Outline of Psychotherapies

1. Clinical/Counseling Psychology
An art & a science…..

2. Clinical & Counseling
Psychologists….
• ….work with people who are struggling
with psychological disorders
• ….help people to make changes that they
want to make in their lives

3. What happens in therapy differs
depending on…
• …the problem: For some specific disorders,
research has determined which approaches
work best
– e.g., cognitive-behavioral therapy is the “treatment
of choice” for depression & for panic disorder
• …the therapist: different therapists have
different orientations or may take an eclectic
approach. An eclectic therapist may combine
ideas from the various therapies as she deems
appropriate for the client and the problem.

4. What happens in therapy differs
depending on…
• …the problem
• …the therapist
• …the client: Just as some client’s problems
may fit more with one approach than others,
the client’s personality may fit more with
one approach than with others. Both
therapist and client need to decide together
what approach is best.

5. The different treatment
approaches are based on the
various approaches to
personality, so you’ve heard them
before….

6. Treatment approaches include:
• Behavioral
• Cognitive
• Freudian (Psychodynamic)
• Humanistic
• Systems approaches
• Biological approaches

7. Behavioral treatment approach
• Remember the behavioral approach says
that people behave in the way that their
environment has taught them to behave,
e.g., through rewards & punishments,
modeling, etc.
• So the behavioral approach
– Attempts to change the way the environment
reinforces particular behaviors
– Works at applying learning principles to help
people to learn new behaviors.

8. Techniques of the Behavioral
Approach
• Systematic desensitization—This is a
technique used specifically with phobias.
Your book gives a very clear description of
systematic desensitization on pp. 569-570.
Make sure you read it.

9. Techniques of the Behavioral Approach
• Systematic desensitization—helps the client to pair
relaxation with a previously feared stimuli
• Aversive therapy—(almost the opposite of systematic
desensitization!)—has the client pair some aversive
stimuli (e.g., nausea, pain, disturbing images, etc.) with
some behavior that he/she is having difficulty giving up.
– For example, a person trying to quit drinking might take a drug
that makes her nauseous whenever she drinks alcohol.
– A person trying to stop being so self-critical might be told to
wear a rubber band around his wrist and snap it while thinking
“No!” each time he thinks a critical thought.

10. Techniques of the Behavioral
Approach
• Both systematic desensitization and aversive
therapy make use of classical conditioning
learning principles. Remember in our brief
discussion of classical conditioning earlier, we
talked about it as associational learning—learning
that occurs when things get paired together.
– systematic desensitization “teaches” the client a
new thing by pairing relaxation with something
they fear
– Aversive therapy “teaches” a new thing by
pairing a bad experience with some behavior
they want to eliminate

11. Techniques of the Behavioral
Approach
• Systematic desensitization
• Aversive therapy
• Behavior Modification programs—These
approaches try to increase positive behavior and
decrease negative behavior by using
reinforcements and punishments in the most
effective ways based on learning principles the
behaviorists have discovered from research.

12. Behavior Modification programs
• For example, therapists might work with the parents of
a troubled child to help them set up a behavior mod
program targeting their child’s behavior. The therapist
will try to help the parents identify in what ways the
undesired behavior is being reinforced and eliminate
that reinforcement & help them develop ways to
reinforce desired behavior
• Another special example of a behavior modification
program is a token economy. This sort of program is
described in your textbook on p. 572.

13. Behavioral Approach
• Basically, a behavioral therapist assumes
that any undesired behavior happens for a
reason, and is going to search for the
reinforcement or association that is
maintaining that behavior and find ways to
eliminate it so as to help the client to change
their behavior in the way that they want to
change it.

14. Humanistic Perspective
• Remember the quote that we looked at when we
began the humanistic perspective: “At their core,
people are good. If people can learn to accept
themselves as they are, then they can grow into
their full potential. “
• Remember that this approach also emphasizes free
will as a significant factor in determining our
behavior.
• Following these ideas, the humanistic approach to
therapy is going to emphasize acceptance of the
client and is going to give the client a lot of
control over what happens in the therapy session.

15. Humanistic treatment approach
• Humanistic therapy is sometimes titled a “client
centered” or “patient centered” approach. In
humanistic therapy, the therapist is nondirective,
meaning that she allows the client to direct the session
rather than directing it herself.
• Remember the humanist approach sees us as having the
potential to be healthy if we are just given positive
regard and allowed to be ourselves. So the therapist’s
job in humanistic treatment is to provide unconditional
positive regard for the client. The therapist provides an
environment in which the client feels safe to reveal the
true self and say whatever he/she feels.

16. The “Tools” of a
Humanistic Therapist
• An environment of unconditional positive regard. Carl
Rogers sometimes called this acceptance/ If you can’t
remember what unconditional positive regard is, you can
go back and read the definition of this on p. 488 of our
textbook.
• Active listening & “Mirroring” the client’s responses
back to him so that the client can “listen to himself’ better
• Empathy—working at seeing the world from the client’s
perspective
• Genuineness—The humanists thought that the character
of the therapist really mattered. The therapist needed to
truly engage and care about the client.

17. The Humanistic Approach
• Read the excerpt from a therapy session on
p. 568 in your textbook to get a sense of how
this sort of therapy “feels.”

18. Cognitive treatment approach
• Look at the example of a cognitive therapist working
with a client given on pp. 573-574 of your textbook.
What do you notice about this? How does it seem
different from the example of the humanist
approach?
• You’ll want to notice (among many other things)
that the therapist in the example focuses on how the
client thinks about things and how those thoughts &
perceptions affect the client. This is how you know
that the therapist is taking a cognitive approach.

19. Cognitive treatment approach
• Remember the cognitive perspective sees our
thoughts as the cause of our personality and
behavior. Thus if clients are having problems it is
because they are thinking of things wrongly.
• Cognitive therapists sometimes call these
problematic ways of thinking “faulty cognitions.”
Albert Ellis, a well known cognitive therapist, calls
this “stinking thinking.”
• Some cognitive therapists can be very
confrontational—working at convincing clients that
they are thinking about things wrongly; others may
take a more gentle approach…

20. Cognitive-Behavioral Treatment
• Often in contemporary therapy, therapists combine the
cognitive & behavioral approaches. They will look for both
the cognitive & environmental factors that trigger the
problem behavior. They often ask the client to record-keep.
• For example, if a client is experiencing panic attacks, a
cognitive behavioral therapist might ask the client to keep a
notebook in which she records each panic attack she
experiences. She may be asked to keep track of what she
was thinking before, during and after the attack, as well as
what was going on in the environment (either reinforcers or
associations—sometimes called “triggers”) before, during
& after. Then the therapist works with the client to
interpret this information to work at making needed
changes in how she thinks, as well as in her environment.

21. Freudian (or Psychodynamic)
treatment approach
• Remember what the Freudian approach says about
the cause of behavior
• The cause of much of behavior in Freudian theory
lies in the unconscious, so the therapist needs to
figure out what is going on in the client’s
unconscious.
• The goal of Freudian therapy is sometimes
summarized as “making the unconscious
conscious”

22. What techniques does a Freudian therapist
use to try to get at the client’s unconscious?
• Free Association—you may remember that
we talked about how Freud had used
hypnosis to get at the unconscious but then
eventually gave this up because he felt it
wasn’t needed. Instead, he started using a
technique called free association in which
the patient was asked to say whatever came
to mind.

23. What techniques does a Freudian therapist
use to try to get at the client’s unconscious?
• Free Association
• Analysis of Transference—Transference, according
to Freud, was a feeling that the client projected upon
the therapist based on unresolved past
relationships—early childhood relationships. For
example, Freud hypothesized that if the client’s
father was cold & withholding & judgmental, then
the client would respond to the psychoanalyst as if
HE were cold & withholding & judgmental. So by
“analyzing” the transference was one way to
discover what childhood realities were influencing
current behaviors.

24. What techniques does a Freudian therapist
use to try to get at the client’s unconscious?
• Free Association
• Analysis of Resistance
• Analysis of Transference—Freudian analysts
typically want to present a “blank slate” to the
patient early in therapy. This is one of the reasons
why in traditional therapy, the patient was asking
to sit on a couch facing away from the analyst so
the patient couldn’t even see the analyst’s facial
expressions! This way, whatever the client
projects onto the therapist is seen as a sign of
unresolved unconscious childhood conflicts.

25. What techniques does a Freudian therapist
use to try to get at the client’s unconscious?
• Free Association
• Analysis of Transference
• Dream analysis—Freud thought that dreams
were “the royal road to the unconscious”!
So he often encouraged patients to tell him
about their dreams and then interpreted
them as conveying something about the
patient’s unconscious

26. What techniques does a Freudian therapist
use to try to get at the client’s unconscious?
• Free Association
• Analysis of Transference
• Dream analysis
• NOTE: Through all these approaches, the goal is
for the psychoanalyst to develop an interpretation
of the patient’s behavior and what is going on in
her unconscious. Once the therapist is confident
of his interpretation, he shares it with the patient,
thus working toward the goal of “making the
unconscious conscious”!!!

27. Freudian (or Psychodynamic) treatment approach
• Read the example of a psychodynamic therapy session on p.
566. What do you notice about the interaction between the
therapist & client?
• The therapist is taking a very directive approach. Notice
that the therapist talks more than the “patient” (client).
Earlier in psychodynamic therapy, the therapist (sometimes
called psychoanalyst) listens to the client’s dreams, free
associations, etc. It is the therapist’s job to listen to what
the client says & to interpret it. The vignette on p. 566 is an
example of the therapist making an interpretation.
• Notice also that the therapist’s interpretation involves
disturbing feelings with which the client is not in touch.
This is a very psychodynamic interpretation (because it
focuses on the unconscious)

28. Systems approach to treatment
• Remember from our earlier discussion of the
systems approach that this approach believes that
the only way to make sense of a person’s behavior
is to understand it in the context of the system in
which it occurs, e.g., in the family
• So according to this approach, if an individual has
a problem, it may be a problem of the entire
system. For example, it may be the entire family
that has to change; not just the person who is
displaying symptoms!

29. Systems approach
• One of the main techniques of the systems
approach is family therapy, but some systems
therapists will work with a lone individual at
sorting out her role within her family and making
changes to it that might make her feel better about
her life.
• Systems therapists look for patterns in the family
in which the “symptoms” are embedded or look
for the purpose that the “symptoms” may serve
within the system

30. Biomedical treatment approaches
1. Psychopharmacology—(psychotropic
drugs) this is the most common biomedical
approach & we’ve already discussed several
examples before—Prozac for depression &
antipsychotic drugs to treat schizophrenia.
– Research has demonstrated that when treating
depression, the combination of antidepressant
drugs and psychotherapy is more effective than
either antidepressant drugs OR therapy alone.

31. Biomedical treatment approaches
1. Psychopharmacology
2. Electroconvulsive Therapy (ECT)—ECT involves the
administration of electrical shock to a depressed
individual. The patient is given a series of weekly
treatments.
– Patients first receive a general anesthetic and muscle relaxant
and then electrical shock is administered via an electrode.
Figure 42.2 on p. 595 of your book illustrates the procedure
– 80% of those receiving ECT recover from their depression
after three treatments
– There are sometimes side effects however—including
memory loss for the treatment period—and so ECT is
typically only used In severe depression that does not respond
to medication (esp. when the risk of suicide is high).

32. Biomedical treatment approaches
1. Psychopharmacology
2. Electroconvulsive Therapy (ECT)
3. Psychosurgery—previously referred to as
“lobotomy”—most drastic and least used
procedure—removes or destroys brain tissue to try
to change behavior. For example, we talked about
how sometimes in severe epilepsy, the corpus
callosum will be severed in an attempt to control
the seizures.

33. Effectiveness of therapy
• You’ll notice from your textbook reading
that there are multiple ways to try to
evaluate the effectiveness of therapy:
clients’ reports, therapists’ reports and
controlled experiments (called “outcome
research” in your textbook)

34. Effectiveness of therapy
• In general, research evidence suggests that
therapy is effective but doesn’t find “one
clear winner” among these approaches.
Because of this, there has been some
interest in discovering commonalities
among therapies—things that different
approaches share in common. You can read
about this on pp. 585-587 in your textbook.

35. Effectiveness of therapy
• Research targeting specific disorders, however,
does sometimes find “winners.” In other words,
some approaches work better for particular
disorders.
• The research question “What therapy is best?”
may not be the best question to ask. Instead,
researchers are beginning to ask “What therapy is
best for this particular disorder for this particular
type of client?”

36. Effectiveness of therapy
• It’s also important to remember that clients are
individuals, and so even if research suggests that a
particular approach is best for a particular disorder,
that does not mean that the approach is going to work
with the particular client with which the therapist is
working. What it does mean is that it makes sense for
the therapist to try the most highly recommended
treatment first (unless there are other compelling
reasons) and if that doesn’t work, to then try other
approaches which just might end up being more
effective for that particular client
• This is why I think it is best to think of psychotherapy
as not just a science, but also an art.

37. Preventative mental health
• Since many psychological disorders are
“understandable responses to a disturbing and
stressful society”, one way we might prevent
psychological disorders is to make changes in those
societal factors that contribute to people developing
mental health problems.
• Preventative mental health is an approach that
attempts to do just that. Those involved in
preventative mental health (such as community
psychologists) attempt to alleviate poverty, racism,
sexism, unemployment and other societal factors that
interfere with people’s good mental health.