Chapter 15 - Therapy

Which therapeutic technique focuses more on the present and future than the past, and involves unconditional positive regard and active listening?

humanistic therapy-specifically Carl Rogers' client-centered therapy

interpretation

in psychoanalysis, the analyst's noting supposed dream meanings, resistances, and other significant behaviors and events in order to promote insight

resistance

in psychoanalysis, the blocking from consciousness of anxiety-laden material

transference

in psychoanalysis, the patient's transfer to the analyst of emotions linked with other relationships (such as love or hatred for a parent)

Those who undergo psychotherapy are ______________ (more/less) likely to show improvement than those who do not undergo psychotherapy.

more

Which of the following is NOT a benefit of group therapy?

more focused attention from the therapist

biomedical therapy

prescribed medications or procedures that act directly on the person's physiology

A therapist who helps patients search for the unconscious roots of their problem and offers interpretations of their behaviors, feelings, and dreams, is drawing from

psychoanalysis

The most enthusiastic or optimistic view of the effectiveness of psychotherapy comes from

reports of clinicians and clients

What are three components of evidence-based practice?

research evidence, clinical expertise, and knowledge of the patient

Compared with psychoanalysts, humanistic therapists are more likely to emphasize

self-fulfillment and growth

The technique of _____ _____ teaches people to relax in the presence of progressively more anxiety-provoking stimuli.

systematic desensitization

group therapy

therapy conducted with groups rather than individuals, permitting therapeutic benefits from group interaction

An influential cognitive therapy for depression was developed by _____ _____.

Aaron Beck

psychoanalysis

Sigmund Freud's therapeutic technique. Freud believed the patient's free associations, resistances, dreams, and transferences - and the therapist's interpretations of them - released previously repressed feelings, allowing the patient to gain self-insight.

How might the placebo effect bias clients' and clinicians' appraisals of the effectiveness of psychotherapies?

The placebo effect is the healing power of belief in a treatment. Patients and therapists who expect a treatment to be effective may believe it was.

How does the placebo effect bias patients' attitudes about the effectiveness of drug therapies?

The placebo effect is the healing power of belief in a treatment. When patients expect a treatment to be effective, they may believe it was.

electroconvulsive therapy (ECT)

a biomedical therapy for severely depressed patients in which a brief electric current is sent through the brain of an anesthetized patient

therapeutic alliance

a bond of trust and mutual understanding between a therapist and client, who work together constructively to overcome the client's problem

unconditional positive regard

a caring, accepting, nonjudgmental attitude, which Carl Rogers believed would help clients to develop self-awareness and self-acceptance

client-centered therapy

a humanistic therapy, developed by Carl Rogers, in which the therapist uses techniques such as active listening within a genuine, accepting, empathic environment to facilitate clients' growth. (Also called person-centered therapy.)

cognitive-behavioral therapy (CBT)

a popular integrative therapy that combines cognitive therapy (changing self-defeating thinking) with behavior therapy (changing behavior)

aversive conditioning

a type of counterconditioning that associates an unpleasant state (such as nausea) with an unwanted behavior (such as drinking alcohol)

systematic desensitization

a type of exposure therapy that associates a pleasant relaxed state with gradually increasing anxiety-triggering stimuli. Commonly used to treat phobias.

insight therapies

a variety of therapies that aim to improve psychological functioning by increasing a person's awareness of underlying motives and defenses

A therapist who restates and clarifies the client's statements is practicing ______________ _______________.

active listening

virtual reality exposure therapy

an anxiety treatment that progressively exposes people to simulations of their greatest fears, such as airplane flying, spiders, or public speaking

eclectic approach

an approach to psychotherapy that uses techniques from various forms of therapy

token economy

an operant conditioning procedure in which people earn a token of some sort for exhibiting a desired behavior and can later exchange the tokens for various privileges or treats

counterconditioning

behavior therapy procedures that use classical conditioning to evoke new responses to stimuli that are triggering unwanted behaviors; include exposure therapies and aversive conditioning

exposure therapies

behavioral techniques, such as systematic desensitization, that treat anxieties by exposing people (in imagination or actuality) to the things they fear and avoid

Exposure therapies and aversive conditioning are applications of _____ conditioning. Token economies are an application of _____ conditioning.

classical; operant

evidence-based practice

clinical decision making that integrates the best available research with clinical expertise and patient characteristics and preferences

_____-_____ therapy helps people to change their self-defeating ways of thinking and to act out those changes in their daily behavior.

cognitive-behavioral

Behavior therapies often use _____ techniques, such as systematic desensitization and aversive conditioning, to encourage clients to produce new responses to old stimuli.

counterconditioning

Cognitive therapy has been especially effective in treating

depression

antianxiety drugs

drugs used to control anxiety and agitation

antidepressant drugs

drugs used to treat depression, anxiety disorders, obsessive-compulsive disorder, and posttraumatic stress disorder. (Several widely used antidepressant drugs are selective serotonin reuptake inhibitors—SSRIs.)

antipsychotic drugs

drugs used to treat schizophrenia and other forms of severe thought disorder

In family therapy, the therapist assumes that

each person's actions trigger reactions from other family members

The goal of behavior therapy is to

eliminate the unwanted behavior

active listening

empathetic listening in which the listener echoes, restates, and clarifies. A feature of Rogers' client-centered therapy

family therapy

therapy that treats the family as a system. Views an individual's unwanted behaviors as influenced by, or directed at, other family members

What should a person look for when selecting a therapist?

A person seeking therapy may want to ask about the therapist's treatment approach, values, credentials, and fees. An important consideration is whether the therapy seeker feels comfortable and able to establish a bond with the therapist.

_____ therapies are designed to help individuals discover the thoughts and feelings that guide their motivation and behavior.

Insight

How do alternative therapies fare under scientific scrutiny?

Abnormal states tend to return to normal on their own, and the placebo effect can create the impression that a treatment has been effective. These two tendencies complicate assessments of alternative therapies (nontraditional therapies that claim to cure certain ailments). Eye movement desensitization and reprocessing (EMDR) has shown some effectiveness—not from the eye movement but rather from the exposure therapy nature of the treatments. Light exposure therapy does seem to relieve depression symptoms for those with a seasonal pattern of major depressive disorder by activating a brain region that influences arousal and hormones.

What three elements are shared by all the forms of psychotherapy?

All psychotherapies offer new hope for demoralized people; a fresh perspective; and (if the therapist is effective) an empathic, trusting, and caring relationship. The emotional bond of trust and understanding between therapist and client—the therapeutic alliance—is an important element in effective therapy.

How does the basic assumption of behavior therapy differ from the assumptions of psychodynamic and humanistic therapies? What techniques are used in exposure therapies and aversive conditioning?

Behavior therapies are not insight therapies. Their goal is to apply learning principles to modify problem behaviors. Classical conditioning techniques, including exposure therapies (such as systematic desensitization or virtual reality exposure therapy) and aversive conditioning, attempt to change behaviors through counterconditioning—evoking new responses to old stimuli that trigger unwanted behaviors.

After a near-fatal car accident, Rico developed such an intense fear of driving on the freeway that he takes lengthy alternative routes to work each day. Which psychological therapy might best help Rico overcome his phobia, and why?

Behavior therapies are often the best choice for treating phobias. Viewing Rico's fear of the freeway as a learned response, a behavior therapist might help Rico learn to replace his anxious response to freeway driving with a relaxation response.

What are the basic themes of humanistic therapy? What are the specific goals and techniques of Rogers' client-centered approach?

Both psychoanalytic and humanistic therapist are insight therapies - they attempt to improve functioning by increasing clients' awareness of motives and defenses. Humanistic therapy's goals have included have included helping clients grow in self-awareness and self-acceptance; promoting personal growth rather than curing illness; helping clients take responsibility for their own growth; focusing on conscious thoughts rather than unconscious motivations; and seeing the present and future as more important than the past. Carl Rogers' client-centered therapy proposed that therapists' most important contributions are to function as a psychological mirror through active listening and to provide a growth-fostering environment of unconditional positive regard, characterized by genuineness, acceptance, and empathy.

How do the humanistic and cognitive therapies differ?

By reflecting clients' feelings in a nondirective setting, the humanistic therapies attempt to foster personal growth by helping clients become more self-aware and self-accepting. By making clients aware of self-defeating patterns of thinking, cognitive therapies guide people toward more adaptive ways of thinking about themselves and their world.

Does psychotherapy work? How can we know?

Clients' and therapists' positive testimonials cannot prove that psychotherapy is actually effective, and the placebo effect makes it difficult to judge whether improvement occurred because of the treatment. Using meta-analyses to statistically combine the results of hundreds of randomized psychotherapy outcome studies, researchers have found that those not undergoing treatment often improve, but those undergoing psychotherapy are more likely to improve more quickly, and with less chance of relapse.

How are brain stimulation and psychosurgery used in treating specific disorders?

Electroconvulsive therapy (ECT), in which a brief electric current is sent through the brain of an anesthetized patient, is an effective, last-resort treatment for severely depressed people who have not responded to other therapy. Newer alternative treatments for depression include repetitive transcranial magnetic stimulation (rTMS) and, in preliminary clinical experiments, deep-brain stimulation that calms an overactive brain region linked with negative emotions. Psychosurgery removes or destroys brain tissue in hopes of modifying behavior. Radical psychosurgical procedures such as lobotomy were once popular, but neurosurgeons now rarely perform brain surgery to change behavior or moods. Brain surgery is a lastresort treatment because its effects are irreversible.

What are the aims and benefits of group and family therapy?

Group therapy sessions can help more people and cost less per person than individual therapy would. Clients may benefit from knowing others have similar problems and from getting feedback and reassurance. Family therapy views a family as an interactive system and attempts to help members discover the roles they play and to learn to communicate more openly and directly.

Some maladaptive behaviors are learned. What hope does this fact provide?

If a behavior can be learned, it can be unlearned, and replaced by other more adaptive responses.

Are some psychotherapies more effective than others for specific disorders?

No one type of psychotherapy is generally superior to all others. Therapy is most effective for those with clear-cut, specific problems. Some therapies—such as behavior conditioning for treating phobias and compulsions—are more effective for specific disorders. Psychodynamic therapy has been effective for depression and anxiety, and cognitive and cognitive-behavioral therapies have been effective in coping with anxiety, PTSD, and depression. Evidence-based practice integrates the best available research with clinicians' expertise and patients' characteristics, preferences, and circumstances.

What is the main premise of therapy based on operant conditioning principles, and what are the views of its proponents and critics?

Operant conditioning operates under the premise that voluntary behaviors are strongly influenced by their consequences. Therapy based on operant conditioning principles uses behavior modification techniques to change unwanted behaviors through positively reinforcing desired behaviors and ignoring or punishing undesirable behaviors. Critics maintain that (1) techniques such as those used in token economies may produce behavior changes that disappear when rewards end, and (2) deciding which behaviors should change is authoritarian and unethical. Proponents argue that treatment with positive rewards is more humane than punishing people or institutionalizing them for undesired behaviors.

What might a psychodynamic therapist say about Mowrer's therapy for bed-wetting? How about a humanistic therapist? How might a behavior therapist reply?

Psychodynamic therapists might be more interested in helping the child develop insight about the underlying problems that have caused the bed-wetting response. Humanistic therapists may prefer to encourage the child towards self-fulfillment and personal growth as a means of combating the problem behavior. Behavior therapists would be more likely to agree with Mowrer that the bed-wetting symptom is the problem, and that counterconditioning the unwanted behavior would indeed bring emotional relief.

What are the drug therapies? How do double-blind studies help researchers evaluate a drug's effectiveness?

Psychopharmacology, the study of drug effects on mind and behavior, has helped make drug therapy the most widely used biomedical therapy. Antipsychotic drugs, used in treating schizophrenia, block dopamine activity. Side effects may include tardive dyskinesia (with involuntary movements of facial muscles, tongue, and limbs) or increased risk of obesity and diabetes. Antianxiety drugs, which depress central nervous system activity, are used to treat anxiety disorders, obsessive-compulsive disorder, and posttraumatic stress disorder. These drugs can be physically and psychologically addictive. Antidepressant drugs, which increase the availability of serotonin and norepinephrine, are used for depression, with modest effectiveness beyond that of placebo drugs. The antidepressants known as selective serotonin reuptake inhibitors (often called SSRI drugs) are now used to treat other disorders, including strokes and anxiety disorders. Lithium and Depakote are mood stabilizers prescribed for those with bipolar disorder. Studies may use a double-blind procedure to avoid the placebo effect and researcher's bias

How do psychotherapy and the biomedical therapies differ?

Psychotherapy is treatment involving psychological techniques; it consists of interactions between a trained therapist and someone seeking to overcome psychological difficulties or achieve personal growth. The major psychotherapies derive from psychology's psychodynamic, humanistic, behavioral, and cognitive perspectives. Biomedical therapy treats psychological disorders with medications or procedures that act directly on a patient's physiology. An eclectic approach combines techniques from various forms of therapy.

How do researchers evaluate the effectiveness of particular drug therapies?

Researchers assign people to treatment and no-treatment conditions to see if those who receive the drug therapy improve more than those who don't. Double-blind controlled studies are most effective. If neither the therapist nor the client knows which participants have received the drug treatment, then any difference between the treated and untreated groups will reflect the drug treatment's actual effect.

What are the insight therapies, and how do they differ from behavior therapies?

The insight therapies—psychodynamic and humanistic therapies—seek to relieve problems by providing an understanding of their origins. Behavior therapies assume the problem behavior is the problem and treat it directly, paying less attention to its origins.

How do culture and values influence the therapist-client relationship?

Therapists differ in the values that influence their goals in therapy and their views of progress. These differences may create problems if therapists and clients differ in their cultural or religious perspectives.

What is cognitive-behavioral therapy, and what sorts of problems does this therapy best address?

This integrative therapy helps people change self-defeating thinking and behavior. It has been shown to be effective for those with anxiety disorders, obsessive-compulsive disorder, depressive disorders, bipolar disorder, and eating disorders.

What are the goals and techniques of psychoanalysis, and how have they been adapted in psychodynamic therapy?

Through psychoanalysis, Sigmund Freud tried to give people self-insight and relief from their disorders by bringing anxiety-laden feelings and thoughts into conscious awareness. Psychoanalytic techniques included using free association and interpretation of instances of resistance and transference. Psychodynamic therapy has been influenced by traditional psychoanalysis but differs from it in many ways, including the lack of belief in id, ego, and superego. This contemporary therapy is briefer, less expensive, and more focused on helping the client find relief from current symptoms. Psychodynamic therapists help clients understand how past relationships create themes that may be acted out in present relationships.

What is evidence-based clinical decision making?

Using this approach, therapists make decisions about treatment based on research evidence, clinical expertise, and knowledge of the client.

The drugs given most often to treat depression are called _____. Schizophrenia is often treated with _____ drugs.

antidepressants; antipsychotic

Therapy is most likely to be helpful for those with problems that ______________ (are/are not) well-defined.

are

Studies show that _____ therapy is the most effective treatment for most psychological disorders.

no one type of

psychodynamic therapy

therapy deriving from the psychoanalytic tradition that views individuals as responding to unconscious forces and childhood experiences, and that seeks to enhance self-insight

behavior therapy

therapy that applies learning principles to the elimination of unwanted behaviors

cognitive therapy

therapy that teaches people new, more adaptive ways of thinking and acting; based on the assumption that thoughts intervene between events and our emotional reactions

At a treatment center, people who display a desired behavior receive coins that they can later exchange for other rewards. This is an example of a(n)

token economy

In psychoanalysis, when patients experience strong feelings for their therapist, this is called _____. Patients are said to demonstrate anxiety when they put up mental blocks around sensitive memories, indicating _____. The therapist will attempt to provide insight into the underlying anxiety by offering a(n) _____ of the mental blocks.

transference; resistance; interpretation

psychotherapy

treatment involving psychological techniques; consists of interactions between a trained therapist and someone seeking to overcome psychological difficulties or achieve personal growth