This document provides an overview of different therapies used to treat psychological disorders and personal problems. It discusses biomedical therapies that use medication and electroconvulsive therapy, as well as various types of psychotherapy including psychoanalytic, humanistic, behavioral, cognitive, and group/family therapies. Key figures and approaches within each therapy type are outlined, along with factors that contribute to effective psychotherapy and considerations for cultural differences.

1. Lecture Slides
Chapter Fifteen
Therapies
By Glenn Meyer
Trinity University

2. Introduction:
Psychotherapy and
Biomedical Therapy
Reasons for Seeking Therapy
• Psychological disorder—troubling thoughts, feelings,
or behaviors that cause psychological discomfort or
interfere with a person’s ability to function
• Troubled relationships—parent-child conflicts,
unhappy marriage
• Life transitions—death of a loved one, dissolving
marriage, adjustment to retirement

5. Two Broad Forms of Therapy
Biomedical Therapies
Click here
Psychotherapy
Click here
• Refers to the use of psychological
techniques to treat emotional,
behavioral, and interpersonal
problems
• Designed to encourage
understanding of problems and
modify troubling feelings, behaviors,
• or relationships
• Many types of psychotherapy
• Assumes psychological factors play
a significant role in person’s troubling
feelings, behaviors, or relationships
• Therapists are now being granted
privileges to prescribe medications in
some areas, but this is controversial
• Involve the use of
medication,
electroconvulsive therapy, or
other medical treatments to
treat the symptoms
associated with
psychological disorder
• Use psychotropic
medications
• Assume symptoms of
psychological disorders
involve biological factors

7. Psychoanalytic Therapy
Sigmund Freud and Psychoanalysis
• Psychoanalysis is a form of
therapy developed by Sigmund
Freud and is based on his theory
of personality
• Repressed conflicts continue to
influence a person’s thoughts and
behaviors, including the dynamics
of his relationships with others
• Psychoanalysis is designed to
help unearth unconscious
conflicts so the patient attains
insight

8. Free association—
spontaneous report of all
mental images, thoughts,
feelings as a way of
revealing unconscious
conflicts; usually done
lying on a couch
Techniques of
Psychoanalysis
to Lift
Repression
Click here
Resistance—
patient’s unconscious
attempt to block
revelation of
unconscious material;
usually sign that
patient is close to
revealing painful
memory
Dream interpretation—
dreams are the “royal
road to the unconscious”;
interpretation often
reveals unconscious
conflicts
Transference—
process by which
emotions originally
associated with a
significant person,
such as a parent, are
unconsciously
transferred to the
therapist
• Seen as most
important
• Therapist remains
neutral to produce
optimal frustration
and bring out
unresolved conflicts
Traditional
psychoanalysis
can take years
and be very
expensive

9. Short-Term Dynamic Therapies
Based on psychoanalytic theory, but differs because it
• is typically time limited–a few months
• has specific goals
• involves an active, rather than neutral, role for therapist
Interpersonal Therapy (IPT)
Focuses on current rather than past relationships;
interpersonal problems seen as core of psychological
symptoms
Four Categories of Personal Problems
• Unresolved grief–death of significant other
• Role disputes–conflict with significant others
• Role transitions–major life changes
• Interpersonal deficits–absent or faulty social skills

10. Humanistic Therapy
• Humanistic perspective emphasizes
human potential, self-awareness, and free-will
• Humanistic therapies focus on self-perception
and individual’s conscious
thoughts and perceptions
• Most important factor in personality is the
individual’s conscious, subjective
perception of his or her self
• Humanistic therapists see people as being
innately good and motivated by the need
to grow psychologically

11. Carl Rogers and Client-
Centered Therapy
• Therapy is nondirective—
therapist does not interpret
thoughts, make suggestions,
or pass judgment
• Therapy focuses on client’s
subjective perception of self
and environment
• Does not speak of “illness” or
“cure”
• Therapist’s role is to create
conditions that allow client to
direct focus of therapy
Therapeutic conditions that
promote self-awareness,
psychological growth, and self-directed
change:
• Genuineness: therapist
honestly and openly shares
thoughts and feelings with client
• Unconditional positive
regard: therapist must value,
accept, and care for client
• Empathic understanding:
therapist must communicate
and listen actively for personal
meaning
The goal is self-actualization:
a
realization his or her
unique potentials and
talents

12. Motivational Interviewing
Helping Clients Commit to Change
• Only one or two sessions; help clients overcome
reluctance to change; encourage client’s self-motivating
statements
• More directive than traditional client-centered therapy
• Has been applied to marital counseling, parenting,
education, business, and community and international
relations

14. Behavior
Therapy/Behavior
Modification
• Uses learning principles
to directly change
problem behaviors
• Assumes that
maladaptive behaviors
are learned, just as
adaptive behaviors are
learned
• Basic strategy involves
unlearning maladaptive
behaviors and learning
more adaptive behaviors
instead

15. Techniques Based on
Classical Conditioning
• Student of Watson’s – worked with
conditioned emotional responses
• Developed counterconditioning, a
behavior therapy technique based on
classical conditioning that involves
modifying behavior by conditioning a
new response that is incompatible with
a previously learned responses
• Also used observational learning
• Successful with Peter who was phobic
to rabbits
• Rabbit presented while 3-year-old
Peter had a favorite snack
• Peter observed other children
playing with rabbit
Mary Cover Jones
The First Behavior
Therapist

16. Systematic
Desensitization
• Phobic responses are reduced by pairing relaxation with mental
images or real-life situations that the person finds progressively
more fear-provoking
• Based on the principle of counterconditioning
• Patient learns a new conditioned response (relaxation) that is
incompatible with old conditioned responses of fear and anxiety
• Three basic steps
• Can be combined with observational learning
• Can be done using virtual reality – for fear of flying, specific
phobias, PTSD
• Virtual reality may be preferred over desensitization with actual
exposure
Patient learns
progressive
relaxation
Patient
constructs
anxiety hierarchy
Process of
desensitization

18. Aversive Conditioning
• Relatively ineffective type of therapy that involves
repeatedly pairing an aversive stimulus with occurrence
of undesirable behaviors or thoughts
• Based in part on the Garcia effect
Example: The use of Antabuse with alcoholism
• Found not to be very effective

19. Techniques Based
on Operant
Conditioning
• Uses Skinnerian principles
such as
• Shaping (useful with
patients who are mentally
disabled with autism,
mental retardation, or
schizophrenia)
• Positive and negative
reinforcement
• Extinction

20. Token Economy
• System for strengthening desired behaviors through
positive reinforcement in a very structured environment
• Tokens or points are awarded as positive reinforcers for
desirable behaviors, and are withheld or taken away for
undesirable behaviors
• Tokens can be exchanged for other reinforcers
• Used for behavior modification in group settings (prisons,
classrooms, hospitals)
• Has been successful with severely disturbed people
• Difficult to implement and administer
Contingency Management
Focuses on one of a small set of behaviors
Useful for outpatient substance abuse treatment

21. Cognitive Therapies
• Assumes that the culprit in psychological problems is
faulty or illogical patterns of thinking
• Cognitive therapists zero in on the faulty, irrational
patterns of thinking that they believe are causing
psychological problems
• Treatment techniques focus on recognizing and altering
these unhealthy thinking patterns

22. Albert Ellis and Rational-
Emotive Therapy (RET)
• Key premise of RET is that
people’s difficulties are
caused by their faulty
expectations and irrational
beliefs
• Psychological problems
are explained by the “ABC”
model
• Activating event (A)
occurs
• Beliefs (B) about the
event…
• Cause emotional
consequences (C)
• Irrational beliefs lead to
self-defeating behaviors,
anxiety disorders,
depression, etc.

23. Steps in RET
• Identifying the core irrational beliefs that underlie personal
distress is the first step
• Therapist then disputes the irrational beliefs
• Client must admit irrational beliefs and accept fact that
they are irrational and unhealthy
• Effective in
• Depression, social phobia, and certain anxiety
disorders
• Overcoming self-defeating behaviors

25. Aaron Beck and Cognitive Therapy
• Problems due to negative cognitive
bias that lead to distorted
perceptions and interpretations of
events
• Beck believes that depression and
other psychological problems are
caused by distorted thinking and
unrealistic beliefs
• Therapist acts as a model and aims
for a collaborative therapeutic
climate

26. Steps in Cognitive Therapy (CT)
Help client learn to
recognize and monitor
automatic thoughts that
occur without conscious
effort or control
CT therapist
encourages client to
empirically test
accuracy of his or her
assumptions and
beliefs
CT therapist creates a
therapeutic climate of
collaboration that
encourages client to
contribute to the
evaluation of logic and
the accuracy of
automatic thoughts
Effective in:
Treating and preventing depression
Anxiety disorders
Borderline personality disorders
Eating disorders
Post-traumatic stress disorder
Relationship problems

28. Cognitive-Behavioral Therapy
• Integrates cognitive and behavioral techniques
• Based on the assumption that thoughts, moods, and
behaviors are interrelated
• The hallmark of cognitive-behavioral therapy is its
pragmatic approach

29. Group and Family Therapy
• May use many different
therapeutic approaches
• Goal of family therapy is
to alter and improve the
ongoing interactions
among family members
• Family therapy involves
many members of
immediate family and
important members of the
extended family
• Enhances effectiveness
of individual
psychotherapy
Group therapy
Form of psychotherapy
that involves one or more
therapists working
simultaneously with a
small group of clients
Click here
Family therapy
Form of psychotherapy
that is based on
assumption that the
family is a system and
treats the family as a unit
Click here
Advantages
• Very cost-effective
• Therapist can observe actual
interactions with others
• Support and encouragement
provided by the other group
members
• Group members may provide one
another with helpful, practical
advice
Self-help groups and support
groups are typically conducted by
nonprofessionals

30. Couple Therapy
• Relationship therapy that helps with difficulties in
marriage or other committed relationships
• Many different approaches: for example, behavioral
couple therapy based on learning theory
• Goals
• Improving communication
• Reducing negative communication
• Increasing intimacy

31. Self-Help Groups
Helping Yourself by Helping
Others
• Format varies (structured
and unstructured)
• Many follow a 12-step
approach
• 12-step attendees who
find sponsors and who
have a high motivation to
change are more likely to
stay involved in a
program
• Have been shown to be very
effective (equal to therapists)
and cost effective
• More research needed about
the reasons for effectiveness
and the kinds of people and
problems that benefit from
this approach

32. Evaluating the Effectiveness of
Psychotherapy
Many people
just seek
help and
support
from friends
and family
Some people
eventually
improve
simply with
the passage
of time;
spontaneous
remission
Most people
do not seek
help with
problems
Basic strategy for investigating effectiveness
Compare people who enter psychotherapy with a carefully
selected, matched control group of people who do not receive
psychotherapy
Researchers use statistical technique called meta-analysis to
combine and interpret large numbers of studies

33. Findings
• Psychotherapy is
significantly more effective
than no treatment
• On average, a person who
completes psychotherapy is
better off than about 80
percent of those in the
untreated control group
• Gains that people make as
a result of psychotherapy
also tend to endure long
after the therapy has ended
• PET scans may show
changes equivalent to drug
therapies

34. Is One Form of Psychotherapy Superior?
Depression
Panic disorder,
obsessive-compulsive
disorder, and phobias
Cognitive
therapy and
interpersonal
therapy
Cognitive,
cognitive-behavioral,
and behavior
therapies
In some
cases,
some
therapies
are more
effective for
different
problems
• Insight-oriented therapies are less effective than other
therapies in treating severe psychotic symptoms, such as in
schizophrenia.
• General finding: no differences among the types of
empirically based forms of psychotherapy
• Beware of untested psychotherapies

35. What Factors
Contribute to
Effective
Psychotherapy?
Click here
Therapeutic relationship characterized by mutual respect
Therapist characteristics are associated with successful therapy
Caring attitude and the ability to listen empathically
Warm, sensitive, and responsive
Sincere and genuine
Sensitivity to cultural differences
Important client
characteristics
Motivated, committed
to therapy, and
actively involved
Stable living situation
and supportive family
members
Good match between
client and specific
therapeutic technique
Personalized approach to
therapy is being
facilitated by eclecticism,
a pragmatic and
integrated use of diverse
psychotherapy
techniques

36. EMDR: Can You
Wave Your
Fears Away?
• Developed by
Francis Shapiro
• Useful for relieving
anxiety and
traumatic memories
• Involves visually
following a moving
finger while holding
mental image of
disturbing event,
situation, or memory,
but the mechanism
for this being
effective has not
been supported
• Too much
pseudoscientific
trappings added to
basic therapeutic
principles
• No more effective
than other therapies

37. Cultural Values and Psychotherapy
Western psychotherapy
tends to reflect European and North
American cultural values
• Clients are encouraged to become more assertive,
more self-sufficient, and less dependent on others in
making decisions
• Problems are assumed to have an internal cause
and are expected to be solved by the client alone

38. Cultural Values and Psychotherapy
Collectivistic Cultures
focus on needs of group, less on internal
causes, not being a burden on community
Latino cultures
Click here
Native Americans:
Network therapy
Click here
• One person’s problems
may be seen as a
problem for entire
community to resolve
• Family members,
friends, and community
members asked to
participate in treatment
or healing rituals
• Network therapy is
conducted in the
person’s home and can
involve as many as 70
members of the
individual’s community
• Interdependen
ce over
independence
• Stress the
value of
familismo—the
importance of
the extended
family network
Japanese psychotherapy:
Naikan therapy
Click here
• Being self-absorbed
is path to
psychological
suffering
• Naikan therapy:
replace focus on self
with a sense of
gratitude and
obligation
• Client is asked to
meditate on how he
or she failed to meet
the needs of others

39. Value Clashes
• Western therapies focus on
insight, but other cultures
emphasize avoiding negative
thinking
• Many cultures do not value
self-disclosure
• Western values may clash
with cultures that feel women
should be subservient

40. Biomedical Therapies
• Medical treatments for
symptoms of
psychological disorders
include medication and
electroconvulsive
therapy
• Past centuries, patients
were whirled, soothed,
drenched, restrained,
and isolated—all in an
attempt to alleviate
symptoms of
psychological disorders
• Most common
biomedical therapy:
Psychotropic
medications—
prescription drugs that
alter mental functions
and alleviate
psychological
symptoms

41. Antipsychotic Medications
• Effective against positive
symptoms of schizophrenia
• Also referred to as
neuroleptics
• Reserpine – discovered in
India
• Chlorpromazine (trade name:
Thorazine)
• Reduce levels of the
neurotransmitter called
dopamine
• Have dramatically decreased
the number of patients in
mental hospitals

43. Drawbacks of Antipsychotic Medications
• Do not cure schizophrenia
• Early antipsychotic medications ineffective with negative
symptoms of schizophrenia
• Unwanted side effects
• Dry mouth, weight gain, constipation, sleepiness, and poor
concentration
• Early antipsychotic medications could produce motor-related
side effects caused by dopamine involvement in motor
systems
• Muscle tremors, rigid movements, a shuffling gait, and a
masklike facial expression
• “Thorazine shuffle”
• Long-term use can produce tardive dyskinesia, an irreversible
motor disorder characterized by severe, uncontrollable facial tics
and grimaces, chewing movements, and other involuntary
movements of the lips, jaw, and tongue
• “Revolving door” pattern of hospitalization, discharge, and
rehospitalization

44. The Atypical
Antipsychotics
Second Generation
• Clozapine and
risperidone
• More recent:
olanzapine,
sertindole
• Less likely to cause
movement-related
dopamine side
effects
• More effective in
treating the negative
symptoms of
schizophrenia
• Lessen revolving
door pattern
• Problems: weight
gain, diabetes,
cardiac problems
• Do not produce
greater
improvements than
older antipsychotics

45. Antianxiety Medications
Antianxiety medications
are prescribed to help people deal with the problems and
symptoms associated with pathological anxiety
Non-benzodiazepine
(Buspar)
Click here
Benzodiazepines
(Valium, Xanax)
Click here
• Reduce anxiety through increasing
level of GABA
• Take effect rapidly and after a week
or two effectively reduce anxiety
levels
• Side effects include decreased
coordination, reaction time, alertness
• Physical addiction and possible life-threatening
withdrawal symptoms
• Effect intensified if combined with
alcohol or over-the-counter drugs like
antihistamines
• Good for short-term relief
• Doesn’t effect GABA,
perhaps effects
dopamine or serotonin
• May take up to two or
three weeks to work
• Does not reduce
alertness or produce
cognitive impairment

47. Lithium
• Used to treat bipolar disorder (manic
depression), interrupt acute manic attacks,
and prevent relapse
• Lithium counteracts both manic and
depressive symptoms in bipolar patients
• Prevents acute manic episodes over the
course of a week or two
• Lithium level problems
• Too low = manic symptoms persist
• Too high = lithium poisoning, which causes
vomiting, muscle weakness, and reduced
muscle coordination
• Lithium blood level must be carefully
monitored
• Action: Lithium affects levels of excitatory
neurotransmitter glutamate
• Stabilizes glutamate availability within a
narrow, normal range, preventing both
abnormal highs and abnormal lows

48. Antidepressant
Medications
Counteract the symptoms of depression—
hopelessness, guilt, dejection, suicidal
thoughts, difficulty concentrating, and
disruptions in sleep, energy, appetite, and
sexual desire.
First generation—tricyclics and MAO inhibitors
• Effective for about 75% of patients
• Increase availability of norepinephrine and
serotonin
• Can take up to six weeks before symptoms begin
to lift
Side effects
• Serious physiological side effects when taken with
common foods: cheese, smoked meats, and red
wine
• Dangerously high blood pressure, stroke, death
• Weight gain, dry mouth, dizziness, sedation

49. Antidepressant
Medications
Third generation—Selective
serotonin reuptake inhibitors
(SSRIs)
• Fluoxetine—Prozac, Zoloft, and
Paxil
• Effect the availability of a single
neurotransmitter: serotonin
• Milder side effects
• Prozac’s: headaches,
nervousness, difficulty
sleeping, loss of appetite,
and sexual dysfunction
Dual-action antidepressants:
Serzone and Remeron
• Affect serotonin levels
Dual-reuptake inhibitors: Effexor
and Cymbalta
• Affect levels of both serotonin
and norepinephrine
Dopamine-norepinephrine
inhibitor: Wellbutrin
Second generation
• Trazodone and
bupropion
• No more
effective than
first generation
• Same side
effects

51. Comparing
Psychotherapy and
Antidepressant
Medication
Results
• PET scans revealed that patients
in both groups showed a trend
toward more normalized brain
functioning
• Similar changes in patients with
panic disorder, post-traumatic
stress disorder, obsessive
compulsive disorder, phobias,
and other anxiety disorders after
psychotherapy treatment
PET scan study: Depressed
individuals showed increased
activity in the prefrontal cortex,
caudate nucleus, and thalamus
Two groups in study; each group was
assigned to either Paxil or interpersonal
therapy

52. Electroconvulsive Therapy
(Electroshock therapy or
shock therapy)
• Involves brief burst of electric current to induce a seizure
in the brain
• Commonly used to treat depression
• Occasionally used to treat mania, schizophrenia
• Used after other forms of treatment have failed to help
• Antidepressive effects can be short-lived
• Half of patients relapse within six months
• Not known exactly how it relieves the symptoms of
depression
• May have cognitive side effects such as memory loss
• Controversial because of its early overuse and punitive
appearance

53. Vagus nerve stimulation (VNS)
Implantation of a device into left
chest wall
Uses brief, intermittent electrical
stimulation to left vagus nerve
Runs through the neck and
connects to the brain stem
New and
Experimental
Treatments
Click here
Deep brain
stimulation (DBS)
Uses electrodes
surgically implanted
in the brain
Transcranial
magnetic
stimulation (TMS)
Stimulation of certain
regions of brain with
magnetic pulses

54. B. F. Skinner
and the
Search for
“Order in
Behavior”
What to Expect in Psychotherapy
1. Strengthen your commitment to change.
Think about the reasons you want to change.
2. Therapy is a collaborative effort.
You must actively participate. Therapist can’t do all
the work.
3. Don’t confuse catharsis with change.
Emotional release alone doesn’t fix the problem.
4. Don’t confuse insight with change.
Insight doesn’t automatically translate into healthier
behavior and attitudes.
5. Don’t expect your therapist to make decisions for you.
You need to decide what to do with the therapist
helping you explore decision making.
6. Expect therapy to challenge how you think and act.
Therapy can be a painful magnifying glass on your
life.