In rogerian therapy, the _____ is responsible for discovering maladaptive patterns.

Therapies13

Enduring Issues in Therapies

Insight Therapies • Psychoanalysis • Client-Centered Therapy • Gestalt Therapy • Recent Developments Behavior Therapies • Therapies Based on

Classical Conditioning

• Therapies Based on Operant Conditioning

• Therapies Based on Modeling Cognitive Therapies • Stress-Inoculation Therapy • Rational–Emotive Therapy • Beck’s Cognitive Therapy Group Therapies • Family Therapy

• Couple Therapy • Self-Help Groups Effectiveness of Psychotherapy • Which Type of Therapy Is

Best for Which Disorder? Biological Treatments • Drug Therapies • Electroconvulsive Therapy • Psychosurgery

Institutionalization and Its Alternatives • Deinstitutionalization • Alternative Forms of

Treatment • Prevention Client Diversity and Treatment • Gender and Treatment • Culture and Treatment

O V E R V I E W

IS B

N 1-256-37427-X

Understanding Psychology, Ninth Edition, by Charles G. Morris and Albert A. Maisto. Published by Prentice Hall. Copyright © 2010 by Pearson Education, Inc.

For most new mothers, giving birth results in an instant bondand feelings of immediate and unconditional love for theirnew baby. Many describe motherhood as the happiest time in their lives and cannot imagine a life without their children. However, for some, another reaction occurs—one of sadness and apathy, and withdrawal from the world around them. Brooke Shields, the well-known actress and model, was one of these women.

In Down Came the Rain: My Journey Through Postpartum Depression, Shields (2006) writes that she had always dreamed of being a mother. Although she and her husband, Chris Henchy, initially had trouble conceiving, Shields eventually became pregnant through in vitro fertilization and gave birth to a daugh- ter in 2003. Just as her attempt at conceiving wasn’t without effort, easing into life as a mother wasn’t effortless, either.

Almost immediately after returning home from the hospital, Shields began to experience symptoms of postpartum depres- sion. Once referred to as the “baby blues,” postpartum depres- sion has recently come to be considered a very legitimate type of depression. Symptoms range from anxiety and tearfulness to feelings of extreme detachment and even being suicidal. Shields notes that her “baby blues” rapidly gave way to full- blown depression, including thoughts of self-harm and frighten- ing visions of harm coming to her baby. In addition to the birth of her child, Shields was also coping with the recent death of her father, as well as the ongoing struggle of coping with the suicide of a close friend 2 years prior. Doctors note that postpartum depression can be exacerbated by events such as these.

425

As Shields’s mental health began to decline, she felt more anxious and panicky. She felt sadness greater than she’d ever experienced, and began thinking that it would never go away. She felt completely detached from the baby she had gone through so much to have. This detachment depressed her fur- ther. It became a vicious cycle, and she suffered tremendously throughout it. It didn’t occur to Shields that she might have post- partum depression until she heard someone comment on the shame and depression associated with the disease. It finally hit home and Shields sought help.

As with nearly all forms of depression, there was no quick and easy solution. Treatment requires patience, help from a doctor, a supportive family, and often medication. Shields began treatment and gradually began to feel better. She eventually was able to feel the love that mothers speak of when referring to their children. She bonded with her baby and became tuned in to the child’s needs instinctively. With her doctor’s guidance, she began to wean herself off the medication. She also sought healing through writing the book that detailed her experience, and in 2006, she and her husband conceived again, adding another child to their family.

Having learned about a wide range of psychological disor- ders in Chapter 12, “Psychological Disorders,” you are probably curious about the kinds of treatments available for them. Brooke Shields’s treatment for depression, a combination of medication and psychotherapy, exemplifies the help that is available. This chapter describes a variety of treatments that mental health professionals provide.

ENDURING ISSUES IN THERAPIES The underlying assumption behind therapy for psychological disorders is the belief that people are capable of changing (stability–change). Throughout this chapter are many opportunities to think about whether people suffering from psychological disorders can change significantly and whether they can change without intervention. In the discussion of biological treatments for psychological disorders we again encounter the issue of mind–body. Finally, the enduring issue of diversity–universality will arise when we discuss the challenges therapists face when treating people from cultures other than their own.

INSIGHT THERAPIES What do insight therapies have in common?

Although the details of various insight therapies differ, their common goal is to give peo- ple a better awareness and understanding of their feelings, motivations, and actions in the hope that this will lead to better adjustment (Huprich, 2009; Messer & McWilliams, 2007; Person, Cooper, & Gabbard, 2005). In this section, we consider three major insight thera- pies: psychoanalysis, client-centered therapy, and Gestalt therapy.

insight therapies A variety of individual psychotherapies designed to give people a better awareness and understanding of their feelings, motivations, and actions in the hope that this will help them to adjust.

L E A R N I N G O B J E C T I V E S • Describe the common goal of all insight

therapies. Compare and contrast psychoanalysis, client-centered therapy, and Gestalt therapy.

• Explain how short-term psychodynamic therapy and virtual therapy differ from the more traditional forms of insight therapy.

psychotherapy The use of psychological techniques to treat personality and behavior disorders.

IS B

N 1-

25 6-

37 42

7- X

Understanding Psychology, Ninth Edition, by Charles G. Morris and Albert A. Maisto. Published by Prentice Hall. Copyright © 2010 by Pearson Education, Inc.

426 Chapter 13

Psychoanalysis How does “free association” in psychoanalysis help a person to become aware of hidden feelings?

Psychoanalysis is designed to bring hidden feelings and motives to conscious awareness so that the person can deal with them more effectively.

In Freudian psychoanalysis, the client is instructed to talk about whatever comes to mind. This process is called free association. Freud believed that the resulting “stream of consciousness” would provide insight into the person’s unconscious mind. During the early stages of psychoanalysis, the analyst remains impassive, mostly silent, and out of the person’s sight. The analyst’s silence serves as a “blank screen” onto which the person projects uncon- scious thoughts and feelings.

Eventually, clients may test their analyst by talking about desires and fantasies that they have never revealed to anyone else. When clients discover that their analyst is not shocked or disgusted by their revelations, they are reassured and transfer to their analyst feelings they have toward authority figures from their childhood. This process is known as transference. It is said to be positive transference when the person feels good about the analyst.

As people continue to expose their innermost feelings, they begin to feel increasingly vulnerable. Threatened by their analyst’s silence and by their own thoughts, clients may feel cheated and perhaps accuse their analyst of being a money grabber. Or they may suspect that their analyst is really disgusted by their disclosures or is laughing at them behind their backs. This negative transference is thought to be a crucial step in psychoanalysis, for it pre- sumably reveals negative feelings toward authority figures and resistance to uncovering repressed emotions.

As therapy progresses, the analyst takes a more active role and begins to interpret or suggest alternative meanings for clients’ feelings, memories, and actions. The goal of interpretation is to help people to gain insight—to become aware of what was formerly outside their awareness. As what was unconscious becomes conscious, clients may come to see how their childhood experi- ences have determined how they currently feel and act. By working through old conflicts, clients have a chance to review and revise the feelings and beliefs that underlie their problems. In the example of a therapy session that follows, the woman discovers a link between her current behaviors and childhood fears regarding her mother, which she has transferred to the analyst.

Therapist: (summarizing and restating) It sounds as if you would like to let loose with me, but you are afraid of what my response would be.

Patient: I get so excited by what is hap- pening here. I feel I’m being held back by needing to be nice. I’d like to blast loose sometimes, but I don’t dare.

Therapist: Because you fear my reaction? Patient: The worst thing would be that

you wouldn’t like me. You wouldn’t speak to me friendly; you wouldn’t smile; you’d feel you can’t treat me and dis- charge me from treatment. But I know this isn’t so; I know it.

Therapist: Where do you think these atti- tudes come from?

Patient: When I was 9 years old, I read a lot about great men in his- tory. I’d quote them and be dramatic, I’d want a sword at my side; I’d dress like an Indian. Mother would scold

Explore on MyPsychLab

free association A psychoanalytic technique that encourages the person to talk without inhibition about whatever thoughts or fantasies come to mind.

transference The client’s carrying over to the analyst feelings held toward childhood authority figures.

The consulting room where Freud met his clients. Note the position of Freud’s chair at the head of the couch. In order to encourage free association, the psychoanalyst has to function as a blank screen onto which the client can project his or her feelings. To accomplish this, Freud believed, the psycho- analyst has to stay out of sight of the client.

insight Awareness of previously unconscious feelings and memories and how they influence present feelings and behavior.

Explore Key Components of Therapies at www.mypsychlab.com

IS B

N 1-256-37427-X

Understanding Psychology, Ninth Edition, by Charles G. Morris and Albert A. Maisto. Published by Prentice Hall. Copyright © 2010 by Pearson Education, Inc.

Therapies 427

me, “Don’t frown; don’t talk so much. Sit on your hands,” over and over again. I did all kinds of things. I was a naughty child. She told me I’d be hurt. Then, at 14, I fell off a horse and broke my back. I had to be in bed. Mother told me that day not to go riding. I’d get hurt because the ground was frozen. I was a stubborn, self-willed child. Then I went against her will and suffered an accident that changed my life: a fractured back. Her attitude was, “I told you so.” I was put in a cast and kept in bed for months.

Therapist: You were punished, so to speak, by this accident. Patient: But I gained attention and love from Mother for the first time. I

felt so good. I’m ashamed to tell you this: Before I healed, I opened the cast and tried to walk, to make myself sick again so I could stay in bed longer.

Therapist: How does that connect with your impulse to be sick now and stay in bed so much?

Patient: Oh. . . . (pause) Therapist: What do you think? Patient: Oh, my God, how infantile, how ungrownup (pause). It must be so. I want

people to love me and feel sorry for me. Oh, my God. How completely child- ish. It is, is that. My mother must have ignored me when I was little, and I wanted so to be loved.

Therapist: So that it may have been threatening to go back to being self-willed and unloved after you got out of the cast (interpretation).

Patient: It did. My life changed. I became meek and controlled. I couldn’t get angry or stubborn afterward.

Therapist: Perhaps if you go back to being stubborn with me, you would be returning to how you were before, that is, active, stubborn, but unloved.

Patient: (excitedly) And, therefore, losing your love. I need you, but after all, you aren’t going to reject me. But the pattern is so established now that the threat of the loss of love is too overwhelming with everybody, and I’ve got to keep myself from acting selfish or angry (Wolberg, 1977, pp. 560–561).

Only a handful of people who seek therapy go into traditional psychoanalysis, as this woman did. As Freud recognized, analysis requires great motivation to change and an abil- ity to deal rationally with whatever the analysis uncovers. Moreover, traditional analysis may take 5 years or longer, with three, sometimes five, sessions a week. Few can afford this kind of treatment, and fewer possess the verbal and analytical skills necessary to discuss thoughts and feelings in this detailed way. And many want more immediate help for their problems. For those with severe disorders, psychoanalysis is ineffective.

Since Freud’s invention around the turn of the 20th century, psychodynamic personal- ity theory has changed significantly. Many of these changes have led to modified psychoan- alytic techniques as well as to different therapeutic approaches (McCullough & Magill, 2009; Monti & Sabbadini, 2005). Freud felt that to understand the present we must under- stand the past, but most neo-Freudians encourage clients to cope directly with current problems in addition to addressing unresolved conflicts from the past. Neo-Freudians also favor face-to-face discussions, and most take an active role in analysis by interpreting their client’s statements freely and suggesting discussion topics.

Client-Centered Therapy Why did Carl Rogers call his approach to therapy “client centered”?

Carl Rogers, the founder of client-centered (or person-centered) therapy, took pieces of the neo-Freudians’ views and revised them into a radically different approach to therapy. According to Rogers, the goal of therapy is to help people to become fully functioning, to open them up to all of their experiences and to all of themselves. Such inner awareness is a form of insight, but for Rogers, insight into current feelings was more important than insight into unconscious wishes with roots in the distant past. Rogers called his approach to

Source: © The New Yorker Collection, 1989, Danny Shanahan from cartoonbank.com. All Rights Reserved.

client-centered (or person-centered) therapy Nondirectional form of therapy developed by Carl Rogers that calls for unconditional positive regard of the client by the therapist with the goal of helping the client become fully functioning.

IS B

N 1-

25 6-

37 42

7- X

Understanding Psychology, Ninth Edition, by Charles G. Morris and Albert A. Maisto. Published by Prentice Hall. Copyright © 2010 by Pearson Education, Inc.

428 Chapter 13

therapy client centered because he placed the responsibility for change on the person with the problem. Rogers believed that people’s defensive- ness, anxiety, and other signs of discomfort stem from their experiences of conditional positive regard. They have learned that love and accep- tance are contingent on conforming to what other people want them to be. By contrast, the cardinal rule in person-centered therapy is for the thera- pist to express unconditional positive regard—that is, to show true acceptance of clients no matter what they may say or do (Bozarth, 2007). Rogers felt that this was a crucial first step toward clients’ self-acceptance.

Rogerian therapists try to understand things from the clients’ point of view. They are emphati- cally nondirective. They do not suggest reasons for a client’s feelings or how they might better handle a difficult situation. Instead, they try to reflect clients’ statements, sometimes asking questions or

hinting at feelings that clients have not articulated. Rogers felt that when therapists provide an atmosphere of openness and genuine respect, clients can find themselves, as portrayed in the following session.

Client: I guess I do have problems at school . . . . You see, I’m chairman of the Sci- ence Department, so you can imagine what kind of a department it is.

Therapist: You sort of feel that if you’re in something that it can’t be too good. Is that . . .

Client: Well, it’s not that I . . . It’s just that I’m . . . I don’t think that I could run it. Therapist: You don’t have any confidence in yourself? Client: No confidence, no confidence in myself. I never had any confidence in

myself. I—like I told you—like when even when I was a kid I didn’t feel I was capable and I always wanted to get back with the intellectual group.

Therapist: This has been a long-term thing, then. It’s gone on a long time. Client: Yeah, the feeling is—even though I know it isn’t, it’s the feeling that I have

that—that I haven’t got it, that—that—that—people will find out that I’m dumb or—or . . .

Therapist: Masquerade. Client: Superficial, I’m just superficial. There’s nothing below the surface. Just

superficial generalities, that ... Therapist: There’s nothing really deep and meaningful to you (Hersher, 1970,

pp. 29–32).

Rogers wanted to discover those processes in client-centered therapy that were associated with positive results. Rogers’s interest in the process of therapy resulted in important and lasting contributions to the field; research has shown that a therapist’s emphasis on empathy, warmth, and understanding increase success, no matter what therapeutic approach is used (Bike, Norcross, & Schatz, 2009; Kirschenbaum & Jourdan, 2005).

Gestalt Therapy How is Gestalt therapy different from psychoanalysis?

Gestalt therapy is largely an outgrowth of the work of Frederick (Fritz) Perls at the Esalen Institute in California. By emphasizing the present and encouraging face-to-face confrontations, Gestalt therapy attempts to help people become more

Carl Rogers (far right) leading a group ther- apy session. Rogers was the founder of client-centered therapy.

Gestalt therapy An insight therapy that emphasizes the wholeness of the personality and attempts to reawaken people to their emotions and sensations in the present.

IS B

N 1-256-37427-X

Understanding Psychology, Ninth Edition, by Charles G. Morris and Albert A. Maisto. Published by Prentice Hall. Copyright © 2010 by Pearson Education, Inc.

Therapies 429

genuine in their daily interactions. The therapist is active and directive, and the emphasis is on the whole person. (The term Gestalt means “whole.”) The therapist’s role is to “fill in the holes in the personality to make the person whole and complete again” (Perls, 1969, p. 2).

Gestalt therapists use various techniques to try to make people aware of their feelings. For example, they tell people to “own their feelings” by talking in an active, rather than a passive way: “I feel angry when he’s around” instead of “He makes me feel angry when he’s around.” They also ask people to speak to a part of themselves that they imagine to be sit- ting next to them in an empty chair. This empty-chair technique and others are illustrated in the following excerpt:

Therapist: Try to describe just what you are aware of at each moment as fully as possi- ble. For instance, what are you aware of now?

Client: I’m aware of wanting to tell you about my problem, and also a sense of shame—yes, I feel very ashamed right now.

Therapist: Okay. I would like you to develop a dialogue with your feeling of shame. Put your shame in the empty chair over here (indicates chair), and talk to it.

Client: Are you serious? I haven’t even told you about my problem yet. Therapist: That can wait—I’m perfectly serious, and I want to know what you have to

say to your shame. Client: (awkward and hesitant at first, but then becoming looser and more involved)

Shame, I hate you. I wish you would leave me—you drive me crazy, always reminding me that I have a problem, that I’m perverse, different, shameful— even ugly. Why don’t you leave me alone?

Therapist: Okay, now go to the empty chair, take the role of shame, and answer your- self back.

Client: (moves to the empty chair) I am your constant companion—and I don’t want to leave you. I would feel lonely without you, and I don’t hate you. I pity you, and I pity your attempts to shake me loose, because you are doomed to failure.

Therapist: Okay, now go back to your original chair and answer back. Client: (once again as himself) How do you know I’m doomed to failure?

(spontaneously shifts chairs now, no longer needing direction from the ther- apist; answers himself back, once again in the role of shame) I know that you’re doomed to failure because I want you to fail and because I control your life. You can’t make a single move without me. For all you know, you were born with me. You can hardly remember a single moment when you were without me, totally unafraid that I would spring up and suddenly remind you of your loathsomeness (Shaffer, 1978, pp. 92–93).

In this way, the client becomes more aware of conflicting inner feelings and, with insight, can become more genuine. Psychoanalysis, client-centered therapy, and Gestalt therapy differ in technique, but all use talk to help people become more aware of their feelings and conflicts, and all involve fairly substantial amounts of time. More recent developments in therapy seek to limit the amount of time people spend in therapy.

Recent Developments What are some recent developments in insight therapies?

Although Freud, Rogers, and Perls originated the three major forms of insight therapy, oth- ers have developed hundreds of variations on this theme. Most involve a therapist who is far more active and emotionally engaged with clients than traditional psychoanalysts thought fit. These therapists give clients direct guidance and feedback, commenting on what they are told rather than just neutral listening.

IS B

N 1-

25 6-

37 42

7- X

Understanding Psychology, Ninth Edition, by Charles G. Morris and Albert A. Maisto. Published by Prentice Hall. Copyright © 2010 by Pearson Education, Inc.

430 Chapter 13

Another general trend in recent years is toward shorter-term “dynamic therapy.” For most people, this usually means meeting once a week for a fixed period. In fact, short- term psychodynamic therapy is increasingly popular among both clients and mental health professionals (Abbass, Joffres, & Ogrodniczuk, 2008; McCullough & Magill, 2009). Insight remains the goal, but the course of treatment is usually limited—for example, to 25 sessions. With the trend to a time-limited framework, insight therapies have become more problem- or symptom-oriented, with greater focus on the person’s current life situ- ation and relationships. Although contemporary insight therapists do not discount child- hood experiences, they view people as being less at the mercy of early childhood events than Freud did.

Perhaps the most dramatic and controversial change in insight therapies is virtual therapy. For a hundred years or so, people who wanted to see a therapist have literally gone to see a therapist—they have traveled to the therapist’s office, sat down, and talked through their problems. In recent years, however, some people have started connecting with their therapists by telephone (S. Williams, 2000). Others pay their visits via cyberspace. The delivery of health care over the Internet or through other electronic means is part of a rapidly expanding field known as telehealth.

Although most therapists believe that online therapy is no substitute for face-to- face interactions (Almer, 2000; Rabasca, 2000c), evidence suggests that telehealth may provide cost-effective opportunities for delivery of some mental health services (J. E. Barnett & Scheetz, 2003). Telehealth is a particularly appealing alternative for people who live in remote or rural areas (Hassija & Gray, 2009; Stamm, 2003). For example, a university-based telehealth system in Kentucky provides psychological services to rural schools (Thomas Miller et al., 2003), and video-conferencing therapy has been used suc- cessfully to treat posttraumatic stress disorder in rural Wyoming (Hassija & Gray, 2009). Clearly, research is needed to determine under what, if any, circumstances vir- tual therapy is effective, as such services are likely to proliferate in the future (Melnyk, 2008; Zur, 2007).

Even more notable than the trend toward short-term and virtual therapy has been the proliferation of behavior therapies during the past few decades. In this next section, we examine several types.

CHECK YOUR UNDERSTANDING

1. ____________ therapies focus on giving people clearer understanding of their feelings, motives, and actions.

2. ____________ ____________ is a technique in psychoanalysis whereby the client lets thoughts flow without interruption or inhibition.

3. The process called ____________ involves having clients project their feelings toward authority figures onto their therapist.

4. Rogerian therapists show that they value and accept their clients by providing them with ____________ ____________ regard.

5. Indicate whether the following statements are true (T) or false (F): a. _____ Psychoanalysis is based on the belief that problems are symptoms of inner

conflicts dating back to childhood. b. _____ Rogers’s interest in the process of therapy was one avenue of exploration that

did not prove very fruitful. c. _____ In Gestalt therapy, the therapist is active and directive. d. _____ Gestalt therapy emphasizes the client’s problems in the present.

Answers:1. Insight.2. Free association.3. transference.4. unconditional positive.a.(T). b. (F).c. (T).d. (T).short-term psychodynamic therapy Insight

therapy that is time limited and focused on trying to help clients correct the immediate problems in their lives.

Quick Review on MyPsychLab

More quizzes and a customized study plan. www.mypsychlab.com

IS B

N 1-256-37427-X

Understanding Psychology, Ninth Edition, by Charles G. Morris and Albert A. Maisto. Published by Prentice Hall. Copyright © 2010 by Pearson Education, Inc.

Therapies 431

BEHAVIOR THERAPIES What do behaviorists believe should be the focus of psychotherapy?

Behavior therapies sharply contrast with insight-oriented approaches. They are focused on changing behavior, rather than on discovering insights into thoughts and feelings. Behavior therapies are based on the belief that all behavior, both normal and abnormal, is learned (D. Richards, 2007). People suffering from hypochondriasis learn that they get attention when they are sick; people with paranoid personalities learn to be suspicious of others. Behavior therapists also assume that maladaptive behaviors are the problem, not symptoms of deeper underlying causes. If behavior therapists can teach people to behave in more appropriate ways, they believe that they have cured the problem. The therapist does not need to know exactly how or why a client learned to behave abnormally in the first place. The job of the therapist is simply to teach the person new, more satisfying ways of behaving on the basis of scientifically studied principles of learning, such as classical condi- tioning, operant conditioning, and modeling (Zinbarg & Griffith, 2008).

Therapies Based on Classical Conditioning How can classical conditioning be used as the basis of treatment?

Classical conditioning involves the repeated pairing of a neutral stimulus with one that evokes a certain reflex response. Eventually, the formerly neutral stimulus alone comes to elicit the same response. The approach is one of learned stimulus-response associations. Several variations on classical conditioning have been used to treat psychological problems.

Desensitization, Extinction, and Flooding Systematic desensitization, a method for gradually reducing fear and anxiety, is one of the oldest behavior therapy techniques (Wolpe, 1990). The method works by gradually associating a new response (relaxation) with anxiety-causing stimuli. For example, an aspiring politician might seek therapy because he is

L E A R N I N G O B J E C T I V E S • Explain the statement that “Behavior

therapies sharply contrast with insight- oriented approaches.”

• Describe the processes of desensitization, extinction, flooding, aversive conditioning, behavior contracting, token economies, and modeling.

APPLY YOUR UNDERSTANDING

1. Consider the following scenario: The client lies on a couch, and the therapist sits out of sight. The therapist gets to know the client’s problems through free association and then encourages the client to “work through” his or her problems. What kind of therapy is this?

a. psychoanalysis b. client-centered therapy c. Gestalt therapy d. rational–emotive therapy

2. Which of the following choices illustrates client-centered therapy with a depressed person?

a. The client is encouraged to give up her depression by interacting with a group of people in an encounter group.

b. The therapist tells the client that his depression is self-defeating and gives the client “assignments” to develop self-esteem and enjoy life.

c. The therapist encourages the client to say anything that comes into her head, to express her innermost fantasies, and to talk about critical childhood events.

d. The therapist offers the client her unconditional positive regard and, once this open atmosphere is established, tries to help the client discover why she feels depressed.

Answers:1. a.2. d.

behavior therapies Therapeutic approaches that are based on the belief that all behavior, normal and abnormal, is learned, and that the objective of therapy is to teach people new, more satisfying ways of behaving.

systematic desensitization A behavioral technique for reducing a person’s fear and anxiety by gradually associating a new response (relaxation) with stimuli that have been causing the fear and anxiety.

IS B

N 1-

25 6-

37 42

7- X

Understanding Psychology, Ninth Edition, by Charles G. Morris and Albert A. Maisto. Published by Prentice Hall. Copyright © 2010 by Pearson Education, Inc.

432 Chapter 13

anxious about speaking to crowds. The therapist explores the kinds of crowds that are most threatening: Is an audience of 500 worse than one of 50? Is it harder to speak to men than it is to women? Is there more anx- iety facing strangers than a roomful of friends? From this information the therapist develops a hierarchy of fears—a list of situations from the least to the most anxiety provoking. The therapist then teaches tech- niques for relaxation, both mentally and physically. Once the client has mastered deep relaxation, she or he begins work at the bottom of the hierarchy of fears. The person is told to relax while imagining the least threat- ening situation on the list, then the next most threaten- ing, and so on, until the most fear-arousing one is reached and the client can still remain calm.

Numerous studies show that systematic desensiti- zation helps many people overcome their fears and phobias (Hazel, 2005; D. W. McNeil & Zvolensky, 2000). The key to success may not be the learning of a new conditioned relaxation response, but rather the extinction of the old fear response through mere expo-

sure. Recall that in classical conditioning, extinction occurs when the learned, conditioned stimulus is repeatedly presented without the unconditioned stimulus following it. Thus, if a person repeatedly imagines a frightening situation without encountering danger, the associated fear should gradually decline. Desensitization is most effective when clients gradually confront their fears in the real world rather than merely in their imaginations.

The technique of flooding is a less familiar and more frightening desensitization method. It involves full-intensity exposure to a feared stimulus for a prolonged period of time (Moulds & Nixon, 2006; Wolpe, 1990). Someone with a fear of snakes might be forced to handle dozens of snakes. Though flooding may seem unnecessarily harsh, remember how debilitating many untreated anxiety disorders can be.

Aversive Conditioning Another classical conditioning technique is aversive condi- tioning, in which pain and discomfort are associated with the behavior that the client wants to unlearn. Aversive conditioning has been used with limited success to treat alco- holism, obesity, smoking, and some psychosexual disorders. For example, the taste and smell of alcohol are sometimes paired with drug-induced nausea and vomiting. Before long, clients feel sick just seeing a bottle of liquor. A follow-up study of nearly 800 people who completed alcohol-aversion treatment found that 63% had maintained continuous abstinence for at least 12 months (Sharon Johnson, 2003; Wiens & Menustik, 1983). The long-term effectiveness of this technique has been questioned; if punishment no longer follows, the undesired behavior may reemerge. Aversive conditioning is a controversial technique because of its unpleasant nature.

Therapies Based on Operant Conditioning How could “behavior contracting” change an undesirable behavior?

In operant conditioning, a person learns to behave a certain way because that behavior is reinforced. One therapy based on the principle of reinforcement is called behavior con- tracting. The therapist and the client agree on behavioral goals and on the reinforcement that the client will receive when he or she reaches those goals. These goals and reinforce- ments are often written in a contract that “legally” binds both the client and the therapist. A contract to help a person stop smoking might read: “For each day that I smoke fewer than 20 cigarettes, I will earn 30 minutes of time to go bowling. For each day that I exceed the goal, I will lose 30 minutes from the time that I have accumulated.”

The clients in these photographs are over- coming a simple phobia: fear of snakes. After practicing a technique of deep relaxation, clients in desensitization therapy work from the bottom of their hierarchy of fears up to the situation that provokes the greatest fear or anxiety. Here, clients progress from han- dling rubber snakes (top left) to viewing live snakes through a window (top center) and finally to handling live snakes. This procedure can also be conducted vicariously in the ther- apist’s office, where clients combine relax- ation techniques with imagining anxiety-provoking scenes.

aversive conditioning Behavioral therapy techniques aimed at eliminating undesirable behavior patterns by teaching the person to associate them with pain and discomfort.

behavior contracting Form of operant conditioning therapy in which the client and therapist set behavioral goals and agree on reinforcements that the client will receive on reaching those goals.

IS B

N 1-256-37427-X

Understanding Psychology, Ninth Edition, by Charles G. Morris and Albert A. Maisto. Published by Prentice Hall. Copyright © 2010 by Pearson Education, Inc.

Therapies 433

Another therapy based on operant conditioning is called the token economy. Token economies are usually used in schools and hospitals, where controlled conditions are most feasible (Boniecki & Moore, 2003; Comaty, Stasio, & Advokat, 2001). People are rewarded with tokens or points for appropriate behaviors, which can be exchanged for desired items and privileges. In a mental hospital, for example, improved grooming habits might earn points that can be used to purchase special foods or weekend passes. The positive changes in behavior, however, do not always generalize to everyday life outside the hospital or clinic, where adaptive behavior is not always reinforced and maladaptive behavior is not always punished.

token economy An operant conditioning therapy in which people earn tokens (reinforcers) for desired behaviors and exchange them for desired items or privileges.

CHECK YOUR UNDERSTANDING

1. The therapeutic use of rewards to encourage desired behavior is based on a form of learning called ____________ ____________.

2. When client and therapist agree on a written set of behavioral goals, as well as a specific schedule of reinforcement when each goal is met, they are using a technique called ____________ ____________.

3. Some therapy involves learning desired behaviors by watching others perform those actions, which is also known as ____________.

4. A ____________ ____________ is an operant conditioning technique whereby people earn some tangible item for desired behavior, which can then be exchanged for more basic rewards and privileges.

5. The technique of ____________ involves intense and prolonged exposure to something feared.

Answers:1. operant conditioning.2. behavior contracting.3. modeling.4. token economy. 5. flooding.

APPLY YOUR UNDERSTANDING

1. Maria is in an alcoholism treatment program in which she must take a pill every morning. If she drinks alcohol during the day, she immediately feels nauseous. This treatment is an example of

a. transference. b. flooding. c. aversive conditioning. d. desensitization.

2. Robert is about to start a new job in a tall building; and he is deathly afraid of riding in elevators. He sees a therapist who first teaches him how to relax. Once he has mastered that skill, the therapist asks him to relax while imagining that he is entering the office building. Once he can do that without feeling anxious, the therapist asks him to relax while imagining standing in front of the elevator doors, and so on until Robert can completely relax while imagining riding in elevators. This therapeutic technique is known as

a. transference. b. desensitization. c. behavior contracting. d. flooding. Answers:1. c.2. b.

modeling A behavior therapy in which the person learns desired behaviors by watching others perform those behaviors.

Therapies Based on Modeling What are some therapeutic uses of modeling?

Modeling—learning a behavior by watching someone else perform it—can also be used to treat problem behaviors. In a now classic demonstration of modeling, Albert Bandura and colleagues helped people to overcome a snake phobia by showing films in which

Quick Review on MyPsychLab

More quizzes and a customized study plan. www.mypsychlab.com

IS B

N 1-

25 6-

37 42

7- X

Understanding Psychology, Ninth Edition, by Charles G. Morris and Albert A. Maisto. Published by Prentice Hall. Copyright © 2010 by Pearson Education, Inc.

434 Chapter 13

models gradually moved closer and closer to snakes (Bandura, Blanchard, & Ritter, 1969). Modeling techniques have also been successfully used as part of job training pro- grams (P. J. Taylor, Russ-Eft, & Chan, 2005) and have been used extensively with people with mental retardation to teach job and independent living skills (Cannella-Malone et al., 2006; Farr, 2008).

COGNITIVE THERAPIES How can people overcome irrational and self-defeating beliefs?

Cognitive therapies are based on the belief that if people can change their distorted ideas about themselves and the world, they can also change their problem behaviors and make their lives more enjoyable (Bleijenberg, Prins, & Bazelmans, 2003). A cognitive therapist’s goal is to identify erroneous ways of thinking and to correct them. Three popular forms of cognitive therapy are stress-inoculation therapy, rational–emotive therapy, and Aaron Beck’s cognitive approach.