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Abnormal Psychology

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Abnormal Psychology ­ PSY404
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LESSON 23
PSYCHOTHERAPY
Humanistic Psychotherapy
Humanistic psychotherapy originally was promoted as a "third force" in psychotherapy. Humanistic
therapists believe that that each of us has the responsibility for finding meaning in our own lives.
Therapy is seen only as a way to help people to make their own life choices and resolve their own dilemmas.
To help clients make choices, humanistic therapists strive to increase emotional awareness. Given the
emphasis on emotional genuineness, humanistic psychotherapists place a great deal of importance on the
therapist­client relationship.
Most other approaches also recognize the importance on the therapist­client relationship, but they view the
relationship primarily as a means of delivering the treatment.
In humanistic therapy, the relationship is the treatment.
Client-Centered Therapy
Carl Rogers and his client-centered therapy provide a clear example of the humanistic focus on the
therapeutic relationship. Rogers wrote extensively about the process of fostering a warm and genuine
relationship between therapist and client. He particularly noted the importance of empathy, or emotional
understanding.
Empathy involves putting yourself in someone else's shoes and conveying your understanding of that
person's feelings and perspectives. The client-centered therapist does not act as an "expert" who knows
more about the client than the client knows about himself or herself. Rather, the therapeutic goal is to share
honestly in another human's experience.
Rogers encouraged self-disclosure on the part of the therapist, intentionally revealing aspects of the
therapist's own, similar feelings and experiences as a way of helping the client. Rogers also felt that client-
centered therapists must be able to demonstrate unconditional positive regard for their clients.
Unconditional positive regard involves valuing clients for who they are and refraining from judging them.
Because of this basic respect for the client's humanity, client-centered therapists avoid directing the
therapeutic process.
According to Rogers, if clients are successful in experiencing and accepting themselves, they will achieve
their own resolution to their difficulties. Thus client-centered therapy is nondirective.
Gestalt therapy
Gestalt therapy is a humanistic form of treatment developed by Perls. Perls viewed life as a series of figure-
ground relationships. For example a picture is hanging on a wall. The picture is a figure and the wall is the
background. For a healthy person current needs can be perceived clearly in that person's life, just as figure
can be perceived against a distinct ground (background).when current needs are satisfied, they fade into the
ground and are replaced by new needs, which stand out in their turn and are equally recognizable.
Perls believed that mental disorders represent disruptions in these figure- ground relationships. People who
are unaware of their needs or unwilling to accept or express them are avoiding their real inner selves. They
lack self awareness and self acceptance, they fear judgment of others. The technique of role playing that is
to act out various roles assigned by the therapist.
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Role reversal
Clients are told to talk as the other person and feel as the other person.
Example: employee-/employer, or mother /daughter.
Existential therapy
Existential therapists encourage clients to accept responsibility, for their lives and for their problems, to
recognize their freedom to choose a different course and to choose to live an authentic life, one full of
meaning and values. The therapist and client must be open to each other, work hard together, and try to
share, learn and grow. The therapist pushes hard for the client to accept responsibility for her choices in
therapy and life.
A Means, Not an End?
Little research has been conducted on whether or not humanistic therapy is an effective treatment for
abnormal behavior.
 Psychotherapy process research shows that the bond or therapeutic alliance between a therapist
and client is crucial to the success of therapy--no matter what approach is used.
 A therapist's caring, concern, and respect for the individual are important to the success of all
treatments for psychological disorders.
 Psychotherapy outcome research shows that psychotherapy does work--for many people and for
many problems.
 Psychotherapy process research indicates that most approaches to psychotherapy share many "active
ingredients" and these commonalities contribute to making most types of treatment at least
somewhat helpful.
 Contemporary research demonstrates more and more that different treatments are more effective
for helping different disorders.
Does Psychotherapy Work?
Psychotherapy outcome research examines the outcome, or result, of psychotherapy--its effectiveness for
relieving symptoms, eliminating disorders, and/or improving life functioning.
Hundreds of studies have compared the outcome of psychotherapy with alternative treatments or with no
treatment at all.
In order to summarize findings across all of these studies, psychologists have invented a new statistical
technique called meta-analysis, a statistical procedure that allows researchers to combine the results from
different studies in a standardized way.
Meta-analysis indicates that the average benefit produced by psychotherapy is .85 standard deviation units.
The statistic indicates that the average client who receives therapy is better off than 80 percent of untreated
persons.
A .85 standard deviation change also shows that roughly two-thirds of clients who undergo psychotherapy
improve significantly, whereas about one-third of people who receive no treatment improve over time.
Thus, we can conclude that therapy "works," but you should remember a very important qualification:
Research shows that many benefits of psychotherapy diminish in the year or two after treatment ends.
Do People Improve without Treatment?
Psychologists widely accept that about two-thirds of clients improve in the short term as a result of
psychotherapy.
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Some skeptics have suggested, however, that far more than one-third of untreated emotional disorders have
a spontaneous remission, that is, the problems may improve without any treatment at all.
It is hard to know how many people with psychological problems improve without treatment.
Researchers have found that as many as one-half of people seeking psychotherapy improve as a result of
simply having unstructured conversations with a professional.
The Placebo Effect
Placebos are any type of treatment that contains no known active ingredients for treating the condition
being evaluated.
The placebo effect, the powerful healing produced by apparently inert treatments, has been demonstrated
widely and repeatedly in psychotherapy, dentistry, optometry, cardiovascular disease, cancer treatment, and
even surgery.
Experts agree that many of the benefits of physical and psychological treatments are produced by placebo
effects, which apparently are caused by the recipient's belief in a treatment and expectation of improvement.
Research shows that the "active ingredients" in placebos include heightened expectations for improvement
and classical conditioning owing to past, successful treatment.
Placebo Control Groups
The ultimate goal of treatment research is to identify therapies that produce change above and beyond
placebo effects.
Many investigations in medicine and psychotherapy include placebo control groups in which patients are given
treatments that are intentionally designed to have no active ingredients.
The double-blind study is a study in which neither the physician nor the patient knows whether the
prescribed pill is the real medication or a placebo.
Unfortunately, a double-blind study cannot be used in psychotherapy outcome research.
Efficacy and Effectiveness
Tightly controlled experiments provide important information about the efficacy of psychotherapy, that is,
whether the treatment can work under prescribed circumstances.
However, such studies provide little information about the effectiveness of the treatment--whether the
therapy does work in the real world.
The magazine Consumer Reports (1995, November) surveyed nearly 3,000 readers who had seen a mental
health professional in the past three years, and the respondents generally rated psychotherapy highly.
Of the 426 people who were feeling "very poor" at the beginning of treatment, 87 percent reported feeling
"very good," "good," or at least "so-so" when they were surveyed.
When Does Psychotherapy Work?
What predicts when treatment is more or less likely to be effective?
 The most important predictor is the nature of a client's problems--the diagnosis.
 If therapy is going to be effective, it usually will be effective rather quickly.
 Clients' background characteristics also predict outcome in psychotherapy.
 The acronym YAVIS was coined to indicate that clients improve more in psychotherapy when they
are "young, attractive, verbal, intelligent, and successful."
 This finding has caused considerable concern, for it seems to indicate that psychotherapy works
best for the most advantaged members of our society.
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Another concern is that men are considerably less likely than women to seek therapy.
The masculine role seems to discourage appropriate help seeking.
Psychotherapy Process Research
Psychotherapy process research is an approach that examines what aspects of the therapist­client
relationship predict better outcome.
A classic study by Sloane and colleagues found that the different paradigms share some surprising
similarities.
In this study, 90 patients who had moderate difficulties with anxiety, depression, or similar problems were
assigned at random to receive either psychodynamic psychotherapy, behavior therapy, or no treatment.
All three groups, including the no-treatment group, improved over time, but the treated groups improved
significantly more than the untreated group.
Behavior therapy was more effective in a few instances, but on most measures, there were no differences
between the two treatment groups.
Much of the effectiveness of different forms of psychotherapy is explained by common factors.
Therapy as Social Support
The therapist­client relationship is one essential common factor across different approaches to therapy.
Carl Rogers argued that warmth, empathy, and genuineness formed the center of the healing process,
and research on psychotherapy process indicates that a therapist's supportiveness is related to positive
outcomes across approaches to treatment.
Objective indicators of a therapist's support are less potent predictors of successful outcome than are a
client's rating of the therapist.
Clients may perceive different therapeutic stances as supportive, depending on the particular types of
relationships with which they are most comfortable.
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Therapy as Social Influence
Psychotherapy is a process of social influence as well as of social support.
Jerome Frank, an American trained in psychology and psychiatry, argued that, in fact, psychotherapy is
a process of persuasion--persuading clients to make beneficial changes in their emotional lives.
Psychotherapy process research clearly demonstrates the therapist's social influence.
Psychotherapy is not value free.
There are values inherent in the nature of therapy itself--for example, the belief that talking is good.
Moreover, the values of individual therapists about such topics as love, marriage, work, and family
necessarily influence clients.
Couples Therapy or Marital Therapy
Couples therapy involves seeing intimate partners together in psychotherapy.
The goal of couple's therapy typically is to improve the relationship, and not to treat the individual.
Couples therapists typically help partners to improve their communication and negotiation skills.
Research shows that couples therapy can improve satisfaction in marriages.
When couples therapy is used in conjunction with individual treatment, the combined approach often is
more effective than individual therapy alone.
Family Therapy
Family therapy might include two, three, or more family members in a treatment designed to improve
communication, negotiate conflicts, and perhaps change family relationships and roles.
Parent management training is an approach that teaches parents new skills for rearing troubled children.
In conjoint family therapy, the therapist focuses on communication to the family system, helping members
recognize harmful patterns of communication appreciate the impact of such patterns on other family
members and change the patterns. A therapist helps a mother, father, and a son to identify their faulty
communication patterns and to modify them for help.
As with individual and couples therapy, there are many different theoretical approaches to family therapy.
Many approaches to family therapy are distinguished, however, by their longstanding emphasis on systems
theory.
In applying systems theory, family therapists emphasize interdependence among family members and the
paramount importance of viewing the individual within the family system.
A common goal in systems approaches to family therapy is to strengthen the alliance between the parents,
to get parents to work together and not against each other.
Group therapy involves treating a collection of people with similar emotional problems
Psychodrama and self help groups
Psychodrama was pioneered by Moreno.
Group members act out dramatic roles as if they are participants or actors in a drama.
There is a stage, background scenery, audience, director (therapist) and supporting actors or auxiliary egos.
The techniques of psychodrama include role playing, role rehearsal, role reversal, the magic shop and the
mirroring technique. In role reversal, two group members play each other's role such as the role of an
employee an employer, father / son, teacher and student. In magic shop, participants exchange one of their
undesirable personal characteristics for a quality that they desire.
In mirroring technique, the group member portrays another individual thus showing how he or she appears
to others. Just as a mirror, gives a reflection, of our own image.
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Self Help Groups
They are made up of people, who have similar problems and they come together to help and support one
another with the direct leadership of a clinician. These groups help people in problems like compulsive
gambling, alcoholism, rape victims, divorced people, etc. In the self help groups, they encourage more
people to help among others by members, so a veteran member of an existing self help group is assigned a
number of new members to be helped.
Encounter Groups
Encounter groups or sensitivity groups develop with Carl Rodgers client center therapy and with Perls
Gestalt therapy. In encounter groups all the members are strangers and the leader is the therapist. The
groups consists of some six to eleven people smaller the group, more the interaction. Larger the group, less
is the interaction. Encounter groups do not provide therapy. They provide help with greater understanding
of group processes and group interaction. Encounter groups are sponsored by employers to improve their
employee work performance.
Group Therapy
Group therapy involves treating a collection of several people who are facing similar emotional problems
or life issues.
Psycho-educational groups are designed to teach group members specific information or skills relevant to
psychological well-being.
In experiential group therapy the relationships formed between group members in a unique setting
become the primary mode of treatment.
In an encounter group, group members may question self-disclosure when it is "phony" but support more
honest appraisals of oneself.
Self-help groups bring together people who face a common problem and who seek to help themselves and
each other by sharing information and experiences.
Technically, self-help groups are not therapy groups, because typically a professional does not lead them.
Available evidence suggests that self-help groups can be beneficial even when they are delivered by
paraprofessionals--people who do have limited professional training, but who have personal experience
with the problem.
Prevention
Community psychology is one approach within clinical psychology that attempts to improve individual
well-being by promoting social change.
Primary prevention tries to improve the environment in order to prevent new cases of a mental disorder
from developing.
In primary prevention, community workers focus on improving community attitudes and policies with the
goal of preventing mental disorders. They work hard in providing recreational programs such as providing
parks for people or child care facilities, or help the school board to formulate the curriculum or offer public
workshops on stress reduction.
The community workers may consult school teachers, ministers, or police officers to teach them how to
involve persons in treatment. They may also offer `hotlines' or walk in clinics that encourage individuals to
make early treatment contacts before their immediate psychological difficulties become extended.
Tertiary prevention may involve any of the treatments discussed in this chapter, because the intervention
occurs after the illness has been identified.
Community workers with the help of day centers or day hospitals, or half way houses or sheltered
workshops provide treatment, residential facility and protective supervised occupational training. These
tertiary prevention services in most communities provide with proper care and help to these rehabilitated
people facing psychological difficulties.
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In addition to providing treatment, however, tertiary prevention also attempts to address some of the
adverse, indirect consequences of mental illness.
Many prevention efforts face an insurmountable obstacle: We simply do not know the specific cause of
most psychological disorders.
Computer Therapy
Computers are powerful holders and sorters of information. They were created to liberate people from time
consuming repetitive tasks, and much of psychological assessment and diagnosis fits that description well.
Many clinicians now use computer programs to help them gather client's histories, assess self-report
inventories, and even make preliminary diagnoses. Such uses of computer programs can save time and make
psychological resting widely available.
Two computer centered therapies, one Eliza program developed in 1966 designed to simulate the CCT
Therapy session.
No. 2 Plato DCS, developed in 1980 is a computer counseling system that helps people to articulate their
problems in form of `if- then' statements. Computers may never fully substitute a trained therapist because
the language, intelligence, emotion and training of a therapist is unique and cannot be replaced by a
computer.
Contemporary psychotherapy researchers are advancing knowledge by studying factors common to all
therapies.
The ultimate goal of treatment research, however, is to identify different therapies that have specific active
ingredients for treating specific disorders.
The identification of effective treatments for specific disorders is necessary if clinical psychology is to fulfill
its scientific promise.
The challenge for the mental health professional is to approach treatment both as a scientist and as a
practitioner.
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Table of Contents:
  1. ABNORMAL PSYCHOLOGY:PSYCHOSIS, Team approach in psychology
  2. WHAT IS ABNORMAL BEHAVIOR:Dysfunction, Distress, Danger
  3. PSYCHOPATHOLOGY IN HISTORICAL CONTEXT:Supernatural Model, Biological Model
  4. PSYCHOPATHOLOGY IN HISTORICAL CONTEXT:Free association, Dream analysis
  5. PSYCHOPATHOLOGY IN HISTORICAL CONTEXT:Humanistic Model, Classical Conditioning
  6. RESEARCH METHODS:To Read Research, To Evaluate Research, To increase marketability
  7. RESEARCH DESIGNS:Types of Variables, Confounding variables or extraneous
  8. EXPERIMENTAL REASEARCH DESIGNS:Control Groups, Placebo Control Groups
  9. GENETICS:Adoption Studies, Twin Studies, Sequential Design, Follow back studies
  10. RESEARCH ETHICS:Approval for the research project, Risk, Consent
  11. CAUSES OF ABNORMAL BEHAVIOR:Biological Dimensions
  12. THE STRUCTURE OF BRAIN:Peripheral Nervous System, Psychoanalytic Model
  13. CAUSES OF PSYCHOPATHOLOGY:Biomedical Model, Humanistic model
  14. CAUSES OF ABNORMAL BEHAVIOR ETIOLOGICAL FACTORS OF ABNORMALITY
  15. CLASSIFICATION AND ASSESSMENT:Reliability, Test retest, Split Half
  16. DIAGNOSING PSYCHOLOGICAL DISORDERS:The categorical approach, Prototypical approach
  17. EVALUATING SYSTEMS:Basic Issues in Assessment, Interviews
  18. ASSESSMENT of PERSONALITY:Advantages of MMPI-2, Intelligence Tests
  19. ASSESSMENT of PERSONALITY (2):Neuropsychological Tests, Biofeedback
  20. PSYCHOTHERAPY:Global Therapies, Individual therapy, Brief Historical Perspective
  21. PSYCHOTHERAPY:Problem based therapies, Gestalt therapy, Behavioral therapies
  22. PSYCHOTHERAPY:Ego Analysis, Psychodynamic Psychotherapy, Aversion Therapy
  23. PSYCHOTHERAPY:Humanistic Psychotherapy, Client-Centered Therapy, Gestalt therapy
  24. ANXIETY DISORDERS:THEORIES ABOUT ANXIETY DISORDERS
  25. ANXIETY DISORDERS:Social Phobias, Agoraphobia, Treating Phobias
  26. MOOD DISORDERS:Emotional Symptoms, Cognitive Symptoms, Bipolar Disorders
  27. MOOD DISORDERS:DIAGNOSIS, Further Descriptions and Subtypes, Social Factors
  28. SUICIDE:PRECIPITATING FACTORS IN SUICIDE, VIEWS ON SUICIDE
  29. STRESS:Stress as a Life Event, Coping, Optimism, Health Behavior
  30. STRESS:Psychophysiological Responses to Stress, Health Behavior
  31. ACUTE AND POSTTRAUMATIC STRESS DISORDERS
  32. DISSOCIATIVE AND SOMATOFORM DISORDERS:DISSOCIATIVE DISORDERS
  33. DISSOCIATIVE and SOMATOFORM DISORDERS:SOMATOFORM DISORDERS
  34. PERSONALITY DISORDERS:Causes of Personality Disorders, Motive
  35. PERSONALITY DISORDERS:Paranoid Personality, Schizoid Personality, The Diagnosis
  36. ALCOHOLISM AND SUBSTANCE RELATED DISORDERS:Poly Drug Use
  37. ALCOHOLISM AND SUBSTANCE RELATED DISORDERS:Integrated Systems
  38. SCHIZOPHRENIA:Prodromal Phase, Residual Phase, Negative symptoms
  39. SCHIZOPHRENIA:Related Psychotic Disorders, Causes of Schizophrenia
  40. DEMENTIA DELIRIUM AND AMNESTIC DISORDERS:DELIRIUM, Causes of Delirium
  41. DEMENTIA DELIRIUM AND AMNESTIC DISORDERS:Amnesia
  42. MENTAL RETARDATION AND DEVELOPMENTAL DISORDERS
  43. MENTAL RETARDATION AND DEVELOPMENTAL DISORDERS
  44. PSYCHOLOGICAL PROBLEMS OF CHILDHOOD:Kinds of Internalizing Disorders
  45. LIFE CYCLE TRANSITIONS AND ADULT DEVELOPMENT:Aging