Robert S.

Feldman | Twelfth Edition

Essentials of
Understanding
Psychology

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 Chapter 13
Treatment of Psychological Disorders

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 Introduction
• Psychotherapy: Treatment in which a trained professional,
called a therapist, uses psychological techniques to help a
person overcome psychological difficulties and disorders,
resolve problems in living, or bring about personal growth
• Biomedical therapy: Therapy that relies on drugs and other
medical procedures to improve psychological functioning

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 MODULE 40 - Psychotherapy:
Psychodynamic, Behavioral, and Cognitive
Approaches to Treatment
• What are the goals of psychologically based and
biologically based treatment approaches?
• What are the psychodynamic, behavioral, and
cognitive approaches to treatment?

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 Psychodynamic Approaches to
Therapy
• Seeks to bring unresolved past conflicts and
unacceptable impulses from the unconscious into the
conscious
• Based on Freud’s psychoanalytic approach to
personality
• Defense mechanisms
• Repression - Pushes threatening and unpleasant thoughts and
impulses back into the unconscious

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 Psychoanalysis: Freud’s Therapy
• Goal is to release hidden unconscious thoughts and feelings in
order to reduce their power in controlling behavior
• Free association
• Dream interpretation
• Manifest content - The surface description of a dream
• Latent content - Underlying meaning

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 Psychoanalysis: Freud’s Therapy
• Resistance: Inability or unwillingness to reveal particular
memories, thoughts, or motivations
• Transference: Transfer of feelings to a psychoanalyst that had
been originally directed to a patient’s parents or other authority
figures

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 Contemporary Psychodynamic
Approaches
• Less emphasis on a patient’s past history, concentrating
instead on current relationships and specific complaints
• Shorter duration
• 3 months or 20 sessions

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 Evaluating Psychodynamic Therapy
• Criticisms
• Time consuming and expensive
• Less articulate patients may not do as well as more articulate
ones
• Difficulty in determining effectiveness of the therapy
• Bias
• Subjective interpretation

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 Behavioral Approaches to Therapy
• Approaches that make use of the basic processes of learning,
such as reinforcement and extinction, to reduce or eliminate
maladaptive behavior
• Based on the fundamental assumption that both abnormal
behavior and normal behavior are learned
• Goal is to change people’s behavior to allow them to function
more effectively

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 Classical Conditioning Treatments
• Aversive conditioning: Reduces the frequency of undesired
behavior by pairing with an aversive stimulus
• Systematic desensitization: Exposure to an anxiety-producing
stimulus is paired with deep relaxation to extinguish the
response of anxiety
• Hierarchy of fears
• Flooding treatments: People are suddenly confronted with a
stimulus that they fear

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 Operant Conditioning Techniques
Token system

• Rewards a person for desired behavior with a token

Contingency contracting
• Agreement is drawn stating the behavioral goals
the client hopes to achieve

Observational learning
• Behavior of other people is modeled, to
systematically teach people new skills

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 Evaluating Behavior Therapy
• Benefits
• Eliminates anxiety disorders
• Treats phobias and compulsions
• Establishes control over impulses
• Helps in learning complex social skills to replace maladaptive
behavior
• Criticisms
• Insight into thoughts and expectations cannot be gained due to
the changing external behavior

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 Cognitive Approaches to Therapy
• Cognitive treatment approaches: Teach people to think in
more adaptive ways by changing their dysfunctional cognitions
about the world and themselves

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 Cognitive Approaches to Therapy
• Cognitive-behavioral approach: Incorporates basic principles
of learning to change the way people think
• Therapists attempt to change the way people think as well as
their behavior
• Therapy is highly structured and focuses on concrete problems

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 Cognitive Approaches to Therapy
• Rational-emotive behavior therapy
• Albert Ellis
• Attempts to restructure a person’s belief system into a more
realistic, rational, and logical set of views by challenging
dysfunctional beliefs

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 Figure 3: Rational-Emotive Behavior Therapy
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 Cognitive Approaches to Therapy
• Cognitive behavior therapy
• Aaron Beck
• Aims to change people’s illogical thoughts about themselves and
the world
• Cognitive appraisal - Evaluation of situations, in terms of one’s
memories, values, beliefs, thoughts, and expectations

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 Evaluating Cognitive Approaches to
Therapy
• Benefits
• Deals with a broad range of disorders
• Willingness of cognitive therapists to incorporate additional
treatment approaches
• Criticisms
• Changing one’s assumptions to make them more reasonable and
logical may not always be helpful

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 MODULE 41: Psychotherapy: Humanistic,
Interpersonal, and Group Approaches to
Treatment
• What are the humanistic approaches to treatment?
• What is interpersonal therapy?
• How does group therapy differ from individual types of
therapy?
• How effective is psychotherapy, and which kind of
psychotherapy works best in a given situation?

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 Humanistic Therapy
• Therapy in which the underlying rationale is that people have
control of their behavior, can make choices about their lives,
and are essentially responsible for solving their own problems
• Self-actualization - State of self fulfillment in which people realize
their highest potentials in their own unique way

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 Person-Centered Therapy
• Goal is to reach one’s potential for self-actualization
• Also referred as client-centered therapy
• Unconditional positive regard
• Expressing acceptance and understanding, regardless of the
feelings and attitudes the client expresses
• Understanding client’s emotional experiences

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 Evaluating Humanistic Approaches
to Therapy
• Benefits
• The idea that psychological disorders result from restricted
growth potential is compelling to many people
• Supportive environment
• Criticisms
• Treatments lack specificity
• Least scientifically and theoretically developed
• Works only for highly verbal client who profits most from
psychoanalytic treatment

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 Interpersonal Therapy (IPT)
• Short-term therapy that focuses on the context of
current social relationships
• Helps patients to control their moods and emotions
• Focuses on interpersonal issues such as conflicts with
others, social skills issues, role transitions, or grief
• Lasts only for 12-16 weeks
• Especially effective in dealing with
• Depression
• Anxiety
• Addictions
• Eating disorders

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 Group Therapies
• Therapy in which people meet in a group with a therapist to
discuss problems
• Centers on a common difficulty
• Example - Alcoholism
• Economical means of therapy compared to individual therapy
• Criticism - Shy and withdrawn individuals may not receive
required attention

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 Group Therapies
• Family therapy: Focuses on the family and its dynamics
• Involves two or more family members, one (or more) of whose
problems led to treatment
• Self-help therapy
• Does not involve a professional therapist
• People with similar problems get together to discuss their shared
feelings and experiences
• Bereavement support group
• Alcoholics Anonymous (AA)

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 Evaluating Psychotherapy: Does
Therapy Work?
• Hans Eysenck published a study challenging the effectiveness
of therapy
• Spontaneous remission: Recovery without formal treatment
• Meta-analysis - Data from a large number of studies when
statistically combined, yielded similar general conclusions

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 Effectiveness of Psychotherapy
• For most people it is effective
• Psychotherapy does not work for everyone
• No single form of therapy works best for every problem
• Specific types of treatment are better for specific types of
problems
• Most therapies share several basic similar elements
• Development of positive relationship between client and
therapist
• Explanation or interpretation of a client’s symptoms
• Confrontation of negative emotions

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 Figure 1: Estimates of the Effectiveness of Different Types of Treatment
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 MODULE 42: Biomedical Therapy:
Biological Approaches to Treatment
• How are drug, electroconvulsive, and psychosurgical
techniques used today in the treatment of psychological
disorders?

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 Drug Therapy
• Treatment of psychological disorders through the use of drugs
• Works by altering the operation of neurotransmitters and
neurons in the brain

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 Figure 1: Classes of Drugs Used to Treat Psychological Disorders
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 Drug Therapy
• Antipsychotic drugs: Temporarily reduce psychotic symptoms
such as agitation, hallucinations, and delusions
• Chlorpromazine
• Risperidone
• Olanzapine
• Paliperidone
• Symptoms reappear when the drug is withdrawn
• Long-term side effects

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 Drug Therapy
• Antidepressant drugs: Medications that improve a severely
depressed patient’s mood and feeling of well-being
• Work by changing the concentration of specific neurotransmitters
in the brain
• Tricyclic drugs
• MAO inhibitors
• Selective serotonin reuptake inhibitors (SSRIs)
• Lexapro, Prozac
• Ketamine blockers may also prove useful in treating
depression
• Produce lasting, long-term recovery from depression
• Side effects - Drowsiness and faintness

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 Drug Therapy
• Mood stabilizers: Drugs used to treat mood disorders
characterized by intense mood swings, especially manic
episodes in bipolar disorder
• Bipolar disorder treatment
• Lithium
• Depakote
• Tegretol
• Can be a preventive treatment, blocking future episodes of
manic depression

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 Drug Therapy
• Antianxiety drugs: Reduce the level of anxiety a person
experiences essentially by reducing excitability and increasing
feelings of well-being
• Alprazolam
• Valium
• Produce a number of potentially serious side effects
• When taken in combination with alcohol, some antianxiety drugs
can be lethal

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 Electroconvulsive Therapy (ECT)
• Procedure used in the treatment of severe depression
• Electric current of 70 to 150 volts is briefly administered to a
patient’s head
• Causes loss of consciousness and seizures
• Controversial treatment
• Transcranial magnetic stimulation (TMS)
• Alternative to ECT
• Directs a precise magnetic pulse in a specific area of the brain

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 Psychosurgery
• Brain surgery once used to reduce the symptoms of mental
disorder but rarely used today
• Prefrontal lobotomy
• Surgically destroying or removing parts of a patient’s frontal lobes,
believed to control emotionality
• Drastic side effects
• Cingulotomy
• For rare cases of obsessive-compulsive disorder (OCD)
• Tissue is destroyed in the anterior cignulate
• Gamma knife surgery
• Radiation is used to destroy areas of the brain related to OCD

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 Biomedical Therapies in
Perspective
• Gene therapy
• Specific genes may be introduced to particular areas of the brain
• May reverse or prevent biochemical events that give rise to disorders
• Critics state that therapies merely provide relief of the
symptoms and not solve the underlying problems
• New symptoms may arise

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 Community Psychology: Focus on
Prevention
• Prevent or minimize the incidence of psychological disorders
• Deinstitutionalization: Transfer of former mental patients out
of institutions and into the community

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 Choosing the Right Therapist
• You should feel comfortable with your therapist
• Therapists should have appropriate training and credentials
• You should feel that you are making progress after therapy has
begun, despite occasional setbacks

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