Psychology G12

Sehizophrenia

Before You Read Reading tocus Vocabulary Use a graphic
1. What are the basic symptoms schizophrenia organizer like
Main ldea catatonic stupor this one to take notes on
Schizophrenia is the most of schizophrenia? the characteristics of the
serious psychological different types of schizo-
disorder, causing thought 2. What are the three major types phrenia.
disruption and a decreased of schizophrenia?
ability to function normally. /\
3. How do psychological and
biological explanations of \5chizcphrenial
schizophrenia differ?
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As artist Louis Wain Trouble Mind
(center) sank into
schizophrenia, Whot can paintings of cats reveol
his painting style obout a human mind? ln the late 18oos,
changed. Londoners were entranced with Louis

Waint humorous paintings of pets dressed as people and
mimicking human activities. Wain specialized in cats-cats
drinking tea, cats attending the opera, cats playing cards,
cats doing all kinds of funny things. Later, Wain painted cats
on their own, just being cats. Gradually, Wain's cat portraits
became more odd, with wild eyes and spiky fur. At the same
time, Wain was sinking into schizophrenia, a mental disorder
marked by a separation from reality. Wain's increasing illness
is reflected in the growing strangeness of his art. Eventually,
his cats became just the starting point for frantic abstract
designs. Louis Wain spent his last years in an asylum for the

mentally ill, painting the asylum's flowers and cats. lil

What ls Schirophrenia?

Schizophrenia, usually considered the most serious of
the psychological disorders, is characterized by loss
of contact with reality. Schizophrenia can be very dis-
abling and can lead to the affected person's inability
to function independently. Typically, schizophrenia

first appears in young adulthood, but it may occur at
other ages. Although it usually develops gradually, it

can also appear suddenly. Schizophrenia can now be

treated more effectively, although if untreated it can

worsen over time.

PSYCHOLOGICAL DISORDERS 519

f-x,i-Ji [! * flai]r; The most striking symptoms of schizo- Thought disorders involve problems in the
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phrenia include hallucinations, delusions, and organization or the content ofmental processes.
auditory related thought disorders. In most cases, the halluci-
nations are auditory-voices telling the indi- The thoughts of a person with schizophrenia
to hearing vidual what to do or commenting on the indi- may skip from topic to topic in an apparently
illogical way. This is reflected in the person's
vidual's behavior. Sometimes they may tell the speech, which sounds disorganized and con-
fused. A person with schizophrenia may also
individual to harm herself or himself or oth-
repeat the same word or phrase over and over,
ers. Robert Bayley, a schizophrenia sufferer, repeat words or phrases that another person
described his hallucinations this way: "The
visions are extremely vivid . . . Paving stones has spoken, or invent new words.
transform into demonic faces . . . Buildings
People with schizophrenia have other
and rooms spin and weave and their walls
close in as I look on, paralyzed by fear . . . symptoms that affect their ability to function.
The voices either ramble in alien tongues or These symptoms include social withdrawal,
impaired social skills, and loss of normal emo-
scream orders to carry out violent acts. They tional responses. Some people with schizo-
phrenia may even go into a catatonic stupor-
also persecute me by way of unwavering com-
an immobile, expressionless, comalike state.
mentary and ridicule to deceive, derange, and
force me into a world of crippling paranoia." Understandably, these symptoms cause
tremendous stress to individuals with schizo-
Individuals with schizophrenia may expe-
rience what are called delusions of grandeur. phrenia and their families. It has been esti-
For example, they may believe that they are mated that as many as 20 percent of people
historical figures, famous celebrities, or on a with schizophrenia attempt suicide and that
special but secret mission to save the world. 10 percent actually do kill themselves.
Sometimes the delusions are of persecution.
Schizophrenia is found in all cultures, and
For example, a person with schizophrenia its symptoms have been recognized for cen-
might believe that he is being pursued by turies. A large number of people have schizo-

spies or some other shadowy enemy. Other phrenia-an estimated 2.4 million in the
delusions may include beliefs that one has
committed unpardonable sins or even that United States alone.
one does not really exist.
ffi Summarize What is the basic

characteristic of schizophrenia?

Descriptions of what we might now The Muslim World
call schizophrenia first appeared in an
Egyptian medical document written in ln response to what they read in z3o
about 1550 BC. The ways in which people the Qur'an, lslamic doctors took
have viewed and reacted to schizophrenia a clinical and humane approach .9
have varied widely over the centuries. to mental illnesses such as o
How hos our understanding of the causes schizophrenia.
of schizophrenia changed over time? EtJ
r-' coo
,.i,1'lJi;g:fr;1ffi.L;- ' g-r-*'-^J-'' i-'a.'l ' ) ;t' -'-!';\J
sFo

I ::*s-?.' ="f 3*i: i;+5:h r*,* Er: 0}ts*rgmmiz*e* Sc*rixetphremi,m People with
Individuals with schizophrenia vary greatly disorganized schizophrenia are incoherent in
their thought and speech and disorganized in
in their symptoms, although virtually all have their behavior. They usually have delusions
thought disorders. Most people with schizo- or hallucinations as well, but these tend to
phrenia exhibit a combination of symptoms. be fragmentary and unconnected, unlike the
more ordered and systematic delusions of
The DSM-IV classification of schizophre- those with paranoid schizophrenia.
nia and other psychotic disorders is based
primarily on the duration and recurrence People with disorganized schizophrenia
of symptoms. The types of schizophrenia are also either emotionless or show inap-
include paranoid, disorganized, and catatonic propriate emotions. Typically, they act silly

schizophrenia. and gidd5r, and they tend to grggle and speak
nonsense. They may neglect their appearance
$taw'astmid $ahfrxmphr*raim People with para- and hygiene. Sometimes they may even lose
noid schizophrenia have delusions or frequent control oftheir bladders and bowels.
auditory hallucinations, all relating to a sin-
gle theme. These people may have delusions of The following case description illustrates
several symptoms of disorganized schizo-
grandeur, persecution, or jealousy. For exam- phrenia. A 4O-year-old man was brought to
the hospital by his distraught mother, who
ple, individuals with paranoid schizophrenia reported that she had become deeply afraid
may be convinced that people have been plot-
ting against them even when there is no evi- of her son. It was the twelfth time he had
dence ofsuch a plot.
been checked into the hospital. The man was
A person with paranoid schizophrenia may dressed in a dirty, tattered overcoat, a base-
be distrustful of everyone except a spouse or baII cap, and house slippers. He spoke with
a special friend. He or she may even accuse a childlike quality and walked with exagger-
people who are trying to help of being part ated movements. His emotions ranged from
of a covert conspiracy. Although people with anger (hurling obscenities) to silliness (gig-
this type of schizophrenia tend to have less gling fbr no apparent reason).
disordered thoughts and obviously bizarre
behavior than do people with other types of Since stopping his medication about a
schizophrenia, they may be agitated, con-
fused, and afraid. month before his hospitalization, the man had

been hearing voices and acting more strangely.

p., The Age of Enlightenment Mental !
illness began to be seen as a disease
1! tlr-1
instead of a curse.
I,t Early Modern Europe Schizophrenia I
Late 1800s Emil Kraepelin was the first
and other mental illnesses were still seen ,,, i
psychiatrist to classify schizophrenia
f as afflictions to be punished. The patients t._

i were often kept in chains like criminals. as a distinct mental disorder. *+ '!
*i Sigmund Freud began to develop I
JI Outsiders paid a penny to watch the
his theories for analyzing mental
3 patients at Bethlem Hospital in London.
illnesses, including schizophrenia.
i$
#il."

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later 20th Century

Schizophrenia was widely
accepted as a disease that can

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PSVCHOiOGiCA'ID15ORCIER5 32?.

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CONNECTION He told the interviewer that he had been "eat- ofother people. One avenue ofbrain research
ing wires and lighting fires." His speech was connects the major problems found in schizo-
The Hinrkley Trial generally incoherent and contained many
John Hinckley Jr. phrenia-problems in attention, memory,
suffers from schizo- rhyming phrases.
phrenia, and brain abstract thinking, and language-with differ-
tests showed that Catatonic Schizophrenia The most obvious ences in the frontal part of the brain. There
there may have been a symptom of catatonic schizophrenia is dis- is some evidence that there are differences in
biological (omponent turbance of movement. Activity may slow to the size and structure of certain brain areas
ofthe disorder. a stupor and then suddenly switch to agita-
tion. Individuals with this disorder may hold in people with schizophrenia.
unusual, uncomfortable body positions for At his trial, John Hinckley Jr.'s lawyers
long periods of time, even after their arms and
Iegs swell and stiffen. They may also exhibit fought to introduce a CAT-scan of Hinckley's
waxy flexibility, a condition in which other
people can mold them into strange poses that brain as evidence that he had schizophrenia.
they continue to hold for hours. The defense lawyers believed that the scan

Summarize What are the three would help prove that Hinckley's brain was
abnormal and show a biological basis for his
types of schizophrenia? schizophrenia. After hearings on the mat-
ter, the judge allowed the scan as evidence.
Hxpleining Sehiacphrenia
It showed that Hinckley's brain had widened
Many different theories have been proposed to
explain schizophrenia. These theories include sulci, the folds and ridges on the brain's sur-
both psychological and biological views. face. According to psychiatrists, widened sulcl

Psyclrologically'iews According to the psy- are far more common in people with schizo-
choanalytic perspective, schizophrenia is the
result of the overwhelming of the ego by urges phrenia than in other peoPle.
from the id. The urges threaten the ego and Research also suggests that people with
cause intense conflict. In response, the indi-
vidual regresses to an early phase ofthe oral schizophrenia may have experienced a loss of
stage of development in which the infant has synapses, the structures that connect neurons

not yet learned that it is separate from the and make it possible for neurons to communi-

mother. In this condition, fantasies become cate with one another. What might cause these
confused with reality, leading to hallucina-
tions and delusions. Like many psychoana- differences in brain structure? Research evi-

Iytic theories, this one has fallen into disfavor dence suggests that there are three biological

over the years. risk factors for schizophrenia: heredity, com-
Other psychological views focus on the plications during pregnancy and birth, and

family environment as the root of schizophre- birth during winter. Schizophrenia, Iike many
nia. One such theory suggests that a family in
which a parent frequently expresses intense other psychological disorders, runs in families.
emotions and has a pushy, critical attitude
People with schizophrenia constitute about 1
puts children at risk of developing schizo- percent of the population. However, children
phrenia. While it is possible that such a fam-
ily environment may increase the chances with one parent who has schizophrenia have
of onset or relapse in individuals who have about a 10 percent chance ofbeing diagnosed
schizophrenia, family environment does not as having schizophrenia themselves, and

actually cause the illness. children with two such parents have about a
35 to 40 percent chance. When one identical
Biologieal Views Schizophrenia appears to twin has schizophrenia, the other has about
be a brain disorder, and many studies have a 40 to 50 percent chance ofalso being diag-
been done to determine how the brains of nosed with it. Many studies have been car-
people with schizophrenia differ from those ried out to try to isolate the gene or genes
involved in schizophrenia. Some studies have

found locations for multiple genes on several
chromosomes. Recent research suggests that
particular genes may provide a vulnerability
to schizophrenia. Further advances in genetic
research techniques may shed more light on

this possibility.

Many people with schizophrenia experi-
enced complications during their mother's
pregnancy and their birth. For example, the

522 CHAPTER 18

mothers of many people with schizophrenia to the development of schizophrenia. Thus,
had influenza during the sixth or seventh people who are not genetically vulnerable are
month of pregnancy. People with the disease unlikely to develop the disorder, regardless of
are also somewhat more likely to have been the environmental risk factors to which they
have been exposed.
born during the winter than would be predicted
E@I!B3' Analyze What are some indica-
by chance. Maternal starvation has also been
related to schizophrenia. These biological risk tions that schizophrenia has a physical basis?

factors suggest that schizophrenia involves Psychoanalytic View The ego is overwhelm-

abnormal prenatal brain development. ingly threatened by the id. The individual
regresses to an early phase ofthe oral stage of
Problems in the central nervous system development, and fantasies become confused
may involve neurotransmitters as well as with reality.

brain structures, and research has focused on Other Psychological Views A family
one particular neurotransmitter: dopamine.
environment in which a parent frequently
According to the dopamine theory of schizo- expresses intense emotions and has a pushy,
critical attitude puts children at risk for
phrenia, the brains of people with schizo- schizophrenia.
phrenia use more dopamine than average,
Biological View Loss of synapses in the brain
although they may not produce more. Why?
They may have more dopamine receptors in have been linked to schizophrenia. Other factors
the brain than other people do, or their dopa- include heredity, complications during pregnancy
mine receptors may be hyperactive. and birth, birth during winter, and the brain's
overuse of dopamine.
Multifactorial Model The multifactorial
model of schizophrenia illustrates how bio- Multifactorial Uiew Biological and psycho-

Iogical and psychological factors may inter- logical factors combine to put people at risk for
act in the development of the disorder. In this schizophrenia.
model, genetic factors create a vulnerability,
or susceptibility, to schizophrenia. Among
people who are genetically vulnerable, other
factors, such as prenatal problems or trauma
during birth, may lead to brain injury and the
development of schizophrenia. Once the dis-
order develops, its course may be negatively
affected by a troubled family environment.

The multifactorial model also suggests
that even severely dysfunctional environ-
mental factors alone are not enough to lead

Assessment 6. Draw Conclusions

Reviewing Main ldeas and Vocabulary Using your notes and a
1. Recall What are four symptoms of schizophrenia? graphic organizer like this
2. Contrast How does paranoid schizophrenia differ from one, explain why
a multifactorial model of
disorganized schizophrenia? schizophrenia may help in
3. Describe How would you describe the varying activity explaining the disorder.

levels of a person experiencing catatonic schizophrenia? 7. Persuasive Write a letter to a friend in which you suggest
that he or she be examined by a psychiatrist for help with
Thinking Critically symptoms that resemble those of schizophrenia, lnclude a
4. Summarize What are some biological explanations for the description ofthe friend's actions and their consequences.

origins of schizophrenia? PSYCHOLOGICALDISORDERs 523
5. Evaluate What are the major psychological views that

attempt to explain schizophrenia?

)

L-)

Fer$snality tlisorders

Be*ere Yqu f;Ead Use a graphic

Main ldea Reading Focus Uocabulary organizer like

Personality disorders are 1. What are personality disorders, personality disorders this one to take notes on
cha racterized by patterns
of unchanging personality and how do they differ from personality disorders.
traits that disrupt people's
social lives and work lives. other psychological disorders? \,/ Persenalrty t,
\\, -/Disorders i
2. What are ten types of personal- -,,f
ity disorders? =-__=-,_//R

3. How do psychological and a
biological views explain the e-; /\ e,,I ) /'----\r-
origins of antisocial personality (

L-/ \I

disorder?

Why does Lisa demand so much ,&.Jf
attention? Perhaps you know
someone like Lisa. At parties, she .,1i

always steers the conversation back to herself. She :i1

makes sure everyone knows how important, accom- jitl,i
plished, and intelligent she is. lf Lisa doesn't get the :l
admiration she thinks she deserves, she'll move on to
another group and take over their conversation. She

thinks nothing of telling-not asking, telling-some-

one to get her a plate of food or something to drink.
Talking to Lisa after the party, you can see another side
of her personality. Even though there were plenty of
guys paying attention to her, she still envled Julia for
talking to the new Swedish exchange student.

What makes Lisa act the way she does? She may
actually have a personality disorder named after
Narcissus, a youth in a Greek myth who fell in love with
his own reflection. That condition is called narcissistic

personality disorder. lll

524 cHnptR ra .r,ri!!rtih .st I ,a:r. ..

What Are Personality Disorders? Personality disorders are inflexible and lasting patterns of behavior that
hamper social functioning. Listed here from the DSM-IV-TR are the 10
Personality disorders are patterns of inflexible specific personality disorders and their main characteristics.
traits that disrupt social life or work and may
distress the affected individual. The American iPersonality Main Characteristics
Psychiatric Association defines a personality
disorder as "an enduringpattern ofinner experi- ;;.';;il;;!;;;;;;;.;*
ence and behavior that deviates markedly from
the expectations of the culture of the individual sltriloia .D:lT,h',-"nll10m 10c!llel1tlo!:hip:
who exhibits it." These patterns usually show a'
up by late adolescence and affect all aspects of Schizotypal
the individual's personality, including thought Acute discomfort in close relationships; eccentrici- i
processes, emotions, and behavior. o."ii':.i; ties of behavior

It is important to note the distinction Borderline i othersDisregard for the rights of 1:

between personality disorders and other psy- Histrionic l
chological disorders that they may resemble. Narcissistic
Psychological disorders, such as major depres- n-voifan! ! lnstability in interpersonal relationships and self- i
sion or a phobic disorder, for example, are D:p,"nl._nl
Obsessive- i r.m'"a"g-e'- - ''
illnesses that an individual experiences as Compulsive ::
episodes. Such illnesses can be clearly dis- ! Excessive emotionality, need for attention l
tinguished from the individual's personality.
In contrast, personality disorders are endur- i Grandiosity, need for admiration, lack of empathy
ing traits that are major components of the
ii Social inhibitions, feelings of inadequacy
individual's personality.
l.!bT]':iy"::linsln-s l
EEIEffi Contrast How are personality
andt Obsession with orderliness, perfectionism, :
disorders different from other disorders that they
control
may resemble?

Types cf Personality Disorders IIITERPRETING CHARTS What is one characteristic
that a person with antisocial personality disorder might have in com-
The chart on this page shows the DSM-IV mon with someone who has narcissistic personality disorder?
classification of personality disorders. They
are described here in detail. do not have tender feelings for, or become
attached to, other people; spending time with
Paranoid Personality Disorder People with others just seems pointiess. Thus, people with
paranoid personality disorder tend to be schizoid personalities tend to be loners, with
suspicious of others and to interpret others' few if any friends.
motives as harmful or evil. They tend to per-
ceive other people's behavior as threatening These symptoms are similar to some of
or insulting, even when it is not. They are dif- the symptoms of schizophrenia. Unlike peo-
ficult to get along with-argumentative, yet ple with schizophrenia, however, people with
cold and aloof. It is not surprising that people schizoid personality disorder do not have
with this disorder often lead isolated lives. delusions or hallucinations. They stay in
touch with reality.
Unlike individuals with paranoid schizo-
phrenia, people with paranoid personality dis- Schizotypal Personality Disorder Symp-
toms of this disorder include odd behaviors,
order are not confused about reality. However, unconventional beliefs, and a need for social
their view ofreality is distorted, and they are isolation. Although the disorder is similar
unlikely to see their mistrust and suspicions to schizoid personality disorder, people with
as unfounded or abnormal. the schizotypal disorder avoid relationships
because of a fear ofnot frtting in, not because
Schizoid Personality Disorder People with they are uninterested in others.

schizoid personality disorder have no interest
in relationships with other people. They also
lack normal emotional responsiveness. They

PSYCHOLOGICALDISORDERS 525

&il&&*rhE,c Antisocial Personality Disorder People with The symptoms of avoidant personality
US(ABt"$E.AHY antisocial personality disorder show a persis- disorder are similar to those of social phobia,
tent behavior pattern ofdisregard for, and vio- and people with avoidant personality disorder
empathy sympa- lation o{ the rights ofothers. Typically, they do virtually always have social phobias as well.
not feel remorse for their antisocial behaviors, However, not all people who have social pho-
thy; understanding and they continue the behaviors despite the bias have avoidant personality disorder. The
of others'feelings threat of social rejection and punishment. Iatter seems to be a more severe condition.

In childhood and early adolescence, a per- Dependent Personality Disorder This dis-
son with antisocial personality disorder may order is characterized by being overly depen-
run away from home, hurt other people or ani- dent on other people. Among the symptoms
mals, lie, or steal. In adulthood, the person are difficulty in making decisions without
may be aggressive and reckless, have a hard extensive advice, reluctance to take responsi-
time holding a job, incur large debts, or break bility for one's own life, diffrculty expressing
the law. disagreement, lack of initiative, and fear of
being left to take care of oneself. People with
Borderline Personality Disorder Instability dependent personality disorder often seek a
of mood, chaotic personal relationships, and a new relationship immediately after the end of
disturbed sense of self are among the symp- another so that they are not left alone.
toms of borderline personality disorder. Self-
mutilating behaviors, such as cutting, can Obsessive-Compulsive Personality Disorder
be evidence of the disorder. The name comes While similar to obsessive-compulsive dis-
from an early description of the disorder as order, this personality disorder is different.
being on the "borderline" between neurosis Obsessive-compulsive personality disorder

and psychosis. is characterized by inflexibility and fixa-
tion on rules, procedures, and orderliness.
Histrionic Personality Disorder People People with the disorder can be particularly
with this disorder are overly emotional
anxious about time, relationships, cleanli-
and dramatic and seek constant attention. ness, and money. They often work many
Inappropriate seductiveness and being easily
influenced by other people are also common more hours than their financial situation
symptoms. Although people with histrionic
personality disorder may be outwardly suc- demands. They do not, however, perform the
cessful in work and social situations, their constant, meaningless rituals that are com-
personal relationships are often troubled, mon in obsessive-compulsive disorder.
partly because the disorder limits one's abil-
ity to cope with loss or failure. Such failures ffi Analyze What are some ways that
are often blamed on others.
personality disorders can make life difficult?
Narclssistic Personality Disorder People
with this disorder believe that they deserve Explaining Personality Disorders

excessive admiration. They may be preoccu- Most personality disorders were not classifred
pied with fantasies oftheir own success, power,
intelligence, or beauty. In addition, they show until 1980, with the publication of the third

little empathy toward other people, treating edition of the DSM. However, both psychologi-
them with arrogance and exploiting them. cal and biological theories have been suggested

Avoidant Personality Disorder People with to explain some of them. Here we will concen-
avoidant personality disorder desire rela- trate on antisocial personality disorder.
tionships with other people, but they are pre-
vented from forming these relationships by Psychological Views Freud's psychoanalytic
tremendous fear of the disapproval of others. theory regarding the antisocial personality
Thus, they act shy and withdrawn in social type states that a lack ofguilt underlies the
situations. They are always afraid they will
say or do something that is foolish or even antisocial personality. This lack of guilt is
due to a problem in the development of the
embarrassing.
conscience, or superego. Research has found
that children who are rejected by adults and

harshly punished rather than treated with
affection tend to lack a sense ofguilt.

526 CHAPTER 18

Some learning theorists have suggested Psychoanalytic View Lack of guilt due to a
that childhood experiences "teach" children
how to relate to other people. If children are problem in the development of the conscience
not reinforced for good behavior and only causes the antisocial personality.
receive attention when they behave badly,
they may learn antisocial behaviors. Such Other Psychological Views Childhood
behaviors may persist into adulthood. Other
learning theorists maintain that antisocial experiences teach children how to relate to other
personality disorder develops when a child people. lf children get attention only when they
Iacks appropriate role models and when the behave badly or don't have appropriate role
role models they do have act aggressively. models, they may develop antisocial behaviors.

Cognitive theorists argue that antisocial BiologicalUiew Heredity plays a role in
adolescents tend to see other people's behav-
ior as threatening, even when it is not. They antisocial disorders, as does having fewer neurons
use this faulty view of other people's actions in the frontal part of the brain.
to justify their own antisocial behavior.
likely to show guilt for their misdeeds and to
ffii*t*giea! \d$*:rus Genetic factors are appar- learn to fear punishment. But a biological fac-
ently involved in the disorders. For example, tor by itself is unlikely to cause the develop-
antisocial personality disorder tends to run ment of an antisocial personality.

in families. Adoptee studies reveal higher Although the origins of personality disor-

incidence of antisocial behavior among the ders are still unresolved, treatment of these
biological parents than among the adoptive
relatives of individuals with the disorder. disorders is more straightforward. Methods of
treatment for psychological disorders are the
The genetics of antisocial personality focus ofthe next chapter.
disorder may involve the frontal part of the
brain, an area that is connected with emo- re Analyze How may childrearing
tional responses. There is some evidence that
people with antisocial personality disorder affect the development of antisocial personality
have fewer neurons in the frontal part of the disorder?
brain than other people. The fewer neurons

could make the nervous system less respon-
sive. As a result, such people would be less

ilal-f.i.{-it
,:t]fi Assessment

{. j!-:::.;

Reviewing Main ldeas and Vocabulary 7. Draw Conclusions Using your notes and a graphic organizer
1. Define How would you define a personality disorder? like this one, explain the major difference between personal-
2. Contrast How does paranoid personality disorder differ ity disorders and other disorders that they may resemble.

from paranoid schizophrenia? i i;;-if,l$ilr l i:*iinrtt*ri l

3. Explain What is the difference between schizoid personality I a':r. I l rirritla .r'rtIi!a-t :,1 i 1
disorder and schizophrenia? I l!,:i;1-: ;i

4. Describe What are three behaviors of an individual with 8. Narrative Review the Psychology Close Up feature about
the girl with narcissistic personality disorder. Write a similar
antisocial personality disorder? profile of someone with one of the other personality disor

Thinking Critically ders. Designate which disorder you are describing.

5. Evaluate Why do you think people with antisocial personal- PSYCHOLOGICALDIsORDERS 527
ity disorder are often more difficult to treat than people with
other types of personality disorders?

6. Support a Position Which seems more sound to you-the

psychological or biological theory about the origins of anti-
social personality disorder? Explain your answer.

*-,

Diagnosing

Psychological Disorders

Can you diagnose a psychological disorder based on a written

description of someone's symptoms?

1. lntroduction 2. Writing the Case Studies

This lab will help you review the major psychological Working as a group, select at least two specific disorders from
disorders covered in this chapter. You will work in small your assigned type of psychological disorders. Then, write case
groups to review one of the six general types of disorders studies for these disorders. Each case study should be written
that you learned about. Then your group will select at on a single sheet of paper and should include each ofthe
least two specific disorders and write fictional case studies items shown in the sample case study below. After your group
describing someone who suffers from each disorder. Finally, is finished writing the case studies, give them to your teacher.
the entire class will evaluate each case study and try to
diagnose the disorder being described. To complete this lab, O A fictional name and age;
follow the steps below. S A description of the person's physical, mental, or behavioral

Following your teacher's instructions, organize the class into symptoms, with relevant details;
six student groups.
@ A description of how the person's disorder affects his or
Your teacher will assign each group one of the six general
her life;
types of psychological disorders covered in this chapter-
@ An "answer"-the specific psychological disorder that the
anxiety disorders, mood disorders, dissociative disorders,
somatoform disorders, schizophrenia, and personality case study describes.
disorders.
oI Andrew, Age 37
Work with the students in your group to review the chapter
material on the general type of disorders that you were Andrew Miller was a delivery driver for an office equipment com-
assigned, along with the specific disorders that fall within pany. Three years ago Andrew was making a delivery when he was
that category. (See the chart titled Major Psychological involved in a horrific car accident. As he was exiting the highway, a
Disorders on the next page.)Write down a few main points four-car collision occuned right in front ofAndrew's van that he was
about both the general type of disorders and the specific unable to avoid. Andrew smashed into the car in front of him, killing
disorders. one person and rolling his van over. He was thrown out of his vehicle
and suffered a broken arm, three broken vertebrae, and multiple
Conduct additional research on your assigned disorders, if cuts and lacerations. He was lucky to survive. lmmediately after the
accident, Andrew ran to the person he hit and nied to help her, but she
your teacher instructs you to do so. Your group is now ready
to write the case studies. ffi died at the scene.

Andrew spent two weeks in the hospital, where he underwent
several surgeries before being discharged. However, Andrew does not
remember his time in the hospital. He also cannot remember any-

,I thing about the accident or even several days before it, despite
his best attempts. Six months after the accident, Andrew has
almost fully recovered physically, but still says that the time period
surrounding his accident is"a complete blank.'

What psychological disorder does Andrew

oI suffer from?
Answer: Dissociative Amnesia

528 cHeprun ra

I7r; t-i

3. Diagnosing the Disorders Anxiety Disorders

Before you and your classmates try to diagnosis the psychological disorders . Specific Phobias
described in the case studies, briefly review the disorders covered in the
chapter. To review the disorders and complete the diagnoses, follow " Panic Disorder
these steps: " Agoraphobia
. Generalized Anxiety Disorder
Have someone from each group share with the rest of the class the main . Obsessive-Compulsive Oiiorder (OCO)
points about the general type of disorder assigned to their group, along with
information on the specific disorders. This will serve as a quick review for the ^ Post-Traumatic Stress Disorder (PTSD)
entire class.
Mood Disorders
Your teacher will then randomly select the case studies and read them aloud " Major Depression
to the class.
. Postpartum Depression
After each case study is read, jot down on a piece of paper which psycho-
logical disorder you think the case study describes and why. Refer to the Dissociative Disorders
chart titled Major Psychological Disorders on this page for a complete list of
the disorders covered in this chapter. . Dissociative Amnesia
. Dissociative Fugue
Your teacher will then ask the class to vote on which psychological disorder
is being described. After the vote, briefly discuss each case study as a group - Dissociative ldentity OisoiOei
to determine the correct answer. (Do not vote on or discuss the case studies - Depersonalization Disorder
that your group wrote unless your teacher calls on you.)
Somatoform Disorders
4. Discussion * Conversion Disorder

What did you learn from this lab? Hold a group discussion that focuses on " Hypochondriasis
the following questions:
Schizophrenia
Overall, how successful was the class at diagnosing the psychological
disorders described in the case studies? ' Paranoid Schizophrenia

Were some disorders particularly easy to diagnose? lf so, which ones, and - Disorganized Schizophrenia
why do you think they were easy? . Catatonic Schizophrenia

Were some disorders particularly difficult to diagnose? lf sq which ones, Personality Disorders
and why do you think they were difficult?
. Paranoid Personality Disorder
How do you think this lab would have been different if some of the case . Schizoid Personality oisoiOei
studies described people with multiple psychological disorders? Do you ' Schizotypal Personality Disorder
think that would have made the lab more realistic?
" Antisocial nersonitity Diiorder
How might being able to personally observe and interview the people * Borderline Personality Disorder
described in the case studies have helped with a diagnosis?
, Histrionic Personality Diiorder

' Narcissistic Personality Disorder

. Avoidant Personality Disorder

" Dependent eersonality Disorder

= Obsessive-Compulsive Personality
Disorder

ffi Comprehension and Critical Thinking Reviewing Vocabulary

*ff:i'i SECTION 1 (pp.498-502) Match the terms below with their correct definitions.

1. a. Describe How common are psychological disor- 6. psychological disorder 11. bipolar disorder
ders in the United States?
7. criteria 12. schizophrenia
b. Summarize What are the four main criteria
that psychologists use to determine the pres- 8. anxiety 13. catatonic stupor
ence of a psychological disorder?
9. phobia 14. personality disorder
c. Support a Position Of the four main criteria
used to diagnose disorders, which do you think 10. depression
is the most significant? Why?
A. feelings of helplessness, hopelessness, worthless-
SECTION 2 (pp.50a-58) ness, guilt, and great sadness
2. a. Define What is an anxiety disorder? What is a
B. an immobile, expressionless, comalike state
mood disorder?
C. behavior patterns or mental processes that cause
b. Analyze Why do you think major depression is serious personal suffering or interfere with a
the most common psychological disorder? person's ability to cope with everyday life

c. Make Judgments In your opinion, when do nor- D. patterns of inflexible traits that disrupt social life
mal feelings of anxiety and uneasiness about or work and may distress the affected individual
a situation cross the line to become an anxiety
disorder? E. a serious psychological disorder characterized by

SECTION 3 (pp.515-518) a loss of contact with reaiity

3. a. Recall What are dissociative and somatoform F. the standards on which a judgment or decision
disorders? may be based

b. Contrast Give an example of a normal form of G. a cycle of mood changes from depression to wild
dissociation in everyday life, and contrast with elation and back again
an example of a dissociative disorder.
H. a general state ofdread or uneasiness that occurs
c. Evaluate Why do you think it is so difficult in response to a vague or imagined danger
to get reliable statistics on the incidence of
l. a persistent excessive or irrational fear
somatoform disorders?
15. How do psychological disorders affect teens?
SECTION 4 (pp. 51e-523) Choose one disorder covered in this chapter,
4. a. Describe What are some of the causes of such as depression or phobic disorder, and use
the Internet to research how the disorder affects
schizophrenia? teenagers. Look for information on how common
the disorder is among teens, recent statistics
b. lnfer Why might dissociative identity disorder and data, and common treatments. Write a short
be confused with schizophrenia? report that summarizes your findings.

c. Make Judgments Do you think the psychologi- Psychology in Your Life
cal views on the causes of schizophrenia are
valid? Support your answer with facts from the 16. What should you do if you encounter someone
text. who you suspect suffers from a psychological dis-
order? Should you talk to the person or contact
SECTION 5 (pp.524-527) an adult or a mental health professional for help?
5. a. ldentify Main Ideas How can personality disor- Think about a realistic situation in which you
might frnd yourself dealing with someone who
ders be distinguished from other psychological has a psychological disorder. Then, write a short
disorders? paragraph describing the situation and your pos-
b. Contrast What are the differences between sible course of action.
schizoid personality disorder and avoidant per-
sonality disorder?

530 cunptR re

SKITLS ACTIVITY: INTERPRETING GRAPHS Visit thinkcentral.com for
review and enrichment
The bar graph below shows how some factors, including family history, activities related to this chapter.

increase the risk of a child developing schizophrenia later in life. The

number l represents the norm, and each number above 1 represents a

100 percent increase in the risk. Therefore, a child born in winter has
about a 10 percent higher risk ofdeveloping schizophrenia than average.
Study the graph and answer the questions that follow.

Place/Time Winter
of Birth Urban

lllness lnfluenza ONtll*lE QUIZZES
of Mother Rubella Take a practice quiz for each
section in this chapter.
Poliovirus
TI,EBQUEST
Famine Complete a structured
lnternet activity for this
Conditions Bereavement* chapter.

for Mother Flood QUICK rAB
atTime of Reinforce a key concept
with a short lab activity.
Birth _ Depression
Family APPTYING WHAT
YOU'VE LEARNED
History Review and apply your
knowledge by completing a
* Grief caused by death of spouse 012 34567I 9 r0 project-based assessment.
or close family member
Relative lncrease in Risk EACTIUITIES
Complete chapter lnternet
Source: adapted from Public Library of Science, 2005 activities for enrichment.

17. Analyze Of the factors listed, which besides family history increases I}ITERACTIVE FEATURE
the odds the most? Explore an interactive version
of a key feature in this chapter.
18. Compare Which mother's illness increases a child's odds of develop-
ing schizophrenia by about 10 percent? by 200 percent? KEEP IT CURRE}IT
Link to current news and
19. Develop How does this graph suggest that events beyond the moth- research in psychology.
er's control can increase the risk of schizophrenia?
Learn more
Use your knowledge of psychological disorders to answer the question about key topics
below. Do not simply list facts. Present a clear description based on your in this chapter.
critical analysis of the question, using the appropriate terminology.
PSYCHOLOGICAL DISORDERS 531
20. Briefly describe each ofthe disorders listed below. For each disorder,
include a general description of the disorder, a review of the symp-
toms, and a description of the possible causes.

(A) Post-traumatic stress disorder (PTSD)
(B) Major depression
(c) Schizophrenia

VIRTuAl-ry%ffiffiffiffiry

The curtain opens and you step out onto the time you turned your head, you would see a
stage. Before you even start speaking, you
different part ofthe virtual scene.
are certain the audience is bored. People With virtual scenes, an operator can

stretch and cough. Is that a snore you hear? control the level of intensity a person
The palms of your hands turn sweaty. Your
stomach flutters. Suddenly, you feel dizzy, experiences. As the person begins to over-
like you might pass out at any moment. come his or her fear, the intensity can be
increased. For example, people who fear
The anxiety you feel is real, but the
flying can experience a virtual airplane
scene is not. What you are seeing is a vir- flight that is smooth and short or bumpy
tual scene created by a company. The vir- and prolonged. People receiving virtual
tual scene is designed to help people over- treatment work with psychologists before
come stage fright. Researcher Albert Rizzo
notes, "To help people deal with their prob- and after the sessions to learn ways to cope
with their anxiety.
lems, you must get them exposed to what
Virtual therapy can be used to tackle
they fear most." Companies create virtual many prohlems: stage fright, fear of eleva-
tors, fear ofheights, fear offlying, and fear
scenes and experiences by combining video of bad weather are just a few. Engineers
have even created a virtual re-enactment
clips of real people with special effects. In ofthe terrorist attacks on September 11,
this way, people can face their fears in a 2001. With this re-enactment, people can
step back in time to learn to cope with their
controlled environment.
memories of the attacks.
To experience a virtual scene, a person
wears a helmet with screens over the eyes Virtual Iraq is an experimental treat-
to create a 3-D effect. A motion sensor in ment program that has been designed to
the helmet changes the scene with the help soldiers work through the trauma
wearer's head position. For example, if you

were wearing one of these helmets, each

Watch theVideo ffiEYIXC*}}$ $

: Explore how psychologists use methods YEIEftfiFtr

oftherapy. l(hapterata Glance

induced by combat in Iraq. Symptoms expe- l:5[m0il WhatTherapy ls and Does
rienced by the soldiers include nightmares, I The various methods of psychotherapy seek to help troubled
flashbacks, obsessive thoughts, detach-
individuals.
ment, and anger. Some soldiers completely
withdraw from society. r There are a variety ofmethods and types ofprofessionals

During the treatment, the soldier involved in psychotherapy.
attempts to deal with PTSD by means of
a computer-simulated environment. He or r lndividual therapy and group therapy both have advantages.
she wears a helmet with video goggles and l:Stfil0t{ The Psythoanalytir and Humanistir
earphones. A modified version of a popular
war video game is also part of the program. Approathes
Sights, sounds, and smells are created to
help manage the painful memories of com- r Psychoanalysis is a method oftherapy that was developed by
bat in Iraq.
Sigmund Freud.
The U.S, Department of Defense is test-
r 50me of the techniques of psychoanalysis include free associa-
ing Virtual Iraq as one of three virtual
reality programs it is developing for the tion, dream analysis, and transference.

treatment of post-traumatic stress disorder. r The primary goal of humanistic therapy is to help individuals

Ifthe virtual reality therapy proves itself reach their full potential.
in clinical tests, it will likely become widely
used in the treatment of PTSD in returning SEffl0N 3: Cognitive Therapy and Behavior
Iraqi war veterans. In this chapter you will Therapy
learn more about different kinds of therapy.
r The aim of cognitive therapy is to help people learn to think
l. Why might virtual therapy have some limitations to its
about their problems in more productive ways.
usefulness?
r The goal of behaviortherapy isto help people develop more
2. Why might people be more willing to face their fears in a
virtual setting than in a real one? adaptive behavior.

Stfil0t{ 4: Biologiral Therapy

r Biological therapy relies on medication, electric shock, and sur-

gery to help people deal with psychological disorders.

I Because these treatments are medical in nature, they must be

administered by a physician.

I Electroconvulsive therapy and psychosurgery are both controver-

sial procedures.

METHODSOFTHERAPY 533

Whnt %erepry
Is amd Xlmes

SeforeYou Read Reading Iocus Uocabulary Use a graphic
1. What are the main goals of psychotherapy organizer like
Main ldea self-help group this one to take notes on
Therapy falls into two basic psychotherapy? the various types of men-
categories: psychologically tal health professionals.
based therapy and biologi- 2. What are the three main catego-
cally based therapy. Both ries of professionals who practice Types of Mental Health
forms of therapy can help psychotherapy? Professionals
people increase awareness
and change behavior. 3. How do individual and group
therapy compare?

How did the name of o hospital ill. Eventually it became notorious for the brutal treatment
become a synonym for uproar of its residents. Visitors would come on holiday outings
and disorder? Bedlam was the to mock the appearance and behavior of the patients.
byname for the first hospital for people with mental ill- Residents endured unsanitary conditions and beatings,
nesses established in England. lt was foundedin 1247 as well as other harsh treatment. Eventually the word
bedlam came to be used for all asylums and is still used to
as a priory (a monastery or convent). The founder was
Simon FitzMary, a former sheriff of London. St. Mary of describe an uproar.
Bethlehem (also called Bethlem)was first mentioned as a Today, the treatment of people with psychological dis-
hospital in 1330. Patients resided there by 1403.
orders has improved. Sophisticated methods of therapy
|n1547, HenryVlll gave Bethlem Hospital and its rev- help individuals with psychological problems to function
enues to the City of London as a hospital for the mentally
in society rather than be separated from society. lil
534 cHRptn rs

Achieving the Goals tivity. Changing this individual's outlook and AEAT'ETIIIIC
perceptions may help to relieve the depressed
of Psychotherapy mood and to improve his or her self-esteem. I'OTABUTARY

Methods for treating psychological problems Providing a caring, trusting relationship eclectic selecting
and disorders fall into two general categories: is important because people with psychologi- elements from a
psychological methods, or methods of psycho- cal problems often feel isolated, afraid, and
distrustful of others. Psychotherapy encour- variety of sources,
therapy, and biological methods. The methods ages individuals to talk freely about their systems, or styles
ofpsychotherapy aim to change the thought feelings and problems. Therefore, a trusting
processes, feelings, or behavior of the individ- relationship with the therapist is essential to
ual. These methods are based on psychologi- the process. Establishing such a relationship
cal principles. In contrast, biological therapies between client and therapist is a key goal of
attempt to alleviate psychological problems
psychotherapy.
by affecting the nervous system in some way.
This chapter examines different methods of In addition to providing hope, a new per-
therapy for psychological problems. Often spective, and a trusting relationship, all psy-
therapists blend these methods. chotherapy methods share the goal of bring-
ing about changes in individuals seeking help.
Therapy is a general term for the variety In the case of an individual who is depressed,
of approaches that mental health profession- for example, the psychotherapist tries to help
als use to treat psychological problems and
disorders. Psychologically based therapy, the client develop a more positive outlook and
known as psychotherapy, involves verbal inter-
actions between a trained professional and a higher self-esteem. In the case of a person
person (the client or patient) who is seeking
help for a psychological problem. Biologically experiencing a phobia, the psychotherapist
based therapies involve the use of drugs or helps the individual become desensitized, or
other medical procedures to treat psychologi- less likely to react, to the object offear,

cal disorders. The most commonly used methods of psy-
Although the various methods of psycho- chotherapy are psychoanalysis, humanistic

therapy use different approaches, they all therapy, cognitive therapy, and behavior ther-
seek to help troubled individuals. They do
this by giving individuals hope for recovery; apy. The chart on the next page summarizes
helping individuals gain insights or new per-
spectives on their problems; and providing the the main features of these methods.
individual with a caring, trusting relationship Each method of psychotherapy has a dif-
with a mental health professional.
ferent goal and different ways of achieving
Providing hope for recovery is very impor- that goal. Some psychotherapists use just
tant because most people who seek therapy one method. Others use an eclectic approach;
have problems they believe they cannot han- that is, they choose from a variety of meth-
dle alone. They may have low self-esteem and ods, depending on what works best for the
individual client. Which method is the most
lack the confidence to recognize that their effective often depends on the nature ofthe
situation can improve. Just the belief that psychological problem.
therapy will help them is enough to put many
This raises the issue ofthe effectiveness of
people on the road to recovery. This reaction is psychotherapy in general. Although some peo-
similar to the placebo effect, about which you
Iearned earlier. ple find that psychotherapy does not help them,
many people seem to benefit from it. However,
Helping the individual gain insight or a
new perspective is important because many it is difficult to know how those who benefit
psychological problems are the result of neg-
ative outlooks and misinterpretations. For would have done in the absence of treatment.
example, someone who is depressed is likely Some people feel better about themselves
to have poor self-esteem. This person may be
able to see only the negative side ofevery situ- as time goes on, even without treatment; oth-
ation and may feel responsible for that nega- ers find solutions to their problems on their
own, without benefit of therapy. Nonetheless,

research on the effectiveness ofpsychotherapy

is encouraging.

fil!ffifi[If Find the Main ldea what is one

ofthe key goals of psychotherapy?

METHODSOFTHERAPY 535

Methods of Psychotherapy physicisns, psychiatrists are the only mental
health professionals in most states who can
The main goals of commonly used methods of psycho- prescribe medication and administer other
therapy are shown below. types of biological therapy, Other profession-

Fryrhonnalyrir to replace avoidant behavior with als who think their clients might benefit from
coping behavior; to reduce inappropriate feelings of medication must consult with a psychiatrist.
anxiety and guilt A psychologist or social worker, for example,
might refer a client to a psychiatrist.
Humanistic Therapy to remove obstacles in the path
of self-actualization Other professionals who help people with
psychological problems include psychiatric
Cognltive Thorapy to replace self-defeating attitudes social workers and psychiatric nurses. Both
and beliefs with rational, self-enhancing attitudes have special training in psychology and usu-
and beliefs ally work with other medical or mental health
professionals. Psychiatric social workers may
Behavior Therapy to replace self-defeating behavior
with adaptive, self-enhancing behavior work in community mental health ciinics, gen-
eral hospitals, and hospitals for the mentally
What goal might all these methods of psychotherapy
have in common? ill. They may also practice psychotherapy in
a private office where they counsel individual
Psychotherapy in Practice clients as well as families.
Many types of professionals are involved in
Teachers, guidance counselors, clergy, and
the treatment of psychological problems and
family doctors may also help individuals with
disorders. However, it is primarily psycholo- problems. Such professionals may have little
formal training in psychology. However, they
gists, psychiatrists, and social workers who are often the people that troubled individuals
practice psychotherapy. turn to first for help. A student, for example,
might go to a teacher for advice on dealing
Types of Mental Health Professionals with test anxiety, or ask a guidance counselor
for help in making a career decision.
Counseling psychologists generally treat peo-
ple with less serious psychological problems, Selecting the Right Professional Those
such as adjustment problems. These psycholo- seeking help for a psychological problem
gists often work in schools and other educa- should familiarize themselves with the vari-
tional institutions, where they counsel people
about their personal problems. ous practitioners and the type of treatment
each offers. One way that people can gain that
Clinical psychologists help people with information is to ask questions.

psychological problems adjust to the demands . What is the professional's field? For
of life. Their clients'problems may range from example, people with psychological prob-
anxiety to loss of motivation. Many clinical
Iems should see people who belong to a
psychologists work in hospitals or clinics, profession, such as psychology, psychia-
while others work in community mental try, medicine, social work, or nursing.

health centers or in private practice. . What degrees does the professional hold?
Psychiatrists are medical doctors, and
Psychiatrists have medical degrees; psy-
many have private practices. Because they are
chologists usually have doctoral degrees;

and social workers usually have master's
degrees. The appropriate degrees ensure
the professional is trained to help people.

. Is the professional Iicensed by the state?
All states require licensing of psycholo-

gists and psychiatrists. Some states also
require the licensing of social workers

and nurses. To be issued a state license,
professionals must pass exams or demon-
strate expertise in other ways.

536 cHnpreR rs

. What are the therapist's plans for treat- therapy also gives individuals a chance to
ment, and how long will treatment likely practice coping and other social skills in a
take? There is variation in the nature
and duration of treatment for different supportive environment.
methods of psychotherapy. The individual One of the most significant advantages
should know in advance what to expect
of group therapy is that it shows individuals
from the treatment method.
that therapy can work to help them with their
. What is the estimated cost of treatment? problems. People see other members of the
Psychotherapy can be expensive, and it is group recovering, and this gives them hope of

not always covered by health insurance recovery for themselves.
plans. Although cost shouid not have to
be the deciding factor in choosing a ther- From a practical standpoint, group

apist, for some people it must be, simply therapy enables the therapist to work with
because they cannot afford to go into
several people at once. In addition, it often
debt to receive treatment.
allows a therapist to immediately see people
ffi ldentify Supporting Details why who might otherwise have to be placed on a

must psychiatrists also be physicians? waiting list to receive individual help. It is

lndividual Versus Group Therapy also more affordable for clients because they
share the cost of the therapist's time and do
Therapists use methods of psychotherapy with not have to bear the full cost ofthe session.
individuals or groups. Frequently, people who
seek help for psychological problems have a Types of Group Ther*py There are several
choice between individual and group therapy.
To make the best choice, it is important to be types of group therapy, including couples ther-
aware ofthe advantages ofeach type. apy, family therapy, and therapy for people
who share similar problems. These problems
Advantages of Individual Therapy Some might include an eating disorder, a substance-
people do better with individual therapy abuse issue, money problems, or the grief cre-
ated by the loss ofa loved one. Couples ther-
because they need more personal attention apy tries to help two people improve or find
than they would receive as part of a group.
Moreover, some people feel uncomfortable more satisfaction in their relationship with
talking about their problems in front of other
people. These individuals are likely to talk each other.
more openly and freely if they are alone with
their therapist. typi-)Seevvertadll tLyyppess oUfl pPrtUofIees5s5iloUnllacllls5 PpIrcalLclt,ilLcee Pps)yyLclhluolt.hlleelrdaPpyy.. Frlivvee darlter ll>ttru li

Advantages of Group Therapy Group ther- here, along with their training, examples of their workplaces, and i
apy can, however, have certain advantages
over individual therapy. In fact, many people cal therapeutic activities.
who begin seeing a therapist individually
eventually switch to group therapy. Counseling Psychotogist, Ph-D., Psy.D., or Ed.D.
busi-Educatlonal institutions such as colleges and high schools, or In
One advantage of group therapy is that :
it helps individuals realize that they are not nesses; referl ctielts w serllu.lnrollems cllnycal e:y:holo?lst
alone. People can see other group members 1! 1o i
struggling with problems similar to their own.
In this way, members of the group can often Clinical Psychologist, Ph.D., Psy.D., or Ed.D.
benefit from the insights gained by other
group members who have gone through simi- Works in hospitals and clinics; assists and treats people with psycho- :
lar struggles.
M.D-Psychiatrist, .
Group members can support each other
because they have had similar experiences- Able to prescribe medicine and perform operations .
they have "been there" themselves. Group
Psychiatric Social Worker, rn.s.W.
Counsels people with everyday personaland family problems

Psychiatric Nurse, RN.
Dispenses medicine and acts as a contact person between counseling

sessions

METHODSOFTHERAPY 537

Couples therapy helps people communr- Members of a self-help group meet regu-
cate more effectively by helping them learn larly-often without a therapist-to discuss
their problems, share solutions, and give and
new ways to listen to each other and to express
their feelings. Such therapy also helps couples receive support.
discover ways to resolve conflicts and handle
intense emotions. Again, take the problem of alcoholism.
There are a variety of treatment options for
Family therapy aims to help troubled fam- alcoholics. Treatment programs include both
ilies by improving communication and rela- inpatient and outpatient care. Inpatient cen-
ters provide a sheltered place to go through
tions among family members. It also seeks to withdrawal while getting counseling.

promote the family's emotional growth. One of the best-known self-help groups is
AlcoholicsAnonymous (AA). AAhas served as
Family therapy is based on the assumption a developmental model for many other self-
help programs. The AA method for recovery
that the lives of family members are inter- involves 12 steps. Through regular meetings
twined. Therefore, the family as a whole is and shared experiences, AA members bring
likely to suffer when one member has a prob- themselves and each other closer to a life that
lem that goes untreated. Inevitably, such an
untreated problem will affect other members is free of alcohol and full of emotional, physi-
of the family. Children, for example, might cal, social, and spiritual well-being.
begin to display symptoms that come to the
notice ofteachers and other students in their Al-Anon and Alateen are programs that
provide treatment and support for the fami-
school. lies of alcoholics. Al-Anon is designed to help
For example, a parent may be addicted to family members talk about and share advice
on the problem of living with an alcoholic.
alcohol and become abusive when intoxicated.
Alateen is specifrcally designed to help teen-
The abuse may lead to low self-esteem, anxi-
ety, and depression in other family members. agers cope with this situation. There are local
Or a family might seek family therapy to help chapters of AA, Al-Anon, and Alateen in just
them cope with a family member's schizophre- about every community in the United States.
nia. Others might seek family therapy to help
them adjust to a divorce. ffi ldentify What are the advantages

Self-help groups are composed of people of a self-help group?
who share the same problem, such as overeat-
ing, drug addiction, or compulsive gambling.

Assessment 6. Evaluate Using your notes and a graphic organizer like the
one below, explain the advantages and disadvantages of
Reviewing Main ldeas and Vocabulary
1. ldentify Which method of therapy attempts to remove each type of psychotherapy

obstacles in the path of self-actualization? 7. Expository Write a paragraph in which you explain which
2. Recall Which therapy involves verbal interactions between method of psychotherapy you think would be most useful
for most people, and why.
a trained professional and a client who is seeking help for a
psychological problem?
3. Describe Which mental health professional may prescribe
medications?

Thinking Critically
4. Summarize What is the goal of couples therapy?

5. Draw Conclusions What questions should one ask when
selecting a psychotherapist?

538 cHRptn ts

TE &ffi XStte m,xtd

m*stte Apprc*ehe$

BeforeYou Read Reading Focus Uocabulary Use a graphic
1. How did Freud view the role of free association organizer like
Main ldea this one to take notes on
psychoanalysis? resistance the methods of psycho-
Psychoanalysis and dream analysis a na lysis.
humanistic therapy 2. What are some of the methods manifest content
are two important of psychoanalysis? latent content Methods of Psychoanalysis
methods of treatment. transference
3. What is the goal of humanistic humanistic therapy Free
therapy? person-centered therapy Associalinn
nondirective therapy
active listening Dream
Analysis

Transference

ffi&ffi&&ffi ffiwmm&mgm

What do dreoms meon? Have you
ever had a recurring dream, one that

kept coming back to haunt your sleep,
maybe a couple of times a week or even nightly? For
example, a six-year-old boy reported a recurring dream
in which he was standing at one end of a dark corridor.
From the other end, silhouetted against a bright light, a
tall darkfigure approached him.The man who walked
toward him had only one arm, and in his hand he carried
a shovel. The boy stood paralyzed, unable to move. Then
just before the dark figure reached him, and before the
boy could see his face, the boy floated up to the ceiling.
Although the dark figure grabbed for him in an attempt
to pluck him down from the ceiling, the boy bobbed up
and out of reach.

You may have had a recurring dream, too. A very
common one is the final exam dream, in which you
arrive for an important test, only to find that you are not
prepared. Perhaps you studied the wrong material, or
you brought the wrong supplies, or you are not appro-
priately dressed or not dressed at all.

ln some methods of therapy, dreams may provide a
way into unconscious hopes and fears. Some psycholo-
gists think that dreams express both apparent and hid-

den fears and desires. fil

METHODSOFTHERAPY 539

*(Am[rV[t( Frsud and Psyrhoanaly$is the more likely it is that the hesitancy reflects
wsffisutfiftY an unconscious thought or feeling.
Psychoanalysis, the model of therapy devei-
repressed oped by Sigmund Freud,literallymeans "anal- Resistance is the term psychoanalysts use
excluded from the ysis of the psyche (mind)." Psychoanalysis was
the first formal method of psychotherapy used to refer to a client's reluctance to discuss issues
conscious mind in Western countries. For many years, it was
the only method used. In recent decades, how- raised during free association. Therapists
ever, it has become less popular. using free association think that resistance
reflects a defense mechanism, such as the
Freud believed that most psychological repression or denial ofpainful feelings.
problems originate in early childhood experi-
ences and inner conflicts. These conflicts can The role ofthe analyst in free association
cause people to develop unconscious sexual is to point out the types of things the client is
and aggressive urges that, in turn, cause saying-or resisting saying-and to help the
anxiety. For Freud, guilt occurs when the client interpret the meaning of the utterances
urges enter conscious thought or when the or lack thereof. Psychoanalysts believe that
individual acts upon them. Guilt aiso leads free association allows the client to express
troubling thoughts and feelings in a safe envi-
to more anxiety. ronment where those thoughts and feelings

Psychoanalysts try to reduce anxiety and may be explored. Through such means, clients
guilt by helping clients become aware of the gain insight into their problems.
unconscious thoughts and feelings that are
beiieved to be at the root of their problems. Dream Analysis Freud believed that dreams
express unconscious thoughts and feelings.
Psychoanalysts call this self-awareness He called them the "royal road into the uncon-
scious." In a technique called dream analysis,
insight. Once insight has been gained, clients the analyst interprets the content of dreams
can use the knowledge to resolve probiems. to unlock these thoughts and feelings.

ffi Find the Main Idea For Freud, Freud also distinguished between the

what was the source of most psychological prob- manifest and latent content of dreams.

lems? Manifest content refers to the actual content
of the dream as it is remembered by the client.
Methods of Psychoanalysis Latent (ontent refers to the hidden meaning
in the dream, which the therapist interprets
Some of the techniques psychoanalysts use to from the manifest content. For example, a cli-
help clients gain insight include free associa- ent may dream about falling from a mountain
tion, dream analysis, and transference. and being unable to grab anything to break

Free Association The primary technique of his fall (manifest content). The therapist
psychoanalysis is free association. In free asso-
ciation, the analyst asks the client to relax might interpret the dream to mean that the
client has repressed feelings that his life is
and then to say whatever comes to mind. Free out ofcontrol (latent content).
association developed from Freud's early use
ofhypnosis to tap into his clients'unconscious Transference As analysis proceeds, many
thoughts and feelings. The use offree associa- clients begin to view their relationship with
tion instead of hypnosis enables the client to their analyst as being similar to one they have
participate more actively in the analysis. or had with another important person in their
lives, often a parent. They experience similar
The topic of the free association might be feelings toward the analyst and expect the
a memory, dream, fantasy, or recent event. analyst to feel and behave as the other person
The assumption is that, as long as the client did. In other words, the client is transferring
associates freely, unconscious thoughts and feelings and expectations from one person to
feelings will "break through" and show up in another. This process is called transference.
what the client says. The client is encouraged
to say whatever comes to mind, no matter how Psychoanalysts make use of transference
trivial, embarrassing, or painful the ideas may to help the client express and analyze uncon-
seem. In fact, psychoanalysts believe that the
more hesitant the patient is to say something, scious feelings he or she has toward that
other important person. In fact, establishing

a transference relationship is a major goal of

540 cHnprrnrs

Free Association Quict f,ab
:,
i1l
..,.

ln free association, the analyst tells the client to
relax and say whatever pops into his or her mind.
lf someone says the word "dog"to you,'tat" might
pop into your mind, or"shoe"might call up"sock."

PROCEDURE ANALYSIS

O Pair off with another student. 1. Make a list with your classmates of
O iVtake up a list of words that words that have to do with the envi-
ronment or politics. For example,
dealwith an important topic for the environment, your list might
include "global warming," "green-
such as the environment or house gases," and so forth.
political elections.
2. Make another list of their responses or
O One of you reads each word associations to the first list of words.

while the other comes up 3. As a group, discuss what your asso-
with a one-word response. ciations reveal about your attitudes
toward politics and the environment.

psychoanalysis. Psychoanalysts believe that Psychoanalysis does not work for everyone.
transference exposes unresolved problems in
earlier relationships. The client can then work For example, it is not the most effective type
through these problems, with the help of the
analyst, in order to solve similar problems in of psychotherapy for individuals who are less
current relationships.
verbal. Nor does it work as well for people who
Evaluation of Psychoanalysis Many psy- are too seriously disturbed to gain insight into
their problems.
chologists believe that Freud placed too much
emphasis on sexual and aggressive urges. Brief Fsychoanalysis Over the past several

Some argue that he underestimated the decades, shorter terms of psychoanalysis have
become more common. In traditional psycho-
importance of conscious ideas and changes in
analysis, a client and therapist may meet
behavior. Despite these criticisms, however, a
classic review of dozens of studies concluded almost daily over the course of several years.
that people who had received psychoanalysis
showed greater well-being than 70 to 75 per- By contrast, in brief psychoanalysis, client
cent of those who had not received treatment. and analyst typically meet just 10 to 20 times
Psychoanalysis has proved especially useful
in the treatment of anxiety, mild depression, over the course of a few months to a year. The
and diffrculty in handling social relationships. shorter treatment makes brief psychoanalysis
available to a wider range of people.
However, it is generally not useful for the
The techniques used in brief psychoanaly-
treatment of major depression, bipolar disor-
der, or schizophrenia. sis are generally the same techniques that are
used in traditional psychoanalysis. The pri-
The techniques of traditional psychoanal- mary difference between the two approaches
ysis often require clients to meet with their is that brief psychoanalysis has a more lim-
analyst four or five times a week, for a period ited focus. Whereas traditional psychoanaly-
of months or years. For some clients, this pro- sis examines the client's entire personality,
vides a supportive, Iong-term relationship briefpsychoanalysis concentrates on fixing a
that fosters emotional growth and insight. For specific problem. For brief psychoanalysis to
others, however, the cost of therapy in time,
money, and emotional distress is too gr:eat to be effective, clients usually must be motivated
make psychoanalysis a real option. and actively involved in applying the insights
in therapy to the events in their lives.

ffim summarize what main goaldo

the techniques of psychoanalysis serve?

METHODSOFTHERAPY 541

Hurnanistic Therapy Active listening is a widely used com-

The primary goal of humanistic therapy is to munication technique in which the listener
repeats, rephrases, and asks for clarification
help individuals reach their full potential. It of the speaker's statements. The goal is to
convey to the speaker that words are heard
does this by helping individuals develop self- and thoughts and feelings are understood.
awareness and self-acceptance. The method The therapist remains nonjudgmental and
assumes that most people are basically good supportive, regardless ofwhat the client says,
and have a tendency to strive for self-actual- providing what Rogers calls unconditional
positiue regard. The support of the therapist
ization-that is, to become all that they are
helps the client accept himself or herself and
capable of being. The method also assumes
his or her true feelings. Self-esteem also rises,
that people with psychological problems
giving the client confidence.
just need help tapping their inner resources
so they can grow and reach their potential. Person-centered therapy is practiced
Person-centered therapy is the most widely widely by school and college counselors. It
used method of humanistic therapy.
helps students deal with anxiety, depression,
Person-Centered Therapy The psychologist and other psychological problems and helps

Carl Rogers developed person-centered therapy students make decisions. Counselors provide a

in the early 1950s. According to Rogers, psy- supportive atmosphere in which students feel
free to explore and make their own choices.
chological problems arise when people act as
others want or expect them to act. The role Evaluation of Fluruanistic Tlterapy In a
of person-centered therapy is to help clients
find their true selves and realize their unique review of several studies, nearly three-fourths
potential. of people obtaining person-centered therapy
showed greater well-being, on average, than
Person-centered therapy is sometimes people who did not receive therapy. Like psy-
called client-centered therapy. The use ofthe choanalysis, person-centered therapy seems to
be most helpful for highly motivated people.
term client instead of patient reflects the sta- Humanistic therapy works best for people who
tus given to individuals seeking help. Clients experience anxiety, mild depression, or prob-
are seen as equals in a working relationship lems in their social relationships.
with the therapist. Clients are encouraged to
take the lead in therapy, talking openly about ffi Summarize What is nondirective

whatever may be troubling them. This method therapy?

is called nondirective therapy because it is not

directed by the therapist.

Reviewing Main ldeas and Vocabulary 6. Evaluate Using your notes and a graphic organizer like the
1. Recall What is another term for a clientt self-awareness one below, evaluate psychoanalysis and humanistic therapy.

achieved in psychoanalysis? 7. Descriptive Write a paragraph in which you descrlbe a
2. Define What is dream analysis? dream that you think reveals both an apparent meaning and
a hidden meaning.
3. Describe What is the goal of active listening?

Thinking Critically
4. lnfer According to psychoanalytic theory, what effect do

unconscious thoughts and feelings have on a person's ability
to form meaningful personal relationships?
5. Analyze What role does the therapist play in person-
centered therapy?

542 cHnprun rs

Pu,,b,}ic Therapy

The quotes at the right are from just opened a New York stage show in interested in exploring their problems
a few of the troubled guests who which she conducted 13-minute
have appeared on Dr. Phll a TV talk "therapy" sessions with volunteers should seek help in therapy. But if
show hosted by psychologist Phil from the audience. ln Milwaukee, a they're only interested in exhibition-
McGraW Ph.D. Many other guests couple set up a counseling service
have willingly paraded symptoms of in the restrooms of nightclubs. Some ism or revenge, they are more likely
their mood, anxiety, and personality clubbers skipped the dance floor and to go on a talk show. He also cited the
disorders before a sometimes jeering, went straight to the restroom lure of celebrity, no matter how brief,
cheering, or laughing audience. for advice. as a reason why people beg produc-
ers to allow them to appear on these
On Celebrity Rehab, drugged-out What is going on here? Why shows.
and alcoholic semi-celebrities tell has psychological therapy, which
Dr. Drew Pinsky-and the American traditionally has been a private mat- One reason for the public display
public-not just about their addic- ter between patient and therapist, of personal burdens may be the way
tions, but also about the traumas that become so public? Why are people that modern society, despite all its
they blame for the addictions. On his not just willing, but eager to discuss electronic networks, has actually
radio show "Dr. Drew" and his co- their problems, including serious isolated many people. Those who
host use the weird problems of their psychological disorders, in front of spend all their free time on their com-
callers for comedy effect. anyone? Why do they accept advice puters or cell phones texting their
from strangers? Has the openness friends may not engage in an actual
Amateurs with no qualifications about highly personal disorders gone face-to-face conversation for days at
have also found remarkable suc- too far?
cess offering public therapy in the a time. lt is no wonder, then, that the
most unlikely settings. Sitting on a A psychologist who has appeared street-corner "therapists" feel that
street corner next to a sign that reads on various TV talk shows observed people come to them for "plain old-
"Talk to Me," a couple have invited that these public displays are intended fashioned conversation."
discussion of everything from drug to entertain, and in so doing they
addiction to failing marriages with sometimes exploit people with serious Perhaps another reason people
thousands of strangers. A woman problems. He makes the further point accept "therapy" from strangers is
with no credentials as a counselor that people who are seriously the popularity of the self-help move-
ment. These people may see the glut
of self-help books as an indication
that anyone can offer valid therapies,
no matter what their qualifications.
And advice from a restroom analyst is
so much faster and cheaper!

l. Analyze What are some of the haz-

ards and possible benefits of public
therapy?

2. Discuss Why do you think therapy

has become public for many people?

METHODSOFTHERAPY 543

Cosmitive Ther*W amd

ehavter Therary

BefoveYou Read Reading Focus Uocabulary Use a graphic
1. What is the aim of rational-emotive behavior therapy organizer like
Main !dea aversive conditioning this one to take notes on
Cognitive therapy and cognitive therapy? successive approximations cognitive therapy and
behavior therapy help behavior therapy.
people develop new ways 2. What is the aim of
of thinking and behaving. behavior therapy? Two Kinds ofTherapy
Co!,nitive Therapy:

Behavior Tirerapy:

"Wlsh I

Could

Be
There,"

Bfc

How do people overcometheir Shawn's memoir demonstrates in great detail how
phobios? Allen Shawn, son of for- his phobias have harmed and constrained his life. Still,
through therapy Shawn has managed to live a productive
mer Neuz Yorker editorWilliam Shawn if not "normal" life. At Roosevelt Hospital in New York, he
and brother of playwright and actor Wallace Shawn, has
published a memoir about his life titled Wish lCould Be underwent group treatment in a program that involved
Ihere. Shawn has agoraphobia. That is, he is afraid of weekly meetings. Activities included group discussions,
public spaces and also of isolation. He avoids fields, park- relaxation exercises, working through a handbook, indi-
ing lots, tunnels, unknown roads, subways, elevators, and vidual sessions with trained helpers, and outings with
bridges. Shawn has nonetheless learned to work around other people with phobias. Allen Shawn is one of many
his phobias. He is a composer and writer on the faculty of people for whom therapy is a means to deal with fears
and lead a more contented life. [il
Bennington College in Vermont.

544 CHAPTER 19

Cognitive Therapy which they base their thinking or actions are
sometimes incorrect. According to Ellis, people
Cognitive therapy and behavior therapy are may develop emotional problems when they
considered together because both methods base their behavior on these kinds of faulty
share the same goal-to help clients develop
new ways of thinking and behaving. Both assumptions.
cognitive and behavior therapists encourage
clients to focus on their thoughts and actions. People are often unaware of their false
Advocates of these two theories contend that assumptions, even though the assump-
only by modifying self-defeating thoughts and tions influence their conscious thoughts and
behavior patterns will the client truly be able actions. The role of the therapist in REBT
to solve his or her own problems. Thus, the is first to identify and then to challenge the
aim of these therapies is to eliminate trou- false assumptions. To teach individuals to
bling emotions or behaviors rather than to think more realistically, REBT therapists use
help patients gain insight into the underlying techniques such as role-playing and model-
cause of their problems, which is a key goal of ing. Role-playing helps individuals see how
psychoanalysis and humanistic therapy. their assumptions affect their relationships.
Therapists use modeling to show individuals
The aim of cognitive therapy is to help other, more realistic assumptions they might
people learn to think about their problems in
adopt.
more productive ways. Cognitive psychologists
focus on the beliefs, attitudes, and thought Individuals in rational-emotive behavior
processes that create and compound their cli- therapy may also receive homework assign-
ents'problems. They believe that some people ments. For example, they may be asked to
develop ways of thinking that are illogical or read relevant literature, listen to tapes ofpsy-

based on faulty assumptions. Such ways of chotherapy sessions, or carry out experiments
thinking can lead to emotional and behavioral designed to test their assumptions. The more

problems for these people. faithfully patients complete their homework,
Cognitive therapists help people change
the more likely it is that their therapy will
their ways of thinking. These therapists also
try to help people develop more realistic and succeed.
logical ways of thinking. Cognitive psycholo-
gists argue that once people have changed Beck's Cognitive Therapy Another form of
their ways of thinking, they become more
capable of solving their emotional and behav- cognitive therapy was introduced in the 1960s
ioral problems.
by psychiatrist Aaron Beck. In contrast to
The two most widely used cognitive
REBT's focus on faulty assumptions, the focus
therapy methods are rational-emotive ther- of Beck's cognitive therapy is on restructuring
apy and psychiatrist Aaron Beck's model of illogical thought processes. Beck has noted
several types of illogical thought processes
therapy, sometimes called cognitive restruc- that may lead to emotional problems. Some
of these include the following.
turing therapy. Both of these methods aim
at modifying people's ways of thinking as a . Arbitrary inference, or drawing con-
means of improving their emotional health.
However, the two methods differ somewhat clusions for which there is no evidence
in the aspects of thinking they maintain must
be changed and in the approach they take to . Selective abstractiorl or drawing con-

bringing about those changes. clusions about a situation or event on the
basis of a single detail and misinterpret-
Rational-Emotive BehaviorTherapy First ing or ignoring other details that would
developed by psychoiogist Albert Ellis in lead to a different conclusion
the L950s, rational-emotive behavior therapy
(REBT) is based on Ellis's belief that people . Overgeneralization, or drawing a gen-
are basically logical in their thinking and
actions. However, the assumptions upon eral conclusion from a single experience

Instead of confronting and challenging cli-
ents about the errors in their ways of think-
ing, as the REBT therapist does, the therapist
using Beck's approach gently guides clients in
testingthe logic oftheir own thought processes
and developing more logical ways of thinking.

METHODS OFTHERAPY 545

e(&*f;,vt*a One technique for doing this is to train cli- more desirable (or healthier) ways of behav-
ents to observe and record their thoughts in ing. To behaviorists, the reasons for the unde-
Et-q4Hr$ms'ryy_ response to the events ofdaily life. Therapists
can later review events with clients and help sirable behavior are unimportant. Changing
coping skills skills them see the illogical thought processes that the behavior is what matters.

to contend with dif- are causing them emotional problems. Many behavioral techniques fall into two
ficulties successfully categories: counterconditioning, which helps
Evaluation of Cognitive Therapy Cognitive people to unlearn undesirable behaviors,
CONNECTION therapy tends to be a short-term method, and operant conditioning, which helps in the
()vercoming Fears Iearning ofdesirable behaviors. The choice of
Virtual therapy is making it a realistic option for more people behavioral techniques for an individual client
another more re(ent depends largely on the nature of the individ-
technique for learning than traditional psychoanalysis. Clients gen-
to dealwith irrational erally meet with their therapist once a week ual's psychological disorder.
fears, Virtual scenes for 15 to 25 weeks.
can be created to help Counterconditioning If undesirable behav-
people slowly over- Studies of cognitive therapy show that iors are conditioned, or learned through
come their fears of, for reinforcement, then presumably they can
example, spiders, modifying irrational beliefs of the type
described by Albert Ellis helps people with be unlearned, or counterconditioned.

problems such as anxiety and depression. Counterconditioning pairs the stimulus that
Modifying self-defeating beliefs of the sort triggers an unwanted behavior (such as fear
outlined byAaron Beck also frequently allevi- of spiders) with a new, more desirable behav-
ates those conditions. Cognitive therapy also ior. Counterconditioning techniques include
helps people with personality disorders. systematic desensitization, modeling, and

Cognitive therapy is helpful for people aversive conditioning.
with major depression who had been consid-
ered responsive only to medicine and other Systematic desensitization was developed
kinds of biological therapies. Many studies by psychiatrist Joseph Wolpe in the 1950s as
show that cognitive therapy is as effective
or even more effective than antidepressant a treatment for phobias and other anxiety dis-
medication. For one thing, cognitive therapy orders. The assumption underlying system-
provides coping skills that reduce the risk
of recurrence of depression once treatment atic desensitization is that a person cannot
ends. A combination of cognitive therapy and feel anxious and relaxed at the same time.
The therapist trains the client to relax in the
antidepressant medication may be superior to
presence of an anxiety-producing situation.
either treatment alone in the case of people
with persistent depression. This is done in a systematic way. First,

ffi Find the Main ldea other than the therapist teaches the client how to relax

Beck's model, what is the most widely used cog- completely. Once this has been accomplished,
the therapist gradually exposes the client to
nitive therapy method? the object or situation that causes the phobic
response. For a person who fears spiders, the
Behavior Thorapy
therapist might first ask the person to sim-
The goal of behavior therapy, which is also ply imagine a spider. If the thought of a spi-
der makes the client feel anxious, the client
called behavior modification, is to help people is told to stop thinking about the spider and
develop more adaptive behavior. Some people relax again. This is done repeatedly until the
seek behavior therapy to eliminate undesir- thought ofa spider no longer causes anxiety.
able behaviors, such as overeating or smok-
ing. Others seek behavior therapy to acquire Gradually, the stimulus is increased-the
desirable behaviors, such as skills needed to person might be shown pictures of spiders,
develop relationships or confront phobias. asked to hold a toy spider, and then asked to
handle a real spider. In each case, the person
Behaviorists believe that both desirable is trained to respond with relaxation until the
stimulus no longer provokes anxiety.
and undesirable behaviors are largely learned
Systematic desensitization may be com-
and that people with psychological problems
have learned unhealthy ways of behaving. bined with other counterconditioning mea-
sures, such as modeling and aversive con-
The aim ofbehavior therapy is to teach people ditioning. Modeling involves observational

546 cHRprun rs

learning. The client observes and then imi- consequence. The rewards for desirable behav-
tates the therapist or another person coping
with the feared object or situation. For the per- ior might be praise or treats, for example,
son with a fear of spiders, the therapist might
ask the person to observe someone watching a depending on the client and the setting.
spider make a web. The client would then be
encouraged to behave in the same way. Operant conditioning has sometimes
proved effective in more severe cases, such
Aversive conditioning is, essentially, the op- as schizophrenia and childhood autism, that
posite of systematic desensitization. In aver- were previously resistant to other types of
treatment. Operant conditioning is often
sive conditioning, the therapist replaces a pos- used in institutional settings, such as mental

itive response to a stimulus with a negative hospitals. In such settings, the therapist may

response. For example, for a person who wants set up a token economy, that is, a system of
to stop smoking, the therapist might replace
rewards. When people in these settings begin
the pleasant feelings associated with smok-
ing with unpleasant ones. The person might to demonstrate appropriate behavior, they are
be asked to smoke several cigarettes at once
through a device that holds two or more ciga- rewarded with a plastic coin or token. The
rettes. This overexposure to cigarette smoke
makes smoking unpleasant. With repetition, tokens can be accumulated and exchanged for
real rewards, such as snacks, extra television
the person may come to avoid smoking. time, a trip to town, or a private room.
People who learn more desirable behav-
The staff at one mental hospital used
iors through counterconditioning often expe-
operant conditioning to convince withdrawn
rience a boost in their self-esteem as well. schizophrenic patients to eat their meals. The
Furthermore, by confronting, challenging,
more the staff coaxed the patients to eat-
and overcoming their fears or bad habits, such sometimes even hand-feeding them-the
people will increase their opportunity to lead
less restrictive lives, worse the problem became. The extra atten-

Operant Conditioning The behavioral tech- tion from the staff was apparently reinforcing
nique ofoperant conditioning is based on the the patients'lack ofcooperation: The greater
assumption that behavior that is reinforced the refusal to eat, the more attention the
tends to be repeated, whereas behavior that patients received.
is not reinforced tends to be extinguished.
Behavioral therapists reinforce desirable The solution was to stop reinforcing the
uncooperative behavior and instead rein-
behaviors with rewards and at the same force cooperative behavior. Patients who
arrived late at the dining hall were locked
time withhold reinforcement for undesirable out, and hospital staffwere prevented from
behaviors. In other words, therapists teach helping patients at mealtime. Thus, unco-
clients in a given situation, or antecedent, to operative behavior was no longer rewarded
behave in a certain way to achieve a desired with extra attention. Only those who cooper-

ated received food. As a result, the uncoop-
erative patients quickly changed their eating

habits.

Goal Technique Rationale
End harmful behavior
Aversive Associate harmful behavior I Associating a behavior with
Operant Encourage adaptive with painful stimulation
behavior aversive stimulation makes the

:' behavior offensive

Reinforce adaptive behavior , Reinforcement increases the
or avoid reinforcement of l frequency of behavior and lack
maladaptive behavior , of reinforcement extinguishes
l behavior

METHODSOFTHERAPY 547

Sometimes people frnd it difficult to adopt behavior, modeling effective behaviors, and
encouraging clients to practice effective behav-
a new behavior aII at once, finding it easier iors. Such techniques have proved successful
in helping students build social relationships.
to change their behavior gradually. Another They have also been used to help people with

method of operant conditioning, called severe psychological disorders. With social
successive approximations, is useful in such skills training, a person who otherwise would
be dependent on others might be able to hold
situations. The term successive approximations
refers to a series ofbehaviors that gradually a job and live on her or his own.

become more similar to a target behavior. Evaluation of tsehavior Therapy Behavior
Through reinforcement of behaviors at each therapy tends to be somewhat more effec-
stage, the target behavior is frnally achieved. tive overall than psychoanalysis or person-
centered therapy. It is also a short-term ther-
Suppose, for example, a student wants to apy, sometimes bringing about lasting results
in just a few months.
increase his study time to two hours a day. On
the first day, he studies for half an hour and Behavior therapy is especially effective for
then gives himself a reward. Each night he well-defined problems such as phobias, post-
adds five minutes to his study time and gives
himself a reward until he reaches his goal. traumatic stress disorder, and compulsions. It

The relationship between antecedents, has helped people overcome depression, social

behavior, and consequences can be seen when problems, and problems with self-control (as
in quitting smoking or drinking).In addition,
operant conditioning is used for social skills behavior therapy has proved very useful for
managing the care of people living in institu-
training. People with severe psychological tions, including people with schizophrenia or
problems may lack social skills because of developmental disabilities.

isolation and social withdrawal. In fact, lack- There is a new, integrated approach to
ing the social skills needed for independent treatment called cognitive-behavior therapy.
living is one of the major symptoms of schizo- It attempts to change the way a person both
phrenia. A therapist might assist a client by thinks and behaves.
teaching him or her to say "hello" in a friendly
ffi summarize what are some of the
way when meeting someone. This technique
techniques of counterconditioning?
would help the client function more comfort-

ably in society-that is, it would help the cli-

ent achieve a desired consequence.
Behavior therapists help people build

their social skills by advising clients on their

trfl#s'* fusessment

:]\- L: L \

Reviewing Main ldeas and Vocabulary 6. Compare and Contrast Using your notes and a graphic
organizer like the one below, explain the basic similarities
, l. Describe What is the focus of Beck's cognitive therapy? and differences between counterconditioning and operant
conditioning.
2. Define What is aversive conditioning?
Operant conditioning
3. Recall What technique did Joseph Wolpe develop as a treat-
7. Descriptive Describe how one treatment in this section can
ment for phobias and other anxiety disorders? be used to relieve a certain kind of phobia.

Thinking Critically
4. Explain What might be an example of behavior and conse-

quences in a behavioral situation?

5. Summarize What techniques do cognitive and behavior
therapists use to help people?

548 cHnpren rs

&ffted %erapiy

ffiefmr*Y*ax ffiead Reading Focus Vocabulary Use a graphic
antianxiety drug organizer
Main ldea l. How are the major antidepressant drug like this one to take notes
Biological therapy relies lithium on various kinds of drug
on methods such as med- categories of drugs used antipsychotic drug therapy.
ication, electric shock, in drug therapy? electroconvulsive therapy
and surgery to help psychosurgery ii ir I in n xi$tv:
people with psychological 2. What is electroconvulsive prefrontal lobotomy Arrir aililrJ "].J I )i:
therapy?
disorders. i,:ti1:rvrl,clic
3. How would you define
psychosurgery?

AffiffiffiffiffiPffi{E*l;ffi

Why was an ice pick ever considered
a surgical toolT A lobotomy is a surgi-

cal procedure in which nerve pathways

linking one or more lobes to the rest of the brain are cut. The
method was invented in the 1930s and became widely used
during the 1940s and 1950s. Lobotomies were supposed
to reduce the agitation and violence of people with serious
disorders, but sometimes their use was seriously abused. ln
1960, a 1 2-year-old boy named Howard Dully was loboto-

mized by Dr. Walter Freeman. Now a bus driver in California,
Dully has over the past couple of years attempted to discover

what happened to him and whY.
Dully's stepmother claimed he was a discipline problem

and managed, with the surgeon's collaboration, to convince
the boy's father to agree to the surgical procedure. lt now
seems clear that he was lobotomized for nothing more
serious than the normal behavior of a young boy' The psy-

chiatrist who performed the operation, Walter Freeman,
thought that mental illness was correlated with emotions
and that cutting the brain would cut away overactive feel-
ings or emotions. He performed lobotomies on some 2,500
patients in 23 states.Todaythis brutal procedure is rarely

performed. Li*l

Dr. Walter Freeman performed a lobotomy on
Howard Dully (above) when Dully was only 12
years of age.

METHODSOFTHERAPY 549

Drug Therapy The major side effects of antianxiety medi-
cations are feelings offatigue. It is also possi-
The methods of psychotherapy described so
far rely on verbal interactions between the ble to become dependent on antianxiety drugs.
psychotherapist and the individual seeking
help. As you have seen, psychotherapists may People who are dependent on these drugs may
give their clients emotional support, advice, lose the ability to face the stresses and strains
and help in understanding and changing their of everyday life without them.
thoughts and behaviors.
Antidepressant Drugs People who suffer
Biological therapy, on the other hand, from major depression are often treated with
attempts to alleviate psychological problems antidepressant drugs. Antidepressant drugs
by affecting the nervous system. Biological are also sometimes used in the treatment of

therapy relies on methods such as medication, such problems as eating disorders and panic

electric shock, and even surgery to help people disorders.
Antidepressants work by increasing the
with psychological disorders. All of these bio-
logical methods affect the brain in a variety amount of one or both of the neurotransmit-
ters. These are norepinephrine (noradrenaline)
of ways. and serotonin. They tend to be most helpful in
reducing the physical s;,.rnptoms of depression.
Because these treatments are medical in They increase activity levels and reduce the
nature, they must be administered or pre- severity of eating and sleeping problems.
scribed by psychiatrists or other physicians.
In order to work effectively, antidepres-
Psychologists do not prescribe drugs or admin-
ister biological treatments, but they may help sant medications must build up in the body to
a certain level. This may take anywhere from
decide whether a certain kind of biological several days to a matter of weeks. Severely
therapy is appropriate for the treatment of a depressed people who are at risk ofsuicide are
particular individual.
sometimes hospitalized until the medication
Drug therapy is the most widely used bio- reaches the level required to improve their
logical treatment for psychological disorders.
depressed mood. This is to prevent them from
It works well for several different problems. taking an overdose of the medication, which
Four major types of medication are com- could be lethal.

monly used: antianxiety drugs, antidepres- In addition, antidepressants sometimes
sant drugs, lithium, and antipsychotic drugs.
All of these medications can be obtained only have negative side effects, such as escalated
with a prescription. heart rate and excessive weight gain. For these
and other reasons, some psychologists believe
Antianxiety Drugs Also called minor tran-
that antidepressant medications should be
quilizers, antianxiety drugs are used as an out- reserved for people who fail to respond to
patient treatment to help people who suffer
from anxiety disorders or panic attacks. They psychotherapy.
are also prescribed for people who are expe-
Mood Stabilizing Drugs Some drugs are
riencing serious distress or tension in their prescribed to stabilize patients' mood dis-
orders. One of the most popular is lithium.
daily lives.
Antianxiety drugs work by depressing the The ancient Greeks and Romans may have
been the first people to use a compound of the
activity of the nervous system. They lower metal lithium to treat psychological disorders.
the heart rate and respiration rate. They also They discovered that mineral water helped

decrease feelings of nervousness and tension. many people with what used to be called
Although antianxiety medications help con- manic depression but is now called bipolar

trol the symptoms of anxiety, they are not a disorder. The mineral water may have con-
permanent cure for anxiety disorders. Thus, tained lithium.
most people use them for a short period of
time. The longer a person takes an antianxi- Today lithium carbonate is given in tab-
ety medication, the less effective the drugmay Iet form to help people with bipolar disorder.
become. Higher doses may be needed in order Lithium seems to flatten out their cycles
to achieve the same effect. of mania and depression. Scientists do not

550 cHRpruR rs

understand completely how lithium does this. $Stpaet iaektlincg-a..l1. y'
Lithium is known, however, to affect the func-
tioning of several neurotransmitters. p"r k li';ir
i*r "
Lithium may have side effects, such as
shakiness, memory impairment, and exces- . l "r
sive thirst. Memory problems are reported to
be the major reason that people stop using

the drug.

Antipsychotic Drugs People who are diag- , l'r ffi"ld*h&
nosed with schizophrenia are likely to be pre-
#.{
scribed antipsychotic drugs. These drugs are
also called major tranquilizers. r" - ilidl

Antipsychotic medications are effective for ,,,ii'i rr*h' *
reducing agitation, delusions, and hallucina-
tions. Their use has enabled many thousands The Homeless and Therapy A targe percentage of the
of people with schizophrenia to live outside of
mental hospitals. homeless population has severe psychological disorders. Some are on
antipsychotic drugs that have allowed them to be deinstitutionalized,
Schizophrenia is associated with high lev- that is, live outside of mental hospitals.
els of dopamine activity. Antipsychotic medi-
cations work by blocking the activity of dopa- 2O-25f, Percentage of the single adult
mine in the brain. Unfortunately, prolonged
use of these medications can lead to problems homeless population that suffers from mental illness

in balance and coordination and produce -7o/,5 Percentage of homeless people with

tremors and twitches. mental illness who require hospitalization
Nonetheless, controlling the symptoms of
3O/" Percentage of homeless with addiction disorders
schizophrenia with medication often allows 17/. Percentage of homeless population with
those with schizophrenia to lead more normal
lives. They can live more independently-even untreated psychiatric illnesses
hold jobs-and maintain better social rela-
m TNTERnRETTNG GHARTs what might have been the
tionships. Greater independence and better
social relationships increase self-esteem and effect on society at large ofthe use of antipsychotic drugs to treat
social support, both of which are likely to have mental patients?
a positive effect on emotional health and the
control of schizophreni a. Sources: National Coalition for the Homeless

ffiffi Find the Main ldea what psycho-

logical disorder is lithium used to treat?

Electroconvulsive Therapy When ECT was introduced, it was used AilJTB#fvl,C

Electroconvulsive therapy (ECT), commonly for many psychological disorders, includ- u&teryut AkY
called electric-shock therapy, was introduced ing schizophrenia. Once antipsychotic drugs
as a treatment for psychological disorders in i;roir;i;r-
the 1930s by Italian psychiatrists Ugo Cerletti became available, ECT was used much less
and Lucio Bini. Before ECT is given, anes- often.In fact, in 1990 theAmerican Psychiatric against onet will
thesia is administered to render the person Association recommended that ECT be used
unconscious throughout the procedure. Then
an electric current is passed through the per- primarily for people with major depression
son's brain. The electric current produces con-
vulsions (violent involuntary contractions of who do not respond to antidepressant drugs.
muscles) th.oughout tt e body. In some cases, ECT is controversial for many reasons. For
muscle relaxant drugs are given to prevent
injury during the convulsions. one thing, many professionals are distressed
by the thought ofpassing an electric shock
through a patient's head and producing con-
vulsions. There are also side effects, including

memory problems.

METHODS OFTHERAPY 551

However, research suggests that for most pathways in the brain between the prefrontal
people, cognitive impairment after ECT tends lobes and the thalamus. However, the treat-
to be temporary. One study followed up on 10 ment produces several serious side effects,
adolescents who had received ECT an aver-
age ofthree and a halfyears earlier. Six of including distractibility, reduced learning
the ten had complained of memory impair- ability, overeating, apathy, social withdrawal,
ment immediately after treatment, but only
one complained of continued problems at the seizures, reduced creativity, and occasionally
follow-up. even death. At the beginning of this section,
you read about Howard Dully, who had a
Psychological tests did not reveal any dif- lobotomy at the age of 12. Since the proce-
dure, he has suffered from feeling different,
ferences in cognitive functioning between
severely depressed adolescents who had abnormal, and ashamed.

received ECT and others who had not. Despite It is not surprising that prefrontal lobot-

the controversies surrounding ECI it appears omy is an even more controversial procedure
to help many people who do not respond to than ECT. Experts challenged the original
rationale behind the surgery, and early suc-
antidepressant drugs. Nonetheless, it is a cess rates were exaggerated by advocates of
the procedure. Because of the side effects of
drastic treatment that is used only in the the surgery and the availability of antipsy-
chotic drugs, prefrontal lobotomies are now
most extreme cases.
performed only rarely.
ffimffiffi tdentifyCauseand Effect Why
Drug therapies, and to a limited extent
did the use of ECT drop off? ECI seem to be effective for some psychologi-
cal disorders that do not respond to psycho-
Psychosurgery
therapy. It is important to realize, however,
Psychosurgery is brain surgery that is per-
formed to treat psychological disorders. The that medications and electric shocks cannot
best-known technique, prefrontal lobotomy, help a person develop more rational ways
has been used to reduce the agitation and of thinking or solve relationship problems.
violence of people with severe psychological Changes such as these are likely to require

disorders. psychotherapy.
The method was developed by Portuguese
Summarize What is the best-
neurologist Ant6nio Egas Moniz in the 1930s.
known technique of psychosurgery?
The procedure involves cutting the nerve

Reviewing Main ldeas and Vocabulary 5. Categorize Using your notes and a graphic organizer like
1. Describe How are antianxiety drugs used? the one below, describe the type of biological therapy that
2. ldentify Which treatment for psychological disorders was might be used for each of the following: panic disorder,
bipolar disorder, schizophrenia, and severe depression.
introduced in the 1930s by Ugo Cerletti and Lucio Bini?
3. ldentify Main ldeas What are some of the side effects of Biologiral Therapy
Drug Iherap;,:
lobotomies?
ECT:
Thinking Critically
4. Explain What are the three major biological treatments for Psychosurgery:

psychological disorders? 7. Narrative Have you ever seen a film or television show in
5. Draw Conclusions Why is electroconvulsive therapy a con- which a person has been subjected to ECT? Write a para-
graph in which you describe the movie or TV show. lf you
troversial treatment for psychological disorders? haven't seen such a show, write a story about what you
imagine the procedure to be like.
552 cHRpreR rs

of et1gs

Antipsychotic drugs are being prescribed for young and old at an
increasingly high rate, even though the effects of these drugs on the
young in particular have not been studied carefully. Dr. William Cooper
is a Vanderbilt University pediatrician and a co-author of a study of
antipsychotic drug use. He believes that antipsychotic drugs are being
prescribed without a full understanding of their possible risks and side
effects (Cooper et al., 2004).

The Vanderbilt study focused on the study was the use of drug therapy Despite the concerns that have
use of antipsychotic drugs among to treat behavioral problems. The been raised, antipsychotic drugs
low income children. lt found that for study found that antipsychotic drugs continue to be widely used to treat
patients covered by Medicaid there were used among 267.1 per 100,000 behavior disorders. One reason is that
was an incentive to prescribe medica- subjects aged 19 and younger (Curtis many managed care plans provide
tion because Medicaid provides com- and Masselink, et al., 2005). Eighty complete coverage for drug therapy
plete coverage for drug therapy. percent of the young patients who but limited coverage for psychiatric
were put on antipsychotic drugs were evaluation. This creates a financial
The behavioral problems that incentive to use drug therapy.
drugs are being used to treat include males.
attention deficit hyperactivity dis- For both adults and children, 1. Explain What are some of the side
order (ADHD), conduct disorders, effects of antipsychotic drugs in
autism, and depression. The study there are potential side effects to children?
found, however, that the medica- these medications. These negative
tions had not been studied carefully slde effects include weight gain, ner- 2. Discuss How many commercials for
enough to prove that they work vous problems, heart rhythm irregu- drugs do you see on television, and
safely in children. larities, diabetes, tooth decay, and what role might that play in the over-
sleepiness. Another risk among those prescription of drugs?
This study raises questions on antipsychotic drugs is depression.
about the financial motives of those
involved in prescribing antipsychotic And the overprescription of
drugs is not just a problem among
drugs. Pharmaceutical companies young patients. lt has become so
common that the Food and Drug
stand to make billions of dollars if Administration recently issued a
warning that people taking antide-
their products become even more pressants must be closely monitored
widely used among the general pop- for an increased risk of suicide. The
ulation of children and adults. Those advisory issued by the agency asked
most at risk because of the overuse of the drug manufacturers to put
antipsychotic drugs include children detailed warnings about an increased
in the juvenile justice system, in a risk of suicidal behavior on the labels
state's custodial care program, and of ten antidepressants: Prozac, Toloft,
the disabled. Paxil, Wellbutrin, Luvox, Celexa,
Lexapro, Effexor, Serzone, and
A Duke University Medical Remeron. The warning included both
Center study found that there is children and adults.
an increased use ofantipsychotic
drugs in pediatric populations. 0ne
ofthe concerns raised by the Duke

METHODSOFTHERAPY 553

I tlil i rllll'-iill
ir',.rn1 |l r..,ar'

SinUlarloq

AOpfV*g What You've Learned

Identifying the Use the workbook to
complete this simulation.
Methods of Therapy

As you have seen in the chapter, there are many methods of
therapy. Which approach do you think is best?

1. lntroduction For example, for psychoanalysis, your notes should look
like this:
This simulation will help you review the different approaches
to therapy and the methods implemented by clinical Name of therapy: Psychoanalysis
psychologists. You will work individually to review the
approaches and then in small groups you will write therapy- Approach: Psychoanalytic approach
session skits. After each therapy session is acted out, the
class will guess what approach and method were being Terms and concepts: free association, resistance,
implemented. To complete this simulation, follow the steps transference, dream analysis
below.
Goal: to reduce anxiety by developing awareness of
On your own, review the approaches to therapy covered in unconscious conflict
this chapter.
Work in groups to write a simulated therapy session using 3. Creating Your Simulation
one of the methods of therapy described in this chapter.
After observing your classmates'simulations, determine what The goal of this part of the activity is to simulate a therapy
method of therapy is being implemented and from what session implementing one of the methods you have just
approach that therapy comes. reviewed. Working in groups organized according to your
teacher's instructions, write a skit that simulates a therapy
2. Reviewing the Methods session. First, review the terms and concepts that are
important when using this therapy as well as its goal. Next,
of Therapy determine which two members of your group will act out the
simulation. Finally, write your skit. As you write your skit, each
0n your own, review the different approaches and methods simulated therapy session should include the information
ofpsychotherapy. As you review these approaches, take listed below.
notes that include the following information:
A. A clear identification of who is the client and who is
Name of the therapy the therapist
Psychological approach of the therapy
lmportant terms and concepts B. A clear description of why the client is in therapy
Goal ofthe therapy C. Terminology that indicates clearly the method of

554 cHnpren rs therapy in practice

Sample:

Therapist Hi, l'm glad that you came to visit me today
Client: Thank you. I wish I didn't have to be here.

Therapist: Why don't you explain to me why you
are here?

Client: l've been experiencing a lot of anxiety lately.
l've been getting angry really easily and I'm

not sure why,

Therapist: Well, why don't you try to relax on the
couch over there? When you are ready, just
tell me the first thing that comes to mind.

r7t' - tY{

4. Determining Methods of Psychoanalysis
Humanistic therapy
Therapy Being Simulated Person-centered therapy
Nondirective therapy
After observing each simulation, be prepared to guess which type of Rational-emotive behavior therapy
therapy was being implemented. Do not blurt out your guesses while the Beck's cog nitive therapy
skit is being performed. Give everyone a chance to process the information. Cou nterconditioning
For each skit, be prepared to answer the following questions: Operant conditioning
Drug therapy
Which type of therapy was being simulated? Electroconvu lsive thera py
Psychosurgery
From which approach does that therapy come?

What language was used during the session, and what does it indicate about
the type oftherapy?

What was the goal of the session?

5. Discussion

What did you learn from this simulation? Hold a group discussion that
focuses on the following questions:

Overall, how successful was the class at determining which method of
therapy was being practiced?

Were some methods of therapy particularly easy to determine? lf so, which
ones and why?

Were some methods of therapy particularly difficult to guess? lf so, which
ones and why?

Which methods of therapy do you think are most effective?

How do you think therapists determine which method to practice in a
given situation?

Comprehension and Critical Thinking Reviewing Vocabulary

SECTION 1 (pp. fia-ffi8) Match the terms below with their correct defrnitions.

1. a. Define Which is the only type of professional 5. psychotherapy 10. aversive conditioning
therapist who can prescribe medication? 6. free association 11. coping skills
7. latent content 12. antianxiety drug
b. Explain How does psychotherapy help troubled 8. humanistic therapy 13. psychosurgery
individuals?
9. active listening
c. Elaborate Why is providing a trusting relation-
ship important in psychotherapy? A. the hidden meaning in a dream
B. therapy intended to help individuals reach their
SECTION 2 (pp.53e-542)
2. a. ldentify Who developed person-centered ther- full potential
C. brain surgery performed to treat psychological
apy in the early 1950s?
b. Explain What is free association? disorders
c. Evaluate What is an example of a transference
D. drugs prescribed to help people with anxiety
relationship and why might a therapist encour-
age such a relationship? disorders

SECTION 3 (pp.Saa-Sag) E. ability to contend with diffrculties successfully
3. a. ldentify Who developed rational-emotive F. therapy in which a positive response to a stimu-

behavior therapy? lus is replaced with a negative response
b. Compare and Contrast What is the difference G. psychologically based therapy
H. psychoanalytic technique in which the analyst
between the two counterconditioning tech-
niques of systematic desensitization and aver- asks the client to relax and then to say whatever
sive conditioning? comes to mind

c. Elaborate Other than the examples given in !. communication technique in which the listener
repeats, rephrases, and asks for clarification of
the text, what is an example of the use of sys- the statements made by the speaker
tematic desensitization?
14. How might the social and cultural conditions of
SECTION 4 (pp.54e-552) Freud's time have influenced his ideas? Use the
4. a. Describe What disorders are antidepressant Internet to research how the social and cultural
conditions of Vienna, Austria, in the late 1800s
drugs used to treat? and early 1900s influenced Freud's ideas about
b. Explain When do therapists use electroconvul- the causes of psychological problems. Write a
brief summary of what you learn.
sive therapy?
c. Develop What are the advantages of treating Psychology in Your life

depression with cognitive therapy instead of 15. How might belief in the assumption that "I must
with antidepressant drugs?
be loved by everyone to be happy" lead to unrea-
sonable expectations and feelings of depression?
Think about a situation in which someone you
know seems to be operating on that assumption.
Then write a short paragraph describing the situ-
ation and what course of action you might recom-
mend to that person.

556 cHnprrR rs

SKILLS ACTIVITY: INTERPRETING CARTOONS Visit thinkcentral.com for
Study the cartoon below. Then use bhe information to help you answer review and enrichment
the questions that follow. activities related to this chapter.

No oNLTNE QUTZZES
Take a practice quiz for each
;aoi€ section in this chapter.

oIoo WEBQUEsT
Complete a structured
<aOE lnternet activity for this
36UUU<=Ei chapter.

t>!o!lEoo QUICK LAB
3.8 Reinforce a key concept
OU with a short lab activity.

-l- APPIY|NG trrHAT
=g2! YOU'UE TEARNED
Review and apply your
"She said,'I'll go fyou go,' and I said,'I'l/ go i.fyou go,' and here lDe are." knowledge by completing a
project-based assessment.
16. Explain In the typical psychoanalytic encounter, how many people
are in the room, and who are they? EACTIVITIES
Complete chapter lnternet
17. Elaborate What does the cartoon suggest about people's attitude activities for enrichment.
toward therapy?
INTERACTIUE FEATURE
Use your knowledge of methods of therapy to answer the question below. Explore an interactive version
Do not simply list facts. Present a clear argument based on your critical of a key feature in this chapter.
analysis of the question, using appropriate psychological terminology.
18. Briefly describe each of the following aspects of person-centered KEEP IT CURRENT
Link to current news and
therapy. research in psychology.

. nondirective Learn more
. active listening about key topics
. unconditional positive regard in this chapter.

METHODSOFTHERAPY 557

Clinical A child displaced by Hurricane Katrina works with Karla :
Psychologist
Leopold, an art therapist, Baker, Louisiana,
Clinical psychologists work in a wide range of in r
settings to help people with various psychological
problems. This flexible career is growing in Clinical psychologists may be self-employed. Or,
popularity with psychology graduates. they may be hired by government, business, schools,
universities, hospitals, or nonprofit organizations, They
About half of all graduate degrees in psychology are
awarded in the field of clinical psychology. Therefore, may be either consultants or fulltime employees.
you could say that clinical psychology is the most popu-
lar branch of psychology. Some clinical psychologists Because clinical psychology is extremely flexible, it is
work with individuals who suffer from severe psycho- becoming more competitive, as is admission to strong
logical disorders, while others limit their practices to graduate programs.
treating people with less severe behavioral or adjust-
ment problems. ln the course of their work, clinical You may confuse clinical psychologists with psy-
psychologists may deal with such diverse problems as chiatrists. The distinction is a significant one. ln treating
severe depression, juvenile delinquency, drug abuse, their patients, clinical psychologists may conduct
marital problems, or eating disorders. interviews, practice methods of psychotherapy, and
administer and interpret psychological tests. They do
Many clinical psychologists with doctoral degrees not, however, prescribe medication or administer other
have private practices, where they see clients who vol- kinds of biological therapy.
untarily come to them for treatment. Others, however,
work in veterans' hospitals, mental health clinics, or Psychiatrists, on the other hand, are medical doctors
prisons, where they are generally assigned to a specific who specialize in the treatment of psychological disor-
number of patients. ders. By law, only psychiatrists can prescribe medication
to their clients.
Some clinical psychologists teach-primarily in
universities or medical schools-where they pass on
their experience and knowledge to others, rather than
apply their skills directly. They also add to knowledge
in the field by conducting research and publishing their
findings. Some clinical psychologists conduct work-
shops and train business leaders or other professionals.

Many clinical psychologists publish arti- gists speak of a person with schizophrenia o
cles in professionaljournals in which they rather than of a schizophrenic. The impll-
discuss people who have various psycho- cation is that the person being discussed THINK !.httkse!1ra.l.!qry.
logical disorders and physical disabili- is first and foremost a human being. The central
ties. ln keeping with guidelines from the person's disorder is secondary.
American Psychological Association phrases that are not respectful along
(APA), the writers try to eliminate negative Through Think Central you can find with phrases that show proper respect.
or insulting language-whether inten- APA style guidelines and more on using
tional or unintentional-when referring respectful language when discussing peo- An example is provided for you.
to these persons. For example, psycholo- ple with psychological disorders. Review
the APA guidelines. Then write several

558 uurro