The Treatment of Psychological Disorders
• modern psychotherapy originated in
systematic treatment (psychoanalysis)
developed by Sigmund Freud
• now, three main categories of treatment:
– insight therapies
– behavior therapies
– biomedical therapies
• therapeutic triad: therapist, treatment, client
• 15% of U.S. population annually uses mental
health services
• why? anxiety, depression, interpersonal
relations, bad habits, poor self control, low
self esteem, marital conflict, self doubt,
emptiness, stagnation
• most common: anxiety and depression
• PROVIDERS:
• friends, relatives, clergy: may help, but their
advice does not qualify as therapy
– requires professional treatment by someone with
special training
• psychologists: clinical and counseling
• psychiatrists: physicians who specialize in the
diagnosis and treatment of psychological
disorders
• other mental health professionals: clinical
social workers, psychiatric nurses, counselors
• INSIGHT THERAPIES: involve verbal
interactions intended to enhance client’s selfknowledge and thus promote healthful
changes in personality and behavior
• psychoanalysis: an insight therapy developed
by Freud that emphasized the recovery of
unconscious conflicts, motives and defenses
through techniques such as free association,
dream analysis and transference
• Freud: neurotic problems are caused by
unconscious conflicts left over from early
childhood
– battles among id, ego and superego, usually over
sexual and/or aggressive impulses
– people depend on defense mechanisms to avoid
confronting these conflicts, but this leads to selfdefeating behavior and only partially successful in
alleviating anxiety, guilt, and other distressing
emotions
• Freud’s therapeutic procedures: probe the unconsciousness,
analyst as detective, using several techniques
• (1) free association: client spontaneously expresses thoughts
and feelings exactly as they occur, with minimal censorship
• (2) dream analysis: therapist interprets symbolic meaning of
client’s dreams
• (3) interpretation: therapist attempts to explain the inner
significance of clients’ thoughts, memories and behaviors
• (4)resistance: largely unconscious defensive maneuvers
intended to hinder the progress of therapy
• (5) transference: client unconsciously starts relating to
therapist in ways that mimic critical relationships in the
client’s life
• MODERN PSYCODYNAMIC THERAPIES
• adaptations of classical psychoanalysis
• interpretation, resistance and transference
continue to play key roles
• CLIENT-CENTERED THERAPY: insight therapy
that emphasizes providing a supportive
emotional climate for client, who plays a
major role in determining the pace and
direction of their own therapy
• therapeutic climate: the process of therapy is
les important than the climate
– warm, supportive, accepting, safe
– lack of threat reduces defensive tendencies
• 3 conditions:
– genuineness (by therapist)
– unconditional positive regard
– empathy
• therapeutic process: client and therapist work
together as equals
– therapist provides little guidance, minimal
interpretation and guidance
– therapist’s key task: provide feedback and
clarification
– highlight themes in rambling client discourse
– like psychotherapy, seeks a major restructuring of
client’s personality
• positive psychology-inspired therapies
• positive psychology: uses theory and research
to better understand the positive, adaptive,
creative, and fulfilling aspects of human
existence
– critical of psychology’s traditional focus on
pathology, weakness, suffering
– emphasize health and resilience, contentment,
well-being, human strength, positive emotions
• well-being therapy: enhance client’s selfacceptance, purpose, autonomy, personal
growth
– success in treatment of mood and anxiety
disorders
• positive psychotherapy: in treatment of
depression, recognize strengths, appreciate
blessings, emphasize positive experiences,
forgiveness, finding meaning in life
• group therapy: simultaneous treatment of several
clients in a group
– 4 to 12 participants
– screened by therapist
– participants function essentially as therapists for each
other
– describe problems, discus coping strategies
– provide acceptance and emotional support
– therapist promotes group cohesiveness, sets goals,
models support, protects clients from harm
– advantages: more affordable, clients learn their
problems are not unique, practice social skills in safe
environment
• Efficacy of Insight Therapies
• spontaneous remission: recovery from a
disorder without formal treatment
• efficacy depends on goals
• outcomes studies demonstrate that insight
therapy is superior to no therapy, and that
effects are reasonably durable
• roughly equal in efficacy to drug therapies
• mechanism of action of insight therapies:
– develop a therapeutic alliance with the
professional helper
– emotional support, empathetic understanding
– cultivation of hope and positive expectations
– provide a rationale for problems and a method for
reducing them
– opportunity to express feelings, confront
problems, gain insight, learn new patterns of
behavior
• BEHAVIOR THERAPIES
• no attempt to achieve grand insight
– considered unnecessary to produce constructive
change
– single goal: eliminate maladaptive behavior
• insight therapists treat pathological symptoms
as signs of underlying problems, while
behavioral therapists assume that the
symptoms are the problem
• behavior therapies: involve the application of
learning principles to direct efforts to change
clients’ maladaptive behaviors
• assumptions:
– behavior is a product of learning
– what has been learned can be unlearned through
• classical conditioning
• operant conditioning
• observational learning
• Systematic Desensitization: reduce phobic
clients’ anxiety responses through
counterconditioning
– assume that most anxiety responses are acquired
through classical conditioning
– goal: weaken the association between the
conditioned stimulus and the conditioned response
• counterconditioning: reverse the process of
classical conditioning by pairing the stimulus
with a new conditioned response
• 3 steps:
– build an anxiety hierarchy
• list and then rank anxiety-arousing stimuli
• train in deep muscle relaxation
• work through hierarchy (least to most) while remaining
relaxed
– underlying principle: anxiety and relaxation are
incompatible responses
• aversion therapy: a behavior therapy in which
an aversive stimulus is paired with a stimulus
that elicits an undesirable response
– most controversial
– not widely used, only as a last resort, and usually
combined with a larger treatment program
– substance abuse, sexual deviance, gambling,
shoplifting, stuttering, smoking, overeating
• social skills training: a behavior therapy designed
to improve interpersonal skills that emphasizes
modeling, behavioral rehearsal, and shaping
– used in treatment of autism, ADD, schizophrenia
– based on principles of operant conditioning and
observational learning
– modeling: watch socially skilled people, acquire their
skills
– behavioral rehearsal: practice techniques in
structured role play
– shaping: gradually handle more complicated, delicate
situations
• cognitive therapy: use specific strategies to
correct habitual thinking errors that underlie
various types of disorders
• goal: change client’s negative thoughts and
maladaptive beliefs
• Cognitive Behavioral Treatments:
• use varied combinations of verbal interactions
and behavior modification techniques to help
clients change maladaptive patterns of
thinking
Biomedical Therapies
• physiological interventions intended to reduce
symptoms associated with psychological
disorders
• treatment with drugs
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antianxiety
antipsychotic
antidepressant
mood stabilizers
ECT
brain stimulation
• antianxiety drugs: relieve tension,
apprehension and nervousness
• antipsychotic drugs: used to gradually reduce
psychotic symptoms, including hyperactivity,
mental confusion, hallucinations, delusions
• antidepressant drugs: gradually elevate mood
and help bring people out of a depression
• mood stabilizing drugs: used to control mood
swings in patients with bipolar mood
disorders
• electroconvulsive therapy (ECT): a biomedical
treatment in which electric shock is used to
produce a cortical seizure accompanied by
convulsions
• brain stimulation:
– transcranial magnetic stimulation (TMS): a technique
that permits scientists to temporarily enhance or
depress activity in a specific area of the brain
– deep brain stimulation (DBS): a thin electrode is
surgically implanted in the brain, connected to an
implanted pulse generator, so that various electrical
currents can be delivered to brain tissue adjacent to
the electrode
Current trends and issues in treatment
• transition from fee-for-service to managed
care
• blended therapy: integrate various
approaches
current trends, cont.
• cultural diversity
• institutionalization
• variety of therapeutic services