Therapies for
Psychological Disorders
Chapter 13
AP Psychology
Juarez Community Academy
Ms. Drew
Vocab Quiz on Friday!
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Active listening
Token economy
Placebo effect
Lobotomy
Lithium
Psychopharmacol
ogy
Double-blind
procedure
Xanax
Free Association
Stress inoculation
training
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Evidence based
practice
Regression
toward the mean
Meta-analysis
Cognitive therapy
Behavior therapy
Systematic
desensitization
Cognitivebehavioral
therapy
Client-centered
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therapy
Exposure therapy
Aversive therapy
Psychoanalysis
Preventive mental
health
Biomedical
therapy
Counterconditioni
ng
Insight therapy
What are Therapists
Therapists are trained
professionals who
know the art of
establishing a helping
relationship and know
how to apply the
knowledge of
psychology to an
individual struggling
with problems and
choices.
Therapy
We often hear that
someone was in
therapy, but what is
therapy?
There are many
stereotypes about
therapy, like the
picture of a bearded
therapist taking
notes while a patient
lies on a couch and
spills his or her guts.
This is a very
Freudian image.
Therapy
Therapy is a term used for any treatment
process; in psychology and psychiatry,
therapy refers to a variety of techniques used
to deal with mental disorders or cope with
problems of living.
There are endless reasons why people go to
see a therapist or counselor including making
difficult decisions, dealing with academic
problems, coping with the loss of a loved one,
or dealing with an unhappy relationship.
Therapy
There are a variety of techniques and
methods therapists and counselors use,
but all center on developing a strong,
supportive relationship with the patient.
Another similarity amongst all therapy
techniques is their end goal of changing a
person’s functioning in some way.
Components of Therapy
In addition to developing a strong
relationship between client/patient and
counselor, the therapeutic process generally
involves some or all of the following
processes:
1. Identifying the problem
2. Identifying the cause of the problem or the
current conditions that maintain the
problem
3. Deciding on and carrying out some form of
treatment
7 Main Types of Professional Help
Professional
Title
Specialty and common work setting
Credential and
qualifications
Counseling
Psychologist
Provides help in dealing with the common
problems of normal living-relationships, child
rearing, school problems. Typically counselors in
schools clinics or other institutions
Depends on the state;
minimum master’s in
counseling, but most
commonly a PhD
Clinical
Psychologist
Trained primarily to work with those who have
more severe disorders, but may also work with
clients having less severe problems. Usually
private practice
Usually required to hold a
PhD and state certificate
Psychiatrist
A specialty of medicine; deals with sever mental
problems-most often prescribes drugs. May be
private practice or employed by clinics and
mental hospitals
MD; licensed by medical
board
Psychoanalyst
Practitioners of Freudian therapy. Usually in
private practice
MD
Psychiatric Nurse
Practitioner
A nursing specialty; licensed to prescribe drugs
for mental disorders. May work in private practice
or in clinics and hospitals
Requires RN credential plus
specialty training
Clinical or
Psychiatric Social
Worker
Social workers with a specialty in dealing with
mental disorders, especially from the viewpoint of
social and environmental contexts
MSW-Masters of Social Work
Pastoral
A member of a religious order or ministry who
Varies
Current Movements
The world of psychology is constantly
changing. One of the current movements is
clinical psychologists who are seeking to
obtain the privilege to give prescriptions to
clients.
New Mexico became the first state to allow
this, putting psychologists through a rigorous
program, including 850 hours of of course
work and a supervised internship.
Not surprisingly this is hotly contested in the
medical profession.
History of Therapy
Much like the history of psychology
itself and psychological disorders,
therapy has had its fair share of
misguided theories.
In medieval Europe, people often
thought mental disorders were the work
of the devil and other demons. The job
the therapists was to perform
exorcisms.
Bedlam and its Origins
One of the most well known asylums
was that of Bethlehem Hospital in
London. On the weekend, a person
could pay a few pence to go sightseeing
and watch the inmates who often put
on a noisy and wild show. As a result,
“Bedlam,” the shortened term
Londoners used for Bethlehem, became
a word used to describe any noisy,
chaotic place (Zimbardo et al.)
Medieval Asylums
In the medieval asylums, patients, at most
only custodial care; at worst, they were
neglected and put in cruel restraints such
as cages and straightjackets.
Some received other forms of torture like
beatings and cold showers.
Modern Approaches to
Therapy
There are two main modern approaches:
Psychological therapies
(psychotherapy) focus on changing
disordered thoughts, feelings and behaviors
using psychological techniques. They come in
two main forms:
 Insight therapy: focuses on helping people understand their
problems and change their thoughts, motives or feelings.
 Behavior therapy: focuses primarily on changing behavior.
Modern Approaches to Therapy
Biomedical therapies focus on treating
mental problems by changing the
underlying biology of the brain. To do so,
a physician or nurse practitioner can use a
variety of drugs, including
antidepressants, tranquilizers and
stimulants.
Disorders and Therapies are
Cultural
The way a disorder is treated relies on the way it is
viewed. The way it is viewed is heavily dependent on
the culture is is being treated in.
Individualistic Western views generally regard
psychological disorders to be a result of disease
process, abnormal genetics, disordered thinking,
unhealthy environments or stressors.
Collectivist cultures often think of mental disorders
as a disconnect between the person and the group.
In such cultures, treating mentally disturbed people
by removing them from society is unthinkable.
How do Psychologists Treat
Disorders?
Treatment of disorders falls into one of
the two categories we just discussed.
Insight therapies were the first truly
psychological treatments used. In recent
years, behavioral therapies have also
become common and effective.
Insight Therapies
Insight therapies attempt to change
people on the inside-changing the way
they think and feel. These are sometimes
called think therapies. These therapies
share the assumption that distressed
persons need to develop an understanding
of the disordered thoughts, emotions and
motives that underline their mental
difficulties.
Freudian Psychoanalysis
In the classical Freudian view, psychological
problems arise from tension in the
unconscious mind by forbidden impulses and
threatening memories.
Psychoanalysis, therefore, probes the
unconscious in an attempt to bring these
issues into the “light of day” or into
consciousness. The major goal of
psychoanalysis, then, is to reveal and
interpret the contents of the unconscious
mind.
Psychoanalysis
In the final stages of psychoanalysis,
patients learn how their relationship
with the therapist mirrors the
unresolved issues they have with their
parents. This is referred to as analysis
of transference.
According to this theory, people will
recover when they are finally released
from the repressive mental restraints
established in the relationship with their
parents during early childhood.
Neo-Freudian Psychodynamic
Therapies
These therapies were developed by
psychologists why embraced some of Freud’s
ideas, but disagreed with others.
While they follow many of the same
techniques, their emphasis is on the
conscious, rather than the unconscious, mind.
Basically they spend less time probing for
hidden conflicts and repressed memories.
Psychotherapy
Insight
Therapies
Psychodynamic
Therapies
Humanistic
Therapies
Freudian
Psychoanalysis
Neo-Freudian
Therapies
Behavior
Therapies
Cognitive
Therapies
Therapies based
on Operant
Conditioning
Therapies Based
On Observational
Learning
Therapies Based
on Classical
Conditioning
Humanistic Therapies
Many people struggle with the problems of
everyday existence. These are commonly
called existential crises.
This term underscores the idea that many
problems deal with questions about the
meaning and purpose of one’s existence.
Humanistic psychology developed theories to
specifically address these problems
Humanistic Therapies
Humanistic psychology believes that people
are generally motivated by healthy needs for
growth and psychological well being.
Problems only occur when conditions
interfere with normal development and
produce low self esteem.
These therapies, then, try to help clients
confront their problems by recognizing their
own freedom, enhancing their self-esteem
and realizing their fullest potential.
Client-Centered Therapy
This therapy assumes that people all have a
need to realize their fullest potential (self
actualization). But, development can be
hindered by a conflict between one’s desire
for a positive self image and criticism by self
and others.
One therapy technique called “reflection of
feeling,” or reflective listening, is where the
therapist paraphrases the clients words,
making sure to capture the emotional tone,
so the client can see and hear themselves.
Listening Empathetically
Empathy is the act of adopting the client’s
perspective, of walking in the client’s shoes.
 Carl Rogers encouraged therapists to exhibit
empathy.
 When they accurately sense and reflect their
clients’ feelings, clients increase in selfunderstanding and self-acceptance.
 An empathetic, trusting, caring relationship is
key to being an effective psychotherapist
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13-3 “Listening Empathetically”
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“As you listen to me role-play a client,
pretend you are a counselor or a
therapist. Your task is to adopt my (or the
client’s) perspective. Try to see the world
through my eyes. Circle only the
statements that demonstrate empathy.
(adopting the patient’s point of view.)”
13-3
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In your groups, try to reach a consensus.
13-4 Role Playing – Practice
with Pat, then with a friend.
Client-centered approach
 1st repeat what the person said as you
understand it.
“What I hear you saying is…”
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 2nd
reflect back the person’s feelings.
“It seems you are feeling …about the
situation.”
Empathic Listening
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What was good about empathic listening
in everyday life?
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What are some possible obstacles about
empathic listening in everyday life?
Humanistic vs. Psychoanalysis
In stark contrast to psychoanalysis,
humanistic therapists assume that
people are generally good and healthy,
but can be negatively effected by
pressure from oneself and society.
Humanistic therapists accomplish
treatment through genuineness,
empathy, and unconditional regard and
acceptance for their clients.
Cognitive Therapies
Cognitive Therapies see rational thinking
as the key to therapeutic change. The
assumption is that psychological problems
arise from erroneous thinking.
Cognitive therapists help the individuals
confront the destructive thoughts that
support depression.
The Way I Think
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Samples of cognitive therapy techniques
Fill in the blank:
1) “I often worry that I _______________.”
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2. “If this worry of yours was indeed true,
what does it mean to you and why does it
bother you so much?”
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In other words, “If what you JUST wrote was
indeed true, what does it mean to you and
why does it bother you so much?”
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“If what you JUST wrote was indeed true,
what does it mean to you and why does it
bother you so much?”
“Look back over the various things you
wrote so far and answer this question:”
3. “What’s the worst thing that could
possibly happen? What do you fear most of
all?”
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4. “When you think of the worst thing that
could happen, do you really think that it’s
likely to happen? If so, how could you
learn to cope with it?”
Look back over the worrisome
thoughts that you have written
about so far, and answer this
questions:
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5. “What do you (perhaps ‘secretly’) get
out of thinking like this? How does it
work to your advantage?”
6. Persuade a Friend
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“Pretend that your friend has some of the same
worrisome beliefs that you do. Look back over
the things you wrote for questions 1-3. Pick
out one of those statements and write it down,
as if your friend just said it. Now skip a line,
and write a response to your friend’s
statement. In that response, be a
compassionate, rational, and realistic thinker.
After you write your response, skip a line and
have your friend reply.
6. Persuade a Friend
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Maybe your friend is a bit stuck in her/his
thinking. Then skip a line, and respond
again to your friend. Keep this
conversation going for 10 lines or so.
7. Positive imagery anecdotes
Select 3 positive images, real memory or
imagination, related to:
1. confidence & strength in your life
2. Safety & peacefulness in your life
3. Love in your life
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Make sure you can see each one clearly.
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Now imagine a real or imaginary scene
related to one of their negative thoughts.
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When the time feels right, move from the
negative image to the positive one that
feels like the right anecdote, then back
again to the negative image, repeating the
cycle until you feel comfortable ending the
exercise with the positive image firmly in
mind.
8. “I accept myself even though I
___________” (Do not use the word “Am”)
By not using the word “am” give yourself a
global label and it should encourage you to
focus on specific trait or behaviors.
Write this sentence 10 times!
Behavior Therapies
Behavior therapy, or behavior modification, is
based on the assumption that undesirable
behaviors have been learned, and therefore, can
be unlearned.
Behavior therapist focus on the problem
behaviors rather than inner thoughts, motives or
emotions. Their goal is to determine how these
behaviors were learned and see if they can
eliminate them.
Systematic Desensitization
One behavioral technique to extinguish
anxiety is systematic desensitization. In
this, a patient is exposed to an anxiety
producing stimulus gradually. Over time,
the anxiety will become extinguised.
Steps of Systematic Desensitization
For a fear of public speaking:
1.
2.
3.
4.
5.
6.
7.
8.
Seeing a picture of a person giving a speech
Watching another person give a speech
Preparing a speech to give
Having to introduce oneself to a large group
Waiting to be called upon to speak at a meeting.
Being introduced as a speaker to a group
Walking to the podium to make a speech
Making a speech to a large group
13-7 –Systematic desensitization
1. What is one thing that gives you anxiety?
2. Adapt handout 13-7 to fit your own fear.
13-8
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Then train yourself in progressive
relaxation.
Aversion Therapy
Aversion therapy takes on the psychological
problems with a conditioning procedure
designed to make tempting stimulus less
provocative by pairing them with an unpleasant
(aversive) stimuli.
In time, the negative reaction (UCR) associated
with the averse stimuli come to be associated
with the conditioned stimuli.
This is usually a last resort type of therapy,
though it has been shown to be successful.
Operant Conditioning Therapies
These therapies rely on the tools of operant
conditioning: reward and punishment.
Contingency Management: An approach to
changing behavior by changing the
consequences associated with a behavior.
Token Economy: A technique involving the
distribution of “tokens” or indicators of
reinforcement contingent on desired behaviors
Cognitive-Behavioral Therapy
This therapy combines a cognitive
emphasis on thoughts and attitudes with
the behavioral strategies.
This approach assumes that an irrational
self-statement often underlies maladaptive
behavior.
Cognitive-Behavioral Therapy
In this form of treatment, therapist and
client work together to modify irrational
self-talk, set attainable behavioral goals
and develop realistic strategies for
attaining them.
In this way, people change the way they
approach problems and gradually develop
new skills and a sense of self-efficacy.
Does Therapy Actually Work?
In 1952, Hans Eysenck shook the psychology
world by releasing a study that suggested 2/3 of
all people with nonspychotic problems recovered
within two years if the onset of the problem,
whether they got therapy or not.
Essentially he was arguing that therapy was
worthless, and no better than having no
treatment at all.
Response to Eysenck
As you can imagine, this set off a fire
storm of studies on this subject.
Overall (375 studies) research supports
two major conclusions:
1. Therapy is more effective than nontherapy.
2. Eysenck overestimated the improvement
rate in no-therapy control groups.
Biomedical Approach
Biomedical therapies seek to treat
psychological disorders by changing the
brain’s chemistry with drugs, its circuitry
with surgery or its patterns of activity with
pulses of electricity or magnetic fields.
Drug Therapy/Psychopharmacology
The first psychological drugs were administered
in 1953 with the antipsychotic drugs.
In 1955, over ½ a million Americans were living
in mental institutions, each staying an average
of a few years. Then, with the introduction of
tranquilizers, the number declined. By 1965, the
number of patients was down to ¼ million, with
most patients staying for only a few months.
Antipsychotic Drugs
Antipsychotic drugs are used to treat the
symptoms of psychosis: delusions,
hallucinations, social withdrawal and agitation.
Most work by reducing the activity of the
neurotransmitter dopamine. Although the exact
reason why this has an antipsychotic effect,
these drugs have proven to be quite effective.
+/- of Antipsychotic Drugs
While these drugs reduce the overall brain
activity, they do not simple put the patient in a
trance. Instead they simply reduce the “positive”
symptoms of psychosis.
Unfortunately, long-term use can cause
problems like tardive dyskinesia, which produces
an uncontrollable disturbance of motor control,
especially in the facial muscles.
Positive and Negative Categories
Often times, researchers now simply
characterize symptoms of schizophrenia
into positive and negative categories.
Positive symptoms refer to active
process such as delusions, and
hallucinations while negative symptoms
refer to passive processes like social
withdrawal.
Antidepressant Drugs
There are three major classes of antidepressant
drugs, and all three work by “turning up the
volume” on messages transmitted over certain
brain pathways, especially those using
norepinephrine and serotonin.
The major downside of these drugs is that it
often takes a few weeks for them to have an
effect. In some cases, time is not a luxury a
mentally ill patient has.
Antianxiety Drugs
Antianxiety drugs most commonly fall into
two categories: barbiturates and
benzodiazepines.
Barbiturates act as a central nervous
system depressant, so they have a
relaxing effect. Benzodiazepines work by
increasing the activity of certain
neurotransmitters.
Stimulants
Stimulants is a broad category that
includes everything from caffeine to
nicotine to amphetamines to cocaine-they
are any drugs that produce excitement or
hyperactivity.
These drugs are prescribed for a variety of
disorders including narcolepsy and ADHD.
Truths About Drugs
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Cannot cure any mental illness
Can alter the brain to suppress some symptoms
Can have negative long term effects
Can be habit forming
Often over prescribed
Psychosurgery
Psychosurgery is the general term given
for any surgical intervention in the brain to
treat a psychological disorder.
These surgeries were far more common in
the past, and today have become a
method of last resort.
Brain-Stimulation Therapies
Electroconvulsive Therapy (ECT)A treatment used primarily for depression that
involves the application of an electric current to
head, producing a generalized seizure.
Transcranial Magnetic Stimulation (TMS)A treatment that involves magnetic stimulation
of specific regions of the brain, but unlike ECT, it
does not produce a seizure.
Study for the Free Response!
Electroconvulsive therapy (ECT)
 Transference
 Token economy
 Systematic desensitization
 Resistance
 Psychopharmacology
 Psychoanalytic perspective
 Learning perspective
 Biological perspective
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