Psychology applied to modern life adjustment in the 21st century, 11e chapter 15

Chapter 15
Psychotherapy


The Treatment Process, continued

•

Treatments: How many types are there?
– All psychotherapies involve “a helping
relationship (the treatment) between a
professional (the therapist) and another
person in need of help (the client)”.
– There are three main categories of
therapy:
1. Insight therapies.
2. Behavior therapies.
3. Biomedical therapies.


The Treatment Process, continued
• Clients: Who seeks therapy?
– Approximately 15% of Americans seek
mental health services each year.
– The most common problems are
excessive anxiety and depression.
– People seek treatment for milder
problems, such as making a career
decision, as well.
– Women, people with medical insurance,
and people with more education are all

more likely to seek treatment.


The Treatment Process, continued
Clients: Who seeks therapy?, continued
– Unfortunately, many who need therapy do
not receive it (see Figure 15.2).
– Common barriers to seeking treatment
include
• Lack of health insurance.
• The “stigma” associated with receiving
mental health services.


Figure 15.2. Therapy utilization rates. Olfson and
colleagues (2002) gathered data on the use of
nonhospital outpatient mental health services in the
United States in relation to various demographic
variables. In regard to marital status, utilization rates
are particularly high among those who are divorced or
separated. The use of therapy is greater among those
who have more education and, in terms of age,
utilization peaks in the 35-44 age bracket. Females
are more likely to pursue therapy than males are, but
utilization rates are extremely low among ethnic
minorities. (Data from Olfson et al., 2002)


The Treatment Process, continued

•

Therapists: Who provides treatment?
– Psychologists and psychiatrists are the
most common providers of treatment.
– However, therapy is also provided by other
professionals, including
• Psychiatric social workers.
• Psychiatric nurses.
• Counselors.


The Treatment Process, continued
Therapists, continued
– Clinical psychologists and counseling
psychologists “specialize in the
diagnosis and treatment of psychological
disorders and everyday behavioral
problems”.
– Both require a doctoral degree (Ph.D.,
Psy.D., or Ed.D).
– Psychologists are more likely to use
behavioral methods over psychoanalysis.
– Psychologists also do psychological
testing and conduct research.


The Treatment Process, continued
Therapists, continued
– Psychiatrists “are physicians who

specialize in the treatment of
psychological disorders”.
– Psychiatrists focus on more severe
disorders (e.g., schizophrenia).
– Psychiatrists earn an M.D. and typically
emphasize drug therapies (psychologists
cannot prescribe medication).
– Psychiatrists are also more likely to use
psychoanalysis.


The Treatment Process, continued
Therapists, continued
• Other mental health professionals
– Psychiatric social workers work as part of
a treatment “team” with a psychologists or
psychiatrist.
– They have a master’s degree and usually
help patients integrate back into the
community.
– Psychiatric nurses earn a bachelor’s or
master’s degree and usually work with
hospitalized patients.


Insight Therapies, continued

•

Insight therapies “involve verbal interactions

intended to enhance clients’ self-knowledge
and thus promote healthful changes in
personality and behavior”.
– Insight therapies include
• Psychoanalysis.
• Client-centered therapy.
• Positive psychology.
• Group therapy.


Insight Therapies, continued

•

Psychoanalysis was developed by
Sigmund Freud, and “emphasizes the
recovery of unconscious conflicts, motives,
and defenses through techniques such as
free association, dream analysis and
transference”.
– Probing the unconscious
• Therapists use two techniques to probe
the unconscious in an attempt to
identify unresolved conflicts causing the
client’s neurotic behavior.


Insight Therapies, continued
Psychoanalysis, continued
– In free association, “clients spontaneously

express their thoughts and feelings exactly
as they occur, with as little censorship as
possible”.
– In dream analysis, “the therapist interprets
the symbolic meaning of the client’s dreams”.
– Both techniques require the therapist to
interpret the clues that these methods
provide about unconscious conflicts.


Insight Therapies, continued
Psychoanalysis, continued
– Interpretation “involves the therapist’s
attempts to explain the inner significance
of the client’s thoughts, feelings,
memories, and behaviors”.
– Resistance “involves largely unconscious
defensive maneuvers intended to hinder
the progress of therapy”.
• Clients may resist by “forgetting”
appointments or being hostile toward
the therapist.


Insight Therapies, continued
Psychoanalysis, continued
– Transference “occurs when clients start
relating to their therapists in ways that
mimic critical relationships in their lives”.
– Although classical psychoanalysis (as

performed by Freud) is rare today, newer
versions of the therapy are used and are
referred to as psychodynamic
approaches.


Insight Therapies, continued

•

Client-centered therapy “is an insight
therapy that emphasizes providing a
supportive emotional climate for clients, who
play a major role in determining the pace and
direction of their therapy”.
– This approach is rooted in the humanistic
perspective and the work of Carl Rogers.
– Therapists try to foster self-acceptance
and personal growth in their clients.
– Therapists also help clients restructure
their self-concept to better correspond with
reality.


Insight Therapies, continued
Client-centered therapy, continued
– Therapeutic climate
• Rogers believed three elements were
necessary to promote positive changes in
therapy:

1. Genuineness (honest
communication).
2. Unconditional positive regard
(therapist remains supportive, nonjudgmental).
3. Empathy (therapist understands
issues from client’s point of view).


Insight Therapies, continued
Client-centered therapy, continued
– Therapeutic process
• With this approach, the client and
therapist work together almost as
equals.
• The therapist’s key task is clarification
– “reflecting the client’s statements with
enhanced clarity”.
• The main goal of therapy is to help
clients become more aware of, and
comfortable with, their “genuine selves”.


Insight Therapies, continued

•

Therapies inspired by positive psychology
– Well-being therapy, developed by Giovanni
Fava, focuses on “self-acceptance, purpose in
life, autonomy, and personal growth”.

– Positive psychotherapy – “ attempts to get
clients to recognize their strengths, appreciate
their blessings, savor positive experiences,
forgive those who have wronged them, and to
find meaning in their lives”.
• It has been successful in treating depression
(see Figure 15.5).


Figure 15.5. Positive psychotherapy
for depression. In a study of the efficacy
of positive psychotherapy, it was
compared to treatment as usual
(clinicians delivered whatever treatment
they deemed appropriate) and to
treatment as usual combined with
antidepressant medication. At the end of
12 weeks of treatment, symptoms of
depression were measured with the
widely used Hamilton Rating Scale for
Depression. The mean depression
scores for each group are graphed here.
As you can see, the positive
psychotherapy group showed less
depression than the other two treatment
groups, suggesting that positive
psychotherapy can be an effective
intervention for depression.
SOURCE: Adapted from Seligman,
M.E.P., Rashid,T.,& Parks, A.C.

(2006). Positive psychotherapy.
American Psychologist, 61, 774778. (Figure 2, p. 784).


Insight Therapies, continued

•

Group therapy “is the simultaneous
treatment of several or more clients (typically
five to ten people) in a group”.
– Participants’ roles
• In group therapy, participants function
like “therapists” for each other.
• The most important role is that of
providing emotional support for fellow
members of the group.


Insight Therapies, continued
Group therapy, continued
– Advantages of the group experience
1. Clients realize their problems are not
unique.
2. It provides an opportunity to practice and
enhance social skills.
3. Certain problems are well-suited for group
therapy. In “peer self-help groups”, all
members share the same kind of problem
(e.g., Alcoholics Anonymous) and can

provide support for each other.


Insight Therapies, continued

•

Evaluating insight therapies
– It is difficult to compare the effectiveness
of one type of insight therapy to another
because of the allegiance effect, in which
researchers often find the most support for
the therapeutic approach they use.
– Despite this, many studies have shown
insight therapy to be superior to placebo
and to produce lasting effects.
– Also, most people find therapy beneficial.


Insight Therapies, continued
Evaluating insight therapies, continued
• Common factors that make various insight
therapies effective:
1. Developing an alliance with a professional
helper.
2. Emotional support and empathic
understanding from the therapist.
3. The cultivation of hope, positive
expectations.

Insight Therapies, continued
Evaluating insight therapies, continued
4. Provision of a rationale for one’s problems
and a method for alleviating them.
5. The opportunity to express feelings,
confront problems, gain new insights, and
learn new patterns of behavior.


Insight Therapies, continued

•

Therapy and the recovered memories
controversy
– Much debate has centered around clients’
“recovery” of forgotten memories of
traumatic events, including abuse by
parents.
– This is controversial because it is not
possible to be absolutely certain whether
or not the memory is real.