Social Psychology - Impressions
People form impressions, or vague ideas, about other people through the process of person perception.
The Influence of Physical Appearance
Physical appearance has a strong effect on how people are perceived by others. Two aspects of physical appearance are particularly important: attractiveness and baby-faced features.
Attractiveness
Research shows that people judge attractive-looking people as having positive personality traits, such as sociability, friendliness, poise, warmth, and good adjustment. There is, however, little actual correlation between personality traits and physical attractiveness.
People also tend to think that attractive-looking people are more competent. Because of this bias, attractive people tend to get better jobs and higher salaries.
Baby-Faced Features
People’s attractiveness does not have much influence on judgments about their honesty. Instead, people tend to be judged as honest if they have baby-faced features, such as large eyes and rounded chins. Baby-faced people are often judged as being passive, helpless, and naïve. However, no correlation exists between being baby-faced and actually having these personality traits.
Evolutionary theorists believe the qualities attributed to baby-faced people reflect an evolved tendency to see babies as helpless and needing nurture. Such a tendency may have given human ancestors a survival advantage, since the babies of people who provided good nurturing were more likely to live on to reproduce.
Cognitive Schemas
When people meet, they form impressions of each other based on their cognitive schemas. People use cognitive schemas to organize information about the world. Cognitive schemas help to access information quickly and easily.
Social schemas are mental models that represent and categorize social events and people. For example, certain social schemas tell people what it means to be a spectator at a baseball game. There are also social schemas for categories of people, such as yuppie or geek. These social schemas affect how people perceive events and others. Once a social schema is activated, it may be difficult to adjust a perception of a person or event.
8/19/2006
Treatment Trends
Treatment Trends
Two current trends that affect the treatment of psychological disorders are managed care and deinstitutionalization.
Managed Care
Managed care is an arrangement in which an organization, such as a health maintenance organization (HMO), acts as an intermediary between a person seeking health care and a treatment provider. People buy insurance plans from HMOs and then pay only a small copayment each time they get healthcare services. Prior to managed care, health care was done through fee-for-service arrangements. In fee-for-service arrangements, people pay for any health care services they believe they need. They may then be reimbursed by insurance companies or government health care programs, such as Medicaid and Medicare.
The advantages of managed care are that consumers pay lower fees to providers and that money is not usually spent on medically unnecessary services.
Criticisms of Managed Care
Managed care systems have many critics who argue that HMOs compromise the quality of health care in the following ways:
Consumers are often denied treatment they need, or the length of treatment is inappropriately limited.
Managed care creates barriers to accessing health care services by requiring people to get referrals through their primary care providers or by authorizing only a small number of therapy sessions at a time.
Because of cost issues, the professionals who provide treatment are often less well-trained to treat severe disorders. For example, they may be counselors with master’s degrees rather than doctoral-level psychologists or psychiatrists.
Physicians might be required to prescribe older, less effective drugs rather than new drugs in order to keep costs down.
Clients’ confidentiality may be threatened because HMOs require therapists to disclose details about the clients’ problems in order to have treatment authorized.
The Community Mental Health Movement
In the past, people with psychological disorders typically received inpatient treatment at mental hospitals, or medical institutions that specialize in providing such treatment. In the 1950s, however, it began to be clear that mental hospitals often made psychological problems worse instead of better. Mental hospitals were very crowded and had few properly trained professionals, and they were often in less populated areas, giving patients little access to support from their friends and families.
In the 1950s, the community mental health movement started. This movement advocated treating people with psychological problems in their own communities, providing treatment through outpatient clinics, and preventing psychological disorders before they arose.
Because of the community mental health movement, deinstitutionalization became popular. Deinstitutionalization refers to providing treatment through community-based outpatient clinics rather than inpatient hospitals. Although people are still hospitalized for serious psychological problems, inpatient stays are usually relatively short and occur in psychiatric wings of general hospitals, rather than in mental hospitals far away from people’s communities.
Advantages of deinstitutionalization: Treatment at outpatient clinics is less costly than inpatient care and often just as effective. Also, people often prefer the freedom of community-based treatment to inpatient hospitals.
Disadvantages of deinstitutionalization: It has contributed to homelessness, since some people released from inpatient facilities have nowhere to go. Also, it has led to what is referred to as a “revolving door” population of chronically mentally ill people who are periodically hospitalized, released, and rehospitalized.
Two current trends that affect the treatment of psychological disorders are managed care and deinstitutionalization.
Managed Care
Managed care is an arrangement in which an organization, such as a health maintenance organization (HMO), acts as an intermediary between a person seeking health care and a treatment provider. People buy insurance plans from HMOs and then pay only a small copayment each time they get healthcare services. Prior to managed care, health care was done through fee-for-service arrangements. In fee-for-service arrangements, people pay for any health care services they believe they need. They may then be reimbursed by insurance companies or government health care programs, such as Medicaid and Medicare.
The advantages of managed care are that consumers pay lower fees to providers and that money is not usually spent on medically unnecessary services.
Criticisms of Managed Care
Managed care systems have many critics who argue that HMOs compromise the quality of health care in the following ways:
Consumers are often denied treatment they need, or the length of treatment is inappropriately limited.
Managed care creates barriers to accessing health care services by requiring people to get referrals through their primary care providers or by authorizing only a small number of therapy sessions at a time.
Because of cost issues, the professionals who provide treatment are often less well-trained to treat severe disorders. For example, they may be counselors with master’s degrees rather than doctoral-level psychologists or psychiatrists.
Physicians might be required to prescribe older, less effective drugs rather than new drugs in order to keep costs down.
Clients’ confidentiality may be threatened because HMOs require therapists to disclose details about the clients’ problems in order to have treatment authorized.
The Community Mental Health Movement
In the past, people with psychological disorders typically received inpatient treatment at mental hospitals, or medical institutions that specialize in providing such treatment. In the 1950s, however, it began to be clear that mental hospitals often made psychological problems worse instead of better. Mental hospitals were very crowded and had few properly trained professionals, and they were often in less populated areas, giving patients little access to support from their friends and families.
In the 1950s, the community mental health movement started. This movement advocated treating people with psychological problems in their own communities, providing treatment through outpatient clinics, and preventing psychological disorders before they arose.
Because of the community mental health movement, deinstitutionalization became popular. Deinstitutionalization refers to providing treatment through community-based outpatient clinics rather than inpatient hospitals. Although people are still hospitalized for serious psychological problems, inpatient stays are usually relatively short and occur in psychiatric wings of general hospitals, rather than in mental hospitals far away from people’s communities.
Advantages of deinstitutionalization: Treatment at outpatient clinics is less costly than inpatient care and often just as effective. Also, people often prefer the freedom of community-based treatment to inpatient hospitals.
Disadvantages of deinstitutionalization: It has contributed to homelessness, since some people released from inpatient facilities have nowhere to go. Also, it has led to what is referred to as a “revolving door” population of chronically mentally ill people who are periodically hospitalized, released, and rehospitalized.
Seeking Treatment
Seeking Treatment
Although many people experience psychological problems over their lifetime, not everyone seeks treatment. Not everyone is willing to get psychotherapy for problems they experience. More women than men get psychotherapy, and people who are more educated and who have medical insurance are also more likely to seek treatment.
Barriers to Getting Treatment
People may not seek treatment even if they feel they need it. Common barriers to getting treatment are:
Concerns about the cost of treatment
Lack of health insurance
The stigma associated with getting psychological treatment
Psychotherapy for Cultural and Ethnic Minorities
Modern psychotherapy is based on individualistic values, and many researchers have argued that such therapy may not be readily applied to ethnic minorities in the United States. Ethnic and cultural minorities may face several barriers to receiving psychotherapy:
Some cultural groups may be hesitant to seek help from professionals, particularly in institutional settings such as hospitals and clinics. They may instead prefer to seek informal help from family, friends, elders, and priests.
Cultural minorities may find it difficult to get psychotherapy services because therapists who speak their language are unavailable.
Therapists trained to treat mainly white, middle-class clients may not be familiar with or responsive to the needs of clients from different ethnic and cultural backgrounds.
Although many people experience psychological problems over their lifetime, not everyone seeks treatment. Not everyone is willing to get psychotherapy for problems they experience. More women than men get psychotherapy, and people who are more educated and who have medical insurance are also more likely to seek treatment.
Barriers to Getting Treatment
People may not seek treatment even if they feel they need it. Common barriers to getting treatment are:
Concerns about the cost of treatment
Lack of health insurance
The stigma associated with getting psychological treatment
Psychotherapy for Cultural and Ethnic Minorities
Modern psychotherapy is based on individualistic values, and many researchers have argued that such therapy may not be readily applied to ethnic minorities in the United States. Ethnic and cultural minorities may face several barriers to receiving psychotherapy:
Some cultural groups may be hesitant to seek help from professionals, particularly in institutional settings such as hospitals and clinics. They may instead prefer to seek informal help from family, friends, elders, and priests.
Cultural minorities may find it difficult to get psychotherapy services because therapists who speak their language are unavailable.
Therapists trained to treat mainly white, middle-class clients may not be familiar with or responsive to the needs of clients from different ethnic and cultural backgrounds.
Effectiveness of Treatment
Effectiveness of Treatment
Research has shown that many people with psychological disorders benefit from treatment. Effectiveness depends on the specific disorder being treated and the skill of the therapist.
Ways of Assessing Effectiveness
The effectiveness of a particular therapeutic approach can be assessed in three ways: client testimonials, providers’ perceptions, and empirical research.
Client Testimonials
Clients who get treatment for psychological problems often testify to their effectiveness. However, such testimonials can be unreliable for several reasons:
Regression toward the mean: People often go into treatment because they are in extreme distress. When their distress becomes less extreme, they may attribute this to the treatment’s effectiveness. But even without treatment, extreme distress tends to decrease. The tendency for extreme states to move toward the average when assessed a second time is called regression toward the mean.
The placebo effect: People often feel better after being in treatment because of their expectations that they will improve. (See Chapter 1 for more information on placebo effects.)
The justification of effort effect: People may believe that treatment was effective because they spent time, effort, and money on it. If people work hard to reach a goal, they are likely to value the goal more. This phenomenon is called justification of effort.
Providers’ Perceptions
Treatment providers can say whether a treatment is effective, but this can be unreliable for several reasons:
Regression toward the mean affects providers’ perceptions of success. They may believe that a client who entered treatment in crisis became less extremely distressed because of the treatment. However, such an improvement may have occurred without any intervention.
Providers’ perceptions may be biased because clients often emphasize improvements in order to justify discontinuing treatment.
Providers may also have biased perceptions because they continue to hear from past clients only when those clients were satisfied with treatment. They don’t often hear from clients who found treatment ineffective.
Empirical Research
Another way to assess effectiveness is through careful empirical research. Research has shown that some treatments are more effective for a particular problem than a placebo or no treatment. These treatments are known as empirically validated treatments. Researchers have to conduct two or more studies in order to conclude that a specific treatment is effective for a particular problem.
Research shows that psychotherapy works for many psychological problems. Although people who do not receive therapy also sometimes improve with time, people who do receive therapy are more likely to improve. Research also shows that all approaches to therapy are about equally effective, though certain kind of therapies do seem somewhat more effective for specific problems.
Specific Disorder Most Effective Treatment
Panic disorders Cognitive therapy
Specific phobias Systematic desensitization
Obsessive-compulsive disorder Behavior therapy or medication
Depression Cognitive therapy
Post–traumatic stress disorder and agoraphobia Exposure treatment
Therapist Factors
Research shows that the effectiveness of therapy does not depend on the level of training or experience of the therapist or on the type of mental health professional providing therapy. However, the effectiveness of therapy does depend on the skill of the therapist. The most effective therapists tend to be empathic, genuine, and warm.
Who Benefits from Treatment?
Clients who are likely to benefit from therapy share some common features:
Motivation to get better
Family support
Tendency to deal actively with problems rather than avoid them
Clients who are less likely to benefit from therapy also share some features:
Hostility and negativity
Personality disorders
Psychotic disorders
Can Therapy Be Harmful?
Under some conditions, therapy can be harmful to the client. Clients may be harmed if:
Therapists engage in unethical behavior, such as by having sexual relationships with clients
Therapists act according to personal prejudices or are ignorant of cultural differences between themselves and their clients
Therapists coerce clients into doing things they don’t want to do
Therapists use techniques that research has not demonstrated as being effective
Therapists lead their clients to produce false memories of past traumas through careless use of techniques such as hypnosis or free association
Research has shown that many people with psychological disorders benefit from treatment. Effectiveness depends on the specific disorder being treated and the skill of the therapist.
Ways of Assessing Effectiveness
The effectiveness of a particular therapeutic approach can be assessed in three ways: client testimonials, providers’ perceptions, and empirical research.
Client Testimonials
Clients who get treatment for psychological problems often testify to their effectiveness. However, such testimonials can be unreliable for several reasons:
Regression toward the mean: People often go into treatment because they are in extreme distress. When their distress becomes less extreme, they may attribute this to the treatment’s effectiveness. But even without treatment, extreme distress tends to decrease. The tendency for extreme states to move toward the average when assessed a second time is called regression toward the mean.
The placebo effect: People often feel better after being in treatment because of their expectations that they will improve. (See Chapter 1 for more information on placebo effects.)
The justification of effort effect: People may believe that treatment was effective because they spent time, effort, and money on it. If people work hard to reach a goal, they are likely to value the goal more. This phenomenon is called justification of effort.
Providers’ Perceptions
Treatment providers can say whether a treatment is effective, but this can be unreliable for several reasons:
Regression toward the mean affects providers’ perceptions of success. They may believe that a client who entered treatment in crisis became less extremely distressed because of the treatment. However, such an improvement may have occurred without any intervention.
Providers’ perceptions may be biased because clients often emphasize improvements in order to justify discontinuing treatment.
Providers may also have biased perceptions because they continue to hear from past clients only when those clients were satisfied with treatment. They don’t often hear from clients who found treatment ineffective.
Empirical Research
Another way to assess effectiveness is through careful empirical research. Research has shown that some treatments are more effective for a particular problem than a placebo or no treatment. These treatments are known as empirically validated treatments. Researchers have to conduct two or more studies in order to conclude that a specific treatment is effective for a particular problem.
Research shows that psychotherapy works for many psychological problems. Although people who do not receive therapy also sometimes improve with time, people who do receive therapy are more likely to improve. Research also shows that all approaches to therapy are about equally effective, though certain kind of therapies do seem somewhat more effective for specific problems.
Specific Disorder Most Effective Treatment
Panic disorders Cognitive therapy
Specific phobias Systematic desensitization
Obsessive-compulsive disorder Behavior therapy or medication
Depression Cognitive therapy
Post–traumatic stress disorder and agoraphobia Exposure treatment
Therapist Factors
Research shows that the effectiveness of therapy does not depend on the level of training or experience of the therapist or on the type of mental health professional providing therapy. However, the effectiveness of therapy does depend on the skill of the therapist. The most effective therapists tend to be empathic, genuine, and warm.
Who Benefits from Treatment?
Clients who are likely to benefit from therapy share some common features:
Motivation to get better
Family support
Tendency to deal actively with problems rather than avoid them
Clients who are less likely to benefit from therapy also share some features:
Hostility and negativity
Personality disorders
Psychotic disorders
Can Therapy Be Harmful?
Under some conditions, therapy can be harmful to the client. Clients may be harmed if:
Therapists engage in unethical behavior, such as by having sexual relationships with clients
Therapists act according to personal prejudices or are ignorant of cultural differences between themselves and their clients
Therapists coerce clients into doing things they don’t want to do
Therapists use techniques that research has not demonstrated as being effective
Therapists lead their clients to produce false memories of past traumas through careless use of techniques such as hypnosis or free association
Biomedical Therapies
Biomedical Therapies
Biomedical therapies include drug therapy, electroconvulsive therapy, and psychosurgery.
Drug Therapies
Drug therapy, or psychopharmacotherapy, aims to treat psychological disorders with medications. Drug therapy is usually combined with other kinds of psychotherapy. The main categories of drugs used to treat psychological disorders are antianxiety drugs, antidepressants, and antipsychotics.
Antianxiety Drugs
Antianxiety drugs include a class of drugs called benzodiazepines, or tranquilizers. Two commonly used benzodiazepines are known by the brand names Valium and Xanax. The generic names of these drugs are diazepam and alprazolam, respectively:
Effects: Benzodiazepines reduce the activity of the central nervous system by increasing the activity of GABA, the main inhibitory neurotransmitter in the brain. Benzodiazepines take effect almost immediately after they are administered, but their effects last just a few hours. Psychiatrists prescribe these drugs for panic disorder and anxiety.
Side effects: Side effects may include drowsiness, light-headedness, dry mouth, depression, nausea and vomiting, constipation, insomnia, confusion, diarrhea, palpitations, nasal congestion, and blurred vision. Benzodiazepines can also cause drug dependence. Tolerance can occur if a person takes these drugs for a long time, and withdrawal symptoms often appear when the drug use is discontinued.
Antidepressant Drugs
Antidepressants usually take a few weeks to have an effect. There are three classes of antidepressants: monoamine oxidase inhibitors, tricyclics, and selective serotonin reuptake inhibitors.
Monoamine oxidase inhibitors (MAOIs): Include phenelzine (Nardil).
Tricyclics: Include amitriptyline (Elavil). Tricyclics generally have fewer side effects than the MAOIs.
Selective serotonin reuptake inhibitors (SSRIs): The newest class of antidepressants, including paroxetine (Paxil), fluoxetine (Prozac), and sertraline (Zoloft).
Antidepressants are typically prescribed for depression, anxiety, phobias and obsessive-compulsive disorder.
Effects: MAOIs and tricyclics increase the level of the neurotransmitters norepinephrine and serotonin in the brain. SSRIs increase the level of serotonin.
Side effects: Although antidepressants are not addictive, they often have side effects such as headache, dry mouth, constipation, nausea, weight gain, and feelings of restlessness. Of the three classes of antidepressants, MAOIs generally have the most side effects. People who take MAOIs also have to restrict their diet, because MAOIs interact negatively with foods that contain the amino acid tyramine, such as beer and some cheeses and meats. SSRIs have fewer side effects than the other two classes of antidepressants. However, SSRIs can cause sexual dysfunction, and if they are discontinued abruptly, withdrawal symptoms occur.
Antipsychotic Drugs
Antipsychotic drugs are used to treat schizophrenia and other psychotic disorders. They include chlorpromazine (Thorazine), thioridazine (Mellaril), and haloperidol (Haldol). Antipsychotic drugs usually begin to take effect a few days after they are administer ed.
Effects: Antipsychotic drugs, or neuroleptics, reduce sensitivity to irrelevant stimuli by limiting the activity of the neurotransmitter dopamine. Many antipsychotic drugs are most useful for treating positive symptoms of schizophrenia, such as hallucinations and delusions. However, a new class of antipsychotic drugs, called atypical antipsychotic drugs, also help treat the negative symptoms of schizophrenia. They reduce the activity of both dopamine and serotonin. Atypical antipsychotic drugs include clozapine (Clozaril), olanzapine (Zyprexa), and quetiapine (Seroquel). Atypical antipsychotic drugs can sometimes be effective for schizophrenia patients who have not responded to the older antipsychotic drugs.
Side effects: Side effects include drowsiness, constipation, dry mouth, tremors, muscle rigidity, and coordination problems. These side effects often make people stop taking the medications, which frequently results in a relapse of schizophrenia. A more serious side effect is tardive dyskinesia, a usually permanent neurological condition characterized by involuntary movements. To avoid tardive dyskinesia, the dosage of antipsychotics has to be carefully monitored. The atypical antipsychotics have fewer side effects than the older antipsychotic drugs and are less likely to cause tardive dyskinesia. In addition, relapse rates are lower if people continue to take the drug. However, the relapse rate is higher with these drugs if people discontinue the drug.
Lithium
One drug used in the treatment of bipolar disorders is lithium.
Effects: Lithium prevents mood swings in people with bipolar disorders. Researchers have suggested that lithium may affect the action of norepinephrine or glutamate.
Side effects: Lithium can cause tremors or long-term kidney damage in some people. Doctors must carefully monitor the level of lithium in a patient’s blood. A level that is too low is ineffective, and a level that is too high can be toxic. Discontinuing lithium treatment abruptly can increase the risk of relapse.
Recently developed alternatives to lithium include the drugs carbamazepine (Tegretol) and divalproex (Depakote).
Criticisms of Drug Therapies
Drug therapies are effective for many people with psychological disorders, especially for those who suffer from severe disorders that cannot be treated in other ways. However, drug therapies have been criticized for several reasons:
Their effects are superficial and last only as long as the drug is being administered.
Side effects can often be more severe and troubling than the disorder for which the drug was given. This can cause patients to discontinue the drugs and experience relapses.
Patients often respond well to new drugs when they are first released into the market because of the enthusiasm and high expectations surrounding the drug. But such placebo effects tend to wane over time.
The therapeutic window for drugs, or the amount of the drug that is required for an effect without toxicity, varies according to factors such as gender, age, and ethnicity. This makes it difficult for physicians to determine the right dose of a drug.
New drugs, even those approved for long-term use, are often tested on only a few hundred people for a few weeks or months. This means that the risks of taking drugs long-term are unknown.
Some critics point out that because of pressure from managed care companies, physicians may overprescribe drugs rather than recommend psychotherapy.
Drugs are tested only on certain populations, for certain conditions. Physicians, however, sometimes prescribe a drug for conditions and populations that were not included in the testing.
Researchers who study the effectiveness of medications may be biased because they often have financial ties to pharmaceutical companies.
Freely prescribing drugs for psychological disorders gives the impression that such disorders can be treated only biochemically. However, the biological abnormalities present in such disorders can often be treated by changing thoughts and behavior.
Electroconvulsive Therapy
Electroconvulsive therapy (ECT) is used mainly for the treatment of severe depression. Electrodes are placed on the patient’s head, over the temporal lobes of the brain. Anesthetics and muscle relaxants help minimize discomfort to the patient. Then an electric current is delivered for about one second. The patient has a convulsive seizure and becomes unconscious, awakening after about an hour. The typical number of ECT sessions varies from six to twenty, and they are usually done while a patient is hospitalized.
ECT is a controversial procedure. Research suggests that there are short-term side effects of ECT, such as attention deficits and memory loss. Critics of ECT believe that it is often used inappropriately and that it can result in permanent cognitive problems. Proponents of ECT, however, believe that it does not cause long-term cognitive problems, loss of memory, or brain damage. They believe that it is highly effective and that it is underused because of negative public ideas surrounding it.
Psychosurgery
Psychosurgery is brain surgery to treat a psychological disorder. The best-known form of psychosurgery is the prefrontal lobotomy. A lobotomy is a surgical procedure that severs nerve tracts in the frontal lobe. Surgeons performed lobotomies in the 1940s and 1950s to treat highly emotional and violent behavior. The surgery often resulted in severe deficits, including apathy, lethargy, and social withdrawal.
Lobotomies are now rarely performed, but some neurosurgeons perform cingulotomies, which involve destruction of part of the frontal lobes. These surgeries are usually performed on patients who have severe depressive or anxiety disorders and who do not respond to other treatments. The effectiveness of these surgeries is unclear.
Transcranial Magnetic Stimulation
Transcranial magnetic stimulation (TMS) is a recently developed, noninvasive procedure. It involves stimulating the brain by means of a magnetic coil held to a person’s skull near the left prefrontal cortex. It is used to treat severe depression.
Biomedical therapies include drug therapy, electroconvulsive therapy, and psychosurgery.
Drug Therapies
Drug therapy, or psychopharmacotherapy, aims to treat psychological disorders with medications. Drug therapy is usually combined with other kinds of psychotherapy. The main categories of drugs used to treat psychological disorders are antianxiety drugs, antidepressants, and antipsychotics.
Antianxiety Drugs
Antianxiety drugs include a class of drugs called benzodiazepines, or tranquilizers. Two commonly used benzodiazepines are known by the brand names Valium and Xanax. The generic names of these drugs are diazepam and alprazolam, respectively:
Effects: Benzodiazepines reduce the activity of the central nervous system by increasing the activity of GABA, the main inhibitory neurotransmitter in the brain. Benzodiazepines take effect almost immediately after they are administered, but their effects last just a few hours. Psychiatrists prescribe these drugs for panic disorder and anxiety.
Side effects: Side effects may include drowsiness, light-headedness, dry mouth, depression, nausea and vomiting, constipation, insomnia, confusion, diarrhea, palpitations, nasal congestion, and blurred vision. Benzodiazepines can also cause drug dependence. Tolerance can occur if a person takes these drugs for a long time, and withdrawal symptoms often appear when the drug use is discontinued.
Antidepressant Drugs
Antidepressants usually take a few weeks to have an effect. There are three classes of antidepressants: monoamine oxidase inhibitors, tricyclics, and selective serotonin reuptake inhibitors.
Monoamine oxidase inhibitors (MAOIs): Include phenelzine (Nardil).
Tricyclics: Include amitriptyline (Elavil). Tricyclics generally have fewer side effects than the MAOIs.
Selective serotonin reuptake inhibitors (SSRIs): The newest class of antidepressants, including paroxetine (Paxil), fluoxetine (Prozac), and sertraline (Zoloft).
Antidepressants are typically prescribed for depression, anxiety, phobias and obsessive-compulsive disorder.
Effects: MAOIs and tricyclics increase the level of the neurotransmitters norepinephrine and serotonin in the brain. SSRIs increase the level of serotonin.
Side effects: Although antidepressants are not addictive, they often have side effects such as headache, dry mouth, constipation, nausea, weight gain, and feelings of restlessness. Of the three classes of antidepressants, MAOIs generally have the most side effects. People who take MAOIs also have to restrict their diet, because MAOIs interact negatively with foods that contain the amino acid tyramine, such as beer and some cheeses and meats. SSRIs have fewer side effects than the other two classes of antidepressants. However, SSRIs can cause sexual dysfunction, and if they are discontinued abruptly, withdrawal symptoms occur.
Antipsychotic Drugs
Antipsychotic drugs are used to treat schizophrenia and other psychotic disorders. They include chlorpromazine (Thorazine), thioridazine (Mellaril), and haloperidol (Haldol). Antipsychotic drugs usually begin to take effect a few days after they are administer ed.
Effects: Antipsychotic drugs, or neuroleptics, reduce sensitivity to irrelevant stimuli by limiting the activity of the neurotransmitter dopamine. Many antipsychotic drugs are most useful for treating positive symptoms of schizophrenia, such as hallucinations and delusions. However, a new class of antipsychotic drugs, called atypical antipsychotic drugs, also help treat the negative symptoms of schizophrenia. They reduce the activity of both dopamine and serotonin. Atypical antipsychotic drugs include clozapine (Clozaril), olanzapine (Zyprexa), and quetiapine (Seroquel). Atypical antipsychotic drugs can sometimes be effective for schizophrenia patients who have not responded to the older antipsychotic drugs.
Side effects: Side effects include drowsiness, constipation, dry mouth, tremors, muscle rigidity, and coordination problems. These side effects often make people stop taking the medications, which frequently results in a relapse of schizophrenia. A more serious side effect is tardive dyskinesia, a usually permanent neurological condition characterized by involuntary movements. To avoid tardive dyskinesia, the dosage of antipsychotics has to be carefully monitored. The atypical antipsychotics have fewer side effects than the older antipsychotic drugs and are less likely to cause tardive dyskinesia. In addition, relapse rates are lower if people continue to take the drug. However, the relapse rate is higher with these drugs if people discontinue the drug.
Lithium
One drug used in the treatment of bipolar disorders is lithium.
Effects: Lithium prevents mood swings in people with bipolar disorders. Researchers have suggested that lithium may affect the action of norepinephrine or glutamate.
Side effects: Lithium can cause tremors or long-term kidney damage in some people. Doctors must carefully monitor the level of lithium in a patient’s blood. A level that is too low is ineffective, and a level that is too high can be toxic. Discontinuing lithium treatment abruptly can increase the risk of relapse.
Recently developed alternatives to lithium include the drugs carbamazepine (Tegretol) and divalproex (Depakote).
Criticisms of Drug Therapies
Drug therapies are effective for many people with psychological disorders, especially for those who suffer from severe disorders that cannot be treated in other ways. However, drug therapies have been criticized for several reasons:
Their effects are superficial and last only as long as the drug is being administered.
Side effects can often be more severe and troubling than the disorder for which the drug was given. This can cause patients to discontinue the drugs and experience relapses.
Patients often respond well to new drugs when they are first released into the market because of the enthusiasm and high expectations surrounding the drug. But such placebo effects tend to wane over time.
The therapeutic window for drugs, or the amount of the drug that is required for an effect without toxicity, varies according to factors such as gender, age, and ethnicity. This makes it difficult for physicians to determine the right dose of a drug.
New drugs, even those approved for long-term use, are often tested on only a few hundred people for a few weeks or months. This means that the risks of taking drugs long-term are unknown.
Some critics point out that because of pressure from managed care companies, physicians may overprescribe drugs rather than recommend psychotherapy.
Drugs are tested only on certain populations, for certain conditions. Physicians, however, sometimes prescribe a drug for conditions and populations that were not included in the testing.
Researchers who study the effectiveness of medications may be biased because they often have financial ties to pharmaceutical companies.
Freely prescribing drugs for psychological disorders gives the impression that such disorders can be treated only biochemically. However, the biological abnormalities present in such disorders can often be treated by changing thoughts and behavior.
Electroconvulsive Therapy
Electroconvulsive therapy (ECT) is used mainly for the treatment of severe depression. Electrodes are placed on the patient’s head, over the temporal lobes of the brain. Anesthetics and muscle relaxants help minimize discomfort to the patient. Then an electric current is delivered for about one second. The patient has a convulsive seizure and becomes unconscious, awakening after about an hour. The typical number of ECT sessions varies from six to twenty, and they are usually done while a patient is hospitalized.
ECT is a controversial procedure. Research suggests that there are short-term side effects of ECT, such as attention deficits and memory loss. Critics of ECT believe that it is often used inappropriately and that it can result in permanent cognitive problems. Proponents of ECT, however, believe that it does not cause long-term cognitive problems, loss of memory, or brain damage. They believe that it is highly effective and that it is underused because of negative public ideas surrounding it.
Psychosurgery
Psychosurgery is brain surgery to treat a psychological disorder. The best-known form of psychosurgery is the prefrontal lobotomy. A lobotomy is a surgical procedure that severs nerve tracts in the frontal lobe. Surgeons performed lobotomies in the 1940s and 1950s to treat highly emotional and violent behavior. The surgery often resulted in severe deficits, including apathy, lethargy, and social withdrawal.
Lobotomies are now rarely performed, but some neurosurgeons perform cingulotomies, which involve destruction of part of the frontal lobes. These surgeries are usually performed on patients who have severe depressive or anxiety disorders and who do not respond to other treatments. The effectiveness of these surgeries is unclear.
Transcranial Magnetic Stimulation
Transcranial magnetic stimulation (TMS) is a recently developed, noninvasive procedure. It involves stimulating the brain by means of a magnetic coil held to a person’s skull near the left prefrontal cortex. It is used to treat severe depression.
Group Therapies
Group Therapies
In group therapy, a therapist meets with several people at once. Psychotherapy groups usually have between four and fifteen people. Group therapies are cost-effective for clients and time saving for therapists.
Self-Help Groups
Self-help groups, such as Alcoholics Anonymous, resemble therapy groups except that they do not have a therapist. These groups allow people to feel less alone in dealing with their problems. Self-help group participants both give and receive help and can usually attend the group free of charge. Self-help groups are used very widely.
Features of Psychotherapy Groups
Groups may be homogeneous or heterogeneous. In homogeneous groups, all members share one or more key characteristics. For example, a group may be composed of people who are all suffering from depression or people who are between the ages of twenty and thirty. Many groups are heterogeneous and contain people who differ in age, type of problem, gender, and so on.
The Therapist’s Role
The therapist usually screens people to determine whether they would be suitable for a group, excluding people who are likely to be highly disruptive. In the group, the therapist’s role is to promote a supportive environment, set goals, and protect the clients from harm.
The Role of Group Members
Group members discuss their problems and experiences with one another and consider different ways of coping. They provide each other with acceptance, support, and honest feedback. A therapy group is a place where people can practice coping strategies and ways of relating to others. Therapy groups also help people to realize they are not alone in their suffering.
In group therapy, a therapist meets with several people at once. Psychotherapy groups usually have between four and fifteen people. Group therapies are cost-effective for clients and time saving for therapists.
Self-Help Groups
Self-help groups, such as Alcoholics Anonymous, resemble therapy groups except that they do not have a therapist. These groups allow people to feel less alone in dealing with their problems. Self-help group participants both give and receive help and can usually attend the group free of charge. Self-help groups are used very widely.
Features of Psychotherapy Groups
Groups may be homogeneous or heterogeneous. In homogeneous groups, all members share one or more key characteristics. For example, a group may be composed of people who are all suffering from depression or people who are between the ages of twenty and thirty. Many groups are heterogeneous and contain people who differ in age, type of problem, gender, and so on.
The Therapist’s Role
The therapist usually screens people to determine whether they would be suitable for a group, excluding people who are likely to be highly disruptive. In the group, the therapist’s role is to promote a supportive environment, set goals, and protect the clients from harm.
The Role of Group Members
Group members discuss their problems and experiences with one another and consider different ways of coping. They provide each other with acceptance, support, and honest feedback. A therapy group is a place where people can practice coping strategies and ways of relating to others. Therapy groups also help people to realize they are not alone in their suffering.
Family Therapies
Family Therapies
In family therapy, a therapist sees two or more members of a family at the same time. Family therapies work on the assumption that people do not live in isolation but as interconnected members of families. A problem that affects one person in the family must necessarily affect the whole family, and any change a person makes will inevitably affect the whole family. Family therapists help people to identify the roles they play in their families and to resolve conflicts within families. Family therapists sometimes use family trees to help family members identify intergenerational patterns of behavior.
In couples therapy, therapists help couples identify and resolve conflicts. Therapists usually see both members of a couple at the same time. Family and couples therapists may use psychodynamic, cognitive, behavioral, or humanistic approaches.
In family therapy, a therapist sees two or more members of a family at the same time. Family therapies work on the assumption that people do not live in isolation but as interconnected members of families. A problem that affects one person in the family must necessarily affect the whole family, and any change a person makes will inevitably affect the whole family. Family therapists help people to identify the roles they play in their families and to resolve conflicts within families. Family therapists sometimes use family trees to help family members identify intergenerational patterns of behavior.
In couples therapy, therapists help couples identify and resolve conflicts. Therapists usually see both members of a couple at the same time. Family and couples therapists may use psychodynamic, cognitive, behavioral, or humanistic approaches.
Psychotherapy
Psychotherapy
Psychotherapy is the treatment of psychological problems through confidential verbal communications with a mental health professional. All psychotherapies offer hope that a problem will improve, present new perspectives on the problem, and encourage an empathic relationship with a therapist. The approach a psychotherapist uses depends on his or her theoretical orientation. Types of approaches include psychodynamic, cognitive, humanistic, and behavioral.
Types of Mental Health Professionals
• Clinical and counseling psychologists have a doctoral degree as well as specialized training for diagnosing and treating psychological disorders and problems of daily living.
• Psychiatrists are physicians. They have a medical degree and specialize in diagnosing and treating psychological disorders. Psychiatrists tend to focus on biomedical therapies, although they sometimes also provide psychotherapy.
• Psychiatric social workers and psychiatric nurses also provide psychotherapy, often in institutional settings, such as hospitals and social service organizations. They sometimes practice independently as well.
• Counselors who provide psychotherapy services usually work in schools, colleges, and social service organizations.
Psychodynamic Approaches
All of the many psychodynamic therapies derive from the treatment called psychoanalysis, which Sigmund Freud developed and used in the late 1800s and early 1900s. (See Chapter 13 for more information on Freud and his theory of psychoanalysis.)
Psychoanalytic treatment focuses on uncovering unconscious motives, conflicts, and defenses that relate to childhood experiences. Freud believed that people experience anxiety because of conflicts among the id, ego, and superego. To manage these conflicts, people use defense mechanisms, which can often be self-defeating and unsuccessful at fully controlling anxiety.
Psychoanalytic Techniques
In the traditional form of psychoanalysis, clients meet with a psychoanalyst several times a week for many years. The psychoanalyst sits out of view of the client, who sometimes lies on a couch.
Some techniques commonly used in psychoanalysis include free association, dream analysis, and interpretation:
Free association: Psychoanalysts encourage clients to say anything that comes to mind. Clients are expected to put all thoughts into words, even if those thoughts are incoherent, inappropriate, rude, or seemingly irrelevant. Free associations reveal the client’s unconscious to the psychoanalyst.
Dream analysis: Dreams also reveal the subconscious. Clients describe their dreams in detail, and the psychoanalyst interprets the latent content, or the hidden meaning, of these dreams.
Interpretation: A key technique in psychoanalysis, interpretation refers to the psychoanalyst’s efforts to uncover the hidden meanings in the client’s free associations, dreams, feelings, memories, and behavior. Psychoanalysts are trained to make interpretations carefully and only when a client is ready to accept them. Ideally, such interpretations increase the client’s insight .
Psychoanalytic Concepts
Three important concepts involved in psychoanalysis are transference, resistance, and catharsis:
Transference refers to the process by which clients relate to their psychoanalysts as they would to important figures in their past. Psychoanalysts usually encourage transference because it helps them to uncover the client’s hidden conflicts and helps the client to work through such conflicts.
Example:
A client who is resentful about her mother’s authority over her might show angry, rebellious behavior toward the psychoanalyst.
Resistance refers to the client’s efforts to block the progress of treatment. These efforts are usually unconscious. Resistance occurs because the client experiences anxiety when unconscious conflicts begin to be uncovered.
Example:
Resistance can take many different forms, such as coming late to sessions, forgetting to pay for sessions, and expressing hostility toward the psychoanalyst.
Catharsis is the release of tension that results when repressed thoughts or memories move into the patient’s conscious mind.
Example:
Jane has a repressed childhood memory of being punished by her father after walking into her parents’ bedroom while they were having sex. This memory comes into her conscious mind while she is undergoing psychotherapy. Subsequently, she feels a release of tension and is able to relate the incident to her current aversion toward sex.
Current Psychodynamic Therapies
Today, the classical form of psychoanalysis is rarely practiced. Psychodynamic therapies, however, are widely used for treating the full range of psychological disorders. Psychodynamic therapies differ in their specific approaches, but they all focus on increasing insight by uncovering unconscious motives, conflicts, and defenses.
Interpretation and the concepts of transference and resistance are important features of psychodynamic therapies. Unlike traditional psychoanalysts, psychodynamic therapists usually sit face-to-face with their clients. Sessions typically occur once or twice a week, and treatment usually does not last as long as psychoanalysis.
Cognitive Approaches
Cognitive therapies aim to identify and change maladaptive thinking patterns that can result in negative emotions and dysfunctional behavior. Psychologist Aaron Beck first developed cognitive therapy to treat depression, although cognitive therapies are now used to treat a wide range of disorders. Beck’s cognitive therapy helps clients test whether their beliefs are realistic.
Cognitive therapists such as Beck believe that depression arises from errors in thinking. According to this theory, depressed people tend to do any of the following:
Blame themselves for negative events. They underestimate situational causes.
Pay more attention to negative events than to positive ones.
Are pessimistic.
Make inappropriately global generalizations from negative events.
Cognitive Therapy Techniques
Cognitive therapists try to change their clients’ ways of thinking. In therapy, clients learn to identify automatic negative thoughts and the assumptions they make about the world. Automatic thoughts are self-defeating judgments that people make about themselves. Clients learn to see these judgments as unrealistic and to consider other interpretations for events they encounter.
Rational-Emotive Therapy
Rational-emotive therapy is a type of cognitive-behavioral therapy started by the psychologist Albert Ellis. In this therapy, the therapist directly challenges the client’s irrational beliefs. Ellis’s therapy hinges on the idea that people’s feelings are influenced not by negative events but by their catastrophic thoughts and beliefs about these events. Ellis points out that catastrophic thinking is based on irrational assumptions about what one must do or be. His therapy aims to identify catastrophic thinking and change the irrational assumptions that underlie it.
Behavioral Approaches
Whereas insight therapies focus on addressing the problems that underlie symptoms, behavior therapists focus on addressing symptoms, which they believe are the real problem. Behavior therapies use learning principles to modify maladaptive behaviors. Many therapists combine behavior therapy and cognitive therapy into an approach known as cognitive-behavior therapy.
Behavior therapies are based on two assumptions:
Behavior is learned.
Behavior can be changed by applying the principles of classical conditioning, operant conditioning, and observational learning. (See Chapter 7 for more information.)
Behavior therapies are designed for specific types of problems. Three important types of behavior therapies include systematic desensitization, aversion therapy, and social skills training.
Systematic Desensitization
Systematic desensitization is a treatment designed by the psychologist Joseph Wolpe. It uses counterconditioning to decrease anxiety symptoms. This therapy works on the assumption that anxiety arises through classical conditioning. That is, a neutral stimulus begins to arouse anxiety when it is paired with an unconditioned stimulus that evokes anxiety.
Example:
A person might develop a fear of high places after experiencing an avalanche on a mountain trail. The avalanche is the unconditioned stimulus, and any high place becomes the conditioned stimulus, producing anxiety similar to that evoked by the avalanche.
Systematic desensitization aims to replace the conditioned stimulus with a response, such as relaxation, that is incompatible with anxiety. If psychotherapists can teach their clients to relax whenever they encounter an anxiety-producing stimulus, the anxiety will gradually decrease.
Exposure Therapies
Systematic desensitization is a type of exposure therapy. Exposure therapies are commonly used to treat phobias. These therapies recognize the fact that people maintain phobias by avoiding anxiety-producing situations, and they involve eliminating anxiety responses by having clients face a real or imagined version of the feared stimulus. In recent years, therapists have started using virtual reality devices to help clients experience feared stimuli.
Flooding is a more extreme type of exposure therapy than systematic desensitization. In flooding, exposure to anxiety-producing stimuli is sudden rather than gradual. For example, the person with the fear of heights would be taken to a mountain trail. No avalanche happens, so the person’s anxiety is extinguished.
Systematic desensitization involves a series of steps, which occur over several therapy sessions:
The therapist and client make up an anxiety hierarchy. The hierarchy lists stimuli that the client is likely to find frightening. The client ranks the stimuli from least frightening to most frightening.
The therapist teaches the client how to progressively and completely relax his body.
Next, the therapist asks the client to first relax and then imagine encountering the stimuli listed in the anxiety hierarchy, beginning with the least-frightening stimulus. If the client feels anxious while imagining a stimulus, he is asked to stop imagining the stimulus and focus on relaxing. After some time, the client becomes able to imagine all the stimuli on the hierarchy without anxiety.
Finally, the client practices encountering the real stimuli.
EMDR
Eye movement desensitization and reprocessing (EMDR) is a method that some therapists use to treat problems such as post–traumatic stress disorder and panic attacks. This treatment is a type of exposure therapy in which clients move their eyes back and forth while recalling memories that are to be desensitized. Many critics of EMDR claim that the treatment is no different from a standard exposure treatment and that the eye movements do not add to the effectiveness of the procedure.
Aversion Therapy
In aversion therapy, a stimulus that evokes an unpleasant response is paired with a stimulus that evokes a maladaptive behavior.
Example:
A therapist might give an alcoholic a nausea- producing drug along with alcoholic drinks.
Therapists use aversion therapy to treat problems such as deviant sexual behavior, substance abuse, and overeating. One major limitation of this type of therapy is that people know that the aversive stimulus occurs only during therapy sessions. Aversion therapy is usually used in combination with other treatments.
Criticisms of Aversion Therapy
Many doctors and psychologists criticize aversion therapy as both inhumane and ineffective. Therapists have sometimes used aversion therapy for controversial ends. For example, in the past, therapists used aversion therapy to “treat” homosexuality.
Social Skills Training
Social skills training aims to enhance a client’s relationships with other people. Techniques used in social skills training include modeling, behavioral rehearsal, and shaping:
Modeling involves having clients learn specific skills by observing socially skilled people.
Behavioral rehearsal involves having the client role-play behavior that could be used in social situations. The therapist provides feedback about the client’s behavior.
Shaping involves having the client approach progressively more difficult social situations in the real world.
Token Economies
A token economy is a behavior modification program based on operant conditioning principles. Token economies are sometimes successfully used in institutional settings, such as schools and psychiatric hospitals. People receive tokens for desirable behaviors, such as getting out of bed, washing, and cooperating. These tokens can be exchanged for rewards, such as candy or TV-watching time.
Humanistic Approaches
Humanistic therapies are derived from the school of humanistic psychology (see Chapter 13). Humanistic therapists try to help people accept themselves and free themselves from unnecessary limitations. The influence of humanistic therapies led to the use of the term clients, rather than patients, in referring to people who seek therapy. Humanistic therapists tend to focus on the present situation of clients rather than their past.
The best-known humanistic therapy is client-centered therapy.
Client-Centered Therapy
Client-centered, or person-centered, therapy was developed by the psychologist Carl Rogers. (See Chapter 13 for more information on Carl Rogers.) It aims to help clients enhance self-acceptance and personal growth by providing a supportive emotional environment. This type of therapy is nondirective, which means that the therapist does not direct the course and pace of therapy. Client-centered therapists believe that people’s problems come from incongruence, or a disparity between their self- concept and reality. Incongruence arises because people are too dependent on others for approval and acceptance. When people have incongruence, they feel anxious. They subsequently try to maintain their self-concept by denying or distorting reality.
In client-centered therapy, people learn to adopt a more realistic self-concept by accepting who they are and thus becoming less reliant on the acceptance of others. To do this, therapists have to be genuine, empathic, and provide unconditional positive regard, which is nonjudgmental acceptance of the client. Client-centered therapists use active listening to show empathy by accurately mirroring, or reflecting, the thoughts and feelings of the client. They help the client to clarify these thoughts and feelings by echoing and restating what the client has said.
Integrative Approaches to Therapy
Many therapists use an integrative approach, which means they use the perspectives and techniques of many different schools of psychology rather than adhering rigidly to one school. For example, a therapist might use a psychodynamic approach to understand the unconscious motivations influencing a client’s behavior, a client-centered approach when interacting empathically with the client, and a cognitive-behavioral approach to suggest strategies that may help the client cope with problems.
Existential Therapies
Existential therapies aim to help clients find meaning in their lives. They address concerns about death, alienation from other people, and freedom. Existential therapists, like humanistic therapists, believe that people are responsible for their own lives.
Psychotherapy is the treatment of psychological problems through confidential verbal communications with a mental health professional. All psychotherapies offer hope that a problem will improve, present new perspectives on the problem, and encourage an empathic relationship with a therapist. The approach a psychotherapist uses depends on his or her theoretical orientation. Types of approaches include psychodynamic, cognitive, humanistic, and behavioral.
Types of Mental Health Professionals
• Clinical and counseling psychologists have a doctoral degree as well as specialized training for diagnosing and treating psychological disorders and problems of daily living.
• Psychiatrists are physicians. They have a medical degree and specialize in diagnosing and treating psychological disorders. Psychiatrists tend to focus on biomedical therapies, although they sometimes also provide psychotherapy.
• Psychiatric social workers and psychiatric nurses also provide psychotherapy, often in institutional settings, such as hospitals and social service organizations. They sometimes practice independently as well.
• Counselors who provide psychotherapy services usually work in schools, colleges, and social service organizations.
Psychodynamic Approaches
All of the many psychodynamic therapies derive from the treatment called psychoanalysis, which Sigmund Freud developed and used in the late 1800s and early 1900s. (See Chapter 13 for more information on Freud and his theory of psychoanalysis.)
Psychoanalytic treatment focuses on uncovering unconscious motives, conflicts, and defenses that relate to childhood experiences. Freud believed that people experience anxiety because of conflicts among the id, ego, and superego. To manage these conflicts, people use defense mechanisms, which can often be self-defeating and unsuccessful at fully controlling anxiety.
Psychoanalytic Techniques
In the traditional form of psychoanalysis, clients meet with a psychoanalyst several times a week for many years. The psychoanalyst sits out of view of the client, who sometimes lies on a couch.
Some techniques commonly used in psychoanalysis include free association, dream analysis, and interpretation:
Free association: Psychoanalysts encourage clients to say anything that comes to mind. Clients are expected to put all thoughts into words, even if those thoughts are incoherent, inappropriate, rude, or seemingly irrelevant. Free associations reveal the client’s unconscious to the psychoanalyst.
Dream analysis: Dreams also reveal the subconscious. Clients describe their dreams in detail, and the psychoanalyst interprets the latent content, or the hidden meaning, of these dreams.
Interpretation: A key technique in psychoanalysis, interpretation refers to the psychoanalyst’s efforts to uncover the hidden meanings in the client’s free associations, dreams, feelings, memories, and behavior. Psychoanalysts are trained to make interpretations carefully and only when a client is ready to accept them. Ideally, such interpretations increase the client’s insight .
Psychoanalytic Concepts
Three important concepts involved in psychoanalysis are transference, resistance, and catharsis:
Transference refers to the process by which clients relate to their psychoanalysts as they would to important figures in their past. Psychoanalysts usually encourage transference because it helps them to uncover the client’s hidden conflicts and helps the client to work through such conflicts.
Example:
A client who is resentful about her mother’s authority over her might show angry, rebellious behavior toward the psychoanalyst.
Resistance refers to the client’s efforts to block the progress of treatment. These efforts are usually unconscious. Resistance occurs because the client experiences anxiety when unconscious conflicts begin to be uncovered.
Example:
Resistance can take many different forms, such as coming late to sessions, forgetting to pay for sessions, and expressing hostility toward the psychoanalyst.
Catharsis is the release of tension that results when repressed thoughts or memories move into the patient’s conscious mind.
Example:
Jane has a repressed childhood memory of being punished by her father after walking into her parents’ bedroom while they were having sex. This memory comes into her conscious mind while she is undergoing psychotherapy. Subsequently, she feels a release of tension and is able to relate the incident to her current aversion toward sex.
Current Psychodynamic Therapies
Today, the classical form of psychoanalysis is rarely practiced. Psychodynamic therapies, however, are widely used for treating the full range of psychological disorders. Psychodynamic therapies differ in their specific approaches, but they all focus on increasing insight by uncovering unconscious motives, conflicts, and defenses.
Interpretation and the concepts of transference and resistance are important features of psychodynamic therapies. Unlike traditional psychoanalysts, psychodynamic therapists usually sit face-to-face with their clients. Sessions typically occur once or twice a week, and treatment usually does not last as long as psychoanalysis.
Cognitive Approaches
Cognitive therapies aim to identify and change maladaptive thinking patterns that can result in negative emotions and dysfunctional behavior. Psychologist Aaron Beck first developed cognitive therapy to treat depression, although cognitive therapies are now used to treat a wide range of disorders. Beck’s cognitive therapy helps clients test whether their beliefs are realistic.
Cognitive therapists such as Beck believe that depression arises from errors in thinking. According to this theory, depressed people tend to do any of the following:
Blame themselves for negative events. They underestimate situational causes.
Pay more attention to negative events than to positive ones.
Are pessimistic.
Make inappropriately global generalizations from negative events.
Cognitive Therapy Techniques
Cognitive therapists try to change their clients’ ways of thinking. In therapy, clients learn to identify automatic negative thoughts and the assumptions they make about the world. Automatic thoughts are self-defeating judgments that people make about themselves. Clients learn to see these judgments as unrealistic and to consider other interpretations for events they encounter.
Rational-Emotive Therapy
Rational-emotive therapy is a type of cognitive-behavioral therapy started by the psychologist Albert Ellis. In this therapy, the therapist directly challenges the client’s irrational beliefs. Ellis’s therapy hinges on the idea that people’s feelings are influenced not by negative events but by their catastrophic thoughts and beliefs about these events. Ellis points out that catastrophic thinking is based on irrational assumptions about what one must do or be. His therapy aims to identify catastrophic thinking and change the irrational assumptions that underlie it.
Behavioral Approaches
Whereas insight therapies focus on addressing the problems that underlie symptoms, behavior therapists focus on addressing symptoms, which they believe are the real problem. Behavior therapies use learning principles to modify maladaptive behaviors. Many therapists combine behavior therapy and cognitive therapy into an approach known as cognitive-behavior therapy.
Behavior therapies are based on two assumptions:
Behavior is learned.
Behavior can be changed by applying the principles of classical conditioning, operant conditioning, and observational learning. (See Chapter 7 for more information.)
Behavior therapies are designed for specific types of problems. Three important types of behavior therapies include systematic desensitization, aversion therapy, and social skills training.
Systematic Desensitization
Systematic desensitization is a treatment designed by the psychologist Joseph Wolpe. It uses counterconditioning to decrease anxiety symptoms. This therapy works on the assumption that anxiety arises through classical conditioning. That is, a neutral stimulus begins to arouse anxiety when it is paired with an unconditioned stimulus that evokes anxiety.
Example:
A person might develop a fear of high places after experiencing an avalanche on a mountain trail. The avalanche is the unconditioned stimulus, and any high place becomes the conditioned stimulus, producing anxiety similar to that evoked by the avalanche.
Systematic desensitization aims to replace the conditioned stimulus with a response, such as relaxation, that is incompatible with anxiety. If psychotherapists can teach their clients to relax whenever they encounter an anxiety-producing stimulus, the anxiety will gradually decrease.
Exposure Therapies
Systematic desensitization is a type of exposure therapy. Exposure therapies are commonly used to treat phobias. These therapies recognize the fact that people maintain phobias by avoiding anxiety-producing situations, and they involve eliminating anxiety responses by having clients face a real or imagined version of the feared stimulus. In recent years, therapists have started using virtual reality devices to help clients experience feared stimuli.
Flooding is a more extreme type of exposure therapy than systematic desensitization. In flooding, exposure to anxiety-producing stimuli is sudden rather than gradual. For example, the person with the fear of heights would be taken to a mountain trail. No avalanche happens, so the person’s anxiety is extinguished.
Systematic desensitization involves a series of steps, which occur over several therapy sessions:
The therapist and client make up an anxiety hierarchy. The hierarchy lists stimuli that the client is likely to find frightening. The client ranks the stimuli from least frightening to most frightening.
The therapist teaches the client how to progressively and completely relax his body.
Next, the therapist asks the client to first relax and then imagine encountering the stimuli listed in the anxiety hierarchy, beginning with the least-frightening stimulus. If the client feels anxious while imagining a stimulus, he is asked to stop imagining the stimulus and focus on relaxing. After some time, the client becomes able to imagine all the stimuli on the hierarchy without anxiety.
Finally, the client practices encountering the real stimuli.
EMDR
Eye movement desensitization and reprocessing (EMDR) is a method that some therapists use to treat problems such as post–traumatic stress disorder and panic attacks. This treatment is a type of exposure therapy in which clients move their eyes back and forth while recalling memories that are to be desensitized. Many critics of EMDR claim that the treatment is no different from a standard exposure treatment and that the eye movements do not add to the effectiveness of the procedure.
Aversion Therapy
In aversion therapy, a stimulus that evokes an unpleasant response is paired with a stimulus that evokes a maladaptive behavior.
Example:
A therapist might give an alcoholic a nausea- producing drug along with alcoholic drinks.
Therapists use aversion therapy to treat problems such as deviant sexual behavior, substance abuse, and overeating. One major limitation of this type of therapy is that people know that the aversive stimulus occurs only during therapy sessions. Aversion therapy is usually used in combination with other treatments.
Criticisms of Aversion Therapy
Many doctors and psychologists criticize aversion therapy as both inhumane and ineffective. Therapists have sometimes used aversion therapy for controversial ends. For example, in the past, therapists used aversion therapy to “treat” homosexuality.
Social Skills Training
Social skills training aims to enhance a client’s relationships with other people. Techniques used in social skills training include modeling, behavioral rehearsal, and shaping:
Modeling involves having clients learn specific skills by observing socially skilled people.
Behavioral rehearsal involves having the client role-play behavior that could be used in social situations. The therapist provides feedback about the client’s behavior.
Shaping involves having the client approach progressively more difficult social situations in the real world.
Token Economies
A token economy is a behavior modification program based on operant conditioning principles. Token economies are sometimes successfully used in institutional settings, such as schools and psychiatric hospitals. People receive tokens for desirable behaviors, such as getting out of bed, washing, and cooperating. These tokens can be exchanged for rewards, such as candy or TV-watching time.
Humanistic Approaches
Humanistic therapies are derived from the school of humanistic psychology (see Chapter 13). Humanistic therapists try to help people accept themselves and free themselves from unnecessary limitations. The influence of humanistic therapies led to the use of the term clients, rather than patients, in referring to people who seek therapy. Humanistic therapists tend to focus on the present situation of clients rather than their past.
The best-known humanistic therapy is client-centered therapy.
Client-Centered Therapy
Client-centered, or person-centered, therapy was developed by the psychologist Carl Rogers. (See Chapter 13 for more information on Carl Rogers.) It aims to help clients enhance self-acceptance and personal growth by providing a supportive emotional environment. This type of therapy is nondirective, which means that the therapist does not direct the course and pace of therapy. Client-centered therapists believe that people’s problems come from incongruence, or a disparity between their self- concept and reality. Incongruence arises because people are too dependent on others for approval and acceptance. When people have incongruence, they feel anxious. They subsequently try to maintain their self-concept by denying or distorting reality.
In client-centered therapy, people learn to adopt a more realistic self-concept by accepting who they are and thus becoming less reliant on the acceptance of others. To do this, therapists have to be genuine, empathic, and provide unconditional positive regard, which is nonjudgmental acceptance of the client. Client-centered therapists use active listening to show empathy by accurately mirroring, or reflecting, the thoughts and feelings of the client. They help the client to clarify these thoughts and feelings by echoing and restating what the client has said.
Integrative Approaches to Therapy
Many therapists use an integrative approach, which means they use the perspectives and techniques of many different schools of psychology rather than adhering rigidly to one school. For example, a therapist might use a psychodynamic approach to understand the unconscious motivations influencing a client’s behavior, a client-centered approach when interacting empathically with the client, and a cognitive-behavioral approach to suggest strategies that may help the client cope with problems.
Existential Therapies
Existential therapies aim to help clients find meaning in their lives. They address concerns about death, alienation from other people, and freedom. Existential therapists, like humanistic therapists, believe that people are responsible for their own lives.
Types of treatment for psychological disorders
Types of treatment for psychological disorders
There are many different types of treatment for psychological disorders, all of which fit into three broad types: insight therapies, behavior therapies, and biomedical therapies.
Insight therapies involve complex conversations between therapists and clients. The aim is to help clients understand the nature of their problems and the meaning of their behaviors, thoughts, and feelings. Insight therapists may use a variety of approaches, including psychodynamic, cognitive, or humanistic.
Behavior therapies also involve conversations between therapists and clients but attempt to directly influence maladaptive behaviors. Behavior therapies are based on learning principles. (See Chapter 7 for more information on learning.)
Biomedical therapies involve efforts to directly alter biological functioning through medication, electric shock, or surgery.
There are many different types of treatment for psychological disorders, all of which fit into three broad types: insight therapies, behavior therapies, and biomedical therapies.
Insight therapies involve complex conversations between therapists and clients. The aim is to help clients understand the nature of their problems and the meaning of their behaviors, thoughts, and feelings. Insight therapists may use a variety of approaches, including psychodynamic, cognitive, or humanistic.
Behavior therapies also involve conversations between therapists and clients but attempt to directly influence maladaptive behaviors. Behavior therapies are based on learning principles. (See Chapter 7 for more information on learning.)
Biomedical therapies involve efforts to directly alter biological functioning through medication, electric shock, or surgery.
Functionalism
Functionalism
In psychology, a broad school of thought that originated in the U.S. in the late 19th century and emphasized the total organism in its endeavours to adjust to the environment. Reacting against the school of structuralism led by Edward Bradford Titchener, functionalists such as William James, George Herbert Mead, and John Dewey stressed the importance of empirical, rational thought over an experimental trial-and-error philosophy. The movement concerned itself primarily with the practical applications of research (&see; applied psychology) and was critical of early forms of behaviourism.
In psychology, a broad school of thought that originated in the U.S. in the late 19th century and emphasized the total organism in its endeavours to adjust to the environment. Reacting against the school of structuralism led by Edward Bradford Titchener, functionalists such as William James, George Herbert Mead, and John Dewey stressed the importance of empirical, rational thought over an experimental trial-and-error philosophy. The movement concerned itself primarily with the practical applications of research (&see; applied psychology) and was critical of early forms of behaviourism.
Fetishism
Fetishism
In psychology, erotic attachment to an inanimate object or a nongenital body part whose real or fantasized presence is necessary for sexual gratification. The object is most commonly some other body part or an article of clothing. From the time of its identification by Sigmund Freud in 1927, fetishism was thought to occur almost exclusively among men, but in the late 20th century that notion was challenged by several new studies. &Seealso; fetish.
In psychology, erotic attachment to an inanimate object or a nongenital body part whose real or fantasized presence is necessary for sexual gratification. The object is most commonly some other body part or an article of clothing. From the time of its identification by Sigmund Freud in 1927, fetishism was thought to occur almost exclusively among men, but in the late 20th century that notion was challenged by several new studies. &Seealso; fetish.
Extrasensory Perception (ESP)
Extrasensory Perception (ESP)
Perception that involves awareness of information about something (such as a person or event) not gained through the senses and not deducible from previous experience. Classic forms of ESP include telepathy, clairvoyance, and precognition. No conclusive demonstrations of the existence of ESP in any individual have been given, but popular belief in the phenomenon remains widespread, and people who claim to possess ESP are sometimes employed by investigative teams searching for missing persons or things. &Seealso; parapsychology.
Perception that involves awareness of information about something (such as a person or event) not gained through the senses and not deducible from previous experience. Classic forms of ESP include telepathy, clairvoyance, and precognition. No conclusive demonstrations of the existence of ESP in any individual have been given, but popular belief in the phenomenon remains widespread, and people who claim to possess ESP are sometimes employed by investigative teams searching for missing persons or things. &Seealso; parapsychology.
Experimental Psychology
Experimental Psychology
Branch or type of psychology concerned with employing empirical principles and procedures in the study of psychological phenomena. The experimental psychologist seeks to carry out tests under controlled conditions in order to discover an unknown effect or law, to examine or establish a hypothesis, or to illustrate a known law. The areas of study that rely most heavily on the experimental method include those of sensation and perception, learning and memory, motivation, and physiological psychology. Experimental approaches are also used in child psychology, clinical psychology, educational psychology, and social psychology.
Branch or type of psychology concerned with employing empirical principles and procedures in the study of psychological phenomena. The experimental psychologist seeks to carry out tests under controlled conditions in order to discover an unknown effect or law, to examine or establish a hypothesis, or to illustrate a known law. The areas of study that rely most heavily on the experimental method include those of sensation and perception, learning and memory, motivation, and physiological psychology. Experimental approaches are also used in child psychology, clinical psychology, educational psychology, and social psychology.
Empathy
Empathy
Ability to imagine oneself in another's place and understand the other's feelings, desires, ideas, and actions. The empathic actor or singer is one who genuinely feels the part he or she is performing. The spectator of a work of art or the reader of a piece of literature may similarly become involved in what he or she observes or contemplates. The use of empathy was an important part of the psychological counseling technique developed by Carl R. Rogers.
Ability to imagine oneself in another's place and understand the other's feelings, desires, ideas, and actions. The empathic actor or singer is one who genuinely feels the part he or she is performing. The spectator of a work of art or the reader of a piece of literature may similarly become involved in what he or she observes or contemplates. The use of empathy was an important part of the psychological counseling technique developed by Carl R. Rogers.
Emotion
Emotion
Affective aspect of consciousness. The emotions are generally understood as representing a synthesis of subjective experience, expressive behaviour, and neurochemical activity. Most researchers hold that they are part of the human evolutionary legacy and serve adaptive ends by adding to general awareness and the facilitation of social communication. Some nonhuman animals are also considered to possess emotions, as first described by Charles Darwin in 1872. An influential early theory of emotion was that proposed independently by William James and Carl Georg Lange (1834–1900), who held that emotion was a perception of internal physiological reactions to external stimuli. Walter B. Cannon questioned this view and directed attention to the thalamus as a possible source of emotional content. Later researchers have focused on the brain-stem structure known as the reticular formation, which serves to integrate brain activity and may infuse perceptions or actions with emotional valence. Cognitive psychologists have emphasized the role of comparison, matching, appraisal, memory, and attribution in the forming of emotions. All modern theorists agree that emotions influence what people perceive, learn, and remember, and that they play an important part in personality development. Cross-cultural studies have shown that, whereas many emotions are universal, their specific content and manner of expression vary considerably.
Affective aspect of consciousness. The emotions are generally understood as representing a synthesis of subjective experience, expressive behaviour, and neurochemical activity. Most researchers hold that they are part of the human evolutionary legacy and serve adaptive ends by adding to general awareness and the facilitation of social communication. Some nonhuman animals are also considered to possess emotions, as first described by Charles Darwin in 1872. An influential early theory of emotion was that proposed independently by William James and Carl Georg Lange (1834–1900), who held that emotion was a perception of internal physiological reactions to external stimuli. Walter B. Cannon questioned this view and directed attention to the thalamus as a possible source of emotional content. Later researchers have focused on the brain-stem structure known as the reticular formation, which serves to integrate brain activity and may infuse perceptions or actions with emotional valence. Cognitive psychologists have emphasized the role of comparison, matching, appraisal, memory, and attribution in the forming of emotions. All modern theorists agree that emotions influence what people perceive, learn, and remember, and that they play an important part in personality development. Cross-cultural studies have shown that, whereas many emotions are universal, their specific content and manner of expression vary considerably.
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