Chapter 16

Question 1

What are insight therapies?

Answer 1

• • “talk therapy”
• • insight therapies involve verbal interactions intended to enhance clients’ self-knowledge and thus promote healthful changes in personality and behaviour.
• • The goal is to pursue increased insight regarding the nature of the client’s difficulties and to sort through possible solutions

Question 2

What are behaviour therapies?

Answer 2

• • based on the principles of learning
• • Instead of emphasizing personal insights, behaviour therapists make direct efforts to alter problematic responses (phobias, for instance) and maladaptive habits (e.g., drug use).
• • Most of their procedures involve classical conditioning, operant conditioning, or observational learning

Question 3

What are biomedical therapies?

Answer 3

• • interventions into a person’s bio- logical functioning

- - drug therapy and electroconvulsive (shock) therapy

Question 4

What type of people seek therapy?

Answer 4

• • Among adults, the two most common presenting problems are depression and anxiety disorders
• • People often delay for many years before finally seeking treatment for their psychological problems
• • Research has shown that women are more likely than men to receive therapy and that there are cultural differences in people’s willingness to pursue treatment
• • Treatment is also more likely when people have workplace medical insurance/benefits and when they have more education
• • Lack of health insurance and cost concerns appear to be major barriers to obtaining needed care for many people, with the biggest barrier being the stigma associated with mental health treatment
• • The rates for unmet needs were particularly high for individuals reporting anxiety or mood disorders

Question 5

What is psychotherapy and who provides it

Answer 5

• • Psychotherapy refers to professional treatment by someone with special training
• • Psychology and psychiatry are the principal professions involved in the provision of psy- chotherapy. However, therapy is increasingly provided by clinical social workers, psychiatric nurses, counsel- lors, and marriage and family therapists

Question 6

What are psychologists?

Answer 6

• • Clinical psychologists’ training emphasizes the treatment of full-fledged disorders
• • Counselling psychologists’ training is slanted toward the treatment of everyday adjustment problems
• • psychologists use either insight or behavioural approaches. In comparison to psychiatrists, they are more likely to use behavioural techniques and less likely to use psychoanalytic methods
• • Clinical and counselling psychologists do psychological testing as well as psychotherapy, and many also conduct research

Question 7

What are psychiatrists?

Answer 7

• • physicians who specialize in the diagnosis and treatment of psychological disorders
• • in comparison to psychologists, psychiatrists devote more time to relatively severe disorders (schizophrenia, mood disorders) and less time to everyday marital, family, job, and school problems
• • psychiatrists are more likely to use psychoanalysis and less likely to use group therapies or behaviour therapies
• • contemporary psychiatrists increasingly depend on medication as their principal mode of treatment

Question 8

What are some other mental health professionals?

Answer 8

• • clinical social workers and psychiatric nurses often work as part of a treatment team with a psychologist or psychiatrist
• • Psychiatric nurses play a large role in hospital inpatient treatment
• • Clinical social workers typically work with patients and their families to ease the patient’s integration back into the community
• • Counsellors are usually found working in schools, colleges, and assorted human service agencies (youth centres). They often specialize in particular types of problems, such as vocational counselling, marital counselling, rehabilitation counselling, and drug counselling.

Question 9

What is psychoanalysis?

Answer 9

• • an insight therapy that emphasizes the recovery of unconscious conflicts, motives, and defences through techniques such as free association and transference
• • therapeutic procedures used: probing the unconscious, interpretation, resistance and transference, and other modern psychodynamic therapies

Question 10

What is probing the unconscious?

Answer 10

• • The analyst attempts to probe the murky depths of the unconscious to discover the unresolved conflicts causing the client’s neurotic behaviour
• • to explore the unconscious, two techniques are used: free association and dream analysis
• • In free association, clients spontaneously express their thoughts and feelings exactly as they occur, with as little censorship as possible. Clients expound on anything that comes to mind, regardless of how trivial, silly, or embarrassing it might be. The analyst studies these free associations for clues about what is going on in the client’s unconscious.
• • In dream analysis, the therapist interprets the symbolic meaning of the client’s dreams. Freud saw dreams as the “royal road to the unconscious,” the most direct means of access to patients’ innermost conflicts, wishes, and impulses. Clients are encouraged and trained to remember their dreams, which they describe in therapy

Question 11

What is interpretation?

Answer 11

• • the therapist’s attempts to explain the inner significance of the client’s thoughts, feelings, memories, and behaviours
• • analysts do not interpret everything, and they generally don’t try to dazzle clients with startling revelations. Instead, analysts move forward inch by inch, offering interpretations that should be just out of the client’s own reach.

Question 12

What is resistance and transference?

Answer 12

• • Resistance refers to largely unconscious defensive manoeuvres intended to hinder the progress of therapy
• • Analysts use a variety of strategies to deal with clients’ resistance; a key consideration is the handling of transference
• • Transference occurs when clients start relating to their therapists in ways that mimic critical relationships in their lives. Thus, a client might start relating to a therapist as if the therapist were an overprotective mother, a rejecting brother, or a passive spouse. Psychoanalysts often encourage trans- ference so that clients can re-enact relations with crucial people in the context of therapy. These re- enactments can help bring repressed feelings and conflicts to the surface, allowing the client to work through the conflicts

Question 13

What are some modern psychodynamic therapies?

Answer 13

• • classical psychoanalysis as done by Freud is not widely practised anymore. As his followers fanned out across Europe and North America, many found it neces- sary to adapt psychoanalysis to different cultures, changing times, and new kinds of patients. hese descendants of psychoanalysis are collectively known as psychodynamic approaches.
• • Modern psychodynamic therapies include (1) a focus on emotional experience, (2) exploration of efforts to avoid distressing thoughts and feelings, (3) identification of recurring patterns in patients’ life experiences, (4) discussion of past experience, especially events in early childhood, (5) analysis of interpersonal relationships, (6) a focus on the therapeutic relationship itself, and (7) exploration of dreams and other aspects of fantasy life

Question 14

What is client-centred therapy?

Answer 14

• • Using a humanistic perspective, Rogers devised client-centred therapy: 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
• • the client and therapist work together as equals. The therapist provides relatively little guidance and keeps interpretation and advice to a minimum
• • Rogers maintains that most personal distress is due to inconsistency, or “incongruence,” between a person’s self-concept and reality
• • Given Rogers’s theory, client-centred therapists help clients to realize that they do not have to worry constantly about pleasing others and winning acceptance. They help people restructure their self-concept to correspond better to reality.

Question 15

What is a therapeutic climate?

Answer 15

• • According to Rogers, it is critical for the therapist to provide a warm, supportive climate that creates a safe environment in which clients can confront their shortcomings without feeling threatened
• • The lack of threat should reduce clients’ defensive tendencies and thus help them open up
• • client-centred therapists must provide three conditions: (1) genuineness (honest communication), (2) unconditional positive regard (non- judgmental acceptance of the client), and (3) accurate empathy (understanding of the client’s point of view)
• • research has found that measures of therapists’ empathy and unconditional positive regard correlate with positive patient outcomes

Question 16

What is the therapeutic process?

Answer 16

• • The therapist’s key task is clarification. Client-centred therapists try to function like human mirrors, reflecting statements back to their clients, but with enhanced clarity
• • they try to help clients better understand their interpersonal relationships and become more comfortable with their genuine selves
• • psychologist Les Greenberg and his colleagues have developed emotion-focused couples therapy; the nature of the relationship issues and underlying emotions are first identified. The partners are then afforded an opportunity to identify and acknowledge their needs and are encouraged to express these needs and to arrive at solutions to the problems.

Question 17

What are therapies inspired by positive psychology?

Answer 17

– positive psychology uses theory and research to better understand the positive, adaptive, creative, and fulfilling aspects of human existence
– well-being therapy, developed by Giovanni Fava: seeks to enhance clients’ self-acceptance, purpose in life, autonomy, and personal growth. It has been used successfully in the treatment of mood disorders and anxiety disorders
– positive psychotherapy, developed by Martin Seligman:
attempts to get clients to recognize their strengths, appreciate their blessings, savour positive experiences, forgive those who have wronged them, and find meaning in their lives. Used mainly in the treatment of depression.
Research suggests that positive psychotherapy can be an effective treatment for depression; positive psychotherapy was compared to treatment as usual and treatment as usual with medication. The lowest depression scores were observed in the group that received positive psychotherapy

Question 18

How did Mongrain study the efficacy of positive psychology?

Answer 18

• • examined the effectiveness of online interventions designed to increase either participants’ self-compassion or optimism.
• • interested in the effects of these interventions on participants’ depression and happiness scores
• • Prior to the interventions, participants were assessed for their vulnerability to depression
• • Both the self-compassion and the optimism interventions were related to increases in happiness and decreases in depression scores, effects that were observed to last for several months.
• • individuals with particular types of vulnerabilities to depression might differentially benefit most from either the self- compassion or optimism interventions

Question 19

What is group therapy?

Answer 19

• • the simultaneous treatment of several clients in a group
• • A therapy group typically consists of four to twelve people, with six to eight participants regarded as ideal (excluding persons who seem likely to be disruptive)
• • Participants essentially function as therapists for one another. Most important, they provide acceptance and emotional support for one another.
• • In group treatment, the therapist’s responsibilities include selecting participants, setting goals for the group, initiating and maintaining the therapeutic process, and preventing interactions among group members that might be psychologically harmful. They play a relatively subtle role in group therapy
• • Group therapies obviously save time and money, which can be critical in understaffed mental hospitals and other institutional settings

Question 20

What is couples and family therapy?

Answer 20

• • Couples or marital therapy involves the treatment of both partners in a committed, intimate relationship, in which the main focus is on relationship issues
• • Family therapy involves the treatment of a family unit as a whole, in which the main focus is on family dynamics and communication
• • Family therapy often emerges out of efforts to treat children or adolescents with individual therapy (A child’s therapist, for instance, might come to the realization that treatment is likely to fail because the child returns to a home environment that contributes to the child’s problems)
• • First, couples/marital therapies seek to understand the entrenched patterns of interaction that produce distress (view individuals as parts of a family ecosystem, and they assume that people behave as they do because of their role in the system). Second, they seek to help couples and families improve their communication and move toward healthier patterns of interaction.

Question 21

How effective are insight therapies?

Answer 21

• • spontaneous remission: when psychological disorders sometimes clear up on their own
• • so, if a client experiences a recovery after treatment, we can’t automatically assume the recovery was due to the treatment
• • Evaluations of insight therapies are especially complicated given that various schools of thought pursue entirely different goals
• • Moreover, people enter therapy with diverse problems of varied severity, which further complicates the evaluation process
• • However, studies consistently indicate that insight therapy is superior to no treatment or to placebo treatment and that the effects of therapy are reasonably durable
• • when insight therapies are compared head-to-head against drug therapies, they usually show roughly equal efficacy
• • Studies generally find the greatest improvement early in treatment (first 10 - 20 weekly sessions), with further gains gradually diminishing over time

Question 22

How do insight therapies work?

Answer 22

• • different therapies achieve similar benefits through different processes
• • An alternative view espoused by many theorists is that the diverse approaches to therapy share certain common factors that account for much of the improvement
• • the common factors include (1) the development of a therapeutic alliance with a professional helper; (2) the provision of emotional support and empathy; (3) the cultivation of hope and positive expectations in the client; (4) the provision of a rationale for the client’s problems and a plausible method for reducing them; and (5) the opportunity to express feelings, confront problems, and gain new insights
• • the benefits of therapy represent the combined effects of common factors and specific procedures
• • When the variance in patient outcomes was divided among various influences, the researchers estimated that 49 percent of this variance was attributable to common factors

Question 23

What are behaviour therapies?

Answer 23

• • Insight therapists treat pathological symptoms as signs of an underlying problem, whereas behaviour therapists think that the symptoms are the problem
• • Behaviour therapists have historically placed more emphasis on the importance of measuring therapeutic outcomes than insight therapists have
• • behaviour therapies involve the application of learning principles to direct efforts to change clients’ maladaptive behaviours (one exception to this exclusive focus on symptoms is referred to as Cognitive-behavioural therapy, which includes both insight and behavioural techniques)
• • behaviour therapy emerged out of three independent lines of research fostered by B. F. Skinner, Hans Eysenck, and Joseph Wolpe
• • Behaviour therapies are based on certain assumptions; First, it is assumed that behaviour is a product of learning and conditioning. Second, it is assumed that what has been learned can be unlearned.
• • Thus, behaviour therapists attempt to change clients’ behaviour by applying the principles of classical conditioning, operant conditioning, and observational learning

Question 24

What is Systematic Desensitization?

Answer 24

• • Devised by Joseph Wolpe, systematic desensitization is a behaviour therapy used to reduce phobic clients’ anxiety responses through counterconditioning. The treatment assumes that most anxiety responses are acquired through classical conditioning. Harmless stimulus (e.g., a bridge) may be paired with a fear- arousing event (lightning striking the bridge), so that it becomes a conditioned stimulus eliciting anxiety. The goal of systematic desensitization is to weaken the association between the conditioned stimulus (the bridge) and the conditioned response of anxiety
• • Involves three steps:
    1) First, the therapist helps the client build an anxiety hierarchy; a list of anxiety-arousing stimuli related to the specific source of anxiety, such as flying, academic tests, or snakes. The client ranks the stimuli from the least anxiety-arousing to the most anxiety-arousing
    2) The second step involves training the client in deep muscle relaxation; begin during early sessions while the therapist and client are still constructing the anxiety hierarchy. The client must learn to engage in deep, thorough relaxation on command from the therapist.
    3) In the third step, the client tries to work through the hierarchy, learning to remain relaxed while imagining each stimulus; Starting with the least anxiety- arousing stimulus, the client imagines the situation as vividly as possible while relaxing. If the client experiences strong anxiety, he or she drops the imaginary scene and concentrates on relax- ation. The client keeps repeating this process until he or she can imagine a scene with little or no anxiety, and then moves on to the next stimulus. As clients conquer imagined phobic stimuli, they may be encouraged to confront the real stimuli.

Question 25

What are exposure therapies?

Answer 25

• • In exposure therapies, clients are confronted with situations they fear so they learn that these situations are really harmless
• • take place in a controlled setting and often involve a gradual progression from less-feared to more-feared stimuli

Question 26

What is aversion therapy?

Answer 26

• • Aversion therapy is a behaviour therapy in which an aversive stimulus is paired with a stimulus that elicits an undesirable response. For example, alcoholics have had an emetic drug (one that causes nausea and vomiting) paired with their favourite drinks during therapy sessions (to create a conditioned aversion to alcohol)
• • Psychologists usually suggest it only as a treatment of last resort, after other interventions have failed
• • Admittedly, alcoholics treated with aversion therapy know that they won’t be given an emetic outside of their therapy sessions. However, their reflex response to the stimulus of alcohol may be changed so that they respond to it with nausea and distaste
• • Troublesome behav- iours treated successfully with aversion therapy have included drug and alcohol abuse, sexual deviance, gambling, shoplifting, stuttering, cigarette smoking, and overeating

Question 27

What is social skills training?

Answer 27

• • Behaviour therapists point out that people are not born with social finesse, they acquire social skills through learning. Social ineptitude can contribute to anxiety, feelings of inferiority, and various kinds of disorders
• • Social skills training is a behaviour therapy designed to improve interpersonal skills that emphasizes modelling, behavioural rehearsal, and shaping
• • can be con- ducted with individual clients or in groups, and depends on the principles of operant conditioning and observational learning
• • With modelling, the client is encouraged to watch socially skilled friends and colleagues in order to acquire appropriate responses (eye contact, active listening, and so on) through observation
• • In behavioural rehearsal, the client tries to practise social techniques in structured role-playing exercises. The therapist provides corrective feedback and uses approval to reinforce progress
• • Shaping is used in that clients are gradually asked to handle more complicated and delicate social situations

Question 28

What is cognitive behavioural therapies?

Answer 28

• • cognitive factors play a key role in the development of many anxiety and mood disorders
• • Cognitive-behavioural treatments use varied combinations of verbal interventions and behaviour modification techniques to help clients change maladaptive patterns of thinking
• • Some of these treatments, such as rational-emotive behaviour therapy and cognitive therapy, emerged out of an insight therapy tradition, whereas other treatments, emerged from the behavioural tradition
• • Cognitive therapy uses specific strategies to correct habitual thinking errors that underlie various types of disorders
• • According to cognitive therapists, depression and other disorders are caused by “errors” in thinking
• • To begin, clients are taught to detect their automatic negative thoughts. Clients are then trained to subject these automatic thoughts to reality testing. The therapist helps them see how unrealistically negative the thoughts are
• • Cognitive therapy uses a variety of behavioural techniques, such as modelling, systematic monitoring of one’s behaviour, and behavioural rehearsal. Clients may be instructed to engage in overt responses on their own, outside of the clinician’s office.
• • Donald Meichenbaum; self-instructional training in which clients are taught to develop and use verbal statements that help them cope with difficult contexts
• • Zindel Segal; traditional cognitive-behavioural techniques are combined with meditation-based techniques to heighten self-awareness of thoughts and emotions and to dysfunctional changes in the mind and body that can be targeted by cognitive- behavioural techniques

Question 29

What is mindfulness/mindfulness-based therapy?

Answer 29

• • Mindfulness emphasizes both attention regulation and an open, accepting approach to one’s thoughts and experience (full attention is given to the present- moment experience). Whatever arises is acknowledged and examined without judgment, elaboration, or reaction
• • In mindfulness meditation, thoughts are acknowledged and accepted, but not evaluated or reacted to.
• • Mindfulness-based therapy was originally designed to prevent relapse in individuals who have previously but who do not currently suffer from depression
• • studies finding that previously depressed individuals who received mindfulness training evidenced reduced rates of relapse and show significantly decreased dysfunctional recollection of past events
• • In other research, mindfulness and mindfulness-based cognitive-behavioural therapy (MBCT) has been found to be associated with less worry, with the generation of more specific future goals, with beliefs about self-efficacy for people with a history of suicidalilty, with distinct neural modes of self-reference, and even with affecting the structure of the brain
• • mindfulness-based cognitive therapy can be delivered effectively in an online format

Question 30

What did Orsillo and Roemer develop?

Answer 30

• • developed a mind- fulness-based therapeutic approach to anxiety
• • suggest that mindfulness practices are not only an important therapeutic tool, but that the skills people acquire will help them live the lives they want to live
• • These skills include (1) increased awareness; being able to notice where our attention is along with the ability to bring it back into focus (2) present moment; being able to bring the mind back to the present moment whenever we begin to think of past difficulties and worries; (3) self-compassion; the ability to have compassion for yourself and your experiences; and (4) accepting things as they are. When we accept and respond to things as they are, we can avoid the dysfunctional reactivity that occurs when we contrast them to the way we want things to be

Question 31

How effective are behaviour therapies?

Answer 31

• • behaviour therapies are not well suited to the treatment of some types of problems (vague feelings of discontent, for instance)
• • it’s misleading to make global statements about the effectiveness of behaviour therapies, because they include many types of procedures designed for very different purposes
• • it is sufficient to note that there is favourable evidence on the efficacy of most of the widely used behavioural interventions