PSYCH ∙ Ms. Wiley ∙ Forms of Therapy & Case Studies, D___
Name:
Information from the Counselling Directory: Psychological therapies generally fall into four categories. These are behavioral
therapies, which focus on behaviors, psychoanalytical therapies, which focus on the unconscious relationship patterns that evolved
from childhood, humanistic therapies, which focus on self-development in the 'here and now,' and art therapies, which use creative
arts within the therapeutic process. Psychological counselling usually overlaps some of these techniques. Some counsellors practice
a form of 'integrative' therapy, which means they draw on and blend specific types of techniques. Below is a breakdown of some of
the different psychological therapies available:
I.
Behavioral Therapies:
Behavioral therapies are based on the way you behave. These therapies recognize that it is possible to change, or recondition, our
thoughts or behavior to overcome specific problems. As its name suggests, behavioral therapy is focused on human behavior and
looks to eradicate unwanted or maladaptive behavior. Examples of this include addictions, anxiety, phobias and obsessivecompulsive disorder (OCD). Practitioners of behavioral therapy believe that behavior is learned and can therefore be un-learned via
therapy. As well as the behavior itself, behavioral therapists will look at thoughts and feelings that lead to the behavior or occur as a
result of the behavior to understand it on a deeper level. Behavioral therapy is an action-based therapy that looks to foster positive
behavior change. Other therapies such as psychoanalytic therapy tend to be more focused on insight and delving into the past. In
behavioral therapy, the past is still important as it often reveals where and when the unwanted behavior was learned, however it
looks more so at present behavior and ways in which it can be rectified. The premise behind behavioral therapy is that behavior can
be both learned and un-learned. The goal is to help the individual learn new, positive behaviors which will minimize or eliminate the
issue. There are two key principles that form the foundations of behavioral therapy - classical conditioning and operant conditioning.
A. Classical Conditioning Examples:
Flooding is a process generally used for those with phobias and anxiety and involves exposing the individual to objects/situations
they are afraid of in an intense and fast manner. An example of this would be exposing a person who is afraid of dogs to a dog for an
extended period of time. The longer this continues with nothing bad happening, the less fearful the person becomes. The idea is that
the person cannot escape the object/situation during the process and therefore must confront their fear head on. Obviously this
method can be disconcerting and may only be suitable for certain situations.
Systematic desensitization works on a similar premise to flooding, however it is more gradual. The therapist would begin by asking
the individual to write a list of fears they have. Once this list is written, the therapist will teach relaxation techniques for the
individual to use while thinking about the list of fears. Working their way up from the least fear-inducing item to the most fearinducing item, the therapist will help the individual confront their fears in a relaxed state. An example of this would be a person who
is afraid of small spaces. They may start by thinking about a small space or looking at an image of a small space while utilizing
relaxation techniques, and work their way up to being in a small space. This pairing of the fear-inducing item and newly learned
relaxation behavior aims to eliminate the phobia or anxiety.
Aversion therapy pairs undesirable behavior with some form of aversive stimulus with the aim of reducing unwanted behavior. An
example of how this is commonly used is when an alcoholic is prescribed a certain drug that induces nausea, anxiety and headaches
when combined with alcohol. This means every time the person drinks, they get negative side effects. This hopes to put off that
person from drinking to help them overcome their addiction.
B.
Operant Conditioning Examples:
Operant conditioning uses techniques such as positive reinforcement, punishment and modelling to help alter behavior. The
following strategies may be used within this type of therapy:
Token economies relies on positive reinforcement - offering individuals 'tokens' that can be exchanged for privileges or desired items
when positive behavior is exhibited. This is a common tactic used by parents and teachers to help improve the behavior of children.
Contingency management is a more formal approach, involving a written contract between the therapist and individual that outlines
goals, rewards and penalties. For some, having this kind of clear agreement helps to change behavior and add a sense of
accountability.
Modelling involves learning through observation and imitation of others. Having a positive role model can give individuals something
to aim for, allowing them to change their behavior to match their role models. This role model may be the therapist or someone the
individual already knows.
Extinction works by removing any type of reinforcement to behavior. An example of this would be a disruptive child who is given a
time-out or told to sit on the 'naughty step'. By removing them from the situation (and associated attention) the behavior should
stop. This premise can be carried across to adults too - however the 'naughty step' will probably be given a different name.
Explain behavioral therapy in your own words:
How effective do you suspect this treatment is? Why?
II.
Psychoanalytical Therapies:
Psychoanalytical therapies are based on an individual's unconscious thoughts and perceptions that have developed throughout their
childhood, and how these affect their current behavior and thoughts.
Psychoanalysis is a therapeutic process that focuses on an individual's unconscious and deep-rooted thoughts. It takes the view that
our current behavior, thoughts and feelings are directly influenced by our childhood and past experiences. Over time these can
become repressed and may manifest themselves as depression or other negative symptoms. Developed by leading psychotherapist,
Sigmund Freud, psychoanalysis therapy is widely used to help clients recognize and understand how unconscious factors affect their
current relationships and patterns of behavior. Through techniques such as free association and dream analysis, clients can learn
how to interpret deeply buried and complex memories or experiences that may be causing them distress and preventing them from
living life to the fullest. Treatment is designed to bring the repressed conflict into consciousness, so a client can make the necessary
changes to overcome them. Generally, psychoanalysis therapy is a long-term, intensive treatment that involves considerable
commitment from both patient and therapist. Clients are usually required to attend regular sessions for several years - depending on
their individual needs and personal circumstances. Regular sessions allow for in-depth exploration and interpretation of these
unconscious patterns.
A range of techniques will be employed in psychoanalysis to enable the client and therapist to interpret and make sense of deeply
buried memories and experiences that are expressed during therapy. Although free association - the client speaking freely about any
subject or topic they feel comfortable with - tends to preside over others, all are significant in fostering the change and personal
development that characterizes psychoanalysis therapy. Freud believed that all people learn through myths, jokes, fairytales, poems
and linguistic languages - symbols which are also used in our dreams. In psychoanalysis, dream analysis involves the interpretation of
these symbols to understand the unconscious mind and indicate any areas of trouble that need to be investigated. The client is
required to recall the dreams that are recurring and/or traumatic so that the therapist can hone in on specific areas (symbols) of
concern. This technique is based on Freud's assertion that our dreams are a disguised fulfillment of a wish, and that the disguise is
caused by repression (latent thoughts that stem from past experiences). It is revolutionary in the sense that it goes beyond simply
analyzing the manifest content of the dream. Although Freud did not explore the cross-cultural differences in the significance of
dreams, therapists using this method will generally be flexible in their interpretation.
Other methods include word association and projective tests. Word association involves the therapist giving a stimulus word, to
which the client must reply with the very first thing that comes into their head. This enables unconscious thoughts to enter the
conscious in preparation for further investigation later on in the therapy. During a projective test, psychoanalysts will present clients
with a series of abstract images, and will invite them to explain what they see, or create a story based on the images. Freud believed
this technique allows the unconscious to become conscious - helping clients to unlock their inner thoughts and desires. A common
projective test used in psychoanalysis today is the blot test. Invented by Hermann Rorschach in 1928 this involves ten speciallydesigned ink blot images.
Explain psychoanalytic therapy in your own words:
How effective do you suspect this treatment is? Why?
III.
Humanistic Therapies:
Humanistic therapies focus on self-development, growth and responsibilities. They seek to help individuals recognize their strengths,
creativity and choice in the ‘here and now’.
A. Person-centered therapy:
Person-centered therapy - also known as person-centered counselling or client-centered counselling - is a humanistic approach that
deals with the ways in which individuals perceive themselves consciously rather than how a counsellor can interpret their
unconscious thoughts or ideas. Created in the 1950s by American psychologist, Carl Rogers, the person-centered approach
ultimately sees human beings as having an innate tendency to develop towards their full potential. However, this ability can become
blocked or distorted by our life experiences - particularly those that affect our sense of value. A variety of factors can affect an
individual's ability to flourish, including low self-esteem, a lack of self-reliance and very little openness to new experiences.
The counsellor or psychotherapist in this approach works to understand an individual's experience from their point of view. The
counsellor must positively value the client as a person in all aspects of their humanity, while aiming to be open and genuine as
another human being. This is vital to helping an individual feel accepted and better understand their own feelings - essentially
helping them to reconnect with their inner values and sense of self-worth. This reconnection with their inner resources enables
them to find their own way to move forward.
The core purpose of the person-centered approach is help a client self-actualize - facilitate the personal growth and relationships of
an individual by allowing them to explore and utilize their own strengths and personal identity. A person-centered counsellor will aid
this process and will provide vital support to help their client's overcome the problems that are thwarting their personal
development and progress. Other related changes that can be cultivated from this therapy include closer agreement between an
individual's idealized and actual selves, better self-understanding and awareness, decreased negative emotions such as
defensiveness, insecurity and guilt, greater ability to trust oneself, healthier relationships, and improvement in self-expression.
Person-centered therapy aims to help individuals unravel and explore the difficult facets of their experience that are challenging to
their self-concept. Self-concept refers to the organized and consistent set of beliefs and perceptions an individual has about him or
herself. These form a core component of a person's total experience and influence their perception of the world. Person-centered
counselling recognizes that a person's self-concept can become displaced if they strive too hard to fit in and be accepted by those
around them.
Typically, individuals cope with any conditional acceptance offered to them by gradually and unconsciously incorporating these
conditions into their own self-image. This can lead to the development of a self-concept that consists of characterized ideas such as
'I am the sort of person who always respects others'. Because human beings generally desire positive regard from others, it is often
easier for individuals to 'be' this accepted, simplified type of person. To be anything else, or different could see them risk losing that
positive regard.
Over time, a person's identity - their personal judgments, meanings and experiences - can become displaced with the ideals of
others. It is for this reason that person-centered counselling aims to help individuals to self-actualize and achieve personal growth.
This is cultivated through the provision of a supportive environment where clients can strengthen and expand on their own identity
and begin to separate themselves from their developed notions of how they should be.
The approach has been found particularly useful in helping individuals to overcome specific problems such as depression, anxiety,
personality disorders, eating disorders and alcohol addictions. These issues can have significant impact on self-esteem, self-reliance
and self-awareness, but person-centered therapy can help individuals to reconnect with their inner self in order to transcend any
limitations.
B.
Mindfulness Therapy:
Multitasking and juggling commitments has become commonplace, with many people feeling as if they aren't truly present in their
own lives. Mindfulness aims to reconnect us with ourselves to alleviate stress. It also helps us to feel more attuned with our
emotions and generally more aware of ourselves both mentally and physically. Mindfulness is a specific way of paying attention to
what is happening in our lives in the present moment, as it truly is. Of course it won't eliminate life's pressures - but with practice it
can help us take notice of (and hopefully stop) negative, habitual reactions to everyday stress.
The most common way this technique is practiced is through mindfulness meditation. Some people struggle with mindfulness
meditation at first, finding it hard to focus their attention, but this is to be expected and may require practice. Practicing the
technique regularly can help people take a step back, acknowledge their 'brain chatter' and view it accurately and without judgment.
Other forms of mindfulness practice may involve physical movement. Exercises such as yoga and Tai Chi both involve meditative
movements that can help improve physical self-awareness and quiet the mind.
In small doses, stress helps us rise to challenges and pushes us to act. In the long-term however, too much stress can be detrimental
to our well-being as these feelings begin to internalize and eat away at us. Symptoms of stress include loss of appetite, insomnia,
anger, anxiety and even chest pains. Research has shown that people who are under prolonged stress are at a greater risk of
developing health problems such as high blood pressure and heart attacks. Mindfulness looks to help people cope with stress using
techniques such as gentle stretching, mindfulness meditation and other mind-body exercises. The aim is to offer a greater clarity on
what is happening, to help people recognize stress triggers and deal with them in a productive manner. According to the Mental
Health Foundation, the majority of those who take part in mindfulness courses are reported to feel more engaged in work, less
anxious and have fewer physical symptoms of stress.
The concept behind mindfulness originated in the Buddhist religion, where it was considered to be of 'great importance' in the path
of enlightenment. Rather than believing in a personal God, Buddhists follow the teachings of Siddhartha Gautama (known as 'The
Buddha', or the 'enlightened one'), with the goal of reaching a state of nirvana/enlightenment. The practice and development of
morality, meditation and wisdom are thought by Buddhists to lead to the path of enlightenment. The Buddha himself advocated
mindfulness and encouraged his followers to establish mindfulness in day-to-day life, maintaining a calm awareness of one's mind
and body.
Since the concept of mindfulness arrived in the west, the claimed benefits have been substantiated by several clinical studies. The
aim of mindfulness is to help individuals do the following:
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see situations with more clarity
respond more effectively to situations
enhance creativity
feel more balanced at work and at home.
According to the Mental Health Foundation, studies looking at the effectiveness of mindfulness have reported the following
benefits:
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70% reduction in anxiety
fewer visits to the doctors
increase in disease-fighting antibodies
better quality of sleep
fewer negative feelings, including tension, anger and depression
improvements in physical health.
Further studies into the role of mindfulness in the workplace are showing that it could improve productivity, decrease sickness
absence and generally improve workplace well-being.
Explain humanistic therapies in your own words:
How effective do you suspect this treatment is? Why?
IV.
Art Therapy:
Art therapy is a type of psychotherapy that utilizes art and artistic mediums to help people explore their thoughts and emotions in a
unique way. The idea behind this type of therapy is to use art as a primary means of communication, something that can be useful
for those who find it difficult to verbalize their feelings. Being practical and using physical objects, such as paintbrushes and paper,
often helps people to feel more connected to the world around them. As well as helping those with mental health issues, art therapy
can be beneficial to a wide range of people including young children, the elderly and those in the justice system. Experience or skill
in art is not required, as your work will not be criticized - it is more about the emotions expressed and felt throughout the process.
Offering an opportunity for creativity and expression, this type of therapy helps to communicate emotions that may otherwise be
difficult to verbalize.
Below is a list of individuals who many benefit from art therapy:
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Those with mental health problems – Art therapy is recommended by the National Institute for Health and Care Excellence
(NICE) as a treatment for schizophrenia and related conditions.
Those with learning difficulties – Art as therapy can be helpful to those who may not be able to verbalize what they feel clearly.
Those on the autistic spectrum – Art therapy can help to improve communication skills and offers an easy way for participants
to express themselves.
Those in the justice system – Art therapists often work in prisons to help offenders deal with their feelings in a healthy way.
Those with dementia – Tapping into the creative part of the brain helps to lower stress levels and restore a sense of personal
identity.
Those with a chronic/terminal illness – This type of therapy can help patients regain a sense of control, freedom and selfexpression.
Anyone who finds it difficult to talk about their feelings or feels distanced from their emotions.
Explain art therapy in your own words:
How effective do you suspect this treatment is? Why?
CASE STUDIES & RECOMMENDED TREATMENT
Instructions: Read through each study and decide what psychological disorder, if any, the individual has. Revisit ‘Psychological
Disorders Assignment’ chart for information about each disorder and feel free to ask the classmate that presented on the topic for
further information. Then describe a course of therapy that would be most effective for that patient. Be specific! Most
recommendations should include a blend of therapy approaches.
1.
Morris has been referred to you for psychotherapy following a suicide attempt. When you interview him he is very teary. He
speaks slowly and looks down at the ground as he speaks. He reports difficulty in falling asleep and staying asleep for the past
month. Morris states that he hasn't had much of an appetite and has lost 15 pounds. He reports that things he used to like just
don't seem enjoyable anymore, and he thinks that life is not worth living. Morris doesn't expect things to improve in the future,
which is why he tried to kill himself.
Disorder: ______________________________
Therapy recommendation:
2.
A 26 year old man is very concerned about cleanliness and hygiene. He spends a significant amount of time each day washing
his hands or showering, especially after touching a toilet seat, doorknob, or any other item he thinks may be dirty or
contaminated. The patient explains that he is concerned about becoming infected or sick from touching these objects. He
periodically acknowledges that the washing is excessive but explains that he becomes very anxious when he tries to avoid
washing and eventually feels compelled to wash even more to make up for the omission.
Disorder: ______________________________
Therapy recommendation:
3.
A 28-year-old woman is a rising junior executive in her investment company. Her increasing duties require her to make periodic
formal presentations to the senior management of the company. However, she becomes intensely anxious at the thought of
speaking in public. When she is forced to give a presentation she begins to feel anxious days in advance of the talk and the
anxiety increases as the time for the talk approaches. She is concerned that her anxiety will become noticeable during the talk
or that she will do something to embarrass herself.
Disorder: ______________________________
Therapy recommendation:
4.
A 36-year-old man and his young son were driving through an intersection when another car ran through a red traffic light and
struck them. The two were trapped in the car until a fire department rescue team freed them. The patient was bruised but not
seriously hurt. His son had a broken leg. The first few days after the accident the patient was preoccupied with arranging care
for his son and getting the car repaired. A few days later he began having recurrent distressing thoughts and images of the
accident. The memory of his son’s screams after the car was struck seemed particularly vivid. The patient became irritable, had
difficulty concentrating, and avoided talking about the accident. He went out of his way to avoid driving down the street where
the accident occurred. These symptoms lasted for several years.
Disorder: ______________________________
Therapy recommendation:
5.
Jack graduated from high school and got a job working in a video store. After working for about 6 months Jack began to hear
voices that told him he was no good. He also began to believe that his boss was planting small video cameras in the returned
tapes to catch him making mistakes. Jack became increasingly agitated at work, particularly during busy times, and began
"talking strangely" to customers. For example one customer asked for a tape to be reserved and Jack indicated that that tape
may not be available because it had "surveillance photos of him that were being reviewed by the CIA". After about a year Jack
quit his job one night, yelling at his boss that he couldn't take the constant abuse of being watched by all the TV screens in the
store and even in his own home.
Disorder: ______________________________
Therapy recommendation:
6.
Create a case study and recommended treatment for one of the disorders learned about during the presentations that was NOT
highlighted in the first five examples: