Chapter 15: Treatment of Psychological Disorders
- different treatments depending on different perspectives
- share common purpose: alterin g client’s behavior, thoughts, and/or feelings
History of Treatment
- early societies = trephining - drilling holes in the skull to “release the harmful spirits”
- Middle Ages = persecution (mental illnesses were interpreted as demonic possession)
- 19 th century = circus sideshow
- 20 th century = Dorothea Dix (US) & Philippe Pinel (France) led mental health reform to create institutions
- 1950s = deinstitutionalization occurred with the development of drugs
- didn’t work
- present = preventative efforts
Types of Therapy
- psychotherapy - talking to a psychologist
- psychoanalytic, humanistic, cognitive approach
- behavioral therapy - changing contingencies of reinforcement for certain behaviors
- behavioral approach
- somatic treatments - taking a drug
- biomedical approach
- most therapists are eclectic
Psychoanalytic Therapy
- designed by Freud
- patient lies on couch while therap ist sits out of patient’s line of vision
- attempt to find underlying cause for unconscious conflicts
- believe other kinds of therapy can help get rid of a symptom,
- symptom substitution can result
- will begin to suffer new psychological problem
- 3 ways to get into someone’s unconscious: but don’t address true problem
1. Hypnosis - less likely to repress thoughts (unreliable)
2. Free Association - less likely to censor what we say
3. Dream Analysis - manifest content holds key to latent content
- all rely heavily on the interpretation of the psychologist
- patient may totally disagree with it (resistance)
- fierce resistance is considered an indication that the psychologist is close to the source of the problem
- transference may also occur
- patients redirect emotions from troubling relationships (usually with parents) onto therapist
Humanistic Therapies
- main goal = self-actualization
- operate on the ideas that people are generally good and have free will (control their own destiny)
- if people are supported and helped to reach their goals, they will reach their highest potential
- Carl Rogers

- client-centered therapy (aka person-centered)
- therapist provides client with unconditional positive regard (total acceptance of person)
- non-directive - psychologist does not tell client what to do
- requires active listening:
1. paraphrase
2. ask for clarification
3. reflect feelings
- Gestalt Therapy
- Fritz Perls
- importance of “the whole”
- encourage clients to get in touch with their whole selves
- body language, actions, feelings should be integrated into a harmonious whole
- Existential Therapies
- help clients achieve a subjectively meaningful perception of their lives
- help them see their lives as worthwhile
Behavioral Therapies
based on classical conditioning, operant conditioning, and modeling
Examples of Classical Conditioning:
counterconditioning – unpleasant conditioned response replaced with a pleasant one
- ex: Charlie is afraid of going to the doctor; cries hysterically as soon as he enters.
Charlie’s mom brings his favorite snack every time they go.
- conditioned response of crying replaced by contentment for snacks
- exposure therapies – people face what they would normally avoid
- systematic desensitization
- most successful with phobias
- uses counterconditioning to replace fear with relaxation
- implosive therapy
- like systematic desensitization, except client imagines most frightening scenario first
- produces a lot of anxiety, but if client can realize fears are irrational, then the anxiety would be extinguished
- flooding = client actually experiences (not imagines) peak fear
- aversive conditioning
- pairs a habit the client wants to break with an unpleasant stimulus
- ex: habit = smoking; stimulus = electric shock
- Examples of Operant Conditioning:
- instrumental conditioning
- using rewards and/or punishments to modify behavior
- ex: token economy – desired behaviors are rewarded with tokens, which can be exchanged for privileges
- modeling
- combo of cognitive and behavioral ideas
Cognitive Therapies
- focus on changing unhealthy thoughts
- can be combative since therapist challenges irrational beliefs of client
- ex: unhealthy attributional style = all failures are internal, global, and permanent aspects of self (see depression from Ch. 14)
- Rational Emotive Therapy (RET)

- Albert Ellis
- therapist tries to expose/confront dysfunctional thoughts of clients
- ex: How likely is it that you will be embarrassed giving a class presentation?
How bad could it be?
- Cognitive Therapy
- Aaron Beck (cognitive triad – your self, your world, your future)
- usually used in treating depression
- therapist tries to get client to engage in pursuing success
- alleviates depression, and also challenges irrational ideas that caused their unhappiness
Group Therapy
- family therapy – reveals patterns of family interaction that may be causing problems to the individual
- self-help groups (ex: AA)
- less expensive for client
- does not involve therapist… relies on insight of peers
Evaluating Psychotherapies
- hard… how do you measure the effectiveness of therapy?
- clients’ reports = usually supportive of therapy… BUT control groups show similar recovery
- placebo effect; self-fulfilling prophesy
- therapists’ reports = generally good… BUT patients who don’t succeed may try another therapist, and the first would never know
- outcome research = people undergoing therapy are more likely to improve than those untreated
- specific problems may be helped by certain therapies
- ex: phobias with behavioral conditioning; depression with cognitive therapy
- the more specific the problem, the greater the chance for recovery
- alternative therapies
- not a lot of research, but TONS of testimonials
- light exposure therapy for treating SAD seems effective
Somatic Therapies
- psychopharmacology (drug therapy) aka chemotherapy
- most common type of somatic therapy
- the more severe a disorder (ex: schizophrenia), the more likely drugs will be used to treat it
- psychotherapy is useless for patients unable to express themselves coherently
- schizophrenia
- antipsychotic drugs – block receptor sites for dopamine
- Thorazine & Haldol = most common
- tardive dyskenesia can result (muscle tremors, like Parkinson’s)
- can increase risk for obesity and diabetes
- atypical antipsychotics
– target dopamine and serotonin
- helps reduce negative symptoms
- may have less negative side effects
- mood disorders
- antidepressants

- increase activity of serotonin or norepinephrine
- tricyclic antidepressants
- monoamine oxidase (MAO) inhibitors
- selective-serotonin-reuptake-inhibitor (SSRI)
- ex: Prozac, Zoloft, Paxil
- negative side effects (dry mouth, weight gain)
… do they really work? (spontaneous recovery, placebo effect, etc.)
- mood-stablizers
- lithium used to treat manic phase of bipolar
- anxiety disorders
- drugs like barbiturates and benzodiazepines (ex: Xanax & Valium) suppress activity of CNS, making people feel more relaxed… but can lead to dependency
- Electroconvulsive Therapy (ECT)
- patients are given a muscle relaxant and then experience a brief seizure and lose consciousness
- less common than chemotherapy
- bilateral – electric current passes through both hemispheres
- generally more effective
- side effects: memory loss
- unilateral – current passes through one hemisphere
- Psychosurgery
- rarest form of somatic therapy
- most intrusive
- purposeful destruction of part of brain to alter behavior
- prefrontal lobotomy
– cutting main neurons leading to the frontal lobe
- calmed behavior, but reduce patient to vegetative state
- Alternative Therapies
- repetitive transcranial magnetic stimulation (rTMS)
- like ECT without the seizures or memory loss
- deep-brain stimulation
- very new so results are unclear