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Bayh, B. (1983). Myths and Realities: A Report of the National Commission on the Insanity Defense.
Arlington, VA: National Mental Health Association. This commission was established by the
National Mental Health Association, a consumer advocacy organization, in order to make
recommendations regarding the insanity plea. Their report is available for purchase from
1800 N. Kent Street, Arlington, VA 22209. Definitely worth reading.
Beck, A. (1997). The Past and Future of Cognitive Therapy. Journal of Psychotherapy Practice and
Research, 6(4), 276-284. Beck describes the development of cognitive-behavioral therapy from
its earliest beginnings to its most recent manifestations.
Beck, A. T. (1985). Anxiety Disorders and Phobias. New York: Basic Books. This book explains
anxiety disorders and phobias as disturbances in cognition that cause disturbances in feeling
and behavior.
Ellis, A. (1997). The Practice of Rational Emotive Behavior Therapy, 2nd Ed. New York: Springer
Publishing. A complete update of Ellis’ earlier work. Contains many new references and new
research.
Goffman, E. (1963). Stigma: Notes on the Management of Spoiled Identity. Though an older
publication, Goffman’s insights into the daily problems of individuals “stigmatized” by the
vagaries of fate or society are excellent; well worth reading.
Maxmen, J. S., & Ward, N. G. (I 995). Essential Psychopathology and Its Treatment, 2nd Ed. New
York: W. W. Norton & Co. May be considered as a “companion” volume to DSM-IV, in that it
explains DSM-IV, presents its diagnostic categories and illuminates them, as well as
providing treatment guidelines and case vignettes.
Robinson, D. (1996). Wild Beasts & Idle Humours: The Insanity Defense from Antiquity to the Present.
Cambridge, Harvard University Press. Documents the uses and abuses of the insanity
defense from antiquity to the present.
Rosenhan, D. I. (1973). On Being Sane in Insane Places. Science, 179, 250-258. This article details
Rosenhan’s classic study of the danger of labeling people as “mentally ill,” and mental health
professionals’ over reliance on stereotypic symptoms.
Rosenhan, D., & Seligman, M. (1995). Abnormal Psychology, 3rd Ed. New York: W. W. Norton. The
definitions, history, and major schools of thought and treatment of abnormality are presented
first. Then, each of the major disorders—their description, their causes, and their
treatments—is laid out in light of the competing schools of thought. An excellent
introductory text.<br />
Seligman, M. (1995). The Effectiveness of Psychotherapy: The Consumer Reports Study. American
Psychologist, 50(12), 965-974. Reports on a large-scale survey that suggests that psychotherapy
produces significant positive change.
Spitzer, R. L., Skodoe, A. E., Gibbon, M., & Williams, J. B. W. (1981). DSM-III Casebook: A Learning
Companion to the Diagnostic and Statistical Manual Of Mental Disorders, 3rd Ed Washington, D
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C: American Psychological Association. Contains a series of descriptive vignettes, based on
actual patients, followed by a rationale for the diagnostic category used for that person. This
book is a treasure of good examples for lecture.
Szasz, T. (1974). The Myth of Mental Illness: Foundations of a Theory of Personal Conduct, (Rev Ed).
New York: Harper & Row. Posits that what is termed “mental illness” is, in fact, behavior
disapproved of by the speaker-a stigmatizing moral judgment, not a medical diagnosis. A
classic text that articulates a fascinating alternative to the dominant view of mental illness.
DISCOVERING PSYCHOLOGY
PROGRAM 21: PSYCHOPATHOLOGY
Overview
The major types of mental illness, including schizophrenia, anxiety, and affective and bipolar
disorders, and the major factors that influence them, both biological and psychological.
Key Issues
Mistreatment of mentally ill patients in psychiatric hospitals, biological versus psychological
study of schizophrenia, the role of genetics in mental disorders, genetic study of
schizophrenic and healthy twins, SPECT analysis, and cultural factors in psychopathology.
Interviews
David Rosenhan details his dehumanizing treatment at a psychiatric hospital after he was
admitted as a patient during an experiment on the perception of mental illness.
Fuller Torrey compares schizophrenia to other biological diseases.
Psychologist Hans Strupp examines the role of early childhood behavior in the development
of schizophrenia.
Irving Gottesman and Torrey Fuller examine the biological and genetic basis of
schizophrenia though NM and SPECT analysis.
Native American psychologist Teresa LaFramboise examines the psychological consequences
of the clash between Native American and generic American cultures.
PROGRAM 22: PSYCHOTHERAPY
Overview
The relationship among theory, research, and practice, and how treatment of psychological
disorders has been influenced by historical, cultural, and social forces.
Key Issues
Psychosurgery, electroconvulsive therapy, drug therapy, genetic counseling, psychodynamic
therapy, rational emotive therapy, behavioral modification therapy, humanistic therapy.
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CHAPTER 15: PSYCHOLOGICAL DISORDERS
Archival Demonstrations
A therapist uses fear reduction strategy to help a young boy overcome his fear of dentists.
Another therapist trains a young girl to control her epileptic seizures.
Actual therapy session with a girl who fears dating.
Interviews
Hans Strupp explains the kinds of patients most suited for psychodynamic therapy. (10:30)
Enrico Jones explains his problems in selecting the most effective therapy for various people
and their various disorders.
Cognitive therapist Albert Ellis explains how to treat patients’ irrational attributes, false
beliefs, and expectations of failure through rational emotive therapy.
Humanistic therapist Rollo May discusses therapy for “normal” people seeking greater
fulfillment.
FILMS AND VIDEOS
Depression: The Dark Side of the Blues (1986). BARR, 25 minutes
Offers an illuminating perspective of the nation’s number one mental health problem. Clinical
depression is a life-threatening disease that affects persons from all occupations. People who are
seriously depressed are profiled, and commentary reveals probable causes and available
treatments. Symptoms and effects of depression are detailed and hope, through early recognition
treatment, is offered.
Dreams So Real: Three Men’s Stories (1981). IFMIJ, 28 minutes
Combines the words and animated films made by three outpatients from a community mental
health center. Struggling to make a transition back into the community, these men are striking in
their nonconformity to the stereotypes expected of mental health patients. A great film for
sensitizing students to the needs and pain of mental health patients.
The Mind Depression (1988). NCAIARR, 24 minutes
Profiles people with bipolar disorders, showing the grandiose delusions that often accompany
the manic phase. Contrasts the normal cycle of emotions with the unpredictable swings of bipolar
disorders. Interviews one family in which the grandmother, father, and several children all suffer
from depression, speculates that their depression is biologically caused, and depicts the
suspected genetic basis of bipolar disorders. Focuses on people who perform well with the help
of antidepressant drugs, including one young M.D. Describes the benefits of talking therapy inr />
conjunction with drug therapy.
The Mind of a Serial Killer (1993). FFHS, 60 minutes
This program goes behind the scenes to give the real story behind the FBI unit popularized in The
Silence of the Lambs. Using a detailed psychological profile, the unit helps the Rochester, New
York, police department catch a notorious serial killer that targeted prostitutes. This NOVA
program is part of the WGBH collection.
Neurotic Behavior: A Psychodynamic View (1973). CRW, 19 minutes
Illustrates the neurotic behavior and classical defense mechanisms of Peter, a college student. A
psychodynamic approach to behavior is used to analyze Peter’s life as he experiences anxiety,
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PSYCHOLOGY AND LIFE
repression, rationalization, displacement, and finally phobias and obsessive-compulsive neurosis
in reaction to the psychological trauma induced by his mother during early training. Although
the use of the term “neurosis” is outdated according to the DSM-IV, the film provides clear
examples of phobic and obsessive-compulsive disorders.
One Man’s Madness (1974). IUTFF, 32 minutes
Documentary of a writer who became a bipolar depressive (bipolar depression was previously
referred to as manic-depression). Swinging in mood from ecstasy to severe depression, his
symptoms of alienation and withdrawal are shown both at home and in the hospital setting.
The Scandal of Psychiatric Hospitals: When the Goal Is Insurance Reimbursement (1993).
FFHS, 52 minutes
At the same time that mentally ill patients are being discharged into the streets because their
insurance benefits have expired, healthy Americans are being locked up in mental hospitals
while the hospital draws their insurance. This shocking program reveals some of these abuses. It
shows how one group of hospitals herded up patients and, in a cynical and sadistic way, held
healthy Americans hostage; it also shows how bona fide psychiatrists are tempted or duped, and
how outnumbered and outgunned law enforcement agencies are trying to restore psychiatry to
its role as a healing profession, not a get-rich-quick business.
Teenage Suicide: The Ultimate Dropout (1980). PBS, 29 minutes
A 14-year-old girl who attempted suicide discusses her feelings of frustration and helplessness.
Advice is given for families with problems involving suicide.
The World of Abnormal Psychology (1991). Intellimation, 60 minutes
A series built around documentary views of people experiencing a variety of behavioral
disorders. Case histories are accompanied by commentaries from educators, clinicians, and
researchers who highlight and help interpret what students see. Programs include:
1. Looking at abnormal behavior
2. The nature of stress
3. The anxiety disorders
4. Psychological factors and physical illness
5. Personality disorders
6. Substance abuse disorders
7. Sexual disorders
8. Mood disorders
9. The schizophrenias
10. Organic mental disorders
11. Behavior disorders of children
12. Psychotherapies
13. An ounce of prevention
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CHAPTER 16
Therapies for Personal Change
LEARNING OBJECTIVES
On completion of this chapter, students should be able to:
1. Identify the overall goals of therapeutic interventions
2. Explain how modern forms of therapy developed
3. Discuss the differences in types of therapists
4. Describe the historical and cultural aspects of treatment of the mentally ill
5. Discuss the differences in the major theoretical models of mental illness
6. Explain what happens when an individual receives therapy
7. Describe the differences and advantages in drug and psychotherapy treatments
8. Comment on the general effectiveness of the different types of treatment for mental
illness
CHAPTER OUTLINE
I. The Therapeutic Context
A. Goals and Major Therapies
1. The Therapeutic Process Involves Four Primary Goals:
a) Reaching a diagnosis and classifying the disorder
b) Proposing a probable etiology
c) Making a prognosis
d) Prescribing and carrying out some mode of treatment
2. Major Therapeutic Models
a) Biomedical therapies attempt alteration of brain functioning
through chemical or physical interventions
b) Psychotherapy focuses on changing learned, maladaptive
behaviors. There are four major types of psychotherapy
(i) Psychodynamic approach views neurotic suffering as
the outer symptom of inner, unresolved trauma and
conflict
(ii) Behavior therapy treats the behaviors themselves as
disturbances that must be modified
(iii) Cognitive therapy attempts restructuring of the
individual’s thoughts away from distorted self-
thoughts
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CHAPTER 16: THERAPIES FOR PERSONAL CHANGE
(iv) Existential-humanistic therapies emphasize
patient/client values, directing energies toward self-
actualization
B. Therapists and Therapeutic Settings
1. Counseling psychologists provide guidance in areas such as vocation
selection, school problems, drug abuse, and marital conflict
2. Clinical social workers are mental health professionals who consider
the social contexts of people’s problems
3. Pastoral counselors are members of a religious order, specializing in
the treatment of psychological disorders
4. Clinical psychologists have a Ph.D. and concentrated their graduate
training in the assessment and treatment of psychological problems,
followed by a supervised internship in a clinical setting
5. Psychiatrists have completed medical school, earned an M.D., and
completed postdoctoral training in mental and emotional disorders;
their training is slanted toward the biomedical basis of psychological
problems, and they are the only therapists who can prescribe
medical or drug-based interventions
6. Psychoanalysts have either an M.D. or Ph.D. and have completed
specialized postgraduate training in the Freudian approach to
understanding and treating mental disorders
C. Historical and Cultural Contexts
1. History of Western Treatment
a) 1403: London’s St. Mary of Bethlehem Hospital admitted its
first patient with psychological problems, For the next 300
years the hospital’s mental patients were chained, tortured,
and exhibited to an admission-paying public. Through
mispronunciation of Bethlehem, the hospital became known
as Bedlam, or chaos, due to the confusion that reigned and
the dehumanized treatment of its patients.
b) Late 1700s: French physician Philippe Pinel described
psychological problems as mental illness
c) Mid-1800s: Psychology was gaining credence as a field of
study in the U.S., and a “cult of curability” emerged
d) 1900s: Clifford Beers spurred on the mental hygiene
movement, with confinement of the mentally ill taking on a
rehabilitative goal, and the asylum became a fixture of the
emerging sociopolitical movement
2. Cultural Symbols and Rituals of Curing
a) Western views and practices emphasize the individual’s
uniqueness, independence, and personal responsibility for
success and failure, consistent with both the disease model
and demonology. Mental disorder is viewed as the failure of
the individual.
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PSYCHOLOGY AND LIFE
b) Cultural anthropology analyzes explanations and treatments
for psychological disorders across various cultures
(i) Shamanism personalizes the forces of fate or chance
that intervene in one’s life, creating problems.
Personalization permits action to be taken against
presumed evildoers and directs help to be sought
from assumed divine healers.
(ii) Ritual healing ceremonies infuse emotional intensity
and meaning into the process of healing.
II.Psychodynamic Therapies
A. Freudian Psychoanalysis
1. Psychoanalytic therapy is an intensive, prolonged technique for
exploration of the neurotic and anxiety-ridden individual’s
unconscious motivations and conflicts
2. The goal is establishment of intrapsychic harmony and
understanding of the patient’s use of repression to handle conflicts
3. Psychodynamic therapy is often called insight therapy
4. The “talking cure” began with Joseph Breuer in 1880, as treatment for
hysterical conversion resulting from psychogenic causes
5. Free Association and Catharsis
a) Free association involves allowing the mind to wander and
giving a running account of thoughts, wishes, while relaxing
comfortably
(i) Freud maintained free associations were
predetermined, not random
(ii) Encouraged expression of strong feelings, repressed
through fear of punishment or retaliation, an
emotional release termed catharsis
6. Resistance is an inability or an unwillingness to discuss certain ideas,
desires, or experiences
7. Dream analysis is a therapeutic technique that examines content of
dreams to discover underlying or disguised motivations and
symbolic meanings of significant life experiences and desires
8. Transference and Countertransference
a) Transference is the development by the patient of emotional
feelings toward the therapist
b) Countertransference occurs when the therapist comes to like
or dislike a patient because the patient is perceived as
similar to significant people in the therapist’s life
B. Neo-Freudian Therapies
1. Freud’s followers placed more emphasis than did Freud on:
a) Patient’s current social environment, less focus on past
b) Patient’s continuing life experiences
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CHAPTER 16: THERAPIES FOR PERSONAL CHANGE
c) The role of social motivation and interpersonal relations of
love
d) The significance of ego functioning and development of self-
> concept
2. Harry Stack Sullivan felt Freudian therapy failed to recognize the
importance of social relationships
a) Posited building of a self-system to keep anxiety at a
tolerable level, with the system deriving from the child’s
interpersonal experiences.
3. Karen Horney stressed importance of environmental and cultural
contexts in which neurotic behavior is expressed, rejecting Freudian
phallocentrism in favor of gynocentrism
4. Heinz Kohut emphasized the self, and founded the object relations
school of psychodynamics
III. Behavior Therapies
A. Behavior therapy and behavior modification both refer to the systematic use of principles
of learning to increase the frequency of desired behaviors and/or decrease that of problem
behaviors
B. Counterconditioning
1. A new response is conditioned to replace or “counter” a maladaptive
response
2. Systematic Desensitization and Other Exposure Therapies
a) Joseph Wolpe’s theory of reciprocal inhibition states that the
nervous system cannot be relaxed and agitated
simultaneously.
b) Systematic desensitization: A behavioral therapy technique in
which a client is taught to prevent the arousal of anxiety by
confronting the feared stimulus while relaxed.
Desensitization therapy involves three major steps:
(i) Identification of anxiety-provoking stimuli, and
arranging them hierarchically, from weakest to
strongest
(ii) Training in progressive deep-muscle relaxation
(iii) Actual process of desensitization, the progressive
imagining of stimuli, from weakest to strongest
c) Implosion therapy: the opposite of desensitization. Client is
exposed immediately to the most frightening stimuli at the
top of his or her anxiety hierarchy, but in a safe setting
d) Flooding: similar to implosion, but involves clients being
placed in the phobic situation
3. Aversion therapy uses counterconditioning to pair stimuli with strong
noxious stimuli
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PSYCHOLOGY AND LIFE
C. Contingency Management
1. Relies on operant conditioning principles pioneered by B. F. Skinner
2. Refers to the general treatment strategy of changing behavior by
modifying its consequences. Major techniques are:
a) Positive reinforcement strategies
(i) Token economies
(ii) Shaping
(iii) Behavioral contracts
b) Extinction strategies are useful when dysfunctional
behaviors have been maintained by unrecognized
reinforcing circumstances
D. Social-Learning Therapy
1. Social-learning therapy is designed to modify problematic behavior
patterns by arranging conditions in which the client will observe
models being reinforced for a desirable form of responding.
2. Two aspects of this approach include imitation of models and social
skills training
a) Imitation of models: Individuals acquire responses through
observation of others (models)
b) Social-skills training: Training individuals with inadequate
social skills to be more effective using behavioral rehearsal
E. Generalization Techniques
1. Do clients use new behavior patterns generated in the therapeutic
setting in everyday situations?