Comprehensive view of psychotherapies

Therapy Comes in Many FormsTherapy Comes in Many Forms
 Many sources and types of treatment areMany sources and types of treatment are
availableavailable
 There are two broad categories of therapyThere are two broad categories of therapy
• Somatic therapySomatic therapy
 Treating psychological disorders by treating theTreating psychological disorders by treating the
bodybody
 Somatic therapy often involves methods thatSomatic therapy often involves methods that
affect hormone levels and brain chemistryaffect hormone levels and brain chemistry

• PsychotherapyPsychotherapy
 Treatment of psychological problemsTreatment of psychological problems
through psychological techniquesthrough psychological techniques
 It is a change-oriented processIt is a change-oriented process
 Its goal is to teach people to cope betterIts goal is to teach people to cope better
and lead more fulfilling livesand lead more fulfilling lives
 It does so by teaching people to relieveIt does so by teaching people to relieve
stress, improve interpersonalstress, improve interpersonal
communication, understand previous lifecommunication, understand previous life
events, and/or modify their thinkingevents, and/or modify their thinking
Therapy Comes in Many Forms

Is Psychotherapy Necessary andIs Psychotherapy Necessary and
Effective?Effective?
 Does psychotherapy simply createDoes psychotherapy simply create
placebo effect?placebo effect?
• AA placebo effectplacebo effect is a nonspecificis a nonspecific
improvement as a result of a person’simprovement as a result of a person’s
expectations of changeexpectations of change
 It is not a result of a therapeuticIt is not a result of a therapeutic
treatmenttreatment
 Some patients in psychotherapy maySome patients in psychotherapy may
show relief from their symptoms simplyshow relief from their symptoms simply
because they are in therapy and maybecause they are in therapy and may

Is Psychotherapy Effective?Is Psychotherapy Effective?
• Researchers must determine ifResearchers must determine if
improvements are due to expectations orimprovements are due to expectations or
real benefits of therapyreal benefits of therapy
• The double-blind technique helpsThe double-blind technique helps
distinguish between improvements due todistinguish between improvements due to
expectations or therapyexpectations or therapy
 Some patients in psychotherapy may showSome patients in psychotherapy may show
relief from their symptoms simply becauserelief from their symptoms simply because
they are in therapy and may expectthey are in therapy and may expect
changechange
 The placebo effect complicates research onThe placebo effect complicates research on
therapy effectivenesstherapy effectiveness

Is Psychotherapy Effective?Is Psychotherapy Effective?
• TheThe double-blind eliminates any potentialdouble-blind eliminates any potential
bias by reducing demand characteristicsbias by reducing demand characteristics
 The double-blind technique helps
distinguish between improvements due to
expectations or therapy
 In the double-blind technique neither the
experimenter nor participants know who is in the
experimental or control groups

 The double-blind eliminates any potentialThe double-blind eliminates any potential
bias by reducing demand characteristicsbias by reducing demand characteristics
• Demand characteristicsDemand characteristics are elements of anare elements of an
experiment that might bias the participantexperiment that might bias the participant
to act in a certain wayto act in a certain way
 By perceiving the situation in a certain way,By perceiving the situation in a certain way,
or becoming aware of the purpose of theor becoming aware of the purpose of the
studystudy
 Demand characteristics distort the resultsDemand characteristics distort the results
of a studyof a study
Is Psychotherapy Effective?

Is Psychotherapy Effective?
 Demand characteristics distort theDemand characteristics distort the
results of a studyresults of a study
 Research studies that compareResearch studies that compare
psychotherapy and placebopsychotherapy and placebo
treatment show the therapies aretreatment show the therapies are
consistently more effectiveconsistently more effective

Research on PsychotherapyResearch on Psychotherapy
 In a 1952 paper, Hans EysenckIn a 1952 paper, Hans Eysenck
challenged the effectiveness ofchallenged the effectiveness of
psychotherapypsychotherapy
• He claimed that it produced no greaterHe claimed that it produced no greater
change in maladjustment than natural lifechange in maladjustment than natural life
experiencesexperiences
• Thousands of studies investigating theThousands of studies investigating the
effectiveness of therapy followedeffectiveness of therapy followed
• These studies, and analyses usingThese studies, and analyses using
sophisticated statistical techniques, foundsophisticated statistical techniques, found
psychotherapy to be effectivepsychotherapy to be effective

 These studies, andThese studies, and
analyses usinganalyses using
sophisticatedsophisticated
statisticalstatistical
techniques, foundtechniques, found
psychotherapy topsychotherapy to
be effectivebe effective
 Effectiveness andEffectiveness and
the client’s speedthe client’s speed
of response varyof response vary
with the type ofwith the type of
problemproblem
 Is one type ofIs one type of
therapy moretherapy more
effective?effective?
• Many researchersMany researchers
contend that mostcontend that most
psychotherapies arepsychotherapies are
equally effectiveequally effective
• If most therapiesIf most therapies
are effective, thereare effective, there
must be a commonmust be a common
underlyingunderlying
component makingcomponent making
them successful

 If most therapies are effective, there mustIf most therapies are effective, there must
be a common underlying componentbe a common underlying component
making them successfulmaking them successful
• Researchers are seeking to systematizeResearchers are seeking to systematize
research strategies to investigate theresearch strategies to investigate the
effectiveness of therapieseffectiveness of therapies
• This research will lead to a clearer picture ofThis research will lead to a clearer picture of
which approaches are best for certain disorderswhich approaches are best for certain disorders
and clients of various ages and ethnic groupsand clients of various ages and ethnic groups

Which Therapy, Which Therapist?Which Therapy, Which Therapist?
 There are hundreds of types ofThere are hundreds of types of
therapytherapy
• Some focus on individuals, some onSome focus on individuals, some on
groups (group therapy) and others ongroups (group therapy) and others on
families (family therapy)families (family therapy)
• Community psychologistsCommunity psychologists focus on wholefocus on whole
communitiescommunities

Which Therapy?Which Therapy?
 CommunityCommunity
psychologistspsychologists
focus on wholefocus on whole
communitiescommunities
 They try toThey try to
develop action-develop action-
orientedoriented
approaches toapproaches to
individual andindividual and
social problemssocial problems
 A therapist’sA therapist’s
training usuallytraining usually
determines thedetermines the
approach takenapproach taken
 Many therapistsMany therapists
take antake an eclecticeclectic
approachapproach,,
combiningcombining
differentdifferent
techniquestechniques

 A number of specificA number of specific
psychotherapeutic approaches are inpsychotherapeutic approaches are in
use todayuse today
• Psychodynamically based approachesPsychodynamically based approaches
are based on Freud’s ideasare based on Freud’s ideas
 Psychodynamic approaches aim to helpPsychodynamic approaches aim to help
patients understand the motivationspatients understand the motivations
underlying their behaviorunderlying their behavior
 They assume abnormal behavior occursThey assume abnormal behavior occurs
when people do not understandwhen people do not understand
themselvesthemselves

• Humanistic approachesHumanistic approaches assumeassume
people are essentially goodpeople are essentially good
 Humanistic approaches try to helpHumanistic approaches try to help
people realize their full potential andpeople realize their full potential and
find meaning in lifefind meaning in life
• Behavior therapyBehavior therapy is based on theis based on the
assumption most behaviors areassumption most behaviors are
learnedlearned
 Behavior therapists encourage clientsBehavior therapists encourage clients
to learn new adaptive behaviorsto learn new adaptive behaviors
Which Therapy?

• Cognitive therapyCognitive therapy focuses on changingfocuses on changing
a client’s behavior by changinga client’s behavior by changing
thoughts and perceptionsthoughts and perceptions
 A new approach,A new approach, psychotherapypsychotherapy
integrationintegration, is now emerging, is now emerging
• It is more than an eclectic approach,It is more than an eclectic approach,
because the goal is to integrate theoriesbecause the goal is to integrate theories
into a new approachinto a new approach
• Research on psychotherapy integration isResearch on psychotherapy integration is
relatively scarcerelatively scarce
Which Therapy?

 The effectivenessThe effectiveness
of different kinds ofof different kinds of
therapy dependstherapy depends
on two things, theon two things, the
disorder treateddisorder treated
and the goals ofand the goals of
the clientthe client
 Research toResearch to
discover the bestdiscover the best
treatment usuallytreatment usually
focuses on specificfocuses on specific
disordersdisorders
 Research onResearch on
integration isintegration is
relatively scarcerelatively scarce
 This is because it isThis is because it is
difficult to generatedifficult to generate
hypotheses based onhypotheses based on
the new points ofthe new points of
view it createsview it creates
Which Therapy?

• These include ethnicity, personality, level ofThese include ethnicity, personality, level of
experience, and degree of empathyexperience, and degree of empathy
• While there are differences among therapists,While there are differences among therapists,
there are also commonalitiesthere are also commonalities
 Research to discover the best treatmentResearch to discover the best treatment
usually focuses on specific disordersusually focuses on specific disorders
 Besides therapeutic approaches, someBesides therapeutic approaches, some
characteristics of the therapist affectcharacteristics of the therapist affect
treatmenttreatment

• Good therapists communicate interest,Good therapists communicate interest,
understanding, respect, tact, and maturityunderstanding, respect, tact, and maturity
• Good therapists use suggestions,Good therapists use suggestions,
interpretation, encouragement, andinterpretation, encouragement, and
perhaps rewards to help clients changeperhaps rewards to help clients change
 While there are differences amongWhile there are differences among
therapists, there are also commonalitiestherapists, there are also commonalities
• Clients receive attention, which helps themClients receive attention, which helps them
maintain a positive attitudemaintain a positive attitude

 Good therapists use suggestions,Good therapists use suggestions,
interpretation, encouragement, andinterpretation, encouragement, and
perhaps rewards to help clients changeperhaps rewards to help clients change
 But clients must be willing to make someBut clients must be willing to make some
changes in their lifestyles and ideaschanges in their lifestyles and ideas
 The therapist and client must form anThe therapist and client must form an
alliance to work together purposefullyalliance to work together purposefully

Culture and TherapyCulture and Therapy
 The therapy process and its outcomeThe therapy process and its outcome
are effected by the client’s ethnicityare effected by the client’s ethnicity
• Care must be taken to be culturallyCare must be taken to be culturally
congruentcongruent
 Have a match between therapist andHave a match between therapist and
clientclient
 At a minimum, the therapist mustAt a minimum, the therapist must
respect multiculturalismrespect multiculturalism

 At a minimum, the therapist must respectAt a minimum, the therapist must respect
multiculturalismmulticulturalism
• The acceptance of and celebration of distinctThe acceptance of and celebration of distinct
cultural heritagescultural heritages
• Therapists must also see beyond theTherapists must also see beyond the
distinct margins of a specific culturedistinct margins of a specific culture
• Therapists must see individuals as made upTherapists must see individuals as made up
of a confluence of different influencesof a confluence of different influences

 Therapists must see individuals as madeTherapists must see individuals as made
up of a confluence of different influencesup of a confluence of different influences
• This view is calledThis view is called transculturalismtransculturalism
 This view reflects changes that haveThis view reflects changes that have
occurred in the world throughoccurred in the world through
globalization, mobility, improvedglobalization, mobility, improved
communication, and intermarriagecommunication, and intermarriage
 Therapists need to be well informedTherapists need to be well informed
about clients’ backgroundsabout clients’ backgrounds

 Therapists need to be well about clients’Therapists need to be well about clients’
backgroundsbackgrounds
• They should provide interventions basedThey should provide interventions based
upon and using cultural symbols andupon and using cultural symbols and
rituals meaningful to the clientrituals meaningful to the client
 Asian culture reflects family and roles inAsian culture reflects family and roles in
the family, so they must be taken intothe family, so they must be taken into
accountaccount
 Some cultures have prohibitions againstSome cultures have prohibitions against
self-disclosure, or toward controlself-disclosure, or toward control

 Some cultures have prohibitionsSome cultures have prohibitions
against self-disclosure, or towardagainst self-disclosure, or toward
controlcontrol
 Some Arab cultures resist emotionalSome Arab cultures resist emotional
explorationexploration
 Such cultures are more likely to valueSuch cultures are more likely to value
and adapt to cognitive therapiesand adapt to cognitive therapies
 Cultural mistrust of therapy situationsCultural mistrust of therapy situations
is common among African-Americansis common among African-Americans

 Cultural mistrust of therapy situations isCultural mistrust of therapy situations is
common among African-Americanscommon among African-Americans
 By contrast, many Hispanic cultures haveBy contrast, many Hispanic cultures have
a high regard for experts like therapistsa high regard for experts like therapists
 The therapists ethnicity is alsoThe therapists ethnicity is also
importantimportant
 Latino, African-American, and Asian-Latino, African-American, and Asian-
American therapists are viewedAmerican therapists are viewed
differently than European-Americandifferently than European-American
therapiststherapists

 Latino, African-American, and Asian-Latino, African-American, and Asian-
American therapists are viewedAmerican therapists are viewed
differently than European-Americandifferently than European-American
 It must be remembered that culture isIt must be remembered that culture is
dynamic, contextual, and even politicaldynamic, contextual, and even political Stereotypes and oversimplifications alsoStereotypes and oversimplifications also
aboundabound
 Therapists must recognize thatTherapists must recognize that
members of other groups may not sharemembers of other groups may not share
their own cultural valuestheir own cultural values

 Therapists must recognize thatTherapists must recognize that
members of other groups may notmembers of other groups may not
share their own cultural valuesshare their own cultural values
 They must also realize that theirThey must also realize that their
preconceived ideas can affect thepreconceived ideas can affect the
outcome of therapyoutcome of therapy
• They may be oppressive to their clientsThey may be oppressive to their clients
• This may constrain their effectiveness asThis may constrain their effectiveness as

Gender and TherapyGender and Therapy
 Not only is ethnicity important, gender isNot only is ethnicity important, gender is
also a significant factor in therapyalso a significant factor in therapy
• Women seek out therapy more often than menWomen seek out therapy more often than men
• They also respond differently to therapy, andThey also respond differently to therapy, and
to drug therapyto drug therapy
• Communication differences may also affectCommunication differences may also affect
therapy (Tannen, 2001)therapy (Tannen, 2001)

• Clients may also experience gender bias inClients may also experience gender bias in
their families that affects their gendertheir families that affects their gender
assumptionsassumptions
• Gender differences can be compounded byGender differences can be compounded by
ethnicityethnicity
 Communication differences may also affectCommunication differences may also affect
therapytherapy
• Men tend to giveMen tend to give reportsreports while women try towhile women try to
establishestablish rapportrapport

• Gay men and lesbians bring still anotherGay men and lesbians bring still another
view to gender roles in the therapeuticview to gender roles in the therapeutic
situationsituation
• Therapists must also understand how theirTherapists must also understand how their
own gender socialization affects therapyown gender socialization affects therapy
 Gender differences can be compounded byGender differences can be compounded by
ethnicityethnicity
• People from different cultural backgrounds mayPeople from different cultural backgrounds may
view masculinity differentlyview masculinity differently

 Therapists must also understandTherapists must also understand
how their own gender socializationhow their own gender socialization
affects therapyaffects therapy
 They must avoid genderThey must avoid gender
stereotypes, and recognize thestereotypes, and recognize the
diversity of men’s and women’sdiversity of men’s and women’s
experiencesexperiences

Managed Care and PsychologyManaged Care and Psychology
 ““Managed care” emphasizes activeManaged care” emphasizes active
coordination and arrangement of healthcoordination and arrangement of health
care servicescare services
• It usually involves three components:It usually involves three components:
 Oversight of the care givenOversight of the care given
 Contractual relationships with, andContractual relationships with, and
organization of, the providers giving careorganization of, the providers giving care
 Determines the covered benefitsDetermines the covered benefits

Managed Care and PsychologyManaged Care and Psychology
 The aim of managed care is to controlThe aim of managed care is to control
costscosts
 There are two major difficulties withThere are two major difficulties with
managed caremanaged care
• First, insurance companies seek to limitFirst, insurance companies seek to limit
the time or type of psychotherapy athe time or type of psychotherapy a
person may accessperson may access
• The second problem is that insuranceThe second problem is that insurance
companies limit who a client can seecompanies limit who a client can see

Managed CareManaged Care
 InsuranceInsurance
companies limitcompanies limit
who a client canwho a client can
seesee
 Many HMOsMany HMOs
require re-require re-
approval ofapproval of
therapy every sixtherapy every six
sessionssessions
 This tends toThis tends to
 It also means theIt also means the
therapist musttherapist must
continually justifycontinually justify
a person’sa person’s
treatmenttreatment
 Edwards (1999)Edwards (1999)
believes thatbelieves that
these factorsthese factors
compromise thecompromise the
practitioner/clientpractitioner/client
alliancealliance

 Edwards (1999) believes that theseEdwards (1999) believes that these
factors compromise the practitioner/clientfactors compromise the practitioner/client
alliancealliance
 Managed care has led toManaged care has led to brief therapybrief therapy
• Six weeks is common, and 16 is consideredSix weeks is common, and 16 is considered
lengthylengthy
• One objective of brief therapy is saving clientsOne objective of brief therapy is saving clients
time and moneytime and money

 One objective ofOne objective of
brief therapy isbrief therapy is
saving clients timesaving clients time
and moneyand money
 Clients may remainClients may remain
in therapy longer ifin therapy longer if
they feel it isthey feel it is
needed and canneeded and can
continue to paycontinue to pay
 Clients can alsoClients can also
return to therapy ifreturn to therapy if
they feel they needthey feel they need
it in the futureit in the future

Brief TherapyBrief Therapy
 Practitioners of brief therapy think inPractitioners of brief therapy think in
terms ofterms of plannedplanned short-term treatmentsshort-term treatments
• They make sure treatment begins in theThey make sure treatment begins in the
first sessionfirst session
 AnAn operational diagnosisoperational diagnosis is madeis made
 The operational diagnosis answers theThe operational diagnosis answers the
question “Why is the client here today?”question “Why is the client here today?”

 The operationalThe operational
diagnosis answersdiagnosis answers
the questionthe question
“Why is the client“Why is the client
here today?”here today?”
 The answer helpsThe answer helps
pinpoint thepinpoint the
specific problemspecific problem
for which thefor which the
client is seekingclient is seeking
helphelp
 During the firstDuring the first
session, the clientsession, the client
also makes aalso makes a
“therapeutic“therapeutic
contract” with thecontract” with the
 The therapeuticThe therapeutic
contractcontract
establishes preciseestablishes precise
goals for thegoals for the
therapytherapy

• Especially when tailored to the clients needsEspecially when tailored to the clients needs
and timeand time
• Brief therapy is highly effective with couplesBrief therapy is highly effective with couples
and when combined with cognitiveand when combined with cognitive
restructuringrestructuring
 The therapeutic contract establishesThe therapeutic contract establishes
precise goals for the therapyprecise goals for the therapy
 Research on brief therapy suggests that itResearch on brief therapy suggests that it
is effective and has long-lasting effectsis effective and has long-lasting effects

 Brief therapy isBrief therapy is
highly effectivehighly effective
with couples andwith couples and
when combinedwhen combined
with cognitivewith cognitive
 However, researchHowever, research
has been limited tohas been limited to
relatively fewrelatively few
clients and aclients and a
narrow range ofnarrow range of
 Further researchFurther research
on brief therapy ison brief therapy is
being conductedbeing conducted
 But, it is inaccurateBut, it is inaccurate
and misleading toand misleading to
say no one getssay no one gets
appropriate careappropriate care
from managed carefrom managed care

• They also fear it is managed by people withThey also fear it is managed by people with
little or no training who never meet patientslittle or no training who never meet patients
• It poses a social policy question whether ourIt poses a social policy question whether our
society wants to provide psychotherapy forsociety wants to provide psychotherapy for
those in needthose in need
 It is inaccurate and misleading to sayIt is inaccurate and misleading to say
no one gets appropriate care fromno one gets appropriate care from
managed caremanaged care
 Still, many practitioners worry that careStill, many practitioners worry that care
is terminated too quicklyis terminated too quickly

Choosing a TherapistChoosing a Therapist
 The best way to choose a therapist is toThe best way to choose a therapist is to
ask aroundask around
• Ask family and friendsAsk family and friends
• Talk to one’s doctorTalk to one’s doctor
 Many doctors work with a team of healthMany doctors work with a team of health
care providers, including psychotherapistscare providers, including psychotherapists
 Doctors can suggest someone they know toDoctors can suggest someone they know to

 Doctors can suggest someone theyDoctors can suggest someone they
know to be effectiveknow to be effective
 Consult the psychology department ofConsult the psychology department of
local colleges or the staff of communitylocal colleges or the staff of community
health care centershealth care centers
 Once one has a list of severalOnce one has a list of several
practitioners, find out if they are licensedpractitioners, find out if they are licensed

 Once one has aOnce one has a
list of severallist of several
practitioners, findpractitioners, find
out if they areout if they are
licensedlicensed
 Ask what kind ofAsk what kind of
treatmenttreatment
procedures theyprocedures they
useuse
 Find out if theyFind out if they
have a specialtyhave a specialty
• Such as workingSuch as working
with children orwith children or
teensteens
• Working withWorking with
eating disorderseating disorders
 In the end, oneIn the end, one
must choose amust choose a

PsychoanalysisPsychoanalysis
And Psychodynamic TherapiesAnd Psychodynamic Therapies
www.ablongman.com/lefton8e

PsychoanalysisPsychoanalysis
 PsychoanalysisPsychoanalysis is a lengthy insightis a lengthy insight
therapy developed by Freudtherapy developed by Freud
• It aims at uncovering unconscious conflictsIt aims at uncovering unconscious conflicts
• It uses techniques such as free associationIt uses techniques such as free association
and dream analysisand dream analysis
 Psychodynamically based therapiesPsychodynamically based therapies useuse
techniques derived from Freud, buttechniques derived from Freud, but
reject or modify parts of his theoryreject or modify parts of his theory

 Psychodynamically based therapiesPsychodynamically based therapies useuse
techniques derived from Freud, buttechniques derived from Freud, but
reject or modify parts of his theoryreject or modify parts of his theory
 Freud’s therapy is anFreud’s therapy is an insight therapyinsight therapy
• It attempts to discover relationshipsIt attempts to discover relationships
between unconscious motivation andbetween unconscious motivation and
abnormal behaviorabnormal behavior
• Any insight therapy has two basicAny insight therapy has two basic
assumptionsassumptions
Psychoanalysis

• Second, the causes of maladjustment areSecond, the causes of maladjustment are
unresolved conflictsunresolved conflicts
 The person is unaware of these conflicts,The person is unaware of these conflicts,
and therefore cannot deal with themand therefore cannot deal with them
 Any insight therapy has two basicAny insight therapy has two basic
assumptions:assumptions:
• First, becoming aware of one’s motivationsFirst, becoming aware of one’s motivations
helps one change and become morehelps one change and become more
adaptiveadaptive
Psychoanalysis

Goal of PsychoanalysisGoal of Psychoanalysis
 The goal is to help patients understand theThe goal is to help patients understand the
unconscious motivations that direct theirunconscious motivations that direct their
behaviorsbehaviors
• Only by becoming aware of these motivationsOnly by becoming aware of these motivations
can they choose behaviors that lead to morecan they choose behaviors that lead to more
fulfilling livesfulfilling lives
• During analysis, patients are encouraged toDuring analysis, patients are encouraged to
express healthy impulses, strengthen day-to-express healthy impulses, strengthen day-to-
day functioning based on reality, and perceiveday functioning based on reality, and perceive
the world as a positive placethe world as a positive place

Techniques of PsychoanalysisTechniques of Psychoanalysis
 Psychoanalysis is geared toward thePsychoanalysis is geared toward the
exploration of early experiencesexploration of early experiences
 Two major techniques are free associationTwo major techniques are free association
and dream analysisand dream analysis
 InIn free associationfree association, the patient is asked to, the patient is asked to
report whatever comes to mind, noreport whatever comes to mind, no
matter how disorganized or trivialmatter how disorganized or trivial

 InIn free associationfree association, the patient is asked to report, the patient is asked to report
whatever comes to mind, no matter howwhatever comes to mind, no matter how
disorganized or trivialdisorganized or trivial
• One purpose is to help patients recognize connectionsOne purpose is to help patients recognize connections
and patterns among their thoughtsand patterns among their thoughts
• It also allows free expression of theIt also allows free expression of the
unconsciousunconscious
 InIn dream analysisdream analysis, patients are asked to, patients are asked to
describe their dreams in detaildescribe their dreams in detail

 InIn dream analysisdream analysis, patients are asked to, patients are asked to
describe their dreams in detaildescribe their dreams in detail
• The dreams are interpreted to provide insightThe dreams are interpreted to provide insight
into unconscious motivationinto unconscious motivation
• Freud believed dreams represent someFreud believed dreams represent some
element of the unconscious seekingelement of the unconscious seeking
expressionexpression
 Both free association and dream analysisBoth free association and dream analysis
involve the therapist’s interpretationsinvolve the therapist’s interpretations

 Both free association and dreamBoth free association and dream
analysis involve the therapist’sanalysis involve the therapist’s
interpretationsinterpretations
 InterpretationInterpretation involves providing ainvolves providing a
context, meaning, or cause, for an idea,context, meaning, or cause, for an idea,
feeling, or set of behaviorsfeeling, or set of behaviors• The therapist attempts to find a common thread in aThe therapist attempts to find a common thread in a
patient’s behaviors and thoughtspatient’s behaviors and thoughts
• Patients’ use of defense mechanisms may point to areasPatients’ use of defense mechanisms may point to areas
that need to be exploredthat need to be explored
Techniques of Psychoanalysis

 Defense mechanisms may point to areasDefense mechanisms may point to areas
that need to be exploredthat need to be explored
 Two processes in psychoanalysis areTwo processes in psychoanalysis are
resistance and transferenceresistance and transference
• ResistanceResistance is an unwillingness to cooperateis an unwillingness to cooperate
• In resistance, the patient may be unwillingIn resistance, the patient may be unwilling
to provide information, or help into provide information, or help in
interpretationinterpretation

 Resistance shows oneResistance shows one
of two thingsof two things
• The patient wishes toThe patient wishes to
avoid talking about aavoid talking about a
topictopic
• Or, a difficult stage ofOr, a difficult stage of
therapy has beentherapy has been
reachedreached
 To minimizeTo minimize
resistance, analystsresistance, analysts
try to accept atry to accept a
patient’s behaviorpatient’s behavior
 In resistance, theIn resistance, the
patient may bepatient may be
unwilling tounwilling to
provideprovide
information, orinformation, or
help inhelp in
interpretationinterpretation
 Resistance mayResistance may
sometimes reachsometimes reach
the point ofthe point of
belligerencebelligerence

 To minimize resistance, analysts try toTo minimize resistance, analysts try to
accept a patient’s behavioraccept a patient’s behavior
 DuringDuring transferencetransference, the therapist, the therapist
becomes the object of a patient’sbecomes the object of a patient’s
emotional attitudes about an importantemotional attitudes about an important
person in the patient’s lifeperson in the patient’s life• The importance of transference is that the therapist willThe importance of transference is that the therapist will
respond differently than the important personrespond differently than the important person
• This allows the patient to experience conflict differentlyThis allows the patient to experience conflict differently

 The therapist canThe therapist can
also guide thealso guide the
person to exploreperson to explore
repressed ideasrepressed ideas
 ExaminingExamining
previouslypreviously
unacceptableunacceptable
thoughts andthoughts and
feelings helpsfeelings helps
patients identifypatients identify
underlyingunderlying
 This allows theThis allows the
patient topatient to
experience conflictexperience conflict
differentlydifferently
 This gives patientsThis gives patients
a new opportunitya new opportunity
to explore theirto explore their
feelingsfeelings

 ExaminingExamining
previouslypreviously
unacceptableunacceptable
thoughts andthoughts and
feelings helpsfeelings helps
patients identifypatients identify
underlying conflictsunderlying conflicts
 PsychoanalysisPsychoanalysis
involves slowlyinvolves slowly
gaining insights intogaining insights into
the unconsciousthe unconscious
 These insightsThese insights
allow the patient toallow the patient to
learn new ways oflearn new ways of
coping withcoping with
instinctual urgesinstinctual urges
 The patient alsoThe patient also
develops maturedevelops mature
ways of dealingways of dealing
with anxiety andwith anxiety and
guiltguilt

 The patient also develops mature ways of dealingThe patient also develops mature ways of dealing
with anxiety and guiltwith anxiety and guilt
 The cycle of interpretation, resistance, andThe cycle of interpretation, resistance, and
transference occurs repeatedly duringtransference occurs repeatedly during
psychoanalysispsychoanalysis
 It is sometimes referred to asIt is sometimes referred to as workingworking
throughthrough

Ego AnalysisEgo Analysis
 Ego analystsEgo analysts are psychoanalysts whoare psychoanalysts who
assume the ego has greater controlassume the ego has greater control
over behavior than Freud suggestedover behavior than Freud suggested
• They focus more on a person’s realityThey focus more on a person’s reality
testing and control over the environmenttesting and control over the environment
• They place less emphasis on unconsciousThey place less emphasis on unconscious
motivation and processesmotivation and processes
 A major disagreement betweenA major disagreement between
“traditional” and “ego” analysts has to“traditional” and “ego” analysts has to
do with the role of the id and the egodo with the role of the id and the ego

 A majorA major
disagreementdisagreement
betweenbetween
“traditional” and“traditional” and
“ego” analysts has“ego” analysts has
to do with the roleto do with the role
of the id and theof the id and the
egoego
 Traditional analystsTraditional analysts
feels the ego growsfeels the ego grows
out of the id and isout of the id and is
controlled by itcontrolled by it
 An ego analystAn ego analyst
asserts the ego isasserts the ego is
independent ofindependent of
the idthe id
 The ego isThe ego is
assumed toassumed to
control memorycontrol memory
and perception,and perception,
and is not inand is not in
constant conflictconstant conflict
with the idwith the id

 The ego is assumed to control memory andThe ego is assumed to control memory and
perception, and is not in constant conflict with theperception, and is not in constant conflict with the
idid
 Traditional analysis focuses on unconsciousTraditional analysis focuses on unconscious
material in the id before trying to increase amaterial in the id before trying to increase a
person’s ego controlperson’s ego control
 Ego analysts begin by trying to strengthenEgo analysts begin by trying to strengthen
the egothe ego

 Ego analysts beginEgo analysts begin
by trying toby trying to
strengthen the egostrengthen the ego
 They may ask aThey may ask a
client to beclient to be
assertive and takeassertive and take
control of acontrol of a
situationsituation
 A weak ego is seenA weak ego is seen
to causeto cause
maladjustment asmaladjustment as
it fails to perceive,it fails to perceive,
understand, andunderstand, and
control the idcontrol the id
 By learning toBy learning to
master andmaster and
develop their ego,develop their ego,
people gain greaterpeople gain greater
control of theircontrol of their
liveslives
Ego Analysis

Criticisms of PsychoanalysisCriticisms of Psychoanalysis
 Critics of psychoanalysis contend it isCritics of psychoanalysis contend it is
unscientific, imprecise, and subjectiveunscientific, imprecise, and subjective
• They assert concepts such as id, ego, andThey assert concepts such as id, ego, and
superego are not linked to realitysuperego are not linked to reality
• Other critics object to Freud’s biologicallyOther critics object to Freud’s biologically
oriented approachoriented approach
• These critics object to the notion that weThese critics object to the notion that we
are bundles of energy caught in conflictare bundles of energy caught in conflict

 These criticsThese critics
object to theobject to the
notion that wenotion that we
are bundles ofare bundles of
energy caught inenergy caught in
conflictconflict
 They also objectThey also object
to the idea we areto the idea we are
driven towarddriven toward
hedonistic goalshedonistic goals
 Freud’s ideasFreud’s ideas
have beenhave been
criticized as sexistcriticized as sexist
 The effectivenessThe effectiveness
of psychoanalysisof psychoanalysis
is open tois open to
questionquestion

• In general, it can beIn general, it can be asas effective as othereffective as other
therapies, but nottherapies, but not moremore effectiveeffective
 Psychoanalysis has certain inherentPsychoanalysis has certain inherent
disadvantagesdisadvantages
 The effectiveness of psychoanalysis isThe effectiveness of psychoanalysis is
open to questionopen to question
• It is more effective for some people thanIt is more effective for some people than
othersothers

 Psychoanalysis has certain inherentPsychoanalysis has certain inherent
disadvantagesdisadvantages
• The patient must be highly motivatedThe patient must be highly motivated
and articulateand articulate
• It is also typically extremely expensiveIt is also typically extremely expensive
• Many people cannot afford the time orMany people cannot afford the time or
money for this type of treatmentmoney for this type of treatment

Humanistic TherapiesHumanistic Therapies
Focusing on the PresentFocusing on the Present

 Humanistic therapies emphasize the abilityHumanistic therapies emphasize the ability
to reflect on conscious experienceto reflect on conscious experience
 They also emphasize that humans haveThey also emphasize that humans have
free willfree will
 Unlike psychoanalysis, humanisticUnlike psychoanalysis, humanistic
therapies tend to focus on the present andtherapies tend to focus on the present and
futurefuture

 To some extent,To some extent,
humanistichumanistic
therapies aretherapies are
insight therapiesinsight therapies
• They focus onThey focus on
helping people seehelping people see
the causes of theirthe causes of their
behaviorbehavior
• Client-centeredClient-centered
therapy is a majortherapy is a major
humanistichumanistic
therapytherapy
 UnlikeUnlike
psychoanalysis,psychoanalysis,
humanistic therapieshumanistic therapies
tend to focus on thetend to focus on the
present and futurepresent and future
 They also assertThey also assert
that people arethat people are
creative and borncreative and born
with a desire towith a desire to
fulfill themselvesfulfill themselves

Client-Centered TherapyClient-Centered Therapy
 Client-centered therapyClient-centered therapy is also known asis also known as
person-centered therapyperson-centered therapy
• It is an insight therapyIt is an insight therapy
 It helps people evaluate the world andIt helps people evaluate the world and
themselves from their own perspectivethemselves from their own perspective
 Client-centered therapy was developed by CarlClient-centered therapy was developed by Carl
Rogers (1902 – 1987)Rogers (1902 – 1987)
 Rogerian therapists hold that problems occurRogerian therapists hold that problems occur
when a person is kept from developing his orwhen a person is kept from developing his or
her unique potentialher unique potential

Techniques of Client-CenteredTechniques of Client-Centered
TherapyTherapy
 The goal of client-centered therapy is toThe goal of client-centered therapy is to
help people discover their ideal selveshelp people discover their ideal selves
• This is then reconciled with their real selvesThis is then reconciled with their real selves
• The wordThe word clientclient rather thanrather than patientpatient isis
important in Roger’s form of therapyimportant in Roger’s form of therapy
 In psychoanalysis, the analystIn psychoanalysis, the analyst directsdirects aa
patient toward a “cure”patient toward a “cure”
 In client-centered therapy, the therapistIn client-centered therapy, the therapist
guidesguides clients to help them find what theyclients to help them find what they
feel is right for themselvesfeel is right for themselves

 First, the therapistFirst, the therapist
must showmust show
unconditionalunconditional
positive regardpositive regard
• Be an acceptingBe an accepting
person who projectsperson who projects
positive feelingspositive feelings
• UnconditionalUnconditional
positive regardpositive regard
counteracts a client’scounteracts a client’s
negative encountersnegative encounters
with unacceptingwith unaccepting
peoplepeople
 In client-centeredIn client-centered
therapy, the therapisttherapy, the therapist
guidesguides clients to helpclients to help
them find what theythem find what they
feel is right forfeel is right for
themselvesthemselves
 Rogers felt a therapistRogers felt a therapist
must have certainmust have certain
characteristics incharacteristics in
order for therapy toorder for therapy to
be successfulbe successful
Techniques

• Therapists are honest and aware of their own feelingsTherapists are honest and aware of their own feelings
• Counselors’ congruence allows them to communicateCounselors’ congruence allows them to communicate
more effectively and help clients be more aware andmore effectively and help clients be more aware and
openopen
 CongruenceCongruence is another componentis another component
Techniques

TechniquesTechniques
 The final ingredient isThe final ingredient is empathicempathic
listeninglistening
• Therapists must sense how their client feels andTherapists must sense how their client feels and
communicate these feelings to the clientcommunicate these feelings to the client
• Therapists help their clients organize their thoughts andTherapists help their clients organize their thoughts and
ideasideas

 Therapists help their clients organizeTherapists help their clients organize
their thoughts and ideastheir thoughts and ideas
• Three techniques can be used to doThree techniques can be used to do
this:this:
 The therapist canThe therapist can paraphraseparaphrase a client’sa client’s
ideasideas
 The client can be asked toThe client can be asked to rephraserephrase an ideaan idea
or feelingor feeling
 The client canThe client can reflectreflect back what they hadback what they had
saidsaid

• They are defensive, and show disorganized behaviorThey are defensive, and show disorganized behavior
• Over time, the client begins to use her or his ownOver time, the client begins to use her or his own
ideas as standards for self-evaluationideas as standards for self-evaluation
 The client canThe client can reflectreflect back what they hadback what they had
saidsaid
 At the beginning of therapy, clients tendAt the beginning of therapy, clients tend
to express attitudes adopted from otherto express attitudes adopted from other
peoplepeople

 Over time, the client begins to use her orOver time, the client begins to use her or
his own ideas as standards for self-his own ideas as standards for self-
evaluationevaluation
• Two things may occur as a resultTwo things may occur as a result The client may adjust the ideal self so it is in lineThe client may adjust the ideal self so it is in line
with his or her own goals, rather than those ofwith his or her own goals, rather than those of
othersothers
 Behavior may change so it is more adaptive andBehavior may change so it is more adaptive and
positivepositive

Criticisms of Client-Centered TherapyCriticisms of Client-Centered Therapy
 No other therapy makes clients feel soNo other therapy makes clients feel so
warm, accepted, and safewarm, accepted, and safe
• Critics argue this may not be enough toCritics argue this may not be enough to
bring about long-lasting changebring about long-lasting change
• Critics also argue that lengthy discussionsCritics also argue that lengthy discussions
about problems do not necessarily helpabout problems do not necessarily help
people with present difficultiespeople with present difficulties
• It is also said that client-centered therapyIt is also said that client-centered therapy
focuses on concepts that are hard to define,focuses on concepts that are hard to define,
such as self-actualizationsuch as self-actualization

Behavior TherapyBehavior Therapy
From the BehavioralFrom the Behavioral
PerspectivePerspective

Behavior TherapyBehavior Therapy
 Behavior therapy has become especiallyBehavior therapy has become especially
popular in the last 30 yearspopular in the last 30 years
• This has occurred for three reasons:This has occurred for three reasons:
 People sometimes have problems that may notPeople sometimes have problems that may not
require insights or in-depth discussions of feelingsrequire insights or in-depth discussions of feelings
 Managed care organizations see it as quicker andManaged care organizations see it as quicker and
less expensive than other approachesless expensive than other approaches
 Finally, behavior therapy can be highly effectiveFinally, behavior therapy can be highly effective

Goals of Behavior TherapyGoals of Behavior Therapy
 Behavior therapyBehavior therapy focuses onfocuses on
changing overt behaviorchanging overt behavior
• It is also calledIt is also called behavior modificationbehavior modification
 It uses learning principles to help peopleIt uses learning principles to help people
replace maladaptive behaviors with morereplace maladaptive behaviors with more
effective oneseffective ones
 Behavior therapists assume changes in theBehavior therapists assume changes in the
environment affect people’s responsesenvironment affect people’s responses

 Behavior therapists assume changes inBehavior therapists assume changes in
the environment affect people’sthe environment affect people’s
responsesresponses
 Unlike psychoanalysis, behaviorUnlike psychoanalysis, behavior
therapy does not try to discover thetherapy does not try to discover the
origins of behaviororigins of behavior
• It only tries to alter behaviorIt only tries to alter behavior
• Behavior therapists try to help people unlearnBehavior therapists try to help people unlearn
faulty behaviors and learn more effectivefaulty behaviors and learn more effective
onesones

 Behavior therapists try to help people unlearnBehavior therapists try to help people unlearn
faulty behaviors and learn more effective onesfaulty behaviors and learn more effective ones
 They do not always focus on the problem leadingThey do not always focus on the problem leading
the client to seek therapythe client to seek therapy
 If behavior therapists see the problem isIf behavior therapists see the problem is
associated with another situation, theyassociated with another situation, they
may try to change that situationmay try to change that situation

 If behavior therapists see the problemIf behavior therapists see the problem
is associated with another situation,is associated with another situation,
they may try to change that situationthey may try to change that situation
 Unlike psychodynamic and humanisticUnlike psychodynamic and humanistic
therapies, behavior therapy does nottherapies, behavior therapy does not
encourage clients to interpret pastencourage clients to interpret past
eventsevents Behavior therapists are dissatisfied withBehavior therapists are dissatisfied with
psychodynamic and humanistic therapiespsychodynamic and humanistic therapies
for three basic reasonsfor three basic reasons

 Second, someSecond, some
studies show thatstudies show that
people who do notpeople who do not
receive thosereceive those
therapies improvetherapies improve
anywayanyway
 Finally, once aFinally, once a
person is labeledperson is labeled
“abnormal” the“abnormal” the
label itself may leadlabel itself may lead
to maladaptiveto maladaptive
behaviorbehavior
 BehaviorBehavior
therapists aretherapists are
dissatisfied withdissatisfied with
psychodynamicpsychodynamic
and humanisticand humanistic
therapies fortherapies for
three basicthree basic
reasonsreasons
 First, thoseFirst, those
therapies usetherapies use
concepts difficultconcepts difficult
to define andto define and
measuremeasure

 Once a person is labeled “abnormal”,Once a person is labeled “abnormal”,
the label itself may lead tothe label itself may lead to
maladaptive behaviormaladaptive behavior
 Behavior therapists assume people doBehavior therapists assume people do
not display maladaptive behaviornot display maladaptive behavior
because they are “abnormal”because they are “abnormal”
• They display maladaptive behaviorThey display maladaptive behavior
because they are having trouble adjustingbecause they are having trouble adjusting
to the environmentto the environment
• If they are taught how to cope,If they are taught how to cope,
maladjustment will disappearmaladjustment will disappear

Behavior Therapy: A CriticismBehavior Therapy: A Criticism
 Most insight therapists believe that if onlyMost insight therapists believe that if only
overt behavior is treated, symptomovert behavior is treated, symptom
substitution will occursubstitution will occur
• InIn symptom substitutionsymptom substitution, a new overt, a new overt
symptom appears to replace one eliminated bysymptom appears to replace one eliminated by
treatmenttreatment
• Research does show, however, that behaviorResearch does show, however, that behavior
therapy is at least as effective as insighttherapy is at least as effective as insight
therapiestherapies

Techniques of Behavior TherapyTechniques of Behavior Therapy
 The techniques of behavior therapyThe techniques of behavior therapy
include operant conditioning, modeling,include operant conditioning, modeling,
and counterconditioningand counterconditioning
• A therapist will use whatever combination ofA therapist will use whatever combination of
techniques is needed to help a clienttechniques is needed to help a client
• Behavior therapy usually involves threeBehavior therapy usually involves three
general proceduresgeneral procedures

Techniques of Behavior TherapyTechniques of Behavior Therapy
 Behavior therapy usually involvesBehavior therapy usually involves
three general procedures:three general procedures:
• First, the problem behavior and itsFirst, the problem behavior and its
frequency is examinedfrequency is examined
• Next, a treatment strategy is used,Next, a treatment strategy is used,
individually tailored to the clientindividually tailored to the client
• Finally, there is continual assessmentFinally, there is continual assessment
as to whether behavior has changedas to whether behavior has changed

Operant ConditioningOperant Conditioning
 Operant conditioning to establish a newOperant conditioning to establish a new
behavior often depends on abehavior often depends on a reinforcerreinforcer
• An event or circumstance that increases theAn event or circumstance that increases the
probability a response will occurprobability a response will occur
• One method of rewarding adaptive behaviorOne method of rewarding adaptive behavior
is through ais through a token economytoken economy

Token EconomiesToken Economies
 In a token economy people whoIn a token economy people who
display appropriate behaviorsdisplay appropriate behaviors
receive tokensreceive tokens
• These can be exchanged for desirableThese can be exchanged for desirable
items and activitiesitems and activities
• Token economies are used to modifyToken economies are used to modify
behavior in social settingsbehavior in social settings

Token EconomiesToken Economies
 Token economiesToken economies
are used to modifyare used to modify
behavior in socialbehavior in social
settingssettings
 The aim is toThe aim is to
strengthenstrengthen
behaviorsbehaviors
compatible withcompatible with
normsnorms
 They have beenThey have been
used successfully inused successfully in
schools and hospitalschools and hospital
settingssettings
 Other operantOther operant
techniques includetechniques include
extinction,extinction,
punishment, andpunishment, and
time outtime out

ExtinctionExtinction
 Extinction occurs when reinforcers areExtinction occurs when reinforcers are
withheldwithheld
• This eventually leads a previously reinforcedThis eventually leads a previously reinforced
behavior to stopbehavior to stop
• It can be used in conjunction with a tokenIt can be used in conjunction with a token
economy, or separately, to stop aneconomy, or separately, to stop an
undesirable behaviorundesirable behavior

PunishmentPunishment
 Another way to stop an undesirableAnother way to stop an undesirable
behavior is to use punishmentbehavior is to use punishment
• This often involves the presentation of anThis often involves the presentation of an
aversive stimulusaversive stimulus
 It only suppresses a behaviorIt only suppresses a behavior
 Punishment does not establish new, desiredPunishment does not establish new, desired
behaviorsbehaviors

 Punishment does not establish new,Punishment does not establish new,
desired behaviorsdesired behaviors
 Thus, it is often combined with positiveThus, it is often combined with positive
reinforcement for desirable behaviorsreinforcement for desirable behaviors
 Punishment has other drawbacksPunishment has other drawbacks
 People (especially young people)People (especially young people)
sometimes imitate aggressionsometimes imitate aggression

 Punishment can be harmfulPunishment can be harmful
 People (especially young people) sometimesPeople (especially young people) sometimes
imitate aggressionimitate aggression
 Punishment can lead to generalized aggressionPunishment can lead to generalized aggression

Time-OutTime-Out
 Time-outTime-out is the removal of a person fromis the removal of a person from
sources of reinforcementsources of reinforcement
• It is used to decrease behaviorIt is used to decrease behavior
• Time-out is principally used with childrenTime-out is principally used with children
• It is especially effective when combined withIt is especially effective when combined with
positive reinforcers for appropriate behaviorpositive reinforcers for appropriate behavior

CounterconditioningCounterconditioning
 InIn CounterconditioningCounterconditioning, a person is taught, a person is taught
a new, more adaptive response to aa new, more adaptive response to a
stimulusstimulus
• It is a process of reconditioningIt is a process of reconditioning
• Joseph Wolpe (1915 – 1997) was one of theJoseph Wolpe (1915 – 1997) was one of the
original proponents of counterconditioningoriginal proponents of counterconditioning
• Wolpe used counterconditioning to inhibitWolpe used counterconditioning to inhibit
anxiety as a responseanxiety as a response

CounterconditioningCounterconditioning
 Wolpe usedWolpe used
counterconditionicounterconditioni
ng to inhibitng to inhibit
anxiety as aanxiety as a
responseresponse
 Therapy using theTherapy using the
technique beginstechnique begins
with a specificwith a specific
stimulus (S1) thatstimulus (S1) that
elicits a specificelicits a specific
response (R1)response (R1)
 After therapy, S1After therapy, S1
should elicit a newshould elicit a new
response (R2)response (R2)
 Two approachesTwo approaches
useuse
counterconditioningcounterconditioning
::
• SystematicSystematic
desensitizationdesensitization
• AversiveAversive
conditioningconditioning

Systematic DesensitizationSystematic Desensitization
 Systematic desensitizationSystematic desensitization is a three-stageis a three-stage
counterconditioning procedurecounterconditioning procedure
• The client is first taught to relaxThe client is first taught to relax
 The client then describes the specificThe client then describes the specific
situations that arouse anxietysituations that arouse anxiety
 While deeply relaxed, the client imaginesWhile deeply relaxed, the client imagines
increasingly vivid scenes of the situationsincreasingly vivid scenes of the situations
causing anxietycausing anxiety

• With each successive experience, the clientWith each successive experience, the client
learns relaxation rather than fear as alearns relaxation rather than fear as a
responseresponse
 While deeply relaxed, the client imaginesWhile deeply relaxed, the client imagines
increasingly vivid scenes of the situationsincreasingly vivid scenes of the situations
causing anxietycausing anxiety
• This gradually exposes the client to theThis gradually exposes the client to the
source of the anxietysource of the anxiety

 With each successive experience, theWith each successive experience, the
client learns relaxation rather than fear asclient learns relaxation rather than fear as
a responsea response
 Systematic desensitization is mostSystematic desensitization is most
successful for people with two types ofsuccessful for people with two types of
problemsproblems
• Problems with impulse controlProblems with impulse control
• Particular forms of anxiety such as phobiasParticular forms of anxiety such as phobias
 It is not effective for people with psychoticIt is not effective for people with psychotic
symptoms, or situations of interpersonalsymptoms, or situations of interpersonal
conflictconflict

Aversive ConditioningAversive Conditioning
 Another method usingAnother method using
counterconditioning iscounterconditioning is aversiveaversive
conditioningconditioning
• A noxious stimulus is paired with aA noxious stimulus is paired with a
stimulus that elicits an undesirablestimulus that elicits an undesirable
behaviorbehavior
 This will cause the undesirable behaviorThis will cause the undesirable behavior
to stopto stop
 The goal is to teach a new response toThe goal is to teach a new response to

ModelingModeling
 Bandura (1997) believes modeling canBandura (1997) believes modeling can
be used effectively for:be used effectively for:
• Teaching a new behaviorTeaching a new behavior
• Helping eliminate fearsHelping eliminate fears
• Enhancing already existing behaviorEnhancing already existing behavior
 One problem is that people may imitateOne problem is that people may imitate
the behavior of inappropriate modelsthe behavior of inappropriate models

Cognitive TherapyCognitive Therapy
An Outgrowth of BehaviorAn Outgrowth of Behavior
TherapyTherapy

 Cognitive therapists assume thatCognitive therapists assume that
distorted, undeveloped ideas preventdistorted, undeveloped ideas prevent
people from establishing effective copingpeople from establishing effective coping
behaviorsbehaviors
 Cognitive therapy focuses on changingCognitive therapy focuses on changing
client behavior by changing the person’sclient behavior by changing the person’s
thoughts or perceptionsthoughts or perceptions
 Cognitive therapy is derived from threeCognitive therapy is derived from three
propositionspropositions

 Cognitive therapy is derived fromCognitive therapy is derived from
three propositions:three propositions:
• Cognitive activity affects behaviorCognitive activity affects behavior
• Cognitive activity can be monitoredCognitive activity can be monitored
• Behavior can be changed by alteringBehavior can be changed by altering
cognitive patternscognitive patterns

• Cognitive therapy is also known asCognitive therapy is also known as cognitivecognitive
• Cognitive therapy is effective for people whoCognitive therapy is effective for people who
have attached narrow or inappropriate labelshave attached narrow or inappropriate labels
to certain behaviors or situationsto certain behaviors or situations
 Many behavior therapists currentlyMany behavior therapists currently
incorporate thought processes intoincorporate thought processes into
treatmenttreatment
• This is calledThis is called cognitive behavior therapycognitive behavior therapy

 Cognitive therapy focuses onCognitive therapy focuses on
current behaviors and thoughtscurrent behaviors and thoughts
• It is not especially concerned with uncoveringIt is not especially concerned with uncovering
childhood experienceschildhood experiences
• It is especially effective if combined withIt is especially effective if combined with
techniques such as use of reinforcementtechniques such as use of reinforcement

Rational Emotive TherapyRational Emotive Therapy
 The best known cognitive therapy isThe best known cognitive therapy is
rational emotive therapyrational emotive therapy
• It emphasizes the importance of logical,It emphasizes the importance of logical,
rational, thought processesrational, thought processes
 It was developed by Albert Ellis over 30It was developed by Albert Ellis over 30
years agoyears ago
 Ellis assumed abnormal behavior is causedEllis assumed abnormal behavior is caused
by faulty and irrational thinking patternsby faulty and irrational thinking patterns

Rational Emotive TherapyRational Emotive Therapy
 Ellis assumed abnormal behavior isEllis assumed abnormal behavior is
caused by faulty and irrational thinkingcaused by faulty and irrational thinking
patternspatterns
 A major goal is to help people examineA major goal is to help people examine
past events that produce irrationalpast events that produce irrational
beliefsbeliefs• Clients adopt different behavior patterns based on moreClients adopt different behavior patterns based on more
rational thought processesrational thought processes
• Research supports the effectiveness of the approachResearch supports the effectiveness of the approach

Beck’s ApproachBeck’s Approach
 Aaron Beck developed another cognitiveAaron Beck developed another cognitive
therapytherapy
• Beck assumes depression is caused byBeck assumes depression is caused by
people’s distorted thoughts about realitypeople’s distorted thoughts about reality
 These lead to negative views of the world,These lead to negative views of the world,
the self, and the futurethe self, and the future
 A goal of Beck’s therapy is to help peopleA goal of Beck’s therapy is to help people
develop realistic appraisals of situationsdevelop realistic appraisals of situations

 A goal of Beck’s therapy is to help peopleA goal of Beck’s therapy is to help people
develop realistic appraisals of situationsdevelop realistic appraisals of situations
 The therapist acts as a trainer andThe therapist acts as a trainer and
coinvestigatorcoinvestigator
• Providing data to be examinedProviding data to be examined
• The therapist also guides the client inThe therapist also guides the client in
understanding how cognitions influenceunderstanding how cognitions influence
behaviorbehavior

 Beck says a successful client passesBeck says a successful client passes
through four stages in moving towardthrough four stages in moving toward
mental healthmental health
• First the client becomes aware of her/his thoughtsFirst the client becomes aware of her/his thoughts
• The client recognizes what thoughts are awryThe client recognizes what thoughts are awry
• Accurate judgments then need to be substituted forAccurate judgments then need to be substituted for
inaccurate onesinaccurate ones
• Finally, the client needs feedback as to whether theFinally, the client needs feedback as to whether the
changes are correctchanges are correct

Meichenbaum’s ApproachMeichenbaum’s Approach
 Meichenbaum developed a thirdMeichenbaum developed a third
cognitive therapycognitive therapy
• He believes that what people say toHe believes that what people say to
themselves determines what they dothemselves determines what they do
 A goal of his therapy is to change whatA goal of his therapy is to change what
people say to themselvespeople say to themselves
 The therapist must change the client’sThe therapist must change the client’s
appraisal of situations and the client’s use ofappraisal of situations and the client’s use of
self-instructionsself-instructions

 The therapistThe therapist
must change themust change the
client’s appraisalclient’s appraisal
of situations andof situations and
the client’s use ofthe client’s use of
self-instructionsself-instructions
 A strength of theA strength of the
approach is that itapproach is that it
can be used incan be used in
many settings formany settings for
many problemsmany problems
 No attempt isNo attempt is
made to changemade to change
irrational beliefsirrational beliefs
 Clients learn aClients learn a
repertoire ofrepertoire of
activities they canactivities they can
use to make theiruse to make their
behavior morebehavior more
adaptiveadaptive

• They may learn to organize their responsesThey may learn to organize their responses
to specific situations in orderly stepsto specific situations in orderly steps
 Clients learn a repertoire of activities theyClients learn a repertoire of activities they
can use to make their behavior morecan use to make their behavior more
adaptiveadaptive
• They may learn to conduct a privateThey may learn to conduct a private
monologue in which they work out adaptivemonologue in which they work out adaptive
ways of copingways of coping

 Cognitive therapy is influencing anCognitive therapy is influencing an
increasing number of therapists whoincreasing number of therapists who
conduct long-term, as well as brief,conduct long-term, as well as brief,
therapytherapy
 It can be applied to a variety of problemsIt can be applied to a variety of problems
including anxiety, depression, maritalincluding anxiety, depression, marital
difficulties, and chronic paindifficulties, and chronic pain
 Cognitive therapy in its many forms hasCognitive therapy in its many forms has
been used with adults and childrenbeen used with adults and children

 Cognitive therapy in its manyCognitive therapy in its many
forms has been used with adultsforms has been used with adults
and childrenand children
 It can be used with groups havingIt can be used with groups having
particular characteristicsparticular characteristics

Group TherapyGroup Therapy
 InIn group therapygroup therapy, several people meet, several people meet
together with a therapist to receivetogether with a therapist to receive
treatmenttreatment
• This allows a therapist to see more clientsThis allows a therapist to see more clients
• Since fees are shared, it is also less expensiveSince fees are shared, it is also less expensive
• Group therapy can also be more effective thanGroup therapy can also be more effective than
individual therapyindividual therapy

 Group therapy can also be more effectiveGroup therapy can also be more effective
than individual therapythan individual therapy
• The social pressure in the group can helpThe social pressure in the group can help
shape members’ behaviorshape members’ behavior
• Group members can also act as useful modelsGroup members can also act as useful models
• Mutual reinforcement and support can also beMutual reinforcement and support can also be
providedprovided

Techniques and Formats ofTechniques and Formats of
 The techniques used are determined byThe techniques used are determined by
the nature of the groupthe nature of the group
 It is also determined by the theoreticalIt is also determined by the theoretical
orientation of the therapistorientation of the therapist
 In traditional group therapy, 6 to 12In traditional group therapy, 6 to 12
clients meet once a weekclients meet once a week

Techniques and FormatsTechniques and Formats
 In traditional group therapy, 6 to 12In traditional group therapy, 6 to 12
clients meet once a weekclients meet once a week
• Members are chosen on the basis of what theyMembers are chosen on the basis of what they
can gain from and offer to the groupcan gain from and offer to the group
• The aim is to construct a group whoseThe aim is to construct a group whose
members are compatible in terms of age,members are compatible in terms of age,
needs, and problemsneeds, and problems

 The format of traditional group therapyThe format of traditional group therapy
variesvaries
• Generally, each member describes his orGenerally, each member describes his or
her problems to the other membersher problems to the other members
 The other members relate theirThe other members relate their
experiences with similar problems, andexperiences with similar problems, and
how they copedhow they coped
 Thus, each member expresses their fearsThus, each member expresses their fears
and anxieties to people who areand anxieties to people who are
acceptingaccepting

 Thus, each member expresses their fearsThus, each member expresses their fears
and anxieties to people who are acceptingand anxieties to people who are accepting
 Group members have an opportunity toGroup members have an opportunity to
role play new behaviors in a saferole play new behaviors in a safe
environmentenvironment Sometimes the therapist is directive in helpingSometimes the therapist is directive in helping
to address problemsto address problems
 At other times, the therapist has the groupAt other times, the therapist has the group
resolve a problem independentlyresolve a problem independently

Family TherapyFamily Therapy
 AA familyfamily is a group of people who areis a group of people who are
committed to one another’s well-committed to one another’s well-
being, preferably for lifebeing, preferably for life
• InIn family therapyfamily therapy, two or more people, two or more people
who are committed to each other’s well-who are committed to each other’s well-
being are treated togetherbeing are treated together
• Family therapists often attempt toFamily therapists often attempt to
changechange family systemsfamily systems

• Therapists assume there are multipleTherapists assume there are multiple
sources of psychological influencesources of psychological influence
 Individuals in a family affect familyIndividuals in a family affect family
interactionsinteractions
 Family interactions affect individualsFamily interactions affect individuals
 Family therapists often attempt to changeFamily therapists often attempt to change
family systemsfamily systems
• Treatment takes place within the dynamicTreatment takes place within the dynamic
social system of the marriage or familysocial system of the marriage or family

 Family interactionsFamily interactions
affect individualsaffect individuals
 Sometimes familySometimes family
therapy is calledtherapy is called
relationshiprelationship
therapytherapy, because, because
relationships are arelationships are a
focus offocus of
interventionintervention
 A useful techniqueA useful technique
is tois to restructurerestructure
the family’sthe family’s
interactionsinteractions
 For example, a sonFor example, a son
may be respondingmay be responding
passively to apassively to a
domineeringdomineering
mothermother

 An issue in family therapy is how allAn issue in family therapy is how all
members of a family may becomemembers of a family may become
enmeshed in one member’s problemsenmeshed in one member’s problems
 A son may be responding passively to aA son may be responding passively to a
domineering motherdomineering mother
 The therapist may suggest he only beThe therapist may suggest he only be
assigned chores by his fatherassigned chores by his father

• A family member may be alcoholic, butA family member may be alcoholic, but
codependence may be an additionalcodependence may be an additional
adjustment problemadjustment problem
• Codependents are often plagued by feelingsCodependents are often plagued by feelings
of shame, fear, anger, and painof shame, fear, anger, and pain
 An issue in family therapy is how allAn issue in family therapy is how all
members of a family may becomemembers of a family may become
enmeshed in one member’s problemsenmeshed in one member’s problems
• This problem is calledThis problem is called codependencecodependence

 Codependents areCodependents are
often plagued byoften plagued by
feelings of shame,feelings of shame,
fear, anger, andfear, anger, and
painpain
 However, they feelHowever, they feel
obligated to careobligated to care
for the person withfor the person with
the disorder orthe disorder or
addictionaddiction
 This prevents themThis prevents them
from expressingfrom expressing
their feelingstheir feelings
 In some cases,In some cases,
peoplepeople needneed thethe
person to stayperson to stay
disordereddisordered

 In some cases, peopleIn some cases, people needneed thethe
person to stay disorderedperson to stay disordered
 This allows them to maintain aThis allows them to maintain a
controlling positioncontrolling position

Family Therapy: AssessmentFamily Therapy: Assessment
 Some researchers believe familySome researchers believe family
therapy to be as effective as individualtherapy to be as effective as individual
therapytherapy
• In some situations they say it is moreIn some situations they say it is more
effectiveeffective
• However, not all families profit equallyHowever, not all families profit equally
 It is difficult with families that areIt is difficult with families that are
disorganizeddisorganized

Family Therapy: AssessmentFamily Therapy: Assessment
 Outcomes are notOutcomes are not
as good whenas good when
depression isdepression is
involvedinvolved
 If family membersIf family members
drop out or refusedrop out or refuse
to participate, theto participate, the
outcome is almostoutcome is almost
always negativealways negative
 Younger couplesYounger couples
seem to haveseem to have
better outcomesbetter outcomes
 There is noThere is no oneone
solution to familysolution to family
problemsproblems

Biologically BasedBiologically Based
TherapiesTherapies
Medical TherapiesMedical Therapies

Biologically Based TherapyBiologically Based Therapy
 The usual approach to aThe usual approach to a
psychological problem is “talkingpsychological problem is “talking
therapy”therapy”
• For some patients, this is not enoughFor some patients, this is not enough
 They may be exhibiting symptoms of bipolarThey may be exhibiting symptoms of bipolar
disorder or schizophreniadisorder or schizophrenia
 Some people may be suicidalSome people may be suicidal

 These therapies often involve medication, orThese therapies often involve medication, or
hospitalizationhospitalization
 Biological therapies are often used inBiological therapies are often used in
combination with traditional psychotherapycombination with traditional psychotherapy
 Some people may be suicidalSome people may be suicidal
• These are cases where biologicallyThese are cases where biologically
based therapies come into playbased therapies come into play

 Biological therapies are often used inBiological therapies are often used in
combination with traditionalcombination with traditional
 Most practitioners and theoreticiansMost practitioners and theoreticians
believe the most effective treatmentbelieve the most effective treatment
is drugs in combination withis drugs in combination with

Drug TherapyDrug Therapy
 Clinicians who use drug therapy mustClinicians who use drug therapy must
be aware of several key issuesbe aware of several key issues
• Dosages are important and must beDosages are important and must be
monitoredmonitored
• Long-term use of many drugs is ill advisedLong-term use of many drugs is ill advised
• No drug will permanently cure theNo drug will permanently cure the
maladjustment of people who are notmaladjustment of people who are not
coping wellcoping well

 Psychotropic drugs are grouped into fourPsychotropic drugs are grouped into four
categoriescategories
 No drug will permanently cure theNo drug will permanently cure the
maladjustment of people who are notmaladjustment of people who are not
coping wellcoping well
 Drugs for the relief of mental problemsDrugs for the relief of mental problems
are sometimes calledare sometimes called psychotropicpsychotropic
drugsdrugs

• Antianxiety drugsAntianxiety drugs
• Antimania drugsAntimania drugs
• Antipsychotic drugsAntipsychotic drugs
 Psychotropic drugs are groupedPsychotropic drugs are grouped
into four categoriesinto four categories
• Antidepressant drugsAntidepressant drugs

Antianxiety DrugsAntianxiety Drugs
 Librium, Xanax, and Valium are tradeLibrium, Xanax, and Valium are trade
names of widely prescribed antianxietynames of widely prescribed antianxiety
drugsdrugs
• They are also known as tranquilizersThey are also known as tranquilizers
• They reduce feelings of stress, and have aThey reduce feelings of stress, and have a
calming effectcalming effect
• Abuse and overreliance can be a problemAbuse and overreliance can be a problem
with antianxiety drugswith antianxiety drugs

Antidepressant DrugsAntidepressant Drugs
 Antidepressants (Antidepressants (thymolepticsthymoleptics))
work by altering levels of brainwork by altering levels of brain
chemicalschemicals
• Selective serotonin reuptakeSelective serotonin reuptake
inhibitors (SSRIs) relieve depressioninhibitors (SSRIs) relieve depression
by affecting the neurotransmitterby affecting the neurotransmitter
serotoninserotonin
• Depression is believed to occurDepression is believed to occur
when serotonin does not bind towhen serotonin does not bind to
receptors on the next neuronreceptors on the next neuron

 Depression isDepression is
believed to occurbelieved to occur
when serotoninwhen serotonin
does not bind todoes not bind to
receptors on thereceptors on the
next neuronnext neuron
 After release,After release,
neurotransmittersneurotransmitters
are neutralized,are neutralized,
or re-uptakeor re-uptake
occursoccurs
 SSRIs prevent theSSRIs prevent the
neutralization orneutralization or
reuptake ofreuptake of
serotoninserotonin
 SSRIs thus allowSSRIs thus allow
serotonin toserotonin to
remain in theremain in the
synapse so it cansynapse so it can

 SSRIs allowSSRIs allow
serotonin to remainserotonin to remain
in the synapse so itin the synapse so it
can be effectivecan be effective
 Prozac, Zoloft, andProzac, Zoloft, and
Paxil are SSRIsPaxil are SSRIs
 Two otherTwo other
categories ofcategories of
antidepressantsantidepressants
are:are:
• TricyclicsTricyclics
• Monoamine oxidaseMonoamine oxidase
(MAO) inhibitors(MAO) inhibitors

Tricyclics and MAO InhibitorsTricyclics and MAO Inhibitors
 Tricyclics block neurotransmitterTricyclics block neurotransmitter
reuptakereuptake
 MAO inhibitors break down monoamineMAO inhibitors break down monoamine
oxidase (MAO)oxidase (MAO)
• MAO is an enzyme that destroysMAO is an enzyme that destroys
neurotransmittersneurotransmitters
• Tricyclics pose less of a danger ofTricyclics pose less of a danger of
complications than MAO inhibitorscomplications than MAO inhibitors

Tricyclics and MAO InhibitorsTricyclics and MAO Inhibitors
 Tricyclics pose less of a danger ofTricyclics pose less of a danger of
complications than MAO inhibitorscomplications than MAO inhibitors
 Therefore, they are used moreTherefore, they are used more
frequentlyfrequently

ProzacProzac
 About 31 million people have taken theAbout 31 million people have taken the
SSRI Prozac since its introduction inSSRI Prozac since its introduction in
19871987
• Yearly sales of Prozac and other SSRIs suchYearly sales of Prozac and other SSRIs such
as Zoloft and Paxil amount to more than $4as Zoloft and Paxil amount to more than $4
billionbillion
• Earlier antidepressants could cause increasedEarlier antidepressants could cause increased
heart rate and blood pressure, nausea, andheart rate and blood pressure, nausea, and
sleeplessnesssleeplessness

ProzacProzac
• However, Prozac does not help everyoneHowever, Prozac does not help everyone
• Psychologists worry that Prozac is soPsychologists worry that Prozac is so
effective that the original problems leadingeffective that the original problems leading
to depression may be overlookedto depression may be overlooked
 Earlier antidepressants could causeEarlier antidepressants could cause
increased heart rate and blood pressure,increased heart rate and blood pressure,
nausea, and sleeplessnessnausea, and sleeplessness
 Prozac has fewer side effectsProzac has fewer side effects

ProzacProzac
 Psychologists worry that Prozac is soPsychologists worry that Prozac is so
effective that the original problemseffective that the original problems
leading to depression may beleading to depression may be
overlookedoverlooked
 Most psychologists feel SSRIs shouldMost psychologists feel SSRIs should
be part of a full treatment programbe part of a full treatment program
that also includes psychotherapythat also includes psychotherapy

Antidepressants: ResearchAntidepressants: Research
 Research on the effectiveness ofResearch on the effectiveness of
antidepressants is contradictoryantidepressants is contradictory
 Some studies show strong effects,Some studies show strong effects,
others report only modest helpothers report only modest help
from the drugsfrom the drugs

Antimania DrugsAntimania Drugs
 Lithium carbonate has long been usedLithium carbonate has long been used
as an effective antimania drugas an effective antimania drug
 The dosage is vitalThe dosage is vital
• Too much produces noxious side effectsToo much produces noxious side effects
• Too little has no effectToo little has no effect

Antipsychotic DrugsAntipsychotic Drugs
 Schizophrenia is treated usingSchizophrenia is treated using
antipsychoticsantipsychotics
• Technically calledTechnically called neurolepticsneuroleptics
 The most common are theThe most common are the
phenothiazinesphenothiazines
 Chlorpromazine (Thorazine) is the mostChlorpromazine (Thorazine) is the most
common phenothiazinecommon phenothiazine

 ClozapineClozapine
(Clozaril) is one of(Clozaril) is one of
these new drugsthese new drugs
• It is effective, butIt is effective, but
has severe sidehas severe side
effectseffects
• Newer drugs suchNewer drugs such
as Risperidoneas Risperidone
(Risperdal) may be(Risperdal) may be
as effective withas effective with
fewer side effectsfewer side effects
 ChlorpromazineChlorpromazine
(Thorazine) is the(Thorazine) is the
most commonmost common
phenothiazinephenothiazine
 Other drugs,Other drugs,
called “atypicalcalled “atypical
antipsychotics,”antipsychotics,”
have beenhave been
introduced in theintroduced in the
last decadelast decade

 Antipsychotics are less effective atAntipsychotics are less effective at
reducing other symptoms, such asreducing other symptoms, such as
problems of emotionsproblems of emotions
 Newer drugs such as RisperidoneNewer drugs such as Risperidone
(Risperdal) may be as effective with(Risperdal) may be as effective with
fewer side effectsfewer side effects
 Antipsychotics are often very effectiveAntipsychotics are often very effective
at treating hallucinations and delusionsat treating hallucinations and delusions

 Antipsychotics areAntipsychotics are
less effective atless effective at
reducing otherreducing other
symptoms, such assymptoms, such as
problems ofproblems of
emotionsemotions
 As with otherAs with other
drugs, dosages aredrugs, dosages are
crucialcrucial
 If patients areIf patients are
maintained onmaintained on
antipsychotics forantipsychotics for
too long, problemstoo long, problems
may emergemay emerge
 One problem withOne problem with
antipsychotics isantipsychotics is
tardive dyskinesiatardive dyskinesia

 One problem with antipsychotics isOne problem with antipsychotics is
tardive dyskinesiatardive dyskinesia
• A nervous system disorderA nervous system disorder
• It involves involuntary, spasmodicIt involves involuntary, spasmodic
movements of the upper body,movements of the upper body,
especially the face and fingersespecially the face and fingers

PsychosurgeryPsychosurgery
 PsychosurgeryPsychosurgery is brain surgeryis brain surgery
• In the 1940s and 50s, a common typeIn the 1940s and 50s, a common type
was thewas the prefrontal lobotomyprefrontal lobotomy
 Removal of parts of the brain’s frontal lobesRemoval of parts of the brain’s frontal lobes
would alleviate symptoms of mentalwould alleviate symptoms of mental
disordersdisorders
 However, prefrontal lobotomies made someHowever, prefrontal lobotomies made some
people become unnaturally calm andpeople become unnaturally calm and
completely unemotionalcompletely unemotional

 PrefrontalPrefrontal
lobotomies madelobotomies made
some peoplesome people
become unnaturallybecome unnaturally
calm andcalm and
completelycompletely
unemotionalunemotional
 Others becameOthers became
unable to controlunable to control
their impulsestheir impulses
 Today, despiteToday, despite
advances,advances,
psychosurgery ispsychosurgery is
rarerare
 Drug therapy hasDrug therapy has
proven moreproven more
effective thaneffective than
surgical proceduressurgical procedures

 Most important,Most important,
psychosurgery ispsychosurgery is
irreversibleirreversible
 Therefore, it isTherefore, it is
morallymorally
objectionable toobjectionable to
many patients andmany patients and
their familiestheir families
 Drug therapy hasDrug therapy has
proven moreproven more
effective thaneffective than
surgicalsurgical
proceduresprocedures
 The long-termThe long-term
effects ofeffects of
psychosurgerypsychosurgery
are alsoare also
questionablequestionable

Electroconvulsive TherapyElectroconvulsive Therapy
 Electroconvulsive therapyElectroconvulsive therapy (ECT) was(ECT) was
once widely employed with depressedonce widely employed with depressed
peoplepeople
• It is a treatment for severe mental illnessIt is a treatment for severe mental illness
• An electric current is briefly applied to theAn electric current is briefly applied to the
head to produce a generalized seizurehead to produce a generalized seizure
(convulsion)(convulsion)
• The duration of the shock is less than aThe duration of the shock is less than a
secondsecond

 In the 1940s and 50s, ECT was routinelyIn the 1940s and 50s, ECT was routinely
given to severely disturbed patients ingiven to severely disturbed patients in
mental hospitalsmental hospitals
 The duration of the shock is less than a secondThe duration of the shock is less than a second
 Patients are treated in 3 to 12 sessions overPatients are treated in 3 to 12 sessions over
several weeksseveral weeks

 Today, ECT is not a widely usedToday, ECT is not a widely used
treatmenttreatment
 In the 1940s and 50s, ECT was routinelyIn the 1940s and 50s, ECT was routinely
given to severely disturbed patients ingiven to severely disturbed patients in
mental hospitalsmental hospitals
 Unfortunately, it was often used withUnfortunately, it was often used with
patients who did not need it, or as apatients who did not need it, or as a
means of controlmeans of control

 Today, ECT is not aToday, ECT is not a
widely usedwidely used
treatmenttreatment
 ECT is effective inECT is effective in
short-termshort-term
management ofmanagement of
severe depressionsevere depression
 It is sometimesIt is sometimes
used when thereused when there
is a risk of suicideis a risk of suicide
 However, theHowever, the
effects of ECT areeffects of ECT are
temporarytemporary

 The effects of ECT are temporaryThe effects of ECT are temporary
 Use of ECT should be followed byUse of ECT should be followed by
psychotherapy and drug therapypsychotherapy and drug therapy
 ECT should also be used only as aECT should also be used only as a
last optionlast option

 Risk of death dueRisk of death due
to ECT is lowto ECT is low
 However, it mayHowever, it may
cause memory losscause memory loss
 Law requires thatLaw requires that
the patient bethe patient be
given the option togiven the option to
refuse ECTrefuse ECT
treatment, as istreatment, as is
true for anytrue for any
treatmenttreatment
 ECT is notECT is not
appropriate forappropriate for
treatingtreating
schizophreniaschizophrenia
 It is alsoIt is also
inappropriate forinappropriate for
managing unrulymanaging unruly
behaviorbehavior

Comprehensive view of psychotherapies

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