioning can be used in therapy.
Explore how operant conditioning can be used in therapy. Operant conditioning principles are used in therapy to bring about a desired (or target) behavior. Shaping (providing rewards for successive approximations of the target behavior) and reinforcement (via tokens) are common behavior therapy techniques based on operant conditioning principles.
Summarize how modeling therapy works.
Summarize how modeling therapy works. Clients attain skills or positive behaviors through observation and imitation of appropriate models as they perform desired behaviors. Bandura used modeling therapy to treat snake phobias, and it is also used in social skills training, such as assertiveness.
Describe two major criticisms of behavior therapies.
Describe two major criticisms of behavior therapies. Behavior therapies are criticized for possible lack of generalizability and the questionable ethics of attempting to control behavior.
Classical Conditioning
Behavior therapists use the principles of classical conditioning to decrease maladaptive behaviors by creating new associations to replace the faulty ones. We will explore two techniques based on these principles: systematic desensitization and aversion therapy.

Recall from Chapter 6 that classical conditioning occurs when a neutral stimulus (NS) becomes associated with an unconditioned stimulus (US) to elicit a conditioned response (CR). Sometimes a classically conditioned response, like a fear of driving on busy freeways, becomes so extreme that we call it a "phobia." To treat this phobia, behavior therapists typically use systematic desensitization, which begins with relaxation training, followed by imagining or directly experiencing various versions of a feared object or situation while remaining deeply relaxed (Wolpe & Plaud, 1997) (Figure 14.7).

Operant Conditioning
One operant conditioning technique for eventually bringing about a desired (or target) behavior is shaping—providing rewards for successive approximations of the target behavior (Chapter 6). One of the most successful applications of shaping and reinforcement has been with developing language skills in children with autism. First, the child is rewarded for connecting pictures (or other devices) with words; later, only for using the pictures to communicate with others.
Shaping can also help people acquire social skills and greater assertiveness. If you are painfully shy, for example, a clinician might first ask you to role-play simply saying hello to someone you find attractive. Then you might practice behaviors that gradually lead you to suggest a get-together or date. During such role-playing, or behavior rehearsal, the clinician would give you feedback and reinforcement.
Adaptive behaviors can also be taught or increased with techniques that provide immediate reinforcement in the form of tokens (Miltenberger, 2011; Reed & Martens, 2011). For example, patients in an inpatient treatment facility might at first be given tokens (to be exchanged for primary rewards, such as food, treats, TV time, a private room, or outings) for merely attending group therapy sessions. Later they will be rewarded only for actually participating in the sessions. Eventually, the tokens can be discontinued when the patient receives the reinforcement of being helped by participation in the therapy sessions.
Observational Learning
We all learn many things by observing others. Therapists use this principle in modeling therapy, in which clients are asked to observe and imitate appropriate models as they perform desired behaviors. For example, Albert Bandura and his colleagues (1969) asked clients with snake phobias to watch other (nonphobic) people handle snakes. After only two hours of exposure, over 92% of the phobic observers allowed a snake to crawl over their hands, arms, and necks. When the therapy combines live modeling with direct and gradual practice, it is called participant modeling. This type of modeling also is involved in social skills training and assertiveness training
Evaluating Behavior Therapies
Behavior therapy has been effective with various problems, including phobias, obsessive-compulsive disorder, eating disorders, sexual dysfunctions, autism, intellectual disabilities, and delinquency (Antony & Roemer, 2011; Haynes, O'Brien, & Kaholokula, 2011; Miltenberger, 2011; Truscott, 2010). Critics of behavior therapy, however, raise important questions that fall into two major categories:

Generalizability
Critics argue that in the "real world" patients are not consistently reinforced, and their newly acquired behaviors may disappear. To deal with this possibility, behavior therapists work to gradually shape clients toward real-world rewards.

Ethics
Critics contend that it is unethical for one person to control another's behavior. Behaviorists, however, argue that rewards and punishments already control our behaviors and that behavior therapy actually increases a person's freedom by making these controls overt and by teaching people how to change their own behavior.

Biomedical Therapies
Biomedical Therapies
Identify the major types of drugs used to treat psychological disorders.
Identify the major types of drugs used to treat psychological disorders. Antianxiety drugs (Valium, Ativan) generally are used to treat anxiety disorders, antipsychotic drugs (Thorazine, Haldol) treat the symptoms of psychotic disorders, such as schizophrenia, mood-stabilizer drugs (Tegretol) can help patients with bipolar disorder, and antidepressant drugs (Prozac, Effexor) treat depression, anxiety disorders, and eating disorders.
Explain what happens in electroconvulsive therapy and psychosurgery.
Explain what happens in electroconvulsive therapy and psychosurgery. During electroconvulsive therapy (ECT), an electric current is passed through the brain, which causes a widespread firing of neurons, or convulsions, and changes in the central and peripheral nervous systems. Psychosurgeries, such as a lobotomy, are operative procedures on the brain designed to relieve severe mental health symptoms.
Describe the risks associated with biomedical therapies.
Describe the risks associated with biomedical therapies. Drug therapy is enormously beneficial, but it also has several problems. For example, it offers symptom relief, but few "cures," patients often stop medications once symptoms are relieved, patients may become dependent, and little is known about the side- or long-term effects and drug interactions. In addition, there are potentially dangerous side effects, and possible overuse. ECT is controversial and the benefits remain uncertain. Psychosurgery can have serious or fatal side effects as well as complications with irreversible consequences.
Psychopharmacology
Since the 1950s, drug companies have developed an amazing variety of chemicals to treat abnormal behaviors. In some cases, discoveries from psychopharmacology have helped correct chemical imbalances. In these instances, using a drug is similar to administering insulin to people with diabetes, whose own bodies fail to manufacture enough. In other cases, drugs have been used to relieve or suppress the symptoms of psychological disturbances even when the underlying cause was not thought to be biological. As shown in Table 14.1, psychiatric drugs are classified into four major categories: antianxiety, antipsychotic, mood stabilizer, and antidepressant.
Drug treatments for psychological disorders
Description

Examples (trade names)
Antianxiety drugs (also known as anxiolytics and "minor tranquilizers") lower the sympathetic activity of the brain—the crisis mode of operation—so that anxiety is diminished and the person is calmer and less tense. However, they are potentially dangerous because they can reduce alertness, coordination, and reaction time. They also can have a synergistic (intensifying) effect with other drugs, which may lead to severe drug reactions and even death.

Ativan

Halcion

Librium

Restoril

Valium

Xanax
Antipsychotic drugs, or neuroleptics, reduce the agitated behaviors, hallucinations, delusions, and other symptoms associated with psychotic disorders, such as schizophrenia. Traditional antipsychotics work by decreasing activity at the dopamine receptors in the brain. A large majority of patients markedly improve when treated with antipsychotic drugs.

Clozaril

Haldol

Mellaril

Navane

Prolixin

Risperdal

Seroquel

Thorazine
Mood-stabilizer drugs, such as lithium, help steady the mood swings of those suffering from bipolar disorder, the condition marked by mood swings from mania to depression. Because lithium acts relatively slowly—it can take 3 or 4 weeks before it takes effect—its primary use is in preventing future episodes and helping to break the manic-depressive cycle.

Eskalith CR

Lithobid

Tegretol
Antidepressant drugs are used primarily to treat people with depression, but they are also effective for some anxiety disorders and eating disorders. There are five types of antidepressant drugs: tricyclics, monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and atypical antidepressants. Each class of drugs affects neurochemical pathways in the brain in slightly different ways, increasing or decreasing the availability of certain chemicals. SSRIs (such as Paxil and Prozac) are by far the most commonly prescribed antidepressants. The atypical antidepressants are prescribed for patients who fail to respond or experience undesirable side effects to the other antidepressants.

Anafranil

Celexa

Cymbalta

Effexor

Elavil

Nardil

Norpramin

Parnate

Paxil

Prozac

Tofranil

Wellbutrin

Zoloft

Pitfalls of psychopharmacology
Drug therapy poses several potential problems. First, although drugs may relieve symptoms for some people, they seldom provide "cures." In addition, some patients become physically dependent on the drugs. Also, researchers are still learning about the drugs' long-term effects and potential interactions. Furthermore, psychiatric medications can cause a variety of side effects, ranging from mild fatigue to severe impairments in memory and movement.
A final potential problem with drug treatment is that its relatively low cost and generally fast results have led to its overuse in some cases. One report found that antidepressants are prescribed roughly 50% of the time a patient walks into a psychiatrist's office (Olfson et al., 1998).
Despite the problems associated with them, psychotherapeutic drugs have led to revolutionary changes in mental health. Before the use of drugs, some patients were destined to spend a lifetime in psychiatric institutions. Today, most patients improve enough to return to their homes and live successful lives if they continue to take their medications to prevent relapse.
Challenges to ECT and psychosurgery
As we mentioned, ECT is a controversial treatment for several reasons. However, it does serve as a valuable last resort treatment for severe depression. Interestingly, similar benefits to ECT also may be available thanks to repetitive transcranial magnetic stimulation (rTMS), which delivers a brief (but powerful) electrical current through a coil of wire placed on the head. Unlike ECT, which passes a strong electrical current directly through the brain, the rTMS coil creates a strong magnetic field that is applied to certain areas in the brain. When used to treat depression, the coil is usually placed over the prefrontal cortex, a region linked to deeper parts of the brain that regulate mood. Currently, the benefits of rTMS over ECT remain uncertain, but studies have shown marked improvement in depression, and, unlike with ECT, patients experience no seizures or memory loss (Hadley et al., 2011; Husain & Lisanby, 2011; Polley et al., 2011).
Because all forms of psychosurgery are potentially dangerous and have serious or even fatal side effects, some critics suggest that they should be banned altogether. Furthermore, the consequences are generally irreversible. For these reasons, psychosurgery is considered experimental and remains a highly controversial treatment.
Psychotherapy in Perspective
Psychotherapy in Perspective
Summarize the goals that are common to all major forms of psychotherapy.
Summarize the goals that are common to all forms of psychotherapy. There are numerous forms of therapy. But they all focus treatment on five basic areas of disturbance—thoughts, emotions, behaviors, interpersonal and life situations, and biomedical problems. Many therapists take an eclectic approach and combine techniques from various theories.
Describe the situations in which group, marital, or family therapy would be most appropriate.
Describe the situations in which group, marital, or family therapy would be most appropriate. Therapists often refer their patients to group or self-help therapy and marital or family therapy to supplement individual therapy. Research on group and self-help groups for alcoholism, obesity, and other disorders suggest that they can be very effective. Marital or family therapy is appropriate when a maladaptive marital or family interaction is involved. Family therapy is useful in treating a number of disorders or clinical problems.
Describe some key cross-cultural similarities and differences in therapy.
Describe some key cross-cultural similarities and differences in therapy. Therapies in all cultures share six culturally universal features: naming the problem, qualities of the therapist, establishing credibility, familiar framework, techniques that bring relief, and a special time and place. Important cultural differences in therapies also exist. For example, therapies in individualistic cultures emphasize the self and control over one's life, whereas therapies in collectivist cultures emphasize interdependence. Japan's Naikan therapy is a good example of a collectivistic culture's therapy.
Explain why therapists need to be sensitive to gender issues that pertain to mental illness.
Explain why therapists need to be sensitive to gender issues that pertain to mental illness. Therapists must take five considerations into account when treating women clients: higher rate of diagnosis and treatment of mental disorders, stresses of poverty, stresses of aging, violence against women, and stresses of multiple roles.
eclectic approach
Although most therapists work with clients in several of these areas, the emphasis varies according to the therapist's training (psychodynamic, cognitive, humanistic, behaviorist, or biomedical). Clinicians who regularly borrow freely from various theories are said to take an eclectic approach.
Summary
Talk Therapies


"Talk therapies," shown in the diagram, are forms of psychotherapy that seek to increase insight into clients' difficulties.
ID2376_su14.001
Figure 14.1
Study Organizer
An overview of the three major approaches to therapy

In psychoanalysis, the therapist seeks to identify the patient's unconscious conflicts and to help the patient resolve them. In modern psychodynamic therapy, treatment is briefer and the therapist takes a more directive approach (and puts less emphasis on unconscious childhood memories) than in traditional psychoanalysis.

Humanistic therapy, such as Rogers's client-centered therapy, seeks to maximize personal growth, encouraging people to actualize their potential and relate to others in genuine ways.

Cognitive therapy seeks to help clients challenge faulty thought processes and adjust maladaptive behaviors. Ellis's rational-emotive behavior therapy (REBT) and Beck's cognitive-behavior therapy are important examples of cognitive therapy.
2.

Behavior Therapies


In behavior therapy, the focus is on the problem behavior itself, rather than on any underlying causes. The therapist uses learning principles to change behavior.

Classical conditioning techniques include systematic desensitization and aversion therapy, shown in the diagram.

Figure 14.9
Aversion therapy

Operant conditioning techniques used to increase adaptive behaviors include shaping and reinforcement.

In modeling therapy, clients observe and imitate others who are performing the desired behaviors.
3.

Biomedical Therapies


Biomedical therapies are based on the premise that chemical imbalances or disturbed nervous system functioning contribute to problem behaviors.

Psychopharmacology is the most common form of biomedical therapy. Major classes of drugs used to treat psychological disorders are antianxiety drugs, antipsychotic drugs, mood stabilizer drugs, and antidepressant drugs (shown in the diagram).

Figure 14.11
How antidepressants affect the brain

In electroconvulsive therapy (ECT), an electrical current is passed through the brain, stimulating convulsions that produce changes in the central and peripheral nervous systems. ECT is used primarily in cases of severe depression that do not respond to other treatments.

The most extreme biomedical therapy is psychosurgery. Lobotomy, an older form of psychosurgery, is now outmoded. Recently, psychiatrists have been experimenting with a more limited and precise surgical procedure called deep brain stimulation (DBS).
4.

Psychotherapy in Perspective


All major forms of therapy are designed to address disturbed thoughts, disturbed emotions, disturbed behaviors, interpersonal and life situation difficulties, and biomedical disturbances. Research indicates that, overall, therapy does work (as shown in the graph).

Figure 14.13
Is therapy generally effective?

In group therapy, multiple people meet together to work toward therapeutic goals. A variation is the self-help group, which is not guided by a professional. Therapists often refer their patients to group therapy and self-help groups to supplement individual therapy.

In family therapy, the aim is to change maladaptive family interaction patterns. All members of the family attend therapy sessions, though at times the therapist may see family members individually or in twos or threes.

Therapies in all cultures have certain key features in common; however, there are also important differences among cultures. Therapists must recognize cultural differences in order to build trust with clients and effect behavioral change. Therapists must also be sensitive to possible gender issues in therapy.

Key Terms
behavior therapy A group of techniques based on learning principles that is used to change maladaptive behaviors.

biomedical therapy Using physiological interventions (drugs, electroconvulsive therapy, and psychosurgery) to reduce or alleviate symptoms of psychological disorders.

cognitive therapy Therapy that focuses on changing faulty thought processes and beliefs to treat problem behaviors.

electroconvulsive therapy (ECT) Biomedical therapy in which electrical current is passed through the brain.

family therapy Treatment to change maladaptive interaction patterns within a family.

group therapy A form of therapy in which a number of people meet together to work toward therapeutic goals.

humanistic therapy Therapy that seeks to maximize
personal growth through affective restructuring (emotional readjustment).

modeling therapy A learning technique in which the subject watches and imitates models who demonstrate desirable behaviors.

psychoanalysis Freudian therapy designed to bring unconscious conflicts into conscious awareness; also Freud's theoretical school of thought.

psychodynamic therapy A briefer, more directive contemporary form of psychoanalysis, focusing more on conscious processes and current problems.

psychopharmacology The study of drug effects on the mind and behavior.

psychosurgery Operative procedures on the brain designed to relieve severe mental symptoms that have not responded to other forms of treatment.

psychotherapy Techniques employed to improve
psychological functioning and promote adjustment to life.

Self-Test
Self-Test
Psychoanalysis/psychodynamic, humanistic, and cognitive therapies are often grouped together as ________.
talk therapy
The system of psychotherapy developed by Freud that seeks to bring unconscious conflicts into conscious awareness is known as ________.
psychoanalysis
________ therapy emphasizes conscious processes and current problems.
Psychodynamic
________ therapy seeks to maximize personal growth through affective restructuring.
Humanistic
In Rogerian therapy, the ________ is responsible for discovering maladaptive patterns.
client
The process by which the therapist and client work to change destructive ways of thinking is called ________.
cognitive restructuring
Beck practices ________, which attempts to change not only destructive thoughts and beliefs, but the associated behaviors as well.
cognitive-behavior therapy
The main focus in behavior therapy is to increase ________ and decrease ________.
adaptive behaviors; maladaptive behaviors
The three steps in systematic desensitization include all EXCEPT ________.
practicing relaxation to anxiety-arousing stimuli, starting at the most arousing
The diagram shows an example of the process of ________, through which the man is learning to associate a negative response of nausea with the alcoholic drink.
aversion therapy
Label the four major categories of psychiatric drugs on the chart.
(a)
antianxiety
(b)
antipsychotic
(c)
mood stabilizer
(d)
antidepressant
In electroconvulsive therapy (ECT), ________.
(a)

current is never applied to the left hemisphere
(b)

convulsions activate the amygdala, causing a change in maladaptive emotions
(c)

electrical current passes through a coil of wire placed on the head
(d)

none of the above

none of the above
Label the five most common goals of therapies on the figure.
(a)
disturbed thoughts
(b)
disturbed emotions
(c)
disturbed behaviors
(d)
interpersonal and life situation difficulties
(e)
biomedical disturbances
A(n) ________ group does not have a professional leader, and members assist each other in coping with a specific problem.
self-help
In Japanese ________ therapy, the client is asked to discover personal guilt for having been ungrateful and troublesome to others.
Naikan
Getting stuck in painful or unproductive patterns of behavior:
can be a good reason to consider psychotherapy
For many people, a goal of psychotherapy for many people is:
helping resolve or adjust to everyday problems of living
The hundreds of different approaches to psychotherapy would not fall into the category of:
gene therapy
Therapy that aims to alter brain function in a specific way has been called:
biomedical
Drug treatment of psychological disorders is known as:
psychopharmacology
Biomedical therapies for psychological disorders are carried out by:
physicians
Basic research on learning led to several forms of therapy categorized as:
behavioral
A behavior therapy will use a form of learning (classical or operant conditioning or observational learning) to:
help the patient replace problematic behaviors with more favorable ones
"Talk therapy" that aims to help gain awareness of how particular habits can cause problems is classified as:
insight therapy
Freudian psychoanalysis is based on the therapist helping the patient gain insight into:
unconscious thoughts that cause current problems
The rationale for humanistic therapy is that:
a therapist helps by nurturing the client's self-concept and growth potential
Cognitive therapists help clients:
identify and correct illogical thought patterns behind maladaptive emotions
The founder of cognitive-behavior therapy was:
Aaron T. Beck
Cognitive-behavioral therapy for depression works on:
challenging distortions in thinking which produce feelings of helplessness and hopelessness
Drawing a conclusion about someone based on a small number of instances is:
overgeneralization
When a client learns to identify distorted thinking that increases distressing emotions:
the client can substitute more accurate thinking to lessen distress and react more adaptively
What are the three major categories of therapy?
biomedical, behavior, insight
What is the connection between distorted thoughts and mental distress?
exaggerating a negative experience can create negative feelings
What is the primary target of cognitive-behavior therapy (CBT)?
faulty thought processes
Q 14.1:
The three major categories of psychotherapy are talk therapies, behavior therapies, and
biomedical therapies
Q 14.2:
Which of the following is considered a "talk therapy"?
cognitive-behavioral therapy
Q 14.3:
According to Freud, why must psychoanalysts use the techniques of free association, dream analysis, analyzing resistance, analyzing transference, and interpretation?
because the ego has strong defense mechanisms
Q 14.4:
Assuming that repressed memories and unconscious conflicts actually exist, what is a major problem critics have with psychoanalysis?
It only applies to a select group of patients with less severe disorders.
Q 14.5:
In what ways does modern psychodynamic therapy contrast with psychoanalysis? Select all that apply.
B
The therapist takes a more directive approach.
C
The therapy focuses more on conscious processes.
D
The patient is treated face to face.
Q 14.6:
Humanists who follow Carl Rogers' methods focus on which four important qualities of communication?
empathy, unconditional positive regard, genuineness, and active listening
Q 14.7:
How are psychoanalysis and cognitive therapy similar?
Both seek insight through exploring a client's unexamined beliefs.
Q 14.8:
Which form of therapy involves examining and disputing negative self-talk and harmful beliefs?
Ellis's Rational-Emotive Behavior Therapy (REBT)
Q 14.9:
Which form of therapy involves teaching clients to actively test their thoughts against reality?
Beck's cognitive-behavior therapy
Q 14.10:
A behavioral therapist treats clients by
shifting the balance between present maladaptive behaviors and missing adaptive behaviors
Q 14.11:
Systematic desensitization and aversion therapy have their basis in
classical conditioning
Q 14.12:
How do behavioral therapists make sure their clients' new, learned behaviors continue to be reinforced after therapy ends?
by shaping their clients toward real-world rewards
Q 14.13:
How do aversion therapy and systematic desensitization contrast one another?
Aversion therapy creates anxiety while systematic desensitization extinguishes it.
Q 14.14:
Which type of treatment involves creating a negative response to a stimulus in order to curb an unwanted behavior?
aversion therapy
Q 14.15:
Psychiatric drugs are administered to patients either to correct chemical imbalances or
to relieve psychological symptoms unrelated to biology
Q 14.16:
Which therapies are used only in extreme cases or as a last resort? Select all that apply.
A
repetitive transcranial magnetic stimulation (rTMS)
B
deep brain stimulation (DBS)
C
electroconvulsive therapy (ECT)
Q 14.17:
Which treatment has been stopped altogether because of its damaging effects?
lobotomy
Q 14.18:
Which conclusion about therapy is based on empirical evidence?
Most people with psychological disturbances will benefit from therapy.
Q 14.19:
Which therapy goal does psychoanalysis primarily attempt to address?
changing destructive thoughts
Q 14.20:
While cultural and gender differences matter, they do not impact the effectiveness of therapy.
False