The treatment of people with psychological problems has changed dramatically.
The mentally ill were seen as possessed by evil spirits.
Human skulls with regular shaped holes have been found.
Researchers theorize that the making of the holes was an early form of treatment that was supposed to let the harmful spirits escape.
Hippocrates lived in Ancient Greece around 500 B.
They lived in Rome in the 200 A century.
During the Middle Ages, Europeans believed that demons and spirits were the cause of psychological illnesses.
Treatment usually resulted in persecution.
There was a more sympathetic view of the Enlightenment.
At the turn of the 19th century, Philippe Pinel in France and Dorothea Dix in the United States were leading the call to treat mental illness in a more humane way.
The system that treated the mentally ill as if they were criminals was railed against by these reformers.
These two helped bring about the creation of separate institutions for people with severe psychological disorders.
There are a number of recent trends in the field of mental health in the United States.
The development of drugs in the 1950s that could moderate the effects of severe disorders led to the release of many people from mental institutions.
Deinstitutionalization was intended to save money and benefit former patients.
Deinstitutionalization was not as successful as hoped.
Many of the former patients were unable to care for themselves after being released.
They were supposed to have their psychological needs met by local clinics.
Many of the people released were homeless and delusional, unable to get the psychological or financial care they needed.
In the United States, a growing emphasis has been placed on preventative efforts.
The cost of providing care can be reduced if psychological problems can be treated before they become severe.
The preventative efforts can be described as primary, secondary, or tertiary.
Mental health issues can be caused by societal problems such as joblessness or homelessness.
Secondary prevention involves working with people who are at risk.
Counselors can help people who live in areas that have experienced a trauma such as a natural disaster or terrorist attack.
tertiary prevention efforts aim to keep people's mental health issues from becoming more severe, for instance, working with earthquake survivors who are already suffering from an anxiety disorder in the hopes of preventing the disorder from becoming more severe.
People's beliefs about effective treatment are based on their ideas about the cause of the problem.
A belief in the power of psychotherapy to treat mental disorders is shared by psychologists.
On the other hand, psychologists who subscribe to a biomedical model say that such problems need drugs.
Talking to a psychologist is the majority of psychotherapies.
Behaviorists believe that psychological problems are caused by the contingencies of reinforcement to which a person has been exposed.
Behavioral therapy focuses on changing the contingencies.
The people who come to psychologists for help are usually referred to as patients.
The term clients is preferred by other therapists.
The various types of therapy will be discussed.
Psychoanalysis, a specific kind of therapy pioneered by Sigmund Freud, is sometimes confused with psychotherapy, a general term used to describe any kind of therapy that treats the mind and not the body.
Psychoanalysis was developed by Sigmund Freud.
A patient undergoing traditional psychoanalysis will usually lie on a couch while the therapist sits in a chair out of the patient's line of vision.
Psychoanalytic theorists believe that disorders are caused by unconscious conflicts.
Identifying the underlying cause of the problem is their focus.
Psychoanalysts believe that other methods of therapy do not address the true problem and may fail to rid a client of a symptom.
Patients will suffer from symptom substitution as a result of this.
Symptom substitution occurs when a person is successfully treated for a psychological disorder and then begins to experience a new psychological problem.
Psychoanalytic therapists say that a person's symptoms are the outward manifestations of deeper problems that can only be solved through analysis.
This approach usually requires a lengthy and expensive course of therapy.
Freud developed a number of techniques to explore the unconscious minds of his patients.
The chapter "States of Consciousness" states that hypnotism is an altered state of consciousness.
People are less likely to suppress troubling thoughts when in this state.
Patients are often asked to say whatever comes to mind without thinking.
The idea that we all censor what we say allows us to hide some of our thoughts from ourselves.
If we force ourselves to say what pops into our heads, we are more likely to find out what's really bothering us.
When they use dream analysis, the patients are asked to describe their dreams.
Since the ego's defenses are relaxed during sleep, they hope the dreams will help the therapist see the root of the patient's problem.
All three techniques rely on the interpretations of the therapists and are criticized for their subjectivity.
The manifest content of a dream is what the patient reports.
The analyst is interested in the hidden content.
As a result of the therapist's interpretive work, the dream's content is revealed.
Patients may disagree with their therapists.
Psychoanalysts can see signs of resistance.
People try to protect themselves through resistance because of the painful process of coming to terms with deeply repressed, troubling thoughts.
A strongly voiced disagreement to an analyst's suggestion is often seen as an indication that the analyst is close to the source of the problem.
Transference is one of the final aspects of psychoanalysis.
Transference is when patients begin to have feelings for their therapists.
Patients may think they are in love with their therapists, may view their therapists as parental figures, or may seethe with hatred toward them.
According to psychoanalysts, in the process of therapy, patients often change their feelings towards people with whom they have had bad relationships onto their therapists.
Analysts try to see patients' transference as a way to find the source of the problem.
Many other psychologists have been influenced by Freud's work but have changed his original theory, as discussed earlier in this book.
Psychodynamic theorists are psychologists.
Psychodynamic psychologists still see the unconscious as an important part of understanding a person's difficulties, but they will use a variety of techniques associated with other perspectives.
Psychoanalytic/psychodynamic treatments and the humanistic therapies that will be discussed in the next section are sometimes referred to as insight therapies.
Insight therapies show how important it is for patients to understand their problems.
Humanistic therapies help people to understand and accept themselves.
Self-actualization is reaching one's highest potential.
Humanistic psychologists think it's a powerful goal.
Humanistic therapists believe that people are innately good and have free will.
People who believe in free will are capable of controlling their own destinies.
Determinism is not the same as belief.
It holds that people have no control over what happens to them and that their choices are made by forces outside of their control.
Humanistic psychologists believe that if people are supported and helped to recognize their goals, they will move toward self-fulfillment.
Carl Rogers is one of the best therapists.
Rogers created client-centered therapy.
Rogers called it a therapeutic method in which the therapist provides the client with positive regard.
blanket acceptance and support of a person regardless of what they say or do is called unconditional positive regard.
Rogers believes in the importance of positive regard.
People who haven't experienced it may see themselves in the negative ways that others have made them feel.
Humanistic therapists try to help their clients accept and take responsibility for themselves by providing positive regard.
The cognitive therapies will be discussed later, but client-centered therapy and other non-directive therapies are not.
Rogerian therapists wouldn't tell their clients what to do, but would try to help them choose their course of action.
Usually, client-centered therapists don't say much.
They encourage the clients to talk about how they feel and sometimes mirror their feelings.
Active listening is a technique.
Gestalt therapy is a type of therapy.
The importance of the whole is emphasized by Gestalt psychologists.
The therapists want their clients to get in touch with themselves.
The importance of body position and seemingly minute actions is emphasized by Gestalt therapists, who encourage their clients to explore feelings of which they may not be aware.
The therapists want their clients to integrate their actions, feelings, and thoughts into a harmonious whole.
One can appreciate the totality of an experience when they are in the present.
Existential therapies help clients achieve a subjectively meaningful perception of their lives.
Existential therapists believe that clients' difficulties are caused by them having lost or failed to develop a sense of their lives' purpose.
These therapists want to help their clients formulate a vision of their lives as worthwhile.
All behavior is learned according to behaviorists.
Classical conditioning, operant conditioning, and modeling were discussed in Chapter 6.
The same learning principles are used by behaviorists.
Counterconditioning is a classical conditioning technique developed by Mary Cover Jones in which an unpleasant conditioned response is replaced with a pleasant one.
As soon as he gets to the doctor's office,Charley will cry uncontrollably because he is afraid of going to the doctor.
His mother could try to replace the conditioned response of crying with contentment by bringing Charley's favorite snacks and toys with them every time they go to the office.
A behaviorist method of treatment has helped people with anxiety disorders.
It was developed by Joseph Wolpe.
The client is taught to replace the feelings of anxiety with relaxation.
The first step in desensitization is to teach the client to relax.
Breathing exercises and meditation are some of the techniques that can be used.
The therapist and client work together to create an anxiety hierarchy.
An anxiety hierarchy is a list of what the client fears, starting with the least frightening and ending with the most frightening.
In the process of desensitization, the client has to confront the feared objects or situations, while in covert desensitization, the client imagines the fear-inducing stimuli.
Imagine if she went to a therapist for help with her fear of spiders and then decided to try covert desensitization.
At the bottom of the anxiety hierarchy is looking at a photograph of a small spider in a magazine while at the top is thinking of a bunch of harmless spiders.
imagining engaging in behaviors such as looking at a live spider in a tank, touching a live spider while wearing gloves, and allowing one small spider to crawl on her leg are possible steps in the anxiety hierarchy.
Once she learns some relaxation techniques and builds an anxiety hierarchy with the therapist, she can begin to use counterconditioning to replace her fear of spiders with relaxation.
The therapist will ask Penelope to relax and then ask her to imagine the first step in the anxiety hierarchy.
She imagines looking at a picture of a spider in a magazine.
The therapist will ask her to imagine the second step of the anxiety hierarchy if she can accomplish this task without fear.
When she feels anxious, she will continue to climb up the hierarchy.
The therapist will tell her to take a step back from the top until she feels better.
This process will continue until she feels no anxiety, even when she reaches the top of the hierarchy.
Learning through classical conditioning is strengthened by repetition.
The stronger the relaxation response becomes, the more times it is combined with the feared stimuli.
Classical conditioning techniques can be used to treat anxiety disorders.
Flooding can be covert or live.
Flooding involves having the client address the most frightening scenario first.
This technique produces a lot of anxiety.
The idea is that if clients face their fears and don't back down, they will soon realize that their fears are irrational.
If she were to imagine that large spiders were crawling on her but that nothing bad was happening as a result, her fear would soon be extinguished.
The therapist could try to cure the fear by using modeling.
Modeling is a process through which one person learns by observing another person's behavior.
Unlike the other techniques described in this section, modeling is a blend of cognitive and behavioral ideas, but it makes sense to discuss it with systematic desensitization and flooding because all three involve some degree of contact with the feared stimuli.
Modeling could be used to treat Penelope's fear by having her watch someone else interact calmly and without ill effect with various spiders and then asking her to reenact what she had seen.
Modeling can be used to help people with a lot of other difficulties.
Aversive conditioning is a way that classical conditioning techniques can be used to treat people.
This process pairs a habit a person wants to break with an unpleasant experience such as electric shock or nausea.
Operant conditioning can be used for treatment.
The principles developed by B. F. Skinner are used to modify a person's behavior.
A token economy is a form of instrumental conditioning used in mental institutions.
In a token economy, desired behaviors are identified and rewarded.
The token can be exchanged for privileges.
The cause of psychological problems in the way people think can be found by cognitive therapists and their methods of therapy focus on changing these unhealthy thought patterns.
As therapists challenge their clients' irrational thinking patterns, cognitive therapy is often quite combative.
A way of thinking is to attribute failures to internal, global, and permanent aspects of the self.
Josephine failed a psychology test.
She can explain the failure in many different ways.
A pessimistic and unhealthy style would involve thinking that she is an idiot who will fail all the tests in her life.
The cause of the failure would be viewed as external, specific, and temporary, and she will do better next time.
Cognitive therapy is used in the treatment of depression.
The method involves trying to get clients to do things that will bring them success.
Identifying and challenging the irrational ideas that cause their unhappiness will alleviate the depression.
Beck explains depression using people's beliefs about themselves, their worlds, and their futures.
People suffering from depression often have irrationally negative beliefs.
These beliefs can be made more positive by cognitive therapy.
The ideas and techniques of cognitive and behavioral psychologists are combined in one popular group of therapies.
This approach to therapy is called cognitive behavioral therapy.
Rational emotive behavior therapy, also known as REBT and sometimes referred to as RET, is an example of a specific type of CBT.
Albert Ellis developed REBT.
Therapists use REBT to expose and confront their clients' thoughts.
Someone with a socialphobia might voice concern over being publicly embarrassed when giving a class presentation.
By using REBT, a therapist would question the likelihood of such embarrassment occurring and the impact that would result.
The goal of the therapist is to show the client that his or her failure is not a big deal, even if it does happen.
REBT focuses on more than just how and what clients think.
Often, clients are given homework assignments in which they are asked to engage in behaviors they fear, thus showing that the outcome they expect does not actually occur.
Group of people can be involved in therapy.
The therapists running groups can have any of the orientations described above.
Group therapy can be used to treat families.
Family therapy is a form of treatment.
Since a client's problems do not occur in a vacuum, many therapists find meeting with the whole family helpful in revealing the patterns of interaction between family members and altering the behavior of the whole family rather than just one member.
Group therapy can involve meeting with people with similar difficulties.
It is less expensive for the clients to use such an approach because they will get feedback from their peers as well as the therapist.
A form of group therapy that does not involve a therapist is self-help groups such as AA.
The cause of psychological disorders in organic causes can be seen by psychologists with a biological orientation.
Structural abnormality in the brain, genetic predispositions that might underlie the other two, and imbalances in neurotransmitters or hormones are included.
Therapies that produce bodily changes are advocated by these psychologists.
Drug therapy is the most common type of therapy.
Drugs can be used to treat a wide range of psychological problems.
Drugs are more likely to be used to treat a disorder that is more severe.
Schizophrenia is almost always treated with drugs.
A shortcoming of most kinds of therapy is the limited use in dealing with patients who are unable to express themselves coherently.
Since the main symptom of schizophrenia is disorganized thought, people suffering from this disorder have difficulty communicating with others, rendering psychotherapy of limited use.
Schizophrenia can be treated with drugs.
The drugs block the dopaminergic sites.
The dopamine hypothesis is supported by their effectiveness.
tardive dyskinesia is a side effect of antipsychotic medication.
Mood disorders respond well to treatment.
Prozac is one of the most common kinds of drugs used to treat unipolar depression.
Tricyclics and MAO inhibitors seem to have different effects.
The manic phase of bipolar disorder is often treated with lithium.
Drugs are used to treat anxiety disorders.
The drugs act by depressing the activity of the central nervous system, making people feel more relaxed.
Valium and Xanax are two of the main types of antianxiety drugs.
The most common drugs used to treat many of the disorders discussed in Chapter 12 are listed in Table 13.3.
ECT is a kind of therapy.
The electric current goes through both hemispheres of the brain.
Unilateral ECT involves only one hemisphere.
Loss of memory is one of the more significant negative side effects of Bilateral ECT.
The electric shock causes patients to have a seizure.
A muscle relaxant is given to patients before they are given ECT.
Patients lose consciousness after a seizure.
ECT is a less common treatment.
It is often used for severe cases of depression after other methods have failed.
One theory suggests that the benefits are the result of a change in the brain's blood flow patterns.
Psychosurgery is the most intrusive form of therapy.
Psychosurgery involves the destruction of part of the brain to change a person's behavior.
It is clear that this procedure is only used as a last resort and only on people who are in dire straits.
The prefrontal lobotomy was an early form of psychosurgery.
The main neurons leading to the brain were cut.
Although this procedure calmed the behavior of patients, it reduced their level of functioning and awareness to a vegetative state.
When surgical procedures have grown much more precise, the debate over the risks of psychosurgery is still going on, and such procedures are done as a last resort.
eclectic therapy includes somatic cognitive therapy.
Drug therapy and cognitive talk therapy are combined by many therapists.
A person diagnosed with unipolar depression might receive a prescription for one of the antidepressants, such as Prozac or Zoloft, while going through cognitive talk therapy to explore negative cognitive functions that might be contributing to his or her depression.
Different levels of training are available for therapists.
Psychiatrists are the only therapists allowed to prescribe medication in most U.S. states.
Because of their background, psychiatrists tend to favor a biomedical model of mental illness and are less trained in psychotherapy.
PhDs require four or more years of study for clinical psychologists.
An internship is part of their training and is overseen by a more experienced professional.
People who are suffering from more severe problems are usually psychologists.
A graduate degree in psychology is required for counseling therapists.
An internship overseen by a more experienced professional is included in their training.
School psychologists and marriage and family therapists are examples of counseling therapists.
People with less severe problems are usually helped by counseling therapists.
Psychoanalysts are trained in Freudian methods.
They may or may not have medical degrees.
Many people recover from a variety of disorders without any intervention, despite the fact that therapy is not always successful.
The success of the treatment process is dependent on the relationship between the client and therapist.
A person who has a bad experience with therapy with one therapist at one time might respond better to another.
Five suggested answers or completions are followed by each of the questions or incomplete statements.
Pick the one that is the best.
During their sessions, Coretta's therapist never makes any recommendations about what she should do.
Craig saw a behaviorist.
After a few months, Craig no longer experiences fear when taking tests, but he has developed an obsessive-compulsive disorder.
Ivan told his therapist at his last appointment that since he lost his job, he felt worthless and depressed.
Maria has been analyzing for over a year.
She is starting to suspect that she has fallen in love with her analyst.
He has been working for the same company for three years.
His salary has not increased despite his increased responsibilities.
He loses his nerve when he talks to his supervisor about a raise.
In therapy, Dr. Flores and her assistant show how to ask for a raise.
The assistant pretends to be Jeb's boss and he practices asking for a raise.