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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 acpanied by mentaries 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 pletion 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。 ment 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 pleted medical school； earned an M。D。； and
pleted 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 pleted
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
fortably
（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 es 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； an