Psychotherapies

Gateway THEME Psychotherapies are based on a common core of therapeutic principles. Medical therapies treat the physical causes of psychological disorders. In many cases, these approaches are complementary.

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9781285519517, Introduction to Psychology: Gateways to Mind and Behavior with Concept Maps and Reviews, Thirteenth Edition, Coon/Mitterer – © Cengage Learning. All rights reserved. No distribution allowed without express authorization.

Joe stared at some ducks through the blinds in his psychology professor’s office. They were quacking as they explored the campus pond. As psychologists, we meet many students with personal problems. Still, Joe’s teacher was surprised to see him at her office door. His excellent work in class and his healthy, casual appearance left her unprepared for his first words. “I feel like I’m losing my mind,” he said. “Can I talk to you?”

Over the next hour, Joe described his own personal hell. In a sense, he was like the ducks outside, appearing peaceful on the surface, but madly paddling underneath. He was working hard to hide a world of crippling fear, anxiety, and depression. At work, he was deathly afraid of talking to coworkers and cus- tomers. His social phobia led to frequent absenteeism and embarrassing behavior. At school, Joe felt “dif- ferent” and was sure that other students could tell he was “weird.” Several disastrous romances had left him terrified of women. Lately, he had been so depressed that he thought of suicide.

Joe’s request for help was a turning point. At a time when he was becoming his own worst enemy, Joe realized he needed help. In Joe’s case, that person was a talented clinical psychologist to whom his teacher referred him. With psychotherapy (and some temporary help from an antidepression medication), the psy- chologist was able to help Joe come to grips with his emotions and regain his balance.

This chapter discusses methods used to alleviate problems like Joe’s. We will begin with a look at the origins of modern therapy before describing therapies that emphasize the value of viewing personal prob- lems with insight and changing thought patterns. Then, we will focus on behavior therapies, which directly change troublesome actions. After that, we will explore medical therapies, which are based on psychiatric drugs and other physical treatments. We conclude with a look at some contemporary issues in therapy.

Gateway QUESTIONS 15.1 How did psychotherapy originate? 15.2 Is Freudian psychoanalysis still used? 15.3 How do psychotherapies differ? 15.4 What are the major humanistic therapies? 15.5 How does cognitive therapy change thoughts

and emotions? 15.6 What is behavior therapy? 15.7 What role do operant principles play in

behavior therapy?

15.8 How do psychiatrists treat psychological disorders?

15.9 Are various psychotherapies effective, and what do they have in common?

15.10 What will therapy be like in the future? 15.11 How are behavioral principles applied to

everyday problems and how could a person find professional help?

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Therapies

9781285519517, Introduction to Psychology: Gateways to Mind and Behavior with Concept Maps and Reviews, Thirteenth Edition, Coon/Mitterer – © Cengage Learning. All rights reserved. No distribution allowed without express authorization.

Chapter 15512

Origins of Therapy— Bored Out of Your Skull

Gateway Question 15.1: How did psychotherapy originate? Fortunately, the odds are that you will not experience problems as serious as those of Joe, the student we just met. But if you did, what help is available? In most cases, it would be some form of psycho- therapy, a psychological technique that can bring about positive changes in personality, behavior, or personal adjustment. It might, as with Joe, also include a medical therapy. Let’s begin with a brief history of mental health care, including a discussion of psychoanaly- sis, the first fully developed psychotherapy.

Early treatments for mental problems give good reasons to appreciate modern therapies (Sharf, 2012). Archaeological find- ings dating to the Stone Age suggest that most primitive approaches were marked by fear and superstitious belief in demons, witchcraft, and magic. If Joe were unlucky enough to have been born several thousand years ago, his “treatment” might have left him feeling “bored.” You see, one of the more dramatic “cures” practiced by primitive “therapists” was a process called trepanning (treh-PAN- ing), also sometimes spelled trephining (Terry, 2006). In modern usage, trepanning is any surgical procedure in which a hole is bored in the skull. In the hands of primitive therapists, it meant boring, chipping, or bashing holes in a patient’s head. Presumably, this was done to relieve pressure or release evil spirits (• Figure 15.1).

Joe would not have been much better off during the Middle Ages. Then, treatments for mental illness in Europe focused on demonology, the study of demons and persons plagued by spirits. Medieval “therapists” commonly blamed abnormal behavior on supernatural forces, such as possession by the devil, or on curses from witches and wizards. As a cure, they used exorcism to “cast out evil spirits.” For the fortunate, exorcism was a religious ritual. More often, physical torture was used to make the body an inhospitable place for the devil to reside.

One reason for the rise of demonology may lie in ergot- ism (AIR-got-ism), a psychotic-like condition caused by ergot poisoning. In the Middle Ages, rye (grain) fields were often infested with ergot fungus. Ergot, we now know, is a natural source of LSD and other mind-altering chemicals. Eating tainted bread could have caused symptoms that were easily mistaken for bewitchment or madness. Pinch- ing sensations, muscle twitches, facial spasms, delirium, and hallucinations are all signs of ergot poisoning (Matossian, 1982). Modern analyses of “demonic possession” suggest that many victims may have been suffering from epilepsy, schizophrenia (Mirsky & Duncan, 2005), dissociative dis- orders (van der Hart, Lierens, & Goodwin, 1996), and depression (Thase, 2006). Thus, many people “treated” by demonologists may have been doubly victimized.

Then, in 1793, a French doctor named Philippe Pinel changed the Bicêtre Asylum in Paris from a squalid “mad- house” into a mental hospital by unchaining the inmates (Harris, 2003). Finally, the emotionally disturbed were

regarded as “mentally ill” and given compassionate treatment. Although it has been more than 200 years since Pinel began more humane treatment, the process of improving care continues today.

When was psychotherapy developed? The first true psychother- apy was created by Sigmund Freud little more than 100 years ago ( Jacobs, 2003). As a physician in Vienna, Freud was intrigued by cases of hysteria. People suffering from hysteria have physical symptoms (such as paralysis or numbness) for which no physical causes can be found.

Such problems are now called somatoform disorders, as discussed in Chapter 14, pages 499–501.