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Reducing Disorder by Confronting It: Psychotherapy

16 February, 2016 - 09:24


  1. Outline and differentiate the psychodynamic, humanistic, behavioral, and cognitive approaches to psychotherapy.
  2. Explain the behavioral and cognitive aspects of cognitive-behavioral therapy and how CBT is used to reduce psychological disorders.

Treatment for psychological disorder begins when the individual who is experiencing distress visits a counselor or therapist, perhaps in a church, a community center, a hospital, or a private practice. The therapist will begin by systematically learning about the patient’s needs through a formalpsychological assessment, which is an evaluation of thepatients psychological and mental health. During the assessment the psychologist may give personality tests such as the Minnesota Multiphasic Personal Inventory (MMPI-2) or projective tests, and will conduct a thorough interview with the patient. The therapist may get more information from family members or school personnel.

In addition to the psychological assessment, the patient is usually seen by a physician to gain information about potential Axis III (physical) problems. In some cases of psychological disorder—and particularly for sexual problems—medical treatment is the preferred course of action. For instance, men who are experiencing erectile dysfunction disorder may need surgery to increase blood flow or local injections of muscle relaxants. Or they may be prescribed medications (Viagra, Cialis, or Levitra) that provide an increased blood supply to the penis, which are successful in increasing performance in about 70% of men who take them.

After the medical and psychological assessments are completed, the therapist will make a formal diagnosis using the detailed descriptions of the disorder provided in the Diagnosticand Statistical Manual of Mental Disorders (DSM; see below). The therapist will summarize the information about the patient on each of the five DSMaxes, and the diagnosis will likely be sent to an insurance company to justify payment for the treatment.

DSM-IV-TRCriteria for Diagnosing Attention-Deficit/Hyperactivity Disorder (ADHD)

To be diagnosed with ADHD the individual must display either A or B below (American Psychiatric Association, 2000): 1

A. Six or more ofthe following symptomsofinattention have been present forat least 6monthstoapoint that isdisruptive and inappropriate for developmental level:

  • Often does not give close attention to details or makes careless mistakes in schoolwork, work, o r other activities
  • Often has trouble keeping attention on tasks or play activities
  • Often does not seem to listen when spoken to directly
  • Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
  • Often has trouble organizing activities
  • Often avoids, dislikes, o r doesn’t want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework)
  • Often loses things needed for tasks and activities (e.g., toys, school assignments, pencils, books, or tools)
  • Is often easily distracted
  • Is often forgetful in daily activities

B. Six or more ofthe following symptomsofhyperactivity-impulsivityhave been present for at least 6monthsto an extent that isdisruptive and inappropriate for developmental level:

  • Often fidgets with hands or feet or squirms in seat
  • Often gets up from seat when remaining in seat is expected
  • Often runs about or climbs when and where it is no t appropriate (adolescents o r adults may feel very restless)
  • Often has trouble playing or enjoying leisure activities quietly
  • Is often “on the go” or often acts as if “driven by a motor”
  • Often talks excessively
  • Often blurts out answers before questions have been finished
  • Often has trouble waiting one’s turn
  • Often interrupts o r intrudes on others (e.g., butts into conversations or games)

If a diagnosis is made, the therapist will select a course of therapy that he or she feels will be most effective. One approach to treatment is psychotherapy, theprofessional treatment for psychological disorder through techniques designed to encourage communication of conflicts and insight. The fundamental aspect of psychotherapy is that the patient directly confronts the disorder and works with the therapist to help reduce it. Therapy includes assessing the patient’s issues and problems, planning a course of treatment, setting goals for change, the treatment itself, and an evaluation of the patient’s progress. Therapy is practiced by thousands of psychologists and other trained practitioners in the United States and around the world, and is responsible for billions of dollars of the health budget.

To many people therapy involves a patient lying on a couch with a therapist sitting behind and nodding sagely as the patient speaks. Though this approach to therapy (known as psychoanalysis) is still practiced, it is in the minority. It is estimated that there are over 400 different kinds of therapy practiced by people in many fields, and the most important of these are shown in Figure 13.1. The therapists who provide these treatments include psychiatrists (who have a medical degree and can prescribe drugs) and clinical psychologists, as well as social workers, psychiatric nurses, and couples, marriage, and family therapists.

Figure 13.1 The Many Types of Therapy Practiced in the United States 
These data show the proportion of psychotherapists who reported practicing each type of therapy.Source: Adapted from Norcross, J. C., Hedges, M., & Castle, P. H. (2002). Psychologists conducting psychotherapy in 2001: A study of the Division 29 membership. Psychotherapy: Theory, Research, Practice, Training, 39(1), 97–102. 

Psychology in Everyday Life: Seeking Treatment for Psychological Difficulties

Many people who would benefit from psychotherapy do not get it, either because they do not know how to find it or because they feel that they will be stigmatized and embarrassed if they seek help. The decision to not seek help is a very poor choice because the effectiveness of mental health treatments is well documented and, no matter where a person lives, there are treatments available (U.S. Department of Health and Human Services, 1999). 2

The first step in seeking help for psychological problems is to accept the stigma. It is possible that some of your colleagues, friends, and family members will know that you are seeking help and some may at first think more negatively of you for it. But you must get past these unfair and close-minded responses. Feeling good about yourself is the most important thing you can do, and seeking help may be the first step in doing so.

One question is how to determine if someone needs help. This question is not always easy to answer because there is no clear demarcation between “normal” and “abnormal” behavior. Most generally, you will know that you or others need help when the person’s psychological state is negatively influencing his o r her everyday behavior, when the behavior is adversely affecting those around the person, and when the problems continue over a period of time. Often people seek therapy as a result of a life-changing event such as diagnosis of a fatal illness, an upcoming marriage or divorce, or the death of a loved one. But therapy is also effective fo r general depression and anxiety, as well as for specific everyday problems.

There are a wide variety of therapy choices, many of which are free. Begin in your school, community, or church, asking about community health or counseling centers and pastoral counseling. You may want to ask friends anfamily memberfor recommendations. You’ll probably be surprised at how many people have been to counseling, and how many recommend it.

There are many therapists who offer a variety of treatment options. Be sure to ask about the degrees that the therapist has earned, and about the reputation of the center in which the therapy occurs. If you have choices, try to find a person or location that you like, respect, and trust. This will allow you to be more open, and you will get more out of the experience. Your sessions with the help provider will require discussing your family history, personality, and relationships, and you should feel comfortable sharing this information.

Remember also that confronting issues requires time to reflect, energy to get to the appointments and deal with consequential feelings, and discipline to explore your issues on your own. Success at therapy is difficult, and it takes effort.

The bottom line is that going for therapy should not be a difficult decision for you. All people have the right to appropriate mental health care just as they have a right to general health care. Just as you go to a dentist for a toothache, you may go to therapy for psychological difficulties. Furthermore, you can be confident that you will be treated with respect and that your privacy will be protected, because therapists follow ethical principles in their practices. The following provides a summary of these principles as developed by the American Psychological Association (2010). 3

  • Psychologists inform their clients/patients as early as possible in the therapeutic relationship about the nature and anticipated course of therapy, fees, involvement of third parties, and limits of confidentiality, and provide sufficient opportunity for the client/patient to ask questions and receive answers.
  • Psychologists inform their clients/patients of the developing nature of the treatment, the potential risks involved, alternative treatments that may be available, and about the voluntary nature of their participation.
  • When the therapist is a trainee, the client/patient is informed that the therapist is in training and is being supervised, and is given the name of the supervisor.
  • When psychologists agree to provide services to several persons who have a relationship (such as spouses, significant others, or parents and children), they take reasonable steps to clarify at the outset which of the individuals are clients/patients and the relationship the psychologist will have with each person.
  • If it becomes apparent that a psychologist may be called on to perform potentially conflicting roles (such as family therapist and then witness for one party in divorce proceedings), the psychologist takes reasonable steps to clarify and modify, or withdraw from, roles appropriately.
  • When psychologists provide services to several persons in a group setting, they describe at the outset the roles and responsibilities of all parties and the limits of confidentiality.
  • Psychologists do not engage in sexual intimacies with current therapy clients/patients, or with individuals they know to be close relatives, guardians, o r significant others of current clients/patients. Psychologists do not terminate therapy to circumvent this standard. Psychologists do no t accept as therapy clients/patients persons with whom they have engaged in sexual intimacies, nor do they have sexual intimacies with former clients/patients for at least 2 years after cessation or termination of therapy.
  • Psychologists terminate therapy when it becomes reasonably clear that the client/patient no longer needs the service, is not likely to benefit, or is being harmed by continued service.