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would be unbearable without the addictive substance。 In the case of anxiety disorders； the
conflict is not so clearly perceived by the patient； who would generally deny getting any rewards
（secondary gains） from holding on to the disorder。
Many disorders develop over a period of years； sometimes beginning in childhood。 Patterns of
abnormal or maladaptive thoughts and behaviors bee an integral part of the personality；
affecting the person’s view of reality and all his or her patterns of thought and behavior。 Freud
believed that restructuring of the personality was a necessity in successful therapy。 This idea was
that once the offending conflict or problem was identified； the person would need to rethink and
reconstruct other aspects of the self that developed； in order to acmodate the abnormal
patterns of thought and behavior。 Most current therapies do not aim at reconstruction of the
personality； but perhaps they should be more mindful of the possibility that you cannot excise an
abnormality without affecting the personality structure from which it is removed。
Consider the example of a hypochondriac who has spent a good part of his life monitoring his
body and looking for pathology to explain every irregularity of function or unfamiliar twitch。 His
illnesses have brought him sympathy and attention； and he has used his poor health to explain to
himself and others why he has not “climbed the ladder of success。” After his life is endangered
by an unnecessary surgery； he goes to a psychotherapist for help。 The issue is； will he be able to
give up his hypochondria and its benefits？ Can he change his perception to see himself as a
normal； healthy person living in a world in which illnesses and the danger of infection can play a
relatively minor role？
It is not easy for people to give up their maladaptive behavior； just as it is not easy for any of us
to break bad habits or improve aspects of our personalities。 The therapist is in the position of
trying to teach old dogs new…or better…tricks。
Prefrontal Lobotomies
The doctor who developed the prefrontal lobotomy was given the Nobel Prize in Medicine。 Ask
students if they have seen movies such as “One Flew Over the Cuckoo’s Nest” and what their
perception is of the procedure。 Do they consider it barbaric； without any possible redeeming
value？ If the answer to that question is “yes；” then you can play devil’s advocate by presenting
the following scenario。
Imagine that you are a doctor on staff in a mental hospital in the late 1940s。 Your mental hospital；
constructed to hold 700 patients； now has over 1；300。 Many of these are violent and need to be
tied to their beds or kept in locked cells。 Antipsychotic drugs will not be invented for another five
328
CHAPTER 16： THERAPIES FOR PERSONAL CHANGE
to ten years。 Patients regularly attack one another； as well as the attendants。 Other patients run
through the hallways； screaming and yelling。 You have one patient who has been in the hospital
for 25 years and has essentially been kept in confinement。 You hold no hope of recovery。
However； you know that there is a therapeutic technique that will take only a half…hour； and if
successful； will result in a significant decrease in episodes of violent behavior in this patient。
Again； if the procedure is successful； the patient will appear to be much happier and more
content with life。 You also know that for most patients receiving this procedure there will be little
difference in measurable IQ。 You know of no behavioral test that routinely shows any mental
deficit from the procedure。 Would you； as this patient’s doctor； use this procedure？
When put into this context； most students begin to understand why prefrontal lobotomies were
used as frequently as they were in the 1940s and 1950s。 Most college students find it difficult to
imagine a world in which there were no drugs that could be effectively used in place of
procedures such as prefrontal lobotomy。 Visiting a mental hospital today； it is difficult for most
of us to imagine the general level of uproar and violence in the hospitals as recently as the 1940s。
The 1948 movie “Snake Pit；” starring Olivia DeHavilland； portrayed the horrors of life as a
patient （and staff member） in state mental hospitals during that “pre…chemotherapy” era。
Identifying Therapists
Ask students to pile a list of therapists in your area。 They should gather information about
the therapists’ professional degrees； fees； areas of specialization； forms of treatment； and other
factors。 You might divide them into groups and have each group attempt to locate therapists
from a particular theoretical orientation （i。e。； psychodynamic； etc。）。 They might call some
therapists for such information； consult a local mental health association； check the web pages of
professional organizations such as the APA； and consult phone book listings as ways of gathering
this information。
Should Psychologists Prescribe Medication？
Since your text contains an excellent review of psychopharmacology； you might want to discuss
the issue of whether counseling or clinical psychologists should be able to prescribe medication。
Some have argued that it is ludicrous to have family physicians and surgical specialists； who may
have no psychological training at all； able to prescribe the entire range of psychoactive drugs for
treating mental illnesses； while psychologists； who specialize in treating mental illnesses； cannot
prescribe any medications。 Although it is true that historically most psychologists did not have
the training in pharmacology that physicians were given； in recent years； many graduate
programs in psychology have added coursework in physiology and pharmacology to narrow this
gap。 While most would agree that psychologists probably should not be able to prescribe
nonpsychoactive medications； the wisdom of prohibiting them from prescribing any medications
seems doubtful。 Since psychologists are pressing for legislative changes in some states that would
allow psychologists to prescribe some medications in some circumstances； this issue is likely to
bee more important in the near future。 How do students feel about this issue？ Do they see
any potential dangers if psychologists begin prescribing medicine？
329
PSYCHOLOGY AND LIFE
BIOGRAPHICAL PROFILES
Albert Ellis （b。 1913）
Obtaining his Ph。D。 from Columbia University in 1947； Albert Ellis made early contributions to
psychoanalytic theory； although he has since bee one of its major dissenters。 Rebelling
against what he perceived to be rigid psychoanalytic dogma； Ellis established Rational Emotive
Therapy or RET in 1955。 The development of RET is considered by many to represent the
informal founding of cognitive therapy； popular in many forms today。 Ellis has also influenced
the development of sex and marital therapy； and his book Sex Without Guilt is recognized as an
important cultural impetus to the American sexual revolution of the 1960s。
Frederick “Fritz” Perls （1893…1970）
Fritz Perls was born in Berlin； studied at the University of Freiburg； and obtained his Ph。D。 at the
University of Berlin。 In 1926； he became Kurt Goldstein’s assistant at the Institute for Brain…
Injured Soldiers； where he developed the notion of “gestalt；” or integrative wholes。 He then
studied psychoanalysis； being analyzed by such luminaries as Wilhelm Reich； Karen Horney； and
Otto Fenichel。 Perls left Germany in 1933； shortly after Hitler’s rise to power； spent the next
decade in Holland and； in 1946； came to the United States； where he established the New York
Institute for Gestalt Therapy。 Although accepting the importance of unconscious conflicts； Perls
believed it was necessary to deal with the present； rather than dwelling exclusively on the past。
The basic philosophy and practice of Gestalt therapy is described in his book Gestalt Therapy
Verbatim （1969）。
Joseph Wolpe （b。 1915）
Joseph Wolpe was born in South Africa。 He developed interests in chemistry as a teen； and
would channel this passion into medical school trai