Unit 2:

Theoretical
Perspectives
 Theoretical Perspectives in
Abnormal Psychology
• --orientations to understanding
▫ causes of human behavior
▫ treatment of abnormality

• guide -- research and clinical work in abnormal

psychology
 Biological Perspective
▫ abnormalities in the body’s functioning 
responsible -- symptoms

▫ primarily -- disturbances in THE NERVOUS

SYSTEM or other systems that have an impact on
the nervous system
 Theories
• 1. Neurotransmitters
▫ transmission of info throughout the NERVOUS SYSTEM takes
place at synapses
points of communication between neurons

▫ Electrical signals containing info  transmit chemically

across the synapse from one neuron to the next

▫ Through this transmission, neurons from complex pathways

along which info travels from one part of the nervous system
to another

▫ Neurotansmitter –
the chemical messengers that
travel across the synapse,
allowing neurons to communicate
with their neighbors
▫ Role of Several Major Neurotransmitters in psychological disorders.

Norepinephrine – Depression Disorders, Anxiety Disorder

Serotonin - Depression Disorders, Anxiety Disorder, Schizophrenia,
Anorexia Nervosa, Substance Use Disorder

Gamma-aminobutyric (GABA) - anxiety disorder, Substance Use

Disorder

Dopamine – Neurocognitive disorder due to Parkinson’s disease,

Schizophrenia, Eating Disorder, Substance use disorder

Acetylcholine – Neurocognitive disorder to due to Alzheimer’s disease

Opioids - Substance use disorder

• 2. Abnormalities in the Brain structures
▫ abnormally developed or functioning brain
structures

▫ Because – cannot directly observe brain

structures

▫  researchers -- developed sophisticated brain

scanning methods -- to measure
How brain -- structured
more importantly, how it performs while it is
processing information
• Causes of nervous system dysfunction range
from Genetic Abnormalities to Brain Damage

• 3. Genetic Abnormalities
▫ through
inheritance of particular combinations of genes,
faulty copying when cells reproduce or
mutations -- person acquires over the course of life
Cells do possess the ability to repair many of these
mutations
If these repair mechanisms fail  mutation can pass
along to the altered cell’s future copies
▫ Genes
contains -- instruction for forming proteins
determine how the cell performs

controls -- manufacturing of neurotransmitters, as

well as the way neurotransmitters behave in the
synapse

Also determines, in part, how the brain’s structures

develop throughout life
Any factor that can alter the genetic code can also alter
how these structures perform
• Inherited disorders
▫ when the genes from each parent combine in such way that the ordinary
functioning of a cell is compromised

• Genotype –is a genetic makeup, which contains the form of each gene
that one inherit , called an allele
▫ Allele A causes a protein to form leads a neuron to form abnormally
▫ Allele B -- entirely healthy
inherited 2 genes containing Allele B  no chance of -- disease

two gene containing Allele A –almost certainly get the disease

one Allele A and One Allele B  situation becomes more complicated

disease – depends on -- whether Allele A is “dominant”
▫ its instructions to code the harmful protein will almost certainly prevail over those of Allele
B
Or Allele A is “recessive,”
▫ then it alone cannot cause the harmful protein to form

▫ one is AB combination (carrier) + with another AB carrrier  child -- could receive the
two AAs, and therefore develop the disorder
• Patterns of Dominant – Recessive Trait
Inheritance
▫ Dominant-Recessive gene inheritance model rarely
account for -- genetic inheritance of disorders

▫ some -- inherited disorders -- through MATERNAL

LINKAGES only --transmit only through – mother

These disorders occur with defects in the

mitochondrial DNA,
DNA -- controls protein formation in the cell’s
mitrochondria (energy-producing structure)

▫ Many disorders reflect -- POLYGENIC MODEL

involving the joint impact of multiple gene
combination
• not only are multiple genes involved -- but --
ENVIRONMENT plays an imp role in contributing
▫ PHENOTYPE –
observed and measurable characteristic -- results from --
combination of environmental + genetic influences
Some phenotypes -- relatively close to their genotypes
eye color
Complex organs such as the brain

▫ study of EPIGENETICS attempts to identifythe ways

that the environment influences genes to produce
phenotypes
• researchers in schizophrenia proposed -- use of the term
“ENDOPHENOTYPES”
▫ Reflecting -- complexity of -- brain’s structure and functions

▫ the combination of genetic and environmental contributors

to complex behaviors
▫ is an internal phenotype
characteristic that is not outwardly observable
Schizophrenia -- several possible endophenotype =outwardly
observed symptoms
▫ Like Abnormalities in Memory, Sensory Processes and particular
Types of Nervous System Cells
▫ assumption -- these observable characteristics, which heredity and
the environment influence  responsible -- behavioral expressions

▫ concept - was probably decades ahead of its time,

because in the 1970s, researchers were limited in what they
should study both in terms of genetics and the brain

▫ With the development of sophisticated DNA testing and

brain imaging methods, the concept is seeing a resurgence
• relationships – genetic + environmental influences fall into
two categories:
▫ 1. gene-environment correlations
exist when people with a certain genetic predisposition are
distributed unequally in particular environments

These correlations can come about in three ways

1. through passive exposure
▫ Children with -- genetic predispositions -- exposed to environments --
parents create based on their genetic predispositions

2. parents treat -- children with genetic predispositions in

particular ways
▫ because their abilities bring out particular responses

3. “niche picking”

psychological disorders  any 3 of these situations can occur

heightening the risk –
children of parents with genetic predisposition -- more likely to develop the
disorder because -- envi’s enhancing effect
2. Interactions Between Genes And The Environment
▫ occur when one factor influences the expression of the
other
major depressive disorder
researchers -found –
▫ high genetic risk + under high stress  more likely --dep sympt
▫ than -- with low genetic risk
◦ Thus -- same stress -- different effects on -- diff genetic predispositions

Conversely -- genetic risk + higher stress levels  higher -dep

▫ than -- who live in low-stress environments
▫ person may have a latent genetic predisposition or vulnerability -- only
manifests -- when --- under environmental stress

In these studies -- researchers defined genetic risk in terms –

▫ whether or not an indi had a close relative with disorder symptoms

genetic risk presence -- did not predict whether or not the

person developed major depressive disorder -- unless --
exposed to a high-stress environment
• Researchers -- aware -- joint contributions of
genes and environment = disorders
▫ diathesis-stress model
proposed -- people -- born with a diathesis (genetic
predisposition) or acquire vulnerability early in life
due to formative events
such as traumas, disease, birth complications or harsh
family environment (Zubin & Spring, 1997)

This vulnerability  risk -- development of a

psychological disorder as ---- they grow
• With advances in genetic science, researchers --
better able to understand the precise ways in
WHICH GENES and ENVIRONMENTAL FACTORS
INTERACT
▫ people inherit two copies of a gene
one from each parent
both copies actively shape the indi’s development

▫ certain genes regulate through a process known as

epigenesis
envi causes them to turn “off” or “on”

▫ If the remaining working gene is deleted or severely

mutated  then a person can develop an illness

The process of DNA Methylation can turn off a gene

as a chemical group, methyl, attaches itself to the
gene
Eg. Through the epigenetic processes of DNA
methylation, maternal care can change gene expression
▫ study -- during pregnancy, a mother’s exposure to
environmental toxins caused DNA methylation in her
unborn child (Furness et al, 2011)

▫ Studies on laboratory animals also show – stress can

affect DNA in specific ways – alter brain development

▫ Researchers -- certain drugs -- mother uses during

pregnancy cause DNA methylation, including nicotine,
alcohol and cocaine.
• To understand -- contributions of genetics – three
methods:
▫ family inheritance studies
▫ DNA linkage studies
▫ genomics combined with brain scan technology.

In family inheritance studies

researcher compare the disorder rates across relatives
who have varying degrees of genetic relatedness.

Similarly studies of parents and children -- confounded by

the fact that the parents create the environment in which
their children are raised.

In order to separate the potential impact of the

environment -- adoption studies
•  For decades, family and twin studies were the
only methods researchers had at their disposal to
quantify the extent of genetic influences on
psychological disorders

• With the advent of genetic testing, however,

researchers became able to examine specific
genetic contributions to a variety of traits
including both physical and psychological
disorders
• in a genome-wide linkage study
▫ researchers study the families -- with specific
psychological traits or disorders

▫ Principle -- characteristics near to each other on a

particular gene are more likely inherited together

▫ With refined-- methods available -- carry this task –

with far greater precision

▫ limitations
primarily -- require study of Large numbers of family
members
may produce only limited findings
• genome-wide association studies (GWAS)
• Researchers scan the entire genome of indi who are not related to find the
associated genetic variations with a particular disease

• They are looking for single nucleotide polymorphism (SNP)

which is a small genetic variation that occur in a person's dna sequence
4 nucleotide letters
Adenine
Guanine
Thymine
Cytosine
▫ Specify the genetic code.
A SNP variation occurs when a single nucleotide, such as A, replaces one
of the other three
For eg., a SNP is the alteration of the DNA segment
AAGGTTA to ATGGTTA, in which a “T” replaces the
second “A” in the first snippet

With high-tech genetic testing methods now more

readily available -- researchers have more powerful
tools to find SNPs that occur with particular traits (or
diseases) across large numbers of people.

▫ many SNPs do not produce physical changes in people,

▫ researchers believe -- other SNPs may predispose people
to disease and even influence their response to drug
regiments
• Imaging genomics -- increasingly augmenting
genetic studies

• Researchers can combine linkage or association

methods with imaging tools ----- to examine
connections between gene variants and
activation patterns in the brain.
Treatment
• At present – cannot address – the disorder
cause in terms of fixing genetic problems.

• Involves
▫ Medications
▫ Surgery
▫ Other direct treatment
• Psychotherapeutic medications
▫ to reduce symptoms BY ALTERING THE LEVELS OF
NEUROTRANSMITTERS

▫ 1950 -- French chemist -- Paul Charpentier -- synthesized

chlorpromazine (Thorazine)
-- widespread acceptance -- in -1960s
 development of a wider range of psychotherapeutic
agents

▫ Currently -- major categories -- include

Antipsychotic, Antidepressants, Mood Stabilizers,
Anticonvulsants, Antianxiety and Stimulants
◦ (Table 4.2)

▫ Some --designed to treat one disorder, such as

antidepressants -- also serve to treat other disorders, such
as anxiety disorder

suggest -- abnormalities involving similar neurotransmitter

▫ medications -- serious side effects
leading patients -- to discontinue their use and try a
different medication, perhaps from a diff category

▫ The Federal Drug Administration

maintains a watch list effect with monthly updates

patients can sign up for a monthly newsletter by

following a list on this website
• PSYCHOSURGERY OR PSYCHIATRIC NEUROSURGERY
▫ second major category of interventions
▫ a neurosurgeon operates on brain regions, most likely
responsible for -- symptoms

▫ first modern use of psychosurgery -- PREFRONTAL

LOBOTOMY
Portuguese neurosurgeon Egas Moniz developed -- 1935
By severing the prefrontal lobes from the rest of the brain
 Moniz found  reduce - symptoms
also caused severe changes -- personality, loss of
motivation
medical field considered -- a major breakthrough at the
time  honored with a Nobel Prize -- 1949

▫ 1960s -- psychotherapeutic medications became

available,
alternative to pre-frontal lobotomies
allowing them to reduce -- symptoms without resorting to
this extreme measure
• Modern psychosurgery relies on targeted
interventions
▫ patients - unresponsive to less radical treatment

• Each forms -- targets a specific region of the brain --

researchers believe is involved as a cause of
symptoms

• With higher levels of precision -- reflect advances in

surgical techniques, neurosurgeons can produce a
lesion in a specific brain region to provide symptom
relief

▫ severe obsessive-compulsive or major depressive

disorder --lesions target the cortex, striatum, and
thalamus.
• Deep Brain Stimulation (DBS) – (neuromodulation)
▫ form of psychiatric neurosurgery
▫ permanently implanted electrodes trigger responses in
specific brain circuits
▫ pacemaker like device -- delivers an adjustable current

▫ consists of three components

1. The lead –
is a thin, insulated wire -- inserted through a small opening in
the skull and implanted in the brain.
The tip of the electrode is positioned within the targeted
brain area.

2. The extension –
is an insulated wire -- passed under the skin of the head,
neck, and shoulder, connecting the lead to the
neurostimulator.

3. The neurostimulator (the "battery pack")

is usually implanted under the skin near the collarbone.
some cases -- implanted lower in the chest or under the skin
over the abdomen

▫ Once the system is in place, ELECTRICAL IMPULSES ARE

SENT from the neurostimulator up along the extension
wire and the lead and into the brain
 ▫ Newer applications of DBS -- investigated for the treatment
of psychological disorders, including obsessive-compulsive
disorder and major depressive disorder

▫ One of the benefits - stimulation can be altered in response

to the client's reactions during treatment

▫ hope -- minimally invasive procedure will have widespread

applicability to a variety of other debilitating conditions for
which conventional treatments have been ineffective

• https://www.youtube.com/watch?v=Lq5rIILcVgA
• https://www.youtube.com/watch?v=j3NjNKm0pio
• Cingulotomy
▫ Probes -- inserted into the brain to destroy a spot
on the anterior cingulate gyrus, to disrupt a circuit
that connects the emotional and conscious
planning centers of the brain.
• Capsulotomy
▫ Probes are inserted deep into the brain and heated
to destroy part of the anterior capsule, to disrupt a
circuit thought to be overactive in people the
severe OCD
• Gamma Knife Surgery
▫ An MRI-like device focuses hundreds of small
beams of radiation at a point within the brain,
destroying small areas of tissues
• ELECTROCONVULSIVE THERAPY (ECT)
▫ attached electrodes across the head produce an electric shock that
produces brief seizures.

▫ Ugo Cerletti, an Italian neurologist seeking a treatment for epilepsy,

developed this method in 1937.

▫ became increasingly popular in the 1940s and 1950s

▫ but, as the movie One Flew over the Cuckoo's Nest depicts, staff in
psychiatric hospitals also misused it as a way to restrain violent
patients.

▫ ECT had largely fallen into disuse by the mid-1970s, psychiatrists

continued to use it to treat a narrow range of disorders.

▫ A comprehensive review of controlled studies using ECT for

treatment of major depressive disorder showed that, in the short-
term  ECT was more effective than medications in producing rapid
improvement of symptoms.

▫ However, there are long-term ECT consequences including

memory impairment (UK ECT Review Gscoup, 2003).
 TRAIT THEORY
• Abnormality – occurs – maladaptive personality
▫ Personality –stable enduring dispositions that
persist over time

• For many personality theories – these long standing

qualities– potentially biological

• Easy to relate with trait theory

• Principle – personality is equivalent to a set of stable

characteristic attributes
• FIVE FACTOR MODEL
▫ Predominant theory of trait
▫ Also called as Big Five (McCrae & Costa, 1987)
▫ Each of the five basic dispositions has six facets,
which leads to a total of 30 personlity components
EXTROVERSION
AGREEABLENESS
CONSCIENTIOUSNESS
NEUROTICISM
OPENESS TO EXPERIENCE
▫ rating
▫ However, Research – using highly sophisticated
data analytic designs – people can change even
their fundamental personality traits.
Most research is based on samples whose scores
falls within normal range of functioning
▫ The main value of understanding personality trait is
that it provides a perspective for examining
personality disorder
Research on Five factor model – became the basis for
current attempts to reformulate the personality
disorders in DSM - 5

▫ Model does not necessarily provide a framework for

psychotherapy, it has proven valuable as a basis for
personality assessment within the context of
understanding an indi’s characteristic beh patterns
PSYCHODYNAMIC PERSPECTIVE
• Emphasis unconscious determinants of behavior

• Greatest emphasis to the role of processes

beneath the surface of awareness as influence
0n abnormalities
 Freud’s Theory
• Mind has 3 structure –
▫ Id,
▫ Ego,
▫ Superego

• Psychodynamic or interplay
among the structure of the
mind – basis for both
normal and abnormal psychological functioning
• Defense mechanism

• Psychosexual stages
of development
2
Post-Freudian Psychodynamic Views
• Freud -- develop theory –in context of --clinical practice
• -- also encouraged like-minded neurologists and
psychiatrists
▫ to work together – to develop -- new theory of
abnormality

• Over a period of yrs -- spent many hrs -- comparing notes

-- their clinical cases and trying to come to a joint
understanding of the cause of abnormality

• Although many -- share same views when – in beginning

• several went on to develop their own unique brand of
psychodynamic theory and now have their own schools
of thought
• most notable departure from Freud’s school -- Swiss
psychiatrist Carl Jung (1975-1961)
▫ revamped -- definition of the UNCONSCIOUS
▫ Jung (1961) - unconscious is formed at its very root
around a set of images common to all human
experience, which he calledarchetypes
people respond to events in their daily lives on the basis
of these archetypes
because they are part of our GENETIC MAKEUP

▫ Jung (1916) -- abnormality

resulted from  AN
IMBALANCE WITHIN
THE MIND, especially when
people fail to pay proper attention
to their unconscious needs
• Alfred Adler (1870-1952) and Karen Horney (1885-1952) –
▫ EGO -- most important aspect of personality
▫ theories represented distinct contributions

▫ gave great emphasis to -- role of a HEALTHY SELF-CONCEPT in

normal psychological functioning

▫ people are Motivated to maintain a CONSISTENT and favorable

view of the self
▫ they develop psychological defenses to protect this positive self-
view

▫ Alder talked about -- NEGATIVE CONSEQUENCES OF AN

“INFERIORITY COMPLEX,” and

▫ Horney - unhappiness comes from trying to live up to a false self

▫ Both -- also emphasized social concerns and interpersonal

relations in the development of personality.
close relationships with family and friends and an interest in the
life of the community as gratifying in their own right
not because a sexual or an aggressive desire is indirectly satisfied
in the process
• only psychodynamic theorist to give attention to the whole
of life, not just childhood, was Erik Erikson (1902-1994)
▫ Like Adler and Homey -- Erikson gave greatest attention to the
ego, or what he called "EGO IDENTITY.“

-- theories of Adler, Horney, and Erikson -- ego psychology group

▫ "identity crisis," a task -- central to development in adolescence

▫ ego goes through a series of transformation throughout life in

which a new strength or ability can mature

▫ each stage builds on the one that precedes it, and in turn,
influences all following stages

▫ However, Erikson proposed -- any stage could become a major

focus at any age –
Eg. identity issues can resurface at any point in adulthood,
even after a person’s identity s relatively set
• object relations
▫ relationships that people have with the others
(“objects") in their live

▫ theorists believed -- individual’s RELATIONSHIP

WITH THE CAREGIVER (usually the mother)
becomes a model for all close adult
relationships

▫ theorists included John Bowlby (1907-1990),

Melanie Klein (1882- . 1960), D. W. Winnicott
(1896-1971), Heinz Kohut (1913-1981), and
Margaret Mahler (1897-1995).

▫ early childhood relationships -- root of abnormality

▫ work of object relations theorists  development of --
framework for understanding adult personality,
▫ particularly as applied to ROMANTIC RELATIONSHIPS
Canadian psychologist Mary Salter Ainsworth (1913- 1999) and
her associates (1978) studied
differences among infants in attachment style, or the way of
relating to a caregiver figure
developed the "strange situation,“
▫ an experimental setting in which researchers separated infants from
and then reunited them with their mothers

▫ Although designed as a theory of child development later

researchers -- adapted the concept of ATTACHMENT STYLE
to adult romantic relationships.
Most children develop secure attachment styles later in life
relate to their close romantic partners
without undue anxiety about whether or not -- partners will care
about them

insecurely attached in childhood  anxious attachment

in which they feel they cannot rely on their partner's love and support
may show a dismissive or avoidant attachment style in which
▫ they fear rejection from others, and
▫ An individual's attachment style -- also influence
how he or she responds to psychotherapy.
Across 19 separate studies involving nearly 1,500
clients, researchers found -- attachment security
was positively related to therapy outcome

secure attachment style -- are better able to

establish a positive working relationship with their
therapists  which, in turn, predicts positive
therapy outcomes. (Levy et al, 2011)
 Treatment
• main goal of traditional psychoanalytic treatment as
developed by Freud (1913-14/1963) was to bring
repressed, unconscious material into conscious
awareness.
▫ To accomplish this task--developed the therapeutic
method of FREE ASSOCIATION,
in which the client literally says whatever comes to
mind.
Freud believed -- clients needed to work through their
unconscious conflicts, bringing them gradually into
conscious awareness.
• Current psychodynamic treatment is focused on
helping clients explore aspects of the self that are
“unsconscious” in the sense that the client does not
recognize them.
▫ Therapists focus on -- how clients reveal and influence
these aspects of the self in their relationship with the
therapist.
▫ The key elements of psychodynamic therapy involve
exploring the client’s emotional exp,
use of defense mechanisms,
close relationships with others,
past experiences, and
exploration of fantasy life in dreams,
Daydreams and fantasies (Shedler, 2010)
• Unlike the stereotyped portrayal in movies or TV,
clinicians need not conduct psychodynamic therapy on a
couch, for a yrs at a time, or with a silent therapist

• However, given the impracticality of maintaining such a

long-term and intense form of treatment,
psychotherapist began developing briefer forms of
psychodynamic therapy.
▫ Instead of attempting to revamp a client's entire psychic
structure,
▫ psychotherapists using these methods focus their work
on a specific symptom or set of symptoms for which the
client is seeking help
▫ number of sessions can vary, but rarely exceeds 25

▫ therapist takes a relatively active approach in

maintaining the focus of treatment on the client’s
presenting problem or issues immediately relevant to
that problems
▫ In one version of brief psychodynamic therapy, the
clincian Identities the client’s "Core Conflictual
Relationship Theme (CCRT)."
clinician assesses –
client's wishes,
expected responses from others, and
client responses either to the responses of others or to
the wish

Clients describe specific instances in their relationships

with others that allow the clinician to make the CCRT
assessment

clinician then works with the clients in a supportive way to

help them recognize and eventually through these
patterns (Jarry. 2010)
 BEHAVIORAL PERSPECTIVES
• the individual maladaptive behavior through
LEARNING.
 Theories
• Classical conditioning
▫ accounts for the learning of emotional, automatic
responses.
▫ type of aversive conditioning in which the
individual associates a maladaptive response with
a stimulus that could not itself cause harm.
• operant conditioning
▫ an individual acquires a maladaptive response by --
learning to pair behavior with its consequences.

▫ The behavior's consequences are its

REINFORCEMENT —the condition that makes the
individual more likely to repeat the behavior in the
future.
▫ Reinforcement can take many forms.
positive reinforcement
negative reinforcement

▫ Both negative and positive reinforcement increase the

frequency of the behaviors that precede them.
• behavioral perspective -- don't have to directly
experience reinforcement in order -- to modify
your behavior.

• Psychologists who study social learning theory

▫ people can learn by watching others.
▫ Through vicarious reinforcement – one become
more likely to engage in these observed behaviors.
▫ can also develop ideas about own abilities, or
sense of self-efficacy  by watching the results
of your own actions or those of other people with
whom you identify.
Treatment
• focus -- on helping –
▫ UNLEARN maladaptive behaviors and
▫ REPLACING them with healthy, adaptive behaviors.

• In counterconditioning,
▫ as developed by physician Joseph Wolpe (1915-1997)
▫ clients learn to pair a new response to a stimulus that formerly provoked
the maladaptive response.
▫ new response is, in fact, incompatible with the old (undesirable) response.
Eg., cannot be physically anxious and relaxed at the same time.
learn to associate the response of relaxation to the stimulus that formerly
caused them to feel anxious.
▫ Clinicians teach clients to relax through a series of progressive steps;
Eg., by first relaxing the head and neck muscles, then the shoulders, arms,
and so forth.
▫ often occurs in gradual stages using the SYSTEMATIC DESENSI-T ATION
method.
therapist breaks down the maladaptive response into its smallest steps
rather than exposing the client all at once to the feared stimulus.

client provides the therapist with a hierarchy or list of images associated

with the feared stimulus.
▫ Starting with the least fearful situation in the
hierarchy, the clinician asks the client to imagine
that image and relax at the same time.

▫ After -- connection between that image and

relaxation -- established  clinician then moves up
the hierarchy to the next level.

▫ Eventually  client can confront the feared situation,

while at the same time feeling entirely relaxed.

▫ At any point – setback  clinician moves back

down the hierarchy to help the client relearn to
associate relaxation with the image one level down.
• Based on principles of operant conditioning,
CONTINGENCY MANAGEMENT
▫ is a form of behavioral therapy
▫ in which cliniciansprovide clients with positive
reinforcement fin performing desired behaviors .
▫ client learns to connect the outcome of the behavior
with the behavior itself, in order to establish a
contingency or connection.

▫ the clinician works with the client to develop a list of

positive reinforcements that the client can receive
only after performing the desired behavior.

• One contingency management form which hospitals

use is the token economy, in which residents who
perform desired activities earn tokens that they can
later exchange for tangible benefits (LePage et al.,
2003).
• Behavioral treatments can also involve the
principle of vicarious reinforcement
▫ in which cliniciansshow models of people
receiving rewards for demonstrating the desired
behaviors (Bandura. 1971).

• The therapist might also use participant

modeling, a form of therapy
▫ in which the therapist firstshows the client a
dewed behavior and then guides the client through
the behavior change.
• homework assignments
▫ The clinician may ask the client to keep a detailed
record of the behaviors that he or she is trying to
change,
▫ along with the situations in which the behaviors
occur.
▫ might also include specific tasks that the clinician
asks the client to perform with specific
instructions for observing the outcome of
completing those tasks.
 Cognitive Perspective
• Focuses – way -- people's thoughts influence
their emotions

• abnormality -- caused by MALADAPTIVE

THOUGHT PROCESSES  result in
dysfunctional behavior
 Theories
• Psychological disorders----PRODUCT OF DISTURBED
THOUGHTS

• By changing people's thoughts  also help clients

DEVELOP MORE ADAPTIVE EMOTIONS

• Dysfunctional attitude

• Experience

• Automatic thought

• Negative emotion
the Relationship Among Dysfunctional Attitude, Experience,
Automatic Thought and Negative Emotion
• AUTOMATIC THOUGHTS-ideas so deeply
entrenched that the individual is not even aware that
they lead to feelings of unhappiness and
discouragement

▫ are -- PRODUCT OF DYSFUNCTIONAL ATTITUDES

negative beliefs about the self that are also deeply
engrained and difficult to articulate

▫ FAULTY LOGICAL PROCESSES contributes to the

problem

▫ psychological disorders -- draw conclusions about

themselves that are CONSISTENTLY DETRIMENTAL to
their feelings of well-being.
• Albert Ellis --“A-B-C” chain of events leading
from faulty cognitions to dysfunctional emotions
(Ellis, 2005).
A -- “activating experience,”
B -- beliefs
C -- consequences
▫ Psychological disorders -- beliefs take an irrational
form of views about the self and the world that are
unrealistic, extreme, and illogical
These  create unnecessary emotional disturbance
by sticking rigidly to the "musts" and then punishing
themselves needlessly.
engage in unnecessary self-pity and refuse to admit-
- they need help
 Treatment
• changing -- thoughts should alleviate the distress
that they cause

• cognitive restructuring
▫ change the client's thoughts by -questioning and
challenging the client's dysfunctional attitudes and
irrational beliefs.
▫ The clinician also makes suggestions -- client can
test in behavior outside the therapy session.
• Cognitive-behavioral therapy (CBT)
▫ focus on changing both maladaptive thoughts and
maladaptive behaviors

▫ behavioral techniques such as

homework
reinforcement

with cognitive methods that increase awareness by clients

of their dysfunctional thoughts

▫ Clients learn to recognize when THEIR APPRAISALS OF

SITUATIONS ARE UNREALISTICALLY contributing to
their dysfunctional emotions.

▫ try to identify situations, behavior, or people -- help them

counteract these emotions.

▫ Goal -- to give clients greater control over their

dysfunctional behaviors, thoughts, and emotions.
• cognitive theorists and therapists -- continued to refine
methods ----
▫ target -- problematic ways in which people view and deal
with their psychological problems

• Acceptance and Commitment Therapy (ACT)

▫ helps clients ACCEPT the full range of their subjective
experiences , including distressing thoughts and feelingsas
they COMMIT THEMSELVES to tasks aimed at achieving
behavior change that will lead to an improved quality of life
(Forman et al, 2007).

▫ Central -- notion -- rather than fighting off disturbing

symptoms, clients should acknowledge that they will feel
certain unpleasant emotions in certain situations

▫ By accepting, rather than avoiding such situations,

individuals can gain perspective and, in the process, 
feel that they are more in control of theirs symptoms.
 HUMANISTIC PERSPECTIVE
• people are motivated to strive for SELF-
FULFILLMENT and MEANING IN LIFE

• "human" in humanistic refers to --on the

QUALITIES that make each individual unique

• focuses specifically -- VALUES, BELIEFS, and

ABILITY
▫ to reflect -- experiences -- separate humans from
other species
 Theories
• a radical departure from the traditional focus of psychology
▫ which minimized the role of free will in human experience

• also saw human behavior in much more positive terms

• psychological disorders --RESTRICTED GROWTH POTENTIAL

• EXISTENTIAL PSYCHOLOGY
▫ heavily influenced the work of humanistic theorists

▫ emphasizes the importance of fully appreciating each moment as it

occurs (May, 1983)
people who are tuned in to the world around them and experience life
as fully as possible in each moment are the psychologically healthiest

▫ Psychological disorders -- UNABLE TO EXPERIENCE LIVING IN THE

MOMENT
not due to fundamental flaws in their biology or thoughts
modern society imposes restrictions on our ability to express our inner
selves
• By the mid-twentieth century, psychologists who
were disappointed with the major theoretical
approaches to understanding human behavior and
psychological disorder had come to believe -
psychology had lost its contact with the human side
of human behavior

• These humanists joined together to form the "third

force" in psychology,
▫ with the intention of challenging psychoanalysis and
behaviorism

• Two of the most prominent theorists -- Carl Rogers

and Abraham Maslow
• Carl Rogers' (1902-1987) PERSON-CENTERED
THEORY
▫ focuses on
each individual's uniqueness,
importance of allowing each individual to achieve
maximum fulfillment of potential, and
individual's need to confront honestly the reality of his or
her experiences in the world.

▫ Rogers (1951) used the term client-centered to reflect

his belief –
person are innately good and
that the potential for self-improvement lies the individual
rather than the therapist or therapeutic techniques
▫ Rogers -- well-adjusted person's self-image should be
congruent with the person’s experiences
In this state of congruence, a person is fully
functioning – meaning thatthe individual is able to
put his or her psychological resources to their
maximal use

psychological disorder-- result of A BLOCKING OF THE

INDI’S POTENTIAL FOR LIVING TO FULL
CAPACITY resulting in a state of incongruence or
mismatch between self-image and reality

However, congruence is not a static state

To be fully functioning means that the individual is

constantly evolving and growing
▫ psychological disorders – origins -- early life, when
a person's parents are harshly critical and
demanding
 develop chronic anxiety about making mistakes
that will subject them to further disapproval

▫ Rogers used the term "conditions of worth"

referto demands that parents place upon children

to be loved -- have to meet these criteria

As adults -- constantly trying to meet the

expectations of others
in that others will value them for their true selves
• Abraham Maslow's (1962) -- self-actualization
▫ the maximum realization of the individual's potential
for psychological growth

▫ self-actualized people
have accurate self-perceptions
are able to find rich sources of enjoyment and stimulation
in their everyday activities
are capable of peak experiences
in which theyfeel a tremendous surge of inner happiness-
---as if they were totally in harmony with themselves and
their world

these individuals are not simply searching for sensual or

spiritual pleasure
also have a philosophy of life that is based on
humanitarian and egalitarian values
▫ Maslow defined the hierarchy of needs,
people are best able to experience self-actualization
when they meet their basic physical and
psychological needs

needs that are lower on the hierarchy deficit needs,

because they describe a state in which the individual
seeks to obtain something that is lacking

An individual who is preoccupied with meeting deficit

needs cannot achieve self-actualization

Self-actualization is not a final end-state in and of

itself, but is a pro in which the individual seeks true
expression
 Treatment
• a theory rich with implications for treatment,
• person-centered theory
▫ forms -- foundation -- therapy and counseling

▫ proposed specific guidelines –

to ENSURE -- to achieve full SELF-REALIZATION

▫ clinicians should focus on the client’s needs, not on the

preconceived clinician notions about what is best for
the client
emphasis on the inherent strengths

Rogers originated the use of the more collegial term "

clients" rather than the illness-oriented term “patients”
▫ Rogers -- clinician's job
help clients discover their inherent goodness
in the process -- greater self-understanding

▫ To counteract the problems caused by conditions of

worth in childhood, Rogers recommended that
therapists treat clients with unconditional positive
regard
This method –total acceptance of what the client says,
does and feels
clients feel better about themselves  better able to
tolerate - anxiety --
-----occurs with acknowledging -- own weakness because
they no longer feel driven to see themselves as perfect

▫ clinician tries to be as empathic as possible and

attempts to see the client's situation as it appears to
the client
• Contemporary humanistic and experiential
therapists
▫ Emphasize-- therapists –effective -- if they can see the
world from the eyes of their clients

▫ Therapists -- trained in the techniques of reflection

and clarification

Reflection
therapist mirrors back what the client has just said,
perhaps rephrasing it slightly .
allow clients to feel that the clinician is empathetically
listening and not judging them.
Gradually--increasingly confident to reveal their true, inner
selves because they know that the clinician will not reject
or label them as inadequate
• Rogers
▫ clinicians should provide a model of genuineness
and willingness TO DISCLOSE THEIR PERSONAL
WEAKNESSES AND LIMITATIONS
By doing so, clients realize that they don't have to
put up a false front of trying to appear to be
something that they're not.
client will see --it is acceptable and healthy to be
honest in confronting one’s experiences, even if
those experiences have less than favorable
implications.
• Motivational interviewing (MI)
▫ client-centered technique
▫ uses empathic understanding as a means of
promoting behavioral change in clients (Miller &
Rose, 2009).

▫ A directive, client-centered style for eliciting behavior

change by helping clients explore and resolve
ambivalence

▫ clinician collaborates with the client to strengthen --

client's motivation to make changes by asking
questions -- elicit the individual’s own arguments for
change

▫ emphasizes the clients autonomy.

 SOCIOCULTURAL PERSPECTIVE
• emphasizesthe ways that people, social
institutions and social forces influence people in
the world around them

• reaches outside the indi-- contribute --

development of psychological disorders
Theories
• family perspective
▫ abnormality -- DISTURBANCES IN PATTERNS OF
INTERACTIONS and RELATIONSHIPS THAT EXIST
WITHIN THE FAMILY

▫  "identified patient";
indi in treatment whose difficulties reflect strains
within the family.
• social discrimination
▫ Discrimination on the basis of GENDER, RACE, SEXUAL
ORIENTATION, RELIGION, SOCIAL CLASS, and AGE, --
can contribute -- physical and mental health

▫ Starting in the 1950s, researchers established the

finding -- psychological disorders -- more commonly
diagnosed among people in lower socioeconomic strata
(Hollingshead & Redlich, 1958).
reflect the fact -- lower social class experience economic
hardships and have limited access to quality education,
health care, and employment.

• Socioeconomic discrimination is further compounded

by membership in ethnic or racial minorities.
▫ few opportunities or encounter oppression because of
unalterable human characteristics are likely to
experience inner turmoil, frustration, and stress, leading
to the development of psychological symptoms.
• a result of destructive historical events, such as the
▫ violence of a political revolution,
▫ the turmoil of a natural disaster, or
▫ the poverty of a nationwide depression.

Since World War I -- American psychologists have

conducted large-scale studies ---- of the ways in which
war negatively affects as psychological functioning.
People who are traumatized as the result of is
▫ terrorists attacks,
▫ exposure to battle,
▫ persecution or imprisonment
▫ are at risk for developing serious anxiety disorders.

Similarly, fires and natural disasters, such as

▫ earthquakes, tornadoes, and hurricanes,
▫ leave more than physical destruction in their wake.
 Treatment
• it is not possible to "change the world."

• clinicians can play a crucial role in helping

people come to grips with problems that have
developed within a family system, the
immediate environment, or extended society.
• family therapy
▫ encourages all family group members TO TRY NEW WAYS
OF RELATING TO EACH OTHER or thinking about their
problems

▫ family therapist -- sometimes works -- co-therapist

▫ Rather than focusing on an individual's problems or

concerns,
▫ family and couples therapists focus on the ways in which
DYSFUNCTIONAL RELATIONAL PATTERNS maintain a
particular problem or symptom.

▫ also use a life-cycle perspective

consider -- developmental issues, not only of each individual,
but of the entire family or couple

▫ therapists see -continuing relationships among the family

members as potentially more healing than the relationship
between clinicians and clients.
• particular techniques that clinicians use -- depend
greatly on the therapist's training and theoretical
approach.
▫ An intergenerational family therapist
might suggest drawing a genogram,
a diagram of all relatives in the recent past
o understand the history of family relationships and to use this
understanding to bring about change .

▫ A structural family therapist

enact a disagreement as if they were characters in a play
about the family

▫ Strategic family therapists

might work with family members to develop solutions to the
issues that are causing difficulty.

▫ An experiential family therapist

might work with the family members to develop insight into
their relationships with each other.
• In group therapy,
▫ people who share similar experiences share their stories
with each other, aided by the facilitation of the therapist .

• According to Irvin Yalom (1995),

▫ a founder of group therapy,
▫ group therapy has a positive impact by allowing clients to
relief and hope in the realization that their problems are not
unique.

▫ can acquire valuable information and advice from people

who share their concerns.

▫ in the process of giving to others  people generally find

that they themselves derive benefit.
• milieu therapy
▫ In treatment settings such as inpatient hospitals to promote positive functioning in
clients by creating a therapeutic community.

▫ Community members participate in group activities, ranging from occupational

therapy to training classes.

▫ Staffmembers encourage clients to work with and spend time with other residents,
even when leaving on passes.

▫ Every staff person, whether a therapist, nurse, or paraprofes-sional, takes part in

the overall mission of providing an environment that supports posi-tive change
and reinforces appropriate social behaviors.

▫ underlying idea -- pressure to conform to conventional social norms of behavior

fosters more adaptive behavior on the part of individual clients.

▫ normalizing effects of a supportive environment are intended to help the individual

make a smoother and more effective transition to life outside the therapeutic
community.
• Although clinicians cannot reverse social discrimination,
they can adopt a multicultural approach to therapy
▫ that relies on awareness, knowledge, and skills of the
client's sociocultural context.
For example, therapists need to be sensitive to the ways in
which the client's cultural background interacts with his or
her specific life experiences and family influences.
• A commitment to learning about the client's cultural,
ethnic, and racial group and how these factors play a
role in assessment, diagnosis, and treatment,
characterize knowledge.
• Multicultural skills include mastery of culture-specific
therapy techniques that are responsive to a client's
unique characteristics.
BIOPSYCHOSOCIAL PERSPECTIVES ON THEORIES AND
TREATMENTS: AN INTEGRATIVE APPROACH
• Most clinicians select aspects of the various models,
rather than adhering narrowly to a single one.

• In recent decades, there has been a dramatic shift

away from clinical approaches that are rooted in a
single therotical model.

• Most clinicians use approached that are intgretive or

eclectic

• Therapist views the needs of the client from multiple

perspectives and develops a treatment plan that
responds to these particular concerns