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Chapter 16

Psychology 2035A/B Chapter Notes - Chapter 16: Generalized Anxiety Disorder, Panic Disorder, Sigmund Freud

Course Code
Doug Hazlewood

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Chapter 16: Psychotherapy
The Elements of the Treatment Process
- all psychotherapies involve a helping relationship (the treatment) b/n the professional with special
training (therapist) and the person in need of help (client) called the “Therapeutic triad”
Treatments: How Many Are There?
- Kazdin estimates there are over 400 distinct types of psychotherapy
- Approaches to treatment can be classified into 3 major categories:
1. Insight Therapies: “talk therapy”- closest to the approach most people invision; clients engage in
complex verbal interaction with their therapist with the goal of these discussions being to pursue
increased insight regarding the nature of the clinet’s difficulties and sort through possible
2. Behaviour Therapies: based on the principles of learning and conditioning where focus is shifted
from personal insifghts to direct efforts to alter problematic responses like phobic behaviours. It
works by changing the clinets’ overt behaviours with different procedures depending on the
3. Biomedical therapies: there involve interventions into a person’s physiological functioning that
are most widely manipulated in the forms of drug therapy and electroconvulsive therapy.
Traditionally only physicians have been able to prescribe medications but psychologists have
been fighintg for privelages and they have obtained privelages in 2 states to date (New Mexico
and Louisiana)
The 3 major classes are not incompatible; someone seen in insight therapy can also be given medication
Clients: Who Seeks Therapy?
- report in 1999 says, ~15% of the US population use mental health services every year
- there are SO many human problems people are treated for but anxiety and depression are the most
-STUDY by Wang Et Al (LOL AT HIS NAME!) found that people delay seeking treatment for years
and the % of people who do seek treatment within the first year is really low- 6yrs on avg for bipolar
and drug dependence (~40% w/in the 1st yr for bipolar and 20-26% for dependence), 8 years for
depression (~37%), 9 years for generalized anxiety (~33%), and 10 years for panic disorder (~33%)
- only about ½ of people who use mental health services in a given year meet the criteria for a full
fledged mental disorder; others seek help for every day problems (e.g. career decisions)
- people vary in their willingness to seek therapy- STUDY found that only 59% of people who perceive
a need for help actually seek it, and women are more likely to seek help then men, and whites are
more likely then blacks of Hispanics to obtain help. The utilization peaks in the 35-44yrs old bracket
- Treatment is also more likely for people with medical insurance and more education; the 2 biggest
barriers to therapy are lack of health insurance and cost concerns
- Biggest roadblock is the “stigma surrounding the receipt of mental health services” many people
adequate seeking help with weakness
- FIG 16.3: Psychological disorders and professional treatment
o15% receive treatment, and 28% have a disorder
o7% have treatment but no psychiatric diagnosis and 20% have a diagnosis and no treatment,
and the overlapping 8% have diagnosis and treatment
Therapists: Who Provides Professional Treatment?
- The 2 types are Clinical and Counseling but the distinction is more theoretical than real- they
specialize in the diagnosis and treatment of psychological disorders and everyday behavioural

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problems. In theory the clinical psy. are more trained towards treatment of full-fledged disorders
whereas counselling is slnted more towards everyday adjustment problems; in practice the overlap is
- They require a PH.d (5-7 years past bachelors) and mostly use insight and behavioural approaches
- they are physicians who specialize in treatment of psychological disorders
- many also treat everyday behavioural problems but devote more time to severe disorders
- they require an MD and a 4 year apprencticeship/residency
- they emphasize drug therapies and are more likely to use psychoanalysis vs. behavioural methods or
group therapies
Other Mental Health Professionals
- psychiatric social workers and psychiatric nurses work at hospitals alongside psychiatrists
- the nurses play a huge role in the hospital inpatient treatment (masters, or bachelor)
- social workers work with patients and their families to ease the patient’\s integration back into the
community (need a masters). Traditionally work in hospitals and agenicies but are many are now
licensed independently
- many counsellors also provide therapeutic services schools, colleges, human service agencies, and
are often specialized in particular problems *drug counselling, marital, vocational..)
Insight Therapies
- all approaches involve verbal interactions intended to enhance client’s self-knowledge and thus
promote healthful changes in personality and behaviour
- there are hundreds but the leading 8-10 make up most of present treatments
- first developed and practiced by Sigmund Freud and emphasized the recovery of unconscious
conflicts, motives, and defenses through techniques such as free association, dream analysis, and
- Freud treated many anxiety-dominated disturbances such as phobic, panic, OCD, and conversion
disorders which are all termed neuroses that he believed all stemed from unresolved unconscious
conficts from childhood (conflicts b/n id, super/ego) usually involving sexual/aggression impulses
- Probing the unconscious
oFree association: clients spontaneously express their feelings/thoughts exactly as they occur-
they lie on a coach and pour out everything that comes to mind without conscious cencorship;
analyst then studies there free associations for clues about the unconscious
oDream analysis: therapist interprets the symbloci meaning of the client’s dreams. Freud
though they were the “royal road to the unconscious” clinets are trained to remember their
dreams, which they then describe in therapy
- CASE: Mr.N had marital problems claimed to love his wife, but prefereed sex with prostitutes; his
parents also had problems in their marriage. In his session, he described a dream about being bumped
from behind and about cars and his father; therapist saw sexual overtones in the dream, and also a
competitive orientation towards his father
- Interpretation
oInvolved the therapist’s attemps to explain the client’s feelings, memories, and behaviours
oE.g the therapist interpreted Mr.N’s thoughts about a box of condoms and his assumtions as
wanting to fulfill his wish-fulfilling fantasy: mother doesn’t want sex with father and father is
not very potent the therapist then concluses that Mr.N’s difficulties are rooted in an Oedipal

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Complex; he has unresolved sexual feelings towards his mother and hostile feelings towards
his father- these unconscious conflicts are now distroing his intimate adult relations
- Resistance
oInvolves largely unconscious defensive maneuvers intended to hinder the progess of therapy
oAssumed to be an inevitable part of the psychoanalytica process
oAlthough people have sought help, they are reluctant to confront their real problems
oPatients can then show up late for sessions, or be hostile towards the therapist
- Transference
oOccurs when clients start relating to their therapists in ways that mimic critical relationships in
their lives trander conflicting feelings about important feelings onto the therapist
oPsychoanalysts encourage transference so clients reeanct relations which helps bring repressed
feelings to the surface and help people work through them
Classical psychoanalysis as done by Freud is not practiced anymore but have evolved into
psychodynamic approaches to therapy
Client-Centered Therapy
- emphasizes providing a supportive emotional climate for clinets, who play a major role in
determining the pace and direction of their own therapy
- focuses on people “finding themselves” and “getting in touch with their own feelings”
- Largely started from the work of Carl Rogers and his belief that most personal distress comes from
incongruence b/n a person’s self concept and reality; incongruence makes people prone to feel
threatned bu relisric feedback about themselves from others
- Therapists help lcients to realize that they do not have to worry constantly about pleasing other people
and winning acceptance and torespect their own feelings and calues- help people reconstruct their
- Try to forster self-acceptance and personal growth
- Therapeutic Climate
othe atmosphere which fosters people to put down their defenses and open up is thought to be
more imporatn then the process of therapy
oRogers believed that client-centered therapists should provide 3 conditions:
1. Genuineness
2. unconditional positive regard
3. empathy
- Therapeutic Process
oclient and therapist work almost as equals; they provide little guidance and advice and their
key is clarification- function like a human mirror to make clients aware of their true themes
and feelings
otry to make clients more aware and comfortable with their own genuine selves
Group Therapy
- became popular after WWII and into the 50s
- most major insight therapies have been adapted for use with groups
- Participants’ Roles: ideally a group of 6-8 somewhat diverse people, with the therapist mostly in the
background maintaining group cohesiveness
- Members function as therapists for each other- supportive environment helps people uncover their
insecurities and work to make healthy changes in order to win the group’s approval
- Advantages of the group experience besides being more affordable as described by Irwin Yalom
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