PSYCHOLOGICAL DISORDERS 98 99
Sleep disorders
50−70 million American adults
have a sleep disorder
CAUSES SYMPTOMS IMPACT TREATMENT
Triggers include worry and The person may have The person cannot relax, Stimulus-control or
stress, for example, trouble falling asleep, and excessive fatigue limits sleep-restriction therapies
problems at work or home wake often during the daytime activities. Work and paradoxical intention
or financial difficulties; a night, wake early and not performance is impaired are behavioral therapies
significant event, such as a go back to sleep, and be and relationships suffer. (pp.122–129)—the person
bereavement; underlying unable to nap. Tiredness Bedtime can be anxiously tries to stay awake for as
health conditions; and causes irritability, anxiety, anticipated, the stress long as possible to reduce
alcohol or drug use. and poor concentration. worsening the insomnia. anxiety around sleep.
Parasomnia often runs Common symptoms are The lack of refreshing Mild or harmless
in families, so it may be sleepwalking, sleep talking, sleep can result in mental parasomnias need only
genetic; it is associated with night terrors, confusional impairment, disorientation, practical safeguards such
medication or physical arousal, rhythmic confusion, and memory as removing possible
conditions such as sleep movement, and leg cramps. problems. Those with REM sources of injury to
apnea. REM sleep behavior More severe are night- sleep behavior disorder sleepwalkers. Medication
disorder can follow a brain eating disorder and REM can become violent. may be needed for REM
disease. sleep behavior disorder. sleep behavior disorder.
Narcolepsy may be genetic Symptoms include daytime Narcolepsy disrupts daily Adopting a healthy diet
or caused by a lack of sleepiness, sleep attacks, life and can be difficult to and lifestyle, regular
melatonin (the brain temporary loss of muscle cope with emotionally. An bedtime routines, and
chemical that regulates control in response to underactive thyroid gland, evenly spaced naps
sleep), hormonal changes emotions such as laughing and other physical to manage excessive
in puberty or menopause, (cataplexy), sleep paralysis, symptoms such as sleep daytime drowsiness
or stress. It can follow and hallucinations on falling apnea or restless legs, can can all help.
infection or inoculation. asleep or before waking. exacerbate problems.
Hypersomnolence may The person may be very The person struggles to Physical causes are treated
be genetic or due to drug sleepy during the day function in daily life. They first. If hypersomnolence
or alcohol abuse or other despite nighttime sleep of may be anxious, irritable, persists, daytime activity
sleep disorders such as at least seven hours, have and restless, and have little is observed. Tailored
narcolepsy or sleep apnea. recurrent daytime naps or appetite and no energy. behavioral therapies
It can follow a tumor, head sleep lapses, struggle to Thinking and speech are include introducing
trauma, or injury in the wake up after long sleep, slow, and memory presleep routines and
central nervous system. or feel unrefreshed after problems can develop. ordered sleep times, which
sleeping for 14–18 hours. are then altered gradually.
Tic disorders
Tics are sudden, painless, nonrhythmic GRIMACING
behaviors that are either motor (related HEAD JERKING/TWITCHING
to movement) or vocal. A disorder may HEAD BANGING
be diagnosed when tics occur repeatedly
and are apparently unconnected to the
environment or situation.
What are they? SHOULDER SHRUGGING
THROAT CLEARING
Tics—small, uncontrollable movements or sounds— COUGHING
are not usually serious and normally improve over time. GRUNTING
However, if they persist they can be frustrating and FREQUENT SPITTING
interfere with everyday activities—especially if the MAKING ANIMAL NOISES
person has more than one tic. HISSING AT PEOPLE
LOUD SWALLOWING
Changes in the parts of the brain that control
movement are thought to cause tics. There is probably
a genetic predisposition, too. Taking drugs such as
amphetamines or cocaine can trigger tics, as can
medical conditions, including cerebral palsy and
Huntington’s disease, or psychological disorders such
as ADHD (pp.66–67) and OCD (pp.56–57).
Tics are more common in children, but they can
begin in adulthood. Statistics vary regarding the
prevalence, with 0.3–3.8 percent of children described
as having severe tics. Treatment may not be needed if
a tic is mild; lifestyle management, such as avoiding
stress or tiredness, is often all that is required.
ADVANCE WARNINGS
Most people have an unusual or uncomfortable feeling JERKING ARMS/HANDS
before the tic occurs. Individuals often describe this as a BENDING/SQUATTING
rising tension that only the tic itself can release. Some
people can suppress their tics for a short period, until the TAPPING FOOT/FEET
urge to do it becomes too strong, which may result in a STEPPING IN PARTICULAR
more severe tic. FORMATION
WARNING URGE NEED TO TIC
❯❯ Burning sensation RELEASE ❯❯ Blinking
TENSION ❯❯ Twitching
behind eyes
❯❯ Tension in a individual
muscle
particular muscle ❯❯ Grunting
❯❯ Dry throat ❯❯ Twitching body
❯❯ Itching
100 101PSYCHOLOGICAL DISORDERS
Tic disorders
EYE BLINKING TOURETTE’S SYNDROME
NOSE TWITCHING/SNIFFING
REPEATING OWN WORDS/ This is a condition characterized by multiple tics, named
PHRASES (PALILALIA) after George de la Tourette, who first described it in 1884.
REPEATING OTHERS’ WORDS/ For a condition to be classified as Tourette’s syndrome,
PHRASES (ECHOLALIA) the tics must last for at least a year and at least one must
UTTERING OBSCENITIES be vocal. Most individuals have a combination of motor
(COPRALALIA) and vocal tics, which can be both simple and complex.
The syndrome often runs in families.
TWISTING THE BODY
Tourette’s syndrome is thought to be linked to
problems with a part of the brain called the basal
ganglia, or possibly to a childhood throat infection
caused by a streptococcal bacteria. The first stage of
diagnosis is to check other possible causes of the
symptoms such as allergies or poor eyesight. A
neurologist or psychiatrist then rules out conditions
such as ASD (pp.68–69) before referring the person for
psychotherapy. In a third of cases, the tics reduce,
become less troublesome, or disappear over a
10-year period.
TENSING ABDOMEN “The rhythm of music is
very, very important
TAPPING/CLICKING FINGERS for … patients with
TOUCHING OBJECTS/PEOPLE Tourette’s.”
Oliver Sacks, British neurologist
Simple and complex tics TREATMENT
Tics take many forms. Some affect body ❯❯Behavioral therapies (pp.122–129) widely used for
movement and others are verbal. They may Tourette’s to expose the unpleasant feelings that
be simple or complex. A simple tic affects a precede the tic and encourage a response that stops it.
small number of muscle groups, for example,
blinking or clearing the throat. A complex tic ❯❯Habit reversal training to teach use of incompatible
involves coordinated patterns of several behaviors in place of the tic, so planned intentional
muscle groups, such as blinking in movements compete with the tic and prevent it.
combination with a shoulder shrug, facial
grimace, and spontaneous shouting. ❯❯Lifestyle management such as relaxation techniques
and listening to music to reduce frequency of tics.
Key
❯❯Antidepressants or anti-anxiety medication (pp.142–
Motor tics 143) to support behavioral interventions if needed.
Vocal tics
PD (personality
disorders)
These are disorders in which individuals display
persistent and consistent unhealthy patterns of
thinking, behavior, and social functioning.
What are they? history of a personality or other Cluster A
mental disorder; an abusive, Cluster B
Individuals with PD have difficulty unstable, or chaotic early life; or Cluster C
not only understanding themselves, a diagnosis of severe aggression
but also relating to other people. and disobedience in childhood.
PD is different from other mental Variations in brain chemistry and
illnesses due to its enduring nature structure may also play a role.
and the fact that it cannot be
compared to a physical illness. There are 10 defined PDs and
The individual’s behavior varies they are considered to fit into three
noticeably from the norm in society, clusters based on broad similarities
but they may manage their own life within each group.
without medical help in a way that
someone with an extreme condition A doctor does not usually attempt
such as schizophrenia (pp.70–71) a diagnosis of PD until early
cannot. PD often goes hand in hand adulthood. For a diagnosis to be
with substance abuse (pp.80−81), made, the symptoms (right and
depression (pp.38−39), and anxiety. pp.104–107) must cause day-to-day
problems with functioning and
The precise causes of personality subjective distress, and the person
disorders are not known, but risk must display some symptoms of
factors appear to include a family at least one of the types.
Cluster A: odd/eccentric
A person with a Cluster A personality disorder shows patterns of behavior
that most onlookers would regard as odd and eccentric, has difficulty
relating to other people, and fears social situations. The individual may not
believe that they have a problem. This group includes three personality
disorders: paranoid, schizoid, and schizotypal.
Paranoid PD 102 103PSYCHOLOGICAL DISORDERS
PD (personality disorders)
❯l❯ma❯Toc❯hi❯Tank❯rde❯khoi❯❯Tqnoe❯Teepf❯hmugs❯vTtshieTeepriehetiearhnynishresyttnuteeoe,hybtifsahpemnpiaaeptnrnovuh’elgsildiecdaslarieuahntispcevhopmityoklkirpeieurnpndeoofeotsgeaednhtabnifrlsehettoreelevhlaeeenimgosivntamgrxsuiifmtgdvit,npalarseoasaeeeeenr.mnnrndsosmadecsppcenpa.eseheoadiilsnnle,osuf,y;ofgstssrsaoaidsreetenrriiiccenpligsoinirutntiolenroyryristutnrgpnietminesvananctnsgenoarftlhto,utiyctcaandoceslelbreoeea.nettervmnhhrdtiiedereosrpeclexmauusloapmatusnt,niri,sosntfaefaparinrisdynniiksstciedgehhsnion.;dfigpucutsleso,.s. TREATMENT
❯❯Paranoid PD Schema-focused
cognitive therapy (p.124) to enable
links between problems, for
example, emotions from
childhood memories and current
life patterns; also uses cognitive
techniques to develop new
appraisals. However, high drop-
out rates from treatment occur,
even if sought, due to difficulty in
building rapport and trust
between therapist and patient.
Schizoid PD ❯❯Schizoid PD Cognitive behavioral
therapy (p.125) or lifestyle support
❯❯❯❯❯❯T❯❯tT❯❯Toh❯❯a❯Th❯Th❯eonT❯hoTehTeryhbpehytehyhpeuyekeypeheyrtiryhynracsrasheaoaiadcvmpsfavrnnhe,eeeeveaini.rnoleazyimaottocppolthtlilipollumideepamterda.vieidPactiikenteDerkleeisagdskudpiicerrssapoaeelrebnyarllsxtadtoinotoultoi,itgtcinadvfyaeibloaeeasotoerltcowmsnacftmeucieeisvvthcosexahiel.tpecsloriesideeeosactsr,erlhahiaaeeriranczleenxonoodpslcanpnpferiteeenodhipom.sdirntslneieidaifonosaflhtneeinsaoi.r.u.pe(crspnerpoitto.fi7cr0ijso–m7y1. ), to reduce anxiety, depression,
angry outbursts, and substance
abuse; social skills training;
medication (pp.142–143)
prescribed for low mood or
psychotic episodes. However,
treatment is rarely sought.
❯❯Schizotypal PD Long-term
psychotherapy to build a trusting
relationship and cognitive
behavioral therapy to help with
identification and reevaluation
of irrational thoughts; medication
prescribed for low mood or
psychotic episodes.
Schizotypal PD
❯❯❯t❯mT❯❯ph❯oT❯hh❯emTe❯ehTarsTeexhrkheotsiahayshseiuyeconmdegmyebyimngluaiippjhrnma’leisleadloaoyeseceyraievnw,ttshcmkedubtogpoaenha,ednoasvnetriimleretnigitaybioetaloanmuuwaevmnipnnisgncefasbipsisaiouo,yccilyrnaeimssnaanoteunvnbhlasgpeceadaplcre,rsrnlobeteveiacwhvauiactfctoletoaiogiagmtetanrmuiyhuyoylevregs.epeintvialhsnooiseosssnatpcf.tarwisrxaenyso,giotpdedofaneelnretuaussmtsteayheesafsksoseanceau.itnrhtcnnvcoaettiegdhnshn,snageoiaostnnemussructwo.critcn.Fateohshhdollpvaeaecureanpurserpgaeteaeitsnhnrd.gydin PEOPLE WITH PD often do not see
themselves as having a problem so
seeking treatment is rare.
PD (PERSONALITY DISORDERS) Cluster A
Cluster B
Cluster B: dramatic/emotional/erratic
Cluster C
A person suffering from a Cluster B personality disorder struggles to regulate
their feelings. They are usually overly emotional and unpredictable and display
behavior patterns that others see as dramatic, erratic, threatening, and even
disturbing. This creates a vicious cycle, as people are uncomfortable near
them, so social and personal relationships are difficult to achieve and maintain,
which in turn intensifies the initial symptoms.
PSYCHOPATHY
Sometimes considered a subset of antisocial personality disorder (below),
psychopathy is one of the hardest disorders to diagnose and is largely resistant
to treatment. Psychopathy presents as a specific set of personality traits and
behaviors. Mental health professionals can use Robert Hare’s Psychopathy
Checklist-Revised (PCL-R) to diagnose the disorder by scoring an individual on
20 listed traits with a value of 0, 1, or 2. A score of 30 and above in the US, or
25 and above in the UK, results in a diagnosis of psychopathy. Interpersonal
traits include grandiosity, deceit, and arrogance; emotion-based traits, lack of
guilt and empathy; and impulsive traits, sexual promiscuity as well as criminal
behaviors such as stealing. Individuals lack inhibition and do not learn from
experience. They can seem charming at first, but their inability to feel guilt,
empathy, or love, along with the presence of casual, reckless attachments and
behavior, quickly becomes evident. Many traits—especially the ability to make
clear, emotion-free decisions—can be found in successful individuals,
particularly in business and sports. Most psychopaths are men, and the
disorder is unrelated to the society or culture they come from.
❯❯❯ATo❯hTn❯fiehnb❯o❯tTept❯etui❯ihyhTem❯ss❯aTehreseo❯h❯gisiherTedr❯oagacsTeeyhabv.dlrnyhiieteoeedaaieesmyashtsinslsshreodabiiraeopevsPreivlnsaeracitgcboDioomt,oppoauerernreudndlsevdilsolecsyeebaioeprstconttyhttreehlbfheenevmtsieeneve,iiafmrocertineosdloolypxrpedcvmwwpentierulrhleioitnoeormlt.neehpspaiatesiolcgelnsenperoe,uvaado.fo.intlobdn;rosrrlteseeevthipnhmqbieaotreulynooelireandbsrlatni’selelmnseecasaaemd.taeftnTsehyishdmtoteetyefhspe.ryttienuehgcyslaehasleaiitn,rvsnnaeadcncaodtonuiofdntnetsen.r.
❯❯❯T❯BT❯hdh❯io❯enTye❯orthspT❯yertldeheo❯lhe❯naeTyregne❯e(srahscTyeuehrgosdraeh-luapfendilalyeetnlvieimeeticyahhesgniordiorpdoaamaitpennblcvosactal)ioeteetlfa,oyPeietgi.rwisdnnnmhfreDnroiiagisolsattiipelftathnulgaiuuyabvgbgilsrlolneiusehseublngiinvotottveseesyeseerufdr,torlHloe.npaafyepr-mrsbe,niaimtamwarlxsaptetcbitoibttaeteete(airholagtpnremnylniedtesa,dour.sposaesotasontnwelcnlsaafnda.diitenntidclidhodldsgeeitnePsadnnolpsonkacDrharnidtnyefniiepfodsthgelssoniacfniorwsovtsee)rnee.isqtpl.shfue-, ehrcnaetr,pmtiaonnd 104 105PSYCHOLOGICAL DISORDERS
PD (personality disorders)
TREATMENT
❯❯Antisocial PD Cognitive
behavioral therapy (p.125);
however, person may seek help
only when ordered to do so by
court because of their criminal
behavior.
❯❯Borderline PD Dialectical
behavior and mentalization-
based therapies combining
psychodynamic (pp.118−121),
cognitive behavioral (pp.122−129),
systemic (pp.138−141), and
❯❯❯❯❯aT❯aTTphthhtpeeeeieyrnpaetdreimorrsesnhoosasttnoliloooitsnrwhsabe.elemlsfh-tsaacevteelenvsteienrsaraetpphdiprdoarlynoudpgshhrriieafptgth,euwyllyash,ircailcyanhlsdaemdpekarpaskeweaastrtatehnnectmeio. n. ecological approaches, and
❯❯dThisepylaayrseoefxecmesositvioenly. dramatic, with exaggerated art therapy (p.137). Group
❯❯❯❯❯❯tTTThhhhaeeenyyytbahceroeelyniessauvtreagengt.htelasyttisbtehleeeki(rereraeaslisalsytuiiornanfnlsuhceeipnoscreadarep).pmroovreali.ntimate psychotherapy if symptoms are
mild; coordinated care program
for moderate-to-severe
symptoms.
❯❯Histrionic PD Supportive and
solution-focused psychotherapy
(pp.118–141) to enable emotion
regulation; however, treatment
is difficult as individual often
exaggerates ability to function.
❯❯Narcissistic PD Psychotherapy
❯❯They menavyirfounnmcteionntsa. t a high level in social and to help the person understand
work the cause of their emotions and
regulate them.
❯❯T❯Nihm❯a❯Taen❯p❯hpTdr❯oepehoT❯cqwecyeerh❯t❯ouriTtxoyeea❯essaamahTroryblgns,glesehnepbeceieigyemptsellxr’ehsiiyair,pewatrplaenrleanbiveioehsoacexetcecearnapecuetltttsincdcePhnaesftuetcspnrvwehehDop,teeycaxeesibimelncaeytcliteiri.hgddonaaawotegnlguafwbtyeaeflhtaaaerneeiyatevansntl,hrrsiotr.deoenteosrsfcrgduaces.aostinnnnaash.gtveandtenaeibndesitpzsloaideueeeekn.sndrteolofqyaefaaburcwssdeoeetsvicslutpuafoht-tapingosrpetnuntaerniciigzonoeceepgrre.,oalsensf,oythof enme
PD (PERSONALITY DISORDERS) Cluster A
Cluster B
Cluster C: anxious/fearful Cluster C
This group of personality disorders is characterized by worried, fearful thinking
or behavior. A person with one of these disorders struggles with persistent and
overwhelming feelings of fear and anxiety and may show patterns of behavior
that most people would regard as antisocial and withdrawn. Cluster C includes
dependent, avoidant, and OC (obsessive compulsive) PDs. A psychiatric
assessment is needed to differentiate between dependent (below) and
borderline PD (p.105), because the two share some symptoms.
❯❯❯T❯❯Df❯The❯w❯Th❯neeThbi❯e❯dthtppT❯he❯eyhbeIhef❯yelaefeocTyipretmnaohashnrteyloolraanectseoeddhctnvelsyphotkiiteoleshofvaalesmeepvseeerrnnreae,,lesistaorblrarrtlfeeyaosys-nnaelPelscfvbnebadcttnore“taD.eeeisymilsnsuniioetint.futtsdinaiiougeedpvyyssneeioh,ptdtaahpninoltp.ebnoe”aclateldyesfhecsars,areaeaiitsvilroitstusareeeis,cfns,eotfaaitshedtswfabusmrrer,aunbayftavrismadtanooueanndmr.iiossddgdksfmeidspsdhvneaiefeiastlosysf,lvaa-yrsaigddpinfmnsreeopgeedsauireetscorcbokitrnvioliticbagn,f.elgf.ainilugre.
Avoidant PD
❯❯❯❯oT❯s❯T❯❯thiTtnh❯hr❯r❯feTheToetee❯wyheselThernyatreyshwilergtptisyoinrehyaltooeyenagavparnrpjyogrbsersresee,yoleiceahyrdwotnrlwscieiipeptoehanoaxhallsvnnligunetyacercty,c.sthfehofrtettrwtmiaeahnchaodnynoaetremieactsntrydylluckyytcosamoftlraiocia.rinnhcteaasbcigdhatukcioiia,vnaeivtiusolietraiomistter.dtdiiuebtsid,peufshsdeifqeafiiaitincfrunsthmisiuacagoacoplutitrtn“nnepelfittsgaonaoartlbovutntoiimhoevnnndmecaldfgavoiamlnk,eafourroefim.usnierecerttanroia”toetdinahinjrosenn.ehnctdyehitcpoieotsri.nonsos
106 107PSYCHOLOGICAL DISORDERS
PD (personality disorders)
10% OCPD OR OCD?
the estimated percentage The need to perform behavioral
of the global population or thinking tasks to reduce the
affected by some form frequency and intensity of
of personality disorder obsessional thoughts and
compulsions that cause extreme
Ocobmsepsusilvsieve PD anxiety characterizes both OCPD
(obsessive compulsive personality
❯❯❯❯TpThheerefypeecartriseoornniigsiimsdp,aranendodcscmtuuebpnbietoadrlnwaniintdhpionurtrdesreupritleinorsefosthns,eailrcontrol. disorder) and OCD (obsessive
❯❯❯❯❯❯pTa❯mT❯maThrTnohiiheehnmdabeeyaecyyjoyneiyfapmaotciarnahlrtereriregsesepesssrfeo.oueiuwavnvrlncedeffosletnaeroeirccbvvkxcwotioliiitebdanohiteleletsneesoracdn.,eoidesdlttnaloonihintstmietcwoeihoyasnoaeruhtbsdrystkhaeedwavitcrpneohsoasdaunor.ntnsofsote-cmthsortefeuuhoonypterrtaumnyoimlleripotogwyeeulrnresoosmtcarriasttnealthfeditvrlnheniaetisltacnulsysiden..s compulsive disorder, pp.56–57).
However, OCPD begins in early
adulthood, whereas OCD can
develop at any life stage. OCPD
is an exaggeration of a
personality style, and
becomes a problem that
interferes with daily life,
whereas OCD is underpinned
by an inflated sense of
responsibility for harm occurring
to the self or others. People
with OCPD believe their
thinking is entirely rational.
Those with OCD are aware
that their thinking is disordered
and that the cycle maintains
their anxiety.
TREATMENT them and to change behavioral and social skills
to improve work and social life.
❯❯Dependent PD Psychotherapy, specifically
assertiveness training to help with self- ❯❯Obsessive compulsive PD Counseling
confidence, and cognitive behavioral therapy and psychotherapy tailored to address every
(p.125) to help develop more robust attitudes aspect of a person’s strongly held beliefs, in
and perspectives about themselves relative to particular, their rigid view of the world and
others. Long-term psychodynamic therapies others. Cognitive behavioral therapy and
(pp.118–121) to examine early developmental psychodynamic therapy to help the person
experiences and help rebuild personality. identify their feelings about a situation, then
stop to think about why the control maintains,
❯❯Avoidant PD Psychodynamic therapy (p.119) rather than solves, the problems.
or cognitive behavioral therapy to help the
person identify strongly held beliefs about
themselves and how they think others see
Other disorders
There are a number of conditions with physiological, developmental,
or cultural origins that can also have a negative effect on a person’s
cognitive and behavioral functioning.
What are they? as well as depression and anxiety. These include
developmental problems (such as Down syndrome),
There are many physical conditions that affect a physiological conditions (such as dyspraxia, which
affects coordinated movement), and degenerative
person’s performance, limit function, and cause
enough distress to trigger behavioral problems
NAME WHAT IS IT? SYMPTOMS
SOMATIC SYMPTOM An excessive focus on physical symptoms such Has high levels of anxiety and panic about
DISORDER as pain or fatigue that causes severe anxiety and physical symptoms and believes they
FACTITIOUS DISORDER problems with functioning indicate serious illness
DOWN SYNDROME
GENDER DYSPHORIA Fabricating symptoms or self-harming—or presenting Person or caregiver deceptively mimics,
SEXUAL DYSFUNCTION others as ill, injured, or impaired—in order to gain causes, or exaggerates physical symptoms,
PARAPHILIC DISORDERS medical attention and seeks treatment from many doctors
ELIMINATION DISORDERS
IN CHILDREN A developmental disorder that has varying impact May have generalized anxiety disorder, OCD,
KORO (GENITAL on intellectual, physical, and social functioning sleep disorders, ADHD in children, and
RETRACTION SYNDROME) autism spectrum disorder
AMOK SYNDROME
TAIJIN KYOFUSHO The conflict that results from a mismatch between Displays feelings and behaviors of the
a person’s biological sex and the gender they opposite sex, distressed by puberty,
identify with disgusted with own genitals
Physical or psychological difficulties experienced Men have erectile dysfunction, premature or
by men or women that prevent them from enjoying retarded ejaculation. Women lack desire or
sexual activity have pain on intercourse (dyspareunia)
Sexual arousal only in response to specific inanimate Can achieve arousal and satisfaction only
objects, acts, or nonconsenting people with specific paraphilia, feels contempt for
the object of the sexual focus
The repeated passing of urine (enuresis) or feces Defecates or urinates in inappropriate places;
(encopresis) in places other than the toilet, either has loss of appetite, abdominal pain, social
voluntarily or involuntarily withdrawal, and depression
A delusional disorder in which a person has an Strongly believes that penis (nipples in
irrational fear that their genitals are retracting women) is shrinking despite lack of evidence,
or disappearing and that this is a sign of death
A rare culture-specific disorder observed in Malay Causes serious injury to self and others in
people, in which a sudden frenzied outburst follows sudden frenzied, often armed assault; has
a period of brooding no memory of the event
A behavior culturally specific to Japan in which Believes themselves to be disgusting,
a person fears embarrassing others by being in overconspicuous, and attracting unwelcome
their presence and unfavorable attention
108 109PSYCHOLOGICAL DISORDERS
Other disorders
illnesses (such as Parkinsonism). Even though not of 10−20%
psychiatric origin, the impairment or distress can be
severe enough to require treatment. of Japanese people suffer
from Taijin Kyofusho
Some disturbances are culturally specific, such as
Koro or Amok, or arise from a conflict between an
individual and their society or culture. Some Western
disorders have Eastern counterparts and vice versa;
for instance, the Japanese condition Taijin Kyofusho
is similar to social anxiety disorder (p.53).
POSSIBLE CAUSES IMPACT TREATMENT
Genetics; emotional sensitivity to pain; Obsession with negative causes; problems Cognitive behavioral therapy to examine
negative personality traits; learned with relationships; poor health; depression; unhelpful thoughts and behaviors that
behaviors; problems processing emotions distrust of medical opinion maintain concern
Combination of psychological factors, Deception impacts social relationships; Psychotherapy to build personal insights
stressful experiences, or complex or serious health-related problems from and find alternative ways to cope with
traumatic relationships in childhood unnecessary medical interventions stress and anxiety
Parent support and training, together
Chromosomal abnormality in which all or Mild to moderate cognitive impairment; with early intervention with techniques
some cells in the body contain an extra copy short- and long-term memory loss; slow that support child’s development
of chromosome 21 acquisition of physical and language skills Psychotherapy to support living in
preferred gender identity; physical
Probably hormonal influences before birth Stress; depression and anxiety; self-harm; transitioning with surgical intervention
and intersex conditions (reproductive suicidal thoughts
anatomy not fully male or female)
Physical causes including illness, medication, Loss of confidence; social anxiety; low self- Specific interventions for physical
and substance abuse; stress; performance esteem; depression; anxiety; panic attacks problems; couple-based anxiety and
anxiety; and depression stress management and sex therapy
Sexual abuse or trauma in childhood; can Negative effect on intimate relationships; Psychoanalysis; hypnotherapy; and
be linked with severe personality disorders adopting risky or illegal behaviors behavioral therapy
such as antisocial PD or narcissistic PD
Trauma and stress; developmental delay; Loss of social confidence; secretive Behavior programs to encourage good
digestive problems behavior; isolation, bullying, and other toilet habits; psychotherapy to help with
problems at school shame, guilt, or loss of self-esteem
Presence of other mental disorders; lack Deep shame; fear; secretive behavior; Psychotherapy and medication for
of psychosexual education in puberty depression; anxiety associated depression, body dysmorphic
Geographical isolation; spiritual practices disorder, or schizophrenia
fueling a self-fulfilling prophecy
Long-term physical damage; social isolation; Psychotherapy for associated mental
incarceration in a psychiatric institution; or personality disorders; tolerance of
imprisonment psychosocial stressors
Linked with specific phobias of blushing, Depression; anxiety; social isolation; low Cognitive behavioral therapy to
deformation, eye-to-eye contact, and foul self-confidence help examine and reevaluate
body odor exaggerated beliefs
HEALING
THERAPIES
There are as many types of therapy as there are
approaches to psychology. Matching the therapy
to the individual’s particular experience of a
disorder is central to restoring peace of mind.
Health and
therapy
Psychologists working in the area of health aim to improve the mental and
associated physical health of individuals, specific groups, and the wider population.
This involves devising and delivering therapies to prevent and treat mental
disorders, and to promote general wellness. They also play a role in evaluating how
therapies improve health and which are the most effective. This influences the
way psychological treatments are delivered at both the individual and public level.
Roles of a psychologist Health psychologist
Whether working independently, as part of an inter- What do they specialize in?
disciplinary health-care team, or in a research institution,
psychologists are concerned with improving mental These specialists look at how people
health and general well-being. Their different roles deal with illness and the psychological
reflect the varied ways of achieving this goal for factors that influence their health. They
individuals or groups. may research and deliver strategies to improve health
and prevent disease, for example, promoting weight
WHO CAN PROVIDE TREATMENT? loss or stopping smoking, or may help individuals
manage specific illnesses such as cancer or diabetes.
Many mental health specialists can deliver psychological
assessments, therapies, and counseling, but only some Who would benefit from their help?
can prescribe medications to treat disorders.
Psychologists ❯❯Chronically ill patients ❯❯Health-care providers
needing help adjusting wanting to know how to
These professionals perform psychological assessments to a serious illness or improve their services.
and deliver a range of talking or behavioral therapies, managing pain.
depending on the needs of the individual or group. ❯❯Patient groups such
Psychiatrists ❯❯Population groups as diabetics, who need
needing lifestyle advice advice to help them
These are medical doctors who specialize in the treatment to prevent disease. manage their condition.
of mental disorders. They are licensed to prescribe
psychiatric drugs as part of a patient’s treatment. Where would you find them?
General medical professionals
Hospitals, community health settings, public health
Doctors (GPs and hospital consultants) and advanced departments, local authorities, research institutions.
psychiatric nurses can prescribe drugs or other therapies.
Other mental health specialists Qualifications
Social workers, psychiatric nurses, and counselors may Doctoral level of education, followed by practical
deliver therapy alone or as part of a mental health team. training, and continuing professional development.
75%More than 112 113HEALING THERAPIES
Health and therapy
of GP appointments
in the US are attributed PSYCHOEDUCATION
to issues related to stress
and anxiety Increasing people’s awareness of living with mental
health issues has become a key part of the therapeutic
process. Whether delivered individually, in groups, or
electronically via the Internet, psychoeducation helps
those with mental disorders better understand their
condition and the treatments, and also helps their
families, friends, and caregivers provide more effective
support. Having detailed information allows people to
take better control of their lives and take positive steps
to deal with their symptoms. It also improves a person’s
compliance with treatment and can play a role in reducing
the stigma often associated with mental health disorders.
Clinical Counseling
psychologist psychologist
What do they specialize in? What do they specialize in?
These psychologists help people to deal These specialists help people facing
with mental and physical health issues such as anxiety, difficult life issues, such as bereavement or domestic
addiction, depression, and relationship issues. After violence, as well as those with mental health disorders.
clinically assessing an individual using tests, discussion, They build a strong client relationship to effect change,
or observation, they will provide appropriate therapy. and may also undergo therapy to inform their practice.
Who would benefit from their help? Who would benefit from their help?
❯❯People with anxiety ❯❯Substance abusers ❯❯Families experiencing ❯❯Sufferers of stress
or depression in need who need help to tackle relationship difficulties. who can be helped to
of individual or group their addiction. address underlying
therapy sessions. ❯❯Children experiencing problems.
❯❯PTSD sufferers in need social, emotional, or
❯❯Children with learning of therapy to overcome behavioral problems, or ❯❯Bereaved individuals
difficulties or behavior past traumatic events who have suffered any needing emotional
problems. and experiences. type of abuse. support and guidance.
Where would you find them? Where would you find them?
Hospitals, community mental health teams, health Hospitals, community mental health teams, health
centers, social services, schools, private practice. centers, social services, industry, prisons, schools.
Qualifications Qualifications
Doctorate in clinical psychology.
Doctoral level of education, followed by practical
training, and continuing professional development.
Physical and
psychological health
Scientific research increasingly links our mental health with physical
health, and psychologists in this field have developed tools for
assessing, and improving, our mind‑body connection.
Making the connection When assessing an individual, the psychologist looks
at all the factors that may contribute to an illness or a
Health psychologists explore how a person’s state of problem, and devises a strategy for change. This might
mind (someone, for example, suffering from the include identifying behaviors that damage a person’s
day-to-day experience of stress) affects their body, and health, such as smoking or poor diet; encouraging
they find ways to improve a person’s physical health positive behavior such as exercise, a healthy diet,
by helping them change the way they think. This may oral hygiene, health checks, and self-examination;
involve changing their lifestyle, social network, and improving sleep practices; and scheduling preventive
attitude and perceptions. Health psychologists work in medical screenings. Health psychologists may also
a variety of roles—in the community to help vulnerable promote cognitive behavior changes that give the
and sick people, advising public authorities on health person more control over their life.
policy, and in hospitals.
Biopsychosocial FORCES FOR
model HEALTH
Health psychologists use this model to PSYCHOLOGICAL
assess three different forces meshing Stress management,
like a honeycomb in a person’s life: positive thoughts,
biological (the impact of physical
traits); psychological (thought patterns resilience, mental
and attitudes); and social (the influence discipline, and giving
of life events and other people). and receiving love.
Psychologists recognize that these
three forces can have either a positive
effect or a negative effect on health
and well-being.
BIOLOGICAL SOCIAL
A healthy diet, The support of social
exercise, a life free groups such as friends,
from addictions, time family, and religious or
to relax, and no other communities, along
genetic predisposition with access to medical
to illness. care and health
education.
114 115HEALING THERAPIES
Physical and psychological health
Managing health conditions RATING MENTAL HEALTH
Health psychologists can help when people are When a formal assessment is needed, psychologists
diagnosed with conditions that require hospitalization use a questionnaire to rate or measure an individual’s
or prolonged treatment, such as cancer, or alcohol or state of mind, differentiating between psychological
drug addiction. The psychologist will assess what health and emotional well-being.
can be changed to help improve the person’s ability Psychological health questions
to cope mentally with physical pain or discomfort and
the potentially life-changing impact of their condition. ❯❯Mood Is your mood generally positive?
❯❯Positive relationships Do you have friends or positive
A diverse range of strategies are also employed to
aid rehabilitation. On the psychological front, health emotional ties?
psychologists work to build and maintain a patient’s ❯❯Cognitive function Can you properly think and
self-esteem and motivation, training them to think
more positively. Rallying the support of friends, family, process information?
and other health professionals is part of this process. Emotional well-being questions
On the physical side, they may implement alternative
therapies, such as yoga and acupuncture, to enhance a ❯❯Anxiety Do you suffer from anxiety?
patient’s well-being, help control cravings, or overcome ❯❯Depression Are you depressed?
depression. They may also recommend regular ❯❯Control Do you feel you have lost control or cannot
exercise, a nutrition program, or vitamin therapy.
control your feelings?
FORCES AGAINST HOW STRESS AFFECTS
HEALTH THE BODY
thaocgsSouugPtpgsrrSpeeihnYsistcgsssCii;;ovsHaakeunnOislpxdl,Lseioe;OprnrtseGyoeos;IgsnvpCiaeamoAtrliiolivtLysyret.ic, Stress is nature’s way of alerting people to danger, putting
their bodies into primitive “fight-or-flight” mode (pp.32–
33). The brain produces a cocktail of chemicals in response
to stress, triggering changes throughout the body.
NERVOUS SYSTEM CARDIOVASCULAR
Headaches, SYSTEM
irritability,
nervousness, Fast heartbeat, raised
blood pressure
heightened sensitivity
pesrxmPecodoeBoiskssIripcniOvodogeLins,eOisapttuil,GoocmaolInlCguhpteAtotoiniolLoieonlnltnr,.icaednsrsud,g eLaoxbepnuxoespselSliuon,OrotieetrCrsaastrItuo;AeiomplLvanoiat;ovi.oaelennrntdsych;eip, RESPIRATORY GASTROINTESTINAL
SYSTEM SYSTEM
Rapid, shallow Diarrhea, nausea,
breathing as constipation, stomach
muscles tense
MUSCULOSKELETAL pain, heartburn
REPRODUCTIVE
SYSTEM
Muscle aches and SYSTEM
pains, especially In women: irregular
in neck, shoulders, periods, reduced libido;
in men: impotence
and back
The role of therapy
Psychotherapies use a range of strategies to help people modify the
thoughts, actions, and emotions that are harmful to their physical
or mental health, and also to promote improved self-awareness.
Therapeutic action Psychotherapy can uncover old wounds and help
a client understand how past negative experiences
Psychotherapies are often referred to as “talking currently affect them in unhealthy ways. It can also
therapies” because communication with a therapist help them change the ways they react to external
is the key agent for change. The aim is to manage stimuli, and how they internally process and interpret
adversity; maximize potential; clarify thought; provide experiences, allowing them to move beyond current
support, encouragement, and accountability; and states of thought and behavior. Therapy can empower
cultivate peace of mind and depth of consciousness. a client to explore their psyche and spiritual self and to
Therapy seeks to improve a client’s understanding of achieve more satisfaction in their lives. It is designed
themselves, others, and their relational dynamics. It to increase self-acceptance and self-confidence, and to
may also be used to define personal goals and organize diminish unhelpful negative or critical thinking.
behavior into achievable systems.
Types of therapy PSYCHOANALYTICAL COGNITIVE AND
AND PSYCHODYNAMIC BEHAVIORAL
Therapeutic approaches and methods
are as diverse and creative as the mind These approaches are based on These therapies stem from the
itself, and psychological progress can the concept that unconscious belief that it is not the things that
be achieved in many ways. The main beliefs underlie maladaptive happen to a person that upset
types of therapy are categorized thoughts and behaviors. Gaining them, but it is the way they think
according to the philosophy on which an insight into these beliefs can about the things that happen to
they are based. Methods of delivery explain and relieve problems. The them, and the meaning that they
vary and might comprise individual therapist and client also work to assign to their experience, that
sessions, group therapy, or online develop healthier ways of dealing upsets them. Cognitive and
guidance and task completion. with these previously repressed behavioral therapies show
feelings, and to foster the client’s people that they hold the power
28% inner resources and capability to to change the way they think
manage their troubles. about things, and the way they
of people in react and behave as a result of
the UK have these thoughts.
consulted a
psychotherapist
116 117HEALING THERAPIES
The role of therapy
GROUP THERAPIES
12-step program SHARING EXPERIENCES in a group allows people to give and
receive support and feedback, and to pool strategies for change.
The 12-step model is a group therapy approach specifically
used to tackle addictions (such as to drugs, alcohol, or sex),
and compulsive behaviors like eating disorders. An
essential part of overcoming addictions or compulsions is
support from and connection to a community. Group
therapy reduces isolation and associated shame, shows
people that they are not alone in their struggle, and
provides a network for support and accountability.
Self-help groups
These support groups focus on self-disclosure. Whereas
some groups have a professional lead, others are peer-led.
Shared experience is valued over professional knowledge.
HUMANISTIC SYSTEMIC ROLE OF MEDICINE
This approach prioritizes listening The “systems” approach The brain and behavior
over observing. To this end, enables people to work out exert a continual reciprocal
therapists use open-ended issues arising from the influence on one another.
questions and qualitative tools to interplay of relationships. Medication can alter brain
study personality and encourage Therapists can gain deeper chemistry to improve mood,
the client to explore their own understanding of problems concentration, memory, and
thoughts, emotions, and feelings. by working with everyone in motivation; increase energy;
The therapist sees the client as a system (family or group), and decrease anxiety. This
inherently capable of and hearing differing points of improved functioning can
responsible for achieving view, and watching people alleviate the symptoms of
personal growth, and not as a set interact. This allows people mental illness and enable
of flawed unconscious drives. to explore their identity as positive behavioral change.
part of a larger group, and
also has the advantage
of strengthening their
community network—useful
for issues that worsen with
isolation, such as addiction.
Psychodynamic
therapies
An umbrella term for all analytic therapies, psychodynamic therapy
is also a method in itself. Analytic therapies follow the root aim of
Sigmund Freud—to bring the unconscious mind into consciousness.
What are they? day gives the client the tools to compartmentalization (mentally
resolve their psychological separating conflicting emotions or
The principle behind the problems as an adult. beliefs), reaction formation (acting
psychodynamic approach is that contrarily to how the person feels),
the unconscious mind harbors Acknowledging buried memories and rationalization (self-justifying
feelings and memories, particularly helps the client to identify, confront, an unacceptable behavior).
from childhood, that shape thought and ultimately change the defense
patterns and behavior in adulthood. mechanisms they have developed In all psychodynamic therapies,
The therapist helps the client to to avoid experiencing painful the therapist listens to the client
talk about these often unwanted realities or facing unpleasant facts talking about their conscious
feelings and so draw them into and unwanted thoughts. These problems while looking for patterns,
the conscious mind. Burying (usually unconscious) mental behaviors, and emotions that hint
unpleasant memories results in strategies include denial (refusal to at their subconscious feelings. The
anxiety, depression, and phobias, accept reality), repression (burying goal is to enable the client to deal
and bringing them into the light of an unwanted thought or feeling), positively with inner conflicts.
The session TRANSFERENCE
The client’s unconscious conflicts
All forms of psychodynamic therapy take surface in their relationship with the
place in a familiar, safe, respectful, non- therapist. They redirect emotions
judgmental environment. Sessions are and feelings, often from childhood,
usually one-on-one and last 50–60 minutes. from themselves to the therapist.
DREAM ANALYSIS FREE ASSOCIATION
A means of accessing the The client talks
unconscious, analyzing dreams spontaneously about
can reveal hidden emotions, whatever comes to
motivations, and associations. mind, without
editing what they say
RESISTANCE ANALYSIS or attempting to give
Showing the client what, how, a linear structure.
and why they are resisting in True thoughts and
thoughts, ideas, or emotions feelings emerge.
can explain defense mechanisms.
THE CLIENT
FREUDIAN SLIP In traditional Freudian analysis, the client lies on
The client reveals what is really a couch and cannot see the therapist. In more
on their mind (their unconscious interactive forms, the client can see the therapist.
thought) by saying something
they did not intend to.
118 119HEALING THERAPIES
Psychodynamic therapies
Psychoanalysis
The purposes of psychoanalysis and psychodynamic therapy as
specific methods are similar—to integrate the unconscious and
conscious mind—but the depths of the processes differ.
What is it? used today. Silences in therapy are Psychoanalysis often takes years,
often as meaningful as what is deconstructing and rebuilding
The founder of psychoanalysis, said. All psychoanalysis assumes the client’s entire belief system.
Sigmund Freud, developed his that psychological problems stem It benefits those who are robust of
“talking therapy” after working in from the unconscious; that mind, with an outwardly successful
Paris with Jean-Martin Charcot, a unresolved issues or repressed life, but are aware of long-term
neurologist who discovered that his trauma hidden in the unconscious worries or torments, such as an
patients’ symptoms lessened after mind cause symptoms such as inability to stay in a relationship.
they talked about past traumas. anxiety and depression; and Psychodynamic therapy is less
that treatment can raise these
In the early 1900s, Freud conflicts to the surface so the intense and focuses on
established techniques such as free client can resolve them. present-day problems, such
association, dream analysis, and as a phobia or anxiety.
resistance analysis, still widely
INTERPRETATION PSYCHOANALYSIS PSYCHODYNAMIC
The therapist stays relatively quiet, THERAPY
reading between the lines of what the
client says to help them overcome
subconscious limitations.
Time 2–5 sessions a week 1–2 sessions a week
Duration Long-term—several Short to mid-term—
years weeks, months
Delivery The patient usually lies The patient usually
on a couch with the faces the therapist,
therapist behind, who remains in sight
out of sight
Relationship The therapist is The therapist is more
with the expert—neutral interactive and acts as
therapist an agent for change
and detached
To provide solutions
THE THERAPIST Focus To promote deeper for immediate
The analyst listens but does not judge long-term change problems
so that the client need not fear saying
something shocking, illogical, or silly. and happiness
PSYCHODYNAMIC THERAPIES
Jungian therapy
Carl Jung expanded Freud’s ideas—he thought the
unconscious mind went far deeper than the merely
personal and was at the core of behavior patterns.
What is it? ee. ShaAdnoiwCmoial/leanctive
OUTER WORLD INNER WORLD
Like his colleague Sigmund Freud, the public image that other people s TRUE SELF
Jung considered that psychological uncoimnsucsisoathureesttihhseothufeegmhdtiesneainpneedsstfiedlaeeylsienorgfosmfthmeanteamanpoderrimsesasccomm
distress occurs when the conscious is found when all parts
and unconscious parts of the mind of the mind, conscious
are unbalanced. But Jung thought and unconscious, work
that personal memories were part
of a much larger whole. in harmony.
Jung noticed that the same myths CONSCIOUS PERSONAL
and symbols occur across the world, EGO UNCONSCIOUS
whatever the culture. He thought
these must be the result of shared Persona is on toulaillnehsuoindmehasindosef.s.women.
experience and knowledge of the
human species, remembered by
everyone as what he called the
collective unconscious. These
memories, in the deepest layer of
the unconscious mind, take the
form of archetypes—instantly
recognizable symbols that shape
behavioral patterns. The conscious
ego is the public image that a
NEED TO KNOW person presents to the world. explore all the layers. Their role
❯❯Word association The client says Its archetype is the persona, is to help the client use the
whatever comes into their mind
when the therapist presents them identifiable as a person being on archetypes to understand and
with a word.
their best behavior. The darker change their own behavior.
❯❯Extrovert Someone whose
attention is directed toward the aspects of the mind that most Jungian therapists use
outside world and other people;
outgoing, responsive, active (even people hide Jung called the shadow. techniques such as dream analysis
reckless), decisive.
Further archetypes are the anima and word association to reveal
❯❯Introvert Someone whose
attention is directed inward to (female traits in men) and the where the inner archetypes collide
their own thoughts and feelings;
shy, contemplative, reserved, animus (male traits in women), with outer-world experiences. This
self-absorbed, indecisive.
which often clash with the conscious process of analysis enables the
ego and the shadow. To find the client to understand which layers of
true self, all the layers of a person’s their mind are in conflict, and then
personality need to work in harmony. make positive changes to restore
Whereas psychoanalysis delves the balance. Like psychoanalysis,
into the top layer of the client’s this therapy is a fascinating journey
unconscious, Jungian therapists into the mind and can take years.
120 121HEALING THERAPIES
Psychodynamic therapies
Self psychology and object relations
Both of these therapies are offshoots of Freudian psychoanalysis. The
therapist uses empathy to understand the client’s unique perspective
of life and create patterns of behavior that improve relationships.
What are they? IN OBJECT RELATIONS, the therapist helps the client relinquish
relationships from childhood and replace them with models
Both self psychology and object relations focus of behavior appropriate to their adult life.
on experiences in a client’s early life as a way to
understand and improve their adult relationships.
The premise of self psychology is that children
deprived of empathy and support in their early years
cannot develop self-sufficiency and self-love as adults.
The therapist fulfills the client’s urge to look to others
to meet their needs, giving them the self-worth and
self-awareness to carry into their own relationships. In
object relations—the name for childhood relationships
that the adult is repeating inappropriately—the aim is
to use the empathy with the therapist as a platform for
analyzing past interactions and emotions and applying
new positive models of behavior.
Transactional analysis
Instead of exploring the unconscious to shed light on
the conscious mind, transactional analysis focuses
on the three “ego states” of an individual’s personality.
What is it? part of their personality giving PARENT
orders from their parent state Can be
Rather than asking the client and another part reacting controlling
questions about themselves, the defensively from their child state. and critical or
therapist observes and analyzes nurturing and
how they interact. Then they help Transactional analysis helps supportive
the client develop a strategy for the client to recognize these three
operating from the adult ego state, states and guides them toward ADULT
rather than copying how their using their adult state in all Makes rational
caregiver treated them when they interactions. It helps the client choices in
were young (the parent ego state) communicate as they wish to, response to the
or acting out how that treatment unhindered by patterns formed in present time
made them feel and behave as a childhood. The adult state is based
child (the child ego state). in the present, and evaluates data CHILD
from the child and parent states Uses feelings
Conflict occurs when a person to draw a logical, intelligent and behavior
operates simultaneously from conclusion that directs behavior. from childhood
different states, for instance, one
EGO STATES
(COMPONENTS OF A
SINGLE PERSONALITY)
Cognitive and
behavioral therapies
What an individual thinks affects how they feel and behave. This
group of therapies focuses on how thoughts affect behavior and
aims to help people change negative patterns.
What are they? false premise. Cognitive-based both cognitive and behavioral
therapy seeks to change patterns of theories. The therapist helps the
These therapies stem from the negative thought. Behavior-based client challenge automatic thoughts
therapy aims to replace unhelpful and practice new ways of reacting.
belief that it is not what happens to behaviors with positive actions that Once the client can change their
then change underlying feelings. viewpoint, they can alter how they
people but how they think about Many therapies take elements from feel and behave.
what happen to them that upsets
them. These thoughts can lead an
individual to behavior based on a
IRRATIONAL THOUGHTS AND BEHAVIOR Rational thoughts
While reality feels absolute, it is subjective and influenced ❯❯Technical error Perhaps the
by individual thought patterns—two people in the same invitation went astray.
situation may feel and react very differently. Many people
automatically make incorrect assumptions and act on them. ❯❯Work function Perhaps it is a party
Therapy helps people to challenge these assumptions. only for work colleagues and limited
to those in the same industry.
A Emotional stimuli
❯❯Limited guest list Perhaps it is just
Outgoing, capable, Two people (A and B) find out that a small gathering for an old group
and confident with a a mutual friend is having a party, of friends she is not part of who have
strong social network. but has not invited either of them. not seen each other for a while.
Despite the identical emotional
B stimuli, A and B process the Irrational thoughts
information in vastly different
Unconfident, shy with ways based on their respective ❯❯Negative personal feelings The
low self-esteem and a cognitive patterns. Person A might lack of an invitation reflects what
poor support network. analyze the rational possibilities the friend feels toward her.
why she has not been invited or
diplomatically confront the friend, ❯❯Deliberate exclusion The friend
whereas person B automatically did not want to invite her because
jumps to the conclusion that she she is bad at socializing in groups.
has been deliberately excluded.
❯❯Self-destructive patterns She
deserves not to be invited because
good things do not happen to her.
122 123HEALING THERAPIES
Cognitive and behavioral therapies
Collaborative approach some clients, especially those client to view their problems from
who do not respond well to feeling a new perspective, and then
Cognitive and behavioral therapies directed or controlled, those who encourages them to take actions
require clients to be actively are sensitive to being judged or that change their patterns of
involved in the therapeutic process. evaluated, those with issues behavior. The process is one of
Rather than the therapist taking a around medical or authority figures, trial and error, so if one course
leadership role, the client and and those who have had negative of action only serves to increase
therapist work in partnership to past experiences in therapy. the client’s distress, client and
resolve issues. Intimacy and therapist can discuss alternative
honesty are integral to progress. In collaborative therapy, however, behaviors and reinforce those that
the relationship between client and work for the individual. The client
In many types of psychotherapy, therapist is equal, reciprocal, and remains actively engaged and
the therapist leads the process, flexible. Both the client and the equally responsible for their part
actively diagnosing the client and therapist make observations, direct in the healing process throughout
directing the course of sessions conversations, and evaluate the therapy sessions.
and dialogues. This authoritarian progress. Discussion helps the
approach can feel alienating to
Rational behaviors Therapy
❯❯Make contact Phones or meets
Regardless of the real situation, person B’s
the friend having the party to have a negative thought patterns created a specific
casual conversation. illusion of reality based on her perceptions.
❯❯Collect answers Asks thoughtful Therapy can help with:
and diplomatic questions, without
making assumptions, to ascertain the ❯❯Recognizing emotional habits In this
real reason for not being invited. case, tending to feel left out and to attribute
self-blame and criticism.
Irrational behaviors
❯❯Avoid Does not confront the friend ❯❯Self-awareness Understanding how
emotional habits—such as poor self-esteem
or situation because it is too difficult. or anxiety—form and what situations trigger
❯❯Confront angrily Feels overly irrational thoughts.
defensive, engages the friend in an ❯❯Behavioral strategies Using assertiveness
angry confrontation and accuses training or working on communication skills.
her of being thoughtless, not caring,
or being deliberately unkind. ❯❯Practice Learning to challenge and
❯❯Act defensively Treats the friend contradict irrational and negative thought
badly in retaliation. patterns and to recognize that other
possibilities are more likely to be true.
❯❯Change Practicing behavioral and cognitive
strategies to create a toolkit for positive
outcomes in the future.
COGNITIVE AND BEHAVIORAL THERAPIES
Behavioral therapy the child. Operant conditioning
uses reward-based systems that
If behavior can be learned, it can also be unlearned. develop and reinforce desirable
Based on this idea, this action-based approach aims behaviors, and discourage and
to replace unwanted behaviors with positive ones. punish unwanted ones. Strategies
include issuing tokens for good
What is it? a person’s behavior. Over time, behavior and giving a child “time-
the stimulus invokes a new out” to defuse a tantrum.
This approach is based on the conditioned response. For example,
concepts of classical conditioning a child who falls over and hurts Repeating tasks that invoke
(learning by association) and themselves at the same time as positive behaviors allows a client to
operant conditioning (learning hearing a dog bark (the neutral relearn responses. Behavioral
through reinforcement) (pp.16–17). stimulus) may develop a fear of therapy is useful for overcoming
dogs. Behavioral therapy can phobias (pp.48–51), OCD (pp.56–57
Classical conditioning works by reverse the process and desensitize and below), ADHD (pp.66–67), and
linking a neutral stimulus with an substance use disorder (pp.80–81).
unconditioned response to modify
Cognitive therapy person how to observe and monitor
their own thoughts and to evaluate
Developed in the 1960s by psychiatrist Aaron Beck, this whether they represent reality or
therapy aims to change the negative thought processes are irrational. Setting tasks to be
and beliefs that lead to problematic behaviors. completed at home, such as diary
keeping, can help the client to
What is it? behaviors reinforce an individual’s identify their negative beliefs and
distorted thought processes. then prove them wrong. Changing
Beck proposed that negative or the underlying beliefs leads to
inaccurate thoughts and beliefs Therapy focuses on breaking this changes in connected behaviors.
about ourselves, others, or the pattern by helping people identify Cognitive therapy is especially
world have an adverse effect on and replace negative thoughts with suitable for depression (pp.38–39)
our emotions and behaviors. This more flexible and positive ways of and anxiety (pp.52–53).
can create a vicious cycle whereby thinking. The therapist teaches the
THERAPY IN PRACTICE
With a disorder such as OCD, which Behavioral therapy Cognitive therapy
has both cognitive and behavioral
elements, therapy that aims to change ❯❯Suitable for those who carry out ❯❯Suitable for those who carry out
either the thoughts that lead to the compulsive behavior to reduce fear. internal checks, practicing avoidance
disorder or what the person does in and rituals in the mind and physically.
response to those thoughts, or both, ❯❯Helps client break the link between a
can help. certain object or situation and fear. ❯❯Helps client unlearn beliefs and
restructure their thought patterns.
❯❯Client learns to confront their anxiety
without performing rituals. ❯❯Challenging the meaning the client
assigns to these thoughts makes them
❯❯This decreases their anxiety so lose their power.
unhealthy behaviors can stop.
❯❯Client has no need to perform rituals.
START 124 125HEALING THERAPIES
Cognitive and behavioral therapies
PHASE 1 CBT (cognitive
Get to know client, behavioral therapy)
build trust, This therapy helps people to identify, understand,
explain cycle: and correct the distorted thoughts that can have
a negative effect on feelings and behavior.
Negative THOUGHT, Behavior What is it? and physical sensations. The
thoughts FEELING, reinforces therapist can then understand
BEHAVIOR thoughts This practical, structured, problem- how the client’s internal dialogue,
create solving approach employs theories their automatic thoughts (usually
feelings CYCLE first used in cognitive therapy (left) negative and unrealistic), affects
to reshape how a client thinks, and their behavior. The therapist helps
Feelings create strategies from behavioral therapy the client to recognize what
unwanted behavior (left) to alter how they act. The aim experiences or situations trigger
is to change the negative thought these unhelpful thoughts, and
PHASE 2 and behavioral cycles that make gives them the skills to change
Aim to break their automatic reactions.
the client unhappy.
this cycle In order to understand the Learning and practicing these
Explore client’s skills is key to the effectiveness
link between thoughts and of the therapy. The therapist sets
problematic behaviors, the therapist breaks tasks for the individual to practice
thoughts and problems down into separate at home. By implementing new
strategies repeatedly in their daily
behaviors parts, analyzing the person’s life, the client creates new patterns
Analyze the effect actions, thoughts, feelings, of positive behavior and realistic
these have on the thinking and learns to apply them
client and on Together develop
others a plan to alter these in the future.
thoughts and actions
PHASE 3
CBT Monitor which Use a range of ACTION
activities help client tools to break PLAN
❯❯Suitable for those who link situations
with fear and exaggerate thoughts. the cycle: Complete tasks between
relaxation sessions, such as thought
❯❯Helps client stop their compulsions techniques,
in the mind and in behavior. problem-solving log, recording anxiety
with client, levels, diary of enjoyable
❯❯Client learns nothing bad happens if exposure therapy
they stop performing compulsions. activities
(p.128)
❯❯Their anxiety decreases and they
break the thought cycle, so the PHASE 4 Road to change
behaviors can stop. Encourage client
The therapist helps the client to
to practice follow and practice small structured
techniques after steps and gain the skills to tackle
new problems independently.
therapy
COGNITIVE AND BEHAVIORAL THERAPIES
Third wave CBT
This group of evolving methods both extend CBT approaches and change
the aim. Rather than focusing on reducing symptoms—though this is a
benefit—they help the client step away from unhelpful thoughts.
What are they? Some people experience intense THE ACT METHOD
emotional reactions and have little
Two therapies that come under the ability to cope with their strong ACT therapists teach the client to
third wave CBT umbrella are ACT feelings. This may lead to defuse the power of their negative
(acceptance and commitment damaging behaviors such as self-judgments.
therapy) and DBT (dialectical self-harm or substance abuse. DBT
behavior therapy). teaches the skills to accept and ❯❯Values Define what is most
tolerate distress and to manage important to you.
ACT aims to change the client’s disturbing or provocative emotional
relationship with their thoughts. stimulation. The process involves ❯❯Acceptance Instead of trying
Rather than trying to alter or stop gaining behavioral control, then to control or change thoughts,
unwanted thoughts, the client experiencing rather than silencing accept them without judgment.
learns to accept and observe them. emotional stress—discussing and
Instead of thinking, “I never do accepting past traumatic ❯❯Cognitive defusion Distance
anything right,” the client switches experiences, and tackling self- yourself from the interpretations
to, “I am having the thought that I blame and dysfunctional thoughts. of your mind—just observe.
never do anything right.” Becoming
an observer of their thoughts Mindfulness (p.129) skills such ❯❯The observing self Maintain a
diminishes the power which that as visualization help the client to stable state of inner consciousness
thought has over their state of mind maintain emotional regularity in and awareness regardless of
and being. The thought no longer everyday life, to build confidence to external stimuli.
has to guide reaction or behavior, deal with problems calmly, and to
and the person can instead choose expand their capacity for joy. ❯❯Commitment Set goals for
actions based on their values. behavioral change and commit
to them, regardless of any
sabotaging thoughts or emotions.
MINDFULNESS DISTRESS
Become aware of the TOLERANCE
emotional experience— Use self-soothing
encouragement in
observe rather stressful situations.
than react.
EMOTIONAL
The four skills INTERPERSONAL REGULATION
of DBT EFFECTIVENESS Choose to behave in a
Stay calm and pay positive way despite
Skills training teaches people who respectful attention negative emotions.
feel at the mercy of their emotions to to other people.
accept themselves and their thoughts
and to replace dysfunctional behaviors
with positive actions.
126 127HEALING THERAPIES
Cognitive and behavioral therapies
CPT (cognitive processing therapy)
This therapy helps people to address and change negative, fear-based
thoughts—referred to as stuck points—that recur after traumatic events
so that they feel calmer and safer.
What is it? CPT aims to help the individual evaluate these stuck
points and ask the question “Do the facts support my
CPT is particularly effective for people with PTSD thoughts?” Clients reexamine the trauma, and are
(p.62). Sufferers often experience biased, upsetting helped to recognize acquired distortions and rewrite
thoughts that delay recovery, including feelings of their negative post-traumatic view. This cognitive
helplessness; loss of trust, control, and self-worth or restructuring helps them to accurately differentiate
deservedness; blame; and guilt. These “stuck points” between what is truly dangerous and what is safe,
keep the person stuck with the symptoms of PTSD, and to modify unhelpful thoughts in the future.
and are usually not based on what actually happened.
STAGES PSYCHO- FORMAL USING NEW SKILLS
EDUCATION PROCESSING Learn and practice
The stages of CPT are Discuss symptoms OF TRAUMA skills to challenge
designed to help the of PTSD, thoughts, Recall trauma to thoughts and modify
individual understand and emotions. gain awareness behaviors.
how trauma has of thoughts.
affected their brain.
REBT (rational emotive ABC FRAMEWORK ACTIVATING EVENT
behavior therapy) The event that triggers irrational thoughts, for
THERAPY example, being passed over for a promotion.
Through this therapy clients come to understand
that how they think about events is more BELIEF
significant than the events themselves. “I am a terrible, worthless person who never
does anything right and will never be happy
What is it?
or successful.”
REBT works to replace the irrational beliefs that cause CONSEQUENCE
misery and self-defeating behaviors with more Unhealthy emotions, such as depression, anger,
productive, rational thoughts. It breaks a client’s rigid blame, self-loathing, and low self-esteem.
thought patterns—often governed by words like
“should,” “ought,” and “must”—such as dwelling DISPUTES
harshly and solely on the negative; thinking in black- “Nothing is that awful—life will have challenges;
and-white absolutisms, especially about themselves;
and global-rating (“total idiot”). Understanding the ABC I can deal with this frustration and
framework (right), clients learn to accept themselves disappointment.”
and other people, to distinguish an irritation from a
crisis, and to meet the challenges of life with tolerance EFFECTIVE EMOTIONS
and assertiveness. REBT is useful for anxiety and “I would have loved that promotion, but
shyness disorders (pp.52–53) and phobias (pp.48–51). I am a worthy and capable person regardless
of the outcome.”
COGNITIVE AND BEHAVIORAL THERAPIES
Methods used in CBTs
People often make their stress or fear worse through poor coping
mechanisms. Two methods that offer practical strategies are
SIT (stress inoculation therapy) and exposure therapy.
What are they? People who have undergone EXPOSURE METHODS
traumatic experiences, or who have
SIT helps people to recognize phobias, tend to avoid exposure to ❯❯Flooding Intense exposure
the triggers and distorted situations, objects, or places to the person’s worst fears to
thought processes that incite (“triggers”) that might cause fear. extinguish the fear response.
a stress response. Many clients This avoidance often makes the
overestimate the threat level of problem worse, allowing the fear ❯❯Systematic desensitization
a situation and underestimate to grow. In exposure therapy, the Gradual exposure to fears to
their ability to deal with it. therapist deliberately exposes eliminate them.
the client to anxiety-provoking
The therapist presents anxiety- stimuli to erode their fears. ❯❯Graded exposure Grading
provoking situations that cue stress anxiety-provoking situations to
through role-playing, visualization, Exposure is incremental and create a hierarchy of fears; the
or recordings of stressors. In starts with “imaginal” exposure— person progresses up the list,
response, the client learns and imagining the feared thing, or tackling the most feared last.
practices new coping mechanisms, recollecting the traumatic memory.
such as relaxation and mindfulness The intensity of exposure increases ❯❯Exposure and response
techniques and assertiveness. with “in vivo” exposure—real prevention Exposing OCD
Gradually the client learns how to exposure in settings that provoke sufferers to a trigger while not
change their reaction to stress and anxiety but are not truly dangerous. letting them engage in their usual
cope with it instead of engaging Various models can be used (right). rituals; for example, a compulsive
the previous unhelpful response. hand washer is not allowed to
wash their hands and finds there
Exposure therapy in practice are no disastrous consequences,
so the compulsion subsides.
Therapists find that exposure is particularly effective
for treating phobias. ❯❯Aversion therapy Pairing an
unpleasant stimulus with the
unwanted behavior to change it.
MPTOM1 Fear EATME2NT Exposure RE 3 Cured
Phobias are an irrational An effective way to When nothing bad
SY
TR
CU
fear of something—the client overcome a phobia is to show happens during exposure, their
cannot use logic to keep themselves the client that the object of their
from being afraid. fear is not harmful. negative emotions subside, and their
body learns not to respond to the
stimulus with the symptoms of panic.
Exposure
can be either
gradual or
sudden
Acute
anxiety
128 129HEALING THERAPIES
Cognitive and behavioral therapies
Mindfulness
Learning to focus awareness on the present—to observe what their
thoughts, feelings, and body are experiencing at any one moment—
can help people understand and manage unhelpful responses.
What is it? POSITIVE PSYCHOLOGY
Mindfulness techniques help people to give their full Traditional psychotherapy concentrates on tackling
attention to what is happening around them and to disorders and problem behaviors; positive psychology,
them. Observing and accepting these experiences and like humanistic therapies, focuses on the goals of self-
sensations in a detached and nonjudgmental way fulfillment and well-being as a catalyst for change.
gives people the space to evaluate whether thoughts Learning to think positively and to focus on what brings
and behaviors are dysfunctional, and then to modify happiness encourages people to pursue positive actions—
their responses. Practices to promote mindfulness to develop their strengths, improve their relationships,
include breathing, visualization, and listening and achieve goals—on a personal and societal level.
exercises; yoga; tai chi; and meditation. Mindfulness techniques are often used to help people
focus their mind and behaviors on positive action.
Benefits of mindfulness
PERMA model
Learning to observe rather than be controlled by their
thoughts allows people to anticipate and deal more Developed by psychologist Martin Seligman, this model
effectively with stressful experiences and anxiety, for change defines the elements that promote well-
and to replace negative thought patterns. Mindfulness being: (P) positive emotion; (E) engagement; (R) positive
exercises also have a calming effect—switching off relationships; (M) meaning; and (A) accomplishments.
the regions of the brain that stress turns on, and Understanding the importance of these elements and
activating the parts that deal with awareness and then taking steps to pursue them through everyday
decision-making. This allows people to focus on thoughts and actions allows people to build on their own
positive actions to promote well-being. strengths and resources to achieve future happiness.
“... refuge to the mind POSITIVE ENGAGEMENT POSITIVE MEANING
is mindfulness.” EMOTIONS Complete RELATIONSHIPS Having a sense
Learning what Fostering a feeling of purpose to
Buddha brings happiness; immersion or of well-being and
positive emotions “flow” in a promoting positive give context
leading to positive satisfying to all aspects
outcomes. activity. emotions.
of life.
STRATEGIES FOR MINDFULNESS
MINDFUL WALKING MINDFUL EATING ACCOMPLISHMENTS
Focusing your awareness Slowing down, taking the Pursuing goals for a
on what you see, hear, and time to bring full attention sense of purpose;
smell; your thoughts; and the to the process and sensation success promoting
physical sensation of walking of eating, focuses your mind self-esteem.
allows you to connect with and can change your
the present. responses.
MINDFUL BODY AWARENESS MINDFUL BREATHING
Practicing yoga or doing a Learning to concentrate on the
“body scan”—bringing your flow of your breath is a useful,
attention to each part of the calming meditation technique
body in turn, and noting how it to relieve stress, anxiety, and
feels—focuses mind and body. negative emotions.
Humanistic therapies
This group of therapies encourages an individual to resolve their
problems and issues and achieve greater fulfillment by recognizing,
understanding, and using their own capacity to develop.
What are they? Humanists viewed these concrete, Therapists emphasize the
methodical approaches as too individual’s inner strengths,
Before humanism developed in the limited in scope to capture the resources, and potential as the
late 1950s, psychological issues broad, colorful, and individualistic foundation for working through
were viewed as flaws within a human experience. In contrast with issues. Life may be filled with
person that required intensive psychoanalysis, humanistic challenges and heartbreak, but
behavioral or psychoanalytic therapies view the person as a humans are essentially good,
treatment. Psychological theories whole being able to exercise free resilient, and capable of enduring
relied on measurements of behavior will and make active choices, rather and overcoming difficulties.
and other scientific, quantitative than as a set of predetermined
(statistical) studies to evaluate and drives, urges, and behaviors. Humanists also expanded the
categorize people. concept of therapy as a
Therapeutic NURTURING ENVIRONMENT
relationship
Constructive atmosphere
Humanistic therapists aim to help client put down
to cultivate a positive and
constructive relationship roots and flourish.
by valuing their client,
and showing genuine, dae❯tbv❯hSeileeilp❯tolaicr❯efpolSl-ilsmeofmetuahnwla❯efnoletvt-n❯fodtitatSairetholieclarlsoaemaeclhcnwsmfbseka-eedolnnparleTntfunoiwt-ommHttraerwoceaaasnopeElgscrtnectrsheacRtioddevherfenvogdaApemgeeVetritarismraP,ostotnsaliehhnuneIwdnleeASsfnen-dmstispataTmeh.nttetsloehfPsdre-HselbutRvogoenceeonlOlldpesiiaaee,nesllMnasfrac..ntsbhtOdtlaooeniTccdeEliseSnt
unconditional, positive
regard. This environment
nurtures the client’s
self-knowledge, confidence
in their own choices, and
emotional development so
that they can self-actualize
(fulfill their own potential).
130 131HEALING THERAPIES
Humanistic therapies
treatment for severe neuroses to responsibility to do so. This idea NEED TO KNOW
a broadly applicable approach for places the individual fully in control
anyone wanting to self-improve. of their choices and goals. ❯❯Therapist/client relationship
They recognized people’s natural In close and collaborative
desire to overcome problems, seek Humanistic approaches for counseling, the therapist
happiness, improve the world, and getting to know a client are as encourages the client to use their
live a satisfying and fulfilling life creative and diverse as people own resources to find solutions.
as the primary, central human themselves, but all are based on
motivation. An individual’s need talking and trust. In a session, ❯❯Qualitative methods Rather
to realize their potential and fulfill rather than relying on their own than evaluating behavior with
their goals and dreams is called observations, the therapist asks a questionnaire (a quantitative
self-actualization. open-ended questions and listens method), listening is the basis of
to what the client makes of their therapy, as the client is seen as the
Humanists believe that not only own behavior and personality. expert in their own experiences.
is a person capable of making All humanistic therapists use their The therapist guides the client
changes and achieving personal empathy and understanding to help toward greater self-awareness.
growth but it is their the client accept themselves.
“[A person is]
a continuing
constellation
of potentialities,
not a fixed
quantity of traits.”
Carl Rogers, American humanistic
boSerCcewoLlfmiI-sEahecNestsutT,hareeAliiarzCliiadzHteeisoaIEltnhsVeeAliEfrt.tSpapoinstyescnthhtoiealiolr,gaginostdal
CLIENT ENGAGES WITH THE PROCESS
Responsibility Takes active role to make the
changes needed for personal growth; therapist
helps the individual take responsibility for their
choices, behaviors, and self-development.
HUMANISTIC THERAPIES
THE CLIENT
Person-centered therapy SELF-
ACTUALIZATION
In this approach, the accepting, supportive relationship Client uses their
between therapist and client promotes self-belief, inherent capacity
confidence, and personal growth.
and desire for
personal growth
and change.
What is it? allows the client to truly accept Therapist creates climate
themselves. Self-esteem, self- to facilitate change.
True to humanism, person-centered understanding, and confidence
therapy holds that all people improve; guilt and defensive
possess the resources they need to reactions lessen.
gain insight, experience personal
growth, and change their attitudes Self-acceptance allows clients
and behaviors to reach their full to have more faith in their abilities,
potential—self-actualization. express themselves better, and
improve their relationships, and can
Therapy sessions focus on the also help with body perception in
present and future, rather than on people with dysmorphic disorders.
the past, and the client leads the
conversation. The therapist listens THE THERAPIST
intently to the client’s experiences,
responding without judgment. CLIENT/ CONGRUENCE UNCONDITIONAL EMPATHY
THERAPIST The therapist is REGARD The therapist
The authenticity and depth RELATIONSHIP positive, optimistic, understands and
(congruence) of this relationship The therapist and genuine. The therapist sees the experiences the
encourages clients to express their is the vehicle client in a positive world through the
thoughts and emotions freely. The for the client’s light, enabling the eyes of the client.
therapist’s unconditional positive self-improvement.
regard validates the client’s client to do the same.
feelings, attitudes, and perspective,
and the therapist’s acceptance
Reality therapy Fun Physiological
Pleasure, (survival)
This problem-solving therapy seeks to help the client fulfillment,
evaluate and change their current behaviors and thought and joy Food, shelter,
processes. It is especially useful for relationship issues. and safety
What is it? the five basic needs (right). Freedom FIVE Love and
Focus is on the present. The Autonomy and BASIC belonging
In reality therapy, the therapist therapist discourages criticizing, NEEDS Part of a family,
helps a client change how they blaming, complaining, and control over Power network of friends,
act, then how they think, as both excuses, all of which harm own life or community
behaviors are easier to control relationships. Instead, client and
than how they feel or react. The therapist together identify and To succeed,
therapy holds that the only monitor behavior patterns and provide, feel
behavior an individual can control create a workable plan of change. competent, and
is their own, which is motivated by be recognized for
accomplishments
132 133HEALING THERAPIES
Humanistic therapies
Existential therapy THE GIVENS
OF EXISTENCE
This philosophical therapy helps people come to terms
with the specific, inherent challenges of simply existing by ❯❯The inevitability of death The
making choices and taking responsibility for their actions. natural drive to exist conflicts with
awareness that death is inevitable.
What is it? drives and impulses. A session may
address questions such as “Why ❯❯Existential isolation Everyone
Existential therapy is based on the are we here?” and “How can life enters the world alone and
premise that if people make peace be good if it involves suffering?” leaves it alone. Regardless of any
with the givens of existence (right), and “Why do I feel so alone?” relationships or connections,
they can lead a more fulfilling and people are innately alone.
enjoyable life, free from anxiety. By learning to accept
Existentialism holds that people responsibility for decisions in ❯❯Attendant isolation People
have free will and are active the past that led to emotional are alone, yet seek connection.
participants in their own lives. disruption, the client gains the
Therapy focuses on increasing power to take control of their ❯❯Meaninglessness People seek
self-awareness by exploring the experiences. The therapist helps purpose, yet finding a path and
meaning, purpose, and value in the the client find individual, nuanced understanding the meaning of
client’s life, and by helping them solutions; and acceptance, growth, existence often eludes them.
understand that they are in charge and welcoming future possibilities
and not just a passive victim of are key themes. ❯❯Freedom and responsibility
All have a responsibility to create
their own purpose and structure,
as existence inherently has none.
Gestalt therapy ENACTMENT
LEADS TO
This lively and spontaneous therapy liberates clients and
helps them become more aware of their thoughts, feelings, SELF-AWARENESS
and behavior and their effect on their surroundings.
What is it? client gains insight into how they
react to certain situations. This
The German word gestalt roughly increased self-awareness allows
translates as “whole,” reflecting the client to identify patterns and
the belief that the individual is see the true, rather than perceived,
more than the sum of their parts effect of their behavior.
and has a unique experience of the Gestalt was developed to
external world. Gestalt therapists treat addiction but helps
believe that discussion alone depression, grief, trauma,
cannot alleviate guilt, unresolved and bipolar disorder, too.
anger, resentment, or sadness. The
client must evoke and experience EMPTY-CHAIR TECHNIQUE
negative feelings in the present to The client addresses a chair as if it
resolve them. The therapist may is an important figure in their life,
use role-play, fantasy, visualization, then changes roles to understand the
or other stimuli to arouse negative opposing view. Releasing feelings and
feelings from the past so that the emotions increases self-awareness.
HUMANISTIC THERAPIES
Emotion-focused therapy EMOTIONALLY
FOCUSED THERAPY
This approach attempts to help people understand their
emotions better and acknowledge them, and to use this Although its title is similar,
newfound self-awareness to guide their behavior. emotionally focused therapy is
different from emotion-focused
What is it? feelings are appropriate to the therapy. It is a relationship therapy
situation, and to learn to use for couples and families to help
This therapy is based on the positive emotions to guide their them understand the emotions
premise that emotions form the actions. Recognizing how unhelpful that govern their interactions.
foundation of people’s identity and emotions, including those linked to Because negative patterns of
govern their decision-making and traumatic experiences, negatively behavior and conflict can occur
behavior. With this approach, the impact choices and behavior also when emotional needs are not met,
client is encouraged to discuss and helps the client to regulate these the therapist helps clients recognize
analyze how they feel or have felt in feelings and to develop strategies their own feelings and acknowledge
past situations to identify which to change their emotional state. those of family members or partners.
emotions are helpful or unhelpful to Learning how to express and
them and to make sense of their Strategies may include using regulate emotions, listen to others,
emotional responses. breathing techniques, using imagery and positively use emotion tightens
and visualization, repeating positive bonds with partners or family
Increasing awareness allows the phrases, or using new experiences members, resolves past issues, and
client to describe their emotions to elicit positive emotions. offers strategies for the future.
more clearly, to assess whether the
Solution-focused brief therapy REACH
GOAL/
This forward-looking therapy encourages individuals to focus on DESIRED
their strengths and to work positively toward achievable goals SITUATION
rather than dwelling on or analyzing the past. ASSESS WHAT
HAS ALREADY
What is it? encourage the person to focus on BEEN ACHIEVED
previous successes, showing them SCALE HOW CLOSE THE
This therapy is based on the belief that they already have the skills, GOAL IS AND DECIDE ON
that everyone has the resources to resourcefulness, and resilience SMALL REALISTIC STEPS
improve their lives but may need to achieve a positive outcome. DESCRIBE THE
help in structuring plans. The GOAL IN DETAIL AND
so-called miracle question (“How is Therapy usually involves about PICTURE A SOLUTION
life different if ...?”) is often asked five sessions. While the therapist DECIDE ON A CLEAR AND
so the person envisions what life provides accountability and REALISTIC GOAL
will be like when their issue is support, the client is always
resolved. From here, the individual considered to be the expert on their
can define a goal, create possible own problems. It is a particularly
solutions, and outline specific steps effective method for young people,
to achieve their goal. Coping who may prefer a short, structured
questions, such as “How have you approach rather than a probing
handled this in the past?” also analysis of their past.
134 135HEALING THERAPIES
Humanistic therapies
Somatic therapies
These therapies—based on the idea that unresolved emotional issues
are stored physiologically as well as psychologically—act on the body
to release negative tension and restore mental health.
What are they? Certain body parts are associated Trauma destabilizes the
with psychological issues. Many autonomic nervous system.
Sometimes psychological healing people carry stress in their Psychological issues are
occurs through methods that shoulders, for instance, and stored in body and mind.
cannot be entirely explained, yet emotional trauma may create
are still effective. This is true of physical pain or digestive problems. Yoga and other somatic
many mind-body healing therapies, Changing body posture can change therapies restore balance by
sometimes called energy the psychological experience—a releasing negative emotions
psychology, which deal holistically broken heart, for example, often held in the body.
with the body and mind. leads to a shoulders-forward,
heart-protected slouch, and a sense The healing power
Somatic therapies consider that of defeat results in a downward improves the person’s
the integration of mind and body gaze. Encouraging the client to state of mind and reduces
is essential for mental health. thrust their shoulders back, sit up physical symptoms of pain.
Massage, body work, breath work, straight, and lift their chin to the
yoga, tai chi, and the use of sky can help them to feel powerful,
essential oils or flower essences are more optimistic, and more open to
all examples of somatic therapies facing the world.
that may relieve physical and
emotional tension.
EMOTIONAL FREEDOM TECHNIQUE
This holistic therapy works on the Tapping these points appears to calm TAPPING POINTS 1
same meridians (energy channels) the amygdala—the part of the brain After the karate-chop 2
as acupuncture and acupressure. The that processes emotions and controls points are tapped,
theory is that traumatic experiences the fight-or-flight response. Over meridian points are 34
can block these channels, causing time, this process reprograms tapped from the head
continuing distress. The therapist the individual’s thoughts, removing downward, 1–8.
uses their fingertips to tap meridian negative emotions and replacing
5
points on the body, while the client them with new, positive feelings
thinks about a specific problem, and behaviors. Individuals can 6
image, or negative feeling, and also learn to perform the tapping
voices positive affirmations. sequence themselves. Karate-
chop point
80% of individuals report a 7
positive effect from EFT 8
HUMANISTIC THERAPIES
EMDR (eye movement
desensitization and reprocessing)
This therapy stimulates the brain using eye movement, reprocesses
traumatic memories so that they lose their power to disturb, and teaches
the client techniques to deal with emotional disturbances.
What is it? system, even though the actual
danger has long since passed, the
In this therapy, the client recalls combination of eye movement and
a picture, scene, or feeling from a psychological recall neurologically
past trauma while tracking bilateral releases the traumatic memory and
stimulation, such as the therapist’s its negative effects. This allows
hand moving back and forth across the memory to be stored neutrally,
their field of vision. The client and helps install a new healthy
thinks of a negative statement belief system.
linked to the trauma (for example,
“I am unworthy,” from a childhood The process mimics the
marred by a disapproving parent) memory processing and physical
and replaces it with a positive, movement thought to occur
preferred self-statement. during REM (rapid eye
movement) dream sleep. The
Based on the idea that the therapy is particularly effective
negative belief system has been in treating individuals with
trapped in the client’s nervous PTSD (p.62) and symptoms
can be significantly reduced
DURING BILATERAL STIMULATION, in as few as three 90-minute
side-to-side eye movements help the sessions.
brain to digest traumatic memories, and
reorganize how they are mentally stored.
Hypnotherapy
During hypnotherapy, the client enters a deep, trancelike state
of relaxation that suppresses the conscious mind, allowing the
subconscious to become more alert and receptive.
What is it? changing the client’s perceptions, childbirth or surgical or dental
thought processes, and behavior. procedures. Another use is to allow
The therapist uses the power of suppressed or hidden memories to
hypnotic suggestion to quiet the Hypnotherapy is particularly surface so that the related issues
analytical parts of the brain and useful for helping clients to and emotions can be addressed.
fully focus the client’s attention overcome unwanted habits such
on the subconscious mind. Once as smoking or overeating. It can Clients practice deep relaxation,
the client is deeply relaxed, the also be used to reduce pain in often using a recording taped by
therapist makes suggestions that future situations that the client the therapist between sessions to
instill different brain patterns, anticipates will be painful such as consolidate the work.
136 137HEALING THERAPIES
Humanistic therapies
Arts-based therapies
These approaches use the alternative languages of art and music to
promote self-discovery, self-expression, and well-being. They can help
people articulate thoughts and feelings and regulate their emotions.
What are they? life, investigate and validate change the individual’s physical
thoughts and feelings, and increase and emotional states. Music acts
It can be difficult for some people to self-awareness. The physical act of on neural pathways throughout
find words to express emotions and producing art can be therapeutic in the brain to alter how a person
perceptions. Art therapy provides a itself too, as it concentrates body processes information, experiences
way for them to describe their inner and mind on a single creative goal. and expresses emotions, uses
language, relates to others,
ACTIVATES AIDS PROCESSING OF The focus in art therapy is not on and moves.
REWARD SOCIAL AND EMOTIONAL the skill of the artist, but
INFORMATION on the creative process as Music can promote long-term
NETWORK behavioral and emotional changes,
IN BRAIN a form of communication. including decreasing symptoms
Displaying their art in public can of depression and anxiety. Its
ENHANCES REGULATES HEART RATE, help individuals overcome their physiological effects include
COGNITION MOVEMENT, BREATHING, self-consciousness and self- triggering the release of mood-
AND SPEECH criticism and lead to greater enhancing chemicals, such as
AIDS acceptance of themselves and dopamine, and lowering heart rate.
COMMUNICATION improved self-esteem.
Music therapy plays a different All styles of music can be used,
and sessions may involve listening
role. When music stimulates the to music, using instruments,
brain (left), it activates a myriad singing, improvising, or composing.
of sensory connections, which can
Animal-assisted therapy
This approach uses the bond between people and animals to improve
communication skills, emotional control, and independence, and to
decrease feelings of loneliness and isolation.
What is it? of the ways vulnerable people “A pet is a
can learn about boundaries, medication
Interacting with animals increases respect, and trust and develop without side
levels of oxytocin, a hormone that self-reliance and independence. effects.”
promotes intimacy and trust, and
mood-enhancing endorphins. In anger-management and Dr. Edward Creagan,
Learning how to handle animals substance-abuse group therapy, American oncologist
also improves behavioral and social the presence of animals can
skills and boosts self-esteem. encourage participants to open up
and talk about lost innocence and
Stroking cats, looking after dogs violent pasts, leading to greater
or horses on a regular basis, and self-acceptance and forgiveness.
swimming with dolphins are some
Systemic therapies
These approaches recognize that people are part of a network of
relationships that shape their behaviors, feelings, and beliefs. The
therapies seek to influence the whole system, not just the individual.
What are they? of the system as a whole— involves considering the
looking for solutions that work perspectives, expectations, needs,
Systemic therapies make use of for everybody. Making a change and personalities of all the people
the concepts of systems theory, to one part of the system—such involved, and encouraging dialogue
which hold that any individual as providing better support for the to enable each person to gain an
object is just one part of a larger individual at work—can benefit insight into the roles and needs
and more complex system. In all members of the network. of others in the group.
human terms, this might be a
family, workplace, organization, As well as viewing the system To resolve issues, all members
or social community. as a whole, these therapies address of the group have to accept that
system dynamics, attempting to change is needed and recognize
Disruption in one part of the identify deeply entrenched patterns how their actions influence others.
system may affect or unbalance and trends. The dynamics of many In many cases, small individual
other parts of the network. For families, for example, are governed changes can lead to large shifts
example, a person experiencing by a series of unwritten rules and in group behavior.
depression may find that it disrupts unconscious behaviors.
their relationships with family Looking at problems systemically
members, but it may also affect By making individuals aware of also reveals how seemingly
interactions with work colleagues the ways in which they interact unrelated issues can be closely
and friends. Rather than treating and influence one another, these
the problems of the individual therapies help people to make linked. Solving one issue may
in isolation, systemic therapies positive changes that benefit the therefore bring the bonus
therefore tackle them in the context dynamics of the group. This of a beneficial effect on
other parts of the system.
“The family crucible must have a
shape, a form, a discipline of sorts,
and the therapist has to provide it.”
Augustus Napier, American author and family therapist
Balancing relationships CONFLICT EMOTIONAL HARMONY
TRIANGLE
When conflict occurs between two people, they HARMONY
may focus on a third person as a way to stabilize
their relationship, rather than resolving the issue
between themselves, so emotional relationships
can be seen to be triangular. Adding a third
person into an existing relationship (for example,
the arrival of a baby) is not always beneficial and
may cause friction between the original two.
138 139HEALING THERAPIES
Systemic therapies
Family systems therapy
Relationships within the family unit are regarded as both the
underlying cause of issues and the means by which they can be
solved in this therapeutic approach that focuses on group dynamics.
What is it? own children. Improving patterns, and enable the family
communication, self-awareness, unit to build on its strengths and
This therapy is based on the and empathy can help individuals to use its interdependence to make
theories of psychiatrist Murray to break these generational positive changes.
Bowen. Bowen used eight
interlocking concepts to find out BOWEN’S EIGHT INTERLOCKING CONCEPTS
how birth order, a person’s role
within the family, personality, Differentiation of self Emotional triangle
and inherited traits all affect how
individuals relate to each other in How a person maintains their How the smallest network
a family system. He defined the own sense of individuality, while in a human relations system,
family by both the people within it in many cases formed by two
and the way in which they interact. still functioning in the group. parents and a child, operates.
Viewing the family as an Family projection process
emotional unit in this way enables
individuals to work together to How parents’ emotions, conflict,
solve problems—these might be or difficulties are passed on to
emotional issues affecting the
whole family, such as death or their children.
divorce, or specific issues related to
an individual member that have an Emotional cutoff Sibling position
impact on the rest of the unit.
How individuals manage conflict How birth order influences
Therapists explore how family within the family network by the way children are treated—
members see their roles and distancing themselves. differences in expectation lead
express them. This exploration them to take on different roles.
allows each person to understand
better how their actions affect other Multigenerational
members of the group, and how transmission
they are affected in turn.
How people seek partners with
Understanding how external similar differentiation, so patterns
factors impact relationships within
the family, and how patterns can repeat down the generations.
be repeated over generations, is
also key. For example, children with Societal emotional Nuclear family
a poorly defined sense of their own process emotional process
individuality (perhaps due to
overbearing parents) may seek out How family emotional systems How any tensions in the
a partner with a similarly low level go on to influence wider systems family affect the relationship
of differentiation. The two of them
then pass on conflicts or problems in society, like the workplace. patterns within the unit.
associated with these traits to their
SYSTEMIC THERAPIES
Strategic family therapy
The therapist plays a key role in this approach, helping families to
identify the problems affecting their relationships and to develop
structured plans and targeted interventions to solve them.
What is it? members adopt new ways of “[In strategic
interacting that they might not have therapy] the
This solution-focused technique, considered before. Individuals might therapist takes
based on the theories of therapist be encouraged to replay common responsibility
Jay Haley, uses strategies specific family interactions or conversations,
to each family’s structure and with the aim of increasing the
dynamics to achieve an agreed-on family’s awareness of how they
outcome. The focus is always on
current problems and solutions operate and how problems arise. for directly
rather than analyzing past causes Strategies for change are based
and events.
influencingon the strengths of family members.
The therapist plays an active role
in helping the family to identify their This allows the family to use their
problems. Together they agree on a people.”
goal achievable in a relatively short own resources to support each
time frame. The therapist develops other in making positive
a strategic plan to help family
changes to behavior, and Jay Haley, American psychotherapist
STRATEGIC ROLE
OF THERAPIST to successfully achieve
❯❯Identify solvable problem their goal as a unit. erappraoylbfeloterpmcrpholabaannkleeigmneptoowsaiittchitvieaonplan
Observes the family and identifies
a problem, such as teenage son MTPautTraSrgIegtedgteonstifoyf th change
Tom not communicating.
❯❯Goal setting Helps the family
decide on a clear goal—Tom
must tell parents where he is.
❯❯Design an intervention
Develops a plan that targets the
problem within the family—Tom
will phone in regularly.
❯❯Implement plan Devises and
reviews role-playing, discussions,
and homework to help the family
understand why Tom is reluctant
to keep in touch.
❯❯Examine the outcome Ensures
parents as well as Tom have made
positive changes.
140 141HEALING THERAPIES
Systemic therapies
Dyadic developmental therapy
This therapy aims to give children who have experienced emotional
trauma a firm base from which they can form stable attachments and
loving relationships with parents or caregivers.
What is it? to build a collaborative relationship Accepting, Curious, and Empathetic
with both the child and the approach—to govern interactions
Children who are neglected, caregiver as a basis for promoting a with the child. This allows the child
abused, or not properly cared strong bond between the child and to feel valued, safe, and understood,
for may be prone to rule-breaking the parent or caregiver. They use and to be open to receiving nurture
and aggressive behavior; the principles of PACE—a Playful, and support in their relationships.
thought, attention, and personality
disorders; anxiety; depression; THERAPIST IS: CLIENT FEELS:
and difficulties in forming PLAYFUL, SAFE, INCLUDED,
healthy attachments. HEALTHY, ACTIVE,
ACCEPTING,
Dyadic therapy aims to establish CURIOUS, NURTURED,
a safe, empathetic, and protective RESPONSIBLE,
environment for children with such EMPATHETIC
a background, where they can learn RESPECTED
new patterns of communication
and behavior. The therapist needs
Contextual therapy FACTORS GOVERNING
FAMILY DYNAMICS
The aim of this approach is to restore balance within a
family so that everyone’s emotional needs are met fully, ❯❯Background Age, social and
fairly, and in a reciprocal manner. cultural factors, and experiences
that make each person individual.
What is it? the family unit provide context
for grievances. The therapist ❯❯Individual psychology The
Imbalances in family relationships encourages each member to personality and psychological
can occur when members feel express their side of the conflict, makeup of each person.
others are treating them unfairly, and to listen to the views of others
ignoring their needs, or not in the family group. They are ❯❯Systemic transactions How
reciprocating feelings. helped to acknowledge the positive family members relate to one
efforts made by others in the family, another—the emotional triangles,
Contextual therapy uses a and also to accept responsibility for alignments, and power struggles,
concept of fairness and equal their own behaviors. including relationships across
rights and responsibilities, called generations and inherited
relational ethics (right), as a Understanding that each person patterns of behavior.
starting point for understanding in the family deserves to have their
the problems in family relationships. needs met, and learning to take ❯❯Relational ethics The balance of
Relational ethics is also the basis mutual responsibility for this, give-and-take and the emotional
for developing strategies to restore allows families to develop new need and fulfillment that governs
balance and harmony. The ages, patterns of behavior that balance family dynamics; to be balanced,
backgrounds, and psychological give-and-take. everyone must take responsibility
characteristics of the members in for their actions and transactions
with other family members.
Biotherapies
These therapies are based around the idea that biological or physical
factors strongly influence mental disorders. They aim to change the
structure of the brain, or how it functions, in order to alleviate symptoms.
What are they? correct the biological irregularities that are linked
with the symptoms of mental illnesses such as bipolar
Unlike psychotherapies, which focus on environmental disorder and schizophrenia. These irregularities may
and behavioral factors and use the client–psychologist result from genetics, abnormalities in brain structure,
relationship as an agent for treatment, biotherapies are or dysfunction in how parts of the brain interact.
prescribed by a psychiatrist and target how the brain
functions mechanically. They are usually delivered Biotherapies are often used to bring symptoms
in the form of medication or, in extreme cases, with under control and work alongside nonbiological
interventions such as ECT (electroconvulsive therapy), approaches, such as behavioral or cognitive therapies,
TMS (transcranial magnetic stimulation), or which help people manage their symptoms and the
psychosurgery. Some of these therapies attempt to factors that contribute to their condition.
Drug therapy
Medication can be used to reduce specific symptoms such as hallucinations, low mood,
anxiety, or mood swings. While psychiatric drugs do not change the underlying mental
health problem, they can help people to cope better and function more effectively.
CATEGORY USED FOR DRUG TYPES
ANTIDEPRESSANTS Depression, including despondent mood; SSRIs (selective serotonin reuptake inhibitors);
ANTIPSYCHOTICS anhedonia (inability to experience pleasure); monoamine oxidase inhibitors; seratonin-
ANTI-ANXIETY DRUGS hopelessness. Sometimes given for anxiety. norepinephrine reuptake inhibitors; tricyclics.
MOOD STABILIZERS Bipolar disorder; schizophrenia; and for A group of drugs that block dopamine.
symptoms such as hallucinations, delusions, Older versions are called “typical”; newer
STIMULANTS difficulty thinking clearly, and mood swings. drugs, “atypical.”
SLEEPING DRUGS GAD (generalized anxiety disorder); panic Benzodiazepines; buspirone; beta blockers;
DRUGS FOR DEMENTIA disorder; social anxiety disorder; PTSD; SSRIs; seratonin-norepinephrine reuptake
OCD; and phobias. inhibitors.
Bipolar disorder; may also be used to Lithium (for mania); anticonvulsants (such
treat mood issues related to schizophrenia, as carbamazepine, used for depression);
depression, and seizure disorders. antipsychotics (such as asenapine).
Narcolepsy and ADHD. Amphetamines; caffeine; nicotine.
Sleep disorders. Antihistamines; sedative hypnotics;
Improving the associated symptoms of benzodiazepines; sleep-wake cycle
dementia and slowing disease progression modifiers.
(not able to cure the underlying cause). Cholinesterase inhibitors.
142 143HEALING THERAPIES
Biotherapies
Treatments MEDICATIONS block or enhance the activity of different chemical
neurotransmitters in the brain. They may increase the production of
Psychiatric drug therapies act on neurotransmitters, a particular neurotransmitter, interfere with how neurotransmitters
such as dopamine and norepinephrine (both associated are absorbed by receptors in the brain, or act directly on receptors.
with reward and pleasure), and serotonin (which
regulates mood and anxiety) (pp.28–29). They can be
very effective in reducing symptoms but may have side
effects, including drowsiness, nausea, or headaches.
Treatments that physically disrupt or stimulate the
brain’s electrical signals are sometimes used when
drug therapy has been ineffective. In ECT and TMS,
low electrical currents are passed through the brain.
Very occasionally, psychosurgery is used to alter
brain functioning. This involves making small lesions
in the brain to disrupt connections in the limbic
system (pp.26–27).
Antidepressant use increased
nearly 65% from 1999 to 2014
US Centers for Disease Control and Prevention, 2017
HOW THEY WORK EFFECT ON PERSON SIDE EFFECTS
TAKING THEM
“Feel-good” neurotransmitters (serotonin, Weight gain; drowsiness; inhibited libido
dopamine, and norepinephrine) are made Improve mood and sense of well-being; and ability to achieve orgasm; sleep
increasingly available for the brain to absorb. increase motivation and optimism; raise disturbance; dry mouth; nausea; headaches.
Block the uptake of dopamine by the brain, energy levels; improve sleep patterns.
as overactivity of the dopamine system
causes psychotic symptoms. Decrease auditory and visual hallucinations; Emotional effects such as irritability and
Vary greatly in their action—some modify stabilize mood; improve clarity of thought. moodiness; neuromuscular effects; body
neurotransmitters; others (beta blockers) temperature problems; dizziness.
address physical symptoms.
Vary in their action—some modify Improve ability to manage stress and face Dizziness; poor balance or coordination;
neurotransmitters, such as dopamine; challenges; decrease muscle tension; lower slurred speech; memory issues; difficulty
others increase calming chemicals. reaction to psychological triggers. concentrating; withdrawal symptoms.
Increase the availability of neurotransmitters
such as dopamine and norepinephrine to Reduce mania; prevent cycle of manic and Weight gain; flat affect (little emotional
the brain, enhancing activity. depressive episodes; alleviate depression. reaction); dry mouth; acne; restlessness;
Block histamines (antihistamines); enhance Improve alertness and concentration; sexual dysfunction; sun sensitivity.
GABA (p.29) (hypnotics, benzodiazepines); increase clarity and organization of thoughts; Anxiety; insomnia; loss of appetite; weight
act on melatonin (cycle modifiers). raise energy levels. loss; increased heart rate; jaw tremors.
Inhibit the action of cholinesterases—
enzymes that break down acetylcholine, a Induce ability to fall asleep and/or Memory loss; daytime drowsiness;
neurotransmitter important for memory. remain asleep. increased risk of falling; risk of tolerance
and dependence.
Prevent successive strokes; delay further Weight loss; nausea; vomiting; diarrhea.
decline of cognitive function.
PSYCHOLOGY
IN THE REAL
WORLD
Specialist psychologists study all aspects
of society. Their aim is to understand how
people interact as children and adults, at
work and play, and ultimately to improve
everyone’s experience of the world.
Psychology of
self-identity
A person’s concept of who they are and how they relate to the real world forms
their self-identity and is expressed through their personality. Psychologists in
this field of individual differences start from the premise that people have enough
self-esteem to want to develop their awareness of themselves and how they relate
to the world. Over time, a person’s identity may change or evolve, and they may
develop a stronger sense of self, even reaching the pinnacle of self-actualization.
The web of identity
Part of a person’s sense of who they are comes from their social
or group identity. The groups they belong to reinforce their
beliefs and values, and give them validation and self-esteem.
As a person goes through life, they add to this web of identities
as they accumulate experiences, meet new people, change jobs,
and make choices and commitments. Social media and new
technologies are changing how people shape their identity,
as the distinction between private and public self blurs.
SOCIALIZATION INDIVIDUAL
People see themselves in IDENTITY
relation to friends and other
RELIGION SUBCULTURE social groups, who may share
Belonging to a religious Identifying with a
particular clique or club views or interests.
group can inform a can be a way of self-
person’s cultural and social defining within a wider REGION PEERS
society or culture. Where a person is A peer group, especially
identity, as well as their born, or chooses to during adolescence, plays a
private belief system. HOBBIES live, can feed certain formative role in establishing
Belonging to a group of characteristics into
EDUCATION people with the same values and identity.
How a person is educated, identity. STATUS
where, and to what level interests fosters self-
informs personal identity esteem and identity. Social and economic status
influences how a person feels
and acquired values.
about themselves, and how
they feel others view them.
146 147PSYCHOLOGY IN THE REAL WORLD
Psychology of self-identity
SELF-ESTEEM AND AWARENESS “The reward for
conformity is
❯❯Self-esteem Sense of self-worth, others, how they would like to be, that everybody
based on a person’s appraisal of and their self-esteem. likes you except
their own thoughts, beliefs, yourself.”
emotions, choices, behaviors, and ❯❯Public self-awareness Linked
appearance; seen in psychology as to a person’s physical attributes, Rita Mae Brown, American writer
a personality trait, which means including their concepts of beauty, and activist
that it is stable and enduring. body language, physical abilities,
public actions, and material
❯❯Private self-awareness A person’s possessions; also how far a person
thoughts, emotions, and feelings chooses to conform to cultural and
(which cannot be seen), including social norms relating to public
the way they view themselves and self-expression.
NORMS POLITICS
Whether a person strives Political affiliations reflect
to follow or to flout cultural a sense of community, and
or social norms defines are a public expression of
who they are. personal values and beliefs.
CULTURE CLASS
The prevailing culture The social categorization
influences self-identity of either belonging to or
through imagery, values, being excluded from a class
beliefs, and social codes. group is part of identity.
AGE ROLES FAMILY
A person’s age group The different public roles a Family provides the
reflects how they think person plays—child, brother, genetic identity and also
about themselves, and lawyer, wife, tennis captain— a set of values and social
how others see them. feed into a sense of self. network within which to
play a part.
SOCIAL MEDIA
Technology allows people
to connect with subgroups
that reflect their personal
interests and beliefs.
GENDER VALUES WORK
A person’s gender Children take on the values Workplace and colleagues
governs how they view of their parents; later they can define a person in terms
themselves, their of status, self-esteem,
relations with others, may adopt the value interests, and choices.
and their place in society. systems of other groups.
Identity formation
Beginning in childhood, individuation (the formation of identity)
is tested in adolescence as young people explore their sense of
themselves and their role in the world, and develops in adulthood.
What is it? of identity that fosters confidence encourage teenagers to redefine
and self-esteem. A secure identity their sense of self. Their self-
Questions such as “Who am I?” also encourages tolerance—the identity is strengthened by
and “What makes me special?” willingness to accept difference increasing independence, and a
underpin the development of and not feel threatened by it. move from attachments to family
personal identity. For infants, how to relationships with friends.
their caregivers treat them answers As children establish a more
these questions. By the age of detailed idea of who they are, they By adulthood, identity or sense of
three, children develop a view of start to compare themselves with self may be fixed in some respects,
themselves and their place in the others (in personality, looks, and but it can continue to evolve in
world according to their personal ability), and also internalize how others. In addition to unique
attributes and abilities, as well they are viewed by others. characteristics, internal or external
as factors such as their age, gender, factors may alter people’s attitudes,
cultural or religious background, Adolescents may question their goals, and professional and social
and interests. Children who are previous notions of identity, which networks, modifying aspects of
supported during this period can cause a period of confusion. their personal and public identities.
develop a strong and positive sense New external influences as well as
physical and mental changes
Stages of identity development
Psychologist Erik Erikson argued that identity develops in eight distinct stages,
influenced by a person’s interactions with the environment. During each stage
some form of psychosocial crisis (conflict) occurs. Personal development (the
achievement of a “virtue”) rests on how this conflict is resolved.
Early years 3–6 YEARS
Children develop a “self-concept”—the abilities, 1–3 YEARS INITIATIVE VS.
attributes, and values that they believe define AUTONOMY VS. GUILT
them. Interactions with caregivers, peers, and,
later, teachers influence this self-concept and SHAME “PURPOSE”
the development of confidence and self-esteem. “WILL”
Children begin to
assert control, but
feel guilt if this is
stifled by caregivers.
1. Age 0–18 MONTHS Children begin
2. Conflict TRUST VS. to practice being
3. “Virtue” MISTRUST independent, but
“HOPE” are afraid of failure.
Infants are uncertain
about the world. Trust
replaces fear if they
have good care.
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