Psychotherapies

Psychodynamic therapies. Psychodynamic therapies, generally lengthy, “insight” therapies based on the psychoanalytic therapy developed by Freud, involve two major techniques. Free association requires clients to report anything that comes to mind. The intent of the process is to allow access to the unconscious. Dream analysis requires clients to report their dreams, which are then interpreted to provide insight into unconscious conflicts and motivations. A therapist uses these two processes to find commonalities in clients' thoughts and behaviors and to interpret them in terms of clients' problems.

At times, the treatment process is blocked by clients' resistance (unwillingness to provide information). Transference is a condition in which clients begin to consider their therapist in the same emotional light they would consider a person emotionally important in their lives, such as a parent or sibling. Dealing with interpretation, resistance, and transference is sometimes called working through, a therapeutic technique in which a therapist helps clients understand their conflicts and how to resolve them.

Humanistic therapies. Humanistic therapies deal with conscious (rather than unconscious) thoughts and with present (rather than past) occurrences and are conducted with goals of client growth and fulfillment.

Person‐centered therapy. Carl Rogers developed person‐centered therapy and advocated a warm, supportive environment ( unconditional positive regard) in which a person feels completely accepted, can reveal true feelings, and can thus experience self‐growth (an increase in self‐esteem). Rogers suggested that people grow up in a world in which there are conditions of worth (that is, they learn that they will be rewarded only if they meet certain conditions and standards imposed by others), a situation that may result in low self‐esteem. Rogers stressed the need for therapists to use empathy, identification with their clients.

Gestalt therapy. In Gestalt therapy, developed by Frederick “Fritz” Perls, therapists challenge clients with questions so that clients increase their awareness of feelings and develop the ability to face daily‐living problems. Gestalt therapists also use a variety of other techniques, such as role playing and confrontation, to help clients learn to cope. Although Gestalt therapy directs clients more than does person‐centered therapy, the therapies are similar in that both encourage clients to assume responsibility for the activities of life.

Existential therapy. Existential therapy, an “insight” therapy based on a client's developing insight, or self‐understanding, focuses on problems of living such as choice, meaning, responsibility, and death. It emphasizes free will, the ability of humans to make choices that have not been dictated by heredity or past conditioning and through which a person can become the individual that she or he wants to be. The therapy attempts to restore meaning to life so that one has the courage to make choices that are both rewarding and socially constructive. After his experiences in a Nazi concentration camp, Victor Frankl developed a type of existential therapy called logotherapy. Frankl believed that prisoners who survived did so because they maintained logos, a sense of meaning. The therapy is directed toward helping clients reappraise what is really important (meaningful) in life.

Behavior therapies. Behavior therapies use learning principles to eliminate or to reduce maladaptive behavior(s). This therapeutic approach does not deal with unconscious conflicts but uses principles of social learning and personality theory to assist individuals in forming accurate perceptions of their feelings and of themselves. Behavior therapists focus on teaching clients to extinguish (unlearn) maladaptive behaviors (those based on groundless fears, for example), which they feel are acquired through classical and operant conditioning in day‐to‐day living. In turn, these same learning procedures can be used to extinguish maladaptive behaviors.

  • Systematic desensitization (developed by Joseph Wolpe) requires clients to learn to associate deep relaxation with successive visualizations of anxiety‐provoking stimuli or situations. Initially clients are taught to relax, next to visualize fearful items or events, and then to combine relaxation with the visualization. This procedure has been found to be especially effective in dealing with phobias.

  • In implosive therapy, clients must imagine and deal with their worst fears in the safe surroundings of a therapist's office, a procedure which often leads to extinction of the anxiety.

  • In flooding, clients, accompanied by a therapist, are placed in the real situation they dread in order to face and extinguish, their fear. For example, a person with agoraphobia (fear of open places) might be accompanied by a therapist into a store or crowd.

  • Biofeedback requires that a bodily function (such as heart rate or muscle tension) be monitored and the information fed back to a client. Through this process, a client learns techniques to control the function, for example, learning to relax to slow the heart rate or decrease muscle tension.

  • Aversive conditioning requires a client repeatedly to pair undesirable behavior(s) with aversive stimuli (for example, electric shocks, nausea‐producing substances, or verbal insults) in order to stop the behavior(s). Mixing alcohol with a nausea‐producing substance, resulting in an association between ingestion of alcohol and unpleasantness, is an example of aversive conditioning.

  • When the learning technique of modeling is used to change behavior, a client watches another person perform the client's feared behavior(s), and with encouragement from the therapist, the client copies that performance.

  • Particularly in institutions, therapists may establish what is known as a token economy, in which tokens are given as rewards (an operant procedure) to encourage (shape) behaviors such as getting out of bed and dressing. A sufficient number of tokens may then be traded for rewards such as food and movies.

Cognitive therapies. Cognitive therapies use learning principles involving cognition to change maladaptive thoughts, beliefs, and feelings that contribute to emotional and behavioral problems.

  • Cognitive therapy for depression was originally developed by Aaron Beck, who suggested that depressed people view themselves and the world around them negatively because of distortions in thinking. These distortions are classified as selective perception (focusing on only bad events), overgeneralization (allowing one discouraging event to be generalized to a negative interpretation of all events), and all‐or‐none thinking (a tendency to see all events as entirely good or entirely bad). A client is helped to recognize and to change these maladaptive cognitive behaviors.

  • Rational‐emotive therapy (ET), developed by Albert Ellis, is one of the best known cognitive therapies and is based on the premise that many problems arise from irrational thinking. People are thought to become unhappy and to develop self‐defeating habits because of faulty beliefs. An example might be a person who has a need to be perfect in all actions and feels dismal after failure. The therapy helps a client to understand the irrationality and the consequences of such a way of thinking, reduce anxiety in a stressful situation, and learn to substitute more effective problem‐solving tactics.

Feminist therapy. Feminist therapy emerged as a challenge to the mental health establishment's role in maintaining social inequities between men and women and other majority and minority groups. Feminist therapists oppose the use of both gender‐role stereotypes, which support cultural beliefs in male superiority and female inferiority, and any type of discrimination on the basis of age, ethnic group, or sexual orientation. Although these therapists use a variety of therapeutic techniques, they always consider the role of society in creating discrimination and thus contributing to a client's problems in daily life. Therapists are encouraged to understand their own social biases and the manner in which those biases operate in the therapeutic process.

Group therapies. Group therapies apply therapeutic principles, except for psychoanalysis, to a group of people. Although in group therapy a therapist's involvement with a single client is not as extensive as in individual therapy, clients learn from the experiences of other clients and from their reactions to one another. Group activities may include self‐help as well as support from and confrontation by other group members. Some groups focus on particular strategies. This procedure is usually less expensive than individual therapy.

  • In family therapy, all family members participate, individually and as a group. The process allows destructive relationships and interaction styles to be identified and changed. A family is considered to be any group of people who are committed to one another's well‐being, preferably for life.

  • Marital therapy assists husbands and wives to work together as a couple to solve their problems and has as a major goal the development of realistic expectations about a marriage relationship.

  • Self‐help groups, so called because they include no professional therapist, consist of people who voluntarily assemble on a regular basis to discuss topics of interest. Group members, including a group leader, provide support to help individual members with problems. Such groups, because they use community resources and are consequently relatively inexpensive, are important for many people. Alcoholics Anonymous (AA) and Take Off Pounds Sensibly (TOPS) are two of the best known self‐help groups.

  • In sensitivity groups, participants engage in activities that encourage individual self‐awareness and awareness and trust of others.

  • Encounter groups help members confront emotion‐laden experiences openly and without distortion. Members of the group identify annoying behaviors of individual members, such as incessant bragging or continual “put‐downs” of others, and openly confront the person for such behavior. The group allows the participants to feel free to express true feelings about each other.

  • In psychodrama, an early group approach, an individual acts out incidents similar to those that cause real‐life problems. The technique uses role‐reversal, with the client assuming the role of the person creating difficulties, as an aid in understanding life's problems.

Community psychology. Community psychology practitioners seek to reach out to the community to provide services such as community health centers and especially to effect social change through planning, prevention, early intervention, evaluation, research, and the empowerment of individuals. A major aim of the effort is to strengthen existing social support networks and to stimulate the formation of new networks to meet challenges. A key idea in community psychology is empowerment, helping people to use existing skills and to develop motivation to acquire new knowledge in order to gain control over their lives.

  • Crisis intervention centers, such as those that assist rape victims, help people deal with short‐term, stressful situations resulting from a crisis. The centers also help in community education about the problems encountered and, based on those problems, often advocate changes in community institutions and organizations.

  • Community halfway houses serve as treatment facilities and residences for those who have been released from a mental hospital or prison and for those who are considered to be at risk of needing mental hospital care. They are run by a nonprofessional staff under the supervision of a professional. The residents work in the community but receive support and some supervision in daily activities.