Chapter 15 Treatment of Psychological Disorders
Why People Cannot or Will Not Seek Treatment
People may fail to get treatment because of three major problems:
o People may not realize that their disorder needs to be treated.
o Some people believe that mental illness is a sign of personal weakness
o People suffering from mental illness are not trying hard enough to help themselves.
There may be barriers to treatment:
o Beliefs and circumstances that keep people from getting help.
Barriers may even arise from treatment providers or facilities themselves
including such factors as long waiting lists, lack of funding for adequate staffing,
or lack of staff education about the most up-to-date treatments
Even people who acknowledge they have a problem may not know where to look for services
finding a good lawyer or plumber,
Finding the right psychologist can be more difficult divided broadly into two kinds:
o Psychotherapy: in which a person interacts with a psychotherapist, and medical or
biological treatments, in which the mental disorder is treated with drugs or surgery
o Psychodynamic therapies: including psychoanalysis, emphasize helping clients gain
insight into their unconscious conflicts.
Behavior therapy applies learning principles to specific behavior problems; cognitive therapy aims at
challenging irrational thoughts. Cognitive behavior therapy (CBT) merges these approaches.
Humanistic approaches (e.g., person-centered therapy) and existential approaches
(e.g., Gestalt therapy) focus on helping people to develop a sense of personal worth.
Group therapies target couples, families, or groups of clients brought together for the purpose of therapy
Psychological Therapies: Healing the Mind through Interaction
Psychotherapy: An interaction between a therapist and someone suffering from a psychological
o Goal of providing support or relief from the problem.
Eclectic psychotherapy: Treatment that draws on techniques from different forms of therapy,
depending on the client and the problem.
o Allows the therapists to apply an appropriate theoretical perspective, suited to the
problem at hand rather than adhering to a single theoretical perspective for all clients and
all types of problems.
Psychodynamic therapies include psychoanalysis and modern psychodynamic therapy, such as
o Free Association client reports every thought that enters the mind, without censorship or
o Dream Analysis. Treats dreams as metaphors that symbolize unconscious conflicts or
wishes and that contain disguised clues that the therapist can help the client understand
o Interpretation: process by which the therapist deciphers the meaning underlying what the
client says and does
o Analysis of Resistance: process of “trying on” different interpretations of the client’s
thoughts and actions, the analyst may suggest an interpretation that the client finds
Resistance is a reluctance to cooperate with treatment for fear of confronting
unpleasant unconscious material
Freud noticed that clients would develop an unusually strong attachment to him
o viewing him as a parent or a lover worried that this could interfere with achieving the
goal of insight Transference: occurs when the analyst begins to assume a major significance in the client’s life
and the client reacts to the analyst based on unconscious childhood fantasies
Jung emphasized what he called the collective unconscious, the culturally determined symbols
and myths that are shared among all people that.
Adler believed that emotional conflicts are the result of perceptions of inferiority and that
psychotherapy should help people overcome problems resulting from inferior social status, sex
roles, and discrimination.
Approaches to psychotherapy stress that the individual is part of a larger society and that conflicts
can reflect the individual’s role in that society
Interpersonal psychotherapy (IPT): a form of psychotherapy that focuses on helping clients
improve current relationships (Weissman, Markowitz, & Klerman, 2000)
Behavioral and Cognitive Therapies
Behavioral and cognitive treatments emphasize the current factors that contribute to the
problem—maladaptive behaviors and dysfunctional thoughts
Behavior therapy assumes that disordered behavior is learned and that symptom relief is achieved
through changing overt maladaptive behaviors into more constructive behaviors
Eliminating Unwanted Behaviors
The study of operant conditioning shows that behavior can be predicted by its consequences (the
reinforcing or punishing events that follow).
Adjusting these might help change the behavior.
Promoting Desired Behaviors: behavior therapy technique sometimes used in such cases is the
o token economy: which involves giving clients “tokens” for desired behaviors, which
they can later trade for rewards.
Token economies have proven to be effective while the system of rewards is in place, but the
learned behaviors are not usually maintained when the reinforcements are discontinued (Glynn,
Reducing Unwanted Emotional Responses: powerful ways to reduce fear is by gradual exposure
to the feared object or situation, a behavioral method originated by psychiatrist Joseph Wolpe
o Exposure therapy: involves confronting an emotion-arousing stimulus directly and
repeatedly, ultimately leading to a decrease in the emotional response
Technique depends on the processes of habituation and response extinction systematic
o a procedure in which a client relaxes all the muscles of his or her body while imagining
being in increasingly frightening situations
Exposure therapy can also help people overcome unwanted emotional and behavioral responses
through exposure with response prevention
Cognitive therapy: focuses on helping a client identify and correct any distorted thinking about
self, others, or the world
o Cognitive theorists might instead emphasize the meaning of the event. It might not be the
event itself that caused the fear, but rather the individual’s beliefs and assumptions about
the event and the feared stimulus
Principal technique called
o cognitive restructuring: which involves teaching clients to question the automatic
beliefs, assumptions, and predictions that often lead to negative emotions and to
replace negative thinking with more realistic and positive beliefs
cognitive therapy include techniques for coping with unwanted thoughts and feelings, techniques that resemble meditation mindfulness meditation, teaches an individual to be fully
present in each moment; to be aware of his or her thoughts, feelings, and sensations; and to
detect symptoms before they become a problem
Blend of cognitive and behavioral therapeutic strategies;
cognitive behavioral therapy, or CBT: technique acknowledges that there may be behaviors
that people cannot control through rational thought but also that there are ways of helping people
think more rationally when thought does play a role
o CBT is “problem focused,” meaning that it is undertaken for specific problems.
o CBT is transparent in that nothing is withheld from the client
o Substantial effects of CBT have been found for unipolar depression, generalized anxiety
disorder, panic disorder, social phobia, post-traumatic stress disorder, and childhood
depressive and anxiety disorders
Humanistic and existential therapies assume that human nature is generally positive, and they
emphasize the natural tendency of each individual to strive for personal improvement
Person-centered therapy (also known as client-centered therapy): assumes that all individuals
have a tendency toward growth and that this growth can be facilitated by acceptance and genuine
reactions from the therapist
o believe that with adequate support the client will recognize the right things to do
congruence, empathy, and unconditional positive regard.
o Congruence refers to openness and honesty in the therapeutic relationship and ensuring
that the therapist communicates the same message at all levels
Empathy refers to the continuous process of trying to understand the client by getting
inside his or her way of thinking, feeling, and understanding the world.
o Seeing the world from the client’s perspective enables the therapist to better
appreciate the client’s apprehensions, worries, or fears positive regard by
providing a nonjudgmental, warm, and accepting environment in which the client
can feel safe expressing his or her thoughts and feelings.
Gestalt therapy: has the goal of helping the client become aware of his or her thoughts,
behaviors, experiences, and feelings and to “own” or take responsibility for them
emphasizes the experiences and behaviors that are occurring at that particular moment in
the therapy session