Bernstein et al., Psychology, 6/e Keyterms

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Psychology, Sixth Edition
Douglas A. Bernstein - University of South Florida and University of Southampton
Louis A. Penner - University of South Florida
Alison Clarke-Stewart - University of California, Irvine
Edward J. Roy - University of Illinois at Urbana-Champaign

Keyterms
Chapter 16: Treatment of Psychological Disorders

Psychotherapy is the treatment of psychological disorders using psychological methods, such as analyzing problems, talking about possible solutions, and encouraging more adaptive ways of thinking and acting. (see introductory section)
Example: Psychoanalysis, client-centered therapy, Gestalt therapy, rational-emotive therapy, and cognitive-behavior therapy are all examples of psychotherapy.
Psychiatrists are medical doctors who specialize in the treatment of mental disorders. Psychiatrists usually use biological treatments and some psychotherapy. (see Basic Features of Treatment)
Psychologists are people who practice some form of psychotherapy. Many have Ph.D.'s in clinical or counseling psychology and advanced specialty training. Currently, psychologists cannot by law prescribe medications to their clients. (see Basic Features of Treatment)
Psychoanalysis, a method of psychotherapy, seeks to help clients gain insight by recognizing, understanding, and dealing with the unconscious thoughts and emotions presumed to cause their problems. Psychoanalysis also aims to help clients work through the many ways in which those unconscious causes appear in everyday behavior and social relationships. (see Psychodynamic Psychotherapy)
Client-centered (or person-centered) therapy, developed by Carl Rogers, assumes that a client has a drive toward self-actualization. This therapy is based on a relationship between client and therapist that is characterized by unconditional positive regard, empathy, and congruence. Wanting the client to learn to solve his or her own problems, the therapist is nondirective and does not give advice. (see Humanistic Psychotherapy)
Unconditional positive regard refers to an attitude of total acceptance and respect that a therapist must have toward a client to create a therapeutic environment. If a therapist does not express unconditional positive regard to the client, therapy will not enable the person to overcome his or her barriers to self-actualization. (see Client-Centered Therapy)
REMEMBER: The therapist communicates acceptance without conditions; even if the client admits to socially undesirable behaviors or views, the therapist is encouraging and respectful.
Empathy, an important feature of client-centered therapy, involves a therapist's trying to see the world as a client sees it. The therapist may show the client that understanding not only by listening attentively but also by reflecting what the client says. (see Client-Centered Therapy)
Example: Yvonne came into therapy because she resented having to care for her younger sisters even though she knew that her mother was working three jobs. Yvonne's therapist must try to see the world from Yvonne's point of view and can accomplish this by understanding the constraints that Yvonne feels as a result of such tremendous responsibility.
Reflection is a method used in client-centered therapy. A therapist restates or paraphrases a client's responses in order to show that she or he is listening and to help the client be more in touch with feelings. (see Client-Centered Therapy)
Example: Read the example for Key Term 7. The therapist might respond to Yvonne by saying, "You're tired of doing so much around the house with your sisters, which prevents you from going out and doing what you want. You're angry at your mom." The therapist has reflected what Yvonne has said, thus also demonstrating empathy.
Congruence (sometimes called genuineness) refers to a consistency in a therapist's feelings and behavior toward a client. The therapist's behavior toward the client must be a reflection of how he or she really feels; it cannot be an act. Ideally, the client will learn that openness and honesty can be the foundation of a human relationship. (see Client-Centered Therapy)
Example: Read the examples for Key Terms 7 and 8. The therapist must genuinely feel empathy and unconditional positive regard for Yvonne. She cannot think to herself that Yvonne is spoiled and selfish. The therapist must actually accept Yvonne's feelings with unconditional positive regard for her worth as a person.
Gestalt therapy is a form of humanistic treatment developed by Frederick Perls. A Gestalt therapist takes an active and directive role in helping a client become aware of denied feelings and impulses and learn how to discard foreign feelings, ideas, and values. Also, the therapist helps the client become more self-accepting. Methods used include dialogues with people, inanimate objects, and various body parts. (see Gestalt Therapy)
Example: When Renee describes how angry she became when her boss asked her to stay late, the therapist suggests they role-play the conversation between Renee and her boss. Renee finds that it really wasn't the request that made her the most angry; it was her perception that the boss assumed she had nothing better to do.
Behavior therapy uses the principles of classical conditioning to change behavior by helping or teaching clients to act and think differently. Usually, an incorrectly learned association between a CS and a UCS is destroyed. (see Behavior Therapy)
Example: Flooding and aversive conditioning are examples of behavior therapies. (See Key Terms 9 and 20.)
Behavior modification uses the principles of operant conditioning to change behavior. (see Behavior Therapy)
Example: Modeling is an example of behavior modification therapy. (See Key Term 15.)
Cognitive-behavior therapy attempts to pinpoint thought patterns that lead to depression, anger, or anxiety. Once these thoughts are recognized, they can be eliminated and replaced with more constructive thought patterns. (see Behavior Therapy)
Systematic desensitization is a behavioral therapy method based on classical conditioning that is especially effective in the treatment of phobias. The technique seeks to extinguish the fear response by pairing fear-producing stimuli with calm, relaxed feelings. (see Techniques for Modifying Behavior)
Example: Carlos is terrified of heights. His therapist asks him to create an anxiety hierarchy. He lists several "height" experiences from the least to the most frightening.
1. Standing on a small step stool
2. Standing on the bottom rung of a ladder
3. Looking out the top-floor window of a three-story building
4. Standing on the middle rung of a ladder
5. Standing on the top rung of a ladder
6. Standing and peering into an empty ten-story elevator shaft
7. Standing on the edge of Niagara Falls
8. Standing on the edge of the lookout tower over the Grand Canyon
9. Riding in a helicopter
Carlos's therapist will gradually work through each of these scenes using systematic desensitization.
Modeling is a behavioral modification method in which a client can learn new behaviors by watching the behavior of others and then practicing these behaviors. (see Techniques for Modifying Behavior)
Example: Kip is afraid of snakes. Modeling therapy might include having him watch films of people handling snakes. Then he might be present in the same room while others are handling snakes. Finally, he might practice handling snakes himself.
Assertiveness and social skills training is a set of behavioral methods used to teach clients how to be more comfortable, expressive, and effective in social situations. (see Techniques for Modifying Behavior)
Example: Nan, a very shy woman, was constantly being taken advantage of despite her knowledge of auto mechanics. Every time she took her car to a mechanic, the garage overcharged her or did unnecessary work. She knew this but just could not bring herself to say something about it until she had gone through assertiveness training.
REMEMBER: People are taught how to be assertive, not aggressive. Nan does not have to be aggressive in order to express herself effectively in the auto shop. Instead, she simply needs to be direct in her demand for fair service.
Positive reinforcement is anything that, when received by a person, increases the likelihood that the person will repeat the behavior that elicited the positive consequence. Positive rewards are contingent on the performance or display of the desired behavior. (see Techniques for Modifying Behavior)
Example: A therapist who is assisting a client with a weight problem may give the client lots of praise (positive reinforcement) when the client loses one pound in the hopes that the praise will motivate the client to continue to follow the program. Praise is contingent on weight loss; that is, if the client loses no weight, no praise is given.
A token economy, based on principles of operant conditioning, is used by behavior therapists, mainly in institutional settings. A system is implemented in which a client must display certain behaviors to receive tokens. These tokens can then be exchanged for extended privileges, such as snacks, movies, and field trips. (see Techniques for Modifying Behavior)
Example: Tony and his therapist have decided that he should be able to complete his daily homework and keep his room neat. For every completed homework assignment, he receives two tokens. When he makes his bed, picks up his clothes, and keeps his dresser organized, he receives three tokens. Tony exchanges his tokens for field trips to local museums or for dinner in town.
REMEMBER: Eventually social reinforcements, such as smiles of approval and encouragement, come to replace tokens.
Extinction occurs when stimuli that previously elicited a conditioned response no longer cause that response. Extinction is a result of the breakdown of the relationship on which the original conditioning was based. Flooding is a behavioral technique based on extinction. (see Techniques for Modifying Behavior)
Flooding is a behavior therapy technique used to treat phobias. A client is placed in a feared but harmless situation. Prevented from escaping, the client has the opportunity to realize that she or he has no reason to be afraid. In classical conditioning terms, the client realizes that the feared thing (CS) doesn't really predict a terrifying or harmful problem (UCS). (see Techniques for Modifying Behavior)
Example: Clint was extremely afraid of riding on buses. He and his therapist rode a city bus for an hour. Clint was very frightened at first, but then he calmed down, and eventually he lost his fear. Clint realized that the bus ride (CS) did not predict any catastrophic event (UCS).
Aversive conditioning is a behavior therapy based on classical conditioning. Negative behaviors often must be eliminated, at least partially, before new behaviors can be learned. Aversive conditioning associates the undesirable behavior with an unpleasant physical feeling. People discontinue using behaviors that result in discomfort. (see Techniques for Modifying Behavior)
Example: In the movie A Clockwork Orange, the main character spends most of his time raping and beating women. Later he is forced to watch movies of these types of behaviors while experiencing the effects of a nausea-producing drug. After the treatment, the mere sight of a woman makes him violently ill.
Punishment, a behavior modification method, is a negative consequence that follows a behavior and that decreases the likelihood that the problem behavior will be repeated. Usually, punishment is used as a last resort to eliminate problem behaviors. (see Techniques for Modifying Behavior)
Example: Peter is seven years old and lives in an institution. He climbs on the roofs of the buildings in the development. He has already fallen and broken his legs and arms three times. Despite repeated attempts to stop this behavior using a token economy, Peter still climbs on the roofs. His therapist has decided that punishment is the only way to keep Peter from putting himself in an extremely dangerous situation.
Rational-emotive behavior therapy is a form of cognitive-behavior therapy developed by Albert Ellis. A client is taught to recognize self-defeating thought patterns and to replace them with more constructive thoughts. (see Cognitive-Behavior Therapy)
Example: Brady is a personnel administrator. He feels uncomfortable because he is often faced with disciplinary decisions that result in angry employees. His therapist has pointed out that it is unrealistic to think that everyone will like him and be happy with his decisions all the time. Brady learns to treat people fairly and not to expect them to like all of his decisions.
Cognitive therapy consists of a type of cognitive restructuring in which a client sees that her or his depression is due in part to erroneous and illogical thought patterns. The therapist helps point out those thoughts that precede anxiety and depression and then works with the client to test the logic of these thoughts. (see Cognitive-Behavior Therapy)
Example: Leslie is convinced that she will never be successful on her new job. As a result, she is very anxious. Her therapist helps her list the skills she will need on the new job. Then Leslie and the therapist recall past jobs where Leslie performed very well using just those skills. Leslie's therapist helps her see that her anxiety-producing thoughts about her performance are wrong.
Group therapy is psychotherapy conducted with groups of about five to ten people. The therapist can observe clients interacting with one another in real social situations; clients feel less alone when they realize that other people are struggling with similar problems; and clients can learn from one another. (see Group, Family, and Couples Therapy)
Example: Misha is in a support group for teen mothers. The group members meet with a therapist once a week to discuss how things are going and to offer each other support.
Family therapy involves two or more individuals from the same family, one whose problems make him or her the initially identified client. The real client in family therapy is the family, and the goal of family therapy is to create harmony within the family by helping each member better understand the family's interactions and the problems they create. (see Group, Family, and Couples Therapy)
Example: Robert has been hostile and depressed lately, but he is not attending therapy alone. Robert's parents and sometimes his siblings go to sessions with him. The therapist observes how the family members interact and tries to help them see how they affect each other.
Couples therapy is similar to family therapy; its focus is on communication between partners. (see Group, Family, and Couples Therapy)
Empirically supported therapies (ESTs) are therapies whose effectiveness has been validated by controlled experimental research. (see Focus on Research Methods: Which Therapies Work Best for Which Problems?)
Electroconvulsive therapy (ECT) involves passing electric current through the brain. Today, shock is applied to only one brain hemisphere, and patients are given a deep muscle relaxant prior to treatment to prevent injury. ECT is used to treat depression when other treatments have failed. (see Electroconvulsive Therapy)
Psychosurgery involves destroying a very small amount of brain tissue in order to alleviate psychological disorders. This treatment is used as a last resort in treating problems involving strong emotional reactions. (see Psychosurgery)
REMEMBER: Psychosurgery treats psychological problems through surgical techniques.
Neuroleptic (antipsychotic) drugs are used to treat severe psychopathology. These drugs are effective in reducing hallucinations, delusions, paranoid suspiciousness, and incoherence. Unfortunately, neuroleptics such as chlorpromazine and haloperidol can cause severe side effects, such as tardive dyskinesia. (see Psychoactive Drugs)
Antidepressants, which increase levels of serotonin and norepinephrine, are useful in treating depression. This class of drugs includes monoamine oxidase inhibitors, tricyclic antidepressants, and fluoxetine. (see Psychoactive Drugs)
Anxiolytics (tranquilizers), such as Librium and Valium, are used to reduce anxiety, tension, and in some cases agoraphobia (Xanax). These drugs can be addictive and should not be combined with alcohol. (see Psychoactive Drugs)
Community psychology attempts to minimize or prevent psychological disorders. Community psychologists' efforts take two forms: attempts to eliminate causative factors of underlying psychological problems (such as poverty and inadequate or crowded housing) and early recognition of psychological problems and interventions designed to prevent problems from becoming worse. (see Community Psychology: From Treatment to Prevention)





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