Chapter 15: Psychological Therapies – Study Guide

Chapter 15: Psychological Therapies

15.1 Treatment of Psychological Disorders: Past to Present

This section explores the historical and modern approaches to treating psychological disorders, highlighting the evolution from inhumane practices to evidence-based therapies.

• Historical Treatments: Before the late 1700s, severe mental disorders were often attributed to possession by demons or evil spirits, leading to harsh and sometimes deadly treatments.

• Philippe Pinel: Advocated for humane treatment of the mentally ill, notably unlocking the chains of patients in a French asylum.

• Therapy: Methods aimed at improving well-being and functioning. Two main categories:

  • Psychological therapies: Based on psychological theory and techniques.

  • Medical therapies: Use medical intervention to control symptoms.

• Eclectic Approach: Combines elements from different therapeutic approaches for tailored treatment.

• Psychotherapy: Involves interaction with a trained professional to modify dysfunctional thoughts, behaviors, or emotions.

  • Insight therapies: Aim to increase self-understanding of thoughts, feelings, and behaviors.

  • Action therapies: Focus on changing problematic behaviors directly.

• Biomedical Therapy: Directly affects biological functioning of the body and brain (e.g., medication, ECT).

15.2–15.3 Insight Therapies: Psychodynamic and Humanistic Approaches

Insight therapies aim to help clients gain awareness of underlying motives and feelings. Two major approaches are psychodynamic and humanistic therapies.

15.2 Freud’s Psychoanalysis and Psychodynamic Approaches

• Psychoanalysis: Developed by Sigmund Freud, this therapy seeks to reveal unconscious conflicts through techniques such as:

  • Dream interpretation: Analyzing manifest (actual) and latent (symbolic) content of dreams.

  • Free association: Encouraging patients to speak freely to uncover unconscious material.

  • Resistance and transference: Resistance is the client’s reluctance to discuss certain topics; transference involves projecting feelings about important people onto the therapist. Countertransference is the therapist’s emotional entanglement with the client.

• Modern Psychodynamic Therapy: More directive and client-centered, with shorter treatment times and a focus on current relationships and emotions.

• Interpersonal Psychotherapy (IPT): Focuses on interpersonal issues and is empirically supported for depression.

15.3 Humanistic Therapies

• Person-Centered Therapy: Developed by Carl Rogers, this nondirective therapy emphasizes the client’s perspective and self-exploration.

  • Congruence (Genuineness): Therapist’s authenticity and honesty.

  • Unconditional Positive Regard: Warm, accepting, nonjudgmental environment.

  • Empathy: Therapist’s ability to understand the client’s feelings and experiences.

  • Reflection: Therapist restates rather than interprets client statements.

• Motivational Interviewing (MI): Aims to reduce ambivalence about change and increase intrinsic motivation.

• Gestalt Therapy: Directive therapy helping clients accept all parts of their feelings and experiences, often using role-play (e.g., empty chair technique). Focuses on the denied past rather than the hidden past.

• Effectiveness: Humanistic therapies work best with intelligent, verbal clients and are less suited for severe disorders like schizophrenia.

15.4–15.5 Action Therapies: Behavior and Cognitive Therapies

Action therapies focus on changing problematic behaviors or thoughts through structured techniques.

15.4 Behavioral Therapies

• Behavior Therapies: Use principles of classical and operant conditioning to change disordered behavior, regardless of its origin.

• Behavior Modification/Applied Behavior Analysis: Uses learning techniques to increase desirable behaviors and decrease undesirable ones.

• Systematic Desensitization: Treats phobias by gradually exposing clients to feared objects/situations while teaching relaxation.

Situation	Fear Level
Being bitten by a rabbit	100
Petting a rabbit on the head	90
Petting a rabbit on the back	80
Holding a rabbit	70
Touching a rabbit held by someone else	60
Seeing someone I trust hold a rabbit	50
Being in a room with a rabbit	40
Thinking about petting a rabbit	30
Looking at pictures of a rabbit	20
Watching the movie Hop	0

• Exposure Therapies: Expose clients to anxiety-provoking stimuli in a controlled way (in vivo, imaginal, virtual, graded exposure).

• Flooding: Rapid, intense exposure to feared stimulus without escape.

• Prolonged Exposure (PE): Used for PTSD, combines exposure with cognitive-behavioral elements.

• Eye-Movement Desensitization Reprocessing (EMDR): Involves recalling distressing events while moving the eyes; used for PTSD.

• Exposure and Response Prevention (EX/RP): Effective for OCD; clients are exposed to triggers but prevented from performing compulsions.

15.5 Cognitive Therapies

• Rational Emotive Behavior Therapy (REBT): Developed by Albert Ellis; challenges irrational beliefs and restructures thinking.

• Beck’s Cognitive Therapy: Identifies and corrects cognitive distortions such as:

  • Arbitrary inference: Drawing conclusions without evidence.

  • Selective thinking: Focusing on one aspect while ignoring others.

  • Overgeneralization: Applying one event to unrelated situations.

  • Magnification/Minimization: Exaggerating negatives or minimizing positives.

  • Personalization: Taking responsibility for unrelated events.

• Cognitive-Behavioral Therapy (CBT): Combines cognitive and behavioral techniques to change maladaptive thoughts and behaviors. Goals:

  1. Relieve symptoms and resolve problems.

  2. Develop coping strategies for future problems.

  3. Change irrational, self-defeating thoughts to rational, positive ones.

• Effectiveness: CBT is effective for depression, anxiety, stress, insomnia, and eating disorders, but may focus more on symptoms than underlying causes.

15.6–15.7 Group Therapies

Group therapies involve multiple clients meeting together with a therapist to address shared concerns.

• Family Counseling: Family members work together to resolve issues affecting the whole family.

• Self-Help/Support Groups: Peers with similar challenges meet for mutual support, often without a therapist.

• Advantages: Lower cost, social interaction, emotional support.

• Disadvantages: Less privacy, shared therapist time, not suitable for severe disorders.

Advantages	Disadvantages
Low cost	Need to share therapist's time
Social interaction	Lack of privacy
Support from peers	Not suitable for severe disorders

15.8–15.9 Effectiveness of Psychotherapy

• Research Findings: Psychotherapy is generally more effective than no treatment; 75–90% of clients report improvement.

• Common Factors Approach: Success is linked to the therapeutic alliance, protected setting, catharsis, learning new behaviors, and positive client experiences.

• Evidence-Based Treatment (EBT): Interventions supported by controlled research.

• Neuroimaging: Shows psychotherapy can alter brain activity related to emotion regulation and reward.

15.10–15.12 Biomedical Therapies

• Psychopharmacology: Study and use of medications for psychological disorders.

  • Antipsychotic drugs: Treat psychosis (e.g., delusions, hallucinations) by blocking dopamine receptors.

  • Antianxiety drugs: Minor tranquilizers for anxiety.

  • Mood stabilizers: For bipolar disorder (e.g., lithium, anticonvulsants).

  • Antidepressants: Treat depression/anxiety (e.g., MAOIs, tricyclics, SSRIs).

• Electroconvulsive Therapy (ECT): Used for severe depression; involves electrical stimulation to induce seizures. Side effects include memory disruption.

• Psychosurgery: Surgical intervention on brain tissue (e.g., prefrontal lobotomy, bilateral anterior cingulotomy).

• Emerging Techniques: Noninvasive brain stimulation (rTMS, tDCS) and invasive deep brain stimulation (DBS).

15.13 Lifestyle Factors: Fostering Resilience

• Resiliency: The ability to adapt and recover from challenges.

• Strategies for Mental Health:

  • Get enough sleep (8–9 hours/night).

  • Eat a healthy diet.

  • Spend time in nature (Attention Restoration Therapy, adventure therapy).

  • Engage in regular physical activity (2.5+ hours/week of aerobic exercise).

15.14 Reducing Stigma of Seeking Help

• Stigma Reduction: Strategies include education, open discussion, and promoting resources for mental health support.

• Importance: Reducing stigma encourages individuals to seek help and improves overall mental health outcomes.