Chapter 15: Psychotherapy
Chapter Summary
I. INSIGHT THERAPIES
A. Psychoanalysis/Psychodynamic Therapies - The psychoanalytic method of therapy was
developed by Sigmund Freud to uncover unconscious conflicts and bring them into conscious
awareness. These conflicts were believed to stem from childhood experiences.
1. Goals and Methods of Freudian Psychoanalysis - The five major techniques of
psychoanalysis are free association, dream analysis, identifying resistance, working
through transference, and interpretation. In free association, the patient says whatever
comes to mind, regardless of how painful, embarrassing, or irrelevant it may seem.
Dream analysis is similar to free association, the content of dreams is examined on a
superficial level (manifest content) and a deeper level (latent content) that is presumed
to reveal the true hidden meaning. Resistance is a stage in psychoanalysis where the
patient avoids (resists) the analyst's attempts to bring unconscious material to conscious
awareness. Transference is the process whereby the patient displaces (or transfers) onto
his or her relationship with the therapist emotions experienced in the past--especially
relationships with the mother or father or other important figures. Interpretation is the
psychoanalyst's explanation of the significance of a patient's free associations, dreams,
resistance, and transference. The therapist attempts to tie what has been learned by these
methods to problem patterns of behavior.
2. Evaluating Psychoanalysis - Like psychoanalytic theories of personality,
psychoanalysis has been the subject of great debate. There are two major areas of
criticism. It has limited availability because it is time-consuming, expensive, and
therefore is restricted to a only a small group of people. It has also been criticized for a
lack of scientific credibility, particularly the inability to prove or disprove its theories.
Modern psychodynamic therapies are designed to overcome some of these limitations.
Critical Thinking/Active Learning: What’s Wrong With Movie Portrayals of
Therapy? - Movie portrayals of harmful therapy and unethical therapists can
create dangerous stereotypes and misconceptions. The Prince of Tides is the
backdrop for a discussion of this topic.
B. Cognitive Therapies - emphasizes the importance of faulty thought processes and beliefs in
the creation of problem behaviors.
1. Rational-Emotive Therapy - Ellis’ rational-emotive therapy (RET) performs a type of
cognitive restructuring by examining the belief system intervening between an
activating experience and a consequence. RET assumes that misconceptions within the
belief system can be consciously evaluated and replaced with more effective ways of
thinking.
2. Cognitive-Behavior Therapy - Beck, a cognitive-behavior therapist, takes a more
active approach with clients—emphasizing changes in thought processes along with
changes in behavior. Beck has identified faulty thinking patterns that lead to depression,
among the most important are perception, overgeneralization, magnification, and all-or-
nothing thinking.
3. Evaluating Cognitive Therapy - Evaluations of cognitive therapies find Beck's
procedures particularly effective for relieving depression; Ellis has had success with a
wide variety of disorders. Both Beck and Ellis, however, have been criticized for
ignoring the importance of unconscious processes and the client's history. Some critics
suggest that when cognitive therapies are successful it is because they have also change
behavior.
C. Humanistic Therapies - Humanistic therapies are based on the premise that problems result
when an individual's normal growth potential is blocked.
1. Client-Centered Therapy - In Rogers' client-centered approach, the therapist offers
empathy, unconditional positive regard, genuineness, and active listening as a means of
facilitating personal growth.
2. Evaluating Humanistic Therapy - Humanistic therapies are difficult to evaluate
scientifically, and research on specific therapeutic techniques has had mixed results.
Nevertheless, the therapy seems to help, particularly the newer form known as
experiential.
D. Group, Family, and Marital Therapies - Group and family therapies treat multiple
individuals simultaneously, often applying psychoanalytic, cognitive, humanistic, and/or
behavioral techniques.
1. Benefits of Group Therapy - The members of the group often provide mutual support
and counseling as they work together toward therapeutic goals. They also provide each
other with information from shared insights. Another advantage is the opportunity to
engage in behavioral rehearsal in which group members role-play the significant
individuals in each others lives to allow members to practice new social skills. A
variation on group therapy is the self-help group in which a professional does not guide
the group. Groups of people sharing a common problem meet to give and receive
support.
2. Family Therapies - In family therapy the members of the family are brought together in
order to change maladaptive interactions and so improve interpersonal relationships.
Critical Thinking/Active Learning: Hunting for Good Therapy Films – The
movie Good Will Hunting portrays several therapy techniques used in therapy.
After a brief overview of these techniques, students are presented with an
opportunity to identify a few insight therapy terms that are demonstrated.
II. BEHAVIOR THERAPIES - Behavior therapies use learning principles to change maladaptive
behaviors.
A. Classical Conditioning Techniques - Behavior therapists use classical conditioning
principles to change associations. In systematic desensitization, the client replaces anxiety
with relaxation, and in aversion therapy, an aversive stimulus is paired with maladaptive
behaviors.
B. Operant Conditioning Techniques - Shaping, reinforcement, punishment, and extinction are
used based on principles of contingency between behaviors and consequences.
C. Observational Learning Techniques - Modeling principles are employed by having clients
watch and imitate positive role models.
D. Evaluating Behavior Therapy - Behavior therapies have been successful with a number of
psychological disorders. But they have also been criticized for lack of generalizability, the
chance of symptom substitution, and the questionable ethics of controlling behavior.
III. BIOMEDICAL THERAPIES - Biomedical therapies use biological techniques to relieve
psychological disorders. Three major forms of biomedical therapy are drug therapy,
electroconvulsive therapy (ECT), and psychosurgery.
A. Psychopharmacology – Psychiatric drug therapy is the most common form of biomedical
therapy and has been divided into four major categories: anti-anxiety, anti-psychotic, anti-
depressant, and mood stabilizers. Anti-anxiety drugs, such as, Valium and Xanax, have been
used in the treatment of anxiety disorders; anti-psychotic drugs, such as Thorazine, are used
to relieve or diminish psychotic symptoms, such as schizophrenia; anti-depressants, such as
Elavil, are used to treat depression; and mood stabilizers, such as lithium, are used to stabilize
bipolar disorders. While drug therapy has been responsible for major improvements in many
disorders, there are also problems with overuse, dosage levels, side effects, and patient
cooperation.
B. Electroconvulsive Therapy and Psychosurgery - Electroconvulsive therapy (ECT) is used
as a last resort because it produces brain seizures, can cause memory loss, and because no one
really knows how it works. Today it is used primarily to relieve serious depression, for which
other methods have been ineffective. Psychosurgeries, such as lobotomies, have been
successful in treating certain disorders, but they are highly risky. Modern techniques seek to
alter very circumscribed areas believed to be responsible for specific disorders.
C. Evaluating Biomedical Therapies – Although drug therapies have been successful in
correcting chemical imbalances in many individuals, drug therapies are not without criticism.
The long-term effects, such as, physical dependence and serious side effects are cited.
Because ECT can not be explained and it seems barbaric, it remains controversial.
Psychosurgery has potentially serious or fatal side effects and complications.
IV. THERAPY AND CRITICAL THINKING
A. Therapy Essentials - Psychotherapy is a general term for the various methods designed to
improve psychological functioning and promote adjustment to life. There are numerous
forms of psychotherapy, but they all focus treatment on five basic areas of disturbance –
thoughts, emotions, behaviors, interpersonal and life situations, and biomedical. Students are
asked to reflect on some common myths in the “Try This Yourself” activity.
Applying Psychology at Work: Careers in Mental Health – Six major types of
mental health professionals including their title, degree, and years of required
education and training are highlighted in a summary table (Table 15.1).
Research Highlight: Therapy in the Electronic Age – The newest mental health
therapy, called “telehealth”, has approximately 200 websites and between 350-
1000 online counselors offering counseling, group support chats, e-mail
correspondence, private instant messages, and videoconferencing therapy. Critics
fear the lack of consumer protection from unethical and unsavory practices and
emphasize the importance of face-to-face contact in psychotherapy. Others are
concerned about the lack of confidentiality and the qualifications of the therapist.
Proponents point out that the Internet and other electronic forms of therapy may
sometimes be more effective than traditional therapy, as well as, be the easiest and
most cost efficient way of increasing contact between patients and healthcare
providers.
Gender and Cultural Diversity - Studies of cultural variations in therapy have
found six key features that are culturally universal: naming a problem, qualities of
the therapist, establishing credibility, placing the problems in a familiar
framework, applying techniques to bring relief, and a special time and place.
Individualistic cultures value self and independence while collectivist cultures
focus on interdependence and accepting one’s life. Additional differences
between men and women’s needs in therapy are highlighted.
B. Institutionalization - People believed to be mentally ill and dangerous to themselves or
others can be involuntarily committed to mental hospitals for diagnosis and treatment. Due to
abuses of involuntary commitments and other problems associated with state mental hospitals,
many states practice a policy of de-institutionalization—discharging as many patients as
possible and discouraging admissions. In place of institutionalization, community services
such as Community Mental Health (CMH) centers have been recommended.
C. Evaluating and Finding Therapy - Research on the effectiveness of psychotherapy has
found that 40 to 80 percent of those who receive treatment are better off than those who do
not receive treatment.
Applying Psychology to Everyday Life: What’s Wrong with Movie Portrayals
of Therapy? – Romantic sexual relationships between therapists and their clients
is a common Hollywood theme. The movie Prince of Tides is explored and
students are given the opportunity to think critically about potentially serious and
long-lasting effects of this behavior.