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CHAPTER 2
CURRENT PARADIGMS
IN PSYCHOPATHOLOGY
CHAPTER SYNOPSIS
Science is a human enterprise, and scientific inquiry is limited by scientists’ human limitations
and by the limited state of our knowledge: people see only what they are able to see, and other
phenomena go undetected because scientists can discover things only if they already have some
general idea about them. A paradigm is a conceptual framework or general perspective. Because
the paradigm within which scientists and clinicians work helps to shape what they investigate
and find, understanding paradigms helps us to appreciate subjective influences that may affect
their work. Several major paradigms are current in the study of psychopathology and therapy:
1.
2.
3.
4.
Genetic.
Neuroscience.
Psychodynamic.
Cognitive Behavioral.
The choice of a paradigm has important consequences for the way in which abnormal behavior is
defined, investigated, and treated.
The Genetic Paradigm
The genetic paradigm focuses on questions such as whether certain disorders are heritable and,
if so, what is actually inherited. Heritability is a population statistic, not a metric of the
likelihood a particular person will inherit a disorder. Environmental effects can be classified as
shared and nonshared. Molecular genetics studies isolate particular genes and gene
polymorphisms that may be involved in psychopathology.
Behavior genetics is the study of the degree to which genes and environmental factors influence
behavior. The total genetic makeup of an individual, consisting of inherited genes, is referred to
as the genotype (physical sequence of DNA); the genotype cannot be observed outwardly. In
contrast, the totality of observable, behavioral characteristics, such as level of anxiety, is referred
to as the phenotype.
Molecular genetics studies seek to find out what exactly is heritable by identifying particular
genes and their functions. Different forms of the same gene are called alleles. A genetic
polymorphism refers to a difference in DNA sequence on a gene that has occurred in a
population.
Research has emphasized the importance of gene-environment interactions. Genes do their
work via the environment in most cases. Recent examples of genetic influence being manifested
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only under certain environmental conditions (e.g., poverty and IQ; early maltreatment and
depression) make clear that we must not look just for the genes associated with mental illness,
but also for the conditions under which these genes may be expressed.
The Neuroscience Paradigm
The neuroscience paradigm is concerned with the ways in which the brain contributes to
psychopathology. Each neuron has four major parts; the cell body, dendrites, axons, and
terminal buttons. The gap between adjacent neurons is called the synapse. Neurotransmitters
such as serotonin, norepinephrine, dopamine, and GABA have been implicated in a number of
disorders. Glial cells interact with neurons and control how neurons work. They have also been
implicated in disorders such as dementia and schizophrenia. A number of different brain areas
are also a focus of research. The autonomic nervous system, which includes the sympathetic
and parasympathetic nervous systems, is also implicated in the manifestations of some
disorders. The sympathetic nervous system prepares us for sudden activity and stress. The
parasympathetic helps us to calm down, though these distinctions are not always so clear-cut.
The brain itself includes a variety of structures important for mental functioning, such as the
prefrontal cortex, hippocampus, hypothalamus, and the amydgala. As part of the
neuroendocrine system, the HPA axis is responsible for the body’s response to stress and
thus is relevant for several stress-related disorders. Biological treatments, primarily
medications, are effective treatments for different disorders, but these treatments are
not necessarily treating the cause of the problems. Although the brain plays an important role in
our understanding of the causes of psychopathology, we must be careful to avoid reductionism.
The Cognitive Behavioral Paradigm
The cognitive behavioral paradigm reflects influences from behavior therapy and cognitive
science. Treatment techniques designed to alter the consequences or reinforcers of a behavior,
such as in time-out or a token economy, are still used today. Exposure is a key component to
cognitive behavioral treatments of anxiety. Cognitive science focuses on concepts such as
schemas (a network of accumulated knowledge or set), attention, and memory, and these
concepts are part of cognitive behavioral theories and treatments of psychopathology. Cognitive
behavior therapy uses behavior therapy techniques and cognitive restructuring. Aaron Beck and
Albert Ellis are two influential cognitive behavior therapists. The boundary between what is
behavioral and what is cognitive is not always so clear in the cognitive behavioral paradigm.
The Psychodynamic Paradigm
The psychodynamic paradigm derives from the work of Freud and his followers. The
contribution of the paradigm has been primarily in treatment. Contemporary psychodynamic
theories include ego analysis, which introduced the concept of pathogenic beliefs; object
relations, which stresses the importance of relationships; and its offshoot, attachment theory,
which emphasizes the role of attachment styles in infancy through adulthood. The theories of
Freud and other psychodynamic theorists do not lend themselves to systematic study, which has
limited their acceptance by some in the field. However, more contemporary psychodynamic
researchers along with researchers in other fields, such as cognitive neuroscience and social
psychology, have generated a body of empirical research on concepts such as the unconscious
and interpersonal relationships. For example, research on implicit memory and the relational
self has promoted acceptance of the ideas of unconscious influences on behavior and the role of
the self in relation to others. Brief psychodynamic therapy and interpersonal therapy are two
contemporary psychotherapies that are based in psychodynamic theory. Although Freud’s early
work is often criticized, this paradigm has been influential in the study of psychopathology in
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that it has made clear the importance of early experiences, the notion that we can do things
without conscious awareness, and the point that the causes of behavior are not always obvious.
Factors that Cut Across the Paradigms
Emotion plays a prominent role in many disorders, but the ways in which emotions can be
disrupted varies quite a bit. Emotions guide our behavior and help us to respond to problems or
challenges in our environment. It is important to distinguish among components of emotion that
may be disrupted, including expression, experience, and physiology. In addition, mood can be
distinguished from emotion. The concept of ideal affect points to important cultural differences
in emotion that may be important for psychopathology. Psychological disorders have different
types of emotion disturbances, and thus it is important to consider which of the emotion
components are affected. In some disorders, all emotion components may be disrupted, whereas
in others, just one might be problematic. Emotion is an important focus in the paradigms.
Sociocultural factors, including culture, ethnicity, gender, poverty, social support, and
relationships are also important factors in the study of psychopathology. Some disorders appear
to be universal across cultures, like schizophrenia or anxiety, yet their manifestations may differ
somewhat and the ways in which society regards them may also differ. Other disorders, like
eating disorders or hikikomori, may be specific to particular cultures. Some disorders are more
frequently diagnosed in some ethnic groups compared to others. (See Table 2.1). It is not clear
whether this reflects a true difference in the presence of disorder or perhaps a bias on the part of
diagnosticians. Social relationships can be important buffers against stress and have benefits for
physical and mental health. Consequently, it is important that clinicians help clients build and
maintain healthy social relationships. This goal is accomplished through a number of different
approaches, including couples therapy, family therapy, and interpersonal therapy. Couples
therapy and family therapy can be used to strengthen social relationships and improve healthy
communication. Interpersonal Therapy aims to help clients strengthen their interpersonal
relationships by helping clients generate solutions to interpersonal problems. Current research is
also examining whether risk factors associated with various disorders differ for men and
women. Sociocultural factors have recently become the focus of people working in the other
paradigms, and this trend will continue.
Diathesis–Stress: An Integrative Paradigm
Because each paradigm seems to have something to offer to our understanding of mental
disorders, it is important to develop more integrative paradigms. The diathesis-stress paradigm,
which integrates several points of view, assumes that people are predisposed to react adversely to
environmental stressors. The diathesis may be genetic, neurobiological, or psychological and
may be caused by early-childhood experiences, genetically influenced personality traits, or
sociocultural influences, among other things.
LEARNING GOALS
1. Be able to describe the essentials of the genetic, neuroscience, psychodynamic,
and cognitive behavioral paradigms.
2. Be able to describe the concept of emotion and how it may be relevant to
psychopathology.
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3. Be able to explain how culture, ethnicity, and social factors figure into the study
and treatment of psychopathology.
4. Be able to recognize the limits of adopting any one paradigm and the importance
of integration across multiple levels of analysis, as in the diathesis-stress
integrative paradigm.
KEY TERMS
agonist, allele, amygdala, antagonist, anterior cingulate, attachment theory, autonomic nervous
system (ANS), behavior genetics, brain stem, brief therapy, cerebellum, cognition, cognitive
behavior therapy (CBT), cognitive behavioral paradigm, cognitive restructuring, corpus
callosum, cortisol, diathesis, diathesis-stress, dopamine, emotion, exposure, frontal lobe,
gamma-aminobutyric acid (GABA), gene, gene expression, gene-environment interaction,
genetic paradigm, genotype, gray matter, heritability, hippocampus, HPA axis, hypothalamus, in
vivo, Interpersonal therapy (IPT), molecular genetics, nerve impulse, neuron, neuroscience
paradigm, neurotransmitters, nonshared environment, norepinephrine, object-relations theory,
occipital lobe, paradigm, parasympathetic nervous system, parietal lobe, phenotype, polygenic,
polymorphism, prefrontal cortex, pruning, psychodynamic paradigm, rational-emotive behavior
therapy (REBT), reciprocal gene-environment interaction, reuptake, schema, second messengers,
septal area, serotonin, serotonin transporter gene, shared environment, sympathetic nervous
system, synapse, temporal lobe, thalamus, time-out, token economy, ventricles, white matter
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LECTURE LAUNCHERS
1.
The Manufacture of a Human Chromosome
For years, scientists have been able to create artificial chromosomes for very simple living
organisms, such as yeast. A mouse chromosome was created in the lab in 1996. But in 1997, the
first artificial human chromosome was created at a lab at Case Western Reserve University in
Cleveland (reported in Nature Genetics, April, 1997).
What are the implications of this new technological leap? While researchers involved in the
federal Human Genome Program have mapped the location of specific genes on specific
chromosomes, creating artificial ones will enable scientists to study the functioning of genes
within their normal context. The next big step would be packaging therapeutic genes in an
artificial chromosome to introduce them to a cell. The new gene could either generate a
medicinal protein or replace a defective gene. The first step in treatment would be using artificial
chromosomes to treat blood diseases and diseases that affect the human immune system.
Eventually, a wide range of inherited or infectious diseases might be amenable to such gene
therapy.
Research in this area has grown considerably. Several websites of interest are:
1.
2.
3.
4.
The Institute for Genomic Research - http://www.tigr.org/
Genome Web - http://www.genomeweb.com/
The Genome Database - http://www.gdb.org/
National Center for Biotechnology Information - http://www.ncbi.nlm.nih.gov/
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2.
Does Everything Come Down to Serotonin?
As readers work their way through the textbook, they will notice that serotonin features
prominently in etiological theories for many mental disorders. Low levels of serotonin have been
associated with everything from eating disorders, depression, and alcoholism to suicide and
aggression.
On the other hand, animal studies have demonstrated repeatedly that environment plays a
tremendously important role in serotonin levels. For example, Suomi and colleagues at the
National Institute of Child, Health, and Human Development have found that childhood
environments affect monkeys' behavior and serotonin systems. Monkeys with low serotonin
levels are markedly aggressive and impulsive, take physical risks, and, when provided access to
alcohol, drink excessively. In the wild, such monkeys are rejected by their peers, fail at mating,
and often die at a young age. Lest we assume that biological factors fully account for the
monkeys' behavior, however, consider the impact of environmental factors on serotonin levels.
Monkeys raised without their mothers (with only peers for support) had low serotonin levels as
early as 14 days of age and continuing into adulthood. Future research by this lab will include
exploring whether ideal rearing environments can ameliorate the negative effects of low
serotonin levels.
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3.
Does the Neuroscience Paradigm Make Other Paradigms Obsolete?
The 1990s were proclaimed the “decade of the brain.” Much of the research conducted has
helped to highlight the impact of neuroscience on our understanding of mental illness. With
this in mind, students might expect that the discovery of biochemical causes for various mental
disorders invalidates the psychological paradigms. If symptoms can be explained by
neurochemical changes or a “chemical imbalance,” is there still a role for paradigms that
emphasize talking, thinking, and behaving in the etiology and treatment of these same
disorders?
In the discussion of obsessive-compulsive disorder in Chapter 6, the text mentions a recent
study (Baxter et al., 1992) that found both a medication (fluoxetine or Prozac) and a form of
behavior therapy (response prevention) resulted in the same changes in brain function on PET
scan in patients who improved following treatment. These findings illustrate an interconnection
between the biological and behavioral paradigms, as a psychological treatment can be shown to
have a direct impact on a biological process.
Another discussion of obsessive-compulsive disorder (OCD) highlights the role of
psychodynamic therapy in a disorder believed to be mainly biologically caused. In
“Psychodynamic psychiatry in the ‘Decade of the Brain,’” Gabbard (1992, American Journal
of Psychiatry, 149, 991-998) emphasizes the way in which mind and brain interact in mental
disorders. While noting the strong biological components of OCD and the lack of empirical
evidence favoring psychodynamic therapy in the treatment of the disorder, Gabbard illustrates
ways in which psychodynamic principles can nonetheless be valuable. Consider the following
case, described by Gabbard:
A 29-year-old man with OCD is so obsessed with avoiding contamination that he insists that
his mother move in with him and care for him 24 hours a day; his father is not allowed in the
house. His mother must follow a 58-step ritual in making dinner, and if one step is not
followed, she must discard the meal and begin again. While the patient had been prescribed
clomipramine, he stopped taking it after one dose and eventually was hospitalized by his
parents. The following interchange occurred with his therapist:
When he came to the hospital, I asked him why he was seeking treatment. He responded,
“I'm determined to be dependent – I mean, independent.” I commented to him that he
had first said “dependent,” and I inquired, “Is there perhaps a part of you that would like
to be dependent?” Mr. A responded, “You mean on my mother?” I replied that I thought
he would know better than I. Mr. A reflected a moment and said, “Well, she does take
pretty good care of me.”
Mr. A's slip of the tongue provided a glimpse into the unconscious motivations for his
resistance to treatment. Any kind of successful treatment threatened his dependent
relationship with his mother. If clomipramine were likely to help him, then he would not
take it.
Mr. A reportedly improved during his stay in the hospital, discovering that the
hospital setting had successfully reduced his anxiety about sexual feelings toward his
mother. While this treating psychiatrist noted the importance of medication in the
standard treatment of OCD, he used this case as an illustration of the role of
psychodynamic principles, both in understanding the unconscious wishes
accompanying the biologically driven symptoms, and in handling noncompliance with
the biologically based intervention.
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28
4.
Future of Psychodynamic Psychotherapy
In a special issue of Psychotherapy (1992, 29), clinicians from various theoretical orientations
were asked to describe the changes they anticipated in their paradigm. Hans Strupp, writing
on “The future of psychodynamic psychotherapy” (pp. 21-27), notes that psychodynamic
thinking continues to be based on the notion of unconscious conflict, while paying greater
attention to incorporating issues related to interpersonal experiences and emphasizing the
client's subjective experience. Strupp identified the following trends in psychodynamic
therapy:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Increasing attention to disturbances and arrests in infancy and early childhood
(in contrast to Freud's emphasis on the Oedipal period).
Focus on treatment of personality disorders and “difficult” patients, as
opposed to the “classical” neurotic conditions that Freud viewed as
the primary focus of analysis.
Focus on the dyadic character of the therapeutic relationship, resulting in
re-definition of the concepts of transference and counter transference.
Recognition of the importance of the patient-therapist relationship or
alliance, which is more collaborative and “human” than the
detached “blank screen” of classical analysts.
Utilization of the advances made in neuroscience and pharmacotherapy,
in combination with psychotherapy.
Wider acceptance of group, family, and marital therapy.
Renewed emphasis on briefer forms of psychotherapy, largely in response
to societal pressures.
Attempts to devise specific treatments for specific disorders, partly due to
developments in the area of managed care and the investigative model
of clinical trials for testing the efficacy of new drugs.
Development of treatment manuals.
Continued search for the mechanisms of change in psychotherapy.
Strupp sees these developments as “[infusing] psychodynamic psychotherapy with
renewed vitality and vigor” (p. 25).
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5.
Carl Rogers (1902-1987)
Carl Rogers died suddenly in 1987 at the age of 85, following surgery for a broken hip.
Obituaries from the Los Angeles Times (February 6, 1987) and the American Psychologist (1988,
43, 127-128) offer a glimpse into the life of this influential champion of the humanistic
paradigm. Rogers was born Jan. 8, 1902, in Oak Park, Illinois. He received his doctorate from
Columbia University Teachers College in 1931. Rogers founded the Center for the Study of the
Person in La Jolla, California in the 1960's, where he remained active until his death. Those
who knew Rogers describe him as a quiet but intent listener who was able to convey his real
interest in and empathy for the phenomenological world of the individual. While caring deeply
about individual persons, he doubted authority, institutions, credentials, and diagnosis. Accused
in the 1940s of “destroying the unity of psychoanalysis,” Rogers successfully pioneered the new
method of nondirective, client-centered therapy, turning the tables on the authority of analysts.
One of Rogers' most important contributions was his concern with conducting research in
psychotherapy. He was one of the first to assert that therapists should demonstrate that their
methods work; he even went so far as to tape therapy sessions at a time when the analytic
relationship was considered almost sacred. Friends report that on his 80th birthday, Rogers
announced that he would devote the rest of his life to working toward world peace, and to that
end traveled to the Soviet Union in 1986 and led workshops in Hungary, Brazil, and South
Africa.
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DISCUSSION STIMULATORS
1. “Medical Student's Syndrome”
Just as medical students often “diagnose” themselves as having many of the diseases they read
about in such detail, Abnormal Psychology students frequently see themselves in the
symptoms of mental illness described in this course. A study by Hardy & Calhoun (1997,
Teaching of Psychology, 24, 192-193) indicated that students who were going to major in
psychology reported more worry about their psychological well-being than did students who
were majoring in another field. This study showed, however, that after completing a course in
abnormal psychology, the same students were less concerned about the possibility that they
might have a psychological disorder.
Because of the potential to diagnose family members as well as themselves, it is important to be
sensitive in lecturing about various topics. It is good practice to give the class information
about a student counseling center or other psychological services early on in the course. Still, be
prepared during office hours to answer questions that are more personal than academic in
nature, and have referral sources available for such times.
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2.
Paradigms: Brain Teasers
One of Kuhn's important arguments is that scientists' investigations are directed by the
assumptions from which they begin. Sometimes the assumptions facilitate the discovery of
interesting phenomena; other times the assumptions stand in the way. The following
demonstrations and “brain teasers” help to illustrate the influence of one's mental set. (In
fact, Kuhn links most of scientific activity to puzzle solving.)
Brain Teaser #1
Using a slide projector, show several slides of any scene (a natural landscape, a cityscape, your
pet dog), beginning with the slide blurry and unrecognizable. (Be sure to set the projector out of
focus in advance, so the students cannot identify the picture.) Ask a volunteer from the class to
describe what he/she sees on the screen, and write the comments on the board. Have an
assistant or another student gradually bring the slide into focus as the volunteer continues to
describe the picture and you continue to write the description on the board. Several points can
be brought out through this demonstration:
The blurry picture can be likened to the state of science in the early days as we groped for
understanding, and the later recognition of the picture to the experience of scientists
discovering a new phenomenon more clearly. This experience can be compared to Kuhn's view
about how “normal science” progresses, rather than developing in a continuous, smooth
manner, our recognition of scientific phenomena often occurs by fits and starts. Similarly,
students will find themselves fumbling to understand the picture during the “pre-recognition”
phase, followed by what is usually an “aha!” experience of recognition.
In order to grasp the “true” meaning of the picture, we must start out with numerous hypotheses
but remain flexible about changing our perspective as new data becomes available. Students
who take a longer time to recognize the subject of the picture may be wedded to cognitive “sets”
established early in the exercise and not abandoned.
Brain Teaser #2
To what does the following enigma, written by Lord Byron, refer?
I'm not in earth, nor the sun, nor the
moon. You may search all the sky - I'm
not there.
In the morning and evening - though not at
noon, You may plainly perceive me, for like a
balloon
I am suspended in air.
Though disease may possess me, and sickness and
pain, I am never in sorrow nor gloom;
Though in wit and wisdom I equally reign,
I am the heart of all sin and have long lived in
vain; Yet I ne'er shall be found in the tomb.
Odds are it will take the class a long time to recognize that the answer is the letter “i”. (But ask
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students not to shout out answers right away; someone may have heard this before or be bright
enough to figure it out, and puzzling over the brain teaser increases the impact of the point
being made.) Once given the answer (and a new “set”), the following puzzle should be easily
solved:
The beginning of eternity
the end of time and
space,
The beginning of every
end, the end of every place.
The answer is “e”, of course.
Brain Teaser #3
“A boy is riding down the highway with his father and gets into a terrible accident. His father
is killed immediately and the boy is in critical condition. He is rushed to the hospital in an
ambulance, where the emergency room doctor exclaims, 'That's my son!' How can this be?”
About half the class will get the answer fairly quickly, so warn people to keep their solutions to
themselves. The solution to this puzzle not only illustrates the concept of set once again, but
also can lead to a discussion of sex roles if you choose. The answer, naturally, is that the doctor
is the boy's mother.
Brain Teaser #4
Hold a box of tacks and a candle in front of the class. Ask how these materials can be used to
fasten the candle to a wall. Students are likely to provide many ingenious answers, but most
are unlikely to be able to break their “paradigmatic set.” The key is to think of using the box
as a candle holder. The box can be fastened to the wall, and the candle can be set in the box.
These brainteaser demonstrations can serve as a lead-in to a discussion of paradigms and their
role in science. What is a paradigm? It is a set of beliefs or a model that explains something
about the world. Most importantly, it is universally accepted as being the best way to look at
and understand a specific problem. There are many characteristics of mature, paradigmatic
science. Among them is that there are no competing schools, each with a claim to the “only true
paradigm.” Another characteristic is that knowledge is accumulated and studied for its present
worth, while the historical predecessors and false starts that led to the knowledge are generally
ignored. By-products of these two characteristics of a mature science are the progressive
obscurity of specific knowledge to the layman and the increasing proliferation of scholarly
reports and papers at the expense of longer books that try to cover a topic from every angle. A
useful question for students to think about (or write about on an exam) is whether or not
psychology is a pre-paradigmatic or a paradigmatic science. The discussion of abnormal
psychology in the text would tend to indicate that the former is the case. The clash of
paradigms is very evident both in the conception and in the treatment of mental disorders.
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3.
Paradigm Shift?
A current debate in clinical psychology involves treatments referred to as the “power
therapies.” The common element among these treatments is the claim that they work very
quickly for a variety of problems. Several of these therapies and some of their claims are listed
below. Proponents of these new therapies say that mainstream psychology is stuck in an old
paradigm. Students might discuss how to evaluate these therapies and whether they represent a
radical change in psychology or something less.
EMDR: Eye Movement Desensitization and Reprocessing – proponents claim that by helping
the patient simulate rapid eye movements while discussing blocked emotional information, they
are able to better process the information, alleviating emotional distress and reducing negative
responses to emotionally traumatic experiences.
TFT: Thought Field Therapy – this treatment was formulated to treat psychological distress
by helping the patient balance the body's energy system. This is achieved through sequential
tapping on specific acupuncture points. According to proponents of TFT, by tapping on these
points according to certain “algorithms,” patients experience a reduction in panic, phobias,
addictive urges, anger and other negative emotions.
EFT: Emotional Freedom Techniques – this therapy relies on tapping “energy meridians” to
treat negative emotions, trauma and pain. Proponents of this therapy say it can be used for a
variety of problems.
BSFF: Be Set Free Fast – is another therapy that uses an algorithm focused on acupuncture
points to help relieve unresolved negative emotions and beliefs that are the cause of problems.
TAT: Tapas Acupressure Technique – proponents of this technique claim that it reduces distress
due to trauma as well as allergies. It also relies on acupressure points to relieve distress.
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4.
Personal Consequences of Paradigms
The view of behavior that a student adopts has an effect not just on the student's view of
psychology, but also on the student's view of him or herself. Do I want to think of my own
behavior as being caused by unconscious processes, by my biological makeup, by past learning
experiences, or by the way I construe the world? How can I change myself, if I can change
myself at all? Can I learn new ways of behaving, must I have my biological make-up altered if I
want to change, will change only occur after many years of analysis, or do I really need some
understanding and caring? While scientists (and students) are striving to be objective, personal
values can affect the answers we seek and those we accept; at times our values may persuade us
more than the data we find.
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5.
The Rise and Fall of Behaviorism?
The APA Monitor is a monthly publication of The American Psychological Association. The
December 1999 issue celebrates the first 100 years of psychology by looking back at significant
events of the past century. An article entitled “Behaviorism: the rise and fall of a discipline” (p.
19) makes the claim that behaviorism has lost favor in the scientific community, partially
because “behavior theories were overly simplistic and inadequate, particularly as they applied to
human beings.” The article concludes with the statement that while behavior modification has
been “fruitful” it has lost growth in the clinical area to cognitive therapies.
It is unclear that behaviorism has “fallen” as the article asserts. Students might be stimulated to
gather evidence over the course of the term to determine what is the dominant paradigm. For
example, the class might be divided into teams based on the paradigms described in the text. As
the course progresses, each team gathers evidence in support of their paradigm as a “better”
explanation for abnormal behavior. They could supplement the text with articles from
professional journals and the popular media. At the end of the term, you might consider oral
presentations, a poster session, or even a debate amongst the teams as they present the data to
support their paradigm.
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6.
Exercise in Types of Therapeutic Communication
To help students get a flavor for the actual interchange of therapy, it is helpful to give them a
chance to talk with each other in purposeful ways and observe the different effects. One method
is to conduct the following exercise using different “response modes” which are commonly used
in therapy.
For the first exercise, have students sit in a circle (or several smaller circles).
1.
Closed-ended questions. Have students go around the circle, asking the person
next to them a closed-ended question (can be yes-no, specific, or
multiple-choice). That person replies, and then asks the next person a
closed question. Continue this for a few minutes, or until everyone has
had a turn.
2.
Open-ended questions. Go around the circle again, but this time, only
open-ended questions may be asked. (Spend some time explaining what
an open-ended question is and give a few examples yourself.)
Discuss students' experiences with this exercise, including the following questions:
1.
2.
3.
4.
What differences did you observe in the types of responses generated to the two
types of questions? (Closed-ended questions usually yield briefer
answers and a narrower range of responses; open-ended questions allow
for a broader range of responses, longer answers, and usually have a
longer latency, as the responder needs more time to think.)
From the point of view of the responder, how did it feel to be asked the two
types of questions? (Most people find answering closed-ended questions
more frustrating, as they are constricted in how they are allowed to
answer.)
From the point of view of the questioner, how did it feel to ask the two types of
questions? (Most people find open-ended questions more difficult to
think of.)
In the context of therapy, which type of question would be used for what
purpose? (Closed-ended questions might be useful in assessment, where
a large amount of information needs to be collected; open-ended are
usually preferable for building rapport, encouraging the client to give his
or her own perspective, etc.)
Silence
1.
2.
“Silence is poison.” For this exercise, the group has to keep talking for 5 minutes
and avoid any silence at all costs. They should be encouraged to interrupt and
talk over each other. Afterward, briefly discuss their reactions.
“Silence is golden.” Now, have another 5-minute discussion, but this time there
must be at least 5 seconds silence between speakers (advise them not to count
out the seconds, though).
In discussing their reactions to this exercise, again consider what happens in the group and how
the individuals feel about the different types of talking. “Poison” leads to talking faster, listening
less, thinking less, and quieter students usually feel frustrated. “Golden” allows the talker more
time and thought, and also provokes more anxiety. You might spend some time talking about
how silence is used in psychotherapy.
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Reflection
While empathic reflection is one of the hallmarks of Rogerian therapy, all therapists use
reflections to some extent in order to build rapport and help the client to feel understood. For
this exercise, first review what a reflection is and demonstrate some reflective statements. Then
have students pair up. One person talks about a topic of their choice and the other person
responds using only reflections (no questions!). After five minutes, the partners switch roles.
Alternatively, you might have the students remain in a group; you make statements that a client
might make, and ask the students to take turns reflecting.
Students might be encouraged to try using reflections when talking to friends outside of class;
first warn them to pick a time when they are prepared to listen, since this way of responding
encourages people to continue talking! You could then discuss their experiences in a later class.
Interpretation
When giving an interpretation, the therapist speaks from another frame of reference, pulls in
related pieces of information, and makes connections for the client. You might pass out a case
description (or use a case in the text) and have the class come up with interpretations of the
behavior or personality described.
Advisement
Advice giving is a controversial aspect of therapy, and interesting to discuss with students. In
some forms of therapy, such as behavioral, “advice” might be common in the form of specific
suggestions for behavior change. In other forms of therapy, such as client-centered, advice
would never be given. You might try an exercise similar to that used for reflections, but this time
only advice can be given. Discuss with students what it feels like to be on the receiving end of
advice, when advisement might be appropriate, etc.
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7. Diathesis-stress model?
The book talks about the diathesis-stress model, which assumes that people are predisposed
to react adversely to environmental stressors. The diathesis may be genetic, neurobiological, or
psychological and may be caused by early-childhood experiences, genetically influenced
personality traits, or sociocultural influences, among other things.
Imagine for a second, a college student named Mary. Mary is a second semester college
freshman at a highly competitive Ivy League school. She is a pre-med student who spends a great
deal of time studying and worrying about her future. She recently did poorly on a series of
important exams. Following these perceived failures, she began to display signs of depression
including, depressed mood, lack of interest in previously enjoyed activities, increased sleep,
weight gain, and thoughts about death. She visits the college counseling center and is diagnosed
with Major Depressive Disorder.
There are many things that may have contributed to Mary’s depression. Let’s think about these
things for a moment.
 Did Mary seek out the stressful situations that triggered her onset of depression?
 What genetic or neurobiological aspects might have been at play?
 What type of early-childhood experiences might predispose a person to
depression?
 What personality traits might put a person at risk for developing depression?
 What social and cultural influences might contribute to depression?
 What do you think contributed to her depression?
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8.
Using Therapy Tapes in Class
The film listed below, Three Approaches to Psychotherapy, includes an interview by Rogers.
The material described above, on different modes of therapeutic communication, can be applied
quite fruitfully to the showing of this film in class. Before showing the film, write the five types
of responses (questions, silence, reflections, interpretations, and advisement) on the board and
ask each student to make headings for each type of response mode on a piece of paper. During
the showing of the film, have the class keep a record of the number of times each response mode
is used. For example, whenever Rogers responds with a reflection, students should make a mark
under the Reflections column. You might limit this exercise to the first five minutes of the
interview. Discussion of the film can then focus on observing the predominant response modes
used by the therapist, theoretical reasons for his choice of response mode, and the impact of the
therapist's responses on the client. Differences between therapists depicted in the tapes will
become quite dramatic as their “scores” are compared.
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INSTRUCTIONAL FILMS
(A list of film distributors can be found at the end of this manual.)
1. Advancements in Neurology and Neurosurgery (FHS, 22 min., color, #BVL6420) “This
program looks at two closely related medical specialties: neurology and
neurosurgery. Dr. Mitchell Brin, co-director of the Movement Disorders Center at
Mt. Sinai Medical Center, explains current knowledge on the role of drug therapy in
treating such diseases as Parkinson's and multiple sclerosis. Dr. Takanori
Fukushima, director of the Skull Base Surgery Center at Allegheny General
Hospital, explains and performs a sophisticated neurosurgical procedure. In both
instances, the doctors explain how these new surgical techniques and drug therapies
are making dramatic improvements in the lives of patients.”
2. Mysteries of the Mind (FHS, 58 min., color, #BVL2029)
“This program explores manic-depression, obsessive-compulsive disorder,
alcoholism, and other mood disorders whose victims show a lack of control over
their behavior. It examines the neurochemical and genetic components of these
disorders, as well as physiological, neurological, and biomedical research into the
mysteries of the brain. The program shows the nature of these mood disorders and
the pain they cause patients and their families.”
3. The Otto Series (IU Media Resources, 25-27 min., color, 1975, #SO1352)
A series of five films that begins with an open-ended dramatization of abnormality
in a middle-aged man, then offers four perspectives for understanding and
treatment: behavioral, phenomenological, psychodynamic, and social.
4. Freud Under Analysis (PBS, Nova Series 14, 58 min, color, video [1/2" VHS], 1987)
This film traces the development of Freud's major ideas, including therapeutic
techniques of psychoanalysis, the unconscious, and the importance of childhood
experience in the psychological development of the adult. The filmmakers consider
whether Freud's legacy of psychoanalysis is scientific or cultural.
5. Sigmund Freud: His Office and Home, Vienna, 1938 (Filmaker's Library, 17 min.,
color) This film shows the birthplace of psychoanalysis with Freud's study and
collection of antiquities photographed shortly before he fled the Nazis. The film
would be useful in a history of psychology class or any class dealing with Freud
and his ideas.
6. Carl Gustav Jung: An Introduction (FHS, 60 min., color, #BVL3034)
“Using Jung's memories as a guideline, this essay-biography explores both his
exterior and his interior life. The program shows where he grew up, lived, and
worked, and visualizations of his dreams and fantasies (including the famous phallus
dream); analyzes the importance of his discoveries and the significance of his break
with Freud; and broadly introduces the revolution Jung created and the questions he
posed.”
7. Dr. Carl Rogers: Part I and Part II (PSPB, 50 min. ea., #40234 and #50314)
Part I: Dr. Rogers discusses motivation, perception, learning, the self, and his
development of client-centered psychotherapy. The film explains his
reaction to encounter groups, pointing out their strengths and weaknesses.
Part II: Dr. Rogers discusses the contemporary American educational system,
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student unrest on college campuses, important issues facing contemporary
psychology, and his most important contributions.
8. Professor Erik Erickson: Part 1 and Part 2 (PSPB, 50 min. ea., #50012 and
#50013) Erikson discusses his involvement with psychoanalysis and the
development of his theories.
9. Everybody Rides the Carousel (Pyramid Media, 72 min., color, 1976)
Based on the writings of psychoanalyst Erik Erikson, this animated film invites the
viewer along on eight rides through the different stages of life. The film reflects the
inner feelings and conflicting emotions experienced during each stage of personality
development.
10. Classical and Operant Conditioning (FHS, 55 min., #BVL6541)
“This program explains the nature of Behaviorism, so central to the study of human
behavior, and its important applications in clinical therapy, education, and childrearing. The program clearly explains, discusses, and illustrates the complex
Classical and Operant conditioning theories of Pavlov and Skinner, and features
archival footage of laboratory work with dogs and present-day research using rats in
Skinner boxes, as well as numerous examples of conditioning in everyday life.”
11. B.F. Skinner and Behavior Change (Research Press, 44 min., color, 1975, #1510)
In this video, professionals from various disciplines join Dr. B.F. Skinner in
addressing the issues and controversies generated by behavioral psychology. Fred
Keller, C.B. Ferster, Sidney Bijou, Joseph Cautela and others discuss questions,
concerns, and contributions of behavioral theory and intervention. The video
shows on-site interventions with patients, clients, and students in a variety of
settings.
12. Dr. B. F. Skinner: Part I and Part II (PSPB, 50 min. ea., #50018 and #50019)
Part I: Dr. Skinner evaluates Freudian theory and discusses his views on
motivation, operant conditioning, schedules of reinforcement,
punishment, and teaching machines.
Part II: Dr. Skinner discusses his novel, Walden Two, illustrating the problems
of creating a society based on positive rather than negative control.
Skinner evaluates the American educational system and describes the
application of operant conditioning to society at large.
13. Three Approaches to Psychotherapy, I, II, and III (PEF)
Wonderful series of with the major theorists (Rogers, Perls, Ellis, etc.)
demonstrating their theories with actual clients.
14. The Wisdom of the Dream: The World of C.G. Jung Series (PSPB, 60 min., #01174)
This film follows Jung's life from his childhood, through his years as a hospital
psychiatrist, to the initial influence of Freud, to their disagreement and split.
Former pupils speak of Jung's impact on their lives.